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Contraction Stress Test

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2601. Cyclo-oxygenase-2, endothelium and aortic reactivity during deoxycorticosterone acetate salt-induced hypertension. (Abstract)

Cyclo-oxygenase-2, endothelium and aortic reactivity during deoxycorticosterone acetate salt-induced hypertension. To test the hypothesis that the enhanced vascular responsiveness to norepinephrine that occurs during deoxycorticosterone acetate (DOCA)-salt induced hypertension is causally related to increased expression of cyclo-oxygenase (COX)-2 and oxidative stress, which diminishes the vasomodulatory influence of endothelium-derived nitric oxide.Four groups of age-matched, male Sprague (...) salt solution (37 degrees C) and bubbled with a 5%CO2/95%O2 gas mixture. Aortic sensitivities (pD2 values) to norepinephrine and serum isoprostanes (8-iso-prostaglandin F2alpha, a marker of oxidative stress) were measured for each experimental paradigm.NS-398 significantly reduced maximal contractions in response to norepinephrine in aortic rings from Sham (44 +/- 3%) and DOCA-salt (96 +/- 2%) group rats. Expression of COX-2 protein increased significantly in vessels from DOCA-salt rats compared

2005 Journal of Hypertension

2602. Age-related reduction in estrogen receptor-mediated mechanisms of vascular relaxation in female spontaneously hypertensive rats. Full Text available with Trip Pro

) than in adult rats (6.2+/-0.3x10(4) N/m2). 17beta-estradiol (E2) caused relaxation of Phe contraction and stimulation of vascular nitrite/nitrate production, which was reduced in aging rats. In endothelium-denuded strips, E2 still caused relaxation of Phe contraction, which was smaller in aging rats than adult rats. KCl (51 mmol/L), which stimulates Ca2+ influx, produced greater active stress in aging rats (9.1+/-0.3) than in adult rats (5.9+/-0.2x10(4) N/m2). E2 caused relaxation of KCl (...) Age-related reduction in estrogen receptor-mediated mechanisms of vascular relaxation in female spontaneously hypertensive rats. Hypertension increases with aging, and changes in vascular estrogen receptors (ERs) may play a role in age-related hypertension in women. We tested whether age-related increases in blood pressure in female spontaneously hypertensive rats (SHRs) are associated with reduction in amount and/or vascular relaxation effects of estrogen and ER. Arterial pressure and plasma

2004 Hypertension

2603. Reduced endothelial NO-cGMP-mediated vascular relaxation and hypertension in IL-6-infused pregnant rats. Full Text available with Trip Pro

Reduced endothelial NO-cGMP-mediated vascular relaxation and hypertension in IL-6-infused pregnant rats. Placental ischemia during pregnancy is associated with increased plasma cytokines such as interleukin-6 (IL-6), which may contribute to increased vascular resistance and hypertension of pregnancy. We tested the hypothesis that an increase in plasma IL-6 during pregnancy is associated with impaired endothelium-dependent relaxation, enhanced vascular contraction, and hypertension. Systolic (...) blood pressure was measured in virgin and pregnant Sprague-Dawley rats non-treated or infused with IL-6 (200 ng/kg per day for 5 days). Isometric contraction was measured in isolated aortic strips, and endothelial nitric oxide (NO) synthase (eNOS) was measured in aortic homogenate using Western blots. Blood pressure was greater in IL-6-infused (146+/-3) than in control pregnant rats (117+/-2 mm Hg). In endothelium-intact vascular strips, phenylephrine (Phe) caused greater increase in active stress

2004 Hypertension

2604. Decreased endothelium-dependent NO-cGMP vascular relaxation and hypertension in growth-restricted rats on a high-salt diet. Full Text available with Trip Pro

. In isolated, endothelium-intact aortic strips, phenylephrine (Phe, 10(-5) mol/L) caused an increase in active stress that was greater in IUGR/NS (13.9+/-0.9 N/m2) than in NS (8.5+/-0.6 N/m2) animals and far greater in IUGR/HS (18.2+/-1.2 N/m2) than in HS (9.4+/-0.8x10(4) N/m2) rats. Acetylcholine caused relaxation of the Phe-mediated contraction and induced vascular nitrite/nitrate production that was less in IUGR/NS than in NS animals and far less in IUGR/HS than in HS rats. N(G)-nitro-L-arginine methyl (...) ester, which inhibits nitric oxide (NO) synthase, or ODQ, which inhibits cGMP production in smooth muscle, inhibited acetylcholine relaxations and enhanced Phe contractions in NS and HS rats but not in IUGR/NS or IUGR/HS rats. Endothelium removal enhanced Phe-induced stress in NS and HS rats but not in IUGR/NS or IUGR/HS rats. Thus, endothelium-dependent relaxation via the NO-cGMP pathway is inhibited in systemic vessels of IUGR rats, particularly during intake of an HS diet. This might explain

2004 Hypertension

2605. Estrogen replacement therapy reverses changes in intramural coronary resistance arteries caused by female sex hormone depletion. (Abstract)

of 10(-6) M), and bradykinin (BK; at 10(-6) M). Finally, Ca2+-free Krebs-induced passive diameter (PD) was measured in each group.Ovariectomy increased spontaneous myogenic tone of coronary arteries (p<0.05), which was normalized by estrogen replacement. Ovariectomy decreased distensibility observed at low pressure, although passive diameter was not changed. Estrogen replacement decreased wall stress and elastic modulus (p<0.05). The thromboxane A2 agonist induced the largest contraction (...) Estrogen replacement therapy reverses changes in intramural coronary resistance arteries caused by female sex hormone depletion. We tested the hypothesis that female sex hormone depletion and estradiol replacement therapy significantly influences the biomechanical properties of intramural coronary resistance arteries.Female rats (n=30) were divided into three groups. In group O, rats were subjected to bilateral ovariectomy. Group HRT was subjected to bilateral ovariectomy and estradiol

2004 Cardiovascular Research

2606. Left ventricular diastolic function in normotensive subjects 2 months after acute myocardial infarction is related to glucose intolerance. (Abstract)

of the early phase/atrial contraction wave, deceleration time of E wave, and isovolumic relaxation time were measured during echocardiograph/Doppler cardiography in 200 normotensive patients 2 months after AMI. Twenty-nine patients were known to be diabetic on admission with AMI. Glucose tolerance test was carried out in the 171 patients who are not known to be diabetic.Independent of LVEF, restrictive LV filling (peak velocity of the early phase/atrial contraction wave > 1 but < 2 associated (...) with deceleration time of E wave < or = 140 milliseconds) was found in 72% of the known-diabetic patients, 70% of the 20 preclinical diabetic patients, 23% of the 35 patients with impaired glucose tolerance, 13% of the 15 patients with stress hyperglycemia, and 7% of the euglycemic patients (P < .01). In the rest of these patients, LV filling was nonrestrictive. No significant difference was observed in LVEF and LV mass index between patient groups.Independent of LVEF, the pattern of abnormal LV filling

2005 American Heart Journal

2607. The effect of regional ischemia on mitral valve annular saddle shape. (Abstract)

The effect of regional ischemia on mitral valve annular saddle shape. The mitral valve annulus has a distinctive saddle shape. Recent finite element analysis indicates this shape may contribute to normal valve function by increasing leaflet curvature and reducing leaflet stress. This study tests the hypothesis that acute ischemic mitral regurgitation (AIMR) is associated with loss of annular saddle shape.Sonomicrometry array localization (SAL) measured the three-dimensional geometry (...) of the mitral annulus in 6 sheep before and after 30 min of posterior ischemia that produced severe AIMR. Using this SAL data the annular height to commissural width ratio (AHCWR), a measure of annular saddle shape, was calculated throughout the cardiac cycle and reported as a percentage.The normal mitral annulus accentuated its saddle shape rapidly during isovolemic contraction: AHCWR increased from 11.6% +/- 1.1%-13.9% +/- 1.6% (p < 0.001). During ejection AHCWR remained relatively constant ranging from

2004 Annals of Thoracic Surgery

2608. Knee stabilization in patients with medial compartment knee osteoarthritis. Full Text available with Trip Pro

and genu varum and 19 control subjects were tested. Subjects stood with the test limb on a movable platform, comprising a plate that translated laterally to rapidly stress the knee's medial periarticular structures and create a potentially destabilizing sensation at the knee joint. Knee motion and muscle responses were recorded. Subjects rated the condition of their knee with a self-report questionnaire about knee instability during daily activities.Prior to plate movement, the OA subjects demonstrated (...) more medial muscle co-contraction than did controls (P = 0.014). Following plate movement, the OA subjects shifted less weight off the test limb (P = 0.013) and had greater medial co-contraction (P = 0.037). OA subjects without knee instability had higher co-contraction of the vastus medialis medial hamstrings than did those who reported having instability that affected their daily activities (P = 0.038). More knee stability correlated positively with higher co-contraction of the vastus medialis

2005 Arthritis and Rheumatism

2609. Effect of anatomic realignment on muscle function during gait in patients with medial compartment knee osteoarthritis. Full Text available with Trip Pro

with medial knee OA and genu varum who were scheduled for OW-HTO were tested prior to and 1 year following OW-HTO. Fifteen age- and sex-matched controls were also tested. Frontal plane laxity was measured from stress radiographs. All participants underwent quadriceps strength testing with a burst superimposition technique and gait analysis with surface electromyography to calculate knee joint kinematics and kinetics and muscle co-contraction during the stance phase of gait. Participants rated their knee (...) function and instability using a self-report questionnaire.Static alignment improved following the surgery. Medial laxity (P = 0.003) and instability (P = 0.002) significantly improved, and statistical reductions in the adduction moment resulted in lower levels of vastus medialis-medial gastrocnemius muscle co-contractions (P = 0.089). Despite improvements in global rating of knee function (P = 0.001), the OA group's ratings remained significantly lower than those of the healthy controls (P = 0.001

2007 Arthritis and Rheumatism

2610. Q Fever

agent: The incubation period depends on the dose. Incubation is usually 2-3 weeks, but ranges from 1-6 weeks. Although it has a low case fatality rate, it meets criteria such as ease of manufacture, stability in the environment, and ability to cause disease. C. burnetii is extremely resistant to physical stresses, including heat and desiccation and can survive in the environment for months to years. The bacteria can become airborne, travelling on wind currents for miles, resulting in distant (...) sweats. Hepatosplenomegaly. Chronic Q fever is rarely reported in children, although when it does occur, osteomyelitis is one of the most common findings. Investigations Because of the nonspecific symptoms, healthcare providers typically do not suspect Q fever during the acute stage of the disease and diagnosis is often retrospective. However, in the acute phase, investigations may show: Blood tests WCC raised in 1/3 of cases. Liver enzymes raised at 2-3 x normal; alkaline phosphatase raised in 70

2008 Mentor

2611. Screening for Depression in Primary Care

of false positives) and a very high sensitivity (very low rate of false negatives), although this is difficult to assess when evaluating a screening tool for depression. The screening test must be relatively cheap or else the cost per case detected is prohibitively expensive. It must be safe, easy to use and acceptable to the patient. Who should be screened? In one sense the General Medical Services (GMS) contract has simplified the situation in identifying patients with coronary heart disease (...) . . [ ] Stressful home environments. The elderly. . Unexplained symptoms. Depression may be more difficult to detect in patients with physical illness because both conditions can have similar symptoms. Screening and assessment tools A number of screening and assessment tools have been validated and are generally available. Initial screening in patients who may have depression [ ] NICE recommends that any patient who may have depression (especially those with a past history of depression or who suffer from

2008 Mentor

2612. Septicaemia

of steroid hormones. Cytokines, proteases, lipid mediators, gaseous substances, vasoactive peptides and cell stress markers play key roles in sepsis pathophysiology [ ] . Current research is focusing on such issues as the immunosuppressive phase of host immune responses, mitochondrial dysfunction and the individual reactions between pathogen and the host immune system [ ] . Epidemiology Sepsis is the most common cause of death among critically ill patients in non-coronary intensive care units [ ] . Lack (...) These should include: FBC - anaemia, neutrophilia or neutropenia, thrombocytopenia may be present (pancytopenia may indicate bone marrow involvement). In viral infections lymphocytosis predominates. Urine dipstick and sample for microscopy, culture and sensitivity. Renal function - looking at extent of dehydration or organ failure. LFTs - hypoalbuminaemia likely to be present. Glucose - hyperglycaemia can be present. Clotting screen, including D-dimer and fibrinogen testing, looking for disseminated

2008 Mentor

2613. Recurrent Abdominal Pain in Children

years. It is uncommon in children under 5 years of age. Girls are more commonly affected than boys (relative prevalence 1.5). There is an association between obesity and RAP [ ] . There is an association between stress and RAP. Children with RAP are more likely to have experienced events such as deaths of family members, domestic violence, harsh punishment from parents, parental job loss and economic stress, hospitalisation and bullying. RAP appears unrelated to socio-economic group (...) -infectious) [ ] . RAP is additionally affected by temperament and by family and school environments (the bio-psychosocial model). Less effective mechanisms of coping with stress may contribute to pain and to associated anxiety and depression [ ] . There is some evidence of altered intestinal flora in paediatric IBS [ , ] . Poor diet, poor fluid intake and lack of exercise can contribute to RAP. Increased prevalence in girls has led to suggestions that levels of sex hormones might play a role. Ovarian

2008 Mentor

2614. Macular Disorders

in the healthy eye and in the diseased eye. Assessment of macular function Visual acuity The most important test is the assessment of visual acuity. Note distant acuity using a Snellen chart, making sure that you have identified any past history of previous visual acuity problem (eg, amblyopia). If you have access to a near vision booklet, assess the near vision too. Ask the patient to hold the booklet at about 30 cm (about an arm's length) and, using their usual reading glasses, read the short passages, one (...) a central scotoma). (If there is no central scotoma): 'I want you to focus on the central dot and tell me whether you can see all four corners of the big box out of the corner of your eye.' 'Still focusing on the central dot: Are any of the small boxes missing? Where? Can you shade out the area where they are missing?' 'Finally, whilst still focusing on the central dot: Do any of the lines appear distorted? Where? Can you draw over those lines that are not straight?' Rest and then test the fellow eye

2008 Mentor

2615. Tremor

. In this article In This Article Tremor In this article See separate related article . Tremor may occur as a symptom or sign of an underlying disease or as an exaggerated physiological phenomenon. It is not a diagnostic term. It can be defined as a rhythmic oscillatory movement of a body part, resulting from the contraction of opposing muscle groups. The vast majority of tremor seen in the primary care setting is due to 'essential tremor' (ET). This condition has previously been termed as benign or familial (...) . Arsenic, heavy metal, organophosphate or industrial solvent poisoning. Vitamin deficiency (especially B1). Classification of tremors Tremors can be initially classified as rest or action tremors. [ ] Rest tremors occur when the body part is supported against gravity - eg, hands at rest in one's lap. Mental stress or general movement makes rest tremors worse. Action tremors are further subdivided into static, postural or kinetic tremors: Static - occurs in a relaxed limb when fully supported at rest

2008 Mentor

2616. Detrusor Instability and Irritable Bladder

be confined to cases where the condition is secondary to a known cause, whilst overactive bladder syndrome should be used in cases which are idiopathic. In practice the term is often used interchangeably. OAB can have a significant impact on quality of life. [ ] Epidemiology OAB is the second most common cause of female urinary incontinence (stress incontinence is the most common). The prevalence of OAB increases with age. [ ] OAB may be associated with Parkinson's disease, spinal cord injury, diabetic (...) ). [ ] There are no specific physical signs and the diagnosis is usually made from the symptoms and confirmed with . Differential diagnosis Functional incontinence Overflow incontinence Urinary fistula Enuresis Investigations Urine dipstick analysis and midstream urine specimen should be sent to the laboratory in order to rule out urinary tract infection. Investigations to consider differential diagnosis - eg, blood tests for renal function, electrolytes, calcium, fasting glucose. Urodynamic studies show involuntary

2008 Mentor

2617. Echocardiography

for the evaluation of patients with coronary heart disease. [ ] Rest and stress images are obtained and compared. It has benefits over standard treadmill exercise testing for detecting myocardial ischaemia. Appearance of reversible systolic regional wall motion abnormalities is typical of coronary artery disease. [ ] How to interpret results of the echocardiogram [ ] Some elements of echocardiogram results Left ventricular ejection fraction (LVEF) Indicator of left ventricular systolic function. 60% LVEF (...) and this can be demonstrated as a colour display. Movement towards the transducer is coded red and away from the transducer is coded blue, with turbulent flow shown as a mosaic pattern. In practice, varying amounts of all three methods are usually used. Structures visualised with echocardiography Valves. Four chambers of the heart. Wall thickness. Amount of muscle contraction. Pericardium. Intracardiac masses. Ascending aorta. Uses of echocardiography [ ] These include: - valve dysfunction, follow-up

2008 Mentor

2618. Cervical Ribs and Thoracic Outlet Syndrome

for the diagnosis of cervical radiculopathy. This sign is described further in the separate article. Some clinicians ask the patient to pull the head forward while maintaining the test position, causing the anterior scalene to contract against the plexus to enhance the stress effect. Hyperabduction of the arm can also be used as a test to stress the outlet. This often causes symptoms and loss of pulse even in normal people and may be misleading. Costoclavicular bracing reduces the space between the clavicle (...) in sportsmen, especially swimmers and throwers. The interval between trauma and symptoms may be hours to weeks. Examination [ ] A careful neurological and musculoskeletal examination is required. Neurological examination is discussed elsewhere - see separate article. Disease of the neck and arm must be excluded. Stress tests or provocative manoeuvres form the basis of examination. They have very low specificity, sensitivity and predictive value [ ] . The most common tests are Adson's manoeuvres. The head

2008 Mentor

2619. Cerebrovascular Events

affects a large proportion of stroke patients [ ] . Differential diagnosis Aways exclude as a cause of sudden-onset neurological symptoms [ ] . in the first 24 hours of the stroke. . . Todd's palsy. Consider a if the patient is comatose. Investigations FBC - thrombocytopenia, polycythaemia. Test for sickle cell disease. Erythrocyte sedimentation rate (ESR) - giant cell arteritis (consider temporal lobe artery biopsy, start steroids). Hypoglycaemia, hyperglycaemia and hyperlipidaemia. Syphilis - active (...) complications include thromboembolism, pneumonia and bedsores Dysphagia affects a large proportion of stroke patients. Swallowing difficulties can result in reduced fluid and food intake, and cause aspiration, which can lead to aspiration pneumonia, undernutrition and dehydration [ ] . NB : morbidity within carers is high - in particular stress, which is only partly relieved by respite admissions. Prognosis [ ] The inpatient death rate for people admitted with a stroke is about 24%. The risk of stroke

2008 Mentor

2620. Benzodiazepine Dependence

, excessive sensitivity to light and sound, depersonalisation and derealisation. Management of benzodiazepine dependence [ , ] Assessment Is this the right time to start a withdrawal programme? It is less likely to be effective if there are significant stresses, social problems, medical problems, etc. Does the person wish to stop using benzodiazepines or reduce the dose? Motivation will increase the chances of success, and whether the person wishes to stop or not will guide the management plan. Has (...) and assistance, advise them on methods available to stop abusing benzodiazepines - eg, graded reduction. Alternative therapy, such as cognitive behavioural therapy (CBT) or relaxation therapy may be offered for their insomnia. If the patient agrees to reduce benzodiazepines then a signed contract may help them to commit. There is no need to match self-reported high doses used illicitly. Doses greater than the equivalent of diazepam 30 mg per day should rarely be prescribed. [ ] This is often a situation

2008 Mentor

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