RESUMO
BACKGROUND: Considering long-term changes in renal sodium handling and blood pressure in maternal protein-restricted (LP) offspring, we assumed that the development of LP hypertension results from abnormal dorsal root ganglia (DRG) neurokinin expression associated with impaired responsiveness of renal sensory receptors, promoting a reduced urinary excretion of sodium. The present study investigates whether increased blood pressure in protein-restricted offspring would be associated with changes in the DRG cells and in renal pelvic wall expression of NK1R, SP and CGRP when compared to NP offspring. In addition, we assessed the tubular sodium handling, estimated by creatinine and lithium clearances before and after bilateral renal denervation in conscious LP offspring relative to age-matched NP counterparts. METHODS: Dams received a normal (NP) or low-protein diet (LP) during their entire pregnancy period. Male NP or LP offspring underwent bilateral surgical renal denervation before the 8-week renal functional test and blood pressure measurements. Immunofluorescence staining in DRG cells was assessed in optical sections by confocal laser scanning microscope. RESULTS: The current data demonstrated a sustained rise in blood pressure associated with a decrease in fractional excretion of sodium (FENa) by reducing post-proximal tubule sodium rejection in 16-wk old LP rats relative to age-matched NP counterparts. According to this study, bilateral renal denervation attenuated blood pressure and increased FENa in LP offspring. Furthermore, an immunohistochemical analysis showed a reduced expression of SP and CGRP in DRGs of LP when compared with NP rats. Renal pelvis of LP rats did not show a strong CGRP expression related to NP rats, whereas there was no change in SP immunostaining. CONCLUSIONS: These observations raise the possibility that impaired DRG and pelvic neurokinin expression associated with responsiveness of renal sensory receptors in 16-wk old LP offspring are conducive to excess renal reabsorption of sodium and development of hypertension in this programmed model.
Assuntos
Pressão Sanguínea/fisiologia , Dieta com Restrição de Proteínas , Gânglios Espinais/metabolismo , Pelve Renal/metabolismo , Neurocinina A/metabolismo , Sódio/metabolismo , Animais , Peptídeo Relacionado com Gene de Calcitonina/genética , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Catecolaminas/análise , Creatinina/metabolismo , Feminino , Rim/fisiologia , Lítio/análise , Lítio/metabolismo , Masculino , Microscopia de Fluorescência , Neurocinina A/genética , Potássio/análise , Ratos , Ratos Wistar , Sódio/análise , Substância P/genética , Substância P/metabolismoRESUMO
Takotsubo cardiomyopathy (MTT) is an acute ventricular dysfunction and reversible in absence of coronary disease. It is a rare presentation of pheochromocytoma and paraganglioma (FPGL). It was described for the first time in 1990 by Sato et al, the physiopathology is not clear yet. It is associated with high levels of catecholamines, vasospasm in the micro vascularization, rupture of atheromatous plaque and myiocarditis. The clinical presentation is similar to an acute myocardial infarction because of that the FPGL must be considered in patients without obstructive coronary lesions. We present a case of a 50 years old women with history of Arterial Hypertension, active smoking and Neurofibromatosis, who is admitted to emergency room with an acute myocardial pain.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cardiomiopatia de Takotsubo/etiologia , Feocromocitoma/complicações , Feocromocitoma/diagnóstico , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Catecolaminas/análise , Feocromocitoma/cirurgia , Neoplasias das Glândulas Suprarrenais/cirurgiaRESUMO
Este trabalho foi composto por 4 estudos. Objetivou-se avaliar:1- os conhecimentos de pais/responsáveis (PR) sobre bruxismo do sono (BS) em crianças e adolescentes (A), por meio de um estudo transversal;2- identificar as evidências científicas sobre diferenças entre os níveis de catecolaminas nos fluídos orgânicos de pacientes com e sem BS, a partir de uma revisão sistemática da literatura; BS;3- relatar o sucesso do uso de medicamento homeopático para tratamento de BN em uma criança acompanhada clinicamente por dois anos;4- investigar a eficácia do uso da Melissa officinalis (MO) em associação ou não com Phytolacca decandra (PD) no tratamento BS através de um estudo clínico controlado e randomizado (ECCR). Crianças de 3 a 12 anos, saudáveis, sem presença de cárie e má-oclusão (n=52) foram selecionadas através do relato de PR sobre a presença de BS. Os pacientes foram numerados de 1-52 e randomicamente alocados de acordo com o tratamento proposto: Placebo (P), Melissa officinalis 12c (MO), Phytolacca decandra 12c (PD), Melissa officinalis 12c + Phytolacca decandra 12c (MO+PD). Os medicamentos foram preparados e organizados em frascos ambar de 15ml (3-6 anos) e 30 ml (6-12anos) e rotulados.Cada tratamento foi realizado por 30 dias com 15 dias de período de descanso. As crianças/pais, o investigador principal e o avaliador que analisou os dados foram mascarados ao tratamento. O desfecho principal foi o efeito da medicação homeopática na redução do BS através de uma Escala Visual Analógica (VAS), analisada pela ANOVA de medidas repetidas com LSD Post-Hoc, assim como os escores traço de ansiedade (TAS) antes e após cada tratamento. A maioria dos PR (73,9%) não tem opinião formada e alguns acreditam que o BN está ligado ao estresse emocional (13,4%) e ao misticismo/religiosidade (3,7%), à saúde (3,7%). Para os PR de crianças sem BN, 81,9% não tinham conhecimento das causas, contra 18,1% daqueles com BN (p=0,011). Os estudos incluídos demonstraram um aumento do nível de catecolaminas na urina de indivíduos com BN. Após terapia homeopática combinada de PD e MO observou-se que o BS e sintomas associados desapareceram no caso relatado. No ECCR houve redução significativa da média dos valores da VAS após as quatro fases de tratamento (p=0,023), sendo P= -1,72±0,29; MO= -2,36 ±0,36; PD= -1,44±0,28; MO+PD= -2,21±0,30. Nenhuma das substâncias testadas provocou efeitos adversos físicos. As leituras do sono (p>0,05), EMG (p>0,05) e ETA (p=0,646) não foram influenciadas por nenhum tratamento. Concluiu-se que a maior parte PR desconhecem as causas e consequências do BS. Além disso, níveis urinários aumentados de catecolaminas foram encontrados em pacientes com BS. Embora no caso clínico o uso de MO e PD tenha sido eficaz, no ECCR, apenas a MO mostrou-se capaz de reduzir o BN, sem efeitos colaterais, enquanto a associação de MO+PD demonstrou efeito antagonista. (AU)
This work is composed of 4 studies. Its main objectives were to evaluate: (1) parent's/guardian's (PG) knowledge about sleep bruxism (SB) in children and adolescents (A), by a transversal study; (2) identify the scientific evidences of different levels of catecholamine in the organic fluids of patients who do not suffer from SB, from a systematic revision of literature; (3) report the success of the use of homeopathic medicine for SB treatment in a child accompanied clinically for two years; (4) investigate the usefulness of Melissa officinalis (MO) in association or not with Phytolacca decandra (PD) in the treatment for SB in a controlled randomized and clinical study (CRCS). Healthy children, aged 3-12 years old and without tooth decay and malocclusion (n=52) were selected in accordance to the PG's statements related to SB. The patients were numbered from 1-52 and randomly allocated in accordance with the proposed treatment: Placebo (P), Melissa officinalis (MO), Phytolacca decandra (PD), Melissa officinalis 12c + Phytolacca decandra 12c (MO + PD). The medication was prepared in amber bottles of 15ml (3-6 years old), 30ml (6-12 years old) and labelled. Each treatment was realized in periods of 30 days with 15 days of rest. The children/parents, principal investigator and the data analyzer were all masked for the treatment. The principal outcome was the effect of the homeopathic medicine in the reduction of SB from an Analog Visual Scale (AVS) and analyzed by ANOVA from repeated metrics with LSD Post-Hoc, as with the scores from the Anxiety Traits (AT) from before and after the treatment. Most of the PG do not have a formed opinion on the matter (73.9%), while others believe that SB is associated with emotional stress (13.4%), mysticism/religion (3.7%) or health (3.7%). The PG of the children without SB (81.9%) had no knowledge of the possible causes versus those with SB (18.1%) (p=0.011). The studies demonstrate an increase in the level of catecholamine in the urine for those who have SB. After the homeopathic treatment combined with PD and MO, it was noted that the symptoms disappeared in the reported cases. In the CRCS there was a large reduction in the mean values for AVS after the 4 stages of treatment (p=0.023), with P= -1.72±0.29; MO= -2.36±0.36; PD= -1.44±0.28; MO+PD= -2.21±0.30. None of the tested substances provoked adverse physical reactions. The sleep readings (p>0.05), EMG (p>0.05) and ETA (p=0.646) were not influenced by any treatment. It was concluded that most PG have no knowledge of the causes and consequences of SB. Also, increased levels of catecholamine were found in the urine samples for patients with SB. Even though in the clinical case the use of MO and PD proved to be efficient, in CRCS only MO proved to be capable of reducing SB without any collateral effects, while the combination of MO + PD demonstrated an antagonist effect. (AU)
Este trabajo se compone de cuatro estudios. Su objetivo es evaluar:1- los conocimientos de padres/responsables (PR) sobre bruxismo del sueño (BS) en niños y adolescentes (A), por medio de un estudio transversal;2- identificar las evidencias científicas sobre diferencias entre los niveles de catecolaminas en los fluidos orgánicos de pacientes con y sin BS, a partir de una revisión sistemática de la literatura; BS;3- relatar el éxito del uso de medicamento homeopático para tratamiento de BS en un niño acompañado clínicamente durante dos años;4- investigar la eficacia del uso de Melissa officinalis (MO) asociado o no a Phytolacca decandra (PD) en el tratamiento BS a través de un estudio clínico controlado y randomizado (ECCR). Niños de 3 a 12 años, sanos, sin presencia de carie ni mala-oclusión (n=52) se seleccionaron por el relato de PR sobre la presencia de BS. Los pacientes se numeraron de 1-52 y de manera aleatoria ubicados de acuerdo al tratamiento propuesto: Placebo (P), Melissa officinalis 12c (MO), Phytolacca decandra 12c (PD), Melissa officinalis 12c + Phytolacca decandra 12c (MO+PD). Los medicamentos fueron preparados y organizados en frascos ámbar de 15ml (3-6 años) y 30 ml (6-12años) y rotulados. Cada tratamiento se llevó a cabo durante 30 días con 15 días como período de descanso. Los niños/padres, el investigador principal y el evaluador que analizó los datos acudieron mascarados al tratamiento. El desenlace principal fue el efecto de la medicación homeopática en la reducción del BS a través de una Escala Visual Analógica (VAS), analizada por la ANOVA de medidas repetidas con LSD Post-Hoc, como los scores de rastro de ansiedad (TAS) antes y después de cada tratamiento. La mayoría de los PR (73,9%) no tiene opinión formada y algunos creen que el BS está ligado al estrés emocional (13,4%) y al misticismo/religiosidad (3,7%), a la salud (3,7%). Para los PR de niños sin BS, 81,9% no tenían conocimiento de las causas, contra 18,1% de aquellos con BS (p=0,011). Los estudios incluidos demostraron un aumento del nivel de catecolaminas en la orina de individuos con BS. Tras terapia homeopática combinada de PD y MO se observó que el BS y síntomas asociados desaparecieron en el caso relatado. No ECCR hubo reducción significativa del promedio de los valores de la VAS después de las cuatro fases de tratamiento (p=0,023), siendo P= -1,72±0,29; MO= -2,36±0,36; PD= -1,44±0,28; MO+PD= - 2,21±0,30. Ninguna de las sustancias experimentadas provocó efectos adversos físicos. Las lecturas del sueño (p>0,05), EMG (p>0,05) y ETA (p=0,646) no fueron influenciadas por ningún tratamiento. Se concluyó que la mayor parte PR desconoce las causas y consecuencias del BS. Además, niveles urinarios aumentados de catecolaminas fueron encontrados en pacientes con BS. Aunque en el caso clínico el uso de MO y PD haya sido eficaz, en el ECCR, apenas la MO se mostró capaz de reducir el BS, sin efectos colaterales, mientras que la asociación de MO+PD demostró efecto antagonista. (AU)
Assuntos
Humanos , Criança , Adolescente , Pais/educação , Melissa/uso terapêutico , Phytolacca decandra/uso terapêutico , Bruxismo do Sono/etiologia , Literatura de Revisão como Assunto , Catecolaminas/análise , HomeopatiaRESUMO
Deltamethrin (DTM) is a type II pyrethroid insecticide that elicits autonomic and neuroendocrine responses that indicate high levels of stress, presumably caused by the neurotoxic effect of the insecticide. This study investigated the effect of DTM exposure (10 mg/kg, p.o.) and an additional stress induced in the forced swim test (FST) in behavioral tasks related to anxiety, serum corticosterone levels, and striatal neurotransmitter levels. Open field behavior and social interaction were evaluated after DTM administration (10 mg kg(-1), p.o). DTM per se reduced rearing frequency in the open field, but no alterations in locomotion frequency or immobility duration were detected. Stress increased immobility duration compared with non-stressed animals. DTM reduced social interaction and increased corticosterone levels, and these effects were enhanced in stressed animals. Mainly stress affected dopaminergic and serotoninergic activity. In anxiety behavior and in both neurotransmitters and metabolites levels it was observed an additive effect of stress in DTM treated rat data. These results indicate that DTM enhanced the anxiogenic responses and stress had an additive effect over the DTM stress. The neurochemical data did not indicate an interaction between stress and DTM exposure. The present results maybe important for implementing pyrethroid insecticide safety standards.
Assuntos
Ansiedade/induzido quimicamente , Ansiedade/psicologia , Catecolaminas/análise , Inseticidas/toxicidade , Nitrilas/toxicidade , Piretrinas/toxicidade , Estresse Psicológico , Animais , Corpo Estriado/química , Corpo Estriado/efeitos dos fármacos , Corticosterona/sangue , Masculino , Atividade Motora/efeitos dos fármacos , Ratos , Ratos Wistar , Comportamento Social , NataçãoRESUMO
Halloysite clay nanotubes were used as a support for the immobilization of the enzyme peroxidase from clover sprouts (Trifolium), and employed together with platinum nanoparticles in 1-butyl-3-methylimidazolium hexafluorophosphate ionic liquid (Pt-BMI·PF(6)) in the development of a new biosensor for the determination of catecholamines by square-wave voltammetry. Under optimized conditions, the analytical curves showed detection limits of 0.05, 0.06, 0.07, 0.12 µM for dopamine, isoproterenol, dobutamine and epinephrine, respectively. The biosensor demonstrated high sensitivity, good repeatability and reproducibility, and long-term stability (18% decrease in response over 150 days). A recovery study of dopamine in pharmaceutical samples gave values from 97.5 to 101.4%. The proposed biosensor was successfully applied to the determination of dopamine in pharmaceutical samples, with a maximum relative error of ±1.0% in relation to the standard (spectrophotometric) method. The good analytical performance of the proposed method can be attributed to the efficient immobilization of the peroxidase in the nanoclay, and the facilitation of electron transfer between the protein and the electrode surface due to the presence of the Pt nanoparticles and ionic liquid.
Assuntos
Silicatos de Alumínio/química , Técnicas Biossensoriais/métodos , Catecolaminas/análise , Líquidos Iônicos/química , Nanopartículas Metálicas/química , Nanotubos/química , Platina/química , Argila , Eletroquímica , Enzimas Imobilizadas/química , Enzimas Imobilizadas/metabolismo , Concentração de Íons de Hidrogênio , Imidazóis/química , Peroxidases/química , Peroxidases/metabolismo , Trifolium/enzimologiaRESUMO
The involvement of sympathoadrenal axis activity in obesity onset was investigated using the experimental model of treating neonatal rats with monosodium L-glutamate. To access general sympathetic nervous system activity, we recorded the firing rates of sympathetic superior cervical ganglion nerves in animals. Catecholamine content and secretion from isolated adrenal medulla were measured. Intravenous glucose tolerance test was performed, and isolated pancreatic islets were stimulated with glucose and adrenergic agonists. The nerve firing rate of obese rats was decreased compared to the rate for lean rats. Basal catecholamine secretion decreased whereas catecholamine secretion induced by carbachol, elevated extracellular potassium, and caffeine in the isolated adrenal medulla were all increased in obese rats compared to control. Both glucose intolerance and hyperinsulinaemia were observed in obese rats. Adrenaline strongly inhibited glucose-induced insulin secretion in obese animals. These findings suggest that low sympathoadrenal activity contributes to impaired glycaemic control in prediabetic obese rats.
Assuntos
Medula Suprarrenal/fisiopatologia , Insulina/metabolismo , Obesidade/fisiopatologia , Estado Pré-Diabético/fisiopatologia , Sistema Nervoso Simpático/fisiopatologia , Medula Suprarrenal/química , Medula Suprarrenal/efeitos dos fármacos , Animais , Glicemia/análise , Cafeína/farmacologia , Carbacol/farmacologia , Catecolaminas/análise , Catecolaminas/metabolismo , Teste de Tolerância a Glucose , Insulina/sangue , Secreção de Insulina , Masculino , Obesidade/induzido quimicamente , Ratos , Ratos Wistar , Glutamato de SódioRESUMO
PURPOSE: To report the risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma. MATERIALS AND METHODS: Over a four-year period, we retrospectively identified four patients who underwent resection of adrenal pheochromocytoma in whom the diagnosis was unsuspected based on preoperative clinical, biochemical, and imaging evaluation. RESULTS: None of the patients exhibited preoperative clinical features of catecholamine excess. Preoperative biochemical screening in two patients was normal. CT scan performed in all patients demonstrated a nonspecific enhancing adrenal mass. During surgical resection of the adrenal mass, hemodynamic instability was observed in two of four patients, and one of these two patients also suffered a myocardial infarct. CONCLUSION: Both surgeons and radiologists should maintain a high index of suspicion for pheochromocytoma, as the tumor can be asymptomatic, biochemically negative, and have nonspecific imaging features. Resection of such unsuspected pheochromocytomas carries a substantial risk of intraoperative hemodynamic instability.
Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Catecolaminas/metabolismo , Complicações Intraoperatórias , Feocromocitoma/cirurgia , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/metabolismo , Adulto , Idoso , Catecolaminas/análise , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/metabolismo , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To report the risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma. MATERIALS AND METHODS: Over a four-year period, we retrospectively identified four patients who underwent resection of adrenal pheochromocytoma in whom the diagnosis was unsuspected based on preoperative clinical, biochemical, and imaging evaluation. RESULTS: None of the patients exhibited preoperative clinical features of catecholamine excess. Preoperative biochemical screening in two patients was normal. CT scan performed in all patients demonstrated a nonspecific enhancing adrenal mass. During surgical resection of the adrenal mass, hemodynamic instability was observed in two of four patients, and one of these two patients also suffered a myocardial infarct. CONCLUSION: Both surgeons and radiologists should maintain a high index of suspicion for pheochromocytoma, as the tumor can be asymptomatic, biochemically negative, and have nonspecific imaging features. Resection of such unsuspected pheochromocytomas carries a substantial risk of intraoperative hemodynamic instability.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias das Glândulas Suprarrenais/cirurgia , Catecolaminas/metabolismo , Complicações Intraoperatórias , Feocromocitoma/cirurgia , Neoplasias das Glândulas Suprarrenais/metabolismo , Neoplasias das Glândulas Suprarrenais , Catecolaminas/análise , Hemodinâmica , Feocromocitoma/metabolismo , Feocromocitoma , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Pheochromocytomas are tumors derived from chromaffin cells that often secrete catecholamines and cause hypertension. The clinical diagnosis of pheochromocytoma depends on the presence of excessive production of catecholamines. Conventional imaging modalities that have been used in the preoperative evaluation include CT, MRI, and 131I-MIBG scintigraphy. Surgical resection is the definitive treatment for patients with pheochromocytoma. The goal of this study was to evaluate the long-term follow-up of 24 patients undergoing laparoscopic adrenalectomy for pheochromocytoma. MATERIALS AND METHODS: From January 1995 to September 2006, 24 patients underwent laparoscopic adrenalectomy for adrenal pheochromocytoma. Twenty (83.3%) patients had arterial hypertension. The inclusion criteria of patients in this retrospective study were laparoscopic approach, unilateral or bilateral adrenal tumor, pathological diagnosis of pheochromocytoma and a minimum follow-up of 18 months. RESULTS: Intra-operative complications occurred in 4 (16.7%) patients. Two (8.3%) patients had postoperative complications. Two patients (8.3%) had blood transfusion. The mean postoperative hospital stay was 3.8 days (range 1 to 11). Eighteen (90%) of the twenty patients who had symptomatic hypertension, returned to normal blood pressure immediately after surgery, during the hospital stay. In one patient, the high blood pressure levels remained unchanged. Another patient persisted with mild hypertension, well controlled by a single antihypertensive drug. CONCLUSIONS: Our results confirmed that laparoscopic adrenalectomy for pheochromocytoma is a safe and effective procedure, providing the benefits of a minimally invasive approach. In our study, the initial positive results obtained in the treatment of 24 patients were confirmed after a mean follow-up of 74 months.
Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Feocromocitoma/cirurgia , Adolescente , Neoplasias das Glândulas Suprarrenais/complicações , Adulto , Idoso , Biomarcadores Tumorais/análise , Catecolaminas/análise , Criança , Feminino , Seguimentos , Humanos , Hipertensão/etiologia , Laparoscopia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Feocromocitoma/complicações , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Purpose: Pheochromocytomas are tumors derived from chromaffin cells that often secrete catecholamines and cause hypertension. The clinical diagnosis of pheochromocytoma depends on the presence of excessive production of catecholamines. Conventional imaging modalities that have been used in the preoperative evaluation include CT, MRI, and 131I-MIBG scintigraphy. Surgical resection is the definitive treatment for patients with pheochromocytoma. The goal of this study was to evaluate the long-term follow-up of 24 patients undergoing laparoscopic adrenalectomy for pheochromocytoma. Materials and Methods: From January 1995 to September 2006, 24 patients underwent laparoscopic adrenalectomy for adrenal pheochromocytoma. Twenty (83.3 percent) patients had arterial hypertension. The inclusion criteria of patients in this retrospective study were laparoscopic approach, unilateral or bilateral adrenal tumor, pathological diagnosis of pheochromocytoma and a minimum follow-up of 18 months. Results: Intra-operative complications occurred in 4 (16.7 percent) patients. Two (8.3 percent) patients had postoperative complications. Two patients (8.3 percent) had blood transfusion. The mean postoperative hospital stay was 3.8 days (range 1 to 11). Eighteen (90 percent) of the twenty patients who had symptomatic hypertension, returned to normal blood pressure immediately after surgery, during the hospital stay. In one patient, the high blood pressure levels remained unchanged. Another patient persisted with mild hypertension, well controlled by a single antihypertensive drug. Conclusions: Our results confirmed that laparoscopic adrenalectomy for pheochromocytoma is a safe and effective procedure, providing the benefits of a minimally invasive approach. In our study, the initial positive results obtained in the treatment of 24 patients were confirmed after a mean follow-up of 74 months.