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Leptomeningeal carcinomatosis (LC) after metastasis of breast cancer is a rare occurrence with potentially devastating complications. Treatment options are limited, and there is a lack of literature on this topic. We report the case of a 38-year-old woman with estrogen/progesterone receptor negative (ER/PR-), human epidermal growth factor receptor 2 positive (HER2+) invasive ductal carcinoma of the left breast who underwent bilateral mastectomies with axillary lymph node dissection and chemotherapy treatment. The patient returned 11 months later with persistent headaches. Imaging and resection found cerebellar metastasis of the breast carcinoma. The brain metastasis was treated with further chemotherapy and stereotactic radiosurgery. Follow-up imaging showed the development of small lesions outside the radiation site. Metabolic studies were performed to determine if the new lesions were due to tumor recurrence or radiation necrosis, but the studies were inconclusive as to the etiology of these lesions. The patient later developed LC that was successfully treated with full resolution of the disease using intrathecal trastuzumab. There are currently no consensuses on treatment guidelines for treating LC. Here, we demonstrate successful treatment of LC from an ER/PR-, HER2+ breast carcinoma with intrathecal trastuzumab.
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We report an unusual case of a dural arteriovenous fistula (dAVF) presenting as acute neck pain and quadripareis in a 55-year-old previously healthy man. Imaging was suspicious for cervicomedullary venous thrombosis and angiography failed to show evidence of arteriovenous malformation or dAVF. The patient was started on warfarin for a presumed cervicomedullary venous thrombosis and there was a significant clinical improvement. However, 3 weeks later, the symptoms recurred and repeat angiography revealed a dAVF fed by a posterior branch of the left middle meningeal artery draining into the posterior fossa vein. We postulated that warfarin caused recanalisation of the previously thrombosed venous pouch allowing for angiographic discovery and treatment of the dAVF. The dAVF was embolised with onyx resulting in the complete obliteration of the dAVF and symptomatic improvement. Although rare, some dAVF can be concealed or disappear on angiography due to thrombosis of the draining vein and warfarin can lead to recanalisation.
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Malformaciones Arteriovenosas/complicaciones , Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Angiografía de Substracción Digital/métodos , Anticoagulantes/uso terapéutico , Malformaciones Arteriovenosas/terapia , Encéfalo/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/terapia , Dimetilsulfóxido/uso terapéutico , Embolización Terapéutica/métodos , Humanos , Masculino , Persona de Mediana Edad , Polivinilos/uso terapéutico , Warfarina/uso terapéuticoRESUMEN
BACKGROUND: In accordance with German neurosurgical and neurological consensus recommendations, lead placements for deep brain stimulation (DBS) in patients with Parkinson's disease (PD) are usually performed with the patient awake and in "medication off" state. This allows for optimal lead position adjustment according to the clinical response to intraoperative test stimulation. However, exacerbation of Parkinsonian symptoms after withdrawal of dopaminergic medication may endanger the patient by inducing severe "off" state motor phenomena. In particular, this can be a problem in awake craniotomies utilizing intraoperative airway management and resuscitation. CASE PRESENTATION: We report the case of a PD patient with progressive orofacial and neck muscle dystonia resulting in laryngeal spasm during DBS lead placement. This led to upper airway compromise and asphyxia, requiring resuscitation. CONCLUSIONS: Laryngeal spasms may occur as a rare "off" state motor complication in patients with PD. Other potential causes of intraoperative difficulties breathing include bilateral vocal cord palsy, positional asphyxia, and silent aspiration. In our practice, we have adjusted our medication regimen and now allow patients to receive their standard dopaminergic medication until the morning of surgery. Neurologists and neurosurgeons performing lead placement procedures for PD should be aware of this rare but unsafe condition to most optimized treatment.
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Estimulación Encefálica Profunda/efectos adversos , Laringismo/diagnóstico , Enfermedad de Parkinson/terapia , Asfixia/diagnóstico , Asfixia/etiología , Reanimación Cardiopulmonar , Estimulación Encefálica Profunda/métodos , Diagnóstico Diferencial , Humanos , Laringismo/etiología , Masculino , Persona de Mediana EdadRESUMEN
OBJECT: The object of this study was to assess outcomes after surgery for recurrent intracranial glioma. METHODS: The authors retrospectively reviewed cases involving adult patients with intracranial glioma patients undergoing initial surgery (biopsy or resection) and one or more additional surgeries at their institution. RESULTS: A total of 323 operations were performed in 131 patients. The median survival was 76 months after first surgery, 36 months after second, 24 months after third, and 26.5 months after 4 or more surgeries. The overall complication rate was 12.8% after first surgery, 27.0% after second (OR 2.52, p = 0.0068), 22.0% after third (OR 1.92, not statistically significant [NS]), and 22.2% after 4 or more (OR 1.95, NS). Neurological complications occurred in 4.8% of patients at first surgery, 12.1% at second (OR 2.7, p = 0.0437), 8.2% at third (OR 1.75, NS), and 11.1% at 4 or more surgeries (OR 2.4583, NS). Regional complications occurred in 6.2% after first surgery, 9.9% after second surgery (OR 2.30, p = 0.095), 13.7% after third surgery (OR 3.31, p = 0.015), and 22.2% after 4 or more surgeries (OR 5.95, p = 0.056). Systemic complications occurred in 3.2% after first surgery, in 7.3% after second surgery (OR 2.3, p = 0.NS), in 4.1% after third surgery (OR 1.3, NS), and 0% after 4 or more surgeries. Reduction in Karnofsky Performance Status score occurred in 0% after first surgery, 8.1% after second surgery (OR 3.13, p = 0.0018), 10.2% after third surgery (OR 5.52, p < 0.0001), and 11.1% after 4 or more surgeries (OR 1.037, NS). CONCLUSIONS: Postoperative survival is relatively prolonged but complication risk increases in patients with glioma who undergo multiple cranial surgeries. The largest increase in neurological risk occurs between the first and second surgery. In contrast, regional complication risk increases consistently with each surgery. The risk of systemic complications is not significantly altered with increasing surgeries. However, these complications only result in a modestly increased risk of functional decline after 2 or more surgeries. These findings may help counsel patients considering multiple glioma surgeries.
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Neoplasias Encefálicas/cirugía , Glioma/cirugía , Recurrencia Local de Neoplasia/cirugía , Procedimientos Neuroquirúrgicos , Adulto , Neoplasias Encefálicas/mortalidad , Femenino , Estudios de Seguimiento , Glioma/mortalidad , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Complicaciones Posoperatorias/epidemiología , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Delineation of glioma extent for surgical or radiotherapy planning is routinely based on MRI. There is increasing awareness that contrast enhancement on T1-weighted images (T1-CE) may not reflect the entire extent of disease. The amino acid tracer (18)F-DOPA (3,4-dihydroxy-6-[18F] fluoro-l-phenylalanine) has a high tumor-to-background signal and high sensitivity for glioma imaging. This study compares (18)F-DOPA PET against conventional MRI for neurosurgical biopsy targeting, resection planning, and radiotherapy target volume delineation. METHODS: Conventional MR and (18)F-DOPA PET/CT images were acquired in 10 patients with suspected malignant brain tumors. One to 3 biopsy locations per patient were chosen in regions of concordant and discordant (18)F-DOPA uptake and MR contrast enhancement. Histopathology was reviewed on 23 biopsies. (18)F-DOPA PET was quantified using standardized uptake values (SUV) and tumor-to-normal hemispheric tissue (T/N) ratios. RESULTS: Pathologic review confirmed glioma in 22 of 23 biopsy specimens. Thirteen of 16 high-grade biopsy specimens were obtained from regions of elevated (18)F-DOPA uptake, while T1-CE was present in only 6 of those 16 samples. Optimal (18)F-DOPA PET thresholds corresponding to high-grade disease based on histopathology were calculated as T/N > 2.0. In every patient, (18)F-DOPA uptake regions with T/N > 2.0 extended beyond T1-CE up to a maximum of 3.5 cm. SUV was found to correlate with grade and cellularity. CONCLUSIONS: (18)F-DOPA PET SUV(max) may more accurately identify regions of higher-grade/higher-density disease in patients with astrocytomas and will have utility in guiding stereotactic biopsy selection. Using SUV-based thresholds to define high-grade portions of disease may be valuable in delineating radiotherapy boost volumes.
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Neoplasias Encefálicas/patología , Dihidroxifenilalanina/análogos & derivados , Glioma/patología , Procedimientos Neuroquirúrgicos , Tomografía de Emisión de Positrones , Radiofármacos , Planificación de la Radioterapia Asistida por Computador , Adulto , Anciano , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/cirugía , Dihidroxifenilalanina/farmacocinética , Femenino , Estudios de Seguimiento , Glioma/diagnóstico por imagen , Glioma/cirugía , Humanos , Técnicas para Inmunoenzimas , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Proyectos Piloto , Pronóstico , Estudios Prospectivos , Radiofármacos/farmacocinética , Radioterapia Guiada por Imagen , Cirugía Asistida por Computador , Distribución Tisular , Adulto JovenRESUMEN
Objectives We sought to identify if preoperative schwannoma magnetic resonance imaging (MRI) intensities might predict intraoperative consistency. We then determined whether consistency correlated with facial nerve outcomes. Design Operative reports from 2000 to 2010 were searched for tumor description as either soft and/or suckable or firm and/or fibrous. Preoperative T1 and T2 sequences were then reviewed to identify intensities relative to gray matter. Facial nerve function was recorded at the time of most recent follow-up. Results Forty-six patients were included. No tumors were T1 hyperintense. Soft and firm schwannomas were equally likely to be T1 hypointense. On T2 sequences, however, soft schwannomas were more likely to be hyperintense (88% versus 14%, p < 0.005) whereas firm schwannomas were more likely to be hypointense (86% versus 6%, p < 0.005). There was a tendency for firm schwannomas to have worse facial nerve outcomes (43% versus 19%, p = 0.14). Conclusions Prediction of vestibular schwannoma intraoperative consistency based on T2 intensity seems promising. Furthermore, though not statistically significant, in this small pilot study firm schwannomas tended to have worse facial nerve outcomes. This potential ability to predict consistency and its correlation with facial nerve outcome may assist the surgeon in preoperative planning and patient counseling, though further data needs to be accumulated.
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BACKGROUND: Frameless stereotaxy commonly registers preoperative magnetic resonance imaging (MRI) to patients by using surface scalp anatomy or adhesive fiducial scalp markers. Patients' scalps may shift slightly between preoperative imaging and final surgical positioning with pinion placement, introducing error. This might be reduced when frameless stereotaxy is performed in a high-field intraoperative MRI (iMRI), as patients are positioned before imaging. This could potentially improve accuracy. OBJECTIVE: To compare frameless stereotactic accuracy using a high-field iMRI with that using standard preoperative MRI. METHODS: Data were obtained in 32 adult patients undergoing frameless stereotactic-guided brain tumor surgery. Stereotactic images were obtained with 1.5T MRI scanner either preoperatively (14 patients) or intraoperative (18 patients). System-generated accuracy measurements and distances from the actual center of each fiducial marker to that represented by neuronavigation were recorded. Finally, accuracy at multiple deep targets was assessed by using a life-sized human head stereotactic phantom in which fiducials were placed on deformable foam to mimic scalp. RESULTS: : System-generated accuracy measurements were significantly better for the iMRI group (mean ± SEM = 1.04 ± 0.05 mm) than for the standard group (1.82 ± 0.09 mm; P < .001). Measured distances from the actual center of scalp fiducial markers to that represented by neuronavigation were also significantly smaller for iMRI (1.72 ± 0.10 mm) in comparison with the standard group (3.17 ± 0.22 mm; P < .001). Deep accuracy in the phantom model was significantly better with iMRI (1.67 ± 0.12 mm) than standard imaging (2.28 ± 0.14 mm; P = .003). CONCLUSION: Frameless stereotactic accuracy is increased by using high-field iMRI compared with standard preoperative imaging.
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Neoplasias Encefálicas/cirugía , Imagen por Resonancia Magnética/métodos , Neuronavegación/métodos , Radiocirugia/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We present a case of an intramedullary melanotic schwannoma (IMS) of the thoracic spinal cord. To our knowledge, this is the seventh reported case of an IMS of the central nervous system. Schwannomas are benign nerve sheath tumors of neural crest origin composed entirely of well differentiated Schwann cells that typically occur in peripheral nerves. Both the intramedullary location and the melanotic component of the reported lesion make it exceedingly rare. We will present our case, theories as to the origin of these tumors, clues in radiographic identification, and current clinical follow-up recommendations.
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BACKGROUND: Intradural spinal metastases are rare, and little is known regarding surgical indications and outcomes. METHODS: A retrospective search identified adults with intradural spinal metastases operated on at the Mayo Clinic from 1994-2011. Data were collected regarding demographics, tumor type and location, and outcomes. RESULTS: Fifteen patients with intradural spinal metastases were investigated. The age range was 38-74 years (mean = 55 years; ±SD = 11.1). Predominant tumor location and type were lumbosacral and adenocarcinoma, respectively: 3 intramedullary and 12 extramedullary. Patients were operated on to relieve or prevent progressive/intractable neurological sequelae and/or pain. Of 13 who underwent resection, gross total removal was reported in 10; simple biopsy was performed in 2. There was one surgical complication, no medical complications, and no surgical mortality. At median follow-up of 1 month postoperatively, 10 of 15 patients were stable or improved. Of 13 patients who underwent resection, 10 were stable or improved. Of two patients who underwent biopsy, neither was stable or improved at follow-up. Using the Modified McCormick Scale, 11 of 15 patients were "functional" preoperatively and 4 went from "functional" preoperatively to "non-functional" postoperatively. Three of those four died within 60 days of surgery from systemic disease progression. Median hospital stay was 8 days. Ten of 15 patients died by the end of the study period, and the median survival of 15 patients was 5 months. CONCLUSIONS: With improved outcomes in metastatic cancer, more patients are encountered in practice. An aggressive surgical approach is warranted for extramedullary lesions, whereas caution is advised for intramedullary lesions. Postoperative functional decline is more likely due to systemic disease progression rather than surgery.
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Neoplasias de la Médula Espinal/cirugía , Adenocarcinoma/patología , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Laminectomía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Neoplasias de la Médula Espinal/patología , Neoplasias de la Médula Espinal/secundario , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine the incidence of and risk factors for cerebrospinal fluid (CSF), wound, and hematoma-related complications following intradural spine surgery. BACKGROUND: Complications of intradural spinal surgery requiring a return to the operating room lengthen hospital stay and increase cost as well as patient risk. Here we present our experience with complications in intradural spinal surgery. METHODS: Between 1993 and 2010, a total of 528 pediatric and adult patients who underwent biopsy and/or resection of intramedullary or extramedullary spinal lesions at Mayo Clinic-Rochester were evaluated. RESULTS: The overall complication rate in this series was 4.9%. Complications, such as neurologic worsening due to an etiology not able to be treated surgically, or medical complications, such as deep venous thrombosis, were not included in this study. The overall complication rates that were CSF-related, wound-related, hematoma-related, and miscellaneous were 3.0%, 1.1%, 0.6%, and 0.2% respectively. Complication rates decreased with age from 15.4% in 0- to 10-year-olds to 4.1% in 61- to 90-year-olds. Tumors represented the majority of pathology at 90.5%. The complication rate for patients who had prior treatment was higher at 6.9% compared with 4.7% in those who had no prior treatment (P = 0.5). Intramedullary tumors had a complication rate of 7.1% vs. 3.6% for extramedullary tumors (P = 0.14). Some patients (5.7%) had coexisting intracranial tumors at the time of their surgery but none had complications with intradural spine surgery. CONCLUSIONS: Complications of intradural spine surgery are most commonly CSF related, may decrease with increasing age of the patient, and are higher with intramedullary tumors.
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Procedimientos Neuroquirúrgicos/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Enfermedades de la Médula Espinal/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Complicaciones Posoperatorias/clasificación , Reoperación , Estudios Retrospectivos , Enfermedades de la Médula Espinal/epidemiología , Enfermedades de la Médula Espinal/patología , Adulto JovenRESUMEN
BACKGROUND: Orthostatic hypotension (OH) is an uncommon, but not rare manifestation of dorsal medullary lesions which has less commonly been described as arising de novo or significantly worsening following surgical resection of the lesion. METHODS: We present a case and review the English literature regarding dorsal medullary lesions and post-operative OH, focusing on the population of patients who develop new or significantly worsened OH after surgery with the hope that this information can be used to counsel patients. RESULTS: A 34-year old hypertensive woman was diagnosed with Von Hippel-Lindau syndrome during evaluation for headache. Magnetic resonance imaging of the brain and cervical spine revealed three posterior fossa hemangioblastomas and a resultant cervical syrinx. She was taken to surgery for resection of two of the posterior fossa hemangioblastomas, one of which was adherent to the obex. Post-operatively, the patient had significant OH requiring treatment. At the three month post-operative assessment, she was off all blood pressure medications. CONCLUSIONS: OH is an uncommon manifestation of dorsal medullary lesions and can rarely show significant worsening in severity following surgical resection of the lesion. Medical management in conjunction with physical rehabilitation may potentially result in recovery.
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Hemangioblastoma/cirugía , Hipotensión Ortostática , Bulbo Raquídeo/cirugía , Complicaciones Posoperatorias , Enfermedad de von Hippel-Lindau/cirugía , Adulto , Femenino , Hemangioblastoma/patología , Humanos , Imagen por Resonancia Magnética , Bulbo Raquídeo/patología , Procedimientos Neuroquirúrgicos , Enfermedad de von Hippel-Lindau/patologíaRESUMEN
BACKGROUND: Meningioma firmness is a critical factor that influences ease of resection and risk, notably when operating on tumors intimate with neurovascular structures such as the mesial sphenoid wing. This study develops a predictive tool using preoperative magnetic resonance imaging (MRI) characteristics to determine meningioma consistency. METHODS: 101 patients with intracranial meningioma (50 soft/51 firm) were included. MRI characteristics of 38 tumors (19 soft/19 firm) were retrospectively reviewed to identify preoperative imaging features that were then correlated with intraoperative description of the tumor as either "soft and/or suckable" or "firm and/or fibrous". Criteria were developed to predict consistency and then blindly applied to the remaining 63 meningiomas (31 soft/32 firm). RESULTS: The overall sensitivities for detecting soft and firm consistency were 90% and 56%, respectively (95% CI = 73-97% and 38-73%; P < 0.001). Compared to gray matter, meningiomas that were T2 hypointense were almost always firm. Soft meningiomas were hyperintense on T2 and hypointense on T1. Soft meningiomas were slightly larger and less likely to be associated with edema. There was a slight preponderance of firm meningiomas in the infratentorial compartment. Grade of meningioma was not predictive. Contrast enhancement, diffusion restriction, changes in overlying bone, intratumoral cysts, and angiographic features were not predictable. CONCLUSIONS: This tool using T1 and T2 series predicts meningioma consistency. Such knowledge should assist the surgeon in preoperative planning and counseling.
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The authors present the case of a 56-year-old right hand-dominant woman who was referred for chronic neck pain and a second opinion regarding a cervical lesion. The patient's pain was localized to the subaxial spine in the midline. She reported a subjective sense of intermittent left arm weakness manifesting as difficulty manipulating small objects with her hands and fingers. She also reported paresthesias and numbness in the left hand. Physical and neurological examinations demonstrated no abnormal findings except for a positive Tinel sign over the left median nerve at the wrist. Electromyography demonstrated bilateral carpal tunnel syndrome with no cervical radiculopathy. Cervical spine imaging demonstrated multilevel degenerative disc disease and a pneumatocyst of the C-5 vertebral body. The alignment of the cervical spine was normal. A review of the patient's cervical imaging studies obtained in 1995, 2007, 2008, and 2010 demonstrated that the pneumatocyst was not present in 1995 but was present in 2007. The lesion had not changed in appearance since 2007. At an outside institution, multilevel fusion of the cervical spine was recommended to treat the pneumatocyst prior to evaluation at the authors' institution. The authors, however, did not think that the pneumatocyst was the cause of the patient's neck pain, and cervical pneumatocysts typically have a benign course. As such, the authors recommended conservative management and repeated MR imaging in 6 months. Splinting was used to treat the patient's carpal tunnel syndrome.
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Quistes Óseos/complicaciones , Vértebras Cervicales , Dolor de Cuello/complicaciones , Enfermedades de la Columna Vertebral/complicaciones , Brazo , Artrografía , Quistes Óseos/diagnóstico , Síndrome del Túnel Carpiano/complicaciones , Síndrome del Túnel Carpiano/diagnóstico , Electromiografía , Femenino , Humanos , Degeneración del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/complicaciones , Imagen por Resonancia Magnética , Persona de Mediana Edad , Debilidad Muscular/etiología , Parestesia/etiología , Enfermedades de la Columna Vertebral/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
The prognosis for patients diagnosed with primary central nervous system tumors, such as gliomas, remains generally poor. Improved treatment (standard therapies and novel strategies) is needed. Glioma surgery is a key part of standard treatment and has established roles in providing tissue for diagnosis and in tumor debulking. Several techniques to increase safe surgical resection have been investigated. In addition, novel surgical modalities introducing therapeutic agents locally are increasingly common. This article reviews recent glioma surgery clinical trials, focusing on outcome studies, novel surgical techniques, and local therapeutic agent delivery.
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Neoplasias Encefálicas/cirugía , Ensayos Clínicos como Asunto/métodos , Glioma/cirugía , Procedimientos Neuroquirúrgicos/métodos , Biopsia con Aguja/métodos , Braquiterapia/métodos , Encéfalo/patología , Encéfalo/cirugía , Mapeo Encefálico/métodos , Neoplasias Encefálicas/tratamiento farmacológico , Glioma/tratamiento farmacológico , Humanos , Imagen por Resonancia Magnética/métodos , Monitoreo Intraoperatorio/métodos , Técnicas EstereotáxicasRESUMEN
AIM: In the present study, we describe the effects of deep tissue massage on systolic, diastolic, and mean arterial blood pressure. MATERIALS AND METHODS: The study involved 263 volunteers (12% males and 88% females), with an average age of 48.5. Overall muscle spasm/muscle strain was described as either moderate or severe for each patient. Baseline blood pressure and heart rate were measured via an automatic blood pressure cuff. Twenty-one (21) different soothing CDs played in the background as the deep tissue massage was performed over the course of the study. The massages were between 45 and 60 minutes in duration. The data were analyzed using analysis of variance with post-hoc Scheffe's F-test. RESULTS: Results of the present study demonstrated an average systolic pressure reduction of 10.4 mm Hg (p<0.06), a diastolic pressure reduction of 5.3 mm Hg (p<0.04), a mean arterial pressure reduction of 7.0 mm Hg (p<0.47), and an average heart rate reduction of 10.8 beats per minute (p<0.0003), respectively. CONCLUSIONS: Additional scientific research in this area is warranted.
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Presión Sanguínea/fisiología , Frecuencia Cardíaca/fisiología , Masaje/métodos , Músculo Esquelético/fisiología , Adulto , Ansiedad/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Estrés Psicológico/prevención & control , Resultado del TratamientoRESUMEN
OBJECTIVE: To test the hypothesis that ma huang induces a pressor response in the pulmonary vascular bed of the cat and identify the alpha (1)-adrenoceptor subtype pathway(s) involved in the mediation or modulation of these effects. DESIGN: Prospective vehicle controlled study. SETTING: University research laboratory. SUBJECTS: Intact chest preparation; adult mongrel cats. INTERVENTIONS: In separate experiments, the effects of phentolamine, the alpha-adrenergic antagonist; prazosin, a selective alpha (1)-adrenoceptor antagonist; BMY 7378, a selective alpha (1) D-subtype adrenoceptor antagonist; 5-methyl-urapidil, the selective alpha (1)A-subtype adrenoceptor antagonist; and chloroethylclonidine, an alpha (1)B-subtype and (1) D-subtype adrenoceptor antagonist, were investigated on pulmonary arterial responses to ma huang and other agonist agents in the pulmonary vascular bed of the cat. MEASUREMENTS AND MAIN RESULTS: Under constant flow conditions, lobar arterial perfusion pressure and systemic pressure were continuously monitored, electronically averaged, and permanently recorded. In the feline vascular bed of the isolated left lower lobe, ma huang induced a dose-dependent vasopressor response that was not significantly attenuated following administration of 5-methyl-urapidil. However, the responses to Ma huang were significantly reduced after administration of phentolamine, prazosin, BMY 7378, and chloroethylclonidine. CONCLUSIONS: The results of the present study suggest that ma huang has potent vasopressor activity in the pulmonary vascular bed of the cat and that this response may be mediated or modulated by both alpha (1)B-subtype and (1)D-subtype adrenoceptor sensitive pathways.
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Antagonistas Adrenérgicos alfa/farmacología , Presión Sanguínea/efectos de los fármacos , Medicamentos Herbarios Chinos/farmacología , Ephedra sinica , Pulmón/efectos de los fármacos , Circulación Pulmonar/efectos de los fármacos , Receptores Adrenérgicos/metabolismo , Animales , Gatos , Clonidina/análogos & derivados , Clonidina/farmacología , Relación Dosis-Respuesta a Droga , Femenino , Pulmón/irrigación sanguínea , Masculino , Fentolamina/farmacología , Piperazinas/farmacología , Prazosina/farmacología , Estudios Prospectivos , Vasoconstrictores/farmacologíaRESUMEN
OBJECTIVE: There are extensive data on roles of cyclooxygenase 1 (COX 1) and cyclooxygenase 2 (COX 2) enzymes in temperature, coagulation, and inflammatory modulation. There is little known of the function of these enzymes in regulating tone in pulmonary vasculature. The purpose of this investigation was to elucidate the roles of COX 1 and 2 enzymes in the feline pulmonary vascular bed. DESIGN: Prospective vehicle controlled study. SETTING: University research laboratory. SUBJECTS: Intact chest preparation; adult mongrel cats. INTERVENTIONS: The effects of intravascular administration of U46619, angiotensin II, prostaglandin E1 (PGE1), arachidonic acid, and norepinephrine, were analyzed before and after intravascular administration of selective COX enzyme inhibitors. MEASUREMENTS AND MAIN RESULTS: Because lobar arterial flow is constant in these experiments, changes in lobar pressure represent changes in pulmonary arterial resistance. Under constant flow conditions, lobar arterial and systemic pressures were continuously monitored, electronically averaged, and recorded. In the isolated left lower lobe of the feline lung bed, U46619, angiotensin II, arachidonic acid, and norepinephrine induced a dose-dependent vasoconstrictor response. PGE1 induced a dose-dependent vasodepressor response. After administration of the COX 1 inhibitor SC 560, the arachidonic acid-induced vasopressor responses were significantly attenuated while U46619, angiotensin II, and norepinephrine-induced vasopressor, and PGE1-induced vasodepressor responses were not significantly altered. After administration of the COX 2 inhibitor nimesulide, both the PGE 1 vasodepressor responses and arachidonic acid-induced vasopressor responses were significantly decreased while the U46619, angiotensin II, and norepinephrine-induced vasopressor responses were not significantly attenuated. CONCLUSIONS: The results of the study indicate that PGE1 has potent vasodepressor effects in the feline lung bed and this response is mediated by COX 2 pathways. The data also suggest that arachidonic acid has potent vasopressor activity in the feline pulmonary vascular bed and this response is mediated by both COX 1 and COX 2 sensitive pathways.
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Ciclooxigenasa 1/fisiología , Ciclooxigenasa 2/fisiología , Inhibidores de la Ciclooxigenasa/farmacología , Pulmón/efectos de los fármacos , Vasoconstrictores/farmacología , Vasodilatadores/farmacología , Ácido 15-Hidroxi-11 alfa,9 alfa-(epoximetano)prosta-5,13-dienoico/farmacología , Alprostadil/farmacología , Animales , Ácido Araquidónico/farmacología , Gatos , Ciclooxigenasa 1/farmacología , Ciclooxigenasa 2/farmacología , Interacciones Farmacológicas , Pulmón/irrigación sanguínea , Norepinefrina/farmacología , Vasoconstrictores/antagonistas & inhibidoresRESUMEN
Congestive heart failure (CHF) is increasingly being recognized as a health problem in the United States. It is estimated that the lifetime risk for CHF is 1 in 5. The clinical anesthesiologist can expect to see several cases involving patients suffering from CHF. Because of the danger associated with surgery in a patient with CHF, a thorough knowledge of the disorder and the potential effects on the delivery of anesthetics must be considered. In addition, knowledge of the disease process and its manifestations is required for smooth guidance of the patient through the perioperative period. The understanding of current pharmacotherapies, surgical procedures and their implications related to interactions with anesthetics are all discussed.
Asunto(s)
Anestesia , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Anestesia/efectos adversos , Anestesia/métodos , Procedimientos Quirúrgicos Cardíacos , Insuficiencia Cardíaca/diagnóstico , Humanos , Atención PerioperativaRESUMEN
The objective of this study was to test the hypothesis that fentanyl induces a depressor response in the pulmonary vascular bed of the cat and to identify the receptors involved in the mediation or modulation of these effects. The authors conducted a prospective vehicle-controlled study at a university research laboratory using intact chest preparation in adult mongrel cats. In separate experiments, the effects of diphenhydramine (histamine receptor blocker), glibenclamide (ATP-sensitive K+ channel blocker), L-N5-(1-Iminoethyl) ornithine hydrochloride (L-NIO) (nitric oxide synthase inhibitor), nimesulide (selective cyclooxygenase [COX]-2 inhibitor), and naloxone (opiate receptor antagonist) were investigated on pulmonary arterial responses to fentanyl and other agonists in the pulmonary vascular bed of the cat. The systemic pressure and lobar arterial perfusion pressure were continuously monitored, electronically averaged, and recorded. In the feline pulmonary vascular bed of the isolated left lower lobe, fentanyl induced a dose-dependent vasodepressor response that was not significantly altered after administration of glibenclamide, L-NIO, and nimesulide. However, the responses to fentanyl were significantly attenuated after administration of diphenhydramine and naloxone. The results of the present study suggest that fentanyl has potent vasodepressor activity in the pulmonary vascular bed of the cat and that this response may be mediated or modulated by both histaminergic and opiate receptor sensitive pathways.
Asunto(s)
Fentanilo/farmacología , Arteria Pulmonar/efectos de los fármacos , Receptores Opioides/efectos de los fármacos , Vasodilatación/efectos de los fármacos , Vasodilatadores/farmacología , Analgésicos Opioides/farmacología , Animales , Presión Sanguínea/efectos de los fármacos , Bradiquinina/metabolismo , Gatos , Ciclooxigenasa 2/metabolismo , Difenhidramina/farmacología , Relación Dosis-Respuesta a Droga , Histamina/metabolismo , Antagonistas de los Receptores Histamínicos H1/farmacología , Naloxona/farmacología , Antagonistas de Narcóticos/farmacología , Óxido Nítrico/metabolismo , Norepinefrina/metabolismo , Arteria Pulmonar/metabolismo , Circulación Pulmonar/efectos de los fármacos , Receptores Opioides/metabolismoRESUMEN
OBJECTIVE: The purpose of this study was to test the hypothesis that meperidine induces a dilator response in the feline pulmonary vascular bed, and to identify receptors involved in the mediation or modulation of these effects. DESIGN: Prospective vehicle controlled study. SETTING: University research laboratory. SUBJECTS: Intact chest preparation; adult mongrel cats. INTERVENTIONS: In separate experiments, the effects of diphenydramine (histamine H(1)-receptor antagonist), glibenclamide (adenosine triphosphate-sensitive K+ channel blocker), L-N(5)-(1-Iminoethyl) ornithine hydrochloride (L-NIO) (nitric oxide synthase inhibitor), naloxone (opioid receptor antagonist), and nimesulide (selective cyclooxygenase-2 inhibitor) were investigated on pulmonary arterial responses to meperidine and other agonists in the feline lung bed. MEASUREMENTS AND MAIN RESULTS: The systemic pressure and lobar arterial perfusion pressure were continuously monitored, electronically averaged, and permanently recorded. Under elevated tone conditions in the isolated left lower lobe vascular bed of the cat, meperidine induced a dose-dependent vasodilator response that was not significantly altered after administration of glibenclamide, L-NIO, and nimesulide. Responses to meperidine were significantly attenuated after the administration of diphenydramine and naloxone. CONCLUSIONS: The results suggest that meperidine has potent vasodilator activity in the feline pulmonary vascular bed, and these responses are mediated or modulated, in part, by opioid and histamine receptor-sensitive pathways.