RESUMO
Vasopressin (VP) levels were evaluated by radioimmunoassay (RIA) in the arterial (A), peripheral (Vp) and jugular (Vj) vein blood and in CSF in 102 patients with brain tumors. In 60 cases the patients' state was complicated by brain edema (BE) and hemodynamic disturbances (HDD). The obtained data revealed significantly higher VP levels: 1) in A, Vp and CSF in patients with BE (Group A) in comparison with patients without BE (Group B), 2) in Vj in patients with HDD only (Group Bc) and 3) in Vp in patients with HDD and BE (Group Ac) in comparison with Group Bc (p < 0.05). There were marked extremely high VP levels in Vj in patients with severe haemorrhage, tachycardia and high blood pressure (BP) and in CSF in patients with tachycardia, high BP and cardiac arrest (p < 0.05 correspondingly in each of the cases). Our results on a clinical basis confirmed CSF VP influence on BE development. We also confirmed the neurohumoral (through blood) and neurotransmitter (possibly through CSF and/or vasopressinergic pathways) VP influences on cardiovascular regulation mechanisms. We content that this is a pathogenetic basis for application of VP direct or indirect antagonists for preventing and treating brain edema in neurosurgical patients.
Assuntos
Barreira Hematoencefálica/fisiologia , Edema Encefálico/líquido cefalorraquidiano , Neoplasias Encefálicas/líquido cefalorraquidiano , Vasopressinas/líquido cefalorraquidiano , Adolescente , Adulto , Idoso , Edema Encefálico/cirurgia , Neoplasias Encefálicas/cirurgia , Hemorragia Cerebral/líquido cefalorraquidiano , Criança , Pré-Escolar , Feminino , Parada Cardíaca/líquido cefalorraquidiano , Hemodinâmica/fisiologia , Humanos , Hipertensão/líquido cefalorraquidiano , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/líquido cefalorraquidiano , Radioimunoensaio , Transmissão Sináptica/fisiologia , Taquicardia/líquido cefalorraquidianoRESUMO
The study of renin-angiotensin-aldosterone (RAA) and vasopressin (VP) systems in neurosurgical patients with brain tumors and brain edema (BE) had revealed an excessive activity of these systems with secondary hyperaldosteronism especially with BE that proves the pathogenetic role of these systems. Measurement of Aldosterone (Ald) in CSF may serve as a diagnostic test to help manage the patient's clinical condition. Mechanisms of Ald penetration in CSF assumed to be the result of blood-brain-barrier (BBB) destruction (especially in astrocytomas) and/or the mediation by neuropeptides (for example increasing activity of VP V1-receptors). Results serve as a basis for application of the neuropeptide and hormone antagonists and inhibitors on all stages of cascade reactions taking part in the water and sodium retention.
