Effects of isoflurane postconditioning on chronic phase of ischemia-reperfusion heart injury in rats.

INTRODUCTION: The application of isoflurane in a postconditioning manner, during early reperfusion of ischemic myocardium, reduces the infarct size. Its favorable effect on highly vascularized granulation tissue formation is very important considering the fact that increased genesis of blood vessels in peri-infarct zone reduces the infarct size and improves cardiac function. Taking into consideration the influence of isoflurane on the subacute phase of infarct healing, by using different immunohistochemical markers, we wanted to explore whether isoflurane postconditioning influences the chronic phase of healing. METHODS: The size of infarcted region was measured, and comparisons between isoflurane-treated and control animals were made. Quality of infarcted area was assessed by detecting vascular endothelial growth factor (VEGF), platelet/endothelial cell adhesion molecule-1 (PECAM-1/CD31) as a marker of angiogenesis, and nestin as a marker of immature progenitor cells, and de novo formed blood vessels (vasculogenesis). RESULTS: There was no difference between the control and isoflurane-treated groups in VEGF and PECAM-1/CD31 expression. However, a large reduction in infarct size was found (68.1% of control). Also, a marked decrease of nestin expression in immature progenitor cells, along with a marked increase of the same marker in cardiomyocytes, (signs of myocardium regeneration), was found in experimental animals when compared to control animals that did not receive isoflurane treatment. CONCLUSIONS: Based on our results, we can emphasize two morphologically detectable benefits of isoflurane postconditioning: a marked reduction in infarct size along with a more mature-looking infarct area in the chronic phase of infarct healing.

Ovarian torsion in adolescent with chronic immune thrombocytopenia.

Ovarian torsions in adolescence are rarity, particularly bilateral, with mostly unknown etiology. Enlargement of the ovary contributes to torsion. Young girl presenting with abdominal pains, nausea and vomiting was for two days suspected and observed as gastroenteritis. By exclusion of gastroenteritis she was admitted for gynecological work-up. Ultrasound showed significantly enlarged right ovary, with tumor-like appearance. At the laparotomy, gynecologist found torsioned, necrotic ovary and ovariectomy was performed. Histology showed massive stromal bleeding (haemorrhage). Asymptomatic enlargement of remaining ovary occurred nine months after the ovariectomy. This enlargement was accompanied with platelets' fall and the possibility of repeated torsion impended. Thrombocytopenia was suspected from the first moment, but diagnosed after the surgery. Thrombocytopenia in adolescence requires additional attention as possible cause of intra-ovarian bleeding with consecutive enlargement and may lead to torsion. Oral contraceptives regulate dysfunctional bleeding, decrease ovarian volume and by so, may minimize risk of torsion. This strategy proved effective in the case we present.

Isoflurane post-conditioning stimulates the proliferative phase of myocardial recovery in an ischemia-reperfusion model of heart injury in rats.

The application of isoflurane in a post-conditioning manner, during early reperfusion following a period of coronary occlusion, has numerous beneficial effects on the ischemic myocardium, including reduction of infarct size. It does so by stimulating a sequence of well studied anti-apoptotic pro-survival mechanisms in a similar manner to various 'ischemic' pre-/post-conditioning approaches which achieve their cardio protective effects in both laboratory and clinical situations. Proliferation of newly formed blood vessels, resulting in formation of highly vascularized granulation tissue, is an essential stage of infarct healing. It can be evaluated by detecting various angiogenic factors, including vascular endothelial growth factor (VEGF) and platelet endothelial cell adhesion molecule-1 (PECAM-1/CD31) or by quantification of expression of vascular smooth muscle progenitors, such as Nestin. Expression of these three markers was used to evaluate the effect of early isoflurane post-conditioning in ischemia-reperfusion type cardiac injury. A large reduction in infarct size (59.3% of control), and marked increase of expression of VEGF (43.4%), PECAM-1/CD31 (136%) and Nestin (77.9%) was found in experimental animals when compared to control animals that did not receive isoflurane treatment. Hence, based on our results, we can emphasize two morphologically detectable benefits of isoflurane post-conditioning: a marked reduction in infarct size and much better organization/vascularization of necrotic tissue.