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1.
Cardiovasc Intervent Radiol ; 42(12): 1777-1785, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31392490

RESUMO

PURPOSE: Contrast-induced nephropathy (CIN) is one of the leading causes of hospital-acquired acute kidney injury due to the use of iodinated contrast media in various interventional procedures like endovascular aneurysm repair. Its pathophysiology remains mostly unclear. The purpose of the present study was to comparatively study the possible protective role of direct intra-arterial administration of mannitol and acetylcysteine and per os administration of simvastatin in a histopathological level. MATERIALS AND METHODS: In the present study, we administered iopromide directly in the infrarenal aorta of 24 New Zealand white rabbits after laparotomy. Animals were divided in four groups of six: G1 received iopromide with no protection, G2 iopromide with mannitol, G3 iopromide with acetylcysteine, and G4 iopromide with simvastatin. Renal function blood parameters were assessed prior to the administration, and in 48 h; histopathological evaluation of the kidneys was performed. RESULTS: CIN was evident only in the no protection group G1. Moreover, G1 demonstrated significantly more severe lesions than groups G2, G3, and G4 regarding histopathological findings in glomeruli, vacuolization of tubular epithelial cells, tubular proteinaceous casts, and tubular necrosis. According to our results, intra-arterial administration of mannitol seems to be effective in protection against tubular necrosis. CONCLUSION: In general, all three agents demonstrated a protective role in preventing the development of CIN, although it seems that there are various pathways that remain to be investigated further.


Assuntos
Acetilcisteína/uso terapêutico , Lesão Renal Aguda/tratamento farmacológico , Meios de Contraste/efeitos adversos , Manitol/uso terapêutico , Sinvastatina/farmacologia , Acetilcisteína/administração & dosagem , Lesão Renal Aguda/induzido quimicamente , Administração Oral , Animais , Modelos Animais de Doenças , Diuréticos Osmóticos/administração & dosagem , Diuréticos Osmóticos/uso terapêutico , Humanos , Infusões Intra-Arteriais , Iohexol/efeitos adversos , Iohexol/análogos & derivados , Masculino , Manitol/administração & dosagem , Coelhos
2.
J Vet Emerg Crit Care (San Antonio) ; 29(5): 578-584, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31448527

RESUMO

OBJECTIVE: To evaluate the effects of iso-osmolar doses of 18% mannitol and 3% sodium chloride (NaCl) solutions in decreasing intracranial pressure (ICP) in animals with severe traumatic brain injury (TBI). DESIGN: Prospective uncontrolled interventional study. SETTING: Veterinary university teaching hospital. ANIMALS: Two cats and 1 dog with TBI with a modified Glasgow Coma Scale score ≤8 after hemodynamic stabilization, and with brain magnetic resonance imaging changes suggestive of intracranial hypertension. INTERVENTIONS: Animals were surgically instrumented for direct ICP measurement, then randomly treated with iso-osmolar doses of 18% mannitol or 3% NaCl. Direct ICP and cerebral perfusion pressure (CPP) were recorded both before treatment and for 120 minutes following drug administration. MEASUREMENTS AND MAIN RESULTS: Direct ICP and CPP were recorded both before treatment and at 5 additional time points following administration over the subsequent 120 minutes. Case 1 received 3% NaCl without any response to therapy; refractory posttraumatic hypertension was suspected. Case 2 was treated with 3% NaCl; ICP decreased by 40.7% and CPP increased by 15%; however, these effects were transient. Case 3 received 18% mannitol, and ICP decreased by 19% and CPP increased to normal. However, there was a rebound increase in ICP that was higher than pretreatment values, and CPP decreased slightly before it gradually increased to normal values towards the end of the study. CONCLUSIONS: Both mannitol and hypertonic saline decrease ICP and improve CPP, but the effect observed in this pilot study suggests that there might be differences in the duration of these effects. Appropriately designed studies in a larger and homogeneous population are warranted to further investigate these findings.


Assuntos
Lesões Encefálicas Traumáticas/veterinária , Doenças do Gato/tratamento farmacológico , Gatos/lesões , Diuréticos Osmóticos/uso terapêutico , Doenças do Cão/tratamento farmacológico , Cães/lesões , Hemorragias Intracranianas/veterinária , Manitol/uso terapêutico , Solução Salina Hipertônica/uso terapêutico , Animais , Lesões Encefálicas Traumáticas/complicações , Doenças do Gato/diagnóstico por imagem , Diuréticos Osmóticos/administração & dosagem , Doenças do Cão/diagnóstico por imagem , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/tratamento farmacológico , Pressão Intracraniana , Imagem por Ressonância Magnética/veterinária , Masculino , Manitol/administração & dosagem , Projetos Piloto , Estudos Prospectivos , Solução Salina Hipertônica/administração & dosagem
4.
Braz J Cardiovasc Surg ; 34(3): 271-278, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310464

RESUMO

OBJECTIVE: The goal of the present study was to compare the myocardial protection obtained with histidine-tryptophan-ketoglutarate (HTK) cardioplegic solution (Custodiol®) and with intermittent hypothermic blood solution. METHODS: Two homogenous groups of 25 children with acyanotic congenital heart disease who underwent total correction with mean aortic clamping time of 60 minutes were evaluated in this randomized study. Troponin and creatine kinase-MB curves, vasoactive-inotropic score, and left ventricular function were obtained by echocardiogram in each group. The values were correlated and presented through graphs and tables after adequate statistical treatment. RESULTS: It was observed that values of all the studied variables varied over time, but there was no difference between the groups. CONCLUSION: We conclude that in patients with acyanotic congenital cardiopathies submitted to total surgical correction, mean aortic clamping time around one hour, and cardiopulmonary bypass with moderate hypothermia, the HTK crystalloid cardioplegic solution offers the same myocardial protection as the cold-blood hyperkalemic cardioplegic solution analyzed, according to the variables considered in our study model.


Assuntos
Soluções Cardioplégicas/uso terapêutico , Cardiopatias Congênitas/cirurgia , Análise de Variância , Creatina Quinase Forma MB/análise , Método Duplo-Cego , Ecocardiografia , Feminino , Glucose/uso terapêutico , Cardiopatias Congênitas/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Manitol/uso terapêutico , Duração da Cirurgia , Cloreto de Potássio/uso terapêutico , Procaína/uso terapêutico , Estudos Prospectivos , Substâncias Protetoras/uso terapêutico , Valores de Referência , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Troponina/análise , Função Ventricular Esquerda
5.
Medicine (Baltimore) ; 98(25): e16145, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232969

RESUMO

RATIONALE: Listeria monocytogenes rarely affects immunocompetent adults, and only a few cases of encephalitis caused by L monocytogenes in humans have been reported in China. PATIENT CONCERNS: A 37-year-old male patient presented with headache and fever of 38°C to 39°C for 2 days and dysphoria and dystrophy for 1 day. DIAGNOSIS: The patient was diagnosed as having encephalitis, and his cerebrospinal fluid (CSF) and blood cultures tested positive for L monocytogenes. INTERVENTIONS: The patient was treated with intravenous vancomycin, meropenem, mannitol, methylprednisolone, and enteral nutrition. The computed tomography (CT) scan showed swelling of the brain and hydrocephalus. The patient was treated with emergent surgery, a ventricular drainage tube was inserted, and the CSF was drained daily. OUTCOMES: Despite adequate therapy, the illness was severe and progressed rapidly. The patient died 2 weeks after admission. LESSONS: We report a rare case of L monocytogenes encephalitis in a previously healthy immunocompetent adult in China. The patient's CT scans showed increasing brain swelling and hydrocephalus, and the patient's condition progressively deteriorated.


Assuntos
Encefalite/diagnóstico , Listeriose/diagnóstico , Adulto , Antibacterianos/uso terapêutico , China , Diuréticos Osmóticos/uso terapêutico , Serviço Hospitalar de Emergência/organização & administração , Encefalite/diagnóstico por imagem , Encefalite/etiologia , Humanos , Listeria monocytogenes/patogenicidade , Listeriose/complicações , Listeriose/diagnóstico por imagem , Masculino , Manitol/uso terapêutico , Meropeném/uso terapêutico , Tomografia Computadorizada por Raios X/métodos , Vancomicina/uso terapêutico
6.
Zhonghua Yi Xue Za Zhi ; 99(23): 1761-1762, 2019 06 18.
Artigo em Chinês | MEDLINE | ID: mdl-31207683
7.
BMC Med Imaging ; 19(1): 35, 2019 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-31039748

RESUMO

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a rare clinic-radiological entity characterized by headache, an altered mental status, visual disturbances, and seizures. Reversible splenial lesion syndrome (RESLES) is a new clinic-radiological syndrome characterized by the presence of reversible lesions with transiently restricted diffusion (cytotoxic edema) in the splenium of the corpus callosum (SCC) on magnetic resonance (MR) images. Here we report a rare case involving a 23-year-old pregnant woman with eclampsia who sequentially developed PRES and RESLES. CASE PRESENTATION: The patient, a 23-year-old pregnant woman, presented with sudden-onset headache, dizziness, and severe hypertension (blood pressure, 170/110 mmHg). Brain MR imaging (MRI) revealed T2 hyperintense lesions in the posterior circulation territories. Immediate cesarean section was performed, and the patient received intravenous infusion of mannitol (125 ml, q8h) for 8 days for the treatment of PRES. Ten days later, or 1 day after the discontinuation of mannitol, T2-weighted MRI showed that the hyperintense lesions (vasogenic edema) had disappeared. However, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping revealed an isolated lesion in the splenium of the corpus callosum (SCC) that was accompanied by restricted diffusion (cytotoxic edema); these findings indicated reversible splenial lesion syndrome (RESLES). Five days after the discontinuation of mannitol, she had no abnormal symptoms and was discharged from our hospital. Brain MRI performed 29 days after the clinical onset of symptoms showed no abnormalities. CONCLUSION: The sequential occurrence of the two reversible diseases in our patient prompted us to propose a novel pathogenesis for RESLES. Specifically, we believe that the vasogenic edema in PRES was reduced with mannitol treatment, which increased the hyperosmotic stress and opened the blood-brain barrier; meanwhile, upregulation of aquaporin-4 expression secondary to the increased osmotic pressure resulted in cytotoxic edema in the astrocytes in SCC (RESLES). Further research is necessary to confirm this possible pathogenesis.


Assuntos
Corpo Caloso/efeitos dos fármacos , Eclampsia/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Cesárea , Corpo Caloso/patologia , Imagem de Difusão por Ressonância Magnética , Eclampsia/tratamento farmacológico , Serviços Médicos de Emergência , Feminino , Humanos , Manitol/uso terapêutico , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico , Gravidez , Resultado do Tratamento , Adulto Jovem
8.
Zhonghua Yan Ke Za Zhi ; 55(4): 289-293, 2019 Apr 11.
Artigo em Chinês | MEDLINE | ID: mdl-30982291

RESUMO

Objective: To investigate the efficacy of 20% mannitol in reducing intraocular pressure (IOP) in eyes with different intraocular tamponades after pars plana vitrectomy (PPV). Methods: Retrospective case-control study. Sixty-eight patients were administered with 20% mannitol and IOP was noted at regular intervals after simple PPV with ocular hypertension, including 24 males (26 eyes) and 44 females (46 eyes), aged (45.6±19.3) years. These cases were divided into three groups according to different tamponades: silicon-oil tamponade, 23 eyes; gas tamponade, 30 eyes; balanced salt solution (BSS), 19 eyes. The data were analyzed using the t test, variance and q test. Results: There was a significant decrease in IOP in all patients after using 20% mannitol. The IOP in the group of silicon-oil decreased from (33.25±2.56) mmHg (1 mmHg=0.133 kPa) to (23.21±1.85) mmHg, with a maximum decrease of 30.10%; the reduction in the group of C(3)F(8) was from (33.25±2.84) mmHg to (12.15±1.12) mmHg, with a maximum decrease of 33.44%. The IOP of the two groups dropped to a minimum both at 75 minutes. In the group of BSS, the IOP decreased from (32.95±2.33) mmHg to (17.50±1.35) mmHg, and the maximum extent of the decrease was 45.82% at 45 minutes. The difference in the IOP among the three groups at 20 min, 30 min, 45 min and 60 min was statistically significant (F=34.02, 112.68, 122.07, 34.83, all P=0.00). There were significant differences between the BSS group and the silicone-oil group (q=6.44, 13.04, 15.00, 17.11, all P=0.00), and between the BSS group and the C(3)F(8) group (q=7.68, 12.56, 12.93, 13.61, all P=0.00). Conclusion: In eyes with different intraocular tamponades, 20% mannitol was useful for short-term IOP reduction after vitrectomy, especially in those with BSS within one hour. But after 75 minutes, there was no statistically significant difference between groups. (Chin J Ophthalmol, 2019, 55:289-293).


Assuntos
Gases/administração & dosagem , Manitol/uso terapêutico , Hipertensão Ocular/terapia , Soluções Farmacêuticas/administração & dosagem , Óleos de Silicone/administração & dosagem , Vitrectomia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
9.
Arch. Soc. Esp. Oftalmol ; 94(3): 130-133, mar. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-178314

RESUMO

Presentamos el caso clínico de una mujer epiléptica de 29 años en tratamiento con topiramato 25 mg/día desde 9 días previos a la presentación del cuadro, que acude a urgencias por disminución de la agudeza visual (AV) tras incrementar la dosis a 50mg/día 2 días antes. En la exploración presenta un glaucoma agudo de ángulo cerrado (GAAC) bilateral y estrías maculares en ambos ojos (AO) objetivadas mediante retinografía y tomografía de coherencia óptica (OCT). El GAAC es un efecto secundario conocido y ampliamente descrito del topiramato, sin embargo, las estrías maculares que ocasionalmente acompañan al GAAC, aunque se han descrito anteriormente en otros casos, muy pocos las documentan mediante imágenes de retinografía y OCT. Es importante diferenciar un caso de GAAC inducido por topiramato de un caso de GAAC primario ya que difieren en su presentación clínica, mecanismo de acción y tratamiento. Su manejo inadecuado puede tener consecuencias potencialmente graves


We report the case of a 29-year-old epileptic woman who had been on treatment with topiramate 25 mg/day for 9 days. She was referred to the Emergency Department due to reduction in far visual acuity (VA) after increasing the dose to 50mg/day two days before. The ocular examination showed bilateral acute angle closure glaucoma (AACG) and macular striae in both eyes (AO) observed by Retinography and Optical Coherence Tomography (OCT). The AACG is a well-known side effect of topiramate, but the macular striae rarely accompanies it. Although macular striae have been previously described in other cases, very few document those using retinography and OCT images. Therefore, it is important to differentiate a case of AACG induced by topiramate from a case of primary AACG, since they differ in their clinical presentation, mechanism of action, and treatment. Mismanagement can have potentially serious consequences


Assuntos
Humanos , Feminino , Adulto , Glaucoma de Ângulo Fechado/induzido quimicamente , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Anticonvulsivantes/efeitos adversos , Acuidade Visual , Tomografia de Coerência Óptica , Refratometria/métodos , Manitol/uso terapêutico
10.
Molecules ; 24(3)2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30754620

RESUMO

Radio-ligand therapy (RLT) with177Lu-PSMA-617 is a promising option for patients with metastatic castration-resistant prostate-cancer (mCRPC). A prospective phase-II study (EUDRACT/RSO,2016-002732-32) on mCRPC is ongoing at IRST (Meldola, Italy). A total of 9 patients (median age: 68 y, range: 53⁻85) were enrolled for dosimetry evaluation of parotid glands (PGs), kidneys, red marrow (RM) and whole body (WB). Folic polyglutamate tablets were orally administered as PGs protectors and 500 mL of a 10% mannitol solution was intravenously infused to reduce kidney uptake. The whole body planar image (WBI) and blood samples were acquired at different times post infusion (1 h, 16⁻24 h, 36⁻48 h and 120 h). Dose calculation was performed with MIRD formalism (OLINDA/EXM software). The median effective half-life was 33.0 h (range: 25.6⁻60.7) for PGs, 31.4 h (12.2⁻80.6) for kidneys, 8.2 h (2.5⁻14.7) for RM and 40.1 h (31.6⁻79.7) for WB. The median doses were 0.48 mGy/MBq (range: 0.33⁻2.63) for PGs, 0.70 mGy/MBq (0.26⁻1.07) for kidneys, 0.044 mGy/MBq (0.023⁻0.067) for RM and 0.04 mGy/MBq (0.02⁻0.11) for WB. A comparison with previously published dosimetric data was performed and a significant difference was found for PGs while no significant difference was observed for the kidneys. For PGs, the possibility of reducing uptake by administering glutamate tablets during RLT seems feasible while further research is warranted for a more focused evaluation of the reduction in kidney uptake.


Assuntos
Dipeptídeos/administração & dosagem , Ácido Glutâmico/administração & dosagem , Compostos Heterocíclicos com 1 Anel/administração & dosagem , Lutécio/administração & dosagem , Manitol/administração & dosagem , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Radioisótopos/administração & dosagem , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Medula Óssea/química , Dipeptídeos/química , Dipeptídeos/farmacocinética , Ácido Glutâmico/uso terapêutico , Meia-Vida , Compostos Heterocíclicos com 1 Anel/química , Compostos Heterocíclicos com 1 Anel/farmacocinética , Humanos , Infusões Intravenosas , Rim/química , Lutécio/farmacocinética , Masculino , Manitol/uso terapêutico , Pessoa de Meia-Idade , Glândula Parótida/química , Estudos Prospectivos , Doses de Radiação , Radioisótopos/farmacocinética , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/farmacocinética , Comprimidos/administração & dosagem
11.
World Neurosurg ; 123: e700-e708, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30743036

RESUMO

OBJECTIVE: Despite no clear evidence from randomized trials, surgical intervention of spontaneous intracerebral hemorrhage (ICH) still occurs. We sought to describe the characteristics of patients undergoing surgical intervention in ICH. METHODS: Data from the ERICH (ERICH Ethnic/Racial Variations of Intracerebral Hemorrhage) study were analyzed, and patients with ICH were categorized into surgical intervention or nonoperative management groups. Patients with primary intraventricular hemorrhage and those without data regarding the use of surgical intervention were excluded. RESULTS: The study cohort comprised 2947 patients, and surgical intervention was performed in 289 (10%). Younger age (odds ratio [OR], 0.967; P < 0.001), lower baseline modified Rankin Scale score (OR, 0.728; P < 0.001), higher admission Glasgow Coma Scale score (OR, 1.059; P = 0.007), larger ICH volume (OR, 1.037; P < 0.001), infratentorial ICH location (OR, 5.966; P < 0.001), lobar ICH location (OR, 1.906; P = 0.001), lack of intraventricular hemorrhage (OR, 0.567; P = 0.001), intracranial pressure (ICP) monitoring (OR, 5.022; P < 0.001), and mannitol use (OR, 2.389; P < 0.001) were independent predictors of surgical intervention. Younger age (OR, 0.953; P < 0.001), lower baseline modified Rankin Scale score (OR, 0.713; P = 0.002), larger ICH volume (OR, 1.033; P < 0.001), lobar ICH location (OR, 2.467; P < 0.001), ICP monitoring (OR, 3.477; P < 0.001), and mannitol use (OR, 2.139; P < 0.001) were independent predictors of surgical interventions in supratentorial ICHs. Larger ICH volume (OR, 1.078; P < 0.001), ICP monitoring (OR, 6.099; P < 0.001), and mannitol use (OR, 2.952; P = 0.005) were independent predictors of surgical interventions in infratentorial ICHs. CONCLUSIONS: We identified multiple factors associated with surgical intervention for patients with ICH. Younger age, good neurologic function at baseline, large ICH volume on presentation, and lobar or infratentorial hematomas were independently associated with surgical intervention in patients with ICH .


Assuntos
Hemorragia Cerebral/cirurgia , Procedimentos Neurocirúrgicos/métodos , Fatores Etários , Estudos de Casos e Controles , Diuréticos Osmóticos/uso terapêutico , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Manitol/uso terapêutico , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
12.
J Med Case Rep ; 13(1): 36, 2019 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-30773142

RESUMO

INTRODUCTION: Cerebral venous thrombosis is relatively rare and characterized by a wide spectrum of clinical features. It is more common in young adults with women affected more than men. The diagnosis of cerebral venous thrombosis is easier nowadays due to easy access to advanced neuroimaging techniques. Abnormalities in thrombophilic profile are associated with enhanced risk of cerebral venous thrombosis. It has varied etiologies such as hypercoagulable states, infection, dehydration, pregnancy, and substance abuse. Hyperhomocysteinemia is found to be closely associated with an enhanced risk of cerebral venous thrombosis. CASE PRESENTATION: Here we report a case of cerebral venous thrombosis secondary to hyperhomocysteinemia caused by vitamin B12 deficiency in a 32-year-old Indo-Aryan man. A detailed coagulation workup led us to find the etiology of cerebral venous thrombosis in this patient who followed a strict vegetarian diet and had vitamin B12 deficiency leading to hyperhomocysteinemia. CONCLUSION: There are conflicting reports in the literature about the association of hyperhomocysteinemia, B12 deficiency, and cerebral venous thrombosis but some reports point to a significant association. We conclude that further studies with a large sample size are required to analyze the effect of hyperhomocysteinemia and low vitamin B12 on the risk of cerebral venous thrombosis.


Assuntos
Hiper-Homocisteinemia/etiologia , Trombose Intracraniana/etiologia , Deficiência de Vitamina B 12/complicações , Adulto , Anticoagulantes/uso terapêutico , Anticonvulsivantes/uso terapêutico , Encéfalo/diagnóstico por imagem , Diuréticos Osmóticos/uso terapêutico , Glicerol/uso terapêutico , Heparina/uso terapêutico , Humanos , Hiper-Homocisteinemia/sangue , Hiper-Homocisteinemia/tratamento farmacológico , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/tratamento farmacológico , Imagem por Ressonância Magnética , Masculino , Manitol/uso terapêutico , Convulsões/complicações , Convulsões/tratamento farmacológico , Ácido Valproico/uso terapêutico , Vitamina B 12/análogos & derivados , Vitamina B 12/uso terapêutico , Deficiência de Vitamina B 12/sangue , Deficiência de Vitamina B 12/tratamento farmacológico , Complexo Vitamínico B/uso terapêutico , Varfarina/uso terapêutico
13.
J Emerg Med ; 56(4): 431-436, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30745195

RESUMO

BACKGROUND: Hypertonic saline (HTS) and mannitol are frequently utilized in the emergency department (ED) to manage elevations in intracranial pressure (ICP). OBJECTIVE: The objective of this study was to compare the incidence of extravasation injury when HTS or mannitol was administered via peripheral i.v. line (PIV). METHODS: This retrospective cohort study evaluated adult and pediatric patients given either 3% HTS or mannitol via PIV while in the ED. The primary outcome was extravasation incidence. RESULTS: One hundred and ninety-two patients were included, of which 85 (44%) received HTS and 107 (56%) received mannitol. Patients who received HTS were younger (27.5 ± 24.3 years vs. 53.9 ± 22.3 years; p < 0.001); 55.3% of patients given HTS received it for traumatic brain injury (TBI) versus 38.3% of patients given mannitol (p = 0.021); and 44.9% of patients given mannitol received it for intracerebral hemorrhage versus 21.2% of patients given HTS (p = 0.001). There was no incidence of extravasation in either group. Patients who received HTS had lower ICP measurement 24 h post admission (2.107 ± 5.5 mm Hg vs. 4.236 ± 8.1 mm Hg; p = 0.047) and higher Glasgow Coma Scale (GCS) score upon discharge (GCS 14; interquartile range [IQR] 3-15 vs. GCS 3; IQR 3-14.2; p = 0.004). In-hospital mortality was higher in the mannitol group (54.7% vs. 32.9%; p = 0.003). Duration of mechanical ventilation was shorter in those patients who received HTS (1 day; IQR 0-56 days vs. 2 days; IQR 0-56 days; p = 0.023). CONCLUSIONS: There were no incidences of extravasation among patients given 3% HTS or mannitol. Clinicians should reconsider recommendations to restrict HTS or mannitol to central lines.


Assuntos
Cateterismo Periférico/normas , Manitol/administração & dosagem , Segurança do Paciente/normas , Solução Salina Hipertônica/administração & dosagem , Adulto , Idoso , Lesões Encefálicas Traumáticas/tratamento farmacológico , Lesões Encefálicas Traumáticas/mortalidade , Cateterismo Periférico/métodos , Estudos de Coortes , Serviço Hospitalar de Emergência/organização & administração , Feminino , Escala de Coma de Glasgow , Humanos , Hipertensão Intracraniana/tratamento farmacológico , Masculino , Manitol/uso terapêutico , Pessoa de Meia-Idade , Estudos Retrospectivos , Solução Salina Hipertônica/uso terapêutico
14.
Curr Urol Rep ; 20(1): 6, 2019 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-30685826

RESUMO

PURPOSE OF REVIEW: Few procedures involve the ischemia-reperfusion injury to organs purposely. Two clear examples in urologic surgery consist on kidney transplantation and partial nephrectomies. RECENT FINDINGS: Mannitol is an osmotic diuretic that is commonly used in partial nephrectomies and kidney transplantation to increase renal blood flow and decrease warm-ischemia-related renal injury to preserve estimated glomerular filtration rate (eGFR). We review the current evidence for the use of mannitol and its effects on these procedures.


Assuntos
Diuréticos Osmóticos/uso terapêutico , Transplante de Rim/métodos , Manitol/uso terapêutico , Nefrectomia/métodos , Traumatismo por Reperfusão/prevenção & controle , Taxa de Filtração Glomerular , Humanos , Rim/irrigação sanguínea , Traumatismo por Reperfusão/etiologia , Isquemia Quente/efeitos adversos
15.
J Neurosurg Anesthesiol ; 31(3): 273-284, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29952815

RESUMO

OBJECTIVE: Despite clinical use spanning 50+ years, questions remain concerning the optimal use of mannitol. The published reviews with meta-analysis frequently focused on mannitol's effects on a specific physiological aspect such as intracranial pressure (ICP) in sometimes heterogeneous patient populations. A comprehensive review of mannitol's effects, as well as side effects, is needed. METHODS: The databases Medline (OvidSP), Embase (OvidSP), and NLM PubMed were systematically searched for randomized controlled trials (RCTs) comparing mannitol to a control therapy in either the critical care or perioperative setting. Meta-analysis was performed when feasible to examine mannitol's effects on outcomes, including ICP, cerebral perfusion pressure, mean arterial pressure (MAP), brain relaxation, fluid intake, urine output, and serum sodium. Systematic literature search was also performed to understand mannitol-related complications. RESULTS: In total 55 RCTs were identified and 7 meta-analyses were performed. In traumatic brain injury, mannitol did not lead to significantly different MAP (SMD [95% confidence interval (CI)] =-3.3 [-7.9, 1.3] mm Hg; P=0.16) but caused significantly different serum sodium concentrations (SMD [95% CI]=-8.0 [-11.0, -4.9] mmol/L; P<0.00001) compared with hypertonic saline. In elective craniotomy, mannitol was less likely to lead to satisfactory brain relaxation (RR [95% CI]=0.89 [0.81, 0.98]; P=0.02), but was associated with increased fluid intake (SMD [95% CI]=0.67 [0.21, 1.13] L; P=0.004), increased urine output (SMD [95% CI]=485 [211, 759] mL; P=0.0005), decreased serum sodium concentration (SMD [95% CI]=-6.2 [-9.6, -2.9] mmol/L; P=0.0002), and a slightly higher MAP (SMD [95% CI]=3.3 [0.08, 6.5] mm Hg; P=0.04) compared with hypertonic saline. Mannitol could lead to complications in different organ systems, most often including hyponatremia, hyperkalemia, and acute kidney injury. These complications appeared dose dependent and had no long-term consequences. CONCLUSIONS: Mannitol is effective in accomplishing short-term clinical goals, although hypertonic saline is associated with improved brain relaxation during craniotomy. Mannitol has a favorable safety profile although it can cause electrolyte abnormality and renal impairment. More research is needed to determine its impacts on long-term outcomes.


Assuntos
Cuidados Críticos/métodos , Diuréticos Osmóticos/uso terapêutico , Manitol/uso terapêutico , Neurocirurgia/métodos , Humanos , Procedimentos Neurocirúrgicos/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Bioelectrochemistry ; 125: 58-69, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30265864

RESUMO

We investigated isolated guinea pig hearts (n = 121) in an ischemia/ reperfusion model with the aim to compare the efficiency of the cardioplegic solution HTK with its novel replacement HTKN. Following consolidation with Tyrode's solution, ischemia started either immediately or after preceding cardioplegia with HTK, HTKN, or modified HTK enriched with Ca. Ischemia lasted either 80 min at 30 °C, or 360 min at 5 °C, or 81 min at 30 °C with intermittent cardioplegic perfusion. During ischemia we measured intracellular calcium (iCa++) and the time of gap junction uncoupling (t-in). During reperfusion we measured the reestablishment of cell coupling (t-ret), left ventricular developed pressure (LVDP), and heart rhythm (VC-RR). In 5 °C groups, iCa++ at t-in was significantly higher than before ischemia, and longest t-in, shortest t-ret, and best VC-RR were observed after HTK-protection. Of all 30 °C groups, the intermittent group with modified HTK showed shortest t-ret, best VC-RR, and the highest LVDP. At 5 °C, HTK groups had higher LVDP than HTK-N groups, but not at 30 °C. The data suggest that the higher calcium level in the HTK-N solution improves reperfusion after short ischemia at 30 °C but for long lasting ischemia at 5 °C it is beneficial to use the HTK solution.


Assuntos
Soluções Cardioplégicas/uso terapêutico , Parada Cardíaca Induzida/métodos , Traumatismo por Reperfusão Miocárdica/terapia , Soluções para Preservação de Órgãos/uso terapêutico , Animais , Cálcio/metabolismo , Feminino , Junções Comunicantes/metabolismo , Junções Comunicantes/patologia , Glucose/uso terapêutico , Cobaias , Manitol/uso terapêutico , Traumatismo por Reperfusão Miocárdica/metabolismo , Traumatismo por Reperfusão Miocárdica/patologia , Traumatismo por Reperfusão Miocárdica/cirurgia , Miocárdio/metabolismo , Miocárdio/patologia , Cloreto de Potássio/uso terapêutico , Procaína/uso terapêutico
18.
J Back Musculoskelet Rehabil ; 32(2): 329-337, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30412481

RESUMO

BACKGROUND: Piriformis syndrome (PS) is an entrapment of the sciatic nerve by the piriformis muscle, or myofascial pain from the piriformis muscle. OBJECTIVE: The aim of this study was to investigate the effectiveness of Mannitol plus Vitamins B regime in the management of PS. METHODS: Twenty two patients were included in this study and received 250 ml of mannitol 20% intravenous infusion for 5 days + Vitamins B (vitamin B1 10 mg + vitamin B2 10 mg + vitamin B12 50 µg PO) for 6 weeks. Clinical outcomes were assessed systematically by clinical tests (tenderness, FAIR test, Beatty's, Freiberg's and Pace's maneuver), Numeric Rating Scale (NRS), Likert Analogue Scale (LAS), and MR examination. RESULTS: The clinical evaluations showed a significant reduction (p< 0.05) of tenderness, FAIR test, Beatty's maneuver, Freiberg's maneuver and Pace's maneuver when compared with baseline evaluation during the 3rd and 6th month follow-ups. A statistically significant improvement of pain was measured by NRS at resting (p< 0.001), at night (p< 0.001) and during activities (p< 0.001) and LAS with prolonged sitting (p< 0.001), standing (p< 0.001) and lying (p< 0.001). Concomitantly, swelling of SN revealed a significant reduction (p= 0.003) from 86.4% to 18.2%. CONCLUSIONS: Mannitol plus Vitamins B is effective in the management of piriformis syndrome and it could be an alternative regime in treating PS.


Assuntos
Diuréticos Osmóticos/uso terapêutico , Manitol/uso terapêutico , Síndrome do Músculo Piriforme/tratamento farmacológico , Complexo Vitamínico B/uso terapêutico , Adulto , Idoso , Feminino , Quadril , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Músculo Esquelético , Medição da Dor , Síndrome do Músculo Piriforme/diagnóstico por imagem , Nervo Isquiático , Vitaminas
19.
Neurosurg Rev ; 42(2): 499-509, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29905883

RESUMO

Hyperosmolar therapy is regarded as the mainstay for treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI). This still has been disputed as application of hypertonic saline (HS) or mannitol for treating patients with severe TBI. Thus, this meta-analysis was performed to further compare the advantages and disadvantages of mannitol with HS for treating elevated ICP after TBI. We conducted a systematic search on PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Wan Fang Data, VIP Data, SinoMed, and China National Knowledge Infrastructure (CNKI) databases. Studies were included or not based on the quality assessment by the Jadad scale and selection criteria. Twelve RCTs with 438 patients were enrolled for the meta-analysis. The comparison of HS and mannitol indicated that they were close in field of improving function outcome (RR = 1.17, 95% CI 0.89 to 1.54, p = 0.258) and reducing intracranial pressure (MD = - 0.16, 95% CI: - 0.59 to 0.27, p = 0.473) and mortality (RR = 0.78, 95% CI 0.53 to 1.16, p = 0.216). The pooled relative risk of successful ICP control was 1.06 (95% CI: 1.00 to 1.13, p = 0.044), demonstrating that HS was more effective than mannitol in ICP management. Both serum sodium (WMD = 5.30, 95% CI: 4.37 to 6.22, p < 0.001) and osmolality (WMD = 3.03, 95% CI: 0.18 to 5.88, p = 0.037) were increased after injection of hypertonic saline. The results do not lend a specific recommendation to select hypertonic saline or mannitol as a first-line for the patients with elevated ICP caused by TBI. However, for the refractory intracranial hypertension, hypertonic saline seems to be preferred.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Diuréticos Osmóticos/uso terapêutico , Hipertensão Intracraniana/tratamento farmacológico , Manitol/uso terapêutico , Solução Salina Hipertônica/uso terapêutico , Humanos , Hipertensão Intracraniana/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Wiad Lek ; 71(7): 1316-1319, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30448803

RESUMO

OBJECTIVE: Introduction: The problem of the influence of infusion solutions on the correction of acid alkaline balance disorders in acute ischemic stroke (AIS) remains unclear. The aim: Compare the dynamics of changes acid alkaline balance (AAB) in the application of isosmolar 0.9% NaCl solution and hyperosmolar solution of mannitol in patients with acute ischemic stroke. PATIENTS AND METHODS: Materials and methods: The study included 50 patients with AIS. As the investigated solutions were used: hyperosmolar mannitol 15% and isosmolar 0.9% NaCl. The control group received only 0.9% NaCl, compared with main group of 0.9% NaCl+mannitol. The research was carried out at 1, 4 and 7 day, a number of indicators were determined: рН, РаО2, РаСО2, АВ, SB, ВВ, ВЕ. RESULTS: Results: The conducted research showed that in all observation groups, on 1st day, manifestations of mixed acidosis were observed. On the 7th day of observation the group of 0.9% NaCl showed results close to the norm of the studied parameters, indicating the leveling of acidosis developed in this group on the 1st day of stroke. Somewhat worse correction of metabolic acidosis was in the group of mannitol, on the 7th day of observation the manifestations of acidosis were not significantly different from the 1st day and were respectively: pH = 7.33 (7.24; 7.36); pO2 = 36 (33; 39); AB = 23 (15; 26); BE = -3.4 (-13.5, 0.2), SB = 22.9 (18.0, 25.4). CONCLUSION: Conclusions: Analysis of changes in the parameters of AAB in the application of different circuits of infusion therapy in patients with acute ischemic stroke showed that all the observation groups had manifestations of metabolic acidosis on the first day of AIS. The ability to normalize the disturbances of acid alkaline balance did not differ significantly (p>0.05) for patients of group 0.9% NaCl solution and mannitol.


Assuntos
Equilíbrio Ácido-Base , Acidose/terapia , Isquemia Encefálica/complicações , Manitol/uso terapêutico , Acidente Vascular Cerebral/complicações , Acidose/complicações , Humanos , Infusões Intravenosas
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