Orthostatic response in rats after hindlimb unloading: effect of transcranial electrical stimulation.

INTRODUCTION: Orthostatic hypotension is a commonly observed phenomenon after exposure to microgravity and in various forms of autonomic failure. It has been suggested that insufficient activation of supraspinal structures responsible for descending sympathetic drive could play a significant role in this disorder. We examined the effect of transcranial electrical stimulation (TES) of autonomic nuclei within the brain on the orthostatic hypotension induced by exposure to simulated microgravity using a hindlimb unloading model. METHODS: There were 20 male Wistar rats that were suspended by their tail with the angle of elevation between the cage floor and the rat's body approximately 40 degrees. There were 11 age-matched Wistar rats used as cage controls. Orthostatic stability was examined by using an orthostatic challenge test (450 head-up test for a period of 3 min). In 10 rats from the tail-suspended group, the orthostatic challenge test was applied during TES. RESULTS: In the rats exposed to simulated microgravity (tail suspension), the orthostatic challenge test caused a significant decrease in mean arterial blood pressure by 18.4 +/- 2.2%. TES attenuated this microgravity-induced orthostatic hypotension to 9.5 +/- 1.8% (P < 0.05), which was similar to the observed response to an orthostatic challenge in the control group (6.9 +/- 1.1%). DISCUSSION: Results of this study suggest that TES significantly reduces the changes in blood pressure during an orthostatic challenge test in animals exposed to simulated microgravity. Our observations support the notion that a reduction in descending sympathoexcitatory input from supraspinal structures could contribute to orthostatic hypotension and intolerance observed in astronauts following their return from spaceflight.

Non-contrast computerized tomography (NCCT) and dynamic renal scintigraphy (DRS) in the patients with refractory renal colic.

OBJECTIVES: To assess the importance of combined use of non-contrast computerized tomography (NCCT) and dynamic renal scintigraphy (DRS) in evaluation of patients with refractory flank pain in the emergency department. METHODS: The study involved 64 consecutive patients with refractory renal colic. All patients were evaluated with plain abdominal films kidneys, ureters and bladder (KUB), NCCT and DRS. We assessed the accuracy of different diagnostic procedures and their combinations; in addition, we determined their importance for different steps of evaluation. RESULTS: Urololithiasis was diagnosed in 76.6% (n=49) of the patients. Twenty-nine percent of calculi were > 4 mm. Surgical intervention were performed in 20 patients (40.8%). A combination of NCCT plus DRS yielded the greatest sensitivity (96%) in establishing final diagnosis, however clinical, laboratory and KUB data in combination with DRS, yielded greater specificity (93%) and PPV (97%). Sex (male), WBC (mean 10.2 x 10(3) +/- 3.1) and KUB (calculus > 4 mm) were chosen in the three-step multi-variant analysis, while only male sex was found to be the strongest predictor (p<0.056) of necessity to perform NCCT. In making decision for definitive treatment NCCT and DRS provided the most important information about stone size and obstruction (kappa=0.734, p<0.001 and kappa=0.625, p<0.001), while DRS was selected as the most important diagnostic procedure in the emergency department (kappa=0.527, p<0.001). CONCLUSIONS: In the emergency department, DRS combined with the results of clinical investigation may indicate candidates for hospitalization with emergency intervention. Immediate NCCT must be strongly considered in men with WBC> or =10 x 10(3) and calculi > 4 mm on the KUB.

Disconnection of port after laparoscopic gastric banding: causes and solution.

BACKGROUND: Gastric banding is a popular operation for the treatment of morbid obesity. However, the procedure itself is not free from complications. Our study describes port disconnection, and our suggested solution. MATERIALS AND METHODS: In 6 of 58 patients who underwent gastric banding, we diagnosed disconnection of the tube from the port and found the tube in the pelvis. This required laparoscopic retrieval and reconnection of the tube. RESULTS: All 6 patients noticed that the moment that the tube disconnected from the port, they felt sharp right abdominal pain. They all sought medical aid, and abdominal plain films showed the tubing in the pelvis. The 6 patients underwent a second laparoscopic procedure, during which the tube was found in the lower abdomen. A grasper was passed through the endoscope, and the tube was pulled out and reconnected to the port. 2 of the 6 patients required complete change of the port to a new one. CONCLUSIONS: Disconnection of the tubing from the port must be considered in patients who previously underwent gastric banding and suffer from acute abdominal pain.

Devices for noninvasive transcranial electrostimulation of the brain endorphinergic system: application for improvement of human psycho-physiological status.

It is well known that deficit of endorphins plays an important role in disturbances of human psycho-physiological status. Previously, we revealed that brain endorphinergic structures have quasiresonance characteristics. On the basis of these data, a method of activation of the brain endorphinergic structures by means of noninvasive and rather selective transcranial electrostimulation (TES) as a kind of functional electrical stimulation (FES) was elaborated. New models of TES devices (TRANSAIR) were developed for indoor and outdoor usage. To increase the efficacy of TES, the frequency modulation according to normal distribution in the limits of the quasiresonance characteristics was put into operation. The blind and placebo-controlled (passive and active placebo) study was produced to estimate the TES effects on stress events and accompanied psycho-physiological and autonomic disturbances of different intensities on volunteers and patients in the following groups: everyday stress and fatigue; stress in regular military service and in field conditions; stress in the relatives of those lost in mass disaster; posttraumatic stress (thermal burns); and affective disorders in a postabstinence period. Some subjective verbal and nonverbal tests and objective tests (including heart rate variability) were used for estimation of the initial level of psycho-physiological status, which changes after TES sessions. It was demonstrated that fatigue, stress, and other accompanied psycho-physiological disturbances were significantly improved or abolished after 2-5 TES sessions. The TES effects were more pronounced in cases of heavier disturbances. In conclusion, activation of the brain endorphinergic structures by TES is an effective homeostatic method of FES that sufficiently improves quality of life.