RESUMO
BACKGROUND: Basolateral amygdala (BLA) excitatory projections to medial prefrontal cortex (PFC) play a key role controlling stress behavior, pain, and fear. Indeed, stressful events block synaptic plasticity at the BLA-PFC circuit. The stress responses involve the action of corticotrophin releasing factor (CRF) through type 1 and type 2 CRF receptors (CRF1 and CRF2). Interestingly, it has been described that dopamine receptor 1 (D1R) and CRF peptide have a modulatory role of BLA-PFC transmission. However, the participation of CRF1 and CRF2 receptors in BLA-PFC synaptic transmission still is unclear. METHODS: We used in vivo microdialysis to determine dopamine and glutamate (GLU) extracellular levels in PFC after BLA stimulation. Immunofluorescence anatomical studies in rat PFC synaptosomes devoid of postsynaptic elements were performed to determine the presence of D1R and CRF2 receptors in synaptical nerve endings. RESULTS: Here, we provide direct evidence of the opposite role that CRF receptors exert over dopamine extracellular levels in the PFC. We also show that D1R colocalizes with CRF2 receptors in PFC nerve terminals. Intra-PFC infusion of antisauvagine-30, a CRF2 receptor antagonist, increased PFC GLU extracellular levels induced by BLA activation. Interestingly, the increase in GLU release observed in the presence of antisauvagine-30 was significantly reduced by incubation with SCH23390, a D1R antagonist. CONCLUSION: PFC CRF2 receptor unmasks D1R effect over glutamatergic transmission of the BLA-PFC circuit. Overall, CRF2 receptor emerges as a new modulator of BLA to PFC glutamatergic transmission, thus playing a potential role in emotional disorders.
Assuntos
Complexo Nuclear Basolateral da Amígdala/metabolismo , Dopamina/metabolismo , Ácido Glutâmico/metabolismo , Córtex Pré-Frontal/metabolismo , Receptores de Hormônio Liberador da Corticotropina/metabolismo , Receptores de Dopamina D1/metabolismo , Animais , Masculino , Microdiálise , Ratos , Ratos Sprague-DawleyRESUMO
Muchos de los hallazgos del diagnóstico antenatal de patología urológica son inespecíficos y sólo nos permiten diferenciar pacientes con un mayor riesgo de infección urinaria o de perder función renal. El hecho de identificar un uréter en la ecografía prenatal es un hallazgo inespecífico, que aún no tenemos claro qué significa y qué pronóstico tiene para nuestros pacientes. A partir de noviembre de 1999, tenemos un protocolo prospectivo para el seguimiento y manejo de pacientes con diagnóstico antenatal de patología urológica. Se revisó en forma retrospectiva los pacientes en que hubo dilatación ureteral en la ecografía prenatal.180 pacientes han sido referidos y seguidos según protocolo. En 21 pacientes (11.7 por ciento) se ha hecho diagnóstico de dilatación ureteral en la ecografía prenatal. Once hombres y 10 mujeres. Los diagnósticos postnatales de estos pacientes fueron: 4 pacientes con doble sistema pieloureteral; 2 pacientes con megauréteres; 1paciente con una cloaca; 5 pacientes con dilataciones transitorias; 2 pacientes con ureterocele en sistemaúnico; 1 paciente con reflujo vesicoureteral en un sistema único y con un riñón multicístico en el contralateral; 1 paciente con valvas de uretra posterior y 5 pacientes con obstrucción pieloureteral. Un total de 13 pacientes de los 21 requirieron cirugía (62por ciento) y 8 se manejaron médicamente (38.09 por ciento).El hecho de identificar el uréter dilatado en la ecografía prenatal nos permite identificar una población prenatal de riesgo, ya que un 57,1 por ciento de nuestros pacientes requirieron de cirugía. Llama la atención que 5 pacientes en que se vio el uréter dilatado en la ecografía prenatal, terminaron operándose de obstrucción pieloureteral. Esto apoya la hipótesis de que estas obstrucciones sean secundarias a dilataciones ureterales prenatales. El consejo prenatal tiene que ser dado con cautela y por gente con experiencia, ya que a pesar de existir un riesgo elevado de cirugía...
Prenatal diagnosis is usually non specific and only allows for early detection of patients with a higher risk of developing urinary tract infections or loss of renal function. The identification of the ureter in a prenatal ultrasound is a nonspecific finding. The relevance of this is unknown. A prospective protocol for the management and follow up of patients with antenatal diagnosis of urologicmal formations was started in 1999. We retrospectively review our patients who presented a ureteral dilatation in the antenatal ultrasound.180 patients were referred and follow up was carried out according to protocol. 21 patients (11.7 percent) had ureteral dilatation on the prenatal ultrasound, 11 male and 10 female. The following post natal diagnoses were registered: 4 patients had a duplex kidney, 2 patients had megaureter, 1 patient had a cloaca, 5 patients had transitory dilatations, 2 patients had ureterocele in an single system, 1 patient had VUR in a single system and a contralateral muticystic kidney, 1 patient had posterior urethral valves, and 5 patients had ureteropelvic obstruction.13 of 21 patients required surgery (62 percent), the other 8 required only prophylaxis and follow up (38.09 percent). Being able to identify a dilated ureter in an prenatal ultrasound allowed us to define a high risk group, in which 62 percent required surgery. Of the patients in this group, it is noteworthy that 5 patients in whom a dilated ureter was visualized were operated on for ureteropelvic obstruction. This fact supports the idea that obstructions are secondary to antenatal ureteral dilations. Antenatal advice should be given carefully and by experienced personnel because, although there was a high percentage of surgery in this group, there was also a group of patients that only required antibiotics prophylaxis and image monitoring.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Dilatação Patológica/diagnóstico , Doenças Ureterais/diagnóstico , Ultrassonografia Pré-Natal , Seguimentos , Obstrução Ureteral/etiologiaRESUMO
La Nefrectomia Radical sigue siendo el tratamniento de elección para Tumores Sólidos del Riñon, Actualmente existen diversas modalidades para efectuarla entre las que cuentan las técnicas endoscópicas, ya sea por Laparoscopia o por Lumboscopia. Describimos una Técnica de Nefrectomía Radical Lumboscóipica utilizando sólo 3 trocares, (diferente de la convencional con 4 trocares), interviniendo a 10 pacientes con Diagnóstico de Tumores sólidos renales. Se presentó una sola complicación intraoperatoria como fue sangramiento profuso de hilio renal que fue controlado con engrapadora endoscópica vascular. Ocho de los diez pacientes egresaron en menos de 60 horas de operados (2,5 días) y solo 2 pacientes egresaron a las 72 horas (3días) debido a inestabilidad hemodinámica que ameritó transfusión de 1-2 concentrados globulares. Los demás pacientes no presentaron complicaciones postoperatorias ni inmediatas ni tardías. Cuando esté indica Nefrectomía Radical por patología maligna, los procedimientos Endoscópicos (Laparoscipia o Lumboscopia) puede ahora considerarse como el estándar de atención en la mayoría de los casos. Los datos de eficacia intraoperatoria son comparables con los de la cirugía abierta convencional, con ventajas significativas en la morbilidad postoperatoria, convalescencia y estética. Al evadir la cavidad peritoneal, retroperitoneal proporciona ventajas adicionales que lo hacen el enfoque preferido en varios centros especializados. La técnica quirúrgica previamente detallada ha resultado un procedimiento confiable y reproducible con excelentes resultados en manos de los autores. Es importante la atención en la localización del trocar primario, la posición del balón adilatador, evitar el amontonamiento de los puertos y la familiarización con las ferencias anatómicas específicas para el abordaje retroperitoneal
Assuntos
Humanos , Masculino , Nefrectomia , Rim/lesões , Urologia , VenezuelaRESUMO
UNLABELLED: With the purpose of elaborating a plan of an epidemiological study to develop an Hepatitis A vigilance program in the most affected areas Tucuman, it was carried out evaluation about antibody, IgM HAV in 191 patients. These patients had been diagnosed with acute Hepatitis. The sample belonged to 15% of the new patients who attended the Gastroenterology Service at time. 75.9% of the studied patients had IgM HAV (+). There was a predominance of consultation within March to July, with a similar distribution according to sex. The range of age was from 3 month till 14 years old with an outstanding high consultation rate of the 75.4% considering the group within 3 years old. A percentage of 63% developed jaundice and 45% had had a close touch with persons infected with hepatitis. About this last item, the outstanding sort of contact was between school partners with a percentage of 41.27%. There were 20 children admitted at the Hospital. Four of them developed fulminant hepatic failure without having determined any etiologic agent. Only one of this group showed a spontaneous resolution. The rest of them could not survive to receive hepatic transplant. There were 95.12% who had current water in their houses and 68% of them had installed bathroom with sewer. CONCLUSIONS: Evaluating the of Hepatitis in childhood with viral markers. Investigating hepatitis during fall and winter. Developing health promotion and prevention at schools as well as carrying out the most extreme hygienic steps to achieve this. Encouraging the obligatory announcement about the real cases so as to determine the geographic distribution and to carry out proper prevention campaigns in the most affected areas. Actualizing a seroprevalence study of hepatitis A in order to carry out a vaccination program based in believeable and actual dates so as to determinate costs and benefits items.
Assuntos
Hepatite A/epidemiologia , Hepatite A/imunologia , Anticorpos Anti-Hepatite/sangue , Imunoglobulina M/sangue , Doença Aguda , Adolescente , Argentina/epidemiologia , Criança , Pré-Escolar , Feminino , Encefalopatia Hepática/epidemiologia , Hepatite A/prevenção & controle , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Estações do Ano , Estudos Soroepidemiológicos , Distribuição por SexoRESUMO
Com el propósito de elaborar un plan de estudio epidemiológico para desarrollar un programa de vigilancia de hepatitis A en las áreas más afectadas de Tucumán, se llevó a cabo una evaluación de Ac. IgM HAV a 191 pacientes que concurrieron a través de un año, al Servicio de Gastroenterología del Hospital de Niños de Tucumán, con el diagnóstico de hepatitis aguda. La muestra correspondió al 15 por ciento del total de los pacientes que concurrieron a Gastroenterología por primera vez. El 75.9 por ciento de los pacientes estudiados tuvieron IgMHAV(+), se notó un predominio de consultas entre los meses de Marzo a Julio, la distribución por sexo fue similar, el rango de la edad fue de 3 meses a 14 años, destacando una alta tasa de consulta en el grupo de 3 a 8 años, (75.4 por ciento). Tuvieron ictericia el 63 por ciento y antecedentes de contacto conocida con personas con hepatitis el 45 por ciento. Resaltando que el tipo de contacto más común encontrado fue el de "compañero de escuela", (41.27 por ciento). El 95.12 por ciento contaban com agua corriente en sus hogares y el 68 por ciento tenían baño instalado com cloacas. Durante el tiempo de estudio merecieron internación 20 niños. Presentaron forma fulminante 4 pacientes, a los que no se les determinó agente etiológico. De este grupo solo uno presentó resolución espontanea, el resto no pudo sobrevivir para recibir transplante hepático. Conclusiones: Evaluar con marcadores virales los casos de hepatitis. Pesquisar hepatitis en los meses de otoño e invierno. Extremar las medidas higiénicas y realizar prevención y promoción de salud en los establecimientos escolares. Estimular la denuncia obligatoria de casos para determinar la distribución geográfica y realizar campañas de prevención en la áreas más afectadas. Dirigir estudio actualizado de seroprevalencia de hepatitis A, para llevar a cabo un prograama de vacunación, con el aporte de los datos fidedignos y creíbles, que permitan determinar los costos beneficios.
Assuntos
Criança , Pré-Escolar , Lactente , Feminino , Humanos , Recém-Nascido , Adolescente , Hepatite A , Anticorpos Anti-Hepatite/sangue , Hepatite A/imunologia , Imunoglobulina M/sangue , Doença Aguda , Argentina , Encefalopatia Hepática , Hepatite A , Prevalência , Estações do Ano , Distribuição por SexoRESUMO
Com el propósito de elaborar un plan de estudio epidemiológico para desarrollar un programa de vigilancia de hepatitis A en las áreas más afectadas de Tucumán, se llevó a cabo una evaluación de Ac. IgM HAV a 191 pacientes que concurrieron a través de un año, al Servicio de Gastroenterología del Hospital de Niños de Tucumán, con el diagnóstico de hepatitis aguda. La muestra correspondió al 15 por ciento del total de los pacientes que concurrieron a Gastroenterología por primera vez. El 75.9 por ciento de los pacientes estudiados tuvieron IgMHAV(+), se notó un predominio de consultas entre los meses de Marzo a Julio, la distribución por sexo fue similar, el rango de la edad fue de 3 meses a 14 años, destacando una alta tasa de consulta en el grupo de 3 a 8 años, (75.4 por ciento). Tuvieron ictericia el 63 por ciento y antecedentes de contacto conocida con personas con hepatitis el 45 por ciento. Resaltando que el tipo de contacto más común encontrado fue el de "compañero de escuela", (41.27 por ciento). El 95.12 por ciento contaban com agua corriente en sus hogares y el 68 por ciento tenían baño instalado com cloacas. Durante el tiempo de estudio merecieron internación 20 niños. Presentaron forma fulminante 4 pacientes, a los que no se les determinó agente etiológico. De este grupo solo uno presentó resolución espontanea, el resto no pudo sobrevivir para recibir transplante hepático. Conclusiones: Evaluar con marcadores virales los casos de hepatitis. Pesquisar hepatitis en los meses de otoño e invierno. Extremar las medidas higiénicas y realizar prevención y promoción de salud en los establecimientos escolares. Estimular la denuncia obligatoria de casos para determinar la distribución geográfica y realizar campañas de prevención en la áreas más afectadas. Dirigir estudio actualizado de seroprevalencia de hepatitis A, para llevar a cabo un prograama de vacunación, con el aporte de los datos fidedignos y creíbles, que permitan determinar los costos beneficios. (AU)
Assuntos
Criança , Pré-Escolar , Lactente , Feminino , Humanos , Recém-Nascido , Adolescente , Hepatite A/epidemiologia , Hepatite A/imunologia , Imunoglobulina M/sangue , Anticorpos Anti-Hepatite/sangue , Hepatite A/prevenção & controle , Argentina/epidemiologia , Doença Aguda , Distribuição por Sexo , Estações do Ano , Prevalência , Encefalopatia Hepática/epidemiologiaRESUMO
OBJECTIVES: The purpose of this study was to determine the causes, epidemiologic baseline data and clinical characteristics of a group of patients referred to a tertiary care center in Puerto Rico with the diagnosis of dilated cardiomyopathy. METHODS: The medical records of 91 new patients with the diagnosis of dilated cardiomyopathy were analyzed. Data was recopilated regarding initial medical history and physical examination, basic blood chemistry, electrocardiograms, chest films and other cardiac studies including echocardiogram, radionuclear ventriculography, cardiac catheterization, contrast ventriculography and coronary angiography. After reviewing the records the etiology for dilated cardiomyopathy was identified in each patient following the World Health Organization Task Force criteria. RESULTS: Ischemic cardiomyopathy was identified as the most common cause of dilated cardiomyopathy, representing 37% of the reviewed patient population; an idiopathic etiology was found in 22% of the patients and valvular heart disease in 14%. DISCUSSION: A comparison with previously described series in the medical literature regarding this subject is presented, along with the most prominent clinical characteristics of the studied population. It is felt that the findings presented will require further study of the underlying causes and clinical course of this condition in a larger patient sample and a longer follow-up period.
Assuntos
Cardiomiopatia Dilatada/etiologia , Centros Médicos Acadêmicos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/tratamento farmacológico , Criança , Feminino , Seguimentos , Doenças das Valvas Cardíacas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Porto Rico , Encaminhamento e Consulta , Fatores de Risco , Distribuição por SexoRESUMO
Necrosis of the outer two-thirds of the cortex (CN) was induced with boiling water in the left kidney of rats. Two days afterward, morphological damage was shown to be limited to the superficial cortex; deep nephron population was well-preserved. Glucose reabsorption under basal and glucose loading conditions, and extraction of p-aminohippurate, used as indices of proximal tubule integrity, were normal in control and experimental kidneys 48 h after cortical necrosis. Basal fractional water and electrolyte excretion did not differ between control and experimental kidneys. Calculated mean single-nephron glomerular filtration rate (GFR) and plasma flow for superficial (SupGFR and SupNPF) and juxtamedullary nephrons (JMGFR and JMPF) were similar to those obtained by micropuncture and Hanssen's technique for SupGFR, and for JMGFR by Hanssen's. Volume expansion led to a 27% increase in calculated SupGFR, but no change in JMGFR. The JMPF increased by 81%, whereas SupNPF increased by only 23%, suggesting that, in this model, GFR of deep nephrons may be independent of plasma flow. The results indicate that deep nephrons retain their functional integrity 48 h after cortical necrosis. After volume expansion fractional excretion of sodium was greater, and fractional water reabsorption less, in CN than in control kidneys. Thus handling of sodium and water by superficial and deep nephrons under basal conditions was similar, but reabsorptive capacity for deep nephrons of CN was lower during volume expansion. The present studies suggest that deep nephrons can maintain relatively normal function in cortical necrosis.
Assuntos
Córtex Renal/patologia , Animais , Feminino , Taxa de Filtração Glomerular , Córtex Renal/fisiopatologia , Córtex Renal/ultraestrutura , Glomérulos Renais/patologia , Glomérulos Renais/fisiopatologia , Glomérulos Renais/ultraestrutura , Microscopia Eletrônica de Varredura , Necrose , Néfrons/patologia , Néfrons/fisiopatologia , Néfrons/ultraestrutura , Potássio/sangue , Potássio/urina , Ratos , Ratos Endogâmicos , Valores de Referência , Circulação Renal , Sódio/sangue , Sódio/urinaRESUMO
Los tumores de testículo representan el 1% de los cánceres en el hombre (7) y constituyen una de las principales causas de muerte en la segunda y tercera décadas de la vida (23). El uso de cirugía, radioterapia y quimioterapia ha cambiado las expectativas de vida de este grupo de pacientes, lográndose un 70% de curaciones (8). En este estudio se hace una revisión de los resultados obtenidos en el Instituto de Oncología Luis Razetti y el Instituto Médico La Floresta, en los casos de tumores malignos del testículo tratados en el período 1956 - 1984
Assuntos
Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Neoplasias TesticularesRESUMO
The involvement of the liver in the control of the renal excretion of water and sodium can be deduced from some recent investigations. Hypertonic or isotonic sodium chloride infusion into the hepatic portal vein enhanced renal sodium excretion when compared with identical infusions into a systemic vein. It has been suggested that a humoral factor produced by the liver could be a functional link between the liver and the kidney. In order to test this hypothesis, the present experiments were carried out in two groups of anesthetized dogs. Animals from group I were infused with NaCl (855 mmol/l) at a rate of 0.05 ml/min/kg b.w. during 30 min, into the portal vein. Blood samples were withdrawn from the suprahepatic vein, before (SH1) and coinciding with the maximal natriuresis after hypertonic saline infusion (SH2). Plasma from SH1 and SH2 were infused into the left renal artery (LRA) of dogs from group II. Two 20 min clearance periods were performed before and after each SH-infusion. After both SH-infusions urinary sodium excretion (UNaV) was significantly increased from preinfusion values in both kidneys, and these increases were significantly greater after SH2 than after SH1. No significant differences were found in UNaV between left and right kidney. After both plasma infusions the increases in urinary volume and osmolar clearance were higher in the infused than in the not infused kidney. These results suggest that the plasma leaving the liver contains a substance with natriuretic activity and that the infusion of hypertonic NaCl into the portal vein could induce either a higher secretion of the same substance or the presence of other different substance.
Assuntos
Fígado/fisiologia , Natriurese , Animais , Cães , Feminino , Taxa de Filtração Glomerular , Fígado/irrigação sanguínea , Masculino , Circulação Renal , Solução Salina HipertônicaRESUMO
The involvement of the liver in the control of the renal excretion of water and sodium can be deduced from some recent investigations. Hypertonic or isotonic sodium chloride infusion into the hepatic portal vein enhanced renal sodium excretion when compared with identical infusions into a systemic vein. It has been suggested that a humoral factor produced by the liver could be a functional link between the liver and the kidney. In order to test this hypothesis, the present experiments were carried out in two groups of anesthetized dogs. Animals from group I were infused with NaCl (855 mmol/l) at a rate of 0.05 ml/min/kg b.w. during 30 min, into the portal vein. Blood samples were withdrawn from the suprahepatic vein, before (SH1) and coinciding with the maximal natriuresis after hypertonic saline infusion (SH2). Plasma from SH1 and SH2 were infused into the left renal artery (LRA) of dogs from group II. Two 20 min clearance periods were performed before and after each SH-infusion. After both SH-infusions urinary sodium excretion (UNaV) was significantly increased from preinfusion values in both kidneys, and these increases were significantly greater after SH2 than after SH1. No significant differences were found in UNaV between left and right kidney. After both plasma infusions the increases in urinary volume and osmolar clearance were higher in the infused than in the not infused kidney. These results suggest that the plasma leaving the liver contains a substance with natriuretic activity and that the infusion of hypertonic NaCl into the portal vein could induce either a higher secretion of the same substance or the presence of other different substance.