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Innovaciones en la compresión de los efectos de la isquemia fría en el injerto renal
Lledó García,E.; Berenguer García,I.; Rodríguez Martínez,D.; Pedemonte,G.; Hernández Fernández,C.; Ca?izo López,J.F. del;
Actas Urológicas Espa?olas , 2005, DOI: 10.4321/S0210-48062005000400010
Abstract: cold ischemia is the best known method to preserve kidneys for transplant. however, it produces several detrimental effects. first, cellular necrosis. secondarily, during the hypothermic period a mithocondrial injury process develops which makes the cell entering a pre-apoptotic state. this apoptosis occurs definitively in the reperfusion. preservation solutions currently available are not perfect and are not able to avoid cold-related cell injuries. the adition of certain substances to uw solution (desferrioxamine) has shown experimentally a reduction in mitochondrial cold-related lesions. isolated hypothermic kidney perfusion reduces initial graft dysfunction about 20% in comparison to hypothermic storage. this fact relates to important either economical as functional consequences.
Histopathological Effects of Ischemia - Reperfusion on Intestinal Anastomotic Wound Healing in Dogs Efectos Histopatológicos de Reperfusión Isquemia en la Anastomosis Intestinal de Heridas Curadas en Perros  [cached]
J. F Akinrinmade,A. O Olatunji-Akioye
International Journal of Morphology , 2007,
Abstract: The histopathological effects of three levels of ischemia-reperfusion (IR) on healing of intestinal anastomotic wound were investigated in dogs. Three groups of dogs in which superior mesenteric artery (SMA) and collaterals were isolated but not occluded (A -control), isolated and occluded immediately distal to the aorta with collateral interruption using an atraumatic arterial clip for fifteen minutes (B) and for forty-five minutes (C) prior to ileal resection and anastomosis after return of normal perfusión in occluded groups was done. Within each group, animals were anaesthesized on third and seventh post-operative day. Grossly, impaired abdominal wound healing, intra-abdominal adhesions and partial and complete anastomotic dehiscence occurred in groups B and C commensurate with intensity of ischemic injury. Histologically, light cellular infiltration with loose granulation tissue was observed in the control group with moderate neovascularization and epithehalization by the seventh day. With mild IR, moderate cellular infiltration was observed four days post operation, but heamorrhage and oedema persisted with minimal mucosal regeneration at seven days post operation. With profound IR, sloughing of the mucosa with cellular infiltration at four days with absence of mucosal regeneration and persistence of inflammatory cellular infiltrates minimal neovascularization and dense granulation tissue. Neutrophilia in the immediate post operative period appears significant to impaired healing due to ischemia-reperfusion Se estudiaron, en perros, los efectos histopatológicos de tres niveles de reperfusión isquemia en la curación de anastomosis intestinal. Fueron utilizados tres grupos de perros, en los cuales las colaterales de la arteria mesentérica superior fueron aisladas, pero no ocluidas (A- control), aisladas y ocluidas inmediatamente distal a la aorta con interrupción colateral usando un clip arterial no traumático, por 15 minutos (B) y por cuarenta y cinco minutos (C), previo a la resección ileal y la anastomosis después de retornar a la perfusión normal en los grupos ocluidos. Dentro de cada grupo, los animales fueron anestesiados al tercer y séptimo días postcirugía. En la cicatrización del da o abdominal se observaron adhesiones y dehiscencias parcial y completa en los grupos B y C, correspondiéndose con la intensidad del da o causado por la isquemia. Histológicamente, se observó en el grupo control, baja infiltración celular con tejido de granulación laxo, con moderada neovasculanzación y epitelización, desde el séptimo día. Con una suave IR, tambié
Effects of Ischemia/Reperfusion on Cells of Pancreas and Protective Effects of Melatonin Treatment Efectos de la Isquemia/Reperfusión sobre Células del Páncreas y Efectos Protectores del Tratamiento de Melatonina  [cached]
Ayse Yildirim,Mehmet Cudi Tuncer,?zlem Pamuk?u,Ayfer Aktas
International Journal of Morphology , 2009,
Abstract: Oxygen free radicals are considered to be important components involved in the pathophysiological tissue alterations observed during ischemia-reperfusion (I/R). In this study, we investigated the putative protective effects of melatonin treatment on pancreatic I/R injury. Sprague Dawley male rats were subjected to 30 min of pancreatic pedicle occlusion followed by 90 min reperfusion. Melatonin (10 mg/kg. s.c) was administrated 30 min prior to ischemia or I/R application. At the end of the reperfusion periods, rats were decapitated. Pancreatic samples were taken for transmission electron microscopy. The results indicated that ischemia created b cell damage as evidenced by dilatation between the nucleus inner and outer membrane and degeneration on islets of Langerhans cells, was reversed by melatonin treatment. As melatonin administration reversed these microscopic damage, it seems likely that melatonin protects pancreatic tissue against oxidative damage. Los radicales libres del oxígeno son considerados como uno de los componentes más importantes que participan en las alteraciones fisiopatológicas del tejido durante la isquemia-reperfusión (I/R). En este estudio, se investigó el supuesto efecto protector del tratamiento de melatonina sobre la lesión pancreática I/R. Ratas Sprague Dawley machos fueron sometidas a 30 minutos de oclusión del pedículo pancreático seguido de 90 minutos de reperfusión. La melatonina (10 mg/kg) fue administrada 30 minutos antes de la isquemia o de la aplicación I/R. Al finalizar los periodos de reperfusión, las ratas fueron decapitadas. Fueron tomadas muestras pancreáticas para el análisis en microscopía electrónica de transmisión. Los resultados indicaron que la isquemia ocasionó da o en las células demostrado por la dilatación entre el núcleo interior y la membrana exterior y la degeneración de los islotes de células pancreáticas, los que fueron revertidos por el tratamiento de melatonina. Como la administración de melatonina revirtió estos da os microscópicos, parece probable que ella proteja al tejido pancreático contra el da o oxidativo.
Diabetes mellitus, factor de riesgo de severidad de enfermedad isquémica crítica aterosclerótica y de viabilidad de miembros inferiores: a risk factor for severity of critical atherosclerotic ischemic disease and for lower limb viability Diabetes mellitus  [cached]
Octavio Martínez,Víctor Alfonso Castrillón
Acta Medica Colombiana , 2010,
Abstract: Objetivo: caracterizar la diabetes mellitus como factor de riesgo independiente para el grado de severidad de isquemia crítica de miembros inferiores y para la viabilidad de extremidades afectadas. Contexto y tipo de estudio: censo de base hospitalaria sobre el registro de pacientes sometidos a revascularización o amputación primaria mayor de miembros inferiores por isquemia crítica aterosclerótica, a partir del primero de enero de 2005 hasta el 30 de junio de 2009. Las unidades de análisis fueron los registros clínicos de todos los pacientes intervenidos que cumplieran con los criterios de ingreso al estudio. Material y métodos: descripciones univariada y bivariada dependiendo del tipo y distribución de las variables. Detección de variables confundidoras y con efectos de modificación de las medidas de asociación entre diabetes y severidad de isquemia crítica, y diabetes y tipo de intervención, mediante estratificación en el análisis. Resultados: ajustada la relación para el efecto confundidor positivo de la hipertensión arterial, la posibilidad de diabetes mellitus en los pacientes Fontaine IV fue 8.23 veces la de los pacientes Fontaine III (X2MH 1gl 13.18; valor p = 0.0003). Controlado el efecto confundidor positivo de la insuficiencia renal crónica, la posibilidad de diabetes mellitus en los pacientes Fontaine IV fue 7.99 veces la de los pacientes Fontaine III (X2MH 1gl 12.00; valor p = 0.0005). Al controlar por la severidad de la isquemia crítica de miembros inferiores, los pacientes con diabetes mellitus conllevan una posibilidad de amputación primaria mayor de 6.32 en relación con los pacientes no diabéticos (X2MH 1gl 8.455; valor p = 0.0036). Conclusión: la diabetes mellitus se se ala como un factor de riesgo independiente para el desarrollo del estado más severo de isquemia crítica de miembros inferiores, Fontaine IV, tras ajustar para hipertensión arterial e insuficiencia renal crónica. Igualmente, la diabetes se constituyó en factor de riesgo independiente para la viabilidad de la extremidad con isquemia crítica (Acta Med Colomb 2010; 35: 40-47). Objective: to characterize diabetes mellitus as an independent risk factor for the severity of critical lower limb ischemia and for viability of affected limbs. Context and type of study: Hospital based census on registers of all surgical patients for revascularization or major amputation by atherosclerotic critical ischemia or lower limbs from 1st January, 2005 until 30th June, 2009. Units of analysis were clinical records of patients who met the study's admission criteria. Material and methods: univa
Cardioprotective Effects of Exogenous and Endogenous Hydrocortisone in the Rabbit Model of Ischemia-Reperfusion Efectos Cardioprotectores de la Hidrocortisona Exógena y Endógena en el Modelo Isquemia-Reperfusión de Conejo
Ali Davarian,Vahid Khori,Mohsen Nayebpour
International Journal of Morphology , 2010,
Abstract: Reducing the infarct size in acute myocardial infarction is one of the most important goals driving new drug research and development. During the last two decades, many clinical studies have found cardioprotective effects of corticosteroids, but their exact role in ischemic preconditioning remains questionable. The aim of the present study was to determine the protective effects of hydrocortisone sodium succinate on myocardial preconditioning in rabbit hearts. Twenty-four male New Zealand rabbits were divided randomly & equally in four groups: 1) control, 2) Infarct, 3) Ischemic preconditioning (IP) and 4) Hydrocortisone (HYD). The HYD group received 50mg/kg Hydrocortisone 45min before major ischemia. Serum levels of cardiac troponin-T(cTNT) and cortisole were measured before and after the protocols. Triphenyl-tetrazolium chloride staining was used to determine the infarcted area. In the present study, exogenous hydrocortisone decreased infarct size by 53% in comparison to the infarct group. Serum level of cortisole was increased in the IP and HYD groups, and was significant in the HYD group (p<0.01). An increasing trend in cortisole level was associated with a decreasing trend in infarct size and cTNT in the IP and HYD groups (p>0.01). In conclusion, we showed that hydrocortisone has cardioprotective effects when injected before the onset of myocardial infarction. In addition, we have proposed for the first time that endogenous hydrocortisone may play a role in ischemic preconditioning phenomena. La reducción del tama o del infarto en el infarto agudo de miocardio es una de las metas más importantes que impulsan la investigación y el desarrollo de nuevos fármacos. Durante las dos últimas décadas, muchos estudios clínicos han encontrado efectos cardioprotectores de los corticosteroides, pero su papel exacto en el preacondicionamiento isquémico sigue siendo cuestionable. El objetivo del presente estudio fue determinar los efectos protectores de succinato sódico de hidrocortisona en el preacondicionamiento del miocardio en el corazón de conejo. Veinticuatro conejos neozelandeses machos fueron divididos al azar en cuatro grupos : 1) control, 2) infarto, 3) preacondicionamiento isquémico (PI) y 4) Hidrocortisona (HYD). El grupo HYD recibió 50 mg/kg de hidrocortisona 45 minutos antes de la isquemia mayor. Los niveles séricos de troponina cardíaca T (cTNT) y cortisol se midieron antes y después de los protocolos. Se utilizó la tinción cloruro de trifenil-tetrazolio para determinar el área infartada. En el presente estudio, la hidrocortisona exógena disminuyóe
Estudio de la carga energética celular en el trasplante renal experimental con diferentes periodos de isquemia caliente (0-30-45 y 90?)
álvarez-Vijande,R.; Luque Gálvez,P.; Alcaraz Asensio,A.; ,;
Actas Urológicas Espa?olas , 2008, DOI: 10.4321/S0210-48062008000100005
Abstract: introduction and goals: renal procurement after a period of heart stop demands a previous knowledge of ischemia-reperfusion injuries means. to study cell injury mechanisms an experimental study has been designed in pigs, with different rangres of warm ischemia (0-30-45 and 90 min). the main goal was to research on the basis of ischemic injury. material and methods: biochemical parameters (creatinine, urine output), energetic loading (atp, adp, amp and global energetic loading) and pathological studies as long as survival analysis by 5th day were completed. results: animal survival and graft viability range from 100% at 5th day in control and 30 min warm ischemia groups to 60% in 90 min warm ischemia group. creatinine levels rises at 1st, 3rd and 5th day, especially in those non-viable organs. atp levels decrease after warm ischemia period, increases adp and amp levels after reperfusion in those viable organs. conclusions. prolonged periods of warm ischemia do not result necessarily in non-viable kidneys. viable organs recover nucleotide levels early. study of energetic cell loading levels is a good way to get on better in the knowledge of injury mechanisms after ischemiareperfusion.
Efectos de la introducción progresiva de los inhibidores de la calcineurina en la función renal de una cohorte de pacientes que recibieron trasplante de hígado Effects of progressive introduction of calcineurin inhibitors on the renal function of a cohort of liver transplant recipients
Yeinis Paola Espinoza,Juan Carlos Restrepo,John Jairo Zuleta,Juan Ignacio Marín
Acta Medica Colombiana , 2011,
Abstract: Introducción: la enfermedad renal aguda (ERA) se presenta en el postrasplante de hígado con una incidencia que varía de 12-64%, con una mortalidad intrahospitalaria asociada de 40-67%. Este estudio utiliza los criterios RIFLE para analizar el efecto del esquema inmunosupresor con inhibidores de la calcineurina en la aparición de ERA en los primeros quince días postrasplante de hígado. También evalúa el protocolo de introducción tardía y progresiva de los medicamentos inhibidores de la calcineurina (CNi) como estrategia para disminuir la incidencia de ERA postrasplante. Métodos: estudio analítico de cohortes de 163 pacientes con trasplante de hígado. Resultados: ciento sesenta y tres pacientes cumplieron con los criterios de inclusión del estudio con un promedio de edad de 51 (46-56) a os. De éstos, sólo 11 (6.74%) presentaron ERA postrasplante. Ciclosporina fue administrada a 126 (77.3%) de los pacientes trasplantados y tacrolimus a 21 (12.88%). Inmediatamente después del trasplante los pacientes fueron clasificados en dos grupos: pacientes con riesgo alto de desarrollar ERA y pacientes sin problemas renales. A los primeros se les inició el CNi a partir del tercer día postrasplante y a los últimos entre seis y 18 horas después del trasplante, a una dosis que se aumentó gradualmente Conclusiones: la introducción tardía y progresiva de los CNi podría ser una estrategia efectiva para disminuir la incidencia de ERA en el postrasplante de hígado (Acta Med Colomb 2011; 36: 130-134). Background: acute renal disease (ARD) occurs in liver transplantation with an incidence ranging from 12 to 64%, with an associated hospital mortality of 40 to 67%.This study used the RIFLE criteria to analyze the effect of an immunosuppressive regime including calcineurin inhibitors (CNi) in the development of ARD in patients with liver transplantation. It also assesses the protocol and progressive late introduction of CNi as a strategy to reduce the incidence of posttransplant ARD Methods: cohort analytic study of 163 patients with liver transplantation Results: 163 patients met the study inclusion criteria with an average age of 51 (46-56) years. Of these patients, only 11 (6.74%) had ARD transplantation. Cyclosporine was administered to 126 (77.3%) of tacrolimus in transplant patients and 21 (12.88%). Immediately after the transplant, patients were classified into two groups: patients with high risk of developing ERA and patients without kidney problems. At first they were introduced to the CNi from the third day after transplantation and the last six to 18 hours after the tran
Utilidad de las citocinas como marcadores de agresión quirúrgica, en el Síndrome de Isquemia-Reperfusión y en la función postrasplante renal, en un modelo experimental de autotraplante renal laparoscópico versus abierto
Linares Quevedo,Ana Isabel; Burgos Revilla,Francisco Javier; Villafruela Sanz,Juan José; Zamora Romero,Javier; Pascual Santos,Julio; Marcén Letosa,Roberto; Cuevas Sánchez,Bego?a; Sáenz Medina,Javier; Correa Gorospe,Carlos;
Archivos Espa?oles de Urología (Ed. impresa) , 2008, DOI: 10.4321/S0004-06142008000100006
Abstract: objectives: to analyze the modifications induced by laparoscopic and open nephrectomies in living donor transplantation on cytokines, to evaluate operative trauma of different surgical techniques and the influence on ischemia/reperfusion syndrome and renal function. methods: thirty pigs underwent left nephrectomy, 15 by laparoscopy and 15 by open approach in an experimental autotransplantation model. results: serum level of il-2, il-6, il-10 and tumor necrosis factor (tnf) were lower during laparoscopic than open nephrectomy: 6,8±0,6 vs 13,9±1,1 pg/ml for il-2, 46,2±2,3 vs 84,4±2,5 pg/ml for il-6, 26,1±2,4 vs 92,8 ± 12,6 pg/ml for il-10, and 17,6 ± 2,1 vs 38,5±4,8 pg/ml for tnf. there was no association between renal blood flow (rbf) and cytokines levels during nephrectomy: il-2 (p= 0,498), il-6 (p=0,117), il-10 (p=0,081) y tnf (p=0,644). however, there was correlation between il-10 and the decrease of rbf after transplantation: (r2 0,48; p= 0,02). initial serum creatinine levels were correlated with rbf and il-2 levels during nephrectomy (r=0,831, r2= 0,691, p= 0,025), and postransplantation rbf (r= 0,784, r2= 0,614, p<0,0001). seventh day creatinine levels were correlated with postransplantation rbf (r= 0,537, r2= 0,289, p= 0,002) and il-2 levels during nephrectomy (r=0,685, r2= 0,469, p= 0,015). conclusions: cytokine levels were higher during the open approach than laparoscopic procedure. high levels of rbf during nephrectomy and transplantation improve early graft function while low levels of rbf and high levels ol il-2 during nephrectomy induce delayed graft function.
Efectos de la introducción progresiva de los inhibidores de la calcineurina en la función renal de una cohorte de pacientes que recibieron trasplante de hígado
Espinoza,Yeinis Paola; Restrepo,Juan Carlos; Zuleta,John Jairo; Marín,Juan Ignacio; Mu?oz,Octavio Germán; Hoyos,Sergio Iván; Guzmán,Carlos; Mena,álvaro; Correa,Gonzalo;
Acta Medica Colombiana , 2011,
Abstract: background: acute renal disease (ard) occurs in liver transplantation with an incidence ranging from 12 to 64%, with an associated hospital mortality of 40 to 67%.this study used the rifle criteria to analyze the effect of an immunosuppressive regime including calcineurin inhibitors (cni) in the development of ard in patients with liver transplantation. it also assesses the protocol and progressive late introduction of cni as a strategy to reduce the incidence of posttransplant ard methods: cohort analytic study of 163 patients with liver transplantation results: 163 patients met the study inclusion criteria with an average age of 51 (46-56) years. of these patients, only 11 (6.74%) had ard transplantation. cyclosporine was administered to 126 (77.3%) of tacrolimus in transplant patients and 21 (12.88%). immediately after the transplant, patients were classified into two groups: patients with high risk of developing era and patients without kidney problems. at first they were introduced to the cni from the third day after transplantation and the last six to 18 hours after the transplant, a dose that was gradually increased conclusions: late and gradual introduction of cni could be an effective strategy to reduce the incidence of acute renal disease in liver transplantation (acta med colomb 2011; 36: 130-134).
Isquemia renal aguda: causa rara de lumbalgia
Xambre,L.; Cerqueira,M.; Silva,V.; Almeida,M.; Prisco,R.; Carreira,F.; Paiva,A.;
Actas Urológicas Espa?olas , 2005, DOI: 10.4321/S0210-48062005000300016
Abstract: acute renal artery occlusion is rarely found in daily clinical practice. its rarity and inespecific clinical presentation are responsible for late diagnosis or diagnostic errors, with symptoms frequently being erroneously attributed to other more common entities. there is no consensus in what concerns therapeutic options. multiple treatment modalities are described in the available literature. some defend anticoagulant therapy and support measures only while others recommend other more invasive alternatives reaching even open surgery. the authors present two additional case reports of acute embolic renal ischemia. a thorough literature review is also presented comprehending etiological, clinic, diagnostic and therapeutic aspects.
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