Made available in DSpace on 2014-06-11T19:29:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-17Bitstream added on 2014-06-13T18:59:00Z : No. of bitstreams: 1 medeiros_tp_me_botfm.pdf: 782559 bytes, checksum: 0672d69927e7c7c176cc5db3fc8ac695 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A cirurgia videolaparoscópica, minimamente invasiva, traz o benefício de menor trauma cirúrgico com conseqüente redução do tempo de internação, necessitando, entretanto, de analgesia pós-operatória (PO) eficaz e segura. A associação de analgésicos tem sido utilizada. O objetivo desta pesquisa clínica prospectiva foi estudar os efeitos, na função renal, da analgesia com tramadol, associado à dipirona ou ao cetorolaco de trometamina, em pacientes submetidos à anestesia inalatória balanceada para colecistectomia por laparoscopia. Realizou-se estudo em 126 pacientes submetidos à anestesia geral com sevoflurano, NzO e remifentanil, com boa hidratação (solução de Ringer lactato, 10 mL. kg-1. h-1), para colecistectomia por laparoscopia, divididos em dois grupos de 63 pacientes cada. O grupo 1 (G1) recebeu placebo por via venosa (iv) no momento da administração da medicação pré-anestésica (MPA), com midazolam, e tramadol 100mg e dipirona 2g, iv, antes do término da cirurgia; o grupo 2 (G2) recebeu tramado I 100mg e cetoro·laco 30mg, iv, antes do término da cirurgia, já tendo recebido 30mg de cetorolaco, iv, no momento da MPA. Foram coletadas amostras de sangue e urina pré- e pós-operatórias (PO) para determinação e comparação da estimativa do ritmo de filtração glomerular (RFG) entre os momentos e os grupos. Os RFGs foram obtidos por meio de três fórmulas, duas dependentes de valores da creatinina (Cr) e uma dependente de valores da cistatina C. Foram estudados, na urina, as enzimas tubulares fosfatase alcalina (FA) e y-glutamiltransferase (y-GT), e o seu produto, sempre indexados aos valores de Cr urinária. Na SRPA, os pacientes foram avaliados quanto à dor, ao nível de consciência, à depressão respiratória e à necessidade de analgesia de resgate com morfina. Houve hemodiluição no PO, o que dificultou a análise do perfil dos RFGs -... / The minimally invasive videolaparoscopic surgery brings the benefit of producing minimum surgical trauma with consequent reduction of hospital stay, needing, however, effective and safe post-operative (PO) analgesia. The association with analgesic has been used. This prospective clinical research aimed at studying the effects of analgesia with tramadol in the renal function, associated with dipyrone or ketorolac tromethamine, in patients submitted to inhalant balanced anesthesia for cholecistectomy through laparoscopy. A study was conducted in 126 patients submitted to general anesthesia with sevoflurane, NzO and remifentanil, with good hydration (Lactated Ringer's solution, 10mL.kg-1.h-1), for videolaparoscopic cholecistectomy, divided into 2 groups of 63 patients each. Group 1 (G1) received intravenous (iv) placebo at the moment of preanesthetic medication (PAM), with midazolam, and tramadol 100mg and dipyrone 2g, iv, before the end of the surgery; group 2 (G2) received tramadol 100mg and ketorolac 30mg, iv, before the end of the surgery, having already received 30mg of ketorolac, iv, at the moment of PAM. Preand PO blood and urine samples were collected for determination and comparison of estimated glomerular filtration rate (GFR) between the moments and groups. The GFRs were obtained via three formulas, two dependants of creatinine (Cr) values and one dependant of the cystatin C values. It was studied, in the urine, the tubular enzymes alkaline phosphatase (AP) and y-glutamiltransferase (Y-GT), and its product, always indexed to the urinary Cr values. At the recovery room (RR), patients wereevaluated in the following - pain, consciousness levels, respiratory depression and necessity of rescue analgesia with morphine. There has been hemodilution in the PO, which made more difficult the analysis of the GFRs' profile - those dependant of Cr increased and ....(Complete abstract click electronic access below)

Orientador: Yara Marcondes Machado Castiglia / Banca: Simone Maria D'Angelo Vanni / Banca: Artur Udelsmann / Resumo: A cirurgia videolaparoscópica, minimamente invasiva, traz o benefício de menor trauma cirúrgico com conseqüente redução do tempo de internação, necessitando, entretanto, de analgesia pós-operatória (PO) eficaz e segura. A associação de analgésicos tem sido utilizada. O objetivo desta pesquisa clínica prospectiva foi estudar os efeitos, na função renal, da analgesia com tramadol, associado à dipirona ou ao cetorolaco de trometamina, em pacientes submetidos à anestesia inalatória balanceada para colecistectomia por laparoscopia. Realizou-se estudo em 126 pacientes submetidos à anestesia geral com sevoflurano, NzO e remifentanil, com boa hidratação (solução de Ringer lactato, 10 mL. kg-1. h-1), para colecistectomia por laparoscopia, divididos em dois grupos de 63 pacientes cada. O grupo 1 (G1) recebeu placebo por via venosa (iv) no momento da administração da medicação pré-anestésica (MPA), com midazolam, e tramadol 100mg e dipirona 2g, iv, antes do término da cirurgia; o grupo 2 (G2) recebeu tramado I 100mg e cetoro·laco 30mg, iv, antes do término da cirurgia, já tendo recebido 30mg de cetorolaco, iv, no momento da MPA. Foram coletadas amostras de sangue e urina pré- e pós-operatórias (PO) para determinação e comparação da estimativa do ritmo de filtração glomerular (RFG) entre os momentos e os grupos. Os RFGs foram obtidos por meio de três fórmulas, duas dependentes de valores da creatinina (Cr) e uma dependente de valores da cistatina C. Foram estudados, na urina, as enzimas tubulares fosfatase alcalina (FA) e y-glutamiltransferase (y-GT), e o seu produto, sempre indexados aos valores de Cr urinária. Na SRPA, os pacientes foram avaliados quanto à dor, ao nível de consciência, à depressão respiratória e à necessidade de analgesia de resgate com morfina. Houve hemodiluição no PO, o que dificultou a análise do perfil dos RFGs - ...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The minimally invasive videolaparoscopic surgery brings the benefit of producing minimum surgical trauma with consequent reduction of hospital stay, needing, however, effective and safe post-operative (PO) analgesia. The association with analgesic has been used. This prospective clinical research aimed at studying the effects of analgesia with tramadol in the renal function, associated with dipyrone or ketorolac tromethamine, in patients submitted to inhalant balanced anesthesia for cholecistectomy through laparoscopy. A study was conducted in 126 patients submitted to general anesthesia with sevoflurane, NzO and remifentanil, with good hydration (Lactated Ringer's solution, 10mL.kg-1.h-1), for videolaparoscopic cholecistectomy, divided into 2 groups of 63 patients each. Group 1 (G1) received intravenous (iv) placebo at the moment of preanesthetic medication (PAM), with midazolam, and tramadol 100mg and dipyrone 2g, iv, before the end of the surgery; group 2 (G2) received tramadol 100mg and ketorolac 30mg, iv, before the end of the surgery, having already received 30mg of ketorolac, iv, at the moment of PAM. Preand PO blood and urine samples were collected for determination and comparison of estimated glomerular filtration rate (GFR) between the moments and groups. The GFRs were obtained via three formulas, two dependants of creatinine (Cr) values and one dependant of the cystatin C values. It was studied, in the urine, the tubular enzymes alkaline phosphatase (AP) and y-glutamiltransferase (Y-GT), and its product, always indexed to the urinary Cr values. At the recovery room (RR), patients wereevaluated in the following - pain, consciousness levels, respiratory depression and necessity of rescue analgesia with morphine. There has been hemodilution in the PO, which made more difficult the analysis of the GFRs' profile - those dependant of Cr increased and ....(Complete abstract click electronic access below) / Mestre

Experiments were performed to test the postulate that exercise training (ExT) improves the blunted renal excretory response to acute volume expansion (VE), in part, by normalizing the neural component of the volume reflex typically observed in chronic heart failure (HF). Diuretic and natriuretic responses to acute VE were examined in sedentary and ExT groups of rats with either HF or sham-operated controls. Experiments were performed in anesthetized (Inactin) rats 6 wk after coronary ligation surgery. Histological data indicated that there was a 34.9 ± 3.0% outer and 42.5 ± 3.2% inner infarct of the myocardium in the HF group. Sham rats had no observable damage to the myocardium. In sedentary rats with HF, VE produced a blunted diuresis (46% of sham) and natriuresis (35% of sham) compared with sham-operated control rats. However, acute VE-induced diuresis and natriuresis in ExT rats with HF were comparable to sham rats and significantly higher than sedentary HF rats. Renal denervation abolished the salutary effects of ExT on renal excretory response to acute VE in HF. Since glomerular filtration rates were not significantly different between the groups, renal hemodynamic changes may not account for the blunted renal responses in rats with HF. Additional experiments confirmed that renal sympathetic nerve activity responses to acute VE were blunted in sedentary HF rats; however, ExT normalized the renal sympathoinhibition in HF rats. These results confirm an impairment of neurally mediated excretory responses to acute VE in rats with HF. ExT restored the blunted excretory responses as well as the renal sympathoinhibitory response to acute VE in HF rats. Thus the beneficial effects of ExT on cardiovascular regulation in HF may be partly due to improvement of the neural component of volume reflex. Copyright © 2006 the American Physiological Society.

Aims There is a high prevalence of hypertension in the African population and it is known that vascular dysfunction (including nitric oxide (NO) bio-availability markers) play an important role in the development of cardiovascular diseases. Since very little is known regarding the role of markers of NO bio-availability in Africans, the aim of this study was to compare markers of NO bio-availability (namely L-arginine, L-citrulline, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA)), ambulatory blood pressure (BP) and markers of end organ damage between African and Caucasian school teachers. Additionally, we also aimed to determine whether these markers of NO bio-availability are associated with ambulatory BP and markers of end organ damage in both ethnic groups. Methods The SABPA (Sympathetic activity and Ambulatory Blood Pressure in Africans) study was a cross-sectional study, including urbanised African (N=181) and Caucasian (N=209) men and women, between the ages of 25 and 65 years. Cardiovascular measurements included ambulatory blood pressure, pulse wave velocity (PWV), electrocardiographic Cornell product and carotid intima media thickness (cIMT). Anthropometric measurements included height, weight and waist circumference. Various bio-markers were analysed, including glucose, L-arginine, ADMA, SDMA, Lcitrulline, reactive oxygen species, albumin-to-creatinine ratio (ACR) and estimated creatinine clearance (eCCR). Characteristics of groups were compared with independent T-tests and Chi-square tests. Single and partial analyses were used to investigate associations between NO bioavailability markers with ambulatory BP measurements and markers of end organ damage. Analyses of covariance (ANCOVA) were used for comparison of variables between groups to determine significant differences, while adjusting for age, body mass index and antihypertensive medication. Forward stepwise multiple regression analyses were performed to determine if independent associations exist between ambulatory BP measurements or markers of end organ damage with either- L-arginine, L-citrulline, ADMA or SDMA as the main independent variable. Results and conclusion The Africans and Caucasians were of similar ages. However, the Africans had higher blood pressure therefore their cardiovascular profile was unfavourable compared to that of the Caucasians. The inhibitors of NO biosynthesis, ADMA and SDMA, were significantly lower in the Africans (p=0.046; p<0.001, respectively). However, the NO bio-availability markers, L-arginine and L-citrulline, were higher in the African compared to the Caucasian participants (all p values <0.05) regarded as significant. When performing unadjusted analyses, we found significant negative associations between eCCR and L-citrulline in all four subgroups: African men (r=-0.27; p=0.013), African women (r=-0.24; p=0.021), Caucasian men (r=-0.21; p=0.044) and Caucasian women (r=-0.28; p=0.003). The association of eCCR with L-citrulline was confirmed to be independent of confounders in all groups: African men (R2=0.46; β=-0.23; p=0.006), African women (R2=0.68; β= -0.12; p=0.046), Caucasian men (R2=0.62; β= -0.24; p<0.001) and Caucasian women (R2=0.72; β= -0.13; p=0.029). This implicates that renal function may be detrimentally affected by L-citrulline concentrations. In the Caucasian men and women negative correlations between eCCR and SDMA were found before adjustments (r=-0.33; p=0.003 and r=-0.26; p=0.006, respectively). This phenomenon was confirmed in the forward stepwise multiple regression analysis in Caucasian men (R2=0.75; β= -0.27; p<0.001) and women (R2=0.73; β= -0.21; p<0.001), while no associations were found in the Africans. This result is not unexpected, since SDMA can only be eliminated by the kidneys and is therefore an important risk marker for the early detection of renal dysfunction. In Caucasian men we found that ADMA correlated with ACR (r=0.36; p=0.001), night-time SBP (r=0.34; p=0.002) and night-time DBP (r=0.25; p=0.023) with single linear regression analyses. A similar trend was shown in African men with night-time SBP (r= 0.20; p=0.089) and night-time DBP (r= 0.21; p=0.078) respectively, but this association was absent in the Caucasian and African women. After adjustments for age and body mass index, the associations with ADMA, ACR and SBP in the Caucasian men remained. However, a negative association between eCCR and ADMA also became evident in the African men (r=- 0.24; p=0.025) and remained significant in the forward stepwise multiple regression analysis (R2=0.44; β= -0.18; p=0.034). It is, however, not clear why our results were gender specific, but we could speculate that the female sex hormones may play a part in protecting the vascular endothelium. Apart from the associations described above, there were no significant independent associations between the markers of the NO cycle (such as L-arginine) and PWV, cIMT, eCCR, ACR or Cornell product. In conclusion, although Africans presented a more vulnerable cardiovascular profile, we found a consistent negative association between renal function and L-citrulline in all participants, which has only been reported previously in patients with chronic renal disease. Additionally we found a gender-specific link between renal function and ADMA in African and Caucasian men. Our results may indicate that in the general population, markers of NO bioavailability may be associated with early changes in renal function, accompanying elevated blood pressure. / Thesis (MSc (Physiology))--North-West University, Potchefstroom Campus, 2013

Aims There is a high prevalence of hypertension in the African population and it is known that vascular dysfunction (including nitric oxide (NO) bio-availability markers) play an important role in the development of cardiovascular diseases. Since very little is known regarding the role of markers of NO bio-availability in Africans, the aim of this study was to compare markers of NO bio-availability (namely L-arginine, L-citrulline, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA)), ambulatory blood pressure (BP) and markers of end organ damage between African and Caucasian school teachers. Additionally, we also aimed to determine whether these markers of NO bio-availability are associated with ambulatory BP and markers of end organ damage in both ethnic groups. Methods The SABPA (Sympathetic activity and Ambulatory Blood Pressure in Africans) study was a cross-sectional study, including urbanised African (N=181) and Caucasian (N=209) men and women, between the ages of 25 and 65 years. Cardiovascular measurements included ambulatory blood pressure, pulse wave velocity (PWV), electrocardiographic Cornell product and carotid intima media thickness (cIMT). Anthropometric measurements included height, weight and waist circumference. Various bio-markers were analysed, including glucose, L-arginine, ADMA, SDMA, Lcitrulline, reactive oxygen species, albumin-to-creatinine ratio (ACR) and estimated creatinine clearance (eCCR). Characteristics of groups were compared with independent T-tests and Chi-square tests. Single and partial analyses were used to investigate associations between NO bioavailability markers with ambulatory BP measurements and markers of end organ damage. Analyses of covariance (ANCOVA) were used for comparison of variables between groups to determine significant differences, while adjusting for age, body mass index and antihypertensive medication. Forward stepwise multiple regression analyses were performed to determine if independent associations exist between ambulatory BP measurements or markers of end organ damage with either- L-arginine, L-citrulline, ADMA or SDMA as the main independent variable. Results and conclusion The Africans and Caucasians were of similar ages. However, the Africans had higher blood pressure therefore their cardiovascular profile was unfavourable compared to that of the Caucasians. The inhibitors of NO biosynthesis, ADMA and SDMA, were significantly lower in the Africans (p=0.046; p<0.001, respectively). However, the NO bio-availability markers, L-arginine and L-citrulline, were higher in the African compared to the Caucasian participants (all p values <0.05) regarded as significant. When performing unadjusted analyses, we found significant negative associations between eCCR and L-citrulline in all four subgroups: African men (r=-0.27; p=0.013), African women (r=-0.24; p=0.021), Caucasian men (r=-0.21; p=0.044) and Caucasian women (r=-0.28; p=0.003). The association of eCCR with L-citrulline was confirmed to be independent of confounders in all groups: African men (R2=0.46; β=-0.23; p=0.006), African women (R2=0.68; β= -0.12; p=0.046), Caucasian men (R2=0.62; β= -0.24; p<0.001) and Caucasian women (R2=0.72; β= -0.13; p=0.029). This implicates that renal function may be detrimentally affected by L-citrulline concentrations. In the Caucasian men and women negative correlations between eCCR and SDMA were found before adjustments (r=-0.33; p=0.003 and r=-0.26; p=0.006, respectively). This phenomenon was confirmed in the forward stepwise multiple regression analysis in Caucasian men (R2=0.75; β= -0.27; p<0.001) and women (R2=0.73; β= -0.21; p<0.001), while no associations were found in the Africans. This result is not unexpected, since SDMA can only be eliminated by the kidneys and is therefore an important risk marker for the early detection of renal dysfunction. In Caucasian men we found that ADMA correlated with ACR (r=0.36; p=0.001), night-time SBP (r=0.34; p=0.002) and night-time DBP (r=0.25; p=0.023) with single linear regression analyses. A similar trend was shown in African men with night-time SBP (r= 0.20; p=0.089) and night-time DBP (r= 0.21; p=0.078) respectively, but this association was absent in the Caucasian and African women. After adjustments for age and body mass index, the associations with ADMA, ACR and SBP in the Caucasian men remained. However, a negative association between eCCR and ADMA also became evident in the African men (r=- 0.24; p=0.025) and remained significant in the forward stepwise multiple regression analysis (R2=0.44; β= -0.18; p=0.034). It is, however, not clear why our results were gender specific, but we could speculate that the female sex hormones may play a part in protecting the vascular endothelium. Apart from the associations described above, there were no significant independent associations between the markers of the NO cycle (such as L-arginine) and PWV, cIMT, eCCR, ACR or Cornell product. In conclusion, although Africans presented a more vulnerable cardiovascular profile, we found a consistent negative association between renal function and L-citrulline in all participants, which has only been reported previously in patients with chronic renal disease. Additionally we found a gender-specific link between renal function and ADMA in African and Caucasian men. Our results may indicate that in the general population, markers of NO bioavailability may be associated with early changes in renal function, accompanying elevated blood pressure. / Thesis (MSc (Physiology))--North-West University, Potchefstroom Campus, 2013

Made available in DSpace on 2014-06-11T19:30:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-24Bitstream added on 2014-06-13T21:01:13Z : No. of bitstreams: 1 lima_rm_dr_botfm.pdf: 2221542 bytes, checksum: 5a61ea17b1e2d421de2a667b0875fa20 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O pneumoperitônio (PP), utilizado durante laparoscopia, produz oligúria transitória e diminui o ritmo de filtração glomerular (RFG) e o fluxo sanguíneo renal (FSR). O diagnóstico da disfunção renal aguda é rotineiramente baseado na elevação sérica da creatinina (Cr) e/ou na detecção de oligúria. A cistatina C (Cis C) tem sido estudada como um novo marcador de função renal. O objetivo foi avaliar a função renal, por meio da estimativa do RFG baseada nas concentrações sérica de Cr ou Cis C, de pacientes submetidos à videolaparoscopia.foram estudados 41 pacientes submetidos à colecistectomia ou à hiatoplastia pela via laparoscópica. A pressão intra-abdominal (PIA) foi mantida em 15 mm Hg durante a cirurgia. Amostras sanguíneas foram coletadas para mensuração dos valores séricos de vasopressina, Cr e Cis C antes da anestesia (M1), 30 min após a insuflação do PP (M2) e 30 min após a deflação do PP (M3). Quando a Cr foi utilizada para a estimativa do RFG, esta foi calculada pela fórmula de Cockcroft-Gault (RFG-CG). Quando a Cis C foi utilizada para o mesmo fim, a fórmula empregada foi a de Larsson (RFG-Larsson).os valores de Cis C aumentaram durante o estudo (M1 = M2 < M3; p < 0.05), enquanto os valores de Cr diminuíram nos momentos estudados, provavelmente decorrente da hemodiluição resultante da reposição volêmica durante o procedimento (M1 = M2 > M3; p < 0.05). Consequentemente, o RFG-Larsson (mL.min-1) diminuiu (M1 = 134,5 ± 38,2; M2 = 128,5 ± 33,8; M3 = 121,3 ± 33,7; M1 = M2 > M3) e o RFGCG aumentou durante os momentos estudados (M1 = 132,9 ± 37,9; M2 = 140,7 ± 45,4; M3 = 155,8 ± 57,0; M1 = M2 < M3). Análise de correlação de Pearson mostrou melhor correlação entre os valores de Cis C e RFG-Larsson (M1 = -0.96; M2 = -0.95; M3 = - 0.94), quando comparada à Cr e RFG-CG (M1 = -0.65; M2 = -0.67; M3 = -0.78). Não foi encontrada correlação... / Pneumoperitoneum (PP) used during laparoscopic procedure has been shown to produce transient oliguria and reduced glomerular filtration rate (GFR) and renal blood flow (RBF). The diagnostic of acute kidney injury is usually based on either an elevation of serum creatinine (Cr) or the detection of oliguria. A relatively new marker for detecting renal injury is the cystatin C (Cys C). Our goal was to evaluate the renal function through analysis of GFR estimated by concentration of serum Cys C and serum Cr during laparoscopic surgery.we evaluated 41 patients subjected to colecistectomy or hiatoplasty by laparoscopic approach. Intraperitonial pressure during PP was maintained in 15 mm Hg. Blood samples were collected for vasopressin, Cys C, and Cr measurements (before intubation (M1), 30 min after PP (M2), and 30 min after the deflation of PP (M3)). To estimate GFR we used Larsson formula to evaluate Cys C (GFR-Larsson) and Cockcroft-Gault formula to evaluate Cr (GFR-CG).the values of Cys C increased during the study (M1 = M2 < M3; p < 0.05). Cr values decreased during the study probably because the hemodilution effect caused by fluid replacement (M1 = M2 > M3; p < 0.05). Consequently, the GFR-Larsson (ml.min-1) decreased (M1 = 134.5 ± 38.2; M2 = 128.5 ± 33.8; M3 = 121.3 ± 33.7 with M1 = M2 > M3), while GFR-CG increased during the study (M1 = 132.9 ± 37.9; M2 = 140.7 ± 45.4; M3 = 155.8 ± 57.0 with M1 = M2 < M3). Person’s analysis showed better correlation between Cys C values and GFRLarsson (M1 = -0.96; M2 = -0.95; M3 = -0.94) versus Cr values and GFR-CG (M1 = - 0.65; M2 = -0.67; M3 = -0.78). No correlation between Cys C and Cr values was found. The vasopressin levels were stable without statistically significant change during the study.This study showed that Cys C was more efficient than serum Cr to detect early alterations in estimated GFR during laparoscopic surgery in patient previous normal

Orientador: Eliana Marisa Ganem / Banca: Norma Sueli Pinheiro Módolo / Banca: Pedro Thadeu Galvão Vianna / Banca: José Fernando Amaral Meletti / Banca: Anita Leocácia de Mattos / Resumo: O pneumoperitônio (PP), utilizado durante laparoscopia, produz oligúria transitória e diminui o ritmo de filtração glomerular (RFG) e o fluxo sanguíneo renal (FSR). O diagnóstico da disfunção renal aguda é rotineiramente baseado na elevação sérica da creatinina (Cr) e/ou na detecção de oligúria. A cistatina C (Cis C) tem sido estudada como um novo marcador de função renal. O objetivo foi avaliar a função renal, por meio da estimativa do RFG baseada nas concentrações sérica de Cr ou Cis C, de pacientes submetidos à videolaparoscopia.foram estudados 41 pacientes submetidos à colecistectomia ou à hiatoplastia pela via laparoscópica. A pressão intra-abdominal (PIA) foi mantida em 15 mm Hg durante a cirurgia. Amostras sanguíneas foram coletadas para mensuração dos valores séricos de vasopressina, Cr e Cis C antes da anestesia (M1), 30 min após a insuflação do PP (M2) e 30 min após a deflação do PP (M3). Quando a Cr foi utilizada para a estimativa do RFG, esta foi calculada pela fórmula de Cockcroft-Gault (RFG-CG). Quando a Cis C foi utilizada para o mesmo fim, a fórmula empregada foi a de Larsson (RFG-Larsson).os valores de Cis C aumentaram durante o estudo (M1 = M2 < M3; p < 0.05), enquanto os valores de Cr diminuíram nos momentos estudados, provavelmente decorrente da hemodiluição resultante da reposição volêmica durante o procedimento (M1 = M2 > M3; p < 0.05). Consequentemente, o RFG-Larsson (mL.min-1) diminuiu (M1 = 134,5 ± 38,2; M2 = 128,5 ± 33,8; M3 = 121,3 ± 33,7; M1 = M2 > M3) e o RFGCG aumentou durante os momentos estudados (M1 = 132,9 ± 37,9; M2 = 140,7 ± 45,4; M3 = 155,8 ± 57,0; M1 = M2 < M3). Análise de correlação de Pearson mostrou melhor correlação entre os valores de Cis C e RFG-Larsson (M1 = -0.96; M2 = -0.95; M3 = - 0.94), quando comparada à Cr e RFG-CG (M1 = -0.65; M2 = -0.67; M3 = -0.78). Não foi encontrada correlação... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Pneumoperitoneum (PP) used during laparoscopic procedure has been shown to produce transient oliguria and reduced glomerular filtration rate (GFR) and renal blood flow (RBF). The diagnostic of acute kidney injury is usually based on either an elevation of serum creatinine (Cr) or the detection of oliguria. A relatively new marker for detecting renal injury is the cystatin C (Cys C). Our goal was to evaluate the renal function through analysis of GFR estimated by concentration of serum Cys C and serum Cr during laparoscopic surgery.we evaluated 41 patients subjected to colecistectomy or hiatoplasty by laparoscopic approach. Intraperitonial pressure during PP was maintained in 15 mm Hg. Blood samples were collected for vasopressin, Cys C, and Cr measurements (before intubation (M1), 30 min after PP (M2), and 30 min after the deflation of PP (M3)). To estimate GFR we used Larsson formula to evaluate Cys C (GFR-Larsson) and Cockcroft-Gault formula to evaluate Cr (GFR-CG).the values of Cys C increased during the study (M1 = M2 < M3; p < 0.05). Cr values decreased during the study probably because the hemodilution effect caused by fluid replacement (M1 = M2 > M3; p < 0.05). Consequently, the GFR-Larsson (ml.min-1) decreased (M1 = 134.5 ± 38.2; M2 = 128.5 ± 33.8; M3 = 121.3 ± 33.7 with M1 = M2 > M3), while GFR-CG increased during the study (M1 = 132.9 ± 37.9; M2 = 140.7 ± 45.4; M3 = 155.8 ± 57.0 with M1 = M2 < M3). Person's analysis showed better correlation between Cys C values and GFRLarsson (M1 = -0.96; M2 = -0.95; M3 = -0.94) versus Cr values and GFR-CG (M1 = - 0.65; M2 = -0.67; M3 = -0.78). No correlation between Cys C and Cr values was found. The vasopressin levels were stable without statistically significant change during the study.This study showed that Cys C was more efficient than serum Cr to detect early alterations in estimated GFR during laparoscopic surgery in patient previous normal / Doutor

Orientador: Luiz Antonio Vane / Banca: Pedro Thadeu Galvão Vianna / Banca: Norma Sueli Pinheiro Módolo / Banca: Oscar César Pires / Banca: Glória Maria Braga Potério / Resumo: Efeito das catecolaminas sobre a expansão volêmica sustentada e função renal em coelhos. Os autores estudaram os efeitos das catecolaminas α, β e dopa sobre a expansão volêmica e a função renal de coelhos anestesiados antes, durante e após infusão em bolus de solução fisiológica a 0,9%.foram estudados 24 coelhos, distribuídos aleatoriamente em quatro grupos experimentais de estudo. Respostas à infusão de um bolus de 24 mL.kg-1 de SF 0,9% em 20 minutos foram avaliadas durante a infusão da catecolamina. Os quatro grupos experimentais eram o controle, SF 0,9% 6 mL.kg-1.h-1, fenilefrina 3,0 ug.kg-1.min-1 (6 mL.kg-1.h-1), isoprenalina 0,1 ug.kg-1.min-1 (6 mL.kg-1.h-1) e dopamina 20 ug.kg-1.min-1 (6 mL.kg-1.h-1). A expansão do volume plasmático foi calculada a partir da variação do hematócrito. Medidas de depuração urinária também foram avaliadas.ao término da expansão volêmica com 24 mL.kg-1 de SF 0,9%, a expansão do volume plasmático foi maior no grupo isoprenalina, seguida dos grupos fenilefrina e controle. O grupo da dopamina mostrou a menor expansão. Terminado o experimento, o grupo isoprenalina mantinha a maior expansão volêmica e o grupo dopamina, uma expansão maior que a do grupo controle. Porém, o grupo da fenilefrina apresentou uma diminuição sustentada da expansão do volume plasmático, atingindo valores próximos aos basais (antes da expansão). Após a expansão com SF 0,9%, o maior aumento no débito urinário ocorreu no grupo fenilefrina comparado com os outros grupos, que não diferiram entre si. Finalizado o procedimento, o grupo submetido a infusão de fenilefrina, mantinha o maior débito urinário, mantendo-se até o término da infusão da catecolamina, seguido do grupo isoprenalina. Com relação à função renal, o clearance de creatinina, 30 minutos após a expansão com solução fisiológica, estava aumentado no grupo da dopamina... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Effects of catecholamines on sustained volume expansion and renal function in rabbits.The authors studied the effects of cathecholamines (alpha, beta and dopamine agonists) on volume expansion and renal function in anesthetized rabbits, before, during, and after a bolus infusion of 0.9% saline.after Institutional Ethics Committee approval, 24 rabbits were randomly distributed in four experimental groups: Control (CRL) - NaCl 0.9% 6 ml.Kg-1.h-1 + 1 ml.Kg-1 of creatinine (Cr), no catecholamines infusion; Phenylephrine (PHE) - 3 ug/kg/min (NaCl 0.9% 6 ml.Kg-1.h-1 + 1 ml.Kg-1 of Cr); isoproterenol (ISU) - 0,1 μg.kg-1.min-1 (NaCl 0.9% 6 ml.Kg-1.h-1 + 1 ml.Kg-1 of Cr); and Dopamine DOP) - 20 μg.kg-1.min-1 (NaCl 0.9% 6 ml.Kg-1.h-1 + 1 ml.Kg-1 of Cr). All groups received a 0.9% NaCl 24 ml.Kg-1 over 20 minutes for volume expansion, starting 30 minutes after the initiation of catecholamine and creatinine infusion. The catecholamine infusion was sustained for 120 minutes after the end of the saline bolus. The plasma volume expansion was calculated based on estimated plasma volume and change in hematocrit. Renal function was also evaluated using Cr infusion since the beginning of the experiment. catecholamines infusion without saline did not change the plasma volume. The plasma volume expansion, after the 24 ml.Kg-1 of NaCl 0.9%, was most sustained in the ISU group, followed by DOP and CRL. The PHE group showed the lowest plasma expansion (least retention of vascular fluid). PHE was associated with the greatest dieresis compared to the other test groups, which did not differ significantly from one another. Regarding the renal function, the Cr clearance 30 minutes after plasma expansion with saline was increased in the DOP group compared to the other groups.The Na+ excretion and clearance 30 minutes after the ending of volume expansion with saline were significantly higher in the PHE group when... (Complete abstract click electronic access below) / Doutor

Made available in DSpace on 2014-06-11T19:23:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-24Bitstream added on 2014-06-13T18:19:59Z : No. of bitstreams: 1 crivelenti_lz_me_jabo.pdf: 1024671 bytes, checksum: 41f7ae2340e1dfe3960e54cfba80f4a7 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O objetivo do presente trabalho foi avaliar os efeitos do tratamento com DMSO sobre alguns aspectos da função renal, do perfil bioquímico sérico, de parâmetros hematológicos e da condição clínica de cães sadios e de cães com doença renal crônica (DRC). As avaliações foram feitas antes, durante e após a administração de DMSO a 10% na dose de 0,5g/kg, cada 24h, por três dias. Os resultados mostraram que apesar de não ter havido alterações significativas da maioria dos parâmetros analisados, houve diminuição da ingestão de água e ração no grupo de cães sadios durante as primeiras 24 horas pós-tratamento. No grupo DRC, embora tenha havido tendência de diminuição dos valores de hemácias e hematócrito, relacionada ao fator tratamento, o processo foi reversível. O DMSO resultou em alguns efeitos adversos nos cães sadios e também nos cães com DRC, nos quais os efeitos foram mais frequentes e mais graves. A gravidade dos efeitos adversos relacionados ao tratamento com DMSO e possível associação com o óbito em cães com DRC em estágio 4, constituem fatores para contraindicação do fármaco. Considerando que o DMSO pode ser indicado para diversas modalidades terapêuticas, os resultados do presente estudo permitem concluir que no que se refere à função renal, tanto para cães sadios quanto para cães com DRC em estágios 2 e 3, não há contraindicações para o uso do fármaco. O DMSO pode resultar em modificações leves das funções relacionadas aos glomérulos e aos túbulos, mesmo em cães com DRC, que, sabidamente, são limitados quanto à expectativa de melhora da função renal, fato que merece investigação, principalmente em pacientes que já possam estar se beneficiando de tratamento médico de manutenção para a insuficiência renal crônica / The objective of this study was to evaluate the effects of DMSO treatment on some aspects of renal function, serum profile, total blood count parameters and clinical condition of health or chronic kidney disease (CKD) dogs. The evaluations were done before, during and after the administration of DMSO 10% at a dose of 0.5g/kg, each 24h, for three days. The results showed that, although there were no significant changes in the majority of the analyzed parameters, there was decrease of the water and food intake in the health dogs group during the first 24 hours post-treatment. In the CKD group, although there was a tendency toward lower values of red blood cell count and hematocrit, related to the treatment, the process was reversible. DMSO resulted in some adverse effects in both healthy and CKD dogs, however the effects were more frequent and worse in CKD dogs. The severity of adverse effects related to the DMSO and its possible association with death in stage 4 CKD dogs, are contraindications for the drug. Considering that DMSO can be indicated for a variety of therapeutic modalities, the results of this study showed that concerning to the renal function, for both healthy and stages 2 or 3 CKD dogs, there are no contraindications for the drug usage. DMSO can result in some modifications on the functions related to glomeruli and tubules, even in CKD dogs, which are known to be limited on the expectation of renal function improvement, a fact that deserves investigation, especially in patients who are already being benefited from maintenance treatment for chronic renal failure

Orientador: Marileda Bonafim Carvalho / Banca: Márcia Mery Kogika / Banca: Áureo Evangelista Santana / Resumo: O objetivo do presente trabalho foi avaliar os efeitos do tratamento com DMSO sobre alguns aspectos da função renal, do perfil bioquímico sérico, de parâmetros hematológicos e da condição clínica de cães sadios e de cães com doença renal crônica (DRC). As avaliações foram feitas antes, durante e após a administração de DMSO a 10% na dose de 0,5g/kg, cada 24h, por três dias. Os resultados mostraram que apesar de não ter havido alterações significativas da maioria dos parâmetros analisados, houve diminuição da ingestão de água e ração no grupo de cães sadios durante as primeiras 24 horas pós-tratamento. No grupo DRC, embora tenha havido tendência de diminuição dos valores de hemácias e hematócrito, relacionada ao fator tratamento, o processo foi reversível. O DMSO resultou em alguns efeitos adversos nos cães sadios e também nos cães com DRC, nos quais os efeitos foram mais frequentes e mais graves. A gravidade dos efeitos adversos relacionados ao tratamento com DMSO e possível associação com o óbito em cães com DRC em estágio 4, constituem fatores para contraindicação do fármaco. Considerando que o DMSO pode ser indicado para diversas modalidades terapêuticas, os resultados do presente estudo permitem concluir que no que se refere à função renal, tanto para cães sadios quanto para cães com DRC em estágios 2 e 3, não há contraindicações para o uso do fármaco. O DMSO pode resultar em modificações leves das funções relacionadas aos glomérulos e aos túbulos, mesmo em cães com DRC, que, sabidamente, são limitados quanto à expectativa de melhora da função renal, fato que merece investigação, principalmente em pacientes que já possam estar se beneficiando de tratamento médico de manutenção para a insuficiência renal crônica / Abstract: The objective of this study was to evaluate the effects of DMSO treatment on some aspects of renal function, serum profile, total blood count parameters and clinical condition of health or chronic kidney disease (CKD) dogs. The evaluations were done before, during and after the administration of DMSO 10% at a dose of 0.5g/kg, each 24h, for three days. The results showed that, although there were no significant changes in the majority of the analyzed parameters, there was decrease of the water and food intake in the health dogs group during the first 24 hours post-treatment. In the CKD group, although there was a tendency toward lower values of red blood cell count and hematocrit, related to the treatment, the process was reversible. DMSO resulted in some adverse effects in both healthy and CKD dogs, however the effects were more frequent and worse in CKD dogs. The severity of adverse effects related to the DMSO and its possible association with death in stage 4 CKD dogs, are contraindications for the drug. Considering that DMSO can be indicated for a variety of therapeutic modalities, the results of this study showed that concerning to the renal function, for both healthy and stages 2 or 3 CKD dogs, there are no contraindications for the drug usage. DMSO can result in some modifications on the functions related to glomeruli and tubules, even in CKD dogs, which are known to be limited on the expectation of renal function improvement, a fact that deserves investigation, especially in patients who are already being benefited from maintenance treatment for chronic renal failure / Mestre