Annals of clinical research最新文献

The psychoendocrine aspects of coping with distress were studied under mental and physical laboratory strain as well as in response to naturalistic stress. In spite of the common underlying endocrine responses to distress, gender differences in psychological response appeared to modify endocrine responses to the experience of pain. If the aspiration level task in the laboratory was well controlled by the subject hypothalamo-pituitary stress hormones were no longer secreted. Furthermore, heavy, physical work elevated blood levels of stress hormones (dopamine, noradrenaline, adrenaline, prolactin, cortisol, somatotropin) but especially hypothalamo-pituitary hormones responded to psychological state factors. Hence the role of psychoendocrine coping mechanisms seems to vary and depends on various psychosocial and biological determinants. Controllability is one of the key factors in an individual's ability to cope.

Autonomic nervous control of the heart and the blood vessels is essential for optimal physical performance. Afferent nerves conduct impulses to the vasomotor and cardioaccelerator and cardioinhibitor centres resulting in efferent sympathetic and vagus output. Information inputs also from the environment and the person's thought processes are mediated from the cortex by the hypothalamus, the limbic system, and the autonomic nervous system to the heart and blood vessels. Emotional factors like anger, anxiety, and fear increase sympathetic output and influence heart rate. On the other hand, fear and the feeling of being in a helpless situation causes intensive vagal activation with ensuing severe bradycardia or asystole and vasovagal syncope. Although psychologic factors can cause extreme grades of tachy- or bradycardia they usually have no acute deleterious effects in the normal heart. In the diseased heart, however, consequences may be hazardous. Emotional factors are known to increase ventricular arrhythmias either directly or indirectly by increasing heart rate and causing ischaemia as in coronary heart disease. In animal experiments ventricular fibrillation threshold is lowered by aversive conditions. In heart diseases with sudden death as a well known complication increased sympathetic activity may give rise to fatal arrhythmias. In man the evidence of psychologic factors as the cause of life-threatening arrhythmias and sudden death is mostly anecdotal or circumstantial. Well designed studies are needed to evaluate the role of psychologic factors in arrhythmias.

During the recent polio epidemic in Finland, 3 patients were initially misdiagnosed as Guillain-Barré polyradiculitis, and 1 of them was treated with plasma exchange. The follow-up until 2 years showed no difference in the recovery between this patient and the 2 other poliomyelitis patients treated without plasma exchange. The importance of the differential diagnosis between acute poliomyelitis and acute Guillain-Barré polyradiculitis is emphasized. An evaluation scheme includes sequential physical and cerebrospinal fluid examinations, together with viral antibody determinations.

Prophylactic diclofenac (Voltaren) in postoperative pain was studied in 60 surgical patients who underwent either abdominal (30 patients) or superficial (30 patients) surgery. During anaesthesia, no analgesic or narcotic drugs were given. Immediately after surgery, an intravenous infusion of 100 ml normal saline or saline with 75 mg of diclofenac was administered over 10 minutes under double-blind randomized conditions. The 2-hour study period was started when the patients complained of pain or half an hour after the end of anaesthesia. For pain relief during the study period, 4 mg of oxycodone was repeatedly given on demand. The initial mean pain intensity values were significantly higher after abdominal surgery than after superficial surgery but there were no statistically significant differences between diclofenac and placebo groups. The mean amount of oxycodone required after diclofenac was not significantly lower than after placebo (10.9 +/- 1.9 mg vs. 13.1 +/- 1.4 mg after abdominal surgery and 3.2 +/- 0.8 mg vs. 4.0 +/- 1.2 mg after superficial surgery). The pain relief obtained with oxycodone was similar after diclofenac and placebo. According to the present results, prophylactic use of diclofenac does not significantly reduce the need for narcotic analgesics in the immediate postoperative phase in general surgery.

Sixty-four geriatric long-stay patients aged 65 years or older participated in the trial. All were using laxatives prior to the study. For the study laxatives the mean dose of magnesium hydroxide was 25 ml daily and for bulk-laxative 8.7 g daily. Magnesium hydroxide caused a more frequent bowel habit (13.2 vs. 10.4/4 weeks, p less than 0.001) than bulk-laxative and additional laxative bisacodyl was not needed as often as with bulk-laxative (2.3 vs. 3.3/4 weeks, p less than 0.01). Also the stool consistency was more normal during the magnesium hydroxide treatment. In two patients serum magnesium was over 1.25 mmol/l after the magnesium hydroxide treatment but there were no clinical signs of hypermagnaesemia. Our study indicated magnesium hydroxide to be more efficient than bulk-laxative in treating constipation in elderly long-stay patients.

A retrospective rationalization of commonly performed tests and procedures for the assessment of patients with suspected thyroid disease was attempted. The final diagnosis, in 392 consecutive new referrals to a central thyroid clinic, was primarily established by combined criteria of clinical/scintigraphic/cytopathologic findings. Detailed statistical analysis and evaluation of the accumulated data have demonstrated that: (a) only 15.8% of patients exhibited measurable thyrometabolic disturbances, thus indicating a rather limited scope for the application of laboratory tests in screening for thyroid diseases; (b) the measurement of serum total thyroxine with the thyroid hormone uptake test and the derivation of the free thyroxine index constitute, at present, the most appropriate initial in vitro laboratory procedure for assessing thyrometabolic function; and (c) recently available innovative methods for estimating serum levels of free thyroid hormones have no advantages over established assays.

Seventeen post-myocardial infarction patients experiencing angina on effort performed 6 different exercise tests until they reached symptom-limited maximal level, 3 after placebo and 3 after oral administration of 10 mg of the Calcium antagonist, nifedipine, in a randomized, double blind, cross-over controlled study. Four of the tests were conventional bicycle and treadmill tests with stepwise increasing load. In 2 of the tests an isometric exercise of carrying a weight averaging 6 kg and corresponding to about 30% of maximal grip strength was added to the treadmill walking. When the exercise was stopped because of moderately severe angina, the product of heart rate and systolic blood pressure did not show any statistically significant difference between the tests. However, in the treadmill plus isometric test the work time was shorter and the slope of the treadmill was less than in the treadmill test. The difference was caused partly by non-cardiac factors, namely fatigue of the hand muscles. In routine exercise tests of coronary patients the addition of an isometric to a dynamic load did not give substantially more information than dynamic exercise alone. Nifedipine caused a modest increase of exercise tolerance in all tests, the increase being greatest in the treadmill plus isometric test. The increase in exercise tolerance was seen also in patients receiving beta-blocking agent.

In a double-blind crossover study, the haemodynamic effects of nitroglycerin discs were compared with placebo in 9 patients with severe chronic congestive heart failure. Hourly measurements were made throughout 24 hours for the placebo and the active treatment; the first 6 hours were used as a dose titration phase to achieve at least a 5 mmHg decrease in pulmonary arterial diastolic pressure. Active treatment, requiring 30 mg of nitroglycerin in most patients, produced a significant improvement in the cardiac index compared with placebo, as assessed from the end of the dose titration period to the 24th hour. Values determined as baseline, as the average from hour 7 to 24, and at the 24th hour for active discs were 2.3, 2.5 and 2.6 litres/min/m2, whereas for the placebo they were 2.3, 2.2. and 2.2 l/min/m2, respectively. Heart rate remained unchanged during the study, though mean systemic arterial blood pressure and vascular resistance were lower during active treatment. Right atrial and pulmonary arterial pressures did not change. In conclusion, nitroglycerin discs decrease afterload and improve cardiac performance over 24 hours in patients with heart failure.