Clinical autonomic research : official journal of the Clinical Autonomic Research Society
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Clinical Trial
Stroke volume monitored by modeling flow from finger arterial pressure waves mirrors blood volume withdrawn by phlebotomy.
Rate-controlled blood withdrawal was used to reduce cardiac preload and consequently stroke volume in patients with normal cardiac function. Twelve patients with asymptomatic hereditary hemochromatosis, undergoing regular phlebotomy therapy, volunteered for the study. An average volume of 375 ml was withdrawn in an average period of 6.4 min. ⋯ Beat-to-beat analysis demonstrated a significant linear regression between most of the hemodynamic indices and the volume withdrawn. The highest correlation coefficients were found for the stroke volume (0.88 +/- 0.01, P < 0.001) and the pulse pressure (0.80 +/- 0.04, P < 0.001) corresponding also to the highest slopes for the lines relating these measures to the relative blood volume withdrawn. The non-invasive estimation of finger blood pressure can be used to derive simple on-line indices (pulse pressure, stroke volume using the Modelflow) of cardiac preload, which are of major interest in the monitoring of cardiovascular status.
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Water immersion skin wrinkling is an indicator of limb sympathetic function. Routine clinical usage of this enigmatic phenomenon is hampered by poor endpoint quantification, which involves counting skin folds. The recent discovery of the importance of vasoconstriction in immersion wrinkling suggests digital blood flow or volume changes as better endpoints. ⋯ Vasoconstriction, through loss of volume, leads to negative digit pulp pressure resulting in a downward pull on the overlying skin, which wrinkles as it is distorted. The degree of wrinkling would directly depend on the change in digit tip volume and implies any process inducing loss of digit volume will precipitate wrinkling. This review discusses the physiology of water immersion wrinkling and explores its potential as an indicator of limb sympathetic dysfunction.
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Complex regional pain syndrome (CRPS) is a neurological syndrome that usually affects one or more extremities, and can cause chronic pain and permanent deformities. This study aimed to analyze the efficacy of endoscopic thoracic sympathicotomy (ETS) in the treatment of pain in patients with CRPS stage II and III operated on in our clinic. Seven patients (four males and three females; mean age 34.7 years; American Society of Anesthesiologists physical status 1 and 3; post-operative follow-up from 5 to 49, mean 33.6 months), with diagnoses of CRPS type I and II, stages II and III, were operated on as outpatients. ⋯ Analgesics were no longer needed after surgery. All patients had their quality of life improved. According to the present investigation, ETS, as described, was efficient for the relief of pain and improvement of the quality of life in patients with CRPS stage II and III.
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Comparative Study
Comparative analysis of T3 selective division of rami communicantes (ramicotomy) to T3 sympathetic clipping in treatment of palmar hyperhidrosis.
Compensatory sweating is a major complaint following endoscopic thoracic sympathetic surgery in treatment of palmar hyperhidrosis. T3 ramicotomy was applied in order to decrease compensatory sweating. From Oct 1999 to June 2002, forty patients underwent T3 sympathetic clipping (group I), and 68 patients underwent T3 ramicotomy (group II) to treat palmar hyperhidrosis. ⋯ The rate of satisfaction was 82.5 % (33/40) in group I and 67.6 % (46/68) in group II with no significant statistic difference (p = 0.067). Excluding patients with persistent sweating postoperatively, the rate of compensatory sweating in group II was 67.4%, which was significantly lower than in group I 94.1%, with a p value of 0.003. Although the rate of persisting sweating after operation was high, T3 ramicotomy resulted in lower rate of compensatory sweating compared to T3 sympathetic clipping.
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The presence of pain may influence autonomic function in patients with painful neurological or cardiovascular disorders. The aim of the present study was to determine whether pain influences cardiac baroreflexes during the Valsalva manoeuvre. Eighteen healthy subjects immersed their hand twice at each temperature in 30 degrees C water and painfully hot (47 degrees C) and cold water (12 degrees C and 7 degrees C) for 2.5 minutes, followed by 5 minute rest periods. ⋯ Pain ratings and heart rate were greater during the 7 degrees C and 47 degrees C immersions than during the 12 degrees C and 30 degrees C immersions. Pain-induced increases in heart rate did not influence peak tachycardia during phase II or III of the Valsalva manoeuvre or peak bradycardia during phase IV, but opposed bradycardia during the post-strain recovery period. Further studies are needed to establish whether pain influences indices of autonomic function during clinical assessment.