Cardioembolic Stroke in Patients with Patent Foramen Ovale and Implanted Cardiac Leads

Implanted cardiac devices, including pacemakers, defibrillators, and resynchronization devices, are known to develop thrombus on their intravascular leads. Patent foramen ovale (PFO) occurs in approximately one‐quarter of the adult population. It is unclear whether paradoxical cardioembolism and clinically relevant stroke occur in patients with implanted cardiac leads and PFO. We present a case series of four patients with cardioembolic stroke, presumed to arise from intravascular cardiac leads and associated PFO that required device closure of the PFO. (PACE 2013; 36:50–54)     

Exteroceptive suppression of temporalis and masseter muscle activity is enhanced in offspring of hypertensives

Exteroceptive suppression of temporalis and masseter muscle activity was examined in young men with and without a parental history of hypertension. Recent clinical studies suggest that the second exteroceptive suppression period is attenuated in several chronic pain disorders and that this brainstem reflex may serve as a noninvasive index of endogenous pain control. In the present study, offspring of hypertensives exhibited a significant protraction of the late exteroceptive suppression period for both muscle sites, suggesting that the decreased pain sensitivity previously observed in individuals at risk for hypertension may be related to enhanced central pain modulation.     

Problem drinking and family history

Data on SADQ, GHQ, disciplinary, financial and relationship problems were collected from 103 problem drinkers and 96 controls. Problem drinkers were significantly more severely affected than controls on all measures except financial problems. Of the problem drinkers, 55% had a positive family history, and this group were more severely affected on SADQ, GHQ and financial problem measures than family history negative subjects. The most severely affected group were those with a positive family history who also reported significant childhood problems, and the least affected were those without a family history who did not report significant childhood problems.     

Parental history of hypertension and enhanced cardiovascular reactivity are associated with decreased pain ratings

Ischemic pain was examined in adult males with and without a parental history of hypertension. Blood pressure and heart rate were recorded during baseline, cold pressor, and ischemia. Repeated pain ratings were obtained during cold pressor and ischemia, and the McGill Pain Questionnaire was completed after each stressor. A median split was used to identify high and low mean arterial pressure and heart rate reactors to cold pressor. Parental history of hypertension, high heart rate reactivity, and high mean arterial pressure reactivity were each associated with significantly lower ischemic pain ratings on the McGill Pain Questionnaire, suggesting that risk for hypertension is associated with hypoalgesia in normotensives.     

Late Endocardial Pacing Lead Body Migration Compromising Fontan Physiology

Migration of intracardiac transvenous pacing leads may occur. There is a known risk of intrapul- monary ventricular pacing lead migration in patients with endocardial lead systems. In the current report we present the late intrapulmonary migration of an endocardial atrial pacing lead body. The patient had undergone antitachycardia pacemaker placement to control recurrent atrial tachyarrhythmias following the Fontan procedure. Although the lead electrode remained in place and continued to pace, the lead body migrated, causing severe obstruction to blood flow. This resulted in severe cardiac decompensation, which was ultimately ameliorated by lead repositioning.     

Comparison of the efficacy, safety, and tolerability of propiverine and oxybutynin for the treatment of overactive bladder syndrome

AIM: To compare the effects of propiverine and oxybutynin on ambulatory urodynamic monitoring (AUM) parameters, safety, and tolerability in patients with overactive bladder. METHODS: This was a randomized, double-blind, placebo-controlled, multicentre, crossover study. Patients (n = 77) received two of the following treatments during two 2-week periods: propiverine 20 mg once daily, propiverine 15 mg three times daily, oxybutynin 5 mg three times daily, and placebo. AUM parameters, salivary flow, visual near point, and heart rate were assessed. RESULTS: A consistent order in the efficacy between active treatment groups was observed for the reduction in mean involuntary detrusor contractions (IDCs; oxybutynin 15 mg 相似文献   

CUE-EXPOSURE TO ALCOHOL-ASSOCIATED STIMULI REDUCES AUTONOMIC REACTIVITY, BUT NOT CRAVING AND ANXIETY, IN DEPENDENT DRINKERS

A controlled trial was conducted of cue-exposure with dependentdrinkers in treatment. All subjects were engaged in an insight-orientatedtherapy programme, and responses to an alcohol-associated, comparedwith a neutral, stimulus were assessed at the beginning andend of treatment. Compared with a control group, which did notreceive intervening cue-exposure sessions, subjects who receivedsuch interventions manifested reductions in heart rate, salivationand arousal responses to the alcohol-associated, compared withthe neutral, stimulus. They did not, however, show similar reductionsin subjective estimates of craving and anxiety. These resultsand the desynchrony in reductions in cue-reactivity across responsedomains are discussed in terms of their implications for cue-exposurein treatment and recent theoretical conceptualizations of therelationship between autonomic reactivity, craving and drinkingbehaviour.