RESUMO
A multitargeted strategy to treat the consequences of ischemia and reperfusion (IR) injury in acute myocardial infarction may add cardioprotection beyond reperfusion therapy alone. We investigated the cardioprotective effect of mild hypothermia combined with local ischemic preconditioning (IPC) or remote ischemic conditioning (RIC) on IR injury in isolated rat hearts. Moreover, we aimed to define the optimum timing of initiating hypothermia and evaluate underlying cardioprotective mechanisms. Compared to infarct size in normothermic controls (56 ± 4%), mild hypothermia during the entire or final 20 min of the ischemic period reduced infarct size (34 ± 2%, p < 0.01; 35 ± 5%, p < 0.01, respectively), while no reduction was seen when hypothermia was initiated at reperfusion (51 ± 4%, p = 0.90). In all groups with effect of mild hypothermia, IPC further reduced infarct size. In contrast, we found no additive effect on infarct size between hypothermic controls (20 ± 3%) and the combination of mild hypothermia and RIC (33 ± 4%, p = 0.09). Differences in temporal lactate dehydrogenase release patterns suggested an anti-ischemic effect by mild hypothermia, while IPC and RIC preferentially targeted reperfusion injury. In conclusion, additive underlying mechanisms seem to provide an additive effect of mild hypothermia and IPC, whereas the more clinically applicable RIC does not add cardioprotection beyond mild hypothermia.
Assuntos
Hipotermia Induzida , Precondicionamento Isquêmico Miocárdico , Doença Aguda , Animais , Terapia Combinada , Infarto do Miocárdio/terapia , RatosRESUMO
Augmented mortality and morbidity following an acute myocardial infarction in patients with diabetes mellitus Type 2 (T2DM) may be caused by increased sensitivity to ischemia reperfusion (IR) injury or altered activation of endogenous cardioprotective pathways modified by T2DM per se or ischemic preconditioning (IPC). We aimed to investigate, whether the duration of T2DM influences sensitivity against IR injury and the efficacy of IPC, and how myocardial glucose oxidation rate was involved. Male Zucker diabetic fatty rats (homozygote (fa/fa)) at ages 6-(prediabetic), 12- (onset diabetes) and 24-weeks of age (late diabetes) and their age-matched non-diabetic controls (heterozygote (fa/+) were subjected to IR injury in the Langendorff model and randomised to IPC stimulus or control. T2DM rats were endogenously protected at onset of diabetes, as infarct size was lower in 12-weeks T2DM animals than in 6- (35±2% vs 53±4%; P = 0.006) and 24-weeks animals (35±2% vs 72±4%; P<0.0001). IPC reduced infarct size in all groups irrespective of the presence of T2DM and its duration (32±3%; 20±2%; 36±4% respectively; (ANOVA P<0.0001). Compared to prediabetic rats, myocardial glucose oxidation rates were reduced during stabilisation and early reperfusion at onset of T2DM, but these animals retained the ability to increase oxidation rate in late reperfusion. Late diabetic rats had low glucose oxidation rates throughout stabilisation and reperfusion. Despite inherent differences in sensitivity to IR injury, the cardioprotective effect of IPC was preserved in our animal model of pre-, early and late stage T2DM and associated with adaptations to myocardial glucose oxidation capacity.
Assuntos
Diabetes Mellitus Experimental/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Precondicionamento Isquêmico Miocárdico , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Animais , Progressão da Doença , Glucose/metabolismo , Hemodinâmica , Preparação de Coração Isolado , Masculino , Traumatismo por Reperfusão Miocárdica/patologia , Miocárdio/metabolismo , Miocárdio/patologia , Oxirredução , Distribuição Aleatória , Ratos Zucker , Fatores de TempoRESUMO
Warfarin has a narrow therapeutic window and side effects include bleeding causing e.g. hospital admission and death. Monitoring of treatment and review of indication are mandatory. We report a case of more than four years of warfarin treatment without indication. Treatment was not discontinued due to inadequate medical record keeping and communication among health-care providers. Medical-record keeping should follow guidelines from the National Board of Health. In addition, clearly stated treatment duration and indication may prevent unwarranted or premature termination of treatment.
Assuntos
Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Transferência da Responsabilidade pelo Paciente/normas , Varfarina/administração & dosagem , Varfarina/efeitos adversos , Idoso , Hematoma/induzido quimicamente , Humanos , Masculino , Prontuários Médicos/normas , Erros de Medicação , Fatores de TempoRESUMO
Slipped capital femoral epiphysis (SCFE) is a relatively rare growth disturbance in the proximal femoral growth plate. It results in posterior displacement of the femoral head. Symptoms are an intermittent hip, knee or groin pain, which is exacerbated by sports, giving restricted hip motion, and sometimes a limping gait with out-toeing. SCFE is typically seen in overweight boys, but may also occur in normal-weight teenage girls. Early image diagnostic assessment of both hips is crucial, since slip severity and consequently the risk of disabling complications are strongly correlated to late diagnosis.