Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction

Abstract. The aim of this study was to investigate in patients with neurogenic orthostatic hypotension the mechanism and usefulness of abdominal compression to increase standing blood pressure. In three protocols, 23 patients underwent abdominal compression. Protocol 1 evaluated in a 40–60° head-up-tilt position, the effect of abdominal compression on caval vein and femoral diameter, arterial blood pressure and hemodynamics. Protocol 2 documented the relationship between the level of compression and the arterial pressure response. Protocol 3 investigated the ability to maintain standing blood pressure by an elastic binder. During head-up-tilt, compression (40 mm Hg) resulted in a reduction in diameter of the caval vein (mean –2.6mm, range –1.4 to 0.6), without a change in femoral vein diameter. Stroke volume increased by 14 % (range –1 to 23) and blood pressure (systolic/diastolic) by 30/14 mmHg (range 7/2 to 69/36), both p < 0.05; 40 mmHg compression was associated with a higher pressure response than 20 mmHg (mean 18/8 mmHg, range 6/2 to 43/20 vs. mean 9/4 mmHg, range –1/0 to 18/8, p < 0.05). Elastic abdominal binding increased standing blood pressure with 15/6mmHg (range –3/3 to 36/14, p < 0.05). We conclude that in patients with neurogenic orthostatic hypotension, abdominal compression increases standing blood pressure to a varying degree by increasing stroke volume.     

Association of lens opacities,intraocular straylight,contrast sensitivity and visual acuity in European drivers

Purpose: To study the relationship between lens opacity and intraocular straylight, visual acuity and contrast sensitivity. Methods: We investigated 2422 drivers in five clinics in different European Union (EU) member states aged between 20 and 89 years as part of a European study into the prevalence of visual function disorders in drivers. We measured visual acuity [Early Treatment Diabetic Retinopathy Study (ETDRS) chart], contrast sensitivity (Pelli–Robson chart) and intraocular straylight (computerized straylight meter). Lens opacities were graded with the Lens Opacities Classification System III (LOCS) without pupillary dilation. Participants answered the National Eye Institute Visual Functioning Questionnaire – 25. Results: Intraocular straylight was related more strongly to LOCS score than to both visual acuity and contrast sensitivity. Visual acuity and contrast sensitivity were correlated to each other well, but to intraocular straylight to a much lesser extent. Self‐reported visual quality was best related to contrast sensitivity; night driving difficulty was best related to visual acuity. Conclusion: Straylight is found to have added value for visual function assessment in drivers, whereas if visual acuity is known contrast sensitivity has limited added value.     

Ventilator-induced endothelial activation and inflammation in the lung and distal organs

Introduction  

Results from clinical studies have provided evidence for the importance of leukocyte-endothelial interactions in the pathogenesis of pulmonary diseases such as acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), as well as in systemic events like sepsis and multiple organ failure (MOF). The present study was designed to investigate whether alveolar stretch due to mechanical ventilation (MV) may evoke endothelial activation and inflammation in healthy mice, not only in the lung but also in organs distal to the lung.     

Cryoperforator surgery: a new treatment of incompetent perforating veins

This study was conducted to determine the feasibility of cryoperforator surgery in the treatment of incompetent perforating veins. Fifteen patients with C2-C4 varicose disease (according to the Clinical-Etiology-Anatomy-Pathophysiology classification) were enrolled in this study. Under local anesthesia, incompetent perforating veins were treated with a duplex-guided cryoprobe. Duplex scans were performed 2 and 4 weeks after treatment. Fifteen patients with 28 incompetent perforating veins were treated with cryoperforator surgery. Distribution of the incompetent perforating veins was as follows: posterior tibial perforator, 12; paratibial perforator, 11; intergemellar perforator, 1; lateral leg perforator, 4 (range = 1-5 incompetent perforating veins per patient). Follow-up showed successful treatment of 12 incompetent perforating veins (43%). This study showed that cryoperforator surgery is feasible for treatment of incompetent perforating veins. Higher success rates could be obtained with our modified diamond-dust coated cryoprobe. Major advantages are the treatment in an outpatient setting and the possibility of treating all incompetent perforating veins, intraluminal or extraluminal.     

Effects of preemptive enoximone on left ventricular diastolic function after valve replacement for aortic stenosis

OBJECTIVE: Left ventricular (LV) hypertrophy is associated with increased diastolic chamber stiffness early after aortic valve replacement for valve stenosis. Enoximone, a phosphodiesterase III inhibitor, has been shown to improve myocardial contractility and relaxation when administered as a single dose after cardiac surgery. The present study investigated, by analysis of transmitral flow velocity patterns and end-diastolic pressure-area relations, whether enoximone administered before aortic valve surgery has an effect on LV diastolic properties. DESIGN: Prospective, randomized study. SETTING: Referral center for cardiothoracic surgery at a university hospital. PARTICIPANTS: Thirty-four patients undergoing aortic valve replacement for aortic stenosis. INTERVENTIONS: Patients in the enoximone group (n = 17) received a bolus dose of 0.35 mg/kg (0.15 mg/kg before aortic cross-clamping and 0.2 mg/kg added to the cardioplegic solution). Individual pressure-area relations (pulmonary capillary wedge pressure v left ventricular end-diastolic area) were obtained by using volume loading by leg elevation before and after surgery with closed chest. MEASUREMENTS AND MAIN RESULTS: The pressure-area relation on the pressure-area plot was shifted to the left after surgery, indicating decreased LV diastolic distensibility in the enoximone and control groups and providing evidence of decreased LV diastolic function. Indices of LV diastolic chamber stiffness, LV operating stiffness (K(LV)) derived from the deceleration time of early ventricular filling, and the constant of chamber stiffness (beta) derived from pressure-area relations were not different after enoximone treatment. Systolic LV function was unaltered after cardiac surgery in both groups. Analysis of changes in transmitral flow patterns identified an increased atrial filling fraction in enoximone-treated patients, suggesting increased atrial systolic function. The unaltered systolic pulmonary venous flow velocity compared with the decrease in the control group after volume loading further supports preservation of left atrial reservoir function with enoximone in the absence of evidence for decreased LV stiffness. CONCLUSION: Preemptive enoximone did not change LV diastolic function based on diastolic filling patterns or LV stiffness indices (K(LV) and beta) derived from Doppler early filling deceleration time and pressure-area relations. Doppler data suggested improvement of left atrial systolic function and preservation of left atrial reservoir function with enoximone.     

The nursing of outpatients with a bipolar disorder: what nurses actually do

This qualitative study was undertaken to gain insight into the daily practice activities of community psychiatric nurses (CPNs) involved in the nursing of outpatients with bipolar disorders in the Netherlands. Semistructured interviews were undertaken with 23 CPNs, and additional focus group interviews were conducted. Information was gained on the problems encountered by the patients with a bipolar disorder, desired outcomes, interventions used, and the role of the CPNs in the treatment of these outpatients. One of the main conclusions is that a systematic approach to the nursing process is simply lacking. Recommendations for improvement are therefore presented in closing.