Preeclampsia: the effect of intravenous fluid preload on vasoactive peptide secretion during caesarean section under spinal anaesthesia

We followed the haemodynamic parameters and determined the peripheral venous levels of ANF, ET-1 and NO before and after, intravenous volume preload of I litre Ringer's solution, followed by a further load of the same volume under spinal anaesthesia in 15 healthy and I5pre-eelamptic women. Blood pressure was decreased significantly in both groups after spinal anaesthesia and such decrease was less in the preeclamptic group. The baseline concentration of ANP was higher in preeclamptic women than in normal pregnancy women. It increased significantly in both groups after the JSI infusion, the.2 nd infusion and after delivery. The CVP increased more during the preload period in the preeclamptic group than in healthy women. The increase in the concentrations of ANP correlated significantly with the increase in CVP in total study group. The baseline concentration of ET-1 was higher in preeclamptic women than in healthy women, it decreased significantly in both groups after the first and second infusions. The plasma concentrations of ET-1 increased significantly in the cord sample both groups. NO increased more in the preeclamptic group during the preload period in healthy women while the same increase was noted after the second infusion in groups. After delivery NO concentration in the cord sample was higher in the preeclamptic group than in healthy women. There was no significant difference in the number of neonates with Apgar score < 7, NACS and the parameters of arterial blood gas between the two groups. We conclude from this study that the release of ANP increases in response to a rapid intravenous infusion of a crystalloid solution during elective Caesarean delivery which is exaggerated in women with preeclampsia. This may help in the vasculatory adaptation to the volume load by increasing its capacity. The increase ANP release was not sufficient to decrease maternal arterial blood pressure, but may counteract vasospasm locally in the maternal and uteroplacental circulation

Cutaneous manifestations of chronic renal failure in children with emphasis on pruritus in Assiut-upper Egypt

One hundred percent of adult patients with chronic renal failure [CRF] develop cutaneous findings as a result of uremia or therapeutic intervention. The incidence of pediatric end stage renal disease [ESRD] is increasing and the life expectancy is also on rise. Despite this, only few studies have assessed cutaneous manifestations of CRF in children. Pruritus is a frequent feature found in uremic patients, and several causes have been implicated in its pathogenesis. The aim of the present work is to define the occurrence of renal failure related skin diseases in children with CRF undergoing hemodialysis with emphasis on pruritus. Also, to evaluate whether uremic pruritus is correlated to clinical data and serum levels of various endogenous substances including parathormone, vitamin A and histamine. Thirty eight children with CRF undergoing hemodialysis were included. Each patient underwent complete history taking and thorough clinical and dermatological examinations. Severity of pruritus was determined. All patients were subjected to measurement of serum calcium, phosphate, parathormone, vitamin A and histamine. In addition to serum creatinine, blood urea, albumin and hemoglobin. The result proved that the overall skin disorders were 97.6%. Xerosis was the commonest one [71.11%] followed by pruritus [52.6%], pallor [52%], sallow yellowish discoloration in 36.8%, ecchymosis [36.8%], ichthyosis [26.3%] and others. Pruritic patients were classified as mild in 45% and moderate to severe in 55% of cases. There was no relation between the presence and severity of pruritus and age, sex, duration of dialysis, xerosis and hematological and biochemical parameters except for serum histamine. However, serum levels of histamine did not correlate with severity of pruritus

Conclusion: Uremia related cutaneous manifestations were common in children undergoing hemodialysis. Serum histamine may have a potential role in the appearance of uremic pruritus in children. However, additional studies in larger scale are needed to clarify the role of histamine in the pathogenesis of pruritus