RESUMO
CONTEXT: The role for hormone parameters at adrenal venous sampling (AVS) in predicting clinical and biochemical outcome remains controversial. OBJECTIVE: To investigate the impact of hormone parameters at AVS under cosyntropin stimulation on lateralization and on complete biochemical and clinical outcome. METHODS: We retrospectively evaluated 150 sequential AVS under cosyntropin infusion. Bilateral successful cannulation rate was 83.3% (n = 140), 47.9% bilateral and 52.1% unilateral. The lateralization index (LI), aldosterone/cortisol ratio (A/C) in the dominant adrenal vein (AV), relative aldosterone secretion index (RASI = A/C in AV divided by A/C in inferior vena cava) were assessed. The contralateral suppression (CS) percentage was defined by (1 - nondominant RASI) *100. RESULTS: A nondominant RASI <0.5 (CS >50%) had 86.84% sensitivity and 92.96% specificity to predict contralateral lateralization. An A/C ratio in dominant AV >5.9 (74.67% sensitivity and 80% specificity) and dominant RASI >4.7 (35.21% sensitivity and 88.06% specificity) had a worst performance to predict ipsilateral lateralization. Complete biochemical and clinical cure were significantly more frequent in the patients with CS >50% [98.41% vs. 42.86% (p < 0.001) and 41.94% vs. 0% (p < 0.001)]. CS correlated with high aldosterone at diagnosis (p < 0.001) and low postoperative aldosterone levels at 1 month (p = 0.019). Postoperative biochemical hypoaldosteronism was more frequent in patients with CS >50% (70% vs. 16.67%, p = 0.014). In multivariable analysis, a CS >50% was associated with complete biochemical cure (OR 125, 95%CI 11.904-5,000; p = 0.001) and hypertension remission (OR 12.19, 95%CI 2.074-250; p = 0.023). CONCLUSION: A CS >50% was an independent predictor of complete clinical and biochemical cure. Moreover, it can predict unilateral PA and postoperative biochemical hypoaldosteronism. Our findings underscore the usefulness of CS for clinical decision-making.
RESUMO
Bone metabolism is influenced by different factors and muscle activity acts as a stimulator of bone plasticity. Conditions such as nerve injuries can compromise bone physiology due to muscle inactivity. Preview studies have shown that nerve damage reduces P substance and calcitonin gene-related peptides, also known as neuropeptides that may have a key role on bone healing. Therefore, this study evaluated the osseointegration of hydroxyapatite implants in tibial defects of rats submitted to unilateral sciatic nerve section. Twelve Wistar rats were divided into two groups (G1 and G2). In G1, the sciatic nerve was left intact and in G2 the left sciatic nerve was completely sectioned. An experimental tibial bone defect was then created in both groups and filled with hydroxyapatite granules. The animals were sacrificed 2 months after implantation and samples were submitted to macroscopic inspection and histological analysis. Good radiopacity of the hydroxyapatite granules and radiographic definition of the bone defect were noted. Histologic analysis revealed formation of new bone adjacent to the hydroxyapatite granules in G1 and, to a lesser extent, in G2 in which the proliferation of connective tissue predominated at the implant site. The formation of new bone stimulated by hydroxyapatite in bone defects can be expected even in animals with limb paralysis due to nerve injury; however, bone formation occurs at a slower speed in these animals and the volume of newly formed bone is lower.
El metabolismo óseo está influenciado por diferentes factores y la actividad muscular como un estimulador de la plasticidad ósea. Condiciones tales como lesiones nerviosas pueden comprometer la fisiología ósea debido a la inactividad muscular. Estudios previos han demostrado que el daño nervioso reduce la sustancia P y el péptido relacionado con el gen de la calcitonina, también conocidos como neuropéptidos que pueden tener un papel clave en la cicatrización ósea. Este estudio evaluó la oseointegración de los implantes de hidroxiapatita en defectos tibiales de ratas sometidas a la sección del nervio ciático unilateralmente. Doce ratas Wistar se dividieron en dos grupos (G1 y G2). En G1, el nervio ciático se dejó intacto y en el G2 el nervio ciático izquierdo fue completamente seccionado. Un defecto óseo tibial fue creado experimentalmente en ambos grupos y se rellenó con gránulos de hidroxiapatita. Los animales se sacrificaron 2 meses después de la implantación y las muestras fueron sometidas a inspección macroscópica y el análisis histológico. Se observó buena radiopacidad de los gránulos de hidroxiapatita y definición radiográfica del defecto óseo. El análisis histológico reveló neoformación ósea adyacente a los gránulos de hidroxiapatita en G1 y, en menor medida en G2, donde la proliferación de tejido conectivo predominó en el sitio de implante. La neoformación ósea estimulada por hidroxiapatita en defectos óseos se puede esperar incluso en animales con parálisis de los miembros producto de una lesión nerviosa; sin embargo, la formación de hueso se produce a menor velocidad en estos animales y su volumen es menor.
