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1.
Rev. Esc. Enferm. USP ; 48(spe): 109-115, 08/2014.
Artigo em Inglês | LILACS | ID: lil-731297

RESUMO

Objective To analyze the practices of primary care focused on the harmful consumption of drugs. Method This is a qualitative study, developed with a dialectical-critical approach. Data collection was carried out through semi-structured interviews with 10 employees of a basic health unit (UBS). Results The demands are not accepted, and if they go beyond the barriers shaped by the historical absence of health care practices for drug users and moralistic and preconceived ideologies, they are not reinterpreted as health needs; practices that meet these demands and go beyond the barriers are poor; the functionalist approach, which explains drug use as a disease and considers drug users as deviants, supports the few existing practices. Conclusion primary health care is mistakenly focused on addiction; it lacks structural elements of the production process in health and internal dynamics of the working processes that would foster the development of collective practices. .


Objetivo El estudio tiene como objetivo analizar las prácticas de atención primaria dirigidos a lo consumo prejudicial de drogas. Método Se trata de un estudio cualitativo, desarrollado en la perspectiva dialéctica crítica. La recolección de datos se realizó a través de entrevistas semiestructuradas con 10 empleados de una Unidad Básica de Salud. Resultados Muestran que: las demandas no son aceptadas, y si van más allá de las barreras - formadas por la ausencia histórica de la práctica de la atención de salud para los consumidores de drogas y las ideologías morales y preconcebidas -, no son reinterpretados como necesidades de salud; las prácticas que satisfagan esas demandas son pobres; detrás de estas escasas prácticas, está la perspectiva funcionalista, que considera el uso de drogas como una enfermedad y los usuarios de drogas como desviados; los trabajadores valoran la formación clínica y culpan a los usuarios por los problemas que enfrentan. Conclusión Se pode concluir que la atención primaria: es equívoca hacia el objeto de la dependencia; carece de los elementos estructurales del proceso de producción en la salud y las dinámicas internas de los procesos de trabajo que fomenten el desarrollo de las prácticas colectivas.

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Objetivo Analisar as práticas de atenção básica voltadas ao consumo prejudicial de drogas. Método Estudo qualitativo, desenvolvido na perspectiva dialético-crítica. A coleta de dados foi realizada através de entrevistas semiestruturadas com 10 trabalhadores de uma Unidade Básica de Saúde (UBS). Resultados As demandas não são acolhidas e, quando ultrapassam as barreiras - conformadas pela ausência histórica de práticas de atenção à saúde ao usuário de drogas e por ideologias moralistas e preconceituosas -, não são reinterpretadas como necessidades de saúde; as práticas que atendem essas demandas são precárias; a perspectiva funcionalista, que compreende o consumo de drogas como doença e considera usuários de drogas como desviantes, embasa as escassas práticas existentes. Conclusão A atenção básica encontra-se equivocamente voltada para a dependência; carece de elementos estruturais do processo de produção em saúde e da dinamicidade interna aos processos de trabalho, que favoreceriam o desenvolvimento de práticas coletivas. .


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Crescimento Endotelial/metabolismo , Linfocinas/metabolismo , Óxido Nítrico Sintase/metabolismo , Neoplasias Gástricas/irrigação sanguínea , Neoplasias Gástricas/metabolismo , Imuno-Histoquímica , Microcirculação/patologia , Estadiamento de Neoplasias , Neovascularização Patológica , Óxido Nítrico Sintase Tipo II , Prognóstico , Neoplasias Gástricas/patologia , Fator A de Crescimento do Endotélio Vascular , Fatores de Crescimento do Endotélio Vascular
2.
Rev. esp. cardiol. (Ed. impr.) ; 64(2): 105-110, feb. 2011. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-84933

RESUMO

Introducción y objetivos. Los valores elevados de endotelina-1 (ET-1) se han relacionado con un mal pronóstico tras un infarto agudo de miocardio con elevación del ST (IAMCEST). La vasoconstricción de la microcirculación coronaria parece ser el mecanismo causal. El objetivo de este estudio es analizar los efectos de la ET-1 sobre la microcirculación coronaria, el tamaño del infarto, la fracción de eyección del ventrículo izquierdo (FEVI) y el miocardio rescatado tras un IAMCEST. Métodos. Se determinaron los valores de ET-1 de 127 pacientes (6-24h) tras un IAMCEST. En 97 pacientes se realizó una resonancia magnética para evaluar la obstrucción microvascular (OM), el tamaño del infarto y la FEVI. El índice de miocardio rescatado (IMR) se definió como el porcentaje de área en riesgo angiográfica sin necrosis en la resonancia. Resultados. La edad media de la población fue de 60,9±11,8 años (77% varones). Los pacientes con valores de ET-1 por encima de la mediana presentaron un mayor porcentaje de OM (77,7% si ET-1>6,8 pg/ml frente a 16,6% si ET-1 ≤ 6,8 pg/ml; p<0,001) y menor IMR (13,8%±26% si ET-1>6,8 pg/ml frente a 37,4%±26% si ET-1 ≤ 6,8 pg/ml; p=0,02). Los valores de ET-1 no se asociaron de manera significativa con el tamaño del infarto (p=0,11) ni con la FEVI (p=0,16). En el análisis multivariable, los valores de ET-1 fueron predictores de OM (odds ratio [OR]=2,78; intervalo de confianza [IC] del 95%, 1,16-6,66; p=0,021) e IMR ≤ percentil 25 (OR=1,69; IC del 95%, 1,01-2,81; p=0,04). Conclusiones. Los valores elevados de ET-1 tras un IAMCEST se asocian a un mayor porcentaje de OM y un menor IMR (AU)


Introduction and objectives: High endothelin-1 (ET-1) levels have been linked to poor clinical outcomes after ST-segment elevation myocardial infarction (STEMI). Vasoconstriction of the coronary microcirculation seems to be the underlying mechanism. The aim of the study was to assess the effect of ET-1 on microvascular integrity, infarct size, left ventricular ejection fraction (LVEF) and myocardial salvage in evolving myocardial infarction (MI). Methods: We measured ET-1 levels acutely (6-24 h) in 127 patients presenting with their first STEMI. Contrast-enhanced cardiac magnetic resonance (ce-CMR) was performed in 94 patients within 1 week to assess microvascular obstruction (MO), infarct size and LVEF. A myocardial salvage index (MSI) was defined as the percentage of at-risk angiographic area without necrosis on the ce-CMR. Results: Mean age was 60.9 >= 11.8 years and 98 (77%) were males. Median ET-1 level within the first 24 h was 6.8 pg/mL (25th –75th percentile range: 5.4–8.5 pg/mL). Patients with ET-1 concentrations over the median presented higher percentage of MO (77.7% for ET-1 > 6.8 pg/mL vs. 16.6% for ET-1 6.8 pg/mL, P < .001) and lower MSI values (13.8 <= 26% for ET-1 > 6.8 pg/mL vs. 37.4 (26%) for ET-1 <= 6.8 pg/mL, P = .02). ET-1 levels did not show a significant association with infarct size (P = .11) and LVEF (P = .16). Multivariate analysis found ET-1 to be a significant predictor of MO (OR = 2.78; CI 95% 1.16-6.66; P = .021) and MSI <= Percentile 25 (OR = 1.69, CI 95% 1.01-2.81; P = .04). Conclusions: High ET-1 levels after myocardial infarction are associated with the presence of microvascular obstruction and lower myocardial salvage index (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Endotelina-1/administração & dosagem , Endotelina-1/uso terapêutico , Infarto do Miocárdio/diagnóstico , Oclusão Coronária/diagnóstico , Microcirculação/patologia , Microcirculação , Vasoconstrição/fisiologia , Radioimunoensaio/métodos , Angiografia Coronária , Imagem por Ressonância Magnética/métodos , Razão de Chances , Infarto do Miocárdio/prevenção & controle , Infarto do Miocárdio/terapia , Intervalos de Confiança , Técnicas de Laboratório Clínico/tendências , Técnicas de Laboratório Clínico , Estudos Prospectivos , Protocolos Clínicos , Análise Estatística
3.
J Neuropathol Exp Neurol ; 67(10): 976-83, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18800010

RESUMO

Spirochetal infections are an important cause of neurological disease. In previous studies of the pathogenesis of spirochetal brain infection, mice inoculated with Borrelia turicatae, an agent of tick-borne relapsing fever in North America, developed mild meningitis and parenchymal activation/infiltration by interleukin 10 (IL-10)-producing microglia/macrophages. Here, we investigated the neuroprotective effects of IL-10 during spirochetal infection by comparing the outcomes of B. turicatae infection in wild-type and IL-10-deficient RAG2-deficient mice. Mice were infected with either serotype 1 (Bt1), which causes more brain infection but lower bacteremia, or Bt2, which causes less brain infection but higher bacteremia. Interleukin 10 deficiency resulted in early death from subarachnoid/intraparenchymal brain hemorrhage in Bt2-infected mice. These mice had marked apoptosis of brain microvascular endothelial cells as assessed by terminal transferase-mediated DNA nick end-labeling staining. In contrast, Bt1 infection caused milder subarachnoid hemorrhage. Neuronal apoptosis was observed in mice infected with both serotypes and was prominent in the cerebellum. Neutralization of tumor necrosis factor prevented death and reduced morbidity and brain injury in mice infected by both serotypes. We conclude that IL-10 plays a critical role protecting the cerebral microcirculation from spirochetal injury possibly by inhibition effects of tumor necrosis factor.


Assuntos
Infecções por Borrelia/patologia , Infecções por Borrelia/prevenção & controle , Encéfalo/patologia , Interleucina-10/genética , Interleucina-10/fisiologia , Microcirculação/patologia , Animais , Infecções por Borrelia/mortalidade , Corantes , Citocinas/biossíntese , Citocinas/genética , Feminino , Hemorragia/etiologia , Hemorragia/patologia , Marcação In Situ das Extremidades Cortadas , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Reação em Cadeia da Polimerase Via Transcriptase Reversa
5.
Curr Mol Med ; 8(6): 510-8, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18781958

RESUMO

Chagas heart disease (CHD), caused by the protozoan parasite Trypanosoma cruzi, is the leading cause of infectious myocarditis in the world. The etiology of CHD is unclear and multiple mechanisms have been proposed to explain the pathogenesis of the disease. This review describes the proposed mechanisms of CHD pathogenesis and evaluates the historical significance and evidence supporting each. Although the majority of CHD-related pathologies are currently attributed to parasite persistence in the myocardium and autoimmunity, there is strong evidence that CHD develops as a result of additive and even synergistic effects of several distinct mechanisms rather than one factor.


Assuntos
Cardiomiopatia Chagásica/etiologia , Miocárdio/metabolismo , Animais , Antígenos de Protozoários/imunologia , Autoimunidade/imunologia , Cardiomiopatia Chagásica/imunologia , Cardiomiopatia Chagásica/patologia , Cardiomiopatia Chagásica/fisiopatologia , Eosinófilos/imunologia , Humanos , Microcirculação/patologia , Miocárdio/patologia , Neurônios/patologia , Neutrófilos/imunologia , Trypanosoma cruzi/imunologia , Trypanosoma cruzi/patogenicidade
6.
World J Gastroenterol ; 14(31): 4915-22, 2008 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-18756600

RESUMO

AIM: To elucidate the relationship between the microvessel count (MVC) by CD34 analyzed by immunohistochemical method and prognosis in hepatocellular carcinoma (HCC) patients who underwent hepatectomy based on our preliminary study. METHODS: We examined relationships between MVC and clinicopathological factors in 128 HCC patients. The modified Japan Integrated Staging score (mJIS) was applied to examine subsets of HCC patients. RESULTS: Median MVC was 178/mm(2), which was used as a cut-off value. MVC was not significantly associated with any clinicopathologic factors or postoperative recurrent rate. Lower MVC was associated with poor disease-free and overall survivals by univariate analysis (P = 0.039 and P = 0.087, respectively) and lower MVC represented an independent poor prognostic factor in disease-free survival by Cox's multivariate analysis (risk ratio, 1.64; P = 0.024), in addition to tumor size, vascular invasion, macroscopic finding and hepatic dysfunction. Significant differences in disease-free and overall survivals by MVC were observed in HCC patients with mJIS 2 (P = 0.046 and P = 0.0014, respectively), but not in those with other scores. CONCLUSION: Tumor MVC appears to offer a useful prognostic marker of HCC patient survival, particularly in HCC patients with mJIS 2.


Assuntos
Carcinoma Hepatocelular , Hepatectomia , Neoplasias Hepáticas , Adulto , Idoso , Antígenos CD34/análise , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/cirurgia , Intervalo Livre de Doença , Feminino , Hepatectomia/mortalidade , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/cirurgia , Masculino , Microcirculação/imunologia , Microcirculação/patologia , Pessoa de Meia-Idade , Projetos Piloto , Modelos de Riscos Proporcionais , Sistema de Registros , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
7.
Arthritis Rheum ; 58(8): 2565-73, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18668584

RESUMO

OBJECTIVE: To assess the prevalence and clinical significance of small-vessel vasculitis (SVV) surrounding an uninflamed temporal artery (TA) in patients diagnosed as having giant cell (temporal) arteritis (GCA) and/or polymyalgia rheumatica (PMR). METHODS: Patients with GCA and/or PMR (n = 490) were included in this multicenter prospective study. Slides of TA biopsy specimens were reviewed by 2 pathologists who were blinded with regard to clinical information. SVV was defined as aggregates of mononuclear inflammatory cells surrounding a capillary, distant from an uninflamed temporal artery. Clinical and biologic data of patients in the SVV group (n = 35) were compared with data of patients with biopsy-proven GCA (n = 280) and with negative TA biopsy findings (n = 175). RESULTS: SVV was diagnosed in 18 women and 17 men (mean +/- SD age 74.5 +/- 9.4 years). The group of patients with SVV had a higher proportion of men than in the entire GCA series, had systemic symptoms, headache, jaw claudication, and an abnormal temporal artery less frequently at clinical examination, but had symptoms of PMR more often than patients in the biopsy-proven GCA group (P = 2.6 x 10(-7), odds ratio 9.17 [95% confidence interval 3.44-24.4]). Levels of inflammation markers were significantly lower in the SVV group. Patients in the SVV group had fever less frequently than patients in the group with negative TA biopsy findings, but otherwise shared the same clinical (including PMR symptoms) and biologic features. Eighteen of the 94 patients with pure PMR (19%) had SVV. CONCLUSION: SVV is often neglected by pathologists, and appears to be strongly associated with PMR symptoms in patients with a clinical diagnosis of GCA and/or PMR. However, SVV as a new diagnostic criterion for PMR must be assessed in prospective studies.


Assuntos
Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/patologia , Polimialgia Reumática/diagnóstico , Polimialgia Reumática/patologia , Artérias Temporais/patologia , Vasculite/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biópsia , Estudos de Casos e Controles , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Masculino , Microcirculação/patologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Sensibilidade e Especificidade , Vasculite/patologia
8.
Pol J Pathol ; 59(2): 107-15, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18669177

RESUMO

The aim of the study was to investigate differences in microvessels between renal tumors. The material consisted of 97 clear cell carcinomas (CCRCC), 20 papillary carcinomas (PapRCC), 33 chromophobe carcinomas and 15 oncocytomas (RO). The endothelia were stained immunohistochemically for CD34 antigen. The vascular features were analyzed with the AnalySIS image processing system. The stains for VEGF, GLUT-1 and Ki67 were performed on tissue microarrays. The mean microvascular density (MVD) was 163.62 profiles/mm2 and microvascular area (MVA) was 3.75%. The highest values were seen in CCRCC and the lowest in PapRCC. The size and shape parameters of the individual vessels were also different between the tumors under consideration. The tumor diameter, MVD and MVA were inversely correlated, the relationship being the strongest for RO. The minimum spanning tree parameters were different between histological types, especially between CCRCC and PapRCC. The mean fractal dimension was 1.32, and similar in all cases. VEGF, Ki67 and GLUT-1 expression was the highest in CCRCC, and lowest in RO. The vascular parameters were correlated with Ki67, GLUT-1 VEGF expression, tumor grade, and inversely correlated with tumor diameter. The relationships in each tumor type were slightly different.


Assuntos
Adenoma Oxífilo/irrigação sanguínea , Carcinoma Papilar/irrigação sanguínea , Carcinoma de Células Renais/irrigação sanguínea , Neoplasias Renais/irrigação sanguínea , Neovascularização Patológica/patologia , Adenoma Oxífilo/metabolismo , Adenoma Oxífilo/patologia , Antígenos CD34/metabolismo , Biomarcadores Tumorais/análise , Carcinoma Papilar/metabolismo , Carcinoma Papilar/patologia , Carcinoma de Células Renais/metabolismo , Carcinoma de Células Renais/patologia , Transportador de Glucose Tipo 1/metabolismo , Humanos , Antígeno Ki-67/metabolismo , Neoplasias Renais/metabolismo , Neoplasias Renais/patologia , Microcirculação/química , Microcirculação/patologia , Neovascularização Patológica/metabolismo , Análise Serial de Tecidos , Fator A de Crescimento do Endotélio Vascular/metabolismo
9.
Curr Pharm Des ; 14(16): 1594-600, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18673200

RESUMO

From a complications standpoint, diabetes mellitus is a disease of the vasculature. Diabetics face a considerably higher risk of developing cardiovascular and cerebrovascular diseases. Both large and small blood vessels are susceptible to alterations from diabetes. Endothelial cell dysfunction associated with small vessel (known as microangiopathy) is a primary factor in the development and progression of diabetes-related disabilities, including blindness, kidney failure, and peripheral neuropathy. Recent clinical evidence show that people with diabetes have increased incidences of vascular dementia, ventricular hypertrophy, lacunar infarcts, hemorrhage, and may be a predisposing factor for Alzheimer's disease. However, the effects of diabetes mellitus on the cerebral microvascular are still largely unknown. This communication will review the relationship between diabetes mellitus and changes in cognition with a particular focus on how alterations in blood-brain barrier structure and function may play a long term role in worsened cognitive abilities.


Assuntos
Barreira Hematoencefálica , Cognição/fisiologia , Diabetes Mellitus/fisiopatologia , Animais , Barreira Hematoencefálica/metabolismo , Barreira Hematoencefálica/fisiopatologia , Barreira Hematoencefálica/ultraestrutura , Encéfalo/irrigação sanguínea , Encéfalo/fisiopatologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/metabolismo , Transtornos Cognitivos/patologia , Diabetes Mellitus/metabolismo , Diabetes Mellitus/patologia , Glucose/metabolismo , Humanos , Microcirculação/metabolismo , Microcirculação/patologia , Microcirculação/fisiopatologia
10.
Am J Med ; 121(9): 748-57, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18724960

RESUMO

Diabetic cardiomyopathy is the presence of myocardial dysfunction in the absence of coronary artery disease and hypertension. Hyperglycemia seems to be central to the pathogenesis of diabetic cardiomyopathy and to trigger a series of maladaptive stimuli that result in myocardial fibrosis and collagen deposition. These processes are thought to be responsible for altered myocardial relaxation characteristics and manifest as diastolic dysfunction on imaging. Sophisticated imaging technologies also have permitted the detection of subtle systolic dysfunction in the diabetic myocardium. In the early stages, these changes appear reversible with tight metabolic control, but as the pathologic processes become organized, the changes are irreversible and contribute to an excess risk of heart failure among diabetic patients independently of common comorbidities, such as coronary artery disease and hypertension. Therapeutic agents specifically targeting processes that lead to these pathophysiologic changes are in the early stages of development. Although glycemic control and early administration of neurohormonal antagonists remain the cornerstones of therapeutic approaches, newer treatment targets are currently being explored.


Assuntos
Complicações do Diabetes/diagnóstico , Complicações do Diabetes/tratamento farmacológico , Insuficiência Cardíaca Diastólica/diagnóstico , Insuficiência Cardíaca Diastólica/tratamento farmacológico , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/tratamento farmacológico , Apoptose/fisiologia , Cobre/metabolismo , Complicações do Diabetes/etiologia , Complicações do Diabetes/fisiopatologia , Ecocardiografia , Ácidos Graxos não Esterificados/metabolismo , Fibrose/patologia , Insuficiência Cardíaca Diastólica/etiologia , Insuficiência Cardíaca Diastólica/fisiopatologia , Humanos , Microcirculação/patologia , Miocárdio/metabolismo , Miocárdio/patologia , Necrose/patologia , Sistema Renina-Angiotensina/fisiologia , Fatores de Risco , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia
12.
J Cereb Blood Flow Metab ; 28(11): 1771-85, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18612314

RESUMO

Microvascular dysfunction is a critical pathology that underlies the evolution of secondary injury mechanisms after traumatic spinal cord injury (SCI). However, little is known of the molecular regulation of endothelial cell (EC) plasticity observed acutely after injury. One reason for this is the relative lack of methods to quickly and efficiently obtain highly enriched spinal microvascular ECs for high-throughput molecular and biochemical analyses. Adult C57Bl/6 mice received an intravenous injection of fluorescein isothiocyanate (FITC)-conjugated Lycopersicon esculentum lectin, and FITC-lectin-bound spinal microvessels were greatly enriched by fluorescence-activated cell sorter (FACS) purification. This technique allows for rapid (<1.5 h postmortem) isolation of spinal cord microvascular ECs (smvECs). The results from cell counting, reverse-transcription polymerase chain reaction (RT-PCR), and western blot analyses show a high degree of EC enrichment at mRNA and protein levels. Furthermore, a focused EC biology microarray analysis identified multiple mRNAs dramatically increased in the EC compartment 24 h after SCI, which is a time point associated with the pathologic loss of spinal vasculature. These included thrombospondin-1, CCL5/RANTES, and urokinase plasminogen activator, suggesting they may represent targets for therapeutic intervention. Furthermore, these novel methodologic approaches will likely facilitate the discovery of molecular regulators of endothelial dysfunction in a variety of central nervous system (CNS) disorders including stroke and other neurodegenerative diseases having a vascular component.


Assuntos
Endotélio Vascular/fisiopatologia , Perfilação da Expressão Gênica , Microcirculação/fisiologia , RNA Mensageiro/genética , Traumatismos da Medula Espinal/genética , Traumatismos da Medula Espinal/fisiopatologia , Medula Espinal/irrigação sanguínea , Transcrição Genética , Animais , Anexinas/genética , Endotélio Vascular/patologia , Feminino , Fibrinolisina/genética , Citometria de Fluxo , Regulação da Expressão Gênica , Imuno-Histoquímica , Camundongos , Camundongos Endogâmicos C57BL , Microcirculação/patologia , Análise de Sequência com Séries de Oligonucleotídeos , Lectinas de Plantas , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Trombospondinas/genética , Ativador de Plasminogênio Tipo Uroquinase/genética
13.
Br J Ophthalmol ; 92(8): 1017-25, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18614569

RESUMO

OBJECTIVE: To examine the evidence for an association between cognitive impairment or dementia and the presence of retinal microvascular abnormalities. METHODS: A systematic review of observational studies identified through searching five electronic databases and reference lists. Studies were required to have both a recognised cognitive function assessment (either a structured neuropsychological test or a clinical evaluation of dementia), and assessment of the retinal microvasculature (either characteristics associated with generalised retinopathy or changes specific to arterioles or venules). RESULTS: 6 studies were included. Studies were clinically and methodologically heterogeneous and of variable quality. Some degree of cognitive impairment was found to be associated with the presence of retinal microvascular abnormalities in all studies, although the extent of the association varied. The presence of retinal vascular signs was mostly associated with poorer verbal memory, mental speed and executive function in the general population, but not consistently associated with other cognitive modalities. CONCLUSIONS: There is some evidence suggesting a positive association between retinal microvascular abnormalities and cognitive impairment or dementia in elderly people and in patients with diabetes. Findings are inconclusive, and further better designed studies are required, with standardised and objective retinal vascular assessment and a range of sensitive cognitive tests.


Assuntos
Transtornos Cognitivos/complicações , Demência/complicações , Doenças Retinianas/complicações , Vasos Retinianos/patologia , Idoso , Transtornos Cognitivos/epidemiologia , Demência/epidemiologia , Feminino , Humanos , Masculino , Microcirculação/patologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Doenças Retinianas/epidemiologia , Terminologia como Assunto
15.
Nihon Kokyuki Gakkai Zasshi ; 46(6): 493-6, 2008 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-18592997

RESUMO

A 69-year-old man was admitted to our hospital with dyspnea on effort. A chest high resolution CT showed enlargement of peripheral vessels and small nodules in both lower and peripheral lung fields. We diagnosed this case as pulmonary tumor thrombotic microangiopathy, because histological findings of specimen obtained by transbronchial lung biopsy revealed microscopic tumor emboli and intimal proliferation in small pulmonary vessels. After conducting systemic examinations, it was found that the patient had gastric cancer. Generally it is difficult to diagnose pulmonary tumor thrombotic microangiopathy in patients during life. To the best of our knowledge, this is the first case of pulmonary tumor thronbotic microangiopthy diagnosed on the basis of transbronchial lung biopsy.


Assuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Biópsia/métodos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Pulmão/patologia , Células Neoplásicas Circulantes/patologia , Adenocarcinoma/patologia , Idoso , Humanos , Pulmão/irrigação sanguínea , Neoplasias Pulmonares/patologia , Masculino , Microcirculação/patologia , Neoplasias Gástricas/patologia , Tomografia Computadorizada por Raios X
16.
J Am Dent Assoc ; 139(7): 940-6, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18594080

RESUMO

BACKGROUND: Burning mouth syndrome (BMS) is an atypical orofacial algesic syndrome. The aim of the authors' research was to investigate the morphological characteristics of peripheral blood circulation in patients with BMS in comparison with those of the peripheral blood circulation in healthy people. METHODS: The authors examined 28 subjects, of whom 14 (10 women and four men) had BMS and 14 (nine women and five men) were healthy control subjects. They performed videocapillaroscopic examination with a capillaroscope with a fiber-optic probe at a magnification of x200, which allowed them to examine the morphological characteristics within the capillaroscopic area accurately. RESULTS: The capillaroscopic examination provided important diagnostic results regarding alterations of the local microcirculation in subjects with BMS when compared with healthy subjects. The results also showed a statistically significant increase in the diameter of the capillary ansae, afferent ansae and efferent ansae in subjects with BMS compared with subjects in the control group (P = .05). CONCLUSION AND CLINICAL IMPLICATIONS: The results revealed a vascular involvement in BMS. This information could improve the understanding of etiopathogenetic factors and aid in the development of therapeutic strategies for treating this disorder.


Assuntos
Síndrome da Ardência Bucal/patologia , Mucosa Bucal/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Capilares/patologia , Feminino , Tecnologia de Fibra Óptica/instrumentação , Gengiva/irrigação sanguínea , Humanos , Processamento de Imagem Assistida por Computador , Freio Labial/irrigação sanguínea , Masculino , Microcirculação/patologia , Angioscopia Microscópica/instrumentação , Microscopia de Vídeo/instrumentação , Pessoa de Meia-Idade , Fibras Ópticas , Língua/irrigação sanguínea
17.
Am J Pathol ; 173(2): 400-10, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18599605

RESUMO

Substance P (SP) regulates important intestinal functions, such as mucosal permeability, motility, chloride secretion, and inflammation via the neurokinin-1 receptor (NK-1R). Previous reports showed that vascularization and expression of angiogenic factors are evident in the colonic mucosa of rats with colitis and patients with inflammatory bowel disease. Here we determined whether SP is associated with angiogenesis. Human NCM460 colonocytes stably transfected with the human NK-1R (NCM460-NK-1R cells) and mice with dextran sodium sulfate-induced colitis were used. We found that expression of the angiogenic factor CCN1 was increased in the colons of patients with Crohn's disease and ulcerative colitis. Mucosal extracts from inflammatory bowel disease patients induced human intestinal microvascular endothelial cell migration that was inhibited by blockade of CCN1 and its receptor integrin alphavbeta3. Both the degree of angiogenesis and CCN1 expression were elevated in the colons of mice with dextran sodium sulfate-induced colitis, which was reduced by treatment with the NK-1R antagonist CJ-12255. SP also increased CCN1 expression in NCM460-NK-1R colonocytes. SP exposure to human intestinal microvascular endothelial cells co-cultured with NCM460-NK-1R cells induced angiogenic activity that was inhibited by CCN1 silencing. In addition, intracolonic overexpression of CCN1 induced angiogenesis in mouse colon. Thus, SP mediates angiogenesis via CCN1 during colitis.


Assuntos
Colite Ulcerativa/metabolismo , Proteínas Imediatamente Precoces/biossíntese , Peptídeos e Proteínas de Sinalização Intercelular/biossíntese , Receptores da Neurocinina-1/metabolismo , Substância P/fisiologia , Animais , Compostos Bicíclicos Heterocíclicos com Pontes/farmacologia , Movimento Celular , Colite Ulcerativa/induzido quimicamente , Colite Ulcerativa/patologia , Colo/irrigação sanguínea , Colo/patologia , Doença de Crohn/metabolismo , Doença de Crohn/patologia , Proteína Rica em Cisteína 61 , Sulfato de Dextrana , Células Endoteliais/fisiologia , Endotélio Vascular/patologia , Endotélio Vascular/fisiopatologia , Humanos , Proteínas Imediatamente Precoces/antagonistas & inibidores , Integrina alfaVbeta3/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microcirculação/patologia , Microcirculação/fisiopatologia , Neovascularização Patológica/metabolismo , Substância P/farmacologia
18.
Neurol Res ; 30(7): 697-700, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18631430

RESUMO

OBJECTIVE: Venous compression might be the main cause of incomplete decompression and symptom recurrence after microvascular decompression (MVD) in patients with trigeminal neuralgia. Although it can be killed in most cases, cutting the vein sometimes has the potential risk arising from venous congestion. To maneuver the vein safely, we introduced a temporary occlusion test of the vein. METHODS: Among 407 consecutive MVD cases, 48 (11.8%) offending and 157 block veins were encountered. The vein was cut directly in 147 (71.7%). Owing to the potential risk following killing of the vein, 58 (28.3%) patients underwent venous occlusion test with neurophysiologic monitoring during the operation. The temporal occlusion should be ceased immediately as soon as any changes in brainstem auditory evoked potential (BAEP) or trigeminal evoked potential (TEP) wave figuration turn up; otherwise, it would last for 15 minutes. RESULTS: The occlusion test was negative in 53 (91.4%), while positive in five patients (8.6%). According to the results, we cut the vein in test-negative patients, which made the operation easy and offered a satisfactory decompression. Among the five positive cases, the vein was finally saved in two and cut in three cases. Yet, all the three patients developed a severe ipsilateral cerebellar edema and brainstem shift after the vein was sacrificed. Despite those patients were reoperated on immediately for posterior fossa decompression, they remained equilibrium disorder with numbness in ipsilateral face and mind hemiparesis in contralateral extremities post-operatively. The residual two patients had an incomplete pain relief. CONCLUSION: This venous occlusion test could help the surgeon in making a right decision before manipulation of the petrosal veins during MVD.


Assuntos
Veias Cerebrais/cirurgia , Descompressão Cirúrgica/métodos , Microcirculação/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neuralgia do Trigêmeo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Edema Encefálico/etiologia , Edema Encefálico/fisiopatologia , Edema Encefálico/prevenção & controle , Infarto Cerebral/etiologia , Infarto Cerebral/fisiopatologia , Infarto Cerebral/prevenção & controle , Veias Cerebrais/patologia , Veias Cerebrais/fisiopatologia , Fossa Craniana Média/anatomia & histologia , Fossa Craniana Média/cirurgia , Cavidades Cranianas/anatomia & histologia , Descompressão Cirúrgica/efeitos adversos , Feminino , Humanos , Masculino , Microcirculação/patologia , Microcirculação/fisiopatologia , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/fisiopatologia , Hemorragia Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Aderências Teciduais/patologia , Aderências Teciduais/fisiopatologia , Aderências Teciduais/cirurgia , Resultado do Tratamento , Nervo Trigêmeo/irrigação sanguínea , Nervo Trigêmeo/fisiopatologia , Nervo Trigêmeo/cirurgia , Neuralgia do Trigêmeo/fisiopatologia , Insuficiência Venosa/etiologia , Insuficiência Venosa/fisiopatologia , Insuficiência Venosa/prevenção & controle
19.
Neurol Res ; 30(4): 341-3, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18544248

RESUMO

OBJECTIVE: To determine the ischemic lesions distribution and extension of patients with basilar artery thrombosis by the means of magnetic resonance imaging (MRI). METHODS: In 17 patients with thrombosis of the basilar artery, MRI was performed, including T2-weighted, magnetic resonance angiography (MRA) and diffusion-weighted imaging (DWI) sequences in the short-term phase (<48 hours). The shapes of ischemic lesions were obtained by graphic software and overlapped on a representative layer outline background. RESULTS: The MRA showed basilar artery occlusion in all cases and the DWI revealed different patterns of ischemic lesions. Most patients showed multiple lesions within the posterior circulation territory. Lesions more often occurred in pontes, cerebellums and mesencephalons than medullas, thalami and occipital lobes. Basilar pons, cerebral crus and cerebellum hemisphere were more susceptible than pontine tegmentum, vermis, midbrain tegmentum and tectum. CONCLUSIONS: When the basilar artery is occluded, basilar pons, cerebral crus and cerebellum hemisphere were most susceptible. The branches with smaller lumen of basilar artery, which are easier to be affected, are thought to be the cause of such a phenomenon.


Assuntos
Artéria Basilar/patologia , Infartos do Tronco Encefálico/patologia , Tronco Encefálico/patologia , Cerebelo/patologia , Imagem por Ressonância Magnética/métodos , Insuficiência Vertebrobasilar/patologia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Basilar/fisiopatologia , Tronco Encefálico/irrigação sanguínea , Tronco Encefálico/fisiopatologia , Infartos do Tronco Encefálico/fisiopatologia , Cerebelo/irrigação sanguínea , Cerebelo/fisiopatologia , Circulação Cerebrovascular/fisiologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Angiografia por Ressonância Magnética/métodos , Masculino , Microcirculação/patologia , Microcirculação/fisiopatologia , Pessoa de Meia-Idade , Vias Neurais/irrigação sanguínea , Vias Neurais/patologia , Vias Neurais/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Fatores de Tempo , Insuficiência Vertebrobasilar/fisiopatologia
20.
Brain ; 131(Pt 7): 1903-11, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18515869

RESUMO

Sensory disturbances are part of the clinical picture of Parkinson's disease. Abnormalities in sensory processing, through a basal ganglia involvement, are thought to be responsible for the sensory dysfunction since sensory nerve conduction velocity (NCV) is usually normal. However, NCV does not examine small fibres or terminal endings of large sensory fibres, whereas skin biopsy is more suitable for these purposes. To evaluate peripheral sensory nerves in Parkinson's disease, we studied cutaneous free and encapsulated sensory nerve endings in 18 patients and 30 healthy controls using 3-mm punch biopsies from glabrous and hairy skin. Ten patients had additional skin biopsies from the contralateral side. Further evaluation included NCV and Quantitative Sensory Testing. Parkinson's disease patients showed a significant increase in tactile and thermal thresholds (P < 0.01), a significant reduction in mechanical pain perception (P < 0.01) and significant loss of epidermal nerve fibres (ENFs) and Meissner corpuscles (MCs) (P < 0.01). In patients with bilateral biopsies, loss of pain perception and ENFs was higher on the more affected side (P < 0.01). We found evidence suggesting attempts at counteracting degenerative processes as increased branching, sprouting of nerves and enlargement of the vascular bed. Morphological and functional findings did not correlate with age or disease duration. Disease severity correlated with loss of MCs and reduction in cold perception and pain perception. We demonstrated a peripheral deafferentation in Parkinson's disease that could play a major role in the pathogenesis of the sensory dysfunction.


Assuntos
Doença de Parkinson/complicações , Doenças do Sistema Nervoso Periférico/etiologia , Transtornos das Sensações/etiologia , Pele/inervação , Idoso , Biópsia , Feminino , Humanos , Masculino , Mecanorreceptores/patologia , Microcirculação/patologia , Microscopia Confocal , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Fibras Nervosas Mielinizadas/patologia , Condução Nervosa , Medição da Dor/métodos , Limiar da Dor , Doença de Parkinson/patologia , Doença de Parkinson/fisiopatologia , Doenças do Sistema Nervoso Periférico/patologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Transtornos das Sensações/patologia , Transtornos das Sensações/fisiopatologia , Limiar Sensorial , Pele/irrigação sanguínea
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