Clinical autonomic research : official journal of the Clinical Autonomic Research Society
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Case Reports
Pyridostigmine in autonomic failure: can we treat postural hypotension and bladder dysfunction with one drug?
In a 66-year-old man with autonomic failure, pyridostigmine (180 mg/day orally) improved both postural hypotension and underactive detrusor bladder dysfunction. Acetylcholinesterase inhibition may be useful in the management of orthostatic hypotension and bladder dysfunction in autonomic failure patients.
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Letter Clinical Trial
Subthalamic nucleus deep brain stimulation does not alter long-term heart rate variability in Parkinson's disease.
The power spectra of the heart rate variability frequency bands, analyzed from 24-hour ECG recordings, did not change 12 months after bilateral subthalamic nucleus operation in 14 patients with Parkinson's disease.
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Comment Letter Case Reports
Acetylcholinesterase inhibition and orthostatic hypotension.
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Clinical Trial
Subtle involvement of the parasympathetic nervous system in patients with irritable bowel syndrome.
This study comprises assessment of autonomic function in irritable bowel syndrome (IBS) patients, focusing on meal-related changes. In 18 IBS patients (4 males, mean age 45+/-3.0 [SEM] years) and 19 healthy volunteers (6 males, mean age 41+/-3.5 years) blood pressure, heart rate, heart rate variability and muscle sympathetic nerve activity (MSNA) were assessed before, during and after consumption of a standardized meal. In pre- and postprandial phase Valsalva maneuver, cold pressor test (CPT) and deep breathing test were carried out and Visual Analog Scale (VAS) scores for nausea, bloating and pain were obtained. ⋯ We conclude that reactivity to food intake, measured as muscle sympathetic nerve activity, is normal in IBS patients. The lower DB ratio and higher LF/HF ratio during food intake in IBS patients is an indication of a reduced parasympathetic reactivity. These results suggest that reduced baseline activity as well as responsiveness of the parasympathetic system could play a role in the pathogenesis of IBS.
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Individuals with spinal cord injury (SCI) are prone to orthostatic intolerance and an increased risk of cardiovascular disease. The use of heart rate variability (HRV) and blood pressure variability (BPV) as indices of cardiovascular regulation would be valuable in this population; however, their reproducibility has yet to be tested in those with SCI. The purpose of this study was to examine the day-to-day reproducibility of resting HRV and BPV in individuals with SCI. ⋯ Measures of blood pressure as well as systolic BPV also showed high reproducibility (R = 0.72-0.93). Measures of diastolic BPV were less reproducible but still acceptable (R = 0.71-0.89) with the exception of LF:HF(DBP) (R = 0.51). In conclusion, despite the autonomic dysfunction associated with SCI, measures of HRV and BPV may still be used as reproducible indices of autonomic cardiovascular regulation in this population.