Atenolol oral comparado con propranolol oral para hemangioma infantil / Oral atenolol compared to oral propranolol for infantile hemangioma

INTRODUCCIÓN: El hemangioma infantil corresponde al tumor vascular benigno más frecuente de la infancia, con una incidencia de 3 a 10%. Entre los pacientes que requieren tratamiento el uso oral de propranolol, un betabloqueador no selectivo de tipo lipofílico, es usualmente considerado como la terapia de elección. Sin embargo, su uso se ha asociado a diversos efectos adversos, relacionados con su acción ß-2, y a su capacidad de cruzar la barrera hematoencefálica. Debido a esto, el uso oral de atenolol, un betabloqueador selectivo de receptores ß-1, de tipo hidrofílico, podría representar una alternativa válida de tratamiento. Sin embargo, aún existe controversia en relación con la eficacia y seguridad del tratamiento con atenolol como monoterapia, en comparación con el uso de propranolol como monoterapia para esta condición. MÉTODOS: Se realizó una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el tamizaje de múltiples fuentes de información, incluyendo MEDLINE/PubMed, EMBASE, Cochrane, entre otras. Se extrajeron los datos desde las revisiones identificadas, se analizaron los datos de los estudios primarios, se realizó un metanálisis y se preparó una tabla de resumen de los resultados utilizando el método , GRADE. RESULTADOS: Se identificaron nueve revisiones sistemáticas, que en conjunto incluyeron 10 estudios primarios y tres ensayos aleatorizados. Se incluyeron los tres ensayos aleatorizados en el análisis del presente trabajo. CONCLUSIONES: El uso de atenolol oral como monoterapia, comparado con el uso de propranolol oral como monoterapia, podría resultar en poca o nula diferencia en cuanto a la probabilidad de remisión completa, la disminución del , la probabilidad de recaída posterior al tratamiento y el riesgo de presentar efectos adversos y efectos adversos severos, en el hemangioma infantil (certeza de la evidencia baja).

INTRODUCTION: Infantile hemangioma is the most frequent benign vascular tumor in childhood, with an incidence of 3 to 10%. When patients require treatment, oral propranolol, a non-selective lipophilic beta-blocker, is usually considered the therapy of choice. However, its use has been associated with several adverse events related to its ß-2 action and its ability to cross the blood-brain barrier. Because of this, oral atenolol, a hydrophilic ß-1 receptor-selective beta-blocker, may represent a valid treatment alternative. Nonetheless, there is still controversy regarding the efficacy and safety of atenolol when compared with propranolol as monotherapy for this condition. METHODS: We searched Epistemonikos, the largest database of systematic reviews in health science, which is maintained by screening multiple sources of information, including MEDLINE/PubMed, EMBASE, and Cochrane, among others. Data were extracted from the identified reviews, data from the primary studies were analyzed, a meta-analysis was performed, and a summary table of the results was prepared using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. RESULTS: Nine systematic reviews were identified, including 10 primary studies and three randomized trials. The three randomized trials were included in the analysis of this investigation. CONCLUSION: The use of oral atenolol compared with oral propranolol as monotherapies may result in little or no difference in terms of likelihood of complete remission, decrease in Hemangioma Activity Score, likelihood of post-treatment relapse, and risk of adverse events and severe adverse events, in infantile hemangioma (low certainty of evidence).

Passive Cigarette Smoking Impact on Blood Pressure Response to Epinephrine and Felypressin in 1K1C Hypertensive Rats Treated or not with Atenolol / Impacto do Tabagismo Passivo na Resposta Pressórica à Epinefrina e Felipressina em Ratos Hipertensos 1K1C Tratados ou não com Atenolol

Abstract Background: Cigarette smoking is usually associated with hypertension and may modify vasoconstrictor response. Objective: The present study aimed to analyze and compare the interaction of passive cigarette smoking and hypertension on epinephrine and felypressin blood pressure effects after intravascular injection. Method: 45-day male Wistar rats had the main left renal artery partially constricted and the right kidney removed (1K1C model). Rats were placed in the chamber for exposition to passive cigarette smoking (10 cigarettes) during 10 min (6 days a week). Hypertensive rats received atenolol (90 mg/kg/day) by gavage for two weeks. Hypotensive and hypertensive response, response duration and heart rate were recorded from direct blood pressure values. The significance level was 5%. Results: Passive cigarette smoking increased maximal hypertensive response to epinephrine in normotensive and 1K1C-atenolol treated rats and to felypressin only in 1K1C-atenolol treated rats; it also reduced epinephrine hypotensive response. Epinephrine increased heart rate in normotensive and hypertensive passive smokers or non-smoker rats. Comparing the two vasoconstrictors, epinephrine showed greater hypertensive response in normotensive smokers, 1K1C-atenolol treated smokers and non-smokers. However, in normotensive-nonsmoker rats, felypressin showed a greater and longer hypertensive effect. Conclusions: Our results suggest that passive cigarette smoking may reduce epinephrine vasodilation and increase hypertensive response when compared to felypressin. Therefore, felypressin may be safe for hypertensive patients to avoid tachycardia and atenolol interaction, but for normotensive and non-smoker patients, epinephrine may be safer than felypressin.

Resumo Fundamento: O tabagismo geralmente está associado à hipertensão e pode modificar a resposta vasoconstritora. Objetivo: O presente estudo teve como objetivo analisar e comparar a interação do tabagismo passivo e hipertensão sobre os efeitos da epinefrina e felipressina na pressão arterial após injeção intravascular. Métodos: Ratos Wistar machos de 45 dias tiveram a artéria renal principal esquerda parcialmente obstruída e o rim direito removido (modelo 1K1C). Os ratos foram colocados na câmara para exposição ao tabagismo passivo (10 cigarros) durante 10 minutos (6 dias por semana). Ratos hipertensos receberam atenolol (90 mg/kg/dia) por gavagem durante duas semanas. A resposta hipotensora e hipertensiva, a duração da resposta e a frequência cardíaca foram registradas a partir da medida dos valores diretos da pressão arterial. O nível de significância foi de 5%. Resultados: O tabagismo passivo aumentou a resposta hipertensiva máxima à epinefrina em ratos normotensos e ratos 1K1C tratados com atenolol e à felipressina apenas em ratos 1K1C tratados com atenolol; também reduziu a resposta hipotensiva à epinefrina. A epinefrina aumentou a frequência cardíaca em ratos fumantes passivos ou não-fumantes, normotensos e hipertensos. Comparando os dois vasoconstritores, a epinefrina apresentou maior resposta hipertensiva em fumantes normotensos, ratos 1K1C fumantes e não fumantes tratados com atenolol. No entanto, em ratos normotensos e não fumantes, a felipressina apresentou um efeito hipertensivo maior e mais prolongado. Conclusões: Nossos resultados sugerem que o tabagismo passivo pode reduzir a vasodilatação da epinefrina e aumentar a resposta hipertensiva quando comparado à felipressina. Portanto, a felipressina pode ser segura para pacientes hipertensos, com o objetivo de evitar a interação entre taquicardia e atenolol, mas para pacientes normotensos e não-fumantes, a epinefrina pode ser mais segura que a felipressina.

Atenolol increases dental mineralization in male offspring of treated hypertensive rats and normotensive rats

Abstract This study evaluates how atenolol affects dental mineralization in offspring of female spontaneously hypertensive rats (fSHR) and normotensive Wistar rats (fW). fSHR and fW were treated with atenolol (100 mg/Kg/day, orally) during pregnancy and lactation. Non-treated fSHR and fW were the control groups. Enamel and dentin hardness were analyzed (Knoop, 15 g load, 10s) in mandibular incisor teeth (IT) and molar teeth (MT) obtained from the male offspring of atenolol-treated and non-treated fWistar and fSHR. Data were analyzed by ANOVA, followed by Tukey post hoc test (p < 0.05). Atenolol reduced the arterial blood pressure (SBP) in fSHR, but it did not change the SBP in fW. The offspring of non-treated fSHR had lower enamel (IT and MT) and dentin (IT) hardness than the offspring of non-treated fW (p < 0.05). Atenolol increased enamel and dentin hardness in the IT obtained from the offspring of fSHR and fW (p<0.05), but the offspring of fSHR presented higher values (p < 0.05). Atenolol did not alter enamel width in the IT obtained from any of the groups, but it increased enamel and dentin hardness in the IT obtained from the offspring of fSHR and fW. Atenolol affected the IT obtained from the offspring of fSHR. Atenolol increased only enamel hardness in the MT obtained from the offspring of fW. In conclusion, maternal hypertension reduces tooth hard tissues, and treatment with atenolol increases tooth hardness in male offspring of hypertensive and normotensive female rats.

Hemangioma infantil: diagnóstico y manejo / Infantile hemangioma: diagnosis and management

El hemangioma infantil es el tumor de partes blandas más frecuente de la infancia; aparece durante las primeras semanas de vida. La fase de crecimiento progresivo ocurre durante el primer año de edad y la fase involutiva, hasta los 7 años. Puede ser único o múltiple, afectar un segmento del cuerpo o asociarse a otras anomalías en otros órganos. El tratamiento de elección para los hemangiomas que amenazan la vida o la función es el propranolol bajo un adecuado monitoreo médico; sin embargo, existen otras alternativas terapéuticas tanto para detener su crecimiento como para las secuelas. El manejo integral del hemangioma infantil varía de acuerdo a su presentación en cada paciente, de ahí la importancia de conocer su comportamiento para un adecuado diagnóstico, tratamiento y pronóstico. Este artículo brinda un enfoque práctico para el diagnóstico del hemangioma infantil, así como pautas y recomendaciones para el tratamiento sobre la base de la literatura.Palabras clave: atenolol, diagnóstico clínico, hemangioma, propranolol

Infantile hemangioma is the most frequent soft tissue tumor of childhood. It appears during the first weeks of life with a progressive growth during the first year of age and a regression phase until the seventh year of age. It can be single or multiple, affect one segment of the body or be associated with other abnormalities in other organs. Propranolol is the treatment of choice for hemangiomas that threaten life or function under adequate medical monitoring, however there are other therapeutic alternatives both to stop the proliferative phase and for the sequels. The integral management of the infantile hemangioma varies according to the presentation in each patient, hence the importance of knowing its behavior for an adequate diagnosis, treatment and prognosis. This article provides a practical approach for the diagnosis of infantile hemangioma, as well as guidelines and recommendations for treatment based on the literature

Cost-Effectiveness of Rate- and Rhythm-Control Drugs for Treating Atrial Fibrillation in Korea

PURPOSE: Although the economic and mortality burden of atrial fibrillation (AF) is substantial, it remains unclear which treatment strategies for rate and rhythm control are most cost-effective. Consequently, economic factors can play an adjunctive role in guiding treatment selection. MATERIALS AND METHODS: We built a Markov chain Monte Carlo model using the Korean Health Insurance Review & Assessment Service database. Drugs for rate control and rhythm control in AF were analyzed. Cost-effective therapies were selected using a cost-effectiveness ratio, calculated by net cost and quality-adjusted life years (QALY). RESULTS: In the National Health Insurance Service data, 268149 patients with prevalent AF (age ≥18 years) were identified between January 1, 2013 and December 31, 2015. Among them, 212459 and 55690 patients were taking drugs for rate and rhythm control, respectively. Atenolol cost $714/QALY. Among the rate-control medications, the cost of propranolol was lowest at $487/QALY, while that of carvedilol was highest at $1363/QALY. Among the rhythm-control medications, the cost of pilsicainide was lowest at $638/QALY, while that of amiodarone was highest at $986/QALY. Flecainide and propafenone cost $834 and $830/QALY, respectively. The cost-effectiveness threshold of all drugs was lower than $30000/QALY. Compared with atenolol, the rate-control drugs propranolol, betaxolol, bevantolol, bisoprolol, diltiazem, and verapamil, as well as the rhythm-control drugs sotalol, pilsicainide, flecainide, propafenone, and dronedarone, showed better incremental cost-effectiveness ratios. CONCLUSION: Propranolol and pilsicainide appear to be cost-effective in patients with AF in Korea assuming that drug usage or compliance is the same.

Pharmacological modulation of b-adrenoceptors as a new cardioprotective strategy for therapy of myocardial dysfunction induced by ischemia and reperfusion

Abstract Purpose: To evaluate the cardioprotective response of the pharmacological modulation of β-adrenergic receptors (β-AR) in animal model of cardiac ischemia and reperfusion (CIR), in spontaneously hypertensive (SHR) and normotensive (NWR) rats. Methods: CIR was induced by the occlusion of left anterior descendent coronary artery (10 min) and reperfusion (75 min). The SHR was treated with β-AR antagonist atenolol (AT, 10 mg/kg, IV) 5 min before CIR, and NWR were treated with β-AR agonist isoproterenol (ISO, 0.5 mg/kg, IV) 5 min before CIR. Results: The treatment with AT increased the incidence of VA, AVB and LET in SHR, suggesting that spontaneous cardioprotection in hypertensive animals was abolished by blockade of β-AR. In contrast, the treatment with ISO significantly reduced the incidence of ventricular arrhythmia, atrioventricular blockade and lethality in NWR (30%, 20% and 20%, respectively), suggesting that the activation of β-AR stimulate cardioprotection in normotensive animals. Serum CK-MB were higher in SHR/CIR and NWR/CIR compared to respective SHAM group (not altered by treatment with AT or ISO). Conclusion: The pharmacological modulation of β-AR could be a new cardioprotective strategy for the therapy of myocardial dysfunctions induced by CIR related to cardiac surgery and cardiovascular diseases.

The role of atenolol in the modulation of the expression of genes encoding pro- (caspase-1) and anti- (Bcl2L1) apoptotic proteins in endothelial cells exposed to intestinal ischemia and reperfusion in rats

Abstract Purpose: To investigate the role of atenolol in the gene expression of caspase 1 (Casp1) and Bcl2L1 on vascular endothelium of rat intestine after ischemia and reperfusion (IR). Methods: Eighteen adult male Wistar rats were randomly divided into 3 groups (n=6): SG (Sham group): no clamping of the superior mesenteric artery; IRG: IR plus saline group: IRG+At: IR plus Atenolol group. Rats from IRG and IRG+At were subjected to 60 min of intestinal ischemia and 120 min of reperfusion. Atenolol (2mg/kg) or saline were injected in the femoral vein 5 min before ischemia, 5 min and 55 min after reperfusion. Thereafter, intestinal segments were appropriately removed and processed for Endothelial Cell Biology Rat RT2 Profiler PCR Array. Results: the anti-apoptotic Bcl2L1 gene expression was significantly down-regulated (-1.10) in the IRG and significantly up-regulated in the IRG+At (+14.15). Meanwhile, despite Casp1 gene expression was upregulated in both groups, it was significantly higher in the IRG (+35.06) than the IRG+At (+6.68). Conclusions: Atenolol presents antiapoptotic effects on rat intestine subjected to IR partly by the up-regulation of the anti-apoptotic Bcl2L1 gene expression. Moreover, atenolol can mitigate the pro-apoptotic and pro-inflammatory effects of Casp1 gene on rat intestine after IR.

β₂-Adrenoceptor Blockade Deteriorates Systemic Anaphylaxis by Enhancing Hyperpermeability in Anesthetized Mice

PURPOSE: Patients treated with propranolol, a nonselective β-adrenoceptor antagonist, develop severe anaphylaxis, but the mechanism remains unknown. We determined effects of β₁- and β₂-adrenoceptor antagonists on the anaphylaxis-induced increase in vascular permeability in mice. METHODS: In anesthetized ovalbumin-sensitized C57BL mice, mean arterial blood pressure (MBP) was measured, and Evans blue dye extravasation and hematocrit (Hct) were assessed at 20 minutes after antigen injection. The following pretreatment groups (n=7/group) were studied: (1) sensitized control (non-pretreatment), (2) propranolol, (3) the selective β₂-adrenoceptor antagonist ICI 118,551, (4) the selective β₁-adrenoceptor antagonist atenolol, (5) adrenalectomy, (6) the selective β₂-adrenoceptor agonist terbutaline, and (7) non-sensitized groups. RESULTS: The antigen injection decreased MBP, and increased Hct and vascular permeability in the kidney, lung, mesentery, and intestine, but not in the liver or spleen. Pretreatment with ICI 118,551, propranolol and adrenalectomy, but not atenolol, reduced the survival rate and augmented the increases in Hct and vascular permeability in the kidney, intestine, and lung as compared with the sensitized control group. Pretreatment with terbutaline abolished the antigen-induced alterations. Plasma epinephrine levels were increased significantly in the sensitize control mice. CONCLUSIONS: Blockade of β₂-adrenoceptor can deteriorate systemic anaphylaxis by augmenting hyperpermeability-induced increase in plasma extravasation by inhibiting beneficial effects of epinephrine released from the adrenal glands in anesthetized mice.

Effect of atenolol pre-treatment in heart damage in a model of intestinal ischemia-reperfusion

Abstract Purpose: To investigate the effects of atenolol in inflammatory mediator and oxidative stress in a myocardial injury by intestinal ischemia/reperfusion in rat model. Methods: Adult Wistar male rats were randomly (n=8), anesthetized and divided in: Sham: submitted to operation only; group SS+IR: intravenous saline infusion following superior mesenteric artery occlusion during 60 minutes (ischemia) and open for 120 minutes (reperfusion); group AT+IR: intravenous atenolol infusion (2 mg/kg) following superior mesenteric artery occlusion during 60 minutes (ischemia) and open for 120 minutes (reperfusion); and group AT+I+AT+R: intravenous atenolol infusion following superior mesenteric artery occlusion during 60 minutes (ischemia) and in the time 45 minutes other atenolol doses were administrated and the artery was open for 120 minutes (reperfusion), all animals were submitted to muscular relaxation for mechanical ventilation. In the end of experiment the animals were euthanized and the hearts tissue were morphology analyzed by histology and malondialdehyde by ELISA, and the plasma were analyzed for tumor necrosis factor-alpha by ELISA. Results: The group SS+IR demonstrated the higher malondialdehyde levels when compared with the atenolol treated-groups (p=0.001) in the heart tissue. The tumor necrosis factor-alpha level in plasma decrease in the treated groups when compared with SS+IR group (p=0.001). Histology analyses demonstrate pyknosis, edema, cellular vacuolization, presence of inflammatory infiltrate and band contraction in the heart tissue of the rats. Conclusion: Atenolol significantly reduce the degree of cardiac damage after intestinal ischemia-reperfusion.

Análise da variação do limiar de captura após a realização de cardioversão elétrica em portadores de dispositivos cardíacos eletrônicos implantáveis / Captured threshold variance analysis after electric cardioversion in patients using cardiaca implantable electronic devices

Introdução: Com o aumento da expectativa de vida da população e a consequente maior incidência de arritmias, que podem necessitar de cardioversão elétrica e crescente desenvolvimento e indicação de dispositivos cardíacos eletrônicos implantáveis, torna-se necessária a reavaliação do comportamento desses dispositivos após a aplicação de terapia elétrica, especialmente naqueles pacientes dependentes de estimulação. Este trabalho teve como objetivo avaliar a variação do limiar de captura ventricular após choque terapêutico para tratamento de taquiarritmias supraventriculares, em condições de prá- tica clínica diária. Método: Entre julho de 2009 e maio de 2015, foram avaliados pacientes portadores de dispositivos cardíacos eletrônicos implantáveis, na cidade de Araras (SP, Brasil), que necessitaram de cardioversão elétrica, sendo determinados os limiares de captura ventricular antes e imediatamente após a terapia. A avaliação teve como objetivo analisar a variação desse parâmetro, que reflete item de segurança do dispositivo. Resultados: Foram incluídos 12 pacientes tratados em 13 episódios de taquiarritmias supraventriculares (fibrilação e taquicardia atriais), com média de idade de 71,6 anos, predominantemente do sexo masculino, com tempo variável de implante do dispositivo, não sendo encontrada variação significativa do limiar de captura ventricular antes e após a cardioversão elétrica. Conclusão: Não há variação significativa do limiar de captura ventricular após cardioversão elétrica em pacientes com taquiarritmias supraventriculares

Background: With the increase in the population's life expectancy, a greater incidence of cardiac arrhythmias is observed. These arrhythmias may require treatment with electric cardioversion. Furthermore, with the increase in the development and indications for cardiac implantable electronic devices, the behavior of these devices after electric therapy must be reevaluated, especially in patients who depended on cardiac stimulation. This study aimed to evaluate the ventricular captured threshold variance after therapeutic countershock for the treatment of supraventricular tachyarrhythmias in daily practice conditions. Method: From July 2009 to May 2015, patients with cardiac implantable electronic devices requiring electric cardioversion were evaluated, in Araras (SP, Brazil). Captured threshold variance before and immediately after therapy was determined. The evaluation aimed at analyzing the variance of this parameter, which reflects a safety feature of the device. Results: 12 patients were included, presenting with 13 episodes of supraventricular tachyarrhythmias (atrial tachycardia and fibrillation). Mean age was 71.6 years, with a prevalence of males and variable device implant times. No significant ventricular captured threshold variation was found before and after electric cardioversion. Conclusion: There is no significant variation of ventricular captured threshold variance after electric cardioversion in patients with supraventricular tachyarrhythmias

Fosfatasa alcalina ósea sérica elevada no mediada por metástasis en un paciente con cáncer renal / Elevated bone alkaline phosphatase not mediated by metastasis in a patient with renal cancer

Presentamos un paciente de 63 años con cáncer renal y aumento de fosfatasa alcalina sérica de tipo óseo de acuerdo con su reactividad con anticuerpos monoclonales específicos. Se descartaron las causas conocidas de aumento de la isoenzima, incluyendo metástasis óseas. Los niveles enzimáticos cayeron abruptamente con la remoción del tumor, por lo que consideramos a este último como su origen. Diversas isoenzimas de fosfatasa alcalina pueden ser producidas y secretadas por tumores como manifestación paraneoplásica. El conocimiento de esto puede, en ocasiones, orientarnos hacia la presencia de una neoplasia oculta. Además, los cambios en los niveles séricos de esas isoenzimas pueden ser indicadores de respuesta al tratamiento o de recidiva tumoral. (AU)

A 63-year old man was seen in the outpatient clinic because of renal cancer and elevation in bone alkaline phosphatase measured by monoclonal antibodies assay. Known causes of bone isoenzyme augmentation, including bone metastases, were ruled out. The tumoral origin of the isoenzyme was diagnosed because after removal of the tumor the enzymatic levels fell sharply. Several alkaline phosphatase isoenzymes can be produced and secreted by tumors as a paraneoplasic manifestation and their elevation could be a manifestation of an occult neoplasia. Furthermore the monitoring of their blood levels can be useful means of treatment response and a tool to monitoring recurrence if a sharp decrease after removal of the tumor is observed. (AU)

Imunomarcação para TRAP em tecido de reparação óssea de ratos espontaneamente hipertensos (SHR) tratados com Atenolol / Immunostaining for TRAP in bone healing tissue of Spontaneously Hypertensive Rats (SHR) treated with Atenolol

Introdução: A hipertensão arterial tem sido um dos maiores problemas de saúde no mundo, com grandes alterações para as doenças cardiovasculares e renais. O tecido ósseo tem função importante no suporte, proteção e locomoção e está sob o controle de fatores sistêmicos como hormônios e fatores locais, entre eles os fatores de crescimento e citocinas. A Fosfatase Ácida Tartarato Resistente (TRAP) é uma enzima que faz parte da família das fosfatases ácidas e apresenta localização intracelular; mais especificamente dentro do compartimento lisossomal de osteoclasto, macrófagos e células dendríticas, tem sido utilizada como um marcador histoquímico da atividade osteoclástica. Objetivos: Avaliar a expressão da proteína TRAP em alvéolos dentários de ratos hipertensos (SHR) e normotensos tratados ou não com atenolol. Métodos: Neste estudo foram utilizados 4 grupos de ratos sendo: 1) W (wistar sem tratamento), 2) WT (wistar tratado com atenolol), 3) S (SHR sem tratamento) e 4) ST (SHR tratado com atenolol), submetidos a exodontia do incisivo superior direito, com eutanásia no 7º, 14º, 21 e 28º dia pós-operatório. A análise dos mecanismos biológicos envolvidos no processo de reparo alveolar foi obtida pela análise da expressão de proteínas TRAP por meio da técnica de imunoistoquímica. Os resultados foram analisados pela média e erro padrão da média e aplicado o teste paramétrico ANOVA, com pos-test de Tukey para avaliar os períodos dentro de cada grupo e entre os grupos, sendo consideradas as diferenças significativas quando p<0,05. Resultados: Os resultados mostraram que a marcação TRAP aumenta em alvéolo dentais de ratos Wistar durante todos os períodos pós ­ operatórios. A marcação TRAP aumenta apenas ao 14o nos dias de reparação alveolar em alvéolo dental de SHR não tratados. O atenolol não altera o processo de reparo alveolar em ratos Wistar, porém o atenolol promoveu a redução da marcação de TRAP em SHR ao 14º dia. Conclusão: A hipertensão aumenta a expressão da proteína TRAP no 14o dia pós-cirúrgico de reparação alveolar e o atenolol promove redução da marcação aumentada de TRAP ao 14º dia pós-cirúrgico em alvéolos de SHR(AU)

Introduction: Arterial hypertension has been one of the world's biggest health problems, with considerable alterations for cardiovascular and renal diseases. The bone tissue has an important role in support, protection and locomotion and is controlled by systemic factors like hormones and local factors, such as growth factors and cytokines. The Tartrate-resistant Acid Phosphatase (TRAP) is an enzyme that belongs to the Acid Phosphatases family and has an intracellular location, more specifically inside the lysosomal compartment of osteoclasts, macrophages and dendritic cells. It has been used as a histochemical marker of the osteoclast activity. Objectives: Evaluate TRAP protein's expression in the dental alveoli of normotensive and hypertensive rats (SHR) treated or not treated with Atenolol. Methods: In this study, four groups of rats were used: 1) W (with no treatment), 2) WT (wistar treated with Atenolol), 3) S (SHR without treatment) and 4) ST (SHR treated with Atenolol), all of which underwent exodontia of the upper right incisor with euthanasia on the 7th, 14th, 21st and 28th day after the operation. The analysis of the biological mechanisms involved in the process of alveolar repair was obtained by the expression of TRAP proteins in the alveolar process through an immunohistochemistry technique. The results were analyzed through the average and its standard error. The parametric test ANOVA was applied with Tukey's posttest were applied to evaluate the periods within each group and between the groups, considering the significant differences when p< 0,05. Results: The results demonstrated that TRAP staining increases in the dental alveoli of Wistar rats during all the post-surgical periods. TRAP staining increases only on the 14th day of alveolar recovery in the dental alveoli of non-treated SHR. Atenolol does not change the process of alveolar repair in Wistar rats, but Atenolol promoted the reduction of TRAP staining among SHR on the 14th day. Conclusion: Hypertension increases the expression of TRAP proteins on the 14th alveolar recovery postsurgical day and Atenolol promotes the reduction of the increased TRAP staining on the 14th postsurgical day in SHR's alveoli(AU)

TeleCondutas: hipertireoidismo / TeleGuides: hyperthyroidism

Hipertireoidismo é o excesso de função da glândula tireoide. É a principal causa de tireotoxicose, que, por sua vez, é a manifestação clínica do excesso de hormônios tireoidianos. O hipertireoidismo é mais comum em mulheres do que em homens (razão de 5:1), tendo como principais causas a Doença de Graves (60 % a 80% dos casos), etiologia típica em mulheres jovens com idade entre 20 a 40 anos, e o bócio multinodular tóxico (10 % a 30% dos casos), mais frequente em idosos. O adenoma tóxico e as tireoidites são menos comuns (1%). Hipertireoidismo e tireotoxicose também podem ser induzidos por medicamentos como amiodarona, interferon, levotiroxina e lítio. A doença deve ser investigada em pacientes com manifestações clínicas, não havendo recomendação para rastreamento populacional. Informações sobre tireotoxicose induzida por levotiroxina (TSH reduzido em paciente que faz uso de levotiroxina) podem ser obtidas no material TeleCondutas Hipotireoidismo. Esta guia apresenta informação que orienta a conduta para casos de hipertiroidismo no contexto da Atenção Primária à Saúde, incluindo: sinais e sintomas, diagnóstico do hipertireoidismo, tratamento do hipertireoidismo, tratamento do hipertireoidismo subclínico, hipertireoidismo na gestação, encaminhamento para serviço especializado.

Effect of selective beta-adrenoceptor blockade and surgical resection of the celiac-superior mesenteric ganglion complex on delayed liquid gastric emptying induced by dipyrone, 4-aminoantipyrine, and antipyrine in rats

There is evidence for participation of peripheral β-adrenoceptors in delayed liquid gastric emptying (GE) induced in rats by dipyrone (Dp), 4-aminoantipyrine (AA), and antipyrine (At). The present study aimed to determine whether β-adrenoceptors are involved in delayed GE induced by phenylpyrazole derivatives and the role of the prevertebral sympathetic nervous system in this condition. Male Wistar rats weighing 220-280 g were used in the study. In the first experiment rats were intravenously pretreated with vehicle (V), atenolol 30 mg/kg (ATE, β1-adrenergic antagonist), or butoxamine 25 mg/kg (BUT, β2-adrenergic antagonist). In the second experiment, rats were pretreated with V or SR59230A 2 mg/kg (SRA, β3-adrenergic antagonist). In the third experiment, rats were subjected to surgical resection of the celiac-superior mesenteric ganglion complex or to sham surgery. The groups were intravenously treated with saline (S), 240 µmol/kg Dp, AA, or At, 15 min after pretreatment with the antagonists or V and nine days after surgery. GE was determined 10 min later by measuring the percentage of gastric retention (%GR) of saline labeled with phenol red 10 min after gavage. The %GR (means±SE, n=6) values indicated that BUT abolished the effect of Dp (BUT+Dp vs V+Dp: 35.0%±5.1% vs 56.4%±2.7%) and At (BUT+At vs V+At: 33.5%±4.7% vs 52.9%±2.6%) on GE, and significantly reduced (P<0.05) the effect of AA (BUT+AA vs V+AA: 48.0%±5.0% vs 65.2%±3.8%). ATE, SRA, and sympathectomy did not modify the effects of treatments. These results suggest that β2-adrenoceptor activation occurred in delayed liquid gastric emptying induced by the phenylpyrazole derivatives dipyrone, 4-aminoantipyrine, and antipyrine. Additionally, the released neurotransmitter did not originate in the celiac-superior mesenteric ganglion complex.

The Effects of Oral Atenolol or Enalapril Premedication on Blood Loss and Hypotensive Anesthesia in Orthognathic Surgery

PURPOSE: The aim of this study was to evaluate the effects of premedication with oral atenolol or enalapril, in combination with remifentanil under sevoflurane anesthesia, on intraoperative blood loss by achieving adequate deliberate hypotension (DH) during orthognathic surgery. Furthermore, we investigated the impact thereof on the amount of nitroglycerin (NTG) administered as an adjuvant agent. MATERIALS AND METHODS: Seventy-three patients undergoing orthognathic surgery were randomly allocated into one of three groups: an angiotensin converting enzyme inhibitor group (Group A, n=24) with enalapril 10 mg, a beta blocker group (Group B, n=24) with atenolol 25 mg, or a control group (Group C, n=25) with placebo. All patients were premedicated orally 1 h before the induction of anesthesia. NTG was the only adjuvant agent used to achieve DH when mean arterial blood pressure (MAP) was not controlled, despite the administration of the maximum remifentanil dose (0.3 microg kg-1min-1) with sevoflurane. RESULTS: Seventy-two patients completed the study. Blood loss was significantly reduced in Group A, compared to Group C (adjusted p=0.045). Over the target range of MAP percentage during DH was significantly higher in Group C than in Groups A and B (adjusted p-values=0.007 and 0.006, respectively). The total amount of NTG administered was significantly less in Group A than Group C (adjusted p=0.015). CONCLUSION: Premedication with enalapril (10 mg) combined with remifentanil under sevoflurane anesthesia attenuated blood loss and achieved satisfactory DH during orthognathic surgery. Furthermore, the amount of NTG was reduced during the surgery.