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PubMed2002

Influence of microgravity on plasma levels of gastroenteropancreatic peptides: a case study.

BACKGROUND: No data are available about the short- or long-term influences of microgravity in space on the release of gastroenteropancreatic peptides, although these peptides are involved in the regulation of gastrointestinal functions. METHODS: Fasting plasma samples were gained during the EUROMIR-94 mission from a European Space Agency (ESA) astronaut who experienced no signs of space motion sickness in orbit. Plasma concentrations of nine gastroenteropancreatic peptides were measured with sensitive and specific radioimmunoassays. RESULTS: Fasting plasma levels of motilin, pancreatic polypeptide (PP), vasoactive intestinal peptide (VIP), and secretin were increased and plasma level of cholecystokinin (CCK) was decreased by acute exposure of the astronaut to microgravity. Chronic (4 wk) exposure caused an enhancement of plasma CCK, motilin, neurotensin, VIP, and insulin whereas plasma concentrations of PP, secretin, gastrin, and somatostatin showed no changes. During the 25-d stay on MIR station plasma levels of CCK, motilin, and neurotensin increased. Short-time body rotations caused an elevation of plasma levels of PP but decreased plasma motilin. CONCLUSIONS: As the influence of microgravity on the peptide levels was not uniform, an effect due to other factors (e.g., change in fluid balance or body weight) is unlikely. Moreover, adaptive changes of some peptides occurred during the stay in orbit. The release of PP and motilin seems to be very sensitive to rotation forces. These results have to be confirmed in more subjects in space to be able to link changes of gastroenteropancreatic peptide release to alterations of gastrointestinal functions.

Adult↗
PubMed2000

Evaluation of body fluid status after cardiac surgery using bioelectrical impedance analysis.

BACKGROUND: In the assessment of fluid status after cardiac surgery, we applied bioelectrical impedance analysis (BIA) to measure the total body water (TBW), extracellular fluid (ECF), and intracellular fluid (ICF), and evaluated its validity. METHODS: Thirty patients who underwent cardiopulmonary bypass (CPB group) and 19 surgical patients not receiving CPB (non-CPB group). RESULTS: The change of BIA values (deltaTBW, deltaECF, deltaICF), body weight and cumulative fluid balance were determined for 120 postoperative hours, and the relationship between BIA values and body weight and fluid balance were evaluated. Postoperative changes in BIA values in the CPB group were compared with those in the non-CPB group. Finally the ECF/ICF ratio and hemodynamic parameters were compared. deltaTBW and deltaECF correlated with changes in body weight and fluid balance, respectively. Especially there was a high correlation in each case although large deviations in the slope of the regression lines were observed. TBW and ECF increased from immediately after operation up to 96 hours (the maximum value was at day 2). On the other hand, ICF decreased from 48 to 72 hours after operation. There were significant high ECF/ICF in the CPB group compared with the non-CPB group from 12 to 72 postoperative hours. We found that ECF/ICF correlated inversely with mean blood pressure, mixed venous oxygen saturation and colloid osmotic pressure, and positively with central venous pressure and pulmonary artery wedge pressure. CONCLUSIONS: It was considered that BIA was useful for evaluating the relative changes in TBW and fluid distribution, and ECF/ICF might be a new parameter for abnormal water metabolism after cardiac surgery.

Aged↗
PubMed2000

Preservation of the right atrial appendage improves reduced plasma atrial natriuretic peptide levels after the maze procedure.

OBJECTIVES: The present study was conducted to determine whether preservation of the right atrial appendage lessens the decrease of plasma atrial natriuretic peptide levels after the maze procedure and whether the increase of plasma atrial natriuretic peptides improves the ability of the kidneys to excrete the fluid load after the operation. METHODS: We evaluated 42 patients who underwent the maze procedure. The right atrial appendage was preserved in 22 patients but not in 20. Blood samples were obtained before and after the operation for measurement of atrial natriuretic peptides. To evaluate the influence of atrial natriuretic peptides on the ability of the kidneys, we also measured body weight, fluid balance, and the doses of furosemide and dopamine administered after the operation. RESULTS: The restoration to sinus rhythm at 1 month after was comparable in the two groups. Plasma atrial natriuretic peptide levels significantly increased after the operation in patients in whom the right atrial appendage was preserved (1 day after: 23.4 +/- 17.8 vs 3 days after: 42.7 +/- 23.6 and 7 days after: 36.3 +/- 23.7 pg/mL, P <.05) but not in patients in whom the right atrial appendage was not preserved (1 day after: 20.0 +/- 19.6, 3 days after: 28.5 +/- 19.3, and 7 days after: 23.0 +/- 16.1 pg/mL). Furthermore, plasma atrial natriuretic peptide levels were significantly lower in patients in whom the right atrial appendage was not preserved than in patients in whom the right atrial appendage was preserved at 3 and 7 days after the operation. The fluid balance during the first 7 days of the postoperative period was comparable in the two groups, although the total dose of dopamine used in the same period was significantly smaller in patients in whom the right atrial appendage was preserved than in patients in whom the right atrial appendage was not preserved (155.3 +/- 119.0 vs 244.9 +/- 129.0 microg/kg, P <.05). CONCLUSIONS: The present study showed that preservation of the right atrial appendage lessens the decrease of plasma atrial natriuretic peptide levels after the maze procedure and that increased plasma atrial natriuretic peptides may improve the ability of the kidneys to excrete the fluid load after the operation.

Atrial Appendage↗
PubMed2001

Does a hyperoncotic cardiopulmonary bypass prime affect extravascular lung water and cardiopulmonary function in patients undergoing coronary artery bypass surgery?

OBJECTIVE: Different types of colloidal priming for cardiopulmonary bypass (CPB) have been used to reduce fluid load and to avoid the fall of plasma colloid osmotic pressure (COP) that leads to edema formation and consequently can cause organ dysfunction. The discussion about the optimal priming composition, however, is still controversial. We investigated the effect of a hyperoncotic CPB-prime with hydroxyethyl starch (HES) 10% (200;0.5) on extravascular lung water (EVLW) and post-pump cardiac and pulmonary functions. METHODS: In 20 randomized patients undergoing elective coronary artery bypass graft surgery (CABG), a colloid prime (COP: 48 mmHg, HES-group, n = 10) and a crystalloid prime (Ringer's lactate, crystalloid group, n = 10) of equal volume were compared with respect to the effects on cardiopulmonary function. Cardiac index (CI), mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), systemic vascular resistance index (SVRI), pulmonary artery pressure (PAP), pulmonary vascular resistance index (PVRI), alveolo-arterial oxygen difference (AaDO(2)), pulmonary shunt fraction (Q(s)/Q(T)), EVLW (double-indicator dilution technique with ice-cold indocyanine green), COP, fluid balance and body weight were evaluated peri-operatively. RESULTS: Pre-operative demographic and clinical data, CPB-time, cross-clamp time and the number of anastomoses were comparable for both groups. During CPB, COP was reduced by 20% in the HES-group (18.9 +/- 3.7 vs. 23.7 +/- 2.2 mmHg, P < 0.05) while it was reduced by more than 50% of the pre-CPB value (9.8 +/- 2.0 vs. 21.4 +/- 2.1 mmHg, P < 0.05) in the crystalloid group (P < 0.05 HES- vs. crystalloid group). Post-CPB EVLW was unchanged in the HES-group but it was elevated by 22% in the crystalloid group (P < 0.05 HES- vs. crystalloid group), CI was higher in the HES-group (3.4 +/- 0.3 vs. 2.7 +/- 0.5l/min, P < 0.05). Fluid balance was less in the HES-group (813 +/- 619 vs. 2143 +/- 538, P < 0.05). Post-operative weight gain could be prevented in the HES-group but not in the crystalloid group (1.5 +/- 1.2 vs. -0.3 +/- 1.5, P < 0.05). No significant differences were seen for MAP, PAP, PCWP, SVRI, PVRI, AaDO(2) and (Q(s)/Q(T)) between the two groups at any time. CONCLUSIONS: Hyperoncotic CPB-prime using HES 10% improves CI and prevents EVLW accumulation in the early post-pump period, while pulmonary function is unchanged. This effect can be of benefit especially in patients with congestive heart failure.

Blood Loss, Surgical↗
PubMed1992

[Clinical significance of HANP (human atrial natriuretic peptide) in patients on maintenance hemodialysis--HANP as a parameter to determine the dry weight (D.W.)].

Human atrial natriuretic peptide (HANP) is a hormone with the physiological characteristics of a regulator of body fluid volume. We studied whether, or not, it is possible to use HANP as a parameter to determine the so-called dry weight (D.W.) in patients on maintenance dialysis. Subjects for experiments included 117 hemodialysis (HD) patients, 18 chronic renal failure (CRF) patients under conservative treatment and 20 normal controls. Plasma HANP level was much higher in HD patients than in controls. In CRF patients treated conservatively, there was no significant correlation between plasma HANP and the degree of renal dysfunction. In HD patients plasma HANP showed a significant positive correlation with CTR (r = 0.408, p less than 0.001), but no correlation with the age or duration of hemodialysis. During hemodialysis, the plasma HANP level fell with the lapse of time significantly (p less than 0.001). In HD patients without complications, plasma HANP level after HD were significantly higher (p less than 0.001) in ones with CTR of 50% or more than with CTR of less than 50%. Plasma HANP may play an important part in regulating the balance of body fluid volume. These findings suggest that plasma HANP is useful as a parameter to determine the D.W. in patients on hemodialysis.

Adolescent↗
PubMed2001

Hippocrates' humoral pathology in nowaday's reflections.

Ancient medicine integrated three components: experience (empirical observation), religion/magic and speculations of natural philosophers. The Greek medicine out-achieved medicine of other ancient nations in starting to investigate the true causes of health and diseases and thus laying foundations for the diagnosis, prognosis and treatment. Hippocrates, the most famous physician of the ancient times, made a synthesis of existing philosophical opinions from the point of view of a physician. His 58 writings were preserved in the collection "Corpus Hippocraticum". The most relevant writing in it--"Peri fyseos anthropu" (On the nature of man)--is ascribed to Hippocrates' son-in-law Polybos to whom we are grateful for the ancient humoral-pathological theory. In explaining human organism and its processes the author integrated ancient teachings on 4 basic humors (humoral theory), elements and qualities with observations of manifestations of health and disease. Normal condition (health) was defined as balance between the body fluids (eukrasia) and external environment. If this balance is disturbed, the result is dyskrasia, i.e. disease studied by pathology. According to Hippocrates disease causes can be understood only through empirical study. A man has a power to overcome disease, but to achieve it the right diet is necessary to keep harmony in body fluids of an organism. The role of a physician was just to support the nature. "Prognosis", another writing included in "Corpus Hippocraticum", reflects Hippocrates' understanding of prognosis as a necessary development of diagnosis based on past knowledge (anamnesis) and present observation. Ideas of Hippocrates and his medical school are still valuable and inspiring especially for today's very sophisticated medicine--concept of fighting diseases by natural means: maintaining healthy lifestyle and harmony within the organism, or an effort for perfect understanding of human creature and for humanization of medicine. (Fig. 3, Ref. 14.)

Greece, Ancient↗
PubMed2003

In vitro fracture toughness of human dentin.

The in vitro fracture toughness of human dentin has been reported to be of the order of 3 MPa (square root)m. This result, however, is based on a single study for a single orientation, and furthermore involves notched, rather than fatigue precracked, test samples. The present study seeks to obtain an improved, lower-bound, value of the toughness, and to show that previously reported values may be erroneously high because of the absence of a sharp crack as the stress concentrator. Specifically, the average measured critical stress intensity, K(c), for the onset of unstable fracture along an orientation perpendicular to the long axis of the tubules in dentin is found to be 1.8 MPa (square root)m in simulated body fluid (Hanks' balanced salt solution), when tested in a three-point bending specimen containing a (nominally) atomically sharp precrack generated during prior fatigue cycling. This is to be compared with a value of 2.7 MPa (square root)m measured under identical experimental conditions except that the bend specimen contained a sharp machined notch (of root radius 30-50 microm). The effect of acuity of the precrack on the fracture toughness of human dentin is discussed in the context of these data.

Apatites↗
PubMed1989

Differences between Kallawaya-Andean and Greek-European humoral theory.

Kallawaya Andeans and Classic Greeks have a humoral epistemology based on analogical thinking and systems of correspondence, but they are culturally different systems. This does not imply that the latter system derived from the earlier but rather than Andeans and Greeks emphasized the relationship of body and humors to climate and land. Ethnographic data indicates that Kallawaya Andeans have a topographical-hydraulic model for understanding the physiology of their bodies. This differs from Greek-European humoral theory, which scholars consider the basis of Latin American folk medicine, in that Greeks try to balance their body fluids, whereas Kallawayas understand their fluids in centripetal and centrifugal motion. Kallawayas conceive of the body in more holistic concepts than Greeks and Europeans who distinguish between thought and matter, body and soul, and inner and outer. The fact that Kallawayas employ hot/cold, and wet/dry categories suggest either that they adopted this from Greek European humoral theory from the Spaniards or that these categories were pre-Columbian. Epistemological similarities facilitate the adoption into Kallawaya ethnophysiology of foods, medicines, and illnesses classified as hot/cold, and wet/dry in Spanish herbal books, which were used in the Andes after the Conquest.

Body Fluids↗
PubMed1998

Anatomy and physiology of the kidney.

The kidneys are complex organs, and they are vital in maintaining normal body functions. A human being's survival depends, to a large degree, on the crucial functions and processes performed by the kidneys. The renal system affects all parts of the body by keeping body fluids in balance and other organ systems functioning normally. Renal and urologic disorders may strike anyone at any age and at any time. An estimated 20 million Americans are affected with renal disorders each year.

Humans↗