Influence of enalapril on the endothelial function of DOCA-salt hypertensive rats

In the present study, we investigated whether the correction of endothelial dysfunction can be independent of the normalization of high blood pressure levels by enalapril in deoxycorticosterone (DOCA-salt) hypertensive rats. Aorta morphology and the response of aortas with (E+) and without (E-) endothelium to noradrenaline, acetylcholine, and sodium nitroprusside were studied. DOCA-salt hypertensive and normotensive (control) rats were or were not treated with enalapril (5 mg/day/rat in the drinking fluid) for 1, 7, or 15 days. Blood pressure was measured before and after 1, 3, 7, and 15 days of enalapril treatment. Enalapril normalized the high blood pressure levels in 50% (responders) of the hypertensive rats after 3 to as many as 15 days but not after 1 day of treatment. Initial blood pressure levels were not different between responders and nonresponders. Blood pressure levels of normotensive control rats were not altered by enalapril treatment. The tunica media of aortas of DOCA-salt hypertensive rats treated or not treated with enalapril for 15 days was thicker than aortas from normotensive rats. Enalapril corrected the reduced response to acetylcholine observed in aorta from hypertensive rats from the first day of treatment. This treatment rendered aortas from normotensive control rats more sensitive (lower EC(50)) to acetylcholine without a change in the maximal responses. The responses to sodium nitroprusside, a nitric oxide donor, were unaltered in aorta E+ or E- from control and hypertensive rats before and after enalapril treatment. Enalapril did not correct the increased responses to noradrenaline observed in aorta E+ of hypertensive rats. These results suggest that the high blood pressure in DOCA-salt hypertension is not correlated with the altered response to endothelium-dependent agents (either dilator or constrictors). The endothelium-dependent vasodilation by antihypertensive agents can be corrected independently of normalization of blood pressure levels or the vascular morphology.     

Sexual dimorphism in the response of thoracic aorta from SHRs to losartan

1. We compared the endothelium-dependent responses of thoracic aortic rings obtained from male and female spontaneously hypertensive rats (SHR) in order to explore gender differences in the normalization of the high blood pressure by antihypertensive drug therapy and in the correction of the endothelial dysfunction found in these animals. 2. Concentration-effect curves to acetylcholine (ACh) and sodium nitroprusside (SNP) were obtained using aortic rings isolated from male and female rats pretreated or not with losartan for 24 h or 15 d. The responses achieved and the EC50s were determined. 3. Losartan, AT(1) receptor antagonist, normalized (around 125 mmHg) the high blood pressure levels in 100% of the females and in 53.3% of males SHR within 24 h of initiating the treatment and remained normal during the remainder of the treatment period (15 d). 4. Losartan (15 d) corrected the decreased response to ACh in male and female SHR, independently of the normalization of blood pressure in male SHR. 5. An increased sensitivity to SNP was observed after chronic treatment with losartan in aortic rings from female SHR. 6. Ridogrel, a TXA(2)/PGH(2) receptor antagonist, restored the decreased response to ACh in aortic rings from male and female SHR. 7. These results suggest that there are gender-related differences in the normalization of the high blood pressure levels by losartan in SHR. The decreased response to ACh observed in male and female is corrected after sustained (15 d) reduction of high blood pressure. In female but not in male SHR, correction seems to involve an increased sensitivity of the smooth muscle to nitric oxide.     

Lung cancer and cigarette smoking in women: a multicenter case-control study in Europe

The association between cigarette smoking and lung cancer risk in women was investigated within the framework of a case-control study in 9 centres from 6 European countries. Cases were 1,556 women up to 75 years of age with histologically confirmed primary lung cancer; 2, 450 controls with age distribution similar to cases were selected. The predominant cell type was adenocarcinoma (33.5%), with similar proportions for squamous-cell type (26.4%) and small-cell carcinoma (22.3%). Overall, smoking cigarettes at any time was associated with a 5-fold increase in lung cancer risk (odds ratio 5.21, 95% confidence interval 4.49-6.04); corresponding figures for current smoking habits were 8.94, 7.54-10.6. The association showed a dose-response relationship with duration of the habit and daily and cumulative lifetime smoking. A significant excess risk of 70% was associated with every 10 pack-years smoked. After 10 years of smoking cessation, the relative risk decreased to 20% compared to current smokers. The following characteristics were associated with a higher relative risk: inhalation of smoke, smoking non-filter cigarettes, smoking dark-type cigarettes and starting at young age. The association was observed for all major histological types, being the strongest for small-cell type carcinoma, followed by squamous-cell type and the lowest for adenocarcinoma. The proportion of lung-cancer cases in the population attributable to cigarette smoking ranged from 14% to 85%. We concluded that women share most features of the association between cigarette smoking and lung cancer observed in men.     

Late Spontaneous Extrusion of a Texturized Silicone Gel Mammary Implant

A case report of late spontaneous extrusion of a 250-cm³, round, texturized silicone gel mammary implant, 14 months after implantation, is presented. The irregular surface of the implant, the location of the implant pocket, and the absence of the fibrous capsule were responsible for alterations in the skin thickness. In addition, the pressure exerted by the implant against the skin provides for stasis with venous trombosis at the inferior portion of the breast. The continuous manipulation of the breast over a thin skin with vascular alterations led to the skin perforation with implant extrusion.     

Acute renal failure in critically ill HIV-infected patients

Acute renal failure (ARF) is common among hospitalized HIV-infected patients [1]. To our knowledge, however, data regarding ARF in HIV-infected patients in the intensive care unit are still lacking.     

Neurofibroma of thyroid in a patient with neurofibromatosis type 1

The neurofibromatosis type 1 (NF1), also known as von Recklinghausens disease, is an autosomal dominant disorder, with high degree of variability of clinical expression, usually involved with formation of tumors, with benign origin in the majority of cases mainly localized in the region of the head and neck and rarely incident in the thyroid area. However, the association with medullary carcinoma of the thyroid (MCT) exists in literature and needs to be excluded. We report a case of a patient with NF1, nonfunctional thyroid nodule and obstructive symptoms. Surgical resection of lesion was performed, with histopathologic findings compatible with neurofibroma in thyroid tissue. This case is relevant not only because of the rarity of the presentation of NF1, but also due to the likely association with MCT, an aggressive tumor that can be cured by surgery.