RESUMEN
Adriamycin cardiotoxicity is associated with oxidative stress in the presence of globally depressed cardiac function. It is unknown if there is a similar profile with early diastolic changes and how it relates to baroreflex control of circulation. In this study, we evaluated baroreflex control of circulation in adriamycin-treated Wistar rats compared with controls, using invasive blood pressure recording processed by a data acquisition system (CODAS, 1 KHz). Baroreflex sensitivity was evaluated by modulating blood pressure with phenylephrine and sodium nitroprusside. Oxidative stress was quantified by chemiluminescence and by glutathione peroxidase enzyme activity. Diastolic dysfunction was characterized by increased left ventricle end-diastolic pressure in adriamycin-treated rats compared with controls with preserved ascending aortic flow. Baroreflex sensitivity in response to blood pressure elevation and reduction were similar in adriamycin (-2+/-0.27 and -3.19+/-0.56 bpm/mm Hg) and control rats (-1.35+/-0.15 and -2.52+/-0.39 bpm/mm Hg). Chemiluminescence was higher (20450+/-1286 versus 16517+/-1020 counts per second/mg protein) and glutathione peroxidase activity was lower (45.6+/-4.3 versus 76.4+/-6.9 micromol. min(-1). mg(-1) protein) in adriamycin rats compared with controls. Inverse correlations were observed between glutathione peroxidase activity and left ventricle end-diastolic pressure (r=-0.72, P=0.02), between baroreflex sensitivity to phenylephrine and left ventricle end-diastolic pressure (r=-0.77, P=0.004), and between chemiluminescence and baroreflex sensitivity to sodium nitroprusside (r=-0.75, P=0.02), whereas a positive correlation was observed between baroreflex sensitivity to sodium nitroprusside and glutathione peroxidase activity (r=0.7, P=0.04). Thus, adriamycin led to increased left ventricle end-diastolic pressure without changes in baroreflex sensitivity, and associated increased oxidative stress appeared to be related to reduction of reflex control of circulation.
Asunto(s)
Barorreflejo/fisiología , Insuficiencia Cardíaca/fisiopatología , Estrés Oxidativo , Análisis de Varianza , Animales , Presión Sanguínea/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Doxorrubicina , Glutatión Peroxidasa/efectos de los fármacos , Glutatión Peroxidasa/metabolismo , Insuficiencia Cardíaca/inducido químicamente , Insuficiencia Cardíaca/metabolismo , Frecuencia Cardíaca/efectos de los fármacos , Ventrículos Cardíacos/efectos de los fármacos , Ventrículos Cardíacos/fisiopatología , Peroxidación de Lípido/efectos de los fármacos , Masculino , Nitroprusiato/farmacología , Fenilefrina/farmacología , Ratas , Ratas Wistar , Vasoconstrictores/farmacología , Vasodilatadores/farmacologíaRESUMEN
Although prevention is the most important step in pressure ulcer care, clinicians should be familiar with the best methods for treating and managing these lesions, because proper care and subsequent vigilance can prevent worsening of the wound. In 1994, the U.S. Department of Health and Human Services published clinical practice guidelines to help standardize and improve ulcer care. Six key areas of ulcer management were addressed. The section on ulcer care--which includes discussions of debridement, wound cleansing, dressings, and adjunctive therapies--is examined here.
Asunto(s)
Desbridamiento/métodos , Úlcera por Presión/terapia , Infección de Heridas/prevención & control , Anciano , Vendajes , Humanos , Masculino , Grupo de Atención al Paciente , Guías de Práctica Clínica como Asunto , Úlcera por Presión/prevención & control , Cicatrización de HeridasRESUMEN
A case of a 66 years old patient suffering from a sigmoido-vaginal fistula and diverticulosis, previously treated with a total laparohysterectomy, is reported. Retrograde studies demonstrated the presence of fistula, whereas colonoscopy and barium enema failed. After laparotomy and an appropriate bowel preparation, surgery was restricted to the bowel resection and anastomosis, whereas the vaginal defect was not closed.