Objetivo: Avaliar os efeitos do citrato de sildenafila na circulação do clitóris em mulheres na pós-menopausa com disfunção orgástica avaliadas por Doppler. Casuística e métodos: Foram selecionadas 22 mulheres atendidas no Setor de Ginecologia Endócrina e Climatério da Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Destas, 11 constituíram o grupo que recebeu 50mg de citrato de sildenafila (Grupo A) e outras 11 o grupo controle (Grupo B-placebo). Em todas aplicaram-se a entrevista Questionário de sexualidade HC e Escala de Griss. A circulação do clitóris foi avaliada por meio de Doppler nos tempos 0(T0), 1(T1) uma hora após a ingestão do comprimido e após 15 (T15) dias de tratamento. Resultados: Os resultados mostraram diferenças estatisticamente significativas, ao avaliarmos alterações nas medidas dos diferentes momentos (T0, T1,.T15), quando comparamos os 2 grupos (medicamento x placebo), utilizando-se os índices de resistência e velocidade. Conclusão: Podemos inferir melhora apresentada pelo grupo A (citrato de sildenafila), consideravelmente superior ao demonstrado pelo grupo B (placebo). / This study has as objective to evaluate the effects of Sildenafil Citrate in the circulation of the clitoris in women in post-menopause with orgastic dysfunction, appraised through color-pulse Doppler. 22 women were selected in the Endocrine Gynecology and Climacteric clinic of Hospital das Clínicas. 11 women received 50mg of Sildenafil Citrate (Group A) and 11 women received Placebo (Group B). All the women were submitted to the interview “Sexuality Questionnaire HC” and to GRISS Scale. The circulation of the clitoris was evaluated through Doppler in different moments: 0 (T0), 1(T1) one-hour after the ingestion of the tablet and 15 (T15) 15-days of treatment. The results showed differences, statistically significant, when evaluating the measures of the different moments (T0, T1, .T15). When comparing the 2 groups (medicine x placebo), using resistance and speed indexes, we can infer that the improvement presented by Group A (Sildenafil Citrate) is considerably superior to the improvement demonstrated by the Group B (placebo).

Cheung Ho Yan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 164-175). / Abstracts in English and Chinese. / Abstract --- p.i / Acknowledgements --- p.vi / Publications based on the work in this thesis --- p.vii / Table of content --- p.viii / Abbreviations --- p.xii / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter 1.1 --- Traditional Chinese Medicine --- p.1 / Chapter 1.1.1 --- Danshen --- p.2 / Chapter 1.1.2 --- Chemical constituents --- p.5 / Chapter 1.1.3 --- Pharmacological effects --- p.7 / Chapter 1.1.3.1 --- On blood vessels --- p.7 / Chapter 1.1.3.2 --- On blood pressure --- p.8 / Chapter 1.1.3.3 --- On heart --- p.8 / Chapter 1.1.3.4 --- On myocardial ischaemia and reperfusion --- p.9 / Chapter 1.1.3.5 --- On platelet activity --- p.10 / Chapter 1.1.3.6 --- Other actions --- p.11 / Chapter 1.1.4 --- Clinical studies --- p.12 / Chapter 1.2 --- The Vascular System --- p.13 / Chapter 1.2.1 --- The circulation network --- p.13 / Chapter 1.2.2 --- Physiology of blood vessels --- p.13 / Chapter 1.2.3 --- Control of vascular lone --- p.14 / Chapter 1.3 --- Mechanisms of Vasodilatation --- p.16 / Chapter 1.3.1 --- Endothelium derived relaxant factors (EDRFs) --- p.16 / Chapter 1.3.1.1 --- Nitric oxide (NO) --- p.16 / Chapter 1.3.1.2 --- Prostacyclin (PGI：) --- p.17 / Chapter 1.3.1.3 --- Endotheliun-derived hyperpolarization factors (EDHFs) --- p.18 / Chapter 1.3.1.3.1 --- Epoxyeicosatrienoic acids (EETs) --- p.19 / Chapter 1.3.1.3.2 --- Potassium ion (IC) --- p.20 / Chapter 1.3.1.3.3 --- Gap junction --- p.20 / Chapter 1.3.2 --- Signal transduction pathways --- p.21 / Chapter 1.3.2.1 --- Guanylyl cyclase-cGMP pathway --- p.21 / Chapter 1.3.2.2 --- Adenylyl cyclase-cAMP pathway --- p.22 / Chapter 1.3.3 --- Ion channels in vascular smooth muscle cell --- p.24 / Chapter 1.3.3.1 --- Potassium channels (K+ channels) --- p.24 / Chapter 1.3.3.2 --- Calcium channels (Ca2+ channels) --- p.24 / Chapter 1.3.3.3 --- Chloride channel (Cl channel) --- p.25 / Chapter 1.3.4 --- Receptor-operated mechanisms --- p.27 / Chapter 1.3.4.1 --- Muscarinic receptors --- p.27 / Chapter 1.3.4.2 --- Adrenoceptors --- p.27 / Chapter 1.3.4.3 --- Histamine receptors --- p.28 / Chapter 1.3.4.4 --- CGRP receptors --- p.29 / Chapter 1.3.4.5 --- Tachykinin receptors --- p.30 / Chapter 1.4 --- Aims of the studies --- p.31 / Chapter CHAPTER 2 --- MATERIALS AND METHODS --- p.32 / Chapter 2.1 --- Extraction of Water and Lipid-solubie Fractions from Danshen --- p.32 / Chapter 2.1.1 --- Preparation of water-soluble and lipid-soluble fractions --- p.33 / Chapter 2.2 --- Experiments on Rat Knee Joint --- p.35 / Chapter 2.2.1 --- Animals --- p.35 / Chapter 2.2.2 --- Materials --- p.35 / Chapter 2.2.3 --- Preparatory protocols --- p.37 / Chapter 2.2.3.1 --- Anaesthesia of animals --- p.37 / Chapter 2.2.3.2 --- Cannulation of trachea --- p.37 / Chapter 2.2.3.3 --- Cannulation of carotid artery --- p.38 / Chapter 2.2.3.4 --- Blood pressure measurement --- p.38 / Chapter 2.2.4 --- Measurement of knee joint blood flow --- p.39 / Chapter 2.2.4.1 --- Preparation for measurement of knee joint blood flow --- p.41 / Chapter 2.2.5 --- Experimental protocols --- p.41 / Chapter 2.2.5.1 --- Danshen on knee joint blood flow --- p.41 / Chapter 2.2.5.2 --- Antagonists on Danshen --- p.41 / Chapter 2.2.5.3 --- Positive controls --- p.43 / Chapter 2.2.6 --- Image analysis --- p.44 / Chapter 2.2.7 --- Data analysis --- p.44 / Chapter 2.3 --- Experiments on Rat Femoral Artery --- p.45 / Chapter 2.3.1 --- Animals --- p.45 / Chapter 2.3.2 --- Materials --- p.45 / Chapter 2.3.2.1 --- Chemicals --- p.45 / Chapter 2.3.2.2 --- Physiological salt solution --- p.48 / Chapter 2.3.3 --- Preparatory protocols --- p.48 / Chapter 2.3.3.1 --- Small vessel myograph --- p.48 / Chapter 2.3.3.2 --- Isolation and mounting of tissue --- p.49 / Chapter 2.3.4 --- Experimental protocols --- p.50 / Chapter 2.3.4.1 --- Studies on the vasodilator response to Danshen --- p.50 / Chapter 2.3.4.2 --- Studies of antagonists on Danshen --- p.50 / Chapter 2.3.4.2.1 --- Endothelium-dependent mechanisms --- p.51 / Chapter 2.3.4.2.2 --- Endothelium-independent mechanisms --- p.54 / Chapter 2.3.4.2.3 --- K+ channel blockers --- p.54 / Chapter 2.3.4.2.4 --- Positive controls --- p.55 / Chapter 2.3.4.3 --- Danshen on Ca2+-induced contraction --- p.56 / Chapter 2.3.5 --- Data analysis --- p.57 / Chapter CHAPTER 3 --- RESULTS --- p.58 / Chapter 3.1 --- Danshen on Rat Knee Joint Blood Flow --- p.58 / Chapter 3.1.1 --- Topical administration of Danshen --- p.58 / Chapter 3.1.2 --- Antagonists on Danshen --- p.59 / Chapter 3.1.2.1 --- Muscarinic receptor antagonist --- p.59 / Chapter 3.1.2.2 --- β-adrenoceptor antagonist --- p.60 / Chapter 3.1.2.3 --- Histamine receptor antagonists --- p.60 / Chapter 3.1.2.4 --- Nitric oxide synthase inhibitor --- p.61 / Chapter 3.1.2.5 --- Cyclo-oxygenase inhibitors --- p.62 / Chapter 3.1.2.6 --- CGRPi receptor antagonist --- p.62 / Chapter 3.1.2.7 --- NK1 receptor antagonist --- p.63 / Chapter 3.1.2.8 --- Potassium channel inhibitor --- p.64 / Chapter 3.1.2.9 --- "Combination of cyclo-oxygenase inhibitor, nitric oxide synthase inhibitor and CGRP1 receptor antagonist" --- p.64 / Chapter 3.1.3 --- Antagonists on water-soluble fraction of Danshen --- p.91 / Chapter 3.1.3.1 --- Nitric oxide synthase inhibitor --- p.91 / Chapter 3.1.3.2 --- Cyclo-oxygenase inhibitors --- p.91 / Chapter 3.1.3.3 --- CGRP1 receptor antagonist --- p.92 / Chapter 3.1.3.4 --- NK1 receptor antagonist --- p.92 / Chapter 3.1.3.5 --- Potassium channel inhibitor --- p.92 / Chapter 3.2 --- Danshen on Rat Femoral Artery --- p.99 / Chapter 3.2.1 --- Danshen on precontracted arterial ring --- p.99 / Chapter 3.2.2 --- Endothelium-dependent mechanisms --- p.106 / Chapter 3.2.3 --- Endothelium-independent mechanisms --- p.114 / Chapter 3.2.4 --- K+ channel blockers --- p.119 / Chapter 3.2.4.1 --- Effect on Danshen --- p.119 / Chapter 3.2.4.2 --- Effect on water-soluble and lipid-soluble fractions of Danshen --- p.121 / Chapter 3.2.4.3 --- Effect on Danshensu --- p.122 / Chapter 3.2.5 --- Danshen on Ca2+-induced contractions --- p.133 / Chapter CHAPTER 4 --- DISCUSSION --- p.138 / Chapter 4.1 --- In Vivo Studies of Danshen on Rat Knee Joint Blood Flow --- p.139 / Chapter 4.2 --- In Vitro Studies of Danshen on Isolated Rat Femoral Artery --- p.148 / Chapter 4.2.1 --- Comparisons of the use of different precontractors --- p.148 / Chapter 4.2.2 --- Investigations on endothelium-dependent mechanisms --- p.151 / Chapter 4.2.3 --- Investigations on endothelium-independent mechanisms --- p.152 / Chapter 4.2.4 --- Effects of K+ channel blockers --- p.154 / Chapter 4.2.5 --- Inhibition of Ca2+ influx in vascular smooth muscle --- p.157 / Chapter 4.3 --- Comparisons of Results from In Vivo and In Vitro Studies --- p.159 / Chapter 4.4 --- Future Studies --- p.161 / Chapter 4.5 --- Conclusion --- p.162 / REFERENCES --- p.164

Ocular neovascularization (NV) associated with corneal NV, ischemic retinopathies and age-related macular degeneration is a leading cause of severe vision loss. While numerous contributing factors have been identified, the potential role of the CD36 scavenger receptor has been largely overlooked notwithstanding its crucial involvement in normal retinal function. Accordingly, the central aim of this work was to elucidate the contribution and regulation of CD36 during ocular NV using the cornea as a model. / Initial work investigating the role of CD36 10 maintaining corneal avascularity, an important feature of the normal cornea, revealed that genetic ablation of CD36 elicits age-related corneal NV. Subsequent studies using a pathophysiologically relevant model of inflammatory corneal NV showed constitutive expression of CD36 in the normal cornea with marked induction in the neovascularized cornea. Importantly, activation of CD36 suppressed and induced regression of corneal NV, effects that proceeded via concerted inhibition of VEGFA, JNK-1, and cJun. / Because hypoxia is a fundamental stimulus for angiogenesis, it was pertinent to explore the role and regulation of CD36 during hypoxia. We demonstrate that CD36 expression was significantly elevated in hypoxia-exposed corneal and retinal tissue and in hypoxic retinal pigment epithelial cells. Essential contributions of hypoxia-inducible factor (HIF)-1 and reactive oxygen species were also established. Functional consequences were depicted by augmentations in CD36 phagocytic and anti-angiogenic activities. / Collectively, data disclose CD36 as an important modulator of corneal avascularity and inflammatory corneal NV; this imparts several interesting avenues for future research on the involvement of CD36 in neovascular diseases of the eye. Novel data further identify CD36 as a hypoxia and HIF-1 regulated gene thus creating a framework for future elucidation of the regulatory aspects of this receptor.

Dissertation (Ph.D.)--University of South Florida, 2007. / Title from PDF of title page. Document formatted into pages; contains 214 pages. Includes vita. Includes bibliographical references.

Made available in DSpace on 2015-07-22T20:50:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-06-30 / A capilaroscopia periungueal (CPU) é um método diagnóstico simples, não invasivo e de baixo custo que permite o estudo in vivo do estado funcional e morfológico da rede capilar através da visualização direta da fileira distal de capilares da região periungueal dos dedos das mãos. Ela é usada para distinguir o fenômeno de Raynaud (FRy) primário do secundário, como preditor de prognóstico para as colagenoses e para diferenciar doença ativa de inativa (principalmente na dermatomiosite). Nossos objetivos foram avaliar o valor da CPU na evolução da atividade de doença na dermatomiosite juvenil (DMJ) e avaliar os achados clínicos e de CPU de uma coorte de crianças e adolescentes com FRy sem critérios para doenças reumáticas auto-imunes (DRAI). Foram avaliados prospectivamente 30 pacientes com DMJ (critérios de Bohan e Peter) e 40 crianças e adolescentes com FRy através do exame clínico (alterações cutâneas e força muscular) e laboratorial (enzimas musculares, provas de fase aguda e anticorpo antinuclear - AAN). A avaliação capilaroscópica foi realizada através de um microscópio óptico com aumentos de 10 e 16 vezes. O grupo de pacientes com DMJ compreendeu 20 pacientes do sexo feminino (66,6%), com média de idade de 10,4 anos e tempo médio de evolução da doença de 4 anos. Na primeira avaliação 22 das 26 capilaroscopias periungueais (84,6%) realizadas durante a fase ativa exibiram padrão escleroderma (padrão SD) e os 4 exames realizados durante a remissão foram normais. Portanto, em 26 dos 30 pacientes (86,6%) avaliados os dados clínicos e laboratoriais foram associados com os achados capilaroscópicos. Na avaliação prospectiva 15 dos 18 pacientes (83,3%) que mantinham atividade de doença persistiam com padrão SD na CPU e 10 dos 12 exames (83,3%) realizados durante a remissão foram normais ou apresentaram melhora do padrão SD. Portanto, em 25 dos 30 pacientes (83,3%) reavaliados a CPU também se associou com a presença ou ausência de atividade da doença. No grupo de crianças e adolescentes com FRy, 30 (75%) eram do sexo feminino, com média de idade de 14,6 anos e tempo médio de evolução de 4,2 anos. A média de idade do início dos sintomas foi de 10,4 anos e o tempo médio até o diagnóstico de 1,4 anos. Treze (32,5%) dos 40 pacientes apresentaram AAN positivo. Cinco pacientes (12,5%) apresentaram alterações na CPU inicial: 4 microangiopatia inespecífica e 1 padrão SD. Todos foram avaliados prospectivamente e 3 (7,5%) apresentaram alterações na CPU com tempo médio entre as avaliações de 1,6 anos (dos quais 2 sem alterações na 1ª avaliação). Dois pacientes com padrão SD na CPU apresentaram durante a evolução doença mista do tecido conjuntivo e hipotireoidismo respectivamente. Em um paciente com CPU normal e presença de auto-anticorpos foi diagnosticado lúpus eritematoso sistêmico após 1 ano da avaliação inicial. A CPU se associa com a atividade da DMJ e é útil para excluir doenças reumáticas ou outra doença auto-imune nas crianças e adolescentes com FRy. / Objective: To evaluate prospectively the clinical features and nailfold capillaroscopy findings of a cohort of children and adolescents who presented Raynaud´s phenomenon without criteria for auto-immune rheumatic diseases. Methods: We included 40 children and adolescents with Raynaud’s phenomenon. Each patient was clinically evaluated and laboratory exams were performed, including antinuclear antibodies. Concomitantly we also performed a nailfold capillaroscopy by using a optical microscope with a magnification of 10 and 16X. Results: Thirty (75%) out of 40 patients were girls with a mean age of 14.6 years and mean follow-up time of 4.2 years. The mean age at disease onset was 10.4 years and the mean time until diagnosis 1.4 years. Thirteen out of 40 patients (32,5%) presented antinuclear antibodies positivity. Five (12.5%) patients had altered nailfold capillaroscopy: 4 inespecific microangiopathy and 1 scleroderma pattern. All patients were prospectively evaluated within a mean interval time of 1.6 years and 3 (7.5%) patients presented nailfold capillaroscopy alterations. Two patients that showed scleroderma pattern at the nailfold capillaroscopy presented during the follow-up mixed connective tissue disease and hypothyroidism, respectively. In a patient with normal nailfold capillaroscopy and auto-antibodies positivity systemic lupus erythematosus was diagnosed after 1 year of initial evaluation. Conclusions: Raynaud´s phenomenon remains primary in most cases, however nailfold capillaroscopy is useful to help in exclusion of auto-immune rheumatic diseases or other auto-immune diseases. / TEDE / BV UNIFESP: Teses e dissertações

No description available.

INTRODUÇÃO: O retalho ântero-lateral da coxa é baseado em vasos perfurantes do ramo descendente da artéria circunflexa lateral femoral. Este retalho tem características muito interessantes para a cirurgia reparadora, como a pequena espessura, pedículo longo e excelente área doadora. No entanto, existem muitas controvérsias na literatura quanto aos vasos perfurantes e ao trajeto do pedículo deste retalho. Neste trabalho procurou-se estabelecer alguns parâmetros anatômicos e esclarecer estas controvérsias. MÉTODO: Estudaram-se 100 coxas de 50 cadáveres quanto aos seguintes aspectos: 1- Número e localização de perfurantes encontrados, 2- Trajeto do pedículo perfurante, 3- Trajetória intramuscular, 4- Comprimento do trajeto intramuscular, 5- Comprimento total do pedículo, 6- Diâmetro dos vasos e 7- Espessura do retalho. RESULTADOS: 1- Encontraram-se de 0 a 4 perfurantes por coxa estudada, todas em um raio de até 6cm do ponto médio entre a espinha ilíaca ântero-superior e a borda lateral da patela. 2- Os vasos perfurantes tinham trajeto músculo-cutâneo em 75,76% das coxas e septo-cutâneo em 24,24%. 3- Dos pedículos perfurantes com trajeto músculo-cutâneo, 86,67% possuíam trajetória indireta contra 13,33% com trajetória direta. 4- O comprimento médio do trajeto intramuscular dos pedículos foi de 3,67 ± 2,01 cm. 5- O comprimento médio do pedículo total foi de 11,31 ± 3,12 cm. 6- O diâmetro médio da artéria na origem do ramo descendente da artéria circunflexa femoral foi de 2,21 ± 0,85 mm e para as veias no mesmo local de 2,66 ± 1,33 mm e 2,10 ± 1,11 mm. 7- A espessura da tela subcutânea foi de 8,98 ±6,23 mm e da pele de 1,60 ± 0,76 mm. CONCLUSÕES: 1- Existiu uma pequena possibilidade de não haver pedículos perfurantes. 2- Quando presentes, os pedículos perfurantes do ramo descendente da artéria circunflexa lateral femoral eram encontrados em numero de 1 a 4, sempre em um raio de 6 cm a partir do ponto médio entre a espinha ilíaca ântero-superior e a borda lateral da patela. 3- Os trajetos dos pedículos perfurantes eram predominantemente músculo-cutâneos. 4- A trajetória intramuscular encontrada foi predominantemente indireta. 5- O comprimento do trajeto intramuscular correspondeu a 31,69% do comprimento total do pedículo. 6- O comprimento total do pedículo se mostrou adequado tanto para transferências locais como à distancia por técnicas microcirúrgicas. 7- Os diâmetros dos vasos, tanto da artéria quanto das veias, se mostraram adequados para a realização de anastomoses microcirúrgicas. 8- A espessura do retalho encontrada foi significantemente maior nas coxas de indivíduos femininos, mas tanto nos homens quanto nas mulheres a espessura foi relativamente fina. / INTRODUCTION: The anterolateral thigh flap is based on the perforator vessels of the descending branch of the lateral circumflex femoral artery. This flap has very interesting characteristics for the reconstructive surgery, like the small thickness, long pedicle and excellent donor site. On the other hand, there are many controversial data on the literature about the perforator vessels and the pedicle course of this flap. The aims of this study are to establish some anatomical parameters and clear some controversies. METHOD: A hundred thighs of 50 cadavers were studied for: 1- The number and location of the perforator vessels. 2- The course of the perforator pedicles. 3- The intramuscular course. 4- The length of the intramuscular course. 5- The total length of the vascular pedicle. 6- The diameter of the vessels. and 7- The thickness of the flap. RESULTS: 1- There were found from 0 to 4 perforators per thigh, all in a 6cm radius from the mid point between the anterosuperior iliac spine and the lateral border of the patella. 2- The pedicles was musculocutaneous in 75,76% of the thighs and septocutaneous in 24,24%. 3- Among the musculocutaneous pedicles, 86,67% had a direct intramuscular course, and 13,33% had indirect course. 4- The mean length of the intramuscular course was 3,67 ± 2,01 cm. 5- The mean total pedicle length was 11,31 ± 3,12 cm. 6-The mean artery diameter on the origin of the descending branch of the lateral circumflex femoral artery was 2,21 ± 0,85 mm and the mean vein diameter on the same spot was 2,66 ±1,33 mm and 2,10 ± 1,11 mm. 7- The mean subcutaneous fat tissue thickness was 8,98 ± 6,23 mm and the mean skin thickness was e 1,60 ± 0,76 mm. CONCLUSIONS: 1- There was a possibility of finding no perforators of the descending branch of the lateral circumflex femoral artery. 2- When present, the perforators pedicles were found in numbers between 1 to 4, always in a 6cm radius from the mid point between the anterosuperior iliac spine and the lateral border of the patella. 3- The perforators pedicles courses were predominantly musculocutaneous. 4- The intramuscular courses were mainly indirect. 5- The intramuscular length was responsible for 31,69% of the total length of the vascular pedicle. 6- The total length of the pedicle was adequate for either local or microsurgical transfers. 7- The arterial and venous diameters were adequate for microsurgical anastomosis. 8- The female cadavers had significantly thicker flaps, but both in the male and the female cadavers the flap was considerably thin.

INTRODUÇÃO: O retalho ântero-lateral da coxa é baseado em vasos perfurantes do ramo descendente da artéria circunflexa lateral femoral. Este retalho tem características muito interessantes para a cirurgia reparadora, como a pequena espessura, pedículo longo e excelente área doadora. No entanto, existem muitas controvérsias na literatura quanto aos vasos perfurantes e ao trajeto do pedículo deste retalho. Neste trabalho procurou-se estabelecer alguns parâmetros anatômicos e esclarecer estas controvérsias. MÉTODO: Estudaram-se 100 coxas de 50 cadáveres quanto aos seguintes aspectos: 1- Número e localização de perfurantes encontrados, 2- Trajeto do pedículo perfurante, 3- Trajetória intramuscular, 4- Comprimento do trajeto intramuscular, 5- Comprimento total do pedículo, 6- Diâmetro dos vasos e 7- Espessura do retalho. RESULTADOS: 1- Encontraram-se de 0 a 4 perfurantes por coxa estudada, todas em um raio de até 6cm do ponto médio entre a espinha ilíaca ântero-superior e a borda lateral da patela. 2- Os vasos perfurantes tinham trajeto músculo-cutâneo em 75,76% das coxas e septo-cutâneo em 24,24%. 3- Dos pedículos perfurantes com trajeto músculo-cutâneo, 86,67% possuíam trajetória indireta contra 13,33% com trajetória direta. 4- O comprimento médio do trajeto intramuscular dos pedículos foi de 3,67 ± 2,01 cm. 5- O comprimento médio do pedículo total foi de 11,31 ± 3,12 cm. 6- O diâmetro médio da artéria na origem do ramo descendente da artéria circunflexa femoral foi de 2,21 ± 0,85 mm e para as veias no mesmo local de 2,66 ± 1,33 mm e 2,10 ± 1,11 mm. 7- A espessura da tela subcutânea foi de 8,98 ±6,23 mm e da pele de 1,60 ± 0,76 mm. CONCLUSÕES: 1- Existiu uma pequena possibilidade de não haver pedículos perfurantes. 2- Quando presentes, os pedículos perfurantes do ramo descendente da artéria circunflexa lateral femoral eram encontrados em numero de 1 a 4, sempre em um raio de 6 cm a partir do ponto médio entre a espinha ilíaca ântero-superior e a borda lateral da patela. 3- Os trajetos dos pedículos perfurantes eram predominantemente músculo-cutâneos. 4- A trajetória intramuscular encontrada foi predominantemente indireta. 5- O comprimento do trajeto intramuscular correspondeu a 31,69% do comprimento total do pedículo. 6- O comprimento total do pedículo se mostrou adequado tanto para transferências locais como à distancia por técnicas microcirúrgicas. 7- Os diâmetros dos vasos, tanto da artéria quanto das veias, se mostraram adequados para a realização de anastomoses microcirúrgicas. 8- A espessura do retalho encontrada foi significantemente maior nas coxas de indivíduos femininos, mas tanto nos homens quanto nas mulheres a espessura foi relativamente fina. / INTRODUCTION: The anterolateral thigh flap is based on the perforator vessels of the descending branch of the lateral circumflex femoral artery. This flap has very interesting characteristics for the reconstructive surgery, like the small thickness, long pedicle and excellent donor site. On the other hand, there are many controversial data on the literature about the perforator vessels and the pedicle course of this flap. The aims of this study are to establish some anatomical parameters and clear some controversies. METHOD: A hundred thighs of 50 cadavers were studied for: 1- The number and location of the perforator vessels. 2- The course of the perforator pedicles. 3- The intramuscular course. 4- The length of the intramuscular course. 5- The total length of the vascular pedicle. 6- The diameter of the vessels. and 7- The thickness of the flap. RESULTS: 1- There were found from 0 to 4 perforators per thigh, all in a 6cm radius from the mid point between the anterosuperior iliac spine and the lateral border of the patella. 2- The pedicles was musculocutaneous in 75,76% of the thighs and septocutaneous in 24,24%. 3- Among the musculocutaneous pedicles, 86,67% had a direct intramuscular course, and 13,33% had indirect course. 4- The mean length of the intramuscular course was 3,67 ± 2,01 cm. 5- The mean total pedicle length was 11,31 ± 3,12 cm. 6-The mean artery diameter on the origin of the descending branch of the lateral circumflex femoral artery was 2,21 ± 0,85 mm and the mean vein diameter on the same spot was 2,66 ±1,33 mm and 2,10 ± 1,11 mm. 7- The mean subcutaneous fat tissue thickness was 8,98 ± 6,23 mm and the mean skin thickness was e 1,60 ± 0,76 mm. CONCLUSIONS: 1- There was a possibility of finding no perforators of the descending branch of the lateral circumflex femoral artery. 2- When present, the perforators pedicles were found in numbers between 1 to 4, always in a 6cm radius from the mid point between the anterosuperior iliac spine and the lateral border of the patella. 3- The perforators pedicles courses were predominantly musculocutaneous. 4- The intramuscular courses were mainly indirect. 5- The intramuscular length was responsible for 31,69% of the total length of the vascular pedicle. 6- The total length of the pedicle was adequate for either local or microsurgical transfers. 7- The arterial and venous diameters were adequate for microsurgical anastomosis. 8- The female cadavers had significantly thicker flaps, but both in the male and the female cadavers the flap was considerably thin.

INTRODUÇÃO: Na restrição de crescimento intrauterino, a resposta adaptativa a hipóxia, com priorização do fluxo sanguíneo para órgãos nobres, causa vasoconstricção periférica, com aumento da resistência nas artérias renais. Com isso, o desenvolvimento renal é prejudicado e fetos restritos apresentam volumes renais menores. No entanto, a literatura é escassa em estudos que utilizem a ultrassonografia tridimensional na avaliação renal e não descreve a relação desse possível dano renal com desfechos neonatais adversos. Tal técnica tem sido utilizada para mensurar volumes de órgãos e quantificar fluxos sanguíneos de baixa resistência, podendo ser também aplicada para melhorar a avaliação do volume e vascularização renal na restrição de crescimento. OBJETIVOS: Comparar a razão entre o volume renal total e o peso fetal estimado (VRT/PFE) entre fetos com e sem restrição. Além disso, correlacionar o VRT/PFE com a dopplervelocimetria fetal e os índices de vascularização renal e avaliar a associação dos parâmetros renais com eventos neonatais adversos nos fetos restritos. MÉTODOS: O volume total e a vascularização renal de fetos restritos e normais foram avaliados pela ultrassonografia tridimensional e a técnica VOCAL. Os índices de vascularização renal foram corrigidos pela profundidade renal (IVcp, IVFcp and IFcp). Os testes t para amostras independentes e Mann-Whitney foram utilizados para a comparação entre os grupos. Modelos lineares generalizados foram aplicados para avaliar a associação entre as características renais e os eventos neonatais adversos. RESULTADOS: Setenta e um fetos restritos foram comparados a 194 fetos com crescimento normal. O VRT/PFE foi menor no grupo restrito (p < 0,001). Porém essa razão não se correlacionaou com os parâmetros dopplervelocimétricos, os índices vasculares renais ou qualquer evento neonatal adverso. CONCLUSÃO: A razão entre o volume renal total e o peso fetal estimado tende a diminuir na restrição de crescimento intrauterino / INTRODUCTION: In fetal growth restriction, the adaptive response to hypoxia, with prioritization of blood flow to noble organs, causes peripheral vasoconstriction, such as increased resistance in the renal arteries. Then, renal development is impaired and restricted fetuses have lower renal volumes. However, the literature is scarse in studies using three-dimensional ultrasound in renal assessment and does not describe the relationship of this potential renal damage with adverse neonatal outcomes. That technique has been used to mesure volumes and quantify blood flows of low resistance and could also be applied to improve the evaluation of renal volume and vascularization in fetal growth restriction. OBJECTIVES: To compare the ratio of total renal volume to estimated fetal weight (TRV/EFW) among fetuses with and without grown restriction. Fhurthermore, we aim to correlate TRV/EFW with fetal dopplervelocimetry and renal vascularization indexes and to evaluate the association of renal parameters with adverse neonatal events in restricted fetuses. METHODS: Total renal volume and renal vascularization of restricted and normal fetuses were evaluated by three-dimensional ultrasonography and the VOCAL technique. Renal vascularization indexes were corrected for renal depth (VIcd, VFIcd and FIcd). The t-tests for independent samples and Mann-Whitney test were used for comparisons between groups. Generalized linear models were applied to evaluate the association between renal characteristics and adverse neonatal events. RESULTS: Seventy-one restricted fetuses were compared to 194 normally growing fetuses. The TRV/EFW was lower in the restricted group (p < 0.001). However, this ratio did not correlate with Doppler velocimetric parameters, renal vascular indexes or any adverse neonatal events. CONCLUSION: The ratio of total renal volume to estimated fetal weight tends to decrease in intrauterine growth restriction

Das Vorkommen von über den Umgebungsdruck erhöhten Sauerstoffpartialdrucken in Geweben ist im Tierreich nur von der Schwimmblase und dem Auge von Knochenfischen bekannt. Die physiologischen Mechanismen dieser Sauerstoffkonzentrierung wurden an der Schwimmblase insbesondere des Aals intensiv untersucht, entsprechende Untersuchungen zu den Vorgängen im Auge der Knochenfische fehlen jedoch. In dieser Arbeit wurde daher eine Methode etabliert, mit der die Sauerstoffkonzentrierung im Auge der Knochenfische an isolierten Augen untersucht werden kann. 1. Das Gefäßsystem der Regenbogenforelle (Oncorhynchus mykiss, Walbaum 1792) wurde durch Gefäßausgüsse dargestellt. Das im Auge gelegene choroidale Rete mirabile wird über die Arteria ophthalmica, die gleichzeitig die efferente Pseudobranchienarterie darstellt, versorgt. Die Pseudobranchie selber empfängt das Blut aus der efferenten Arterie des ersten Kiemenbogens. Diese Gefäßtopologie, Versorgung der Pseudobranchie mit bereits im ersten Kiemenbogen oxygeniertem Blut und auschließliche Versorgung des choroidalen Rete mirabile mit Blut aus der Pseudobranchie, weist auf die Bedeutung der Pseudobranchie für die Prozesse im Auge hin. 2. Die Retina der Regenbogenforelle wurde mikroskopisch untersucht. Die einzelnen Schichten der Retina entsprechen denen anderer Wirbeltiere. Die Forellenretina ist mit 407 µm aber wesentlich dicker als z.B. die Retina von Mammaliern. Zusätzlich fehlt der Retina der Forelle die bei vielen Mammaliern vorhandene retinale Blutgefäßversorgung. Mit den der Retina am nächsten gelegenen Gefäßen in der Choroidea bestehen bei der Forelle wesentlich größere Diffusionsstrecken von den Blutgefäßen zum Ort des Sauerstoffverbrauchs in den Zellen der Retina als bei anderen Wirbeltieren. Dies wir durch den erhöhten Sauerstoffpartialdruck in den Choriokapillaren kompensiert. 3. Für die Messung des intraretinalen Sauerstoffpartialdrucks wurden im Rahmen dieser Arbeit Sauerstoffmikroelektroden inklusive der zur Betreibung der Elektroden notwendigen Elektronik entwickelt. Die Elektroden waren vom Recess-Typ: die reaktive Oberfläche schloss nicht mit dem Ende der Glaskapillare ab, sondern war unter Belassung eines Hohlraumes in der Elektrodenspitze (Recess) in das innere der Glaskapillare verlagert. Dadurch waren die Elektroden unempfindlich gegenüber Rühreffekten. Die Mikroelektroden hatten eine Spitzendurchmesser von < 10 µm und eine mittlere Empfindlichkeit von 172 fA Torr-1 O2. Die Linearität der Elektroden über eine Partialdruckbereich von 0 bis 760 Torr O2 war besser als r = 0,9998. 4. Zur Überprüfung des normale Sauerstoffpartialdrucks in der Retina wurden Regenbogenforellen betäubt und künstlich ventiliert. Die systemischen Parameter wie arterieller PO2-Wert, Blutdruck und Herzschlag entsprachen dabei im Mittel mit 99 Torr (arterieller PO2), 28 Torr (Blutdruck) und 1,23 Hz (Herzschlag) den Werten unbetäubter, freischwimmender Forellen. Lediglich der arterielle pH-Wert war mit 8,02 während der künstlichen Ventilation durch eine ungenügende Kompensation einer respiratorischen Alkalose leicht gegenüber dem normalen Wert von 7,9 erhöht. 5. Die Auswirkungen der Präparation des Auges zur Messung des intraretinalen Sauerstoffpartialdrucks auf den Augeninnendruck wurde überprüft. Der Augeninnendruck betrug 4,9 Torr. Die Einbringung der Sauerstoffmikroelektrode hatte keine Auswirkung auf den Augeninnendruck. Erst das Entfernen der Elektrode nach der Messung führte zu einer deutlichen Verringerung des Augeninnendrucks. 6. Zum ersten Mal wurde in der vorliegenden Arbeit die Durchblutungsrate des Auges eines Knochenfisches bestimmt. Aus präparatorischen Gründen wurde die Messung an der afferenten Pseudobranchienarterie durchgeführt. Der mittlere Blutfluss in dem Gefäß betrug 745 µl min-1 kg-1. Durch Verschluss des kontralateralen Gefäßes stieg der Fluss auf 135% des ursprünglichen Wertes, da jetzt durch das ipsilaterale Gefäß und über die zwischen den beiden Gefäßen bestehende Anastomose beide Augen durch das ipsilaterale Gefäß mit Blut versorgt wurden. 7. Die Funktion der Retina während der intraretinalen Sauerstoffmessung wurde durch Ableitung des Elektroretinogramms kontrolliert. Trotz der während der Versuche fortbestehenden Betäubung mit dem Betäubungsmittel MS222, welches sich negativ auf das Elektroretinogramm auswirken soll, konnten normale Elektroretinogramme aufgezeichnet werde. Die invasive Messung des intraretinalen PO2 wirkte sich nicht negativ auf die Funktionalität der Retina aus. 8. Der intraretinale Sauerstoffpartialdruck wurde an betäubten, künstlich ventilierten Forellen überprüft. Der mittlere maximale PO2 im Bereich der Bruch´schen Membran betrug 382 Torr. An der Innenseite der Retina wurde ein PO2 von 10 Torr gemessen. Der Bereich des O2-Partialdruckgradienten in der Retina, gemessen über den Vorschub der Sauerstoffmikroelektrode vom niedrigsten bis zum höchsten PO2, betrug 433 µm, ein Wert der gut mit der mikroskopisch bestimmten Dicke der Retina (407 µm) übereinstimmt. 9. Zur Untersuchung der Einflüsse von Blutparametern auf die Sauerstoffkonzentrierung im Auge der Forelle wurden isolierte Augen künstlich mit verschiedenen Erythrozytensuspensionen perfundiert. Dazu wurde zum einen eine Suspension von Forellenerythrozyten eingesetzt, bei der erst der Root-Effekt in Abhängigkeit vom pH-Wert der Suspension bestimmt wurde. Bei basischem pH-Werten war das Hämoglobin der Erythrozyten vollständig gesättigt. Bei einem pH-Wert von 7,68 war noch eine Sättigung von 90% vorhanden, die bis zu einem pH-Wert von 7,31 auf 50% abnahm. 10% Sättigung wurden bei einem pH-Wert von 6,94 erreicht. Für die Perfusion wurde die Suspension der Forellenerythrozyten mit einem pH-Wert von 7,48 eingesetzt. Bei diesem pH-Wert liegt die Sättigung bei ca. 82% und eine Änderung des pH hat in diesem Bereich eine deutliche Änderung der Sättigung zur Folge, was die Freisetzung von O2 von Hämoglobin erleichtert. Als alternative Perfusionslösung wurde eine Suspension von Humanerythrozyten eingesetzt. Humanhämoglobin weist keinen Root-Effekt auf, es kann also durch die im Auge der Knochenfische vorhandenen Mechanismen kein Sauerstoff freigesetzt werden. 10. Der mittlere intraretinale Sauerstoffpartialdruck isolierter Augen betrug bei Perfusion mit der Suspension von Forellenerythrozyten 99 Torr. Nach dem Wechsel auf die Suspension mit Humanerythrozyten fiel der intraretinale Sauerstoffpartialdruck sofort auf 30 Torr ab. Der Perfusionsdruck änderte sich bei dieser Umstellung nicht. Bei Perfusion mit Ringerlösung fiel der intraretinale PO2 auf 20 Torr, gleichzeitig fiel jetzt auch der Perfusionsdruck ab. 11. Eine Konzentrierung des Sauerstoffs konnte bei der künstlichen Perfusion isolierter Augen nicht nachgewiesen werden. Die Notwendigkeit des Root-Effekts für einen hohen Sauerstoffpartialdruck im Auge wird trotzdem deutlich, da bei Perfusion mit einer Suspension von Humanerythrozyten, die einen höheren Sauerstoffgehalt aufwies als die Suspension der Forellenerythrozyten, der intraretinale Sauerstoffpartialdruck deutlich geringer war. 12. Das Modell des isoliert perfundierten Auges ist zur physiologischen Untersuchung des choroidalen Rete mirabile und Sauerstoffkonzentrierung besser geeignet als in vivo - Experimente, da systemische Einflüsse vermieden und die Auswirkungen der Pseudobranchie auf die Blutchemie ausgeschaltet werden können. / Oxygen partial pressures (Po2) above ambient levels are found only in the swimbladder and the eye of teleost fish species. The mechanisms related to the involved oxygen concentration processes have been investigated to some detail in eel swimbladder, but little attention has been paid to analogous mechanisms of the teleost eye. This thesis has accordingly concentrated on developing a method promoting investigation of oxygen concentrating mechanisms in teleost eyes by application of an isolated perfused eye preparation. 1. The vascular supply of eye and pseudobranch in rainbow trout (Oncorhynchus mykiss, Walbaum, 1792) was depicted by corrosion casts of the vascular system. The choroid rete mirabile is supplied with blood by the ophthalmic artery as the efferent blood vessel of the pseudobranch, with a small anastomosis to the contralateral vessel. The pseudobranch in turn is fed by the efferent artery of the first gill arch. This pattern of serial vascular connection suggests a role for the pseudobranch in the process of providing high oxygen tensions required for the high metabolic demand of the visual perception in the retina. 2. Eyes of various fish species were sectioned after paraffin embedding and examined microscopically. The organisation of teleost fish retinae is characterised by the same features and organisation well known from other vertebrates. However, the total thickness of 407 µm found for the retina of the rainbow is much larger than that observed in other animals such as mammals. The conditions of diffusive oxygen supply of retinal nerve cells is further hampered by the complete lack of intraretinal blood vessels commonly found in mammals. In trout, blood is supplied to only the choroid layer, leaving large diffusion distances to the retinal nerve cells to be spanned by oxygen partial pressures, elevated as compared to the bulk arterial system in the choroid capillaries. 3. Intraretinal oxygen partial pressure was determined in long-term anaesthetised specimens of Oncorhynchus mykiss, using specially developed oxygen microelectrodes and required electronic circuitry. Characteristic features of the electrodes include insensitivity of the signal to stirring, achieved by a recess of the reactive metal surface in a glass capillary, an average tip diameter of less than 10 µm and a characteristic sensitivity to oxygen of 172 fA Torr-1. The response of the electrodes to oxygen was linear over a range of partial pressures from 0 to 760 Torr O2 (r= 0,9998). 4. Normal oxygen partial pressures in trout retina were measured in long-term anaesthetised and artificially ventilated specimens of Oncorhynchus mykiss. In order to conduct the experiments under conditions as close as possible to normal homoiostasis, several systemic valuables were monitored continuously. During experimentation arterial Po2 averaged 99 Torr, mean blood pressure was 28 Torr and heart frequency was on the average 74 bpm, respectively, data in the range of values determined in unanesthetized, freely swimming trout. As the one exception, arterial pH (8,02) was slightly elevated during artificial ventilation as compared to control values (7,89), a shift induced by an inadequately high rate of artificial ventilation. 5. The impact of insertion of electrodes required for intraretinal Po2 measurement into the eye was found to have little effect. The intraocular pressure remained unaffected by opening the eye by puncture with leading cannula and inserted micro-Po2-electrode. The intraocular pressure fell only after removing the electrode after completion of the experiment. 6. Normal function of the retina during experimentation in vivo was checked by repeatedly measuring electroretinograms provoked by light flashes under dark ambient conditions. Although extended anaesthesia with MS222 is expected to affect the electroretinogram in fish, there was no indication of abnormal or reduced electroretinograms during experimentation. Also puncture of the eye with insertion of electrodes did not affect the electroretinogram. 7. Intraretinal Po2 was measured in anaesthetised and artificially ventilated trout. Oxygen profiles were recorded during advancement of the electrode tip though the retina, from the lowest Po2 at the inner surface with about 10 Torr to the highest Po2 in the region of Bruch´s membrane with about 382 Torr, travelling a total distance of 433 µm. This distance closely corresponds to the thickness of the retina measured by microscopic sectioning. 8. Blood flow to the eye as an important parameter for the establishment of an isolated eye preparation was measured in the afferent artery of the pseudobranch. Due to the anatomical situation this represents the closest possible approximation to measurement of flow in the ophthalmic artery. The blood flow was estimated by ultrasonic Doppler techniques with in situ calibration to be 216 µl min-1. Occlusion of the contralateral vessel resulted in an increase of the blood flow in the ipsilateral vessel to 135% of the original as a result of flow through the small anastomosis between the two ophthalmic arteries. This estimate is the first performed for blood flow to the eye of a fish. 9. An isolated eye preparation was used to investigate the influence of specific blood parameters on oxygen concentrating processes in the eye of Oncorhynchus mykiss. Eyes were perfused with suspensions of trout erythrocytes, human erythrocytes and Ringer´s solution. The Root Effect of trout haemoglobin was confirmed in suspension of erythrocytes. The haemoglobin was fully saturated at pH 8.45, still 90% saturated at 7.68, 50% at 7.31 and 10% at pH 6.94. In order to provide optimal starting conditions for the release of oxygen by relatively small changes in pH, pH 7.48 (resulting in 82 % saturation) was chosen for the perfusion of isolated eyes. As a control perfusion, suspensions of human erythrocytes provided a perfusate lacking any Root effect, thus not supporting the oxygen concentrating processes in fish eyes. 10. Perfusion of isolated trout eyes with pH 7.48 trout erythrocyte suspension resulted in an average intraretinal Po2 of 99 Torr, whereas perfusion with human erythrocytes resulted in an immediate decrease of Po2 to (of) 30 Torr, with a further drop to 20 Torr during perfusion with Ringer´s solution. Changes in perfusion between erythrocyte suspensions were performed without any changes in perfusion pressure, but the switch to control perfusion with Ringer´s solution exhibited a drop in perfusion pressure due to the reduced viscosity of the medium. 11. Although perfusion of isolated eyes did not exhibit Po2 above ambient values, the effect of oxygen concentrating processes were clearly indicated by comparison with Root effect-lacking human erythrocyte perfusate (Po2´s of 99 vs. 30 Torr, respectively). 12. It is concluded that studies of oxygen concentrating mechanisms are to be performed preferably on isolated eye preparations. For closer analysis of the involved mechanisms this preparation allows for isolated control of individual parameter of the perfusate. In particular, uncontrolled effects of the pseudobranch on the perfusate can be eliminated.