[DIAGNOSIS, TREATMENT AND PREVENTION OF VIBRATION SICKNESS].
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Cerebrovascular Disorders↗
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Motion sickness-like syndrome among tank simulator drivers.
A military tank driving simulator has recently been introduced as a training aid for tank drivers in the Israel Defense Forces. Reports of nausea and vomiting among the first users of the simulator launched our investigation of the possible existence of a motion sickness-like syndrome among simulator drivers. Although the 59 subjects drove the simulator without any report of vomiting, other motion sickness-like symptoms were frequently reported. A comparison of symptoms reported after simulator and real tank driving show that dizziness, nausea, disorientation and hypersalivation were more frequently reported by simulator drivers and were of greater intensity. However, sweating and drowsiness were more prevalent among real tank drivers. The objective effect of driving the simulator was evaluated by instability and performance tests that were conducted before, during and after driving the simulator. A greater decrement in test results was observed among subjects reporting higher frequency of motion sickness-like symptoms.
Adult↗
Responses of sympathetic outflow to skin during caloric stimulation in humans.
We previously showed that caloric vestibular stimulation elicits increases in sympathetic outflow to muscle (MSNA) in humans. The present study was conducted to determine the effect of this stimulation on sympathetic outflow to skin (SSNA). The SSNA in the tibial and peroneal nerves and nystagmus was recorded in nine subjects when the external meatus was irrigated with 50 ml of cold (10 degrees C) or warm (44 degrees C) water. During nystagmus, the SSNA in tibial and peroneal nerves decreased to 50 +/- 4% (with baseline value set as 100%) and 61 +/- 4%, respectively. The degree of SSNA suppression in both nerves was proportional to the maximum slow-phase velocity of nystagmus. After nystagmus, the SSNA increased to 166 +/- 7 and 168 +/- 6%, respectively, and the degree of motion sickness symptoms was correlated with this SSNA increase. These results suggest that the SSNA response differs from the MSNA response during caloric vestibular stimulation and that the SSNA response elicited in the initial period of caloric vestibular stimulation is different from that observed during the period of motion sickness symptoms.
Adult↗
Susceptibility to reflex vestibular disturbances and motion sickness as a function of mental states of alertness and sleep.
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Adult↗
Pulmonary gas exchange and urinary electrolyte excretion during saturation-excursion diving to pressure equivalent to 800 and 1000 feet of seawater.
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Adult↗
[Progressive study of EEG and evoked potentials in Lafora disease].
OBJECTIVE: The aim of this paper is to present a simultaneous evolutionary study of EEG and multimodality evoked potentials (EP) in a patient with progressive myoclonus epilepsy (PME) with Lafora bodies in the sweat glands from the axillary skin biopsy. CLINICAL CASE: The EEG showed progressive deterioration characteristic of this entity. Epileptiform activity was modified in distribution and morphology throughout the sickness. Abnormalities appeared in serial sleep records, although with acceptable preservation of its structure. The EEG findings supported the diagnosis of PME prior to clinical suspicion. A gradual increase in the somatosensory EP amplitude was observed, leading to an early giant configuration. However, an asymmetry persisted between both hemispheres, with the right cortex being more affected. Recording simultaneously on C3 and C4 after unilateral stimulation, a high-amplitude ipsilateral response was found in both hemispheres, suggesting hyperexcitability of cortical and subcortical neural structures. CONCLUSION: These somatosensory EP findings--progressive deterioration, interhemispheric asymmetry and ipsilateral giant response--have not, to our knowledge, been previously described.
Adolescent↗
A randomised, placebo-controlled study comparing two formulations of dimenhydrinate with respect to efficacy in motion sickness and sedation.
It is known that sedation by H1 antihistaminic drugs can be reduced or avoided if slow release formulations are used for their administration, probably because of a slower increase of the drug concentration in plasma and brain. The aim of this study was to compare two different formulations of dimenhydrinate (CAS 523-87-5), a single fast release tablet with three chewing gums (divided dose principle), with regard to their efficacy in a motion sickness model and their detrimental effect on vigilance and central nervous system (CNS) performance. Caloric stimulation of the eardrum (air at 44 degrees C) was used to induce the symptoms of motion sickness in 24 symptomatic volunteers in a three-way cross-over design comparing three chewing gums (Superpep forte, chewed for 30 min each) containing 20 mg dimenthydrinate each with a 50 mg dimenhydrinate tablet and placebo. During caloric stimulation the following parameters were measured in order to compare efficacy: Quantitative analysis of sodium excretion by sweat (main target parameter), subjective well being (vertigo) by visual analogue scales (VAS) and frequency of binocular nystagmus by computer nystagmography. Unwanted effects on vigilance and CNS performance were measured by means of the N1-P2 peak to peak amplitudes of auditory evoked potentials (AEPs) as an objective, quantitative parameter of vigilance and the latency to correct responses and the number of correct responses (complex choice reaction task) in the oculodynamic test (ODT) as parameters of complex choice reaction ability. As a main efficacy result sodium excretion by sweat was markedly reduced by the chewing gums and by the tablet. The differences to placebo were highly significant (chewing gums vs. placebo p < 0.0001, tablet vs. placebo p < 0.0001). There was no relevant and no significant difference between both medications (p = 0.308). The secondary efficacy parameters, frequency of binocular nystagm and the VAS vertigo were markedly reduced by both medications in comparison to placebo, i.e. both medications were markedly effective. In both cases, however, this result failed statistical significance. The unwanted depressing effects on vigilance and CNS performance of the chewing gums were less pronounced than that of tablets. The N1/P2 peak-to-peak amplitudes of the AEPs were significantly reduced by both the chewing gums and the tablets. The effect of the tablets was, however, larger than that of the chewing gums. This highly significant (tablet vs. chewing gums, p = 0.0003) difference shows that the tablet had a larger depressing effect on vigilance (greater sedation). In line with this result, the number of correct responses in the ODT was markedly and significantly reduced by the tablet (p = 0.0027) but not significantly by the chewing gums (p = 0.8140). The difference between the tablet and the chewing gums was highly significant (p = 0.0052). The complex choice reaction time was markedly and nearly significantly (p = 0.0558) prolonged by the tablet whereas the chewing gums produced only a very small and insignificant prolongation. That the objective measurements of vigilance and CNS performance showed significantly larger detrimental effects of the tablet than of the chewing gums is probably a consequence of a faster increase of the dimenhydrinate concentration in the CNS after administration of the tablet in comparison to the divided dose principle of the chewing gums.
Antiemetics↗
Quality-of-life during DDD and dual sensor VVIR pacing.
Twenty-one patients (mean age 68 +/- 8 years) with dual-sensor (QT+activity) DDDR pacemaker were randomly assigned to a crossover, double-blind study in order to evaluate their quality-of-life scores. All pacemakers were implanted for sick sinus syndrome (8 patients) or complete heart block (13 patients). The pacemakers were randomly programmed to VVIR or DDD pacing modes for 2-week periods and then the pacing mode was switched for another 2-week period. At the end of each period, the quality-of-life was evaluated by a questionnaire with regard to cardiovascular symptoms, physical activity, psychosocial and emotional functioning, and self-perceived health. Nineteen questions were scored 0-5 points each. Significant improvement in the mean total quality-of-life score (20.5 +/- 14.9 vs 34.8 +/- 17.4) as well as in dyspnea on effort, dizzy spells, palpitation, sweating, fatigue, lethargy, emotional functioning, and self-perceived health was observed during DDD compared to VVIR pacing. No question was scored in favor of VVIR pacing mode. Significant improvements during DDD pacing was demonstrated in all subgroups of patients (sick sinus syndrome, chronotropically competent and incompetent patients, and patients with high degree AV block). Eighteen patients preferred DDD pacing mode, while only one preferred VVIR pacing mode. Two remaining patients expressed no preference. The results suggest that DDD pacing offers better quality-of-life than dual sensor VVIR pacing in all subgroups of patients commonly indicated for pacemaker implantation.
Aged↗
Early autonomic dysreflexia.
INTRODUCTION: During the stage of spinal shock the conventional view is that autonomic activity is abolished. Here, evidence is presented that autonomic activity is still present. PATIENTS: Four patients with acute cord transactions are presented: one new case and three from the literature. DEFINITIONS: The definitions of spinal shock and autonomic dysreflexia are given. METHODS: All four cases showed acute autonomic dysreflexia between 7 and 31 days after acute cord transection at a stage when the tendon reflexes were abolished. RESULTS: Two cases showed a severe rise in blood pressure; the two earlier cases, before blood pressure was routinely recorded, profuse sweating. In two cases autonomic dysreflexia was obtained when the bladder was overdistended with 1000 ml and 1600 ml. In the other two cases it occurred in response to traumatic catheterisation. This was found when supramaximal stimuli were applied. It has not been recorded routinely as, with modern management, the bladder does not get overdistended or traumatised. DISCUSSION: Other evidence, the blood pressure, and urethral tone is presented to show that sympathetic reflex activity of the cord is not abolished during spinal shock. CLINICAL SIGNIFICANCE: The clinical importance of this is that autonomic dysreflexia can be seen at an early stage and it should be considered in the differential diagnosis of a sick patient immediately after spinal injury.
Autonomic Dysreflexia↗
Comparison of the effects of a selective muscarinic receptor antagonist and hyoscine (scopolamine) on motion sickness, skin conductance and heart rate.
AIMS: Hyoscine (scopolamine), which is effective in the prophylaxis of motion sickness, shows similar binding affinities to all of the five known muscarinic receptor sub-types. The effectiveness of hyoscine was compared with zamifenacin (UK-76654), which binds selectively to the muscarinic M3 and m5 receptors. METHODS: Eighteen subjects received hyoscine hydrobromide 0.6 mg, zamifenacin 20 mg, or placebo (double-blind cross-over design). Sessions were 1 week apart and the drug (oral) was given 90 min prior to a motion sickness test. Motion sickness was elicited by cross-coupled stimulation on a turntable. The rotational velocity was incremented by 2 degrees s-1 every 30 s, and a sequence (seq) of eight head movements of 45 degrees was completed every 30 s. Motion tolerance was assessed as the number of sequences of head movement required to achieve moderate nausea. Pulse rate was recorded before and at 1 and 2 h after drug administration. Skin conductance activity in the frequency band 0.005-0.48 Hz, an index of sweat gland activity, was measured using Ag/AgCl electrodes on the palmar surfaces of fingers and across the forehead. RESULTS: Both zamifenacin and hyoscine produced an increase in tolerance to the motion challenge (P < 0.01) with no significant difference between the two drugs (5.0 +/- 1.6 vs 5.7 +/- 1.6 seqs. respectively, mean +/- s.e.mean). Compared with placebo or zamifenacin, pulse rate fell following hyoscine administration (9 beats min-1, P < 0.01). Skin conductance was reduced following hyoscine compared with zamifenacin or placebo (P < 0.001). CONCLUSIONS: These results suggest that compounds with selective M3 and/or m5 antagonism possess activity against motion sickness. Antagonism at these receptors may be the basis of the anti-motion sickness action of hyoscine.
Adult↗
Lidocaine pharmacokinetics during hyperbaric hyperoxia in humans.
METHODS: The disposition of drugs may be influenced by hyperbaric conditions, in particular by changes of liver perfusion. The effect of hyperbaric hyperoxia on the pharmacokinetics of lidocaine, a drug eliminated in the liver with a perfusion-limited clearance, was investigated in human volunteers in a crossover trial. METHODS: A single dose lidocaine i.v. bolus (0.69 or 0.75 mg x kg(-1)) was administered to two volunteers under normobaric conditions (NB: 1 bar or 0.1 MPa, air) and under hyperbaric/hyperoxic conditions (HBO: 2.5 bar or 0.25 MPa, alternating 100% O2-breathing for 20 min and air breathing for 5 min). Blood samples were serially collected for 5 h (NB) or 75 min (HBO), and lidocaine concentration in serum was measured by immunoassay. Data were analyzed assuming linear kinetics and an open two-compartment model. RESULTS: At 1 bar or 0.1 MPa, lidocaine injection caused only slight dizziness and buzzing in the ear. Heart rate and blood pressure were not influenced. Under HBO, lidocaine injection caused marked dizziness and buzzing in the ears, sweating, tremor and coordination-disturbances, even though maximal lidocaine concentrations (0.63 mg x L(-1) and 0.70 mg x L(-1)) were far below therapeutic serum concentrations (1.5-5.0 mg x L(-1)). Pharmacokinetic parameters of lidocaine were similar to those published earlier (T1/2beta: 110+/-16 min; CI: 12.6+/-2.9 ml x min(-1) x kg(-1); Vss: 1.73+/-0.18 L x kg(-1)). There was no indication for effects of HBO on the disposition of lidocaine (p > 0.05). CONCLUSION: The pharmacokinetics of lidocaine do not seem to be influenced in a clinically relevant way in humans by a single HBO-exposure under usual therapeutic conditions. Side effects of lidocaine at 2.5 bar or 0.25 MPa may be caused by pharmacodynamic interactions between lidocaine and hyperbaric/hyperoxic conditions.
Adult↗
Skin potential reflex corresponding to transient motion discomfort.
The qualitative and quantitative correspondence between the degree of motion discomfort and the skin potential reflex (SPR) was examined in four subjects. Head movement was provided three times during body rotation at three different angular velocities (Coriolis stimulus) to induce motion discomfort, and at rest as a control. SPRs were caused in the arousal sweat area by head movement. The wave form, latency, time-to-peak, and amplitude of SPR were analyzed. The amplitude of the depolarizing response (P response) of SPR increased proportionally to the angular velocity of body rotation and decreased in the course of repetitive Coriolis stimulation. It was revealed that the amplitude of P response of SPR in the arousal sweat area corresponds to the degree of transient motion discomfort.
Adult↗
Thoracoscopic sympathicotomy for hyperhidrosis--surgical technique, complications and side effects.
Thoracic sympathectomy is a very effective treatment of palmar hyperhidrosis. The described endoscopic technique has given good primary results in 99% of patients. After another session with this type of "minimal invasive surgery" 100% of the hands were satisfactorily dry. The hospital stay is just one post-operative day and the sick-leave is about a week. The drawbacks are minimal. Pain is tolerable and only eight patients needed a post-operative Bülau-drainage because of pneumothorax or bleeding. About 50% of patients experience a compensatory increased sweating of the trunk, but this is related to a warm environment and regulation of body temperature and seems to decrease with time. This technique makes it possible to treat all those suffering from palmar hyperhidrosis which can be a substantial, but underestimated handicap. To meet this kind of patient after a successful operation is extremely satisfying even for the surgeon. The post-operative wet and cold hand has immediately post-operatively become warm and dry.
Adolescent↗
NMR studies of body fluids.
High resolution, high frequency, in vitro, proton NMR spectra of various body fluids, including urine, sweat, aqueous humour, amniotic fluid, seminal plasma, cerebrospinal fluid, synovial fluid and blood plasma are described and discussed. Applications include the detection of metabolic disorders, investigations of the biochemical basis of drug and xenobiotic metabolism, organ damage, and diagnoses for sick babies. The determination of metabolite concentrations is straightforward for fluids with a low protein content such as urine. In fluids with a high protein content such as blood plasma, it is possible to detect not only small molecules but also mobile regions of macromolecules, and to demonstrate the interaction of anions such as lactate with proteins. It seems likely that these methods will soon become established in modern pathology laboratories.
Body Fluids↗
Environmental hazards and health.
Significant health hazards to the traveller arise from altitude, heat, cold and water. Altitude-induced illness encompasses the benign but common syndrome of acute mountain sickness and also life-threatening pulmonary and cerebral oedema; inadequate acclimatization and rapid ascent are important precipitating factors in each case. Prophylaxis and up to date choices of treatment are discussed in the context of underlying physiological changes. Heat illnesses include exhaustion and heat stroke; they result from increased core temperature and/or physiological responses including peripheral vasodilation and sweating. Preventive measures include acclimatization, ample water without added salt, and matching dress and exercise to the environment. Cold environments pose risk of hypothermia and local cold injury which include frostbite and non-freezing cold injury; as frostnip is only diagnosed after treatment, it is a category of limited usefulness. Prevention of each disorder requires correct clothing and equipment and good training. Other hazards include immersion, and flying too soon after diving.
Altitude Sickness↗
[Hospitalisation of patients with pulmonary tuberculosis (author's transl)].
The clinical symptoms of patients with pulmonary tuberculosis, transferred from other hospitals to the Pulmological Center of Vienna, were analyzed. Among 373 transferred patients there were 113 cases (30.3%) of pulmonary tuberculosis. A significant change in the range of symptoms between the examined period (1976/77) and former periods could be shown. By a more accurate regard of the symptoms a primary admission to pulmonary center should be possible in about half the cases and the interval between the primary symptoms and the initial treatment would be shortened in this way. It seems, that tuberculosis of the lung as common sickness only has historical significance, as acute illness of single patient it is still important.
Asthma↗
[Botulinophilia. The new life style venenophilia].
BACKGROUND AND OBJECTIVE: Botulinum toxin is effective in the treatment of hyperhidrosis and the demand for therapy is increasing. Simultaneously we have observed an increase in patients with body dysmorphic disorders who also want botulinum toxin therapy. This botulinophilie is a new variant of venenophilie. We investigated the prevalence of this new diagnosis in our patient population. PATIENTS/METHODS: In the first quarter of 2000 we studied the biopsychosocial features of 13 patients with hyperhidrosis. RESULTS: In 23.1% of our cases we were able to confirm a botulinophilie with body dysmorphic disorder and a normal Minor sweat test. CONCLUSIONS: Botulinophilie is not an indication for botulinum toxin therapy but for psychotherapy.
Adult↗
Green-tobacco sickness. An illness of tobacco harvesters.
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Abdomen↗