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1.
Int Heart J ; 61(3): 595-600, 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32418958

RESUMO

Cold ischemic injury in heart storage is an important issue pertaining to heart transplantation. This study aims to evaluate the addition of compound glycyrrhizin (CG) in histidine-tryptophan-ketoglutarate (HTK) solution on chronic isograft injury in comparison to traditional HTK solution.Hearts of mouse were stored for 8 h in 4°C cold preservation solution and then transplanted heterotopically into mouse. Five groups were evaluated: HTK, low dose of CG solution (LCG), medium dose of CG solution (MCG), high dose of CG solution (HCG), and hearts without cold ischemia (sham). Survival was assessed. Time to restoration of heartbeat and strength of the heartbeat was measured. Lactate dehydrogenase (LDH) and creatine kinase (CK) levels in the preservation solution were determined. The myocardial damage and interstitial fibrosis of transplanted hearts were evaluated. TGF-ß1 expression in the transplanted hearts was assessed.Addition of CG to HTK solution significantly attenuated cold ischemic injury during cold storage, as evidenced by the lower time to restoration of heartbeat, higher strength of the heartbeat, lower LDH, and CK leakage. After transplantation, hearts stored in HTK solution containing CG had decreased the myocardial damage and interstitial fibrosis, compared with those stored without CG. The percentage of TGF-ß1-positive cells and TGF-ß1 level in the transplanted hearts were also decreased when stored in CG-containing HTK solution.The addition of CG to HTK solution attenuates cold ischemic injury during cold storage.


Assuntos
Anti-Inflamatórios/uso terapêutico , Isquemia Fria/efeitos adversos , Ácido Glicirrízico/uso terapêutico , Transplante de Coração , Isquemia Miocárdica/tratamento farmacológico , Animais , Avaliação Pré-Clínica de Medicamentos , Glucose , Masculino , Manitol , Camundongos Endogâmicos C57BL , Isquemia Miocárdica/etiologia , Cloreto de Potássio , Procaína
2.
Circ Heart Fail ; 13(4): e006409, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32264717

RESUMO

BACKGROUND: Ischemic tolerance of donor hearts has a major impact on the efficiency in utilization and clinical outcomes. Molecular events during storage may influence the severity of ischemic injury. METHODS: RNA sequencing was used to study the transcriptional profile of the human left ventricle (LV, n=4) and right ventricle (RV, n=4) after 0, 4, and 8 hours of cold storage in histidine-tryptophan-ketoglutarate preservation solution. Gene set enrichment analysis and gene ontology analysis was used to examine transcriptomic changes with cold storage. Terminal deoxynucleotidyl transferase 2´-Deoxyuridine, 5´-Triphosphate nick end labeling and p65 staining was used to examine for cell death and NFκB activation, respectively. RESULTS: The LV showed activation of genes related to inflammation and allograft rejection but downregulation of oxidative phosphorylation and fatty acid metabolism pathway genes. In contrast, inflammation-related genes were down-regulated in the RV and while oxidative phosphorylation genes were activated. These transcriptomic changes were most significant at the 8 hours with much lower differences observed between 0 and 4 hours. RNA velocity estimates corroborated the finding that immune-related genes were activated in the LV but not in the RV during storage. With increasing preservation duration, the LV showed an increase in nuclear translocation of NFκB (p65), whereas the RV showed increased cell death close to the endocardium especially at 8 hours. CONCLUSIONS: Our results demonstrated that the LV and RV of human donor hearts have distinct responses to cold ischemic storage. Transcriptomic changes related to inflammation, oxidative phosphorylation, and fatty acid metabolism pathways as well as cell death and NFκB activation were most pronounced after 8 hours of storage.


Assuntos
Temperatura Baixa/efeitos adversos , Transplante de Coração , Ventrículos do Coração/metabolismo , Preservação de Órgãos , Disfunção Primária do Enxerto/genética , Transcriptoma , Apoptose/efeitos dos fármacos , Apoptose/genética , Metabolismo Energético/efeitos dos fármacos , Metabolismo Energético/genética , Perfilação da Expressão Gênica , Glucose/farmacologia , Transplante de Coração/efeitos adversos , Ventrículos do Coração/efeitos dos fármacos , Ventrículos do Coração/patologia , Humanos , Inflamação/genética , Inflamação/patologia , Manitol/farmacologia , Preservação de Órgãos/efeitos adversos , Soluções para Preservação de Órgãos/farmacologia , Cloreto de Potássio/farmacologia , Disfunção Primária do Enxerto/patologia , Disfunção Primária do Enxerto/prevenção & controle , Procaína/farmacologia , Fatores de Risco , Fatores de Tempo , Transcriptoma/efeitos dos fármacos
3.
J Cardiothorac Surg ; 15(1): 4, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915024

RESUMO

BACKGROUND: Because hearts in acute myocardial infarction are often prone to ischemia-reperfusion damage during cardiac surgery, we investigated the influence of intracellular crystalloid cardioplegia solution (CCP) and extracellular blood cardioplegia solution (BCP) on cardiac function, metabolism, and infarct size in a rat heart model of myocardial infarction. METHODS: Following euthanasia, the hearts of 50 rats were quickly excised, cannulated, and inserted into a blood-perfused isolated heart apparatus. A regional myocardial infarction was created in the infarction group (18 hearts) for 120 min; the control group (32 hearts) was not subjected to infarction. In each group, either Buckberg BCP or Bretschneider CCP was administered for an aortic clamping time of 90 min. Functional parameters were recorded during reperfusion: coronary blood flow, left ventricular developed pressure (LVDP) and contractility (dp/dt max). Infarct size was determined by planimetry. The results were compared between the groups using analysis of variance or parametric tests, as appropriate. RESULTS: Cardiac function after acute myocardial infarction, 90 min of cardioplegic arrest, and 90 min of reperfusion was better preserved with Buckberg BCP than with Bretschneider CCP relative to baseline (BL) values (LVDP 54 ± 11% vs. 9 ± 2.9% [p = 0.0062]; dp/dt max. 73 ± 11% vs. 23 ± 2.7% [p = 0.0001]), whereas coronary flow was similarly impaired (BCP 55 ± 15%, CCP 63 ± 17% [p = 0.99]). The infarct in BCP-treated hearts was smaller (25% of myocardium) and limited to the area of coronary artery ligation, whereas in CCP hearts the infarct was larger (48% of myocardium; p = 0.029) and myocardial necrosis was distributed unevenly to the left ventricular wall. CONCLUSIONS: In a rat model of acute myocardial infarction followed by cardioplegic arrest, application of BCP leads to better myocardial recovery than CCP.


Assuntos
Soluções Cardioplégicas/farmacologia , Soluções Cristaloides/farmacologia , Infarto do Miocárdio/cirurgia , Miocárdio/patologia , Compostos de Potássio/farmacologia , Animais , Circulação Coronária/efeitos dos fármacos , Glucose/farmacologia , Parada Cardíaca Induzida/métodos , Masculino , Manitol/farmacologia , Miocárdio/metabolismo , Necrose , Cloreto de Potássio/farmacologia , Procaína/farmacologia , Ratos , Função Ventricular Esquerda/efeitos dos fármacos
4.
Ann Thorac Surg ; 109(3): 763-770, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31470011

RESUMO

BACKGROUND: Various solutions are used for donor heart preservation. We examined the outcomes in our heart transplant population where histidine-tryptophan-ketoglutarate (HTK) solution has been used for heart preservation since 2004. METHODS: This was a retrospective review of the United Network for Organ Sharing (UNOS) database (2004-2016) comparing our heart transplant outcomes with other national centers. Propensity matching in a 1:3 ratio was performed to adjust for preoperative recipient variables. RESULTS: After propensity matching comparing UNOS outcomes (n = 1080) with our institutional data (n = 360), there was no difference in matched preoperative variables. Donor hearts were similar for donor age, sex, donor-to-recipient size ratio, LVEF, and ischemic time. Our HTK cohort had a larger proportion with donor cardiac arrest (26.3% vs 6.1%, P < .001) and longer cardiac arrest duration (22.1 ± 16.0 vs 17.2 ± 14.0 minutes, P = .052). Our primary graft dysfunction (PGD) rate requiring mechanical support was 4.2% (n = 1). Postoperative mechanical support use for PGD included extracorporeal membrane oxygenation in 9 (60.0%), intraaortic balloon pump in 4 (26.7%), right ventricular assist device in 3 (20%), and biventricular assist device in 3 (20%). Overall survival at our institution was similar to the national average (P = .649). Survival at 1, 5, and 10 years with HTK was 92.2%, 81.3%, and 70.8%, and for the UNOS population was 91.6%, 80.3%, and 62.0%, respectively. CONCLUSIONS: Use of HTK solution for donor hearts was associated with a low rate of severe PGD. Overall survival was not significantly different from other institutions using a variety of preservation solutions in the UNOS database during the same period. HTK solution is efficacious for preservation of donor hearts.


Assuntos
Transplante de Coração/métodos , Preservação de Órgãos/métodos , Disfunção Primária do Enxerto/prevenção & controle , Doadores de Tecidos , Feminino , Glucose/farmacologia , Sobrevivência de Enxerto , Humanos , Incidência , Masculino , Manitol/farmacologia , Michigan/epidemiologia , Pessoa de Meia-Idade , Soluções para Preservação de Órgãos/farmacologia , Cloreto de Potássio/farmacologia , Disfunção Primária do Enxerto/epidemiologia , Procaína/farmacologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo
5.
DNA Cell Biol ; 39(1): 37-49, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31750745

RESUMO

Cloning using somatic cell nuclear transfer (SCNT) has many potential applications such as in transgenic and genomic-edited animal production. Abnormal epigenetic reprogramming of somatic cell nuclei is probably the major cause of the low efficiency associated with SCNT. Strategies to alter DNA reprogramming in donor cell nuclei may help improve the cloning efficiency. In the present study, we aimed to characterize the effects of procaine and S-adenosyl-l-homocysteine (SAH) as demethylating agents during the cell culture of bovine skin fibroblasts. We characterized the effects of procaine and SAH on the expression of genes related to the epigenetic machinery, including the DNA methyltransferase 1 (DNMT1), DNA methyltransferase 3 alpha (DNMT3A), DNA methyltransferase 3 beta (DNMT3B), TET1, TET2, TET3, and OCT4 genes, and on DNA methylation levels of bovine skin fibroblasts. We found that DNA methylation levels of satellite I were reduced by SAH (p = 0.0495) and by the combination of SAH and procaine (p = 0.0479) compared with that in the control group. Global DNA methylation levels were lower in cells that were cultivated with both compounds than in control cells (procaine [p = 0.0116], SAH [p = 0.0408], and both [p = 0.0163]). Regarding gene expression, there was a decrease in the DNMT1 transcript levels in cells cultivated with SAH (p = 0.0151) and SAH/procaine (0.0001); a decrease in the DNMT3A transcript levels in cells cultivated with SAH/procaine (p = 0.016); and finally, a decrease in the DNMT3B transcript levels in cells cultivated with procaine (p = 0.0007), SAH (p = 0.0060), and SAH/procaine (p = 0.0021) was found. Higher levels of TET3 transcripts in cells cultivated with procaine (p = 0.0291), SAH (p = 0.0373), and procaine/SAH (p = 0.0013) compared with the control were also found. Regarding the OCT4 gene, no differences were found. Our results showed that the use of procaine and SAH during bovine cell culture was able to alter the epigenetic profile of the cells. This approach may be a useful alternative strategy to improve the efficiency of reprogramming the somatic nuclei after fusion, which in turn will improve the SCNT efficiency.


Assuntos
Metilação de DNA/efeitos dos fármacos , Epigênese Genética/efeitos dos fármacos , Fibroblastos/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos dos fármacos , Procaína/farmacologia , S-Adenosil-Homocisteína/farmacologia , Animais , Bovinos , Células Cultivadas , DNA (Citosina-5-)-Metiltransferases/genética , Dioxigenases/genética , Fibroblastos/citologia , Fibroblastos/metabolismo , Fator 3 de Transcrição de Octâmero/genética , Proteínas Proto-Oncogênicas/genética , Pele/citologia
6.
J Endod ; 46(1): 74-80, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31843129

RESUMO

INTRODUCTION: Histidine-tryptophan-ketoglutarate (HTK) is a preservation solution used for organ transplantation. The physiological pH and osmolality of this solution are known to facilitate cell proliferation and cell membrane stabilization. The purpose of the present study was to investigate the efficacy of several concentrations of HTK solution as a storage medium for avulsed teeth. METHODS: Cultured human periodontal ligament cells were stored in different concentrations of HTK solutions. After 1, 3, 6, 12, 24, 48, and 72 hours, cell viability was assessed using the Cell-Counting Kit-8 (Dojindo Molecular Technologies, Kumamoto, Japan) and LIVE/DEAD (Invitrogen, Carlsbad, CA) assay. Cell response of the most effective concentrations of HTK solution were further analyzed by gene expression profiling, and their cell viability was compared with other storage media. RESULTS: The highest cell viability was observed in 50% HTK solution in various concentrations of HTK solution (P < .05). In periodontal ligament cells stored in 50% HTK solution for 3 hours, the expression of genes related to angiogenesis, the inflammatory response, and cell proliferation was increased compared with the control. Compared with other storage media, the highest cell viability was observed in 50% HTK solution. CONCLUSIONS: Our study suggests that 50% HTK solution containing cell culture medium represents a suitable storage medium for avulsed teeth.


Assuntos
Soluções para Preservação de Órgãos , Avulsão Dentária , Glucose , Glutationa , Humanos , Insulina , Manitol , Preservação de Órgãos , Cloreto de Potássio , Procaína
7.
Interact Cardiovasc Thorac Surg ; 30(1): 136-143, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31873745

RESUMO

OBJECTIVES: The optimal myocardial protective solution in the neonatal arterial switch operation remains controversial. The aim of this study was to demonstrate that Bretschneider's histidine-tryptophan-ketoglutarate crystalloid solution (Custodiol) offers protection at least similar to that of cold blood cardioplegia. METHODS: Patients who underwent the neonatal arterial switch operation with Custodiol between January 2016 and December 2018 (n = 23) were compared with an historical cohort from August 2010 to December 2015 in which cold blood cardioplegia was used (n = 41). A linear mixed-effect model for repeated measures was performed to test the recovery of myocardial function based on inotropic and vasoactive inotropic scores, cardiac enzyme release and left ventricular ejection fraction. RESULTS: Patients in the cold blood cardioplegia group had higher inotropic scores in the first 24 h (0 h, P = 0.001 and 24 h, P = 0.006) and higher vasoactive inotropic scores in the first 72 h (0 h, 24 h and 48 h, P < 0.001; 72 h, P = 0.012). Cardiac troponin-I concentrations were higher in the cold blood cardioplegia group at postoperative hours 1-72 (1 h, 6 h, 12 h and 24 h, P < 0.001; 48 h, P = 0.001 and 72 h, P = 0.003). Creatinine-kinase-MB concentrations were higher in the cold blood cardioplegia group at postoperative hours 1-24 (1 h, 6 h and 12 h, P < 0.001; 24 h, P = 0.042). The left ventricular ejection fraction was higher in the Custodiol group just after the operation (P = 0.005), at 24 h (P = 0.001) and on the first day without inotropic support (P = 0.011). CONCLUSIONS: Neonatal myocardium protected with Custodiol during the arterial switch operation presented optimal ventricular function recovery with less inotropic support and less myocardial damage compared with cold blood cardioplegia.


Assuntos
Transposição das Grandes Artérias/métodos , Parada Cardíaca Induzida/métodos , Miocárdio/metabolismo , Transposição dos Grandes Vasos/cirurgia , Soluções Cardioplégicas/farmacologia , Feminino , Glucose/farmacologia , Humanos , Recém-Nascido , Masculino , Manitol/farmacologia , Cloreto de Potássio/farmacologia , Procaína/farmacologia , Transposição dos Grandes Vasos/sangue , Troponina I/sangue , Função Ventricular Esquerda/efeitos dos fármacos
8.
Am J Vet Res ; 81(1): 13-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31887088

RESUMO

OBJECTIVE: To assess onset of analgesia for 3% chloroprocaine hydrochloride and 2% mepivacaine hydrochloride when used for median and ulnar nerve blocks in lame horses. ANIMALS: 6 naturally lame horses. PROCEDURES: A crossover experiment was conducted. Horses were assigned to 1 of 2 treatment groups (3% chloroprocaine or 2% mepivacaine first). Median and ulnar nerve blocks were performed in the lame limb with the assigned treatment. Lameness was objectively evaluated before treatment administration and at various points for 120 minutes after treatment with a wireless inertial sensor-based motion analysis system. Following a 7-day washout period, horses then received the other treatment and lameness evaluations were repeated. RESULTS: Median and ulnar nerve blocks performed with 3% chloroprocaine resulted in more consistent, rapid, and profound amelioration of lameness than did blocks performed with 2% mepivacaine. Lameness decreased more between 20 and 40 minutes after injection when 3% chloroprocaine was used than when 2% mepivacaine was used. Complete resolution of lameness was detected a mean of 9 minutes after injection when median and ulnar nerve blocks were performed with 3% chloroprocaine and a mean of 28 minutes after injection when performed with 2% mepivacaine. CONCLUSIONS AND CLINICAL RELEVANCE: 3% chloroprocaine had a more rapid onset and provided better analgesia for median and ulnar nerve blocks in horses with naturally occurring lameness, compared with 2% mepivacaine. These favorable properties suggest that 3% chloroprocaine would be useful for performance of median and ulnar regional nerve blocks during complicated lameness evaluations.


Assuntos
Marcha/efeitos dos fármacos , Doenças dos Cavalos/tratamento farmacológico , Coxeadura Animal/tratamento farmacológico , Bloqueio Nervoso/veterinária , Dor/veterinária , Procaína/análogos & derivados , Analgesia/veterinária , Anestésicos Locais/farmacologia , Anestésicos Locais/uso terapêutico , Animais , Estudos Cross-Over , Cavalos , Masculino , Mepivacaína/farmacologia , Mepivacaína/uso terapêutico , Dor/tratamento farmacológico , Procaína/farmacologia , Procaína/uso terapêutico
9.
Mediators Inflamm ; 2019: 5648051, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31885497

RESUMO

Background: Single-dose cardioplegia is preferred in minimal invasive mitral valve surgery to maintain the adjustment of the operative site without change of preset visualization. The aim of our study was to compare two widely used crystalloid cardioplegias Bretschneider (Custodiol®) versus St. Thomas 2 in patients who underwent mitral valve repair via small anterolateral right thoracotomy. Material and Methods: From May 2012 until February 2019, 184 isolated mitral valve procedures for mitral valve repair via anterolateral right thoracotomy were performed using Bretschneider (Custodiol®) cardioplegia (n = 123) or St. Thomas (n = 61). Primary efficacy endpoint was peak postoperative high-sensitivity cardiac troponin (hs-cTnT) during hospitalization. Secondary endpoints were peak creatine kinase-muscle brain type (CK-MB) and creatine kinase (CK) as well as safety outcomes. We used inverse probability of treatment weighting (IPTW) in order to adjust for confounding by indication. Results: Peak hs-cTnT was higher after use of Bretschneider (Custodiol®) (geometric mean 716 mg/L, 95% confidence interval (CI) 605-847 mg/L) vs. St. Thomas 2 (561 mg/L, CI 467-674 mg/L, p = 0.047). Peak CK-MB (geometric mean after Bretschneider (Custodiol®): 40 µg/L, CI 35-46, St. Thomas 2: 33 µg/L, CI 27-41, p = 0.295) and CK (geometric mean after Bretschneider (Custodiol®): 1370 U/L, CI 1222-1536, St. Thomas 2: 1152 U/L, CI 972-1366, p = 0.037) showed the same pattern. We did not see any difference with respect to postoperative complications between treatment groups after IPTW. Conclusion: Use of St. Thomas 2 cardioplegia was associated with lower postoperative peak levels of all cardiac markers that reflect cardiac ischemia such as hs-cTnT, CK, and CK-MB as compared to Bretschneider (Custodiol®) in propensity-weighted treatment groups.


Assuntos
Soluções Cardioplégicas/uso terapêutico , Valva Mitral/efeitos dos fármacos , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Soluções Cardioplégicas/efeitos adversos , Intervalos de Confiança , Feminino , Glucose/efeitos adversos , Glucose/uso terapêutico , Coração/efeitos dos fármacos , Humanos , Masculino , Manitol/efeitos adversos , Manitol/uso terapêutico , Pessoa de Meia-Idade , Valva Mitral/metabolismo , Valva Mitral/cirurgia , Isquemia Miocárdica/metabolismo , Isquemia Miocárdica/prevenção & controle , Miocárdio/metabolismo , Cloreto de Potássio/efeitos adversos , Cloreto de Potássio/uso terapêutico , Procaína/efeitos adversos , Procaína/uso terapêutico , Toracotomia/métodos
10.
J Card Surg ; 34(10): 969-975, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31332833

RESUMO

OBJECTIVES: Cold crystalloid cardioplegia for donor heart harvesting and cold ischemic storage conditions during the transportation is the standard of care during heart transplantation procedure. Organ care system (OCS) was introduced for more prolonged and reliable ex vivo organ management. This study evaluated the two different techniques used for myocardial preservation during the procurement and transportation of the heart using the OCS. METHODS: We performed prospective analysis of 43 patients with heart failure undergoing heart transplantation and using the OCS for donor organ transport. Donor hearts were arrested using blood cardioplegia and conditioning (n = 30) or standard Custodiol (SC) solution ( n = 13). Perfusion and cardiac function parameters were continuously monitored while the donor hearts were perfused in the OCS. Impact of preservation techniques on biochemical parameters and clinical outcomes were evaluated. RESULTS: All donor hearts had stable perfusion and lactate characteristics in the OCS, with similar measures between the two groups at the beginning of the ex vivo perfusion. Ex vivo heart perfusion mean ending concentration of Interleukin (IL)-6 and IL-8 was significantly lower in the blood cardioplegia group compared to the standard care group. Clinical outcomes were comparable between the two groups of patients. CONCLUSIONS: The use of blood cardioplegia and conditioning could be a safe method for myocardial protection in distant procurement and preservation of donor hearts in the OCS.


Assuntos
Parada Cardíaca Induzida/métodos , Insuficiência Cardíaca/cirurgia , Transplante de Coração/métodos , Preservação de Órgãos/métodos , Perfusão/métodos , Doadores de Tecidos , Adulto , Feminino , Seguimentos , Glucose/farmacologia , Humanos , Masculino , Manitol/farmacologia , Soluções para Preservação de Órgãos/farmacologia , Cloreto de Potássio/farmacologia , Procaína/farmacologia , Estudos Prospectivos
11.
Prog Urol ; 29(8-9): 402-407, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31266700

RESUMO

INTRODUCTION: Spinal anesthesia in outpatient urology is controversial (longer hospital stay, risk of urinary retention). The main goal was to evaluate outpatient spinal anesthesia and to compare 2 local anesthetics secondarily. MATERIAL: Monocentric retrospective study including all patients undergoing surgery in urological ambulatory surgery under spinal anesthesia between December 2011 and May 2015, split into two groups according to the local anesthetic used: bupivacaine (BP) and chloroprocaine (CP). Quantitative variables were compared by Student's t-test, qualitative variables by χ2 test. RESULTS: Seventy-one (95%) out of the 75 patients included have been discharged the same day. Discharge was impossible in these cases: patient alone at home (1), bladder clot (1), JJ intolerance (1), delayed micturition (1). The mean duration of the procedure was 27±19min, the SSPI's was 55±31min, the stay's was 360±91min. A total of 45 patients (60%) received BP and 30 (40%) received CP. The mean residence time in SSPI was significantly reduced in the CP group (47±24min vs. 61±34min, P=0.04). One patient experienced urination delay in the BP group with no significant difference. No significant difference for the other criteria studied despite the mean age, which is higher in the CP group (P=0.02). CONCLUSION: Spinal anesthesia is adapted to ambulatory urology, and does not increase the risk of urinary retention, especially with CP that would decrease the length of stay in SSPI compared to BP. LEVEL OF EVIDENCE: 4.


Assuntos
Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Procaína/análogos & derivados , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/métodos , Raquianestesia/efeitos adversos , Anestésicos Locais/efeitos adversos , Bupivacaína/efeitos adversos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procaína/administração & dosagem , Procaína/efeitos adversos , Estudos Retrospectivos , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia
12.
Braz J Cardiovasc Surg ; 34(3): 271-278, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310464

RESUMO

OBJECTIVE: The goal of the present study was to compare the myocardial protection obtained with histidine-tryptophan-ketoglutarate (HTK) cardioplegic solution (Custodiol®) and with intermittent hypothermic blood solution. METHODS: Two homogenous groups of 25 children with acyanotic congenital heart disease who underwent total correction with mean aortic clamping time of 60 minutes were evaluated in this randomized study. Troponin and creatine kinase-MB curves, vasoactive-inotropic score, and left ventricular function were obtained by echocardiogram in each group. The values were correlated and presented through graphs and tables after adequate statistical treatment. RESULTS: It was observed that values of all the studied variables varied over time, but there was no difference between the groups. CONCLUSION: We conclude that in patients with acyanotic congenital cardiopathies submitted to total surgical correction, mean aortic clamping time around one hour, and cardiopulmonary bypass with moderate hypothermia, the HTK crystalloid cardioplegic solution offers the same myocardial protection as the cold-blood hyperkalemic cardioplegic solution analyzed, according to the variables considered in our study model.


Assuntos
Soluções Cardioplégicas/uso terapêutico , Cardiopatias Congênitas/cirurgia , Análise de Variância , Creatina Quinase Forma MB/análise , Método Duplo-Cego , Ecocardiografia , Feminino , Glucose/uso terapêutico , Cardiopatias Congênitas/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Manitol/uso terapêutico , Duração da Cirurgia , Cloreto de Potássio/uso terapêutico , Procaína/uso terapêutico , Estudos Prospectivos , Substâncias Protetoras/uso terapêutico , Valores de Referência , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Troponina/análise , Função Ventricular Esquerda
13.
Pharmacology ; 104(3-4): 126-138, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31212291

RESUMO

The aim of the present study was to determine the protective effect of novel 1,3,5-triazine-procaine derivatives against myocardial ischemia/reperfusion (I/R) injury. Initially, the experiment has been started by the synthesis of procaine, which later got substituted with diverse 1,3,5-triazine derivatives to furnish the final compounds. The target compounds were tested for nuclear factor-κB (NF-κB) inhibitory activity in lipopolysaccharide (LPS)-stimulated RAW264.7 cells. The antioxidant activity of most potent compound 9i was investigated using hydroxyl radical, DPPH, and superoxide anion scavenging assay. Compound 9i was further evaluated for protective effect against myocardial I/R injury on the basis numerous parameters, for example, hemodynamic parameters (left ventricular developed pressure [LVDP], ±dp/dtmax, coronary flow [CF], and heart rate [HR]), myocardial enzymes (creatine kinase and lactate dehydrogenase), thiobarbituric acid reactive substance (TBARS), oxidative stress (super oxide dismutase [SOD], catalase [CAT], glutathione [GSH], and glutathione peroxidise [GPx]), histopathology, western blots analysis for B-cell lymphoma 2 (Bcl-2), Bcl-2-associated x protein (Bax), lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1), and NF-κB in cardiac tissues. Compounds showed significant inhibition of NF-ĸB transcriptional activity in LPS-stimulated RAW264.7 cells, revealing compound 9i as a most potent derivative. In vitro results showed efficient reduction of reduced hydroxyl radical, DPPH, and superoxide anion by 9i. The level LVDP, ±dp/dtmax, CF, HR, TBARS, SOD, CAT, GSH, GPx, and damaged cardiac histopathology were completely restored to normal in 9i-treated group, as compared to I/R group. In western blot analysis, the expression of Bax, LOX-1, and NF-ĸB was found to be decreased, while the level of Bcl-2 was found to be increased in 9i-treated group. The procaine-1,3,5-triazine derivatives showed significant cardioprotective action via inhibition of NF-ĸB.


Assuntos
Traumatismo por Reperfusão Miocárdica/tratamento farmacológico , Miócitos Cardíacos/efeitos dos fármacos , NF-kappa B/antagonistas & inibidores , Procaína/farmacologia , Substâncias Protetoras/farmacologia , Triazinas/farmacologia , Animais , Cardiotônicos/farmacologia , Catalase/metabolismo , Glutationa/metabolismo , Glutationa Peroxidase/metabolismo , Traumatismo por Reperfusão Miocárdica/metabolismo , Miocárdio/metabolismo , Miócitos Cardíacos/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Superóxido Dismutase/metabolismo
14.
Artigo em Alemão | MEDLINE | ID: mdl-31212342

RESUMO

OBJECTIVE: Comparison of the effectiveness of local anaesthesia (LA) in piglet castration with the combination of scrotal and inguinal application of procaine 2 % and lidocaine 5 % to the intratesticular application of lidocaine 1 % using following parameters: adrenaline (A), noradrenaline (NA), defensive movements and coordinated movement patterns. MATERIAL AND METHODS: In 2 substudies 232 male suckling piglets (3-6 days of age) were randomly allocated to study groups. In groups L5 and group P2 lidocaine 5 % and procaine 2 % was applied inguinally and scrotally, respectively, while piglets of groups H (handling) and K (castration without local anaesthesia) were only fixated as for an injection. In group L1 lidocaine 1 % was injected intratesticularly. After 30 min piglets were were castrated, whereas animals of group H were again only fixated. In substudy 1 (n = 112) blood samples were taken to determine the concentration of catecholamines after castration. During injection and castration defensive movements were judged. In substudy 2 (n = 120) piglets completed a chute to document the individual stress level. RESULTS: Groups H and L1 demonstrated significantly less defensive movements during fixation for injection/injection compared to the other study groups (p ≤ 0.05). After the injection piglets of group P2 had significantly more difficulties in the chute and needed > 50 % more time to complete the course. In all study groups defensive movements during castration were the highest at the moment of severing the spermal cord. Group K obtained the highest possible rating of 8 and differed significantly from the other groups as well as when cutting the skin (p ≤ 0.05). Both the concentration of A and NA significantly rose in all groups. The increase in A and NA was significantly higher in group 2, as well as the increase in NA in group K, both in comparison to the other study groups (p ≤ 0.05). CONCLUSION: None of the applied techniques for local anaesthesia achieved a complete elimination of pain during castration of suckling piglets. The behaviour analysis indicated an altogether higher distress for P2. After castration, this injection led to a neuroendocrine pain reaction that was comparable to or higher than that of group K. In both lidocaine groups (L1, L5) the pain reaction after castration tended to be lower. These results provide approaches to apply longer acting LA with a higher analgesic potency in an appropriate dosage and with an appropriate method of application.


Assuntos
Anestésicos Locais , Lidocaína , Orquiectomia , Dor , Procaína , Anestésicos Locais/administração & dosagem , Anestésicos Locais/farmacologia , Anestésicos Locais/uso terapêutico , Animais , Animais Lactentes , Comportamento Animal/efeitos dos fármacos , Catecolaminas/sangue , Injeções/efeitos adversos , Lidocaína/administração & dosagem , Lidocaína/farmacologia , Lidocaína/uso terapêutico , Masculino , Orquiectomia/efeitos adversos , Orquiectomia/veterinária , Dor/tratamento farmacológico , Dor/etiologia , Dor/veterinária , Procaína/administração & dosagem , Procaína/farmacologia , Procaína/uso terapêutico , Estresse Fisiológico/efeitos dos fármacos , Suínos
15.
Hernia ; 23(6): 1155-1161, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31172320

RESUMO

PURPOSE: Inguinal hernias are the most common type of abdominal wall hernias. Although surgery is the only effective treatment for these hernias in adults, several problems associated with surgical treatment have been reported. If the hernia exits from a weak point of the abdominal wall, it can obstruct the bowel, thereby causing serious complications, including intestinal obstruction or strangulation. Through this study, we aimed to analyze the optimal incarceration induction time taken to cause some degree of necrosis from which recovery would be possible in a rat incarcerated abdominal wall hernia model and to determine the efficacy of heparin for expedite recovery from intestinal incarceration. METHODS: A rat incarcerated abdominal wall hernia model was constructed, intestinal activity and the incarceration induction time were determined based on the color of the intestine and HE staining of intestinal sections. Heparin and procaine were sprayed onto intestinal surfaces, and their effects on the recovery from intestinal incarceration were evaluated. RESULTS: Recovery from intestinal incarceration would be better if the incarceration induction time was maintained below 2.5 h in our rat model, and heparin was found to be superior to procaine in the expedite recovery from intestinal incarceration, particularly immediately after relieving such intestines. CONCLUSIONS: The results of this study are significant for planning the treatment of incarcerated inguinal hernia. Further, heparin is superior to procaine in terms of expedite recovery from intestinal incarceration.


Assuntos
Fármacos Cardiovasculares/farmacologia , Heparina/farmacologia , Hérnia Abdominal/cirurgia , Obstrução Intestinal/cirurgia , Intestinos/efeitos dos fármacos , Procaína/farmacologia , Animais , Fármacos Cardiovasculares/administração & dosagem , Modelos Animais de Doenças , Heparina/administração & dosagem , Hérnia Abdominal/complicações , Obstrução Intestinal/etiologia , Intestinos/irrigação sanguínea , Intestinos/patologia , Intestinos/cirurgia , Masculino , Necrose/etiologia , Necrose/prevenção & controle , Procaína/administração & dosagem , Ratos , Ratos Sprague-Dawley , Recuperação de Função Fisiológica , Fatores de Tempo
16.
Acta Cir Bras ; 34(4): e201900402, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31038582

RESUMO

PURPOSE: To evaluate the effect of amniotic fluid in liver preservation in organ transplantation, and compare it with standard preservation solutions. METHODS: The groups consisted of Group 1: Ringer Lactate (RL) group, Group 2: HTK group, Group 3: UW group, Group 4: AF group. The livers of rats from Group 1, 2, 3, and 4 were perfused and placed into falcon tubes containing RL, HTK, UW, and AF solutions at +4 °C, respectively. The tubes were stored for 12 hours in the refrigerator at +4°C. Tissue samples were taken at the 6th and 12th hours for histopathological examinations of the perfused livers, and storage solutions for biochemical analyzes at 6th and 12th hours. RESULTS: AF was shown to maintain organ viability by reducing the number of cells undergoing apoptosis. Histopathological changes such as sinusoidal dilatation, hydropic degeneration, and focal necrosis were found to be similar to the groups in which the standard organ preservation solutions were used. Additionally, the results of INOS, IL-10, and TNF-α,which were evaluated immunohistochemically, have been shown to be similar to the UW and HTK groups. CONCLUSIONS: AF provided conservation similar to UW and HTK in the 12-hour liver SCS process. The fact that apoptosis values are comparable to standard preservation solutions supports the success of AF in the cold storage of the liver.


Assuntos
Líquido Amniótico , Criopreservação/métodos , Fígado , Soluções para Preservação de Órgãos/farmacologia , Animais , Glucose/farmacologia , Imuno-Histoquímica , Marcação In Situ das Extremidades Cortadas , Interleucina-10/análise , Fígado/irrigação sanguínea , Fígado/patologia , Masculino , Manitol/farmacologia , Óxido Nítrico Sintase Tipo II/análise , Preservação de Órgãos/métodos , Cloreto de Potássio/farmacologia , Procaína/farmacologia , Distribuição Aleatória , Ratos Wistar , Valores de Referência , Traumatismo por Reperfusão/prevenção & controle , Reprodutibilidade dos Testes , Solução de Ringer/farmacologia , Fatores de Tempo , Sobrevivência de Tecidos , Fator de Necrose Tumoral alfa/análise
17.
J Surg Res ; 242: 157-165, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31078900

RESUMO

BACKGROUND: Limited data exist that compare the predominant cardiac preservation solutions (CPSs). MATERIALS AND METHODS: The United Network for Organ Sharing database was retrospectively reviewed from January 1, 2004 to March 31, 2018, for donor hearts. Of 34,614 potential donors, 21,908 remained after applying the exclusion criteria. The CPS analyzed included saline, the University of Wisconsin (UW), cardioplegia, Celsior, and Custodiol. The primary endpoints were recipient survival and posttransplant rejection. Logistic and Cox models were used to quantify survival endpoints. RESULTS: Saline was used as the CPS in 2549 patients (12%), UW in 10,549 (48%), cardioplegia in 1307 (6%), Celsior in 5081 (23%), and Custodiol in 2422 (11%). Donor age ranged from 15 to 68 y (mean = 32.0 y, median = 30.0 y), and 71% were male. Adjusted survival probabilities of recipients whose donor hearts were procured with saline was 96% 30 d, 90% 1 y, UW: 97% 30 d, 92% 1 y, cardioplegia: 95% 30 d, 87% 1 y, Celsior: 96% 30 d, 90% 1 y, and Custodiol: 97% 30 d, 92% 1 y. When these comparisons were adjusted for donor age, sex, ethnicity, ischemic time, recipient age, sex, ethnicity, creatinine, ventricular assist device (VAD), length of stay, region and days on waiting list, cardioplegia solution was demonstrated to have a higher risk of death (30 d, 1 y, overall) and posttransplant rejection versus UW (odds ratio 1.70, P = 0.001; odds ratio 1.63, P < 0.001; hazard ratio 1.22, P < 0.001; hazard ratio 1.21, P < 0.001, respectively). CONCLUSIONS: Cardioplegia solutions for cardiac preservation are associated with a higher mortality in heart transplant recipients.


Assuntos
Soluções Cardioplégicas/efeitos adversos , Rejeição de Enxerto/epidemiologia , Insuficiência Cardíaca/cirurgia , Soluções para Preservação de Órgãos/efeitos adversos , Preservação de Órgãos/efeitos adversos , Adenosina/efeitos adversos , Adolescente , Adulto , Idoso , Aloenxertos/efeitos dos fármacos , Alopurinol/efeitos adversos , Dissacarídeos/efeitos adversos , Eletrólitos/efeitos adversos , Feminino , Seguimentos , Glucose/efeitos adversos , Glutamatos/efeitos adversos , Glutationa/efeitos adversos , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Coração/efeitos dos fármacos , Insuficiência Cardíaca/mortalidade , Transplante de Coração/efeitos adversos , Histidina/efeitos adversos , Humanos , Insulina/efeitos adversos , Masculino , Manitol/efeitos adversos , Pessoa de Meia-Idade , Preservação de Órgãos/métodos , Cloreto de Potássio/efeitos adversos , Procaína/efeitos adversos , Rafinose/efeitos adversos , Estudos Retrospectivos , Solução Salina/efeitos adversos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
18.
Complement Med Res ; 26(3): 206-209, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-30982038

RESUMO

Hintergrund: Wir berichten über eine 27-jährige Patientin, die nach operativem Magenhochzug bei Ösophagusatresie unter massiv einschränkenden Symptomen wie Sodbrennen, Erbrechen, Regurgitation, Übelkeit und Magenkrämpfen litt, trotz maximaler konservativer Therapie. Falldarstellung: Die Patientin erhielt im Rahmen einer Gastroskopie eine endoluminale Procaininfiltration in die narbige Anastomosenregion, woraufhin sich die klinische Symptomatik deutlich reduzierte und auch im Langzeitverlauf stabil vermindert blieb. Schlussfolgerung: Wir beschreiben die unseres Wissens nach erste endoluminale Infiltration von Procain in narbige Gewebsareale einer enteralen Anastomosenregion nach operativem Magenhochzug. BACKGROUND: We present a 27-year-old female who, despite maximum conservative therapy, suffered from severely restricting symptoms such as heartburn, vomiting, regurgitation, nausea and stomach spasms after a gastric pull-up because of an esophageal atresia. CASE REPORT: During a gastroscopy, an endoluminal injection of procaine in scar tissue in the area of the anastomosis was performed whereupon the symptoms diminished considerably and remained in this diminished state over a long course. CONCLUSION: We described the first successful endoluminal injection with procaine into scar tissue after enteral anastomosis because of an esophageal atresia.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Anestésicos Locais/administração & dosagem , Atresia Esofágica/cirurgia , Injeções , Procaína/administração & dosagem , Adulto , Cicatriz/tratamento farmacológico , Feminino , Gastroscopia , Humanos , Resultado do Tratamento
19.
MAGMA ; 32(4): 511-517, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30937576

RESUMO

OBJECTIVE: To estimate pancreas graft relaxation times and concentrations of total fat, and the intracellular lipids of non-adipose pancreatic cells (NAPC) using proton (1H) magnetic resonance spectroscopy (MRS) during cold preservation. MATERIALS AND METHODS: Grafts from 11 human donors were investigated. Each pancreas was perfused in situ with histidine-tryptophan-ketoglutarate (HTK) or with University of Wisconsin solution and placed into a transport container. Temperature of the grafts was maintained at 4 ± 2 °C during transport to our hospital and MR scanning. A 1.5 T clinical scanner was used for the measurements. Single-voxel PRESS spectra were acquired using transmit-receiver head coil. RESULTS: Relaxation times were measured for lipid (-CH2-)n (T1, 287 ± 60 ms; T2, 27 ± 4 ms), and tissue water (T1, 670 ± 69 ms; T2, 77 ± 17 ms). Average total fat, and intracellular lipids of NAPC concentrations were 79.2 ± 100.8 (range 2.4-304.4), and 2.9 ± 1.2 mmol/kg ww, respectively. CONCLUSION: We have shown that 1H-MRS is a useful tool for the estimation of pancreas graft lipid concentrations. Total pancreatic fat and especially content of intracellular lipids of NAPC are valuable measures for inspection of graft quality prior to transplantation or islet of Langerhans isolation.


Assuntos
Aloenxertos/diagnóstico por imagem , Preservação de Órgãos , Transplante de Pâncreas , Pâncreas/diagnóstico por imagem , Espectroscopia de Prótons por Ressonância Magnética , Adenosina , Adulto , Idoso , Alopurinol , Feminino , Glucose , Glutationa , Humanos , Insulina , Lipídeos , Masculino , Manitol , Pessoa de Meia-Idade , Soluções para Preservação de Órgãos , Cloreto de Potássio , Procaína , Rafinose , Temperatura
20.
Artigo em Alemão | MEDLINE | ID: mdl-30999349

RESUMO

OBJECTIVE: Comparison of the effectiveness of local anaesthesia (LA) in piglet castration by procaine 2 % and lidocaine 5 % both through combined inguinal and scrotal application as well as by intratesticular application of lidocaine 1 %. The parameters used were serum cortisol and chromogranin A (CgA) concentrations as well as wound healing, body weight and animal losses. MATERIAL AND METHODS: In 2 substudies, a total of 232 male piglets aged 3-6 days were included. Substudy 1 (112 piglets): Group H: fixation of piglets as for an injection; group L5: inguinal and scrotal injection of lidocaine 5 %; group P2: inguinal and scrotal injection of procaine 2 %; group L1: intratesticular injection of lidocaine 1 %. In all the groups, blood samples were taken 45 minutes before and 30 minutes post-injection (p. i.). Substudy 2 (120 piglets): Group H: handling only as for an injection and castration; group K: handling as for an injection and castration without LA after 30 minutes. Groups L5, P2 and L1: management as in substudy 1 and castration after 30 minutes. Blood samples were taken 75 minutes before as well as 30, 60 and 240 minutes post-castration (p. c.). The evaluated parameters were serum cortisol and CgA concentrations, wound healing, body weight and piglet losses. RESULTS: Substudy 1: The elevation of the cortisol and CgA concentrations in group P2 p. i. were significantly higher than in the other groups. The mean total cortisol concentration of group P2 p. i. was significantly higher than those of the other groups. Substudy 2: At 30 minutes p. c., all the groups displayed a significant increase in the cortisol concentration compared to group H. In group P2, the highest total cortisol concentration was measured 60 minutes p. c. and the elevation of the cortisol level was significantly higher than in the other groups. In group L1, a significantly greater increase in the CgA level was observed at 60 minutes p. c. when compared to the other groups. Regarding wound healing, body weight and losses, there were no significant differences between the groups. CONCLUSION: The combined inguinal and scrotal injection of procaine 2 % induced a greater neuroendocrine stress response than the inguinal and scrotal injection of lidocaine 5 % and the intratesticular injection of lidocaine 1 %. LA using procaine 2 %, lidocaine 5 % or lidocaine 1 % did not completely eliminate pain during castration. Castration under LA with procaine 2 % induced a greater pain reaction than castration without LA. Both groups castrated with LA using lidocaine (L1, L5) tended to display lower pain responses after castration than group K. On the basis of the findings of this study, other local anaesthetics that have a stronger effect could be further investigated according to their pain-killing effects in an appropriate application route.


Assuntos
Anestesia Local/veterinária , Anestésicos Locais/administração & dosagem , Cromogranina A/sangue , Hidrocortisona/sangue , Dor/veterinária , Doenças dos Suínos/etiologia , Anestesia Local/efeitos adversos , Anestesia Local/métodos , Animais , Animais Lactentes , Peso Corporal , Manobra Psicológica , Lidocaína/administração & dosagem , Masculino , Orquiectomia/efeitos adversos , Orquiectomia/métodos , Orquiectomia/veterinária , Dor/etiologia , Dor/fisiopatologia , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/veterinária , Procaína/administração & dosagem , Suínos , Doenças dos Suínos/fisiopatologia , Perda de Peso , Cicatrização
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