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O angioedema é uma condição potencialmente fatal que pode surgir em qualquer momento no perioperatório. Pode decorrer da liberação de histamina, em uma reação de hipersensibilidade a drogas ou ser desencadeado pela bradicinina, em reações não alérgicas, de etiologia hereditária ou adquirida. O objetivo desse relato é descrever um caso de angioedema, no pós‐operatório imediato, em um paciente em uso de medicação anti‐hipertensiva da classe dos inibidores da enzima conversora da angiotensina. Paciente de 67 anos, masculino, negro, hipertenso e em uso do maleato de enalapril, foi submetido a cirurgia ortopédica de ombro sob anestesia geral associada a bloqueio do plexo braquial. O procedimento durou 3 horas, sem intercorrências. Após a alta da sala de recuperação pós‐anestésica, apresentou angioedema com grave comprometimento das vias aéreas. Tentou‐se fazer intubação traqueal, mas foi impossível devido ao edema que acometia os lábios, a língua e região orofaringeana. Fez‐se a cricotireoidostomia de emergência. O aparecimento do angioedema não apresentou relação causal com a administração de qualquer medicação, não houve manifestações cutâneas e também não respondeu à terapêutica para reação de hipersensibilidade a drogas, como anti‐histamínicos, corticoide e adrenalina. Foi considerado como mediado pela bradicinina, pois o paciente já havia apresentado dois episódios semelhantes e estava em uso regular de medicação (enalapril). A evolução foi satisfatória. O angioedema é uma condição potencialmente fatal quando atinge as vias aéreas e deve ser de conhecimento do anestesiologista e dos médicos que trabalham nos setores de emergência. Angioedema is a potentially fatal condition that may occur at any time in the perioperative period. It may result from histamine release, hypersensitivity reaction to drugs, or be triggered by bradykinin, in non‐allergic reactions of hereditary or acquired etiology. The aim of this report is to report a case of angioedema in the early postoperative period in a patient on antihypertensive medication involving angiotensin‐converting enzyme inhibitors. A 67‐year‐old male, Afro‐descendant, hypertensive, and taken enalapril maleate underwent orthopedic shoulder surgery under general anesthesia combined with brachial plexus block. The procedure lasted 3 hours uneventfully. After discharge from the post‐anesthesia care unit, the patient presented with angioedema and severe airway impairment. Tracheal intubation was attempted but it was impossible due to edema affecting the lips, tongue, and oropharyngeal region Emergency cricothyroidotomy was performed. The onset of angioedema had no causal relationship with the administration of any medication; there were no cutaneous manifestations and also not response to therapy for hypersensitivity reaction to drugs, such as antihistamines, corticoid, and adrenaline. It was considered to be mediated by bradykinin, as the patient had already had two similar episodes and was on regular medication (enalapril). The evolution was satisfactory. Angioedema is a potentially fatal condition when it affects the airway, and should be recognized by anesthesiologists and physicians working in the emergency departments. [ABSTRACT FROM AUTHOR]

La insuficiencia cardiaca es la segunda patología en perros longevos. Se ha sugerido que la insuficiencia cardiaca puede ser vista como un modelo neurohormonal o neuroendocrino, ya que la progresión de la enfermedad se da como resultado de la sobreexpresión de moléculas activadas biológicamente que son capaces de ejercer un efecto deletéreo sobre el corazón y la circulación. Dentro de estas moléculas está el Sistema Renina Angiotensina Aldosterona y su principal péptido efector, la angiotensina II. En los últimos años, las consecuencias fisiopatológicas del sistema han sido el foco principal de atención, siendo más relevantes las vías alternativas de síntesis de la angiotensina II y la participación de otras enzimas similares a la enzima convertidora de angiotensina. Por lo tanto, esta revisión pretende describir el valor fisiopatológico del sistema renina angiotensina aldosterona sobre la Insuficiencia Cardíaca Congestiva.A insuficiência cardíaca é a segunda doença em cães longevos. Tem sido sugerido que a insuficiência cardíaca pode ser vista como um modelo neurohormonal ou neuroendócrino, já que a progressão da doença apresenta-se como um resultado da sobre-expressão de moléculas activadas biologicamente que são capazes de exercer um efeito deletério sobre o coração e a circulação. Dentre estas moléculas está o sistema renina-angiotensina-aldosterona e o seu peptídeo efetor principal, a angiotensina II. Nos últimos anos, as consequências fisiopatológicas deste sistema têm sido o foco principal de interesse, tendo maior relevância a síntese da angiotensina II e o envolvimento de outras enzimas como a enzima conversora da angiotensina. Portanto, esta revisão tem como objetivo descrever o valor fisiopatológico que tem o sistema renina-angiotensina-aldosterona sobre a insuficiência cardíaca congestiva.Heart failure is the second pathology of importance in long-lived dogs. It has been suggested that heart failure can be considered as a neurohormonal or neuroendocrine model, in which heart failure progresses as a result of over-expression of biologically active molecules that are able to exert a deleterious effect on the heart and circulation. Among these molecules is the rennin angiotensin aldosterone and its main effector peptide: the angiotensin II. In recent years, the pathophysiological consequences of the system have been the main focus of attention, being more relevant the alternative routes of angiotensin II synthesis and the participation of other enzymes such as the angiotensin converting enzyme. Therefore, this review aimed to describe the pathophysiological importance of the renin angiotensin aldosterone on Congestive Heart Failure.

Endometriosis is a chronic gynecological disease that displays some features similar to malignancy, such as local invasion, aggressive spread to distant organs and angiogenesis. Polymorphisms of the ACE gene have been linked with some vascular disease. To determine the frequency of the ACE I/D polymorphism in Brazilian patients with endometriosis compared to controls. This case-control study included a total of 134 women (49 endometriosis patients and 85 controls) who had undergone a laparoscopy or laparotomy. Molecular analysis was performed by polymerase chain reaction (PCR). For the statistical analysis, the chi-square and multiple logistic regression tests were used. The I/D ACE genotype frequencies in cases and controls were, respectively: II 16.3% and 16.5%; ID 24.5% and 20%; DD 59.2% and 63.5%. There was no statistically significant difference between cases and controls, either in the genotype frequencies (χ2 = 0.385; p = 0.825) or in the allele frequencies (χ2 = 0.098; p = 0.75) of the ACE I/D polymorphism. However, the genotype distribution was not consistent with the Hardy-Weinberg equilibrium, either in patients (χ2 = 7.84; p = 0.005) or in controls (χ2 = 20.09; p <0.0001). Multiple logistic regression analysis has not shown any differences amongst groups for the polymorphism studied [(OR 1.51; CI 95% 0.52-4.41); p=0.4523]. Despite of the small sample size, the present study suggests that I/D ACE polymorphism is not related with endometriosis in brazilian patients. [ABSTRACT FROM AUTHOR]

A alta incidência de doenças cardiovasculares e o sucesso no tratamento de pacientes infartados, através do uso de inibidores da enzima conversora da angiotensina (ECA), intensificaram os estudos que objetivaram determinar uma associação entre o gene da ECA e o infarto agudo do miocárdio (IAM). A prévia identificação de uma provável associação do polimorfismo I/D do gene da ECA ao IAM é a principal justificativa desta investigação, e visa determinar as freqüências genotípicas e alélicas deste polimorfismo na população brasileira .Tais freqüências foram obtidas de amostras aleatórias provenientes de um banco de sangue de um hemocentro estadual, apenas com a identificação da origem amostral por região. O DNA foi isolado a partir da camada de leucócitos e o polimorfismo I/D (presença e/ou ausência de uma inserção Alu no intron 16) do gene da ECA foi determinado pela reação em cadeia da polimerase. A freqüência alélica na população brasileira, em geral, foi de 0,39 e 0,61 para os alelos I e D, respectivamente, semelhante a outras populações. Contudo, houve pequena variabilidade genotípica entre as regiões brasileiras, com variações principalmente entre os homozigotos II e DD, tendo como freqüências genotípicas médias II=0.20, ID=0,43 e DD=0,37, exceto para a região Sul, que foi uma variação genotípica significativamente diferente das demais, com tendência ao aumento do genótipo DD (0,54) e diminuição do heterozigoto (0,24), provavelmente devido à diferente composição étnica. UNITERMOS: Enzima conversora da angiotensina, População Brasileira, Freqüência Alélica, Freqüência Genotípica.

Hypertension is considered a risk factor for coronary artery disease (CAD). Hypertension and atherosclerosis are the two major diseases of the arterial system and are closely associated. The renin-angiotensinaldosterone system (RAAS) has been identified as a critical path for the control of blood pressure and kidney function. This system has an important role in regulating blood pressure by influencing homeostasis salt / water and therefore having an intimate relationship with the process of hypertension. Since hypertension emerges as a risk factor for CAD, the RAAS is also related to this disease. Most human diseases are polygenic and multifactorial, they are governed by many genes and caused by a combination of factors acting together and simultaneously. Due to the strong relationship already mentioned between RAAS and hypertension and CAD, polymorphisms in candidate genes of this system, as well as polymorphisms in the angiotensin converting enzyme gene (ACE) and angiotensinogen gene (AGT) have been analyzed extensible as genetics determinants of these diseases. Studies of genetic polymorphisms have several functions, among them the determination of molecular markers linked to disease development. This becomes important because the development of molecular markers may lead to a new prognosis. In the case of CAD and hypertension, changes in the RAAS are closely related to the occurrence of these diseases, and consequently polymorphisms in genes that control this system can direct us to understand how the genetic influences the development of these diseases. [ABSTRACT FROM AUTHOR]

Background and Objectives: Angioedema is a potentially fatal condition that may occur at any time in the perioperative period. It may result from histamine release, hypersensitivity reaction to drugs, or be triggered by bradykinin, in non-allergic reactions of hereditary or acquired etiology. The aim of this report is to report a case of angioedema in the early postoperative period in a patient on antihypertensive medication involving angiotensin-converting enzyme inhibitors., Case Report: A 67-year-old male, Afro-descendant, hypertensive, and taken enalapril maleate underwent orthopedic shoulder surgery under general anesthesia combined with brachial plexus block. The procedure lasted 3hours uneventfully. After discharge from the post-anesthesia care unit, the patient presented with angioedema and severe airway impairment. Tracheal intubation was attempted but it was impossible due to edema affecting the lips, tongue, and oropharyngeal region Emergency cricothyroidotomy was performed. The onset of angioedema had no causal relationship with the administration of any medication; there were no cutaneous manifestations and also not response to therapy for hypersensitivity reaction to drugs, such as antihistamines, corticoid, and adrenaline. It was considered to be mediated by bradykinin, as the patient had already had two similar episodes and was on regular medication (enalapril). The evolution was satisfactory., Conclusion: Angioedema is a potentially fatal condition when it affects the airway, and should be recognized by anesthesiologists and physicians working in the emergency departments., (Copyright © 2019 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)