RESUMO
OBJECTIVES: To evaluate the usefulness of iodine-123 metaiodobencylguanidine (123I-MIBG) in the study of the cardiac autonomic neuropathy in insulin-dependent diabetic patients, by means of: a) analysis of heart to mediastinic ratio and tomographic images with 123I-MIBG; b) comparison with conventional non-invasive cardiac reflex test, and c) analysis of left ventricle ejection fraction. POPULATION AND METHODS: Ten patients submitted for cardiac evaluation with 123I-MIBG were compared with a control group of 11 patients. In both groups we excluded the presence of coronary pathology by means of an exercise test. We carried out planar and SPECT studies, using 123I-MIBG, and the calculation of the ejection fraction by equilibrium ventriculography. RESULTS: The uptake of 123I-MIBG in diabetic patients was significantly smaller than the control group in the calculated index (heart to mediastinic ratio: 1.64 +/- 0.20 vs 2.00 +/- 0.26; p < 0.001; SPECT index: 44.87 +/- 8.37 vs 55.54 +/- 3.96; p < 0.001). In polar images we noted a more reduced uptake in the diabetic group in the inferior wall (p = 0.020). Patients with cardiac sympa-thetic dysinnervation demonstrated less uptake in both indexes (p < 0.05 and 0.005, respectively), essentially in the inferior wall and in basal and medium territories (p < 0.05). No differences in respect to the ejection fraction parameter were found. CONCLUSIONS: Despite the small sample population, insuli-dependent diabetic patients in show a significant reduction of the uptake of 23I-MIBG, more accentuated in the base. Scintigraphy using 123I-MIBG can be an approach to investigate the pattern and the natural history of the sympathetic innervation in these patients.
Assuntos
3-Iodobenzilguanidina , Diabetes Mellitus Tipo 1/diagnóstico por imagem , Neuropatias Diabéticas/diagnóstico por imagem , Coração/inervação , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Compostos Radiofarmacêuticos , Sistema Nervoso Simpático/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , CintilografiaRESUMO
To asses the possible role of prostaglandins in the fetoplacental circulation during delivery PGE and PGF2-alfa plasma levels were measured in the umbilical vessels of term newborns. The levels of PGF2-alfa in blood from the umbilical vein are significantly higher and more variable than in the umbilical artery; 83.38 +/- 78.05 pg/ml versus 43.28 +/- 5.32 pg/ml. PGE levels are also higher in the vein 114.73 +/- 25.16 pg/ml than in the artery 83.63 +/- 9.22 pg/ml. There was a statistically significant negative correlation between the arterial pH and PGE in the umbilical vein these results support the idea that the plasmatic umbilical prostaglandins are synthetized by the placenta the variability in the values obtained in venous umbilical blood may reflect the different times of ligation of the umbilical cord. A decrease in fetal pH may be the stimulus for the prostaglandin synthesis by the placenta.
Assuntos
Equilíbrio Ácido-Base , Dinoprosta/sangue , Prostaglandinas E/sangue , Artérias Umbilicais/análise , Cordão Umbilical/irrigação sanguínea , Índice de Apgar , Feminino , Idade Gestacional , Humanos , Recém-Nascido , GravidezRESUMO
A study of urinary osmolarities and plasmatic level of arginine-vasopressin (AVP) 48 hours after birth in a group of 70 newborns (30 of which are normal and 40 of which have acute perinatal hypoxia), selected according to previously established criteria is carried out. An evolutionary study of urinary osmolarities of newborns with acute perinatal hypoxia, osmolar index and its relation to plasmatic levels of AVP during the first week of life is also considered. AVP 48 hours after birth was blatantly more elevated among those newborns who had shown acidosis at birth (p less than 0.001) which correlated significantly with urinary osmolarity, although it showed low figures (p less than 0.05). This same correlation (p less than 0.001 and p less than 0.05) appears with osmolar index and urinary osmolarity on successive days, but it is important to point out that vasopressin decreased to base values at the end of the first week of life while osmolarities in urine increased. Conclusions are: 1) AVP is higher after 48 hours of life among those newborns with acute perinatal hypoxia and decreases progressively during the first week of life, being comparable to values obtained from normally born children 48 hours after birth at the eight day of life. 2) Renal response to this hormone is slight during the first days of life.