Enhancement of carotid chemoreceptor reflex and cardiac chemosensitive reflex in the acute phase of myocardial infarction of the anesthetized rabbit.

In the acute phase of cardiac ischemia there is an imbalance of the autonomic outflow with a depression of the baroreceptor reflex. Carotid chemoreceptor stimulation evokes an increase on arterial blood pressure and bradycardia in the anesthetized and paralyzed animal. The activation of cardiac chemosensitive fibers elicit the Bezold-Jarisch reflex comprising a decrease of arterial blood pressure and bradycardia. In the present study, we studied the modifications of the carotid chemoreceptor reflex and the Bezold-Jarisch reflex elicited during the acute phase of myocardial infarction (MI) in the anesthetized and paralyzed rabbit. Rabbits were anesthetized with pentobarbitone, paralyzed and artificially ventilated. The carotid sinus region was exposed and a cannula was inserted retrogradely through the external carotid artery into the carotid bifurcation; the carotid body was stimulated by a lobeline injection. A catheter was advanced, via the right carotid artery, to the origin of the aorta and the Bezold-Jarisch reflex was evoked by an injection of ATP. The baroreflex was provoked by an increase in after-load or by clamping the common carotid artery. Heart ischemia was provoked by ligation of the descending coronary artery. Arterial blood pressure, carotid artery pressure, heart rate and electrocardiogram were monitored. Stimulation of cardiovascular and cardiac receptors was performed before and after coronary ligation. Results show an overall increase in the cardiovascular reflex responses elicited by stimulation of chemically activated receptors and an overall decrease of the baroreceptor responses after MI. In conclusion, these data show the existence of an enhancement of the reflex cardiovascular responses to carotid chemoreceptor and cardiac chemosensitive receptors stimulation and confirmed the depression of baroreceptor reflexes following heart ischemia that could account for the imbalance of the autonomic output observed in the acute phase of myocardial infarction.

[Cardiac effects of acute poisoning with tricyclic antidepressants: systematic review of the literature -- Part II]. / Os efeitos cardíacos da intoxicação aguda por antidepressivos tricíclicos: revisão sistemática da literatura--Parte II.

Tricyclic antidepressant overdose is a frequent diagnosis in the emergency room. It is responsible for a significant percentage of hospital admissions for observation and treatment. This is due to its cardiac (as well as neurologic) toxicity, and the difficulty in predicting its clinical gravity. The authors present this paper with two objectives in mind: 1) information about a common and significant cardiological emergency; 2) presentation of the methodology concerning systematic reviews of the literature. In this second (of four) articles, the clinical presentation and diagnosis of tricyclic antidepressant overdose are presented (in the first article--published in the previous issue of the Journal--we discussed the epidemiological aspects). In the remaining two papers we will present its management, prognosis and prevention. NOTE: This is the second of a series of four articles on the cardiac toxicity of tricyclic antidepressant overdose; the next two articles will be presented in the September and October issues of the Revista.

[Cardiac effects of acute poisoning with tricyclic antidepressants: systematic review of the literature -- Part IV]. / Os efeitos cardíacos da intoxicação aguda por antidepressivos tricíclicos: Revisão sistemática da literatura--Parte IV.

Tricyclic antidepressant overdose is a frequent diagnosis in the emergency room. It is responsible for a significant percentage of hospital admissions for observation and treatment. This is due to its cardiac (as well as neurologic) toxicity, and the difficulty in predicting its clinical gravity. The authors present this paper with two objectives in mind: 1) information about a common and significant cardiological emergency; 2) presentation of the methodology concerning systematic reviews of the literature. In this fourth article (the last in a series), we present the prevention and management of tricyclic antidepressant overdose (in the three previous articles--published in previous issues of the Revista--we discussed the epidemiological aspects as well as the clinical presentation and the diagnosis, and the prognosis). Note: this is the fourth and last article on the cardiac toxicity of tricyclic antidepressant overdose.

[Cardiac effects of acute poisoning with tricyclic antidepressants: systematic review of the literature -- Part III]. / Os efeitos cardíacos da intoxicação aguda por antidepressivos tricíclicos: revisão sistemática da literatura--Parte III.

Tricyclic antidepressant overdose is a frequent diagnosis in the emergency room. It is responsible for a significant percentage of hospital admissions for observation and treatment. This is due to its cardiac (as well as neurologic) toxicity, and the difficulty in predicting its clinical gravity. The authors present this paper with two objectives in mind: 1) information about a common and significant cardiological emergency; 2) presentation of the methodology concerning systematic reviews of the literature. In this third (of four) articles, the prognosis of tryciclic antidepressant overdose is presented (in the two previous articles--published in previous issues of the Revista--we discussed the epidemiological aspects as well as the clinical presentation and the diagnosis). In the remaining paper we will present its management, and prevention. Note: this is the third of a series of four articles on the cardiac toxicity of tricyclic antidepressant overdose; the final article will be presented in the October issue of the Revista.

Interaction of the Bezold-Jarisch reflex with the urinary bladder function.

OBJECTIVES: The Bezold-Jarisch reflex involves a marked increase in vagal (parasympathetic) efferent discharge to the heart. During micturition, there is a marked increase in parasympathetic activity to the bladder (pelvic nerve activity) and this coincides with periods of phasic bladder contractions. In recent studies, we have shown that regions of the CNS that modulate pelvic nerve activity also affect cardiovascular variables. Recent anatomical studies have shown neuronal connections between the areas of the CNS that modulate both reflexes. Accordingly, in the present study we investigate if during the Bezold-Jarisch reflex there are simultaneous changes in pelvic nerve activity. METHODS: Experiments were performed in Wistar female rats, anaesthetised with alpha-chloradose i.p. (80 micrograms/Kg) supplemented i.v. as required. Arterial blood pressure, ECG heart rate, urinary bladder pressure and pelvic nerve activity were recorded. RESULTS: Stimulation of cardiac chemosensitive nerve endings with veratridine evoked a decrease in arterial blood pressure from 88.6 +/- 1.72 to 66.1 +/- 2.50 mmHg (n = 30; p < 0.0001) and of heart rate from 420.3 +/- 5.56 to 248.8 +/- 17.58 bpm (n = 13; p < 0.0001) There were simultaneous changes of pelvic nerve activity that preceded an increase in urinary bladder pressure from 10.2 +/- 0.28 to 26.3 +/- 1.52 cmH2O (n = 30; p < 0.0001) and bladder contractions. We believe that the reflex changes resulted from activation of cardiac chemosensory nerve endings, as equivalent injections of warm saline into the left ventricle produced no changes in either cardiovascular variables or pelvic nerve activity. CONCLUSIONS: These observations suggest a significant role for cardiac afferents in modulating bladder contractions. The integration and functional significance of these inputs remain to be elucidated. The clinical importance of this physiological result may contribute to a better understanding of the mechanism of some semiologic findings, notably the association of urgency to micturate with myocardial ischemia and myocardial infarction.

Sexually transmitted diseases in homosexual and bisexual males from a cohort of human immunodeficiency virus negative volunteers (Project Horizonte), Belo Horizonte, Brazil

Sexually transmitted diseases (STD) are very frequent in the whole world. Males who do not use a condom during their sexual relations are at great risk. We report cases of STD during six months of observation, among homosexual/bisexual males who participate in the Project Horizonte. There were 16 cases of genital warts, 6 cases of human immunodeficiency virus infection, 24 cases of unspecific urethritis, 28 cases of herpes simplex virus infection, 30 cases of syphilis, 58 cases of gonorrhea and 84 cases of pediculosis. We concluded that a condom must be used in all sexual relations and new counseling techniques are needed, to avoid this situation

Sexually transmitted diseases in homosexual and bisexual males from a cohort of human immunodeficiency virus negative volunteers (Project Horizonte), Belo Horizonte, Brazil.

Sexually transmitted diseases (STD) are very frequent in the whole world. Males who do not use a condom during their sexual relations are at great risk. We report cases of STD during six months of observation, among homosexual/bisexual males who participate in the Project Horizonte. There were 16 cases of genital warts, 6 cases of human immunodeficiency virus infection, 24 cases of unspecific urethritis, 28 cases of herpes simplex virus infection, 30 cases of syphilis, 58 cases of gonorrhea and 84 cases of pediculosis. We concluded that a condom must be used in all sexual relations and new counseling techniques are needed, to avoid this situation.

Normal relationships between cardiovascular variables in active orthostatism and clinostatism in postural change.

OBJECTIVE: Autonomic modulation of hemodynamics, essential for the preservation of homeostasis, is well tested by the abrupt postural change from clinostatism to active orthostatism. The aim of this work was to study normal relationships between the cardiovascular variables in active orthostatism and those in clinostatism. METHODS: Hemodynamic parameters in clinostatism and orthostatism were easily measured in 20 healthy subjects of both sexes, aged between 33 and 78 years, without treatment, using the non-invasive thoracic electric bioimpedance method. RESULTS: Cardiovascular variables values in orthostatism are linearly related with their values in clinostatism. CONCLUSIONS: Results show that cardiovascular variables in active orthostatism are linearly related with their values in clinostatism, each variable being specially regulated. A clinostatism and orthostatism intraindividual correlation was obtained, which provides an easily accessible method of detection and interpretation of autonomic dysfunctions, without deleterious consequences for the subjects, which can be very useful for research on physiopathologic mechanisms.

Factors associated with AIDS and AIDS-like syndrome among homosexual and bisexual men in Minas Gerais, Brazil.

A case-control study to determine factors associated with AIDS and AIDS-like syndrome among homosexual/bisexual men was conducted in the State of Minas Gerais (Brazil). Eighty-three per cent (45 patients) of all AIDS/AIDS-like syndrome cases in homosexual/bisexual men reported in Minas Gerais between February, 1986 and June, 1987 were compared to 133 seronegative controls seen at the same clinic. Blood samples were tested by ELISA and confirmed by Western blot. Sex with men from the USA, sex with someone who developed AIDS, number of male partners (greater than or equal to 100 lifetime), age (greater than or equal to 30 years old) and ethnicity (white) were independently associated with AIDS/AIDS-like syndrome (Odds Ratios = 5.5, 4.3, 3.9, 3.5 and 2.7, respectively). Thirty-nine per cent of cases and 44% of controls reported bisexual activity during the previous two years. From these, a high proportion reported anal intercourse with women in the same period (53% of bisexual cases and 33% of bisexual controls). Bisexual men had more male partners than female partners in the previous two years (median male partners = 20 for cases and five for controls; median female partners = three for both cases and controls). This explains in part why the epidemic has increased more rapidly among men then among women in Minas Gerais, despite the large proportion of bisexuals with the disease.

PIP: A case control study to determine factors associated with AIDS and AIDS- like syndrome among homosexual/bisexual men was conducted in the state of Minas Gerais, Brazil. 83% (45 patients) of all AIDS/AIDS-like syndrome cases in this group of men reported in Minas Gerais between February 1986-June 1987 were compared to 133 seronegative controls seen at the same clinic. Blood samples were tested by ELISA and confirmed by western blot. Sex with men from the US, with someone who developed AIDS, number of male partners ( or = 100 lifetime), age ( or = 30 years old), and ethnicity (white) were independently associated with AIDS/AIDS-like syndrome (odds ratio=5.5, 4.3, 3.9, 3.5, and 2.7, respectively). 39% of cases and 44% of controls reported bisexual activity over the previous 2 years. From these, a high proportion reported anal intercourse with women in the same period (53% of bisexual cases and 33% of bisexual controls). Bisexual men had more male partners than female ones in the previous 2 years (median number=20 for cases and 5 for controls; median number of female partners=3 for both cases and controls). This explains in part why the epidemic has increased more rapidly among men than women in Minas Gerais, despite the large proportion of bisexuals with the disease.