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Diagnostic value of the tilt-table test for the assessment of syncope in children and adolescents

Wu,Tan Chen; Hachul,Denise; Scanavacca,Mauricio; Sosa,Eduardo
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2001 EN
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66.67%
OBJECTIVE - To assess the diagnostic value, the characteristics, and feasibility of tilt-table testing in children and adolescents. METHODS - From August 1991 to June 1997, we retrospectively assessed 94 patients under the age of 18 years who had a history of recurring syncope and presyncope of unknown origin and who were referred for tilt-table testing. These patients were divided into 2 groups: group I (children) - 36 patients with ages ranging from 3 to 12 (mean of 9.19±2.31) years; group II (adolescents) - 58 patients with ages ranging from 13 to 18 (mean of 16.05±1.40) years. We compared the positivity rate, the type of hemodynamic response, and the time period required for the test to become positive in the 2 groups. RESULTS - The positivity rates were 41.6 % and 50% for groups I and II, respectively. The pattern of positive hemodynamic response that predominated in both groups was the mixed response. The mean time period required for the test to become positive was shorter in group I (11.0±7.23 min) than in group II (18.44±7.83 min). No patient experienced technical difficulty or complications. CONCLUSION - No difference was observed in regard to feasibility, positivity rate, and pattern of positive response for the tilt-table test in children and adolescents. Pediatric patients had earlier positive responses.

Does a Role Exist for Tilting-Guided Therapy in the Management of Neurocardiogenic Syncope?

Hachul,Denise; Scanavacca,Mauricio; Sosa,Eduardo
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2002 EN
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46.29%
PURPOSE: Upright tilt-table testing (UTT) is an useful method for identifying patients with neurocardiogenic syncope, but its role in the evaluation of therapeutic efficacy is controversial. The aim of this study was to determine the correlation between negative UTT after therapy introduction (acute efficacy) and symptom recurrence during follow-up (chronic efficacy). METHODS: We studied 56 severely symptomatic patients (age 27±19 years) with recurrent (7±12 episodes) neurocardiogenic syncope (positive UTT). Once empirical pharmacological therapy was initiated, all patients underwent another UTT (therapeutic evaluation test - TET). Therapy was not modified after TET results. The probability of symptom recurrence was analyzed with the Kaplan-Meier method and compared by log-rank test in patients with negative and positive TET. RESULTS: Negative UTT after therapy was related to a significantly lower probability of recurrence during follow-up (4.9 versus 52.4% in 12 months, P<0.0001). CONCLUSION: A good correlation exists between acute and long-term efficacy of pharmacological therapy for neurocardiogenic syncope, so that serial UTT may be considered a good method for identifying an effective therapeutic strategy.

Comparison between tilt-table testing results performed during different periods of the day

Wu,Tan Chen; Hachul,Denise; Scanavacca,Mauricio; Sosa,Eduardo
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2002 EN
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66.48%
OBJECTIVE: To evaluate the influences of circadian variations on tilt-table testing (TTT) results by comparing the positivity rate of the test performed during the morning with that of the test performed in the afternoon and to evaluate the reproducibility of the results in different periods of the day. METHODS: One hundred twenty-three patients with recurrent unexplained syncope or near-syncope referred for TTT were randomized into 2 groups. In group I, 68 patients, TTT was performed first in the afternoon and then in the morning. In group II, 55 patients, the test was performed first in the morning and then in the afternoon. RESULTS: The TTT protocol was the prolonged passive test, without drug sensitization. Twenty-nine (23.5%) patients had a positive result in at least one of the periods. The positivity rate for each period was similar: 20 (16.2%) patients in the afternoon and 19 (15.4%) in the morning (p=1.000). Total reproducibility (positive/positive and negative/negative) was observed in 49 (89%) patients in group I and in 55 (81%) in group II. Reproducibility of the results was obtained in 94 (90.4%) patients with first negative tests but in 10 (34%) patients with first positive tests. CONCLUSION: TTT could be performed during any period of the day...

The fainting patient: value of the head-upright tilt-table test in adult patients with orthostatic intolerance

Lamarre-Cliche, Maxime; Cusson, Jean
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 06/02/2001 EN
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46.29%
THE HEAD-UPRIGHT TILT-TABLE (HUT) TEST IS USED primarily for the investigation of orthostatic symptoms. Although this test is frequently the gold standard for the evaluation of neurocardiogenic syncope, dysautonomia and postural orthostatic tachycardia syndrome, there is a debate over its diagnostic value and method. The authors review the physiologic basis of the HUT test, the method, patterns of response, indications and contraindications, and diagnostic validity. Despite its limitations, the HUT test is useful in patients with a variety of clinical manifestations induced by orthostatism. It is most useful in documenting objective measures of orthostatic hypertension that cannot be obtained in a clinical setting.

Serious response during tilt-table test in elderly and its prophylactic management

Han, Yang; Li, Xiao-xia; Jiang, Wei-li; Wang, Zhao-di; Chen, Tian-zhi
Fonte: Zhejiang University Press Publicador: Zhejiang University Press
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.47%
Objective: To evaluate the serious response during tilt-table test (TTT) and its prophylactic management. Method: Seventy-six elderly patients were tested at a tilt angle of 70 degrees for a maximum of 45 min and then subjected to isoproterenol-provocative tilt testing. ECG and blood pressure were monitored during the test and patients were kept at normal saline condition through a peripheral intravenous duct. Results: Fifty-one of 76 patients were defined as positive including 23 having serious response; 6 of the 23 patients had arteriosclerosis involving internal carotid arteries and 7 cases had bradycardia, two of which were associated with II°-I A-V block and the others with chronic atrial fibrillation. The serious response consisted of cardiac arrest for more than 5 s (6 cases), or serious bradycardia for more than 1 min (7 cases) or serious hypotension for more than 1 min (10 cases). Those with serious response were managed by returning to supine position, thus driving up legs and intravenous atropine, CPR (2 cases with cardiac arrest) and needing oxygen supplementation (11 cases). Only 2 hypotension patients recovered gradually by 10 min after emergency management, while others recovered rapidly with no complications. Conclusion: Although non-invasive...

Comparing two different protocols for tilt table testing: sublingual glyceryl trinitrate versus isoprenaline infusion

Oraii, S; Maleki, M; Minooii, M; Kafaii, P
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/1999 EN
Relevância na Pesquisa
46.51%
OBJECTIVE—To assess the diagnostic value and safety of sublingual glyceryl trinitrate tilt testing compared with isoprenaline infusion in patients with unexplained syncope.
DESIGN—Glyceryl trinitrate and isoprenaline tilt tests were performed in two successive days on a random basis in cases and controls.
SETTING—Outpatient cases with syncope referred to Shahid Rajaii Heart Hospital.
SUBJECTS—65 consecutive patients with unexplained syncope after thorough work up; 20 healthy volunteers.
RESULTS—Positive responses were observed in 20 patients during the passive phase. Of the other 45 patients, positive responses occurred in 25 cases during the glyceryl trinitrate phase and in 26 cases during the isoprenaline phase. In the control group, positive responses during the passive, glyceryl trinitrate, and isoprenaline phases occurred in one, one, and two cases, respectively. The sensitivity and specificity of the protocols were 55% and 94.7%, respectively, for glyceryl trinitrate v 58% and 89.4% for isoprenaline. Owing to discordant responses in 75% of the cases, the sequential use of the tests (if one was negative) would increase the sensitivity to 84% while decreasing the specificity slightly (to 84%). Side effects were less frequent with glyceryl trinitrate.
CONCLUSIONS—Sublingual glyceryl trinitrate tilt testing is an effective and safe alternative to the isoprenaline infusion test and can be used as a complementary test.


Keywords: syncope; tilt table test; isoprenaline; glyceryl trinitrate

Usefulness of Tilt Testing in Children with Syncope: A Survey of Pediatric Electrophysiologists

Batra, Anjan S; Balaji, Seshadri
Fonte: Indian Heart Rhythm Society Publicador: Indian Heart Rhythm Society
Tipo: Artigo de Revista Científica
Publicado em 01/11/2008 EN
Relevância na Pesquisa
36.76%
The role of tilt table testing as a diagnostic modality in children with unexplained syncope is unclear. We sent a questionnaire to members of the Pediatric and Congenital Electrophysiology Society to assess the current practice pattern. Of the 186 members, 97 (52%) replied. Twenty four percent of the pediatric electrophysiologists have completely stopped doing tilt table tests and of those performing the tests, a majority (76%) did < 10 tests/yr (median=3 tilts/yr, range 0-100/yr). Of those performing the test, 95% rarely or never accepted direct referrals from the general practioners and 62% felt that the frequency of tilt table tests being performed had decreased since they had started practicing. The median usefulness of the test was rated at 3 (range 1-9) on a scale of 1 to 10 with 10 being very useful. A majority (68%) felt they rarely or never altered treatment based on the results of the tilt test. Wide variability was noted in the test protocol including the tilt angle, tilt duration, use of pharmacologic agents and the duration of fasting prior to the test. We therefore conclude that there is significant lack of standardization in tilt table tests performed in children. Tilt table testing, as perceived by pediatric electrophysiologists...

A somatostatin analog improves tilt table tolerance by decreasing splanchnic vascular conductance

Jarvis, S. S.; Florian, J. P.; Curren, M. J.; Pawelczyk, J. A.
Fonte: American Physiological Society Publicador: American Physiological Society
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.78%
Splanchnic hemodynamics and tilt table tolerance were assessed after an infusion of placebo or octreotide acetate, a somatostatin analog whose vascular effects are largely confined to the splanchnic circulation. We hypothesized that reductions in splanchnic blood flow (SpBF) and splanchnic vascular conductance (SpVC) would be related to improvements in tilt table tolerance. In randomized, double-blind, crossover trials, hemodynamic variables were collected in 14 women and 16 men during baseline, 70° head-up tilt (HUT), and recovery. A repeated-measures analysis of variance was used to compare changes from baseline with respect to sex and condition. HUT elicited an increase in heart rate and decreases in mean arterial pressure, cardiac index, stroke index, and systemic vascular conductance. Additionally, SpVC and non-SpVC were lower during HUT. Octreotide reduced SpBF and SpVC and increased systemic vascular conductance and non-SpVC. Changes in SpBF and SpVC between supine and HUT were smaller in women (P < 0.05). Tilt table tolerance was increased after administration of octreotide [median tilt time: 15.7 vs. 37.0 min (P < 0.05) and 21.8 vs. 45.0 min (P < 0.05) for women and men, respectively]. A significant relationship existed between change (Δ) in SpBF (placebo-octreotide) and Δtilt time in women (Δtilt time = 2.5–0.0083 ΔSpBF...

Tilt Table Practice Improved Ventilation in a Patient with Prolonged Artificial Ventilation Support in Intensive Care Unit

Hashim, Asiah M; Joseph, Leonard H; Embong, Juleida; Kasim, Zalila; Mohan, Vikram
Fonte: Shiraz University of Medical Sciences Publicador: Shiraz University of Medical Sciences
Tipo: Artigo de Revista Científica
Publicado em /03/2012 EN
Relevância na Pesquisa
46.59%
Patients who are on prolonged ventilator support in critical care unit present wide variety of complications, which range from reduction in oxygen uptake to various musculoskeletal impairments. Early mobilization and rehabilitation are encouraged to manage these complications effectively. Use of tilt table to motivate early mobilization in the intensive care unit for ventilator practices is not a usual practice. However, this new technique has attracted involvements of clinicians and therapists for its therapeutic benefits to the patient. Herein we describe a case of a seventy eight-year-old male patient who suffered Motor car accident, and was on ventilator support in intensive care unit for more than one month. He underwent treatment using a tilt table protocol with other routine treatment, which benefited him based on clinical as well as physiological variables. For practitioners in intensive care units, this report may offer perceptivity into the alternate practice of early mobilization using tilt table, and for investigators it may promote interest for further studies.

Early Poststroke Rehabilitation Using a Robotic Tilt-Table Stepper and Functional Electrical Stimulation

Kuznetsov, Alexey N.; Rybalko, Natalia V.; Daminov, Vadim D.; Luft, Andreas R.
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.8%
Background. Stroke frequently leaves survivors with hemiparesis. To prevent persistent deficits, rehabilitation may be more effective if started early. Early training is often limited because of orthostatic reactions. Tilt-table stepping robots and functional electrical stimulation (FES) may prevent these reactions. Objective. This controlled convenience sample study compares safety and feasibility of robotic tilt-table training plus FES (ROBO-FES) and robotic tilt-table training (ROBO) against tilt-table training alone (control). A preliminary assessment of efficacy is performed. Methods. Hemiparetic ischemic stroke survivors (age 58.3 ± 1.2 years, 4.6 ± 1.2 days after stroke) were assigned to 30 days of ROBO-FES (n = 38), ROBO (n = 35), or control (n = 31) in addition to conventional physical therapy. Impedance cardiography and transcranial doppler sonography were performed before, during, and after training. Hemiparesis was assessed using the British Medical Research Council (MRC) strength scale. Results. No serious adverse events occurred; 8 patients in the tilt-table group prematurely quit the study because of orthostatic reactions. Blood pressure and CBFV dipped <10% during robot training. In 52% of controls mean arterial pressure decreased by ≥20%. ROBO-FES increased leg strength by 1.97 ± 0.88 points...

Nonlinear and Conventional Biosignal Analyses Applied to Tilt Table Test for Evaluating Autonomic Nervous System and Autoregulation

Tseng, Li; Tang, Sung-Chun; Chang, Chun-Yuan; Lin, Yi-Ching; Abbod, Maysam F.; Shieh, Jiann-Shing
Fonte: Bentham Open Publicador: Bentham Open
Tipo: Artigo de Revista Científica
Publicado em 6 /09/2013 EN
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46.29%
Tilt table test (TTT) is a standard examination for patients with suspected autonomic nervous system (ANS) dysfunction or uncertain causes of syncope. Currently, the analytical method based on blood pressure (BP) or heart rate (HR) changes during the TTT is linear but normal physiological modulations of BP and HR are thought to be predominately nonlinear. Therefore, this study consists of two parts: the first part is analyzing the HR during TTT which is compared to three methods to distinguish normal controls and subjects with ANS dysfunction. The first method is power spectrum density (PSD), while the second method is detrended fluctuation analysis (DFA), and the third method is multiscale entropy (MSE) to calculate the complexity of system. The second part of the study is to analyze BP and cerebral blood flow velocity (CBFV) changes during TTT. Two measures were used to compare the results, namely correlation coefficient analysis (nMxa) and MSE. The first part of this study has concluded that the ratio of the low frequency power to total power of PSD, and MSE methods are better than DFA to distinguish the difference between normal controls and patients groups. While in the second part, the nMxa of the three stages moving average window is better than the nMxa with all three stages together. Furthermore the analysis of BP data using MSE is better than CBFV data.

Sub–Lingual Spray Versus Pearl of TNG as A Provocative Agent for Tilt Table Test

Karbasi-Afshar, Reza; Saburi, Amin; Shahmari, Ayat; Khosravi, Arezoo
Fonte: JCDR Research and Publications (P) Limited Publicador: JCDR Research and Publications (P) Limited
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.29%
Objective: The aim of this study was to determine the false positive ratio of Tilt Table Test (TTT) result by using TNG spray (Sub–lingual; SL) as compared to TNG pearl in patients referred to military service.

Comparison of Peak Cardiopulmonary Performance Parameters on a Robotics-Assisted Tilt Table, a Cycle and a Treadmill

Saengsuwan, Jittima; Nef, Tobias; Laubacher, Marco; Hunt, Kenneth J.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Publicado em 10/04/2015 EN
Relevância na Pesquisa
46.48%
Robotics-assisted tilt table (RATT) technology provides body support, cyclical stepping movement and physiological loading. This technology can potentially be used to facilitate the estimation of peak cardiopulmonary performance parameters in patients who have neurological or other problems that may preclude testing on a treadmill or cycle ergometer. The aim of the study was to compare the magnitude of peak cardiopulmonary performance parameters including peak oxygen uptake (VO2peak) and peak heart rate (HRpeak) obtained from a robotics-assisted tilt table (RATT), a cycle ergometer and a treadmill. The strength of correlations between the three devices, test-retest reliability and repeatability were also assessed. Eighteen healthy subjects performed six maximal exercise tests, with two tests on each of the three exercise modalities. Data from the second tests were used for the comparative and correlation analyses. For nine subjects, test-retest reliability and repeatability of VO2peak and HRpeak were assessed. Absolute VO2peak from the RATT, the cycle ergometer and the treadmill was (mean (SD)) 2.2 (0.56), 2.8 (0.80) and 3.2 (0.87) L/min, respectively (p < 0.001). HRpeak from the RATT, the cycle ergometer and the treadmill was 168 (9.5)...

Vasodepressor syncope and the diagnostic accuracy of the head-up tilt test with sublingual glyceryl trinitrate

Athanasos, P.A.; Sydenham, D.; Latte, G.; Faunt, J.; Tonkin, A.
Fonte: Dr Dietrich Steinkopf Verlag Publicador: Dr Dietrich Steinkopf Verlag
Tipo: Artigo de Revista Científica
Publicado em //2003 EN
Relevância na Pesquisa
46.25%
Thirteen syncopal subjects and thirteen asymptomatic controls were examined by head-up tilt (HUT) with and without sublingual GTN.Adding GTN to HUT improved the sensitivity of the test (8 % to 46%) but decreased; Peter Athanasos, Daniel Sydenham, Jenny Latte, Jeffrey Faunt and Anne Tonkin

Reaktionsmuster und Komplikationen bei Kipptischuntersuchungen Analyse von 1.892 Untersuchungen an 1.097 Patienten; Clinical response and occurrence of complications during head-up tilt-table-testing – evaluation of 1.892 tests of 1.097 patients

Glag, Silvia
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
DE_DE
Relevância na Pesquisa
66.73%
Hintergrund: Der Kipptischtest gilt als Goldstandard in der Diagnostik der neurokardiogenen Synkope, die bei fehlender kardialer Grunderkrankung die häufigste Synkopenform darstellt. Bei dieser Untersuchung wird eine vasovagale Reaktion mit Präsynkope oder Synkope provoziert. Vereinzelt wurden Extremvarianten mit Asystolie, höhergradigem AV-Block (>= II°) oder konvulsiver Komponente beobachtet. Ziel dieser Studie war die Analyse der Art, Häufigkeit, Alters- und Geschlechtsspezifität der Reaktionsmuster sowie die Untersuchung möglicher Komplikationen mit der Frage, ob der Kipptischtest eine sichere Untersuchungsmethode ist. Material und Methode: Von 11/94 bis 12/04 wurden 1892 Kipptischuntersuchungen, z.T. unter Isoprenalinzufuhr (n=430) oder vorangegangener Applikation von Nitroglycerin (n=30), an 1097 Patienten im Klinikum am Steinenberg in Reutlingen durchgeführt und retrospektiv ausgewertet. Ergebnisse: Bei 272 Patienten (24,8%) wurde im ersten Test nach durchschnittlich 16 min eine Synkope oder Präsynkope induziert. Von den erstmalig mit Isoprenalin (n=360) stimulierten Patienten reagierten 59 Patienten (16,4%) positiv, bei den mittels Nitroglycerin (n=16) provozierten Patienten waren es 8 (50%). Ein signifikant erhöhtes Auftreten von Ereignissen wurde bei jüngeren Patienten im unstimulierten (p<0...

Investigation of Softening Instability Phenomena Under Simulated Infinite Slope Conditions in Centrifuge Tilting Table Tests

Wolinsky, Eric
Fonte: Quens University Publicador: Quens University
Tipo: Tese de Doutorado
EN; EN
Relevância na Pesquisa
56.53%
Element test results reported in the literature under both triaxial and plane strain conditions indicate that loose saturated granular specimens can experience softening instability at stress ratios lower than what might otherwise be expected given the critical state friction angle of the soil. The region of potential softening instability in stress-space is often explained using the framework of the instability line. This phenomenon is particularly relevant to shallow slopes of 1 to 2 m depth. However, the practical realities of sample preparation for triaxial testing make performing tests below 20 to 30 kPa of confining stress exceptionally difficult. In this thesis, the development of a centrifuge tilt-table test device is described which aims to test the behaviour of loose granular slopes under stress paths of increasing slope inclination or increasing pore water pressure. A system of instrumentation including pore pressure transducers, inclinometers, displacement transducers, and high-resolution cameras was designed to monitor the behaviour of the slope model. The development of a system to provide a controlled groundwater level within the slope model proved to be particularly challenging. The results of two competing design concepts are presented for the water boundary condition and discussed. The centrifuge tilt-table is used to compare the physical response of a slope to the behaviour predicted by the infinite slope and softening instability models using scale model centrifuge testing. If softening instability is a rigorous concept...

Pulsed Wave Doppler Ultrasound Is Useful to Assess Vasomotor Response in Patients with Multiple System Atrophy and Well Correlated with Tilt Table Study

Chang, Ke-Vin; Chen, Wen-Shiang; Wu, Ruey-Meei; Chen, Ssu-Yuan; Shen, Hsiu-Yu; Lan, Ching; Wang, Yen-Ho
Fonte: The Scientific World Journal Publicador: The Scientific World Journal
Tipo: Artigo de Revista Científica
Publicado em 03/01/2012 EN
Relevância na Pesquisa
46.69%
The study aim was to assess sympathetic vasomotor response (SVR) by using pulsed wave Doppler (PWD) ultrasound in patients with multiple system atrophy (MSA) and correlate with the tilt table study. We recruited 18 male patients and 10 healthy men as controls. The SVR of the radial artery was evaluated by PWD, using inspiratory cough as a provocative maneuver. The response to head-up tilt was studied by a tilt table with simultaneous heart rate and blood pressure recording. The hemodynamic variables were compared between groups, and were examined by correlation analysis. Regarding SVR, MSA patients exhibited a prolonged latency and less heart rate acceleration following inspiratory cough. Compared with the tilt table test, the elevation of heart rate upon SVR was positively correlated to the increase of heart rate after head-up tilt. The correlation analysis indicated that the magnitude of blood pressure drop from supine to upright was positively associated with the SVR latency but negatively correlated with the heart rate changes upon SVR. The present study demonstrated that blunted heart rate response might explain MSA's vulnerability to postural challenge. PWD may be used to predict cardiovascular response to orthostatic stress upon head-up tilt in MSA patients.

Autonomic Testing in Functional Gastrointestinal Disorders: Implications of Reproducible Gastrointestinal Complaints during Tilt Table Testing

Safder, Shaista; Chelimsky, Thomas C.; O'Riordan, Mary Ann; Chelimsky, Gisela
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.48%
Background: The pathophysiology of functional abdominal pain (FAP) is unknown. The upright portion of a tilt table test triggers typical symptoms in certain children. Aim: To compare the pathophysiology and treatment response of children with FAP whose gastrointestinal symptoms (GI) were replicated (RGI) by tilt table testing (TTT) to those in whom TTT did not have this effect (NRGI). Methods: An IRB-approved retrospective review of the autonomic laboratory database identified all children tested for GI complaints. We compared results of TTT, Valsalva maneuver, deep breathing and the axon reflex sweat test. Overall treatment response and that specific to fludrocortisone was ranked from 1 to 5, with 1 “much worse,” 3 “neutral,” and 5 “much better.” Results: 32/76 identified children had reproducible symptoms on TTT (RGI) and 44 did not (NRGI). The RGI group was younger, had a shorter duration of symptoms, more postural tachycardia syndrome (POTS) and benefited more from fludrocortisone (73% in RGI vs. 25% in NRGI). Conclusion: Dividing patients with FAP according to the effect of TTT on their symptoms appears to delineate 2 fundamentally different groups, with potentially different pathophysiologies and treatment responses. A prospective study is needed.

Tilt Table Therapies for Patients with Severe Disorders of Consciousness: A Randomized, Controlled Trial

Krewer, Carmen; Luther, Marianne; Koenig, Eberhard; Müller, Friedemann
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Publicado em 01/12/2015 EN
Relevância na Pesquisa
46.83%
One major aim of the neurological rehabilitation of patients with severe disorders of consciousness (DOC) is to enhance patients’ arousal and ability to communicate. Mobilization into a standing position by means of a tilt table has been shown to improve their arousal and awareness. However, due to the frequent occurrence of syncopes on a tilt table, it is easier to accomplish verticalization using a tilt table with an integrated stepping device. The objective of this randomized controlled clinical trial was to evaluate the effectiveness of a tilt table therapy with or without an integrated stepping device on the level of consciousness. A total of 50 participants in vegetative or minimally conscious states 4 weeks to 6 month after injury were treated with verticalization during this randomized controlled trial. Interventions involved ten 1-hour sessions of the specific treatment over a 3-week period. Blinded assessors made measurements before and after the intervention period, as well as after a 3-week follow-up period. The coma recovery scale-revised (CRS-R) showed an improvement by a median of 2 points for the group receiving tilt table with integrated stepping (Erigo). The rate of recovery of the group receiving the conventional tilt table therapy significantly increased by 5 points during treatment and by an additional 2 points during the 3-week follow-up period. Changes in spasticity did not significantly differ between the two intervention groups. Compared to the conventional tilt table...

Prueba de basculación (Tilt Table Testing): Comparación de dos protocolos: isoproterenol versus nitroglicerina

Jiménez-Cohl,Pedro; Vega,Sebastián; Cáceres,Rocío; Gómez,Constanza; Rojas,Nadia
Fonte: Sociedad Médica de Santiago Publicador: Sociedad Médica de Santiago
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2015 ES
Relevância na Pesquisa
36.39%
Background: There is debate about the advantages of different protocols usefulness of tilt test for the diagnosis of vasovagal collapse. Aim: To compare the sensitivity, specificity, adverse reactions, complications and time requirements of two different Tilt test protocols. Material and Methods: A Tilt test using isoproterenol in progressive doses (2 μg for 10 min and 5 μg for 5 min posteriorly was performed in 159 patients aged 9 to 84 years (59 males). Another Tilt test using sublingual nitroglycerine in doses of 0.3 mg was performed in 201 patients aged 8 to 87 years (62 males). Also, 20 healthy volunteers were tested. Results: The positivity rates of the tests using isoproterenol and nitroglycerin were 75.5 and 77.6% respectively (NS). The figures for sensitivity were 98.4 and 99.3% (NS). The figures for specificity were 93.2 and 98.4% (NS). The test using isoproterenol requires 15 more minutes. As adverse reactions, 38% of participants experienced palpitations with isoproterenol and 22% experienced headache with nitroglycerin. Conclusions: The Tilt test with nitroglycerin is shorter, simpler, painless, with less personnel involved and has the same diagnostic accuracy than the test with isoproterenol.