[Personal experience with clomiphene].
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Adult↗
Biomedical subjects
E Salas
Publications and source records attributed to E Salas.
[Regulation of the response of the hypothalamo-hypophyseal-adrenal axis during anesthesia with diazepam-fentanyl in heart surgery].
OBJECTIVES: To study the response of the hypothalamic-hypophysial-adrenal axis during heart surgery under anesthesia with diazepam-fentanyl (D-F) at high doses. MATERIAL AND METHODS: We studied the intraoperative response of cortisol, ACTH, and 11-deoxycortisol and aldosterone (RIA) to heart surgery under anesthesia with 0.5 mg/kg diazepam and 0.1 mg/kg fentanyl in 12 patients (group D-F) and the effect on that response of blocking peripheral cortisol production with etomidate (0.15 mg/kg bolus) (group D-F-E, n = 12). RESULTS: Sharp drops in cortisol, ACTH and 11-deoxycortisol levels were observed in group D-F before the start of extracorporeal circulation (ECC). Albumin and red blood cell counts fell less sharply than did hormone levels. ACTH levels increased after ECC. Throughout surgery, ACTH and cortisol never rose over preanesthetic levels. The response in group D-F-E was similar, with a clear early rise in 11-deoxycortisol and a later rise in ACTH. CONCLUSIONS: Anesthesia with D-F lowers levels in the hypothalamic-hypophysial-adrenal axis below baseline in the phase before ECC, despite the stimulus of surgery and the effect of hemodilution. After ECC, ACTH levels rise. The response seen in group D-F-E suggests that levels in the hypothalamic-hypophysial-adrenal axis are below normal, but that the mechanism is functioning appropriately.
Adrenocorticotropic Hormone↗
Impaired vascular smooth muscle nitric oxide-dependent relaxation in human coronary arteries from "transplanted heart vasculopathy".
The long-term prognosis after heart transplant is mainly determined by the development of transplant vasculopathy. The pathogenic mechanism of transplant vasculopathy remain uncertain, although endothelial dysfunction has been postulated. The objective of this work is to evaluate the smooth muscle and endothelium nitric oxide relaxing mechanisms in coronary arteries from patients with transplant vasculopathy. We studied human coronary arteries obtained from heart transplant surgery specimens of patients with heart transplant vasculopathy, ischaemic cardiopathy or dilated cardiomyopathy. Rings from the coronary arteries were mounted on stainless steel hooks in 40 ml organ bath. The tissues were contracted with phenylephrine (approx. ED 80-90) and concentration-response curves were performed with glyceryltrinitrate and acetylcholine. Glyceryltrinitrate relaxed arterial rings from patients with dilated cardiomyopathy and ischaemic cardiopathy. Arterial rings from patients with heart transplant vasculopathy showed a lower response to glyceryltrinitrate. Acetylcholine induced dilatation of coronary arteries from dilated cardiomyopathy but increased the tension in coronary rings from heart transplant vasculopathy and inschaemic cardiopathy. In conclusion, there is a lower response to glyceryltrinitrate and a paradoxical response to acetylcholine in arteries from patients with transplant vasculopathy. The response to glyceryltrinitrate may be a meaningful tool in the early diagnosis of transplant vasculopathy.
Acetylcholine↗