Este estudo teve por objetivos analisar a experiência do cateterismo vesical intermitente por crianças e adolescentes portadores de bexiga neurogênica e suas mães, bem como analisar os fatores limitantes e facilitadores para o autocateterismo vesical intermitente nessas crianças e adolescentes na realidade das suas vidas cotidianas. No referencial teórico, buscamos a compreensão dessa construção da realidade, do cuidar/cuidado humano como uma questão de cidadania e valorização da vida nesse cotidiano, e a educação em saúde como uma prática de enfermagem para a valorização do cuidar cuidado. A pesquisa é de natureza qualitativa, aplicando as representações sociais como categoria de análise. Para a coleta dos dados, utilizamos os prontuários das crianças, formulário com questões semi-estruturadas, entrevista e diário de campo. A análise dos dados baseou-se em aspectos da hermenêutica dialética. A interposição das categorias empíricas com o referencial teórico fez emergir dimensões que mostraram esses atores sociais pertencentes a um contexto micro e macro social que determinam o seu modo de agir na e para a vida. A realidade no dia-a-dia das crianças, adolescentes e respectivas mães revelou-se em seis categorias empíricas: “CVI – corpo e sexualidade em evidência" e “CVI – conformação e relutância" são as categorias empíricas que traduzem as falas das crianças e adolescentes; “A responsabilização materna", “A agenda da vida", “O enfrentamento" e “A acomodação/compartilha" são as categorias empíricas que surgiram das falas das mães. Nessas seis categorias, revelam-se importantes elementos limitantes e facilitadores à experiência de cuidar da vida e, conseqüentemente, à experiência do autocateterismo pelas crianças e adolescentes. Cabe aos profissionais de saúde e em especial ao enfermeiro uma atitude solidária, num esquema de co-responsabilidade por meio da educação em saúde, que deverá ser desenvolvida como um processo emancipatório que, além do enfoque biológico, dê importância considerável aos aspectos ligados à vida cotidiana e amplie a consciência de cidadania desses atores sociais para viverem de modo mais pleno nos seus limiares próprios. / This study is aimed at analyzing the experience of intermittent vesical catheterism of children and adolescents with neurogenic bladders and their mothers, as well as analyzing limiting and facilitating factors for intermittent vesical autocatheterism in these children and adolescents in their daily lives. As for theoretical referentials, we sought to understand this construction of reality in human care as a matter of citizenship and valorization of life in this daily life; moreover, the health education as nursing practice on these values were the theoretical reference used in this study. This research is of a qualitative nature applying social representations as an analysis category. For data collection, we used children's reference books, forms with semi-structured questions, interviews and field diaries. The data analysis was based on aspects of dialectic hermeneutics. The interposition of empirical categories with the theoretical basis led to the appearance of dimensions which showed these social actors belonging to a micro- and macro-social context which determines their way of acting in and for life. The children's, adolescents' and their mothers' daily reality was revealed through six empirical categories: “CVI – body and sexuality in evidence" and “CVI – conformation and reluctance" are empirical categories which translate children's and adolescents' speech; “Maternal responsibility", “Life agenda", “Confrontation" and “Acceptance / sharing" are empirical categories which arose from the mothers' speech. In these six categories, important limiting and facilitating elements for the experience of taking care of life are revealed and, consequently, for autocatheterism by children and adolescents. It is the responsibility of the health professional, and especially of the nurse, to express a supportive attitude in a scheme of co-responsibility by means of health education, which should be developed as an emancipatory process which, besides the biological focus, values the aspects related to daily life and increases the citizenry conscience of these social actors so that they can live more fully according to their own thresholds.

Este estudo teve por objetivos analisar a experiência do cateterismo vesical intermitente por crianças e adolescentes portadores de bexiga neurogênica e suas mães, bem como analisar os fatores limitantes e facilitadores para o autocateterismo vesical intermitente nessas crianças e adolescentes na realidade das suas vidas cotidianas. No referencial teórico, buscamos a compreensão dessa construção da realidade, do cuidar/cuidado humano como uma questão de cidadania e valorização da vida nesse cotidiano, e a educação em saúde como uma prática de enfermagem para a valorização do cuidar cuidado. A pesquisa é de natureza qualitativa, aplicando as representações sociais como categoria de análise. Para a coleta dos dados, utilizamos os prontuários das crianças, formulário com questões semi-estruturadas, entrevista e diário de campo. A análise dos dados baseou-se em aspectos da hermenêutica dialética. A interposição das categorias empíricas com o referencial teórico fez emergir dimensões que mostraram esses atores sociais pertencentes a um contexto micro e macro social que determinam o seu modo de agir na e para a vida. A realidade no dia-a-dia das crianças, adolescentes e respectivas mães revelou-se em seis categorias empíricas: “CVI – corpo e sexualidade em evidência" e “CVI – conformação e relutância" são as categorias empíricas que traduzem as falas das crianças e adolescentes; “A responsabilização materna", “A agenda da vida", “O enfrentamento" e “A acomodação/compartilha" são as categorias empíricas que surgiram das falas das mães. Nessas seis categorias, revelam-se importantes elementos limitantes e facilitadores à experiência de cuidar da vida e, conseqüentemente, à experiência do autocateterismo pelas crianças e adolescentes. Cabe aos profissionais de saúde e em especial ao enfermeiro uma atitude solidária, num esquema de co-responsabilidade por meio da educação em saúde, que deverá ser desenvolvida como um processo emancipatório que, além do enfoque biológico, dê importância considerável aos aspectos ligados à vida cotidiana e amplie a consciência de cidadania desses atores sociais para viverem de modo mais pleno nos seus limiares próprios. / This study is aimed at analyzing the experience of intermittent vesical catheterism of children and adolescents with neurogenic bladders and their mothers, as well as analyzing limiting and facilitating factors for intermittent vesical autocatheterism in these children and adolescents in their daily lives. As for theoretical referentials, we sought to understand this construction of reality in human care as a matter of citizenship and valorization of life in this daily life; moreover, the health education as nursing practice on these values were the theoretical reference used in this study. This research is of a qualitative nature applying social representations as an analysis category. For data collection, we used children\'s reference books, forms with semi-structured questions, interviews and field diaries. The data analysis was based on aspects of dialectic hermeneutics. The interposition of empirical categories with the theoretical basis led to the appearance of dimensions which showed these social actors belonging to a micro- and macro-social context which determines their way of acting in and for life. The children\'s, adolescents\' and their mothers\' daily reality was revealed through six empirical categories: “CVI – body and sexuality in evidence\" and “CVI – conformation and reluctance" are empirical categories which translate children\'s and adolescents\' speech; “Maternal responsibility", “Life agenda", “Confrontation" and “Acceptance / sharing" are empirical categories which arose from the mothers\' speech. In these six categories, important limiting and facilitating elements for the experience of taking care of life are revealed and, consequently, for autocatheterism by children and adolescents. It is the responsibility of the health professional, and especially of the nurse, to express a supportive attitude in a scheme of co-responsibility by means of health education, which should be developed as an emancipatory process which, besides the biological focus, values the aspects related to daily life and increases the citizenry conscience of these social actors so that they can live more fully according to their own thresholds.

Este estudo teve por objetivos analisar a experiência do cateterismo vesical intermitente por crianças e adolescentes portadores de bexiga neurogênica e suas mães, bem como analisar os fatores limitantes e facilitadores para o autocateterismo vesical intermitente nessas crianças e adolescentes na realidade das suas vidas cotidianas. No referencial teórico, buscamos a compreensão dessa construção da realidade, do cuidar/cuidado humano como uma questão de cidadania e valorização da vida nesse cotidiano, e a educação em saúde como uma prática de enfermagem para a valorização do cuidar cuidado. A pesquisa é de natureza qualitativa, aplicando as representações sociais como categoria de análise. Para a coleta dos dados, utilizamos os prontuários das crianças, formulário com questões semi-estruturadas, entrevista e diário de campo. A análise dos dados baseou-se em aspectos da hermenêutica dialética. A interposição das categorias empíricas com o referencial teórico fez emergir dimensões que mostraram esses atores sociais pertencentes a um contexto micro e macro social que determinam o seu modo de agir na e para a vida. A realidade no dia-a-dia das crianças, adolescentes e respectivas mães revelou-se em seis categorias empíricas: “CVI – corpo e sexualidade em evidência” e “CVI – conformação e relutância” são as categorias empíricas que traduzem as falas das crianças e adolescentes; “A responsabilização materna”, “A agenda da vida”, “O enfrentamento” e “A acomodação/compartilha” são as categorias empíricas que surgiram das falas das mães. Nessas seis categorias, revelam-se importantes elementos limitantes e facilitadores à experiência de cuidar da vida e, conseqüentemente, à experiência do autocateterismo pelas crianças e adolescentes. Cabe aos profissionais de saúde e em especial ao enfermeiro uma atitude solidária, num esquema de co-responsabilidade por meio da educação em saúde, que deverá ser desenvolvida como um processo emancipatório que, além do enfoque biológico, dê importância considerável aos aspectos ligados à vida cotidiana e amplie a consciência de cidadania desses atores sociais para viverem de modo mais pleno nos seus limiares próprios. / This study is aimed at analyzing the experience of intermittent vesical catheterism of children and adolescents with neurogenic bladders and their mothers, as well as analyzing limiting and facilitating factors for intermittent vesical autocatheterism in these children and adolescents in their daily lives. As for theoretical referentials, we sought to understand this construction of reality in human care as a matter of citizenship and valorization of life in this daily life; moreover, the health education as nursing practice on these values were the theoretical reference used in this study. This research is of a qualitative nature applying social representations as an analysis category. For data collection, we used children's reference books, forms with semi-structured questions, interviews and field diaries. The data analysis was based on aspects of dialectic hermeneutics. The interposition of empirical categories with the theoretical basis led to the appearance of dimensions which showed these social actors belonging to a micro- and macro-social context which determines their way of acting in and for life. The children's, adolescents' and their mothers' daily reality was revealed through six empirical categories: “CVI – body and sexuality in evidence" and “CVI – conformation and reluctance” are empirical categories which translate children's and adolescents' speech; “Maternal responsibility”, “Life agenda”, “Confrontation” and “Acceptance / sharing” are empirical categories which arose from the mothers' speech. In these six categories, important limiting and facilitating elements for the experience of taking care of life are revealed and, consequently, for autocatheterism by children and adolescents. It is the responsibility of the health professional, and especially of the nurse, to express a supportive attitude in a scheme of co-responsibility by means of health education, which should be developed as an emancipatory process which, besides the biological focus, values the aspects related to daily life and increases the citizenry conscience of these social actors so that they can live more fully according to their own thresholds.

Neurogenic inflammatory responses can be induced by antidromic electrical stimulation or intravenous capsaicin injection. These responses were thought to be caused by neuropeptides released from the sensory axon of C-fiber nerve endings. The relation of tachykinins, reactive oxygen species (ROS) and reactive nitrogen species (RNS) on electrical stimulation of thoracic vagus nerve (TVNS) or capsaicin-evoked neurogenic inflammation in respiratory tract of atropine-treated rats was not clear. In the present studies, the role of ROS and RNS on neurogenic inflammation were investigated in TVNS and capsaicin injected rats. The experiments were divided into two parts. In the first part, TVNS was performed by thoracotomy, non-cholinergic regulation of neurogenic plasma extravasation in the trachea and bronchi were examined, and whether TVNS via NK receptor facilitates neurogenic inflammation by nuclear factor-kappaB (NF-£eB) activation and ROS production were expored. Our results in this part showed that TVNS evoked substance P release, hypotension, bronchoconstriction (as shown by increases in smooth muscle electromyographic activity and total pulmonary resistance), trachea plasma extravasation as well as increases in blood O2- and H2O2 ROS amount in a frequency-dependent manner. Histopathological examination demonstrated silver-stained leaky venules, India-ink labeled plasma extravasation, and accumulations of inflammatory cells in the right lower trachea after TVNS. L-732138 (NK1 receptor antagonist), SR-48968 (NK2 receptor antagonist), dimethylthiourea (H2O2 scavenger) or catechins (O2- and H2O2 scavenger) pretreatment reduced TVNS-enhanced hypotension, bronchoconstriction, and plasma extravasation. TVNS upregulated the expression of NF-£eB in nuclear protein and intercellular adhesion molecule-1 (ICAM-1) in total protein of the lower respiratory tract tissue in a frequency-dependent manner. The upregulation of NF-£eB and ICAM-1 was attenuated by NK receptor antagonist and antioxidants. In the second part, the contribution of nitric oxide (NO) to capsaicin-evoked airway responses was investigated in rats. The measurement of plasma NO level, airway dynamics, airway smooth muscle electromyogram, and plasma extravasation by India ink and Evans blue leakage technique was adapted. Our results in this part showed that capsaicin injection evoked hypotension, bronchoconstriction, trachea plasma extravasation as well as increases in plasma NO level in a dose-dependent manner. L-732138 or SR-48968 pretreatment reduced capsaicin-enhanced hypotension, bronchoconstriction, plasma extravasation, and plasma NO level. Inhibition of a non-selective NO synthase (NOS) inhibitor (NG-nitro-L-Arginine methyl ester, L-NAME), or a selective inducible NO synthase (iNOS) inhibitor (aminoguanidine), reduced capsaicin-induced increases in plasma NO level and protected against capsaicin-induced plasma extravasation, whereas L-arginine (a NO precursor), enhances capsaicin-evoked plasma NO level and plasma extravasation. L-Arginine pretreatment ameliorated capsaicin-induced bronchoconstriction, whereas L-NAME and aminoguanidine exaggerated capsaicin-induced bronchoconstriction. In summary, both TVNS and capsaicin injection may increase oxidative stress responses. TVNS enhances proinflammatory NF-£eB and ICAM-1 expression, increases the production of O2- and H2O2 activity in the respiratory tract of atropine-treated rats. Pretreatment with antioxidants and selective NK receptor antagonists attenuate TVNS evoked airway hyperactivity, proinflammatory response, and oxidative stress. Capsaicin injection stimulates the release of tachykinins, which act on NK1 and NK2 receptors located on the smooth muscles of airways and blood vessels. The interaction of NK receptors with tachykinin enhances furtherly the NO formation, bronchoconstriction, vasodilation, and plasma extravasation in the trachea. The released tachykinins also increase the production of NO via iNOS, and iNOS -evoked NO counteracts tachykinin-mediated bronchoconstriction, but exacerbates tachykinin-mediated plasma extravasation.

Stimulation of C-fiber sensory neurons innervating the respiratory tract with electricity or capsaicin leads to the liberation of substance P, CGRP and other neuropeptides from the nerve terminals. Substance P (SP) binds to the NK-receptors on the membrane of vascular endothelial cells and elicits neurogenic inflammatory responses. These inflammatory responses include plasma leakage and the subsequent edema formation (Lundberg and Saria, 1983¡FMcDonald et al., 1988). Evans blue is a hydrophilic dye and is often used as a tracer of plasma leakage due to its¡¦ high affinity to the plasma proteins. Plasma leakage causes Evans blue extravasates from the blood vessels and remains in the tissues. The more plasma leaks from the blood vessels, the more Evans blue will extravasate into the tissues. Measuring extravasated Evans blue dye that is extracted from tissues, is useful for evaluation of the amount of plasma leakage. Potassium channel openers can inhibit neurogenic plasma leakage in the airways and urinary bladder (Hollywood et al., 1998). Evans blue directly stimulates large-conductance Ca2+-activated K+ channels in cultured endothelial cells of human umbilical vein (Wu et al., 1999). This suggests that it may influence the permeability of the microvessels in vivo. A previous study shows that Evans blue dye blocks capsaicin-induced cough and bronchospasm in the guinea pig (Bolaer et al., 1995). We postulated that pretreatment with Evans blue may influence the extent of neurogenic inflammation in the rat airways induced by the application of either SP or capsaicin. India ink was used as a colloidal tracer dye to label the leaky vessels. The present study investigated whether different concentration of Evans blue (0, 3, 15 and 30 mg/ml/kg) pretreatment could affect the plasma leakage and edema formation in rat lower airways in response to intravenous injection of either SP or capsaicin. The amount of plasma leakage was expressed by the area density of India ink-labeled leaky blood vessels. We also investigated whether Evans blue influenced the ultra-structural change in tracheal serous cells induced by intravenous injection of SP. Our results showed that pretreatment with high concentration of Evans blue reduced more than seven tenths of the area density of plasma leakage in the trachea caused by SP application (P<0.01); reduced more than seven tenths in the left main bronchus (P<0.01) and reduced about seven tenths in the right main bronchus (P<0.01), compared to the control group that received saline prior to SP. However, no statistical significance was observed in edema ratio between any two groups (P>0.05). In the neurogenic inflammation of the airways caused by injection of capsaicin, pretreatment with high concentration of Evans blue reduced more than seven tenths of the area density of plasma leakage in the trachea (P<0.01); reduced more than seven tenths in the left main bronchus (P<0.01) and reduced about seven tenths in the right main bronchus (P<0.01), respectively, compared to the control group that received saline prior to capsaicin. Pretreatment with high concentration of Evans blue prior to capsaicin also reduced more than eight-tenth in edema ratio (P<0.01). In the ultra-structure change of serous cells and the stastical analysis of the number of active serous per 1000£gm2 of tracheal epithelium, Evans blue pretreatment prior to SP significantly reduced the number of active serous cells by seven tenths (P<0.01) as compared to control group that received saline prior to SP. Therefore, we concluded that pretreatment with high concentration of Evans blue exerted its¡¦ effect by opening large-conductance Ca2+-activated K+ channels and inhibited the plasma leakage induced by SP or capsaicin. But no significant inhibition was observed in edema formation induced by SP application. Low concentration of Evans blue might enhance the neurogenic inflammation of the airway. Under the observation with SEM, we found that SP activated serous cells in airway epithelium, and high concentration of Evans blue pretreatment lowered the secretory activity of serous cells. Therefore Evans blue might inhibit the activation of serous cells.

¡iAbstract¡j Neurogenic inflammation is an acute inflammatory tissue response, that is mediated by sensory axon reflex. Accompanied with neurogenic inflammation, plasma extravasation, occurs in the eyes, esophagus, bladder, joints, the tip of tongue, and the respiratory tract of the mammal. Recently, many studies have investigated the neurogenic inflammation by electrical stimulation of nerves and intravascular injection of irritants. Upon stimulation, the sensory nerve endings in mucosa can release neuropeptides such as substance P, that causes formation of the venular endothelial gaps, plasma extravasation and tissue edema in various organs. Substance P also cause smooth muscle contraction and mucus secretion in the respiratory tract. Neurogenic plasma extravasation has been studied extensively in the trachea, and bronchi, but rarely in the esophagus. It is known that a plexus of substance P-immunoreactive axons exists in the mucosal and submucosal layers. They play an important role in releasing substance P to act on the receptors of the venular endothelium through diffusion. Based on plasma extravasation and other studies related to the respiratory tract, the purpose of the present study was to investigate neurogenic inflammatory response in the esophagus of the digestive tract. In this study, capsaicin (90 &#x00B5;g/ml/kg) and substance P (3 &#x00B5;g/ml/kg) were used as the irritant and inflammatory mediator, respectively to reduce neurogenic inflammation in the esophagus. India ink was used to label the affected venules. The magnitude of the neurogenic inflammation was expressed as area density of India ink-labeled leaky venules. Histopathological changes in the esophageal tissue were studied under the light microscope. The result of this study indicated that capsaicin at the dose of (90 &#x00B5;g/ml/kg) and substance P at the dose of (3 &#x00B5;g/ml/kg) caused similar magnitude of inflammation in the esophagus. India ink-labeled venules distributed like a network in the mucosal tissue and in connective tissue of the submucosal layer. The upper, middle and lower parts of esophagus exhibited the same degree of inflammatory response, that was similar to that in the lower respiratory tract as the previous studies reported. These results suggest that nerve branches from the vagal trunk send sensory axons to innervate both the esophagus and airways.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Patoloji Anabilim Dalı, 2003. / Bibliyografya var.

Thesis (M.S.)--University of Michigan, 2002. / Includes bibliographical references.

Este estudo teve por objetivos analisar a experiência do cateterismo vesical intermitente por crianças e adolescentes portadores de bexiga neurogênica e suas mães, bem como analisar os fatores limitantes e facilitadores para o autocateterismo vesical intermitente nessas crianças e adolescentes na realidade das suas vidas cotidianas. No referencial teórico, buscamos a compreensão dessa construção da realidade, do cuidar/cuidado humano como uma questão de cidadania e valorização da vida nesse cotidiano, e a educação em saúde como uma prática de enfermagem para a valorização do cuidar cuidado. A pesquisa é de natureza qualitativa, aplicando as representações sociais como categoria de análise. Para a coleta dos dados, utilizamos os prontuários das crianças, formulário com questões semi-estruturadas, entrevista e diário de campo. A análise dos dados baseou-se em aspectos da hermenêutica dialética. A interposição das categorias empíricas com o referencial teórico fez emergir dimensões que mostraram esses atores sociais pertencentes a um contexto micro e macro social que determinam o seu modo de agir na e para a vida. A realidade no dia-a-dia das crianças, adolescentes e respectivas mães revelou-se em seis categorias empíricas: “CVI – corpo e sexualidade em evidência” e “CVI – conformação e relutância” são as categorias empíricas que traduzem as falas das crianças e adolescentes; “A responsabilização materna”, “A agenda da vida”, “O enfrentamento” e “A acomodação/compartilha” são as categorias empíricas que surgiram das falas das mães. Nessas seis categorias, revelam-se importantes elementos limitantes e facilitadores à experiência de cuidar da vida e, conseqüentemente, à experiência do autocateterismo pelas crianças e adolescentes. Cabe aos profissionais de saúde e em especial ao enfermeiro uma atitude solidária, num esquema de co-responsabilidade por meio da educação em saúde, que deverá ser desenvolvida como um processo emancipatório que, além do enfoque biológico, dê importância considerável aos aspectos ligados à vida cotidiana e amplie a consciência de cidadania desses atores sociais para viverem de modo mais pleno nos seus limiares próprios. / This study is aimed at analyzing the experience of intermittent vesical catheterism of children and adolescents with neurogenic bladders and their mothers, as well as analyzing limiting and facilitating factors for intermittent vesical autocatheterism in these children and adolescents in their daily lives. As for theoretical referentials, we sought to understand this construction of reality in human care as a matter of citizenship and valorization of life in this daily life; moreover, the health education as nursing practice on these values were the theoretical reference used in this study. This research is of a qualitative nature applying social representations as an analysis category. For data collection, we used children\'s reference books, forms with semi-structured questions, interviews and field diaries. The data analysis was based on aspects of dialectic hermeneutics. The interposition of empirical categories with the theoretical basis led to the appearance of dimensions which showed these social actors belonging to a micro- and macro-social context which determines their way of acting in and for life. The children\'s, adolescents\' and their mothers\' daily reality was revealed through six empirical categories: “CVI – body and sexuality in evidence\" and “CVI – conformation and reluctance” are empirical categories which translate children\'s and adolescents\' speech; “Maternal responsibility”, “Life agenda”, “Confrontation” and “Acceptance / sharing” are empirical categories which arose from the mothers\' speech. In these six categories, important limiting and facilitating elements for the experience of taking care of life are revealed and, consequently, for autocatheterism by children and adolescents. It is the responsibility of the health professional, and especially of the nurse, to express a supportive attitude in a scheme of co-responsibility by means of health education, which should be developed as an emancipatory process which, besides the biological focus, values the aspects related to daily life and increases the citizenry conscience of these social actors so that they can live more fully according to their own thresholds.

No description available.