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1.
Am J Transplant ; 16(4): 1312-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26603283

RESUMO

We developed a protocol to procure lungs from uncontrolled donors after circulatory determination of death (NCT02061462). Subjects with cardiovascular collapse, treated on scene by a resuscitation team and transferred to the emergency room, are considered potential donors once declared dead. Exclusion criteria include unwitnessed collapse, no-flow period of >15 min and low flow >60 min. After death, lung preservation with recruitment maneuvers, continuous positive airway pressure, and protective mechanical ventilation is applied to the donor. After procurement, ex vivo lung perfusion (EVLP) is performed. From November 2014, 10 subjects were considered potential donors; one of these underwent the full process of procurement, EVLP, and transplantation. The donor was a 46-year-old male who died because of thoracic aortic dissection. Lungs were procured 4 h and 48 min after death, and deemed suitable for transplantation after EVLP. Lungs were then offered to a rapidly deteriorating recipient with cystic fibrosis (lung allocation score [LAS] 46) who consented to the transplant in this experimental setting. Six months after transplantation, the recipient is in good condition (forced expiratory volume in 1 s 85%) with no signs of rejection. This protocol allowed procurement of lungs from an uncontrolled donor after circulatory determination of death following an extended period of warm ischemia.


Assuntos
Fibrose Cística/cirurgia , Circulação Extracorpórea , Transplante de Pulmão , Perfusão/métodos , Alvéolos Pulmonares , Obtenção de Tecidos e Órgãos/métodos , Adulto , Idoso , Causas de Morte , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Respiração Artificial , Doadores de Tecidos
3.
Bioelectrochemistry ; 149: 108321, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36410189

RESUMO

Corrosion is an important issue for alloys in natural seawater, where microorganisms can accelerate or mitigate corrosion. Al-Mg alloys are used for marine activities and various associated technologies. Here, the behaviour of AA5083 alloy was investigated in natural seawater with marine exposure lasting up to 50 days and detailing the first 8 days in two experimental series. Experimental work was carried out, including semi-field tests in natural seawater (biotic conditions) compared with abiotic conditions. The open circuit potential (OCP) measurements, during the immersion time, exhibited significantly different behaviours: an OCP downward displacement occurred under abiotic conditions, while, in biotic conditions OCP remained generally stable since the beginning of the immersion, revealing an inhibiting effect of the biological activity on the Al-Mg corrosion. This was accompanied by different surface modifications under biotic conditions: surface and cross-section characterization, performed by scanning electron microscopy with energy dispersive X-ray spectroscopy, showed less corrosion developed on the surface after 8-day immersion and formation of a protective layer during 50-day immersion. The present study shows that marine biological activity positively influences the Al alloy corrosion process, with surface modifications resulting in a protective effect counteracting the aggressiveness of chloride ions.


Assuntos
Ligas , Magnésio , Ligas/química , Corrosão , Magnésio/química , Alumínio/química , Água do Mar
5.
Vet Rec ; 163(23): 679-82, 2008 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-19060316

RESUMO

Renal cortical biopsies from 74 dogs with different degrees of renal failure were studied by immunofluorescence to assess the frequency and extent of the deposition of immunoglobulins G, M and A (IgG, IgM, IgA) and complement C3. The dogs were divided into two groups on the basis of their clinical signs, and standard histological and electron microscopical examinations, according to whether their disease was an immune-mediated nephropathy (IMN) or a non-immune-mediated nephropathy (NIMN). In the dogs with an imn there was strong immunofluorescence due to IgG in the mesangium and the glomerular basement membrane and to IgM in the mesangium. The mechanism of immune complex trapping in the glomerulus also resulted in positive reactions to IgM in the dogs with an NIMN.


Assuntos
Complemento C3/análise , Doenças do Cão/imunologia , Imunofluorescência/veterinária , Imunoglobulinas/análise , Glomérulos Renais/imunologia , Insuficiência Renal/veterinária , Animais , Doenças do Cão/patologia , Cães , Feminino , Imunofluorescência/métodos , Mesângio Glomerular/imunologia , Imunoglobulina A/análise , Imunoglobulina G/análise , Imunoglobulina M/análise , Glomérulos Renais/ultraestrutura , Masculino , Microscopia Eletrônica/métodos , Microscopia Eletrônica/veterinária , Insuficiência Renal/imunologia , Insuficiência Renal/patologia
6.
J Clin Invest ; 99(5): 944-52, 1997 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-9062352

RESUMO

We examined the effect of ventilation strategy on lung inflammatory mediators in the presence and absence of a preexisting inflammatory stimulus. 55 Sprague-Dawley rats were randomized to either intravenous saline or lipopolysaccharide (LPS). After 50 min of spontaneous respiration, the lungs were excised and randomized to 2 h of ventilation with one of four strategies: (a) control (C), tidal volume (Vt) = 7 cc/kg, positive end expiratory pressure (PEEP) = 3 cm H2O; (b) moderate volume, high PEEP (MVHP), Vt = 15 cc/kg; PEEP = 10 cm H2O; (c) moderate volume, zero PEEP (MVZP), Vt = 15 cc/kg, PEEP = 0; or (d) high volume, zero PEEP (HVZP), Vt = 40 cc/kg, PEEP = 0. Ventilation with zero PEEP (MVZP, HVZP) resulted in significant reductions in lung compliance. Lung lavage levels of TNFalpha, IL-1beta, IL-6, IL-10, MIP-2, and IFNgamma were measured by ELISA. Zero PEEP in combination with high volume ventilation (HVZP) had a synergistic effect on cytokine levels (e.g., 56-fold increase of TNFalpha versus controls). Identical end inspiratory lung distention with PEEP (MVHP) resulted in only a three-fold increase in TNFalpha, whereas MVZP produced a six-fold increase in lavage TNFalpha. Northern blot analysis revealed a similar pattern (C, MVHP < MVZP < HVZP) for induction of c-fos mRNA. These data support the concept that mechanical ventilation can have a significant influence on the inflammatory/anti-inflammatory milieu of the lung, and thus may play a role in initiating or propagating a local, and possibly systemic inflammatory response.


Assuntos
Pulmão/imunologia , Pulmão/patologia , Respiração com Pressão Positiva/efeitos adversos , Animais , Northern Blotting , Líquido da Lavagem Broncoalveolar/química , Quimiocina CCL4 , Ensaio de Imunoadsorção Enzimática , Genes fos , Inflamação/imunologia , Interferon gama/análise , Interferon gama/imunologia , Interleucina-1/análise , Interleucina-1/imunologia , Interleucina-10/análise , Interleucina-10/imunologia , Interleucina-6/análise , Interleucina-6/imunologia , Lipopolissacarídeos/farmacologia , Complacência Pulmonar , Proteínas Inflamatórias de Macrófagos/análise , Proteínas Inflamatórias de Macrófagos/imunologia , Masculino , Respiração com Pressão Positiva/métodos , Proteínas/análise , RNA Mensageiro/análise , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/imunologia
7.
J Comp Pathol ; 136(4): 279-82, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17459407

RESUMO

A 2-year-old male West Highland white terrier with a 4-month history of seizures was referred for investigation. Depressed mentation, proprioceptive deficit and decreased menace response were noted at neurological examination. Post-mortem examination of the brain revealed multifocal lesions located principally in the left side of the diencephalon and mesencephalon. The lesions consisted of non-suppurative inflammation and large areas of cavitation. The clinical evaluation and histopathological findings were consistent with a diagnosis of necrotizing meningoencephalitis (NME). Immunofluorescence performed on frozen sections of kidney revealed strong smooth linear labelling of the glomerular basement membrane with anti-IgG serum as well as weaker linear labelling with anti-IgM serum. This histomorphological pattern was consistent with anti-glomerular basement membrane glomerulonephritis. The association of this type of glomerulonephritis with a necrotizing encephalitis would support the hypothesis of an immune-mediated aetiology for NME.


Assuntos
Doenças do Cão/patologia , Encefalite/complicações , Encefalite/veterinária , Glomerulonefrite/complicações , Glomerulonefrite/veterinária , Animais , Doenças Autoimunes/patologia , Doenças Autoimunes/veterinária , Doenças do Cão/imunologia , Cães , Encefalite/patologia , Imunofluorescência , Membrana Basal Glomerular/patologia , Glomerulonefrite/patologia
8.
Transplant Proc ; 48(2): 431-4, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27109971

RESUMO

INTRODUCTION: Uncontrolled donors after circulatory determination of death (uDCDD) represent a yet unexplored pool of organs potentially available for transplantation. The aims of this study were to validate a protocol of cardiac death in the pig and to investigate lung function during the process. MATERIALS AND METHODS: Cardiac death was induced in preanesthetized animals with an injection of 600 mg propofol; once systolic blood pressure was <50 mm Hg (Agonal Phase), a 20 mEq bolus of KCl was given and, after asystolia was documented, cardiopulmonary resuscitation (CPR) started, followed by 5 minutes no touch (end-CPR). Invasive blood pressure (BP) and heart rate (HR) were recorded; blood samples taken at baseline, 15 minutes after CPR, and after the no touch period (end-CPR). Computed tomography (CT) scans were taken at baseline and at end-CPR. RESULTS: Agonal phase was reached in 6 ± 1 minutes and lasted 3 ± 1 minutes; average HR was 49 ± 16 beats/min, and BP was 41 ± 12 mm Hg. CPR lasted 35 ± 3 minutes; average HR and BP were 113 ± 32 beats/min and 86 ± 63 mm Hg, respectively. PaO2/FiO2 decreased from 442 ± 31 mm Hg at baseline to 63 ± 36 at end-CPR (P < .001). pH decreased from 7.378 ± 0.045 to 6.931 ± 0.042 (P < .001), with a corresponding increase of lactate from 0.9 ± 0.2 to mmol/L to 12.8 ± 2.1 (P < .001). As assessed using CT scan, total lung volume decreased (baseline vs end-CPR 1107 ± 106 mL vs 617 ± 95; P < .001), whereas noninflated tissue (ie, atelectasis) significantly increased (46 ± 10 g vs 131 ± 89; P = .008). CONCLUSIONS: Lung function greatly deteriorated after cardiac death. The model we set may constitute a reproducible platform for future investigations on lung uDCDD.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca/fisiopatologia , Pulmão/fisiopatologia , Animais , Pressão Sanguínea , Modelos Animais de Doenças , Parada Cardíaca/terapia , Frequência Cardíaca , Concentração de Íons de Hidrogênio , Pulmão/diagnóstico por imagem , Medidas de Volume Pulmonar , Sus scrofa , Suínos , Obtenção de Tecidos e Órgãos , Tomografia Computadorizada por Raios X
9.
Minerva Anestesiol ; 81(5): 507-15, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25319135

RESUMO

BACKGROUND: Aim of this study was to compare early graft function after transplantation of recipients transplanted with livers procured from donors after brain death who experienced transient or sustained cardio-circulatory collapse. METHODS: We retrospectively analysed patients who underwent liver transplantation (LTx) at our Institution from January 2010 to May 2012. Recipients were divided into 3 groups: those who received livers from brain death donors who experienced reversible cardio-circulatory arrest before organ procurement (RCA); those who experienced sustained cardio-circulatory collapse, treated with extra-corporeal membrane oxygenation support as rescue therapy of refractory cardiogenic shock (ECMO). Standard donors were considered as reference group (REF). Postoperative graft function, Primary Non-Function (PNF), and complications during the first 30 days were analysed. RESULTS: 102 LTx were analysed (76 REF, 22 RCA and 4 ECMO). The main cause of donor's death was post-anoxic coma in RCA and ECMO, cerebrovascular accident in REF. SGOT in REF, RCA, and ECMO donors were 27 [17-43], 54 [34-92], 716 [190-962] respectively, SGPT 17 [12-34], 46 [27-73], 84 [51-175] UI/L respectively, both P<0.01. All recipients had similar SGOT (P=0.48), SGPT (P=0.75) and Model for End-Stage Liver Disease scores (P=0.98) before LTx; similar graft cold and warm ischemia time and serum lactate levels at the end of surgery. After LTx, Intensive Care Unit stay and the incidence of PNF were similar. CONCLUSION: The use of livers procured from donors after brain death that experienced transient or sustained cardio-circulatory collapse was associated with early graft function comparable to that of standard donors.


Assuntos
Morte Encefálica , Transplante de Fígado/métodos , Choque , Adulto , Idoso , Feminino , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Doadores de Tecidos , Resultado do Tratamento
10.
Clin Neuropathol ; 22(4): 176-9, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12908753

RESUMO

A 13-year-old, male German Shepherd dog was euthanasized for a frontal temporal mass revealed by the MRI. The histological examination showed a proliferation composed of small round undifferentiated cells arranged in sheets or nests and sometimes in pseudorosettes interrupted by hypocellular zones of fibrovascular stroma. Immunohistochemical studies revealed the expression of neuroblastic epitopes. The presented neoplasm has many histological and immunohistochemical features in common with the group of olfactory neuroblastomas reported in man, so it could be classified as primitive neuroectodermal tumor with neuronal differentiation.


Assuntos
Neoplasias Encefálicas/veterinária , Doenças do Cão/patologia , Lobo Frontal/patologia , Neuroblastoma/veterinária , Bulbo Olfatório/patologia , Animais , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patologia , Doenças do Cão/metabolismo , Cães , Lobo Frontal/metabolismo , Proteína Glial Fibrilar Ácida/metabolismo , Imuno-Histoquímica , Masculino , Neuroblastoma/metabolismo , Neuroblastoma/patologia , Proteínas de Neurofilamentos/metabolismo , Bulbo Olfatório/metabolismo , Fosfopiruvato Hidratase/metabolismo , Proteínas S100/metabolismo , Vimentina/metabolismo
11.
J Comp Pathol ; 100(1): 47-58, 1989 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-2918109

RESUMO

Mature and immature male rabbits were fed for 120 and 20 days, respectively, a commercial diet containing theobromine in amounts of 0, 0.5, 1 and 1.5 per cent. Clinical, haematological, histopathological and histoenzymological examinations were performed. Mortality, which appeared dose- and time-related, was severe and rapid, mostly in the 1 and 1.5 per cent groups and was attributed to cardiac failure. Theobromine administration resulted in marked changes in thymus and testes and the severity of lesions appeared to be related to the amounts of the ingested methylxanthine. The earliest thymic alterations in immature rabbits consisted of a blurring of demarcation between cortex and medulla accompanied, in the more advanced stages, by a decreased lymphocyte density. Similar lesions were observed in mature animals which had died in the earlier phase of the study. Testicular alterations ranged from vacuolation of spermatids and spermatocytes to multinucleated cell formation and oligospermia or aspermia with extensive degeneration of tubule cells. Some necrotic and post-necrotic myocardial foci were also recorded. The increase in testicular activity of beta-glucuronidase in immature rabbits compared to the untreated animals provided further evidence of an early theobromine-induced damage of the testes.


Assuntos
Envelhecimento/efeitos dos fármacos , Teobromina/toxicidade , Administração Oral , Animais , Peso Corporal/efeitos dos fármacos , Masculino , Miocárdio/patologia , Coelhos , Testículo/patologia , Teobromina/administração & dosagem , Timo/patologia
12.
Res Vet Sci ; 49(3): 275-8, 1990 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-2267415

RESUMO

Although neoplastic changes in canine hepatoid perianal glands (HPG) are quite common, the biological behaviour is sometimes difficult to assess on the basis of the histopathological examination. In an attempt to detect differences in the glycoconjugate expression between normal and neoplastic HPG, and to verify their relation to the degree of neoplastic progression, normal and neoplastic HPG were studied in 13 dogs, using 11 biotinylated lectins. In HPG adenomas the majority of the cells did not stain or stained weakly after incubation with pokeweed mitogen, LCA and UEA-I. In HPG carcinoma the basal cells lost the specific binding for WGA while heterogeneous distribution of conconavalin-A staining was observed.


Assuntos
Adenoma/veterinária , Neoplasias das Glândulas Anais/química , Carcinoma/veterinária , Doenças do Cão/metabolismo , Glicoconjugados/análise , Adenoma/química , Animais , Carcinoma/química , Cães , Histocitoquímica , Lectinas , Masculino , Glândulas Perianais/química
13.
Am J Vet Res ; 52(10): 1717-22, 1991 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-1767996

RESUMO

The toxicity of zinc ethylene-bis-dithiocarbamate (zineb), a widely used fungicide, was studied in four 4-week-old Friesian calves with immature rumen function. Calves were first subjected to liver biopsy, and thereafter, 3 of them were orally administered 200 mg of zineb/kg of body weight daily for 80 days, whereas the fourth calf served as control and remained untreated. Clinical, hematologic, and pathologic (including ultrastructural) findings were recorded. The distribution in body fluids and tissues of the parent compound and one of its main metabolites, ethylenethiourea (ETU), also was examined. Treated calves had unthrifty appearance and reduction in weight gain. They also had remarkable impairment of thyroid function, as reflected by reduction in serum concentrations of triiodothyronine and thyroxine and increase in weight of the thyroid gland associated with epithelial vacuolization and foci of hyperplasia. Moderate increase in liver glycogen content and impairment in maturation of germ cells were recorded consistently. Whereas zineb was widely distributed in body tissues, ETU accumulated mainly in the liver and the thyroid gland, although noticeable concentrations also were attained in muscle. Data were consistent with involvement of ETU mainly in the pathogenesis of thyroid gland lesions, and indicate that unweaned calves given zineb develop a clinicopathologic syndrome that does not differ qualitatively from that already described in adult cattle exposed to zineb.


Assuntos
Bovinos/metabolismo , Etilenotioureia/metabolismo , Rúmen/fisiologia , Zineb/toxicidade , Fatores Etários , Animais , Ingestão de Alimentos/efeitos dos fármacos , Hematócrito/veterinária , Hemoglobinas/análise , Fígado/efeitos dos fármacos , Fígado/metabolismo , Fígado/ultraestrutura , Masculino , Microscopia Eletrônica , Testículo/efeitos dos fármacos , Testículo/metabolismo , Timo/efeitos dos fármacos , Glândula Tireoide/efeitos dos fármacos , Glândula Tireoide/metabolismo , Glândula Tireoide/ultraestrutura , Hormônios Tireóideos/sangue , Distribuição Tecidual , Aumento de Peso/efeitos dos fármacos , Zineb/farmacocinética
14.
Schweiz Arch Tierheilkd ; 132(2): 87-91, 1990.
Artigo em Italiano | MEDLINE | ID: mdl-2320990

RESUMO

The authors found during a study concerning the gastric pathology in pigs 2828 cases of hypertrophic gastropathy in 8408 regularly slaughtered animals. After a description of the morphologic patterns of the lesions, the authors make some pathogenetic hypothesis and conclude that this lesion is like Ménétrier's disease of man.


Assuntos
Gastrite Hipertrófica/veterinária , Gastrite/veterinária , Doenças dos Suínos/patologia , Animais , Feminino , Mucosa Gástrica/patologia , Gastrite Hipertrófica/patologia , Masculino , Suínos
15.
Transplant Proc ; 46(7): 2354-6, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25242786

RESUMO

Among patients with respiratory insufficiency awaiting lung transplantation, small adult patients have a lower opportunity of receiving size-matched pulmonary grafts, because of the shortage of donors, particularly those of small size. Reducing the size of an oversized graft is one of the methods to increase the donor pool; similarly, ex vivo lung perfusion is an emerging technique aimed toward the same purpose. We describe how we combined the 2 techniques (lobar transplantation plus contralateral nonanatomic graft reduction during ex vivo lung perfusion) to overcome graft shortage in a clinical case. For the 1st time, this case report demonstrates that surgical manipulation during ex vivo lung perfusion does not affect the functional improvement in a lung previously judged to be not suitable for transplantation. The 6-month follow-up results are similar to those of standard bilateral lung transplantation.


Assuntos
Transplante de Pulmão/métodos , Pulmão/anatomia & histologia , Pulmão/cirurgia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Perfusão
16.
Minerva Anestesiol ; 79(4): 342-8, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23370124

RESUMO

BACKGROUND: Obese patients are at risk of developing postoperative pulmonary complications. We hypothesized that preoperative changes in dynamic spirometry due to body posture would correlate with the drop of forced vital capacity (FVC) measured early after surgery. METHODS: Thirty consecutive morbidly obese patients undergoing gastric banding were investigated. All subjects were studied the day before surgery (T0) and on postoperative day one (T1). Forced Vital Capacity (FVC) was measured, together with heart rate, mean arterial pressure and respiratory rate. At T0 measurements were taken in a random fashion with subjects in upright and in supine position. Subjects were then investigated after surgery in the supine position (T1). Postoperative pain was assessed at T1 using visual analogue scale. Intraoperative variables were also collected. RESULTS: Body Mass Index (BMI) of the investigated subjects was 43.9 ± 5.7 Kg/m2 (range 33.8-60); their age was 40 ± 8 years. All dynamic spirometric data decreased significantly from upright to supine position (P<0.05) and after surgery from 3.07 L (2.77-3.71) to 1.50 (1.15-2.12) (FVC T0 supine vs. T1, P<0.05). Changes of FVC due to body position did not correlate with changes of FVC occurring after surgery (R2=0.105, P=0.081). When subjects were stratified by the median postoperative drop of FVC (45.74%), preoperative (anthropometric and spirometric data), intraoperative (ventilatory settings and hemodynamics) and postoperative (FVC and pain) parameters were similar between groups. The duration of pneumoperitoneum was correlated with the drop of FVC (R2=0.551, P<0.05). CONCLUSION: The derangement of FVC that occurs in obese subjects after gastric banding is not predictable before surgery from anthropometric or spirometric data. The duration of pneumoperitoneum significantly contributes to postoperative impairment of respiratory function.


Assuntos
Cirurgia Bariátrica/métodos , Obesidade/fisiopatologia , Obesidade/cirurgia , Posicionamento do Paciente , Período Pré-Operatório , Testes de Função Respiratória , Capacidade Vital/fisiologia , Adulto , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Pneumoperitônio Artificial , Valor Preditivo dos Testes , Decúbito Dorsal/fisiologia , Adulto Jovem
17.
Animal ; 6(11): 1839-47, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22717052

RESUMO

Lipomatous myopathy is a degenerative muscle pathology characterized by the substitution of muscle cells with adipose tissue, sporadically reported in cattle, pigs, and rarely in sheep, horses and dogs. This study investigated the pathology of this myopathy in 40 muscle samples collected from regularly slaughtered Piedmontese cattle living in Piedmont region (Italy). None of the animals showed clinical signs of muscular disease. Muscle specimens were submitted to histological and enzymatic investigations. Gross pathology revealed a different grade of infiltration of adipose tissue, involving multiple or single muscles. The most affected regions were the ventral abdomen and the shoulders, especially the cutaneous muscles and the muscles of the thoracic group. Morphological staining revealed an infiltration of adipose tissue varying in distribution and severity, changes in muscle fibre size and increased number of fibres with centrally located nuclei, suggesting muscle degeneration-regeneration. Necrosis and non-suppurative inflammatory cells were also seen. Furthermore, proliferation of connective tissue and non-specific myopathic changes were present. Chemical and physical characteristics of the affected tissue were also evaluated. The authors discuss about the aetiopathogenesis and classification of this muscle disorder whose histological lesions were similar to those reported in human dystrophies.


Assuntos
Doenças dos Bovinos/patologia , Distrofia Muscular Animal/patologia , Tecido Adiposo/patologia , Animais , Bovinos , Gorduras/análise , Feminino , Itália , Masculino , Proteínas Musculares/análise , Músculo Esquelético/química , Músculo Esquelético/patologia
18.
Transplant Proc ; 44(7): 1830-4, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22974848

RESUMO

INTRODUCTION: The feasibility and utility of a lung donor score that has been recently proposed was tested among a pool of lung donors referred to the Nord Italia Transplant program (NITp) organ procurement organization. MATERIAL AND METHODS: Each lung donor was assigned an Oto score including, age, smoking history, chest X-ray, secretions and ratio of arterial oxygen tension to inspired oxygen fraction (PaO(2)/FiO(2)). Based on clinical compromise, each variable received a score between 0 and 3, except for PaO(2)/FiO(2), which was scored between 0 and 6 given its overall relevance. RESULTS: Throughout 2010, 201 multiorgan donors were initially considered to be potential lung donors. Among these, 59 (29.4%) eventually yielded 67 lung transplantations (named "Used group"). Among the 142 (70.6%) refused lungs, 28 were not used due to logistic or medical problems ("general exclusion" group, GE) and 114, because of poor lung function ("lung exclusion" group, LE). Median lung donor scores were 1 (range, 0 to 3), 4 (range, 2.5 to 6.5), and 7 (range, 5 to 9) in the Used, GE, and LE groups, respectively (one-way analysis of variance, P < .001). Some donors with Oto scores ≤7 worsened over time so that the score had significantly increased by the time of organ retrieval. Overall, subjects who died after lung transplantation were characterized by higher lung donor scores, (2 [1-4] versus 0.5 [0-3], P = .003). CONCLUSION: Our analysis suggested that the use of a donor score as a dynamic tool over the donation process was of great utility to describe and analyze a pool of lung donors.


Assuntos
Transplante de Pulmão , Doadores de Tecidos , Adulto , Criança , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Transplant Proc ; 44(7): 1826-9, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22974847

RESUMO

INTRODUCTION: Ex vivo lung perfusion (EVLP) has been validated as a valuable technique to increase the pool of organs available for lung transplantation. MATERIAL AND METHODS: After a preclinical experience, we obtained permission from the Ethics Committee of our institution to transplant lungs after EVLP reconditioning. ABO compatibility, size match, and donor arterial oxygen pressure (PaO(2))/fraction of inspired oxygen (FiO(2)) ≤ 300 mm Hg were considered to be inclusion criteria, whereas the presence of chest trauma and lung contusion, evidence of gastric content aspiration, pneumonia, sepsis, or systemic disease were exclusion criteria. We only considered subjects on an extra corporeal membrane oxygenation (ECMO) bridge to transplantation with rapid functional deterioration. Using Steen solution with packed red blood cells oxygenated with 21% O(2), 5% to 7% CO(2) was delivered, targeted with a blood flow of approximately 40% predicted cardiac output. Once normothermic, the lungs were ventilated with a tidal volume of 7 mL/kg a PEEP of 5 cmH(2)O and a respiratory rate of 7 bpm. Lungs were considered to be suitable for transplantation if well oxygenated [P(v-a) O(2) > 350 mm Hg on FiO(2) 100%], in the absence of deterioration of pulmonary vascular resistance and lung mechanics over the perfusion time. RESULTS: From March to September 2011, six lung transplantations were performed, including two with EVLP. The functional outcomes were similar between groups: at T72 posttransplantation, the median PaO(2)/FiO(2) were 306 mm Hg (range, 282 to 331 mm Hg) and 323 mm Hg (range, 270 to 396 mm Hg) (P = 1, EVLP versus conventional). Intensive care unit ICU and hospital length of stay were similar (P = .533 and P = .663, respectively) with no mortality at 60 days in both groups. EVLP donors were older (49 ± 6 y versus 21 ± 7 y, P < .05), less well oxygenated (184 ± 6 mm Hg versus 570 ± 30, P < .05), displaying higher Oto scores (9.5 ± 0.7 versus 1.7 ± 1.5, P < .05). CONCLUSIONS: The first 6 months of the EVLP program allowed us to increase the number of organs available for transplantation with short-term outcomes comparable to conventional transplantations.


Assuntos
Oxigenação por Membrana Extracorpórea , Transplante de Pulmão , Pulmão/fisiologia , Doadores de Tecidos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória
20.
Intensive Care Med ; 37(3): 461-8, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21152898

RESUMO

PURPOSE: To define the rule according to which crystalloid solutions characterized by different strong ion difference (SID) modify the acid-base variables of human plasma. METHODS: With a previously validated software, we computed the effects of diluting human plasma with crystalloid solutions ([SID] 0-60, 10 mEq/l stepwise). An equation was derived to compute the diluent [SID] required to maintain the baseline pH unchanged, at constant PCO2 and at every dilution fraction. The results were experimentally tested using fresh frozen plasma, re-warmed at 37°C, equilibrated at PCO2 35 and 78 mmHg, at baseline and after the infusion of crystalloid solutions with 0, 12, 24, 36, 48 mEq/l [SID]. RESULTS: The mathematical analysis showed that the diluent [SID] required to maintain unmodified the baseline pH equals the baseline bicarbonate concentration, [HCO3⁻], assuming constant PCO2 throughout the process. The experimental data confirmed the theoretical analysis. In fact, at the baseline [HCO3⁻] of 18.3 ± 0.3 mmol/l (PCO2 35 mmHg) the pH was 7.332 ± 0.004 and remained 7.333 ± 0.003 when the diluting [SID] was 18.5 ± 0.0 mEq/l. At baseline [HCO3⁻] of 19.5 ± 0.3 mmol/l (PCO2 78 mmHg) the pH was 7.010 ± 0.003 and remained 7.004 ± 0.003 when the diluting [SID] was 19.1 ± 0.1 mEq/l. At both PCO2 values infusion with [SID] lower or greater than baseline [HCO3⁻] led pH to decrease or increase, respectively. CONCLUSIONS: The baseline [HCO3⁻] dictates the pH response to crystalloid infusion. If a crystalloid [SID] equals baseline [HCO3⁻], pH remains unchanged at constant PCO2, whereas it increases or decreases if the [SID] is greater or lower, respectively.


Assuntos
Soluções Isotônicas/farmacologia , Plasma/efeitos dos fármacos , Plasma/fisiologia , Equilíbrio Ácido-Base/efeitos dos fármacos , Equilíbrio Ácido-Base/fisiologia , Desequilíbrio Ácido-Base/sangue , Gasometria , Soluções Cristaloides , Humanos , Concentração de Íons de Hidrogênio/efeitos dos fármacos , Íons/farmacologia , Soluções Isotônicas/administração & dosagem , Modelos Estatísticos
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