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Impaired purinergic neurotransmission to mesenteric arteries in salt-sensitive hypertensionDemel, Stacie Leigh. January 2008 (has links)
Thesis (Ph. D.)--Michigan State University. Neuroscience, 2008. / Title from PDF t.p. (Proquest, viewed on Aug. 17, 2009) Includes bibliographical references (p. 202-230). Also issued in print.
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On acute thrombo-embolic occlusion of the superior mesenteric artery /Acosta, Stefan, January 2004 (has links)
Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 6 uppsatser.
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Consequências da presença de periodontite induzida por ligadura em ratos sobre a resposta vaso motora in vitro de anéis de artéria mesentérica. / Consequences in the presence of ligature-induced periodontitis in rats on \"in vitro\" vasomotor response of mesenteric artery rings.Jesus, Flávia Neto de 14 April 2014 (has links)
A destruição crônica do aparato periodontal devido a resposta inflamatória a bactérias, leva a um quadro clínico conhecido como doença periodontal. Patógenos periodontais podem ser translocados e liberados do sulco gengival à circulação sanguínea e apresentar efeitos periféricos. A bolsa periodontal também é importante reservatório de mediadores inflamatórios. A periodontite pode apresentar efeitos em órgãos distantes. Estudos passaram a documentar a relação entre doença periodontal e disfunção endotelial, reversível pelo tratamento odontológico. Nosso laboratório estudou a resposta vasomotora in vitro de anéis de aorta de ratos com periodontite, e os resultados preliminares mostram um aumento da resposta contrátil destes anéis à norepinefrina, quando comparado aos animais controle. O presente estudo objetiva avaliar a influência da periodontite induzida por ligadura em ratos sobre a resposta vasomotora in vitro de anéis de artéria mesentérica. Ainda, caracterizar os mediadores envolvidos, com ênfase nas enzimas ciclooxigenase e óxido nítrico sintase. / Chronic destruction of periodontal apparatus due to an intense inflammatory response to bacteria leads to a clinical condition known as periodontal disease. Periodontal pathogens can then translocate to the gingival sulcus and reach the bloodstream, and thus have peripheral effects. The periodontal pocket is also an important reservoir of inflammatory mediators. The periodontitis may have effects on organs distant. Studies have also documented the relationship between periodontal disease and endothelial dysfunction, which was reversible by dental treatment. In our laboratory we are studying the vasomotor response \"in vitro\" of aortic rings from rats with periodontitis, and the preliminary results show an increase in the contractile response of the rings to norepinephrine, when compared with control animals. This project aims to evaluate the influence of ligature-induced periodontitis in rats on the \"in vitro\" vascular reactivity of mesenteric artery vessels. Also, the characterization of the mediators involved, with emphasis on the enzyme of cyclooxygenase and nitric oxide synthase.
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Efeitos do tratamento crônico com fluoxetina na reatividade da artéria mesentérica de resistência e no leito arterial mesentérico isolado de ratos / Effects of chronic treatment with fluoxetine on the reactivity of mesenteric resistance arteries and mesenteric arterial bed isolated from ratsPereira, Camila André 03 June 2014 (has links)
A fluoxetina, fármaco inibidor seletivo da recaptação de serotonina (ISRS), tem sido amplamente utilizada no tratamento da depressão. Este antidepressivo possui diversos efeitos sobre o sistema cardiovascular podendo alterar a função cardíaca e a inibição da função de diversos receptores e canais iônicos diretamente envolvidos na regulação do tônus vasomotor. Crestani et al. (2011) demonstraram que ratos tratados cronicamente com fluoxetina exibem aumento da pressão arterial e redução do componente simpático do baroreflexo. Estes resultados sugerem aumento do tônus vasomotor e desequilíbrio de fatores responsáveis por sua regulação. A hipótese do trabalho é que o tratamento crônico com fluoxetina aumentará a reatividade vascular a estímulos contráteis e diminuirá para estímulos relaxantes. Portanto o objetivo do presente trabalho foi investigar se o tratamento crônico com fluoxetina promove alterações de reatividade no leito mesentérico arterial isolado de ratos e em artérias mesentéricas isoladas. Foram utilizados ratos Wistar (230-270 gr) divididos em 2 grupos: (I) veículo (água por 21 dias) e (II) fluoxetina crônico (fluoxetina 10 mg/kg/dia por 21 dias na água de beber). Protocolos de reatividade vascular da artéria mesentérica de resistência e do leito arterial mesentérico (LAM), de expressão gênica e proteica de componentes das vias de sinalização envolvidos nestas respostas foram realizados. O tratamento crônico com fluoxetina promoveu redução da resposta contrátil a fenilefrina. Este resultado foi associado a uma menor expressão de tirosina hidroxilase e recaptação de noradrenalina nas terminações simpáticas do LAM. A sinalização da ERK1/2 também foi diminuída. Em contraste, houve aumento da resposta contrátil ao cloreto de potássio, sem alteração da contração a estimulação elétrica periarterial. O tratamento com fluoxetina promoveu ainda aumento de óxido nítrico (NO), maior fosforilação do resíduo serina1177 da eNOS e sensibilidade dos canais para K+ ativados por ATP (KATP). Em conclusão, a fluoxetina promove redução da resposta contrátil no LAM devido ao aumento de NO e participação de canais para K+. Além disso, a regulação negativa da liberação de noradrenalina e da sinalização da ERK1/2 pode contribuir para a menor resposta contrátil no músculo liso vascular. O aumento da resposta relaxante na artéria mesentérica de resistência pode ser mediado pelo aumento de NO, maior fosforilação da eNOS e ativação de canais para KATP . / Fluoxetine, a selective serotonin reuptake inhibitor (SSRI) drug, has been widely used in the treatment of depression. This antidepressant has several effects on the cardiovascular system and may alter cardiac function and also inhibits the function of several receptors and ion channels directly involved in the regulation of vasomotor tone. Crestani et al. (2011) reported that rats chronically treated with fluoxetine exhibit increased blood pressure and reduced sympathetic component of the baroreflex. These results suggest increased vasomotor tone and imbalance of factors responsible for its regulation. We hypothesize that the chronic treatment with fluoxetine will increase vascular reactivity to contractile stimulus and will reduce to relaxant stimulus. Therefore the objective of this study was to investigate whether chronic treatment with fluoxetine promotes changes on the reactivity of isolated mesenteric arterial bed and resistance mesenteric arteries from rats. Wistar rats (230-270 g) were used and divided in two groups: (I) vehicle (water for 21 days) and (II) chronic fluoxetine (fluoxetine 10 mg/ kg/ day for 21 days in drinking water). Protocols of vascular reactivity were performed on resistance mesenteric arteries and mesenteric arterial bed (MAB). In addition, gene and protein expression of the signaling pathways involved in these responses was evaluated. Chronic treatment with fluoxetine decreased contractile response to phenylephrine. This result was associated with reduced tyrosine hydroxylase expression as well as noradrenaline (NA) reuptake in MAB sympathetic nerve endings. Similarly, ERK 1/2 signaling was decreased. In contrast, fluoxetine treatment increased contractile response to potassium chloride (KCl) without changing the electric field stimulation-(EFS)-induced contraction. Fluoxetine treatment also increased nitric oxide (NO), the phosphorylation levels of eNOS at serine1177 residue and KATP channels sensitivity. In conclusion, fluoxetine promotes reduction of the contractile response in MAB due to increase in NO and K+ channels contribution. In addition, negative regulation of NA release and ERK 1/2 signaling may contribute to decrease smooth muscle contractile response. Increased resistance mesenteric artery relaxant response may be mediated by increased NO, eNOS phosphorylation and KATP channels activation.
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Efeitos do tratamento crônico com fluoxetina na reatividade da artéria mesentérica de resistência e no leito arterial mesentérico isolado de ratos / Effects of chronic treatment with fluoxetine on the reactivity of mesenteric resistance arteries and mesenteric arterial bed isolated from ratsCamila André Pereira 03 June 2014 (has links)
A fluoxetina, fármaco inibidor seletivo da recaptação de serotonina (ISRS), tem sido amplamente utilizada no tratamento da depressão. Este antidepressivo possui diversos efeitos sobre o sistema cardiovascular podendo alterar a função cardíaca e a inibição da função de diversos receptores e canais iônicos diretamente envolvidos na regulação do tônus vasomotor. Crestani et al. (2011) demonstraram que ratos tratados cronicamente com fluoxetina exibem aumento da pressão arterial e redução do componente simpático do baroreflexo. Estes resultados sugerem aumento do tônus vasomotor e desequilíbrio de fatores responsáveis por sua regulação. A hipótese do trabalho é que o tratamento crônico com fluoxetina aumentará a reatividade vascular a estímulos contráteis e diminuirá para estímulos relaxantes. Portanto o objetivo do presente trabalho foi investigar se o tratamento crônico com fluoxetina promove alterações de reatividade no leito mesentérico arterial isolado de ratos e em artérias mesentéricas isoladas. Foram utilizados ratos Wistar (230-270 gr) divididos em 2 grupos: (I) veículo (água por 21 dias) e (II) fluoxetina crônico (fluoxetina 10 mg/kg/dia por 21 dias na água de beber). Protocolos de reatividade vascular da artéria mesentérica de resistência e do leito arterial mesentérico (LAM), de expressão gênica e proteica de componentes das vias de sinalização envolvidos nestas respostas foram realizados. O tratamento crônico com fluoxetina promoveu redução da resposta contrátil a fenilefrina. Este resultado foi associado a uma menor expressão de tirosina hidroxilase e recaptação de noradrenalina nas terminações simpáticas do LAM. A sinalização da ERK1/2 também foi diminuída. Em contraste, houve aumento da resposta contrátil ao cloreto de potássio, sem alteração da contração a estimulação elétrica periarterial. O tratamento com fluoxetina promoveu ainda aumento de óxido nítrico (NO), maior fosforilação do resíduo serina1177 da eNOS e sensibilidade dos canais para K+ ativados por ATP (KATP). Em conclusão, a fluoxetina promove redução da resposta contrátil no LAM devido ao aumento de NO e participação de canais para K+. Além disso, a regulação negativa da liberação de noradrenalina e da sinalização da ERK1/2 pode contribuir para a menor resposta contrátil no músculo liso vascular. O aumento da resposta relaxante na artéria mesentérica de resistência pode ser mediado pelo aumento de NO, maior fosforilação da eNOS e ativação de canais para KATP . / Fluoxetine, a selective serotonin reuptake inhibitor (SSRI) drug, has been widely used in the treatment of depression. This antidepressant has several effects on the cardiovascular system and may alter cardiac function and also inhibits the function of several receptors and ion channels directly involved in the regulation of vasomotor tone. Crestani et al. (2011) reported that rats chronically treated with fluoxetine exhibit increased blood pressure and reduced sympathetic component of the baroreflex. These results suggest increased vasomotor tone and imbalance of factors responsible for its regulation. We hypothesize that the chronic treatment with fluoxetine will increase vascular reactivity to contractile stimulus and will reduce to relaxant stimulus. Therefore the objective of this study was to investigate whether chronic treatment with fluoxetine promotes changes on the reactivity of isolated mesenteric arterial bed and resistance mesenteric arteries from rats. Wistar rats (230-270 g) were used and divided in two groups: (I) vehicle (water for 21 days) and (II) chronic fluoxetine (fluoxetine 10 mg/ kg/ day for 21 days in drinking water). Protocols of vascular reactivity were performed on resistance mesenteric arteries and mesenteric arterial bed (MAB). In addition, gene and protein expression of the signaling pathways involved in these responses was evaluated. Chronic treatment with fluoxetine decreased contractile response to phenylephrine. This result was associated with reduced tyrosine hydroxylase expression as well as noradrenaline (NA) reuptake in MAB sympathetic nerve endings. Similarly, ERK 1/2 signaling was decreased. In contrast, fluoxetine treatment increased contractile response to potassium chloride (KCl) without changing the electric field stimulation-(EFS)-induced contraction. Fluoxetine treatment also increased nitric oxide (NO), the phosphorylation levels of eNOS at serine1177 residue and KATP channels sensitivity. In conclusion, fluoxetine promotes reduction of the contractile response in MAB due to increase in NO and K+ channels contribution. In addition, negative regulation of NA release and ERK 1/2 signaling may contribute to decrease smooth muscle contractile response. Increased resistance mesenteric artery relaxant response may be mediated by increased NO, eNOS phosphorylation and KATP channels activation.
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Cytomegalovirus and Vascular Function During PregnancyGombos, Randi B Unknown Date
No description available.
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Regulation of venular hydraulic conductivity by estradiolHouston, Sonia A., January 2002 (has links)
Thesis (Ph. D.)--University of Missouri--Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 132-150). Also available on the Internet.
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Minimally Invasive Approach to Vascular Compression of The DuodenumAhmed, Aws E., Strand, Matthew S., Iannitti, David A. 25 April 2023 (has links)
Complete or partial obstruction of the duodenum by the superior mesenteric artery (SMA) is a rare cause of bowel obstruction. SMA syndrome results from the compression of the 3rd part of the duodenum between the superior mesenteric artery and the abdominal aorta. Causes include anatomical variation in the superior mesenteric artery, trauma, burns, surgeries, malignancy, and rapid weight loss. Diagnosis of SMA syndrome in patients may be difficult, as the clinical findings often resemble other forms of small bowel obstructions. This syndrome was first described in the literature by Carl Freiherr von Rokitansky in 1861. Subsequently, David Wilke provided a comprehensive description of the disease in a series of 75 patients. There has been skepticism about the existence of SMA syndrome due to scant literature reports and non-specific symptomatology. However, modern cross-sectional imaging has confirmed the existence of this rare syndrome. Here we present the case of a 50-year-old female with longstanding symptoms of gastrointestinal discomfort, weight loss, nausea, and vomiting. She underwent an exhaustive gastrointestinal workup until a diagnosis of SMA syndrome was made. We elected to proceed with a minimally invasive three-port laparoscopic, trans-mesenteric side-to-side duodenojejunostomy. The patient was discharged on postoperative day one after tolerating a regular diet. On one month follow-up, our patient reported improvement in symptoms with no postprandial pain or nausea and normal bowel movements. In conclusion, we report a case of superior mesenteric artery syndrome in a patient with recurrent abdominal pain and nausea. CT scan has the highest sensitivity for the diagnosis of SMA syndrome, findings suggestive of the diagnosis include an abnormal aortomesenteric angle and distance. While supplemental tube feeds and gastric drainage may resolve the condition without the need for surgery, this often takes many weeks to months to be effective. Minimally invasive surgical bypass is an attractive option because of the rapidity of symptom resolution, lack of need for long-term invasive tubes, short inpatient length of stay, and high success rate.
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Estudo da maturação da resposta vascular da artéria mesentérica superior em recém-nascidos prematuros através do dopplerfluxometria / Evolution of superior mesenteric artery blood flow by means of doppler velocimetry in health premature neonatesChia, Chang Yin 16 April 2009 (has links)
INTRODUÇÃO: O conhecimento de valores de normalidade do fluxo sanguíneo da artéria mesentérica superior (AMS) em recém-nascidos prematuros (RNPT) saudáveis pode prevenir quadros de intolerância alimentar e a ocorrência da enterocolite necrosante. MÉTODOS: Com o objetivo de descrever a evolução dos índices de avaliação da dopplerfluxometria da AMS em RNPT saudáveis de idade gestacional entre 27 e 34 semanas completas, no primeiro, no terceiro, no sétimo e semanalmente (14, 21, 28, 35 e 42 dias de vida), foi realizado este estudo coorte prospectivo em RNPT de idade gestacional ao nascimento entre 27 e 34 semanas completas. O exame dopplerfluxométrico foi realizado, após o consentimento livre e esclarecido dos responsáveis pelos RNPT, através do aparelho Logic Book 8C-RS (General Eletric EUA); obtendo-se as seguintes medidas: pico de velocidade sistólica (PVS), pico de velocidade diastólica final (PVDF) e média de velocidade de fluxo; sendo, após, calculadas o Índice de Pourcelot, sendo: [pico de velocidade sistólico pico diastólico final] / pico de velocidade sistólico, que representa um índice de resistência (IR); e índice de pulsatilidade (IP). Foram excluídos: recém-nascidos com instabilidade hemodinâmica; em ventilação assistida com altos parâmetros; síndromes mal-formativas; intolerância alimentar ou enterocolite necrosante; fototerapia; presença de cateteres umbilicais, persistência de canal arterial e pequenos para a idade gestacional. O exame pré-prandial foi realizado antes da alimentação (até 30 minutos) e pós-prandial entre 15 e 60 minutos após a alimentação. Foram realizados no primeiro dia (entre 6 a 24 horas de vida), no terceiro, no sétimo, e após, semanalmente até 42 dias de vida. Os resultados foram expressos em médias e desvios-padrão e descritos de maneira evolutiva. RESULTADOS: Ao total, foram estudados 77 RNPT e realizados 125 exames. Os valores em média±desvio-padrão são descritos na seqüência do primeiro, terceiro, sétimo e, consecutivamente a cada semana, até 42 dias de vida; sendo: IR pré-prandial de 0,69±0,09; 0,67±0,15; 0,75±0,07; 0,74±0,07; 0,75±0,07; 0,76±0,07; 0,79±0,03; 0,78±0,05 e IR pós-prandial de 0,66±0,10; 0,70±0,21; 0,74±0,07; 0,73±0,08; 0,75±0,06; 0,76±0,06; 0,77±0,04; 0,77±0,03. Os resultados de IP pré-prandial foram: 1,45±0,30; 1,35±0,28; 1,68±0,29; 1,50±0,23; 1,47±0,22; 1,52±0,20; 1,62±0,09; 1,68±0,06 e IP pós-prandial: 1,38±0,39; 1,40±0,29; 1,58±0,26; 1,46±0,26; 1,45±0,24; 1,50±0,27; 1,58±0,10; 1,64±0,04. Obtivemos PVS pré-prandial: 60,51±22,24; 55,24±26,04; 90,61±12,74; 95,33±18,11; 92,89±15,40; 96,96±12,18; 63,18±14,08; 58,12±9,78 e pós-prandial: 59,60±24,14; 110,82±32,45; 118,10±20,15; 121,95±24,18; 124,15±25,16; 126,07±18,17; 96,68±11,12; 96,12±8,98. Quanto a PVDF pré-prandial, obtivemos: 18,85±6,09; 18,66±10,01; 20,99±8,12; 22,02±8,50; 23,04±7,89; 22,24±8,02; 11,99±6,15; 12,05±5,12 e PVDF pós-prandial: 20,63±6,89; 30,15±12,78; 27,98±9,72; 29,02±10,05; 34,56±9,00; 32,02±8,45; 19,02±4,95; 21,15±3,43. A partir dos resultados acima, demonstra-se que o fluxo sanguíneo da AMS em RNPT saudáveis apresenta uma evolução peculiar a partir do nascimento tanto dos valores basais quanto após a estimulação com a dieta, representados por uma evolução característica dos índices de resistência, melhora dos picos de velocidades sistólica e diastólica e melhora da resposta vasodilatadora após a alimentação enteral. CONCLUSÕES: RNPT saudáveis de idade gestacional ao nascimento de 27 a 34 semanas completas apresentam uma evolução do fluxo sanguíneo da artéria mesentérica superior de maneira peculiar, do nascimento até 42 dias de vida, tanto dos valores basais quanto em resposta à alimentação. O conhecimento destes valores pode indicar a dopplerfluxometria como um método preventivo de avaliação específico de cada RNPT para a introdução e progressão mais segura da alimentação, reduzindo a ocorrência de quadros gastrintestinais, melhorando os índices de morbi-mortalidade neonatal. / INTRODUCTION: The knowledge of the normal values of indices of Doppler velocimetry of the superior mesenteric artery in healthy premature neonates may help to prevent feeding intolerance situations and necrotizing enterocolitis. METHODS: In order to describe the indices for evaluation of Doppler velocimetry of the superior mesenteric artery in healthy premature neonates with gestational age between 27 and 34 weeks, on the first, third, seventh days, and then weekly, until six weeks of life; this is a prospective cohort study. The Doppler velocimetric examination was done by means of the Logic Book 8C-RS (General Electric USA), using a 8 MHz imaging transducer, with the pulsed color Doppler readings being obtained by sonographic waves at 4 MHz. The neonate was kept in a supine position, with the transducer positioned in the epigastric region, immediately below the xyphoid appendix, obtaining two-dimensional images of the celiac trunk and of the superior mesenteric artery, a few millimeters after its emergence from the aorta in the sagittal plane. The flux measurements were obtained in the longitudinal direction of the vessel and at an angle of insonation between 0 and 20 degrees. The blood flow curves were recorded after a sequence of five stable measurements, with respect to the quality of the waves, and with respect to their audible characteristics; thus obtaining the following measurements: peak systolic velocity (PSV), end diastolic velocity (EDV) and average flow velocity; with the Pourcelot Index being calculated subsequently, that is: [peak of systolic velocity end diastolic velocity / peak of systolic velocity, which represents a resitance index (RI); and pulsatility index (PI). The values obtained were expressed as averages and standard deviations. The results were stored in an Excel database, with blind analysis after the conclusion of data gathering. Uncomplicated and appropriate for gestational age premature neonates with gestational age between 27 and 34 weeks at birth were included in the study. We adopted as criteria for exclusion from the study: neonates in unstable hemodynamic conditions; needing assisted ventilation with high parameters; large deformations or clinical syndromes; feeding intolerance or diagnosis of necrotizing enterocolitis; conditions that alter the mesenteric flow, such as: phototherapy, presence of umbilical catheters, patent ductus arteriosus and sepsis. The exams were done prior to feeding (up to 30 minutes) and after feeding (between 15 and 60 minutes). If the neonate was fasting, only one of the above parameters was measured, in order to establish behavior of the basal mesenteric flow at that moment. The exams were done on the first day (between the 6th and 24th hours of life), third, seventh days, and then weekly, until six weeks of life. Data are shown as the mean ± standard deviation and described for each postnatal age group. RESULTS: A total of 77 neonates were studied and realized 125 exams. The values of the resistance and pulsatility indices (RI and PI); peaks of systolic (PSV) and final diastolic velocity (EDV) on the first, third, seventh days, and then, on sequentially for each week until six weeks of postnatal life; as mean and standard deviations, was described: RI prior to feeding were 0,69±0,09; 0,67±0,15; 0,75±0,07; 0,74±0,07; 0,75±0,07; 0,76±0,07; 0,79±0,03; 0,78±0,05 and RI after feeding were 0,66±0,10; 0,70±0,21; 0,74±0,07; 0,73±0,08; 0,75±0,06; 0,76±0,06; 0,77±0,04; 0,77±0,03. The results of PI prior to feeding: 1,45±0,30; 1,35±0,28; 1,68±0,29; 1,50±0,23; 1,47±0,22; 1,52±0,20; 1,62±0,09; 1,68±0,06 and PI after feeding: 1,38±0,39; 1,40±0,29; 1,58±0,26; 1,46±0,26; 1,45±0,24; 1,50±0,27; 1,58±0,10; 1,64±0,04. The values of PSV prior to feeding were: 60,51±22,24; 55,24±26,04; 90,61±12,74; 95,33±18,11; 92,89±15,40; 96,96±12,18; 63,18±14,08; 58,12±9,78 and after feeding: 59,60±24,14; 110,82±32,45; 118,10±20,15; 121,95±24,18; 124,15±25,16; 126,07±18,17; 96,68±11,12; 96,12±8,98. And the results of EDV prior to feeding: 18,85±6,09; 18,66±10,01; 20,99±8,12; 22,02±8,50; 23,04±7,89; 22,24±8,02; 11,99±6,15; 12,05±5,12 and EDV after feeding: 20,63±6,89; 30,15±12,78; 27,98±9,72; 29,02±10,05; 34,56±9,00; 32,02±8,45; 19,02±4,95; 21,15±3,43. These results shows that healthy premature neonates with gestational age between 27 and 34 weeks presents a peculiar evolution in blood flow in the superior mesenteric artery after birth, represented by the resistance patterns caracteristics, improvement in peaks of systolic and diastolic velocity, and improvement in vasodilation in response to feeding. CONCLUSION: These results suggest for the Doppler velocimetry as specific and preventive evaluation method for each premature neonate, as a way to a safer introduction and progression of feeding, reducing the prevalence of gastrointestinal inflammatory diseases in neonates, and improving the indices of neonatal morbidity and mortality. Knowledge of blood-flow velocity in the superior mesenteric artery in uncomplicated preterm infants might provide a clue in investigating the maturation of intestinal circulation and the pathogenesis or pathophysiology of gastrointestinal diseases in newborn infants.
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Estudo da maturação da resposta vascular da artéria mesentérica superior em recém-nascidos prematuros através do dopplerfluxometria / Evolution of superior mesenteric artery blood flow by means of doppler velocimetry in health premature neonatesChang Yin Chia 16 April 2009 (has links)
INTRODUÇÃO: O conhecimento de valores de normalidade do fluxo sanguíneo da artéria mesentérica superior (AMS) em recém-nascidos prematuros (RNPT) saudáveis pode prevenir quadros de intolerância alimentar e a ocorrência da enterocolite necrosante. MÉTODOS: Com o objetivo de descrever a evolução dos índices de avaliação da dopplerfluxometria da AMS em RNPT saudáveis de idade gestacional entre 27 e 34 semanas completas, no primeiro, no terceiro, no sétimo e semanalmente (14, 21, 28, 35 e 42 dias de vida), foi realizado este estudo coorte prospectivo em RNPT de idade gestacional ao nascimento entre 27 e 34 semanas completas. O exame dopplerfluxométrico foi realizado, após o consentimento livre e esclarecido dos responsáveis pelos RNPT, através do aparelho Logic Book 8C-RS (General Eletric EUA); obtendo-se as seguintes medidas: pico de velocidade sistólica (PVS), pico de velocidade diastólica final (PVDF) e média de velocidade de fluxo; sendo, após, calculadas o Índice de Pourcelot, sendo: [pico de velocidade sistólico pico diastólico final] / pico de velocidade sistólico, que representa um índice de resistência (IR); e índice de pulsatilidade (IP). Foram excluídos: recém-nascidos com instabilidade hemodinâmica; em ventilação assistida com altos parâmetros; síndromes mal-formativas; intolerância alimentar ou enterocolite necrosante; fototerapia; presença de cateteres umbilicais, persistência de canal arterial e pequenos para a idade gestacional. O exame pré-prandial foi realizado antes da alimentação (até 30 minutos) e pós-prandial entre 15 e 60 minutos após a alimentação. Foram realizados no primeiro dia (entre 6 a 24 horas de vida), no terceiro, no sétimo, e após, semanalmente até 42 dias de vida. Os resultados foram expressos em médias e desvios-padrão e descritos de maneira evolutiva. RESULTADOS: Ao total, foram estudados 77 RNPT e realizados 125 exames. Os valores em média±desvio-padrão são descritos na seqüência do primeiro, terceiro, sétimo e, consecutivamente a cada semana, até 42 dias de vida; sendo: IR pré-prandial de 0,69±0,09; 0,67±0,15; 0,75±0,07; 0,74±0,07; 0,75±0,07; 0,76±0,07; 0,79±0,03; 0,78±0,05 e IR pós-prandial de 0,66±0,10; 0,70±0,21; 0,74±0,07; 0,73±0,08; 0,75±0,06; 0,76±0,06; 0,77±0,04; 0,77±0,03. Os resultados de IP pré-prandial foram: 1,45±0,30; 1,35±0,28; 1,68±0,29; 1,50±0,23; 1,47±0,22; 1,52±0,20; 1,62±0,09; 1,68±0,06 e IP pós-prandial: 1,38±0,39; 1,40±0,29; 1,58±0,26; 1,46±0,26; 1,45±0,24; 1,50±0,27; 1,58±0,10; 1,64±0,04. Obtivemos PVS pré-prandial: 60,51±22,24; 55,24±26,04; 90,61±12,74; 95,33±18,11; 92,89±15,40; 96,96±12,18; 63,18±14,08; 58,12±9,78 e pós-prandial: 59,60±24,14; 110,82±32,45; 118,10±20,15; 121,95±24,18; 124,15±25,16; 126,07±18,17; 96,68±11,12; 96,12±8,98. Quanto a PVDF pré-prandial, obtivemos: 18,85±6,09; 18,66±10,01; 20,99±8,12; 22,02±8,50; 23,04±7,89; 22,24±8,02; 11,99±6,15; 12,05±5,12 e PVDF pós-prandial: 20,63±6,89; 30,15±12,78; 27,98±9,72; 29,02±10,05; 34,56±9,00; 32,02±8,45; 19,02±4,95; 21,15±3,43. A partir dos resultados acima, demonstra-se que o fluxo sanguíneo da AMS em RNPT saudáveis apresenta uma evolução peculiar a partir do nascimento tanto dos valores basais quanto após a estimulação com a dieta, representados por uma evolução característica dos índices de resistência, melhora dos picos de velocidades sistólica e diastólica e melhora da resposta vasodilatadora após a alimentação enteral. CONCLUSÕES: RNPT saudáveis de idade gestacional ao nascimento de 27 a 34 semanas completas apresentam uma evolução do fluxo sanguíneo da artéria mesentérica superior de maneira peculiar, do nascimento até 42 dias de vida, tanto dos valores basais quanto em resposta à alimentação. O conhecimento destes valores pode indicar a dopplerfluxometria como um método preventivo de avaliação específico de cada RNPT para a introdução e progressão mais segura da alimentação, reduzindo a ocorrência de quadros gastrintestinais, melhorando os índices de morbi-mortalidade neonatal. / INTRODUCTION: The knowledge of the normal values of indices of Doppler velocimetry of the superior mesenteric artery in healthy premature neonates may help to prevent feeding intolerance situations and necrotizing enterocolitis. METHODS: In order to describe the indices for evaluation of Doppler velocimetry of the superior mesenteric artery in healthy premature neonates with gestational age between 27 and 34 weeks, on the first, third, seventh days, and then weekly, until six weeks of life; this is a prospective cohort study. The Doppler velocimetric examination was done by means of the Logic Book 8C-RS (General Electric USA), using a 8 MHz imaging transducer, with the pulsed color Doppler readings being obtained by sonographic waves at 4 MHz. The neonate was kept in a supine position, with the transducer positioned in the epigastric region, immediately below the xyphoid appendix, obtaining two-dimensional images of the celiac trunk and of the superior mesenteric artery, a few millimeters after its emergence from the aorta in the sagittal plane. The flux measurements were obtained in the longitudinal direction of the vessel and at an angle of insonation between 0 and 20 degrees. The blood flow curves were recorded after a sequence of five stable measurements, with respect to the quality of the waves, and with respect to their audible characteristics; thus obtaining the following measurements: peak systolic velocity (PSV), end diastolic velocity (EDV) and average flow velocity; with the Pourcelot Index being calculated subsequently, that is: [peak of systolic velocity end diastolic velocity / peak of systolic velocity, which represents a resitance index (RI); and pulsatility index (PI). The values obtained were expressed as averages and standard deviations. The results were stored in an Excel database, with blind analysis after the conclusion of data gathering. Uncomplicated and appropriate for gestational age premature neonates with gestational age between 27 and 34 weeks at birth were included in the study. We adopted as criteria for exclusion from the study: neonates in unstable hemodynamic conditions; needing assisted ventilation with high parameters; large deformations or clinical syndromes; feeding intolerance or diagnosis of necrotizing enterocolitis; conditions that alter the mesenteric flow, such as: phototherapy, presence of umbilical catheters, patent ductus arteriosus and sepsis. The exams were done prior to feeding (up to 30 minutes) and after feeding (between 15 and 60 minutes). If the neonate was fasting, only one of the above parameters was measured, in order to establish behavior of the basal mesenteric flow at that moment. The exams were done on the first day (between the 6th and 24th hours of life), third, seventh days, and then weekly, until six weeks of life. Data are shown as the mean ± standard deviation and described for each postnatal age group. RESULTS: A total of 77 neonates were studied and realized 125 exams. The values of the resistance and pulsatility indices (RI and PI); peaks of systolic (PSV) and final diastolic velocity (EDV) on the first, third, seventh days, and then, on sequentially for each week until six weeks of postnatal life; as mean and standard deviations, was described: RI prior to feeding were 0,69±0,09; 0,67±0,15; 0,75±0,07; 0,74±0,07; 0,75±0,07; 0,76±0,07; 0,79±0,03; 0,78±0,05 and RI after feeding were 0,66±0,10; 0,70±0,21; 0,74±0,07; 0,73±0,08; 0,75±0,06; 0,76±0,06; 0,77±0,04; 0,77±0,03. The results of PI prior to feeding: 1,45±0,30; 1,35±0,28; 1,68±0,29; 1,50±0,23; 1,47±0,22; 1,52±0,20; 1,62±0,09; 1,68±0,06 and PI after feeding: 1,38±0,39; 1,40±0,29; 1,58±0,26; 1,46±0,26; 1,45±0,24; 1,50±0,27; 1,58±0,10; 1,64±0,04. The values of PSV prior to feeding were: 60,51±22,24; 55,24±26,04; 90,61±12,74; 95,33±18,11; 92,89±15,40; 96,96±12,18; 63,18±14,08; 58,12±9,78 and after feeding: 59,60±24,14; 110,82±32,45; 118,10±20,15; 121,95±24,18; 124,15±25,16; 126,07±18,17; 96,68±11,12; 96,12±8,98. And the results of EDV prior to feeding: 18,85±6,09; 18,66±10,01; 20,99±8,12; 22,02±8,50; 23,04±7,89; 22,24±8,02; 11,99±6,15; 12,05±5,12 and EDV after feeding: 20,63±6,89; 30,15±12,78; 27,98±9,72; 29,02±10,05; 34,56±9,00; 32,02±8,45; 19,02±4,95; 21,15±3,43. These results shows that healthy premature neonates with gestational age between 27 and 34 weeks presents a peculiar evolution in blood flow in the superior mesenteric artery after birth, represented by the resistance patterns caracteristics, improvement in peaks of systolic and diastolic velocity, and improvement in vasodilation in response to feeding. CONCLUSION: These results suggest for the Doppler velocimetry as specific and preventive evaluation method for each premature neonate, as a way to a safer introduction and progression of feeding, reducing the prevalence of gastrointestinal inflammatory diseases in neonates, and improving the indices of neonatal morbidity and mortality. Knowledge of blood-flow velocity in the superior mesenteric artery in uncomplicated preterm infants might provide a clue in investigating the maturation of intestinal circulation and the pathogenesis or pathophysiology of gastrointestinal diseases in newborn infants.
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