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1.
Diabetes Res Clin Pract ; 155: 107813, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31408665

RESUMO

AIMS: To assess cardiac autonomic control and its association with submaximal exercise measured using the 6-minute walk test (6MWT) in subjects with type-2 diabetes mellitus (DM2). METHODS: Cardiac autonomic control was assessed using Ewing's tests and heart rate variability (HRV) in DM2 volunteers (DG, n = 22) and sex-, age- and body mass index-matched non-diabetic controls (CG, n = 22) before, during and after 6MWT. RESULTS: Before the 6MWT, DG presented lower HRV represented by reduced SDNN [median 28.9 ms2 (IQR:18.6-35.4) vs. 45.1 (IQR:39.2-62.67), p < 0.001] and Total Power [median 785 ms2 (IQR:256-1264) vs. 1757 ms2 (IQR:1006-2912), p = 0.004]. Exercise capacity was reduced in DG [maximal predicted distance (%) = 88.4 ±â€¯6.4 vs. 95.2 ±â€¯11.0%, p = 0.018]. DG demonstrated lower global HRV during recovery and lower parasympathetic drive, represented by reduced RMSSD, during all phases of the 6MWT. Moreover, supine HR (r = -0.32), HR orthostatism (ρ = -0.40), SDNN pre-6MWT (ρ = 0.39), TP pre-6MWT (ρ = 0.38), Valsalva ratio (ρ = 0.39) and 30:15 ratio (ρ = 0.38) were all correlated with maximal walked distance. CONCLUSIONS: DM2 subjects presented abnormal HRV during and after submaximal exercise. Furthermore, autonomic control impairment in orthostatism, represented by lower global HRV (SDNN, Total power) and lower Ewing's indexes (Valsalva and 30:15 ratios), was associated with lower exercise capacity.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Teste de Esforço/métodos , Tolerância ao Exercício/fisiologia , Exercício/fisiologia , Frequência Cardíaca/fisiologia , Manobra de Valsalva/fisiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
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
5.
Graefes Arch Clin Exp Ophthalmol ; 257(7): 1467-1472, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31111251

RESUMO

BACKGROUND: It has been shown in the literature that the Valsalva manoeuvre influences ocular perfusion by changing intraocular pressure and central retinal venous pressure (CRVP). High-resistance wind instrument (HRWI) playing is a common situation resembling a Valsalva manoeuvre. The aim of this investigation was to explore the influence of amateur trumpet playing on CRVP. METHODS: The left eyes of 20 healthy non-professional trumpet players (median age 26, range 19-52 years; 17 males, 3 females) were included in this investigation. Subjects, sitting at a slit lamp, were asked to play the tone b' flat with their own mouthpiece on the same trumpet for at least 30 s with moderate loudness. The following data were obtained: intraocular pressure (IOP) by applanation tonometry before and during playing, CRVP by contact lens dynamometry before and during playing, airway pressure (AirP) using a pressure sensor during playing and blood pressure and heart rate using the common cuff method before and during playing. RESULTS: The results are presented as the medians before vs during playing: a calculated mean ophthalmic artery pressure of 66 vs 72 mmHg, heart rate of 76 vs 82 beats per minute, airway pressure of 0 vs 17 mmHg, IOP 12 vs 13 mmHg and CRVP of 24 vs 55 mmHg (Wilcoxon test: p = 0.00009), respectively. A correlation between the CRVP during playing and the height of the spontaneous CRVP is noted (Spearman rank correlation coefficient: ρ = 0.68). CONCLUSIONS: Amateur trumpet playing increases CRVP, airway pressure and IOP. The increase in CRVP is greater than that of the intraocular pressure. The increase in CRVP seems to be more important for retinal perfusion changes during trumpet playing than the increase of IOP. It can be hypothesised that high airway pressure during playing may cause a permanent increase in CRVP, at least in a subgroup of trumpet players.


Assuntos
Pressão Venosa Central/fisiologia , Glaucoma/fisiopatologia , Pressão Intraocular/fisiologia , Retina/fisiopatologia , Manobra de Valsalva/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Fatores de Risco , Tonometria Ocular , Adulto Jovem
6.
Echocardiography ; 36(4): 783-786, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30803022

RESUMO

Patent foramen ovale (PFO) is the most common type of inter-atrial shunt, with prevalence as high as 30%. Detection of PFO has implications in patients with stroke, peripheral embolism, decompression illness, and other conditions. Transesophageal echo (TEE) with saline contrast injection is the current standard for PFO detection, but even with TEE, PFOs are sometimes missed. With advances in percutaneous PFO closure therapies and proven long-term benefit of closure, accurate PFO detection takes on cardinal importance. Various provocative maneuvers to enhance PFO detection are in clinical use and have been studied. The Valsalva maneuver has long-held position as the ideal provocation to unmask PFO, but other maneuvers such as cough, sniff, Müller's, and more have gained relevance. In this article, we will examine various maneuvers and discuss their utility in PFO detection.


Assuntos
Tosse , Ecocardiografia Transesofagiana/métodos , Forame Oval Patente/diagnóstico por imagem , Manobra de Valsalva/fisiologia , Forame Oval/diagnóstico por imagem , Forame Oval/fisiopatologia , Forame Oval Patente/fisiopatologia , Humanos
7.
Am J Rhinol Allergy ; 33(3): 331-337, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30616365

RESUMO

BACKGROUND: Sneezing is an almost universal daily phenomenon as a reflex to evacuate irritants from the nasal cavities. An autonomic-controlled buildup of intrathoracic pressure against a closed glottis followed by sudden release results in a burst of 1 kPa of air through the upper airway. Active intervention to limit a sneeze can be deleterious. Closure of the airway during a sneeze can result in over 20 times the airway pressures resulting in a variety of untoward events. This review summarizes all reported injuries that occurred as the result of a sneeze. OBJECTIVE: The objective of this review is to summarize the risks of closed-airway sneezing and determine if there are any trends which can help understand such injuries. METHODS: A comprehensive literature review was performed from 1948 to 2018 to identify all reports of sneeze-related injuries. Information was compiled from reports to gain insights into comorbidities and risk factors for sneeze injuries. RESULTS: There were 52 unique reports of sneeze-related injuries in the literature that were categorized into 6 areas of injury: intrathoracic, laryngeal/pharyngeal, ocular/orbital, intracranial/neurological, otologic, and other. The mean age of subjects who suffered a sneeze injury was 40 years old (range: 15-84 years), with 81% being male gender. Thirty percent had a risk factor for injury of prior trauma (5) or respiratory compromise (5). CONCLUSION: A variety of injuries can occur during a sneeze, especially when a closed-airway sneeze is attempted, and high Valsalva pressure is transmitted to the other systems. Men are more at risk for these injuries with the majority occurring in patients with no known risk factor. When triggered, a sneeze should be allowed to proceed without intervention to prevent associated injuries.


Assuntos
Espirro , Ferimentos e Lesões/etiologia , Humanos , Fatores de Risco , Espirro/fisiologia , Manobra de Valsalva/fisiologia
8.
Can J Physiol Pharmacol ; 97(2): 107-111, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30517028

RESUMO

In evaluating autonomic dysfunction, the autonomic reflex screen (ARS) is an established set of standardized tests to evaluate the presence and severity of autonomic dysfunction. Our laboratory previously reported normative data on 121 healthy individuals; however, the sample size in older individuals was reduced compared with other age groups. Therefore, the objective of the current study was to provide updated normative values representative of young, middle-aged, and older individuals from Southwestern Ontario. Two hundred and fifty-two healthy individuals completed quantitative sudomotor axon reflex testing, heart rate responses to deep breathing (HRDB), and Valsalva maneuver using standard protocols of the ARS. All 4 sweat sites demonstrated a significant effect of sex (p < 0.001). In addition, the proximal leg, distal leg, and foot were all significantly affected by age (p < 0.001). Cardiovagal parameters, measured via HRDB and Valsalva ratio revealed a significant regression with age (p < 0.001). These results show similar trends with previously reported normative data sets. All normative data as a function of age and sex, where appropriate, are expressed as percentiles (2.5th, 5th, 95th, 97.5th). The current study provides updated normative data describing autonomic functioning in healthy individuals obtained from the sudomotor and cardiovagal components of the ARS.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Sistema Nervoso Autônomo/fisiologia , Conjuntos de Dados como Assunto/normas , Reflexo/fisiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Manobra de Valsalva/fisiologia , Adulto Jovem
9.
Emerg Med J ; 36(1): 27-31, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30504456

RESUMO

BACKGROUND: The Valsalva manoeuvre (VM) is used to treat supraventricular tachycardia (SVT) by inducing a vagal response (drop in HR). There is debate as to the best position in which to carry out the VM and how the strain should be delivered in practice. We aimed to compare vagal responses induced with supine and modified VMs using strains delivered with a standardised manometer or novel Valsalva Assist Device (VAD), a simple device to provide resistance to exhalation. METHODS: We conducted a repeated measures randomised trial of four VMs (two supine VM and two modified VMs), in healthy adult volunteers, with strains delivered using an adapted sphygmomanometer (manometer) or a VAD. Changes in HR, pressure and duration of strain and adverse events were monitored and compared between the techniques and devices. The trial was approved by the University of Exeter Medical School Research ethics committee. RESULTS: 75 healthy participants aged 19-55 years were recruited over a 4-month period. A mixed-effects linear regression showed the modified VM resulted in a 3.8 beats per min (bpm) greater drop in HR compared with the supine VM (p=0.002, 95% CI 2.2 to 5.4). VM strains produced by the VAD were of a similar pressure but of slightly shorter duration and resulted in a 1.9 bpm smaller drop in HR compared with the manometer (p=0.01, 95% CI 0.4 to 3.4). There were no differences in adverse events. CONCLUSIONS: Modified VM was associated with a greater drop in HR than a supine VM with no increase in adverse events in healthy volunteers. The VAD can be used to safely generate the recommended VM strain pressure, but produced a smaller drop in HR compared with a manometer and requires modification to enable the recommended strain duration to be achieved consistently. TRIAL REGISTRATION NUMBER: NCT03298880.


Assuntos
Desenho de Equipamento/normas , Frequência Cardíaca/fisiologia , Estimulação do Nervo Vago/instrumentação , Manobra de Valsalva/fisiologia , Adulto , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Decúbito Dorsal/fisiologia , Nervo Vago/fisiologia , Estimulação do Nervo Vago/métodos
10.
Clin Neurophysiol ; 130(1): 189-195, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30527385

RESUMO

OBJECTIVE: Compare activation patterns within the cortical autonomic network in patients with neurogenic orthostatic hypotension (NOH) versus healthy age-matched controls during an orthostatic challenge. METHODS: Fifteen health controls and 15 NOH patients performed 3 Valsalva maneuvers, and 5-min of lower-body negative pressure (LBNP) during a functional brain MRI. RESULTS: Compared to controls, NOH patients had significantly less activation within the cerebellum during both LBNP and VM. Both groups had significant activation of the bilateral insula and left thalamus during LBNP. No significant differences were found during the recovery phase of LBNP. CONCLUSIONS: The cerebellum, which plays an important role in vestibulo-sympathetic reflexes, important for blood pressure adjustments during postural changes, appear to be affected in patients with NOH. The cerebellum also appears to be affected during other baroreflex mediated stressors such as the VM. SIGNIFICANCE: Orthostatic reflexes mediated by the cerebellum may be impaired in patients with NOH. The results suggest an additional pathological pathway in patients with autonomic failure.


Assuntos
Barorreflexo/fisiologia , Pressão Sanguínea/fisiologia , Cerebelo/fisiopatologia , Hipotensão Ortostática/diagnóstico por imagem , Manobra de Valsalva/fisiologia , Idoso , Cerebelo/diagnóstico por imagem , Feminino , Humanos , Hipotensão Ortostática/fisiopatologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade
11.
Am J Obstet Gynecol ; 220(2): 189.e1-189.e8, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30321525

RESUMO

BACKGROUND: The Valsalva maneuver is normally accompanied by relaxation of the levator ani muscle, which stretches around the presenting part, but in some women the maneuver is accompanied by levator ani muscle contraction, which is referred to as levator ani muscle coactivation. The effect of such coactivation on labor outcome in women undergoing induction of labor has not been previously assessed. OBJECTIVE: The aim of the study was to assess the effect of levator ani muscle coactivation on labor outcome, in particular on the duration of the second and active second stage of labor, in nulliparous women undergoing induction of labor. STUDY DESIGN: Transperineal ultrasound was used to measure the anteroposterior diameter of the levator hiatus, both at rest and at maximum Valsalva maneuver, in a group of nulliparous women undergoing induction of labor in 2 tertiary-level university hospitals. The correlation between anteroposterior diameter of the levator hiatus values and levator ani muscle coactivation with the mode of delivery and various labor durations was assessed. RESULTS: In total, 138 women were included in the analysis. Larger anteroposterior diameter of the levator hiatus at Valsalva was associated with a shorter second stage (r = -0.230, P = .021) and active second stage (r = -0.338, P = .001) of labor. Women with levator ani muscle coactivation had a significantly longer active second stage duration (60 ± 56 vs 28 ± 16 minutes, P < .001). Cox regression analysis, adjusted for maternal age and epidural analgesia, demonstrated an independent significant correlation between levator ani muscle coactivation and a longer active second stage of labor (hazard ratio, 2.085; 95% confidence interval, 1.158-3.752; P = .014). There was no significant difference between women who underwent operative delivery (n = 46) when compared with the spontaneous vaginal delivery group (n = 92) as regards anteroposterior diameter of the levator hiatus at rest and at Valsalva maneuver, nor in the prevalence of levator ani muscle coactivation (10/46 vs 15/92; P = .49). CONCLUSION: Levator ani coactivation is associated with a longer active second stage of labor.


Assuntos
Segunda Fase do Trabalho de Parto/fisiologia , Trabalho de Parto Induzido , Contração Muscular/fisiologia , Diafragma da Pelve/fisiopatologia , Manobra de Valsalva/fisiologia , Adulto , Feminino , Humanos , Paridade , Diafragma da Pelve/diagnóstico por imagem , Períneo/diagnóstico por imagem , Gravidez , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Tempo , Ultrassonografia
12.
Ultrasound Obstet Gynecol ; 54(1): 119-123, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30461093

RESUMO

OBJECTIVES: To confirm our previous observation that levator hiatal dimensions and mean echogenicity of the puborectalis muscle (MEP) are significantly different at 12 weeks' gestation in women who delivered by Cesarean section due to failure to progress compared with those who delivered vaginally. The secondary objective was to assess the association between the echogenicity of the cervix and vastus lateralis muscle and mode of delivery. METHODS: In this prospective multicenter study, 306 nulliparous women with a singleton pregnancy underwent ultrasound assessments of the pelvic floor at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver, of the cervix and of the vastus lateralis muscle at 12 weeks' gestation. Dimensions of the levator hiatus, MEP and mean echogenicity of the cervix and vastus lateralis muscle were measured and compared according to mode of delivery. RESULTS: Two hundred and forty-nine women were included in the analyses. We were unable to confirm our previous finding that MEP and levator hiatal transverse diameter and area at 12 weeks' gestation are associated significantly with mode of delivery. In addition, we could not demonstrate a significant association between echogenicity of the cervix or vastus lateralis muscle and mode of delivery. Overall, MEP was a mean of 20 points lower in women in the new database as compared with the previous study, despite the use of the same ultrasound equipment. CONCLUSION: In a second, independent multicenter dataset, we were unable to confirm our previous finding that levator hiatal dimensions and MEP on pelvic floor muscle contraction are associated significantly with mode of delivery. We also found no association between echogenicity of the cervix or vastus lateralis and mode of delivery. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Colo do Útero/diagnóstico por imagem , Parto Obstétrico/tendências , Diafragma da Pelve/diagnóstico por imagem , Músculo Quadríceps/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Colo do Útero/anatomia & histologia , Colo do Útero/fisiologia , Cesárea/métodos , Feminino , Idade Gestacional , Humanos , Imagem Tridimensional/instrumentação , Contração Muscular/fisiologia , Países Baixos/epidemiologia , Diafragma da Pelve/anatomia & histologia , Diafragma da Pelve/fisiologia , Gravidez , Estudos Prospectivos , Músculo Quadríceps/fisiologia , Manobra de Valsalva/fisiologia
13.
Ultrasound Obstet Gynecol ; 53(5): 686-692, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30353589

RESUMO

OBJECTIVE: To assess the effect of levator ani muscle (LAM) coactivation at term on outcome of labor in nulliparous women. METHODS: This was a prospective study of 284 low-risk nulliparous women with a singleton pregnancy at term recruited before the onset of labor. The anteroposterior diameter of the levator hiatus was measured in each woman on transperineal ultrasound at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver before and after visual feedback. LAM coactivation was defined as a reduction in the anteroposterior diameter of the levator hiatus on maximum Valsalva maneuver in comparison with that at rest. The association of pelvic hiatal diameter values and LAM coactivation with mode of delivery and duration of labor was assessed. RESULTS: No significant difference was found between women who underwent Cesarean delivery and those who had a vaginal delivery with regard to the anteroposterior diameter of the levator hiatus at rest, on pelvic floor muscle contraction and on Valsalva maneuver. Longer second stage of labor was associated with shorter anteroposterior diameter of the levator hiatus on all assessments, but in particular at rest and on Valsalva both before and after visual feedback. LAM coactivation was found in 89 (31.3%) and 75 (26.4%) women before and after visual feedback, respectively. Post visual feedback, women with LAM coactivation had a significantly longer second stage of labor than did those without LAM coactivation (83 ± 63 vs 63 ± 42 min; P = 0.006). On Cox regression analysis, LAM coactivation post visual feedback was an independent predictor of longer second stage of labor (adjusted hazard ratio, 1.499 (95% CI, 1.076-2.087); P = 0.017). CONCLUSION: LAM coactivation in nulliparous women at term is associated with a longer second stage of labor. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Segunda Fase do Trabalho de Parto/fisiologia , Contração Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Diafragma da Pelve/fisiopatologia , Manobra de Valsalva/fisiologia , Adulto , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Músculo Esquelético/diagnóstico por imagem , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/fisiopatologia , Paridade , Diafragma da Pelve/diagnóstico por imagem , Gravidez , Modelos de Riscos Proporcionais , Estudos Prospectivos , Análise de Regressão , Nascimento a Termo/fisiologia , Fatores de Tempo , Ultrassonografia Pré-Natal/métodos , Adulto Jovem
14.
World Neurosurg ; 121: e670-e674, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30292662

RESUMO

INTRODUCTION: With a rapidly expanding elderly population in the United States, the incidence of pituitary adenomas in elderly will continue to rise. In this study, we aim to evaluate the safety and efficacy of transsphenoidal endoscopic endonasal resection for pituitary adenomas in the elderly population. METHODS: A retrospective review of 131 consecutive patients who underwent transsphenoidal endoscopic endonasal resection for pituitary adenomas at the University of Miami Hospital between 2012 and 2016 was performed. Preoperative, intraoperative, and surgical outcomes were analyzed in elderly (>70 years) versus nonelderly (<70 years) patients. RESULTS: Of the 131 patients, 23 of them were >70 years (18%), of which 14 were septuagenarians and 9 were octogenarians. Elderly patients were more likely to present with vision loss (80.8% vs. 56.6%; P = 0.013) and larger tumors on imaging (2.7 ± 1.0 cm vs. 2.4 ± 1.3 cm; P = 0.042). Overall surgical and endocrinologic outcomes between the 2 groups were similar. However, patients <70 years old were more likely to have a gross total resection (86.7% vs. 65.4%; P = 0.011), as well as transient diabetes insipidus (54.3% vs. 26.9% P = 0.012) and intraoperative cerebrospinal fluid leak (83.5% vs. 58.5%; P = 0.013). However, permanent postoperative complication rates were similar including rate of permanent diabetes insipidus (4.3% elderly vs. 12.1% adult), cerebrospinal fluid leak (8.7% elderly vs. 8.4% adult), and meningitis (4.3% elderly vs. 2.8% adult). There were no medical complications or deaths in our cohort. CONCLUSION: The transsphenoidal endoscopic endonasal approach can be a safe and effective technique for resection of pituitary adenomas in patients >70 years old with appropriate patient selection.


Assuntos
Adenoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Nariz/cirurgia , Neoplasias Hipofisárias/cirurgia , Osso Esfenoide/cirurgia , Adenoma/complicações , Adenoma/diagnóstico por imagem , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Endoscopia/métodos , Feminino , Humanos , Hiperlipidemias/complicações , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Osso Esfenoide/diagnóstico por imagem , Tomógrafos Computadorizados , Resultado do Tratamento , Manobra de Valsalva/fisiologia , Transtornos da Visão/etiologia , Transtornos da Visão/cirurgia , Adulto Jovem
15.
Int Ophthalmol ; 39(4): 803-812, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29508190

RESUMO

PURPOSE: To evaluate the long-term course of primary angle-closure ocular hypertension and primary open-angle ocular hypertension and possible risk factors for progression to glaucoma. METHODS: A total of 109 eyes of 109 ocular hypertension (OHT) patients with a minimum follow-up period of 5 years having complete ocular/medical records were evaluated. They were classified into primary angle closure or primary open angle based on gonioscopy at baseline. Baseline and review data of Humphrey field analyser, HFA, and Heidelberg retinal tomography, HRT, were recorded. Guided progression analysis (GPA) and univariate Cox regression were used for time to event analysis in identifying progression to glaucoma. RESULTS: Over a mean follow-up of 12.18 ± 4.8 years, progression to glaucoma was 17.43% (19 eyes), out of whom 5.5% (6 eyes) showed ≥ 3 loci on GPA. Sub-classifying them, progression to primary angle-closure glaucoma was 19.72%, and that of primary open-angle glaucoma was 13.16%. The mean time to progression was 9.34 ± 3.6 years. Significant risk factors included small disc area (≤ 1.99 sq.mm on HRT), requirement of ≥ 2 drugs to maintain target IOP and those engaged in activities yielding a Valsalva effect in daily life. Coronary artery disease (CAD) and systemic use of steroids were associated with increased severity. CONCLUSION: Overall progression of OHT to glaucoma was 17.43% over a mean of 9 years, with target IOP of ≤ 18 mm Hg. Patients with smaller discs, CAD, exercising Valsalva type activities and using ≥ 2 glaucoma medications or systemic steroids should be closely monitored.


Assuntos
Glaucoma de Ângulo Fechado/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Pressão Intraocular/fisiologia , Hipertensão Ocular/fisiopatologia , Idoso , Análise de Variância , Anti-Hipertensivos/uso terapêutico , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Disco Óptico/anatomia & histologia , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Tonometria Ocular , Manobra de Valsalva/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologia
16.
Ultrasound Obstet Gynecol ; 53(2): 262-268, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30084230

RESUMO

OBJECTIVE: To study possible associations between pelvic floor muscle contraction, levator ani muscle (LAM) trauma and/or pelvic organ prolapse (POP) ≥ Stage 2 in parous women recruited from a general population. METHODS: This was a secondary analysis of data from a cross-sectional study of 608 parous women from a general population examined using the POP quantification system (POP-Q) and three-dimensional/four-dimensional transperineal ultrasound for identification of LAM macrotrauma (avulsion) and microtrauma (distension of levator hiatal area > 75th percentile on Valsalva maneuver). Muscle contraction was assessed using the modified Oxford scale (MOS), perineometry and ultrasound measurement of proportional change of anteroposterior hiatal diameter and levator hiatal area at rest and on pelvic floor muscle contraction. The Mann-Whitney U-test was used to study associations between pelvic floor muscle contraction, LAM trauma and POP. RESULTS: Women with macrotrauma (n = 113) had significantly weaker median pelvic floor muscle contraction, as measured using MOS and perineometry, than did women with an intact LAM (n = 493) (contraction strength was 1.5 (range, 0.0-5.0) vs 3.5 (range, 0.0-5.0) on MOS, and vaginal squeeze pressure was 15.0 (range, 0.0-78.0) cmH2 O vs 28.0 (range, 0.0-129.0) cmH2 O on perineometry; P < 0.001). This was also demonstrated by ultrasound measurement, with a proportional change in hiatal area of 19.9% (range, 4.1-48.0%) vs 34.0% (range, 0.0-64.0%) (P < 0.001) and proportional change in anteroposterior diameter of 16.2% (range, -5.7 to 42.6%) vs 26.0% (range, -3.4 to 49.4%) (P < 0.001). No statistically significant difference between women with (n = 65), and those without (n = 378), microtrauma was found after excluding women with macrotrauma. Women with POP had weaker muscle contraction than those without; in those with POP-Q ≥ 2 (n = 275) compared with those with POP-Q < 2 (n = 333), muscle contraction strength was 3.0 (range, 0.0-5.0) vs 3.5 (range, 0.0-5.0) on MOS, vaginal squeeze pressure was 21.0 (range, 0.0-98.0) cmH2 O vs 28.0 (range, 3.0-129.0) cmH2 O on perineometry, proportional change in hiatal area was 29.6% (range, 0.0-60.9%) vs 33.8% (range, 0.0-64.4%) and proportional change in anteroposterior diameter was 22.8% (range, -5.7 to 49.4%) vs 25.7% (range, -3.4 to 49.4%) (P < 0.001 for all). CONCLUSIONS: LAM macrotrauma was associated with weaker pelvic floor muscle contraction measured using palpation, perineometry and ultrasound. Women with POP had weaker contraction than did women without POP. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Contração Muscular/fisiologia , Diafragma da Pelve/lesões , Prolapso de Órgão Pélvico/etiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Imagem Tridimensional , Escala de Gravidade do Ferimento , Pessoa de Meia-Idade , Força Muscular/fisiologia , Diafragma da Pelve/diagnóstico por imagem , Prolapso de Órgão Pélvico/classificação , Prolapso de Órgão Pélvico/diagnóstico por imagem , Estatísticas não Paramétricas , Ultrassonografia , Manobra de Valsalva/fisiologia
17.
Acta Diabetol ; 56(1): 39-43, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30159748

RESUMO

AIMS: Cardiovascular autonomic testing is time consuming when adopting the entire Ewing battery of tests, hence, clinicians usually adopt an empirically reduced number of tests which may give controversial results. Our purpose was to examine the reliability of the cardiovascular tests most commonly used in autonomic diagnoses. METHODS: We tested 334 subjects, from an original group of 3745, who had shown an altered deep breathing test to both Lying to standing and Valsalva manoeuvre, assuming a value of postural hypotension of more than 15 mmHg as a sign of almost true dysautonomia. RESULTS: VM showed the highest sensitivity (85%) and, when coupled to LS, highest specificity (83%). CONCLUSIONS: VM could be useful when screening for possible or early autonomic neuropathy, VM + LS is useful as a diagnostic tool for probable or advanced autonomic neuropathy, and VM + LS + PH is useful for certain diagnosis of definite or late stage autonomic neuropathy.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças Cardiovasculares/diagnóstico , Sistema Cardiovascular/fisiopatologia , Angiopatias Diabéticas/diagnóstico , Neuropatias Diabéticas/diagnóstico , Técnicas de Diagnóstico Cardiovascular , Idoso , Sistema Nervoso Autônomo/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Angiopatias Diabéticas/fisiopatologia , Técnicas de Diagnóstico Endócrino , Feminino , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Manobra de Valsalva/fisiologia
18.
Ultrasound Obstet Gynecol ; 54(1): 124-127, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30584675

RESUMO

OBJECTIVE: Levator ani trauma and hiatal overdistension have been shown to be associated with female pelvic organ prolapse (POP); however, the role of the shape of the levator hiatus in POP has not been examined to date. The aim of this study was to investigate the association between the configuration of the levator ani hiatus and POP. METHODS: This was a retrospective study of 547 women who attended a tertiary urogynecological center for symptoms of pelvic floor and lower urinary tract dysfunction between October 2014 and August 2016. All women underwent a standardized interview and prolapse assessment using the International Continence Society (ICS) Pelvic Organ Prolapse Quantification (POP-Q) method and four-dimensional translabial ultrasound (TLUS). Measurements of the hiatal anteroposterior diameter (APD), coronal diameter (CD) and hiatal area (HA), at rest and on maximal Valsalva maneuver, and those of organ descent were performed offline at a later date by an investigator blinded to all other data. Hiatal configuration was defined as the ratio APD/CD. Associations between HA and HA adjusted by APD/CD at rest and on maximal Valsalva and symptoms and signs of prolapse were analyzed statistically using logistic regression modelling. RESULTS: The mean age of the women was 54 ± 13.6 (range, 16-89) years. Of the 547 women included, 241 (44%) presented with prolapse symptoms. Clinically significant POP was detected in 406 (74%) patients and significant prolapse on TLUS was detected in 331 (61%). Hiatal ballooning was observed in 310 (57%) women and this was strongly associated with signs and symptoms of POP. HA at rest and on Valsalva was associated with significant POP both on clinical examination and on TLUS. Adjusted odds ratios for hiatal shape showed no effect of the hiatal configuration on the association between HA and POP. CONCLUSION: Hiatal shape does not seem to influence the association between HA and symptoms and signs of prolapse. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Diafragma da Pelve/diagnóstico por imagem , Prolapso de Órgão Pélvico/diagnóstico por imagem , Períneo/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Feminino , Humanos , Imagem Tridimensional/métodos , Pessoa de Meia-Idade , Diafragma da Pelve/anatomia & histologia , Diafragma da Pelve/lesões , Prolapso de Órgão Pélvico/classificação , Prolapso de Órgão Pélvico/fisiopatologia , Períneo/anatomia & histologia , Estudos Retrospectivos , Doenças Urológicas/fisiopatologia , Manobra de Valsalva/fisiologia
19.
Echocardiography ; 36(4): 651-653, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30592781

RESUMO

As part of an evaluation for source of embolism, transthoracic echocardiography with peripheral saline contrast injection during normal respirations and also Valsalva release is routinely performed to evaluate for an atrial level shunt. We present a preliminary observation of addition of a modified Müller's maneuver early during the Valsalva release. The Müller's maneuver has been described to occur with sleep apnea and will increase right-to-left shunting through a PFO. Of 34 patients, 24 were negative for a right-to-left shunt with normal respiration or Valsalva release. Of these 24 patients, 8 were then positive for a shunt by addition of a modified Müller's maneuver. One additional patient could not perform the modified Müller's maneuver. This preliminary observation suggests that in patients referred to an echocardiography laboratory for evaluation of source of embolism, adding the modified Müller's maneuver to those negative for shunting during normal respirations and Valsalva release may yield an increase in right-to-left atrial level shunt detection.


Assuntos
Ecocardiografia/métodos , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/fisiopatologia , Aumento da Imagem/métodos , Solução Salina , Manobra de Valsalva/fisiologia , Adulto , Meios de Contraste , Feminino , Átrios do Coração/anormalidades , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Masculino
20.
Sci Rep ; 8(1): 17888, 2018 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-30559367

RESUMO

Cerebral stiffness (CS) reflects the biophysical environment in which neurons grow and function. While long-term CS changes can occur in the course of chronic neurological disorders and aging, little is known about acute variations of CS induced by intracranial pressure variations. Current gold standard methods for CS and intracranial pressure such as magnetic resonance elastography and direct pressure recordings are either expensive and slow or invasive. The study objective was to develop a real-time method for in vivo CS measurement and to demonstrate its sensitivity to physiological aging and intracranial pressure variations induced by the Valsalva maneuver in healthy volunteers. We used trans-temporal ultrasound time-harmonic elastography (THE) with external shear-wave stimulation by continuous and superimposed vibrations in the frequency range from 27 to 56 Hz. Multifrequency wave inversion generated maps of shear wave speed (SWS) as a surrogate maker of CS. On average, cerebral SWS was 1.56 ± 0.08 m/s with a tendency to reduce with age (R = -0.76, p < 0.0001) while Valsalva maneuver induced an immediate stiffening of the brain as reflected by a 10.8 ± 2.5% increase (p < 0.0001) in SWS. Our results suggest that CS is tightly linked to intracranial pressure and might be used in the future as non-invasive surrogate marker for intracranial pressure, which otherwise requires invasive measurements.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Pressão Intracraniana/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Técnicas de Imagem por Elasticidade/métodos , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Manobra de Valsalva/fisiologia , Adulto Jovem
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