Autonomic nervous system laboratories: a European survey

Lahrmann, Heinz; Magnifico, Fabiola; Haensch, Carl-Albrecht; Cortelli, Pietro

doi:10.1111/j.1468-1331.2004.01114.x

Cited by 21 publications

(17 citation statements)

References 10 publications

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“…The problem is that there is no definite agreement on how to study the ANS. A recent European survey revealed the difficulty in interpreting results from so many different diagnostic tests, in which 520 BRAVO AND WOLFF different equipment and different laboratory methods are used (42). The upright tilt table test was not regularly done, since it is not practical and does not provide a definite diagnosis (it has a sensitivity of 75% and specificity of 88-93%) (43).…”

Section: Discussionmentioning

confidence: 99%

Clinical study of hereditary disorders of connective tissues in a Chilean population

Bravo¹,

Wolff²

2006

Arthritis & Rheumatism

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Objective. To demonstrate the high frequency and lack of diagnosis of joint hypermobility syndrome (JHS) and the seriousness of vascular Ehlers-Danlos syndrome (VEDS).Methods. Two hundred forty-nine Chilean patients with hereditary disorders of the connective tissues (CTDs) and 64 control subjects were evaluated for the diagnoses of JHS and VEDS using the validated Brighton criteria, as compared with the traditional Beighton score. In addition, the presence of blue sclera was determined, with the degree of intensity graded as mild, moderate, or marked.Results. The frequency of hereditary CTDs was 35%, with diagnoses of JHS in 92.4% of subjects, VEDS in 7.2%, and osteogenesis imperfecta in 0.4%. The Beighton score proved to be insufficient for the diagnosis of JHS (35% of subjects had a negative score), whereas the Brighton criteria yielded positive findings (a diagnosis of JHS) in 39% of control subjects. Blue sclera was frequent, being identified in 97% of JHS patients and 94% of VEDS patients. Moderate osteopenia/osteoporosis was observed in 50% of patients with VEDS and 26% of those with JHS. Dysautonomia, dyslipidemia, and scoliosis were more frequent in VEDS patients than in JHS patients. The typical JHS facial appearance and the "hand holding the head sign" were identified. Raynaud's phenomenon was extremely rare in JHS patients (2%). Ruptured uterus and cerebral aneurysm occurred in 12% and 6% of VEDS patients, respectively. Spontaneous pneumothorax was more frequent in VEDS patients (11%) than in JHS patients (0.9%).Conclusion. JHS is very frequent but usually undiagnosed. The Beighton score is an insufficient method for JHS diagnosis. We recommend that physicians learn to recognize the typical facial features of JHS and be able to identify blue sclera. We also propose that validated hypermobility criteria be routinely used. Further research is needed to determine why the prevalence of JHS is so high in Chile.Hippocrates first described hypermobile joints 2,400 years ago, but the condition of joint hypermobility was not described as a medical problem until 1967, by Kirk et al (1). Although many people have hypermobile joints, the general public as well as many physicians consider hypermobility to be a curiosity rather than a potentially serious medical problem (2,3). The prevalence of hypermobility is difficult to evaluate because it varies with age, sex, and ethnic background and because multiple criteria are being used. It is more frequent in female subjects and children, is more frequent in Asian than in black populations, and is more frequent in both Asian and black populations than in whites. It is generally agreed that it exists in ϳ10% of individuals in Western populations (4) and up to 25% in Iraqis (5). Most cases of joint hypermobility are pauciarticular rather than generalized, which makes the diagnosis more difficult. Because of this, many people are unaware of having lax joints (6). In spite of this laxity in the joints, most people with hypermobility do not experience joint or musculoskelet...

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Section: Discussionmentioning

confidence: 99%

Clinical study of hereditary disorders of connective tissues in a Chilean population

Bravo¹,

Wolff²

2006

Arthritis & Rheumatism

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“…This condition reflects the wide variation in cardiovascular test methods, equipment, staff and educational profile still present in autonomic laboratories, as highlighted in Europe [13]. Among the controversial aspects of orthostatic testing, there is the cut-off value for the diagnostic fall in systolic BP, i.e.…”

Section: Introductionmentioning

confidence: 98%

Reappraisal of the diagnostic role of orthostatic hypotension in diabetes

et al. 2009

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“…One area of knowledge translation for this important health issue is the dissemination of the latest evidence from systematic reviews to clinicians and the development of standards for bone health management based on the outcomes of well-designed studies. As with surveys of practice patterns in other clinical areas, 23 results are often an important starting point for discussion, and an international collaboration of health professionals would be ideal to discuss these important issues.…”

Section: Discussionmentioning

confidence: 99%

Physiatrists' opinions and practice patterns for bone health after SCI

2008

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Study design: Self-report survey Objective: To ascertain physiatrists' opinions and current practice patterns for bone health management after spinal cord injury (SCI). Participants: Physiatrists who work in teaching rehabilitation centers in Canada. Methods: A 4-page 17-question survey (available in French and English) was sent to working physiatrists in all major Canadian SCI rehabilitation centers. Results: We had an 85% response rate (22 responses). Physiatrists reported that they should be managing bone health issues after SCI in conjunction with family physicians, and most respondents assess and treat for bone health after SCI. However, just over one-third of the physiatrists reported that the current treatment options are not effective for low bone mass; there was more support for pharmacological treatments than there was for rehabilitation modalities. Conclusion: Bone health after SCI is an important health concern that is being managed by physiatrists; however, more discussion and research is needed to ascertain the effectiveness of assessment and treatment options for low bone mass. Spinal Cord IntroductionBone health after a spinal cord injury (SCI) is an important issue that needs to be addressed because of an increased risk for fragility fractures 1-5 and the majority of these fractures occur during transfers or other activities that involve minimal or no trauma. 1 Contributing to the increased risk for fragility fracture is the loss of bone mineral density (BMD) in the lower extremity that was initially thought to stabilize around 1 year after injury 6 but below that of ablebodied peers. More recent literature supports a continual loss of bone mass with time since injury suggesting that bone mineral loss continues 7 and contributes to the increased risk of fractures. In the general population, people who sustain a low-impact trauma fracture (falling from a standing height or less) have an increased risk for subsequent fracture, thus practice guidelines emphasize that these fragility fractures should prompt a workup to determine possible causes and appropriate management. 8 For people with SCI, previous literature suggests that the mean incidence of lower limb fracture is approximately 2% per year. 9 Yet despite these data there has been little published studies to highlight physiatrist practice patterns for bone health specifically for people with SCI.Prevention and treatment of osteoporosis following SCI has been investigated as early as a few days after the initial injury. 10 However, in practice, bone health interventions are generally initiated in the in-patient rehabilitation setting where physiatrists, specialists in rehabilitation medicine, are most often involved. In Canada, as advocated from best practice guidelines, people with SCI are treated in specialized rehabilitation centers that are teaching hospitals. After being discharged from rehabilitation and living in the community, bone health evaluation may involve the ongoing care by physiatrists and/or family physicians. Family physici...

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Autonomic nervous system laboratories: a European survey

Cited by 21 publications

References 10 publications

Clinical study of hereditary disorders of connective tissues in a Chilean population

Clinical study of hereditary disorders of connective tissues in a Chilean population

Reappraisal of the diagnostic role of orthostatic hypotension in diabetes

Physiatrists' opinions and practice patterns for bone health after SCI

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