Ergotism, a relatively unknown mimic of vasculitis: A case report and review of literature / Ergotismo: un imitador poco conocido de vasculitis. Reporte de caso y revisión de la literatura

ABSTRACT Introduction: Ergotism is a vasospasm that affects visceral and peripheral muscle arteries. Classically, symmetrical involvement of lower limb arteries is described, and is often associated with a history of chronic consumption of ergotamine derived medications (Cafergot). Case report: A 22 year-old healthy man with infectious mononucleosis syndrome, who presented with a sudden onset of paraesthesias in the lower limbs, as well as livedo reticularis. The initial diagnosis was a medium-sized vessel vasculitis (polyarteritis nodosa). The symptoms were preceded by the administration of Cafergot for headache treatment, and resolved spontaneously. The magnetic resonance angiography (MRA) of the lower limbs showed occlusion of peroneal arteries, with filiform distal flow. Other infectious, autoimmune and cardiovascular origins were ruled out. Discussion: Ergotism is an important differential diagnosis in the study of the patient with vasculitis, especially in acute onset presentations. Its treatment is the suspension of the causal drug, with vasodilator and surgical vascular procedures, if necessary. Conclusions: Ergotism is an imitator of vasculitis, especially in young patients with a history of difficult to control migraine. The concomitant administration of CYP3A4 inhibitors (mainly, protease inhibitors and macrolides) enhances the toxic effects of ergot.

RESUMEN Introducción: El ergotismo es un vasoespasmo que afecta las arterias musculares periféricas y viscerales. Clásicamente se describe la afectación simétrica de las arterias de las extremidades inferiores, a menudo asociada con el consumo crónico de medicamentos derivados de ergotamina (Cafergot®). Caso clínico: Varón sano de 22 anos con síndrome de mononucleosis, presentó parestesias en las extremidades inferiores y livedo reticularis de forma súbita, el diagnóstico inicial fue una vasculitis de mediano vaso (poliarteritis nodosa). Los síntomas fueron precedidos por la administración de Cafergot® para el tratamiento de cefalea, y se resolvieron espontáneamente. La angiografía por resonancia magnética (ARM) de las extremidades inferiores mostró oclusión de las arterias peroneas, con flujo distal filiforme. Se descartaron otras etiologías infecciosas, autoinmunes y cardiovasculares. Discusión: Los ergotismos son un diagnóstico diferencial importante en el estudio del paciente con vasculitis, especialmente en presentaciones de inicio agudo. Su tratamiento es la suspensión del fármaco causal, vasodilatadores y procedimientos vasculares quirúrgicos, si es necesario. Conclusiones: El ergotismo es un imitador de vasculitis, especialmente en pacientes jóvenes con antecedentes de migrana de difícil control. La administración concomitante de inhibidores del CYP3A4 (principalmente, inhibidores de proteasa y macrólidos) potencia los efectos tóxicos del ergot.

Vértigo como presentación clínica de asa vascular de la arteria cerebelosa antero inferior / Vertigo as a clinical presentation of a vascular loop of the anterior inferior cerebellar artery

Resumen El vértigo es un frecuente motivo de consulta cuyo origen puede ser periférico o central; causas poco frecuentes de este último son las asas vasculares que afectan el VIII par craneal llevando a acúfenos, pérdida de la audición y mareo. Se presenta una mujer de 47 años de edad, quien consulta por un cuadro de mareo, náuseas, pérdida del tono postural, cefalea y parestesia facial, cuyo examen físico revela signos de vértigo periférico, iniciándose tratamiento con antieméticos, anticinetósicos y vasodilatadores que llevan a empeoramiento del cuadro, por lo que se sospecha de patología a nivel de sistema nervioso central (SNC) que ejerce compresión con la vasodilatación. Se realiza una resonancia magnética que muestra un asa vascular en la arteria cerebelosa inferior anterior (AICA) que ingresa al conducto auditivo interno (CAI) explicando la sintomatología y cuyo efecto compresivo de los nervios centrales genera un efecto paradójico con la toma de vasodilatadores. (Acta Med Colomb 2018; 43: 226-229).

Abstract Vertigo is a frequent reason for consultation whose origin can be peripheral or central; infrequent causes of the latter are the vascular loops that affect the VIII cranial nerve leading to tinnitus, hearing loss and dizziness. The case of a 47-year-old woman who consulted for a picture of dizziness, nausea, loss of postural tone, headache and facial paraesthesia, and whose physical examination revealed signs of peripheral vertigo, is presented. Treatment was started with antiemetics, anticinetics and vasodilators that lead to worsening of the condition, for which pathology exerting compression due to vasodilation at the central nervous system (CNS) level, is suspected. An MRI is performed showing a vascular loop in the Anterior Lower Cerebellar Artery (AICA) that enters the Internal Auditory Canal (IAC) explaining the symptomatology and whose compressive effect of the central nerves generates a paradoxical effect with the taking of vasodilators. (Acta Med Colomb 2018; 43: 226-229).

Potential pharmacological use of salivary compounds from hematophagous organisms / Uso potencial farmacológico de los compuestos salivares de organismos hematófagos

Abstract Introduction: The saliva of hematophagous or blood-sucking insects contains different substances that allow obtaining and ingesting the blood of their vertebrate hosts without being detected. Objective: To explore the salivary compounds of hematophagous insects which have vasodilator, anticoagulant, anti-inflammatory, immunomodulatory and anesthetic properties, and that can be exploited due to their high pharmacological potential. Materials and methods: A non-systematic literature review was done in PubMed, EMBASE, and ScienceDirect OvidSP; data was not limited by date, language nor item type. Articles on salivary compounds of blood-sucking insects, whose main topic was the effects on hemostasis, immunomodulation and drug use, were sought. 59 articles met the criteria for inclusion in the review. Conclusions: The saliva of hematophagous insects has a wide variety of molecules that constitute a source of research and have an incalculable potential for the discovery of compounds that could be pharmacologically useful.

Resumen Introducción. La saliva de los artrópodos hematófagos contiene un arsenal de compuestos que les permite acceder a la sangre de sus hospederos vertebrados sin ser detectados. Objetivo. Explorar los compuestos salivares de insectos hematófagos que tienen propiedades vasodilatadoras, anticoagulantes, antiinflamatorias, inmunomoduladoras y anestésicas, las cuales se pueden aprovechar por su alto potencial farmacológico. Materiales y métodos. Se realizó una revisión no sistemática de la literatura mediante búsqueda electrónica en las bases de datos PubMed, EMBASE, OvidSP y ScienceDirect; la búsqueda no se limitó por fecha, idioma ni tipo de artículo. Se buscaron artículos sobre los compuestos salivares de los insectos hematófagos, cuyo tema central fuese los efectos en la hemostasia, inmunomodulación y uso farmacológico. Se encontraron 59 artículos que cumplían con los criterios para ser incluidos en la revisión. Conclusión. La saliva de los insectos hematófagos posee gran variedad de moléculas, lo que ofrece una fuente de investigación y un potencial incalculable para el descubrimiento de compuestos que podrían llegar a tener utilidad farmacológica.

Validation of an instrument regarding nursing intervention in patients in vasoactive therapy / Validación de instrumentos para intervención de la enfermería en el paciente pasando por terapia vasoactiva / Validação de instrumento para intervenção de enfermagem ao paciente em terapia vasoativa

ABSTRACT Objective: to validate the content of a Standard Operational Procedure, regarding nursing interventions in emergency patients treated with vasoactive drugs. Method: methodological study, carried out from December 2015 to January 2016. Content validity was determined by 16 experts (13 nurses, 2 pharmacists and one biomedical scientist), who judged it through a four-point Likert scale. The items were evaluated in terms of: feasibility, objectivity, simplicity, clearness, pertinence and accuracy. The Content Validity Index was applied, accepting the value ≥ 0.90. Results: two rounds of evaluation were required to achieve the minimum index. The items were reviewed regarding writing, dilution, indication and replacement interval. The instrument was validated with 33 items and with total Content Validity Index of 0.99. Conclusion: the instrument was considered appropriate, fractionally and globally, for nursing care for the patient treated with vasoactive drugs in emergency, in a safe and reliable way.

RESUMEN Objetivo: validar el contenido del Procedimiento Operacional Estándar para la intervención de la enfermería en el paciente que usa fármacos vasoactivos en la emergencia. Método: estudio metodológico, realizado entre diciembre de 2015 y enero de 2016. La validación del contenido fue determinada mediante la escala tipo Likert de cuatro puntos por 16 jueces, de los cuales 13 eran enfermeros, dos farmacéuticos y uno biomédico. Los apartados se clasificaron en: ejecutabilidad, objetividad, simplicidad, claridad, pertinencia y precisión. Se aplicó el Índice de Validez de Contenido con la aceptación del valor ≥ 0,90. Resultados: se necesitaron dos rondas de validación para alcanzar el índice. Los apartados se alteraron en la redacción, la dilución, la indicación y el intervalo de cambio. El instrumento se validó con 33 tópicos y con Índice de Validez del Contenido total de 0,99. Conclusión: los resultados se consideran adecuados separadamente, y de manera global, para que el enfermero cuide del paciente usuario de fármacos vasoactivos de forma segura y confiable en la emergencia.

RESUMO Objetivo: validar o conteúdo do Procedimento Operacional Padrão, para intervenção de enfermagem ao paciente em uso de fármacos vasoativos na emergência. Método: estudo metodológico, realizado de dezembro de 2015 a janeiro de 2016. A validação de conteúdo deu-se por 16 juízes, sendo 13 enfermeiros, dois farmacêuticos e um biomédico, que o julgaram por meio da escala tipo Likert de quatro pontos. Os itens foram avaliados em: exequibilidade, objetividade, simplicidade, clareza, pertinência e precisão. Aplicou-se o Índice de Validade de Conteúdo, aceitando-se o valor ≥ 0,90. Resultados: foram necessárias duas rodadas de validação para atingir o índice. Os itens foram alterados: na redação, diluição, indicação, intervalo de troca. O instrumento foi validado com 33 itens e com Índice de Validade de Conteúdo total de 0,99. Conclusão: considerou-se adequado, separadamente, e de maneira global, para que o enfermeiro possa cuidar do paciente em uso de fármacos vasoativos na emergência, de forma segura e confiável.

Oral Sildenafil for Severe Pulmonary Hypertension Developing after Ibuprofen Use in a Neonate.

Background: Severe pulmonary hypertension may following ibuprofen administration for ductal closure. Case characteristics: An extremely preterm infant who developed severe pulmonary hypertension unresponsive to inhaled nitric oxide after ibuprofen administration. Outcome: Pulmonary hypertension reversed after the administration of oral sildenafil, but the infant died due to complications related to bronchopulmonary dysplasia. Message: Sildenafil may have a role in treatment of severe pulmonary hypertension after ibuprofen treatment for ductal closure.

Iloprost inhalado, un vasodilatador pulmonar selectivo. Evidencia clínica de su uso en la hipertensión pulmonar del perioperatorio de cirugía cardiovascular / Inhaled iloprost, a selective pulmonary vasodilator. Clinical evidence from its use in perioperative pulmonary hypertension cardiovascular surgery

El iloprost inhalado es uno de los fármacos más recientes del grupo de prostanoides en el tratamiento de la hipertensión arterial pulmonar. No se ha definido su importancia en la hipertensión pulmonar en el perioperatorio de cirugía cardiovascular. En esta revisión se analizan los grupos con hipertensión pulmonar susceptibles de cirugía cardiaca, la importancia de la hipertensión pulmonar en cirugía cardiaca y, además, la evidencia clínica actual del uso del fármaco en este contexto.

Inhaled iloprost is one of the most recent drugs from prostanoids group's in the treatment of pulmonary arterial hypertension. His place in pulmonary hypertension seen in the perioperative cardiovascular surgery has not been defined. In this review we analyze pulmonary hypertension group's susceptibles of cardiac surgery and its importance, besides the current clinical evidence from drug use in this context.

Stepwise Approach Using Combined Management in Patients with Congenital Heart Disease and Borderline Pulmonary Vascular Disease

BACKGROUND AND OBJECTIVES: Despite remarkable advances in pediatric cardiology, pulmonary arterial hypertension associated with congenital heart disease remains a major problem. In the past decade new vasodilators have been introduced and appear to be effective in reducing pulmonary vascular resistance (PVR). SUBJECTS AND METHODS: From 2000 to 2011, we retrospectively reviewed the records of 22 patients who had congenital septal defects and borderline pulmonary vascular disease (PVD). The PVR in these patients was from 6 to 16 wood units . m2, and/or the systolic pulmonary arterial pressure was more than 2/3 of the systemic arterial pressure. RESULTS: The median age was 16 years (range, 9 months-46 years). The median duration of follow-up was 7.4 years (range, 1.4-11.7 years). According to hemodynamic data and clinical symptoms, the initial management comprised targeted medical therapy in four (18%), complete closure in four (18%), and partial closure in 14 patients (63.6%). In the four patients who had a high PVR and negative vasoreactivity, the PVR decreased and vasoreactivity increased after targeted medical therapy; three of these patients underwent cardiac surgery later. Finally, 11 (50%) received targeted medical therapy and 21 patients (95.4%) underwent cardiac surgery. Complete closure resulted in six patients and partial closure in 17 patients. Mortality was observed in two patients. The other 19 patients (91%) had New York Heart Association functional class I. CONCLUSION: Targeted medical therapy may be effective in reducing PVR in patients with congenital heart disease and borderline PVD. A stepwise approach may help to achieve improved outcomes in these patients.

Utilidad clínica del iloprost inhalado en la hipertensión arterial pulmonar / Clinical utility of inhaled iloprost in pulmonary arterial hypertension

El iloprost inhalado es un fármaco del grupo de las prostaciclinas utilizado en el tratamiento de la hipertensión arterial pulmonar. La eficacia y seguridad de su administración han permitido su uso como monoterapia y en terapia combinada. En esta revisión se describen las características del medicamento, los grupos susceptibles de tratamiento y la evidencia clínica actualizada del uso del fármaco.

Inhaled iloprost is a drug from the group of prostacyclins used in the treatment of pulmonary arterial hypertension. Its efficacy and safety have allowed its use as monotherapy and combination therapy. This review describes the product characteristics, amenable to treatment groups, and updated clinical evidence of drug use.

Impacto do ecocardiograma transesofágico intraoperatório na mortalidade em cirurgia de revascularização do miocárdio com circulação extracorpórea / Impact of intraoperative transesophageal echocardiography in mortality in coronary artery bypass grafting

OBJETIVO: avaliar as taxas de mortalidade e morbidade de doentes submetidos à revascularização do miocárdio (RVM) com circulação extracorpórea (CEC) que utilizaram rotineiramente o ecocardiograma transesofágico intraoperatório (ETEio). MÉTODOS: estudo retrospectivo, observacional com avaliação de prontuários de 360 doentes no período entre abril de 2010 a abril de 2012. Foram analisados: idade, peso, altura sexo, EUROscore, diabete melito, fração de ejeção e artérias acometidas. Os desfechos foram compilados no intra e no pós-operatório (infarto do miocárdio, acidente vascular cerebral, disfunção renal, hemodiálise, fibrilação atrial, tempo de internação no centro de tratamento intensivo). RESULTADOS: foram incluídos 53 doentes, com 27 recebendo a monitoração. Foram excluídos 307 porque não foram operados pela mesma equipe cirúrgica. Os dois grupos foram homogêneos quanto a idade, peso e sexo, porém, a fração ejeção foi menor no grupo que recebeu o ecotransesofágico (G ETEio: 56,3%; G Não ETEio: 65,9% ± 11; p=0,01). Nos doentes em que não foi utilizado o ETEio, a mortalidade foi maior (G ETEio: 0% e G Não ETEio: 7,6%; p=0,01). Não houve diferença significativa entre os grupos quanto à incidência de acidente vascular encefálico, infarto agudo do miocárdio, fibrilação atrial aguda e lesão renal. CONCLUSÃO: a utilização do ecocardiograma transesofágico intraoperatório em pacientes submetidos à revascularização do miocárdio, com circulação extracorpórea, diminuiu a mortalidade perioperatória; orientou quanto a utilização dos fármacos inotrópicos e vasodilatadores e contribuiu para uma melhor evolução dos doentes.

OBJECTIVE: To evaluate the rates of mortality and morbidity in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) using routine intraoperative transesophageal echocardiography (ITEE). METHODS: We conducted a retrospective, observational review of medical records of 360 patients from April 2010 to April 2012. We analyzed: age, weight, height, gender, EuroSCORE, diabetes mellitus, ejection fraction and number of diseased vessels. Outcomes were compiled in intraoperative and postoperative (myocardial infarction, stroke, renal failure, hemodialysis, atrial fibrillation, length of stay in the intensive care unit). RESULTS: 53 patients were included, with 27 receiving monitoring; we excluded 307 individuals, as they were not operated by the same surgical team. The two groups were homogeneous for age, weight and gender. However, the ejection fraction was lower in the group submitted to ITEE (ITEE group 56.3% versus Non-ITEE group 65.9 ± 11%, p = 0.01). In patients not subjected to ITEE, mortality was higher (ITEE group 0% versus Non-ITEE group 7.6%, p = 0.01). There was no significant difference between groups as for the incidence of stroke, myocardial infarction, atrial fibrillation and acute kidney injury. CONCLUSION: The use of intraoperative transesophageal echocardiography in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass decreased perioperative mortality, warranted the use of inotropic drugs and vasodilators and contributed to a better patient outcome.

Hipertensão pulmonar persistente neonatal: recentes avanços na fisiopatologia e tratamento / Persistent pulmonary hypertension of the newborn: recent advances in pathophysiology and treatment

OBJETIVOS: Embora reconhecida há décadas, ainda pouco se sabe a respeito da etiologia, fisiopatologia e prevenção da hipertensão pulmonar persistente neonatal (HPPN), e seu tratamento continua a ser um grande desafio para os neonatologistas. Nesta revisão, vamos abordar as características clínicas e os mecanismos fisiopatológicos da síndrome, assim como seu tratamento geral e específico. FONTES DE DADOS: Fizemos uma revisão nas bases de dados PubMed, Cochrane Library e MRei Consult , procurando por artigos relacionados à síndrome e publicados entre 1995 e 2011. SÍNTESE DE DADOS: São discutidos os fatores de risco e os mecanismos fisiopatológicos da síndrome. O quadro clínico depende dos diferentes fatores envolvidos, que provavelmente estão relacionados com a etiologia e o mecanismo fisiopatológico. Além das medidas utilizadas para permitir a queda da resistência vascular pulmonar após o nascimento, alguns casos necessitam de vasodilatadores pulmonares. Embora o óxido nítrico tenha se provado efetivo, recentemente, outros vasodilatadores têm sido usados, mas ainda faltam evidências clínicas para comprovar seus benefícios no tratamento da HPPN. CONCLUSÕES: Apesar dos recentes avanços tecnológicos e dos novos conhecimentos fisiopatológicos, a mortalidade associada à HPPN ainda é de 10%. São necessárias mais pesquisas clínicas e resultados experimentais baseados em evidências para prevenir, tratar e reduzir a morbimortalidade associada a esta síndrome neonatal.

OBJECTIVES: Although recognized for decades, little is known about the etiology, physiopathology, and prevention of persistent pulmonary hypertension of the newborn (PPHN). and its treatment remains a major challenge for neonatologists. In this review, the clinical features and physiopathology of the syndrome will be addressed, as well as its general and specific treatments. DATA SOURCE: A review was carried out in PubMed, Cochrane Library, and MRei consult databases, searching for articles related to the syndrome and published between 1995 and 2011. DATA SYNTHESIS: Risk factors and the physiopathological mechanisms of the syndrome are discussed. The clinical picture depends on the different factors involved, which are probably related to the etiology and physiopathological mechanisms. In addition to the measures used to allow the decrease in pulmonary vascular resistance after birth, some cases will require pulmonary vasodilators. Although nitric oxide has proved effective, other vasodilators have been recently used, but clinical evidence is still lacking to demonstrate their benefits in the treatment of PPHN. CONCLUSIONS: Despite recent technological advances and new physiopathological knowledge, mortality associated with PPHN remains at 10%. More clinical research and evidence-based experimental results are needed to prevent, treat, and reduce the morbidity/mortality associated with this neonatal syndrome.

The Pharmacologic Treatment of Acute Heart Failure / 대한내과학회지

Acute heart failure (HF) is commonly encountered in the emergency department and thus, the hospital admissions for worsening HF are increasing. However, the patients presenting with acute HF are heterogenous and complex at high risk of morbidity and mortality. The main goals of treatment for hospitalized patients with HF are to restore euvolemia and to maintain the hemodynamic status without causing adverse events. Currently, the recommendations are usually based on a clinical factor considering the initial systolic blood pressure and other symptoms. Accordingly, initial managements in the hospital generally include diuretics, vasodilators, morphine, and inotropic agents, all of which have been considered as traditional therapies. These agents should mainly increase cardiac output and improve symptoms, and importantly it should improve the clinical outcomes. The aim of this review is to describe the available and new pharmacologic drugs for patients presenting with acute HF.

Efeito da cafeína na detecção de isquemia à cintilografia de perfusão miocárdica associada ao estresse com adenosina / Effects of caffeine on ischemia detection in myocardial perfusion scyntigraphy induced by adenosine stress

A utilização da cintilografia de perfusão miocárdica (CPM) estava limitada a pacientes que podiam realizar algum tipo de exercício, para ampliarmos a disponibilidade clínica da CPM, vários protocolos com estresses farmacológicos foram desenvolvidos. A adenosina fármaco amplamente utilizado, potente vasodilatador coronariano, apresenta uma importante interação com outras substâncias que anatagonizam seus efeitos, o dipiridamol, alimentos com cafeína e derivados de xantinas. O tempo de suspensão de cafeína da dieta para o uso exógeno da adenosina na realização da CPM ainda não está definido. Para testar essa hipótese avaliamos a influência da abstinência de cafeína em 24h, 12h e 1h, através de sua dosagem sérica, antes do estresse farmacológico com adenosina e sua possível repercussão nas imagens da CPM e o efeito vasodilatador no sistema cardiovascular. Definimos como objetivo primário: comparar a presença e a extensão dos defeitos reversíveis da CPM verificados em pacientes com abstinência de café por 24 horas (E1) com as imagens da randomização com 1 hora e 12 horas (E2) sem cafeína e como objetivos secundários: avaliar a presença e intensidade dos paraefeitos, comportamento da frequência cardíaca e da pressão arterial sistêmica. Foram submetidos ao estresse farmacológico com adenosina 194 pacientes para a realização da CPM, dos quais 43 pacientes preencheram os critérios para a randomização (defeitos perfusionais transitórios na CPM com adenosina). Excluímos seis pacientes (13,9%), três (6,9%) se recusaram a realizar a fase da randomização e os outros três (6,9%) nos quais não houve consenso entre os observadores em relação aos defeitos de perfusionais transitórios. A média de idade dos 37 pacientes analisados foi de 61,4 ± 8,3 anos, sendo 21 pacientes do sexo masculino (56,8%). Na avaliação das imagens da CPM, não houve diferença entre as imagens obtidas no grupo E1 comparadas as imagens de 1 (2,0 ± 1,5) hora ou 12 (12,6 ± 3,1) horas sem cafeína (E2)...

Myocardial perfusion imaging (MPI) in the past was only available to patients who were able to perform some type of exercise. Many protocols were developed with pharmacologic stress in order to enlarge the clinical availability of myocardial perfusion imaging (MPI). Adenosine is widely used and a potent coronary vasodilator, exhibits a significant interaction with other substances which antagonize its effects, such as dipyridamole, food products containing caffeine and xanthine derivatives. We found no clear consensus as to the time between caffeine ingestion and a cardiovascular adenosine stress test. To test this hypothesis we evaluated the influence of 24-hour, 12-hour and 1-hour caffeine abstinence, by assessing plasma caffeine levels before adenosine pharmacological stress, the possible repercussions on MPI images and vasodilatory effects on the cardiovascular system. The primary endpoint was to compare the presence and extent of reversible myocardial perfusion defects found in patients with 24-hour abstinence from coffee (E1), with images from patients randomized to 1-hour or 12-hour caffeine abstinence (E2). As secondary endpoints we evaluated the presence and intensity of paraeffects, as well as heart rate and systemic arterial blood pressure behavior. For this purpose, 194 patients underwent pharmacological stress with adenosine for MPI, 43 of whom fulfilled criteria for randomization (patients with transient perfusion defects detected on adenosine MPI). Six patients were excluded (13.9%), three patients (6.9%) who refused to undergo randomization, and other three (6.9%) in whom the observers could not reach consensus regarding transient perfusion defects. Mean age for the 37 patients analyzed was 61.4 ± 8.3 years, 21 patients male (56.8%). In the evaluation of myocardial perfusion images, no differences were detected between images obtained in the 24-hour E1 arm, and those from 1 (2.0 ± 1.5) hour or 12 (12.6 ± 3.1) hours...

Vasodilator activity of extracts of field Alpinia purpurata (Vieill) K: Schum and A. zerumbet (Pers.) Burtt et Smith cultured in vitro / Vasodilatador de extratos de Alpinia purpurata campo (Vieill) K. Schum e A. zerumbet (Pers.) Burtt et Smith cultivadas in vitro

Nowadays, the high blood pressure is one of the main causes of death and cardiovascular diseases. Vasodilator drugs are frequently used to treat arterial hypertension. Experiments were undertaken to determine whether hydroalcoholic extracts obtained from leaves of field-grown Alpinia purpurata and A. zerumbet cultured in vitro under different plant growth regulators induce a vasodilator effect on Wistar rat mesenteric vascular bed pre-contracted with norepinephrine. Plant extracts were able to induce a long-lasting endothelium-dependent vasodilation. Efficiency on activity of A. purpurata reached 87 percent at concentration of 60 μg. The extract of A. zerumbet maintained in medium containing IAA, induced the relaxation (17.4 percent) at 90 μg, as compared to the control (MS0) that showed a better vasodilator effect (60 percent). These results are in agreement with the quantification of phenolic compounds in the extracts, which were 50 percent lower for those plants cultured in IAA. A. purpurata was assayed for the first time in relation to its vasodilator activity. This paper showed a strong probability of correlation between the pharmacological activities of A. purpurata with their content in phenolic compounds.

Atualmente, a hipertensão arterial é uma das maiores causas de morte e de doenças cardiovasculares. Os vasodilatadores são freqüentemente utilizados no tratamento da hipertensão. Extratos hidroalcoólicos de Alpinia purpurata de campo e de A. zerumbet cultivada in vitro sob diferentes reguladores de crescimento vegetal foram ensaiados no leito mesentérico de ratos Wistar. Os extratos de A. purpurata e A. zerumbet produziram efeito vasodilatador com padrão de resposta dose-dependente de duração prolongada. Extratos da espécie A. purpurata tiveram efeito vasodilatador de 87 por cento na dose de 60 μg. O extrato obtido de folhas de A. zerumbet oriundas das culturas mantidas em meio contendo AIA (ácido indol acético) inibiu o relaxamento (17,4 por cento) na dose de 90 μg em relação ao controle (MS0), com o qual foi verificado melhor efeito vasodilatador (60 por cento). Estes resultados estão de acordo com a concentração de fenóis totais que foi 50 por cento menor para os extratos de plantas cultivadas in vitro em AIA. A espécie A. purpurata foi pela primeira vez ensaiada quanto à atividade vasodilatadora. Os resultados obtidos indicaram a presença de substâncias fenólicas provavelmente correlacionadas à ação terapêutica de A. purpurata.

Anesthetic Management in a Patient with Severe Primary Pulmonary Hypertension with Right Ventricular Dysfunction: A case report / 대한마취과학회지

Primary pulmonary hypertension is characterized by progressive increase in pulmonary vascular resistance leading to right ventricular (RV) failure and death.The desirable goal of primary pulmonary hypertension is preserving coronary perfusion of RV while decreasing pulmonary arterial pressure with selective pulmonary vasodilators.We report a case in which anesthetic management was successfully performed in a 67 years old man, who had experienced ventricular tachycardia at the previous anesthesia induction, with severe pulmonary hypertension and right ventricular dysfunction.

Therapeutic strategy towards renal restoration in chronic kidney disease.

Background: The population with end-stage renal disease is increasing. This continued growth is related to: i) diagnostic failure in screening for early chronic kidney disease (CKD) associated with tubulointerstitial fibrosis (TIF), ii) failure in preventing renal disease progression due to lack of understanding of the precise determinants that induce TIF, and iii) delayed treatment which simply slows renal disease progression, but is unable to restore renal function. Objective: To review therapeutic strategy to restore renal function in CKD stressing fractional excretion of magnesium (FE Mg) as a sensitive biomarker for screening early CKD associated with TIF. Results: There is much evidence to support the crucial role of renal microvascular disease as the determinant of TIF and disease progression. A unique pattern of hemodynamic maladjustment is characterized by a preferential constriction of the efferent arteriole that induces peritubular capillary flow reduction in CKDs. Conclusion: The present information leads to a therapeutic strategy to restore renal function in early CKD patients.

Antihemostatic Molecules From Saliva of Blood-Feeding Arthropods / 生物化学与生物物理进展

The ability to feed on vertebrate blood has evolved many times in various arthropod clades. Consequently, saliva of blood-feeding arthropods has proven to be a rich source of antihemostatic molecules. A variety of platelet aggregation inhibitors antagonize platelet responses to wound-generated signals, including ADP, thrombin, and collagen. Anticoagulants disrupt elements of both the intrinsic and extrinsic pathways. Vasodilators include nitrophorins (nitric oxide storage and transport heme proteins), a variety of peptides that mimic endogenous vasodilatory neuropeptides, and proteins that catabolize or sequester endogenous vasoconstrictors. Multiple salivary proteins may be directed against each component of hemostasis, resulting in both redundancy and in some cases cooperative interactions between antihemostatic proteins. The complexity and redundancy of saliva ensures an efficient blood meal for the arthropod, but it also provides a diverse array of novel antihemostatic molecules for the pharmacologist.

Influence of Vasoactive Substances on the Regulation of Cardiac ATP-Sensitive Potassium Channel Activity

BACKGROUND AND OBJECTIVES: It has been known that various vasoactive agents are involved in the regulation of cardiac function through the modification of the K+ channel activities, including the ATP-sensitive K+ channel (KATP). We examined the effects of several vasoactive agents on the cardiac KATP currents in isolated cardiac myocytes. MATERIALS AND METHODS: Ventricular myocytes were isolated from the hearts of ICR mice by enzymatic digestion. The channel currents were recorded by the excised inside-out and cell-attached patch clamp configurations. RESULTS: In the excised inside-out patches, bradykinin (BRK; 1-10 micrometer) and prostaglandin I2 (PGI; 10-50 micrometer) did not affect the channel activities, whereas the vasodilators increased the attenuated channel activities in the presence of 100 micrometer ATP. BRK and PGI in parallel shifted the dose-response curves of ATP (1-1,000 micrometer), and this inhibited the KATP currents to the right. Endothelin (ET-1; 0.1-1 nM) and leukotriene D4 (LTD; 3-10 micrometer) decreased the channel activities immediately after making the inside-out patches. However, the vasoconstrictors did not affect the attenuated channel activities by ATP. In the cell-attached patches, both BRK and PGI increased the channel activities and these effects were markedly attenuated by glibenclamide (50 micrometer). ET-1 and LTD did not affect the baseline channel activities in the cell-attached patches, but they markedly attenuated the dinitrophenol-induced activities. CONCLUSION: It was inferred that certain vasoactive substances are involved in the regulation of cardiac KATP channel activities, and that bradykinin and PGI2 enhance the channel activities, and ET-1 and LTD4 inhibit the channel activities.

Vasomotor Reactivity of the Spasm Model by the Polystyrene Latex Bead

OBJECTIVE: It has been reported that the presence of a pharmacologically inactive foreign substance, polystyrene latex bead, in subarachnoid space activates a non-specific immunological response and elicits arterial narrowing. In vivo study was undertaken to characterize vascular reactivity of bead-induced constriction. METHODS: The spasm models similar to that by subarachnoid blood injection were created by injection of bead(5 volume% or 10 volume %) into rabbit cisterna magna. The basilar artery was visualized using transclival exposure, and its diameter was monitored using videomicroscopy on day two after cisternal injection. Consequently, many kinds of vasodilators such as papaverine, endothelin receptor antagonist, nicardipine, H7, dibutyryl-c-AMP, 8-bromo-c-GMP, nitroglycerine, forskolin, calcitonin gene-related peptide, and cromakalim were topically applied to determine what vasodilators attenuate arterial constriction induced by bead in 31 rabbits. RESULTS: Injection of bead elicited an arterial constriction, reducing arterial diameter to 78.5% of resting tone in 5 volume% and 67.7% in 10 volume%. ATP-sensitive potassium channel activator, cromakalim, inhibited 5 volume% or 10 volume% bead induced constriction. This effect achieved statistical significance (p<0.05) at a concentration of 10nM. However, other vasodilators did not make a significant vasodilatation of bead induced constriction. CONCLUSION: These results suggest that inactivation of ATP-sensitive potassium channel by inflammation is possibly responsible for the polysytrene latex bead-induced vasospasm, and support the concept that targeting vascular potassium channels can be of benefit in preventing the development of vasospasm.

Vasomotor Reactivity of the Spasm Model by the Polystyrene Latex Bead

OBJECTIVE: It has been reported that the presence of a pharmacologically inactive foreign substance, polystyrene latex bead, in subarachnoid space activates a non-specific immunological response and elicits arterial narrowing. In vivo study was undertaken to characterize vascular reactivity of bead-induced constriction. METHODS: The spasm models similar to that by subarachnoid blood injection were created by injection of bead(5 volume% or 10 volume %) into rabbit cisterna magna. The basilar artery was visualized using transclival exposure, and its diameter was monitored using videomicroscopy on day two after cisternal injection. Consequently, many kinds of vasodilators such as papaverine, endothelin receptor antagonist, nicardipine, H7, dibutyryl-c-AMP, 8-bromo-c-GMP, nitroglycerine, forskolin, calcitonin gene-related peptide, and cromakalim were topically applied to determine what vasodilators attenuate arterial constriction induced by bead in 31 rabbits. RESULTS: Injection of bead elicited an arterial constriction, reducing arterial diameter to 78.5% of resting tone in 5 volume% and 67.7% in 10 volume%. ATP-sensitive potassium channel activator, cromakalim, inhibited 5 volume% or 10 volume% bead induced constriction. This effect achieved statistical significance (p<0.05) at a concentration of 10nM. However, other vasodilators did not make a significant vasodilatation of bead induced constriction. CONCLUSION: These results suggest that inactivation of ATP-sensitive potassium channel by inflammation is possibly responsible for the polysytrene latex bead-induced vasospasm, and support the concept that targeting vascular potassium channels can be of benefit in preventing the development of vasospasm.