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PubMedDate not supplied

Cardiovascular and pupillary autonomic nervous dysfunction in patients with rheumatoid arthritis - a cross-sectional and longitudinal study.

OBJECTIVES: Patients with inflammatory diseases often demonstrate autonomic nervous dysfunction. This study was initiated to investigate cardiovascular (CAD) or pupillary autonomic dysfunction (PAD) in patients with rheumatoid arthritis (RA). METHODS: Between 1997 and 1998, 33 RA patients were examined for characteristics, and parameters of CAD and PAD. In a longitudinal part of this study, thirty patients have been re-evaluated 8.3 +/- 0.1 yr later (response rate = 91%). RESULTS: A total of 18 patients (60%) demonstrated either CAD or PAD. The prevalence of CAD was 6/30 (20%) and the prevalence of PAD was 15/30 (50%). Of all cardiovascular tests, the Ewing test demonstrated the worst results (13/30 patients were below the 5th percentile). Similar as in other diseases, several RA patients demonstrated autonomic nervous hyperreflexia with values above the 95 th percentile (relative variation coefficient: 7/30; respiratory sinus arrhythmia measure: 12/30; Valsalva measure: 1/30; Ewing measure: 0/30; latency time of pupillary light reflex: 5/30; maximal pupillary area: 0/30). During the 8-year observation period, 4/30 RA patients died. Non-survivors as compared to survivors had increased heart rate variation in the respiratory arrhythmia test (p= 0.038, hyperreflexia) but largely decreased heart rate variation in the Ewing test (p= 0.009, hyporeflexia). Non-survivors as compared to survivors demonstrated more frequent pupillary autonomic dysfunction (100% vs. 42%, p= 0.035). CONCLUSION: This study demonstrates that CAD and PAD were frequent in patients with RA. Patients with a poor test result in the Ewing test and PAD might have an increased risk of death. This study in RA patients demonstrates similar results as in patients with diabetes mellitus.

Adult↗
PubMed1991

[Visual evoked potential and relative afferent pupillary defect in patients with unilateral optic neuritis].

The relationships between relative afferent pupillary defect (RAPD) and visual evoked potential (VEP), visual acuity or visual field in 14 patients with idiopathic unilateral optic neuritis, were investigated during the period of recovery from an acute episode. Grading of RAPD into four steps mainly based upon an escape phenomenon in a swinging flashlight test, was used to determine the degree of RAPD. The degree of RAPD significantly correlated with a reduction in VEP amplitude, visual acuity and loss of central visual field, while it did not correlate with delay in VEP latency. These results suggest that RAPD is mainly related to the integrity of central vision, and that grading of RAPD, as well as a comparison of VEP amplitude between the affected and contralateral eyes, is useful for an objective evaluation of visual functions of the affected eyes in patients with unilateral optic neuritis.

Adolescent↗
PubMed1991

Optic tract syndrome with relative afferent pupillary defect.

Two cases are reported of optic tract lesions with complete homonymous hemianopia, characteristic optic atrophy and retinal nerve fiber bundle defect, and relative afferent pupillary defect (RAPD). RAPD was 0.6 log units in both cases. Infrared pupillography revealed pupillary light response of the ipsilateral side to be 1.2 or 1.3 times higher than that of the contralateral side. We confirmed that the detection of RAPD is helpful in differentiating optic tract lesions from suprageniculate lesions in cases of complete homonymous hemianopia.

Fundus Oculi↗
PubMed1991

[A follow-up study of pupillary dynamics in patients with ocular hypertension and primary open angle glaucoma].

The authors previously reported light reflex abnormalities and adrenergic supersensitivity to topical epinephrine (DPE; dipivalyl epinephrine) of the pupils in patients with ocular hypertension (OH) and those with primary open angle glaucoma (POAG). In this investigation, we attempted to reconfirm pupillary light reflex abnormalities we reported previously, and to investigate the relationship between the normotensive effect of 0.1% DPE and the pupillary light reflex abnormalities in OHs and POAGs. A total of 11 OHs and 11 POAGs under good oculotensive control with neither mydriatics nor miotics were examined. They were measured by an open-loop photically stimulated infrared videopupilogram, and were neurologically diagnosed by comparing the simulated patterns of the light reflex made by topical autonomic agents. When we considered the progress of the stage of POAG, both OHs and POAGs showed satisfactory reproducibility of pupillary light reflex abnormalities. Other cases in which light reflexes altered, showed worsening of the visual field deficit, which was prominent when OHs developed into POAG. OHs with significant reduction of intraocular pressure (IOP) after topical administration of 0.1% DPE showed various kinds of abnormal pupillary light reflexes. On the contrary, cases with little reduction of IOP after 0.1% DPE instillation showed normal pupillary light reflexes in OHs and afferent pupillary defect on POAGs.

Adult↗
PubMed1991

Total pupillary capture with a foldable silicone intraocular lens.

We report a case of total pupillary capture on the 1st postoperative day in a patient who had undergone phacoemulsification and placement of a silicone foldable posterior chamber intraocular lens. Anterior displacement of the lens optic resulted in 2.25 diopters of induced myopia. Dilation of the pupil corrected the lens capture and reversed the induced myopia, yielding a refraction of plano. Higher rates of pupillary capture have been associated with sulcus fixation and nonangulated flexible (polypropylene) haptics. Contraction of the capsular bag on the flexible polypropylene haptics of this silicone lens is thought to force the optic anteriorly, increasing the probability of lens capture by the iris.

Adult↗
PubMed1991

Anterior capsule adherence to iris leading to pseudophakic pupillary block.

We present a rare case of anterior capsule adherence to the iris following extracapsular cataract extraction with posterior chamber intraocular lens implantation and leading to pseudophakic pupillary block. There were no synechiae at the pupillary margins associated with the capsule/iris adherence, but aqueous was entrapped behind the iris and intraocular pressure rose. Laser iridotomy was temporarily beneficial, but it had to be repeated several times.

Aged↗
PubMed1991

[Pupillography in unilateral retinal detachment].

The reaction of the pupil for light was checked in 25 patients with an unilateral retinal detachment. The sore eye and the fellow-eye were examined separately. The deterioration of the reaction was dependent on the area of detachment and on the condition of the macula.

Adolescent↗
PubMed1991

[A case of acute polyradiculoneuritis associated with autonomic involvement of the pupils].

Acute polyradiculoneuritis relapses rarely, and autonomic nerve involvement is less frequent than motor cranial nerve involvement. An 11-year-old boy exhibited acute relapsing polyradiculoneuritis associated with two types of autonomic dysfunction of pupils 6 months after the onset of the disease. Parasympathetic dysfunction of pupils with ocular palsies preceded neuropathy of limbs at the onset. Thereafter, sympathetic dysfunction of pupils without ocular palsies was revealed by pupillography at the 2nd attack of limb palsies.

Autonomic Nervous System Diseases↗
PubMed1990

Pupillary dynamics in patients with primary open angle glaucoma.

In patients with primary open angle glaucoma (POAG), the evaluation of neurological status is clinically important. A detailed analysis of the pupillary dynamics under the control of the autonomic nervous system was performed in patients with POAG. Pupil size and pupillary light reflex were measured by an infrared videopupillogram in 13 patients with POAG (from 25 to 67 years old) with good oculotensive controls without applications mydriatics nor miotics revealed. Pupillary light reflexes were analyzed by comparing the simulated patterns obtained after the studies with topical autonomic agents. Effects of topical adrenergics (dipivalyl epinephrine: DPE 0.025%) on the pupil were also investigated. Three types of autonomic abnormalities (cholinergic, adrenergic and physiological mydriatic reflex patterns) of the light reflex were detected in 11 eyes of 6 patients, and a normal pattern was found in only 2 eyes of one patient. Afferent pupillary defect (APD) pattern was detected in 13 eyes. Although APD was generally described as a reduced visual input, the degree of APD was not related to the stage of the visual field defect in POAG.

Adult↗
PubMed1990

[A retrospective multicenter study of severe aneurysms].

From these 196 aneurysms of high grade at the admission 61% die, but 16% have a good recovery. The high mortality of early surgical operations must be moderate by the seriousness of rebleeding in attempting a further surgery.

Cerebral Hemorrhage↗
PubMed1990

Posttraumatic yellow maculopathy.

Blunt trauma to the eye may cause several types of macular abnormalities, including commotio retinae, macular hole, intraretinal and subretinal hemorrhage, and choroidal rupture. In most cases the diagnosis is readily apparent; however, the complex appearance of simultaneous hemorrhage, pigmentary change, and ruptured tissue planes may be confusing. The authors present two cases of blunt trauma in young males that resulted in a subretinal hemorrhage that became yellow and was initially misinterpreted as a vitelliform lesion. A history of trauma should be sought in any patient with the clinical appearance of a yellow subretinal lesion.

Adult↗
PubMed1989

[Galand disk implant and pupillary block].

We have implanted 530 Galand's disc lens in the last 15 months. Stability and self-centering of implant were good when peroperative vitreous pressure was normal and in any case when wound was closed. Pupillary blocks, specific complications of this lens were rare (less than 1%); they can be prevented occurred by simple and adequate protocols.

Adolescent↗
PubMed1989

Acute opioid physical dependence in postaddict humans: naloxone dose effects after brief morphine exposure.

Antagonist-precipitated withdrawal after acute opioid administration (acute physical dependence) is an interesting phenomenon in that the opioid abstinence syndrome is generally thought to develop only after prolonged exposure to opioid agonists. The purpose of this study was to examine further this phenomenon in humans by characterizing the antagonist dose-response function. The effects of i.m. naloxone (0, 0.1, 0.3, 1, 3, 10 and 30 mg/70 kg) were assessed 6 hr after single i.m. injections of morphine (18 or 30 mg/70 kg) in six subjects with a history of chronic opiate use. Naloxone reversed residual morphine effects, including miosis and respiratory depression. The degree of reversal was dose-related to 10 mg/70 kg of naloxone with no further increases at the highest naloxone dose. Simultaneously, observer ratings of withdrawal signs and subjective reports of withdrawal symptoms were increased in an orderly dose-related manner to 30 mg/70 kg of naloxone. Reversal of residual morphine effects and onset of precipitated withdrawal were evident by 5-min postnaloxone; peak effects occurred within 15 min. This study confirmed the occurrence of antagonist-precipitated withdrawal after brief opioid exposure in humans, demonstrated the rapid onset of withdrawal effects and characterized the naloxone dose-response function.

Adult↗