RESUMO
BACKGROUND: The bed nucleus of the stria terminalis (BNST) is a structure with a peculiar neurochemical composition involved in modulating anxietylike behavior and fear. AIM: The present study investigated the effects on the BNST neurochemical composition and neuronal structure in critical moments of the postnatal period in gestational protein-restricted male rats' offspring. METHODS: Dams were maintained during the pregnancy on isocaloric rodent laboratory chow with standard protein content [NP, 17%] or low protein content [LP, 6%]. BNST from male NP and age-matched LP offspring was studied using the isotropic fractionator method, Neuronal 3D reconstruction, dendritic-tree analysis, blotting analysis, and high-performance liquid chromatography. RESULTS: Serum corticosterone levels were higher in male LP offspring than NP rats in 14-day-old offspring, without any difference in 7-day-old progeny. The BNST total cell number and anterodorsal BNST division volume in LP progeny were significantly reduced on the 14th postnatal day compared with NP offspring. The BNST HPLC analysis from 7 days-old LP revealed increased norepinephrine levels compared to NP progeny. The BNST blot analysis from 7-day-old LP revealed reduced levels of GR and BDNF associated with enhanced CRF1 expression compared to NP offspring. 14-day-old LP offspring showed reduced expression of MR and 5HT1A associated with decreased DOPAC and DOPA turnover levels relative to NP rats. In Conclusion, the BNST cellular and neurochemical changes may represent adaptation during development in response to elevated fetal exposure to maternal corticosteroid levels. In this way, gestational malnutrition alters the BNST content and structure and contributes to already-known behavioral changes.
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Animal evidence has suggested that maternal emotional and nutritional stress during pregnancy is associated with behavioral outcomes in offspring. The nature of the stresses applied may differ, but it is often assumed that the mother's hippocampus-hypothalamic-pituitary-adrenal (HHPA) axis response releases higher levels of glucocorticoid hormones. The bed nucleus of the stria terminalis (BNST) is in a pivotal position to regulate the HHPA axis and the stress response, and it has been implicated in anxiety behavior. In the current study, to search whether BNST structural changes and neurochemical alterations are associated with anxiety-related behavior in adult gestational protein-restricted offspring relative to an age-matched normal protein diet (NP) rats, we conduct behavioral tests and, BNST dendritic tree analysis by Sholl analysis, associated to immunoblotting-protein quantification [11ß-HSD2, GR, MR, AT1R, 5HT1A and 5HT2A, corticotrophin-releasing factor (CRH) and CRH1]. Dams were maintained either on isocaloric standard rodent chow [with NP content, 17% casein or low protein content (LP), 6% casein] chow throughout their entire pregnancy. Here, in rats subjected to gestational protein restriction, we found: (a) a significant reduction in dendritic length and impoverished dendritic arborization in BNST neurons; (b) an elevated plasmatic corticosterone levels; and (c) associated with enhanced anxiety-like behavior when compared with age-matched NP offspring. Moreover, altered protein (11ß-HSD2, GR, MR and type 1 CRH receptors) expressions may underlie the increase in anxiety-like behavior in LP offspring. This work represents the first demonstration that BNST developmental plasticity by maternal protein restriction, resulting in fine structural changes and neurochemical alterations that are associated with modified behavioral states.
Assuntos
Ansiedade , Dieta com Restrição de Proteínas , Efeitos Tardios da Exposição Pré-Natal , Núcleos Septais/embriologia , Animais , Comportamento Animal , Peso Corporal , Feminino , Masculino , Fenômenos Fisiológicos da Nutrição Materna , Estado Nutricional , Gravidez , Ratos , Ratos Wistar , Núcleos Septais/patologiaRESUMO
Metabolic acidosis has profound effects on vascular tone. This study investigated the in vivo effects of acute metabolic acidosis (AMA) and chronic metabolic acidosis (CMA) on hemodynamic parameters and endothelial function. CMA was induced by ad libitum intake of 1% NH4Cl for 7 days, and AMA was induced by a 3-h infusion of 6 M NH4Cl (1 mL/kg, diluted 1:10). Phenylephrine (Phe) and acetylcholine (Ach) dose-response curves were performed by venous infusion with simultaneous venous and arterial blood pressure monitoring. Plasma nitrite/nitrate (NOx) was measured by chemiluminescence. The CMA group had a blood pH of 7.15±0.03, which was associated with reduced bicarbonate (13.8±0.98 mmol/L) and no change in the partial pressure of arterial carbon dioxide (PaCO2). The AMA group had a pH of 7.20±0.01, which was associated with decreases in bicarbonate (10.8±0.54 mmol/L) and PaCO2 (47.8±2.54 to 23.2±0.74 mmHg) and accompanied by hyperventilation. Phe or ACh infusion did not affect arterial or venous blood pressure in the CMA group. However, the ACh infusion decreased the arterial blood pressure (ΔBP: -28.0±2.35 mm Hg [AMA] to -4.5±2.89 mmHg [control]) in the AMA group. Plasma NOx was normal after CMA but increased after AMA (25.3±0.88 to 31.3±0.54 µM). These results indicate that AMA, but not CMA, potentiated the Ach-induced decrease in blood pressure and led to an increase in plasma NOx, reinforcing the effect of pH imbalance on vascular tone and blood pressure control.
Assuntos
Acetilcolina/administração & dosagem , Acidose/fisiopatologia , Pressão Sanguínea/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Hipotensão/induzido quimicamente , Desequilíbrio Ácido-Base/metabolismo , Acidose/induzido quimicamente , Acidose/metabolismo , Doença Aguda , Animais , Bicarbonatos/sangue , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial , Dióxido de Carbono/análise , Doença Crônica , Endotélio Vascular/metabolismo , Hemodinâmica/fisiologia , Hiperventilação/metabolismo , Luminescência , Masculino , Nitratos/sangue , Óxido Nítrico/metabolismo , Nitritos/sangue , CoelhosRESUMO
Metabolic acidosis has profound effects on vascular tone. This study investigated the in vivo effects of acute metabolic acidosis (AMA) and chronic metabolic acidosis (CMA) on hemodynamic parameters and endothelial function. CMA was induced by ad libitum intake of 1% NH4Cl for 7 days, and AMA was induced by a 3-h infusion of 6 M NH4Cl (1 mL/kg, diluted 1:10). Phenylephrine (Phe) and acetylcholine (Ach) dose-response curves were performed by venous infusion with simultaneous venous and arterial blood pressure monitoring. Plasma nitrite/nitrate (NOx) was measured by chemiluminescence. The CMA group had a blood pH of 7.15±0.03, which was associated with reduced bicarbonate (13.8±0.98 mmol/L) and no change in the partial pressure of arterial carbon dioxide (PaCO2). The AMA group had a pH of 7.20±0.01, which was associated with decreases in bicarbonate (10.8±0.54 mmol/L) and PaCO2 (47.8±2.54 to 23.2±0.74 mmHg) and accompanied by hyperventilation. Phe or ACh infusion did not affect arterial or venous blood pressure in the CMA group. However, the ACh infusion decreased the arterial blood pressure (ΔBP: -28.0±2.35 mm Hg [AMA] to -4.5±2.89 mmHg [control]) in the AMA group. Plasma NOx was normal after CMA but increased after AMA (25.3±0.88 to 31.3±0.54 μM). These results indicate that AMA, but not CMA, potentiated the Ach-induced decrease in blood pressure and led to an increase in plasma NOx, reinforcing the effect of pH imbalance on vascular tone and blood pressure control.
Assuntos
Animais , Masculino , Coelhos , Acetilcolina/administração & dosagem , Acidose/fisiopatologia , Pressão Sanguínea/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Hipotensão/induzido quimicamente , Doença Aguda , Desequilíbrio Ácido-Base/metabolismo , Acidose/induzido quimicamente , Acidose/metabolismo , Determinação da Pressão Arterial , Bicarbonatos/sangue , Pressão Sanguínea/fisiologia , Doença Crônica , Dióxido de Carbono/análise , Endotélio Vascular/metabolismo , Hemodinâmica/fisiologia , Hiperventilação/metabolismo , Luminescência , Nitratos/sangue , Óxido Nítrico/metabolismo , Nitritos/sangueRESUMO
Herein, we describe 34 microsatellite loci developed using an enrichment genomic library for the tree species Hancornia speciosa Gomes (Apocynaceae). Thirty-five individuals were genotyped using 34 primers to analyze the polymorphisms at each locus. The number of alleles per locus ranged from 4 to 20. The average number of alleles was 8.11, and the expected heterozygosity ranged from 0.62 to 0.94. These microsatellite primers will be useful in population genetics studies for this species.
Assuntos
Apocynaceae/genética , Repetições de Microssatélites/genética , Genética Populacional , Genótipo , Polimorfismo Genético , Árvores/genéticaRESUMO
INTRODUCTION: Liver transplant recipients are at an increased oxidative stress risk due to pre-existing hepatic impairment, ischemia-reperfusion injury, immunosuppression, and functional graft rejection. This study compared the oxidative status of healthy control subjects, patients with liver cirrhosis on the list for transplantation, and subjects already transplanted for at least 12 months. PATIENTS AND METHODS: Sixty adult male patients, aged between 27 and 67 years, were subdivided into 3 groups: a control group (15 healthy volunteers), a cirrhosis group (15 volunteers), and a transplant group (30 volunteers). Oxidative stress was evaluated by activity of reduced glutathione, malondialdehyde, and vitamin E. RESULTS: There was a significant difference (P < .01) in the plasma concentration of reduced glutathione in the 3 groups, with the lowest values observed in the transplanted group. The malondialdehyde values differed significantly (P < .01) among the 3 groups, with the transplanted group again having the lowest concentrations. The lowest concentrations of vitamin E were observed in patients with cirrhosis compared with control subjects, and there was a significant correlation (P < .05) among the 3 groups. No correlations were found between reduced glutathione and vitamin E or between vitamin E and malondialdehyde. However, there were strong correlations between plasma malondialdehyde and reduced glutathione in the 3 groups: control group, r = 0.9972 and P < .0001; cirrhotic group, r = 0.9765 and P < .0001; and transplanted group, r = 0.8981 and P < .0001. CONCLUSIONS: In the late postoperative stage of liver transplantation, oxidative stress persists but in attenuated form.
Assuntos
Transplante de Fígado , Estresse Oxidativo , Adulto , Estudos de Casos e Controles , Glutationa/sangue , Humanos , Imunossupressores/administração & dosagem , Masculino , Malondialdeído/metabolismo , Período Pós-OperatórioRESUMO
Este estudo teve por objetivo conhecer o perfil dos pacientes em tratamento contra o câncer da Unidade Oncológica de Anápolis quanto ao uso de plantas medicinais. Foram entrevistados 59 pacientes (42,12% da população estudada) por meio de questionários avaliativos enfatizando características sócio-demográficas e dados referentes à utilização de plantas medicinais. Evidenciou-se o uso indiscriminado de plantas medicinais entre os pacientes. A maioria dos entrevistados compartilha a opinião errônea de que plantas medicinais não fazem mal. A orientação sobre a forma de utilização das plantas ocorre, principalmente, pela informação de familiares ou amigos, e os profissionais da saúde muitas vezes são ignorados neste processo. Constatou-se que as plantas medicinais são utilizadas para o tratamento de enfermidades de baixa a alta gravidade, como o câncer. Dentre as 14 espécies usadas pelos pacientes com finalidade antineoplásica as mais mencionadas foram as popularmente conhecidas como noni, babosa, graviola e romã. Apesar de alguns estudos relatarem atividade antineoplásica ou quimiopreventiva para algumas espécies vegetais, muitas delas podem ser tóxicas ou apresentar potencial risco quando usadas concomitantemente ao tratamento convencional. Desta forma, observa-se que é preciso mais profissionais especializados para orientação sobre o risco de reações adversas e interações medicamentosas no que se refere ao uso de espécies vegetais e a terapêutica do câncer.
This study aims to survey the profile ofcancer patients in the Oncology Unit of Anápolis in relation to the use of medicinal plants. To evaluate socio-demographic characteristics and to retrieve data about on the use of medicinal plants, a questionnaire was filled by 59 patients, or 42.12% of the population under study. A widespread use of plants was found. Most of patients share the wrong idea that medicinal plants are not harmful. Guidance on the use of medicinal plants is given primarily by relatives and friends, and health professional are often ignored in this process. Among the 14 species used by patients with antineoplastic purpose, the most mentioned were popularly species known as "noni", "aloe", "soursop" and "pomegranate". Although some studies have reported chemopreventive or antineoplastic activity for some plant species, many may be toxic or show potential risk when used concurrently with conventional treatment. Thus, we can observe that there is a need for more specialized professionals for the guidance on the risk of adverse reactions and drug interactions in relation to the use of plant species and cancer therapeutics.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Plantas Medicinais/classificação , Coleta de Dados/métodos , Pacientes/classificação , Terapêutica/efeitos adversos , Neoplasias/diagnósticoRESUMO
Studies have demonstrated that nutrient deficiency during pregnancy or in early postnatal life results in structural abnormalities in the offspring hippocampus and in cognitive impairment. In an attempt to analyze whether gestational protein restriction might induce learning and memory impairments associated with structural changes in the hippocampus, we carried out a detailed morphometric analysis of the hippocampus of male adult rats together with the behavioral characterization of these animals in the Morris water maze (MWM). Our results demonstrate that gestational protein restriction leads to a decrease in total basal dendritic length and in the number of intersections of CA3 pyramidal neurons whereas the cytoarchitecture of CA1 and dentate gyrus remained unchanged. Despite presenting significant structural rearrangements, we did not observe impairments in the MWM test. Considering the clear dissociation between the behavioral profile and the hippocampus neuronal changes, the functional significance of dendritic remodeling in fetal processing remains undisclosed.
Assuntos
Região CA3 Hipocampal/patologia , Dendritos/patologia , Dieta com Restrição de Proteínas , Aprendizagem em Labirinto/fisiologia , Neurônios/patologia , Efeitos Tardios da Exposição Pré-Natal/patologia , Animais , Atrofia/patologia , Atrofia/fisiopatologia , Região CA3 Hipocampal/fisiopatologia , Feminino , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Ratos , Ratos WistarRESUMO
Preoperative progressive pneumoperitoneum (PPP) is a safe and effective procedure in the treatment of large incisional hernia (size > 10 cm in width or length) with loss of domain (LIHLD). There is no consensus in the literature on the amount of gas that must be insufflated in a PPP program or even how long it should be maintained. We describe a technique for calculating the hernia sac volume (HSV) and abdominal cavity volume (ACV) based on abdominal computerized tomography (ACT) scanning that eliminates the need for subjective criteria for inclusion in a PPP program and shows the amount of gas that must be insufflated into the abdominal cavity in the PPP program. Our technique is indicated for all patients with large or recurrent incisional hernias evaluated by a senior surgeon with suspected LIHLD. We reviewed our experience from 2001 to 2008 of 23 consecutive hernia surgical procedures of LIHLD undergoing preoperative evaluation with CT scanning and PPP. An ACT was required in all patients with suspected LIHLD in order to determine HSV and ACV. The PPP was performed only if the volume ratio HSV/ACV (VR = HSV/ACV) was >or=25% (VR >or= 25%). We have performed this procedure on 23 patients, with a mean age of 55.6 years (range 31-83). There were 16 women and 7 men with an average age of 55.6 years (range 31-83), and a mean BMI of 38.5 kg/m(2) (range 23-55.2). Almost all patients (21 of 23 patients-91.30%) were overweight; 43.5% (10 patients) were severely obese (obese class III). The mean calculated volumes for ACV and HSV were 9,410 ml (range 6,060-19,230 ml) and 4,500 ml (range 1,850-6,600 ml), respectively. The PPP is performed by permanent catheter placed in a minor surgical procedure. The total amount of CO(2) insufflated ranged from 2,000 to 7,000 ml (mean 4,000 ml). Patients required a mean of 10 PPP sessions (range 4-18) to achieve the desired volume of gas (that is the same volume that was calculated for the hernia sac). Since PPP sessions were performed once a day, 4-18 days were needed for preoperative preparation with PPP. The mean VR was 36% (ranged from 26 to 73%). We conclude that ACT provides objective data for volume calculation of both hernia sac and abdominal cavity and also for estimation of the volume of gas that should be insufflated into the abdominal cavity in PPP.
Assuntos
Hérnia Abdominal/diagnóstico por imagem , Hérnia Abdominal/cirurgia , Insuflação/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumoperitônio Artificial , RecidivaRESUMO
Acid-base homeostasis maintains systemic arterial pH within a narrow range. Whereas the normal range of pH for clinical laboratories is 7.35-7.45, in vivo pH is maintained within a much narrower range. In clinical and experimental settings, blood pH can vary in response to respiratory or renal impairment. This altered pH promotes changes in vascular smooth muscle tone with impact on circulation and blood pressure control. Changes in pH can be divided into those occurring in the extracellular space (pHo) and those occurring within the intracellular space (pHi), although, extracellular and intracellular compartments influence each other. Consistent with the multiple events involved in the changes in tone produced by altered pHo, including type of vascular bed, several factors and mechanisms, in addition to hydrogen ion concentration, have been suggested to be involved. The scientific literature has many reports concerning acid-base balance and endothelium function, but these concepts are not clear about acid-base disorders and their relations with the three known mechanisms of endothelium-dependent vascular reactivity: nitric oxide (NO/cGMP-dependent), prostacyclin (PGI2/cAMP-dependent) and hyperpolarization. During the last decades, many studies have been published and have given rise to confronting data on acid-base disorder and endothelial function. Therefore, the main proposal of this review is to provide a critical analysis of the state of art and incentivate researchers to develop more studies about these issues.
Assuntos
Equilíbrio Ácido-Base/fisiologia , Vasos Sanguíneos/fisiopatologia , Endotélio Vascular/fisiopatologia , Músculo Liso Vascular/fisiopatologia , Vasodilatação/fisiologia , Acidose/metabolismo , Acidose/fisiopatologia , Alcalose/metabolismo , Alcalose/fisiopatologia , Animais , Epoprostenol/fisiologia , Humanos , Concentração de Íons de Hidrogênio , Músculo Liso Vascular/metabolismo , Óxido Nítrico/fisiologiaRESUMO
Acid-base homeostasis maintains systemic arterial pH within a narrow range. Whereas the normal range of pH for clinical laboratories is 7.35-7.45, in vivo pH is maintained within a much narrower range. In clinical and experimental settings, blood pH can vary in response to respiratory or renal impairment. This altered pH promotes changes in vascular smooth muscle tone with impact on circulation and blood pressure control. Changes in pH can be divided into those occurring in the extracellular space (pHo) and those occurring within the intracellular space (pHi), although, extracellular and intracellular compartments influence each other. Consistent with the multiple events involved in the changes in tone produced by altered pHo, including type of vascular bed, several factors and mechanisms, in addition to hydrogen ion concentration, have been suggested to be involved. The scientific literature has many reports concerning acid-base balance and endothelium function, but these concepts are not clear about acid-base disorders and their relations with the three known mechanisms of endothelium-dependent vascular reactivity: nitric oxide (NO/cGMP-dependent), prostacyclin (PGI2/cAMP-dependent) and hyperpolarization. During the last decades, many studies have been published and have given rise to confronting data on acid-base disorder and endothelial function. Therefore, the main proposal of this review is to provide a critical analysis of the state of art and incentivate researchers to develop more studies about these issues.
Assuntos
Animais , Humanos , Equilíbrio Ácido-Base/fisiologia , Vasos Sanguíneos/fisiopatologia , Endotélio Vascular/fisiopatologia , Músculo Liso Vascular/fisiopatologia , Vasodilatação/fisiologia , Acidose/metabolismo , Acidose/fisiopatologia , Alcalose/metabolismo , Alcalose/fisiopatologia , Epoprostenol/fisiologia , Concentração de Íons de Hidrogênio , Músculo Liso Vascular/metabolismo , Óxido Nítrico/fisiologiaRESUMO
The present study investigated the protective effect of N-acetylcysteine (NAC) against oxygen radical-mediated coronary artery injury. Vascular contraction and relaxation were determined in canine coronary arteries immersed in Kreb's solution (95 percent O2-5 percent CO2), incubated or not with NAC (10 mM), and exposed to free radicals (FR) generated by xanthine oxidase (100 mU/ml) plus xanthine (0.1 mM). Rings not exposed to FR or NAC were used as controls. The arteries were contracted with 2.5 µM prostaglandin F2alpha. Subsequently, concentration-response curves for acetylcholine, calcium ionophore and sodium fluoride were obtained in the presence of 20 µM indomethacin. Concentration-response curves for bradykinin, calcium ionophore, sodium nitroprusside, and pinacidil were obtained in the presence of indomethacin plus Nomega-nitro-L-arginine (0.2 mM). The oxidative stress reduced the vascular contraction of arteries not exposed to NAC (3.93 ± 3.42 g), compared to control (8.56 ± 3.16 g) and to NAC group (9.07 ± 4.0 g). Additionally, in arteries not exposed to NAC the endothelium-dependent nitric oxide (NO)-dependent relaxation promoted by acetylcholine (1 nM to 10 µM) was also reduced (maximal relaxation of 52.1 ± 43.2 percent), compared to control (100 percent) and NAC group (97.0 ± 4.3 percent), as well as the NO/cyclooxygenase-independent receptor-dependent relaxation provoked by bradykinin (1 nM to 10 µM; maximal relaxation of 20.0 ± 21.2 percent), compared to control (100 percent) and NAC group (70.8 ± 20.0 percent). The endothelium-independent relaxation elicited by sodium nitroprusside (1 nM to 1 µM) and pinacidil (1 nM to 10 µM) was not affected. In conclusion, the vascular dysfunction caused by the oxidative stress, expressed as reduction of the endothelium-dependent relaxation and of the vascular smooth muscle contraction, was prevented by NAC.
Assuntos
Animais , Masculino , Feminino , Cães , Acetilcisteína , Estresse Oxidativo , Espécies Reativas de Oxigênio , Vasos Coronários , Endotélio Vascular , Traumatismo por Reperfusão MiocárdicaRESUMO
The present study investigated the protective effect of N-acetylcysteine (NAC) against oxygen radical-mediated coronary artery injury. Vascular contraction and relaxation were determined in canine coronary arteries immersed in Kreb's solution (95% O2-5% CO2), incubated or not with NAC (10 mM), and exposed to free radicals (FR) generated by xanthine oxidase (100 mU/ml) plus xanthine (0.1 mM). Rings not exposed to FR or NAC were used as controls. The arteries were contracted with 2.5 microM prostaglandin F2alpha. Subsequently, concentration-response curves for acetylcholine, calcium ionophore and sodium fluoride were obtained in the presence of 20 microM indomethacin. Concentration-response curves for bradykinin, calcium ionophore, sodium nitroprusside, and pinacidil were obtained in the presence of indomethacin plus Nomega-nitro-L-arginine (0.2 mM). The oxidative stress reduced the vascular contraction of arteries not exposed to NAC (3.93 +/- 3.42 g), compared to control (8.56 +/- 3.16 g) and to NAC group (9.07 +/- 4.0 g). Additionally, in arteries not exposed to NAC the endothelium-dependent nitric oxide (NO)-dependent relaxation promoted by acetylcholine (1 nM to 10 microM) was also reduced (maximal relaxation of 52.1 +/- 43.2%), compared to control (100%) and NAC group (97.0 +/- 4.3%), as well as the NO/cyclooxygenase-independent receptor-dependent relaxation provoked by bradykinin (1 nM to 10 microM; maximal relaxation of 20.0 +/- 21.2%), compared to control (100%) and NAC group (70.8 +/- 20.0%). The endothelium-independent relaxation elicited by sodium nitroprusside (1 nM to 1 microM) and pinacidil (1 nM to 10 microM) was not affected. In conclusion, the vascular dysfunction caused by the oxidative stress, expressed as reduction of the endothelium-dependent relaxation and of the vascular smooth muscle contraction, was prevented by NAC.
Assuntos
Acetilcisteína/farmacologia , Vasos Coronários/efeitos dos fármacos , Endotélio Vascular/efeitos dos fármacos , Estresse Oxidativo , Animais , Vasos Coronários/fisiopatologia , Cães , Endotélio Vascular/fisiopatologia , Feminino , Masculino , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Espécies Reativas de Oxigênio , Vasoconstrição/efeitos dos fármacos , Vasodilatação/efeitos dos fármacosRESUMO
Subcapsular hematoma of the graft is an underreported complication of liver transplantation (LT). Among 408 LT performed from September 1, 1985, to September 1, 2000, eight patients developed a subcapsular hematoma within 30 days after LT (8/408 = 2.0%). Among the six early cases observed, five required further surgical approaches due to hematoma progression, rupture, and hemorrhage. One patient underwent liver retransplantation due to uncontrollable hepatic hemorrhage. The two more recent cases were successfully treated by early opening of the Glisson's capsule with hemostasis of the hepatic raw bleeding surface. The five patients who developed acute renal failure required dialysis. Three patients died during hospitalization. Among the survivors, two were discharged on the postoperative (PO) day 15; the others on PO day 37, 38, and 56. In conclusion, subcapsular hematoma of the graft is a potentially serious complication of LT that may produce severe hemorrhage, shock, and in extreme cases, graft loss or even death. The severity of the complication is related to the extension of the decapsulated area of the graft. An early surgical approach with intentional opening of the hematoma before progression of the lesion seems to facilitate hemostasis and improve results.
Assuntos
Hematoma/epidemiologia , Transplante de Fígado/efeitos adversos , Adulto , Pré-Escolar , Feminino , Humanos , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Período Pós-OperatórioRESUMO
To determine if radiocontrast impairs vascular relaxation of the renal artery, segments (4-5 mm in length) of canine renal artery were suspended in vitro in organ chambers to measure isometric force (95% O2/5% CO2, at 37 C). Arterial segments with and without endothelium were placed at the optimal point of their length-tension relation and incubated with 10 microM indomethacin to prevent synthesis of endogenous prostanoids. The presence of nonionic radiocontrast (iohexol, Omnipaque 350, 1 ml in 25 ml control solution, 4% (v/v)) did not alter endothelium-dependent relaxation to acetylcholine in rings precontracted with both norepinephrine and prostaglandin F2alpha (N = 6). When the rings were precontracted with prostaglandin F2alpha, the presence of ionic contrast did not inhibit the relaxation of the arteries. However, in canine renal arteries contracted with norepinephrine, the presence of ionic radiocontrast (diatrizoate meglumine and diatrizoate sodium, MD-76, 1 ml in 25 ml control solution, 4% (v/v)) inhibited relaxation in response to acetylcholine, sodium nitroprusside (N = 6 in each group), and isoproterenol (N = 5; P < 0.05). Rings were relaxed less than 50% of norepinephrine contraction. Following removal of the contrast, vascular relaxation in response to the agonists returned to normal. These results indicate that ionic radiocontrast nonspecifically inhibits vasodilation (both cAMP-mediated and cGMP-mediated) of canine renal arteries contracted with norepinephrine. This reversible impairment of vasodilation could inhibit normal renal perfusion and act as a mechanism of renal failure following radiocontrast infusion. In the adopted experimental protocol the isoproterenol-induced relaxation of renal arteries precontracted with norepinephrine was more affected, suggesting a pivotal role of the cAMP system.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Diatrizoato/efeitos adversos , Artéria Renal/efeitos dos fármacos , Vasodilatação/efeitos dos fármacos , Animais , Cães , Endotélio Vascular/efeitos dos fármacos , Feminino , Masculino , Norepinefrina/farmacologia , Resistência Vascular/efeitos dos fármacos , Vasoconstritores/farmacologia , Vasodilatadores/farmacologiaRESUMO
To determine if radiocontrast impairs vascular relaxation of the renal artery, segments (4-5 mm in length) of canine renal artery were suspended in vitro in organ chambers to measure isometric force (95 percent O2/5 percent CO2, at 37ºC). Arterial segments with and without endothelium were placed at the optimal point of their length-tension relation and incubated with 10 æM indomethacin to prevent synthesis of endogenous prostanoids. The presence of nonionic radiocontrast (iohexol, Omnipaque 350, 1 ml in 25 ml control solution, 4 percent (v/v)) did not alter endothelium-dependent relaxation to acetylcholine in rings precontracted with both norepinephrine and prostaglandin F2alpha (N = 6). When the rings were precontracted with prostaglandin F2alpha, the presence of ionic contrast did not inhibit the relaxation of the arteries. However, in canine renal arteries contracted with norepinephrine, the presence of ionic radiocontrast (diatrizoate meglumine and diatrizoate sodium, MD-76, 1 ml in 25 ml control solution, 4 percent (v/v)) inhibited relaxation in response to acetylcholine, sodium nitroprusside (N = 6 in each group), and isoproterenol (N = 5; P < 0.05). Rings were relaxed less than 50 percent of norepinephrine contraction. Following removal of the contrast, vascular relaxation in response to the agonists returned to normal. These results indicate that ionic radiocontrast nonspecifically inhibits vasodilation (both cAMP-mediated and cGMP-mediated) of canine renal arteries contracted with norepinephrine. This reversible impairment of vasodilation could inhibit normal renal perfusion and act as a mechanism of renal failure following radiocontrast infusion. In the adopted experimental protocol the isoproterenol-induced relaxation of renal arteries precontracted with norepinephrine was more affected, suggesting a pivotal role of the cAMP system.
Assuntos
Animais , Masculino , Feminino , Cães , Injúria Renal Aguda , Meios de Contraste , Diatrizoato , Artéria Renal , Vasodilatação , Endotélio Vascular , Resistência Vascular , VasodilatadoresRESUMO
The employment of synthetic mesh for incisional hernia repair in kidney-transplanted patients is rarely reported in the present literature. Many authors believe that mesh employment in such conditions is not safe due to fear of mesh related complications. From 1965 through 1999, a total of 1685 kidney transplants were performed at our Kidney Transplant Unit and 19 patients developed eventrations in the kidney transplant incision, an incidence of 1.1%. From September 1996 eight of these patients had prosthetic repair of the abdominal wall with onlay polypropylene mesh. All patients were under immunosuppressive therapy with prednisone, ciclosporine and azathioprine. Mean age was 48.8 years, mean body mass index was 22.5 and mean number of previous abdominal operations was 2.5. A large polypropylene mesh (Marlex mesh) was fixed over the aponeurosis after primary closure of the aponeurotic borders, as an onlay graft. There was neither morbidity nor mortality associated to the surgical procedure. No recurrences or long-term complications associated with mesh employment were verified after a follow-up ranging from one year to three years. We concluded that prosthetic repair of incisional hernia in transplanted patients can be performed routinely.
Assuntos
Hérnia Ventral/cirurgia , Hospedeiro Imunocomprometido , Transplante de Rim/imunologia , Telas Cirúrgicas , Feminino , Seguimentos , Hérnia Ventral/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Polipropilenos , Técnicas de Sutura/efeitos adversosRESUMO
A specific course on sectional anatomy was developed to help medical students improve their knowledge of cross-sectional imaging. The educational methodology consists of identifying anatomical structures displayed in plastinated sections from human cadavers and corresponding anatomical structures in computed tomography (CT) sections from healthy patients. The course has a self-study format. To assess and verify the impact of learning sectional anatomy on radiological knowledge, students were asked to identify ten anatomical structures in CT images. This test was applied to two groups of students: Group I had been taught sectional anatomy with CT images 2 years before the test; Group II had not received instruction in sectional anatomy prior to the test. Analysis of the results revealed a significant difference in test scores (median percentages of correctly identified structures) between Group I and Group II, with scores of 100% and 63.4%, respectively. These results provide evidence that the inclusion of sectional anatomy training in medical school curricula has a great impact on subsequent CT interpretation.
Assuntos
Anatomia/educação , Currículo , Tomografia Computadorizada por Raios X , Educação de Pós-Graduação em Medicina/normas , Humanos , Variações Dependentes do Observador , Competência ProfissionalRESUMO
The authors describe how to use the three-dimensional (3D) anaglyphic method to produce stereoscopic prints for anatomical and surgical teaching and reports preparation by using currently available nonprofessional photographic and computer methods. As with any other method of producing stereoscopic images, the anaglyphic procedure is based on the superimposition of two slightly different images of the object to be reproduced, one seen more from a left-sided point of view and the other seen more from a right-sided point of view. The pictures are obtained using a single camera, which following the first shot can be slid along a special bar for the second shot, or by using two cameras affixed to a surgical microscope. After the images have been distinguished from each other by applying different complementary color dyes, the images are scanned and superimposed on each other with the aid of nonprofessional imaging-manipulation software used on a standard personal computer (PC), and are printed using a standard printer. To be seen stereoscopically, glasses with colored lenses, normally one red and one blue, have to be used. Stereoscopic 3D anaglyphic prints can be produced using standard photographic and PC equipment; after some training, the prints can be easily reproduced without significant cost and are particularly helpful to disclose the 3D character of anatomical structures.