Medically unexplained symptoms in women as related to physiological stress responses

The present, cross‐sectional study explored whether self‐reported symptoms are related to physiological stress indicators in a group of 43‐year‐old women representing the general population in Sweden. Analyses were performed both on raw scores of physiological indicators and on a multisystem summary index of allostatic load as a measure of cumulative biological burden. Participants answered a health questionnaire and underwent a medical examination including blood pressure, heart rate measurements, determination of blood lipids and stress hormones. Urinary epinephrine and norepinephrine were measured both on a working day and a work free day at home. In addition, salivary morning cortisol was measured on a non‐work day. The physiological profiles based on raw scores from 222 women showed that women with a high symptom load had significantly higher levels of cortisol (p < 0.05), and higher heart rate (p < 0.05) than did those with a low symptom load. In contrast, women with a low symptom load had significantly higher levels of epinephrine on a work free day than did women with a high symptom load (p < 0.05). No significant differences were found in norepinephrine responses. When analysing the summary measure of allostatic load in relation to symptom prevalence no significant difference between the symptom groups emerged. One possible explanation for this result could be that a majority of the study population was healthy, reporting a low level of symptoms in general. However, the results support the notion that common, medically unexplained symptoms among women are associated with certain biological parameters known to play a role in the development of ill health. Copyright © 2004 John Wiley & Sons, Ltd.     

Autonomic response to stress in interstitial cystitis

PURPOSE: Previous studies have documented elevations in indices of sympathetic activity in cats and humans with interstitial cystitis (IC). To examine potential autonomic dysregulation in IC we examined the effects of a laboratory mental stress challenge on blood pressure and heart rate (HR) in patients with IC and healthy controls. MATERIALS AND METHODS: A total of 14 female patients with IC and 14 age matched controls participated in a laboratory session, including a 25-minute mental stress challenge. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR were measured at intervals before, during and following the stressor. The level of chronic stress, symptom severity and pain at voiding were assessed. RESULTS: Mean age was 49 years (range 32 to 66). The resting HR of patients with IC (82.02 bpm) was significantly higher than that of controls (63.31 bpm, p = 0.0001). There was also suggested evidence of elevated resting DBP in patients with IC (p = 0.07) but no significant difference in mean resting SBP. Autonomic arousal elicited by the laboratory stressor did not differ between the groups and subjects in each group perceived the task as equally stressful. Patients with IC had significantly elevated HR at each time point compared with controls (p <0.0001) with an average mean difference +/- SD between the groups of 19.5 +/- 4.0 (main effect for group p <0.0001). Although consistent increases in SBP and DBP were observed in patients after baseline, these differences were not significant. CONCLUSIONS: Patients with IC had an increased HR at baseline and throughout a laboratory mental stress challenge compared to healthy age matched women. No differences in HR or blood pressure reactivity were observed between the 2 groups.     

A comparison of induced hypotensive anesthesia using trimetaphan, prostaglandin E1 and nicardipine for neurosurgery

We performed hypotensive anesthesia using trimetaphan, prostaglandin E1, or nicardipine for eighteen patients undergoing cerebral aneurysm clipping. We measured the hemodynamic parameters (systolic arterial pressure, diastolic arterial pressure, and heart rates), concentration of catecholamines in blood (epinephrine, norepinephrine), blood platelet counts, and aggregation of blood platelets, before induction of anesthesia, before induced hypotension, during hypotension, after hypotension, and at the end of operation. Hypotension was produced rapidly, and hemodynamics was stable with any of the three drugs. In trimetaphan group, however, recovery time of arterial pressure was longer than in other two groups. There was no significant change of catecholamine during induced hypotension in prostaglandin E1 and nicardipine groups. However, in trimetaphan group, concentration of norepinephrine in blood decreased significantly during hypotension. No significant change was observed in either platelet count or platelet aggregation. These results suggest that trimetaphan has an effect to suppress excretion of stress hormones, and prostaglandin E1 and nicardipine have no influence on blood catecholamine levels and aggregation of platelet. We consider that nicardipine is useful as a hypotensive drug for neurosurgery.     

Preoperative blood pressure and catecholamines related to hypothermia during general anesthesia

BACKGROUND: We previously demonstrated that preoperative blood pressure values affect intraoperative hypothermia during general anesthesia. We hypothesized that increased catecholamine secretion could be responsible for the relationship between preoperative blood pressure and hypothermia. METHODS: To evaluate the effect of preoperative systolic blood pressure (SBP) and plasma catecholamine levels on core temperature during general anesthesia, 40 male patients who were scheduled for open abdominal surgery were allocated to two groups: those whose preoperative SBP was 140 mmHg or greater (high SBP group, n = 20), and those whose SBP was less than 140 mmHg (normal SBP group, n = 20). Anesthesia was maintained with 0.4% isoflurane and opioids. RESULTS: The average age, height, and weight of the patients in the two groups did not differ. Preoperative SBP, mean blood pressure, diastolic blood pressure and heart rate in the high SBP group were significantly higher than those in the normal SBP group. Plasma norepinephrine concentrations in the high SBP group were significantly greater than those in the normal SBP group before and 1 h after the induction of anesthesia. Tympanic membrane temperatures in the normal SBP group started to decline further just after the induction of anesthesia, more so than that in the high SBP group. The vasoconstriction threshold in the normal SBP group was significantly lower than that in the high SBP group. CONCLUSION: These results suggest that the higher levels of preoperative catecholamine secretion contributed to the lesser degree of intraoperative hypothermia observed in the high SBP group.     

Plasma alpha-human atrial natriuretic polypeptide levels during surgery for pheochromocytoma]

We measured plasma alpha-human atrial natriuretic polypeptide (alpha-hANP) and catecholamine concentrations during anesthesia and surgery for pheochromocytoma in five patients ranging in ages from 19 to 69. Plasma catecholamine concentrations and systemic blood pressure increased extremely during surgical manipulation of the tumor, while plasma alpha-hANP levels did not change even during surgical manipulation or after removal of the tumor as compared with preanesthetic values. Our findings suggest that plasma alpha-hANP levels were unchanged during anesthesia and surgery for human pheochromocytoma.     

Levels of circulating norepinephrine and epinephrine before, during, and after cardiopulmonary bypass in man.

Little information is available on the levels of circulating catecholamines during cardiac surgery. A study was undertaken to measure the serum levels of epinephrine and norepinephrine before, during, and after cardiopulmonary bypass in 16 patients. Sampling were drawn before induction, after intubation, before bypass, 2 and 8 minutes after initiation of the bypass, and 20 minutes after bypass. The findings of this study show that the initiation of cardiopulmonary bypass was associated with a significant but transient fall in mean blood pressure accompanied by an increased secretion of adrenal epinephrine and norepinephrine. The cause of the observed hypotension may be due to an initial hemodilution of the circulating catecholamines by the 2 L. pump-priming solution. The secretion of adrenal catecholamines appears to be a compensatory response to the lowered blood pressure as indicated by the rapid return of the blood pressure in the ensuing minutes. Twenty minutes after bypass, both the blood pressure and serum catecholamine levels were observed to have returned to preinduction levels.     

Serum epinephrine and norepinephrine during valve replacement and aorta-coronary bypass.

A comparison of the levels of serum epinephrine, norepinephrine and blood pressure was made in 25 patients undergoing aorta-coronary bypass or valve replacement who were anaesthetized with a nitrous oxide-narcotic technique. Serum epinephrine and norepinephrine were measured in arterial samples drawn pre-induction, post-induction, before cardiopulmonary bypass, two and eight minutes after initiation of cardiopulmonary bypass, 20 minutes before termination and after termination of cardiopulmonary bypass. In both patient groups significant increases in epinephrine and norepinephrine occurred befored cardiopulmonary bypass, with accompanying increase of blood pressure in the valve replacement patients. During cardiopulmonary bypass an initial hypotensive response (p less than 0.001) was recorded, followed by a significant increase in blood pressure and epinephrine in both groups. After cardiopulmonary bypass, aorta-coronary bypass patients had epinephrine, norepinephrine and blood pressure equal to levels before cardiopulmonary bypass. In contrast, serum epinephrine continued to rise in the valve replacement patients, with a gradual recovery of blood pressure to pre-bypass levels. These findings demonstrate significant differences in blood pressure and catecholamine response in patients with valvular disease from patients with coronary artery disease.     

急性脑死亡对移植供体心脏的影响

目的探讨急性脑死亡(BD)对机体造成的病理生理改变和对心脏造成的损伤及其机制。方法采用30～40kg体重的猪8只，制造BD前为对照组，BD后为实验组。测定BD前后血流动力学指标和血中生化学指标，并进行心肌活检。结果BD后心率增加了88％，收缩压升高了132％，心排量增加了80％、肾上腺素和去甲肾上腺素分别升高240％和241％，三碘甲腺原氨酸浓度显著下降，心肌形态学检查发现有心肌损害。结论BD可造成机体血流动力学的剧烈改变和心肌损害，血中儿茶酚胺含量升高和T3含量下降是造成心肌损伤的重要因素。     

Stress Reactions and Coping Strategies among Bedouin Arab Adolescents Exposed to Demolition of Houses

The aim of this study was to examine emotional reactions and coping strategies of Bedouin adolescents against the backdrop of house demolitions in the unrecognized Bedouin villages in the Negev, Israel. We compared two groups of adolescents living in unrecognized Bedouin villages, teenagers whose houses had been destroyed (acute + chronic group) and their counterparts whose houses had not been destroyed (chronic group). Data were gathered during October to December 2010 from 465 Bedouin adolescents aged 13–18 years. Adolescents filled out self‐report questionnaires, which included demographics, objective and subjective exposure to house demolition, state anxiety, state anger, psychological distress and Adolescent Coping Scale. Results show differences between the two groups in stress reactions as well as in objective exposure to house demolition with the acute + chronic group reporting more stress and more exposure. In addition, different variables explained stress reactions in the different groups. Whereas in the acute + chronic group, objective and subjective exposure were the most significant variables, in the chronic group, the coping strategies explained stress with more variance. Results are discussed in terms of differentiating between types of stress, chronic versus acute + chronic and in relation to the interactionist model of coping with stress. Copyright © 2013 John Wiley & Sons, Ltd.     

Posttraumatic Stress Disorder Among Incarcerated Battered Women: A Comparison of Battered Women Who Killed Their Abusers and Those Incarcerated for Other Offenses

The present study examined differences in the amount and severity of spousal violence and posttraumatic stress symptoms between incarcerated battered women who killed/seriously assaulted their abusers and battered women incarcerated for other offenses. Additionally, several risk and buffering variables suggested by trauma research were tested to determine their ability to predict present posttraumatic stress disorder (PTSD) symptomatology. Findings revealed that battered women who killed/seriously assaulted their batterers experienced more frequent and severe spousal abuse than those in the comparison group. No significant group differences were found for present PTSD symptom levels. Predictors of present PTSD symptomatology included: childhood sexual abuse, childhood physical abuse, past PTSD symptomatology, length of time elapsed since living with partner and receiving counseling in prison. The implications of the findings are discussed.     

Effects of lidocaine infusion on the sympathetic response to abdominal surgery

Activation of afferent nerves in the area of surgery is a cause for surgical pain and stress. Intravenous (IV) lidocaine has been shown to inhibit postoperative pain. In the present double-blind study, the effects of a continuous IV infusion of lidocaine (2 mg/min) on the sympathoadrenal stress response to surgery were evaluated in 38 patients scheduled for elective cholecystectomy who were randomly assigned to two groups. In one group, lidocaine infusion was started 30 min before the operation and continued for 24 hr after surgery (n = 18). In the second group (n = 20), saline was infused. The increases in heart rate and blood pressure after tracheal intubation were not significantly different between the groups, but tachycardia and hypertension associated with extubation was prevented in patients given lidocaine. Differences in blood pressure and heart rate between the two groups were otherwise not significant intra- or postoperatively, nor were differences in blood glucose or plasma catecholamine concentrations during the first 24 hr after skin incision. Urinary catecholamine concentrations did not differ significantly in the two groups during the first postoperative day, but during the second postoperative day urinary output of epinephrine and norepinephrine were significantly less in the group of patients receiving lidocaine infusion. It was concluded that the IV infusion of lidocaine during and after major abdominal surgery suppresses extubation-induced hypertension and tachycardia but does not inhibit the general sympathetic response during the first postoperative day. However, lidocaine infusion reduces urinary output of catecholamines during the second postoperative day, suggesting a more rapid decline in the sympathoadrenal response postoperatively in the experimental group.     

Laparoscopic approach to pheochromocytoma: is a lower intraabdominal pressure helpful?

Laparoscopic adrenalectomy is gaining popularity because of its well-documented benefits. The aim of our study was to see if a decreased intraoperative intraabdominal pressure during laparoscopic adrenalectomy would affect the hemodynamic variables and the serum levels of catecholamines. We randomly divided 9 patients into 2 groups, maintaining either an intraabdominal pressure of 15 mm Hg (group A) or 8-10 mm Hg (group B). Norepinephrine and epinephrine blood levels were measured preoperatively, during endotracheal intubation, carboperitoneum, surgical manipulation of tumor just before the ligation of the adrenal vein, and tracheal extubation; the hemodynamic variables were recorded. The introduction of carboperitoneum resulted in an increase in heart rate and mean arterial blood pressure (MAP), although it was statistically insignificant. The norepinephrine levels showed a statistically significant increase in group A as compared with group B (P = 0.0002). Surgical manipulation of the tumor resulted in a significant increase in MAP and norepinephrine levels in group A (P = 0.007 and P = 0.0001, respectively). The epinephrine levels did not change as much because the tumor was probably predominantly norepinephrine-secreting. Norepinephrine levels continued to be high even during tracheal extubation in group A patients (P = 0.027). We conclude that a low intraabdominal pressure of 8-10 mm Hg causes less catecholamine release and fewer hemodynamic fluctuations.     

Cross-cultural response to trauma: A study of traumatic experiences and posttraumatic symptoms in Cambodian refugees

Despite a growing literature of cross-cultural research on mental illness, little is known about the universality of most psychiatric disorders. This study was designed to determine whether people from a very different culture have the same symptoms in response to traumatic experiences as do trauma survivors in the United States. We were also interested to find out if the severity of the current symptoms is related to the amount of trauma experienced. Furthermore, we gathered information about the perceived severity of traumatic experiences among refugees. Fifty Cambodian refugees living in the U.S. were asked about their traumatic experiences and their current symptoms of posttraumatic stress, dissociation, depression, and anxiety. High levels of all symptoms were found along with statistically significant relationships between each symptom measure and the amount of trauma experienced. We conclude that the basic symptom picture in this group was similar to that observed in U.S. trauma survivors.     

Biochemical changes after surgical stress in rabbits

Biochemical changes in blood, i.e. glucose, ketone bodies, lactate, protein, blood urea nitrogen (BUN), and free alanine before and after surgical stress were measured in normal and diabetic rabbits. Both the normal and diabetic rabbits were divided into two groups; the acute phase (0 to 180 minutes after surgery) and the subacute phase (1 to 3 postoperative days). Surgical stress was induced by performing laparotomy under anesthesia. Glucose, ketones, lactate, BUN, and alanine were higher in diabetic than normal animals. Protein level was lower in the diabetics. In the acute phase, normal and diabetic animals showed a similar reaction. In the subacute phase, ketone bodies and BUN increased predominantly in normal animals with no change of glucose levels. In two of the diabetics, an increase in glucose, lactate and alanine was seen. These phenomena support Bessman's postulation of stress which has two phases, the catecholamine phase and the pituitary-adrenal phase. It is considered that this reaction to surgical stress in the acute phase is due to glycogenolysis i.e., glucose from glycogen and lipolysis i.e., ketones from fat induced by catecholamine, and that increased ketone bodies and glucose levels in the subacute phase are due to ketogenesis i.e., ketones from protein and gluconeogenesis i.e., glucose from protein. In both phases ketonemia is predominant in normal rabbits after surgical stress, suggesting that insulin does not reduce directly lipolysis in the acute phase and ketogenesis in the subacute phase, under conditions of stress.     

急性有机磷中毒患者治疗前后的氧化应激变化研究

目的：探讨急性有机磷中毒患者治疗前后的氧化应激变化情况。方法选取2011年1月～2013年10月于本院进行治疗的34例急性有机磷中毒患者为观察组,同期的34名健康人员为对照组,然后将观察组治疗前、治疗后1d、3d、5d和对照组的血清氧化应激指标进行检测与比较。结果观察组治疗前、治疗后1d、3d、5d的血清MDA均高于对照组,血清TAC、SOD及GSH-Px均低于对照组,且观察组治疗后3d及5d血清MDA低于治疗前及治疗后1d,TAC、SOD及GSH-Px则高于治疗前及治疗后1d,P均＜0.05,均有显著性差异。结论急性有机磷中毒患者治疗前后的氧化应激变化较大,治疗后3d后改善开始显著。     

Levels of catecholamine in plasma and cerebrospinal fluid in aneurysmal subarachnoid hemorrhage.

Despite intensive investigation into the cause of cerebral vasospasm (focal ischemic deficit) after subarachnoid hemorrhage, the morbidity and mortality associated with this condition remain high. Various studies have shown levels of catecholamine in plasma and cerebrospinal fluid (CSF) to be increased in subarachnoid hemorrhage, and it is possible that these vasoactive substances play an important role in the subsequent vasospasm. In an attempt to elucidate this possibility, the study presented here was undertaken to investigate the relationship between catecholamine levels in plasma and CSF and focal ischemic deficit (FID); the rupture of aneurysms on blood vessels supplying the hypothalamus as compared with the rupture of aneurysms on blood vessels supplying other areas of the brain; and the clinical outcome of the patients. Concentrations of adrenaline and noradrenaline in plasma and CSF samples obtained from 21 patients who had suffered aneurysmal subarachnoid hemorrhage were determined by a radioenzymatic technique. Significantly higher levels of adrenaline were found at the time of surgery in the CSF of patients with FID. A similar trend, though not statistically significant, was also observed for plasma. Patients with a rupture of aneurysms on blood vessels supplying the hypothalamus showed a tendency towards higher catecholamine levels in plasma and CSF. Subjects with a bad clinical outcome (i.e., those who were severely disabled or had died) had significantly higher levels of catecholamine in plasma than did those with a good clinical outcome (i.e., those with moderate or no disability). Further detailed analysis of the interrelationships showed that, within the group of patients with FID, those with rupture of aneurysms on blood vessels supplying the hypothalamus had significantly higher catecholamine levels in plasma than did those with rupture of aneurysms on other cerebral vessels. Furthermore, in the group of patients with rupture of aneurysms on blood vessels supplying the hypothalamus, those with a bad clinical outcome had significantly higher catecholamine levels in plasma than did those with a good clinical outcome. These findings lend support to the possibility that damage to the hypothalamus and subsequent elevations in catecholamine levels may be associated with FID and poor clinical outcome.     

Changes in catecholamine level in hypotensive patients subjected to dialysis

An increase in the long-term survival ratio of patients with chronic renal failure has led to an increase in constant hypotensive accidents and cases of hypotension attacks during hemodialysis in spite of no prior abnormal physical findings, leading to difficulty in maintaining further dialysis. Many investigators have examined the plasma noradrenalin (NA) levels in dialysis patients, but the relationship between blood pressure and the plasma catecholamine concentration remains unknown. In our time-course plasma catecholamine level measurements, no significant difference was observed between the pre- and post-hemodialysis period, but a comparison of the plasma catecholamine levels for respective time periods revealed that a decrease in plasma NA levels corresponded to a decrease in blood pressure 3 to 4 hours after the beginning of hemodialysis. Administration of amezinium, which was thought to increase the plasma NA level, succeeded in maintaining and facilitated maintenance of a favorable blood pressure. The plasma NA concentration was considered to be related to a reduction of blood pressure during hemodialysis.     

不同压力持续气道正压对单肺通气氧化应激反应的影响

目的比较不同压力持续气道正压(CPAP)对单肺通气氧化应激反应的影响。方法择期行食管癌根治术患者48例,随机均分为双肺通气组(A组)、单肺通气组(B组)、单肺通气非通气肺给予2cmH2OCPAP组(C组)及5cmH2OCPAP组(D组)。分别于开胸前(T0)、单肺通气后(A组于开胸后)30min(T1)、90min(T2)、150min(T3)、手术结束(T4)时测定血清超氧化物歧化酶(SOD)活性、丙二醛(MDA)、NO浓度。结果 T1～T4时B、C组及T2～T4时D组的SOD活性明显低于A组,T1～T4时B、C、D组MDA及NO浓度高于A组(P0.05)。T1～T4时C、D组MDA及NO浓度均显著低于B组(P0.05),T3时C、D组SOD活性显著高于B组(P0.05);T3时D组MDA及NO浓度高于C组(P0.05)。结论 CPAP能减轻单肺通气氧化应激反应,且2cmH2OCPAP优于5cmH2OCPAP。     

Test anxiety and cardiovascular responses to daily academic stressors

Routine academic events may cause stress and produce temporary elevations in blood pressure. Students who experience test anxiety may be especially prone to cardiovascular activation in response to academic stress. This study drew on self-reported stress and ambulatory blood pressure measurements provided by 99 undergraduate participants (30% men, mean age=21 years) who participated over 4 days. Posture, activity level, recent consumption and the previous same-day reading were considered as covariates in a series of hierarchical linear models. Results indicate elevations in systolic blood pressure at times of acute academic stressors; neither diastolic blood pressure nor heart rate was linked with academic stress. In addition, those participants higher in test anxiety exhibited especially pronounced elevations in systolic blood pressure during times of acute academic stress. This research suggests that everyday academic stressors are linked with temporary increases in blood pressure and that test anxiety may contribute to these elevations. Test anxiety has implications for future academic and job success, and cardiovascular responses to everyday stress may contribute to health problems later in life.