Thesis (M.S. )--University of Tennessee Health Science Center, 2007. / Title from title page screen (viewed on April 18, 2008 ). Research advisor: Mona N. Wicks, Ph.D., RN. Document formatted into pages (xi, 109 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 79-86).

Orientador: Edgard Ferro Collares / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T00:13:29Z (GMT). No. of bitstreams: 1 Vinagre_AdrianaMendes_D.pdf: 6789809 bytes, checksum: 05de43a9be5ce48b46cb5b0b6ab54ec7 (MD5) Previous issue date: 2011 / Resumo: O esvaziamento gástrico (EG) é um processo de transferência do conteúdo gástrico para o intestino delgado, resultante da ação de mecanismos inibidores e estimuladores que controlam a atividade motora do estômago, piloro e duodeno. A dipirona, um derivado da fenilpirazolona, por via intravenosa (iv) e intra-cérebro-ventricular (icv), em ratos, retarda o esvaziamento gástrico (EG) de uma refeição líquida (salina). Quando administrada por via iv, o fenômeno foi abolido pela vagotomia sub-diafragmática e lesão eletrolítica do núcleo para-ventricular do hipotálamo. Em observação adicional, foi demonstrado que este efeito foi bloqueado pela injeção icv de baclofen, um agonista de receptores GABAB. O derivado fenilpirazolônico antipirina injetado iv também retarda o EG de líquido e este efeito foi reduzido significativamente pela vagotomia sub-diafragmática e abolido pela injeção icv de baclofen. Adicionalmente, demonstramos que a administração iv de 4-aminoantipirina (um metabólito da dipirona) diminui o EG de líquido em ratos e, da mesma forma que com a antipirina, foi reduzido significativamente pela vagotomia sub-diafragmática e abolido pela injeção icv de baclofen. Em situações em que há alteração no EG, a participação do estômago no processo pode ser inferida através da determinação in vivo do volume e da complacência gástrica, como indicadores do tônus gástrico. O tônus desta região é resultado, em grande parte, da atividade do nervo vago. Demonstramos que, para as condições de estudo as três drogas aumentam a complacência gástrica. O conjunto destes estudos sugere a participação do sistema nervoso central (SNC) e do nervo vago no fenômeno de retardo do EG induzido por estas drogas. Como somente a dipirona induziu o mesmo efeito quando administrada icv e o retardo do EG induzido pelas três drogas iv foi abolido pela vagotomia sub-diafragmática, em continuidade especulamos que o estímulo inibitório do EG, quando da administração por via iv, chegue ao SNC através de vias aferentes. A capsaicina é uma neurotoxina que administrada a ratos recém nascidos resulta em degeneração irreversível da maioria dos neurônios aferentes periféricos com axônios não mielinizados (fibras C) e de uma minoria de fibras escassamente mielinizadas (fibras A?). Constatamos que a administração desta neurotoxina, no período neonatal, a ratos, aboliu o efeito destas três drogas administradas iv, mas não da dipirona icv, sugerindo a participação das vias aferentes no fenômeno e de que o mecanismo (ou mecanismos) envolvido no efeito da administração dipirona no SNC difere daquele quando a droga é administrada iv. Embora os estudos relacionados ao efeito dos derivados fenilpirazolônicos sobre o EG, indicarem a participação do nervo vago no fenômeno, sabe-se que os efeitos do sistema nervoso simpático e parassimpático sobre os sistemas podem ser sinérgicos, exclusivos e até mesmo concomitantes. O sistema nervoso simpático, que tem efeito inibitório sobre o EG, libera norepinefrina nas terminações pós-ganglionares. Foram identificados subtipos de "alfa"- e ß-adrenoceptores em diferentes níveis do trato gastrointestinal que podem ter participação importante no controle da motricidade gástrica. Há evidências que neurônios aferentes e eferentes do nervo vago possuam beta-adrenoceptores, sendo que o subtipo ß2-adrenoceptor parece ser o predominante. Avaliando a participação do sistema adrenérgico no retardo do EG, os resultados do estudo sugerem: 1) que a simpatectomia química ou o pré-tratamento com propranolol (antagonista não seletivo ß-adrenérgico) aboliram o efeito da dipirona e antipirina e reduziram o da 4-aminoantipirina sobre o EG; 2) como pouco provável que retardo do EG induzido por estas drogas ocorra por ativação de "alfa"1-, "alfa"2-, ß1- , ß2- e ß3-adrenoceptores periféricos. Estes últimos resultados aventam a possibilidade que no efeito destas drogas haja envolvimento da ativação de receptores ß1- e/ou ß2-adrenérgicos no SNC e, que o mesmo, não ocorra em grande parte do efeito da 4-aminoantipirina / Abstract: Gastric emptying (GE) is the process of transfer of the gastric contents to small intestine, as result of inhibitory and stimulatory mechanisms that control the stomach, pylorus and duodenum motor activity. Dipyrone, a phenylpyrazole derivative, administrated intravenously (iv) and intracerebroventricularly (icv), in rats, slows the gastric emptying (GE) of a liquid meal (saline). When administrated iv, this phenomenon was abolished by sub-diaphragm vagotomy and electrolytic lesion of the hypothalamus paraventricular nucleus. In an additional study, it was demonstrated that this effect was blocked by icv injection of baclofen, a GABAB receptor agonist. The phenylpyrazole derivative antipyrine when injected by iv slows the GE of liquid also, and this effect was significantly decreased by sub-diaphragm vagotomy and abolished by bacloflen icv injection. Moreover, we demonstrated that the 4-aminoantipyrine (a dipyrone metabolite) administration iv decrease the GE of liquids in rats and as antipyrine, it was significantly reduced by subdiaphragm vagotomy and abolished by bacloflen icv injection. When happen alterations on GE, the stomach activity in this process can be inferred by in vivo determination of gastric volume and complacency, as indicators of gastric tone. The tone of this region is a result, mostly, of vagus nerve activity. We showed that in our studies conditions, the three drugs increased gastric complacence. Putting these results together we suggested the action of central nervous system (CNS) and vagus nerve in the GE retardation induced by these drugs. Taking into account that only dipyrone induced the same effect when administrated icv and that GE retardation induced by the three drugs was abolished by sub-diaphragm vagotomy, we speculated whether the GE inhibitory stimulus, when the drugs were administrated iv, reach the CNS through afferent pathway. The capsaicin is a neurotoxin which when administrated to new born rats, results in irreversible degeneration of the most part of peripheral afferent neurons with unmyelinated axons (fiber C) and a minority of thinly myelinated fibers (fiber A"sigma"). Our studies showed that the administration of this neurotoxin, during neonatal period, nullify the effect of these three drugs when administrated by iv, but didn't when dipyrone was gave by icv, what suggests the role of afferent pathways in this phenomenon and that the mechanism (or mechanisms) involved in the effect of dipyrone administration on CNS id different when the drug is administrated by iv. Although the studies related to phenylpyrazole derivative effects on the GE indicated the action of vagus nerve on this phenomenon, we know that the effects of sympathetic and parasympathetic system on the systems can be synergics, exclusives and to concomitant. The sympathetic nervous system, which has inhibitory effect on the GE, releases norepinephrine in the postganglionic endings. It was identified subtypes of "alfa"- and ß- adrenoreceptors in different sites in gastrointestinal tract that may have important roles in the control of gastric motor. It's evidences that afferent and efferent neurons of vagus nerve have beta-adrenoreceptors and the subtype ß2-adrenoreceptor seems to be the predominant. Evaluating the participation of adrenergic system on the GE retardation, the results of our study suggest: 1) the chemistry sympathectomy or the early treatment with propanolol (ß-adrenergic non selective antagonist) abolished the effect of dipyrone and antipyrine and reduced the effect of 4-aminoantipyrine on the GE; 2) it's almost unlikely that the slow GE induce by these drugs occur by activation of "alfa"1-, "alfa"2-, ß1- , ß2- e ß3- peripherics adrenoreceptors. The last results suggest the possibility that in this drugs effects have involvement of receptor ß1- and/or ß2-adrenergics activation on the CNS and that this don't occur at mostly of 4-aminoantipyrine effect / Doutorado / Doutor em Farmacologia

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Tendo em vista que o comportamento motor do trato gastrointestinal parece ter intima relaÃÃo com a atividade do sistema cardiovascular, decidimos verificar se a redistribuiÃÃo do volume sanguÃneo atravÃs de fistula aorto-caval com agulhas de calibres (21, 23 ou 26G) afeta a motilidade do trato gastrintestinal em ratos acordados. Ratos machos albinos (230 a 280g) foram divididos em grupos falso-operado (FO) ou com fÃstula designados (F), alÃm disso, tiveram grupos fÃstula+sangria (FS), fÃstula+vagotomia (FV) bem como fÃstula+esplancnotomia (FE), todos estudados com 24 horas apÃs a confecÃÃo da fistula com agulha (21G). Os parÃmetros hemodinÃmicos de pressÃo arterial mÃdia (PAM), freqÃÃncia cardÃaca (FC), e pressÃo venosa central (PVC) foram monitorados continuamente e o dÃbito cardÃaco (DC) determinado por termo-diluiÃÃo. ApÃs os procedimentos cirÃrgicos os ratos FO e os (F) tiveram os parÃmetros hemodinÃmicos e o esvaziamento gÃstrico (EG) estudados nos tempos pÃs-prandial (10, 20 ou 30min.). A PA dos ratos (F) tiveram valores inferiores (p < 0,05) quando comparados aos FO (116,3  3,5 vs 101,3  3,3mmHg). Por outro lado, nos ratos (F) houve aumento (p < 0,05) nos valores da PVC (1,9  0,4 vs 5,8  0,6cmH2O) da FC (365,0  7,0 vs 417,0  7,0bpm) e do DC (119,9  9,6 vs 172  5,3ml/min) quando comparados aos ratos FO. Em relaÃÃo ao FO ocorreu uma retenÃÃo gÃstrica nos ratos (F) nos tempos pÃs-prandial 10, 20 e 30min (45,6 Â3,6 vs 57,5  2,1%; 36,4  2,7 vs 50,5  3,3 % e 33,3  2,7 vs 44,7  3,0 %, respectivamente). Os ratos do grupo (FS), apresentaram valores de (EG) inferiores aos animais (F) (36,5  3,2 vs 50,5  3,3%, p<0,05), mas similares aos FO (36,4  2,7%). Em relaÃÃo à vagotomia (FV), a mesma reverteu o retarde no (EG) induzido pela FÃstula (F) (40,4  2,3 vs 50,5  3,3%), em contrapartida, os ratos submetidos a esplancnotomia (FE) nÃo apresentaram diferenÃas com os (F) (50,5  3,3 e 50,1  1,4%). AlÃm do mais, nÃo foi encontrada participaÃÃo da secreÃÃo Ãcida no retarde do (EG) apÃs fÃstula. Portanto, a sobrecarga cardÃaca advinda de fÃstula arteriovenosa com agulhas de calibre (21, 23 ou 26G) alÃm de promover alteraÃÃes nos parÃmetros hemodinÃmicos, induz retarde no (EG) e interfere no trÃnsito intestinal de lÃquidos em ratos acordados. Tal retarde no (EG) inclusive foi abolido apÃs sangria ou vagotomia subdiafragmÃtica prÃvias, mas nÃo havendo alteraÃÃo apÃs esplancnotomia. / In view that the behaviour of gastrointestinal tract seems to have intimate relationship with the activity of the cardiovascular system, we decided to verify whether the redistribution of blood volume through fistula aorto-caval with sizes of needles (21, 23 or 26G) affect the motility of the gastrointestinal tract in rats awaked. Male albino rats (230 to 280g) were divided into groups false-operated (FO) or designated with fistula (F), moreover, had groups fistula + bleeding (FS), fistula + vagotomy (FV) and fistula + esplancnotomy (FE), all with studied 24 hours after preparation of the fistula with needle (21G). Hemodynamic parameters of mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP) were monitored continuously and cardiac output (CO) determined by term-dilution. After the surgical procedures the rats FO and (F) had the hemodynamic parameters and gastric emptying (GE) studied in the time post-prandial (10, 20 or 30min.). The MAP of rats (F) had lower values (p <0.05) when compared to FO (116.3  3.5 vs. 101.3  3.3 mmHg). Moreover, in rats (F) increased (p <0.05) the values of CVP when compared to rats FO (1.9  0.4 vs 5.8  0.6 cmH2O), HR (365.0  7.0 vs 417.0  7.0 bpm) and the CO (119.9  9.6 vs 172  5.3 ml / min). In relation the rats the FO was a gastric retention increased in (F) in the time post-prandial 10, 20 and 30min (45.6  3.6 vs 57.5  2.1%; 36.4  2.7 vs 50.5  3.3% and 33.3  2.7 vs 44.7  3.0%, respectively). The rats of the group (FS), showed values of (GE) lower than the animals (F) (36.5  3.2 vs 50.5  3.3%, p <0.05) but similar to FO ( 36.4  2.7%). The vagotomy (FV), it reversed the delay in the (GE) induced by fistula (F) (40.4  2.3 vs 50.5  3.3%), in contrast, the rats undergoing esplancnotomy (FE) showed no differences in comparation with the (F) (50.5  3.3 and 50.1  1.4%). Moreover, was not found involvement of acid secretion in the delays of the (GE) after fistula. Therefore, the overload heart arisen from arteriovenous fistula with needles, size (21, 23 or 26G) to promote changes in hemodynamic parameters, leads decreases the (GE) and interfere in the intestinal transit of liquids in rats awaked. This delay in the (GE) was also abolished after bleeding or prior the subdiaphragmatic vagotomy, but no change after esplancnotomy.

O presente estudo teve como objetivo avaliar o esvaziamento gástrico e o trânsito intestinal em 31 pacientes (sendo 10 controle e 21 com vômitos) após cirurgia bariátrica de DGYR e a relação das alterações destas duas variáveis entre si e com quadro sintomático e ainda tentar definir o tempo de esvaziamento gástrico desejável. O esvaziamento gástrico e o trânsito gastrintestinal foram avaliados mediante cintilografia, segundo técnicas padronizadas e previamente empregadas em outros estudos. A análise das imagens obtidas e armazenadas foi feita mediante o delineamento de regiões de interesse (ROI, da expressão, em Lingua Inglesa, region of interest) correspondendo ao coto gástrico, para a quantificação do esvaziamento gástrico, e para este segmento e também para as porções proximal e distal do intestino delgado e para a região ileocecal, para o trânsito gastrintestinal. A mesma região de interesse foi utilizada para as contagens de todas as imagens consecutivas, para a mesma projeção e para o mesmo paciente. Para a determinação do esvaziamento gástrico, a atividade em cada momento do estudo foi expressa pela média geométrica das contagens das imagens anteriores e posteriores, para correção do efeito da eventual movimentação intragástrica das partículas do radiotraçador (30, 60, 90 e 120 minutos após ingerir a refeição). Foi feita também correção adicional das contagens para compensar o declínio físico do 99m Tecnécio. Ambas as correções foram feitas automaticamente pelo equipamento. As contagens corrigidas permitiram a construção, para cada sujeito do estudo, da correspondente curva de esvaziamento gástrico, expressa como porcentuais de retenção intragástrica do radiotraçador ingerido, em cada um dos momentos de aquisição das imagens. Foi considerado como tempo inicial o momento em que se deu o término da ingestão da refeição contendo o radioisótopo, que corresponderia idealmente a um estado caracterizado por retenção intragástrica alimentar de todo o ingerido (100%). Após a realização da cintilografia, as imagens permaneceram armazenadas num sistema computadorizado acoplado à gama câmara e, no momento da análise, foram então definidas manualmente as ROI correspondentes ao estômago, ao jejuno, ao íleo e à região ileocecal. Em todos os casos, atentou-se para que as áreas destas ROI fossem semelhantes, o que foi feito levando-se em conta o número de pixels englobado por cada uma das regiões. Foi feita uma subdivisão do grupo com sintomas em 2 subgrupos: 8 pacientes com quadro de vômitos e exames de imagem alterados (EDA e seriografia) e 11 pacientes com quadro de vômitos e exames de imagem normais.O teste de Mann-Whitney bicaudal foi utilizado para comparações entre os dois grupos e entre os dois subgrupos. Os resultados foram apresentados como mediana e percentis, com significância de p < 0,05. Para a verificação das correlações entre esvaziamento gástrico e trânsito intestinal foi utilizado o coeficiente de correlação de Spearman, com significância de p < 0,05: não houve diferença significativa entre os dois grupos nos diversos tempos estudados (30, 60, 90 e 120 minutos) com relação ao esvaziamento gástrico. Também não houve diferença significativa com relação ao trânsito intestinal de acordo com o centro geométrico nos tempos 0, 30, 60, 90 e 120 minutos. Entretanto, houve diferença significativa entre os dois subgrupos extraídos do grupo com sintomas em todos os tempos do esvaziamento gástrico e nos tempos 0, 30, 60 e 90 minutos do trânsito intestinal (centro geométrico). Não houve diferença significativa entre os subgrupos no tempo 120 e na progressão do centro geométrico. Descritores: esvaziamento gástrico, trânsito intestinal, DGYR. / The objective of the present study was to assess gastric emptying and intestinal transit in 31 patients (10 controls and 21 with vomiting as a symptom) after bariatric surgery by RYGB and the relation of the alterations of these two variables between them and with the signs and symptoms, and also to try to define the desirable time of gastric emptying. Gastric emptying and gastrointestinal transit were evaluated by scintigraphy according to standardized techniques previously employed in other studies. The images obtained and stored were analyzed by delineating the regions of interest (ROI) corresponding to the gastric stump for the quantitation of gastric emptying and also for the proximal and distal portions of the small bowel and for the ileocecal region, for the gastrointestinal transit. The same ROI was used to count all the consecutive images for the same projection and for the same patient. For the determination of gastric emptying, the activity at each time point in the study was expressed as the geometric mean of the counts of the anterior and posterior images, for the correction of the effect of eventual intragastric movement of the radiotracer particles (30, 60, 90 and 120 minutes after meal ingestion). The counts were also additionally corrected to compensate for the physical decline of 99m Technetium. Both corrections were automatically made by the equipment. The corrected counts permitted the construction for each subject of the corresponding gastric emptying curve, expressed as percentage of intragastric retention of the ingested radiotracer at each time of image acquisition. The initial time was considered to be the moment when the ingestion of the meal containing the radioisotope occurred, which would ideally correspond to a state characterized by intragastric retention of all the food ingested (100%). After scintigraphy, the images were stored in a computerized system coupled to the gamma camera and, at the time of analysis, the ROI corresponding to the stomach, jejunum, ileum and ileocecal region were defined manually. In all cases, an attempt was made for these ROI to be similar, by taking into account the number of pixels included in each region. The group with symptoms was divided into 2 subgroups: 8 patients with vomiting and altered imaging exams (UDE and seriography) and 11 patients with vomiting and normal imaging exams. The two-tailed Mann-Whitney test was used to compare the two groups and the two subgroups. Data are reported as median and interquartile range, with significance set at p < 0.05. The Spearman correlation coefficient was used to determine the correlations between gastric emptying and intestinal transit, with significance set at p < 0.05. There was no significant difference between the two groups at the various time points studied (30, 60, 90 and 120 minutes) regarding gastric emptying. Also, there was no significant difference regarding intestinal transit according to the geometric center at 0, 30, 60, 90 and 120 minutes. However, there was a significant difference between the two subgroups extracted from the group with symptoms at all times of gastric emptying and at times 0, 30, 60 and 90 minutes of intestinal transit (geometric center). There was no significant difference between subgroups at 120 minutes or in the progression of the geometric center.

Poisoning is common and carries considerable morbidity and mortality. Two to three patients are admitted to the Emergency Unit at Groote Schuur Hospital every day with drug overdose. As absorption occurs in the small intestine the rates at which ingested poisons pass into and through the small bowel are important factors in determining the amount of poison potentially available for absorption. Although the effects of pharmacological doses of many drugs on gastric emptying and motility are known, information on the effects of higher doses is limited. I investigated patients who took overdoses of certain commonly used drugs to determine their effects on gastric emptying and motility and small intestinal transit. The study was divided into two parts. One hundred and four patients were studied in Part 1. These patients took overdoses of tricyclic antidepressants (n = 31), carbamazepine (n = 15), phenytoin (n = 12), paracetamol (n = 29) and opioid-paracetamol mixtures (n = 17). They received standard hospital management of which sorbitol was not a part. Part 2 consisted of sixty-one patients who had sorbitol added to their treatment. These patients had taken overdoses of the tricyclic antidepressants (n = 15), carbamazepine (n = 7), phenytoin (n = 8), paracetamol (n = 13) and opioid-paracetamol mixtures (n = 18). The effects of sorbitol on gastric emptying and small intestinal transit were evaluated. A third study-the paracetamol control test was done on 5 healthy volunteers. Each subject was studied twice; the first time after taking 1 G of paracetamol and the second time after no drug ingestion.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21450号 / 医博第4417号 / 新制||医||1032(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 木原 正博, 教授 福原 俊一, 教授 森田 智視 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

This research examines the hypothesis that the satiety effect of cholecystokinin octapeptide (CCK-8) is mediated by changes in gastric emptying. A method for collection of gastric emptying data, the double sampling procedure, is developed and validated for use in the rat. The double sampling technique permits repeated measurements of liquid gastric volume and thus describes the time course of emptying within a single experimental session. Further, the method allows determination of the amount of gastric secretion, volume emptied into the intestines, and amount of gastric load remaining in the stomach. Experiments are presented which: i) demonstrate the utility of the technique; ii) validate its accuracy in determining gastric volume; iii) indicate the stability of measurements obtained with this procedure; and iv) provide a procedure for quantitative evaluation of data obtained with this technique. Using the double sampling procedure, the ability of CCK-8 to delay gastric emptying and to influence feeding are then compared under similar experimental conditions. The effect of CCK-8 on gastric emptying is assessed in 6 hr deprived rats receiving 10 ml intragastric test loads of either .15M saline or 15% sucrose. Intraperitoneal (ip) injections of CCK-8 in doses of 1.4-22.4 ug/kg produce a dose-dependent retardation of gastric emptying of both saline and nutrient. Lower doses of CCK-8, 0.01 and 0.1 ug/kg, have no effect on gastric emptying. The effect of CCK-8 on feeding is assessed in rats tested under the same experimental conditions used in the gastric emptying studies. Doses of CCK-8 capable of retarding gastric emptying also suppress eating in a dose-dependent manner. These findings provide necessary correlational support for the hypothesis that satiety produced by CCK-8 is mediated by inhibition of gastric emptying. However, a further quantitative analysis of the correspondence of the gastric emptying and feeding effects of CCK-8 suggest that retardation of emptying may not account for the entire satiety effect of the peptide. The next set of studies provide direct tests of whether changes in gastric emptying mediate CCK-induced satiety. If gastric emptying plays a significant role in the satiety produced by CCK-8 then: i) the effects of CCK-8 on emptying and feeding should share similar kinetics, and ii) peptides that inhibit emptying should also inhibit feeding. I show that CCK-8 (5.6 ug/kg) injected coincident with introduction of an intragastric load or presentation of a test meal produces a rapid inhibition of both emptying and feeding. In contrast, the identical dose of CCK-8 administered 15 min before testing causes no inhibition of emptying, even though the peptide retains its ability to produce satiety. I also test the abilities of the peptides pentagastrin (100 ug/kg), bombesin (8 & 16 ug/kg) and secretin (2.86, 14.3 & 28.6 ug/kg) to reduce food intake and inhibit gastric emptying. Pentagastrin does not affect food intake or gastric emptying. Bombesin causes a small transient delay in emptying but a large and sustained suppression of eating. High dose secretin (14.3 ug/kg) causes no significant reduction of food intake, even though this dose of secretin inhibits emptying to the same degree as 1.4 ug/kg CCK-8, which does reduce intake. Thus, although CCK-8 does influence the rate of gastric emptying, the present results indicate that the inhibition of emptying by CCK is neither necessary nor sufficient to explain its satiety effect. / Thesis / Doctor of Philosophy (PhD)

The consequences of ingesting different carbohydrate solutions on fluid movement and availability have not been systematically examined. In addition, the role of carbohydrate in the post-exercise rehydration period has received little attention despite the need for substrate replenishment following exercise and the role of carbohydrates in stimulating water absorption in the intestine. The aims of this thesis were to assess fluid absorption characteristics and availability of solutions containing increasing concentrations of glucose and to evaluate their role in the restoration and maintenance of fluid balance following a period of exercise-induced dehydration. The ingestion of a single bolus of a commercially available hypertonic 18% carbohydrate solution (chapter 3) and a hypertonic 10% glucose solution (chapter 4) resulted in reductions in plasma volume that are most likely due to acute net secretion of water into the intestinal lumen. When investigating recovery of whole body hydration status after sweat loss, a hypertonic 10% glucose-electrolyte solution maintained whole body fluid balance for a longer period than a hypotonic 2% glucose-electrolyte solution and an electrolyte only solution when a fixed volume of fluid was consumed during a rehydration period of one hour following cycle exercise in the heat (chapter 5). When fluid was consumed ad libitum over a two hour period following similar cycle exercise in the heat, a hypertonic 10% glucose-electrolyte solution was as effective in restoring and maintaining fluid balance as a 2% hypotonic glucose-electrolyte solution and an electrolyte only solution (chapter 6). The reduced rate of gastric emptying that accompanies the ingestion of high carbohydrate solutions was likely to be the primary cause for the difference in urine production reported between thetrials during this study (chapter 7). In conclusion, ingestion of hypertonic carbohydrate solutions results in a reduction in extracellular fluid volume that is most likely due to secretion of water into the intestinal lumen and the carbohydrate content of an ingested solution is of importance in the post-exercise rehydration period.

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CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / A hemorragia subaracnÃidea (HSA) pode advir de diversos agravos ao sistema nervoso central. A HSA pode aumentar a pressÃo intracraniana (PIC) a patamares de grande morbidade. AlÃm de sintomas neurolÃgicos e cardiovasculares, bem descritos na literatura; sintomas gastrintestinais como nÃuseas, vÃmitos e gastrenterites sÃo comuns, mas pouco estudados. O retardo do esvaziamento gÃstrico (EG) à uma das alteraÃÃes fisiolÃgicas encontrada em pacientes com hipertensÃo intracraniana (HIC). Tal distÃrbio reduz as respostas terapÃuticas tendo em vista a reduÃÃo na absorÃÃo dos nutrientes e fÃrmacos, alÃm de levar à aspiraÃÃo pulmonar, que pode levar a Ãbito. Avaliamos o efeito da HSA sobre as alteraÃÃes da motilidade gastrintestinal (Esvaziamento GÃstrico - EG; TrÃnsito Intestinal â TI e ComplacÃncia GÃstrica â CG), dos parÃmetros hemodinÃmicos (PressÃo Arterial MÃdia â PAM, FreqÃÃncia CardÃaca - FC) e sobre a PIC. Bem como os mecanismos neuro-humorais relacionados a essas alteraÃÃes. Utilizamos ratos Wistar (300-350g, N=113), sob auspÃcios do COBEA (CEUA/UFC- Protocolo 41/13). ApÃs anestesia (Ketamina/Xilasina 20-10mg/Kg-IP), os animais foram contidos por estereotÃxico sendo injetados 0,1; 0,2 ou 0,3ml na cisterna magna (sangue autÃlogo â grupo HSA ou Liquor sÃmile â grupo Sham). No momento da induÃÃo da HSA os animais foram submetidos à canulaÃÃo dos ventrÃculos laterais para monitoraÃÃo da PIC e dos vasos femorais Direito a fim de se obter dados hemodinÃmicos. ApÃs 72h da induÃÃo, e sob jejum (24h) com soluÃÃo de reidrataÃÃo oral ad libitum, procedemos aos estudos de EG, TI e CG. Para determinaÃÃo da taxa de EG, uma refeiÃÃo teste (1ml/100g) (vermelho-fenol 0,5mg/ml em glicose-5%) foi administrada via gavagem. Jà o TI foi determinado com administraÃÃo direta da refeiÃÃo no duodeno por meio de cÃnula previamente implantada. Jà a CG foi avaliada utilizando um sistema de barostato a 4, 8 e 12 cm de pressÃo de distensÃo gÃstrica. A PA, FC e PIC foram aferidas no momento da avaliaÃÃo da motilidade gastrintestinal. Os dados, mÃdiaÂEPM, foram analisados pelo teste âtâ de Student (P<0,05). A HSA retardou o EG (38,90Â2,73 vs 47,00Â0,72%; 52,85Â5,14 vs 31,12Â2,0% ou 22,89Â4,46 vs 46,24Â3,56%) e aumentou a PIC (3,33Â0,47 vs 16,10Â0,47cmH2O; 7,68Â0,650 vs 30,86Â0,82cmH2O ou 17,50Â1,29 vs 37,90Â1,38cmH2O) nos diferentes volumes de sangue, seja 0,1; 0,2 ou 0,3ml respectivamente, quando comparados ao controle. A HSA tambÃm promoveu retarde no TI e diminuiÃÃo da CG, aumento da PA e diminuiÃÃo da FC. A vagotomia subdiafragmÃtica, a esplancnotomia e o prÃ-tratamento com guanetidina reverteram o efeito da HSA sobre as alteraÃÃes do EG. Os resultados sugerem que os agravos gastrintestinais advindos da HSA refletem um padrÃo de dismotilidade secundÃrios a HIC, mostrando uma forte correlaÃÃo com os valores de PIC / Subarachnoid hemorrhage (SAH) can arise from various types of damage to the central nervous system. The HSA can increase intracranial pressure (ICP) to levels high morbidity. In addition to neurological and cardiovascular symptoms, well described in the literature; gastrointestinal symptoms such as nausea, vomiting and gastroenteritis are common but little studied. The delay gastric emptying (GE) is one of the physiological changes found in patients with intracranial hypertension (ICH). This disorder reduces therapeutic responses with a view to reducing the absorption of nutrients and drugs, and lead to lung aspiration, which can lead to death. We evaluated the effect of HSA on gastrointestinal motility disorders (Gastric Emptying - EG; Intestinal Transit â IT or Gastric Compliance - CG), hemodynamic parameters (Mean Arterial Pressure - MAP, Heart Rate - HR) and the PIC. As well as neurohumoral mechanisms related to these changes. We used Wistar rats (300 - 350g, N=113) under the auspices COBEA (CEUA/UFC- Protocol 41/13). After anesthesia (Ketamine/Xylazine 20-10mg/Kg-IP), the animals were restrained by stereotactic aparatus being injected 0.1, 0.2 or 0.3 ml in the cisterna magna (autologous blood - HSA group or Liquor simile - Control group). At the time of induction of HSA, the animals were subjected to cannulation of the lateral ventricles for measurement of ICP and rigth femoral vessels in order to obtain the hemodynamic data. After 72h of induction, and fasted (24h) animals with oral rehydration solution ad libitum, proceeded studies EG, IT and CG. To determine the rate of GE a test meal (1ml/100g - phenol red - 0.5 mg/ml in 5 % glucose) was administered by gavage. The IT was already determined on direct administration of the meal into the duodenum through previously implanted cannula. Since the CG was evaluated using a barostat system at 4, 8 and 12 cm of gastric pressure distension. The MAP, HR and ICP were measured when assessing gastrointestinal motility. Data, mean  SEM, were analyzed by the "t" Student test (p<0.05). The HSA delayed gastric emptying (38.90  2.73 vs 47.00  0.72 %; 52.85  5.14 vs 31.12  2.0 % and 22.89  4.46 vs 46,24  3.56 % ) and increased the ICP (3.33  0.47 vs 16.10  0.47 cmH2O; 7.68  0.650 vs 30.86Â0.82 cmH2O and 17.50  1.29 vs 37.90  1.38 cmH2O ) in different volumes of blood, either 0.1, 0.2 or 0.3 ml, respectively, when compared to control. The HSA also promoted delay in IT and GC, increased BP and decreased HR. The subdiaphragmatic vagotomy, the esplancnotomia and pretreatment with guanethidine reversed the effect of HSA on changes in EG. The results suggest that the SAH arising gastrointestinal diseases reflect a pattern of secondary gut dysmotility, showing a strong correlation with the values of ICP