RESUMEN
OBJECTIVE: Antiphospholipid antibodies are associated with increased risk of thrombosis, particularly as in antiphospholipid syndrome. This study aims to determine the acute effects of anticardiolipin antibodies on nitric oxide production and vascular function. METHODS: Ex vivo aortic rings from male Sprague Dawley rats were incubated with IgG monoclonal anticardiolipin antibody (IS4) or a non-specific IgG control. In organ baths, response to phenylephrine and acetlycholine was determined alone and with nitro-L-arginine methyl ester (L-NAME), 1,400 W, D-arginine, L-arginine, sodium nitroprusside and cardiolipin. In vivo antibodies were injected into anaesthetised, spontaneously breathing male Sprague Dawley rats. Haemodynamic variables and serum nitric oxide were measured. Immunohistochemistry for iNOS and eNOS was performed in kidney vessels. RESULTS: Phenylepherine contraction was decreased in the IS4 group compared to controls (p < 0.001). L-NAME, 1,400 W and cardiolipin, abolished this effect. L-Arginine caused significant relaxation in the IS4 group (p = 0.005). Mean arterial pressure in rats injected with IS4 was reduced compared to IgG and saline controls (p < 0.001). NO in plasma increased significantly after IS4 administration (p < 0.001). Immunohistochemistry showed increased iNOS expression in kidney arteries in the IS4 group, with no change in eNOS. CONCLUSION: Anticardiolipin antibodies induce NO production acutely via increased expression of iNOS in both ex vivo and in vivo models.
Asunto(s)
Anticuerpos Anticardiolipina/farmacología , Anticuerpos Monoclonales/farmacología , Inmunoglobulina G/farmacología , Óxido Nítrico Sintasa/metabolismo , Animales , Anticuerpos Anticardiolipina/inmunología , Aorta/fisiología , Presión Sanguínea/efectos de los fármacos , Inhibidores Enzimáticos/farmacología , Humanos , Inmunohistoquímica , Técnicas In Vitro , Masculino , NG-Nitroarginina Metil Éster/farmacología , Óxido Nítrico/sangre , Óxido Nítrico Sintasa/antagonistas & inhibidores , Óxido Nítrico Sintasa de Tipo II/metabolismo , Óxido Nítrico Sintasa de Tipo III/metabolismo , Fenilefrina/farmacología , Ratas , Ratas Sprague-Dawley , Arteria Renal/efectos de los fármacos , Arteria Renal/enzimología , Arteria Renal/fisiología , Vasoconstricción , Vasoconstrictores/farmacologíaRESUMEN
With the advent of antibiotics syphilis and its complications appear to have been declining as an important cause of cardiovascular disease. We describe a patient with an unusual aorto-pulmonary communication secondary to syphilitic aortitis. The case illustrates the difficulty in defining the anatomy of this rare association preoperatively. The reason for the rarity of this manifestation is discussed and finally doubt is cast upon the assumption that cardiovascular syphilis is of only historical interest.
Asunto(s)
Aorta Torácica/anomalías , Aneurisma de la Aorta Torácica/complicaciones , Rotura de la Aorta/complicaciones , Fístula Arterio-Arterial/etiología , Arteria Pulmonar/anomalías , Sífilis Cardiovascular/complicaciones , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/cirugía , Fístula Arterio-Arterial/cirugía , Dolor en el Pecho/diagnóstico , Diagnóstico Diferencial , Conducto Arterioso Permeable/diagnóstico , Electrocardiografía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Sífilis Cardiovascular/diagnóstico , Ultrasonografía Doppler en ColorRESUMEN
The management of a young woman with congenital kyphoscoliosis, who developed symptomatic nocturnal hypoventilation during the third trimester of pregnancy, is described. Nasal intermittent positive pressure ventilation (NIPPV) was safely and effectively used to correct nocturnal hypoxaemia and hypercapnia from the 30th-36th week of gestation, when a healthy boy was delivered by Caesarean section. Following delivery, the mother no longer required NIPPV and returned to her prepregnancy level of activity.