RESUMO
Sepsis causes long-term disability, such as immune dysfunction, neuropsychological disorders, persistent inflammation, catabolism, and immunosuppression, leading to a high risk of death in survivors, although the contributing factors of mortality are unknown. The purpose of this experimental study in rats was to examine renal (rSNA) and splanchnic (sSNA) sympathetic nerve activity, as well as baroreflex sensitivity, in acute and chronic post-sepsis periods. The rats were divided into two groups: control group with naïve Wistar rats and sepsis group with 2-mL intravenous inoculation of Escherichia coli at 108 CFU/mL. Basal mean arterial pressure, heart rate, rSNA, sSNA, and baroreflex sensitivity were evaluated in all groups at the acute (6 h) and chronic periods (1 and 3 months). Basal rSNA and sSNA were significantly reduced in the surviving rats, as was their baroreflex sensitivity, for both pressor and hypotensive responses, and this effect lasted for up to 3 months. A single episode of sepsis in rats was enough to induce long-term alterations in renal and splanchnic sympathetic vasomotor nerve activity, representing a possible systemic event that needs to be elucidated. These findings showed that post-sepsis impairment of sympathetic vasomotor response may be one of the critical components in the inability of sepsis survivors to respond effectively to new etiological illness factors, thereby increasing their risk of post-sepsis morbidity.
RESUMO
The presence of a cerebral aneurysm in patients with pituitary adenoma is a rare event. Diagnostic suspicion may stem from magnetic resonance imaging, which should lead to complementary investigation. As for treatment, even in conditions in which there has been no previous bleeding, the simultaneous approach should be considered, prioritising the aneurysm most of the time. The present report describes the case of a patient with a history of pituitary macroadenoma, who had undergone a partial transsphenoidal resection ten years earlier. Admission to our service occurred after a sudden headache followed by mental confusion. A cranial computed tomography showed subarachnoid haemorrhage and expansive suprasellar lesion. Cerebral angiography showed a saccular aneurysm of the anterior communicating complex. The patient underwent a surgical procedure for microsurgical clipping of the aneurysm and partial resection of the pituitary tumour. We have also included a brief review of the literature on this subject
La presencia de aneurisma cerebral en pacientes con adenoma pituitario es un evento raro. La sospecha diagnóstica se puede obtener con la resonancia magnética, que debería conducir a una investigación complementaria. En cuanto al tratamiento, incluso en condiciones en las que no ha habido ningún sangrado previo, el enfoque simultáneo debe ser considerado, priorizando el aneurisma mayor parte del tiempo. El presente informe describe el caso de una paciente con antecedentes de macroadenoma hipofisario, que fue sometido a una resección transesfenoidal parcial diez años antes. La entrada a nuestro servicio se produjo después de que un dolor de cabeza repentino seguido por la confusión mental. Una tomografía computarizada craneal mostró hemorragia subaracnoidea y lesión supraselar expansiva. La angiografía cerebral mostró un aneurisma sacular del complejo comunicante anterior. El paciente se sometió a un procedimiento quirúrgico para clipaje de aneurisma y la resección parcial del tumor pituitario. También hemos incluido una breve revisión de la literatura sobre este tema
