BACKGROUNDThe abnormal blood volume regulation is one of the most important pathogenesis in postural tachycardia syndrome in children. This study was designed to investigate the plasma atrial natriuretic peptide and antidiuretic hormone levels in postural tachycardia syndrome children, and their associations with the changes in heart rate and blood pressure in head-up test.

METHODSTwenty-one postural tachycardia syndrome patients ((12 ± 2) years) and 26 healthy children ((12 ± 1) years) were included. According to blood pressure changes in head-up test, the postural tachycardia syndrome patients were divided into two subgroups: postural tachycardia syndrome with orthostatic hypertension and postural tachycardia syndrome without orthostatic hypertension. The plasma atrial natriuretic peptide and antidiuretic hormone levels were measured using enzyme-linked immunosorbent assay.

RESULTSThe plasma atrial natriuretic peptide level in postural tachycardia syndrome patients was higher than the control (P = 0.004), whereas the difference in plasma antidiuretic hormone level between postural tachycardia syndrome and controls was not significant (P = 0.222). The plasma antidiuretic hormone level of patients suffering from postural tachycardia syndrome with orthostatic hypertension was much higher than that of children having postural tachycardia syndrome without orthostatic hypertension (P < 0.05). In postural tachycardia syndrome patients, the upright max heart rate was positively correlated with the plasma atrial natriuretic peptide level (r = 0.490, P < 0.05) and the upright systolic blood pressure was positively correlated with the plasma antidiuretic hormone levels (r = 0.472, P < 0.05).

CONCLUSIONSThere was a disturbance of plasma atrial natriuretic peptide and antidiuretic hormone in postural tachycardia syndrome children.

Adolescent ; Atrial Natriuretic Factor ; blood ; Case-Control Studies ; Child ; Humans ; Hypertension ; blood ; Postural Orthostatic Tachycardia Syndrome ; blood ; Vasopressins ; blood

BACKGROUND: AVP (arginine vasopressin) shows unique hemodynamic characteristics, as a vasopressor. AVP has been tried in many cathecholamine refractory vasodilatory situations, and sometimes resulted in effective hemodynamic improvement. In this study, we hypothesized that low dose AVP infusion could recover the decreased SVR (systemic vascular resistance) induced by milrinone infusion with minimal effect on PVR (pulmonary vascular resistance). METHODS: Sixteen patients undergoing OPCAB participated in this study. After a loading dose milrinone was infused, low dose vasopressin infusion was started and titrated until the systemic blood pressure increased by 20%. During the study, hemodynamic factors including pulmonary capillary wedge pressure and cardiac output were measured using a continuous thermodilution technique with a Swan-Ganz catheter. RESULTS: Milrinone infusion reduced both SVR and PVR. And vasopression infusion increased SVR, but show relatively less effect on PVR. CONCLUSIONS: Low-dose vasopressin infusion could be used to recover the SVR decrease caused by milirinone infusion with little effect on PVR.
Blood Pressure ; Cardiac Output ; Catheters ; Hemodynamics* ; Humans ; Milrinone* ; Pulmonary Wedge Pressure ; Thermodilution ; Vasopressins*

OBJECTIVETo observe the changes of plasma renin activity, antidiuretic hormone and brain natriuretic peptide in chronic heart failure (CHF) and their correlation with hyponatremia.

METHODSPlasma levels of PRA, ADH, and BNP were measured by radioimmunology in 76 CHF patients. Forty-one out of 76 CHF patients with hyponatremia and 35 CHF patients without hyponatremia were identified by serum sodium. The rates of rehospitalization within 3 months were compared in two groups.

RESULTSLevels of plasma renin activity, ALD, and BNP in CHF patients with hyponatremia were notably higher than those in patients without hyponatremia classified by New York Heart Association (NYHA) grade II - IV: PRA [(2.7 +/- 1.0) ng.ml(-1).h(-1) vs. (1.8 +/- 0.7) ng.ml(-1).h(-1), (4.3 +/- 1.2) ng.ml(-1).h(-1) vs. (3.0 +/- 0.9) ng.ml(-1).h(-1), (5.6 +/- 1.3) ng.ml(-1).h(-1) vs. (3.5 +/- 1.1) ng.ml(-1).h(-1), respectively, P < 0.05], ADH [(59.7 +/- 17.4) ng/L vs. (48.6 +/- 15.3) ng/L, (68.4 +/- 17.6) ng/L vs. (56.3 +/- 19.2) ng/L, (75.3 +/- 20.0) ng/L vs. (51.4 +/- 16.2) ng/L, respectively, P < 0.05] and BNP [(276.4 +/- 75.2) ng/L vs. (185.3 +/- 55.3) ng/L, (380.1 +/- 113.6) ng/L vs. (258.5 +/- 62.1) ng/L, (564.0 +/- 125.2) ng/L vs. (405.3 +/- 102.9) ng/L, respectively, P < 0.05]. In the simple regression analyses, hyponatremia was negative correlated with PRA, ADH and BNP (r = -0.31, P < 0.05; r = -0.28, P < 0.05, r = -0.80, P < 0.01). The rate of rehospitalization within 3 months in hyponatremia group was higher than that in control group.

CONCLUSIONSThere is relation of hyponatremia to the changes of plasma renin activity, antidiuretic hormone and brain natriuretic peptide in chronic heart failure. Hyponatremia may accelerate the excretion of plasma PRA, ADH and BNP in chronic heart failure. Neuroendocrine activation in patients of congestive heart failure with hyponatremia is higher than that of normal natremia group.

Aged ; Aged, 80 and over ; Female ; Heart Failure ; blood ; Humans ; Hyponatremia ; blood ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Renin ; blood ; Sodium ; blood ; Vasopressins ; blood

OBJECTIVETo investigate the changes and clinical significance of arginine vasopressin (AVP) in elderly patients with acute traumatic cerebral injury.

METHODSWith radioimmunoassay, the plasma levels of AVP were measured in 32 elderly patients with acute traumatic cerebral injury, 30 traumatic patients without cerebral injury and 30 healthy elderly volunteers, respectively.

RESULTSThe plasma level of AVP in patients with acute traumatic cerebral injury in the early stage (48.30 ng/L +/- 8.28 ng/L) was much higher than that of the traumatic patients without cerebral injury (25.56 ng/L +/- 4.64 ng/L, P<0.01), which was much higher than that of the healthy volunteers (5.06 ng/L +/- 4.12 ng/L, P<0.01). The level of AVP in the patients with acute traumatic cerebral injury was negatively related with GCS scores.

CONCLUSIONSAVP may play an important role in the pathophysiological process in patients with acute traumatic cerebral injury in the early stage. The severer the cerebral injury is, the higher the level of AVP is, which indicates that the level of AVP may be one of the severity indices of traumatic cerebral injury in elderly patients.

Acute Disease ; Aged ; Aged, 80 and over ; Brain Injuries ; blood ; metabolism ; Female ; Glasgow Coma Scale ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Neurophysins ; blood ; Protein Precursors ; blood ; Vasopressins ; blood

To investigate the mechanisms underlying the cholinergic agonist carbachol-induced cardiovascular responses, changes of renin-angiotensin system were examined in fetal hormonal systems. In the ovine fetal model under stressless condition, the cardiovascular function was recorded. Blood samples were collected before (during baseline period) and after the intravenous administration of carbachol. Simultaneously, the levels of angiotensin I (Ang I), angiotensin II (Ang II) and vasopressin in the fetal plasma were detected by immunoradiological method. Also, blood gas, plasma osmolality and electrolyte concentrations were analyzed in blood samples. Results showed that in chronically prepared ovine fetus, intravenous infusion of carbachol led to a significant decrease of heart rate (P < 0.05), and a transient decrease followed by an increase of blood pressure (P < 0.05) within 30 min. After the intravenous infusion of carbachol, blood concentrations of Ang I and Ang II in near-term ovine fetus were both significantly increased (P < 0.05); however, blood concentration of vasopressin, values of blood gas, electrolytes and plasma osmolality in near-term ovine fetus were not significantly changed (P > 0.05). Blood levels of Ang I and Ang II in the atropine (M receptor antagonist) + carbachol intravenous administration group was lower than those in the carbachol group without atropine administration (P < 0.05). In conclusion, this study indicates that the near-term changes of cardiovascular system induced by intravenous administration of carbachol in ovine fetus, such as blood pressure and heart rate, are associated with the changes of hormones of circulatory renin-angiotensin system.
Angiotensin I ; blood ; Angiotensin II ; blood ; Animals ; Blood Pressure ; Carbachol ; pharmacology ; Cholinergic Agonists ; pharmacology ; Fetus ; Heart Rate ; Renin-Angiotensin System ; Sheep ; Vasopressins ; blood

BACKGROUND: We determined the effect of spinal cord injury (SCI) on sevoflurane requirements and stress hormone responses, and sevoflurane concentration to block autonomic hyperreflexia (AHR) in SCI patients. METHODS: In the first series, sevoflurane concentrations to maintain bispectral index score (BIS) at 40-50 and stress hormone response were examined in 27 SCI patients undergoing surgery below the level of injury.Fifteen patients without SCI served as control.Measurements included end-tidal sevoflurane concentrations (ET(SEVO)), systolic blood pressure (SBP), heart rate (HR), catecholamines, vasopressin, and cortisol concentrations.In the second series, sevoflurane concentration to block AHR was examined in 31 SCI patients undergoing transurethral litholapaxy.When a patient developed an episode of AHR, the target sevoflurane concentration was maintained for 10 min, and then the procedure was repeated.Each target concentration was determined by up-down method based on SBP. RESULTS: During surgery, SBP, HR, and BIS were comparable between SCI and control.However, ETSEVO was significantly smaller in the SCI than the control.Plasma concentrations of norepinephrine, epinephrine and cortisol were significantly lower in the SCI than the control.SBP rose by 67 +/- 31 mmHg, whereas HR fell by 13 +/- 8 bpm during the 1st trial in the SCI (P < 0.01).Hypertensive events were associated with increases of norepinephrine concentrations.ETSEVO required to prevent AHR were 3.12% in 50% of patients, 3.83% in 95% of patients. CONCLUSIONS: SCI reduces the anesthetic requirement by 39%, and decreases stress hormone responses during surgery below the level of injury.To prevent AHR in 95% of SCI patients undergoing litholapaxy, ETSEVO 3.83% may be required.
Autonomic Dysreflexia ; Blood Pressure ; Catecholamines ; Epinephrine ; Heart Rate ; Humans ; Hydrocortisone ; Lithotripsy ; Methyl Ethers ; Mustard Compounds ; Norepinephrine ; Spinal Cord Injuries ; Vasopressins

Vasopressin, an extremely potent vasoconstrictor, has been widely used for surgical hemostasis in gynecological practices. But, Intramyometrial infiltration of vasopressin is not free of side effects and may cause lethal complications including pulmonary edema, myocardial infarction, and cardiac arrest in spite of infrequency of reported cases. Sudden cardiac arrest was encountered just after intramyometrial injection of vasopressin in our patient undergoing dilation and curettage. We believe that this awful complication was due to baroreflex-mediated regulation of blood pressure, caused by unintentional penetration of vasopressin into the vessels. We herewith discuss the complications of the local injection of vasopressin and the safe dose of vasopressin for intramyometrial injection.
Anesthesia, General* ; Baroreflex ; Blood Pressure ; Curettage* ; Death, Sudden, Cardiac ; Heart Arrest* ; Hemostasis, Surgical ; Humans ; Myocardial Infarction ; Pulmonary Edema ; Vasopressins*

BACKGROUND: Vasodilatory shock has been implicated in life-threatening complications after open heart surgery, where the systemic inflammatory reaction is attributed to the cardiopulmonary bypass (CPB). The secretion of arginine vasopressin (AVP) has been found to be defective in a variety of vasodilatory shock states and administration of AVP markedly improves vasomotor tone and blood pressure. So we reviewed our experience of AVP therapy in patients with vasodilatory shock following heart surgery using CPB. MATERIAL AND METHOD: From January 2004 to July 2006, we reviewed the records of patients who received AVP therapy for vasodilatory shock following heart surgery using CPB. Vasodilatory shock was defined as a mean arterial pressure lower (MAP) than 70 mmHg, a cardiac index greater than 2.5 L/min/m2, peripheral vascular resistance lower than 800 dyn/s/cm5, and vasopressor requirements. The hemodynamic responses of patients who received AVP therapy for vasodilatory shock after cardiac surgery were analyzed retrospectively. RESULT: One hundred ninety nine open cardiac surgery patients were consecutively included in this study. Twenty two patients (11.1%) met criteria for vasodilatory shock. Despite the administration of high dose catecholamine vasopressor, all patients were hypotensive with a mean arterial pressure less than 70 mmHg. AVP therapy increased MAP from 53.3+/-7.4 to 82.0+/-12.0 mmHg at 1 hour (p <0.001) and decreased other vasopressor requirements from 25+/-7 to 18+/-6 at 1 hour (p <0.001) and individually maintained it for 12 hours. CONCLUSION: Our date suggest that AVP may be a safe and an effective vasopressor in patients with vasodilatory shock. In patients exhibiting vasodilatory shock after heart surgery, replacement of AVP increases blood pressure and reduces catecholamine vasopressor requirements.
Arginine Vasopressin* ; Arginine* ; Arterial Pressure ; Blood Pressure ; Cardiopulmonary Bypass ; Hemodynamics ; Humans ; Retrospective Studies ; Shock* ; Thoracic Surgery* ; Vascular Resistance ; Vasodilation ; Vasopressins

Capsaicin, the pungent algesic substance of the red pepper is known to be a neurotoxic substance, interrupting the pain conducting pathway. To investigate the effects on the adult animals, immunohistochemical staining have been done after capsaicin treatment. Capsaicin 50 mg/kg was injected subcutaneously to the adult rats and after 1 week, 1 month and 2 months later, the morphometric change of vasopressin & oxytocin-secreting cells in supraoptic and paraventricular nuclei of the hypothalamic area were investigated. The count of vasopressin- and oxytocin-immunoreactive cells in supraoptic & paraventricular nuclei were decreasing from 1 month after capsaicin treatment and these decreasing was continued until 2 months. The area of neurons in the supraoptic & paraventricular nuclei were measured and they diminished in the all kinds of neurons. With the above results, capsaicin treatment in adult rats had no effects in central nervous system neurotransmitters, however, some part of the hypothalamus where blood brain barrier was not formed were affected. Therefore central nervous system could be affected by capsaicin depending upon the location.
Adult* ; Animals ; Blood-Brain Barrier ; Capsaicin* ; Capsicum ; Central Nervous System ; Humans ; Hypothalamus ; Immunohistochemistry ; Neurons ; Neurotransmitter Agents ; Oxytocin ; Rats* ; Vasopressins

BACKGROUND: Vasoplegic syndrome is an increasingly recognized disease in perioperative medicine and is characterized by severe hypotension, normal or elevated cardiac output, and decreased systemic vascular resistance. It occurs commonly after cardiopulmonary bypass but may also occur after other types of surgery.CASE: Vasoplegic syndrome developed in our patient during posterior lumbar interbody fusion because of administering nicardipine after phenylephrine. However, the blood pressure did not increase as expected despite simultaneous use of norepinephrine and vasopressin to increase the reduced systemic vascular resistance.CONCLUSIONS: We present a case of vasoplegic syndrome that developed during posterior lumbar interbody fusion and was treated successfully with methylene blue.
Blood Pressure ; Cardiac Output ; Cardiopulmonary Bypass ; Humans ; Hypotension ; Methylene Blue ; Nicardipine ; Norepinephrine ; Phenylephrine ; Vascular Resistance ; Vasoplegia ; Vasopressins