Orientador: Salomón Soriano Ordinola Rojas / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T03:31:12Z (GMT). No. of bitstreams: 1 Miguel_GabrielAntonioStanisci_D.pdf: 3265608 bytes, checksum: 8e5fab35107186e1c25936f84d45682f (MD5) Previous issue date: 2013 / Resumo: Introdução: O transplante (TC) cardíaco é uma alternativa para os indivíduos com doença cardíaca terminal. Na evolução pós-TC, a ocorrência de episódios de rejeição é um evento frequente, sendo responsável pelo aumento da morbi-mortalidade. Uma alternativa relevante seria o emprego de um exame não invasivo que tivesse uma boa acurácia na detecção das alterações da função sisto-diastólica do coração transplantado, pois a biópsia endomiocárdica (BEM) não é um procedimento isento de complicações. Objetivo: Analisar o Índice de Performance Miocárdica como ferramenta para o diagnóstico de rejeição cardíaca e demonstrar sua possibilidade de triagem na seleção de pacientes para BEM. Método: Foram realizados ecocardiogramas transtorácicos no período de janeiro de 2006 a janeiro de 2008, para a avaliação prospectiva de 58 pacientes; sendo 17 pacientes (29,3 %) pertencentes ao grupo controle (grupo GC), 22 (37,9%) pertencentes ao grupo de pacientes transplantados sem rejeição (TX0) e 19 (32,9%) pertencentes ao grupo de pacientes transplantados com rejeição (TX1). Comparou-se a função sisto-diastólica entre os três grupos (GC, TX0, TX1). O teste de Qui-quadrado foi utilizado para verificar se as proporções de gênero e raça eram homogêneas. Para a comparação entre os três grupos, foi utilizado a ANOVA, em caso de normalidade (verificada por meio do teste de Kolmogorov-Smirnov) e homocedasticidade (verificada por meio do teste de Levene) entre as variáveis; caso contrário, optou-se por utilizar o teste não-paramétrico de Kruskal-Wallis. O nível de significância utilizado para os testes foi de 5%. Resultados: Os grupos não diferiram em relação à idade [38,47 (±11,17) X 41,18 (±13,83) X 45,95 (±12,87) p = 0,212], ao peso [71,95 (±15,90) X 68,68 (±13,14) X 66,09 (±11,91) p = 0,442], altura [1,66 (±0,11) X 1,67 (±0,05) X 1,68 (±0,06) p = 0,894] e superfície corpórea [1,82 (±0,25) X 1,78 (±0,18) X 1,75 (±0,17) p = 0,603]. O grupo GC quando comparado com o grupo TX0, apresentou alteração da função sisto-diastólica do ventrículo esquerdo, expressa através do aumento do IPM, sendo esta mais intensa nos pacientes do grupo TX1 [0,38 (0,29 - 0,39) X 0,47 (0,42 - 0,49) X 0,60 (0,52 - 0,71) p <0,001]. Conclusão: Foi evidenciado que o ÍPM encontra-se bastante aumentado nos pacientes transplantados com rejeição em relação aos pacientes transplantados sem rejeição e também em relação ao controle; portanto, este índice mostrou-se como informação não invasiva e de boa acurácia na detecção das alterações da função sisto-diastólica do coração transplantado, podendo auxiliar na triagem de pacientes transplantados, clinicamente descompensados e que anteriormente seriam submetidos à biópsia de rotina / Abstract: Introduction: The transplant (TC) cardiac is an alternative for the individuals with terminal cardiac illness. In the evolution after TC, the occurrence of rejection episodes is a frequent event, being responsible for the increase of morbi-mortality. An excellent alternative would be the job of a not invasive examination that had a good acurácia in the detention of the alterations of the diastolic function of the transplantated heart, therefore the endomyocardial biopsy (EMB) is not an exempt procedure of complications. Objective: Analyze the Myocardial Performance Index (MPI) as a tool for the diagnosis of cardiac rejection and demonstrate their ability to triage in the selection of patients for EMB. Methods: Transthoracic echocardiograms in the period of January of 2006 had been carried through the January of 2008, for the prospective evaluation of 58 patients; being 17 patients (29,3%) pertaining to the group it has controlled (group GC), 22 (37,9%) pertaining to the group of patients transplantated without rejection (TX0) and 19 (32,9%) pertaining ones to the group of patients transplantated with rejection (TX1). It was compared sisto-diastolic function between the three groups (GC, TX0, TX1). The Qui-quadrado test was used to verify that the proportions of gender and race were homogeneous. For comparison between groups, ANOVA was used, in case of normality (verified by the Kolmogorov-Smirnov test) and homoscedasticity (verified by Levene's test) between the variables; otherwise opted to using the nonparametric Kruskal-Wallis test. The significance level used for the tests was 5% Results: The groups did not differ in age [38,47 (±11,17) X 41,18 (±13,83) X 45,95 (±12,87) p = 0,212], weight [71,95 (±15,90) X 68,68 (±13,14) X 66,09 (±11,91) p = 0,442], height [1,66 (±0,11) X 1,67 (±0,05) X 1,68 (±0,06) p = 0,894] and body surface area [1,82 (±0,25) X 1,78 (±0,18) X 1,75 (±0,17) p = 0,603]. The GC group compared with the group TX0, had an alteration of the systolic-diastolic function of left ventricle, expressed by increasing the Miocardic Performance Index (IPM), which is more significant for patients in group TX1 [0,38 (0,29 - 0,39) X 0,47 (0,42 - 0,49) X 0,60 (0,52 - 0,71) p <0,001]. Conclusion: It was shown that the PMI is greatly increased in patients with transplant rejection compared to patients transplanted without rejection and also in relation to the control, so this index proved to be as non-invasive and accurate method for the detection of changes in systolic and diastolic function of the transplanted heart to assist in screening transplant patients clinically decompensated and who previously underwent biopsy would be routine / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências

No description available.

The aims of the present investigation are fourfold: (i) to review the range of non-invasive methods that may be used to diagnose acute cardiac allograft rejection; (ii) to review the use of the bioptome in sampling the donor heart endomyocardium; (iii) to review the light microscopic and histological grading of acute cardiac rejection; (iv) to characterise the mononuclear populations in endomyocardial biopsy samples and correlate the findings with the light microscopic appearances of the same biopsy specimens.

No description available.

A. INTRODUCTION<p>A.1. The sympathetic nervous system.<p>A.1.1. General considerations and historical perspective.<p>A.1.1.1. Historical perspective<p>A.1.1.2. Reflex regulation of the autonomic nervous system<p>A.1.1.3. Central control of the autonomic nervous system<p>A.1.1.4. Sympathetic and parasympathetic components of the autonomic<p>nervous system<p>A.1.1.5. Organisation of the sympathetic nervous system<p>A.1.1.6. Functions of the sympathetic nervous system<p>A.1.1.7. Neurotransmitters of the sympathetic nervous system<p>A.1.1.8. Neurotransmitter secretion at effectors organ synapse<p>A.1.1.9. Adrenoreceptors<p>A.1.2. Control mechanisms<p>A.1.2.1. Aortic arch and carotid baroreceptors<p>A.1.2.2. Low pressure baroreceptors<p>A.1.2.3. Chemoreceptors<p>A.1.2.4. Effects of exercise on sympathetic nervous system activation<p>A.1.2.5. Effects of left ventricular dysfunction on sympathetic nervous<p>system activation<p>A.1.2.6. Effects of right ventricular dysfunction and heart<p>transplantation on sympathetic nervous system activity<p>A.2. Methodological considerations.<p>A.2.1. Assessment of sympathetic activity in humans<p>A.2.2. Circulating catecholamines<p>A.2.3. Microneurography<p>A.3. Ergospirometry<p>A.3.1. Several aspects of physiology of exercise<p>A.3.2. Principles of exercise testing<p>A.3.3. Exercise ventilation<p>A.4. Assessment of chemoreceptor regulation in humans<p>A.4.1. Peripheral chemoreceptor inhibition<p>A.4.2. Peripheral and central chemoreceptor activation<p>A.5. Brief summary of still unresolved questions<p>A.5.1. Pulmonary arterial hypertension<p>A.5.2. Heart transplantation<p>B. SYMPATHETIC CONTROL IN PULMONARY ARTERIAL HYPERTENSION<p>B.1. Hypothesis tested<p>B.2. Study populations<p>B.2.1. Study investigating sympathetic activity in PAH patients<p>B.2.2. Study investigating the effects of atrial septostomy on MSNA in PAH<p>patients<p>B.3. Material, methods and study protocols<p>B.3.1. Particular measurements in the study investigating sympathetic activity<p>in PAH patients<p>B.3.2. Particular measurements in the study investigating effects of atrial<p>septostomy on MSNA in PAH patients<p>B.4. Sympathetic nervous activity in PAH and effects of disease severity<p>B.5. Effects of chemoreflex activation<p>B.6. Effects of atrial septostomy<p>C. SYMPATHETIC CONTROL AFTER HEART TRANSPLANTATION<p>C.1. Hypothesis tested<p>C.2. Patient population<p>C.3. Material and methods<p>C.4. Effects of chemoreflex activation on sympathetic activity and blood pressure<p>C.5. Effects of chemoreflex activation on exercise intolerance<p>D. DISCUSSION<p>D.1. Sympathetic nervous system activation in patients with pulmonary arterial<p>hypertension<p>D.2. Effects of atrial septostomy on sympathetic nervous system activation<p>D.3. Chemoreceptors in heart transplant recipients<p>D.3.1. Peripheral chemoreceptors deactivation<p>D.3.2. Peripheral and central chemoreceptors sensitivity<p>E. CONCLUSIONS<p>F. REFERENCE LIST<p>G. ANNEXES<p>G.1. Publications<p>G.1.1. Velez-Roa and Ciarka et al, Increased sympathetic nerve activity in<p>pulmonary artery hypertension, Circulation. 2004 Sep 7;110(10):1308-<p>12.<p>G.1.2. Ciarka et al, Atrial septostomy decreases sympathetic overactivity in<p>pulmonary arterial hypertension, Chest. 2007 Jun;131(6):1831-7.<p>G.1.3. Ciarka et al, Effects of peripheral chemoreceptors deactivation on<p>sympathetic activity in heart transplant recipients. Hypertension. 2005<p>May;45(5):894-900.<p>G.1.4. Ciarka et al, Increased peripheral chemoreceptors sensitivity and<p>exercise ventilation in heart transplant recipients. Circulation. 2006 Jan<p>17;113(2):252-7.<p>G.2. Annexe thesis title.<p>G.3. Brief summary in French of described research / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

The purpose of this study was to generate a grounded theory explaining the social and psychological processes used by spouses during the waiting period prior to heart transplantation. Theory discovery was accomplished using the grounded theory methodology. Life on Hold was identified as the basic social psychological process generated from the data that explains the responses of spouses during the waiting period prior to heart transplantation. Life on Hold is the process of "tabling" life's activities for an indefinite period of time in order to devote one's life to another person(s) or event. Spouses of heart transplant candidates set aside life's activities and focus all thoughts, actions, and energy on maintaining the life of the candidate until a donor heart is obtained. The process consists of two stages: Freeing Self and Making Life the Transplant. The theory provides a basis for the development of relevant interventions to assist family members to cope with the uncertainty and stress of the transplant experience.

No description available.

Differences in cardiovascular/aerobic function in heart transplant patients might be attributed to the rate of corticosteroid withdrawal and/or to skeletal muscle function. This hypothesis was tested among nine male, cardiac transplant recipients. Prednisone dosage was monitored, and isokinetic strength testing was performed at 4 different time periods throughout the first year post-transplantation. Cardiovascular/aerobic measurements were obtained at the fourth time period. Pre-surgery characteristics were obtained from the patient's medical record. Significant Pearson-product moment correlations were only found between muscle function and aerobic function and between pre-surgery characteristics and cardiovascular/aerobic performance. The results of this study show no evidence that rapid reduction of prednisone dosage enhances aerobic function by benefiting skeletal muscle function.

Nära patienten i samband med hjärt- eller lungtransplantation finns ofta anhöriga. Anhöriga upplever påfrestningar och har ett kunskapsbehov i samband med transplantationen. Liksom patienten är anhöriga sårbara och det är av betydelse att undersöka anhörigas upplevelser, det kan medföra att anhöriga bättre förbereds för den påfrestning transplantationen innebär. Litteraturstudiens syfte var att undersöka upplevelsen av att vara anhörig i samband med hjärt- eller lungtransplantation. Studien genomfördes som en allmän litteraturstudie och analysen gjordes med stöd av hermeneutisk metod. Resultatet visar att anhörigas stöd till patienten var en akt av kärlek som medförde att anhöriga bland annat försakade vänner och förändrade det dagliga livet. Transplantationen innebar en väntan och mycket känslor för anhöriga, allt från glädje när samtalet om att det var dags för transplantation kom, till oro för att patientens tillstånd efter transplantationen kunde försämras igen. Anhöriga upplevde brist i tillgängligheten från vården gällande information, uppmärksamhet och stöd i sin roll. I litteraturen är omvårdnadsprocessen relaterat till anhörigas upplevelser i samband med hjärt- eller lungtransplantation bristande, därför är framtida forskning betydelsefull för att skapa ytterligare evidensbaserad kunskap till omvårdnadsprocessen om anhörigas upplevelser. / Next of kins are often close to patients in heart- or lung transplantation. In connection with transplantation next of kins experience strain and has a need for knowledge. Like patients next of kins are vulnerable and it is important to explore next of kins’ experiences, this to better prepare for the burden of transplantation. The aim of the study was to explore the experience of being a next of kin in connection with heart- or lung transplantation. The study was conducted as a general literature study and the analysis was guided by a hermeneutic method. The results show that next of kin’s support for the patient is an act of love resulting in sacrificed relationships with friends and changes in their daily lives. The transplantation generated waiting and a lot of feelings for next of kins, such as joy when the call came about transplant, and later on after the transplantation worries that the patient’s condition would worsen again. Furthermore, next of kins experienced lack of availability from the health care services regarding information, attention and support in their role. In the literature the nursing process regarding next of kins’ experiences in heart- or lung transplantation is inadequately described, therefore it is of importance that future research creates new evidence based knowledge.

Cardiac transplantation is the treatment of choice for eligible patients with advanced heart failure; however, it is limited by a critical shortage of suitable organs from traditional brain-dead donors. Organs donated following circulatory death (DCD) have been used to successfully expand the pool of organs available for kidney, liver, and lung transplantation; however, concerns regarding the severity of injury sustained by the heart following withdrawal of life sustaining therapy have deterred the clinical transplantation of DCD hearts. Investigations aiming to optimize the resuscitation, preservation, and evaluation of DCD hearts may facilitate the development of an evidence based protocol for DCD heart transplantation that can be translated to the clinical area and expand the donor pool. Therefore, the objectives of this thesis are to develop a clinically relevant large animal model of DCD and gain a greater understanding regarding the physiologic impact of donor extubation on the DCD heart, demonstrate as a ‘proof-of-concept’ that utilizing an approach to donor heart resuscitation, preservation, and evaluation that is tailored to the DCD context can facilitate successful transplantation, and finally to investigate ways to optimize the resuscitation, preservation, and evaluation of DCD hearts for transplantation. The results of this thesis may then be used to inform the development of an evidence-based protocol for DCD heart transplantation that can be translated to the clinical area. The clinical adoption of such a protocol has the potential to expand the donor pool and improve outcomes for patients with end-stage heart failure. / May 2017