RESUMEN
BACKGROUND: Kounis syndrome is defined as the concurrence of acute coronary syndromes in the setting of allergic or anaphylactic reactions. It primarily affects men aged 40-70 years and is often associated with chest pain. This syndrome is often unrecognized and undiagnosed in clinical practice due to a low level of awareness. Herein, we present a case of type I Kounis syndrome in a young woman without chest pain. CASE PRESENTATION: A 28-year-old Japanese woman with a history of atopic dermatitis received a glycyrrhizin, glutathione, and neurotropin preparation (a preparation of inflamed skin extract from rabbits inoculated with vaccinia virus) at a dermatology clinic to treat pruritus caused by atopic dermatitis. Immediately after the administration, the patient developed abdominal pain and generalized body wheals. The patient was diagnosed with anaphylaxis and was transported to our hospital. She had no chest pain on arrival at our hospital; however, a 12-lead electrocardiogram showed ST elevation in leads I, aVL, V2, and V3, and an echocardiogram showed decreased wall motion in the anterior and lateral walls of the left ventricle. Sublingual nitroglycerin administration improved ST-segment elevation and left ventricular wall motion abnormalities. The patient underwent emergency coronary angiography, which revealed no significant stenosis, and was diagnosed with type I Kounis syndrome. CONCLUSION: Kounis syndrome without chest pain is rare in young women. Since it can be fatal in cases with severe allergic symptoms such as anaphylaxis, the possibility of concurrent acute coronary syndrome should be considered when treating systemic allergic reactions, regardless of age, sex, or the presence or absence of chest symptoms.
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Síndrome de Kounis , Femenino , Humanos , Síndrome de Kounis/diagnóstico , Síndrome de Kounis/etiología , Síndrome de Kounis/fisiopatología , Síndrome de Kounis/tratamiento farmacológico , Adulto , Angiografía Coronaria , Resultado del Tratamiento , Electrocardiografía , Vasodilatadores/administración & dosificación , Nitroglicerina/administración & dosificación , Anafilaxia/diagnóstico , Anafilaxia/inducido químicamente , Anafilaxia/tratamiento farmacológico , Administración SublingualRESUMEN
Iatrogenic acute limb ischaemia (ALI) in neonates is a rare but severe event with potentially deleterious outcomes. In the neonatal intensive care unit, this risk is increased due to the high rate of catheterisation procedures. ALI management includes pharmacological and non-pharmacological interventions, but no commonly accepted clinical guidelines are available. In the present case, a peripheral catheter was erroneously placed in the left brachial artery of a term infant, causing blockage and ischaemia in the limb. The catheter was immediately removed, the affected limb was elevated and warm compresses were applied to the contralateral limb. The patient was treated with fresh frozen plasma, heparin, iloprost and topical nitroglycerin. Three nerve block procedures were also performed. At 6-8 days of age, significant improvement was observed. The patient was discharged at 17 days of age with near-complete resolution, whereas complete resolution was observed at postdischarge follow-up.
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Enfermedad Iatrogénica , Isquemia , Humanos , Recién Nacido , Isquemia/etiología , Isquemia/terapia , Cateterismo Periférico/efectos adversos , Arteria Braquial/diagnóstico por imagen , Heparina/administración & dosificación , Heparina/uso terapéutico , Masculino , Nitroglicerina/administración & dosificación , Nitroglicerina/uso terapéutico , Femenino , Vasodilatadores/uso terapéutico , Vasodilatadores/administración & dosificación , Iloprost/administración & dosificación , Iloprost/uso terapéutico , Enfermedad Aguda , Bloqueo Nervioso/métodosRESUMEN
BACKGROUND: Nitroglycerin has been of considerable interest as a treatment for ischaemic stroke. Recent clinical trials with nitroglycerin transdermal patches during the acute phase of stroke failed to improve functional outcomes. Systematic review and meta-analysis of the effectiveness of nitroglycerin in preclinical models of ischaemic stroke has not previously been reported, despite several clinical trials. OBJECTIVE: To conduct a systematic review and meta-analysis of preclinical evidence regarding the effect of nitroglycerin on infarct volume in animal models of ischaemic stroke. SUMMARY OF REVIEW: The protocol was registered in PROSPERO (CRD42023432644). Our search identified 238 publications. Three publications met inclusion criteria (including 10 comparisons of infarct size). Study quality was modest (median 6 out of 9), with no evidence of publication bias. Nitroglycerin did not significantly reduce infarct volume (NMD point estimate 20.2 % reduction, 95 % CI -1.52-52.7 %, p = 0.068). Subgroup analysis suggested greater efficacy of nitroglycerin with direct intracarotid administration to the ischaemic territory at the time of reperfusion. CONCLUSIONS: A small number of studies (three) were included in this review. Overall, nitroglycerin did not reduce infarct volume in experimental stroke models. However, nitroglycerin may be of benefit when administered directly into the ischaemic territory. Given nitroglycerin's short half-life, we propose this route may minimise harmful reduction of cerebral perfusion pressure resulting from hypotension following systemic administration.
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Isquemia Encefálica , Nitroglicerina , Nitroglicerina/administración & dosificación , Nitroglicerina/farmacología , Nitroglicerina/uso terapéutico , Animales , Isquemia Encefálica/tratamiento farmacológico , Vasodilatadores/uso terapéutico , Vasodilatadores/farmacología , Vasodilatadores/administración & dosificación , Modelos Animales de EnfermedadRESUMEN
AIMS: The study evaluated the positivity rate, haemodynamic responses, and prognosis in terms of syncopal recurrence among patients with situational syncope (SS) stratified according to the underlying situational triggers. METHODS AND RESULTS: We retrospectively evaluated all consecutive patients with SS who underwent nitroglycerine (NTG)-potentiated head-up tilt test (HUTT) at Syncope Unit of the University of Campania 'Luigi Vanvitelli'-Monaldi Hospital from 1 March 2017 to 1 May 2023. All patients were followed for at least one year. The study population was divided according to the underlying triggers (micturition, swallow, defaecation, cough/sneeze, post-exercise). Two hundred thirty-six SS patients (mean age 50 ± 19.3 years; male 63.1%) were enrolled; among them, the situational trigger was micturition in 109 patients (46.2%); swallow in 32 (13.6%) patients; defaecation in 35 (14.8%) patients; post-exercise in 41 (17.4%) patients; and cough/sneeze in 17 (7.2%) patients. There were no significant differences in baseline clinical characteristics and HUTT responses between different situational triggers. The Kaplan-Meier analysis did not show a statistically different rate of syncope recurrence across patients stratified by baseline situational triggers (log-rank P = 0.21). CONCLUSION: Situational syncope appears to be a homogenous syndrome, and different triggers do not impact the HUTT response or syncope recurrence at 1 year.
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Recurrencia , Síncope , Pruebas de Mesa Inclinada , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Síncope/fisiopatología , Síncope/diagnóstico , Síncope/etiología , Pronóstico , Anciano , Adulto , Tos/fisiopatología , Tos/diagnóstico , Deglución , Nitroglicerina/administración & dosificación , Valor Predictivo de las Pruebas , Hemodinámica , Factores de RiesgoRESUMEN
BACKGROUND: Migraine is a neurological disorder characterized by complex, widespread, and sudden attacks with an unclear pathogenesis, particularly in chronic migraine (CM). Specific brain regions, including the insula, amygdala, thalamus, and cingulate, medial prefrontal, and anterior cingulate cortex, are commonly activated by pain stimuli in patients with CM and animal models. This study employs fluorescence microscopy optical sectioning tomography (fMOST) technology and AAV-PHP.eB whole-brain expression to map activation patterns of brain regions in CM mice, thus enhancing the understanding of CM pathogenesis and suggesting potential treatment targets. METHODS: By repeatedly administering nitroglycerin (NTG) to induce migraine-like pain in mice, a chronic migraine model (CMM) was established. Olcegepant (OLC) was then used as treatment and its effects on mechanical pain hypersensitivity and brain region activation were observed. All mice underwent mechanical withdrawal threshold, light-aversive, and elevated plus maze tests. Viral injections were administered to the mice one month prior to modelling, and brain samples were collected 2 h after the final NTG/vehicle control injection for whole-brain imaging using fMOST. RESULTS: In the NTG-induced CMM, mechanical pain threshold decreased, photophobia, and anxiety-like behavior were observed, and OLC was found to improve these manifestations. fMOST whole-brain imaging results suggest that the isocortex-cerebral cortex plate region, including somatomotor areas (MO), somatosensory areas (SS), and main olfactory bulb (MOB), appears to be the most sensitive area of activation in CM (P < 0.05). Other brain regions such as the inferior colliculus (IC) and intermediate reticular nucleus (IRN) were also exhibited significant activation (P < 0.05). The improvement in migraine-like symptoms observed with OLC treatment may be related to its effects on these brain regions, particularly SS, MO, ansiform lobule (AN), IC, spinal nucleus of the trigeminal, caudal part (Sp5c), IRN, and parvicellular reticular nucleus (PARN) (P < 0.05). CONCLUSIONS: fMOST whole-brain imaging reveals c-Fos + cells in numerous brain regions. OLC improves migraine-like symptoms by modulating brain activity in some brain regions. This study demonstrates the activation of the specific brain areas in NTG-induced CMM and suggests some regions as a potential treatment mechanism according to OLC.
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Encéfalo , Modelos Animales de Enfermedad , Trastornos Migrañosos , Nitroglicerina , Animales , Nitroglicerina/toxicidad , Nitroglicerina/farmacología , Nitroglicerina/administración & dosificación , Trastornos Migrañosos/inducido químicamente , Trastornos Migrañosos/diagnóstico por imagen , Trastornos Migrañosos/metabolismo , Trastornos Migrañosos/tratamiento farmacológico , Ratones , Encéfalo/diagnóstico por imagen , Encéfalo/efectos de los fármacos , Encéfalo/metabolismo , Masculino , Proteínas Proto-Oncogénicas c-fos/metabolismo , Ratones Endogámicos C57BL , Mapeo Encefálico , Vasodilatadores/farmacología , Vasodilatadores/administración & dosificación , Umbral del Dolor/efectos de los fármacosRESUMEN
OBJECTIVES: To investigate if daily treatment with glyceryl trinitrate (GTN) ointment, over 24 weeks combined with a 12-week eccentric exercise programme is more effective for chronic mid-portion Achilles tendinopathy than placebo ointment and eccentric exercise. METHODS: This was a single-site randomised double-blind placebo-controlled trial at an acute hospital, Dublin, Ireland. Patients with chronic mid-portion Achilles tendinopathy were randomised to either 24 weeks of daily GTN ointment or placebo ointment. Both groups received an identical 12-week eccentric exercise programme. The primary outcome measure was the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire at 24 weeks, which measures pain, function and activity. Secondary outcomes included pain severity, self-reported physical function, calf muscle function, pressure pain thresholds and ultrasound changes. Statistical analyses were performed according to intention-to-treat principles. RESULTS: 76 patients (30 women; 46 men, mean age±SD, 45.6±8.2 years) were recruited for the trial. Significant improvements in VISA-A scores occurred in both groups at 6-week, 12-week and 24-week follow-up. The increase was not significantly different between groups, adjusted mean between-group difference from baseline to week 6, -1.33 (95% CI -6.96 to 4.31); week 12, -1.25 (95% CI -8.0 to 5.49) and week 24, -3.8 (95% CI -10.6 to 3.0); negative values favour GTN. There was no significant between-group difference in any of the secondary outcome measures at 6, 12 and 24 weeks. CONCLUSIONS: Adding daily GTN ointment over 24 weeks to a 12-week eccentric exercise programme did not improve pain, function and activity level in patients with chronic mid-portion Achilles tendinopathy when compared with placebo ointment.
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Tendón Calcáneo , Terapia por Ejercicio , Nitroglicerina , Pomadas , Tendinopatía , Humanos , Nitroglicerina/administración & dosificación , Masculino , Femenino , Tendinopatía/terapia , Tendinopatía/tratamiento farmacológico , Método Doble Ciego , Persona de Mediana Edad , Adulto , Resultado del Tratamiento , Terapia por Ejercicio/métodos , Terapia Combinada , Vasodilatadores/administración & dosificación , Dimensión del DolorRESUMEN
BACKGROUND: Nocturnal hemodialysis (nHD) restores the attenuated brachial artery vasodilator responsiveness of patients receiving conventional intermittent hemodialysis (iHD). Its impact on coronary vasodilatation is unknown. METHODS: We evaluated 25 patients on hemodialysis who fulfilled transplant criteria: 15 on iHD (4-hour sessions, 3 d/wk) and 10 on nHD (≈40 h/wk over 8-10-hour sessions) plus 6 control participants. Following diagnostic angiography, left anterior descending (LAD) coronary flow reserve and mean luminal diameter were quantified at baseline and during sequential intracoronary administration of adenosine (infusion and bolus), nitroglycerin (bolus), acetylcholine (infusion), acetylcholine coinfused with vitamin C, and, finally, sublingual nitroglycerin. RESULTS: Coronary flow reserve in those receiving nHD was augmented relative to iHD (3.28±0.26 versus 2.17±0.12 [mean±SEM]; P<0.03) but attenuated, relative to controls (4.80±0.63; P=0.011). Luminal dilatations induced by intracoronary adenosine and nitroglycerin were similar in nHD and controls but blunted in the iHD cohort (P<0.05 versus both). ACh elicited vasodilatation in controls but constriction in both dialysis groups (both P<0.05, versus control); vitamin C coinfusion had no effect. Sublingual nitroglycerin increased mid-left anterior descending diameter and reduced mean arterial pressure in controls (+15.2±2.68%; -16.00±1.60%) and in nHD recipients (+14.78±5.46%; -15.82±1.32%); iHD responses were markedly attenuated (+1.9±0.86%; -5.89±1.41%; P<0.05, all comparisons). CONCLUSIONS: Coronary and systemic vasodilator responsiveness to both adenosine and nitroglycerin is augmented in patients receiving nHD relative to those receiving iHD, whereas vasoconstrictor responsiveness to acetylcholine does not differ. By improving coronary conduit and microvascular function, nHD may reduce the cardiovascular risk of patients on dialysis.
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Nitroglicerina , Diálisis Renal , Vasodilatación , Vasodilatadores , Humanos , Femenino , Masculino , Diálisis Renal/métodos , Persona de Mediana Edad , Vasodilatadores/administración & dosificación , Vasodilatadores/farmacología , Vasodilatación/efectos de los fármacos , Vasodilatación/fisiología , Nitroglicerina/farmacología , Nitroglicerina/administración & dosificación , Anciano , Circulación Coronaria/efectos de los fármacos , Circulación Coronaria/fisiología , Acetilcolina/farmacología , Acetilcolina/administración & dosificación , Fallo Renal Crónico/terapia , Fallo Renal Crónico/fisiopatología , Arteria Braquial/efectos de los fármacos , Arteria Braquial/fisiopatología , Adenosina/administración & dosificación , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/fisiopatología , Vasos Coronarios/efectos de los fármacos , Angiografía CoronariaRESUMEN
BACKGROUND: Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP), with an incidence of approximately 9.7% according to some literature reviews. Recent clinical guidelines propose that glyceryl trinitrate (GTN) can reduce the incidence of post-ERCP pancreatitis (PEP). However, currently, no guidelines provide an exact opinion on GTN and nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent post-ERCP pancreatitis. OBJECTIVE: A meta-analysis was performed of published, full-length, randomized controlled trials (RCTs) evaluating the effects of prophylactic use of GTN, including GTN alone or GTN in combination with NSAIDs, on the prevention of PEP. METHODS: Literature searches were conducted using PubMed, Embase, Web of Science, and The Cochrane Library. Search terms included "endoscopic retrograde cholangiopancreatography" OR "ERCP," "OR 'PEP' OR 'post-endoscopic retrograde cholangiopancreatography pancreatitis', pancreatitis," "GTN" OR "glyceryl trinitrate" OR "nitroglycerin," "NSAIDs" OR "Nonsteroidal Anti-inflammatory Drugs" and limited to RCT. RESULTS: A total of 10 RCTs comprising 3240 patients undergoing ERCP were included. Meta-analysis revealed that the administration of GTN was associated with a significant reduction in the overall incidence of PEP. Moreover, PEP incidence was significantly lower in the GTN combined with the NSAIDs group than in the GTN alone group. GTN alone or GTN combined with NSAIDs may not reduce the severity of PEP (risk ratioâ =â 0.64; 95% confidence interval: 0.41-0.99; Pâ =â .04). The difference in incidence between the 2 groups is 1.01% (6/594) in the GTN with NSAIDs group and 2.36% (14/592) in the placebo group. CONCLUSION: GTN has a significant benefit in preventing postoperative ERCP pancreatitis (Pâ <â .001). And neither GTN nor GTN plus NSAIDs reduces the incidence of non-mild ERCP postoperative pancreatitis. These conclusions need to be confirmed by high-quality randomized controlled studies with multicenter, large samples, and long-term follow-up.
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Antiinflamatorios no Esteroideos , Colangiopancreatografia Retrógrada Endoscópica , Quimioterapia Combinada , Nitroglicerina , Pancreatitis , Ensayos Clínicos Controlados Aleatorios como Asunto , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Humanos , Antiinflamatorios no Esteroideos/uso terapéutico , Antiinflamatorios no Esteroideos/administración & dosificación , Nitroglicerina/uso terapéutico , Nitroglicerina/administración & dosificación , Pancreatitis/prevención & control , Pancreatitis/etiología , Vasodilatadores/uso terapéutico , Vasodilatadores/administración & dosificaciónRESUMEN
BACKGROUND: Conventional anesthesia used to reduce central venous pressure (CVP) during hepatectomy includes fluid restriction and vasodilator drugs, which can lead to a reduction in blood perfusion in vital organs and may counteract the benefits of low blood loss. In this study, we hypothesized that milrinone is feasible and effective in controlling low CVP (LCVP) during laparoscopic hepatectomy (LH). Compared with conventional anesthesia such as nitroglycerin, milrinone is beneficial in terms of intraoperative blood loss, surgical environment, hemodynamic stability, and patients' recovery. METHODS: In total, 68 patients undergoing LH under LCVP were randomly divided into the milrinone group (n = 34) and the nitroglycerin group (n = 34). Milrinone was infused with a loading dose of 10 µg/kg followed by a maintenance dose of 0.2-0.5 µg/kg/min and nitroglycerin was administered at a rate of 0.2-0.5 µg/kg/min until the liver lesions were removed. The characteristics of patients, surgery, intraoperative vital signs, blood loss, the condition of the surgical field, the dosage of norepinephrine, perioperative laboratory data, and postoperative complications were compared between groups. Blood loss during LH was considered the primary outcome. RESULTS: Blood loss during hepatectomy and total blood loss were significantly lower in the milrinone group compared with those in the nitroglycerin group (P < 0.05). Both the nitroglycerin group and milrinone group exerted similar CVP (P > 0.05). Nevertheless, the milrinone group had better surgical field grading during liver resection (P < 0.05) and also exhibited higher cardiac index and cardiac output during the surgery (P < 0.05). Significant differences were also found in terms of fluids administered during hepatectomy, urine volume during hepatectomy, total urine volume, and norepinephrine dosage used in the surgery between the two groups. The two groups showed a similar incidence of postoperative complications (P > 0.05). CONCLUSION: Our findings indicate that the intraoperative infusion of milrinone can help in maintaining an LCVP and hemodynamic stability during LH while reducing intraoperative blood loss and providing a better surgical field compared with nitroglycerin. TRIAL REGISTRATION: ChiCTR2200056891,first registered on 22/02/2022.
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Pérdida de Sangre Quirúrgica , Presión Venosa Central , Hepatectomía , Laparoscopía , Milrinona , Nitroglicerina , Vasodilatadores , Humanos , Milrinona/administración & dosificación , Nitroglicerina/administración & dosificación , Hepatectomía/métodos , Masculino , Femenino , Método Doble Ciego , Laparoscopía/métodos , Persona de Mediana Edad , Presión Venosa Central/efectos de los fármacos , Vasodilatadores/administración & dosificación , Pérdida de Sangre Quirúrgica/prevención & control , Anciano , Adulto , Complicaciones Posoperatorias/prevención & controlRESUMEN
Objectives: To compare the outcome of botulinum toxin injection with and without glyceryl trinitrate with respect to postoperative pain and healing in the treatment of anal fissures. METHODS: The prospective, comparative study was conducted at the Department of General Surgery, Mayo Hospital, Lahore, Pakistan, from September 1, 2021, to August 31, 2022, and comprised adult chronic anal fissure patients of either gender. They were randomised using the lottery method into group A which received botulinum toxin injection, and group B which received botulinum toxin injection plus 1g of 0.2% topical glyceryl trinitrate cream. Post-operative pain was measured 24 hours after the procedure using the visual analogue scale. Healing was assessed by examining the wound for the appearance of granulation tissue 4 weeks post-procedure. Data was analysed using SPSS 26. RESULTS: Of the 88 patients, 44(50%) were in group A; 32(72.7%) males and 12(27.3%) females with mean age 33.91±14.8 years. There were 44(50%) patients in group B; 35(79.5%) males and 9(20.5%) females with mean age range 36.33±14.9 years. The mean postoperative pain at 24 hours in group A was 4.67±1.16 and it was 3.06±0.65 in group B (p=0.009). In group A, 23(69.7%) patients showed complete healing at 4 weeks compared to 30(90.9%) in group B (p=0.030). CONCLUSIONS: Botulinum toxin injection with glyceryl trinitrate could be considered as first line of treatment for chronic anal fissure in patients who refuse surgery and with previous sphincter surgery.
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Toxinas Botulínicas Tipo A , Fisura Anal , Nitroglicerina , Dolor Postoperatorio , Cicatrización de Heridas , Humanos , Fisura Anal/tratamiento farmacológico , Fisura Anal/cirugía , Femenino , Masculino , Nitroglicerina/administración & dosificación , Nitroglicerina/uso terapéutico , Adulto , Dolor Postoperatorio/tratamiento farmacológico , Toxinas Botulínicas Tipo A/administración & dosificación , Toxinas Botulínicas Tipo A/uso terapéutico , Persona de Mediana Edad , Enfermedad Crónica , Cicatrización de Heridas/efectos de los fármacos , Estudios Prospectivos , Adulto Joven , Vasodilatadores/administración & dosificación , Vasodilatadores/uso terapéutico , Fármacos Neuromusculares/administración & dosificación , Fármacos Neuromusculares/uso terapéutico , Quimioterapia Combinada , Resultado del Tratamiento , Dimensión del DolorRESUMEN
BACKGROUND: Nurses adjust intravenous nitroglycerin infusions to provide acute relief for angina by manually increasing or decreasing the dosage. However, titration can pose challenges, as excessively high doses can lead to hypotension, and low doses may result in inadequate pain relief. Clinical decision support systems (CDSSs) that predict changes in blood pressure for nitroglycerin dose adjustments may assist nurses with titration. OBJECTIVE: This study aimed to design a user interface for a CDSS for nitroglycerin dose titration (Nitroglycerin Dose Titration Decision Support System [nitro DSS]). METHODS: A user-centered design (UCD) approach, consisting of an initial qualitative study with semistructured interviews to identify design specifications for prototype development, was used. This was followed by three iterative rounds of usability testing. Nurses with experience titrating nitroglycerin infusions in coronary care units participated. RESULTS: A total of 20 nurses participated, including 7 during the qualitative study and 15 during usability testing (2 nurses participated in both phases). Analysis of the qualitative data revealed four themes for the interface design to be (1) clear and consistent, (2) vigilant, (3) interoperable, and (4) reliable. The major elements of the final prototype included a feature for viewing the predicted and actual blood pressure over time to determine the reliability of the predictions, a drop-down option to report patient side effects, a feature to report reasons for not accepting the prediction, and a visual alert indicating any systolic blood pressure predictions below 90 mm Hg. Nurses' ratings on the questionnaires indicated excellent usability and acceptability of the final nitro DSS prototype. CONCLUSION: This study successfully applied a UCD approach to collaborate with nurses in developing a user interface for the nitro DSS that supports the clinical decision-making of nurses titrating nitroglycerin.
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Sistemas de Apoyo a Decisiones Clínicas , Nitroglicerina , Interfaz Usuario-Computador , Nitroglicerina/administración & dosificación , Nitroglicerina/uso terapéutico , Humanos , Relación Dosis-Respuesta a DrogaRESUMEN
OBJECTIVE: To describe the clinical course and treatment of 3 dogs with peripheral vasopressor extravasation. CASE SERIES SUMMARY: Although vasopressor extravasation (VE) is a well-documented complication in human medicine, literature describing VE and its management in veterinary patients is sparse. VE increases patient morbidity by causing local tissue injury and necrosis. The gold standard treatment for VE, phentolamine, has been periodically limited in supply in human medicine and is not consistently available for use in veterinary medicine. An alternative protocol proposed for use in people with VE combines topical nitroglycerin application with subcutaneous terbutaline infiltration. In this report, a treatment protocol utilizing these therapies was used to treat 3 dogs with VE and secondary tissue injury. NEW OR UNIQUE INFORMATION PROVIDED: This report describes 3 cases of VE-induced tissue injury in dogs. In addition, this report describes the use of perivascular terbutaline infiltration and topical nitroglycerin application as therapeutic management for VE in dogs.
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Administración Tópica , Enfermedades de los Perros , Nitroglicerina , Terbutalina , Animales , Perros , Nitroglicerina/administración & dosificación , Nitroglicerina/uso terapéutico , Terbutalina/administración & dosificación , Terbutalina/uso terapéutico , Enfermedades de los Perros/tratamiento farmacológico , Masculino , Femenino , Extravasación de Materiales Terapéuticos y Diagnósticos/veterinaria , Extravasación de Materiales Terapéuticos y Diagnósticos/tratamiento farmacológico , Inyecciones Subcutáneas/veterinaria , Vasoconstrictores/administración & dosificación , Vasoconstrictores/uso terapéutico , Pomadas , Vasodilatadores/administración & dosificación , Vasodilatadores/uso terapéuticoRESUMEN
BACKGROUND: This study aimed to investigate the effectiveness of combining sevoflurane with remifentanil, esmolol, or nitroglycerin for hypotensive anesthesia and determine the suitable hypotensive anesthesia method for orthognathic surgery. MATERIAL AND METHODS: This retrospective study included 60 patients who underwent orthognathic surgery for developmental malocclusion. They were divided into three groups based on the hypotensive agent preferences: Group 1 (n = 20), sevoflurane and remifentanil; Group 2 (n = 20), sevoflurane and esmolol; Group 3 (n = 20), sevoflurane and nitroglycerin. Bleeding volume, heart rate, systolic, diastolic, and mean arterial blood pressure were recorded at certain times during the perioperative period, including at stages with increased stress levels in the body, such as incision and osteotomy. The patients' blood pressure, analgesic consumption and pain level were recorded in the postoperative period. RESULTS: Bleeding volume, surgery satisfaction related to bleeding, and total operation time did not differ significantly between groups. Intraoperatively, heart rates were significantly higher in Group 3 than in Groups 1 and 2 (p = 0.001). However, hemodynamic stability was similar in Groups 1 and 2. Postoperatively, analgesic consumption, pain levels, and blood pressure dynamics did not differ significantly between groups (p > 0.05). CONCLUSIONS: Based on this study's results, it was concluded that infusing remifentanil, esmolol, or nitroglycerin with sevoflurane during orthognathic surgery successfully achieved the targeted hypotensive anesthesia and can be considered alternative methods. The decision on which method to use should consider the patient's overall health status and additional medical conditions.
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Procedimientos Quirúrgicos Ortognáticos , Remifentanilo , Sevoflurano , Humanos , Estudios Retrospectivos , Sevoflurano/administración & dosificación , Femenino , Masculino , Remifentanilo/administración & dosificación , Procedimientos Quirúrgicos Ortognáticos/métodos , Adulto , Adulto Joven , Nitroglicerina/administración & dosificación , Propanolaminas/administración & dosificación , Propanolaminas/uso terapéutico , Hipotensión Controlada/métodos , Piperidinas/administración & dosificación , Éteres Metílicos/administración & dosificación , Adolescente , Anestésicos por Inhalación/administración & dosificaciónRESUMEN
INTRODUCTION: To evaluate the maternal and fetal hemodynamic effects of treatment with a nitric oxide donor and oral fluid in pregnancies complicated by fetal growth restriction. METHODS: 30 normotensive participants with early fetal growth restriction were enrolled. 15 participants were treated until delivery with transdermal glyceryl trinitrate and oral fluid intake (Treated group), and 15 comprised the untreated group. All women underwent non-invasive assessment of fetal and maternal hemodynamics and repeat evaluation 2 weeks later. RESULTS: In the treated group, maternal hemodynamics improved significantly after two weeks of therapy compared to untreated participants. Fetal hemodynamics in the treated group showed an increase in umbilical vein diameter by 18.87 % (p < 0.01), in umbilical vein blood flow by 48.16 % (p < 0.01) and in umbilical vein blood flow corrected for estimated fetal weight by 30.03 % (p < 0.01). In the untreated group, the characteristics of the umbilical vein were unchanged compared to baseline. At the same time, the cerebro-placental ratio increased in the treated group, while it was reduced in the untreated group, compared to baseline values. The treated group showed a higher birthweight centile (p = 0.03) and a lower preeclampsia rate (p = 0.04) compared to the untreated group. DISCUSSION: The combined therapeutic approach with nitric oxide donor and oral fluid intake in fetal growth restriction improves maternal hemodynamics, which becomes more hyperdynamic (volume-dominant). At the same time, in the fetal circuit, umbilical vein flow increased and fetal brain sparing improved. Although a modest sample size, there was less preeclampsia and a higher birthweight suggesting beneficial maternal and fetal characteristics of treatment.
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Retardo del Crecimiento Fetal , Donantes de Óxido Nítrico , Venas Umbilicales , Humanos , Femenino , Retardo del Crecimiento Fetal/metabolismo , Retardo del Crecimiento Fetal/fisiopatología , Embarazo , Proyectos Piloto , Donantes de Óxido Nítrico/farmacología , Donantes de Óxido Nítrico/administración & dosificación , Adulto , Nitroglicerina/farmacología , Nitroglicerina/administración & dosificación , Hemodinámica/efectos de los fármacos , Feto/irrigación sanguínea , Feto/metabolismo , Adulto Joven , Oxígeno/metabolismo , Oxígeno/sangreRESUMEN
Reduced peripheral microvascular reactivity is associated with an increased risk for major adverse cardiac events (MACEs). Tools for noninvasive assessment of peripheral microvascular function are limited, and existing technology is poorly validated in both healthy populations and patients with cardiovascular disease (CVD). Here, we used a handheld incident dark-field imaging tool (CytoCam) to test the hypothesis that, compared with healthy individuals (no risk factors for CVD), subjects formally diagnosed with coronary artery disease (CAD) or those with ≥2 risk factors for CAD (at risk) would exhibit impaired peripheral microvascular reactivity. A total of 17 participants (11 healthy, 6 at risk) were included in this pilot study. CytoCam was used to measure sublingual microvascular total vessel density (TVD), perfused vessel density (PVD), and microvascular flow index (MFI) in response to the topical application of acetylcholine (ACh) and sublingual administration of nitroglycerin (NTG). Baseline MFI and PVD were significantly reduced in the at-risk cohort compared with healthy individuals. Surprisingly, following the application of acetylcholine and nitroglycerin, both groups showed a significant improvement in all three microvascular perfusion parameters. These results suggest that, despite baseline reductions in both microvascular density and perfusion, human in vivo peripheral microvascular reactivity to both endothelial-dependent and -independent vasoactive agents remains intact in individuals with CAD or multiple risk factors for disease.NEW & NOTEWORTHY To our knowledge, this is the first study to comprehensively characterize in vivo sublingual microvascular structure and function (endothelium-dependent and -independent) in healthy patients and those with CVD. Importantly, we used an easy-to-use handheld device that can be easily translated to clinical settings. Our results indicate that baseline microvascular impairments in structure and function can be detected using the CytoCam technology, although reactivity to acetylcholine may be maintained even during disease in the peripheral microcirculation.
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Enfermedad de la Arteria Coronaria , Microcirculación , Microvasos , Humanos , Masculino , Femenino , Persona de Mediana Edad , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Anciano , Proyectos Piloto , Microvasos/diagnóstico por imagen , Microvasos/fisiopatología , Acetilcolina/farmacología , Adulto , Vasodilatadores/farmacología , Nitroglicerina/administración & dosificación , Nitroglicerina/farmacología , Estudios de Casos y Controles , Suelo de la Boca/irrigación sanguínea , Densidad Microvascular , Vasodilatación/efectos de los fármacosRESUMEN
We present the case of a 60-year-old male, with active smoking and cocaine use disorder, who reported progressive chest pain. Various anatomical and functional cardiac imaging, performed to further evaluate chest pain etiology, revealed changing severity and distribution of left main artery (LMA) stenosis, raising suspicion for vasospasm. Intracoronary nitroglycerin relieved the vasospasm, with resolution of the LMA pseudostenosis. A diagnosis of vasospastic angina (VA) led to starting appropriate medical therapy with lifestyle modification counselling. This case highlights VA, a frequently underdiagnosed etiology of angina pectoris. We discuss when to suspect VA, its appropriate work-up, and management.
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Angiografía Coronaria , Estenosis Coronaria , Vasoespasmo Coronario , Nitroglicerina , Vasodilatadores , Humanos , Masculino , Persona de Mediana Edad , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/terapia , Estenosis Coronaria/fisiopatología , Vasoespasmo Coronario/diagnóstico por imagen , Vasoespasmo Coronario/fisiopatología , Vasoespasmo Coronario/tratamiento farmacológico , Vasoespasmo Coronario/terapia , Vasoespasmo Coronario/diagnóstico , Nitroglicerina/administración & dosificación , Resultado del Tratamiento , Vasodilatadores/uso terapéutico , Vasodilatadores/administración & dosificación , Valor Predictivo de las Pruebas , Trastornos Relacionados con Cocaína/complicaciones , Índice de Severidad de la Enfermedad , Angina de Pecho/etiología , Angina de Pecho/diagnóstico por imagen , Diagnóstico Diferencial , Fumar/efectos adversosAsunto(s)
Cateterismo Periférico , Procedimientos Endovasculares , Arteria Femoral , Inyecciones Intraarteriales , Nitroglicerina , Vasodilatadores , Humanos , Lactante , Arteria Femoral/diagnóstico por imagen , Nitroglicerina/administración & dosificación , Vasodilatadores/administración & dosificación , Preescolar , Inyecciones Subcutáneas , Femenino , Masculino , Punciones , Procedimientos NeuroquirúrgicosRESUMEN
Filler-induced alopecia is a transient alopecia characterized by localized hair loss and often attributed to vascular compromise following dermal filler injections in facial regions. Although an uncommon phenomenon, the rising incidence of filler-induced alopecia underscores the importance of understanding and managing this condition. We performed an extensive PubMed review of articles reporting filler-induced alopecia and summarizing the implicated filler types, injection areas, hair loss patterns, symptom onset, course progression, treatments, and prognosis. Hyaluronic acid injections were the most implicated in filler-induced alopecia cases, with calcium hydroxylapatite and autologous fat less frequently associated. No cases involved other dermal filler types. Although recovery times varied depending on the treatment, hyaluronidase (HAase) injections rapidly restored near-normal hair density within 3-4 months. Minoxidil and platelet-rich plasma play a more minor role in restoring hair growth but may be used as adjuncts with HAase to facilitate hair growth. Finally, alternative interventions like intralesional triamcinolone, warm compresses, and nitroglycerin warrant exploration, given limited robust clinical data. Our study promotes awareness of filler-induced alopecia's rising incidence and offers practical insights and evidence-based recommendations for effective management. By equipping dermatologists with this knowledge, our aim is to improve patient outcomes and reduce adverse events in filler-based procedures.
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Alopecia , Rellenos Dérmicos , Durapatita , Folículo Piloso , Ácido Hialurónico , Hialuronoglucosaminidasa , Minoxidil , Humanos , Alopecia/inducido químicamente , Alopecia/terapia , Rellenos Dérmicos/efectos adversos , Rellenos Dérmicos/administración & dosificación , Ácido Hialurónico/efectos adversos , Ácido Hialurónico/administración & dosificación , Hialuronoglucosaminidasa/administración & dosificación , Hialuronoglucosaminidasa/uso terapéutico , Durapatita/efectos adversos , Durapatita/administración & dosificación , Minoxidil/administración & dosificación , Minoxidil/efectos adversos , Plasma Rico en Plaquetas , Técnicas Cosméticas/efectos adversos , Nitroglicerina/administración & dosificación , Nitroglicerina/efectos adversos , Triamcinolona/administración & dosificación , Triamcinolona/efectos adversos , Tejido Adiposo/trasplanteRESUMEN
Pulmonary edema refers to the accumulation of excessive fluid in the alveolar walls and alveolar spaces of the lungs. It is a life-threatening condition with a high mortality rate and requires immediate assessment and management. Use of intravenous nitroglycerin has been advocated for such cases. The authors present a case series of 3 patients who presented to the emergency department with sympathetic crashing acute pulmonary edema (SCAPE) and were managed with high-dose intravenous nitroglycerin and bilevel positive airway pressure support using the SCAPE treatment protocol, leading to early correction of blood pressure, avoidance of endotracheal intubation, and no episodes of hypotension or rebound hypertension. The authors recommend emergency physicians utilize the SCAPE treatment protocol while managing patients with SCAPE.