Subject(s)
Appendicitis/complications , Ileal Diseases/complications , Intestinal Obstruction/complications , Ischemia/complications , Meckel Diverticulum/complications , Abdominal Pain/etiology , Acute Disease , Adult , Appendicitis/surgery , Diagnosis, Differential , Humans , Ileal Diseases/surgery , Intestinal Obstruction/surgery , Ischemia/surgery , Male , Meckel Diverticulum/surgeryABSTRACT
BACKGROUND: Antagonists of platelet-activating factor (PAF) reduce myocardial postischemia reperfusion injury when given before the onset of ischemia. However, the effects of PAF antagonists when administered at a clinically modelled time (during ischemia but before reperfusion) are controversial. Moreover, the extended survival (eight day) and the characteristics of scar formation after treatment with PAF antagonists have not been investigated. OBJECTIVES: To determine the therapeutic potential of PAF antagonist TCV-309 for the treatment of regional myocardial ischemia-reperfusion injury; and to determine the effects of TCV-309 on cardiovascular recovery, evolution of scar formation and survival eight days after a myocardial infarction treated with reperfusion. ANIMALS AND METHODS: Swine underwent regional myocardial ischemia for 60 mins by ligation of the left anterior descending coronary artery, followed by reperfusion for eight days. The treated group (n=7) received PAF antagonist TCV-309 (0.1 mg/kg) 45 mins after ligation; the untreated group (n=7) received vehicle only. RESULTS: Untreated animals experienced significantly (P<0.001) lower systemic arterial blood pressure during the reperfusion period than animals treated with TCV-309. Furthermore, untreated animals required significantly more (P<0.01) antiarrhythmic and inotropic support. Only two of seven animals in the untreated group survived, which was significantly different (P<0.05) from the six of seven treated animals that survived for eight days. Morphometric analyses did not show differences between groups in the characteristics of scar formation following reperfusion for eight days. CONCLUSIONS: PAF antagonist TCV-309 improves survival and reduces cardiovascular dysfunctions associated with regional myocardial ischemia reperfusion injury when administered at a clinically modelled time.
Subject(s)
Isoquinolines/therapeutic use , Myocardial Infarction/drug therapy , Myocardial Reperfusion Injury/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Pyridinium Compounds/therapeutic use , Tetrahydroisoquinolines , Animals , Female , Myocardial Infarction/mortality , Myocardial Reperfusion , Myocardial Reperfusion Injury/mortality , Random Allocation , Swine , Time FactorsABSTRACT
A fragile 72-year-old female with previous coronary artery disease sustained blunt abdominal trauma in a motor vehicle crash. A ruptured duodenum was identified by computed tomography scanning. Exploratory laparotomy revealed that the duodenal rupture was caused by perforation of a diverticulum in the second portion of the duodenum. The surgical management of the injury to the duodenum is described in detail.
