Effect of methylprednisolone on perivascular pulmonary edema, inflammatory infiltrate, VEGF and TGF-beta immunoexpression in the remaining lungs of rats after left pneumonectomy

Pneumonectomy is associated with high rates of morbimortality, with postpneumonectomy pulmonary edema being one of the leading causes. An intrinsic inflammatory process following the operation has been considered in its physiopathology. The use of corticosteroids is related to prevention of this edema, but no experimental data are available to support this hypothesis. We evaluated the effect of methylprednisolone on the remaining lungs of rats submitted to left pneumonectomy concerning edema and inflammatory markers. Forty male Wistar rats weighing 300 g underwent left pneumonectomy and were randomized to receive corticosteroids or not. Methylprednisolone at a dose of 10 mg/kg was given before the surgery. After recovery, the animals were sacrificed at 48 and 72 h, when the pO2/FiO2 ratio was determined. Right lung perivascular edema was measured by the index between perivascular and vascular area and neutrophil density by manual count. Tissue expression of vascular endothelial growth factor (VEGF) and transforming growth factor-beta (TGF-β) were evaluated by immunohistochemistry light microscopy. There was perivascular edema formation after 72 h in both groups (P = 0.0031). No difference was observed between operated animals that received corticosteroids and those that did not concerning the pO2/FiO2 ratio, neutrophil density or TGF-β expression. The tissue expression of VEGF was elevated in the animals that received methylprednisolone both 48 and 72 h after surgery (P = 0.0243). Methylprednisolone was unable to enhance gas exchange and avoid an inflammatory infiltrate and TGF-β expression also showed that the inflammatory process was not correlated with pulmonary edema formation. However, the overexpression of VEGF in this group showed that methylprednisolone is related to this elevation.

Effects of pneumonectomy on nitric oxide synthase expression and perivascular edema in the remaining lung of rats

Pneumonectomy is associated with high mortality and high rates of complications. Postpneumonectomy pulmonary edema is one of the leading causes of mortality. Little is known about its etiologic factors and its association with the inflammatory process. The purpose of the present study was to evaluate the role of pneumonectomy as a cause of pulmonary edema and its association with gas exchange, inflammation, nitric oxide synthase (NOS) expression and vasoconstriction. Forty-two non-specific pathogen-free Wistar rats were included in the study. Eleven animals died during or after the procedure, 21 were submitted to left pneumonectomy and 10 to sham operation. These animals were sacrificed after 48 or 72 h. Perivascular pulmonary edema was more intense in pneumonectomized rats at 72 h (P = 0.0131). Neutrophil density was lower after pneumonectomy in both groups (P = 0.0168). There was higher immunohistochemical expression of eNOS in the pneumonectomy group (P = 0.0208), but no statistically significant difference in the expression of iNOS. The lumen-wall ratio and pO2/FiO2 ratio did not differ between the operated and sham groups after pneumonectomy. Left pneumonectomy caused perivascular pulmonary edema with no elevation of immunohistochemical expression of iNOS or neutrophil density, suggesting the absence of correlation with the inflammatory process or oxidative stress. The increased expression of eNOS may suggest an intrinsic production of NO without signs of vascular reactivity.

Efeitos hemodinâmicos da estimulação ventricular e atrioventricular sequencial / Hemodynamic effect of ventricular and sequential atrioventricular stimulation

Foram estudados os efeitos hemodinamicos da estimulacao ventricular e atrioventricular (AV) sequencial em caes previamente submetidos a bloqueio cirurgico da conducao AV. Observa-se neste estudo que nao houve uma sincronizacao AV adequada com a estimulacao AV sequencial devido a frequencia atrial propria dos animais. Em relacao ao indice cardiaco, a estimulacao AV sequencial leva a uma melhora de 8% em relacao a estimulacao ventricular. Os resultados obtidos, por outro lado, se devem em parte aos casos em que os batimentos atriais e ventriculares estavam perfeitamente sincronizados. Quando se analisa o desempenho ventricular esquerdo e as pressoes na aortica e na arteria pulmonar, nao e observada nenhuma alteracao significativa destas variaveis com a estimulacao AV sequencial. Concluiu-se que a estimulacao AV sequencial em pacientes portadores de bloqueios da conducao AV leva a uma melhora muito pequena do debito cardiaco e do desempenho ventricular devido as falhas de sincronismo dependentes da frequencia sinusal

Crohn's disease with exclusive gastric involvement: a case report and review of the literature.

E relatado o caso de um paciente com doenca de Crohn com envolvimento exclusivamente gastrico. As queixas principais do paciente eram vomitos, epigastralgia e perda de peso ha tres meses. As avaliacoes clinica, radiologica e da endoscopia com biopsia sugeriam rinite plastica. Com o diagnostico de cancer gastrico o paciente foi submetido a gastrectomia total.O estudo histopatologico do estomago revelou granulomas e celulas gigantes, foi feito o diagnostico de doenca de Crohn.Evoluiu bem no pos operatorio com melhora das condicoces clinicas sendo perdido para seguimento apos a alta hospitalar. E realizada revisao completa da literatura dos 46 casos com envolvimento gastrico 11 dos quais acometendo somente o estomago. Os autores concluem que o conhecimento dos aspectos clinicos e cirurgicos da localizacao gastrica da doenca de Crohn e muito importante para diagnostico preciso e um tratamento compativel com a fisiopatologia da doenca

Reutilização de geradores de marca-passo / Reuse of pacemaker generators

E apresentada a experiencia do Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, na reutilizacao de geradores de marca-passo, realizada em 22 pacientes. Os metodos empregados para reutilizacao foram a limpeza mecanica, a descontaminacao quimica e o emprego do oxido de etileno.A indicacao foi bloqueio atrioventricular (AV) em 19 pacientes, doenca do no sinusal em 2 e bloqueio AV trifascicular em 1.Como complicacoes, ocorrem extrusao traumatica do gerador implantado em 1 paciente e 3 pacientes sofreram troca de gerador, por razoes nao relacionadas ao processo de reutilizacao. Os autores concluem que a reutilizacao de geradores de marca-passo pode ser realizada com grande beneficio para os pacientes, sendo um procedimento com resultados comparaveis ao implante primario do gerador