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1.
Acta cir. bras ; 38: e387523, 2023. tab, graf, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1527602

ABSTRACT

Purpose: Vasoplegia, or vasoplegic shock, is a syndrome whose main characteristic is reducing blood pressure in the presence of a standard or high cardiac output. For the treatment, vasopressors are recommended, and the most used is norepinephrine. However, new drugs have been evaluated, and conflicting results exist in the literature. Methods: This is a systematic review of the literature with meta-analysis, written according to the recommendations of the PRISMA report. The SCOPUS, PubMed, and ScienceDirect databases were used to select the scientific articles included in the study. Searches were conducted in December 2022 using the terms "vasopressin," "norepinephrine," "vasoplegic shock," "postoperative," and "surgery." Meta-analysis was performed using Review Manager (RevMan) 5.4. The endpoint associated with the study was efficiency in treating vasoplegic shock and reduced risk of death. Results: In total, 2,090 articles were retrieved; after applying the inclusion and exclusion criteria, ten studies were selected to compose the present review. We found no significant difference when assessing the outcome mortality comparing vasopressin versus norepinephrine (odds ratio = 1.60; confidence interval 0.47-5.50), nor when comparing studies on vasopressin versus placebo. When we analyzed the length of hospital stay compared to the use of vasopressin and norepinephrine, we identified a shorter length of hospital stay in cases that used vasopressin; however, the meta-analysis did not demonstrate statistical significance. Conclusions: Considering the outcomes included in our study, it is worth noting that most studies showed that using vasopressin was safe and can be considered in managing postoperative vasoplegic shock.


Subject(s)
Atrial Fibrillation , Vasopressins , Norepinephrine , Vasoplegia
2.
Rev. chil. obstet. ginecol. (En línea) ; 87(3): 241-244, jun. 2022. ilus
Article in Spanish | LILACS | ID: biblio-1388731

ABSTRACT

Resumen La gestación cornual, también conocida como intersticial, es una gestación ectópica infrecuente que ocurre en 1/2500 a 1/5000 de los embarazos cuando el embrión implanta en el trayecto intramiometrial de la porción proximal de la trompa. Puede debutar como shock hipovolémico en un 25% de los casos, conllevando una mortalidad de hasta un 2,5%. Mediante ecografía se encuentra un saco gestacional excéntrico y rodeado por una fina capa de miometrio. El tratamiento, en la mayoría de los casos, es quirúrgico, y el control de la hemostasia supone todo un reto. Se presentan dos casos clínicos de mujeres con diagnóstico de gestación intersticial en quienes se realizó exéresis por laparoscopia tras inyección de vasopresina, permitiendo así controlar el sangrado. En una de las pacientes se practicaron también puntos transfixivos transitorios en la arteria uterina y el ligamento útero-ovárico.


Abstract Cornual gestation, also known as interstitial, is a rare ectopic gestation that occurs in 1/2500 to 1/5000 of pregnancies when the embryo implants in the intramyometrial tract of the proximal tube. It can debut as hypovolemic shock in 25% of cases, leading to a mortality rate of up to 2.5%. Using ultrasound, we will find an eccentric gestational sac surrounded by a thin layer of myometrium. Treatment, in most cases, is surgical and control of hemostasis is a challenge. Two clinical cases are presented of women with a diagnosis of interstitial pregnancy in whom transient transfixive sutures were performed at the level of the uterine artery and uterine-ovarian ligament and injection of vasopressin prior to laparoscopic exeresis, thus allowing the bleeding to be controlled.


Subject(s)
Humans , Female , Pregnancy , Adult , Vasopressins/administration & dosage , Hemostatics/administration & dosage , Laparoscopy/methods , Pregnancy, Cornual/surgery , Blood Loss, Surgical/prevention & control , Suture Techniques , Injections
3.
Rev. Assoc. Méd. Rio Gd. do Sul ; 66(1): 01022105, 20220101.
Article in English | LILACS | ID: biblio-1424901

ABSTRACT

Introduction: There is scarce evidence on the efficacy of vasopressin as a vasopressor agent in pediatric catecholamine-refractory shock. The aim of this study is to describe hemodynamic changes during the first hours of administration vasopressin as rescue therapy in patients with catecholamine-refractory shock. Methods: This is a retrospective study including children from 1 month to 18 years admitted to the PICU who received vasopressin as rescue therapy for catecholamine-refractory shock (noradrenalin ≥1µg/ kg/min and variable doses of other inotropic / vasopressor agents). For analysis purposes, blood pressure means and modified vasoactive scores were calculated at two time periods: 2 hours prior to vasopressin therapy (T-2) and within the first 10 hours of vasopressin therapy (T10). Results: Using the paired Students' t test, mean blood pressure and vasoactive-inotropic scores modified by Wernovsky in the 2 hours before the use of vasopressin (T-2) were compared with the means of the first 10 hours of vasopressin administration (T10). The sample consisted of 16 patients. Median initial dose of vasopressin was 0.0005U/kg/min (interquartile range 0.00024-0.00168). Mean blood pressure and diastolic blood pressure increased with the use of vasopressin (p=0.0267 and p=0.0194, respectively). There was no reduction in vasoactive-inotropic score or increased diuresis. Conclusion: The administration of vasopressin increased blood pressure in this sample but did not promote a reduction in catecholamine scores nor increased diuresis.


Introdução: Há escassez de evidências sobre a eficácia da vasopressina como agente vasopressor no choque refratário à catecolamina em crianças. O objetivo foi descrever as alterações hemodinâmicas que ocorrem nas primeiras horas de administração da vasopressina, como terapia de resgate em pacientes com choque refratário à catecolamina. Métodos: Estudo retrospectivo. Foram incluídas crianças de 1 mês a 18 anos internadas na UTIP que receberam vasopressina como terapia de resgate para choque refratário à catecolamina (noradrenalina ≥1µg/kg/min e doses variáveis de outros inotrópicos /vasopressores). Para fins de análise, as medidas da pressão arterial e os escores vasoativos modificados foram calculados em dois períodos: nas 2 horas anteriores ao início da terapia com vasopressina (T-2) e nas primeiras 10 horas da terapia com vasopressina (T10). Resultados: Utilizando o teste t de Student pareado, a pressão arterial média e o escore vasoativo-inotrópico modificado por Wernovsky nas 2 horas anteriores ao uso de vasopressina (T-2) foram comparados com as médias dessas variáveis durante as primeiras 10 horas de administração de vasopressina (T10). A amostra foi composta por 16 pacientes. A dose mediana inicial de vasopressina foi de 0,0005U/kg/min (intervalo interquartil 0,00024-0,00168). A pressão arterial média e a pressão arterial diastólica aumentaram com o uso de vasopressina (p=0,0267 e p=0,0194, respectivamente). Não houve redução no escore vasoativo-inotrópico ou aumento na diurese. Conclusão: A administração de vasopressina aumentou a pressão arterial nesta amostra, mas não teve efeitos na redução dos escores de catecolaminas ou no aumento da diurese.


Subject(s)
Vasopressins
4.
Rev. colomb. anestesiol ; 49(4): e200, Oct.-Dec. 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1341236

ABSTRACT

Abstract Introduction Vasopressors are essential in the management of various types of shock. Objective To establish the trend of vasopressors use in the intensive care units (ICU) in a population of patients affiliated with the Colombian Health System, 2010-2017. Methods Observational trial using a population database of patients hospitalized in eleven ICUs in various cities in Colombia. The drugs dispensed to hospitalized patients over 18 years old, from January 2010 until December 2017 were considered. A review and analysis of the vasopressors dispensed per month was conducted, taking into account sociodemographic and pharmacological variables (vasopressor used and daily doses defined per 100/beds/day (DBD). Results 81,348 dispensations of vasopressors, equivalent to 26,414 treatments in 19,186 patients receiving care in 11 hospitals from 7 cities were reviewed. The mean age of patients was 66.3±18.1 years and 52.6 % were males. Of the total number of treatments recorded, 17,658 (66.8 %) were with just one vasopressor. Norepinephrine was the most frequently prescribed drug (75.9 % of the prescriptions dispensed; 60.5 DBD), followed by adrenaline (26.6 %; 41.6 DBD), dopamine (19.4%), dobutamine (16.0 %), vasopressin (8.5 %) and phenylephrine (0.9 %). The use of norepinephrine increased from 2010 to 2017 (+6.19 DBD), whilst the use of other drugs decreased, particularly the use of adrenaline (-60.6 DBD) and dopamine (-10.8 DBD). Conclusions Norepinephrine is the most widely used vasopressor showing a growing trend in terms of its use during the study period, which is supported by evidence in favor of its effectiveness and safety in patients with shock.


Resumen Introducción Los fármacos vasopresores son fundamentales en el manejo de los diferentes tipos de choque. Objetivo Determinar la tendencia de utilización de fármacos vasopresores en unidades de cuidados intensivos (UCI) en una población de pacientes afiliados al Sistema de Salud de Colombia, 2010-2017. Métodos Estudio observacional, a partir de una base de datos poblacional con pacientes hospitalizados en once UCI de diferentes ciudades de Colombia. Se obtuvieron las dispensaciones de pacientes mayores de 18 años hospitalizados desde enero de 2010 hasta diciembre de 2017. Se hizo revisión y análisis de la dispensación mensual de vasopresores. Se consideraron variables sociodemográficas y farmacológicas (medicamento vasopresor usado y dosis diarias definidas por 100 camas/día [DCD]). Resultados Se revisaron 81.348 dispensaciones de vasopresores, equivalentes a 26.414 terapias en 19.186 pacientes atendidos en 11 hospitales de 7 ciudades, cuya edad promedio fue 66,3±18,1 años y el 52,6 % eran hombres. Del total de terapias registradas, 17.658 (66,8 %) fueron con un solo vasopresor. La norepinefrina fue el más comúnmente prescrito (75,9 % de las dispensaciones; 60,5 DCD), seguido por adrenalina (26,6 %; 41,6 DCD), dopamina (19,4 %), dobutamina (16,0 %), vasopresina (8,5 %) y fenilefrina (0,9 %). El uso de norepinefrina se incrementó de 2010 a 2017 (+6,19 DCD), mientras que el de otros fármacos disminuyó, especialmente adrenalina (-60,6 DCD) y dopamina (-10,8 DCD). Conclusiones La norepinefrina es el fármaco vasopresor más utilizado y el que ha demostrado una tendencia de uso incremental durante el periodo de estudio, lo cual está respaldado por evidencia a favor de su efectividad y seguridad en pacientes con choque.


Subject(s)
Humans , Male , Middle Aged , Aged , Shock , Vasoconstrictor Agents , Vasopressins , Intensive Care Units , Phenylephrine , Pharmaceutical Preparations , Dopamine , Epinephrine , Norepinephrine , Dobutamine , Drug Utilization , Dosage , Prescriptions
5.
Rev. gaúch. enferm ; 42: e20190449, 2021. graf
Article in English | LILACS, BDENF | ID: biblio-1149943

ABSTRACT

ABSTRACT Objective: To analyze the effects of the ice popsicle on vasopressin, osmolality, thirst intensity, and thirst discomfort. Method: This is a quasi-experimental, pre- and post-test study conducted in a laboratory. The sample consisted of nine healthy male volunteers, who received 2% hypertonic saline solution. Results: Popsicle intake did not result in a statistically significant reduction in vasopressin levels (F=0.876 and p=0.428). However, there was a reduction in the hormonal physiological profile of vasopressin from 7.1 pg/ml to 5.8 pg/ml after the first two interventions. Osmolality concentration changed from 270.65 to 286.51 mOsm/kg, with no statistical difference (F=2.207; p=0.09). Ice popsicles significantly reduced thirst intensity (F=10.00; p=0.001) and thirst discomfort (F=10.528; p <0.001). Conclusion: There was a reduction in thirst intensity and discomfort after the use of the 20 ml ice popsicle. There was no statistical difference for vasopressin and osmolality. However, there was a reduction in the hormonal physiological profile of vasopressin during 30 minutes of intervention.


RESUMEN Objetivo: Evaluar los efectos del picolé de hielo sobre el perfil hormonal de la vasopresina, la osmolaridad, y la intensidad y el malestar de la sed. Método: Estudio casi-experimental pre- y pos-test, realizado en laboratorio. Nueve varones voluntarios sanos recibieron solución salina endovenosa al 2% y un picolé de hielo de 20 ml cada 15 minutos. Resultados: Ingerir el picolé no derivó en una caída estadísticamente significativa del nivel de vasopresina (F=0,876 y p=0,428). Entretanto, se registró una reducción en el perfil hormonal de la vasopresina de 7,1 pg/ml a 5,8 pg/ml después de las dos intervenciones. La osmolaridad plasmática se modificó de 270,65 a 286,51 mOsm/kg sin diferencia estadística (F=2,207; p=0,09). Se registraron reducciones en la intensidad (F=10,00 y p= 0,001) y en el malestar de la sed (F= 10,528; p<0,001). Conclusión: Se registraron reducciones en la intensidad y el malestar de la sed después de la intervención. No hubo diferencia estadística para la vasopresina y la osmolaridad. De esta manera, se observa la reducción en el perfil fisiológico de la vasopresina durante los 30 minutos de la intervención.


RESUMO Objetivo: Avaliar efeitos do picolé de gelo sobre perfil hormonal de vasopressina, osmolaridade, intensidade e desconforto da sede. Método: Quase-experimental, pré e pós-teste, realizado em laboratório. Nove voluntários saudáveis receberam solução salina endovenosa 2% e um picolé de gelo 20 ml a cada 15 minutos. As variáveis foram coletadas em cinco momentos. Resultados: Ingestão do picolé não resultou queda estatisticamente significativa da vasopressina (F = 0,876 e p = 0,428). Houve redução no perfil hormonal da vasopressina de 7,1 pg/ml para 5,8 pg/ml após duas intervenções. Osmolaridade plasmática alterou de 270,65 para 286,51 mOsm/kg, sem diferença estatística (F=2,207; p= 0,09). Houve redução da intensidade (F=10,00 e p= 0,001) e desconforto da sede (F=10,528; p < 0,001). Conclusão: Houve redução na intensidade e desconforto da sede. Não houve diferença estatística para vasopressina e osmolaridade. Observou-se redução no perfil fisiológico da vasopressina durante 30 minutos de intervenção.


Subject(s)
Humans , Male , Osmolar Concentration , Thirst , Vasopressins , Ice-cold Foods , Perioperative Nursing
6.
Rev. medica electron ; 42(6): 2540-2559, nov.-dic. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1150036

ABSTRACT

RESUMEN Introducción: se sabe que las concentraciones plasmáticas de hormona antidiurética o vasopresina son más altas en las mujeres con dismenorrea primaria (DiPr) y podría ser causa de retención de agua con signos y síntomas concomitantes que agravan su cuadro clínico. La monoterapia con AINEs en ocasiones alcanza solo un alivio parcial porque no incide sobre la vasopresina. Objetivo: evaluar la eficacia y tolerabilidad del dexketoprofeno + pamabrom en la DiPr tomando como referencia el acetaminofén. Materiales y métodos: estudio doble ciego, controlado, randomizado, en pacientes con DiPr asignados al azar. Fueron aleatorizadas 172 pacientes, 86 en cada grupo 1) Grupo casos (DP): dexketoprofeno + pamabrom o 2) Grupo control (AC): acetaminofén. Se evaluó la evolución de la intensidad del dolor, el alivio del dolor, la gravedad de otros síntomas presentes y la satisfacción global del médico y paciente. Se registró las reacciones adversas. Resultados: la disminución de la intensidad del dolor, de los síntomas acompañantes y el alivio del dolor evaluados por la EVA, la PID, la SPID, el PAR y el TOTPAR respectivamente es mayor y más rápida de modo significativo en todos los tiempos para la combinación DP. Las reacciones adversas fueron mínimas. La satisfacción global de pacientes y médicos respecto al tratamiento es significativa a favor de la combinación DP. Conclusiones: dexketoprofeno + pamabrom es significativamente más eficaz y rápido en el control del dolor y otros síntomas presentes en la dismenorrea primaria que acetaminofén demostrando la validez de añadir un diurético suave a un AINE para incrementar su eficacia. El tratamiento DP es bien tolerado (AU).


ABSTRACT Background: It is known that plasma concentrations of antidiuretic hormone or vasopressin are higher in women with primary dysmenorrhea (DiPr) and could cause water retention with concomitant signs and symptoms that aggravate the illness. Monotherapy with NSAIDs sometimes achieves only partial relief because it does not affect vasopressin. Objective: The aim was to evaluate the efficacy and tolerability of dexketoprofen + pamabrom in DiPr taking as reference acetaminophen. Materials and methods: Double-blind, controlled, randomized study in patients with DiPr random to 1) Case group (PD): dexketoprofen + pamabrom or 2) Control group (CA): acetaminophen. The evolution of pain intensity, pain relief, severity of other present symptoms and overall satisfaction of the doctor and patient were evaluated. Adverse reactions were recorded. Results: 172 patients were randomized, 86 in each group. The decrease in pain intensity, accompanying symptoms and pain relief evaluated by VAS, PID, SPID, PAR and TOTPAR respectively is significantly greater and faster at all times for the combination DP. Adverse reactions were minimal. The overall satisfaction of patients and doctors regarding treatment is significant in favor of the DP combination. Conclusions: Dexketoprofen + pamabrom is significantly more effective and faster in the control of pain and other symptoms present in primary dysmenorrhea than acetaminophen demonstrating the validity of adding a mild diuretic to an NSAID to increase its effectiveness. DP treatment is well tolerated (AU).


Subject(s)
Humans , Female , Vasopressins/pharmacology , Dysmenorrhea/drug therapy , Treatment Outcome , Drug Combinations , Dysmenorrhea/classification , Dysmenorrhea/metabolism , Dysmenorrhea/pathology , Observational Studies as Topic
7.
Article in English | WPRIM | ID: wpr-886630

ABSTRACT

@#BACKGROUND: Septic shock causes life threatening organ dysfunction needing vasopressor despite adequate fluid resuscitation. Numerous studies and meta-analysis have proven norepinephrine as the initial vasopressor of choice in septic shock with vasopressin as add-on. Although guidelines have established the goal monitoring response in septic shock, optimal approach in discontinuation of the vasopressors in the recovery phase of septic shock remains limited. METHODS: A systematic review and meta-analysis was performed on randomized controlled trials (RCTs) and nonrandomized studies comparing incidence of hypotension within 24 hours of discontinuing norepinephrine first versus vasopressin. Three reviewers independently selected studies, assessed their quality, and extracted the following data: the number and characteristics of patients enrolled, inclusion and exclusion criteria for each study, the description of interventions (discontinuing norepinephrine first versus discontinuing vasopressin first) and outcomes (incidence of hypotension within 24 hours). RESULTS: Seven retrospective cohort studies and one prospective randomized control trial were included. Compared with norepinephrine, risk of hypotension is higher when vasopressin is discontinued first among patients in the recovery phase of septic shock (RR 2.06; 95% CI [1.11,3.82]; I 2 91%). Results were consistent in the subgroup analysis after excluding abstract-only and poor-quality studies (RR 1.73; 95% CI [0.74, 4.03]; I 2 93%). There is no difference in ICU (RR 0.97; 95% CI [0.71, 1.32]; I 2 38%) and in-hospital mortality (RR 0.88; 95% CI [0.66, 1.16]; I 2 41%) between the two vasopressor weaning strategies. Finally ICU length of stay was reported on 5 studies with no significant difference between the two strategies. CONCLUSION: Based on the results, there is increased risk of hypotension when vasopressin is discontinued first versus norepinephrine.


Subject(s)
Norepinephrine , Shock, Septic , Vasopressins , Vasoconstrictor Agents , Neurophysins
8.
Article in Chinese | WPRIM | ID: wpr-1008547

ABSTRACT

The aim of this paper was to investigate the effect of Faeces Bombycis(FB) on the intestinal microflora in rats with syndrome of damp retention in middle-jiao, and to explore its mechanism in regulating intestinal microflora from the perspective of microorganisms contained in FB. The contents of antidiuretic hormone(ADH) and C-reactive protein(CRP) in serum and aquaporin 3(AQP3) in jejunum were determined by enzyme-linked immunosorbent assay(ELISA). Illumina Miseq platform was used for high-throughput sequencing of the rat feces and FB. The ELISA results showed that as compared with the normal control group, the contents of ADH and CRP in the model group were significantly increased(P<0.05), and the content of AQP3 was significantly decreased(P<0.05). After drug administration, the ADH, CRP and AQP3 contents were recovered. Sequencing of rat feces showed that the ACE, Chao1 and Shannon indexes of the intestinal microflora were the lowest in the model group. As compared with the normal control group, the levels from phylum to genus were all significantly changed in model group, and Proteobacteria, Acinetobacter, Anaerobacter, Pseudomonas, and Parabacteroides levels were significantly increased(P<0.05), while Marvinbryantia level was significantly decreased(P<0.05). As compared with the model group, Proteobacteria was significantly decreased in the FB low and high dose groups(P<0.05), and Acinetobacter, Anaerobacter, Pseudomonas, Parabacteroides levels were significantly decreased in the low, medium and high dose groups(P<0.05), while Lachnoanaerobaculum, Intestinimonas and Marvinbryantia were increased significantly in the high dose group(P<0.05). Sequencing analysis of FB showed that the relative abundance of Leclercia, Pantoea, Brachybacterium, Shimwellia, Hartmannibacter, Klebsiella, Serratia, Aurantimonas, Paenibacillus and Bacillus was high in the FB, but they were basically not present or little in the rat feces. In conclusion, FB may play a role in the treatment of "syndrome of damp retention in middle-jiao" by balancing the intestinal microflora, and this effect may be related to the metabolites of microorganisms in the FB.


Subject(s)
Animals , Rats , Aquaporin 3/analysis , Bombyx/chemistry , C-Reactive Protein/analysis , Feces/chemistry , Gastrointestinal Microbiome , High-Throughput Nucleotide Sequencing , Medicine, Chinese Traditional , Vasopressins/blood
9.
Article in English | WPRIM | ID: wpr-785360

ABSTRACT

BACKGROUND: Vasoplegic syndrome is an increasingly recognized disease in perioperative medicine and is characterized by severe hypotension, normal or elevated cardiac output, and decreased systemic vascular resistance. It occurs commonly after cardiopulmonary bypass but may also occur after other types of surgery.CASE: Vasoplegic syndrome developed in our patient during posterior lumbar interbody fusion because of administering nicardipine after phenylephrine. However, the blood pressure did not increase as expected despite simultaneous use of norepinephrine and vasopressin to increase the reduced systemic vascular resistance.CONCLUSIONS: We present a case of vasoplegic syndrome that developed during posterior lumbar interbody fusion and was treated successfully with methylene blue.


Subject(s)
Humans , Blood Pressure , Cardiac Output , Cardiopulmonary Bypass , Hypotension , Methylene Blue , Nicardipine , Norepinephrine , Phenylephrine , Vascular Resistance , Vasoplegia , Vasopressins
10.
Article in English | WPRIM | ID: wpr-763150

ABSTRACT

PURPOSE: Control of metastatic spread of colorectal cancer (CRC) remains as a major therapeutic challenge. [V4 Q5 ]dDAVP is a vasopressin peptide analog with previously reported anticancer activity against carcinoma tumors. By acting as a selective agonist of arginine vasopressin type 2 membrane receptor (AVPR2) present in endothelial and tumor cells, [V⁴Q⁵]dDAVP is able to impair tumor aggressiveness and distant spread. Our aim was to evaluate the potential therapeutic benefits of [V⁴Q⁵]dDAVP on highly aggressive CRC disease using experimental models with translational relevance. MATERIALS AND METHODS: Murine CT-26 and human Colo-205 AVPR2-expressing CRC cell lines were used to test the preclinical efficacy of [V⁴Q⁵]dDAVP, both in vitro and in vivo. RESULTS: In syngeneic mice surgically implanted with CT-26 cells in the spleen, sustained intravenous treatment with [V⁴Q⁵]dDAVP (0.3 µg/kg) dramatically impaired metastatic progression to liver without overt signs of toxicity, and also reduced experimental lung colonization. The compound inhibited in vivo angiogenesis driven by Colo-205 cells in athymic mice, as well as in vitro endothelial cell migration and capillary tube formation. [V⁴Q⁵]dDAVP exerted AVPR2-dependent cytostatic activity in vitro (IC₅₀ 1.08 µM) and addition to 5-fluorouracil resulted in synergistic antiproliferative effects both in CT-26 and Colo-205 cells. CONCLUSION: The present preclinical study establishes for the first time the efficacy of [V⁴Q⁵]dDAVP on CRC. These encouraging results suggest that the novel second generation vasopressin analog could be used for the management of aggressive CRC as an adjuvant agent during surgery or to complement standard chemotherapy, limiting tumor angiogenesis and metastasis and thus protecting the patient from CRC recurrence.


Subject(s)
Animals , Humans , Mice , Arginine Vasopressin , Capillaries , Cell Line , Colon , Colorectal Neoplasms , Complement System Proteins , Drug Therapy , Endothelial Cells , Fluorouracil , In Vitro Techniques , Liver , Lung , Membranes , Mice, Nude , Models, Theoretical , Neoplasm Metastasis , Recurrence , Robenidine , Spleen , Vasopressins
11.
Article in Korean | WPRIM | ID: wpr-761388

ABSTRACT

Adipsic hypernatremia is a rare disease where patients do not feel thirst even in the increased serum osmotic pressure and results in electrolyte imbalance, severely increased osmotic pressure and neurologic symptoms like nausea, vomiting, and seizures. We report a 12-year-old male patient who had underwent a trans-sphenoidal surgery for craniopharyngioma newly diagnosed with adipsic hypernatremia after having growth hormone replacement for growth hormone deficiency. The patient visited emergency room complaining of generalized weakness, tremor in both legs, and poor oral intake including water after starting growth hormone replacement therapy. Laboratory test revealed serum sodium 168 mmol/L and serum osmolality 329 mOsm/kg, despite the patient didn't feel any thirst at all. We treated him with scheduled water intake of 2.5 L a day with intranasal vasopressin. He admitted to Soonchunhyang University Gumi Hospital and Soonchunhyang University Seoul Hospital for 4 times during the following 8 months and serum sodium level and osmolality was controlled by scheduled water intake combined with intranasal vasopressin treatment. It is still unclear whether growth hormone replacement worked as a trigger of hypernatremia.


Subject(s)
Child , Humans , Male , Craniopharyngioma , Drinking , Emergency Service, Hospital , Growth Hormone , Hypernatremia , Leg , Nausea , Neurologic Manifestations , Osmolar Concentration , Osmotic Pressure , Rare Diseases , Seizures , Seoul , Sodium , Thirst , Tremor , Vasopressins , Vomiting , Water
12.
Rev. bras. ter. intensiva ; 30(4): 423-428, out.-dez. 2018. tab
Article in Portuguese | LILACS | ID: biblio-977991

ABSTRACT

RESUMO Objetivo: Avaliar a evolução em curto prazo de pacientes com choque séptico refratário à norepinefrina tratados com vasopressina em uma unidade de terapia intensiva de um hospital universitário. Métodos: Foi realizado estudo retrospectivo não comparado (série de casos). Foram coletados dados clínicos, laboratoriais e antropométricos de pacientes que receberam infusão de vasopressina para tratamento de choque refratário a catecolaminas no período de dezembro de 2014 a junho de 2016. Para a avaliação de gravidade, foram utilizados o APACHE II e o SOFA. O desfecho principal foi mortalidade em 3 e em 30 dias. Resultados: Foram incluídos 80 pacientes, sendo 60% do sexo masculino. Em 86,3% dos casos, verificou-se APACHE II nas faixas mais altas (> 20). A mortalidade em 30 dias foi de 86,2%, sendo que 75% dos pacientes foram a óbito dentro de 72 horas após início do uso da vasopressina. Conclusão: A série avaliada apresentou alta mortalidade nas primeiras 72 horas de tratamento com vasopressina. O uso de vasopressina em pacientes refratários à norepinefrina teve pouco ou nenhum impacto na mortalidade. Não é possível excluir que a alta mortalidade no presente estudo esteja vinculada ao início relativamente tardio (após estabelecida refratariedade à norepinefrina) da vasopressina, devendo essa hipótese ser melhor avaliada por estudo randomizado.


ABSTRACT Objective: To evaluate the short-term evolution of patients with septic shock refractory to norepinephrine treated with vasopressin in an intensive care unit of a university hospital. Methods: An unmatched retrospective study (case series) was performed. Clinical, laboratory, and anthropometric data were collected from patients who received vasopressin infusion for treatment of catecholamine-refractory shock from December 2014 to June 2016. For the assessment of severity, APACHE II and SOFA scores were used. The main outcome was mortality at 3 and 30 days. Results: A total of 80 patients were included, of which 60% were male. In 86.3% of the cases, APACHE II was observed in the highest ranges (> 20). The 30-day mortality was 86.2%, and 75% of the patients died within 72 hours after starting vasopressin. Conclusion: The series evaluated had high mortality in the first 72 hours of treatment with vasopressin. The use of vasopressin in patients who are refractory to norepinephrine had little or no impact on mortality. It was not possible to exclude the possibility that the high mortality in the present study was linked to the relatively late onset (after established refractoriness of norepinephrine) of vasopressin; this hypothesis should be further evaluated in a randomized study.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Shock, Septic/drug therapy , Vasoconstrictor Agents/therapeutic use , Vasopressins/therapeutic use , Intensive Care Units , Shock, Septic/mortality , Severity of Illness Index , Norepinephrine/therapeutic use , Retrospective Studies , Treatment Outcome , APACHE , Organ Dysfunction Scores , Hospitals, University , Middle Aged
13.
Clinics ; 72(12): 750-757, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-890702

ABSTRACT

OBJECTIVES: To assess the impact of vasopressin on the microcirculation and to develop a predictive model to estimate the probability of microcirculatory recruitment in patients with septic shock. METHODS: This prospective interventional study included patients with septic shock receiving noradrenaline for less than 48 hours. We infused vasopressin at 0.04 U/min for one hour. Hemodynamic measurements, including sidestream dark-field imaging, were obtained immediately before vasopressin infusion, 1 hour after vasopressin infusion and 1 hour after vasopressin withdrawal. We defined patients with more than a 10% increase in total vascular density and perfused vascular density as responders. ClinicalTrials.gov: NCT02053675. RESULTS: Eighteen patients were included, and nine (50%) showed improved microcirculation after infusion of vasopressin. The noradrenaline dose was significantly reduced after vasopressin (p=0.001) and was higher both at baseline and during vasopressin infusion in the responders than in the non-responders. The strongest predictor for a favorable microcirculatory response was the dose of noradrenaline at baseline (OR=4.5; 95% CI: 1.2-17.0; p=0.027). For patients using a noradrenaline dose higher than 0.38 mcg/kg/min, the probability that microcirculatory perfusion would be improved with vasopressin was 53% (sensitivity 78%, specificity 77%). CONCLUSIONS: In patients with septic shock for no longer than 48 h, administration of vasopressin is likely to result in an improvement in microcirculation when the baseline noradrenaline dose is higher than 0.38 mcg/kg/min.


Subject(s)
Humans , Male , Female , Middle Aged , Shock, Septic/drug therapy , Vasoconstrictor Agents/administration & dosage , Vasopressins/administration & dosage , Norepinephrine/administration & dosage , Microcirculation/drug effects , Shock, Septic/physiopathology , Vasoconstrictor Agents/pharmacology , Vasopressins/pharmacology , Norepinephrine/pharmacology , Prospective Studies , Drug Therapy, Combination
14.
Biomédica (Bogotá) ; 37(1): 8-10, ene.-feb. 2017.
Article in English | LILACS | ID: biblio-888437

ABSTRACT

Abstracts We report the case of a patient presenting with multiple severe electrolyte disturbances who was subsequently found to have small cell lung cancer. Upon further evaluation, she demonstrated three distinct paraneoplastic processes, including the syndrome of inappropriate antidiuretic hormone, Fanconi syndrome, and an inappropriate elevation in fibroblast growth factor-23 (FGF23). The patient underwent one round of chemotherapy, but she was found to have progressive disease. After 36 days of hospitalization, the patient made the decision to enter hospice care and later she expired.


Resumen Se reporta el caso de una paciente que ingresó al hospital para evaluación de múltiples trastornos electrolíticos y, posteriormente, se le hizo el diagnóstico de cáncer de pulmón de células pequeñas. Tras la evaluación médica, se detectaron tres síndromes paraneoplásicos: síndrome de secreción inadecuada de hormona antidiurética, síndrome de Fanconi y elevación inapropiada del factor 23 de crecimiento de fibroblastos. Se le administró quimioterapia sin éxito, por lo cual se decidió darle tratamiento paliativo y, un tiempo después, falleció.


Subject(s)
Humans , Paraneoplastic Syndromes/etiology , Protein Precursors/physiology , Neurophysins/physiology , Vasopressins/physiology , Small Cell Lung Carcinoma/complications , Lung Neoplasms/etiology , Protein Precursors/genetics , Protein Precursors/chemistry , Neurophysins/genetics , Neurophysins/chemistry , Vasopressins/genetics , Vasopressins/chemistry , Small Cell Lung Carcinoma/pathology , Fibroblast Growth Factor-23 , Lung Neoplasms/pathology
15.
Article in English | WPRIM | ID: wpr-120968

ABSTRACT

Arginine vasopressin (AVP), also known as antidiuretic hormone, is a peptide endogenously secreted by the posterior pituitary in response to hyperosmolar plasma or systemic hypoperfusion states. When administered intravenously, it causes an intense peripheral vasoconstriction through stimulation of V₁ receptors on the vascular smooth muscle. Patients in refractory shock associated with severe sepsis, cardiogenic or vasodilatory shock, or cardiopulmonary bypass have inappropriately low plasma levels of AVP (‘relative vasopressin deficiency’) and supersensitivity to exogenously-administered AVP. Low doses of AVP and its synthetic analog terlipressin can restore vasomotor tone in conditions that are resistant to catecholamines, with preservation of renal blood flow and urine output. They are also useful in the treatment of refractory arterial hypotension in patients chronically treated with renin-angiotensin system inhibitors, cardiac arrest, or bleeding esophageal varices. In the perioperative setting, they represent attractive adjunct vasopressors in advanced shock states that are unresponsive to conventional therapeutic strategies.


Subject(s)
Humans , Arginine Vasopressin , Cardiopulmonary Bypass , Catecholamines , Esophageal and Gastric Varices , Heart Arrest , Hemorrhage , Hypotension , Muscle, Smooth, Vascular , Plasma , Renal Circulation , Renin-Angiotensin System , Sepsis , Shock , Shock, Hemorrhagic , Shock, Septic , Vasoconstriction , Vasopressins
16.
Article in English | WPRIM | ID: wpr-99764

ABSTRACT

Pituitary stalk interruption syndrome (PSIS) involves the occurrence of a thin or absent pituitary stalk, hypoplasia of the adenohypophysis, and ectopic neurohypophysis. Diagnosis is confirmed using magnetic resonance imaging. Patients with PSIS have a variable degree of pituitary hormone deficiency and a wide spectrum of clinical manifestations. The clinical course of the disease in our patient is similar to that of a syndrome of inappropriate antidiuretic hormone secretion. This is thought to be caused by failure in the suppression of vasopressin secretion due to hypocortisolism. To the best of our knowledge, there is no case report of a patient with PSIS presenting with hyponatremia as the first symptom in Korean children. Herein, we report a patient with PSIS presenting severe recurrent hyponatremia as the first symptom, during adolescence and explain the pathophysiology of hyponatremia with secondary adrenal insufficiency.


Subject(s)
Adolescent , Child , Humans , Adrenal Insufficiency , Delayed Diagnosis , Diagnosis , Hyponatremia , Hypopituitarism , Inappropriate ADH Syndrome , Magnetic Resonance Imaging , Pituitary Gland , Pituitary Gland, Anterior , Pituitary Gland, Posterior , Vasopressins
17.
Article in English | WPRIM | ID: wpr-158001

ABSTRACT

Anesthetic experience in frontotemporal dementia (FTD) with severe hypotension associated autonomic dysfunction has not yet been reported. Here in case, we report on the case of treatment with vasopressin to refractory hypotension in FTD patient. A 54-year-old male presented with a ten-year history of FTD with frequent syncope. The patient was scheduled to undergo subtotal gastrectomy for resection of stomach cancer. During the operation, sudden hypotension occurred and it was refractory to fluid and 1 unit of blood resuscitation and did not respond to catecholamine. Transesophageal echocardiography showed normal heart with adequate volume state. After intravenous administration of arginine vasopressin, the patient's vital signs returned to baseline values. Arginine vasopressin might be considered as a valuable alternative for treatment of severe refractory hypotension in autonomic dysfunction patients with FTD.


Subject(s)
Humans , Male , Middle Aged , Administration, Intravenous , Arginine Vasopressin , Echocardiography, Transesophageal , Frontotemporal Dementia , Gastrectomy , Heart , Hypotension , Resuscitation , Stomach Neoplasms , Syncope , Vasopressins , Vital Signs
18.
Article in English | WPRIM | ID: wpr-149598

ABSTRACT

BACKGROUND: Determining risk factors for diabetes insipidus (DI) after pituitary surgery is important in improving patient care. Our objective is to determine the factors associated with DI after pituitary surgery. METHODS: We reviewed records of patients who underwent pituitary surgery from 2011 to 2015 at Philippine General Hospital. Patients with preoperative DI were excluded. Multiple logistic regression analysis was performed and a predictive model was generated. The discrimination abilities of the predictive model and individual variables were assessed using the receiving operator characteristic curve. RESULTS: A total of 230 patients were included. The rate of postoperative DI was 27.8%. Percent change in serum Na (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.15 to 1.69); preoperative serum Na (OR, 1.19; 95% CI, 1.02 to 1.40); and performance of craniotomy (OR, 5.48; 95% CI, 1.60 to 18.80) remained significantly associated with an increased incidence of postoperative DI, while percent change in urine specific gravity (USG) (OR, 0.53; 95% CI, 0.33 to 0.87) and meningioma on histopathology (OR, 0.05; 95% CI, 0.04 to 0.70) were significantly associated with a decreased incidence. The predictive model generated has good diagnostic accuracy in predicting postoperative DI with an area under curve of 0.83. CONCLUSION: Greater percent change in serum Na, preoperative serum Na, and performance of craniotomy significantly increased the likelihood of postoperative DI while percent change in USG and meningioma on histopathology were significantly associated with a decreased incidence. The predictive model can be used to generate a scoring system in estimating the risk of postoperative DI.


Subject(s)
Humans , Area Under Curve , Craniotomy , Diabetes Insipidus , Discrimination, Psychological , Hospitals, General , Incidence , Logistic Models , Meningioma , Neuroendocrinology , Neurosurgery , Patient Care , Postoperative Complications , Risk Factors , Specific Gravity , Vasopressins
19.
Article in English | WPRIM | ID: wpr-29647

ABSTRACT

A 17-year-old girl presented with polyuria (7 L/day) and polydipsia for one year. Initial urine osmolality was 113mOsm/kg H₂O. Following 6 h of fluid restriction, serum plasma osmolality reached 300mOsm/kg H₂O, whereas urine osmolality was 108mOsm/kg H₂O. Urine osmolality was increased by 427% from 108 to 557mOsm/kg after vasopressin challenge. The patient was diagnosed with central diabetes insipidus, possibly derived from the atypical occupation of a Rathke's cleft cyst at the pituitary stalk following magnetic resonance imaging with enhancement. She was discharged with desmopressin nasal spray (10 µg); urine output was maintained at 2-3 L/day, and urine osmolality was >300 mOsm/kg. Additional pituitary image studies and evaluation of hypopituitarism should be included in the differential diagnosis of patients with central diabetes insipidus.


Subject(s)
Adolescent , Female , Humans , Deamino Arginine Vasopressin , Diabetes Insipidus, Neurogenic , Diagnosis, Differential , Hypopituitarism , Magnetic Resonance Imaging , Occupations , Osmolar Concentration , Pituitary Gland , Plasma , Polydipsia , Polyuria , Vasopressins
20.
Araçatuba; s.n; 2017. 113 p. graf, ilus.
Thesis in Portuguese | LILACS, BBO | ID: biblio-911129

ABSTRACT

O envelhecimento é considerado processo multidimensional no qual fatores ambientais podem proteger ou, inversamente, agravar seus sinais, de maneira não linear, nos processos fisiológicos e neurocomportamentais. Durante este processo, os ritmos circadianos são interrompidos ou fragmentados com dissociação consequente dos ritmos circadianos do indivíduo e disfunções relacionadas ao relógio circadiano contribuem para o envelhecimento e para patologias a ele relacionadas. O objetivo deste estudo foi averiguar possível alteração temporal do sistema CLOCK no eixo HPG e a relação com às alterações hormonais que caracterizam a periestropausa. Foram utilizadas fêmeas adultas com ciclo estral regular (CD) na fase do diestro e fêmeas senis com ciclo estral irregular e persistência da fase do diestro (IDP). Para análises de expressão gênica dos clock genes Per2, Rev-erbα e Bmal1 no eixo HPG, foram utilizados punchs das regiões do NSQ, onde também foi analisado RNAm de AVP, APO e HMB destes animais, além da adenohipófise e ovários dos quais se extraiu o RNA para confecção do cDNA e realização de qPCR. A determinação da atividade neuronal vasopressinérgica no NSQ foi realizada por imunoistoquíca com dupla marcação para cFos e AVP em tecido previamente fixado com paraformaldeído. A concentração plasmática de gonadotrofinas foi determinada por radioimunoensaio. De modo geral, os animais IDP revelaram alterações no perfil de expressão gênica durante o fotoperíodo, com redução de amplitude, deslocamento/desalinhamento de fase e ausência de antifase. O NSQ de animais IDP apresentou menor expressão de Rev-erbα e maior expressão de RNAm para AVP em relação ao grupo CD. A quantificação relativa de Bmal1 foi semelhante em ambos os grupos e não houve diferenças entre grupos na expressão de Per2. Na APO, animais IDP apresentaram maior expressão de Per2 e menor quantidade de RNAm para Rev-erbα. No HMB observou-se menor expressão para Per2 e Rev-erbα e maior expressão de Bmal1 nas fêmeas IDP. Per2 e Bmal1 na adenohipófise tiveram menor expressão que o gene Rev-erbα no grupo senil e o ovário destes animais revelou maior expressão para Per2 e Rev-erbα, em comparação com os animais CD. As concentrações plasmáticas de FSH foram maiores nas fêmeas com ciclo irregular (2,05 ± 0,44 ng/mL), principalmente durante a fase clara, assim como o LH (0,24 ± 0,07 ng/mL), cujos maiores valores foram encontrados durante a fase escura e com perfil semelhante ao RNAm de AVP. As imunomarcações revelaram alta atividade vasopressinérgica na porção dorsomedial do NSQ das fêmeas IDP. Juntos estes dados permitem concluir que há desarranjo na expressão temporal dos genes Per2, Rev-erbα, Bmal1 que compõem a maquinaria molecular do relógio circadiano, bem como de RNAm para AVP no NSQ, de fêmeas Wistar na periestropausa. Além disso, a maior atividade neuronal vasopressinérgica e a ausência de oscilação de Rev-erbα e Bmal1 no NSQ destes animais, comprometem a correta comunicação do relógio central do NSQ com o eixo HPG, inviabilizando a manutenção da fertilidade feminina e contribuindo para a senescência reprodutiva(AU)


Aging is considered a multidimensional process in which environmental factors can protect or, conversely, aggravate its signals, non-linearly, in physiological and neurobehavioral processes. During this process, circadian rhythms are disrupted or fragmented with consequent dissociation of the individual's circadian rhythms and circadian clock-related dysfunctions contribute to aging and related pathologies. The objective of this study was to investigate possible temporal alteration of the CLOCK system in the HPG axis and the relation with the hormonal changes that characterize periestropause. Adult females with regular estrus cycle in the diestrous phase (RD) and old females with irregular estrous cycle and persistent diestrous phase (IPD). For analyzes of the gene expression of the genes Per2, Rev-erbα and Bmal1 in the HPG axis, punchs from the NSQ regions were used, where AVP, POA and MBH RNAm from these animals were also analyzed, as well as the adenohypophysis and ovaries from which they were extracted the RNA for cDNA production and qPCR performance. The determination of the vasopressinergic neuronal activity in the NSQ was performed by immunohistochemical with double labeling for cFos/AVP in tissue previously fixed with paraformaldehyde. The plasma concentration of gonadotrophins was determined by radioimmunoassay. In general, the IPD animals show alterations in the gene expression profile during the period analyzed, with amplitude reduction, phase shift / misalignment and absence of antiphase. The NSQ of IPD animals presented lower expression of Rev-erbα and higher RNAm expression for AVP than RD group. The relative quantification of Bmal1 was similar in both groups and there were no differences between groups in the expression of Per2. In PAO, IPD animals showed higher expression of Per2 and less amount of RNAm for Rev-erbα. MBH showed lower expression for Per2 and Rev-erbα and higher Bmal1 expression in IPD females. Per2 and Bmal1 in the adenohypophysis had lower expression than the Rev-erbα gene in the old group and the ovary of these animals showed higher expression for Per2 and Rev-erbα, in related to to the RD animals. Plasma concentrations of FSH were higher in females with irregular cycle (2.05 ± 0.44 ng / mL), mainly during the light phase, as well as LH (0.24 ± 0.07 ng / mL) whose values were found during the dark phase and with a profile similar to AVP RNAm. Immunolabeling demonstrated high vasopressinergic activity in the dorsomedial portion of the NSQ of the IPD females. Together these data allow us to conclude that there is a breakdown in the temporal expression of the Per2, Rev-erbα, Bmal1 genes that make up the molecular machinery of the circadian clock, as well as RNAm for AVP in NSQ of Wistar females in peri-masterpause. In addition, the increased vasopressinergic neuronal activity and the absence of Rev-erbα and Bmal1 oscillation in the NSQ of these animals compromise the correct communication of the central clock of the NSQ with the HPG axis, making it impossible to maintain female fertility and contributing to reproductive senescence(AU)


Subject(s)
Animals , Rats , Aging , Circadian Rhythm , CLOCK Proteins , Circadian Rhythm , Rats, Wistar , Vasopressins
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