RESUMO
INTRODUCTION: The objective of this study was to investigate regional organ perfusion acutely following uncontrolled hemorrhage in an animal model that simulates a penetrating vascular injury and accounts for prehospital times in urban trauma. We set forth to determine if hypotensive resuscitation (permissive hypotension) would result in equivalent organ perfusion compared to normotensive resuscitation. METHODS: Twenty four (n=24) male rats randomized to 4 groups: Sham, No Fluid (NF), Permissive Hypotension (PH) (60% of baseline mean arterial pressure - MAP), Normotensive Resuscitation (NBP). Uncontrolled hemorrhage caused by a standardised injury to the abdominal aorta; MAP was monitored continuously and lactated Ringer's was infused. Fluorimeter readings of regional blood flow of the brain, heart, lung, kidney, liver, and bowel were obtained at baseline and 85 minutes after hemorrhage, as well as, cardiac output, lactic acid, and laboratory tests; intra-abdominal blood loss was assessed. Analysis of variance was used for comparison. RESULTS: Intra-abdominal blood loss was higher in NBP group, as well as, lower hematocrit and hemoglobin levels. No statistical differences in perfusion of any organ between PH and NBP groups. No statistical difference in cardiac output between PH and NBP groups, as well as, in lactic acid levels between PH and NBP. NF group had significantly higher lactic acidosis and had significantly lower organ perfusion. CONCLUSIONS: Hypotensive resuscitation causes less intra-abdominal bleeding than normotensive resuscitation and concurrently maintains equivalent organ perfusion. No fluid resuscitation reduces intra-abdominal bleeding but also significantly reduces organ perfusion.
RESUMO
The authors investigated the vasorelaxant properties of the aqueous (Aq-EF) and acid n-butanolic (acn-BuOH) extractable fractions from Ilex paraguariensis leaves. Perfusion pressure was evaluated using isolated and perfused mesenteric arterial beds (MABs) from rats fed hypercholesterolemic and standard diets. Extract-induced vasorelaxation in the presence and absence of various inhibitors was examined following precontraction of the MABs with methoxamine (30 microM) solution. In hypercholesterolemic-diet rats, relaxation in intact MABs was significantly decreased with ac-n-BuOH-EF bolus (300, 600, 900 microg) in comparison to those in standard-diet rats. After the endothelium was stripped from the MABs, the vascular responses to ac-n-BuOH-EF and 900 microg bolus of Aq-EF were significantly changed. Treatment of the MABs with an inhibitor of nitric oxide synthase, N(G)-nitro-L-arginine methylester hydrochloride (L-NAME, 10 mM), did not change either ac-n-BuOH-EF- or Aq-EF-induced vasodilation except for the 900 microg bolus of Aq-EF. The guanilate cyclase inhibitor methylene blue (100 microM) did not affect vasodilation for either fraction in the MABs from the hypercholesterolemic-diet rats. The chronic oral administration of I. paraguariensis extract in hypercholesterolemic-diet rats resulted in a significant reduction in serum levels of cholesterol and triglycerides. These results suggest that I. paraguariensis ac-n-BuOH-EF and Aq-EF induce vasodilation in standard-diet rats in a dose-dependent manner and that the hypercholesterolemic diet substantially reduced the effect of ac-n-BuOH-EF on precontracted MABs.
Assuntos
Hipercolesterolemia/prevenção & controle , Ilex paraguariensis , Fitoterapia , Extratos Vegetais/farmacologia , Vasodilatação/efeitos dos fármacos , Análise de Variância , Animais , Relação Dose-Resposta a Droga , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/metabolismo , Masculino , Artérias Mesentéricas/efeitos dos fármacos , Ratos , Ratos WistarRESUMO
Este artigo tem a finalidade de descrever a conduta cirúrgica para a reconstrução de maxila atrófica em paciente que sofreu perda precoce de vários elementos dentais, resultando em uma relação interarcos invertida. O procedimento consistiu no preparo do leito ósseo para a instalação futura de implantes osseointegrados, visando a reabilitação estética e funcional da paciente. Várias áreas doadoras podem ser utilizadas em grandes reconstruções maxilo-mandibulares como: calota craniana, tíbia, costela, fíbula e osso ilíaco (crista anterior e posterior). A área doadora de eleição para este caso foi a crista anterior do osso ilíaco por apresentar facilidade na remoção, pequena morbidade cirúrgica e taxa de infecção pós-operatória inferior a 4 por cento. Grande quantidade de osso pode ser removido, sob a forma de blocos córtico-medulares ou de fragmentos, obtidos através de curetagem da porção medular ou trituração de blocos. A evolução da paciente não apresentou intercorrências. A avaliação radiográfica pós-operatória mostrou uma melhora evidente no perfil da paciente, e uma relação maxilo-mandibular mais favorável. Clinicamente, observou-se abertura do ângulo naso-labial, resultando em melhora do perfil