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Cesarean Section in the Setting of Fibroid Uterus and Cesarean Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Andrea Tinelli, Marina Vinciguerra, Antonio Malvasi, Michael Stark
Vasopressin is a synthetic antidiuretic hormone, widely used in gynecological surgery as a vasoconstrictor agent, mostly during high risk for bleeding procedures like myomectomy. Already in 1996, Fletcher et al. showed in two cases of myomectomy that vasopressin was associated with less blood loss and lower risk for transfusion or blood loss of more than one liter [101]. Vasopressin can be administrated in different ways, but a local administration has to be preferred, because it allows the induction of local vasoconstriction lasting approximately for 30 min, avoiding as much as possible the systemic effects typical to this kind of compounds, like cardiac rhythm disorders, blood pressure alterations or other cardiovascular adverse effects [102]. Therefore, even if cases of safe myomectomies after paracervical injection of vasopressin are described [103], the technique is often done by an intramyometrial infiltration around the myoma by diluted vasopressin [100]. A recent retrospective case-control study on laparoscopic myomectomy showed that the use of intraoperative intramyometrial injection of dilute vasopressin (20 IU/100 mL normal saline), did not reduce the operation time for a skilled surgeon, but significantly reduced the blood loss in laparoscopic myomectomy without serious cardiovascular adverse events. In addition, the occurrence of hypercapnia was higher in untreated cases and contributed to conversion to laparotomy [102].
Minimizing Blood Loss
Published in John C. Petrozza, Uterine Fibroids, 2020
Elise Bardawil, Jessica B. Spencer
Intracervical injections of dilute vasopressin have been proven to decrease blood loss during hysteroscopy [18]. The majority of research into intracervical injection of vasopressin occurred in the 1990s. One such study examined whether or not adding intracervical vasopressin injections to patients already pretreated with depot leuprolide acetate would further decrease intraoperative blood loss. The results of this small, randomized, double-blinded study showed that the patients treated with intracervical vasopressin had a lower intraoperative blood loss of 20.3 mL versus the 33.4 mL experienced by the placebo group who did not receive vasopressin. Although this difference in blood loss is numerically small, it was statistically significant [19]. Newer research on vasopressin examines its use when injected directly into the submucosal fibroid. A small, prospective, randomized, double-blinded study used dilute vasopressin, which was injected into the myoma using a single-lumen ovum aspiration needle connected to a 10 mL syringe. The vasopressin was injected until blanching was observed or 10 mL of solution was used. For the control group, normal saline was injected. This study showed that the vasopressin group had a blood loss of 5 mL versus 20 mL in the control group [20]. The difference was significant and the authors noted improved visual clarity.
The Endocrine System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
A condition called diabetes insipidus results from hyposecretion of vasopressin by the pituitary gland. The disorder in which there is continual release of ADH unrelated to plasma osmolality is known as the syndrome of inappropriate diuretic hormone (SIADH). This occurs in association with several clinical disorders, particularly malignant tumors such as oat-cell carcinoma of the lung. Symptoms include weight gain, weakness, lethargy, mental confusion, and progression to convulsions and coma.
Recent advances in proteolytic stability for peptide, protein, and antibody drug discovery
Published in Expert Opinion on Drug Discovery, 2021
Xianyin Lai, Jason Tang, Mohamed E.H. ElSayed
The small intestine is another major part of the human digestive system and further processes macromolecules into tri-, di-, and mono-peptides [38]. In small intestinal fluids, proteins showed greater stability than peptides. The reason might be that proteins have more complex secondary and tertiary structures, leading to less easily accessible peptide bonds [40]. Therefore, peptides were more often evaluated in small intestinal fluids than proteins were. Oxytocin and vasopressin are pituitary neuropeptides, functioning as an integrated, adaptive system, allowing the mammalian body to survive, maintain homeostasis, and reproduce [41]. The two molecules are potential drugs to treat social deficits in neurodevelopmental disorders, including autism spectrum disorder [42]. A modified vasopressin, 1- deamino-8-D-arginine-vasopressin (dDAVP), has been successfully intranasally used in patients with central diabetes insipidus. Buccal administration of oxytocin in pregnant women at term is followed by uterine contractions and increased plasma concentrations of oxytocin. However, their oral bioavailability was only 0.1–0.2% in healthy volunteers. Arginine-vasopressin, oxytocin, and their synthetic analogues were incubated in human small intestinal fluid from healthy volunteers. The quantification of degradation was carried out by reversed-phase high performance liquid chromatography (RP-HPLC). Arginine-vasopressin was completely degraded in 30 min, while dDAVP remained 50% of the intact after 35 min. Oxytocin showed much more stability than dDAVP and arginine-vasopressin [43].
‘Drink clean, safe water and/or other fluids through-out the day even if you do not feel thirsty’: a food-based dietary guideline for the elderly in South Africa
Published in South African Journal of Clinical Nutrition, 2021
Upasana Mukherjee, Carin Napier, Wilna Oldewage-Theron
The most important hormones in the maintenance of body fluid levels are part of the renin-angiotensin system. In response to extracellular fluid loss, rennin is secreted and it increases water uptake and retention by the kidneys. Renin also stimulates the secretion of angiotensin, which induces thirst sensations through the hypothalamus of the brain. With the progression of age, the rennin function is lowered and the kidneys lose the ability to concentrate urine. Angiotensin stimulation of thirst may also be impaired as studies on rats reported that adding angiotensin stimulants in drinks does not increase thirst in the elderly as it would normally do in younger animals.13,27 The second important set of hormones regulating water balance are part of the arginine vasopressin system. Vasopressin is called the antidiuretic hormone because of its potent ability to increase fluid retention in the kidneys. Aldosterone is a mineralocorticoid that primarily regulates sodium balance in the kidneys by stimulating sodium reabsorption and potassium excretion. Both secretion and sensitivity of the hormone is reduced due to ageing.13,27,52
New approved and emerging pharmacological approaches to alcohol use disorder: a review of clinical studies
Published in Expert Opinion on Pharmacotherapy, 2021
Kirsten C Morley, Christina J Perry, Joshua Watt, Tristan Hurzeler, Lorenzo Leggio, Andrew J Lawrence, Paul Haber
Oxytocin is a neuropeptide that acts via oxytocin receptors, but also at vasopressin receptors, that are widely distributed in the central nervous system. There is a growing body of evidence supporting the role of the brain oxytocin system in emotional regulation, stress, and addictive behaviors [99]. The mechanism by which oxytocin may affect alcohol seeking behavior is likely to be complex and involving multiple systems. Chronic exposure to alcohol leads to upregulation of oxytocin receptor or peptide itself [100,101], and general downregulation of oxytocin release [102]. Oxytocin has been observed to regulate changes in extracellular glutamate and GABA levels [103]. Oxytocin also interacts with stress systems (hypothalamic pituitary adrenal axis and CRF) [104], and prevents stress-induced increases in alcohol-seeking [103,105].