RESUMEN
PURPOSE OF REVIEW: Few procedures involve the ischemia-reperfusion injury to organs purposely. Two clear examples in urologic surgery consist on kidney transplantation and partial nephrectomies. RECENT FINDINGS: Mannitol is an osmotic diuretic that is commonly used in partial nephrectomies and kidney transplantation to increase renal blood flow and decrease warm-ischemia-related renal injury to preserve estimated glomerular filtration rate (eGFR). We review the current evidence for the use of mannitol and its effects on these procedures.
Asunto(s)
Diuréticos Osmóticos/uso terapéutico , Trasplante de Riñón/métodos , Manitol/uso terapéutico , Nefrectomía/métodos , Daño por Reperfusión/prevención & control , Tasa de Filtración Glomerular , Humanos , Riñón/irrigación sanguínea , Daño por Reperfusión/etiología , Isquemia Tibia/efectos adversosRESUMEN
BACKGROUND: Mannitol has been employed to ameliorate renal warm ischemia damage during partial nephrectomy, however, there is limited scientific evidence to support the use of mannitol during partial nephrectomy. The objective of the present study was to investigate the glomerular number after renal warm ischemia, with and without the use of mannitol in a Pig Model. METHODS: Twenty-four male pigs were assigned into three groups. Eight animals were allocated to the sham group that was subjected to laparoscopic dissection of the left renal hilum, without renal ischemia. Eight animals were allocated to the ischemia group that had the left renal hilum clamped for 30 min through laparoscopic access. Eight animals received mannitol (250 mg/kg) before the occlusion of renal hilum for 30 min. The kidneys were collected after the euthanasia of the pigs 21 days post surgery. The right kidney was utilized as a self-control for each animal. Serum creatinine, urea levels, the weight and volume of the kidneys were measured. Glomerular volumetric density, volume-weighted glomerular volume, and cortical volume were quantified through stereological methods and employed to determine the number of nephrons per kidney. Student's t test and ANOVA were used for statistical analysis. RESULTS: In the ischemia group, the left kidney recorded a reduction of 24.6% (290, 000 glomeruli) in the number of glomeruli in comparison to the right kidney. Kidneys subjected to ischemia also displayed decreased weight and volume in comparison to the sham and mannitol groups. No difference was observed between the left and right kidneys from the sham and mannitol groups. Further, no distinction in serum creatinine and urea among the groups was observed. CONCLUSION: The use of mannitol significantly reduces nephron loss during warm ischemia in pigs.
Asunto(s)
Diuréticos Osmóticos/farmacología , Manitol/farmacología , Modelos Animales , Nefronas/efectos de los fármacos , Isquemia Tibia/métodos , Animales , Recuento de Células/métodos , Masculino , Nefronas/patología , Porcinos , Isquemia Tibia/efectos adversosRESUMEN
OBJECTIVE: To evaluate whether the pathophysiology of shock syndromes can be better understood by comparing central hemodynamics with kinetic data on fluid and electrolyte shifts. METHODS: We studied the dilutional hyponatremic shock that developed in response to overhydration with electrolyte-free irrigating fluid - the so-called 'transurethral resection syndrome' - by comparing cardiac output, arterial pressures, and volume kinetic parameters in 17 pigs that were administered 150 ml/kg of either 1.5% glycine or 5% mannitol by intravenous infusion over 90 minutes. RESULTS: Natriuresis appeared to be the key factor promoting hypovolemic hypotension 15-20 minutes after fluid administration ended. Excessive sodium excretion, due to osmotic diuresis caused by the irrigant solutes, was associated with high estimates of the elimination rate constant (k10) and low or negative estimates of the rate constant describing re-distribution of fluid to the plasma after translocation to the interstitium (k21). These characteristics indicated a high urinary flow rate and the development of peripheral edema at the expense of plasma volume and were correlated with reductions in cardiac output. The same general effects of natriuresis were observed for both irrigating solutions, although the volume of infused 1.5% glycine had a higher tendency to enter the intracellular fluid space. CONCLUSION: Comparisons between hemodynamics and fluid turnover showed a likely sequence of events that led to hypovolemia despite intravenous administration of large amounts of fluid.
Asunto(s)
Hemodinámica/fisiología , Hiponatremia/fisiopatología , Hipotensión/fisiopatología , Irrigación Terapéutica/efectos adversos , Resección Transuretral de la Próstata/efectos adversos , Animales , Gasto Cardíaco/efectos de los fármacos , Diuréticos Osmóticos/administración & dosificación , Electrólitos , Glicina/administración & dosificación , Glicinérgicos/administración & dosificación , Hiponatremia/etiología , Hipotensión/etiología , Hipovolemia/etiología , Hipovolemia/fisiopatología , Infusiones Intravenosas , Cinética , Manitol/administración & dosificación , Complicaciones Posoperatorias/fisiopatología , Porcinos , Síndrome , Factores de TiempoRESUMEN
OBJECTIVE: To evaluate whether the pathophysiology of shock syndromes can be better understood by comparing central hemodynamics with kinetic data on fluid and electrolyte shifts. METHODS: We studied the dilutional hyponatremic shock that developed in response to overhydration with electrolyte-free irrigating fluid - the so-called ‘transurethral resection syndrome' - by comparing cardiac output, arterial pressures, and volume kinetic parameters in 17 pigs that were administered 150 ml/kg of either 1.5% glycine or 5% mannitol by intravenous infusion over 90 minutes. RESULTS: Natriuresis appeared to be the key factor promoting hypovolemic hypotension 15-20 minutes after fluid administration ended. Excessive sodium excretion, due to osmotic diuresis caused by the irrigant solutes, was associated with high estimates of the elimination rate constant (k10) and low or negative estimates of the rate constant describing re-distribution of fluid to the plasma after translocation to the interstitium (k21). These characteristics indicated a high urinary flow rate and the development of peripheral edema at the expense of plasma volume and were correlated with reductions in cardiac output. The same general effects of natriuresis were observed for both irrigating solutions, although the volume of infused 1.5% glycine had a higher tendency to enter the intracellular fluid space. CONCLUSION: Comparisons between hemodynamics and fluid turnover showed a likely sequence of events that led to hypovolemia despite intravenous administration of large amounts of fluid. .
Asunto(s)
Animales , Hemodinámica/fisiología , Hiponatremia/fisiopatología , Hipotensión/fisiopatología , Irrigación Terapéutica/efectos adversos , Resección Transuretral de la Próstata/efectos adversos , Gasto Cardíaco/efectos de los fármacos , Diuréticos Osmóticos/administración & dosificación , Electrólitos , Glicinérgicos/administración & dosificación , Glicina/administración & dosificación , Hiponatremia/etiología , Hipotensión/etiología , Hipovolemia/etiología , Hipovolemia/fisiopatología , Infusiones Intravenosas , Cinética , Manitol/administración & dosificación , Complicaciones Posoperatorias/fisiopatología , Porcinos , Síndrome , Factores de TiempoRESUMEN
PURPOSE: To evaluate hemodynamic effects of mannitol infusion in patients with acute intracerebral hemorrhage. METHODS: Thirty patients with acute intracerebral hemorrhage were enrolled. Transcranial doppler was used to detect variables of bilateral middle cerebral arteria (MCA) including mean velocity (Vm) and pulsitility index (PI) before and after 125 ml and 250 ml mannitol infusion (0, 30, 60, 90, 120, 180, 240 min). RESULTS: When 125 ml or 250 ml mannitol was infused in patients with acute intracerebral hemorrhage, Vm of bilateral MCA elevated, and reached the top at 30 min, and then decreased. PI decreased in the affected MCA (250 ml) and in the unaffected MCA (125 ml and 250 ml). CONCLUSION: Mannitol infusion in patients with acute intracerebral hemorrhage can improve cerebral blood flow in bilateral hemispheres and decrease intracranial pressure in the hemorrhagic hemisphere (250 ml) and in the nonhemorrhagic hemisphere (125 ml and 250 ml).
Asunto(s)
Hemorragia Cerebral/terapia , Circulación Cerebrovascular/efectos de los fármacos , Diuréticos Osmóticos/administración & dosificación , Hemodinámica/efectos de los fármacos , Presión Intracraneal/efectos de los fármacos , Manitol/administración & dosificación , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Diuréticos Osmóticos/farmacología , Ecocardiografía Doppler de Pulso , Femenino , Humanos , Infusiones Intravenosas , Masculino , Manitol/farmacología , Persona de Mediana Edad , Arteria Cerebral Media/efectos de los fármacosRESUMEN
PURPOSE: To evaluate hemodynamic effects of mannitol infusion in patients with acute intracerebral hemorrhage. METHODS: Thirty patients with acute intracerebral hemorrhage were enrolled. Transcranial doppler was used to detect variables of bilateral middle cerebral arteria (MCA) including mean velocity (Vm) and pulsitility index (PI) before and after125ml and 250ml mannitol infusion (0, 30, 60, 90, 120, 180, 240 min). RESULTS: When 125ml or 250ml mannitol was infused in patients with acute intracerebral hemorrhage, Vm of bilateral MCA elevated, and reached the top at 30min, and then decreased. PI decreased in the affected MCA (250ml) and in the unaffected MCA (125ml and 250ml). CONCLUSION: Mannitol infusion in patients with acute intracerebral hemorrhage can improve cerebral blood flow in bilateral hemispheres and decrease intracranial pressure in the hemorrhagic hemisphere (250ml) and in the nonhemorrhagic hemisphere (125ml and 250ml).
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hemorragia Cerebral/terapia , Circulación Cerebrovascular/efectos de los fármacos , Diuréticos Osmóticos/administración & dosificación , Hemodinámica/efectos de los fármacos , Presión Intracraneal/efectos de los fármacos , Manitol/administración & dosificación , Enfermedad Aguda , Diuréticos Osmóticos/farmacología , Ecocardiografía Doppler de Pulso , Infusiones Intravenosas , Manitol/farmacología , Arteria Cerebral Media/efectos de los fármacosRESUMEN
BACKGROUND AND OBJECTIVES: Cerebral relaxation during intracranial surgery is necessary, and hiperosmolar therapy is one of the measures used to this end. Frequently, neurosurgical patients have sodium imbalances. The objective of the present study was to quantify and determine cerebral relaxation and duration of hydroelectrolytic changes secondary to the use of mannitol versus hypertonic isoncotic solution (HIS) during neurosurgery. METHODS: Cerebral relaxation and hydroelectrolytic changes were evaluated in 29 adult patients before de beginning of infusion, and 30 and 120 minutes after the infusion of equiosmolar loads of approximately 20% mannitol (250 mL) or HIS (120 mL). The volume of intravenous fluids infused and diuresis were recorded. A p < 0.05 was considered significant. RESULTS: A statistically significant difference in cerebral relaxation between both groups was not observed. Although several changes in electrolyte levels and acid-base balance with mannitol or HIS reached statistical significance only the reduction in plasma sodium 30 minutes after infusion of mannitol, mean of 6.42 ± 0.40 mEq.L(-1), and the increase in chloride, mean of 5.41 ± 0.96 mEq.L(-1) and 5.45 ± 1.45 mEq.L(-1) 30 and 120 minutes after infusion of HIS, caused a transitory dislocation of serum ion levels from normal range. The mannitol (20%) group had a significantly greater diuresis at both times studied compared with HIS group. CONCLUSIONS: A single dose of hypertonic isoncotic saline solution [7.2% NaCl/6% HES (200/0.5)] and mannitol (20%) with equivalent osmolar loads were effective and safe in producing cerebral relaxation during elective neurosurgical procedures under general anesthesia.
Asunto(s)
Anestesia , Encéfalo/cirugía , Craneotomía , Diuréticos Osmóticos/uso terapéutico , Soluciones Hipertónicas/uso terapéutico , Manitol/uso terapéutico , Equilibrio Hidroelectrolítico , Adulto , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Cystic fibrosis (CF) is characterised by impaired mucociliary clearance (MCC), chronic inflammation and infection, and progressively deteriorating lung function. Inhaled mannitol (Bronchitol) has been shown to increase MCC and cough clearance and FEV(1) in CF patients, contributing to better lung hygiene and consequently a slower decline in lung function. This study was designed to determine the dose relationship of mannitol treatment and improvement in FEV(1) and FVC as well as safety. METHODS: This was a randomised, open-label, crossover, dose response study. Following a 2-week treatment with mannitol 400mg b.i.d., 48 CF patients with a mean (SD) FEV(1) % predicted of 64 (13.2), received a further 3 treatments with 40mg, 120mg or 240mg b.i.d. for 2weeks each, in random order. RESULTS: The study demonstrated a dose dependent increase in FEV(1) and FVC. The 400mg dose showed the greatest improvement and the 40mg dose had no discernible effect. The mean percent change in FEV(1) was -1.57%, 3.61%, 3.87% and 8.75% respectively for the 40mg, 120mg, 240mg and 400mg treatments. There was a statistically significant change in FEV(1) for 400mg compared to 40mg (p<0.0001) but the difference with 120mg and 240mg did not reach significance. The mean % change in FVC was -0.90, 1.74, 3.07 and 8.14, for the 40mg, 120mg, 240mg and 400mg treatment arms, with p=0.0001, p=0.0037 and p=0.0304 respectively when compared to 400mg. The highest tested dose of 400mg had a similar safety profile to the other doses tested. The change in FEV(1) and FVC by dose in the paediatric age group (<18years) was similar to the results in the adult population. CONCLUSION: Based on these results the 400mg b.i.d. dose has been further studied in phase III trials.
Asunto(s)
Fibrosis Quística/diagnóstico , Fibrosis Quística/tratamiento farmacológico , Pulmón/efectos de los fármacos , Manitol , Depuración Mucociliar/efectos de los fármacos , Pruebas de Función Respiratoria , Administración por Inhalación , Adolescente , Adulto , Anciano , Espasmo Bronquial/inducido químicamente , Niño , Enfermedad Crónica , Fibrosis Quística/complicaciones , Fibrosis Quística/fisiopatología , Diuréticos Osmóticos/administración & dosificación , Diuréticos Osmóticos/efectos adversos , Relación Dosis-Respuesta a Droga , Monitoreo de Drogas , Reposicionamiento de Medicamentos , Inhaladores de Polvo Seco/efectos adversos , Femenino , Humanos , Pulmón/patología , Pulmón/fisiopatología , Masculino , Manitol/administración & dosificación , Manitol/efectos adversos , Persona de Mediana Edad , Neumonía/etiología , Resultado del TratamientoRESUMEN
We investigated the influence of captopril (an angiotensin converting enzyme inhibitor) treatment during pregnancy and lactation period on hydromineral balance of the male adult offspring, particularly, concerning thirst and sodium appetite. We did not observe significant alterations in basal hydromineral (water intake, 0.3M NaCl intake, volume and sodium urinary concentration) or cardiovascular parameters in adult male rats perinatally treated with captopril compared to controls. However, male offspring rats that perinatally exposed to captopril showed a significant attenuation in water intake induced by osmotic stimulation, extracellular dehydration and beta-adrenergic stimulation. Moreover, captopril treatment during perinatal period decreased the salt appetite induced by sodium depletion. This treatment also attenuated thirst and sodium appetite aroused during inhibition of peripheral angiotensin II generation raised by low concentration of captopril in the adult offspring. Interestingly, perinatal exposure to captopril did not alter water or salt intake induced by i.c.v. administration of angiotensin I or angiotensin II. These results showed that chronic inhibition of angiotensin converting enzyme during pregnancy and lactation modifies the regulation of induced thirst and sodium appetite in adulthood.
Asunto(s)
Apetito/fisiología , Peptidil-Dipeptidasa A/metabolismo , Cloruro de Sodio , Sed/fisiología , Agonistas Adrenérgicos beta/farmacología , Análisis de Varianza , Angiotensina I/farmacología , Angiotensina II/farmacología , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Animales , Animales Recién Nacidos , Apetito/efectos de los fármacos , Presión Sanguínea/efectos de los fármacos , Peso Corporal/efectos de los fármacos , Captopril/farmacología , Deshidratación/patología , Deshidratación/fisiopatología , Diuréticos Osmóticos/farmacología , Ingestión de Líquidos/efectos de los fármacos , Ingestión de Líquidos/fisiología , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Inyecciones Intraventriculares/métodos , Isoproterenol/farmacología , Riñón/citología , Riñón/efectos de los fármacos , Lactancia/efectos de los fármacos , Masculino , Embarazo , Resultado del Embarazo , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Efectos Tardíos de la Exposición Prenatal/patología , Efectos Tardíos de la Exposición Prenatal/fisiopatología , Ratas , Ratas Wistar , Cloruro de Sodio/orina , Sodio en la Dieta/farmacología , Sed/efectos de los fármacos , Factores de Tiempo , Equilibrio Hidroelectrolítico/efectos de los fármacosRESUMEN
Osmotically active solutions, particularly mannitol, havebeen used for more than 30 years in the treatment ofintracranial hypertension. Recently hypertonic saline hasemerged as an alternative to mannitol. Both solutions areused worldwide, and their indications and long-term sideeffects are well known. More recently, knowledge abouttheir effects has increased, both limiting and expandingtheir clinical use. Here, we compare the systemic andcerebral effects of mannitol and hypertonic saline, as well astheir side effects and complications. Finally, we makerecommendations about their clinical use.
Asunto(s)
Diuréticos Osmóticos/uso terapéutico , Hipertensión Intracraneal/prevención & control , Manitol/uso terapéutico , Solución Salina Hipertónica/uso terapéutico , Barrera Hematoencefálica/efectos de los fármacos , Gasto Cardíaco , Cuidados Críticos , Humanos , Hipertensión Intracraneal/inducido químicamente , Microcirculación , Concentración OsmolarRESUMEN
PURPOSE: Colonoscopy plays an essential role in the therapeutic and diagnostic approach in various colonic pathologies, the aim of the present study was to compare three solutions and their efficacy for the bowel preparation in adult patients submitted to elective colonoscopy. METHODS: Sixty patients were randomly divided into three groups of 20 each. Each group was submitted to a bowel preparation with one of the following solutions: 10% manitol, sodium picosulphate or sodium phosphate. The parameters evaluated were: taste, tolerance, associated side effects and quality of cleansing. Postural blood pressure and pulse rate as well as serum sodium, potassium, calcium and phosphate were compared. RESULTS: Sodium phosphate and 10% manitol solutions provided superior results in terms of colon cleansing compared to sodium picosulphate solution. All serum electrolytes evaluated were significantly altered in the three groups, without important clinical signs. DISCUSSION: High levels of serum phosphate were the most striking alteration in patients prepared with sodium phosphate solution, again with no clinical signs. Variations related to blood pressure and pulse rate suggested contraction of intravascular volume, with no clinical effects. CONCLUSION: Sodium phosphate and 10% manitol solutions are equivalent in providing good quality colon cleansing, with no significant side effects that could compromise the procedure.
Asunto(s)
Catárticos/uso terapéutico , Colonoscopía/métodos , Manitol/uso terapéutico , Fosfatos/uso terapéutico , Picolinas/uso terapéutico , Cuidados Preoperatorios/normas , Adulto , Citratos , Diuréticos Osmóticos/uso terapéutico , Humanos , Compuestos Organometálicos , Cuidados Preoperatorios/métodos , Soluciones/uso terapéutico , Resultado del TratamientoRESUMEN
Postdiarrhea hemolytic uremic syndrome (HUS) is the most common cause of acute renal failure in children in Argentina. It is well established that Shiga toxin type 2 (Stx2) causes direct damage to glomerular endothelial cells and tubular epithelial cells, leading to a reduction in the water handling capacity of the kidney. In this study, we demonstrate that Stx2 and its B subunit (Stx2B) were able to inhibit water absorption across human renal tubular epithelial cell (HRTEC) monolayers without altering the short circuit current and the (3)H-mannitol permeability. Quantitative evaluation of (14)C-inulin transport across HRTEC monolayers showed a similar transport rate both before and after HRTEC treatment with Stx2 that confirmed the integrity of the paracellular pathway. Furthermore, Stx2 produced significant protein synthesis inhibition of HRTEC at concentrations as low as 0.001 ng/ml and 1 h of incubation, whereas Stx2B did not modify it at concentrations as high as 10,000 ng/ml and 6 h of incubation. Our findings suggest that whereas the action of Stx2 appears to be caused mainly by the inhibition of protein synthesis mediated by the A subunit, the binding of Stx2B subunit to the Gb3 receptor may affect the membrane mechanisms related to water absorption. We speculate that inhibition of water absorption may occur in proximal tubular cells in vivo in response to Stx2 and may contribute to the early event of HUS pathogenesis.
Asunto(s)
Lesión Renal Aguda/metabolismo , Células Epiteliales/metabolismo , Síndrome Hemolítico-Urémico/metabolismo , Túbulos Renales Proximales/metabolismo , Toxina Shiga II/farmacología , Agua/metabolismo , Lesión Renal Aguda/patología , Adulto , Apoptosis/efectos de los fármacos , Apoptosis/fisiología , Radioisótopos de Carbono , Supervivencia Celular/efectos de los fármacos , Supervivencia Celular/fisiología , Células Cultivadas , Cámaras de Difusión de Cultivos , Diuréticos Osmóticos/farmacología , Conductividad Eléctrica , Células Epiteliales/citología , Células Epiteliales/efectos de los fármacos , Síndrome Hemolítico-Urémico/patología , Humanos , Inulina/farmacocinética , Túbulos Renales Proximales/citología , Túbulos Renales Proximales/efectos de los fármacos , Manitol/farmacología , TritioRESUMEN
PURPOSE: Colonoscopy plays an essential role in the therapeutic and diagnostic approach in various colonic pathologies, the aim of the present study was to compare three solutions and their efficacy for the bowel preparation in adult patients submitted to elective colonoscopy. METHODS: Sixty patients were randomly divided into three groups of 20 each. Each group was submitted to a bowel preparation with one of the following solutions: 10 percent manitol, sodium picosulphate or sodium phosphate. The parameters evaluated were: taste, tolerance, associated side effects and quality of cleansing. Postural blood pressure and pulse rate as well as serum sodium, potassium, calcium and phosphate were compared. RESULTS: Sodium phosphate and 10 percent manitol solutions provided superior results in terms of colon cleansing compared to sodium picosulphate solution. All serum electrolytes evaluated were significantly altered in the three groups, without important clinical signs. DISCUSSION: High levels of serum phosphate were the most striking alteration in patients prepared with sodium phosphate solution, again with no clinical signs. Variations related to blood pressure and pulse rate suggested contraction of intravascular volume, with no clinical effects. CONCLUSION: Sodium phosphate and 10 percent manitol solutions are equivalent in providing good quality colon cleansing, with no significant side effects that could compromise the procedure.(AU)
INTRODUÇÃO: A colonoscopia é exame fundamental na avaliação das doenças do cólon e na abordagem terapêutica de determinado grupo de patologias. O preparo intestinal é obrigatório para a realização das colonoscopias eletivas, e a qualidade encontra-se relacionada ao sucesso do procedimento. Comparou-se três soluções para limpeza anterógrada do cólon em pacientes adultos, submetidos à colonoscopia. METODOS: Sessenta pacientes foram distribuídos em três grupos de vinte. Cada grupo realizou o preparo do cólon com uma das três soluções estudadas: manitol a 10 por cento (MN), picossulfato sódico (PS) e fosfato monobásico e dibásico de sódio (NaP). O sabor, a tolerância, os efeitos colaterais, os custos e a qualidade de limpeza do preparo foram avaliados. Frequência cardíaca e pressão arterial sistêmica foram analisados. Variações dos eletrólitos foram dosados antes e após o preparo. RESULTADOS: Os resultados foram semelhantes em relação aos efeitos colaterais. O sabor da solução de NaP não chegou a comprometer a sua aceitação. DISCUSSÃO: Soluções de NaP e MN proporcionaram resultados superiores tanto em qualidade de limpeza colônica, como em relação aos custos, quando comparadas à solução de PS. CONCLUSÃO: Comparados os três, os eletrólitos avaliados apresentaram diferenças significativas, sendo a hiperfosfatemia dos pacientes com a solução de NaP, a mais importante.(AU)
Asunto(s)
Humanos , Adulto , Catárticos/uso terapéutico , Colonoscopía/métodos , Manitol/uso terapéutico , Fosfatos/uso terapéutico , Picolinas/uso terapéutico , Cuidados Preoperatorios/normas , Diuréticos Osmóticos/uso terapéutico , Cuidados Preoperatorios/métodos , Soluciones/uso terapéutico , Resultado del TratamientoRESUMEN
PURPOSE: Colonoscopy plays an essential role in the therapeutic and diagnostic approach in various colonic pathologies, the aim of the present study was to compare three solutions and their efficacy for the bowel preparation in adult patients submitted to elective colonoscopy. METHODS: Sixty patients were randomly divided into three groups of 20 each. Each group was submitted to a bowel preparation with one of the following solutions: 10 percent manitol, sodium picosulphate or sodium phosphate. The parameters evaluated were: taste, tolerance, associated side effects and quality of cleansing. Postural blood pressure and pulse rate as well as serum sodium, potassium, calcium and phosphate were compared. RESULTS: Sodium phosphate and 10 percent manitol solutions provided superior results in terms of colon cleansing compared to sodium picosulphate solution. All serum electrolytes evaluated were significantly altered in the three groups, without important clinical signs. DISCUSSION: High levels of serum phosphate were the most striking alteration in patients prepared with sodium phosphate solution, again with no clinical signs. Variations related to blood pressure and pulse rate suggested contraction of intravascular volume, with no clinical effects. CONCLUSION: Sodium phosphate and 10 percent manitol solutions are equivalent in providing good quality colon cleansing, with no significant side effects that could compromise the procedure.
INTRODUÇÃO: A colonoscopia é exame fundamental na avaliação das doenças do cólon e na abordagem terapêutica de determinado grupo de patologias. O preparo intestinal é obrigatório para a realização das colonoscopias eletivas, e a qualidade encontra-se relacionada ao sucesso do procedimento. Comparou-se três soluções para limpeza anterógrada do cólon em pacientes adultos, submetidos à colonoscopia. METODOS: Sessenta pacientes foram distribuídos em três grupos de vinte. Cada grupo realizou o preparo do cólon com uma das três soluções estudadas: manitol a 10 por cento (MN), picossulfato sódico (PS) e fosfato monobásico e dibásico de sódio (NaP). O sabor, a tolerância, os efeitos colaterais, os custos e a qualidade de limpeza do preparo foram avaliados. Frequência cardíaca e pressão arterial sistêmica foram analisados. Variações dos eletrólitos foram dosados antes e após o preparo. RESULTADOS: Os resultados foram semelhantes em relação aos efeitos colaterais. O sabor da solução de NaP não chegou a comprometer a sua aceitação. DISCUSSÃO: Soluções de NaP e MN proporcionaram resultados superiores tanto em qualidade de limpeza colônica, como em relação aos custos, quando comparadas à solução de PS. CONCLUSÃO: Comparados os três, os eletrólitos avaliados apresentaram diferenças significativas, sendo a hiperfosfatemia dos pacientes com a solução de NaP, a mais importante.
Asunto(s)
Adulto , Humanos , Catárticos/uso terapéutico , Colonoscopía/métodos , Manitol/uso terapéutico , Fosfatos/uso terapéutico , Picolinas/uso terapéutico , Cuidados Preoperatorios/normas , Diuréticos Osmóticos/uso terapéutico , Cuidados Preoperatorios/métodos , Soluciones/uso terapéutico , Resultado del TratamientoRESUMEN
We present the first known complication of forearm compartment syndrome after mannitol infusion during partial nephrectomy. We stress the importance of excellent intravenous catheter access and constant visual monitoring of the intravenous catheter site during and after mannitol infusion as ways to prevent this complication. Prompt recognition of compartment syndrome with appropriate intervention can prevent long-term sequelae.
Asunto(s)
Síndromes Compartimentales/etiología , Diuréticos Osmóticos/efectos adversos , Extravasación de Materiales Terapéuticos y Diagnósticos/complicaciones , Antebrazo/irrigación sanguínea , Manitol/efectos adversos , Nefrectomía/efectos adversos , Adulto , Síndromes Compartimentales/cirugía , Femenino , Antebrazo/cirugía , HumanosRESUMEN
We present the first known complication of forearm compartment syndrome after mannitol infusion during partial nephrectomy. We stress the importance of excellent intravenous catheter access and constant visual monitoring of the intravenous catheter site during and after mannitol infusion as ways to prevent this complication. Prompt recognition of compartment syndrome with appropriate intervention can prevent long-term sequelae.
Asunto(s)
Humanos , Femenino , Adulto , Síndromes Compartimentales/etiología , Extravasación de Materiales Terapéuticos y Diagnósticos/complicaciones , Antebrazo/irrigación sanguínea , Manitol/efectos adversos , Síndromes Compartimentales/cirugía , Diuréticos Osmóticos/efectos adversos , Antebrazo/cirugía , Nefrectomía/efectos adversosRESUMEN
BACKGROUND: Continuous infusion of short life vasodilators are employed to test reversibility of pulmonary hypertension in cardiac transplant candidates. Sublingual isosorbide administration has not been described in the literature and it might be a simpler alternative. AIM: To evaluate sublingual isosorbide administration as a test of reversibility of pulmonary hypertension in heart failure. PATIENTS AND METHODS: Prospective evaluation of patients referred for cardiac transplant evaluation. Patients underwent right catheterization for hemodynamic measurements at baseline and after repeated doses of 5 mg sublingual isosorbide every 5 minutes until observing a decrease in pulmonary vascular resistance decrease or symptomatic hypotension. RESULTS: Twenty one patients, 18 men, age 49+/-15 years, were studied. Fourteen (66%) were transplanted. The mean sublingual isosorbide dose was 15+/-5 mg. After isosorbide administration, there was a significant decrease in mean arterial pressure (80+/-8.5 to 71+/-6.6 mmHg, p <0.0001), mean pulmonary artery pressure (38+/-11 to 26+/-7.8 mmHg, p <0.0001), systemic vascular resistance (1540+/-376 to 1277+/-332 dyn*s/cm5 p <0.001), pulmonary vascular resistance (3.5+/-2.2 to 2,5+/-1.6 Wood Units, p <0.05) and transpulmonary gradient (13+/-7 a 10+/-4 mmHg, p <0.004). The cardiac output increased from 3.96+/-0.7 to 4.38+/-0.9 L/min, p=0.05. The relation between pulmonary and systemic vascular resistance before and after isosorbide was 0.17 and 0.15, respectively (p=0.04). One transplanted patient with partial reversibility of pulmonary hypertension developed acute right heart failure. CONCLUSIONS: Sublingual isosorbide administration is useful and well tolerated to evaluate the reversibility of pulmonary hypertension prior cardiac transplant.
Asunto(s)
Gasto Cardíaco Bajo/cirugía , Diuréticos Osmóticos/administración & dosificación , Trasplante de Corazón , Hipertensión Pulmonar/tratamiento farmacológico , Isosorbida/administración & dosificación , Vasodilatadores/administración & dosificación , Administración Sublingual , Cateterismo Cardíaco , Gasto Cardíaco Bajo/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Background: Continuous infusion of short life vasodilators are employed to test reversibility of pulmonary hypertension in cardiac transplant candidates. Sublingual isosorbide administration has not been described in the literature and it might be a simpler alternative. Aim: To evaluate sublingual isosorbide administration as a test of reversibility of pulmonary hypertension in heart failure. Patients and Methods: Prospective evaluation of patients referred for cardiac transplant evaluation. Patients underwent right catheterization for hemodynamic measurements at baseline and after repeated doses of 5 mg sublingual isosorbide every 5 minutes until observing a decrease in pulmonary vascular resistance decrease or symptomatic hypotension. Results: Twenty one patients, 18 men, age 49±15 years, were studied. Fourteen (66%) were transplanted. The mean sublingual isosorbide dose was 15±5 mg. After isosorbide administration, there was a significant decrease in mean arterial pressure (80±8.5 to 71±6.6 mmHg, p <0.0001), mean pulmonary artery pressure (38±11 to 26±7.8 mmHg, p <0.0001), systemic vascular resistance (1540±376 to 1277±332 dyn*s/cm5 p <0.001), pulmonary vascular resistance (3.5±2.2 to 2,5±1.6 Wood Units, p <0.05) and transpulmonary gradient (13±7 a 10±4 mmHg, p <0.004). The cardiac output increased from 3.96±0.7 to 4.38±0.9 L/min, p=0.05. The relation between pulmonary and systemic vascular resistance before and after isosorbide was 0.17 and 0.15, respectively (p=0.04). One transplanted patient with partial reversibility of pulmonary hypertension developed acute right heart failure. Conclusions: Sublingual isosorbide administration is useful and well tolerated to evaluate the reversibility of pulmonary hypertension prior cardiac transplant.