RESUMEN
BACKGROUND AND PURPOSE: Cyclophosphamide induces urotoxicity characterized by the development of cystitis, which involves bladder overactivity and inflammation. Here, we investigated the roles of chemokine receptor 2 (CXCR2) and transient receptor potential vanilloid 1 (TRPV1) channels in a rat model of cyclophosphamide-induced cystitis. EXPERIMENTAL APPROACH: Cystitis induced by cyclophosphamide in rats was assessed by gross morphology, histology and immunohistochemistry of bladder tissue. mRNA for CXCR2 and TRPV1 channels were measured by RT-PCR. Nociceptive responses in paw and abdomen, along with cystometric measures were recorded. KEY RESULTS: Cyclophosphamide, i.p., induced pain behaviour, bladder inflammation and voiding dysfunction. The CXCR2 antagonist, SB225002, the TRPV1 channel antagonist, SB366791 or their combination reduced the mechanical hypersensitivity of paw and abdominal area and nociceptive behaviour after cyclophosphamide. Cyclophosphamide-induced cystitis was characterized by haemorrhage, oedema, neutrophil infiltration and other inflammatory changes, which were markedly decreased by the antagonists. Up-regulation of CXCR2 and TRPV1 mRNA in the bladder after cyclophosphamide was inhibited by SB225002, SB366791 or their combination. Expression of CXCR2 and TRPV1 channels was increased in the urothelium after cyclophosphamide. Bladder dysfunction was shown by increased number of non-voiding contractions (NVCs) and bladder pressures and a reduction in bladder capacity (BC), voided volume (VV) and voiding efficiency (VE). SB225002 or its combination with SB366791 reduced bladder pressures, whereas SB225002, SB366791 or their combination increased BC, VV and VE, and also reduced the number of NVCs. CONCLUSIONS AND IMPLICATIONS: CXCR2 and TRPV1 channels play important roles in cyclophosphamide-induced cystitis in rats and could provide potential therapeutic targets for cystitis.
Asunto(s)
Antineoplásicos Alquilantes , Conducta Animal/efectos de los fármacos , Ciclofosfamida , Cistitis/patología , Trastornos Hemorrágicos/patología , Inflamación/patología , Receptores de Interleucina-8B/metabolismo , Canales Catiónicos TRPV/metabolismo , Animales , Cistitis/inducido químicamente , Cistitis/tratamiento farmacológico , Citocinas/metabolismo , Femenino , Trastornos Hemorrágicos/inducido químicamente , Trastornos Hemorrágicos/tratamiento farmacológico , Hiperalgesia/inducido químicamente , Hiperalgesia/psicología , Inmunohistoquímica , Neutrófilos/metabolismo , Tamaño de los Órganos/efectos de los fármacos , Dimensión del Dolor/efectos de los fármacos , Peroxidasa/metabolismo , Ratas , Reacción en Cadena en Tiempo Real de la Polimerasa , Receptores de Interleucina-8B/antagonistas & inhibidores , Canales Catiónicos TRPV/antagonistas & inhibidores , Vejiga Urinaria/patologíaRESUMEN
INTRODUCTION AND GOALS: Adenotonsillar surgery represents a major haemostatic challenge in paediatric patients with mild inherited platelet dysfunction. While there are recommendations for perioperative haemostatic management, there are no reports of the outcomes with the different recommendations in these children when undergoing adenotonsillectomy. Our objective was to evaluate the management of perioperative bleeding with desmopressin in children with mild platelet dysfunctions who underwent adenotonsillar surgery in our hospital. METHODS: We performed a retrospective study aimed at determining the perioperative bleeding and complication rate in children with mild inherited platelet dysfunction in whom desmopressin was used while undergoing adenotonsillar procedures. RESULTS: Between 2004 and 2010, 27 children with mild inherited platelet dysfunction underwent adenotonsillar procedures in our hospital and were treated with desmopressin. One patient developed perioperative bleeding (3.7%) and there was 1 child (3.7%) who presented transitory hypotension as a side effect of desmopressin. CONCLUSIONS: The use of desmopressin allowed adequate perioperative bleeding prophylaxis management in children with mild inherited platelet dysfunction who underwent adenotonsillar procedures without presenting severe complications.
Asunto(s)
Adenoidectomía , Pérdida de Sangre Quirúrgica/prevención & control , Trastornos de las Plaquetas Sanguíneas/tratamiento farmacológico , Desamino Arginina Vasopresina/uso terapéutico , Trastornos Hemorrágicos/tratamiento farmacológico , Hemorragia Posoperatoria/prevención & control , Medicación Preanestésica , Tonsilectomía , Acetaminofén/uso terapéutico , Adolescente , Analgésicos/uso terapéutico , Trastornos de las Plaquetas Sanguíneas/complicaciones , Niño , Preescolar , Codeína/uso terapéutico , Desamino Arginina Vasopresina/efectos adversos , Evaluación de Medicamentos , Femenino , Trastornos Hemorrágicos/etiología , Humanos , Hipotensión/inducido químicamente , Masculino , Dolor Postoperatorio/tratamiento farmacológico , Complicaciones Posoperatorias/inducido químicamente , Hemorragia Posoperatoria/epidemiología , Receptores de Vasopresinas/efectos de los fármacos , Ácido Tranexámico/uso terapéuticoRESUMEN
La eficacia del tratamiento con factor VII activado recombinante (FVIIar) durante episodios hemorrágicos en pacientes hemofílicos con inhibidores y el conocimiento de su mecanismo de acción, determiná que en los últimos años se ampliara rápidamente su uso en pacientes con hemorragia de diversas causas no controladas con la terapéutica habitual; entre otras, defectos congénitos de la coagulación, trastornos plaquetarios, hepatopatías, cirugía, hemorragia intracraneal, sangramientos digestivos. Aunque un grupo importante de estas comunicaciones se han realizado en forma de casos reportados y serie de casos, se considera que los resultados obtenidos son importantes y que la administración de FVIIar es una alternativa en pacientes con hemorragia grave no controlada. A pesar de su potente acción procoagulante, el riesgo de complicaciones tromboembólicas es bajo y esté relacionado en un grupo importante de pacientes con la presencia de otros factores protrombóticos. En la actualidad se considera que el FVIIar esta indicado en aquellos pacientes con hemorragia masiva que no responden a la terapia con componentes sanguíneos ni a medidas quirúrgicas apropiadas(AU)
Effectiveness of the treatment with recombinant activated factor VII (raVII) during the hemorrhagic episodes in hemophilic patients using inhibitions and the knowledge of its action mechanism determined that in pas years its use will be expanded in patients with hemorrhage from non-controlled diverse causes using the usual therapeutics among other, congenital coagulation defects, platelet disorders, liver diseases, surgery, intracranial hemorrhage, digestive bleedings. Although a significant group of these communications have been carried out in reported cases and in cases series, it is considered that the results obtained are important and that the administration of raVII is an alternative in patients presenting with non-controlled severe hemorrhage. Despite its potent pro-coagulant action, thromboembolism complications risk is low and it is related to a significant group of patients with other prothrombotic factors. Nowadays, it is considered that raVII is prescribed in those patients with massive hemorrhage without response either to therapy using blood components or appropriate surgical measures(AU)
Asunto(s)
Humanos , Trastornos Hemorrágicos/tratamiento farmacológico , Factor VII/uso terapéutico , Hemofilia A/complicaciones , Informes de CasosRESUMEN
La eficacia del tratamiento con factor VII activado recombinante (FVIIar) durante episodios hemorrágicos en pacientes hemofílicos con inhibidores y el conocimiento de su mecanismo de acción, determiná que en los últimos años se ampliara rápidamente su uso en pacientes con hemorragia de diversas causas no controladas con la terapéutica habitual; entre otras, defectos congénitos de la coagulación, trastornos plaquetarios, hepatopatías, cirugía, hemorragia intracraneal, sangramientos digestivos. Aunque un grupo importante de estas comunicaciones se han realizado en forma de casos reportados y serie de casos, se considera que los resultados obtenidos son importantes y que la administración de FVIIar es una alternativa en pacientes con hemorragia grave no controlada. A pesar de su potente acción procoagulante, el riesgo de complicaciones tromboembólicas es bajo y esté relacionado en un grupo importante de pacientes con la presencia de otros factores protrombóticos. En la actualidad se considera que el FVIIar esta indicado en aquellos pacientes con hemorragia masiva que no responden a la terapia con componentes sanguíneos ni a medidas quirúrgicas apropiadas
Effectiveness of the treatment with recombinant activated factor VII (raVII) during the hemorrhagic episodes in hemophilic patients using inhibitions and the knowledge of its action mechanism determined that in pas years its use will be expanded in patients with hemorrhage from non-controlled diverse causes using the usual therapeutics among other, congenital coagulation defects, platelet disorders, liver diseases, surgery, intracranial hemorrhage, digestive bleedings. Although a significant group of these communications have been carried out in reported cases and in cases series, it is considered that the results obtained are important and that the administration of raVII is an alternative in patients presenting with non-controlled severe hemorrhage. Despite its potent pro-coagulant action, thromboembolism complications risk is low and it is related to a significant group of patients with other prothrombotic factors. Nowadays, it is considered that raVII is prescribed in those patients with massive hemorrhage without response either to therapy using blood components or appropriate surgical measures
Asunto(s)
Humanos , Factor VII/uso terapéutico , Hemofilia A/complicaciones , Trastornos Hemorrágicos/tratamiento farmacológico , Informes de CasosRESUMEN
Es ampliamente conocido que la cirugía oral se acompaña de hemorragia postoperatoria, a causa del trauma producido en tejidos duros y blandos durante el acto quirúrgico. En pacientes normales, sin alteraciones de la hemostasia, las hemorragias se tratan mediante la comprensión de las zonas hemorrágicas durante algunos minutos mediante el uso de algodón o gasa. Sin embargo, en pacientes con diátesis hemorrágicas y en aquellos que se encuentran bajo tratamiento médico con anticoagulantes, ya sea heparina o los anticoagulantes orales, se espera la ocurrencia de una hemorragia profusa en el período postoperatorio. En atención a lo anterior, durante muchos años se ha considerado pertinente reducir o suspender la terapia anticoagulante, para prevenir la hemorragia postoperatoria. En este artículo se actualizan los conceptos actuales para el tratamiento de pacientes bajo tratamiento anticoagulante en los cuales se efectuará cirugía oral. Se describe el I.N.R. (International Normalized Ratio o Razón Normalizada Internacional) y de acuerdo con el grado de efecto anticoagulante obtenido expresado en este parámetro, se propone un esquema de procedimiento simple, concluyendo que la mayoría de los procedimientos quirúrgicos en la cavidad oral pueden efectuarse sin suspender o reducir la terapia anticoagulante, siempre que se tomen las medidas de hemostasia local en los sitios intervenidos
Asunto(s)
Humanos , Anticoagulantes , Hemorragia Bucal , Procedimientos Quirúrgicos Orales , Anticoagulantes , Hemostasis , Heparina , Hemorragia Bucal , Procedimientos Quirúrgicos Orales/métodos , Trastornos Hemorrágicos/tratamiento farmacológico , Trombosis de la VenaRESUMEN
There is little experience in the prevention of the severe hemorrhagic diathesis of factor X coagulation factor deficiency, before surgical procedures. A female with congenital deficiency of factor X that received prothrombin complex concentrates that contained 1000 IU of factor X (16.7 U/I Kg BW) inmediately prior to a cesarean section in two occasions, is reported. Factor X concentration rose from 1 to 25 percent in the first ocassion and from 10 to 63 percent in the second. In both episodes, factor X decreased in the first 24 h of the postoperative period and required new infusions of prothrombin complex concentrates. No episodes of abnormal bleeding were observed. It is concluded that the infusion of prothrombin complex concentrates prevents the hemorrhagic diathesis of factor X deficiency, despite its modest increase in plasma. A initial infusion of 1.000 UI of factor X (16-20 IU/Kg BW), followed by 500 IU (8-10 IU/Kg) every 24 hours is suggested for an adequate management of this condition
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Trastornos de la Coagulación Sanguínea/congénito , Deficiencia del Factor X/congénito , Trastornos Hemorrágicos/tratamiento farmacológico , Tiempo de Protrombina , Factor X/administración & dosificación , Cesárea/métodos , Complicaciones Hematológicas del Embarazo/tratamiento farmacológicoRESUMEN
Grey-platelet syndrome is a rare familial platelet impairment characterised by lack of alpha granules and giant vacuolated platelets. A Mexican family with grey-platelet syndrome associated to Marfan disease is presented. The family was comprised of 22 members, of whom 3 (the propositus and two of his nephews) could be studied. Two of them, with haemorrhagic symptoms since childhood, had moderate prolongation of the Ivy bleeding time which improved after DDAVP administration, plus moderate thrombocytopenia, giant platelets and abnormal platelet aggregation induced by adrenalin, ADP and collagen. Platelet factor 4 was normal. Electron microscope examination of platelets showed lack of alpha granules and increased dense bodies. The rarity of the casual association of two low-frequency genetic diseases, namely Marfan disease and the grey-platelet syndrome, is commented, along with the response attained with DDAVP in the two affected individuals.
Asunto(s)
Plaquetas/ultraestructura , Trastornos Hemorrágicos/complicaciones , Síndrome de Marfan/complicaciones , Adulto , Tiempo de Sangría , Gránulos Citoplasmáticos/ultraestructura , Desamino Arginina Vasopresina/uso terapéutico , Femenino , Trastornos Hemorrágicos/tratamiento farmacológico , Trastornos Hemorrágicos/genética , Humanos , Lactante , Masculino , Síndrome de Marfan/genética , México , Linaje , Agregación Plaquetaria/efectos de los fármacosRESUMEN
The effectiveness of a commercial drug containing fibrinogen, thrombin and factor XIL (Tissucol, Immuno) was assessed in 127 patients receiving oral anticoagulant treatment with acenocoumarin who were subjected to 183 minor surgical procedures: 107 exodontia, 53 periodontal procedures, 17 combinations of the former, 4 liver biopsies and 2 skin biopsies. All but the liver biopsies were performed in the outpatient clinic. Mild haemorrhage appeared in 21 instances. None of the patients required systemic administration of coagulation factors, and the maneuvers did not take any longer than in patients with integrity of the coagulation mechanisms. The outstanding benefits of this technique are: less discomfort for patients, who can be subjected to a single procedure while otherwise requiring several sessions; anticoagulation needs not be discontinued, subcutaneous heparin being otherwise necessary; low risk of complications and avoidance of substitutive therapy; lesser economic burden, as no hospital admission is needed.
Asunto(s)
Acenocumarol/efectos adversos , Biopsia/efectos adversos , Adhesivo de Tejido de Fibrina/uso terapéutico , Hemorragia/prevención & control , Trastornos Hemorrágicos/inducido químicamente , Hemostasis Quirúrgica/métodos , Periodoncia , Extracción Dental/efectos adversos , Adulto , Anciano , Procedimientos Quirúrgicos Ambulatorios , Evaluación de Medicamentos , Femenino , Trastornos Hemorrágicos/tratamiento farmacológico , Humanos , Hígado/patología , Masculino , Persona de Mediana Edad , Seguridad , Piel/patologíaRESUMEN
We describe six new cases of a hemorrhagic diathesis induced by contact with Lonomia achelous caterpillars. Onset of clinical bleeding varied between a few hours and 10 days post-exposure. Laboratory coagulation tests showed prolonged PT, PTT and ThT; normal platelets and a marked decrease of fibrinogen, factor V, plasminogen and factor XIII (including its subunits A and S). Factors VII, II and alfa 2 anti-plasmin were variably affected. In addition, activation of the fibrinolytic system and the generation of a procoagulant effect could also be demonstrated. Two cases developed severe hemorrhagic diathesis and one of them died of a cerebral hemorrhage. Different aspects of this rare syndrome are discussed in relation to its complex physiopathology and the variability observed in all clinical and laboratory manifestations. Therapeutic recommendations and some possible hazards following replacement transfusions are also considered.