Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.191
Filtrar
1.
Support Care Cancer ; 28(1): 35-42, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31444641

RESUMO

Impaired cardiovascular and autonomic function during treatment and during recovery from leukemia has been indicated. In this context, heart rate variability (HRV) is a non-invasive measure that describes the oscillations of the intervals between consecutive heart beats (RR intervals), influenced by the autonomic nervous system. We intend to review literature showing HRV changes in leukemia subjects. The articles selected in the current review were attained up to March 2018, and the search was limited to articles in English language, published in peer-reviewed journals, with both adult and child age samples. The articles were investigated in the five electronic databases: PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Clinical Trials, Scientific Electronic Library Online (SciELO), and Excerpta Medica dataBASE (EMBASE). Towards the end of the research, 9 studies were included. Subjects undergoing treatment for leukemia have reduced HRV, signifying decreased vagal control of heart rate. The subjects that undertook leukemia treatment and their survivors experienced a reduction in HRV with subsequent recovery, but the recovery time is ill defined. HRV is reduced in leukemia subjects who progress to neuropathy secondary to chemotherapy, accompanied by cardiac dysfunction. We advocate the use of HRV to evaluate autonomic function and decide the treatment to prevent autonomic impairment in leukemia subjects.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Cardiopatias/diagnóstico , Frequência Cardíaca/fisiologia , Leucemia/tratamento farmacológico , Leucemia/fisiopatologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Doenças do Sistema Nervoso Autônomo/induzido quimicamente , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Criança , Eletrocardiografia , Cardiopatias/induzido quimicamente , Cardiopatias/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Leucemia/diagnóstico , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos
2.
J Oncol Pharm Pract ; 26(1): 43-50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30890065

RESUMO

PURPOSE: Multiple myeloma is a chronic, uncurable hematological cancer with the involvement of multiple organ systems. As a disease affecting older patients, the treatment of multiple myeloma should be based on individual patient characteristics. Polypharmacy is an increasing problem in the care of older patients and in patients with multiple myeloma, polypharmacy is almost inevitable. We aimed to evaluate the applicability of polypharmacy definitions and the relation of polypharmacy with disease outcomes in patients with multiple myeloma. METHODS: Eighty patients older than 65 years and diagnosed with multiple myeloma were retrospectively enrolled. Patient files, prescriptions, evaluations for polypharmacy were determined according to Beers and START/STOPP criteria. Outcomes were recorded from files in terms of fractures, autonomous neuropathy, and renal functions. RESULTS: Polypharmacy with ≥4 drugs was observed in 65 patients while polypharmacy with ≥5 drugs was observed in 51 patients. Autonomous neuropathy, polypharmacy with more than four or five medications, and use of multiple medications in the same category were related with poor ECOG performance status in women, while prolonged use of benzodiazepines and central nervous system (CNS) affecting drugs and inappropriate polypharmacy were more frequent in men with poor ECOG performance status. The majority of patients aged 75-84 years were observed to use inappropriate polypharmacy. Autonomous neuropathy and fall risk were observed to be significantly related with inappropriate polypharmacy. CONCLUSIONS: Drugs affecting balance and perception should be reconsidered in patients with multiple myeloma.


Assuntos
Acidentes por Quedas , Doenças do Sistema Nervoso Autônomo/induzido quimicamente , Prescrição Inadequada/efeitos adversos , Mieloma Múltiplo/tratamento farmacológico , Polimedicação , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/epidemiologia , Feminino , Humanos , Prescrição Inadequada/tendências , Masculino , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/epidemiologia , Lista de Medicamentos Potencialmente Inapropriados/tendências , Estudos Retrospectivos , Fatores de Risco
4.
Orthopade ; 48(12): 1042-1044, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31620827

RESUMO

Harlequin syndrome is a rare combination of symptoms, characterized by unilateral facial anhidrosis and paleness on the affected side, becoming obvious by contralateral flushing mainly during sports activity. The syndrome is mostly idiopathic, however it is also described as a complication of thoracic surgery, i.e. superior lobectomy. Here, we report on two cases of Harlequin syndrome following scoliosis surgery at the cervicothoracic junction.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Rubor/diagnóstico , Hipo-Hidrose/diagnóstico , Escoliose/cirurgia , Adolescente , Doenças do Sistema Nervoso Autônomo/complicações , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Criança , Rubor/complicações , Rubor/fisiopatologia , Humanos , Hipo-Hidrose/complicações , Hipo-Hidrose/fisiopatologia , Masculino
5.
Cir. pediátr ; 32(4): 177-180, oct. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184105

RESUMO

Introducción. La hiperhidrosis primaria palmar es una patología que comienza ya en la niñez y puede representar una importante reducción de la calidad de vida del adolescente. El tratamiento de elección actual es la simpaticolisis toracoscópica. El objetivo de nuestro estudio es evaluar los resultados de la cirugía en pacientes pediátricos. Material y métodos. Hemos estudiado retrospectivamente los pacientes diagnosticados de hiperhidrosis palmar y/o palmoaxilar que han sido tratados en nuestro centro durante los últimos 5 años. Resultados. En este periodo han sido tratados 28 pacientes (10 varones y 18 mujeres), con una edad media de 13,8 años (8-18 años). La simpaticolisis toracoscópica bilateral se practicó, con monopolar, entre los niveles T2-T4 con un tiempo quirúrgico medio de 63 minutos. La estancia media fue de 1,1 días. No se registraron neumotórax ni otras complicaciones intraoperatorias. Dos casos presentaron enfisema subcutáneo postoperatorio. No hubo otras complicaciones postoperatorias. Excepto un caso de recurrencia parcial, en el resto de pacientes la sudoración desapareció por completo y quedaron totalmente satisfechos con la cirugía (96,42%). Apareció sudoración compensatoria transitoria en el 57,14% de los casos, efecto colateral que no modificó su nivel de satisfacción. Conclusiones. La hiperhidrosis palmar puede ser un problema importante para la sociabilización y la calidad de vida del niño o adolescente que la padece. La simpaticolisis toracoscópica en el paciente pediátrico es un tratamiento efectivo, altamente resolutivo y de escasa morbilidad. A pesar de la sudoración compensatoria, los pacientes es-tán altamente satisfechos con los resultados del tratamiento quirúrgico


Introduction. Primary palmar hyperhidrosis is a pathology that begins during childhood and can represent a significant reduction in the quality of life of adolescents. The current treatment of choice is thoracoscopic sympathicolysis.The aim of our study is to evaluate the results of surgery in paediatric patients. Material and methods. Retrospective study of patients with primary palmar or palmoaxillary hyperhidrosis who underwent thoracoscopic sympathicolysis in our hospital during the last 5 years. Results. We operated and included in the study 28 patients, 10 men and 18 women. Mean age was 13.8 (8-18) years. Bilateral thoracoscopic sympatholysis was performed with monopolar cautery, between T2-T4 ribs. Mean operative time was 63 minutes and mean hospitalisation time was 1.1 days. The incidence on intraoperative complications was zero. 2 patients presented postoperative subcutaneous emphysema. There were no other postoperative complications.1 patient presented partial recurrence. In all the rest, sweating completely disappeared and they were totally satisfied with the surgery (96.42%). Temporary compensatory sweating appeared in 57.14% of the cases, a collateral effect that did not change their level of satisfaction. Conclusions. Palmar hyperhidrosis can be a major problem for socialization and quality of life for the child or adolescent who suffers it. Thoracoscopic sympatholysis in the pediatric patient is an effective treatment, highly resolutive and with low morbidity. Despite compensatory sweating, patients are highly satisfied with the results of surgical treatment


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Hiperidrose/cirurgia , Satisfação do Paciente , Qualidade de Vida , Toracoscopia/métodos , Estudos Retrospectivos , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/cirurgia , Cauterização
6.
Pan Afr Med J ; 33: 141, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558939

RESUMO

Harlequin's syndrome is a rare dysautonomic syndrome of the face characterized by sweating with flush of one side and anhidrosis of the contralateral side. Mostly idiopathic although several secondary cases have been reported in the literature, the purpose of the treatment is mainly aesthetic and functional. We report the case of a patient having harlequin syndrome in its idiopathic form with a literature review.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Rubor/diagnóstico , Hipo-Hidrose/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Face , Rubor/fisiopatologia , Humanos , Hipo-Hidrose/fisiopatologia , Masculino , Adulto Jovem
7.
Chin Med J (Engl) ; 132(16): 1919-1924, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31373907

RESUMO

BACKGROUND: Differential diagnosis of idiopathic Parkinson disease (IPD) and multiple system atrophy-Parkinson type (MSA-P) is challenging since they share clinical features with parkinsonism and autonomic dysfunction. To distinguish MSA-P from IPD when the symptoms are relatively mild, we investigated the usefulness of the quantitative fractionalized autonomic indexes and evaluated the correlations of autonomic test indexes and functional status. METHODS: Thirty-six patients with parkinsonism (22 with IPD and 14 with MSA-P) in Soonchunhyang University Bucheon Hospital from February 2014 to June 2015 were prospectively enrolled in the study. We compared fractionalized autonomic indexes and composite autonomic scoring scale between patients with IPD and MSA-P with Hoehn and Yahr (H&Y) score ≤3. Parasympathetic indexes included expiratory/inspiratory ratio during deep breathing, Valsalva ratio (VR), and regression slope of systolic blood pressure (BP) in early phase II (vagal baroreflex sensitivity) during Valsalva maneuver. Sympathetic adrenergic indexes were pressure recovery time (PRT) and adrenergic baroreflex sensitivity (BRSa) (BP decrement associated with phase 3 divided by the PRT), sympathetic index 1, sympathetic index 3, early phase II mean BP drop, and pulse pressure reduction rate. Additionally, we compared the unified multiple system atrophy rating scale (UMSARS) and H&Y scores and the autonomic indexes in all patients. RESULTS: PRT was significantly different between the IPD and MSA-P groups (P = 0.004) despite the similar BP drop during tilt. Cut-off value of PRT was 5.5 s (sensitivity, 71.4%; specificity, 72.7%). VR (r = -0.455, P = 0.009) and BRSa (r = -0.356, P = 0.036) demonstrated a significant correlation with UMSARS and H&Y scores. CONCLUSIONS: Among the cardiovascular autonomic indexes, PRT can be a useful parameter in differentiating the early stage of MSA-P from that of IPD. Moreover, VR, and BRSa may be the optimal indexes in determining functional symptom severity.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Atrofia de Múltiplos Sistemas/diagnóstico , Doença de Parkinson/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Doenças do Sistema Nervoso Autônomo/patologia , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Pressão Sanguínea/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atrofia de Múltiplos Sistemas/patologia , Atrofia de Múltiplos Sistemas/fisiopatologia , Doença de Parkinson/fisiopatologia , Estudos Prospectivos
8.
Neurology ; 93(12): e1127-e1137, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31427501

RESUMO

OBJECTIVE: Despite the similar phenotypes, comparison between short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with autonomic features (SUNA) has hitherto not been possible due to the dearth of studies validating the phenotype of SUNA. Therefore, these 2 syndromes have been kept separate in the International Classification of Headache Disorders. The aim of this study is to characterize and compare the clinical phenotypes of large clinic-based cohorts of patients with SUNA and SUNCT. METHODS: The clinical phenotype of consecutive patients with SUNA identified from a single specialist headache center in the United Kingdom between 2007 and 2012 was studied and compared to that of patients with SUNCT. RESULTS: Sixty-three patients with SUNA (18 male, 28.6%) and 70 patients with SUNCT (32 male, 35.7%) were included. The demographic and clinical characteristics of patients with SUNA were similar to those of patients with SUNCT. Ptosis and rhinorrhea were predictors of SUNCT. The corresponding odds ratios (ORs) (95% confidence interval) were 3.79 (1.64-8.77, p = 0.002) and 2.46 (1.09-5.59, p = 0.031), respectively. The presence of spontaneous only attacks was a predictor for SUNA (OR 2.58 [1.10-6.05], p = 0.029). CONCLUSION: No major clinical differences have emerged between SUNCT and SUNA, bar the fact that SUNCT is characterized by more prominent cranial autonomic features and triggerability. We propose that the 2 disorders be placed together in a single diagnostic category for which new diagnostic criteria are proposed.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Síndrome SUNCT/diagnóstico , Síndrome SUNCT/fisiopatologia , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/diagnóstico , Neuralgia/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Adulto Jovem
9.
Med Hypotheses ; 131: 109296, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31443773

RESUMO

BACKGROUND: Among the most common autonomic signs visible in preterm neonates, apnea can represent the first sign of several neurologic and non-neurologic disorders, and seizure is a relatively infrequent cause. Herein authors present a case of neonatal autonomic apnea, discussing the polygraphic video-EEG features of this pathological entity and the differential diagnosis with central apnea and autonomic apnea. CASE REPORT: A female preterm Caucasian infant (29 + 4 weeks' gestational age (GA)), first twin of a twin pregnancy, at birth was intubated and surfactant administration was performed. She was ventilated via invasive ventilation for three days, with subsequent weaning with non-invasive ventilation for other two days, when she stopped requiring any ventilator support. After one week the ventilation weaning, the child presented episodes of cyanosis associated with sudden oxygen desaturation, skin pallor, apnea, and bradycardia. Therefore, the child underwent a continuous video-eeg recording with polygraphic study. The exam showed the presence of apneic episodes with an abrupt and clear start, associated with oxygen desaturation at 70%, with minimal thoracic effort at onset, and then evolving into central apnea. Central apnea lasted about 16 s and presented clear start- and end-points. These episodes were also associated with suppression of the EEG trace in frequency and amplitude, and after about 10 s of central apnea an abrupt decrease of the child's heart rate (more than 50% variation, from 160 bpm to 65 bpm) was recorded. In the suspect of epileptic apneas of autonomic origin, a therapy with oral Levetiracetam, at a starting dose of 10 mg/Kg/day, then increased up to 40 mg/Kg/day, was initiated, and after about 48 h the first administration of the anticonvulsant therapy, no new episodes of cyanosis or electrical apneas were recorded. HYPOTHESIS: Herein the authors suggest to consider the diagnosis of autonomic seizures in those neonates with apneic events associated with EEG suppression. Considering that apnea events are not only present in preterm infants but also in term neonates, it is mandatory to diagnose in this context neonatal seizures for a correct diagnosis and a proper therapeutic choice.


Assuntos
Apneia/diagnóstico , Doenças do Sistema Nervoso Autônomo/diagnóstico , Eletroencefalografia , Hipóxia/etiologia , Doenças do Prematuro/diagnóstico , Anticonvulsivantes/uso terapêutico , Apneia/classificação , Apneia/complicações , Apneia/fisiopatologia , Doenças do Sistema Nervoso Autônomo/complicações , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Bradicardia/etiologia , Bradicardia/fisiopatologia , Cianose , Diagnóstico Diferencial , Doenças em Gêmeos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Levetiracetam/uso terapêutico , Convulsões/diagnóstico , Apneia do Sono Tipo Central/diagnóstico , Apneia do Sono Tipo Central/etiologia , Apneia do Sono Tipo Central/fisiopatologia , Gravação em Vídeo
10.
Orv Hetil ; 160(35): 1366-1375, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31448646

RESUMO

Cardiac autonomic neuropathy (CAN) is a common complication in type 1 and 2 diabetes and is defined as the impairment of autonomic control of the cardiovascular system. CAN is strongly associated with increased mortality, and in some studies with morbidity of vascular complications, such as stroke, coronary artery disease and myocardial infarction. At the early stages, CAN can be subclinical and it becomes clinically evident as the disease progresses. Subclinically, the disease is defined by cardiovascular reflex testing, which may have prognostic implications. Clinically, the impairment in autonomic function is associated with resting tachycardia, exercise intolerance, orthostatic hypotension, syncope, intraoperative cardiovascular instability, silent myocardial infarction and ischemia, and increased mortality. Although very common and serious, CAN is a frequently overlooked complication of diabetes. Because the progression of cardiovascular denervation is partly reversible or can be slowed down in the early stages of the disease, recent guidelines strongly recommend screening for CAN in patients with diabetes. In this review we summarize the diagnostic tools suggested in the screening for diabetic CAN. Orv Hetil. 2019; 160(35): 1366-1375.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Cardiomiopatias Diabéticas/diagnóstico , Neuropatias Diabéticas/diagnóstico , Cardiopatias/complicações , Doenças do Sistema Nervoso Autônomo/complicações , Neuropatias Diabéticas/complicações , Coração/inervação , Humanos
11.
J Stroke Cerebrovasc Dis ; 28(9): e127-e128, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31301985

RESUMO

Harlequin syndrome is a disorder of the autonomic nervous system. It clinically presents as a distinct line of hemifacial sympathetic denervation. We describe a case of Harlequin syndrome with co-existing central first-order Horner syndrome in the setting of a large thalamic hemorrhage with intraventricular extension.


Assuntos
Doenças do Sistema Nervoso Autônomo/etiologia , Rubor/etiologia , Síndrome de Horner/etiologia , Hipo-Hidrose/etiologia , Hemorragias Intracranianas/complicações , Tálamo/irrigação sanguínea , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Feminino , Rubor/diagnóstico , Rubor/fisiopatologia , Síndrome de Horner/diagnóstico , Síndrome de Horner/fisiopatologia , Humanos , Hipo-Hidrose/diagnóstico , Hipo-Hidrose/fisiopatologia , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/fisiopatologia , Pessoa de Meia-Idade
12.
Handb Clin Neurol ; 160: 407-418, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277865

RESUMO

The autonomic nervous system has widespread innervation to nearly every organ system in the body. In order to understand the basics of autonomic function, knowledge of the neuroanatomy of the autonomic nervous system is necessary. Frequently considered to control the "fight or flight" and "rest and digest" functions, the autonomic nervous system has an intricate network of connections to finely tune the systemic response to nearly any situation. Although traditionally considered two discrete systems (sympathetic and parasympathetic), the enteric nervous system is now considered a third component of the autonomic nervous system. This chapter reviews the background of the neuroanatomical distribution of the autonomic nervous system in order to facilitate understanding the basics of autonomic function.


Assuntos
Sistema Nervoso Autônomo/fisiologia , Encéfalo/fisiologia , Medula Espinal/fisiologia , Animais , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Sistema Nervoso Entérico/fisiologia , Frequência Cardíaca/fisiologia , Humanos
13.
Handb Clin Neurol ; 160: 419-433, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277866

RESUMO

The evaluation of autonomic function requires indirect assessment of neurophysiologic function using specialized equipment that is often available only at tertiary care centers, with few specialists available. However, the evaluation of autonomic function is rooted in basic physiology, and the results can be interpreted by careful consideration of the context of the problem. Many automated devices have become widely available to test autonomic function, but they tend to gather inadequate data leading to frequent misdiagnosis and clinical confusion. We review the details necessary for the neurophysiologist to properly perform, and interpret, autonomic function testing.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Sistema Nervoso Autônomo/fisiologia , Reflexo/fisiologia , Sudorese/fisiologia , Manobra de Valsalva/fisiologia , Sistema Nervoso Autônomo/fisiopatologia , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Humanos , Teste da Mesa Inclinada/métodos
16.
Eur Arch Otorhinolaryngol ; 276(8): 2283-2287, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31177327

RESUMO

PURPOSE: To assess autonomic nerve function in patients with laryngopharyngeal reflux disease (LPRD) and determine the correlation between LPRD and autonomic nerve dysfunction. METHODS: Patients with suspected LPRD who visited our outpatient department were assessed using the reflux symptom index (RSI) and reflux finding score (RFS) scales. Eighty-one suspected LPRD patients with RSI > 13 and RFS > 7 were examined using 5-min short-range heart rate variability, and all were given proton pump inhibitor diagnostic treatment. RESULTS: The root mean square of successive R-R intervals, high-frequency (HF) power, standardized HF, and HF % were significantly lower in the case group than in the control group (p < 0.05); however, the low frequency (LF)/HF ratio was significantly higher in the case group (p < 0.05). There were no significant differences in the standard deviation of the average normal-to-normal interval, total power, LF power, and LF % between the two groups (p > 0.05). RSI, RFS, and disease duration were negatively correlated with HF power (r = - 0.89, -0.77, and -0.315, respectively; p < 0.05). The LF/HF ratio and disease duration were positively correlated (r = 0.315, p < 0.05). CONCLUSIONS: Autonomic nerve dysfunction was observed in our patients with LPRD. LPRD severity was significantly correlated with autonomic nerve dysfunction and negatively correlated with vagal nerve function.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/etiologia , Vias Autônomas/fisiopatologia , Refluxo Laringofaríngeo/complicações , Adulto , Idoso , Feminino , Frequência Cardíaca , Humanos , Refluxo Laringofaríngeo/diagnóstico , Refluxo Laringofaríngeo/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico
17.
Pathol Int ; 69(7): 414-419, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31237002

RESUMO

We report a case of an extremely rare type of duodenal gastrointestinal stromal tumor (GIST) that included neuronal components. Although gastrointestinal autonomic nerve tumors (GANTs), a subtype of GISTs, exhibit ultrastructural features of the nerve plexus, neuronal cells have not been observed within GANTs or GISTs. GISTs originate from interstitial cells of Cajal (ICCs), which are markedly different from the progenitor cells of neural elements and neural-crest-derived stem cells. This may explain why GISTs typically lack neuronal elements. It remains unclear that the neuronal components of this tumor are neoplastic or hyperplastic, but proliferation and survival of ICCs have recently been reported to be closely related to neurons. Although we could not find the KIT, PDGFR, and BRAF mutation as far as we examined, it may have had a rare mutation in NF1, a fusion of EVT6-NTRK3, or an as-yet-unknown KIT mutation that affected neurogenesis. Further investigation of related genetic mutations and accumulation of data from other similar cases is needed.


Assuntos
Doenças do Sistema Nervoso Autônomo/patologia , Tumores do Estroma Gastrointestinal/patologia , Mutação/genética , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/genética , Sarcoma/patologia , Idoso , Doenças do Sistema Nervoso Autônomo/diagnóstico , Biomarcadores Tumorais/genética , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/ultraestrutura , Humanos , Masculino , Proteínas Proto-Oncogênicas c-kit/genética , Sarcoma/diagnóstico , Sarcoma/ultraestrutura
18.
Clin Exp Rheumatol ; 37 Suppl 121(6): 35-42, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943130

RESUMO

OBJECTIVES: Autonomic dysfunction (AD) has been described in various chronic inflammatory diseases. Studies of AD in patients with familial Mediterranean fever (FMF) are inconclusive. We aimed to assess AD in a cohort of FMF patients. METHODS: Signs and symptoms of AD were investigated in patients with FMF and compared to age and gender matched healthy controls. Symptoms of AD were assessed by COMPASS-31, a validated questionnaire to evaluate orthostatic, vasomotor, secretomotor, gastrointestinal, pupillomotor and bladder function domains. Assessment of objective AD comprised heart rate variability during deep breathing, skin conductance changes during mental arithmetic, blood pressure response to pain and dynamic infrared pupillometry. RESULTS: 25 patients and 25 healthy controls were included and evaluated by COMPASS-31 and objective testing of AD. FMF patients had higher median COMPASS-31 total scores than controls (23.7 vs. 1.6, p=0.024). Significant differences were also found in the secretomotor and gastrointestinal sub-domains (4.2 vs. 0.0; p<0.001 and 8.0 vs. 0.0; p=0.004, respectively). Symptoms of autonomic dysfunction were correlated with patient reported global disease activity (r=0.71; p<0.001) and pain level (r=0.68; p<0.001). There were no differences in heart rate variability (HRV), skin conductance, blood pressure response to pain or sympathetic pupillomotor function between patients and controls. FMF patients revealed impaired parasympathetic pupillomotor function that was not associated with clinical parameters. However, patients that were on IL-1-blocking therapy had better parasympathetic pupillary function than patients on conventional treatment. CONCLUSIONS: FMF patients have AD in terms of symptoms and parasympathetic pupillomotor function. Dynamic pupillometry can provide additional information on autonomic regulation in patients with FMF.


Assuntos
Doenças do Sistema Nervoso Autônomo , Febre Familiar do Mediterrâneo , Sistema Nervoso Autônomo , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/etiologia , Estudos de Casos e Controles , Estudos Transversais , Febre Familiar do Mediterrâneo/complicações , Febre Familiar do Mediterrâneo/diagnóstico , Frequência Cardíaca , Humanos
19.
Cardiol Young ; 29(4): 488-491, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30992090

RESUMO

INTRODUCTION: Migraine is a common neurovascular disease characterised with recurrent attacks by pain-free periods. It has been suggested that both sympathetic and parasympathetic dysfunctions play a role in its pathophysiology. AIM: The aim of our study was to investigate the ECG changes during attack-free period in children with migraine, in terms of QTc interval, QTc, and P-wave dispersion to evaluate the autonomic nervous system disturbance. METHODS: Sixty children who were diagnosed with migraine were included as patient group and 50 healthy, age- and body mass index-matched children who were examined for innocent murmur were included as control group. The patients' routine ECG records were screened from the outpatient clinic files. The durations of P-wave, QT, and QTc intervals and dispersion values and heart rates (beats/minute) were compared between the patient and control groups. RESULTS: P maximum and P dispersion were significantly higher, and P minimum was significantly lower in the migraine group compared with the control group. QT-QTc maximum and QT-QTc dispersion were significantly higher and QT-QTc minimum was significantly lower in the migraine group compared with the control group. CONCLUSION: According to our findings, although migraine patients were asymptomatic and no arrhythmia was detected in the surface ECG, sympathovagal balance in the sympathetic system, which may be disrupted in favour of the sympathetic system, should continue even in the attack-free period, and we should be careful in terms of serious arrhythmias that may develop in these patients.


Assuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Transtornos de Enxaqueca/fisiopatologia , Adolescente , Arritmias Cardíacas/complicações , Doenças do Sistema Nervoso Autônomo/complicações , Criança , Eletrocardiografia , Feminino , Humanos , Masculino , Transtornos de Enxaqueca/complicações , Estudos Retrospectivos , Turquia
20.
Int J Rheum Dis ; 22(6): 1029-1035, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30989785

RESUMO

AIM: Autonomic dysfunction (AD) is an early feature of systemic sclerosis (SSc). A regular endothelial function is a prerequisite for normal response of the myocardial blood flow (MBF) to cold pressure test (CPT). The aim of the study was to evaluate the relation between MBF and AD at rest and after CPT in asymptomatic SSc patients. METHODS: Twenty SSc patients and 10 age-, sex- and body mass index-matched healthy controls underwent cardiac magnetic resonance at rest and after CPT. All subjects underwent 24 hours ambulatory 3-channel electrocardiogram Holter to evaluate AD by heart rate variability. RESULTS: We did not observe any significant difference in MBF (mL/g/min) at rest and after CPT between SSc patients and healthy controls. Delta of MBF (difference between MBF after CPT and rest MBF) was lower (P = 0.039) in SSc patients than healthy controls (0.28 [0.04-0.40] vs 0.33 [0.24-0.54]). The low frequency/high frequency (LF/HF) was higher (P = 0.002) in SSc patients than healthy controls (3 [1.7-6] vs 1.8 [1.1-2.8]). The high frequencies (HF), modulated mainly by paraympathetic system, was lower (P = 0.003) in SSc patients than healthy controls (30 [16-42] vs 36.5 [24-44]). Sympathetic hyperactivity, due to reduction of parasympathetic activity (HF), is present in SSc patients. A negative correlation was observed between Delta of MBF and LF/HF (r = -0.572, P = 0.0031). CONCLUSION: AD, characterized by sympathovagal imbalance due to a reduced parasympathetic tone with high LF/HF ratio, could be responsible for the reduced myocardial vasodilatory response after CPT.


Assuntos
Doenças do Sistema Nervoso Autônomo/etiologia , Sistema Nervoso Autônomo/fisiopatologia , Circulação Coronária , Cardiopatias/diagnóstico por imagem , Coração/diagnóstico por imagem , Coração/inervação , Imagem Cinética por Ressonância Magnética , Imagem de Perfusão do Miocárdio/métodos , Escleroderma Sistêmico/complicações , Adulto , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Estudos de Casos e Controles , Feminino , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/fisiopatologia , Vasodilatação , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA