Changes in lipidemic and metabolic factors following ketamin and losartan administration in rats with renal artery stenosis

This experiment examinea the effect of losartan and ketamin on serum lipids, insulin and angiotensin II concentration in plasma as well as angiotensin II content and lipoprotein lipase activity in adipose tissue in hypertensive rats. Renovascular hypertension appeared a significant decrease in insulin and a significant increase in angiotensin II concentrations in plasma. Additionally, in adipose tissue, LPL activity demonstrated a significant decrease, while angiotensin II content did not exhibit any significant difference. On the other hand, losartan administration seemed to improve the insulin concentrations in plasma, thus indirectly resulting in the LPL activity up regulation in the adipose tissue. Conversely, ketamin administration did not affect the metabolic parameters in the normal and in the hypertensive rats. These results suggest that renovascular hypertension interferes in lipid metabolism by reducing LPL activity in adipose tissue, while losartan administration increases insulin release, thereby indirectly promoting the LPL activity up-regulation in the adipose tissue.Στην παρούσα εργασία μελετήθηκε ο ρόλος της κεταμίνης και της λοσαρτάνης στο μεταβολισμό επίμυων με νεφραγγειακή υπέρταση. Για το λόγο αυτό μελετήθηκαν τα επίπεδα ινσουλίνης, αγγειοτενσίνης II και λιπιδαιμικών παραμέτρων στο πλάσμα και τον ορρό αντίστοιχα, καθώς και η ενεργότητα του ενζύμου της λιποπρωτεϊνικής λιπάσης(LPL) στο περινεφρικό λιπώδη ιστό, υπερτασικών επίμυων. Σύμφωνα με τα αποτελέσματά μας διαπιστώσαμε ότι κατά τη φάση της νεφραγγειακής υπέρτασης τα επίπεδα ινσουλίνης μειώθηκαν, η δραστηριότητα της LPL ελαττώθηκε, μεταβάλλοντας παράλληλα τα επίπεδα των λιπιδίων στο πλάσμα. Η χορήγηση κεταμίνης δεν επηρρέασε τους μεταβολικούς παράγοντες στους φυσιολογικούς και υπερτασικούς επίμυες. Αντίθετα, η χορήγηση λοσαρτάνης οδήγησε σε άνοδο τα επίπεδα της ινσουλίνης, αύξησε την δραστηριότητα της LPL στο λιπώδη ιστό, επαναφέροντας έτσι τα επίπεδα των λιπιδίων σε φυσιολογικές τιμές

Transthoracic echocardiography for the diagnosis of left ventricular thrombosis in the postoperative care unit

Introduction: Transthoracic echocardiography (TTE) is a reliable, noninvasive imaging method that is useful in the evaluation of cardiovascular thrombosis. We conducted a retrospective study of all the echocardiograms from patients in the postoperative care unit to assess the role of TTE in thrombus identification in the left ventricle. Methods: This retrospective database evaluation included all echocardiograms during a 14-month period. The echocardiographic examination protocol included the subcostal four-chamber view, the apical four-chamber view, the apical two-chamber view and the parasternal view, along the long and short axes in both spontaneously and mechanically ventilated patients. All echocardiograms were obtained within the 48 hours immediately following surgery. Results: In total, 160 postoperative echocardiograms were obtained from 160 patients and resulted in the detection of five cases of left ventricular thrombosis. Subgroup analysis showed that 21 and 35 of the 160 patients examined had either dilated or ischemic cardiomyopathy, respectively. In these patients, preoperative echocardiograms had been obtained recently prior to surgery and were negative for left ventricular thrombus. In three of 35 patients with ischemic cardiomyopathy and two of 21 patients with dilated cardiomyopathy, thrombus was identified in the left ventricle. The thrombi were mobile, uncalcified and pedunculated and were located in the apex of the left ventricle. In addition, no clinical consequences of the left ventricular thrombi were recorded. Conclusions: Low-flow conditions in heart chambers due to ischemic or dilated cardiomyopathy in conjunction with the hypercoagulability caused by perioperative prothrombotic factors may lead to thrombotic events in the left ventricle

Ultrasound-guided anterior axilla musculocutaneous nerve block

Purpose This paper presents a technique of ultrasound-guided localisation and block of the musculocutaneous nerve through the anterior wall of the axilla. Twenty patients (7 males and 13 females; mean age, 35 years) had axillary nerve block for upper extremity trauma. With the arm adducted, the ultrasound probe was positioned on the anterior axillary wall; the axillary artery, coracobrachialis and pectoralis major muscles and lateral cord of brachial plexus were visualised in cross section. With continuous imaging of the axillary artery in cross section, the ultrasound probe was slowly moved towards the biceps muscle until the musculocutaneous nerve appeared crossing the coracobrachialis muscle. After ultrasound localisation of the musculocutaneous nerve, the arm was abducted and externally rotated, and the nerve was identified with nerve stimulation and blocked. The quality of sensory and motor nerve block, as well as of ultrasound imaging were evaluated. Ultrasound-guided block of the musculocutaneous nerve was excellent and complete in 18 of the 20 patients. In two patients, the musculocutaneous nerve was fused with the median nerve and the nerve block was repeated successfully with the same technique. The quality of ultrasound imaging was excellent in all patients. No patient experienced pain or tourniquet discomfort during surgery, or any other nerve block-related complication. The anterior axillary ultrasound view provides for complete nerve block and imaging of the entire course of the musculocutaneous nerve and its relations with adjacent structures with excellent quality