ABSTRACT
Introdução: A persistência transitória de defeitos perfusionais imediatamente após intervenção coronária percutânea bem sucedida para correção de estenoses coronárias é bem documentada. Método: Para testar a hipótese de que tais anormalidades perfusionais sejam associadas a distúrbios microcirculatórios causados por microembolização coronária, comparou-se a intensidade e extensão desses defeitos perfusionais detectados com cintilografia miocárdica em grupos randomicamente constituídos de pacientes tratados com angioplastia coronária por balão (AB) ou submetidos a aterectomia rotacional complementada por balão (AR + B). As características clínicas e angiográficas foram comparáveis nos dois grupos, assim como o sucesso do procedimento de angioplastia coronária. Resultados: Antes da intervenção coronária percutânea, o índice de defeito miocárdico, englobando a extensão e a gravidade da hipoperfusão, foi comparável nos dois grupos, na condição de estresse (AB = 7,72±1,91 vs AR + B = 8,61±3,38) e de repouso (AB = 3,11±1,22 vs AR + B = 2,40±1,63). Após o procedimento, o índice de defeito perfusional decresceu em ambos os grupos durante o estresse, mas com significância estatística apenas no grupo AB = 3,96±1,40 vs AR + B = 3,71 ±1,89. O contraste entre os dois grupos se acentuou na condição de repouso após a intervenção coronária: o índice de defeito decresceu de forma marginalmente significante no grupo AB para 1,46±0,66 e aumentou, embora sem significância estatística, no grupo AR + B, para 3,47±1,92. Conclusão: Esses resultados são compatíveis com o conceito de que a persistência transitória de defeitos perfusionais após angioplastia coronária bem sucedida seja dependente de distúrbios microcirculatórios associados à microembolização durante o procedimento.
Introduction: The transitory persistence of perfusion defects immediately after successful percutaneous coronary interventions to correct coronary stenosis is well known. Methods: To test the hypothesis that such perfusion abnormalities are associated with microcirculatory disorders caused by coronary microembolization we compared the intensity and extent of these perfusion defects detected using myocardial scintigraphy in groups of patients randomly assigned to coronary balloon angioplasty (BA) or to rotational atherectomy plus balloon angioplasty (RA + B). The clinical and angiography characteristics were comparable in both groups, as well as the successof the coronary angioplasty procedure. Results: Before the percutaneous coronary intervention the myocardium defect index, related to the extent and severity of hypoperfusion, was comparable for the two groups, both under stress (AB =7.72±1.91 vs. RA + B = 8.61±3.38) and at rest (AB = 3.11±1.22vs. RA + B = 2.40±1.63). After the procedure, the perfusion defect index decreased for both groups during stress, but with statistical significance only in the AB Group = 3.96±1.40 vs. RA + B = 3.71±1.89. The difference between the two groups was greater at rest after the coronary intervention procedure: the defect index decreased with marginal significance for the AB Group to 1.46±0.66 and increased, though without statistical significance, for the RA + B Group to 3.47±1.92. Conclusion: These results are compatible with the notion that transitory persistence of perfusion defects after successful coronary angioplasty are dependent on microcirculatory disorders associated to microembolization during the procedure
Subject(s)
Humans , Male , Female , Adult , Angioplasty, Balloon, Coronary/methods , Angioplasty, Balloon, Coronary , Atherectomy, Coronary/methods , Atherectomy, Coronary , Microcirculation/abnormalitiesSubject(s)
Humans , Male , Female , Adult , Angioplasty, Balloon, Coronary/methods , Angioplasty, Balloon, Coronary , Echocardiography, Transesophageal/methods , Echocardiography, Transesophageal , Echocardiography/methods , Echocardiography , Internal Mammary-Coronary Artery Anastomosis/methods , Microcirculation/abnormalities , Myocardial Revascularization/methods , StentsABSTRACT
Para estudar os efeitos hemodinâmicos sistêmicos e regionais da expansão volêmica em modelo de choque séptico, vinte e um cães anestesiados e sob ventilação mecânica receberam dose letal de E. coli vivas por via endovenosa, randomizados em três grupos: Ringer lactato 16 ou 32ml/Kg em 30min ou controle e observados 120min. A bacteremia promoveu hipotensão, redução do débito cardíaco, fluxo porta e renal, acompanhados por aumento da extração sistêmica e regional de oxigênio, acidose láctica e aumento dos gradientes veno-arterial, porta-arterial e gastro-arterial de CO2. A expansão volêmica promoveu benefícios parciais e temporários insuficientes para reverter os déficits perfusionais.To study the regional and systemic hemodynamics effects of fluid resuscitation in a model of septic shock. Twenty-one anesthetized and mechanically ventilated dogs received a lethal doses of live E. coli in blood circulation, randomized in three groups: Lactate Ringer 16 or 32ml/kg in 30 min and control and observed 120 min. The bacteremia resulted in hypotension, decrease of cardiac output, portal and renal flow, accompanied by an increase in the systemic and regional oxygen extraction, lactic acidosis and increase in venous-arterial, porto-arterial and gastro-arterial of CO2 gradients. Fluid replacement resulted in partial and temporary benefits unable to restore the perfusional deficits...
Subject(s)
Animals , Male , Adult , Dogs , Shock, Septic/physiopathology , Escherichia coli/pathogenicity , Chemotherapy, Cancer, Regional Perfusion , Disease Models, Animal , Dogs , Fluid Therapy/methods , Manometry , Microcirculation/abnormalities , Intestinal Mucosa/physiopathologyABSTRACT
Presentamos nuevos conceptos relativos a la etiología de la Enfermedad de Parkinson (EP). Basado en los hallazgos sobre la angio-arquitectura, relaciones neurono-vasculares y actividad metabólica de la zona compacta de la sustancia negra normal y parkinsoniana, nosotros creemos que una reducción subóptima en el flujo sanguíneo y su persistencia crónica a al sustancia negra, puede ser la clave en la patogénesis de la EP. Por el contrario, suponiendo que nuestra hipótesis es correcta, una revascularización de la sustancia negra podría detener o mejorar esta enfermedad.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Parkinson Disease/etiology , Substantia Nigra/injuries , Microcirculation/abnormalities , Substantia Nigra/anatomy & histologyABSTRACT
Alterations in Relative Plasma Viscosity (RPV) and Plasma Fibrinogen Concentration (PFC) were compared in 24 insulin-dependent (IDDM) and33 non-insulin-dependent (NIDDM) black Nigerian diabetics, during the course of treatment. Both PFC and RPV were significantly (p<0.001) increased in the diabetics, as a group, compared to a non-diabetic control group. PFC and RPV showed consistently marginal, though insignificant, increases in the IDDM vs NIDDM. Hypertensive diabetics, as a group, had significantly greater PFC (p<0.025), and RPV (p<0.025) than normotensive diabetics. Although PFC was significantly (p<0.05) raised in hypertensive IDDM, there was no marked change between hypertensive and normotensive NIDDM. The implication of the present findings is that insulin-dependent diabetics may be more prone than non-insulin-dependent diabetics to develop haemorheological and hence circulatory disorders