BACKGROUND: Posterior inferior cerebellar artery (PICA) aneurysms are an uncommon, heterogeneous group of aneurysms with poorer neurological outcomes compared to other intracranial aneurysms. At first, as part A, we conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies for PICA-aneurysms. Subsequently, as part B, we performed a multicenter retrospective study to analyze the outcome in a large series of patients treated with contemporary microsurgical and endovascular techniques. METHODS: For the meta-analysis, a systematic search of Medline, EMBASE, Scopus and Web of Science was done for studies published through November 2015. We included studies that described treatment of PICA-aneurysms with ≥10 patients. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality, stroke rates, aneurysm recurrence/rebleed, CN-palsies rates, and long-term neurological morbidity/mortality. As the second part, aiming to report the current trends and results in treatment strategies for PICA-aneurysms, records of 94 patients treated for PICA-aneurysms between 2000 and 2015 at 3 large referral neurovascular centers were retrospectively reviewed. RESULTS: In the meta-analysis, we...

Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2005. / Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2012-10-29T12:49:36Z No. of bitstreams: 1 claudiazamberlan.pdf: 751930 bytes, checksum: ab892361ad7a32be95ee6c853e6689f4 (MD5) / Approved for entry into archive by Bruna Vieira(bruninha_vieira@ibest.com.br) on 2012-11-22T16:47:05Z (GMT) No. of bitstreams: 1 claudiazamberlan.pdf: 751930 bytes, checksum: ab892361ad7a32be95ee6c853e6689f4 (MD5) / Made available in DSpace on 2012-11-22T16:47:06Z (GMT). No. of bitstreams: 1 claudiazamberlan.pdf: 751930 bytes, checksum: ab892361ad7a32be95ee6c853e6689f4 (MD5) Previous issue date: 2005 / A questão norteadora deste estudo surgiu a partir da prática assistencial em unidade de hemodinâmica. Ao pesquisar o tema qualidade de vida de clientes submetidos a procedimentos hemodinâmicos buscou-se respostas para a questão norteadora: Como é a qualidade de vida de clientes submetidos a intervenção coronária percutânea no contexto domiciliar? Para que esta e outras indagações pudessem ser respondidas objetivou-se investigar a qualidade de vida de clientes submetidos a intervenções coronárias percutâneas no contexto domiciliar. Justifica-se este objetivo a partir dos pressupostos de que a qualidade de vida pode ser mensurada através de escalas específicas permitindo o entendimento da objetividade, subjetividade, multidimensionalidade e presença de questões positivas e negativas relacionadas aos sujeitos, além do que a qualidade de vida influencia no restabelecimento de clientes submetidos a intervenções coronarianas, especialmente no que se refere a sua adaptação a essa nova condição de vida. Neste sentido, realizou-se um levantamento documental no Serviço de Hemodinâmica e Cardiologia do Rio Grande, para buscar os sujeitos a serem pesquisados. Após esta etapa a coleta de dados processou-se através da observação sistemática e da aplicação do instrumento WHOQOL-bref, que mensura a percepção dos sujeitos acerca da qualidade de vida, a partir de quatro domínios e vinte e seis facetas. A partir da coleta de dados os mesmos foram analisados quantitativamente seguidos de uma discussão qualitativa onde se encontrou os seguintes achados quanto aos domínios e facetas do instrumento: os sujeitos pesquisados inseriram-se no nível intermediário de satisfação quanto aos domínios. Em relação ao domínio físico as facetas melhor avaliadas foram capacidade de locomoção, necessidade de tratamento para levar a vida diária e satisfação com a capacidade de desempenhar as atividades cotidianas, contrapondo-se a estas encontra-se a faceta pior avaliada que foi a dor física como empecilho para fazer o que se precisa. Em relação ao domínio psicológico a faceta melhor avaliada diz respeito ao sentido da vida, em contra ponto a que refere sentimentos negativos, como mau humor, desespero, ansiedade foi a pior avaliada. Quanto ao domínio social destacou-se a faceta relativa a satisfação com as relações pessoais, porém, a satisfação com a atividade sexual foi a pior avaliada. Em relação ao domínio ambiental a faceta que tende ser melhor avaliada relaciona-se com a satisfação com o local onde o sujeito reside, porém possuir dinheiro suficiente para satisfazer as necessidades diárias foi a faceta pior avaliada neste domínio. A avaliação destes dados permite um conhecimento da qualidade de vida dos sujeitos pesquisados, além do que, propicia subsídios para elencar ações educativas que vão ao encontro das necessidades dos sujeitos pesquisados. / The main subject of this study appeared from the aiding practice in haemodynamics unit. Researching the theme of quality life of customers submitted to haemodynamic procedures, answers were looked for to the northern subject: how is the life quality of customers submitted to coronary intervention in home context? For answer this and other inquiries it was aimed at investigate the quality of life of customers submitted to coronary interventions in home context. This aim is justified by the suppositions that the life quality can be measured through specific scales, allowing the understanding of objectivity, subjectivity, multidimensionality and presence of positive and negative inquiries in relation to the patients, and in what way the life quality influences in the customers' re-establishing, especially in referring their adaptation to new life conditions. In this sense, took place a documental research in Haemodynamics and Cardiology Service of Rio Grande, to look for patients in those conditions. After this stage, data collection was processed by the systematic observation and through WHOQOL-bref instrument application, which measures quality life, from four upper hands and twenty-six facets. Data were analyzed quantitatively, followed by a qualitative discussion, when were identified these discoveries reporting to the instrument domains and facets: the researched subjects point out an intermediate level of satisfaction in relating to the domains. Relating to the physical domain, the facets better evaluated were locomotion capacity, treatment need to take the daily life and satisfaction with the capacity to carry out the daily activities, and the worse facet was the physical pain as difficulty to do what one needs. In relation to the psychological domain the appraised better facet concerns to the sense of the life, and the worse refers negative feelings, as bad mood, despair, anxiety. In the social domain stood out as the relative facet the satisfaction with the personal relationships, however, the bad satisfaction with the sexual activity was appraised worst. In relation to the environmental domain the facet that tends to be better-evaluated satisfaction point to place where the subject resides, and not to possess enough money to satisfy the daily needs was the appraised worse facet in this domain. The evaluation of these data allows understanding the researched subjects life quality; in addition, it propitiates subsidies for point out to educational actions that satisfy the needs of researched subjects. / El asunto principal de este estudio apareció de la práctica ayudando en una unidad de hemodinámica. Investigando el tema de la calidad de vida de clientes sometidos a los procedimientos de hemodinámica, se han buscado las respuestas para esta pregunta al asunto: Cómo está la calidad de vida de los clientes sometidos a la intervención coronaria, en el contexto de su casa? Para responder a esta y a otras preguntas se ha propuesto como objetivo una pesquisa de campo. Este objetivo está justificado por las suposiciones que la calidad de vida puede medirse a través de escalas específicas, permitiendo la comprensión de objetividad, subjetividad, dimensionalidad y la presencia de cuestiones positivas y negativas, con relación a los sujetos y de qué manera la calidad de vida influencia él restablecimiento del cliente, sobre todo refiriéndose a su adaptación a las nuevas condiciones de vida. En este sentido, tuve lugar una investigación documentaria en el Servicio de Hemodinámica y Cardiología de Río Grande, para buscar a los pacientes en esas condiciones. Después de esta fase, la colección de los dados se procesó por la observación sistemática y a través de la aplicación del instrumento WHOQOL-bref que mide la calidad de vida de cuatro dominios y veintiséis facetas. Se analizaron los dados colectados cuantitativamente, siguiendo una discusión cualitativa, cuando se identificó estos descubrimientos: los asuntos investigados señalan un nivel intermedio de satisfacción relacionado a los dominios. En relación con el dominio físico, las facetas bien evaluadas eran la capacidad de locomoción, necesidad del tratamiento para llevar su vida diaria y satisfacción con la capacidad de hacer las actividades diarias, y la más peor faceta era el dolor físico por la dificultad de hacer lo que uno necesita. Respecto al dominio psicológico, la faceta que obtuve mejor evaluación fu el sentido de la vida, y él más peor se refiere a los sentimientos negativos, como humor malo, desespero, ansiedad. En el dominio social, se destacó como positiva la faceta relativa a la satisfacción con las relaciones personales, sin embargo, se estimó como la mala satisfacción la actividad sexual peor. Respecto al dominio medioambiental, la faceta que fue bueno-evaluada es la satisfacción con el lugar donde se reside, y no poseer bastante dinero para satisfacer las necesidades diarias era la más peor faceta estimada en este dominio. La evaluación de estos dados permite la comprensión de la calidad de vida de los sujetos evaluados y, además, propicia los subsidios para establecer acciones educativas que satisfagan las necesidades de los pacientes investigados.

Orientadores: José Antonio Rocha Gontijo, Konradin Metze / Tese (doutorado) - Universidade Estadual de Campinas. Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T09:14:09Z (GMT). No. of bitstreams: 1 Borges_RafaeldeCamargoPenteado_D.pdf: 2255338 bytes, checksum: 0a8e55e3d0ad46a2d03da9d085f9fc64 (MD5) Previous issue date: 2010 / Resumo: A hipertensão arterial (HA) é um dos principais fatores de risco para a elevada morbidade e mortalidade cardiovascular. O exercício físico aeróbico promove alterações fisiológicas e morfológicas importantes para o controle da HA mediados pelo sistema renina angiotensina (SRA), porém muitos destes mecanismos continuam obscuros. Foram utilizados 80 animais, SHR (n=40) e WKy (n=40), controle (c) (n=20) e exercício (e) (n=20), com acesso livre a ração padrão e água, em um ciclo dia/noite 12h cada. Os animais SHRe e WKye realizaram treinamento de natação com sobrecarga durante 8 semanas consecutivas. Ao término do período experimental, foram aferidas a freqüência cardíaca (FC), pressão arterial sistólica (PAS) e manipulação tubular de sódio. Após o período experimental os animais (n=12 por grupo) foram perfundidos para análise morfológica da aorta (Ao), artéria mesentérica (AMes) e massa cardíaca (MCard), e para análise de western blotting (WB) (n=8 por grupo) para Ao, ventrículo esquerdo (VE) e rim. Os animais WKye e SHRe responderam com uma redução significativa (p<0,05) da FC, sendo que, o SHRe reduziu (p<0,05) a PAS quando comparado ao SHRc. A fração de excreção de sódio e fração de excreção pós proximal de sódio apresentaram-se aumentadas (p<0,05) para SHRe e reduzidas (p<0,05) para WKye. As análises morfológicas indicaram que os animais Wkye aumentaram (p<0,05) o número de camadas da Ao e MCard, e reduziram (p<0,05) a distância média entre camadas da AMes; enquanto os SHRe aumentaram a MCard (p<0,05), porém reduziram (p<0,05) o número de camadas da Ao e a espessura total da AMes. As análises de WB demonstraram que os WKye tiveram um aumento (p<0,05) da razão AT1R/AT2R no VE e Ao, e redução (p<0,05) no rim, enquanto os SHRe tiveram um aumento (p<0,05) da razão AT1R/AT2R somente no VE, e redução (p<0,05) na Ao e rim. As alterações morfológicas da Ao no Wkye foram promovidas pelo aumento (p<0,05) das vias ERK1, ERK2 e AKT, no VE pela ERK2, e no rim mediado pela via JAK2/STAT3. Já nos animais SHRe as alterações na Ao foram mediadas pela redução (p<0,05) da via ERK1 e ERK2, no VE pelo aumento (p<0,05) da via ERK2 e no rim pelo aumento (p<0,05) das vias ERK1, ERK2 e STAT3. Este estudo evidenciou que o exercício promoveu mecanismos distintos para manipulação tubular de sódio, adaptações morfológicas da Ao, AMes e MCard mediados pela razão AT1R/AT2R e hemodinâmicas em normotensos e hipertensos, este com redução de PAS, através do SRA atuante de forma sistêmica e localizada através de sinalização intracelular mediada por AKT, ERK1 e ERK2, JAK2 e STAT3 / Abstract: Systemic hypertension is one of the main risk factors for the high morbidity and mortality. Aerobic exercise promotes important morphological and physiological changes for the hypertension control mediated by renin angiotensin system (RAS), however many of these mechanisms are still obscure. 80 animals were used, SHR (n = 40) and WKy (n = 40), (c) (n = 20) and (e) (n = 20), with free access to standard rat chow and tap water in a day/night cycle 12 each. Animals SHRe and WKye practiced swimming with overload for 8 consecutive weeks. At the end of the experimental period, was measured the heart rate (HR), systolic blood pressure (SBP) and tubular sodium handling. After the experimental period animals (n = 12 per group) have been perfused for segmentation of the aorta (Ao), mesenteric artery (MesA) and cardiac mass (CardM), and for analysis of western blotting (WB) (n = 8 per group) to the Ao, left ventricle, (LV) and kidney. Animals WKye and SHRe replied with a significant reduction (p<0,05) to HR, were, SHRe reduced (p<0,05) the SBP when compare with SHRc. The fraction of sodium excretion and fraction of post proximal sodium excretion showed a increase (p<0,05) for SHRe and reduction (p<0,05) for WKye. The morphological analysis indicated that Wkye animals increased (p<0,05) the Ao layers number and CardM, and reduced (p<0,05) the distance between layers of MesA; while the SHRe increased the CardM (p<0,05), but reduced (p<0,05) the layers number of Ao and the total thickness of MesA. The WB analysis, showed that Wkye answered with the increase (p<0,05) in AT1/AT2 ratio in LV and Ao, and a decrease (p<0,05) in kidney, during SHRe answer only with an increase (p<0,05) of AT1/AT2 ratio in LV, and reduction (p<0,05) in Ao and kidney. The morphologic alterations of Ao in WKye was promoted by increase (p<0,05) of ERK1, ERK2 and AKT stream, in the LV by ERK2, and in the kidney the increase (p<0,05) by ERK1, ERK2 and STAT3. This study showed that the exercise promoted different mechanisms for tubular sodium handling, morphological adaptations to MesA and CardM mediated by AT1R/AT2R ratio and hemodynamic in normotensive and hypertensive rats, which answer with SBP reduction by RAS acts of systemic form and located by intracellular signaling mediated AKT, ERK1 and ERK2, JAK2 and STAT3 / Doutorado / Medicina Experimental / Doutor em Fisiopatologia Medica

Hintergrund: Diese Studie wurde initiiert, um die langfristige Wertigkeit der Implantation von selbstexpandierenden Nitinol-Stents in der Arteria femoralis superficialis zu untersuchen. Die Effektivität wurde anhand von Primärerfolg, Offenheitsraten und klinischem Erfolg überprüft. Komplikationsraten und unerwünschte Folgeereignisse definierten die Sicherheit dieser interventionellen Therapiemethode. Methoden: Retrospektiv wurden 278 Zielextremitäten von 263 Patienten über durchschnittlich 4,7 ± 1,9 Jahre hinweg beobachtet. Die Daten wurden aus internen Krankenakten sowie externen Befunden gewonnen. Gruppenvergleiche wurden mit t-Test, Fisher-Exact-Test und multivariater logistischer Regression durchgeführt. Überlebenszeitanalysen wurden mit der Kaplan-Meier-Methode berechnet. Univariate Risikofaktoren wurden mit dem Log-Rank-Test bestimmt und anschließend in das multivariate Cox-Model eingeschlossen. Ergebnisse: Das Durchschnittsalter der Patienten betrug 67,2 ± 9,5 Jahre, 74,1 % waren männlich, 21,2 % litten an einer kritischen Extremitätenischämie. Die mittlere Läsionslänge maß 11,5 ± 7,9 cm. Es handelte sich in 21,1 % um Restenosen und in 31,6 % um TASC-II-C/D-Läsionen. Der primäre technische Erfolg der Stentimplantation belief sich auf 96,8 %. Nach ein, drei und fünf Jahren lagen die primären Offenheitsraten bei 77 %, 56 % und 46 %, die sekundären Offenheitsraten bei 98 %, 94 % und 89 % sowie die Majoramputations-raten bei 0,4 %, 1,4 % und 4,2 %. Das Rutherford-Stadium ist von 3 ± 0,9 auf 1,8 ± 1,8 gesunken. Ein Todesfall war Folge eines Stentverschlusses. Signifikante Risikofaktoren für verkürzte Stentoffenheiten waren lange Gefäßläsionen, TASC-II-C/D-Läsionen sowie Luminexx®-Stents. Diabetes mellitus, Adipositas und kritische Extremitätenischämie waren mit erhöhten Amputationsraten assoziiert. Fazit: Hohe technische Erfolgsraten, relativ niedrige Komplikationsraten, befriedigende kurz- und mittelfristige Offenheitsraten sowie zufriedenstellender klinischer Erfolg zeichnen die Stentimplantationen in der Arteria femoralis superficialis aus. Langfristig stellen die Entstehung von In-Stent-Restenosen und damit verbundene Folgen jedoch ein Problem dar. Allerdings ist die Einführung von medikamenten-freisetzenden Ballons zur Sekundärbehandlung in dieser Hinsicht erfolgversprechend.

BACKGROUND: Posterior inferior cerebellar artery (PICA) aneurysms are an uncommon, heterogeneous group of aneurysms with poorer neurological outcomes compared to other intracranial aneurysms. At first, as part A, we conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies for PICA-aneurysms. Subsequently, as part B, we performed a multicenter retrospective study to analyze the outcome in a large series of patients treated with contemporary microsurgical and endovascular techniques. METHODS: For the meta-analysis, a systematic search of Medline, EMBASE, Scopus and Web of Science was done for studies published through November 2015. We included studies that described treatment of PICA-aneurysms with ≥10 patients. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality, stroke rates, aneurysm recurrence/rebleed, CN-palsies rates, and long-term neurological morbidity/mortality. As the second part, aiming to report the current trends and results in treatment strategies for PICA-aneurysms, records of 94 patients treated for PICA-aneurysms between 2000 and 2015 at 3 large referral neurovascular centers were retrospectively reviewed. RESULTS: In the meta-analysis, we...

Objetivo: describir la frecuencia de factores de riesgo cardiovascular en pacientes con Síndrome isquémico coronario agudo (SICA) de dos hospitales del Perú. Materiales y métodos: se realizó un estudio descriptivo transversal. Participaron 100 pacientes hospitalizados con SICA, en quienes se exploraron factores de riesgo cardiovascular. También se utilizó la escala ronquido somnolencia y escala de somnolencia de Epworth (versión peruana) para evaluar síntomas relacionados a apnea de sueño. Resultados: la frecuencia de los factores de riesgo cardiovascular más prevalentes entre los participantes fueron: obesidad según índice cintura cadera 98,86% (87/88), edad mayor a 55 años en varones y 65 años en mujeres, 78% (78/100), hipertensión arterial 71% (71/100), Dislipidemia 55,67% (54/97), sedentarismo 50,51% (49/97). La frecuencia de roncadores crónicos fue de 85,56% (83/97). Conclusiones: el factor de riesgo cardiovascular más frecuente fue la obesidad según Índice cintura-cadera y el menos frecuente fue el tener antecedente familiar de SICA. La frecuencia de ronquido en estos pacientes fue elevada.

121 9. Summárý Purpose: This study was designed to evaluate the role of interventional radiology in liver transplantation programme. The aim is to present our experience, technical outcomes and long-term clinical results with chemoembolization of hepatocellular carcinoma in patients before liver transplantation and with percutaneous treatment of vascular and biliary complication after orthotopic liver transplantation. Methods: Twenty five patients (17 men, 8 women, mean age 57.76 years) with HCC were scheduled for TACE prior to liver transplantation from 2008 to 2012. Twenty three procedures were performed, 7 c-TACE in 2008 and 16 DEB TACE in next years. Thirty patients (13 men, 17 women, mean age 46.4 years) with biliary strictures after liver transplantation without endoscopic access possibility were treated with balloon dilatation and biliary duct drainage from 1996 and 2010. Twenty patients (13 men, 7 women, mean age 45.25 years) were treated with PTA/stent due to hepatic artery stenosis after liver transplantation between 1996 and 2011. Stents were placed to the hepatic/celiac artery in 16 PTAs, balloon dilatation alone was performed in 7 stenosis due to tortuosity of the vessel. Results: Liver transplantation was performed to 20 patients after TACE. Only one patient (4.5 %) was excluded from waiting...

Das Ziel: der Arbeit war die Überprüfung der Aussagekraft der MRA in time-of-flight-technique der Arteria caroits bei 1,0 Tesla im Vergleich zur intaarteriellen DSA und der Wertigkeit in der Einsatzfähigkeit in der klinischen Routine bei der Diagnostik von Carotisstenosen. 101 Patienten wurden zur Abklärung einer Stenose der Arteria carotis vergleichend mittels TOF-MRA und i.a. DSA der Arteriae carotis untersucht. Morphologische Veränderungen wurden für sämliche Gefässe erfasst, wobei die Stenosen der Arteriae carotis entsprechend den NASCET-Kriterien graduiert wurden (geringgrade, mittelgradige,hochgradige Stenose oder Verschluss).Die Ergebnisse wurden mit folgenden drei verschiedenen statistischen Tests ausgewertet: Kappa Test, gewichteter Kappa Test und Intraklassenkorrelationskoeffizient. Von den 84 in die Auswertung eingebezogenen Gefässen wurden 66 Stenosen in der DSA als geringgradig klassifiziert. In dieser Kategorie wurden 60 dieser Stenosen von der MRA korrekt als geringgradig klassifiziert. In der DSA wurden 60 Stenosen der Arteria carotis als mittelgradig klassifiziert. 29 dieser Stenosen wurden von der MRA korrekt als mittelgradig eingeschätzt. 21 Stenosen wurden von der DSA als hochgradig klassifiziert. 20 dieser Stenosen wurden von der MRA korrekt als hochgradige Stenosen eingeschätzt. Die 16 kompletten Gefäsverschlüsse wurden alle von der MRA detektiert. Der Kappa Test ergab eine starke Korrelation der Ergebnisse. Insgesamt zeigte sich eine gute Überstimmung zwischen MRA und DSA. Aber gerade im Bereich der mittelgradigen Stenosen neigte die MRA dazu den Stenosegrad zu überschätzen. Das Ziel der Gefässdiagnostik ist eine präzise und reproduzierbare Bestimmung des Stenosegrades. Die Magnetresonanzangiographie kann als eine akkurate und zuverlässige Methode zur Bestimmung von Carotisstenosen angesehen werden / The purpose was to evaluate the efficiacy of the time-of-flight MRA of the carotid artery with a 1.0 Tesla system in comparison to intraarterial digital subtraction angiography for the assessment of carotid artery disease. 101 patients with suspected stenosis of the carotid artery were examined with a 1.0 Tesla scanner in time-of-flight-technique and with the selective i.a. DSA in parallel. Morphological pathologies were registered for all arteries, stenosis of the internal carotid artery of both examinations were blindly graded by applying the NASCET criteria (mild, moderately, severely or occluded). Three different assessment methods were conducted for the MRA data. Kappa, weighted kappa, intraclass correlation were calculated for MRA results compared to DSA. Of the 84 common carotid bifurcation, 66 were classified as mild stenosis by DSA. In this category, MRA correctly identified 60 of these as mild stenosis. Among 60 common carotid artery bifurcation graded as moderate by DSA, 29 were correctly graded as moderate by MRA. Among 21 common carotid artery bifurcation graded as severe by DSA, 20 of these were correctly graded by the MRA. There were 16 complete occlusions which were all correctly graded by MRA. A good kappa value was calculated for the data. In general the MRA were considered to find a good agreement with the DSA, but tended to overestimate stenosis, especially in the range of moderate stenosis. The aim of diagnosis is exact grading of carotid stenosis. MRA with its high agreement with DSA can be regarded as an accurate screening method of the common carotid bifurcation.

Vergleich des Nabelschnur-Resistance-Index von monochorialen und dichorialen Geminischwangerschaften Burkhardt T, Kilavuz Ö, Vetter K Abteilung für Geburtsmedizin, Vivantes Krankenhaus Neukölln, Berlin Fragestellung: Ziel der Untersuchung war die Klärung, ob monochoriale Gemini andere Strömungsverhältnisse in der A. umbilicalis aufweisen als dichoriale. Methode: Prospektiv wurden die Aa. umbilicales bei 75 dichorialen und 30 monochorialen Geminischwangerschaften zwischen 15 und 38 Schwangerschaftswochen dopplersonographisch untersucht. Verglichen wurden die Messergebnisse der monochorialen mit den der dichorialen Zwillinge und denen von Einlingen in fünf Schwangerschaftsaltersgruppen (< 24, 24-27, 28-31, 32-35 und 36-39 SSW). Berücksichtigt wurden ausserdem fünf Fälle mit fetofetalem Transfusionssyndrom (FFTS). Ergebnis: Kein signifikanter Unterschied konnte zwischen den Medianwerten der monochorialen Gemini (mit und ohne FFTS) und denen der dichorialen Gemini bzw. denen der Einlinge festgestellt werden. Nachweisbar sind Unterschiede im Abfall des Resistance-Index im Schwangerschaftsverlauf. Benachbarte Altersgruppen gleicher Chorionizität weisen signifikante Sprünge (p / The Resistance-Index in the umbilical artery in dichorionic twins compared with monochorionic twins. Burkhardt T, Kilavuz Ö, Vetter K Department of Obstetrics, Vivantes Hospital Neukolln Berlin Objective: The aim of this study was to detect differences in the resistance-index in the umbilical artery between dichorionic and monochorionic twins. Additional, the resistance-index in twin pregnancies was compared to the reference values of single pregnancies. Methods: In a prospective study Doppler recordings of the umbilical arteries of 75 dichorionic and 30 monochorionic twins were obtained. The Doppler examinations were performed between 15 and 38 weeks of gestation. According the gestational age the Doppler findings were divided in five week groups (< 24, 24-27, 28-31, 32-35 and 36-39 weeks) and were compared within placentation and between the different placentations. In five monochorionic twins a twin-to-twin transfusion syndrome (TTTS) was diagnosed. These five pairs were analyzed in a separate group. Results: There are no significant differences in the resistance index in the umbilical arteries in monochorial without TTTS and dichorial twins compared to the reference values of single pregnancies. Monochorial twins without TTTS compared with dichorial twins showed no significant increased resistance indices in the umbilical arteries. Dichorial twins showed significant (p

Die Azidose gehört zu den stärksten dilatatorischen Stimuli zerebraler Arterien. Obwohl schon 1890 von Roy und Sherrington beschrieben, sind die Faktoren, die die Vasodilatation zerebraler Arterien auf Azidose vermitteln, bis heute nicht bekannt. Untersuchungen über die Rolle des schnell flüchtigen Bioradikals Stickstoffmonoxid (NO) haben gezeigt, daß NO bei der azidotischen Vasodilatation zerebraler Arterien als Modulator agiert. Darüber hinaus nimmt NO in der neurovaskulären Kopplung, d.h. bei der Vermittlung der regionalen Blutflußantwort nach neuronaler Stimulation, eine permissive Funktion ein. Die Vasodilatation auf Azidose wurde in der vorliegenden Arbeit als Modellstimulus zur Untersuchung der NO-abhängigen Dilatation zerebraler Arterien verwendet. Dabei wurde die Rolle der Kaliumkanäle und die Funktion des cGMP an der Vasodilatation auf Azidose mittels spezifischer Inhibitoren untersucht. Die Experimente erfolgten an der isolierten und perfundierten A. cerebri media der Ratte. Bei der Untersuchung der Signaltransduktion von NO auf Ebene des cGMP wurde eine ausgeprägte Abhängigkeit der azidotischen Vasodilatation von cGMP beobachtet. Durch Restitution des basalen cGMP-Spiegels nach vorheriger Inhibition der löslichen Guanylatzyklase wurde gezeigt, daß NO über cGMP bei der Vermittlung dieser Reaktion als Modulator wirkt. Unter Blockade der einzelnen Kaliumkanalfamilien konnte eine Beteiligung der KCa an der Vasodilatation auf Azidose sowie am Gefäßtonus unter Ruhebedingungen beobachtet werden. Für eine Beteiligung der KATP, der KV und der Kir an diesen Reaktionen wurden dagegen keine Hinweise gefunden. Ebenso sprechen die Untersuchungen unter Blockade der Na+/K+-ATPase gegen eine Beteiligung dieses Enzyms an der Azidosereaktivität zerebraler Arterien. Um ein mögliches Zusammenwirken der Kaliumkanäle zu erfassen, wurde die Vasodilatation auf Azidose unter Blockade von jeweils zwei Kaliumkanaltypen untersucht. Unter Hemmung der KCa und der KATP, sowie unter Hemmung der BKCa und der KATP wurde keine Vasodilatation mehr auf Azidose beobachtet. Die Ergebnisse sprechen dafür, daß die Vasodilatation der A. cerebri media auf Azidose durch BKCa und KATP in redundanter Weise vermittelt wird. Dabei scheinen KCa die Funktion der KATP vollständig substituieren zu können. Die Resultate dieser Arbeit bilden den Ausgangspunkt für derzeit laufenden Untersuchungen über die funktionelle Modulation der KATP und der BKCa durch das NO/cGMP-System. Weiterhin bilden die vorliegenden Untersuchungen eine wichtige Grundlage zur Überprüfung der zentralen Rolle der KCa und der KATP auf weitere, durch das NO/cGMP-System modulierten Stimuli, wie z.B. der funktionellen Stimulation. Die in dieser Arbeit vorgestellten Experimente wurden mit Mitteln der Deutschen Forschungsgemeinschaft (SFB 507), der Hermann und Lilly Schilling Stiftung, sowie der Humboldt Universität zu Berlin gefördert. / Acidosis is one of the most potent vasodilators in the cerebral circulation. Although first described 1890 by Roy and Sherrington the mechanisms of vasodilation to acidosis are still unknown. Experimental data show, that nitric oxide (NO) is a modulator but not a mediator of cerebral arterial pH reactivity. NO also acts as a modulator of neurovascular coupling in the rat somatosensory cortex. We used the experimental in vitro model of the isolated and perfused middle cerebral artery (MCA) to elucidate the general mechanisms of NO-modulated dilations. The present study was performed to clarify the role of cGMP and potassium channels for mediation of acidosis-induced dilation of cerebral arteries. The results indicate, that vasodilation to acidosis is mediated by cGMP. Restoring the basal cGMP-level we could demonstrate a permissive role of cGMP in the vasodilation to acidosis. We could also show that KCa are active under resting conditions and are able to contribute to the relaxation of the MCA to acidosis. Other potassium channels like KATP, Kir, KV and the Na+/K+ATPase appeared not to be involved in the process of dilation to acidosis. After administration of a selective inhibitor of KATP in addition to an inhibitor of KCa the relaxation to acidosis was completely abolished. Simultaneous application of selective inhibitors of KATP and BKCa also prevented from vasodilation to acidosis. These results indicate, that relaxation to acidosis is mediated by activation of KATP and BKCa. This potassium channels seem to have a redundant activity, in such a way that KCa could substitute for KATP. The present findings are a starting point for further studies concerning the modulation of KATP and BKCa by the NO/cGMP-System. This studies are a basis for coming experiments to determine the role of KATP and BKCa in the neurovascular coupling.