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Systolic
Kinds of Systolic Terms modified by Systolic Selected AbstractsOutcomes and Prognostic Factors of Systolic as Compared With Diastolic Heart Failure in Urban AmericaCONGESTIVE HEART FAILURE, Issue 1 2005Peter A. McCullough MD We sought to describe a large heart failure (HF) population with respect to systolic and diastolic abnormalities in terms of demographics, echocardiographic parameters, and survival. Using data abstracted from the Resource Utilization Among Congestive Heart Failure (REACH) study, a targeted subpopulation of 3471 patients had electrocardiographic, echocardiographic, and clinical data taken from automated sources during the first year of diagnosis. Among the HF population, 1811 (52.2%) had diastolic HF. Prevalence of diastolic HF trended with age, from 46.4% in those less than 45 years to 58.7% in those 85 years or older (p=0.001 for trend). Patients with diastolic HF had a higher mean ejection fraction (55.7% vs. 28.0%), lower left ventricular end-systolic diameter (3.11 vs. 4.74 cm), and lower left atrium: aortic outlet ratio (1.28 vs. 1.38) (p=0.001 for each comparison). Annualized age, sex, and race-adjusted mortality were 11.2% and 13.0% for those with diastolic and systolic HF, respectively (p=0.001). In a large, racially mixed, urban HF population, those with diastolic HF predominate and enjoy better-adjusted survival than counterparts with systolic HF. [source] Diabetes mellitus, hypertension and medial temporal lobe atrophy: the LADIS studyDIABETIC MEDICINE, Issue 2 2007E. S. C. Korf Abstract Hypothesis, Based on recent findings on the association between vascular risk factors and hippocampal atrophy, we hypothesized that hypertension and diabetes mellitus (DM) are associated with medial temporal lobe atrophy (MTA) in subjects without disability, independent of the severity of white matter hyperintensities. Methods, In the Leukoaraiosis And DISability in the elderly (LADIS) study, we investigated the relationships between DM, hypertension, blood pressure and MTA in 582 subjects, stratified by white matter hyperintensity severity, using multinomial logistic regression. MTA was visually scored for the left and right medial temporal lobe (score 0,4), and meaned. Results, Mean age was 73.5 years (sd 5.1), 54% was female. Of the subjects, 15% had DM, and 70% had a history of hypertension. The likelihood of having MTA score 3 was significantly higher in subjects with DM (OR 2.9; 95% CI: 1.1,7.8) compared with an MTA score of 0 (no atrophy). The odds ratio for MTA score 2 was not significantly increased (OR 1.8; CI: 0.9,4). Systolic and diastolic blood pressure and a history of hypertension were not associated with MTA. There was no interaction between DM and hypertension. Stratification on white matter hyperintensities (WMH) did not alter the associations. Conclusion Our study strengthens the observation that MTA is associated with DM, independently of the amount of small vessel disease as reflected by WMH. [source] Comparison of Tissue Doppler Velocities Obtained by Different Types of Echocardiography Systems: Are They Compatible?ECHOCARDIOGRAPHY, Issue 3 2010Mónika Dénes M.D. Background: Both systolic and diastolic tissue Doppler (TD) velocities have an important diagnostic and prognostic role in cardiology. We aimed to compare TD velocities between two different echocardiography systems. Patients: Thirty-one consecutive patients (mean age: 65.2 ± 17.5 years; 12 males) were enrolled. Methods: Systolic (Sa), early (Ea), and late (Aa) diastolic velocities were measured by TD at the lateral mitral annulus by a Sonos 2000 (Hewlett-Packard, Andover, MA, USA) and a Philips iE33 system. The E/Ea ratio was calculated. Results: Ea, Aa, and Sa velocities were higher when measured by the Sonos system (Ea: 13.2 ± 4.1 cm/s vs. 8.3 ± 3.6 cm/s; Aa: 14.8 ± 3.8 cm/s vs. 9.3 ± 2.3 cm/s; Sa: 15.2 ± 3.6 cm/s vs. 8.4 ± 2.0 cm/s; P < 0.0001 all). A significant correlation was found in Ea and in Ea/Aa (r = 0.84 and r = 0.85 resp; P < 0.0001 for both), and a weaker in Aa (r = 0.43; P = 0.02) between the machines. The Bland-Altman analysis showed broad limits of agreement between the measurements for Ea, Aa, and Sa (mean difference: 4.95 cm/s; 5.52 cm/s; 6.73 cm/s, respectively; limits: 0.64,9.25 cm/s; ,1.39,12.39 cm/s; ,0.37,13.83 cm/s, respectively). An E/Ea ratio >5.6 by the Sonos system showed 75% sensitivity and 79% specificity for elevated left ventricular filling pressure, defined as E/Ea >10 by the reference Philips system. Conclusions: Although diastolic TD velocities had excellent correlations between the two machines, there was a systematic overestimation by the Sonos system. Since the limits of agreement do not allow replacing the measurements, we suggest using the same echocardiographic equipment at patient follow-up. (Echocardiography 2010;27:230-235) [source] Is There Any Relationship between Metabolic Parameters and Left Ventricular Functions in Type 2 Diabetic Patients without Evident Heart Disease?ECHOCARDIOGRAPHY, Issue 7 2008Mehmet Yazici M.D. Background: The aim of the present study was to evaluate left ventricle (LV) systolic and diastolic function, using tissue Doppler echocardiography (TDE) and color M-mode flow propagation velocity, in relation to blood glucose status in normotensive patients with type 2 diabetes mellitus (T2DM) who had no clinical evidence of heart disease. Methods: Seventy-two patients with T2DM (mean age 49.1 ± 9.8 years) without symptoms, signs or history of heart disease and hypertension, and 50 ages matched healthy controls (mean age 46.1 ± 9.8 years) had echocardiography. Systolic and diastolic LV functions were detected by using conventional echocardiography, TDE and mitral color M-mode flow propagation velocity (VE). Fasting blood glucose level (FBG) after 8 hours since eating a meal, postprandial blood glucose level (PPG), and HbA1C level were determined. The association of FBG, PPG and HbA1C with the echocardiographic parameters was investigated. Results: It was detected that although systolic functions of two groups were similar, diastolic functions were significantly impaired in diabetics. No relation of FBG and PPG with systolic and diastolic functions was determined. However, HbA1C was found to be related to diastolic parameters such as E/A, Em/Am, VE and E/VE (,=,0.314, P = < 0.05; ,=,0.230, P < 0.05; ,=,0.602, P < 0.001, ,= 0.387, P < 0.005, respectively). In addition to HbA1C, LV, diastolic functions were also correlated with age and diabetes duration. Conclusion: Diastolic LV dysfunction may develop even in absence of ischemia, hypertension, and LVH in T2DM. FBG and PPG have no effect on LV functions, but HbA1C levels may affect diastolic parameters. [source] Relationship between Left Ventricular Geometry and Left Ventricular Systolic and Diastolic Functions in Patients with Chronic Severe Aortic RegurgitationECHOCARDIOGRAPHY, Issue 6 2008Murat Çayli M.D. Background: Chronic aortic regurgitation (AR) is a form of volume overload inducing left ventricle (LV) dilatation. Myocardial fibrosis, apoptosis, progressive LV dilatation, and eventually LV dysfunction are seen with the progression of disease. The aim of the study was to assess the relation between LV geometry and LV systolic and diastolic functions in patients with chronic severe AR. Methods: The study population consisted of 88 patients with chronic severe AR and 42 healthy controls. The LV ejection fraction (LVEF) was calculated. Subjects were divided as Group I (controls, n = 42), Group II (LVEF > 50%, n = 47), and Group III (LVEF < 50%, n = 41). Transmitral early and late diastolic velocities and deceleration time were measured. The annular systolic (Sa) and diastolic (Ea and Aa) velocities were recorded. Diastolic function was classified as normal, impaired relaxation (IR), pseudonormalization (PN), and restrictive pattern (RP). Results: The LVEF was similar in Group I and II, while significantly lower in Group III. Sa velocity was progressively decreasing, but LV long- and short-axis diameters were increasing from Group I to Group III. Forty-six, 31 and 11 patients had IR, PN, and RP, respectively. LV long-axis systolic and diastolic diameters were significantly increasing, while LVEF and Sa velocity were significantly decreasing from patients with IR to patients with RP. The LV long-axis diastolic diameter is independently associated with LV systolic and diastolic functions. Conclusions: The LV long-axis diastolic diameter is closely related with LV systolic and diastolic functions in patients with chronic severe AR. [source] Metoprolol CR/XL Improves Systolic and Diastolic Left Ventricular Function in Patients with Chronic Heart FailureECHOCARDIOGRAPHY, Issue 3 2004Torstein Hole M.D. Aims: To investigate whether metoprolol controlled release/extended release (CR/XL) once daily would improve diastolic and systolic left ventricular function in patients with chronic heart failure and decreased ejection fraction. Methods: In an echocardiographic substudy to the Metoprolol CR/XL Randomized Intervention Trial in Heart Failure (MERIT-HF), 66 patients were examined three times during a 12-month period blinded to treatment group, assessing left ventricular dimensions and ejection fraction, and Doppler mitral inflow parameters, all measured in a core laboratory. Results: In the metoprolol CR/XL group left ventricular ejection fraction increased from 0.26 to 0.31 (P = 0.009) after a mean observation period of 10.6 months, and deceleration time of the early mitral filling wave (E) increased from 189 to 246 ms (P = 0.0012), time velocity integral of E-wave increased from 8.7 to 11.2 cm (P = 0.018), and the duration of the late mitral filling wave (A) increased from 122 to 145 ms (P = 0.014). No significant changes were seen in the placebo group regarding any of these variables. Conclusion: Metoprolol CR/XL once daily in addition to standard therapy improved both diastolic and systolic function in patients with chronic heart failure and decreased ejection fraction. (ECHOCARDIOGRAPHY, Volume 21, April 2004) [source] Evaluation of Left Ventricular Systolic and Diastolic Global Function: Peak Positive and Negative Myocardial Velocity Gradients in M-Mode Doppler Tissue ImagingECHOCARDIOGRAPHY, Issue 1 2002Yoshiki Ueno M.D. Objectives: To evaluate a new indicator of left ventricular global function: Myocardial velocity gradient (MVG) M-mode Doppler tissue imaging (DTI). Background: MVG is a new indicator of regional left ventricular function and global left ventricular diastolic function. However, it is unclear whether MVG also is an indicator of left ventricular global function in comparison with invasive indices. Methods: We performed conventional imaging and M-mode DTI in 85 subjects and calculated MVG at the posterior wall. We obtained satisfactory images in 65 subjects, who we divided into three groups: Noninvasive study group, invasive study group, and hemodialysis group. The noninvasive study group was divided into three subgroups (a younger normal subgroup, an older normal subgroup, and a cardiomyopathy subgroup), and MVG was compared with indices of conventional imaging. In the invasive study group, we compared MVG and indices of conventional imaging with hemodynamic data (peak positive and negative dp/dt, and the time constant T) using a high fidelity micromanometer-tipped catheter. In the hemodialysis group, we compared indices before hemodialysis with those after hemodialysis. Results: Peak positive MVG correlated well with peak positive dp/dt (r = 0.79), and this did not change with hemodialysis (P = 0.87). Peak negative MVG also correlated well with peak positive dp/dt and the time constant T (r = 0.88 and r = 0.80), and this did not change with hemodialysis (P = 0.97). Conclusions: Peak positive and negative MVG are sensitive and load-insensitive indicators of left ventricular function. [source] Effect of deep brain stimulation of the posterior hypothalamic area on the cardiovascular system in chronic cluster headache patientsEUROPEAN JOURNAL OF NEUROLOGY, Issue 9 2007P. Cortelli The objective of this study was to determine the cardiovascular effects of chronic stimulation of the posterior hypothalamic area (PHA) in cluster headache (CH) patients. Systolic and diastolic blood pressure (SBP, DBP), cardiac output, total peripheral resistance (TPR), heart rate (HR) and breathing were monitored at supine rest and during head-up tilt test (HUTT), Valsalva manoeuvre, deep breathing, cold face test and isometric handgrip in eight drug-resistant chronic CH patients who underwent monolateral electrode implantation in the PHA for therapeutic purposes. Autoregressive power spectral analysis (PSA) of HR variability (HRV) was calculated at rest and during HUTT. Each subject was studied before surgery (condition A) and after chronic deep brain stimulation (DBS) of PHA (condition B). Baseline SBP, DBP, HR and cardiovascular reflexes were normal and similar in both conditions. With respect to condition A, DBP, TPR and the LF/HF obtained from the PSA of HRV were significantly (P < 0.05) increased during HUTT in condition B. In conclusion, chronic DBS of the PHA in chronic CH patients is associated with an enhanced sympathoexcitatory drive on the cardiovascular system during HUTT. [source] Narcissism and Cardiovascular Reactivity to Rejection Imagery,JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 5 2009Kristin L. Sommer This study examined the interactive effects of imagined rejection and narcissism on cardiovascular reactivity (CVR). Participants completed measures of overt narcissism (Narcissistic Personality Inventory, NPI; Raskin & Hall, 1979), overt,covert narcissism (Margolis & Thomas, 1980), and trait self-esteem. They then imagined 2 scenarios culminating in either interpersonal acceptance or rejection. Systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were assessed before, during, and after the imagery. Overt,covert narcissism was positively associated with task increases in SBP and DBP and recovery elevation of HR following rejection, but not acceptance. Similar effects on SBP were found for the Entitlement/Exploitativeness dimension of the NPI. Lower self-esteem predicted greater task increases in SBP, DBP, and HR across conditions. Implications for health are discussed. [source] Efficacy, Safety, and Pharmacokinetics of Candesartan Cilexetil in Hypertensive Children Aged 6 to 17 YearsJOURNAL OF CLINICAL HYPERTENSION, Issue 10 2008Howard Trachtman MD This 4-week randomized, double blind, placebo-controlled study (N=240), 1-year open label trial (N=233), and single-dose pharmacokinetic study (N=22) evaluated candesartan cilexetil (3 doses) in hypertensive children aged 6 to 17 years. Seventy-one percent were 12 years of age or older, 71% were male, and 47% were black. Systolic (SBP)/diastolic (DBP) blood pressure declined 8.6/4.8,11.2/8.0 mm Hg with candesartan and 3.7/1.8 mm Hg with placebo (P<.01 compared to placebo for SBP and for the mid and high doses for DBP; placebo-corrected 4.9/3.0,7.5/6.2 mm Hg). The slopes for dose were not, however, different from zero (P>.05). The response rate (SBP and DBP <95th percentile) after 1 year was 53%. The pharmacokinetic profiles in 6- to 12- and 12- to 17-year-olds were similar and were comparable to adults. Eight candesartan patients discontinued treatment because of an adverse event. Candesartan is an effective, well-tolerated antihypertensive agent for children aged 6 to 17 years and has a pharmacokinetic profile that is similar to that in adults. [source] The effect of crossing legs on blood pressure in hypertensive patientsJOURNAL OF CLINICAL NURSING, Issue 9-10 2010Rukiye Pinar Aims., The aim of this study was to examine whether there is any difference between BP readings with patients crossing a leg at the knee level and uncrossing during BP measurement. Background., It is clear that numerous factors influence an individual's blood pressure (BP) measurement. However, guidelines for accurately measuring BP inconsistently specify that the patient should keep feet flat on the floor. Design., Repeated measures. Method., Using a mercury-filled column sphygmomanometer, BP was measured at uncrossed leg position, crossed leg position and again at uncrossed leg position in 283 unmedicated or medicated patients. Three experienced nurses specially trained for the study performed BP measurements. Results., The results indicated that BP increased significantly with the crossed leg position. Systolic and diastolic BP significantly increased approximately 10 and 8 mmHg, respectively. Conclusion., Crossing the leg at knee results in a significant increase in BP. Relevance to clinical practice., Leg position during measurement of BP should be standardised and mentioned in publications. [source] Dietary Approaches to Stop Hypertension (DASH) diet: applicability and acceptability to a UK populationJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2010K. E. Harnden Abstract Background:, The Dietary Approaches to Stop Hypertension (DASH) diet is widely promoted in the USA for the prevention and treatment of high blood pressure. It is high in fruit and vegetables, low-fat dairy and wholegrain foods and low in saturated fat and refined sugar. To our knowledge, the use of this dietary pattern has not been assessed in a free-living UK population. Methods:, The DASH diet was adapted to fit UK food preferences and portion sizes. Fourteen healthy subjects followed the adapted DASH diet for 30 days in which they self-selected all food and beverages. Dietary intake was assessed by 5-day food diaries completed before and towards the end of the study. Blood pressure was measured at the beginning and end of the study to assess compliance to the DASH style diet. Results:, The DASH diet was easily adapted to fit with UK food preferences. Furthermore, it was well tolerated and accepted by subjects. When on the DASH style diet, subjects reported consuming significantly (P < 0.01) more carbohydrate and protein and less total fat (5%, 6% and 9% total energy, respectively). Sodium intakes decreased by 860 mg day,1 (P < 0.001). Systolic and diastolic blood pressure decreased significantly (P < 0.05) by 4.6 and 3.9 mmHg, respectively when on the DASH style diet. Conclusions:, The DASH style diet was well accepted and was associated with a decrease in blood pressure in normotensive individuals and should be considered when giving dietary advice to people with elevated blood pressure in the UK. [source] Melatonin interactions with blood pressure and vascular function during l -NAME-induced hypertensionJOURNAL OF PINEAL RESEARCH, Issue 2 2010Ludovit Paulis Abstract:, The mechanisms responsible for the antihypertensive effect of melatonin are not completely understood. To elucidate the possible role of the nitric oxide (NO) pathway in the hemodynamic actions of melatonin, the effects of this indolamine on vascular function during hypertension induced by the NO-synthase (NOS) inhibitor, N, -nitro- l -arginine-methyl ester (l -NAME) were investigated. Four groups of male adult Wistar rats were employed: control, L-NAME (40 mg/kg), melatonin (10 mg/kg) and l -NAME + melatonin for 5 wks. Systolic and diastolic blood pressure were measured invasively in the carotid artery. Conjugated dienes concentration (an oxidative load marker), NOS RNA expression and its activity and RNA expression of cyclooxygenase-(COX)-1 and COX-2 were determined in the aorta. Acetylcholine-induced responses and their NO-mediated component were evaluated in femoral and mesenteric artery. Moreover, endothelium-derived constricting factor (EDCF)-dependent vasoconstriction and inner diameter were determined in the femoral artery. Chronic l -NAME treatment induced hypertension, elevated the oxidative load and inhibited NOS activity. Moreover, impaired NO-dependent relaxation, augmented EDCF-constriction, increased COX-2 expression and reduced arterial inner diameter were observed. Melatonin added to l -NAME treatment completely prevented elevation of the oxidative load in the aorta. However, melatonin was not able to prevent NOS activity decline, elevation of COX-2 expression or the impairment of vascular responses (except moderate improvement in relaxation of small mesenteric arteries) and it exerted only slight antihypertensive effect. In conclusion, in addition to the reduction of the oxidative load, the restoration of the NO pathway seems to play an important role in the antihypertensive effect of melatonin. [source] Cardiovascular effects of desflurane following acute hemorrhage in dogsJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 1 2003Paulo S.P. Santos DVM Abstract Objective: To determine the cardiovascular effects of desflurane in dogs following acute hemorrhage. Design: Experimental study. Animals: Eight mix breed dogs. Interventions: Hemorrhage was induced by withdrawal of blood until mean arterial pressure (MAP) dropped to 60 mmHg in conscious dogs. Blood pressure was maintained at 60 mmHg for 1 hour by further removal or replacement of blood. Desflurane was delivered by facemask until endotracheal intubation could be performed and a desflurane expiratory end-tidal concentration of 10.5 V% was maintained. Measurements and main results: Systolic, diastolic, and mean arterial blood pressure (SAP, DAP and MAP), central venous pressure (CVP), cardiac output (CO), stroke volume (SV), cardiac index (CI), systemic vascular resistance (SVR), heart rate (HR), respiratory rate (RR), partial pressure of carbon dioxide in arterial blood (PaCO2), and arterial pH were recorded before and 60 minutes after hemorrhage, and 5, 15, 30, 45 and 60 minutes after intubation. Sixty minutes after hemorrhage, SAP, DAP, MAP, CVP, CO, CI, SV, PaCO2, and arterial pH decreased, and HR and RR increased when compared with baselines values. Immediately after intubation, MAP and arterial pH decreased, and PaCO2 increased. Fifteen minutes after intubation SAP, DAP, MAP, arterial pH, and SVR decreased. At 30 and 45 minutes, MAP and DAP remained decreased and PaCO2 increased, compared with values measured after hemorrhage. Arterial pH increased after 30 minutes of desflurane administration compared with values measured 5 minutes after intubation. Conclusions: Desflurane induced significant changes in blood pressure and arterial pH when administered to dogs following acute hemorrhage. [source] Descending thoracic aortic blood flow parameters during emergent surgery in anesthetized critically ill dogsJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 4 2002Richard J. Mills DVM Abstract Objective: To explore the potential value of transesophageally-determined descending thoracic aortic blood flow parameters in critically ill dogs undergoing surgery. Design: Observational case series. Setting: Private small animal referral hospital. Animals: Ten anesthetized critically ill dogs that underwent emergent surgery. Interventions: Placement of the ultrasonic transesophageal probe. Measurements and main results: Transesophageally-determined descending thoracic aortic blood flow, stroke volume, blood velocity, blood acceleration, left ventricular ejection time interval, and heart rate parameters were recorded every minute. Systolic and mean arterial blood pressures were non-invasively determined and recorded at 1,5 minute intervals. The anesthetist and surgeon were blinded to the descending thoracic aortic blood flow parameters. All dogs received fluid challenges as part of their management, and 2 dogs received dopamine. The variability of the descending thoracic aortic blood flow parameters within each dog was greater than has been reported in non-critically ill anesthetized dogs. Consistent trends in descending thoracic aortic blood flow parameters after fluid challenges were not found. An escalating dopamine infusion was, however, accompanied by increasing aortic blood flow, stroke volume, acceleration, and peak velocity. Conclusions: Descending thoracic aortic blood flow parameters may eventually be useful for evaluating the responses to and suggesting the need for cardiovascular interventions during emergent surgeries in anesthetized critically ill canine patients. For this to occur, more experience with this technology will be required. [source] The electrocardiographic and hemodynamic effect of metohexital and propofol with and without esmololACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2006R. Korpinen Background:, Metohexital and propofol are short-acting induction agents, which have a tendency to prolong the QTc interval of the ECG. We studied whether this increase could be prevented by combining a beta-blocking agent, esmolol, with these drugs. Simultaneously, we studied the hemodynamic effects of these combinations. Methods:, In a randomized, double-blind study, 80 ASA I,II young adults were premedicated with oxycodone and atropin and allocated to one of four groups: propofol (P), propofol + esmolol (P + E), metohexital (E) or metohexital + esmolol (M + E). The doses were 2 mg/kg propofol/metohexital and 1 mg/kg esmolol. Alfentanil 15 µg/kg was used in all groups. The hemodynamic parameters were measured non-invasively and the electrocardiographic parameters using the signal processing method. Result:, The highest QTc values, which often exceeded the normal upper limit of 440 ms, were recorded at the baseline or immediately after the administration of the induction drugs. The intervals were significantly shorter if esmolol was co-administered with either propofol or metohexital. The heart rate increased in the group M and decreased in the group P + E but remained unchanged in the groups P and M + E. Systolic and diastolic arterial pressures decreased during the study in all groups, most prominently in group P + E. Conclusions:, During the anesthesia induction, the QTc interval was significantly shorter when esmolol was co-administered with either propofol or metohexital. The hemodynamic responses were properly controlled with the combination of metohexital and esmolol as well as with propofol alone, but the combination of propofol and esmolol tended to cause hemodynamic depression. [source] Effect of an intravenous single dose of ketamine on postoperative pain in tonsillectomy patientsPEDIATRIC ANESTHESIA, Issue 9 2006MARIO JOSE DA CONCEIÇÃO MSC MD TSA Summary Background:, Tonsillectomy has a high incidence of postoperative pain. The aim of the present study was to determine whether the use of low-dose IV ketamine, before the start of surgery or after the end of the operation, would lead to significantly improved pain control after tonsillectomy in pediatric patients. Methods:, Ninety children, 5,7 years old, scheduled for elective tonsillectomy were randomly assigned to one of three groups of 30 patients each; groups I, II and III. Patients in group I received no ketamine. Patients in group II received 0.5 mg·kg,1 of ketamine before the surgical start and for group III the same dose was given after the operation ended. Postoperative pain was scored by the Oucher scale. Systolic and diastolic pressures and heart rate were recorded perioperatively. Unwanted side effects were recorded by the ward staff personnel on a 24-h study-specific questionnaire. Statistical tests consisted of Student's t -test, chi-square and anova as appropriated. Results:, The number of patients complaining of pain was greater in group I compared with patients in groups II and III with a significative statistical difference (P < 0.05). The degree of postoperative pain was significantly higher in patients of group I compared with groups II and III (P < 0.05). Eight patients in group I needed rescue doses of morphine, three for group II and none for group III. In group I, three of eight patients required two doses of morphine during the first 249h postoperatively. No unwanted side effects were noted. Conclusions:, The use of a single small dose of ketamine in a pediatric population undergoing tonsillectomy could reduce the frequency or even avoid the use of rescue analgesia in the postoperative period independent of whether used before or after the surgical procedure. [source] Systolic blood pressure peak during maximal exercise testing: A possible determinant of endothelial turnover in healthy subjects,AMERICAN JOURNAL OF HEMATOLOGY, Issue 7 2009Michele M. Ciulla No abstract is available for this article. [source] Investigation of the antihypertensive effect of oral crude stevioside in patients with mild essential hypertensionPHYTOTHERAPY RESEARCH, Issue 9 2006Letícia A. F. Ferri Abstract The antihypertensive effect of crude stevioside obtained from the leaves of Stevia rebaudiana (Bertoni) Bertoni (Compositae) on previously untreated mild hypertensive patients was examined. Patients with essential hypertension were submitted to a placebo phase for 4 weeks. The volunteers selected in this phase were randomly assigned to receive either capsules containing placebo during 24 weeks or crude stevioside 3.75 mg/kg/day (7 weeks), 7.5 mg/kg/day (11 weeks) and 15.0 mg/kg/day (6 weeks). All capsules were prescribed twice a daily (b.i.d.), i.e. before lunch and before dinner. After the placebo phase and after each dose of crude stevioside, body mass index, electrocardiogram and laboratory tests were performed. During the investigation blood pressure (BP) was measured biweekly and the remaining data were collected at the end of each stevioside dose step. All adverse events were prospectively recorded but no major adverse clinical effects were observed during the trial. Systolic and diastolic BP decreased (p < 0.05) during the treatment with crude stevioside, but a similar effect was observed in the placebo group. Therefore, crude stevioside up to 15.0 mg/kg/day did not show an antihypertensive effect. Moreover, the results suggest that oral crude stevioside is safe and supports the well-established tolerability during long term use as a sweetener in Brazil. Copyright © 2006 John Wiley & Sons, Ltd. [source] Association between bone lead concentration and blood pressure among young adultsAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2002Fredric Gerr MD Abstract Background Occupational and environmental exposure to lead has been examined for its effect on blood pressure (BP) in adults with varying results. The present analyses assessed the association between bone lead concentration and BP in early adult life in persons exposed during childhood. Methods Study participants included young adult members of two cohorts with different past histories of lead exposure. Lead exposure was assessed using noninvasive K-X-ray fluorescence spectroscopy to quantify bone lead concentration, an index of long-term lead exposure superior to current blood lead concentration. Systolic and diastolic BP measurements were obtained using conventional clinical methods. Multiple linear regression models were constructed to allow for control of covariates of BP identified a priori. Results Analyses were performed on 508 participants. While controlling for potential confounders, systolic BP was 4.3 mm,Hg greater among members of the highest of four bone lead concentration groups (>,10 ,gPb/g bone) when compared with the lowest bone lead concentration group (<,1 ,gPb/g bone; P,=,0.004), and diastolic BP was 2.8 mm,Hg greater among members of the highest bone lead concentration group when compared with the lowest bone lead concentration group (P,=,0.03). Conclusions These results suggest that substantial lead exposure during childhood can increase BP during young adulthood. Am. J. Ind. Med. 42:98,106, 2002. © 2002 Wiley-Liss, Inc. [source] Comparison of hemodynamic responses to social and nonsocial stress: Evaluation of an anger interviewPSYCHOPHYSIOLOGY, Issue 6 2001Kenneth M. Prkachin Hemodynamic responses to an anger interview and cognitive and physical stressors were compared, and the stability of associated hemodynamic reactions examined. Participants experienced control, handgrip, counting, and mental arithmetic tests and an anger interview on two occasions. Systolic and diastolic blood pressure, heart rate, stroke volume, and cardiac output were measured. Total peripheral resistance was also derived. The anger interview produced larger, more sustained changes in blood pressure in both sessions than the other stressors. These changes were largely a consequence of increased peripheral resistance. Consistent with previous findings, handgrip was associated with a resistance-type reaction whereas arithmetic was associated with a cardiac output-type reaction. There was low-to-modest stability of hemodynamic reactions to the interview. Further research is necessary to optimize its utility in studies of cardiovascular function. Nevertheless, the findings underscore the ability of ecologically relevant stressors to provoke unique configurations of cardiovascular activity. [source] Intracervical application of the nitric oxide donor isosorbide dinitrate for induction of cervical ripening: a randomised controlled trial to determine clinical efficacy and safety prior to first trimester surgical evacuation of retained products of conceptionBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2005Gabriel Arteaga-Troncoso Objective To determine the therapeutic efficacy and safety of a nitric oxide (NO) isosorbide dinitrate donor to induce cervical ripening of women with missed abortions before surgical evacuation of the uterus. Design A prospective, randomised, double-blind controlled trial. Setting Tertiary referral maternity teaching hospital. Population Sixty women with missed abortions and no cervical dilation. Methods Women requesting surgical evacuation of the uterus were randomly selected to receive endocervical 80 mg/1.5 mL isosorbide dinitrate gel solution (n= 30) or 400 ,g/1.5 mL misoprostol gel solution (n= 30) every 3 hours to a maximum of four doses or until reaching cervical ripening. Vital signs and symptoms were recorded at baseline and then every 3 hours until finishing therapy. Adverse events, such as headache, abdominal pain, pelvic pain, backache, nausea and vomiting, were evaluated. Main outcome measures Probability of reaching cervical ripening >8 mm Hegar dilator; evaluated at 3, 6, 9 and 12 hours after application of isosorbide dinitrate or misoprostol. Results The probabilities of induction of cervical ripening by isosorbide dinitrate and misoprostol after four repeated doses at 3-hour intervals were significantly different (P < 0.001). Efficacy of therapy after 12 hours was 97% for the isosorbide dinitrate group and 70% for the misoprostol group. Systolic and diastolic blood pressures were lower after administration of isosorbide dinitrate than prostaglandin analogues. The difference in the mean systolic and diastolic blood pressure between treatment groups was greatest at 3 hours, with a difference of 7.7 mmHg (P < 0.001) and 5.9 mmHg (P < 0.003), respectively. The most frequent side effect associated with isosorbide dinitrate administration was headache, which occurred in 18 out of 30 patients, compared with only 5 out of 30 women in the misoprostol group [relative risk (RR) 2.41, 95% confidence interval (CI) 1.45,4.03, P < 0.001). Women treated with misoprostol reported mainly pelvic pain (RR 3.24, 95% CI 1.99,5.27, P < 0.001). Conclusions Intracervical administration of 80 mg isosorbide dinitrate in women with missed abortions appears to be effective for cervical ripening prior to surgical evacuation of the uterus. Differences in the incidence of non-serious adverse events are not likely to be clinically significant. [source] 2356: Diurnal variation of ocular pulse amplitude in primary open angle glaucoma patientsACTA OPHTHALMOLOGICA, Issue 2010LA PINTO Purpose (1) to determine the diurnal behaviour of the ocular pulse amplitude (OPA) in primary open angle glaucoma (POAG) patients. (2) To identify any variables modulating OPA. Methods In this prospective study we included 22 POAG patients under topical intraocular pressure (IOP)-lowering treatment, who underwent contour dynamic tonometry measurements every three hours from 9am to 6pm for IOP and OPA readings. Heart rate (HR) and blood pressure (BP) were simultaneously recorded during the ocular measurements. Only the eye with greater glaucomatous damage was selected per patient. Results Both IOP and OPA did not change during the day (OPA: 3.0±1.3, 3.2±1.4, 2.9±1.5, 3.0±1.3; IOP: 19.3±2.9, 20.0±3.0, 19.1±3.0, 19.8±2.6; multiple comparisons p=0.21, p=0.27 respectively). Systolic, diastolic and did not present significant diurnal variation (p<0.05 all measurements). OPA was significantly correlated at all time-measurements with arterial pulse pressure, but not by IOP, median ocular pulse pressure(MOPP) nor median arterial pressure (p<0.05). Univariate analysis revealed HR to negatively correlate OPA at the 15h and 18h measurements (r= -0,42, p=0.049; r= -0,53, p=0.01; respectively). Multiple linear regression analysis identified blood pressure amplitude as an independent factor contributing to OPA (p<0.05 at all measurements). These observations were more pronounced in patients with high blood pressures. Conclusion OPA readings seem to be influenced by blood pressure amplitude in POAG patients. High blood pressure amplitude values may overcome the eye self-regulation mechanisms, resulting in the OPA becoming dependent on the blood pressure amplitude rather than of the IOP. [source] Prolongation of the QT interval in primary aldosteronismCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 1-2 2005Kiyoshi Matsumura SUMMARY 1.,Only limited information is available concerning the changes in the electrocardiogram in primary aldosteronism. The aim of the present study was to determine factors influencing the QTc interval in patients with primary aldosteronism. 2.,Nineteen patients with primary aldosteronism caused by a Conn's adenoma and 69 patients with essential hypertension, in whom all possible causes of secondary hypertension had been excluded, were included in the present study. Before and 10,20 days after adrenalectomy, blood and electrocardiographic examinations were conducted. 3.,Systolic and diastolic blood pressures in primary aldosteronism were found to be comparable to those in essential hypertension. However, the QTc interval was significantly prolonged and serum potassium concentrations were significantly decreased in patients with primary aldosteronism compared with patients with essential hypertension (492.7 ± 20.3 vs 428.5 ± 3.1 msec for QTc interval, respectively (P < 0.01); 3.07 ± 0.12 vs 4.07 ± 0.05 mEq/L for serum potassium concentrations, respectively (P < 0.01)). The QTc interval was significantly correlated with serum potassium concentrations in primary aldosteronism (P = 0.0011; r = ,0.6902), but not in patients with essential hypertension. 4.,Blood pressure significantly decreased after adrenalectomy. Furthermore, serum potassium concentrations increased significantly and did not correlate with the QTc interval after adrenalectomy (P = 0.54; r = ,0.1500). 5.,Our results indicate that the QTc interval is prolonged in patients with primary aldosteronism, probably owing to hypokalaemia. [source] DOSE,RESPONSE OF ROPIVACAINE ADMINISTERED CAUDALLY TO CHILDREN UNDERGOING SURGICAL PROCEDURES UNDER SEDATION WITH MIDAZOLAMCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 7 2004F Tonatiu Aguirre-Garay SUMMARY 1.,In a double-blind randomized controlled design, 50 children were allocated to receive bupivacaine 0.25% or ropivacaine 0.25%, 0.32%, 0.40% or 0.50% by caudal block. 2.,Caudal block was performed after induction of anaesthesia with 2,5% sevoflurane, atropine 10 µg/kg and midazolam 100,300 µg/kg. During the surgical procedure, patients were maintained under spontaneous ventilation and no intravenous or inhalatory anaesthetic agent was administered. For transoperative sedation, midazolam 100,300 µg/kg was administered every 0.5,1.0 h. Transoperative cardiovascular response, postoperative analgesia and local and systemic complications were evaluated. 3.,Groups were similar (P > 0.05) in sex, age, weight and in the time elapsed from caudal block to the beginning of the surgical procedure. The surgical time was significantly lower in the ropivacaine 0.25% group. The duration of analgesia was 24 h with ropivacaine 0.25% and approximately 10 h in the other four groups (P < 0.001). Linear regression analysis revealed a significant relationship between the postoperative analgesic period produced by ropivacaine and the surgical time (r = , 0.48, two-sided P = 0.002). Systolic and diastolic blood pressures remained in the physiologically normal range for the duration of the transoperative period. Vomiting was present in only one patient receiving ropivacaine 0.50%. 4.,In children, the duration of analgesia produced by caudal block with ropivacaine may be affected by surgical time. At surgical times of 0.5,1 h, ropivacaine 0.25% produced at least 24 h postoperative analgesia. At similar surgical times, ropivacaine 0.32%, 0.40% and 0.50% produced similar analgesic times to bupivacaine 0.25%. [source] Cardiac diastolic dysfunction in renal-transplant recipients is associated with increased circulating AdrenomedullinCLINICAL TRANSPLANTATION, Issue 3 2006Bernard Geny Abstract:, Background:, Renal transplantation is an excellent therapeutic alternative for end-stage renal diseases. Nevertheless, the cardiac function is often impaired in renal-transplant patients (RTR) and importantly determines their prognosis. Adrenomedullin (ADM), a peptide involved in cardiovascular homeostasis, is believed to protect both cardiac and renal functions , by increasing local blood flows, attenuating the progression of vascular damage and remodelling and by reducing glomerular injury , and might be involved in renal-transplantation physiopathology. This work was performed to investigate whether an increase in circulating ADM might be related to RTR cardiac function. Methods:, Twenty-nine subjects, 19 RTR and 10 healthy subjects, participated in the study. After 15 min rest in supine position, heart rate and systemic blood pressure were measured together with cyclosporine through levels, creatinine and ADM. Systolic and diastolic cardiac functions were assessed, using Doppler echocardiography. Results:, Subjects were similar concerning age, weight, heart rate and blood pressure. Creatinine and ADM (53.8±6.9 vs. 27.2±4.1 pmol/L, p = 0.02) were significantly increased in RTR (73±10 months after transplantation). Cardiac systolic function was normal, but a reduced mitral E:A ratio was observed in RTR (0.90±0.06 vs. 1.38±0.10, p<0.001), reflecting their impaired left ventricular relaxation. Such a ratio was negatively correlated with ADM (r = ,0.55, p = 0.002). Conclusions:, RTR present with an increased ADM is likely related to cardiac diastolic dysfunction. In view of its protective effect on the cardiovascular system, these data support further studies to better define the role and the therapeutic potential of ADM after renal transplantation. [source] Assessment of endothelial function and blood metabolite status following acute ingestion of a fructose-containing beverageACTA PHYSIOLOGICA, Issue 1 2010A. J. Bidwell Abstract Aim:, Fructose intake has increased concurrent with sugar intake and this increase has been implicated in contributing to the development of metabolic syndrome risk factors. Recent evidence suggests a role for uric acid (UA) as a potential mediator via suppression of nitric oxide (NO) bioavailability. The aim of this study was to explore this hypothesis by measuring changes in UA concentration and systemic NO bioavailability as well as endothelial function in response to acute ingestion of a glucose-fructose beverage. Methods:, Ten young (26.80 ± 4.80 years), non-obese (body mass index: 25.1 ± 2.55 kg m,2; percent body fat: 13.5 ± 6.9%) male subjects ingested either a glucose (100 g dextrose in 300 mL) or isocaloric glucose-fructose (glucose : fructose; 45 : 55 g in 300 mL) beverage. Blood was sampled pre- and every 15-min post-ingestion per 90 min and assayed for glucose, lactate, fructose, total nitrate/nitrate, UA and blood lipids. Forearm blood flow and pulse-wave velocity were recorded prior to and at 30 and 45 min time intervals post-ingestion, respectively, while heart rate, systolic and diastolic blood pressure were recorded every 15 min. Results:, The glucose-fructose ingestion was associated with a significant (P < 0.05) increase in plasma lactate concentration and altered free fatty acid levels when compared with glucose-only ingestion. However, UA was not significantly different (P = 0.08) between conditions (AUC: ,1018 ± 1675 vs. 2171 ± 1270 ,mol L,1 per 90 min for glucose and glucose-fructose conditions respectively). Consequently, no significant (P < 0.05) difference in endothelial function or systemic NO bioavailability was observed. Conclusion:, Acute consumption of a fructose-containing beverage was not associated with significantly altered UA concentration, endothelial function or systemic NO bioavailability. [source] Acute Adaptation to Volume Unloading of the Functional Single Ventricle in Children Undergoing Bidirectional Glenn AnastomosisCONGENITAL HEART DISEASE, Issue 2 2009Catherine Ikemba MD ABSTRACT Objective., Volume unloading of the functional single ventricle after a bidirectional Glenn anastomosis (BDG) prior to 1 year of age leads to improved global ventricular function as measured by the myocardial performance index (MPI), a Doppler-derived measurement of combined systolic and diastolic ventricular function. Systolic function remains unchanged after BDG according to previous studies; however, acute changes in global and diastolic function have not been previously investigated in this cohort. Our objective was to assess the short-term effects of the BDG on global ventricular function in patients with a functional single ventricle. Design., Echocardiograms to obtain MPI, isovolumic contraction time, and isovolumic relaxation time were performed at four time periods: in the operating room, in the operating room prior to BDG, shortly after separation from cardiopulmonary bypass, less than 24 hours postoperatively, and either prior to hospital discharge or at the first clinic follow-up visit. Results., Twenty-six patients were enrolled. There was significant ventricular dysfunction noted shortly after separation from cardiopulmonary bypass, median MPI 0.63 (0.39,0.81), that persisted in the short term postoperatively median MPI 0.50 (0.40,0.63). Isovolumic contraction time did not change, however, isovolumic relaxation time was significantly prolonged following BDG. Conclusion., In the postoperative patient after BDG, systolic function is preserved; however, there is evidence of diastolic and global ventricular dysfunction, at least in the short term. [source] Serum Uric Acid Levels Correlate With Left Atrial Function and Systolic Right Ventricular Function in Patients With Newly Diagnosed Heart Failure: The Hellenic Heart Failure StudyCONGESTIVE HEART FAILURE, Issue 5 2008Christina Chrysohoou MD The authors sought to investigate whether serum uric acid levels are associated with systolic left and right ventricular function, as well as left atrial function in patients with newly diagnosed heart failure. The authors enrolled 106 consecutive patients (mean age 65±13 years). Echocardiographic and biochemical assessment was performed during the third day of hospitalization. Pulsed tissue Doppler imaging of the systolic function of mitral and tricuspid annulus was characterized by the systolic waves (Smv and Stv, respectively), expressed in cm/s, and the left atrial function by the Amv wave. Left atrial kinetics was calculated using an equation. Serum uric acid levels were inversely correlated with Stv (P=.005) and left atrial kinetics (P=.05), after controlling for potential confounders. Uric acid levels appear to be correlated with more impaired right ventricular systolic function and decreased left atrial work in patients with heart failure. [source] The Use of B-Type Natriuretic Peptides in the Intensive Care UnitCONGESTIVE HEART FAILURE, Issue 2008Christian Mueller MD B-type natriuretic peptide levels are quantitative markers of cardiac stress and heart failure that summarize the extent of systolic and diastolic left ventricular dysfunction, valvular dysfunction, and right ventricular dysfunction. Initial observational pilot studies have addressed 7 potential indications in the intensive care unit: identification of cardiac dysfunction, diagnosis of hypoxic respiratory failure, risk stratification in severe sepsis and septic shock, evaluation of patients with shock, estimation of invasive measurements, weaning from mechanical ventilation, as well as perioperative and postoperative risk prediction. Although additional studies are required to better define the clinical utility of B-type natriuretic peptide values in the intensive care unit, current data suggest that the diagnosis of hypoxic respiratory failure and timing of extubation seem to be the most promising indications. Congest Heart Fail. 2008;14(4 suppl 1):43,45. ©2008 Le Jacq [source] | |||||||||||||||||||||||||||||||||||||||||||