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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A review of 550 consecutively transplanted liver grafts stored in University of Wisconsin solution (UW) was performed during a 4-year period to ascertain whether graft function was impaired by flushing the aorta with Eurocollins (EC) rather than UW during the harvesting. The outcome of 255 liver grafts flushed with UW in both the aorta and portal vein (group UW/UW) was compared with 295 liver grafts flushed with EC through the aorta and UW through the portal vein (group ECUW). Liver grafts in both groups were flushed with 1 L of UW during the back table procedure and subsequently stored in UW at 4 degrees C before transport. Donor and recipient characteristics, cold and warm ischemia times, and methods of transplantation were similar in both groups, except that the recipient prothrombin time (PT) before liver transplantation (LT) was lower in the UW/UW group. There was no significant difference between the groups with peak transaminases aspartate aminotransferase (AST) and alanine aminotransferase, maximum value of serum bilirubin within 10 days following LT, incidence of primary nonfunction, need for retransplantation, and patient and graft survival at 1 month. Results were improved, however, in the EC/UW group in regard to PT after LT, operative bleeding and proportion of grafts with histologic lesions at the reperfusion biopsy (P<0.001). These better results in the EC/UW group were confirmed when grafts transplanted in urgent situations were excluded from analysis and by multivariate analysis assessing the effects of pretransplant PT and AST values of the recipients combined with the method of liver cooling with each of the aforementioned criteria. In conclusion, the method of using EC for the aortic flush during liver procurement reduces the amount of UW solution by 50% with improved graft function. This method seems justified in that it is less expensive while affording improved graft function.
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PMID:Beneficial effects of Eurocollins as aortic flush for the procurement of human livers. 860 71

Lactate-edited 1H NMR difference spectra have been acquired from intact rat liver tissue following flushing and preservation in ice. A peak, initially at 1.26 ppm, was seen to increase in the liver tissue with preservation time. This peak was assigned to lactate, despite the fact that its chemical shift was initially shifted by approximately -0.1 ppm relative to an externally added standard. The assignment was based on the following: (a) the peak increased over a 24-h ischemic storage period; (b) it was coupled to a signal 2.78 +/- 0.02 ppm upfield; and (c) a parallel increase in lactate was noted in perchloric acid extracts of tissue from the same liver. An additional peak, assigned to alanine, was also observed during storage and was also shifted by approximately -0.1 ppm. Inclusion of dimethyl sulfoxide, which readily permeates liver tissue, demonstrated that this chemical shift alteration was a tissue-specific effect. These results demonstrate that 1H NMR spectroscopy of intact liver tissue during hypothermic ischemia is possible, though chemical shift assignments should be made with caution.
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PMID:Proton nuclear magnetic resonance spectroscopy of lactate production in isolated rat liver during cold preservation. 867 59

The extent of mesenteric infarctions caused by intestinal circulation disorders essentially depends on reactive vasoconstriction and oxygen radical induced lesions of enteric mucosa. Animal experiments indicated protective effects of an intraarterial flushing perfusion of mesenteric arteries with vasodilators and anti-oxidants. We carried out a transaortic perfusion of the superior mesenteric artery with lactated Ringer's-solution and vasodilators (papaverin, tolazolin, PGE1) in acute occlusion of mesenteric arteries in 12 patients (case reports). Three patients were treated successfully without reconstruction by conservative method alone. Only one patient (8.33%) died because of uncontrolled enteric ischemia. Angiological therapy is necessary in modern treatment of acute mesenteric ischemia. Surgical goals are elimination of central vascular occlusions and resection of necrobiotic areas of intestinal organs.
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PMID:[Perioperative intra-arterial irrigation perfusion for adjuvant therapy of acute intestinal circulatory disorders]. 885 43

Postischemic kidney function may be influenced by donor conditioning. The sulfamoyl-benzoate "piretanide" (P) is a diuretic agent with an inhibitory effect on the luminal Na-K-2CL-transporter system in the ascending part of the loop of Henle. A clinical pilot study demonstrated a lower rate of organ dysfunction following transplantation in humans when the donor organs were pretreated with piretanide. In an experimental ex vivo model the effect of piretanide on immediate organ function following long or short cold ischemia was studied. Porcine kidneys (n = 36) were removed after in situ transaortal hypothermic flushing with 21 Eurocollins solution. Following short storage (1 h, n = 18) or long storage (24 h, n = 18) the kidneys were reperfused with intraoperatively drawn heparinized autologous blood diluted with Ringer's lactate to a hematocrit of 25%. Urine flow was higher in the piretanide-pretreated group (p), especially after long storage. The electrolyte loss was comparable in both groups. Postischemic endogenous creatinine clearance was significantly elevated in the treatment group (4.45 +/- 0.6 ml/min per 100 mg in P vs 1.91 +/- 0.4 ml/min per 100 mg, in control, P < 0.05 Mann-Whitney test). Renal hemodynamics were improved by piretanide, resulting in significantly lower resistance and allowing higher flow during pressure-controlled perfusion. O2 consumption, representing general metabolic activity, was higher after long storage, indicating an earlier recovery from cold ischemia. In this ex vivo model, autologous reperfusion of porcine kidneys could be improved by piretanide pretreatment. Autoregulation of kidney vasculature was maintained as well as functional parameters such as creatinine clearance or gluconeogenesis. Therefore, piretanide may be used in larger clinical trials to further improve organ quality in times of donor shortage.
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PMID:Na-K/2Cl transporter inhibition for reduction of postischemic kidney failure tested in autologous reperfusion. 895 81

This study was undertaken to evaluate whether the renal damage induced by cold ischemia-reperfusion was worsened by neutrophils (PMN), and if blockade of platelet-activating factor (PAF) could effectively decrease this injury. After flushing with EuroCollins, 85 kidneys from Sprague-Dawley rats underwent either no cold ischemia or a 4-h cold ischemia, and then were reperfused for 75 min at 37 degrees C and 100 mm Hg in an isolated perfusion circuit. Reperfusion was performed with a Krebs-Henseleit solution containing 4.5% albumin, with and without human PMN (7.5 x 10(5) cells/ml) and with and without addition of a PAF receptor antagonist (BN 52021). Hemodynamic and functional parameters were continuously assessed during reperfusion. At end of the study, PAF production was evaluated. Presence of PMN during reperfusion of nonischemic kidneys produced no alteration of functional parameters or PAF production. After 4-h cold ischemia, the presence of PMN during reperfusion produced a significant worsening of plasma flow rate, glomerular filtration rate and sodium reabsorption in comparison with kidneys reperfused without PMN. Also, higher production of PAF was observed in the kidneys reperfused with PMN than in the kidneys reperfused without PMN. After 4-h cold ischemia, addition of BN 52021 during reperfusion in the presence of PMN significantly increased the plasma flow rate, glomerular filtration rate and sodium reabsorption in comparison with kidneys reperfused without this PAF antagonist. This effect was dose dependent. After 4-h cold ischemia, addition of BN 52021 during reperfusion in the absence of PMN produced no significant effect on functional parameters in comparison with kidneys reperfused without this PAF antagonist. These results indicate that PMN contribute to renal cold ischemia-reperfusion injury evaluated in the isolated perfused kidney. Treatment with a PAF receptor antagonist attenuated this injury in a dose-dependent manner, which suggests that it is mediated by PAF.
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PMID:Neutrophils accentuate renal cold ischemia-reperfusion injury. Dose-dependent protective effect of a platelet-activating factor receptor antagonist. 902 92

In this study we present the technical details, adaptations and modifications of the original procedure of pancreaticoduodenal transplantation in rats described by Lee et al. in 1972. We also present the results and technical failures observed in a follow-up of 12 years. From March, 1982 to December, 1994, we performed in the Laboratory of Surgical Technique and Experimental Surgery of Faculty of Medicine, Botucatu-UNESP, Brazil, 665 duodenopancreatectomies in donor rats and 592 surgeries for revascularization of the pancreatic graft in recipient animals. The observed percentage of technical failures in donor rats was 11% due to bleeding and/or vascular complications, irregular flushing of the graft with saline and respiratory insufficiency. In recipients of grafts, we observed a percentage of technical failures of 22.5% due to porto-caval thrombosis, vascular bleeding, pancreatitis and graft ischemia. In both surgeries, the successful results are directly related to the technical performance of the surgeon and the cares in the postoperative period.
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PMID:[Microsurgical pancreatoduodenal transplantation in rats. Technique and results following 12 years of investigation]. 920 29

The role of true cold ischemia times (CIT) and rewarming ischemia times (WIT) in determining outcome after liver transplantation was investigated in 230 adult recipients. Using multivariate analysis, WIT (time from the start of implantation until restoration of arterial and portal blood supply) and donor intensive care stay (P = .04 and .0004, respectively) but not CIT (the time from donor portal vein flushing until the graft was removed from University of Wisconsin solution; P > .30) emerged as independent determinants of graft survival. In the small number of patients with a WIT of greater than 180 minutes, there were reductions in graft survival (58% v 80% for WIT greater than 180 minutes) but these just failed to reach significance (P = .055). CIT had no influence on graft survival using cut-offs of 12 or 18 hours. A WIT of greater than 180 minutes was associated with an increased median area under the curve of day 1 through 7 serum bilirubin (1,370 v 915 mumol/L.day; P = .048) and trends towards an increased incidence of primary graft nonfunction or dysfunction (22.2% v 6.2% for WIT of less than 180 minutes; P = .065) and the day 1 through 7 area under the curve of serum aspartate aminotransferase (3,310 v 1,440 IU/L.day; P = .092). A prolonged CIT (greater than 18 hours) led to a prolonged hospital stay (69 v 31 days; P = .03), an increased area under the curve of day 8 through 14 serum bilirubin (2,500 v 995 mumol/L.day; P = .003), and a trend towards an increased incidence of initial poor graft function (33.3% v 6.3% for less than 18 hours; P = .092). The incidence of acute rejection increased (to 64.3% from 53.4%; P = .04) in patients with preservation injury (serum aspartate aminotransferase greater than 1,500 IU/L during the first 2 postoperative days). True CIT and WIT are important determinants of outcome after liver transplantation.
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PMID:Contribution of true cold and rewarming ischemia times to factors determining outcome after orthotopic liver transplantation. 934 86

The authors examined the effects of ischemic preconditioning on lung preservation using a canine single left lung transplantation. Twelve adult mongrel dogs underwent left lung allotransplantation. Donor lungs were perfused and flushed with cold Euro-Collins solution (ECS) and stored at 4 degrees C ECS for 2 hours. Six donors were preconditioned by occuluding left lung hilum for 10 minutes and releasing for 15 minutes before flushing (Group PC); other six donors without ischemic preconditioning served as the controls (Group C). Left inferior pulmonary vein blood gas analysis, mean pulmonary artery pressure measurement and donor lung histology examination were made to evaluate the function of transplanted lung after transplantation. Oxygen tension at 2 hrs after reperfusion were significantly better in Group PC than in Group C (431 +/- 130 mmHg vs 246 +/- 66 mmHg, P < 0.05); mean pulmonary artery pressure was much lower in Group PC than in Group C after reperfusion (20.6 +/- 1.3 mmHg vs 36.9 +/- 3.1 mmHg, P < 0.01). Histological findings showed less injury in Group PC. These indicate that ischemic preconditioning combined with cold ECS perfusion is superior to cold ECS perfusion alone in canine lung preservation of 3 hours ischemia with 2 hours reperfusion.
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PMID:[Effects of ischemic preconditioning on protection of canine donor lung]. 986 10

In lung transplantation, the safety period of the ischemic time of the graft is within 6 hours. Because of the problem of donor shortage, it is essential to extend the safety period of the preservation time of the donor lung. However, the longer the preservation time is, the more severe is the resulting ischemia-reperfusion injury. This study was designed to evaluate the efficacy of initial controlled perfusion pressure in the reduction of ischemia-reperfusion injury in a 24-hour preserved lung. Japanese white rabbit lungs were flushed with a low-potassium dextran solution (4C, 500 ml) after injection of prostaglandin E1 (20 microgram, bolus via PA) and submersed in the same solution for 24 hours at 4C. After preservation, the left lung was reperfused using an extracorporeal lung perfusion model which comprised of a closed circuit combined with a membrane deoxygenator. Assessment of lung function included gas analysis of influent and effluent blood and mean pulmonary artery perfusion pressure. Then the lung wet/dry weight ratio was calculated. In group I of the control group (n=6), the left lung was reperfused immediately following flushing (without preservation) at a flow rate of 50 ml/min for 60 minutes. In groups II and III, grafts were stored for 24 hours. In group II, grafts (n=6) were reperfused at a flow rate of 50 ml/min for 60 minutes. In group III (n =6), the flow rate was controlled by maintaining the perfusion pressure below 30 mmHg during the initial 5 minutes and was increased to 50 ml/min for the subsequent 60 minutes. In group II, the mean pulmonary artery pressure during perfusion increased rapidly, and oxygenation deteriorated. All grafts developed pulmonary edema within 12 minutes after reperfusion. Examination of the specimen revealed that the peripheral lung was not perfused. In group III, the mean pulmonary artery perfusion pressure was maintained below 30 mmHg, and oxygenation was preserved sufficiently throughout the experiment (delta PO2 > 100 mmHg) with no significant difference from control values. In conclusion, ischemia-reperfusion injury of the 24-hour preserved lung was attenuated prominently by controlling initial perfusion pressure for 5 minutes.
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PMID:Efficacy of initial controlled perfusion pressure for ischemia-reperfusion injury in a 24-hour preserved lung. 1007 64

The characteristics of alcohol-induced flushing response were studied in some Siberian Native populations (Chukchi, Eskimo, Jakuts, Udege, and Nanaian). Flushing peculiarities were estimated and the interrelationship with drinking patterns, the ethanol patch test (EPT), and somatic disorders were analyzed. Frequency of flushing response varied from 9.0% to 66.7%, and was more often apparent among females. Only the Nanaian demonstrated typical flushing, which did not allow them to consume high doses of alcohol. In the rest of the populations flushing was "atypical," i.e., appearing sometimes after high doses of alcohol but not interrupting alcohol drinking, and not associated with a positive EPT. Direct genotyping in DNA samples of Chukotka Natives did not reveal atypical allele aldehyde dehydrogenase (AIDH 2/2). Frequencies of alcohol problems, alcohol dependence symptoms, and somatic disorders (arterial hypertension, silent ischemia, diffuse liver lesions, and noncalculous cholecystitis) were higher among atypical flushers compared to nonflushers (p < 0.05-0.01). The mechanism of the observed atypical flushing response is unknown. We speculate on its hereditary nature, since flushing alcoholics, compared to nonflushers, reported that their parents had flushing responses significantly more often. Further studies are required.
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PMID:Flushing response and its role in alcohol disease in Siberian populations. 1009 24


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