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Jonathan G Stine, Jennifer Wang, Scott L Cornella, Brian W Behm, Zachary Henry, Neeral L Shah, Stephen H Caldwell, Patrick G Northup
INTRODUCTION: Type-1 hepatorenal syndrome (HRS-1) portends a poor prognosis in patients with cirrhosis. Currently available medical therapies are largely ineffective, save for liver transplantation. We aimed to determine if pentoxifylline (PTX) therapy in addition to the standard of care of volume expansion with albumin and vasoconstriction with midodrine and octreotide (AMO) is safe and efficacious compared to AMO in HRS-1 treatment. MATERIAL AND METHODS: Hospitalized subjects with decompensated cirrhosis and HRS-1 were enrolled...
March 1, 2018: Annals of Hepatology
David E Riley, Alberto J Espay
Background: Cognitive fluctuations refer to alterations in cognition, attention, or arousal occurring over minutes to hours, most commonly in patients with dementias associated with advanced Lewy body pathology. Their pathophysiologic underpinning remains undetermined. Case presentation: We documented serial blood pressure (BP) measurements in an 86-year-old man with Parkinson's disease dementia experiencing cognitive fluctuations during an office visit. This patient's associated dysautonomia included labile BP with orthostatic hypotension and nocturnal hypertension...
2018: Journal of Clinical Movement Disorders
Kyle Ball, Thomas P Vacek
A rare cause of reflex syncope is metastatic cancers involving the head and neck. These can irritate the glossopharyngeal nerve and lead to glossopharyngeal neuralgia with associated syncope. This type of syncope is difficult to treat since it commonly involves both a vasodepressor and cardioinhibitory response, and typically requires removal of the irritative focus. We report a case of a 52-year-old male who presented from home with syncope. He endorsed a 5-week history of progressively worsened positional headaches and dramatic 40-pound weight loss with night sweats over 6 months...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Victoria A Serhiyenko, Alexandr A Serhiyenko
Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes mellitus (DM) that is strongly associated with approximately five-fold increased risk of cardiovascular mortality. CAN manifests in a spectrum of things, ranging from resting tachycardia and fixed heart rate (HR) to development of "silent" myocardial infarction. Clinical correlates or risk markers for CAN are age, DM duration, glycemic control, hypertension, and dyslipidemia (DLP), development of other microvascular complications...
January 15, 2018: World Journal of Diabetes
Holly Emms, George Farah, Brian Shine, Christopher Boot, Barry Toole, Martin McFadden, Leo Lam, Zong-Quan Ou, Gerald A Woollard, Hima Madhavaram, Campbell Kyle, Ashley Grossman
Plasma metanephrines have become the biochemical test of choice for suspected phaeochromocytoma and paragangliomas (PPGL) in many institutions. We encountered two separate cases of significantly elevated plasma metanephrines in patients taking midodrine, a sympathomimetic drug used in the treatment of severe postural hypotension, in the absence of a diagnosis of PPGL. Upon stopping midodrine treatment, plasma metanephrine levels returned to normal in both patients. To explore the hypothesis that midodrine or its metabolite desglymidodrine might interfere with the metanephrines assay, we tested the interaction of midodrine with metanephrine assays from two different centres...
January 1, 2018: Annals of Clinical Biochemistry
Marcalee Alexander, Lesley Marson
STUDY DESIGN: narrative review OBJECTIVES: To determine the percentage of persons with SCI able to achieve orgasm and ejaculation, the associations between ejaculation and orgasm and the subjective and autonomic findings during these events, and the potential benefits with regards to spasticity. SETTING: Two American medical centers METHODS: Data bases were searched for the terms orgasm and SCI and ejaculation and SCI. Search criteria were human studies published in English from 1990 to 12/2/2016...
December 20, 2017: Spinal Cord
Isabelle Colle, Pierre-François Laterre
Hepatorenal syndrome (HRS) is a unique form of acute kidney injury seen in cirrhotic patients and associated with significant mortality and morbidity. Despite its impact, diagnosis and treatment of HRS remains challenging and this review aims to assess and compare the available vasoconstrictors used as first-line treatment for HRS. Areas covered: A literature review was undertaken on the use of vasoconstrictors in HRS, using PubMed/Medline database searches of: 'hepatorenal syndrome', 'HRS' and 'vasoconstrictor'...
February 2018: Expert Review of Gastroenterology & Hepatology
Georgios N Kalambokis, Gerasimos Baltayiannis, Dimitrios Christodoulou, Leonidas Christou
No abstract text is available yet for this article.
December 2017: European Journal of Gastroenterology & Hepatology
Sabine Eschlböck, Gregor Wenning, Alessandra Fanciulli
Neurogenic orthostatic hypotension, postprandial hypotension and exercise-induced hypotension are common features of cardiovascular autonomic failure. Despite the serious impact on patient's quality of life, evidence-based guidelines for non-pharmacological and pharmacological management are lacking at present. Here, we provide a systematic review of the literature on therapeutic options for neurogenic orthostatic hypotension and related symptoms with evidence-based recommendations according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE)...
December 2017: Journal of Neural Transmission
Carlos G Grijalva, Italo Biaggioni, Marie R Griffin, Cyndya A Shibao
BACKGROUND: Orthostatic hypotension causes ≈80 000 hospitalizations per year in the United States. Treatments for orthostatic hypotension include fludrocortisone, a mineralocorticoid analog that promotes sodium reabsorption; and midodrine, an α-1 adrenergic agonist that is a direct vasoconstrictor. Although both medications are used to treat orthostatic hypotension, few studies have compared their relative safety. METHODS AND RESULTS: We compared incidence rates of hospitalizations for all causes, and for congestive heart failure between users of fludrocortisone and users of midodrine in a retrospective cohort study of Tennessee Medicaid adult enrollees (1995-2009)...
October 12, 2017: Journal of the American Heart Association
Arjun Nanda, Rewanth Reddy, Humaira Safraz, Salameh Habeeb, Ashwani K Singal
BACKGROUND: Hepatorenal syndrome (HRS) is a serious complication of advanced chronic liver disease. Different pharmacological therapies have variable efficacy. We performed a systematic review and meta-analysis to compare the efficacy of various drugs in the treatment of HRS. STUDY: Randomized controlled trials comparing active drug with placebo or comparing 2 different drugs were included in this analysis. Primary study outcome was reversal of HRS. Secondary outcomes were HRS relapse and patient survival...
October 4, 2017: Journal of Clinical Gastroenterology
Philip L Mar, Satish R Raj
PURPOSE OF REVIEW: Orthostatic hypotension is a phenomenon commonly encountered in a cardiologist's clinical practice that has significant diagnostic and prognostic value for a cardiologist. Given the mounting evidence associating cardiovascular morbidity and mortality with orthostatic hypotension, cardiologists will play an increasing role in treating and managing patients with orthostatic hypotension. RECENT FINDINGS: The American College of Cardiology, American Heart Association, and Heart Rhythm Society recently published consensus guidelines on the diagnosis, treatment, and management of syncope and their instigators, including orthostatic hypotension...
January 2018: Current Opinion in Cardiology
Mads Israelsen, Aleksander Krag, Andrew S Allegretti, Manol Jovani, Alison H Goldin, Rachel W Winter, Lise Lotte Gluud
BACKGROUND: Hepatorenal syndrome is defined as severe renal failure occurring in people with cirrhosis and ascites. Systematic reviews of randomised clinical trials found that, compared with placebo, terlipressin may reduce mortality and improve renal function in people with hepatorenal syndrome, but we need current evidence from systematic reviews on the benefits and harms of terlipressin versus other vasoactive drugs. OBJECTIVES: To evaluate the beneficial and harmful effects of terlipressin versus other vasoactive drugs for people with hepatorenal syndrome...
September 27, 2017: Cochrane Database of Systematic Reviews
Kannan Sridharan, Gowri Sivaramakrishnan
BACKGROUND: Hepatorenal syndrome (HRS) is a common complication among patients with cirrhosis, primarily attributable to vasodilation of renal vessels. Vasoactive agents are commonly used to treat HRS. The present network meta-analysis compares the vasoactive agents used in HRS. METHODS: We searched electronic databases for appropriate randomized controlled clinical trials in patients with HRS, comparing active interventions with either placebo or standard of care...
January 2018: Journal of General Internal Medicine
Kelli Patrick, Tina Martin
The question of this review is: what is the effectiveness of droxidopa compared to midodrine on standing blood pressure and orthostatic intolerance symptoms in adults with neurogenic orthostatic hypotension?
September 2017: JBI Database of Systematic Reviews and Implementation Reports
Lawrence B Gutman, Ben J Wilson
Midodrine is an oral, peripherally acting alpha-adrenergic agonist. After gaining Food and Drug Administration (FDA) approval in 1996 for orthostatic hypotension, its use has evolved to target vasoplegic conditions such as intradialytic hypotension in the end-stage renal disease population, refractory ascites in cirrhotic patients to support diuresis, and in hepatorenal syndrome. Upon oral ingestion, the drug undergoes enzymatic hydrolysis to an active metabolite, desglymidodrine. Its use has been well tolerated at 2...
August 23, 2017: Journal of Population Therapeutics and Clinical Pharmacology
Amy C Arnold, Satish R Raj
The maintenance of blood pressure upon the assumption of upright posture depends on rapid cardiovascular adaptations driven primarily by the autonomic nervous system. Failure of these compensatory mechanisms can result in orthostatic hypotension (OH), defined as sustained reduction in systolic blood pressure > 20 mm Hg or diastolic blood pressure > 10 mm Hg within 3 minutes of standing or > 60° head-up tilt. OH is a common finding, particularly in elderly populations, associated with cardiovascular and cerebrovascular morbidity and mortality...
December 2017: Canadian Journal of Cardiology
Jung-Ick Byun, Jangsup Moon, Do-Yong Kim, Hyerim Shin, Jun-Sang Sunwoo, Jung-Ah Lim, Tae-Joon Kim, Woo-Jin Lee, Han Sang Lee, Jin-Sun Jun, Kyung-Il Park, Soon-Tae Lee, Keun-Hwa Jung, Ki-Young Jung, Sang Kun Lee, Kon Chu
OBJECTIVE: To evaluate the long-term (for up to 3 months) efficacy and safety of single or combined therapy with midodrine and pyridostigmine for neurogenic orthostatic hypotension (OH). METHODS: This was a randomized, open-label clinical trial. In total, 87 patients with symptomatic neurogenic OH were enrolled and randomized to receive 1 of 3 treatments: midodrine only, pyridostigmine only, or midodrine + pyridostigmine. The patients were followed up at 1 and 3 months after treatment...
September 5, 2017: Neurology
Tara I Chang
Intradialytic hypotension (IDH) is a common complication of hemodialysis and is associated with numerous adverse outcomes including cardiovascular events, inadequate dialysis, loss of vascular access, and death. It is estimated that approximately 20%-30% of all dialysis sessions are affected by IDH. In seeking ways to reduce the occurrence of IDH, dialysis providers often turn to pharmacological approaches: withholding antihypertensive medications prior to hemodialysis or administering vasoconstrictor medications...
November 2017: Seminars in Dialysis
Adrien Joseph, Ruben Wanono, Martin Flamant, Emmanuelle Vidal-Petiot
Orthostatic hypotension, defined by a drop in blood pressure of at least 20mmHg for systolic blood pressure and at least 10mmHg for diastolic blood pressure within 3minutes of standing up, is a frequent finding, particularly in elderly patients. It is associated with a significant increase in morbidity and mortality. Although it is often multifactorial, the first favoring factor is medications. Other etiologies are divided in neurogenic orthostatic hypotension, characterized by autonomic failure due to central or peripheral nervous system disorders, and non-neurogenic orthostatic hypotension, mainly favoured by hypovolemia...
April 2017: Néphrologie & Thérapeutique
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