Backgrounds: Cardioversion for atrial fibrillation(AF) is the most effective treatment for the restoration of sinus rhythm(SR). Recently, an elevated level of hs-CRP has been shown to be associated with AF burden, sug...Backgrounds: Cardioversion for atrial fibrillation(AF) is the most effective treatment for the restoration of sinus rhythm(SR). Recently, an elevated level of hs-CRP has been shown to be associated with AF burden, suggesting that inflammation increases the propensity for persistence of AF. We examined whether the level of high-sensitivity C-reactive protein(hs-CRP) was predictive of the outcome of cardioversion for AF. Methods and results: One hundred and six patients with a history of symptomatic AF lasting ≥ 1 day(age 63± 14 years, mean± S.D.) underwent cardioversion. Echocardiography and hs-CRP assay were performed immediately prior to cardioversion. SR was restored in 84 patients(79% ). By using selected cutoff values,multiple discriminant analysis revealed significant associations between successful cardioversion and a shorter duration of AF(AF duration≤ 36 days, odds ratio(OR), 0.98; 95% confidence interval(CI), 0.97-0.99), smaller left atrial diameter(left atrial diameter ≤ 40 mm, OR 0.82, 95% CI 0.71-0.94), better-preserved left ventricular ejection fraction(left ventricular ejection fraction ≥ 60% , OR 0.92, 95% CI 0.86-0.99), and lower hs-CRP level(hs-CRP ≤ 0.12 mg/dL, OR 0.33, 95% CI 0.21-0.51). During a follow-up period of 140± 144 days, AF recurred in 64 patients(76% ). By using a cutoff value of hs-CRP ≥ 0.06 mg/dL, Cox proportional-hazards regression model found that only hs-CRP level was an independent predictor of AF recurrence(OR 5.30, 95% CI 2.46-11.5) after adjustment for coexisting cardiovascular risks. When patients were divided by the hs-CRP level of 0.06 mg/dL, percentage of maintenance of SR below and above the cutoff was 53% and 4% , respectively(log-rank test, p< 0.0001). Conclusions: hs-CRP level determined prior to cardioversion represents an independent predictor of both successful cardioversion for AF and the maintenance of SR after conversion.展开更多
Background: The micturition reflex is under the tonic influence of suprapontin e structures including the anteromedial frontal cortex, basal ganglia, and hypot halamus. However, there have been few reports about the r...Background: The micturition reflex is under the tonic influence of suprapontin e structures including the anteromedial frontal cortex, basal ganglia, and hypot halamus. However, there have been few reports about the role of the hypothalamus on the lower urinary tract (LUT) function in humans. Objective: To investigate LUT function in patients with pituitary adenomas.Methods: Urodynamic studies wer e carried out in three patients with LUT symptoms who had pituitary adenomas ext ending upwards to the hypothalamus. Results: All three male patients(age 28 to 6 2 years) developed LUT symptoms (urinary urgency and frequency (3); urinary inco ntinence (3); voiding difficulty and retention (2)) along with weight loss, psyc hiatric symptoms,unsteady gait, and/or visual disturbances. One had the syndrome of inappropriate secretion of antidiuretic hormone,but none had diabetes insipi dus. Two had resection of the tumour and subsequent radiation therapy, but LUT d ysfunction persisted. The third patient had partial resection of the tumour to a meliorate hydrocephalus. Urodynamic studies showed detrusorover activity during the storage phase in all patients; during the voiding phase there was underactiv e detrusor in two andnon-relaxing sphincter in one. Conclusions: Hypothalamic l esions can cause severe LUT dysfunction in both the storage and voiding phases o f micturition. This may reflect the crucial role of the hypothalamus in regulati ng micturition in humans.展开更多
Abstract:Objectives: Lumbar spondylosis (LS) is a common spinal degenerative disorder which causes various types of lower urinary tract dysfunction (LUTD). However, it is not certain whether LS may cause urinary reten...Abstract:Objectives: Lumbar spondylosis (LS) is a common spinal degenerative disorder which causes various types of lower urinary tract dysfunction (LUTD). However, it is not certain whether LS may cause urinary retention in elderly women. Methods: In a period covering the past 3 years, we retrospectively reviewed: a) urodynamic case records of women with urinary retention (post-void residuals, PVR > 100 ml), b) the records of women with LUTD due to LS (cauda equina syndrome and spinal canal narrowing by MRI), and c) uro-neurological features of women who belonged to both a) and b). Results: a) One-hundred women with a mean age of 58 years had urinary retention. The most common underlying disease was multiple system atrophy [19], followed by multiple sclerosis [13] and cervical/thoracic tumours [8]. LS was the fourth most common [5], with the highest age (71 years) of all diseases. b) Nineteen women with LUTD had LS (12, canal narrowing of 50-70%; 7 > 70 %), with a mean PVR volume of 60 ml. A fourth [5] of them had urinary retention, with severe spinal canal narrowing (all 5 > 70%). c) Thus, 5 women belonged to both a) and b). In 4 of these women, LUTD followed or occurred together with typical cauda equina syndrome symptoms such as sciatica and saddle anesthesia. However, one elderly woman presented with painless urinary retention, and absent ankle reflexes were the sole neurological abnormality. The urodynamic abnormalities underlying urinary retention included an underactive detrusor in all 5, bladder sensory impairment in 3, an unrelaxing sphincter in 2, a low compliance detrusor in one, neurogenic sphincter motor unit potentials in 2 of 4 studied, and cholinergic supersensitivity of the detrusor in one of 3 studied. Surgical decompression ameliorated urinary retention in 1 of 2 women who had surgery. Conclusions: In our series, only 5 percent of the women with urinary retention had LS, but LS poses a potential risk for retention, particularly in elderly women with severe spinal canal narrowing. Preganglionic somato-autonomic dysfunctions underlie this condition. It may appear as the sole initial complaint in cases in which no other obvious neurological abnormalities are found.展开更多
文摘Backgrounds: Cardioversion for atrial fibrillation(AF) is the most effective treatment for the restoration of sinus rhythm(SR). Recently, an elevated level of hs-CRP has been shown to be associated with AF burden, suggesting that inflammation increases the propensity for persistence of AF. We examined whether the level of high-sensitivity C-reactive protein(hs-CRP) was predictive of the outcome of cardioversion for AF. Methods and results: One hundred and six patients with a history of symptomatic AF lasting ≥ 1 day(age 63± 14 years, mean± S.D.) underwent cardioversion. Echocardiography and hs-CRP assay were performed immediately prior to cardioversion. SR was restored in 84 patients(79% ). By using selected cutoff values,multiple discriminant analysis revealed significant associations between successful cardioversion and a shorter duration of AF(AF duration≤ 36 days, odds ratio(OR), 0.98; 95% confidence interval(CI), 0.97-0.99), smaller left atrial diameter(left atrial diameter ≤ 40 mm, OR 0.82, 95% CI 0.71-0.94), better-preserved left ventricular ejection fraction(left ventricular ejection fraction ≥ 60% , OR 0.92, 95% CI 0.86-0.99), and lower hs-CRP level(hs-CRP ≤ 0.12 mg/dL, OR 0.33, 95% CI 0.21-0.51). During a follow-up period of 140± 144 days, AF recurred in 64 patients(76% ). By using a cutoff value of hs-CRP ≥ 0.06 mg/dL, Cox proportional-hazards regression model found that only hs-CRP level was an independent predictor of AF recurrence(OR 5.30, 95% CI 2.46-11.5) after adjustment for coexisting cardiovascular risks. When patients were divided by the hs-CRP level of 0.06 mg/dL, percentage of maintenance of SR below and above the cutoff was 53% and 4% , respectively(log-rank test, p< 0.0001). Conclusions: hs-CRP level determined prior to cardioversion represents an independent predictor of both successful cardioversion for AF and the maintenance of SR after conversion.
文摘Background: The micturition reflex is under the tonic influence of suprapontin e structures including the anteromedial frontal cortex, basal ganglia, and hypot halamus. However, there have been few reports about the role of the hypothalamus on the lower urinary tract (LUT) function in humans. Objective: To investigate LUT function in patients with pituitary adenomas.Methods: Urodynamic studies wer e carried out in three patients with LUT symptoms who had pituitary adenomas ext ending upwards to the hypothalamus. Results: All three male patients(age 28 to 6 2 years) developed LUT symptoms (urinary urgency and frequency (3); urinary inco ntinence (3); voiding difficulty and retention (2)) along with weight loss, psyc hiatric symptoms,unsteady gait, and/or visual disturbances. One had the syndrome of inappropriate secretion of antidiuretic hormone,but none had diabetes insipi dus. Two had resection of the tumour and subsequent radiation therapy, but LUT d ysfunction persisted. The third patient had partial resection of the tumour to a meliorate hydrocephalus. Urodynamic studies showed detrusorover activity during the storage phase in all patients; during the voiding phase there was underactiv e detrusor in two andnon-relaxing sphincter in one. Conclusions: Hypothalamic l esions can cause severe LUT dysfunction in both the storage and voiding phases o f micturition. This may reflect the crucial role of the hypothalamus in regulati ng micturition in humans.
文摘Abstract:Objectives: Lumbar spondylosis (LS) is a common spinal degenerative disorder which causes various types of lower urinary tract dysfunction (LUTD). However, it is not certain whether LS may cause urinary retention in elderly women. Methods: In a period covering the past 3 years, we retrospectively reviewed: a) urodynamic case records of women with urinary retention (post-void residuals, PVR > 100 ml), b) the records of women with LUTD due to LS (cauda equina syndrome and spinal canal narrowing by MRI), and c) uro-neurological features of women who belonged to both a) and b). Results: a) One-hundred women with a mean age of 58 years had urinary retention. The most common underlying disease was multiple system atrophy [19], followed by multiple sclerosis [13] and cervical/thoracic tumours [8]. LS was the fourth most common [5], with the highest age (71 years) of all diseases. b) Nineteen women with LUTD had LS (12, canal narrowing of 50-70%; 7 > 70 %), with a mean PVR volume of 60 ml. A fourth [5] of them had urinary retention, with severe spinal canal narrowing (all 5 > 70%). c) Thus, 5 women belonged to both a) and b). In 4 of these women, LUTD followed or occurred together with typical cauda equina syndrome symptoms such as sciatica and saddle anesthesia. However, one elderly woman presented with painless urinary retention, and absent ankle reflexes were the sole neurological abnormality. The urodynamic abnormalities underlying urinary retention included an underactive detrusor in all 5, bladder sensory impairment in 3, an unrelaxing sphincter in 2, a low compliance detrusor in one, neurogenic sphincter motor unit potentials in 2 of 4 studied, and cholinergic supersensitivity of the detrusor in one of 3 studied. Surgical decompression ameliorated urinary retention in 1 of 2 women who had surgery. Conclusions: In our series, only 5 percent of the women with urinary retention had LS, but LS poses a potential risk for retention, particularly in elderly women with severe spinal canal narrowing. Preganglionic somato-autonomic dysfunctions underlie this condition. It may appear as the sole initial complaint in cases in which no other obvious neurological abnormalities are found.
