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M.Sc. (Med.)--Faculty of Health Sciences, University of the Witwatersrand, 2011 / In-part through a decrease in cardiac cavity dimensions (reverse remodelling), β-adrenergic receptor blockers have been demonstrated to produce marked benefits to morbidity and mortality in patients with chronic heart failure. However, maximum doses of these agents are often difficult to achieve in patients with chronic heart failure because of the negative inotropic, hypotensive and other side effects. Whether blockade of the excessive adrenergic effects achieves complete reverse remodelling in progressive heart failure is nevertheless uncertain. To test this hypothesis I simulated the adverse effects of chronic adrenergic stimulation on the heart by administering daily doses of the β-adrenergic receptor agonist, isoproterenol (ISO) (2.42 X 10-8 mmol.kg-1) to rats for 6 months and compared left ventricular (LV) dimensions and systolic function to Saline-vehicle treated rats. To imitate the effects of complete adrenergic receptor blockade following the development of adrenergic-induced adverse cardiac changes, I similarly administered ISO for 6 months and then subsequently withdrew the daily ISO administration for a further 4 months (ISO+Recovery) before comparing left ventricular dimensions and function to Saline+Recovery treated rats. In comparison to a Saline vehicle-treated group, after 6 months of ISO administration, LV end diastolic and systolic diameters, and the volume intercept of the left ventricular diastolic pressure-volume relationship (LV V0), were markedly increased and LV endocardial fractional shortening (FSend), LV end systolic chamber (slope of the systolic pressure-volume relationship-Ees) and myocardial (slope of the systolic stress-strain relationship-En) contractility were substantially decreased. The extent of the adverse remodelling produced by chronic ISO administration was exemplified by the 2.5 times increase in LV V0 (ISO=0.40±0.04 vs Saline=0.16±0.01, p<0.001), a change proportionate to that noted in humans with chronic heart failure. iii The proportion of ISO-treated rats with LV chamber diameters, and LV V0 values above the 95% confidence interval for Saline-treated rats was markedly greater than the proportion of Saline-treated rats above their own 95% confidence intervals. Moreover, the proportion of ISO-treated rats with FSend, LV Ees and LV En values below the 95% confidence interval for Saline-treated rats was markedly greater than the proportion of Saline-treated rats below their own 95% confidence intervals. Following a 6 month period of ISO administration and a subsequent period of withdrawal of ISO administration for a further 4 months, LV chamber diameters, LV V0, FSend, LV Ees and LV En were all noted to be similar to age-matched Saline+Recovery control rats. Indeed, the increases in LV V0 observed after 6 months of ISO administration were completely reversed (ISO+Recovery=0.21±0.02 vs Saline=0.23±0.02, p<0.001). The proportion of ISO+Recovery rats with LV chamber diameters, and LV V0 values above the 95% confidence interval for the Saline+Recovery rats was similar to the proportion of Saline+Recovery rats above their own 95% confidence intervals. Moreover, the proportion of ISO+Recovery rats with FSend, LV Ees and LV En values below the 95% confidence interval for Saline+Recovery rats was similar to the proportion of Saline+Recovery rats below their own 95% confidence intervals. Chronic ISO administration and the withdrawal of ISO administration was not associated with changes in myocardial necrosis (pathological score and myocardial collagen concentrations). In conclusion, marked cardiac dilatation and pump dysfunction produced by chronic β-adrenergic receptor activation can be completely reversed by withdrawal of the excessive adrenergic stimulus. These data highlight the importance in chronic heart failure of achieving complete blockade of the pathways activated by excessive β-adrenergic receptor stimulation even in individuals with advanced cardiac dilatation.

Made available in DSpace on 2014-06-11T19:29:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-25Bitstream added on 2014-06-13T19:37:58Z : No. of bitstreams: 1 pereira_idf_me_botfm.pdf: 342153 bytes, checksum: d9563004493660e5ddc47166bc75326a (MD5) / A anestesia regional (AR) apresenta vantagens quando comparada à anestesia geral, como determinação de menor morbidade e mortalidade, analgesia pós-operatória de melhor qualidade e menor tempo de internação hospitalar. Diversas complicações podem ser decorrentes dos bloqueios do neuroeixo, algumas de maior gravidade, como as infecções do sistema nervoso central, lesões neurológicas devidas a hematomas espinhais, toxicidade pelos anestésicos locais ou trauma direto, e outras menos graves, como hipotensão e bradicardia, até mesmo consideradas fisiológicas. O objetivo desta pesquisa foi avaliar as complicações intra-operatórias desencadeadas pelos bloqueios do neuroeixo, em pacientes com idades iguais ou superiores a 18 anos submetidos a procedimentos não obstétricos, em um período de 18 anos, em hospital de atendimento terciário – Hospital das Clínicas da Faculdade de Medicina de Botucatu- UNESP. A partir do banco de dados do departamento de anestesiologia (Microsoft Access), foi realizada análise retrospectiva, de maio de 1990 a maio de 2008, de todas as complicações relacionadas às anestesias do neuroeixo (anestesias subaracnóidea simples e contínua, peridural simples e contínua e duplo bloqueio – raqui-peridural). As complicações encontradas foram: hipoxemia, hipoventilação, hipertensão arterial, hipotensão arterial, bradicardia sinusal, taquicardia sinusal, agitação, cefaléia, convulsão, oligúria, reação vaso-vagal, falha de bloqueio, perfuração acidental da dura-máter, disritmias ventriculares, parada cardíaca e óbito. Estas foram correlacionadas com a técnica anestésica, estado físico descrito pela Sociedade Americana de Anestesiologia (ASA), idade, sexo e comorbidades pré-operatórias, como hipertensão arterial, disritmias atriais e ventriculares, obesidade... / The regional anesthesia (RA) presents advantages when compared to the general anesthesia, as determination of smaller morbidity and mortality, postoperative analgesia of better quality and smaller time of hospitalar internment. Several complications can be resulting from the neuraxial blockades, some of larger gravity, as the infections of the central nervous system, neurological lesions owed to spinal or epidural hematomas, toxicity due to the local anesthetics or direct trauma, and other less serious, as hypotension and bradycardia, even considered physiological. The goal of this research was to assess the intraoperative complications caused by the neuraxial blockades in patients 18 years of age or older not submitted to obstetrician procedures, during a period of 18 years, in a hospital with tertiary treatment – Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP. Starting from the database (Microsoft Access) of the Anesthesiology Department, retrospective analysis was accomplished, from May 1990 to May 2008, of some of the complications related to the neuraxial anesthesias (spinal, continuous spinal, epidural, continuous epidural and combined spinal-epidural anesthesias). The found complications were: hypoxemia, hypoventilation, arterial hypertension, arterial hypotension, sinusal bradycardia and tachycardia, agitation, headache, convulsion, oliguria, vasovagal reaction, blockade failure, accidental perforation of the duramater, ventricular dysrhythmias, cardiac arrest and death. These were correlated with the anesthetic technique, physical state described by the American Society of Anesthesiology (ASA), age, sex and preoperative comorbidities, as arterial hypertension, atrial and ventricular dysrhythmias, obesity, diabetes mellitus, coronary artery disease, congestive heart failure,... (Complete abstract click electronic access below)

This investigation resulted from a pilot research paper prepared in conjunction with a graduate course on the Civil War. This study suggested that the Federal blockade of the Confederacy may not have contributed significantly to its defeat. Traditionally, historians had assumed that the Union's Anaconda Plan had effectively strangled the Confederacy. Recent studies which compared the statistics of ships captured to successful infractions of the blockade had somewhat revised these views. While accepting these revisionist findings as broadly valid, this investigation strove to determine specifically the effectiveness of Admiral Farragut's West Gulf Blockading Squadron. Since the British Foreign Office maintained consulates in three blockaded southern ports and in many Caribbean ports through which blockade running was conducted, these consular records were vital for this study. Personal research in Great Britain's Public Record Office disclosed valuable consular reports pertaining to the effectiveness of the Federal blockade. American consular records, found in the National Archives in Washington, D.C. provided excellent comparative reports from those same Gulf ports. Official Confederate reports, contained in the National Archives, various state archives and in the published Official Records of the Union and Confederate Armies revealed valuable statistical data on foreign imports. Limited use was made of Spanish and French consular records written from ports involved in blockade running. Extensive use was made of Senate and House documents in determining Federal blockade policy during the war. The record of the Navy's enforcement of the blockade was found in The Official Records of the Union and Confederate Navies. The contemporary reports of Union and Confederate governmental officials was found in James D. Richardson's respective works on The Messages and Papers, and in the published diaries of Gideon Welles and Gustavas Fox. Contemporary newspapers and first hand accounts by participants on both sides provided color and perspective. In evaluating the performance of the West Gulf Blockading Squadron, a review of the international laws governing blockading was undertaken, emphasizing America's traditional posture regarding the blockades of other nations. Under Gideon Welles, the Federal navy became a powerful and efficient force, although the navy's enforcement of the blockade often resulted in serious diplomatic embarrassment, especially from maritime incidents occurring near the mouth of the Rio Grande River. Nearby Matamoros, Mexico virtually became an international trade mart for Confederate cotton and imports. However, much contraband trade was conducted through blockaded Gulf ports such as Galveston, Texas. It is concluded that the West Gulf Blockading Squadron performed only satisfactorily at best. This did not result so much from innate limitations as from outside factors. Among the latter were the open door at Matamoros, the Lincoln administration's diplomatic timerity and national policies that authorized a type of cotton trade with the south. Further, the better vessels were assigned land campaign priorities. The statistics of the cotton trade in this portion of the Confederacy show that cotton exports were significantly high. Most of these exports egressed via Matamoros, but a high percentage existed through blockaded Gulf ports. The fact that 10,000 bales of cotton left the heavily guarded port of Galveston in the last six months of the war indicates the inefficiency of the West Gulf Blockade. It appears that the West Gulf Blockade was effective enough to create scarcity but never effective enough to seriously interdict the flow of trade. That the Trans-Mississippi Confederacy was largely sustained by imports underscores the blockade's limited effectiveness.

During the American Civil War Wilmington, North Carolina and the Bermudian ports of St. Georges and Hamilton served as vital links in a complex trading network that developed to facilitate the exchange of southern agricultural products for war materials and civilian merchandise through a Union blockade of the Confederacy. Although that material contributed significantly to the Confederate war effort, Anglo-Confederate blockade running has received limited scholarly attention. Much of the associated literature is based on memoirs rather than scholarship and does not accurately, reflect that necessarily clandestine trade. The primary goal of this thesis is to produce a more comprehensive and detailed picture of blockade running, the cargoes carried through the Union blockade and the powerful steam vessels that made Anglo-Confederate commerce possible. Unlike previous treatments, this thesis combines the results of both archival and archaeological research. The results illustrate the evolution of strategies involved in both establishing and maintaining the blockade and those developed for running the blockade. Assessment of the vessel remains and historical data associated with the construction and procurement of steamers identifies the vessel types and confirms that blockade runners adapted extant technology. Contrary to the popularly held impression, no technological innovations were specifically developed to address the demands of the trade. The spatial distribution of wrecks and the minimal amount of cultural material surviving in association with them, provides strong evidence that cargoes were more valuable than the vessels. That premise influenced the strategy adopted by blockade runners. While Confederate salvors left little evidence of cargo, historical research revealed a wealth of new insight into the specific nature of that material. This new evidence provides a more accurate and detailed picture of Anglo- Confederate blockade running and the strategies, ships and cargoes that made blockade running between Wilmington and Bermuda a success.

The Anglo-Confederate mercantile house of Fraser, Trenholm and Company played an important, even vital role in the Confederate war effort. Recognizing its inferiority to the North in terms of manufacturing facilities, capital, and foreign trade, the Southern Confederacy relied upon British commercial interests and an ideology of free trade to overcome this disadvantage. Fraser, Trenholm and Company was a driving force in the formulation of this unique alliance between the Confederate government and private British business interests. The wartime experience of Fraser, Trenholm and Company illustrates the fundamental flaws in Confederate financial policy. The blockade running trade, the outward manifestation of the Anglo-Confederate alliance, although successful, could not be controlled by the Confederacy, and the free trade ideology prevented reform of the trade until it was too late. / Department of History

Orientador: Eliana Marisa Ganem / Banca: Yara Marcondes Machado Castiglia / Banca: Flora Margarida Barra Bisinotto / Resumo: A anestesia regional (AR) apresenta vantagens quando comparada à anestesia geral, como determinação de menor morbidade e mortalidade, analgesia pós-operatória de melhor qualidade e menor tempo de internação hospitalar. Diversas complicações podem ser decorrentes dos bloqueios do neuroeixo, algumas de maior gravidade, como as infecções do sistema nervoso central, lesões neurológicas devidas a hematomas espinhais, toxicidade pelos anestésicos locais ou trauma direto, e outras menos graves, como hipotensão e bradicardia, até mesmo consideradas fisiológicas. O objetivo desta pesquisa foi avaliar as complicações intra-operatórias desencadeadas pelos bloqueios do neuroeixo, em pacientes com idades iguais ou superiores a 18 anos submetidos a procedimentos não obstétricos, em um período de 18 anos, em hospital de atendimento terciário - Hospital das Clínicas da Faculdade de Medicina de Botucatu- UNESP. A partir do banco de dados do departamento de anestesiologia (Microsoft Access), foi realizada análise retrospectiva, de maio de 1990 a maio de 2008, de todas as complicações relacionadas às anestesias do neuroeixo (anestesias subaracnóidea simples e contínua, peridural simples e contínua e duplo bloqueio - raqui-peridural). As complicações encontradas foram: hipoxemia, hipoventilação, hipertensão arterial, hipotensão arterial, bradicardia sinusal, taquicardia sinusal, agitação, cefaléia, convulsão, oligúria, reação vaso-vagal, falha de bloqueio, perfuração acidental da dura-máter, disritmias ventriculares, parada cardíaca e óbito. Estas foram correlacionadas com a técnica anestésica, estado físico descrito pela Sociedade Americana de Anestesiologia (ASA), idade, sexo e comorbidades pré-operatórias, como hipertensão arterial, disritmias atriais e ventriculares, obesidade... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The regional anesthesia (RA) presents advantages when compared to the general anesthesia, as determination of smaller morbidity and mortality, postoperative analgesia of better quality and smaller time of hospitalar internment. Several complications can be resulting from the neuraxial blockades, some of larger gravity, as the infections of the central nervous system, neurological lesions owed to spinal or epidural hematomas, toxicity due to the local anesthetics or direct trauma, and other less serious, as hypotension and bradycardia, even considered physiological. The goal of this research was to assess the intraoperative complications caused by the neuraxial blockades in patients 18 years of age or older not submitted to obstetrician procedures, during a period of 18 years, in a hospital with tertiary treatment - Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP. Starting from the database (Microsoft Access) of the Anesthesiology Department, retrospective analysis was accomplished, from May 1990 to May 2008, of some of the complications related to the neuraxial anesthesias (spinal, continuous spinal, epidural, continuous epidural and combined spinal-epidural anesthesias). The found complications were: hypoxemia, hypoventilation, arterial hypertension, arterial hypotension, sinusal bradycardia and tachycardia, agitation, headache, convulsion, oliguria, vasovagal reaction, blockade failure, accidental perforation of the duramater, ventricular dysrhythmias, cardiac arrest and death. These were correlated with the anesthetic technique, physical state described by the American Society of Anesthesiology (ASA), age, sex and preoperative comorbidities, as arterial hypertension, atrial and ventricular dysrhythmias, obesity, diabetes mellitus, coronary artery disease, congestive heart failure,... (Complete abstract click electronic access below) / Mestre

Orientador: Angelica de F. de Assunção Braga / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T23:53:56Z (GMT). No. of bitstreams: 1 Loyola_YolandaChristinadeSousa_D.pdf: 22412843 bytes, checksum: 64766635e73a046988de0b090a234fe6 (MD5) Previous issue date: 2006 / Resumo: Os anestésicos locais comumente empregados na prática clínica podem interagir com os bloqueadores neuromusculares e potencializar seus efeitos. Muitos autores estudaram esta interação mas o mecanismo envolvido na potencialização do bloqueio neuromuscular e a ação dos anestésicos locais nos sítios pré e pós juncionais não foram completamente elucidados. Neste trabalho através de experimentos específicos na junção neuromuscular foram estudados os seguintes parâmetros: o efeito dos anestésicos locais procaína e lidocaína na transmissão neuromuscular; a sua influência no bloqueio neuromuscular produzido pela d-tubocurarina e pelo rocurônio; a eficácia da neostigmina e da 4-aminopirídina na reversão do bloqueio produzido pela associação anestésicos locais - bloqueadores neuromusculares; os efeitos dos anestésicos locais nos potenciais de membrana e potenciais de placa terminal em miniatura. Avaliou-se também em preparações diafragma de rato cronicamente desnervado e biventer cervicis de pintainho os efeitos dos anestésicos locais na ação contraturante da acetilcolina. Os resultados foram expressos em médias e desvios padrão e analisados através dos testes de Wilcoxon e Mann-Witney, adotando-se um nível de significância de 5% (p < 0,05). Nas preparações nervo frênico - diafragma de rato, sob estimulação elétrica indireta, os anestésicos locais nas concentrações empregadas, não alteraram a amplitude das respostas musculares mas potencializaram os efeitos da d- tubocurarina e do rocurônio.. Este bloqueio foi parcialmente e totalmente revertido pela neostigmina e pela 4-aminopiridina, respectivamente. A procaína e a lidocaína não causaram alteração significativa nos potenciais de membrana, não demonstrando ação despolarizante na fibra muscular. A procaína causou diminuição na amplitude e na freqüência dos potenciais de placa terminal em miniatura (pptms) e a lidocaína, ao contrário, promoveu um aumento inicial na freqüência dos pptms seguida de bloqueio. Nas preparações biventer cervicis de pintainho e diafragma de rato cronicamente desnervado, a procaína e a lidocaína promoveram diminuição significativa na resposta contraturante da acetilcolina evidenciando um efeito pós-juncional. Os resultados obtidos demonstram um sinergismo entre as drogas devido principalmente a um efeito pós-juncional / Abstract: Local anesthetics commonly used in clinical practice can interact with neuromuscular blockers and potentiate their effects. Many authors studied this interaction, but the mechanism involved in the potentiation of neuromuscular blockers and the action of local anesthetics in the pre and postjunctional sites were not completely elucidated- In this study, in specific experiments in the neuromuscular junction the following parameters were studied: the effects of the local anesthetics procaine and lidocaine in the neuromuscular transmission; its influence on the neuromuscular blockade produced by d-tubocurarine and by rocuronium; the efficacy of neostigmine and of 4-aminopyhdine in the reversion of the blockade produced by the association of local anesthetics - neuromuscular blockers; the effects of local anesthetics on the membrane potentials and miniature end - plate potentials. It was also evaluated in chronically denervated rat diaphragm preparation and chick biventer cervicis preparation the effects of local anesthetics on acetylcholine contracture. The results were expressed in average and standard deviation and analyzed through the Wilcoxon and Mann-Witney tests, adopting a level of significance of 5% (p <0.05). In rat phrenic nerve diaphragm preparations under indirect electric stimulation, local anesthetics in the concentrations used did not change the amplitude of the muscle response but potentiated the effects of d-tubocurarine and of rocuronium. This blockade was partially and totally reverted by neostigmine and by 4-aminopyridine, respectively. Procaine and lidocaine caused no significant alteration in the membrane potentials, not demonstrating depolarizing action in the muscle fiber. Procaine caused a decrease in the amplitude and frequency of the miniature end - plate potentials {meps) and lidocaine, in contrast, promoted an initial increase in the frequency of meps followed by blockade. In chick biventer cervicis preparations and chronically denervated rat diaphragm, procaine and lidocaine promoted a significant decrease in the response to acetylcholine contracture evidencing a post-junctional effect. The results obtained demonstrate a synergism among the drugs mainly due to a postjunctional effect / Doutorado / Doutor em Farmacologia

The thesis deals with the perspective of the Austrian newspapers like Die Presse and Kurier on the Czech-Austrian relationship between years 1999 and 2004, or more precisely the issue of Temelín NPP. The main topics for the Austrian press became the approval of completion by the Czech government and of course the launch of Temelín NPP. Significant moments were the blockades and demonstrations of Austrian citizens at the Czech-Austrian border crossings, Austria's attempt to veto the accession negotiations between Czech Republic and EU or internal political struggle in the Austrian government.

Of the large amount of writings concerning the Civil War only a small percentage pertains to the Federal Navy's role. This is understandable since this was primarily a land war. A few of the Navy's exploits such as the capture of New Orleans, the sinking of the Alabama, the capture of the Florida in Brazilian waters, and the Trent affair received great amounts of publicity, but the majority of the naval activities were of a routine nature, each individually warranting little notice but collectively contributing immensely to the final Federal victory. The purpose of this paper is to show in detail the role of only a portion of the Navy, the West Gulf Blockading Squadron, during this struggle.