Manometric Abnormalities in the Postural Orthostatic Tachycardia Syndrome: A Case Series

2013 ◽  
Vol 58 (11) ◽  
pp. 3207-3211 ◽  
Author(s):  
Robert J. Huang ◽  
Carlene L. Chun ◽  
Karen Friday ◽  
George Triadafilopoulos
Keyword(s):  
Case Series ◽  
Postural Orthostatic Tachycardia Syndrome

scholarly journals Hospital Records of Pain, Fatigue, or Circulatory Symptoms in Girls Exposed to Human Papillomavirus Vaccination: Cohort, Self-Controlled Case Series, and Population Time Trend Studies

2020 ◽  
Vol 189 (4) ◽  
pp. 277-285 ◽  
Author(s):  
Reimar Wernich Thomsen ◽  
Buket Öztürk ◽  
Lars Pedersen ◽  
Sia Kromann Nicolaisen ◽  
Irene Petersen ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Hpv Vaccine ◽  
Time Trend ◽  
Hpv Vaccination ◽  
Case Series ◽  
Public Confidence ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Hospital Records ◽  
Trend Analyses ◽  
Increased Risk

Abstract Human papillomavirus (HPV) vaccination has been associated with subsequent diffuse symptoms in girls, reducing public confidence in the vaccine. We examined whether girls have nonspecific outcomes of HPV vaccination, using triangulation from cohort, self-controlled case series (SCCS), and population time trend analyses carried out in Denmark between 2000 and 2014. The study population consisted of 314,017 HPV-vaccinated girls and 314,017 age-matched HPV-unvaccinated girls (cohort analyses); 11,817 girls with hospital records (SCCS analyses); and 1,465,049 girls and boys (population time trend analyses). The main outcome measures were hospital records of pain, fatigue, or circulatory symptoms. The cohort study revealed no increased risk among HPV vaccine-exposed girls, with incidence rate ratios close to 1.0 for abdominal pain, nonspecific pain, headache, hypotension/syncope, tachycardia (including postural orthostatic tachycardia syndrome), and malaise/fatigue (including chronic fatigue syndrome). In the SCCS analyses, we observed no association between HPV vaccination and subsequent symptoms. In time trend analyses, we observed a steady increase in these hospital records in both girls and (HPV-unvaccinated) boys, with no relationship to the 2009 introduction of HPV vaccine to Denmark’s vaccination program. This study, which had nationwide coverage, showed no evidence of a causal link between HPV vaccination and diffuse autonomic symptoms leading to hospital contact.

scholarly journals Juvenile fibromyalgia: A call for diagnostic refinement, a case report

2020 ◽  
Author(s):  
Elisha Peterson ◽  
Caylynn Yao ◽  
Sangeeta D. Sule ◽  
Julia C. Finkel
Keyword(s):  
Immune System ◽  
Mood Disorders ◽  
Orthostatic Intolerance ◽  
Case Series ◽  
Clinical Syndrome ◽  
Somatic Complaints ◽  
Pain Clinic ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Juvenile Fibromyalgia ◽  
Immune System Dysfunction

Abstract BackgroundFibromyalgia is a clinical syndrome consisting of widespread musculoskeletal tenderness and various somatic complaints including nonrestorative sleep, mood disorders such as anxiety or depression, abdominal pain, and/or headaches. There is a great deal of heterogeneity in its expression which leads to difficulty in identifying predisposing factors. A singular review of patients in an academic pediatric pain clinic reveal immune system dysfunction, mood disorders, infection, postural orthostatic tachycardia syndrome, complex regional pain syndrome, and hypermobility are premorbid conditions. It is unclear if these premorbid conditions confer a distinct fibromyalgia clinical phenotype that can provide insight into targeted therapies. Current diagnostic measures for fibromyalgia do not allow for this level of discrimination and are not validated in children.Case Presentation20 children who demonstrated widespread musculoskeletal pain, tenderness to pressure on exam and multiple somatic complaints were diagnosed with fibromyalgia. Average time from start of pain to diagnosis is 2 years. Over half the patients have psychopathology, a third have an immune system dysfunction related to autoimmunity or an infectious exposure, a third with orthostatic intolerance or postural orthostatic tachycardia syndrome, a quarter relating to hypermobility, and a quarter of the cohort with dysmenorrhea were pre or comorbid conditions. Effective therapeutic regimens among patients varied widely from responding to medical monotherapy to multimodal treatment. Trigger point injections worsened pain in one fibromyalgia patient but decreased pain in another. Patients with comorbid autoimmunity report appreciating a difference between a flare in their arthritis as opposed to a flare in their fibromyalgia. Such varying responses within the same clinical syndrome suggest distinct phenotypes within fibromyalgia which is difficult to distinguish using our current diagnostic tools.ConclusionThere is a need for clear diagnostic criteria for both the recognition of juvenile fibromyalgia and tools to distinguish phenotypes within fibromyalgia. Currently, the recognition of clinical symptoms renders it an often-overlooked neuropathic pain condition. This case series suggest there are different phenotypes within fibromyalgia. Some patients respond remarkably to serotonin norepinephrine reuptake inhibitors alone whereas others require multidisciplinary therapy. A diagnostic tool refined to capture these nuances can facilitate targeted treatment recommendations.

Median Arcuate Ligament Syndrome and Its Associated Conditions

2019 ◽  
Vol 85 (10) ◽  
pp. 1162-1165 ◽  
Author(s):  
Desmond T. K. Huynh ◽  
Kevin Shamash ◽  
Miguel Burch ◽  
Edward Phillips ◽  
Scott Cunneen ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Delayed Gastric Emptying ◽  
Case Series ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Ehlers Danlos Syndrome ◽  
Arcuate Ligament ◽  
Associated Conditions ◽  
Danlos Syndrome

The risk factors and associated conditions of median arcuate ligament syndrome (MALS) have not been well characterized in the literature. In this study, we aim to investigate the presentation and outcomes of MALS patients with an emphasis on the prevalence of other uncommon disorders. To this end, data of patients with MALS who underwent surgery between 2013 and 2018 were collected and compiled into a retrospective database and analyzed. Eleven patients were identified. Seven of these eleven patients underwent diagnostics to evaluate gastric emptying. Five of these seven patients (71.4%) had radiographic evidence of delayed gastric emptying. Four of the eleven patients (36.4%) were found to have anatomic abnormalities of their visceral vasculature. Two of the eleven patients (18.2%) were found to have connective tissue disorders, both with Ehlers-Danlos syndrome. Three of the eleven (27.3%) had a diagnosis of postural orthostatic tachycardia syndrome. This is the first case series reporting on an association between MALS and delayed gastric emptying. We also explored the relationship between MALS and visceral vascular abnormalities, Ehlers-Danlos syndrome, and postural orthostatic tachycardia syndrome. It is notable that these conditions are more prevalent in the MALS population than in the general population, suggesting a possible pathophysiologic relationship.

scholarly journals Association between quadrivalent human papillomavirus vaccination and selected syndromes with autonomic dysfunction in Danish females: population based, self-controlled, case series analysis

BMJ ◽  
2020 ◽  
pp. m2930 ◽  
Author(s):  
Anders Hviid ◽  
Nicklas M Thorsen ◽  
Palle Valentiner-Branth ◽  
Morten Frisch ◽  
Kåre Mølbak
Keyword(s):  
Human Papillomavirus ◽  
Chronic Fatigue Syndrome ◽  
Complex Regional Pain Syndrome ◽  
Autonomic Dysfunction ◽  
Case Series ◽  
Pain Syndrome ◽  
Chronic Fatigue ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Human Papillomavirus Vaccination ◽  
Fatigue Syndrome

Abstract Objective To evaluate the association between quadrivalent human papillomavirus vaccination and syndromes with autonomic dysfunction, such as chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome. Design Population-based self-controlled case series. Setting Information on human papillomavirus vaccinations and selected syndromes with autonomic dysfunction (chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome) identified using ICD-10 (international classification of diseases, revision 10) diagnostic codes from Danish nationwide registers. Participants 869 patients with autonomic dysfunction syndromes from a cohort of 1 375 737 Danish born female participants aged 10 to 44 years during 2007-16. Main outcome measures Self-controlled case series rate ratios (95% confidence intervals) of the composite outcome of chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome, adjusted for age and season, comparing female participants vaccinated and unvaccinated with the quadrivalent human papillomavirus vaccine. Chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome were also considered separately in secondary analyses. Results During 10 581 902 person years of follow-up, 869 female participants with syndromes of autonomic dysfunction (136 with chronic fatigue syndrome, 535 with complex regional pain syndrome, and 198 with postural orthostatic tachycardia syndrome) were identified. Quadrivalent human papillomavirus vaccination did not statistically significantly increase the rate of a composite outcome of all syndromes with autonomic dysfunction in a 365 day risk period following vaccination (rate ratio 0.99, 95% confidence interval 0.74 to 1.32) or the rate of any individual syndrome in the risk period (chronic fatigue syndrome (0.38, 0.13 to 1.09), complex regional pain syndrome (1.31, 0.91 to 1.90), or postural orthostatic tachycardia syndrome (0.86, 0.48 to 1.54)). Conclusions When vaccination is introduced, adverse events could occur in close temporal relation to the vaccine purely by chance. These results do not support a causal association between quadrivalent human papillomavirus vaccination and chronic fatigue syndrome, complex regional pain syndrome, or postural orthostatic tachycardia syndrome, either individually or as a composite outcome. An increased risk of up to 32% cannot be formally excluded, but the statistical power of the study suggests that a larger increase in the rate of any syndrome associated with vaccination is unlikely.

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