Perfusão cerebral e análise individual automatizada utilizando SPECT em uma população com transtorno obsessivo-compulsivo

Objective: To make individual assessments using automated quantification methodology in order to screen for perfusion abnormalities in cerebral SPECT examinations among a sample of subjects with OCD. Methods: Statistical parametric mapping (SPM) was used to compare 26 brain SPECT images from patients with OCD individually with an image bank of 32 normal subjects, using the statistical threshold of p < 0.05 (corrected for multiple comparisons at the level of individual voxels or clusters). The maps were analyzed, and regions presenting voxels that remained above this threshold were sought. results: Six patients from a sample of 26 OCD images showed abnormalities at cluster or voxel level, considering the criteria described above, which represented 23.07%. However, seven images from the normal group of 32 were also indicated as cases of perfusional abnormality, representing 21.8% of the sample. Conclusion: The automated quantification method was not considered to be a useful tool for clinical practice, for analyses complementary to visual inspection.

Maintaining Tissue Perfusion in High-Risk Surgical Patients: A Systematic Review of Randomized Clinical Trials

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Gastric mucosal perfusion in dogs: Effects of halogenated anesthetics and of hemorrhage

The gastrointestinal tract is one of the first organs affected by hypoperfusion during hemorrhagic shock. The hemodynamics and oxygen transport variables during hemorrhagic shock and resuscitation can be affected by the anesthetics used. In a model of pressure-guided hemorrhagic shock in dogs, we studied the effects of three halogenated anesthetics - halothane, sevoflurane, and isoflurane - at equipotent concentrations on gastric oxygenation. Thirty dogs were anesthetized with 1.0 minimum alveolar anesthetic concentration (MAC) of either halothane, sevoflurane, or isoflurane. A gastric tonometer was placed in the stomach to determine mucosal gastric CO2 (PgCO(2)) and for the calculation of gastric-arterial PCO2 gradient (PCO2 gap). The dogs were splenectomized and hemorrhaged to hold mean arterial pressure at 40-50 mm Hg over 45 min and then resuscitated with the shed blood volume. Hemodynamics, systemic oxygenation, and PCO2 gap were measured at baseline, after 45 min of hemorrhage, and at 15 and 60 min after blood resuscitation. Hemorrhage induced reductions of mean arterial pressure and cardiac index, while systemic oxygen extraction increased (p < .05), without significant differences among groups (p > .05). Halothane group showed significant lower PCO2 gap values than the other groups (p < .05). After 60 min of shed blood replacement, all groups restored hemodynamics, systemic oxygenation, and PCO2 gap to the prehemorrhage levels (p > .05), without significant differences among groups (p > .05). We conclude that halothane is superior to preserve the gastric mucosal perfusion in comparison to isoflurane and sevoflurane, in dogs submitted to pressure-guided hemorrhagic shock at equipotent doses of halogenated anesthetics.

FUNCTIONAL AND ULTRASTRUCTURAL EVALUATION OF MYOCARDIAL PROTECTION PROVIDED BY INTERMITTENT CORONARY SINUS PERFUSION IN THE ISOLATED DOG HEART

1. The protection offered by intermittent perfusion of of cardioplegic solution through the coronary sinus was investigated in isovolumic blood-perfused dog heart preparations submitted to 60 min of ischemia and 45 min of reperfusion.2. The preparations were divided into three treatment groups: a) coronary sinus, consisting of preparations (N = 10) perfused through the coronary sinus under 40 cm water pressure; b) aortic, consisting of preparations (N = 10) perfused through the aortic stump under 100 mmHg pressure; c) control, consisting of hearts (N = 9) that were not perfused with cardioplegic solution.3. Properties of contractile capacity and relaxation were markedly impaired in the control group but were preserved to a comparable extent in the groups perfused with cardioplegic solution through the aorta and coronary sinus. Developed pressure decreased in the control group (before ischemia: 70 +/- 5.5 mmHg; after reperfusion: 35 +/- 12 mmHg; P < 0.05) and didn't vary in the aortic group (from 69 +/- 4 mmHg to 65 +/- 13 mmHg; P > 0.05) and coronary sinus group (from 69 +/- 4.6 mmHg to 60 +/- 10 mmHg; P > 0.05). Myocardial relaxation was evaluated by the +/- dp/dt ratio. In the control group there was impairment of myocardial relaxation as indicated by an increase of this index after reperfusion (from 1.05 +/- 0.05 to 1.46 +/- 0.23; P < 0.05), whereas in the aortic (from 1.10 +/- 0.13 to 1.15 +/- 0.20; P > 0.05) and the coronary sinus (from 1.03 +/- 0.14 to 1.08 +/- 0.16; P > 0.05) groups there was no variation. Ultrastructural changes in the myocardium were negligible in all three groups at the end of reperfusion.4. We conclude that intermittent perfusion of a hypothermic cardioplegic solution through the coronary sinus is effective for the protection of the myocardium during total ischemia.

INTERACTION AMONG ZINC, GLUCOSE, AND INSULIN IN NORMAL INDIVIDUALS DURING GLUCOSE AND TOLBUTAMIDE PERFUSION

Reports in the literature have shown that acute or chronic zinc administration may cause hyperglycemia, with a fall in serum or insular insulin occurring in experimental animals. on the other hand, under conditions of both acute and chronic hyperglycemia, an increase, a decrease, or a normal level of blood zinc has been observed in studies conducted on humans. Thus, the objective of the investigation described here was to determine the relationship existing among zinc, glucose, and insulin under acute conditions. Thirty-six subjects of both sexes (mean age, 23 yr) were tested at 7:00 A.M. after a 12-h fast. Two antecubital veins of both forearms were punctured and maintained with physiological saline. Three experiments were performed in which zinc was administered orally, and hypertonic glucose and tolbutamid were administered intravenously. Blood samples were then collected over a period ranging from 93 to 240 min after the basal times of - 30 and 0 min. Hyperzincemia did not cause changes in plasma glucose or insulin either in the absence of or during perfusion of glucose. Hyperglycemia, hypoglycemia, and hyperinsulinemia did not modify serum zinc levels. These results demonstrate that acute zinc administration did not change carbohydrate metabolism and that sudden variations in glucose and insulin levels did not modify the serum profile of zinc.

Effect of intraluminal distention on microvascular perfusion in the equine small colon

Objective-To determine the effect of experimental intraluminal distention on microvascular perfusion of the small colon in horses.Animals-6 mixed-breed healthy horses (mean age [+/- SD], 9.1 +/- 2 years).Procedure-Under general anesthesia, the small colon was exposed by celiotomy and 3 segments were demarcated. In 1 of these segments, intraluminal obstruction was created by placement of a latex balloon inflated to a pressure of 40 mm Hg (obstructed segment). The other segments were the sham-operated segment and the control segment. Microvascular perfusion was evaluated in the mucosal, submucosal, muscular, and serosal layers by injection of 15-mum-diameter colored microspheres into branches of the caudal mesenteric artery. Recovery of microspheres was performed by tissue digestion, washing, and centrifugation. Distribution of microspheres in the intestinal layers was evaluated by direct observation of stained frozen sections by light microscopy.Results-A significant reduction was observed in total microvascular perfusion of obstructed segments, which was 26.4% of that of control segments. This reduction was not evident in the mucosal layer.Conclusions and Clinical Relevance-Intraluminal distention of the equine small colon wall can promote ischemia by a reduction in microvascular perfusion in the intestinal wall. Intestinal layers do not seem to be affected to the same extent, because the absolute value for mucosal perfusion did not decrease in the obstructed segment.

DIAGNOSIS of REGIONAL CEREBRAL BLOOD FLOW ABNORMALITIES USING SPECT: AGREEMENT BETWEEN INDIVIDUALIZED STATISTICAL PARAMETRIC MAPS and VISUAL INSPECTION BY NUCLEAR MEDICINE PHYSICIANS WITH DIFFERENT LEVELS of EXPERTISE IN NUCLEAR NEUROLOGY

INTRODUCTION: Visual analysis is widely used to interpret regional cerebral blood flow (rCBF) SPECT images in clinical practice despite its limitations. Automated methods are employed to investigate between-group rCBF differences in research Studies but have rarely been explored in individual analyses.OBJECTIVES: To compare visual inspection by nuclear physicians with the automated statistical parametric mapping program using a SPECT dataset of patients with neurological disorders and normal control images.METHODS: Using statistical parametric mapping, 14 SPECT images from patients with various neurological disorders were compared individually with a databank of 32 normal images using a statistical threshold of p<0.05 (corrected for multiple comparisons at the level of individual voxels or clusters). Statistical parametric mapping results were compared with Visual analyses by a nuclear physician highly experienced in neurology (A) as well as a nuclear physician with a general background of experience (B) who independently classified images as normal or altered, and determined the location of changes and the severity.RESULTS: of the 32 images of the normal databank, 4 generated maps showing rCBF abnormalities (p<0.05, corrected). Among the 14 images from patients with neurological disorders, 13 showed rCBF alterations. Statistical parametric mapping and physician A completely agreed on 84.37% and 64.28% of cases from the normal databank and neurological disorders, respectively. The agreement between statistical parametric mapping and ratings of physician B were lower (71.18% and 35.71%, respectively).CONCLUSION: Statistical parametric mapping replicated the findings described by the more experienced nuclear physician. This finding suggests that automated methods for individually analyzing rCBF SPECT images may be a valuable resource to complement visual inspection in clinical practice.

Cognitive Deficits in Machado-Joseph Disease Correlate with Hypoperfusion of Visual System Areas

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Treatment of Pythiosis in Equine Limbs Using Intravenous Regional Perfusion of Amphotericin B

Objective To evaluate the effects of intravenous regional limb perfusion (IRLP) administration of amphotericin B in horses to treat pythiosis after surgical excision and thermocautery. Study Design Case series. Animals Horses (n = 12) with Pythium insidiosum infection of the distal aspect of the thoracic or pelvic limbs. Methods After surgical excision of granulation tissue and thermocautery, 50 mg amphotericin B was administered by IRLP through a catheter placed in a superficial vein of the affected limb next to the lesion after placing a tourniquet above the injection site. The lesions and locomotor system were evaluated before treatment and at 7, 14, 21, 28, 35, and 60 days. Results Ninety-two percent of horses treated with amphotericin B had complete lesion resolution 35 or 60 days after 1 or 2 IRLP treatments, respectively. IRLP induced limb edema and pain during regional palpation in 42%, and inflammation of the injection site in 33% of horses; however these signs resolved after 14 days. Conclusions IRLP administration of amphotericin B was effective for treating pythiosis in equine limbs, resolving infection with manageable side effects.

Evaluation of the microvascular density in astrocytomas in adults correlated using SPECT-MIBI

Microvascular density (MVD) may be an additional prognostic marker for astrocytomas, but the heterogeneity of these tumors limits its use. Thus, imaging examinations such as SPECT-MIBI (2-methoxyisobutyl isonitrile) may take on an indirect role in astrocytoma evaluation. The aim of this study was to evaluate MVD in astrocytomas using immunohistochemistry with anti-CD34 monoclonal antibodies. The relationship between the immunohistochemical data and the parameters obtained from SPECT-MIBI was evaluated. This cross-sectional study evaluated 48 patients with brain tumors including low-grade astrocytomas (LGAs), anaplastic astrocytomas (AAs) and glioblastoma multiformes (GBMs). Patients had been admitted to the Hospital de Cancer de Barretos - Fundação Pio XII, and underwent brain SPECT-MIBI prior to any treatment. MVD was determined under an optical microscope by counting microvessels on slides from each case. SPECT-MIBI images were analyzed visually and semiquantitatively. GBMs, AAs and LGAs represented 50, 16.7 and 33.3% of the total sample, respectively. There were 13 normal and 35 abnormal SPECT-MIBI images. Significant differences in MVD were found between AA and LGA cases (p=0.040), but not between normal and abnormal SPECT-MIBI. The mean counts from SPECT-MIBI were not correlated with MVD. Among the GBM cases, there were no significant findings, except for an increased likelihood of abnormal histological test results. MVD was related to histological grade (in AA and LGA cases) but was not correlated with SPECT-MIBI.

Coronary perfusion pressure as a determinant of ventricular performance

The results observed in this work support the view that coronary perfusion pressure affects ventricular performance independently of metabolic effects; a mechanism operating in beat-to-beat regulation is proposed.

Influence of different routes of flush perfusion on the distribution of lung preservation solutions in parenchyma and airways

Objective: The present study was performed to investigate the influence of different routes of perfusion on the distribution of the preservation solutions in the lung parenchyma and upper airways. Methods: Pigs were divided into four groups: control (n = 6), pulmonary artery (PA) (n = 6), simultaneous PA + bronchial artery (BA) (n = 8), and retrograde delivery (n = 6). After preparation and cannulation, cardioplegia solution and Euro- Collins solution (ECS) for lung preservation were given simultaneously. After removal of the heart, the double lung bloc was harvested. Following parameters were assessed: total and regional perfusion (dye-labeled microspheres), tissue water content, PA, aorta, left atrial and left ventricular pressures, cardiac output and lung temperature. Results: Our data show that flow of the ECS in lung parenchyma did not reach control values (9.4 ± 1.0 ml/min per g lung wet weight) regardless of the route of delivery (PA 6.3 ± 1.5, PA + BA 4.8 ± 0.9, retrograde 2.7 ± 0.9 ml/min per g lung wet weight). However, flow in the proximal and distal trachea were significantly increased by PA + BA delivery (0.970 ± 0.4, respectively, 0.380 ± 0.2 ml/min per g) in comparison with PA (0.023 ± 0.007, respectively, 0.024 ± 0.070 ml/min per g), retrograde (0.009 ± 0.003, respectively, 0.021 ± 0.006 ml/min per g) and control experiments (0.125 ± 0.0018, respectively, 0.105 ± 0.012 ml/g per min). Similarly the highest flow rates in the right main bronchus were achieved by PA + BA delivery (1.04 ± 0.4 ml/min per g) in comparison with 0.11 ± 0.03 in control, 0.033 ± 0.008 in PA, and 0.019 ± 0.005 ml/min per g in retrograde group. Flows in the left main bronchus were 0.09 ± 0.02 ml/min per g in control, 0.045 ± 0.012 ml/min per g in PA, and 0.027 ± 0.006 ml/min per g in retrograde group. The flow rates were significantly (P = 0.001) increased by PA + BA delivery of the storage solution (0.97 ± 0.3 ml/min per g). Conclusions: Our data show that the distribution of ECS for lung preservation is significantly improved in airway tissues (trachea and bronchi) if a simultaneous PA + BA delivery is used.