RESUMEN
Un paciente, de sexo masculino, de 55 años, con diagnóstico de mieloma múltiple, en tratamiento con QMT yX RT, que ingresa con un cuadro de dolor abdominal de 24 hs. de evolución. Al examen físico se objetiva abdomen doloroso a la palpación profunda en forma difusa, con peritonismo, sindefensa y signo del psoas (+). En la ecografía no se visualiza apéndice cecal y se realiza una tomografía abdominal con el objetivo de descartar patología apendicular. Se descarta apendicitis. A las 48 hs. de internación, presenta erupción vesicular en muslo y glúteo derecho compatible con Herpes Zoster. A las 72 hs., aparecen vesículas en MMSS y se diagnostica herpes Zoster diseminado.
Asunto(s)
Apendicitis , Apendicitis/diagnóstico , Tomografía , UltrasonografíaRESUMEN
Chronic inhibition of nitric oxide (NO) synthase with the competitive l-arginine analog NG-nitro-l-arginine methyl ester (l-NAME) leads to an elevated systemic blood pressure and reduction in renal blood flow without significant changes in urinary sodium and water excretion. Simultaneous administration of ANG II AT1 receptor antagonist losartan and l-NAME prevents the alterations in blood pressure and renal hemodynamics. Microcomputed tomography (micro-CT) was used to investigate the role of ANG II in the changes of renal microvasculature during chronic NO inhibition. Sprague-Dawley rats were given l-NAME with or without AT1 receptor antagonist losartan (40 mg. kg-1. day-1 each) in their drinking water for 19 days. Kidneys from each group (control, l-NAME-, and l-NAME + losartan-treated rats) were perfusion-fixed in situ, infused with a silicon-based polymer containing lead chromate, and scanned by micro-CT. The microvasculature in the reconstructed three-dimensional renal images was studied using computerized analytic techniques. Kidneys of l-NAME-treated rats had significantly fewer normal glomeruli (28,824 +/- 838) than those of control rats (36,266 +/- 3,572). Losartan normalized the number to control values (34,094 +/- 1,536). The amount of vasculature in the cortex, outer medulla, and inner medulla of l-NAME-treated rats was about two-thirds that of control rats; losartan normalized the values to control levels. These data indicate that chronic treatment with the NO synthase inhibitor l-NAME produces a generalized rarefaction of renal capillaries. Because simultaneous AT1 receptor blockade abolished those changes, the data suggest that the reduction in vasculature is mediated by ANG II through AT1 receptors.