Galactocele medicamentosa pós-mamoplastia de aumento: relato de caso e revisão da literatura / Galactocele due to drugs prescribed after augmentation mammoplasty: a case report and literature review

A mamoplastia de aumento é um procedimento cirúrgico muito comum e seguro na cirurgia plástica, mas o mesmo não está isento de complicações. A galactocele após mamoplastia de aumento é raramente descrita na literatura. Este relato de caso refere-se a uma paciente de 34 anos de idade, que fazia uso de sulpirida há 2 anos e 4 meses e desenvolveu galactocele cerca de 100 dias após mamoplastia de aumento. O diagnóstico deve ser suspeitado quando se observar uma mama aumentada de volume, associada a calor local, dor ou desconforto mamário no pós-operatório. Acredita-se que a melhor conduta seja a drenagem cirúrgica, a fim de confirmar o diagnóstico de galactocele e excluir a presença de abscesso mamário.

Augmentation mammaplasty is a common and safe plastic surgery procedure, but it is not free from complications. Galactocele after augmentation mammaplasty is rarely described in the literature. We discuss the case of a 34-year-old woman who had been taking sulpiride for 2 years and 4 months and developed galactocele approximately 100 days after augmentation mammaplasty. However, diagnosis should be suspected if breast size increases and it is associated with postoperative local heat, pain or breast discomfort. We believe that the surgeon must surgically drain galactocele to confirm diagnosis, especially to exclude the presence of breast abscess.

Uso de galactagogos na prática clínica para o manejo do aleitamento materno / Use of galactagogues in the practical clinical for the management of breastfeeding

Galactagogos são substâncias que auxiliam o início e a manutenção da produção adequada de leite, porém, alguns autores têm adotado o termo galactagogo. Nesta revisão foram selecionados artigos nos bancos de dados eletrônicos PubMEd, Medline, Lilacs e SciELO nos últimos 10 anos, nas línguas portuguesa e inglesa, utilizando os descritores aleitamento materno, lactação, transtornos da lactação, uso de medicamentos. Os fármacos galactagogos utilizados atualmente são antagonistas dopaminérgicos, que aumentam a prolactina sérica. Os mais conhecidos são metoclopramida e domperidona. O mecanismo de ação de alguns medicamentos e de plantas com relato de efeito galactagogo ainda são desconhecidos. Antes de indicar galactagogos é necessário avaliar freqüência e técnica da amamentação; uma vez que, a baixa produção do leite pode estar associada com técnica inadequada da amamentação, esvaziamento incompleto das mamas e baixa freqüência das mamadas. Por conseguinte, grande parte dos problemas em aleitamento materno pode ser prevenido e solucionado com conhecidas práticas que mantenham a lactação fisiológica, como amamentação sob livre demanda, pega adequada do complexo aréolo-mamilar e esvaziamento das mamas.

Galactagogues are substances that help the beginning and the maintenance of the adequate output of milk, by, some authors has adopted the term galactogogue. In this revision were selected articles in the electronic databases PubMEd, Medline, Lilacs and SciELO in the last 10 years, in the English and Portuguese languages, utilizing the descritores breastfeeding, lactation, perturbations of the lactation, use of medicines. The medicines galactagogues utilized at present are dopamine antagonists which increase the level of prolactin. The most know medicines are metoclopramide and domperidone. The mechanisms of action of some medicines and of plants with accounts of effect galactagogue are still unknown. Despite of easier and comfortable, the prescription of galactagogues should not be used for replace the correct management of problems related to the breastfeeding. Like this most of the problems in maternal breast-feeding can be prevented and solved with practical acquaintances that maintain the physiological lactation, as breastfeeding under free demand, adequate suckling and emptying of the breast.

Amisulpride: a Brief Review.

Amisulpride, belonging to second generation antipsychotics, is a substituted benzamide derivative indicated for the treatment of acute and chronic schizophrenia with prominent positive and/or negative symptoms. Amisulpride has high affinity for the dopamine D2/D3 receptors. It inhibits dopamine transmission by blocking postsynaptic D2/D3 receptors in the limbic system, which is predicative of potent antipsychotic activity. The elimination half-life is 12 hours. Metabolism is limited with most of the drug excreted unchanged in the feces (64%). Clinical studies have supported that Amisulpride (400-1200mg/day) is at least as effective as Haloperidol and Risperidone and more effective than flupenthixol in acute exacerbation. In the treatment of patients with predominantly negative symptoms, Amisulpride was more effective than placebo. Recently some studies have shown it to be having efficacy in dysthymia also. Its favorable characteristics also include low incidence of EPSE and weight gain, however, it has a high incidence of prolactin elevation.

Chronic effect of antidopaminergic drugs or estrogen on male Wistar rat lactotrophs and somatotrophs

The aim of the present study was to evaluate the effect of antidopaminergic agents on the somatotrophs in the presence of hyperprolactinemia. Adult male Wistar rats were divided into 6 groups: a control group and five groups chronically treated (60 days) with haloperidol, fluphenazine, sulpiride, metoclopramide or estrogen. Somatotrophs and lactotrophs were identified by immunohistochemistry and the data are reported as percent of total anterior pituitary cells counted. The drugs significantly increased the percentage of lactotrophs: control (mean + or - SD) 21.3 + or - 4.4, haloperidol 27.8 + or - 2.2, fluphenazine 34.5 + or - 3.6, sulpiride 32.7 + or - 3.5, metoclopramide 33.4 + or - 5.5 and estrogen 42.4 + or - 2.8. A significant reduction in somatotrophs was observed in animals treated with haloperidol (23.1 + or - 3.0), fluphenazine (22.1 + or - 1.1) and metoclopramide (24.2 + or - 3.0) compared to control (27.3 + or - 3.8), whereas no difference was observed in the groups treated with sulpiride (25.0 + or - 2.2) and estrogen (27.1 + or - 2.8). In the groups in which a reduction occurred, this may have simply been due to dilution, secondary to lactotroph hyperplasia. In view of the duplication of the percentage of prolactin-secreting cells, when estrogen was applied, the absence of a reduction in the percent of somatotrophs suggests a replication effect on this cell population. These data provide additional information about the direct or indirect effect of drugs which, in addition to interfering with the dopaminergic system, may act on other pituitary cells as well as on the lactotrophs.

Antipsychotic profile of alstonine: ethnopharmacology of a traditional Nigerian botanical remedy

Although recently developed drugs have brought significant improvement, the treatment of psychotic disorders still presents serious drawbacks. Since inherent complexity and lack of satisfactory understanding of the underlying pathophysiology impose limits for rational drug design, resourceful approaches in the search for antipsychotics are pertinent. This paper reports pharmacological properties of alstonine, a heteroyohimbine type alkaloid, Which exbitited an antipsychotic-like profile, inhibiting amphetamine-induced lethaly, apomorphine-induced steotypy and potentiating barbiturate-induced slleping time. Atypical features of alstonine were the prevention of haloperidol-induced catalepsy and lack of direct interaction with D1, D2 and 5-HT2A receptors, classically linked to antipsychotic mechanism of action.

Corea inducido por el uso de anticonceptivos orales en dos casos / Chorea induced by oral contraceptives in 2 cases

We report two women using oral contraceptives, aged 17 and 33 years old, who presented with hemichorea. In both patients all other possible causes of chorea were discarded and the disease disappeared when contraceptives were discontinued. Four months later, the 33 years old patient used again oral contraceptives and chorea reappeared. This rare complication of contraceptive use has been previously reported in young and mainly nulliparous women

Involvement of dopamine D2 and 5-HT1A receptors in roxindole-induced antinociception.

Roxindole, a DA D2 receptor agonist (2-16 mg/kg) produced dose-dependent increase in percentage antinociception. The effect which was blocked by DA D2 antagonist (-)sulpiride (50 mg/kg) and 5-HT1A receptor antagonist (-) pindolol (5 mg/kg). Roxindole (4 and 8 mg/kg) reversed both naloxone (20 mg/kg)-induced hyperalgesia and reserpine (2 mg/kg)-induced hyperalgesia. This reversal was sensitive to blockade by both (-)sulpiride (50 mg/kg) and (-) pindolol (5 mg/kg). The present study suggests that roxindole-induced antinociception is mediated by postsynaptic DA D2 and 5-HT1A receptors.

Preferential blockade by clozapine of hyperlocomotion induced by non-competitive NMDA antagonist MK-801.

Effect of clozapine on MK-801-induced hyperlocomotion and stereotypy as well as open field behavior was studied. Clozapine (0.1-7.5 mg/kg) dose-dependently blocked MK-801(0.5 mg/kg)-induced stereotypy. Both total and ambulatory responses were blocked by even the lower doses (0.1-0.5 mg/kg) of clozapine. In open field test, clozapine selectively blocked hyperambulation induced by MK-801 (0.1 mg/kg) whereas it potentiated MK-801 (0.1 mg/kg)-induced stereotypy at all the doses used. Haloperidol (0.25 and 0.5 mg/kg) and SCH 23390 (0.5 and 1 mg/kg) showed a dose-dependent effect on MK-801-induced behaviors while sulpiride (25 and 50 mg/kg) failed to modify MK-801-induced open field behavior. This study supports the preferential effect of clozapine on dopamine receptors located in mesolimbic area and further suggests the possibility of using open field behavior induced by MK-801 as a model for studying atypical antipsychotics.

Efeito da sulpiride sobre o aparelho genital da ratas virgens / Effects of sulpiride between genital arrangement in virgin rats

Com o objetivo de acompanhar os efeitos da sulpiride, droga neuroléptica derivada das benzaminas de açäo hiperprolactinêmica por bloqueio dos receptores da dopamina, nas mamas, no útero e nos ovários de ratas virgens. Utilizaram-se 40 ratas Wistar, virgens, com idade entre 70 a 100 dias e peso variando de 224 a 299 g aleatoriamente divididas em dois grupos de 20 ratas, SF e MED. Às ratas do grupo MED administrou-se 10 mg/100g de peso de sulpiride por sondagem orogástrica, diarimente e ao grupo SF, soluçäo fisiológica em igual volume. Cinco animais de cada grupo foram sorteados para sacrifício nos 7§, 14§, 21§ e 42§ dias após o início do tratamento. Ressecava-se 1 cm² de pele e tela subcutânea contendo o mamilo inguinal direito e por laparotomia, o útero e os ovários. No estudo histopatológico avaliava-se nas mamas: concentraçäo de alvélos por campo, o diâmetro dos ductos e a presença ou ausência de secreçäo no interior dos mesmos. No útero observa-se: a fase do endométrio e a sua espessura. As medidas foram feitas com ocular milimetrada. Nos ovários, verificava-se a predominância de folículos e a presença de corpos lúteos. Cinco animais foram excluídos do experimento. O estudo histológico das mamas mostrou aumento do número de folículos por campo à partir do 14§ dia (p<0,05). Estes mostrava-se dilatados em todos os tempos observados (p<0,05). Secreçäo esteve presente a partir do 14§ dia e em grande quantidade (p14=0,0397, p21=0,0079, p42=0,0397). Todos os endométrios do SF encontravam-se em fase proliferativa. No grupo MED cinco endométrios estavam em fase secretora e 14 em fase proliferativa. Näo se observou diferença significante quanto a espessura do endométrio. Os ovários exibiam folículos em diferentes fases de desenvolvimento e näo havia diferença entre os grupos. Conclui-se que a sulpiride atua sobre as glândulas mamárias de ratas estimulando seu desenvolvimento e galactogênese, sendo diretamente proporcional ao tempo de uso. Näo se observou influência sobre o endométrio e os ovários

Effect of estrogen and neuroleptics on prolactin secretion and immunoreactive prolactin cells

The use of estrogen and dopamine receptor antagonists is associated with elevated prolactin levels and, in rats, chronic estrogen treatment is also associated with lactotroph proliferation. In this study, haloperidol, fluphenazine, sulpiride and metoclopramide, alone or combined with estradiol, were administered to Wistar rats. Pituitary weight, serum prolactin levels and percent of immunoreactive prolactin cells in the anterior pituitary glands were determined at the end of 60 days of treatment. The pituitary weight of rats treated with estrogen alone or in combination with other drugs was significantly higher than the control group. The serum prolactin level was higher than the upper confidence limit in all but three of the 90 treated rats. While in the control group the percent of immunoreactive prolactin cells was 20 per cent, administration of the neuroleptic drugs and metoclopramide increased this percent to approximately 30 per cent, and estrogen alone or in combination with one of the neuroleptic drugs increased it to approximately 40 per cent. The results presented here demonstrate the elationship between prolactin secretion and prolactin cell number when different neuroleptics and related drugs are used.

Dopamine receptor mediated antidepressant action of B-HT 920 in mice.

Possible involvement of dopaminergic (DAergic) system in forced swimming-induced immobility (despair behaviour) was investigated in mice. B-HT 920 (0.05 and 0.1 mg/kg), a post-synaptic DAergic agonist, produced a dose dependent reduction in immobility period, which was sensitive to blockade by haloperidol (0.5 mg/kg) and sulpiride (100 mg/kg). This effect was also blocked by alpha 2 antagonist yohimbine (5 mg/kg). SKF 38393 (5 mg/kg), a D1-DA agonist potentiated the action of B-HT 920. Reserpinization (2 mg/kg, 24 hr prior) produced despair immobility in mice. When a low dose of B-HT 920 (0.05 mg/kg) was given to reserpinized animals, the duration of immobility period was further increased. But on the other hand, a higher dose (0.1 mg/kg) of it reduced reserpine-induced immobility. Desipramine (5 and 10 mg/kg), elicited a dose dependent reduction in the immobility period, which was sensitive to blockade by sulpiride (100 mg/kg). Desipramine (10 mg/kg) showed a diphasic response in combination with B-HT 920, i.e., a potentiation of the response due to a low dose of B-HT 920 (0.05 mg/kg) and an antagonism of the response due to a higher dose of B-HT 920 (0.1 mg/kg), respectively. SKF 38393 (5 mg/kg), potentiated the action of desipramine (5 mg/kg). SKF 38393 (5 mg/kg) further potentiated the action of desipramine (5 mg/kg) and B-HT 920 (0.05 mg/kg). These observations suggests that B-HT 920 reduces behavioural immobility by DAergic mechanism and desipramine also modulates D2-DA receptors in its anti-depressant action.

On the characterization of dopamine-induced contractile response of rat anococcygeus muscle preparation.

Presence of specific dopamine (DA) receptors and their characterization was attempted in rat anococcygeus muscle preparation. Dopamine (10(-6) M) and B-HT 920 (10(-6) M) produced concentration dependent contractions of the rat anococcygeus muscle preparation. The response of DA was shifted towards right in presence of haloperidol (10(-6) M; pA2 = 6.8) and sulpiride (10(-4) M) in a competitive manner. Alpha 2 antagonists yohimbine (10(-5) M) and idazoxan (10(-5) M) blocked the response to DA in a competitive manner, while alpha 1 antagonist prazosin (10(-5) M) completely blocked the response to DA. SCH 23390 (10(-5) M), a D1 DA antagonist potentiated the response to DA. Reserpinization (5 mg/kg, 24 hr prior) brought about a shift towards the right, and this response was similarly blocked by haloperidol, sulpiride and yohimbine without affecting the maximum response. Desipramine (10(-5) M) blocked the response of DA in a non-competitive manner. Pretreatment of animals with desipramine (10 mg/kg) followed by reserpine, brought about a reversal of action of reserpine. The response to B-HT 920 (10(-6) M), was blocked similarly by haloperidol and yohimbine. However, the effect of desipramine was more pronounced when compared to DA per se. SKF 38393, a D1 DA agonist, potentiated the response to B-HT 920. The findings suggest the presence of both D1 and D2 DA receptors in rat anococcygeus muscle and that DA also acts on adrenergic receptors to produce a contractile response of this muscle preparation.

Aspectos morfologicos e morfometricos de glandulas mamarias de ratas albinas tratadas com sulpiride / Morphological and morphometric aspects of mammary glands of albinic female rats treated with sulpiride

Procurou-se observar aspectos morfologicos e morfometricos das glandulas mamarias de ratas albinas tratadas com sulpiride, submetidas ou nao a ooforectomia. Tivemos como resultados da morfologia, no grupo de ratas na fase de estro e nas ooforectomizadas, tratadas ou nao pelo sulpiride, glandulas mamarias atrofiadas. Nas ratas apenas tratadas com sulpiride as glandulas mamarias apresentaram-se bem desenvolvidas, com alveolos contendo secrecao no seu interior. A proporcao de ductos e de alveolos mamarios se mostrou significantemente maior no grupo de ratas tratadas apenas com sulpiride.

Locomotor activity and one-way active avoidance after intrahyppocampal injection of neurotransmitter antagonists

Sixty-three rats with previous training in a T-maze, bilaterally implanted with cannulae directed toward the dorsal hippocampus, were used in this study. All rats received bilateral 1-microngl injections 20 min before testing for locomotor activity (day 1) and one-way active avoidance (day 3). The following drugs were injected into groups of 4 to 8 animals: scopolamine (9 or 18 microng/micronl), propranolol (5 or 10 microng/micronl), cimetidine (0.75 or 1.5 microng/micronl), sulpiride (5 or 10 microng/micronl), or vehicle (Krebs-ringer). Locomotor activity was not changed by injection of any drug. However, intrahippocampal injections of scolpolamine (9 microng/micronl) and sulpiride (10 microng/micronl) impoaired avoidance bahavior, particularly during the last five trials of the task. We conclude that muscarinic-cholinergic and D2-dopaminergic, but not beta-adrenergic or H2-histaminergic, mechanisms in the hippocampus are involved in the performance of one-way active avoidance behavior

The cholinergic and dopaminergic systems of the prelimbic sector of frontal cortex and memory in the rat

Rats were trained to perform delayed non-matching to sample (a working/representational memory task) and visual discrimination(a reference/dispositional memory task) in a T-maze, and implanted bilaterally with cannulae in the prelimbic cortex. The rats were tested postoperatively after bilateral 1 - micronl injections of vehicle (Krebs-Ringer), sulpiride (10 microng/micronl) or scopolamine (18 microng/micronl). Sulpiride had no effect on the performance of either task, whereas scopolamine interfered only with the performance of delayed non-matching to sample. We conclude that dopaminergic mechanisms in the prelimbic cortex are not involved in either type of memory and that cholinergic, but not dopaminergic, mechanisms are important for working/representational memory process

Tamoxifeno como supresor de la carcinogenesis mamaria inducida por 7,12-dimetil-benzoantraceno y nitroso-metilurea, en ratas hembras con hiperprolactinemia provocada / Tamoxifen as a suppressor of mammary carcinogenesis induced by 7,12-dimetil-benzanthracene and methylnitrosourea, in female rats with induced hyperprolactinemia

El efecto del tamoxifeno sobre tumores mamarios inducidos con DMBA (7, 12-dimetil-benzoantraceno) y NMU (nitroso-metilurea) se analiza. De 7 lotes de ratas Sprague-Dayley, 4 (A-B-C-D) reciben adiconalmene sulpirida 0,5 mg/100g durante 5 días de la semana y hasta finalizar el experimento. Dos lotes (C-D) recibieron una sola inyección intraperitoneal de 900 microcuries por 100g de peso de I. Tres lotes (E-F-G) recibieron sólo I para activar secreción de prolactina, y de ellos, 2(F-G)recibieron tamoxifeno. Los tumores que se desarrollaron fueron todos del tupo adenocarcinoma papilífero. Los receptores hormonales estrogénicos fueron positivos. El estudio por microscopia electrónica mostró vacuolas acuosas grasosas en el citoplasma y la falta de organoides y mitocondrias en algunas células. Los lotes que recibieron tamoxifeno (F-G) no desarrollaron tumores