Roles of estrogen and progesterone in modulating renal nerve function in the rat kidney

The maintenance of extracellular Na+ and Cl- concentrations in mammals depends, at least in part, on renal function. It has been shown that neural and endocrine mechanisms regulate extracellular fluid volume and transport of electrolytes along nephrons. Studies of sex hormones and renal nerves suggested that sex hormones modulate renal function, although this relationship is not well understood in the kidney. To better understand the role of these hormones on the effects that renal nerves have on Na+ and Cl- reabsorption, we studied the effects of renal denervation and oophorectomy in female rats. Oophorectomized (OVX) rats received 17β-estradiol benzoate (OVE, 2.0 mg·kg-1·day-1, sc) and progesterone (OVP, 1.7 mg·kg-1·day-1, sc). We assessed Na+ and Cl- fractional excretion (FENa+ and FECl- , respectively) and renal and plasma catecholamine release concentrations. FENa+ , FECl- , water intake, urinary flow, and renal and plasma catecholamine release levels increased in OVX vs control rats. These effects were reversed by 17β-estradiol benzoate but not by progesterone. Renal denervation did not alter FENa+ , FECl- , water intake, or urinary flow values vs controls. However, the renal catecholamine release level was decreased in the OVP (236.6±36.1 ng/g) and denervated rat groups (D: 102.1±15.7; ODE: 108.7±23.2; ODP: 101.1±22.1 ng/g). Furthermore, combining OVX + D (OD: 111.9±25.4) decreased renal catecholamine release levels compared to either treatment alone. OVE normalized and OVP reduced renal catecholamine release levels, and the effects on plasma catecholamine release levels were reversed by ODE and ODP replacement in OD. These data suggest that progesterone may influence catecholamine release levels by renal innervation and that there are complex interactions among renal nerves, estrogen, and progesterone in the modulation of renal function.

Takotsubo Cardiomyopathy: A Case of Persistent Apical Ballooning Complicated by an Apical Mural Thrombus

Takotsubo cardiomyopathy (TTC) is an infrequent cardiac syndrome characterized by acute onset chest pain with apical ballooning on echocardiography. It is often triggered by severe emotional or physical stress, and in contrast to acute myocardial infarction (AMI), the regional wall motion abnormality returns to normal within days. Here, we describe a 62-year-old female who presented with acute onset chest pain during treatment for a liver abscess. We presumed a diagnosis of AMI because of ST segment elevation on electrocardiography and elevated cardiac enzyme levels. However, the patient's coronary arteries were normal on angiography, and apical ballooning was seen on echocardiography. A diagnosis of TTC was made, and the patient was managed with intensive cardiopulmonary support using vasopressors in our hospital's medical intensive care unit. The patient's symptoms improved, but persistent severe left ventricular dysfunction was detected on follow-up echocardiography. After 5 weeks, a new apical mural thrombus appeared, and anticoagulation therapy was started. The apical ballooning persisted 3 months later, although the patient's overall ejection fraction was slightly improved. The apical thrombus was completely resolved without any embolic event. Non-adrenergic inotropics can be recommended in TTC with shock, and clinicians should keep in mind the potential risk of thrombus formation and cardioembolism.

A case of pulmonary oedema induced by suffocation / Un caso de edema pulmonar inducido por sofocación

A 57-year old female civilian was suffocated by an intruder. The victim (experienced severe dyspnoea) but violently resisted the assault. Two hours after this event, on admission to a Trauma Centre, she demonstrated left facial swelling with low percutaneous oxygen saturation. Chest X-ray and computed tomography demonstrated pulmonary oedema. This improved dramatically within a short time and she was discharged on the 5th hospital day. Pulmonary oedema induced by suffocation has been reported only rarely. The possible mechan-isms by which pulmonary oedema might form after the relief of airway obstruction are discussed.

Una ciudadana de 57 años fue sofocada por un intruso. La víctima experimentó una disnea severa, pero resistió violentamente el ataque. Dos horas después de este acontecimiento, al ser ingresada en un Centro de Traumas, se le observó hinchazón en el lado izquierdo de la cara, con una baja saturación percutánea de oxígeno. La radiografía del pecho y la tomografía computarizada mostraron un edema pulmonar. Este cuadro clínico mejoró dramáticamente en corto tiempo, y fue dada de alta al quinto día de su hospitalización. El edema pulmonar inducido por sofocación ha sido raramente reportado. Se discuten los posibles mecanismos por los cuales el edema pulmonar podría formarse después de desbloquearse la obstrucción de la vía respiratoria.

Uso tópico da adrenalina em diferentes concentrações na cirurgia endoscópica nasal / Topical use of adrenaline in different concentrations for endoscopic sinus surgery

A concentração ideal de adrenalina tópica a promover hemostasia adequada sem toxicidade ainda é motivo de controvérsia. OBJETIVO: Comparar soluções tópicas de adrenalina em diferentes concentrações. DESENHO DO ESTUDO: Prospectivo, duplo-cego, seleção aleatória. MATERIAIS E MÉTODOS: 49 pacientes submetidos à cirurgia endoscópica nasal, divididos em 3 grupos usando exclusivamente adrenalina tópica, nas concentrações de 1:2000, 1:10.000 e 1:50.000. Comparou-se o tempo operatório, o sangramento, as concentrações plasmáticas de adrenalina e noradrenalina e a variação dos parâmetros cardiovasculares. RESULTADOS: O tempo operatório por procedimento foi menor no grupo que utilizou adrenalina 1:2000, assim como o sangramento (p < 0,0001). As concentrações plasmáticas de adrenalina subiram em todos os 3 grupos, porém mais no grupo que utilizou adrenalina 1:2000. Houve uma tendência de aumento dos níveis tensionais nos pacientes que usaram adrenalina 1:2000 e 1:10.000, com maior ocorrência de picos hipertensivos. Discussão: Os benefícios do uso da solução de adrenalina mais concentrada foram evidentes, principalmente em relação ao sangramento. A tendência de aumento dos níveis tensionais pode ter ocorrido por não termos utilizado técnica anestésica intravenosa exclusiva. CONCLUSÃO: Analisando os prós e contras, sugerimos o uso de solução de adrenalina tópica 1:2000; mais pesquisas que corroborem nossos achados são necessárias.

The ideal adrenaline concentration remains unknown. AIM: Compare topical adrenaline solutions in different concentrations. STUDY DESIGN: Prospective, double blind, randomized trial. PATIENTS AND METHODS: 49 patients divided in 3 groups underwent endoscopic sinus surgery, using only topical solutions of adrenaline in different concentrations (1:2,000, 1:10,000 and 1:50,000). We compared the duration of surgery, intra-operative bleeding, plasmatic levels of catecholamines, hemodynamic parameters and changes in heart rhythm. RESULTS: Surgery time was shorter in the group using adrenaline 1:2,000, which also showed less bleeding in all evaluations (objective and subjective - p < 0.0001). Plasmatic levels of epinephrine rose in all groups, more sharply in the 1:2,000 group. There was a trend towards elevation of blood pressure in the groups using adrenaline 1:2,000 and 1:10,000, with a greater occurrence of hypertensive peaks. DISCUSSION: We found a very significance bleeding difference favoring the 1:2,000. The blood pressure elevation in the 1:2,000 and 1:10,000 groups was progressive but very slow throughout the procedure, which could be associated with the anesthesia technique. CONCLUSION: We favor the use of topical adrenalin 1:2,000 due to a clear superiority in hemostasis. Further investigation is needed to corroborate our findings.

Effects of cerastes cerastes cerastes and cerastes vipera venoms on some hormonal levels in the white rat

Viprine venoms have drastic effects on the metabolic performance of their victims. The venoms of these two vipers, Certastes cerastes cerastes [C.c.cerastes] and Cerastes vipera [C. vipera] were studied in a comparative manner focusing on some hormones related to glucose level in the blood. Both studies, in vivo and in vitro, were conducted to pinpoint the site and mechanism of action. Levels of insulin, epinephrine, norepinephrine and corticosterone significantly changed by venom injection and by perifusing isolated pancreatic islets with crude venoms. This study primarily concluded that venom of C.c.cerastes has a peptide of hypoglycemic effect. Besides, this peptide may have enough amino acid sequence to bind to anti-insulin antibodies. Venom was milked from C.c.cerastes and C.vipera reared in the serpentarium of the department. White adult male albino rats were purchased and kept in the animal house for acclimatization before experimentation. Radioimmunoassay [RIA] and spectroflourometry were used for hormonal estimation. In vitro study included isolating the pancreatic islets of Langerhans, testing their viability and testing direct effect of the venom on insulin release. While C.c.cerastes venom is hyperinsulinemic and hypoglycemic C. vipera is just the opposite. The two venoms do not adopt opposite mechanisms to effect their roles. Cc. cerastes venom includes apeptide of hypoglycemic effect, it also binds to anti-insulin antibody. Crude venoms of C.c.cerastes and C. vipera are crowds of different peptides. These peptides manifest various effects by working directly on the relevant site or by being a step in a cascade of events. These venoms showed major effects on the blood levels of insulin, epinephrine, norepinephrine and corticosterone. Furthermore, the insulinic effect shown is largely due to a peptide that mimics insulin in its activity. We concluded the presence of a hypoglycemic peptide in the venom of C.c.cerastes that demands further study and characterization

Hemodynamic and catecholamine stress responses to insertion of the combitube as an alternative airway management in general anaesthesia for caesarean section

The introduction of Combitube to the field of airway management brought about a solution of the problem of difficult airway in trauma patients and during cardiopulmonary resuscitation. This trial was designed to assess the efficacy of Combitube in preventing the lethal complications of failed Intubation during caesarean section and compare the haemodynamic and stress response to the device with that resulting from endotracheal intubation. Forty-five healthy parturients scheduled for CS were randomized Into three equal groups. Combitube was inserted blindly in group I and facilitated by laryngoscopy in group II In group III, endotracheal intubation was performed under laryngoscopy. Patients were assessed for the degree of difficulty of insertion of the Combitube, manifestation of regurgitation or trauma to the oropharynx. haemodynamic changes and hormonal response to Combitube Insertion and endotracheal intubation. There was no significant difference in the degree of ease on Introduction of Cornbitube in group I as compared to group II. Combitube proved to be a safeguard against regurgitation as group I and II were compared to group III A high incidence of trauma was noticed in group I during blind insertion of Combitube as compared to laryngoscopy aided insertion in group II or endotracheal Intubation in group III Laryngoscopy aided Insertion of Combitube [group II] or endotracheal intubation [group III] produced a significant increase In heart rate as compared to blind insertion in group I. Comparison between groups II and III showed a significant increase In HR in group III. Systolic blood pressure Increased significantly in group III while the other two groups manifested an insignificant increase. Stress hormones manifested increases in all the groups. Nor- adrenaline level increased insignificantly in group I and II. while it was statistically significant In group III. Adrenaline levels increased insignificantly in all the study groups. Prolactine level increased insignificantly In group I and manifested a significant increase in groups II and III. This Increase was significantly higher in group III as compared to group II. It is concluded that Combitube provides a safe patent airway not only in emergency situations but also in patients scheduled for surgery if they were at risk of aspiration or difficult intubation as those scheduled for caesarean section

Swimming training increases cardiac vagal activity and induces cardiac hypertrophy in rats

The effect of swimming training (ST) on vagal and sympathetic cardiac effects was investigated in sedentary (S, N = 12) and trained (T, N = 12) male Wistar rats (200-220 g). ST consisted of 60-min swimming sessions 5 days/week for 8 weeks, with a 5 percent body weight load attached to the tail. The effect of the autonomic nervous system in generating training-induced resting bradycardia (RB) was examined indirectly after cardiac muscarinic and adrenergic receptor blockade. Cardiac hypertrophy was evaluated by cardiac weight and myocyte morphometry. Plasma catecholamine concentrations and citrate synthase activity in soleus muscle were also determined in both groups. Resting heart rate was significantly reduced in T rats (355 ± 16 vs 330 ± 20 bpm). RB was associated with a significantly increased cardiac vagal effect in T rats (103 ± 25 vs 158 ± 40 bpm), since the sympathetic cardiac effect and intrinsic heart rate were similar for the two groups. Likewise, no significant difference was observed for plasma catecholamine concentrations between S and T rats. In T rats, left ventricle weight (13 percent) and myocyte dimension (21 percent) were significantly increased, suggesting cardiac hypertrophy. Skeletal muscle citrate synthase activity was significantly increased by 52 percent in T rats, indicating endurance conditioning. These data suggest that RB induced by ST is mainly mediated parasympathetically and differs from other training modes, like running, that seems to mainly decrease intrinsic heart rate in rats. The increased cardiac vagal activity associated with ST is of clinical relevance, since both are related to increased life expectancy and prevention of cardiac events.

Estudo da função ventricular na técnica de plicatura da parede livre do ventrículo esquerdo em cães / Left ventricular function after plication of the left ventricular free wall in dogs

OBJETIVO: Avaliar os efeitos da técnica na função ventricular esquerda em cães hígidos e com cardiomiopatia dilatada induzida pela doxorrubicina. MÉTODO: De 13 cães, oito receberam doxorrubicina até que a fração de encurtamento (FE) fosse menor que 20 por cento. Destes, quatro animais e os cinco não induzidos foram submetidos à plicatura da parede livre do ventrículo esquerdo (PPLVE). Os demais cães não foram operados. Foram avaliados débito cardíaco (DC), pressão arterial, exame físico, eletrocardiografia, sistema "Holter" e ecocardiografia, por 180 dias. RESULTADOS: Houve redução do volume ventricular esquerdo. Os cães induzidos melhoraram após a operação e a fração de ejeção (FEj) retornou aos valores normais para a espécie. O DC e a FE aumentaram após a operação. Um cão foi a óbito. Nos cães não operados, a FE diminuiu e foram a óbito em torno de 40 dias após a indução; nos cães não induzidos, esta não se alterou. Houve extra-sístoles ventriculares, que se resolveram espontaneamente. CONCLUSÕES: A PPLVE sem circulação extracorpórea reduz o volume ventricular esquerdo e melhora a função cardíaca dos cães com cardiomiopatia dilatada induzida pela doxorrubicina, demonstrando baixa morbidade e mortalidade tardia.

Acute hypercalcemia-induced hypertension: the roles of calcium channel and alpha-1 adrenergic receptor.

OBJECTIVE: To study the mechanism(s) of acute hypercalcemia-induced hypertension in dogs. MATERIAL AND METHOD: Adult male mongrel dogs were intravenously infused with: 1) normal saline solution, 2) CaCl2 solution, 3) CaCl2 + calcium channel blocker (verapamil), 4) CaCl2 + selective alpha-1 adrenergic receptor blocker (prazosin), or 5) CaCl2 + verapamil + prazosin. Either verapamil or prazosin treatment was started at forty minutes before CaCl2 infusion and then was co-administered throughout the three-hour experimental period. Systemic and renal hemodynamics parameters were determined. RESULTS: Infusion of CaCl2 caused increases in mean arterial blood pressure (p < 0.01), total peripheral resistance (p < 0.001), and renal vascular resistance (p < 0.001). Prior treatment with either verapamil or prazosin lowered baseline blood pressure (p < 0.01) and could prevent hypercalcemia-induced hypertension. This occurred accompanying regaining to near normal values of abnormal systemic hemodynamics parameters. Combination of both drugs showed more profound effects, particularly on lowering renal vascular resistance. CONCLUSION: Acute hypercalemic hypertension is caused by an increase in vascular resistance mediated via the direct effect of calcium on vascular smooth muscle as well as the indirect effect of calcium induced hypercatecholaminemia. The stimulatory effect of hypercalcemia on renal vascular resistance is more prominent than that on peripheral vascular resistance.

Effect of violence films viewing on serum catecholamines and nitrites in male adolescents

This study is an attempt to determine the physiological effects of violence films viewing [VFV] in teenagers. For this purpose, 100 male teenagers volunteers [11-15 years] participated in this study. They were divided into 2 equal groups. The first group [Group I] was accustomed to VFV, while the second group [Group II] was not accustomed to VFV. Violence films [Natural Born Killer and Scream I "R-rated"] were viewed to participant volunteers for 3 hours. Blood samples were withdrawn before and after VFV [pre and post viewing samples]. Serum catecholamines [epinephrine [E], norepinephrine [N] and dopamine [D]] and nitrites [as an indicator of nitric oxide [NO]] were measured in pre-viewing and post viewing samples so that each participant acted as his own control. Results of the first group clearly revealed that serum catecholamines [E, N and D] levels were significantly increased. While nitrite levels were significantly decreased in post viewing samples compared to, pre- viewing samples. In the second group, serum E and nitrites were significantly increased, while serum N and D were significantly decreased in post viewing samples compared to pre-viewing samples. It is concluded that previous experience with VFV caused an aggressive stress response in group I; while lack of this past experience in group II was reflected as an attenuated stress response

Evaluation of the possible effects of microwaves on some vasoactive substances serotonin [Part I] and some metabolite [part II] steptozotocin induced diabetic rats

The objective of this study was the evaluation of the possible adverse effects of microwaves [e.g. mobile, microwave ovens, etc.] on some vasoactive substances as catecholamine [norepinephrine and epinephrine], 5 hydroxy tryptamine [serotonin] and histamine as well as histaminase enzyme activity and the possible role of Nigella sativa oil [NSO] administration in albino rats. Male adult albino rats were divided into control group [n=10], group II [n=10] received microwaves for 7 days consecutively at a dose of 170 mW/Cm2 and frequency of 2.06 GHz for 3 hours [acute group], the third group [group III] [n=10] received the same dose as group II but for 28 consecutive days [chronic group], the fourth group [group IV] was treated as group II with concomitant administration of Nigella sativa oil [NSO] 100 mg/kg/day/orally by gastric tube. The fifth group [n=10] was treated as group III with concomitant oral administration of Nigella sativa oil in the same dose as group IV for 28 days. At the end of experiments, the animals were sacrificed and blood examined for norepinephrine, epinephrine, serotonin, histamine and histaminase enzyme activity. The result of the present study showed that microwaves produced significant reduction of histaminase activity significant increase in histamine, serotonin, norepinephrine and epinephrine, all were highly significantly changed in acute group of irradiation

Adrenal cortical and medullar hyperplasia--a retrospective analysis of 6 cases / 华中科技大学学报（医学）（英德文版）

The features of the symptoms, laboratory tests and pathological characteristics of adrenal cortical and medullary hyperplasia were studied. In 6 cases of hypercatecholaminenia, plasma norepinephrine (NE), epinephrine (E), catecholamine (CA) and 24-h urinary vanillylmandelic acid (VMA), 17-hydroxycorticosteroid (OHCS) and 17-ketosteroid (KS) were determined. Adrenal glands were examined by CT scan and 131I-MIBG imaging. Pathological examination was performed after operation. The results showed that in 6 cases of hypercatecholaminenia (3 men and 3 women) aged from 34-50 years, the clinical features were just like "pheochromocytoma", for example, episodic headache, perspiration, palpitation, pallor, apprehension, nausea, tremor, anxiety and so on. Plasma levels of CA, NE and E were elevated in all 6 cases. 24-h urinary samples obtained at the onset revealed elevated VMA in 1 case. 24-h urinary cortisol was obviously elevated in all 6 cases. 24-h urinary 17-OHCS, 17-KS was normal. B-type ultrasound, CT, MRI and 131I-MIBG revealed 9 lateral adrenal gland diffuse or nodular enlargement in 6 cases. Pathologic examination showed adrenal cortical and medullary hyperplasia. Clinically, adrenal cortical and medullary hyperplasia resembled "pheochromocytoma". The most significant feature of this disease was both elevated plasma CA and 24-h urinary cortisol obviously. Pathologic examination showed adrenal cortex nodular hyperplasia and medullar diffuse or limit hyperplasia. Whether it is an independent disease or symptoms of the other disease has not final conclusion up till now.

Avaliaçäo hormonal e de reflexos cardiovasculares em portadora de falência autonômica pura / Hormonal and cardiovascular reflex assessment in a female patient with pure autonomic failure

We report the case of a 72-year-old female with pure autonomic failure, a rare entity, whose diagnosis of autonomic dysfunction was determined with a series of complementary tests. For approximately 2 years, the patient has been experiencing dizziness and a tendency to fall, a significant weight loss, generalized weakness, dysphagia, intestinal constipation, blurred vision, dry mouth, and changes in her voice. She underwent clinical assessment and laboratory tests (biochemical tests, chest X-ray, digestive endoscopy, colonoscopy, chest computed tomography, abdomen and pelvis computed tomography, abdominal ultrasound, and ambulatory blood pressure monitoring). Measurements of catecholamine and plasmatic renin activity were performed at rest and after physical exercise. Finally the patient underwent physiological and pharmacological autonomic tests that better diagnosed dysautonomia.

Catecholamine response to exercise in individuals with different levels of paraplegia

The purpose of this study was to investigate the effect of the level of injury on the serum level of norepinephrine (Nor) and epinephrine (Epi) at rest and after maximal exercise in individuals with paraplegia. Twenty-six male spinal cord-injured subjects with complete paraplegia for at least 9 months were divided into two groups of 13 subjects each according to the level of injury, i.e., T1-T6 and T7-T12. Serum Nor and Epi concentrations were measured by HPLC-ECD, at rest (PRE) and immediately after a maximal ergospirometric test (POST). Statistical analysis was performed using parametric and non-parametric tests. Maximal heart rate, peak oxygen uptake, and PRE and POST Nor were lower in the T1-T6 than in the T7-T12 group (166 Ý 28 vs 188 Ý 10 bpm; 18.0 Ý 6.0 vs 25.8 Ý 4.1 ml kg-1 min-1; 0.54 Ý 0.26 vs 0.99 Ý 0.47 nM; 1.48 Ý 1.65 vs 3.07 Ý 1.44 nM). Both groups presented a significant increase in Nor level after exercise, while only the T7-T12 group showed a significant increase in Epi after exercise (T1-T6: 0.98 Ý 0.72 vs 1.11 Ý 1.19 nM; T7-T12: 1.24 Ý 1.02 vs 1.89 Ý 1.57 nM). These data show that individuals with paraplegia above T6 have an attentuated catecholamine release at rest and response to exercise as compared to subjects with injuries below T6, which might prevent a better exercise performance in the former group