RESUMEN
OBJECTIVE: Although the relationship between delayed 201Tl distribution and blood flow in acutely ischemic and infarcted myocardium has been widely explored in the experimental setting, its behaviour in chronically hypoperfused dysfunctioning human myocardium has not yet been evaluated. METHODS: In tissue samples of excised failing hearts taken from ischemic (IHD) patients and idiopathic dilated cardiomyopathy (IDC) controls, we evaluated the relationship between delayed 201Tl retention (4 h redistribution), blood flow (assessed by means of 99mTc-labelled human albumin microspheres injected during transplantation) and biochemically-assessed fibrosis. 201Tl activity was expressed as the percent of the activity in the region with highest flow and the least fibrosis. RESULTS: Fibrosis and 201Tl activity were inversely related (r = -0.62, P = 0.0001). In IDC controls, low flows corresponded to uniformly preserved 201Tl retention. In IHD, 46 segments with flows < or = 0.60 ml.min-1.g-1 and 20 segments with flows > 0.60 ml.min-1.g1 showed matching delayed 201Tl retention and flow values; in the remaining 27, there was a disproportionately high tracer accumulation in comparison with flow (flow/201Tl mismatch). Despite significantly less fibrosis and lower flows, the mismatch segments showed significantly greater. 201Tl activity than the segments with concordantly high tracer retention and flow values. Conversely, at equivalent flow rates, the mismatch regions had less fibrosis than the areas with concordantly depressed 201Tl activity and perfusion. CONCLUSIONS: This super-normal 201Tl retention in hibernating myocardium may indicate a mechanism of cell adaptation to chronic hypoperfusion.
Asunto(s)
Aturdimiento Miocárdico/metabolismo , Miocardio/metabolismo , Radioisótopos de Talio/metabolismo , Adulto , Circulación Coronaria , Femenino , Fibrosis , Trasplante de Corazón , Humanos , Masculino , Microesferas , Persona de Mediana Edad , Aturdimiento Miocárdico/patología , Miocardio/química , Miocardio/patología , Norepinefrina/análisisRESUMEN
The effects of thoracic peridural analgesia (TEA) on the neuroendocrine response to surgery are well known, but, at the present this technique is not widely used especially in Italy. The aim of this paper is to give information and suggestions on thoracic epidural analgesia in thoracic and cardiac surgery, and to discuss how anticoagulant therapy may interfere on this technique.
Asunto(s)
Analgesia Epidural/métodos , Anticoagulantes/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Anciano , Analgesia Epidural/efectos adversos , Analgésicos/administración & dosificación , Analgésicos/efectos adversos , Analgésicos/farmacología , Anticoagulantes/efectos adversos , Anticoagulantes/clasificación , Anticoagulantes/farmacología , Coagulación Sanguínea/efectos de los fármacos , Procedimientos Quirúrgicos Cardíacos , Interacciones Farmacológicas , Duramadre/lesiones , Femenino , Fibrinolíticos/efectos adversos , Fibrinolíticos/farmacología , Fibrinolíticos/uso terapéutico , Hematoma/etiología , Hemodinámica/efectos de los fármacos , Humanos , Inmunidad Celular/efectos de los fármacos , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/farmacología , Inhibidores de Agregación Plaquetaria/uso terapéutico , Complicaciones Posoperatorias/etiología , Respiración/efectos de los fármacos , Estrés Fisiológico/etiología , Estrés Fisiológico/inmunología , Procedimientos Quirúrgicos Torácicos , Terapia TrombolíticaRESUMEN
The potentialities of vertebral body section roentgenography have recently been enlarged to include the direct study of soft tissues within the vertebral canal. The writers report a series of observations on the pathology of disc protrusion, spinal stenosis and cicatricial stenosis following laminectomy, carried out by means of a third generation scanner, the Somatom SF. This apparatus makes it possible to integrate the data furnished by traditional radiological investigations and by scanners of previous generations, thus demonstrating new aspects of the pathology of the lumbar nerve roots.