Prevenção de nefropatia induzida por contraste após intervenções coronárias percutâneas com uso de contraste isosmolar / Prevention of contrast-induced nephropathy after percutaneous coronary interventions using isosmolar contrast

INTRODUÇÃO: A despeito dos benefícios da angiografia coronária, para fins diagnósticos e/ou terapêuticos, esse método requer a injeção de contraste iodado, o que em alguns pacientes pode induzir a nefropatia induzida por contraste (NIC). METODOLOGIA: Foram avaliadas de maneira consecutiva todas as intervenções coronárias percutâneas (ICP) realizadas em hospital público terciário, entre janeiro e dezembro de 2016, buscando os pacientes de maior risco para NIC. Incluímos aqueles que utilizaram como contraste, o ioxaglato (baixa osmolaridade) ou iodixinol (isosmolar) e excluímos pacientes que utilizaram outros tipos de contraste ou já realizava hemodiálise. Objetivou-se determinar a taxa de NIC, definida como a elevação da creatinina acima de 25% ou aumento de 0,5mg/dL em relação ao valor basal. Secundariamente, avaliou-se também a mortalidade e necessidade de diálise nos primeiros 30 dias após a ICP. RESULTADOS: De um total de 1219 angioplastias, 382 pacientes fora incluídos em nossa análise. Todos os pacientes receberam hidratação padrão (0,5 a 1ml/kg/h de soro fisiológico 0,9%) pré e pós-procedimento. Contraste de baixa osmolaridade foi usado em 280 (73,2%) casos. Oito pacientes foram excluídos da análise, 5 por já realizarem hemodiálise e 3 por não apresentarem dados de creatinina após procedimento...(AU)

Corticotropin-releasing hormone receptor type 1-deficiency enhances hippocampal serotonergic neurotransmission: an in vivo microdialysis study in mutant mice.

Corticotropin-releasing hormone plays an important role in the coordination of various responses to stress. Previous research has implicated both corticotropin-releasing hormone and the serotonergic system as causative factors in the development and course of stress-related psychiatric disorders such as major depression. To delineate the role of the corticotropin-releasing hormone receptor type 1 (CRH-R1) in the interactions between corticotropin-releasing hormone and serotonergic neurotransmission, in vivo microdialysis was performed in CRH-R1-deficient mice under basal (home cage) and stress (forced swimming) conditions. Hippocampal dialysates were used to measure extracellular levels of serotonin and its metabolite 5-hydroxyindoleacetic acid, and free corticosterone levels to monitor the status of the hypothalamic-pituitary-adrenocortical axis. Moreover, behavioural activity was assessed by visual observation and a scoring paradigm. Both wild-type and heterozygous mutant mice showed a clear diurnal rhythm in free corticosterone. Free corticosterone concentrations were, however, lower in heterozygous mutant mice than in wild-type animals and undetectable in homozygous CRH-R1-deficient mice. Homozygous CRH-R1-deficient mice showed enhanced hippocampal levels of 5-hydroxyindoleacetic acid but not of serotonin during the light and the dark phase of the diurnal cycle, which may point to an enhanced synthesis of serotonin in the raphe-hippocampal system. Moreover, the mutation resulted in higher behavioural activity in the home cage during the light but not during the dark period. Forced swimming caused a rise in hippocampal serotonin followed by a further increase after the end of the stress paradigm in all genotypes. Homozygous and heterozygous mutant mice showed, however, a significantly amplified serotonin response to the forced swimming as compared to wild-type control animals. We conclude that CRH-R1-deficiency results in reduced hypothalamic-pituitary-adrenocortical axis activity, in enhanced synthesis of serotonin during basal conditions, and in an augmented response in extracellular levels of serotonin to stress. These data provide further evidence for the intricate relationship between corticotropin-releasing hormone and serotonin and the important role of the CRH-R1 herein.

Early activation of thyrotropin-releasing-hormone and prolactin plays a critical role during a T cell-dependent immune response.

Functional interaction between the immune and neuroendocrine systems is mediated by humoral mediators, neurotransmitters, and cytokines, including TRH and PRL. We examined the role of neuroendocrine changes, particularly TRH and PRL, during the T cell-dependent immune response. After immunization of rats with sheep red blood cells (SRBC, a T cell-dependent antigen), an increase of hypothalamic TRH messenger RNA (mRNA) was observed at 4-24 h post immunization, in contrast to the decrease observed after treatment with lipopolysaccharide (LPS). During the above period, with SRBC, there was an increase in pituitary TRH receptor mRNA and plasma PRL levels but no changes in TSH and GH. Also, in contrast to the early corticosterone peak induced by LPS, the activation of the hypothalamic-pituitary-adrenocortical suppressive response appears in a late phase, 5-7 days after SRBC. Intracerebroventricular injection of antisense oligonucleotide complementary to rat TRH mRNA in conscious freely-moving rats immunized with SRBC resulted in a significant inhibition of specific antibody production and a concomitant inability to produce the peak in plasma PRL levels. These studies demonstrate, for the first time, that the T cell-dependent immune response is critically dependent on the early activation of TRH and PRL and that the neuroendocrine changes occurring during it are profoundly different from those occurring during the T cell-independent and inflammatory responses (LPS model).

Turning behavior induced by injections of glutamate receptor antagonists into the substantia nigra of the rat.

We have found recently that muscimol microinjections into the subthalamic nucleus produce contralateral turning activity [Murer and Pazo (1993) NeuroReport, 4:1219-1222]. To test the hypothesis that a reduced glutamate action on substantia nigra pars reticulata neurons mediates this turning response, we examined the effect of unilateral intranigral microinjections of the AMPA/kainate receptor antagonist 6,7-dinitro-quinoxaline-2,3-dione (DNQX) and the competitive N-methyl-D-aspartate (NMDA) receptor antagonist DL-2-amino-5-phosphonovaleric acid (AP-5). DNQX and AP-5 both produced a dose-dependent contralateral turning response, while vehicle administration did not induce turning activity. Application of glutamate receptor antagonists at adjacent regions of the mesencephalic tegmentum were also ineffective. Coadministration of NMDA or AMPA significantly reduced the turning response induced by AP-5 or DNQX, respectively. Lesions of the nigrostriatal pathway by 6-hydroxydopamine did not modify the response to DNQX or AP-5 administration into the nigra. However, their behavioral effects were significantly reduced by a lesion of the ipsilateral subthalamic nucleus. Our results show that the blockade of a tonic input acting on AMPA/kainate and NMDA receptors located at the substantia nigra produces contralateral turning behavior. The effect seems to involve pars reticulata cells since this area remains unchanged after destruction of dopaminergic neurons. The subthalamic nucleus seems to be the endogenous source of the agonist acting on the nigral glutamate receptors related to turning behavior.

[Lower digestive hemorrhage. Its etiology and the diagnostic efficacy of different explorations. A study of 2646 patients]. / Hemorragia digestiva baja. Etiología y rentabilidad diagnóstica de diversas exploraciones. Un estudio sobre 2.646 enfermos.

Lower gastrointestinal bleeding (LGB) is more frequent than upper gastrointestinal bleeding (UGB) with a better course and a more difficult diagnosis. We reviewed retrospectively 8544 cases from patients who were admitted at the Coloproctology Unit of Hospital de la Princesa. Those with the diagnosis of LGB with visible blood in stools (2646-31%) were outpatients, with a mean age of 43 years (range 9-91). Males represented 56.4% and females 43.6. All of them underwent at least sigmoidoscopic examination. The more frequent disorder was hemorrhoids (48.5%) and the bleeding source was found in the anus in 61%. Most of lesions (86%) could be reached with the short colonoscope and 92.7% of the bleeding sources were found with total colonoscopy. In 7.3% colonoscopy was not diagnostic and fiber gastroscopy identified the bleeding spot in 1.5% of the total. Barium studies were diagnostic in 0.5%, arteriography in 0.25% and radionuclide bleeding scan in 0.1%. Finally in 130 patients the bleeding source could not be found. We conclude that most of hemorrhagic lesions occur in the descending colon and that total colonoscopy can localize more than 92%. When total colonoscopy fails only 33% of the lesions can be found (2.35% from total) and 19% (1.5% from the total number) with UGB are identified with the fiber gastroscopic examination.

[Obstructive uropathy as initial manifestation of Crohn disease]. / Uropatía obstructiva como manifestación inicial de enfermedad de Crohn.

A patient with renal colicky pain caused by urinary tract obstruction, as a result of psoas abscess, is presented. It was the first manifestation of Crohn's disease. A Gram negative bacteria was isolated from the abscess. The CT images performed to evaluate the abscess suggested this etiology, even though there were no previous symptoms.