Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 21
Filtrar
1.
Mol Hum Reprod ; 14(1): 53-9, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18204072

RESUMO

Increased prostaglandin H synthase-2 (PGHS-2) expression in the amnion is critical for the production of prostaglandins that induce labour. The aim of the present investigation was to determine whether PGHS-2 gene activity is controlled by NFkappaB transcription factors in term amnion in vivo as suggested by in vitro findings. Amnion membranes were collected after elective Caesarean section (n = 14) or spontaneous labour (n = 12) at term, and histone acetylation and transcription factor binding to the PGHS-2 and IkappaBalpha promoters were determined in fresh tissues by chromatin immunoprecipitation. High level of histone-3 and -4 acetylation was detected in the proximal 1000 bp region of the PGHS-2 promoter indicating permissive chromatin structure in an area that contains two consensus NFkappaB binding sites and other transcription factor binding motifs. The TATA-box was occupied by TATA-binding protein (TBP) demonstrating that the PGHS-2 gene was transcriptionally active before and after labour. NFkappaB (p65 and p50) binding to the consensus sites, however, was detected only before, but not after, labour. Moreover, NFkappaB factor binding before labour was unrelated to TBP binding to the PGHS-2 TATA-box in the same tissues. Further, p65 binding to the NFkappaB-responsive IkappaBalpha promoter increased at labour and correlated strongly with TBP binding to the TATA-box of this gene. We conclude that the proximal 1000 bp region is involved in PGHS-2 promoter regulation in term amnion. The NFkappaB system is activated at labour and stimulates the IkappaBalpha gene, but the NFkappaB factors do not drive PGHS-2 transcription using consensus promoter sites in normal term amnion in vivo.


Assuntos
Âmnio/metabolismo , Ciclo-Oxigenase 2/genética , Histonas/metabolismo , NF-kappa B/genética , Regiões Promotoras Genéticas/genética , Acetilação , Imunoprecipitação da Cromatina , Ciclo-Oxigenase 2/metabolismo , Feminino , Humanos , Trabalho de Parto , NF-kappa B/metabolismo , Subunidade p50 de NF-kappa B/genética , Subunidade p50 de NF-kappa B/metabolismo , Reação em Cadeia da Polimerase , Gravidez , Proteína de Ligação a TATA-Box/genética , Proteína de Ligação a TATA-Box/metabolismo , Fator de Transcrição RelA/genética , Fator de Transcrição RelA/metabolismo
2.
Med Hypotheses ; 63(6): 1057-64, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15504576

RESUMO

The pathogenesis of preeclampsia stems from aberrant changes at the placental interface. The trophoblastic endovascular invasion of tonic spiral arteries that converts them to passive conduits falters. Uteroplacental insufficiency and fetoplacental hypoxemia result. Secondary maternal oxidative stress and an excessive inflammatory response to pregnancy generate the clinical syndrome of preeclampsia. Current treatment focuses on preventing seizures, controlling hypertension, preserving renal function and delivering the baby. We propose that the pathophysiological changes induced by preeclampsia in the placenta parallel those caused by persistent hypoxemia in the lungs at high altitude or with chronic obstructive pulmonary disease. Unrelenting pulmonary hypoxic vasoconstriction induces pulmonary hypertension and cor pulmonale. Inhalation of nitric oxide and phosphodiesterase-5 inhibitors opposes pulmonary hypoxic vasoconstriction, alleviates pulmonary hypertension and improves systemic oxygenation. Notably nitric oxide donor therapy also counters hypoxemic fetoplacental vasoconstriction, a biological response analogous to pulmonary hypoxic vasoconstriction. Fetal oxygenation and nutrition improve. Placental upstream resistance to umbilical arterial blood flow decreases. Fetal right ventricular impedance falls. Heart failure (cor placentale) is avoided. Emergency preterm delivery can be postponed. Other than low dose aspirin and antioxidants vitamins C and E no available therapy specifically targets the underlying disease profile. We hypothesize that, like nitric oxide donation, pharmacological inhibition of placental phosphodiesterase-5 will also protect the fetus but for a longer time. Biological availability of guanosine 3'5'-cyclic monophosphate is boosted due to slowed hydrolysis. Adenosine 3'5'-cyclic monphosphate levels increase in parallel. Cyclic nucleotide accumulation dilates intact tonic spiral arteries and counters hypoxemic fetoplacental vasoconstriction. Intervillous and intravillous perfusion pick up. Maternal to fetal placental circulatory matching improves. Enhanced placental oxygen uptake alleviates hypoxemic fetal stress. Appropriate fetal nutrition resumes. Cor placentale and severe intrauterine growth restriction are averted. Increased maternal cyclic nucleotide concentrations promote systemic vasodilatation so that blood pressures fall. Preemption of oxidative stress initiated by "consumptive" oxidation of nitric oxide stabilizes the vascular endothelium and corrects coagulopathy. Anti-inflammatory and immunosuppressant adenosine 3'5'-cyclic monphosphate offsets the extreme gestational inflammatory response. Cellular injury and multi-organ damage are prevented. One tablet a day of the new long acting phosphodiesterase-5 inhibitor, tadalafil (half life of 17.5 h) theoretically should allow a preterm pregnancy affected by preeclampsia to continue safely. Selective monitoring of vital organ functions guards against life-threatening maternal complications. Regular biophysical profiling warns the obstetrician of impending fetal compromise. Fetal growth and vital organ maturation can continue. As a result workloads imposed upon neonatal intensivists will lighten. Parental anxiety and concern will be allayed. The cost of treating preeclamptic mothers and their extremely low birth weight infants will decrease. Money saved by midwifery services in poorer states can be used to pay for better prenatal care. Severe preeclampsia/eclampsia will be less common. Maternal and perinatal morbidity and mortality will be reduced. Because the human immunodeficiency virus often infects individuals at a workforce eligible age, the global acquired immunodeficiency syndrome pandemic has already brought many nations to the brink of economic ruin. Potentially productive lives saved for the future will help restore them fiscally.


Assuntos
Modelos Biológicos , Insuficiência de Múltiplos Órgãos/enzimologia , Insuficiência de Múltiplos Órgãos/prevenção & controle , Diester Fosfórico Hidrolases/efeitos dos fármacos , Diester Fosfórico Hidrolases/metabolismo , Pré-Eclâmpsia/tratamento farmacológico , Pré-Eclâmpsia/metabolismo , 3',5'-GMP Cíclico Fosfodiesterases , Nucleotídeo Cíclico Fosfodiesterase do Tipo 5 , Inibidores Enzimáticos/administração & dosagem , Feminino , Humanos , Insuficiência de Múltiplos Órgãos/etiologia , Óxido Nítrico/metabolismo , Placenta/efeitos dos fármacos , Placenta/metabolismo , Pré-Eclâmpsia/complicações , Gravidez , Resultado do Tratamento
3.
Arch Virol ; 149(1): 93-111, 2004 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-14689278

RESUMO

We have previously shown that mitochondrial-aconitase binds specifically to the 3' terminal 42 nucleotides of the Murine hepatitis virus (MHV) RNA along with three additional proteins of 70, 58 and 40 kDa to form a stable RNA-protein complex. Supershift and western blot assays have identified these three proteins as mitochondrial HSP70 (mtHSP70), HSP60, and HSP40. A series of co-immunoprecipitation assays have established that these four MHV RNA binding proteins are associated, even in the absence of MHV RNA. However, the presence of a synthetic RNA containing the sequence bound by these four proteins does increase the amount of co-precipitated protein, in particular the amount of HSP60 which is brought down with antibodies directed against HSP40 and mtHSP70. We have provided evidence for the interaction of these four proteins with the 3' end region of MHV RNA in infected cells by a series of immunoprecipitation RT-PCR assays. We believe it is likely that MHV RNA interacts with m-aconitase prior to its import into mitochondria in cooperation with extra-mitochondrial mtHSP70, HSP60, and HSP40.


Assuntos
Regiões 3' não Traduzidas/metabolismo , Proteínas de Choque Térmico/metabolismo , Proteínas Mitocondriais/metabolismo , Vírus da Hepatite Murina/genética , RNA Viral/metabolismo , Adenosina Trifosfatases/metabolismo , Animais , Sítios de Ligação , Linhagem Celular , Chaperonina 60/metabolismo , Genoma Viral , Proteínas de Choque Térmico HSP40 , Proteínas de Choque Térmico HSP70/metabolismo , Camundongos , Mitocôndrias/enzimologia , Proteínas de Ligação a RNA/metabolismo
4.
Anesthesiology ; 95(4): 868-74, 2001 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11605926

RESUMO

BACKGROUND: A new system has been developed that circulates warm water through a whole body garment worn by the patient during surgery. In this study the authors compared two different strategies for the maintenance of intraoperative normothermia. One strategy used a new water garment warming system that permitted active warming of both the upper and lower extremities and the back. The other strategy used a single (upper body) forced-air warming system. METHODS: In this prospective, randomized study, 53 adult patients were enrolled in one of two intraoperative temperature management groups during open abdominal surgery with general anesthesia. The water-garment group (n = 25) received warming with a body temperature (rectal) set point of 36.8 degrees C. The forced-air-warmer group (n = 28) received routine warming therapy using upper body forced-air warming system (set on high). The ambient temperature in the operating room was maintained constant at approximately 20 degrees C. Rectal, distal esophageal, tympanic, forearm, and fingertip temperatures were recorded perioperatively and during 2 h after surgery. Extubated patients in both groups were assessed postoperatively for shivering, use of additional warming devices, and subjective thermal comfort. RESULTS: The mean rectal and esophageal temperatures at incision, 1 h after incision, at skin closure, and immediately postoperatively were significantly higher (0.4-0.6 degrees C) in the group that received water-garment warming when compared with the group that received upper body forced-air warming. The calculated 95% confidence intervals for the above differences in core temperatures were 0.7-0.1, 0.8-0.2, 0.8-0.2, and 0.9-0.1, retrospectively. In addition, 14 and 7% of patients in the control upper body forced-air group remained hypothermic (< 35.5 degrees C) 1 and 2 h after surgery, respectively. No core temperature less than 35.5 degrees C was observed perioperatively in any of the patients from the water-garment group. A similar frequency of the thermal stress events (shivering, use of additional warming devices, subjective thermal discomfort) was observed after extubation in both groups during the 2 h after surgery. CONCLUSIONS: The investigated water warming system, by virtue of its ability to deliver heat to a greater percentage of the body, results in better maintenance of intraoperative normothermia that does forced-air warming applied only to the upper extremities, as is common practice.


Assuntos
Abdome/cirurgia , Temperatura Corporal/fisiologia , Idoso , Anestesia Geral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Postura/fisiologia , Estudos Prospectivos , Estremecimento/fisiologia , Resultado do Tratamento , Vasoconstrição/fisiologia
5.
Exp Neurol ; 167(2): 260-71, 2001 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11161614

RESUMO

The objective of the present study was to define the optimum conditions for using replication-defective adenovirus (Ad) to transfer the gene for the green fluorescent protein (GFP) to the hypothalamic paraventricular (PVN) and supraoptic (SON) nuclei and cells of the neurohypophysis (NH). As indicated by characterizing cell survival over 15 days in culture and in electrophysiological whole cell patch-clamp studies, viral concentrations up to 2 x 10(7) pfu/coverslip did not affect viability of transfected PVN and NH cultured cells from preweanling rats. At 2 x 10(7) pfu, GFP gene expression was higher (40% of GFP-positive cells) and more sustained (up to 15 days). Using a stereotaxic approach in adult rats, we were able to directly transduce the PVN, SON, and NH and visualize gene expression in coronal brain slices and in the pituitary 4 days after injection of Ad. In animals receiving NH injections of Ad, the virus was retrogradely transported to PVN and SON neurons as indicated by the appearance of GFP-positive neurons in cultures of dissociated cells from those brain nuclei and by polymerase chain reaction and Western blot analyses of PVN and SON tissues. Adenoviral concentrations of up to 8 x 10(6) pfu injected into the NH did not affect cell viability and did not cause inflammatory responses. Adenoviral injection into the pituitary enabled the selective delivery of genes to the soma of magnocellular neurons. The experimental approaches described here provide potentially useful strategies for the treatment of disordered expression of the hormones vasopressin or oxytocin.


Assuntos
Adenoviridae/metabolismo , Técnicas de Transferência de Genes , Sistema Hipotálamo-Hipofisário/metabolismo , Sistema Hipotálamo-Hipofisário/cirurgia , Adenoviridae/genética , Animais , Células Cultivadas , Feminino , Expressão Gênica , Proteínas de Fluorescência Verde , Sistema Hipotálamo-Hipofisário/citologia , Proteínas Luminescentes/biossíntese , Proteínas Luminescentes/genética , Masculino , Núcleo Hipotalâmico Paraventricular/citologia , Núcleo Hipotalâmico Paraventricular/metabolismo , Núcleo Hipotalâmico Paraventricular/virologia , Técnicas de Patch-Clamp , Neuro-Hipófise/citologia , Neuro-Hipófise/metabolismo , Neuro-Hipófise/cirurgia , Neuro-Hipófise/virologia , Ratos , Ratos Sprague-Dawley , Núcleo Supraóptico/citologia , Núcleo Supraóptico/metabolismo , Núcleo Supraóptico/virologia , Transfecção
6.
Laryngoscope ; 111(10): 1828-33, 2001 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11801953

RESUMO

OBJECTIVES/HYPOTHESIS: Fistulae of the otic capsule occur in approximately 10% of cholesteatoma cases. Preoperative imaging of this complication is valuable in limiting intraoperative morbidity. Three-dimensional virtual endoscopic imaging provides a new method for analysis of conventional computed tomography (CT) imaging data. The purpose of the study was to examine the feasibility and efficacy of this technique in detecting labyrinthine fistulae caused by cholesteatoma. STUDY DESIGN: Retrospective case study. METHODS: Fifteen patients with surgically confirmed lateral semicircular canal fistula and preoperative CT scan were included. Scans meeting inclusion criteria were imported into a software program for production of virtual endoscopic images. Dehiscent and normal lateral semicircular canals were navigated while varying threshold values for surrounding bone. Changes in threshold values produce the effect of thickening or thinning the bone enveloping the semicircular canal. Threshold parameters that produced easy circumnavigation ("open") and intact inner surface of the lateral canal ("closed") were recorded. RESULTS: The fistula group demonstrated a significantly lower "closed" threshold level and, consequently, a greater range of navigation between "open" and "closed" thresholds. Intrasubject absolute differences in threshold values between normal and abnormal ears appeared to be the most accurate method for detecting a fistula. The suggested imaging parameters displayed an overall sensitivity for fistula detection of 67% with a specificity of 93%. CONCLUSIONS: The three-dimensional virtual endoscopic algorithm shows promise as a method for confirmation of otic capsule dehiscences. Sensitivity for detection is suboptimal but can be improved by alterations in image acquisition parameters.


Assuntos
Colesteatoma da Orelha Média/diagnóstico , Fístula/diagnóstico , Imageamento Tridimensional , Doenças do Labirinto/diagnóstico , Otoscópios , Canais Semicirculares , Interface Usuário-Computador , Adolescente , Adulto , Idoso , Colesteatoma da Orelha Média/cirurgia , Feminino , Fístula/cirurgia , Humanos , Doenças do Labirinto/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Canais Semicirculares/cirurgia , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
8.
Anesth Analg ; 90(5): 1208-12, 2000 May.
Artigo em Inglês | MEDLINE | ID: mdl-10781481

RESUMO

We compared the effects of an IV administration of chloroprocaine and lidocaine on circulatory responses associated with endotracheal intubation. Thirty patients were randomly allocated to receive normal saline (placebo), lidocaine (1.5 mg/kg), or preservative-free chloroprocaine (4.5 mg/kg) 45 s before endotracheal intubation. Blood pressures and heart rate and rhythm were recorded before laryngoscopy and at 0.5, 1, 1.5, 2, 3, and 5 min after intubation. Blood samples were analyzed for catecholamine and chloroprocaine concentrations. Chloroprocaine reduced increases in blood pressure in response to intubation when compared with patients receiving normal saline and lidocaine. Systolic blood pressures at 0.5 and 1 min after intubation were significantly lower in the chloroprocaine group when compared with both the control and lidocaine groups (P < 0.05). Diastolic and mean blood pressures were significantly lower in the chloroprocaine group at all time points until 5 min after intubation (P < 0.05). Chloroprocaine and, to a lesser degree, lidocaine, produced marked attenuation of intubation-induced increases in plasma concentration of epinephrine and norepinephrine. Plasma concentrations of norepinephrine were significantly smaller in the chloroprocaine group at 0.5, 1, and 1.5 min, and plasma concentrations of epinephrine were significantly smaller at 0.5 after intubation when compared with control and lidocaine groups (P < 0.05). Measurable concentrations of chloroprocaine were recorded in plasma samples for 2 min after its administration. No adverse chloroprocaine effects (i.e., circulatory disturbances, venous irritation) were detected. The IV administration of chloroprocaine effectively blunted cardiovascular response produced by laryngoscopy and endotracheal intubation, and this effect was more pronounced when compared with IV lidocaine.


Assuntos
Anestésicos Locais/administração & dosagem , Hemodinâmica/efeitos dos fármacos , Intubação Intratraqueal/efeitos adversos , Laringoscopia/efeitos adversos , Procaína/análogos & derivados , Adulto , Pressão Sanguínea/efeitos dos fármacos , Epinefrina/sangue , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Injeções Intravenosas , Lidocaína/administração & dosagem , Masculino , Norepinefrina/sangue , Procaína/administração & dosagem
9.
J Cancer Educ ; 15(1): 46-50, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10730804

RESUMO

BACKGROUND: African American women have higher incidences of breast and cervical cancers and African American men present with more advanced stages of colon and prostate cancers than do their non-African American counterparts. Since the church is central to the organization of the African American community, the authors set out to determine whether a church-directed educational project could influence parishioners to obtain cancer screening. METHODS: Three African American churches having memberships of 250, 500, and 1,500, respectively, were selected for their different socioeconomic strata: one congregation was composed mostly of working poor, the second was more affluent, and the third consisted primarily of retirees. During a five-week summer period, appropriate literature, health fairs, testimonials by cancer survivors, and visits by representatives of the medical community were used to increase awareness of cancer screening. Surveys regarding cancer-screening behaviors were distributed at the end of church services. Using the guidelines established by the American Cancer Society, individual recommendations for screening examinations were developed and sent to parishioners based on their survey responses. RESULTS: Of 437 parishioners surveyed (73% female, 27% male), 75% were 40 years old or older. Many reported up-to-date screening for breast (84%), cervical (78%), colon (62%), and prostate (89%) cancers. The results were remarkably similar in all three churches. Telephone follow-up seven months after the survey directed at the 120 parishioners identified as noncompliant for at least one cancer screening revealed that 49% had obtained the appropriate screenings. CONCLUSIONS: These African American churchgoers were well screened compared with estimated national averages, possibly due to previous efforts of the activist ministers in the churches selected. The message for cancer screening is heeded when delivered through the African American church.


Assuntos
Atitude Frente a Saúde/etnologia , Negro ou Afro-Americano , Educação em Saúde/organização & administração , Programas de Rastreamento/organização & administração , Neoplasias/prevenção & controle , Religião e Medicina , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/etnologia , Participação do Paciente , Philadelphia , Vigilância da População , Inquéritos e Questionários
10.
Exp Neurol ; 154(2): 353-65, 1998 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9878173

RESUMO

The present studies used defined cells of the subfornical organ (SFO) and supraoptic nuclei (SON) as model systems to demonstrate the efficacy of replication-deficient adenovirus (Ad) encoding green fluorescent protein (GFP) for gene transfer. The studies investigated the effects of both direct transfection of the SON and indirect transfection (i.e., via retrograde transport) of SFO neurons. The SON of rats were injected with Ad (2 x 10(6) pfu) and sacrificed 1-7 days later for cell culture of the SON and of the SFO. In the SON, GFP fluorescence was visualized in both neuronal and nonneuronal cells while only neurons in the SFO expressed GFP. Successful in vitro transfection of cultured cells from the SON and SFO was also achieved with Ad (2 x 10(6) to 2 x 10(8) pfu). The expression of GFP in in vitro transfected cells was higher in nonneuronal (approximately 28% in SON and SFO) than neuronal (approximately 4% in SON and 10% in SFO) cells. The expression of GFP was time and viral concentration related. No apparent alterations in cellular morphology of transfected cells were detected and electrophysiological characterization of transfected cells was similar between GFP-expressing and nonexpressing neurons. We conclude that (1) GFP is an effective marker for gene transfer in living SON and SFO cells, (2) Ad infects both neuronal and nonneuronal cells, (3) Ad is taken up by axonal projections from the SON and retrogradely transported to the SFO where it is expressed at detectable levels, and (4) Ad does not adversely affect neuronal viability. These results demonstrate the feasibility of using adenoviral vectors to deliver genes to the SFO-SON axis.


Assuntos
Adenoviridae , Técnicas de Transferência de Genes , Indicadores e Reagentes/metabolismo , Proteínas Luminescentes/genética , Canais de Potássio de Abertura Dependente da Tensão da Membrana , Órgão Subfornical/citologia , Núcleo Supraóptico/citologia , Animais , Western Blotting , Células Cultivadas , Canais de Potássio de Retificação Tardia , Feminino , Regulação Viral da Expressão Gênica/fisiologia , Genes Reporter , Proteínas de Fluorescência Verde , Indicadores e Reagentes/análise , Proteínas Luminescentes/análise , Masculino , Potenciais da Membrana/fisiologia , Neurônios/química , Neurônios/citologia , Neurônios/fisiologia , Técnicas de Patch-Clamp , Canais de Potássio/fisiologia , Ratos , Ratos Sprague-Dawley , Transfecção , Replicação Viral
11.
Anesth Analg ; 84(3): 527-32, 1997 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-9052295

RESUMO

We studied the maternal pharmacokinetics of epidural lidocaine and bupivacaine in 20 healthy parturients with institutional review board approval and written, informed consent. Epidural anesthesia was induced using either 2% lidocaine with epinephrine 1:200,000, n = 10, or 0.5% plain bupivacaine, n = 10. Maternal arterial (Ma) blood was sampled at regular intervals and umbilical venous (Uv) blood at delivery. Results for lidocaine and bupivacaine, respectively, were (mean +/- SEM): age 30.4 +/- 1.5 and 24.7 +/- 1.6 yr; weight 74.0 +/- 4.2 and 74.9 +/- 4.5 kg; duration of surgery 55.5 +/- 4.3 and 53.1 +/- 3.5 min; epidural dosage 6.1 +/- 0.6 and 1.5 +/- 0.2 mg/kg; elimination half-life 113.9 +/- 5.6 and 110.4 +/- 20.4 min; plasma clearance 6.1 +/- 0.4 and 13.6 +/- 1.3 mL.kg-1.min-1; volume of distribution 0.98 +/- 0.1 and 1.67 +/- 0.3 L/kg; time to peak concentration 31 +/- 2.3 and 40.5 +/- 1.7 min; peak Ma concentration 6.4 +/- 0.65 and 0.8 +/- 0.1 microgram/mL; and Uv/Ma gradient 0.43 +/- 0.05 and 0.26 +/- 0.1. Peak Ma lidocaine concentrations in 2 of 10 patients reached potentially toxic levels without producing clinical toxicity, whereas peak bupivacaine Ma concentrations never approached levels considered unsafe. The results suggest that epidural bupivacaine reliably produces acceptable Ma concentrations below the toxic range.


Assuntos
Bupivacaína/farmacocinética , Lidocaína/farmacocinética , Adolescente , Adulto , Anestesia Epidural , Cesárea , Epinefrina/administração & dosagem , Feminino , Hemodinâmica , Humanos , Gravidez
12.
Ann Thorac Surg ; 64(6): 1619-25, 1997 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9436545

RESUMO

BACKGROUND: To effectively palliate large airway obstruction in advanced unresectable lung cancer (stage IIIB or IV), we developed an airway imaging technique to guide selective endobronchial metallic stent placement. METHODS: Fourteen consecutive patients with severe dyspnea (American Thoracic Society grade 4) had a combination of fiberoptic bronchoscopy, chest roentgenography, computed tomographic scanning, helical computed tomography with three-dimensional reconstruction, and intraluminal bronchography with selective bronchial guidewire placement under fluoroscopy to visually reconstruct and simulate the abnormal airway before and during stent placement. Wallstent or Gianturco intraluminal stents were used alone or in combination (up to five stents) to establish patency of the distal trachea and the major bronchi. RESULTS: All 14 patients had successful deployment with initial relief of airway stenosis (>75% predicted diameter). No procedural complications were noted. However, technical problems included stent foreshortening and imprecision of placement, misinterpretation of bronchography (mucous versus tumor), and airway maintenance during manipulation. Length of stay attributable to the procedure averaged 4 days. Stent placement initially improved the dyspnea score in 7 of 14 patients. Five of 14 died in less than 1 month, with the remainder alive at up to 8 months' follow-up. Of those surviving more than 1 month, the Karnofsky score improved in 4 and was unchanged in 5, with 2 dependent (Karnofsky score <50), 3 functional (Karnofsky score, 50 to 70), and 4 active (Karnofsky score >70). CONCLUSIONS: A protocol combining helical computed tomography with three-dimensional reconstruction, bronchography, and bronchoscopy allows accurate assessment of malignant airway obstruction to facilitate intralumenal stent placement for relief of stenosis. Patient selection to favor effective palliation and cost effectiveness has yet to be defined.


Assuntos
Obstrução das Vias Respiratórias/terapia , Neoplasias Pulmonares/complicações , Stents , Adulto , Idoso , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Brônquios , Broncografia , Análise Custo-Benefício , Dispneia/terapia , Feminino , Humanos , Tempo de Internação , Masculino , Métodos , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Seleção de Pacientes , Tomografia Computadorizada por Raios X
13.
J Neurosurg ; 85(4): 685-8, 1996 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-8814176

RESUMO

Intracranial tuberculomas generally present as either solitary or multiple lesions in the brain parenchyma. They are characterized by a ring-enhancing area on either computerized tomography scans or magnetic resonance images. A case is presented in which an intracranial tuberculoma was dural based and had an appearance similar to an en plaque meningioma.


Assuntos
Neoplasias Encefálicas/patologia , Neoplasias Meníngeas/patologia , Meningioma/patologia , Tuberculoma/patologia , Adulto , Humanos , Imageamento por Ressonância Magnética , Masculino
14.
Neurosurgery ; 38(4): 830-7, 1996 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-8692407

RESUMO

Arachnoid cysts of the quadrigeminal cistern have been managed by cyst shunting and craniotomy with cyst fenestration. Two children are presented who underwent successful burr hole neuroendoscopic fenestration of symptomatic quadrigeminal plate cysts. The literature is reviewed with regard to the treatment of quadrigeminal arachnoid cysts, and the neuroendoscopic management of these cysts is described.


Assuntos
Cistos Aracnóideos/cirurgia , Endoscópios , Teto do Mesencéfalo/cirurgia , Trepanação/instrumentação , Adolescente , Cistos Aracnóideos/patologia , Criança , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Teto do Mesencéfalo/patologia
15.
J Neurochem ; 66(3): 1011-8, 1996 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-8769861

RESUMO

Differentiation of NG108-15 neuroblastoma cells following exposure to either 1.5% dimethyl sulfoxide (DMSO)/0.5% fetal bovine serum (FBS) or serum starvation resulted in significant differences in angiotensin (AT) receptor levels and the AT1/AT2 receptor ratio. When NG108 cells were differentiated for 4 days with DMSO/low serum, the number of AT binding sites increased 30-fold compared with the binding levels on undifferentiated (blast) cells. However, cells differentiated by serum starvation for 4 or 14 days resulted in only a modest 2.5- and fivefold increase in AT receptor levels, respectively, over the levels seen with the undifferentiated cells. KD values for all treatment conditions were not significantly different (0.71 +/- 0.11 nM, p = 0.06). Using the AT1 and AT2 isoform-specific receptor antagonists losartan and PD123319, the relative numbers of AT receptor subtypes on undifferentiated and differentiated cells were determined by competitive inhibition against 125I-[Sar1,Ile8]-angiotensin II (sarile). A majority of the AT receptors on undifferentiated NG108 cells were the AT1 subtype (AT1/AT2 receptor ratio of 8:3). Differentiation by serum starvation and DMSO/low serum treatment resulted in fivefold and 30-fold increases in AT receptor levels, respectively, compared with the levels seen with the undifferentiated cells. Although serum starvation increased the total number of AT1 and AT2 receptors, it did not significantly alter the AT1/AT2 receptor ratio. In contrast, differentiation with DMSO/low serum both increased the total number of AT1 and AT2 receptors and reversed the AT1/AT2 receptor ratio (1:3). The increase in AT receptors following differentiation with DMSO/low serum for 4 days was largely accounted for by an 80-fold increase in the AT2 receptor level. Previous studies by Tallant at al. (1991) and Bryson et al. (1992) reported increased AT2 receptor expression following neuroblastoma differentiation with dibutyryl cyclic AMP and DMSO/low serum, respectively, and suggested a role for the AT2 receptor in neuronal differentiation. In the present study, we have extended these earlier observations by demonstrating that the method of differentiation significantly affects both the AT receptor level and the ratio of AT1 to AT2 receptor expression. Finally, our findings indicate that the AT2 receptor is expressed as a consequence of neuronal maturation and dose not mediate morphological differentiation.


Assuntos
Sangue , Dimetil Sulfóxido/farmacologia , Neuroblastoma/metabolismo , Neuroblastoma/patologia , Receptores de Angiotensina/metabolismo , Ligação Competitiva , Compostos de Bifenilo/metabolismo , Diferenciação Celular , Meios de Cultura Livres de Soro , Imidazóis/metabolismo , Losartan , Piridinas/metabolismo , Tetrazóis/metabolismo , Células Tumorais Cultivadas
16.
J Lab Clin Med ; 120(6): 885-92, 1992 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-1453110

RESUMO

Genital Herpes simplex infection is noted increasingly in women of childbearing age and in neonates. Concern about transmission of herpes to the newborn has led to cesarean delivery of many pregnant women with a history of genital herpes. Severe herpes hepatitis has also been noted in pregnancy. Acyclovir is the drug of choice for this infectious organism. Because there are no data on the mechanism(s) of transport of this drug by the human placenta, this study addressed this issue. We used normal term human placentas. For study of overall placental transport of acyclovir, we used the single, isolated perfused cotyledon technique. For assessment of initial acyclovir uptake, we used microvesicles prepared from the maternal-facing syncytiotrophoblast. Overall transfer of acyclovir at therapeutic concentrations from maternal to fetal compartment was at a rate of about 30% that of a freely diffusible marker, antipyrine. The overall transport was not saturable, was not inhibited by 50-fold adenine concentration, and did not proceed against a concentration gradient. There was no placental metabolism of the drug. Fetal-to-maternal transfer of acyclovir was at a similar rate. In maternal-facing microvesicles net uptake of acyclovir was not saturable, but was temperature dependent and was inhibited by high concentrations of adenine and ganciclovir, but not by nucleosides (adenosine, cytidine, cytosine). These data are most consistent with a carrier-dependent, nucleobase-type uptake of the drug, but passive overall net transfer of acyclovir, dependent on its solubility characteristics.


Assuntos
Aciclovir/farmacocinética , Troca Materno-Fetal , Placenta/metabolismo , Antipirina/farmacocinética , Transporte Biológico , Feminino , Humanos , Taxa de Depuração Metabólica , Nucleosídeos/farmacologia , Gravidez
17.
Biochem Biophys Res Commun ; 165(1): 442-8, 1989 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-2590240

RESUMO

Ecdysone 20-monooxygenase activity and the factors which may regulate this steroid hydroxylase were examined in the midgut of the tobacco hornworm, Manduca sexta, during the last larval stadium. Radioassay experiments revealed that midgut ecdysone 20-monooxygenase undergoes a single 50-fold increase in activity temporally coincident with the onset of the wandering stage. The increase in midgut monooxygenase activity was prevented by actinomycin D and cycloheximide, and could be elicited in head (but not thoracic) ligated animals by a brain-retrocerebral complex factor(s) released at the same time as prothoracicotropic hormone. In contrast, ecdysone or 20-hydroxyecdysone could elicit the increase in enzyme activity in both head and thoracic ligated animals. These data suggest the operation of a neuroendocrine-endocrine axis in the regulation of midgut ecdysone 20-monooxygenase activity.


Assuntos
Hidrocarboneto de Aril Hidroxilases , Lepidópteros/crescimento & desenvolvimento , Mariposas/crescimento & desenvolvimento , Esteroide Hidroxilases/metabolismo , Animais , Sistema Digestório/enzimologia , Sistema Digestório/crescimento & desenvolvimento , Cinética , Larva , Mariposas/enzimologia , Pupa
18.
Alcohol ; 6(4): 289-96, 1989.
Artigo em Inglês | MEDLINE | ID: mdl-2765197

RESUMO

Ethanol abuse and smoking during pregnancy both result in decreased offspring weight. One explanation for this may be impaired placental nutrient transport. This study assessed this possibility utilizing the 4-hr perfused human placental system and human placental vesicles exposed to "physiological," 0.2 microM and large (about 20 microM) nicotine concentrations alone, as well as nicotine combined with ethanol, 200 or 400 mg/ml, for up to 48 hr. Two nonmetabolizable amino acids, alpha-aminoisobutyric acid (AIB) and cycloleucine (CLEU) were used as probes. Nicotine was measured by gas chromatography in the placental perfusion system and vesicles and verified as to concentration. There was no statistically significant evidence of decreased transport of these amino acids with exposure to nicotine alone or nicotine and ethanol together in either test system. Thus, brief exposure to nicotine and ethanol does not impair amino acid transport by the human placenta.


Assuntos
Aminoácidos/farmacocinética , Etanol/farmacologia , Nicotina/farmacologia , Placenta/efeitos dos fármacos , Ácidos Aminoisobutíricos/farmacocinética , Cicloleucina/farmacocinética , Feminino , Humanos , Perfusão , Placenta/metabolismo , Gravidez , Trofoblastos/efeitos dos fármacos , Trofoblastos/metabolismo
19.
AJR Am J Roentgenol ; 150(2): 319-23, 1988 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-3276088

RESUMO

The results of 45 MR examinations were prospectively compared with the clinical course and biopsy results in 38 renal transplant patients to determine the role of MR in evaluating allograft dysfunction. Twenty-six patients underwent allograft biopsy. In eight patients in whom the biopsy was performed more than 48 hr after MR examination and in 19 patients who did not have a biopsy, the subsequent clinical course was sufficiently diagnostic to determine the specific cause of the transplant dysfunction. Corticomedullary differentiation, graded from 0 to 3, was not helpful in separating rejection (n = 20) from acute tubular necrosis (n = 9), drug toxicity (n = 7), pyelonephritis (n = 2), or normal grafts (n = 7) because of overlap between groups (sensitivity =; 60%, specificity = 60%). In the six patients with two or more MR studies, serial changes in corticomedullary differentiation were not consistent and could not be used to diagnose rejection. When any abnormality of allograft sinus fat, size or shape, or corticomedullary differentiation was considered, the sensitivity for the diagnosis of rejection approached 80%; however, specificity was low (48%). We conclude that MR imaging is not sufficiently accurate to replace transplant biopsy and therefore has a limited role in the evaluation of transplant dysfunction.


Assuntos
Transplante de Rim , Imageamento por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico , Ciclosporinas/efeitos adversos , Rejeição de Enxerto , Humanos , Rim/efeitos dos fármacos , Necrose Tubular Aguda/diagnóstico , Pielonefrite/diagnóstico
20.
Behav Neurosci ; 99(6): 1162-75, 1985 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-3843546

RESUMO

Daily patterns of food intake and activity were determined for normal cats and cats with pontile lesions. Food intake in the dark and in the light of LD (light/dark) cycles were determined separately by weighing the food, and a "percentage nocturnal" score was calculated. The measure of activity was infrared photobeam interruptions, with the photobeam placed in front of the cages, over the food bowl. No differences between normal cats and cats with pontile lesions were detected for any of the measures. Food intake of cats was influenced by simulated starlight and moonlight conditions and by the presence of humans. Cats in isolation from humans and human noises exhibited random patterns of activity in constant light and free-running circadian rhythms in constant dark. Idiosyncratic differences in entrainment to LD cycles were found among cats, and the relevance of this variability is noted for studies of photoperiodic phenomena in this species.


Assuntos
Gatos , Ritmo Circadiano , Ingestão de Alimentos , Atividade Motora , Animais , Nível de Alerta/fisiologia , Gatos/fisiologia , Comportamento Alimentar/fisiologia , Masculino , Atividade Motora/fisiologia , Ponte/fisiologia , Meio Social
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA