ABSTRACT
Background and objectives: In children undergoing congenital heart surgery, plasma brain natriuretic peptide levels may have a role in development of low cardiac output syndrome that is defined as a combination of clinical findings and interventions to augment cardiac output in children with pulmonary hypertension. Methods: In a prospective observational study, fifty-one children undergoing congenital heart surgery with preoperative echocardiographic study showing pulmonary hypertension were enrolled. The plasma brain natriuretic peptide levels were collected before operation, 12, 24 and 48 h after operation. The patients enrolled into the study were divided into two groups depending on: (1) Development of LCOS which is defined as a combination of clinical findings or interventions to augment cardiac output postoperatively; (2) Determination of preoperative brain natriuretic peptide cut-off value by receiver operating curve analysis for low cardiac output syndrome. The secondary end points were: (1) duration of mechanical ventilation ≥72 h, (2) intensive care unit stay >7days, and (3) mortality. Results: The differences in preoperative and postoperative brain natriuretic peptide levels of patients with or without low cardiac output syndrome (n = 35, n = 16, respectively) showed significant differences in repeated measurement time points (p = 0.0001). The preoperative brain natriuretic peptide cut-off value of 125.5 pg mL−1 was found to have the highest sensitivity of 88.9% and specificity of 96.9% in predicting low cardiac output syndrome in patients with pulmonary hypertension. A good correlation was found between preoperative plasma brain natriuretic peptide level and duration of mechanical ventilation (r = 0.67, p = 0.0001). Conclusions: In patients with pulmonary hypertension undergoing congenital heart surgery, 91% of patients with preoperative plasma brain natriuretic peptide levels above 125.5 pg mL−1 ...
Justificativa e objetivo: Em crianças submetidas à cirurgia cardíaca congênita, os níveis plasmáticos de peptídeo natriurético cerebral (PNC) podem ter um papel no desenvolvimento da síndrome de baixo débito cardíaco (SBDC), definida como uma combinação de achados clínicos e intervenções para aumentar o débito cardíaco em crianças com hipertensão pulmonar. Métodos: Em um estudo prospectivo observacional, foram inscritas 51 crianças submetidas à cirurgia cardíaca congênita, com avaliação ecocardiográfica pré-operatória que mostrava hipertensão pulmonar. Os níveis plasmáticos de PNC foram avaliados antes e 12, 24 e 48 h após a operação. Os pacientes incluídos no estudo foram divididos em dois grupos em função de: (1) desenvolvimento de SBDC; (2) determinação dos valores de corte de PNC no pré-operatório pela análise da curva de funcionamento do receptor para SBDC. Os desfechos secundários foram: (1) duração da ventilação mecânica ≥ 72 h, (2) permanência em unidade de terapia intensiva > 7 dias e (3) mortalidade. Resultados: Os níveis de PNC nos períodos pré- e pós-operatório dos pacientes com ou sem SBDC (n = 35, n = 16, respectivamente) apresentaram diferenças significantes nos tempos de mensuração repetidos (p = 0,0001). O valor de corte de PNC de 125,5 pg mL−1 no pré-operatório obteve a maior sensibilidade de 88,9% e especificidade de 96,9% para prever a SBDC em pacientes com hipertensão pulmonar. Uma boa correlação foi descoberta entre o nível plasmático de PNC no pré-operatório e duração a ventilação mecânica (r = 0,67, p = 0,0001). Conclusões: Em ...
Justificación y objetivo: En niños sometidos a cirugía de cardiopatía congénita, los niveles plasmáticos de péptido natriurético cerebral pueden tener un papel en el desarrollo del síndrome de bajo gasto cardíaco, definido como una combinación de hallazgos clínicos e intervenciones para aumentar el gasto cardíaco en niños con hipertensión pulmonar. Métodos: En un estudio prospectivo observacional, se inscribieron 51 niños sometidos a cirugía de cardiopatía congénita, y cuya evaluación ecocardiográfica preoperatoria mostró hipertensión pulmonar. Los niveles plasmáticos de péptido natriurético cerebral fueron evaluados antes de la operación, y 12, 24 y 48 h después de la operación. Los pacientes incluidos en el estudio fueron divididos en 2 grupos en función de: (1) desarrollo de síndrome de bajo gasto cardíaco, definido como una combinación de hallazgos clínicos o de intervenciones para aumentar el gasto cardíaco en el postoperatorio; (2) determinación de los valores de corte de péptido natriurético cerebral en el preoperatorio por el análisis de la curva de funcionamiento del receptor para el síndrome de bajo gasto cardíaco. Los resultados secundarios fueron: (1) duración de la ventilación mecánica ≥ 72 h, (2) permanencia en unidad de cuidados intensivos (UCI) > 7 días, y (3) mortalidad. Resultados: Los niveles de péptido natriurético cerebral en los períodos pre y postoperatorio de los pacientes con o sin síndrome de bajo gasto cardíaco (n = 35 y n = 16, respectivamente) tuvieron diferencias significativas en los tiempos de medida repetidos (p = 0,0001). El valor de corte de péptido natriurético cerebral de 125,5 pg/mL−1 en el preoperatorio obtuvo la mayor ...
Subject(s)
Humans , Child , Postoperative Period , Cardiac Output, Low/etiology , Natriuretic Peptides/blood , Heart Defects, Congenital/surgery , Hypertension, Pulmonary/physiopathology , Prospective Studies , Extracorporeal CirculationABSTRACT
Congenital Heart Block (CHB) is the most serious complication of neonatal lupus erythematosus. Transplasental transfer of maternal anti-SSA/Ro or anti-SSB/La antibodies around 12th week of gestation is associated with development of CHB. This may lead to inflammation, fibrosis and scarring of fetal conduction system in the early second trimester. Different degrees of atrioventricular (AV) block may be seen in the affected fetus. First and second-degree AV blocks may change in severity; however, third degree AV block is irreversible. CHB is mostly diagnosed between 18- 24th weeks of gestation. Even if most of the mothers carrying autoantibodies of several rheumatic diseases such as systemic lupus erythematosus or Sjogren’s syndrome are not aware of their diseases until their children are born with CHB, it is recommended that antibody-positive mothers or the mothers having babies with neonatal lupus erythematosus should be referred for close fetal echocardiographic surveillance beginning from the early second trimester. Although their utility is still controversial, various therapeutic regimes such as sympathomimetic, plasmapheresis, steroids, intravenous immunoglobulin, digoxin, diuretic and in utero pacing have been used for intrauterine treatment of CHB. Aggressive medical treatment is coupled with pacing in infants who do not respond to medical therapy alone.
ABSTRACT
In this study, we evaluated the ultrastructural findings of testis with systemic administration of different doses of melatonin during ischemic period in a rat model of testicular torsion/detorsion (T/D). Testis ischemia-reperfusion (I/R) injury was induced by torsion of the left testis, with a 720 degrees twisting of the spermatic cord so as to produce a total occlusion of testis for 2.5 hours. Subsequently, the same testis was then detorsioned. According to surgical procedure in each group, unilateral orchiectomies were performed for histopathologic examination. The groups were labelled as control group, torsion group (T), torsion and detorsion group (T/D), torsion-detorsion and melatonin group (T/D+20,50 and 100 mg/kg melatonin). For the histological examination, testicular tissues were fixed in 2.5 percent glutheraldehyde and postfixation 1 percent osmic acid solutions. They were examined under transmission electron microscopy after application of contrast stained. In torsion group testis cross-sections, cytoplasm residues of mature sperms and large vacuole-like structures were noticeable. In detorsion group testis cross-sections, dissociations in spermatocide nuclei, many vacuoles and residual particles resulting from organelle degeneration, local voids in cytoplasms of spermatogonia, dilatation in granulated endoplasmic reticulum, large lipid droplets, chromatid particles, along with mitochondrial crystalisis were determined. In the testis cross-sections of the group of T/D+50 mg/kg melatonin administration, sertoli and spermatogonia cells that showed membrane-like structures and cytoplasmic voids were observed. Testis cross-sections of rats that were administered with T/D+50 mg/kg melatonin showed small mitochondrions and vacuole-like structures placed on the edge. Testis cross-sections of rats that were administered with T/D+100 mg/kg melatonin resulted in views similar to those of controls in the microstructural level. As a result, the most effective...
Se evaluaron, en un modelo de torsión/detorsión (T/D) testicular en rata, los cambios ultraestructurales producidos en los testículos, posterior a la administración sistémica de diferentes dosis de melatonina, durante el período de isquemia. La lesión de isquemia-reperfusión (I/R) testicular fue inducida por la torsión del testículo izquierdo, con un giro de 720 grados del cordón espermático con el fin de producir una oclusión total de los testículos durante 2,5 horas. Posteriormente, los mismos testículos fueron detorsionados. De acuerdo con el procedimiento quirúrgico en cada grupo, fueron realizados exámenes histopatológicos de las orquiectomías unilaterales. Los grupos fueron divididos en grupo control, grupo torsión (T), grupo torsión/destorsión (T/D), y grupo torción/destorsión con melatonina (T/D +20, 50 y 100 mg/kg de la melatonina). Para el examen histológico, los tejidos testiculares fueron fijados en soluciones de glutaraldehído al 2,5 por ciento y postfijados al 1 por ciento en ácido ósmico. Luego fueron examinados, después de la aplicación de contrastes de colores, a través de microscopía electrónica de transmisión. En las secciones transversales del grupo con torsión testicular, fueron visibles residuos citoplas-máticos de espermatozoides maduros y grandes estructuras vacuolares. En las secciones transversales del grupo con destorsión testicular, se observaron disociaciones en los núcleos espermáticos, numerosas vacuolas y partículas residuales derivadas de la degeneración de organelos; además de espacios localizados en el citoplasma de las espermatogonias, dilatación en el retículo endoplasmático rugoso, grandes gotas de lípidos y partículas de cromátidas, junto con cristálisis mitocondrial. En las secciones transversales del grupo T/D +50 mg/kg de administración de melatonina, células sustentaculares y espermatogonias mostraron estructuras tipo membrana y vacíos citoplasmáticos. Las secciones transversales del grupo con torsión en la que fue ...
Subject(s)
Animals , Male , Adult , Rats , Melatonin/administration & dosage , Melatonin/therapeutic use , Spermatic Cord Torsion/drug therapy , Spermatic Cord Torsion/therapy , Spermatic Cord Torsion/veterinary , Rats, Sprague-Dawley/abnormalities , Testis/anatomy & histology , Testis/cytology , Testis , Testis/embryologyABSTRACT
Oxygen free radicals are considered to be important components involved in the pathophysiological tissue alterations observed during ischemia-reperfusion (I/R). In this study, we investigated the putative protective effects of melatonin treatment on pancreatic I/R injury. Sprague Dawley male rats were subjected to 30 min of pancreatic pedicle occlusion followed by 90 min reperfusion. Melatonin (10 mg/kg. s.c) was administrated 30 min prior to ischemia or I/R application. At the end of the reperfusion periods, rats were decapitated. Pancreatic samples were taken for transmission electron microscopy. The results indicated that ischemia created b cell damage as evidenced by dilatation between the nucleus inner and outer membrane and degeneration on islets of Langerhans cells, was reversed by melatonin treatment. As melatonin administration reversed these microscopic damage, it seems likely that melatonin protects pancreatic tissue against oxidative damage.
Los radicales libres del oxígeno son considerados como uno de los componentes más importantes que participan en las alteraciones fisiopatológicas del tejido durante la isquemia-reperfusión (I/R). En este estudio, se investigó el supuesto efecto protector del tratamiento de melatonina sobre la lesión pancreática I/R. Ratas Sprague Dawley machos fueron sometidas a 30 minutos de oclusión del pedículo pancreático seguido de 90 minutos de reperfusión. La melatonina (10 mg/kg) fue administrada 30 minutos antes de la isquemia o de la aplicación I/R. Al finalizar los periodos de reperfusión, las ratas fueron decapitadas. Fueron tomadas muestras pancreáticas para el análisis en microscopía electrónica de transmisión. Los resultados indicaron que la isquemia ocasionó daño en las células beta demostrado por la dilatación entre el núcleo interior y la membrana exterior y la degeneración de los islotes de células pancreáticas, los que fueron revertidos por el tratamiento de melatonina. Como la administración de melatonina revirtió estos daños microscópicos, parece probable que ella proteja al tejido pancreático contra el daño oxidativo.