RESUMEN
INTRODUCCIÓN: El uso de ultrasonografía para la inserción de catéteres centrales ha mostrado ser coste-efectivo en adultos; en neonatos se desconoce esta información. El objetivo del estudio fue comparar el coste-efectividad de la cateterización venosa umbilical guiada por ultrasonografía con la cateterización convencional en un servicio de cuidados intensivos neonatales de un hospital universitario y público. PACIENTES Y MÉTODOS: Estudio observacional retrospectivo en recién nacidos que requirieron catéter venoso umbilical antes de cumplir las primeras 24 h de vida extrauterina; se conformaron 2 cohortes históricas, una con cateterización guiada por ultrasonografía y otra con cateterización convencional. La efectividad se midió con 2 variables: colocación de posición ideal e inserción sin complicaciones. Se estimó el coste de recursos humanos y materiales (fungibles y no fungibles), la razón coste-efectividad y la razón coste-efectividad incremental; y se realizó análisis de sensibilidad. RESULTADOS: La obstrucción del catéter fue más frecuente en la cateterización guiada que en la convencional (7,7 vs. 0%, p = 0,04) y la disfunción del catéter fue superior en esta última (79 vs. 3,8%, p < 0,0001). La razón coste-efectividad de la cateterización guiada fue 153,9 euros y de la convencional 484,6 euros; la razón coste-efectividad incremental fue 45,5 euros. El análisis de sensibilidad incrementó 2,6 euros en la razón coste-efectividad de la cateterización guiada y 47 euros, en la convencional. CONCLUSIONES: El uso de la ultrasonografiacute;a para guiar la cateterización umbilical es más eficiente ya que, a pesar de suponer un mayor consumo de recursos económicos, ofreció una mayor efectividad
INTRODUCTION: Although the use of ultrasound for the insertion of central catheters has proven to be cost-effective in adults, it is not known if this is the case in the neonatal population. This study compared the cost-effectiveness of ultrasound-guided umbilical venous catheterisation with conventional catheterisation in a neonatal intensive care unit of a Public University Hospital. PATIENTS AND METHODS: A retrospective observational study was conducted on newborns that required an umbilical venous catheter before completing their first 24hours of extra-uterine life. Two retrospective cohorts were formed, including one with ultrasound-guided catheterisation and the other with conventional catheterisation. The effectiveness was measured using 2 variables: placement of ideal position and insertion without complications. The cost of human and material resources (consumable and non-consumable), the cost-effectiveness ratio, and the incremental cost-effectiveness ratio were estimated, as well as carrying out a sensitivity analysis. RESULTS: Catheter obstruction was more frequent in guided catheterisation than in conventional catheterisation (7.7% vs. 0%, p = .04) and catheter dysfunction was higher in the latter (79% vs. 3.8%, p < .0001). The cost-effectiveness ratio of the guided catheterisation was 153.9, and 484.6 for the conventional one. The incremental cost-effectiveness ratio was 45.5. The sensitivity analysis showed a 2.6 increase in the cost-effectiveness ratio of the guided catheterisation and 47 in the conventional one. CONCLUSIONS: The use of ultrasound to guide umbilical catheterisation is more efficient than conventional catheterisation since, despite using more economic resources, it offers greater effectiveness
Asunto(s)
Humanos , Recién Nacido , Ultrasonografía Intervencional/economía , Análisis Costo-Eficiencia , Cateterismo/métodos , Cateterismo/economía , Venas Umbilicales , Hospitales Universitarios , Estudios Retrospectivos , Hospitales PúblicosRESUMEN
INTRODUCTION: Although the use of ultrasound for the insertion of central catheters has proven to be cost-effective in adults, it is not known if this is the case in the neonatal population. This study compared the cost-effectiveness of ultrasound-guided umbilical venous catheterisation with conventional catheterisation in a neonatal intensive care unit of a Public University Hospital. PATIENTS AND METHODS: A retrospective observational study was conducted on newborns that required an umbilical venous catheter before completing their first 24hours of extra-uterine life. Two retrospective cohorts were formed, including one with ultrasound-guided catheterisation and the other with conventional catheterisation. The effectiveness was measured using 2 variables: placement of ideal position and insertion without complications. The cost of human and material resources (consumable and non-consumable), the cost-effectiveness ratio, and the incremental cost-effectiveness ratio were estimated, as well as carrying out a sensitivity analysis. RESULTS: Catheter obstruction was more frequent in guided catheterisation than in conventional catheterisation (7.7% vs. 0%, p=.04) and catheter dysfunction was higher in the latter (79% vs. 3.8%, p<.0001). The cost-effectiveness ratio of the guided catheterisation was 153.9, and 484.6 for the conventional one. The incremental cost-effectiveness ratio was 45.5. The sensitivity analysis showed a 2.6 increase in the cost-effectiveness ratio of the guided catheterisation and 47 in the conventional one. CONCLUSIONS: The use of ultrasound to guide umbilical catheterisation is more efficient than conventional catheterisation since, despite using more economic resources, it offers greater effectiveness.
Asunto(s)
Cateterismo Venoso Central/métodos , Costos de la Atención en Salud/estadística & datos numéricos , Ultrasonografía Intervencional/economía , Venas Umbilicales , Cateterismo Venoso Central/economía , Análisis Costo-Beneficio , Femenino , Humanos , Recién Nacido , Masculino , México , Estudios RetrospectivosRESUMEN
BACKGROUND AND AIMS: Temporal occlusion of the hepatoduodenal ligament (HDL) is often used during liver surgeries in order to reduce blood loss, resulting in ischemia/reperfusion injury (I/R). The aim of the study was to investigate the effects of atorvastatin (ATOR) on hepatic I/R injury and on serum levels of tumor necrosis factor-alpha (TNF-α), endothelin-1 (ET-1), antithrombin III (ATIII) and intracellular adhesion molecule-1 (ICAM-1). METHODS: Liver ischemia was induced in Wistar rats by clamping the HDL for 60 min, followed by either 60 or 180 min reperfusion. Rats received either vehicle or 10 mg/kg ATOR before hepatic I/R. Control group received sham surgery. Livers were examined for histological damage and serum AST, ALT, TNF-α, ET-1, ATIII and ICAM-1 concentrations were measured. RESULTS: After I/R, AST and ALT were significantly elevated, ATIII levels were significantly depleted, both TNF-α and ICAM-1 levels increased and ET-1 was significantly elevated (at 180 min). ATOR pretreatment attenuated these alterations and diminished histological injury scores. CONCLUSIONS: Our results show that ATOR protects the liver from I/R injury.
Asunto(s)
Ácidos Heptanoicos/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hígado/efectos de los fármacos , Pirroles/uso terapéutico , Daño por Reperfusión/tratamiento farmacológico , Animales , Antitrombina III/análisis , Atorvastatina , Endotelina-1/sangre , Molécula 1 de Adhesión Intercelular/sangre , Hígado/irrigación sanguínea , Hígado/patología , Masculino , Ratas Wistar , Daño por Reperfusión/sangre , Daño por Reperfusión/patología , Factor de Necrosis Tumoral alfa/sangreRESUMEN
OBJECTIVE: It is essential to identify a serological marker of injury in order to study the pathophysiology of intestinal ischemia reperfusion. In this work, we studied the evolution of several serological markers after intestinal ischemia reperfusion injury in rats. The markers of non-specific cell damage were aspartate aminotransferase, alanine aminotransaminase, and lactic dehydrogenase, the markers of inflammation were tumor necrosis factor alpha, interleukin-6, and interleukin-1 beta, and the markers of intestinal mucosal damage were intestinal fatty acid binding protein and D-lactate. We used Chiús classification to grade the histopathological damage. METHODS: We studied 35 Wistar rats divided into groups according to reperfusion time. The superior mesenteric artery was clamped for 30 minutes, and blood and biopsies were collected at 1, 3, 6, 12, 24, and 48 hours after reperfusion. We plotted the mean ± standard deviation and compared the baseline and maximum values for each marker using Student's t-test. RESULTS: The maximum values of interleukin-1 beta and lactic dehydrogenase were present before the maximal histopathological damage. The maximum tumor necrosis factor alpha and D-lactate expressions coincided with histopathological damage. Alanine aminotransaminase and aspartate aminotransferase had a maximum expression level that increased following the histopathological damage. The maximum expressions of interluken-6 and intestinal fatty acid binding protein were not significantly different from the Sham treated group. CONCLUSION: For the evaluation of injury secondary to acute intestinal ischemia reperfusion with a 30 minute ischemia period, we recommend performing histopathological grading, quantification of D-lactate, which is synthesized by intestinal bacteria and is considered an indicator of mucosal injury, and quantification of tumor necrosis factor alpha as indicators of acute inflammation three hours after reperfusion.
Asunto(s)
Biomarcadores/sangre , Intestinos/irrigación sanguínea , Daño por Reperfusión/sangre , Animales , Aspartato Aminotransferasas/sangre , Biopsia , Citocinas/sangre , Modelos Animales de Enfermedad , Proteínas de Unión a Ácidos Grasos/sangre , Femenino , Intestinos/patología , Lactato Deshidrogenasas/sangre , Ratas , Ratas Wistar , Valores de Referencia , Factores de TiempoRESUMEN
OBJECTIVE: It is essential to identify a serological marker of injury in order to study the pathophysiology of intestinal ischemia reperfusion. In this work, we studied the evolution of several serological markers after intestinal ischemia reperfusion injury in rats. The markers of non-specific cell damage were aspartate aminotransferase, alanine aminotransaminase, and lactic dehydrogenase, the markers of inflammation were tumor necrosis factor alpha, interleukin-6, and interleukin-1 beta, and the markers of intestinal mucosal damage were intestinal fatty acid binding protein and D-lactate. We used Chiús classification to grade the histopathological damage. METHODS: We studied 35 Wistar rats divided into groups according to reperfusion time. The superior mesenteric artery was clamped for 30 minutes, and blood and biopsies were collected at 1, 3, 6, 12, 24, and 48 hours after reperfusion. We plotted the mean ± standard deviation and compared the baseline and maximum values for each marker using Student's t-test. RESULTS: The maximum values of interleukin-1 beta and lactic dehydrogenase were present before the maximal histopathological damage. The maximum tumor necrosis factor alpha and D-lactate expressions coincided with histopathological damage. Alanine aminotransaminase and aspartate aminotransferase had a maximum expression level that increased following the histopathological damage. The maximum expressions of interluken-6 and intestinal fatty acid binding protein were not significantly different from the Sham treated group. CONCLUSION: For the evaluation of injury secondary to acute intestinal ischemia reperfusion with a 30 minute ischemia period, we recommend performing histopathological grading, quantification of D-lactate, which is synthesized by intestinal bacteria and is considered an indicator of mucosal injury, and quantification of tumor necrosis ...
Asunto(s)
Animales , Femenino , Ratas , Biomarcadores/sangre , Intestinos/irrigación sanguínea , Daño por Reperfusión/sangre , Aspartato Aminotransferasas/sangre , Biopsia , Citocinas/sangre , Modelos Animales de Enfermedad , Proteínas de Unión a Ácidos Grasos/sangre , Intestinos/patología , Lactato Deshidrogenasas/sangre , Ratas Wistar , Valores de Referencia , Factores de TiempoRESUMEN
After peripheral nerve injury, a process of axonal degradation, debris clearance, and subsequent regeneration is initiated by complex local signaling, called Wallerian degeneration (WD). This process is in part mediated by neuroglia as well as infiltrating inflammatory cells and regulated by inflammatory mediators such as cytokines, chemokines, and the activation of transcription factors also related to the inflammatory response. Part of this neuroimmune signaling is mediated by the innate immune system, including arachidonic acid (AA) derivatives such as prostaglandins and leukotrienes. The enzymes responsible for their production, cyclooxygenases and lipooxygenases, also participate in nerve degeneration and regeneration. The interactions between signals for nerve regeneration and neuroinflammation go all the way down to the molecular level. In this paper, we discuss the role that AA derivatives might play during WD and nerve regeneration, and the therapeutic possibilities that arise.
Asunto(s)
Ácido Araquidónico/farmacología , Ciclooxigenasa 2/metabolismo , Regeneración Nerviosa , Nervios Periféricos/efectos de los fármacos , Degeneración Walleriana/metabolismo , Ácido Araquidónico/metabolismo , Inhibidores de la Ciclooxigenasa/farmacología , Eicosanoides/metabolismo , Humanos , Inflamación/metabolismo , Mediadores de Inflamación/metabolismo , Leucotrienos/metabolismo , Traumatismos de los Nervios Periféricos/tratamiento farmacológico , Traumatismos de los Nervios Periféricos/metabolismo , Nervios Periféricos/metabolismo , Fosfolipasas/metabolismo , Prostaglandinas/metabolismo , Transducción de Señal , Degeneración Walleriana/tratamiento farmacológicoRESUMEN
PURPOSE: Intestinal ischemia reperfusion (I/R) induces severe injury and significant mortality. New therapeutic interventions are needed; ketamine is an anesthetic with anti-inflammatory properties, which has shown protective effects on I/R in various organs. This study investigated effects of ketamine on intestinal I/R injury. METHODS: Male Wistar rats underwent either sham surgery or 30 min of intestinal ischemia followed by 60 min reperfusion. Ketamine pretreatment was administered by intraperitoneal injections at doses of 100, 50, 12.5, or 6.25 mg/kg. The intestinal morphology, mucosal damage, leukocyte infiltration, serum P-selectin, serum intracellular adhesion molecule-1 (ICAM-1), serum antithrombin-III (ATIII), and myenteric ganglion cell structure were evaluated. RESULTS: Intestinal I/R led to severe mucosal damage, leukocyte (especially neutrophil) infiltration, P-selectin and ICAM-1 elevations, ATIII depletion, and myenteric ganglion cell morphological alterations. The ketamine dose dependently diminished these alterations (except for ICAM-1 serum levels), reaching statistical significance at 100, 50, and 12.5 mg/kg. CONCLUSIONS: Ketamine protects the intestine against I/R injury. Ketamine anesthesia has been recommended for clinical situations of sepsis and hemodynamic instability, both frequent during intestinal I/R. The clinical application of ketamine in situations of intestinal I/R warrants consideration.
Asunto(s)
Antagonistas de Aminoácidos Excitadores/uso terapéutico , Inflamación/prevención & control , Intestinos/irrigación sanguínea , Isquemia/tratamiento farmacológico , Ketamina/uso terapéutico , Daño por Reperfusión/prevención & control , Análisis de Varianza , Animales , Antitrombina III/análisis , Modelos Animales de Enfermedad , Antagonistas de Aminoácidos Excitadores/administración & dosificación , Antagonistas de Aminoácidos Excitadores/farmacología , Inyecciones Intraperitoneales , Molécula 1 de Adhesión Intercelular/sangre , Intestinos/efectos de los fármacos , Intestinos/patología , Isquemia/complicaciones , Ketamina/administración & dosificación , Ketamina/farmacología , Masculino , Plexo Mientérico/patología , Selectina-P/sangre , Ratas , Ratas Wistar , Receptores de N-Metil-D-Aspartato/antagonistas & inhibidoresRESUMEN
Wallerian degeneration, the self-destructive set of cellular and molecular processes by which degenerating axons and myelin are cleared after injury, is initiated by macrophages and Schwann cells. Molecular inflammatory mediators such as cytokines (IL-1, IL-6, IL-10, and TNF-alpha, among others), transcription factors (NF-kappaB, c-Jun), the complement system and arachidonic acid metabolites have been shown to modulate these processes in various studies. However, the exact role that each of these mediators plays during axonal degeneration and regeneration has not been fully established. Understanding the molecular basis of these interactions between the immune system and peripheral nerve injury would open the possibility of targeting these inflammatory mediators as therapeutic interventions. In this review we attempt to integrate the current evidence generated around this issue, and to explore the therapeutic possibilities that arise.
Asunto(s)
Mediadores de Inflamación/fisiología , Inflamación/fisiopatología , Regeneración Nerviosa/fisiología , Nervios Periféricos/fisiopatología , Degeneración Walleriana/fisiopatología , Animales , Humanos , Inflamación/inmunología , Inflamación/metabolismo , Nervios Periféricos/inmunología , Nervios Periféricos/metabolismo , Degeneración Walleriana/inmunología , Degeneración Walleriana/metabolismoRESUMEN
BACKGROUND AND AIMS: Intestinal ischemia/reperfusion (I/R) is a common clinical entity with severe consequences. We studied the effects of ketamine and the participation of the myenteric plexus in I/R injury. METHODS: Rats were divided into six groups: sham, IR (30 min ischemia/60 min reperfusion), KET+IR (50 mg/kg i.p. ketamine injection before I/R), DEN (myenteric plexus ablated with benzalkonium chloride (BAC) and sham operation performed), DEN+IR (BAC treated and I/R induced), and DEN+KET+IR (BAC treated, ketamine administered, and I/R induced). Serum concentrations of p-selectin, intracellular adhesion molecule-1 (ICAM-1), and antithrombin III (ATIII) were measured, and tissue samples were obtained for histological analysis. RESULTS: IR group had higher intestinal mucosa injury and elevated serum concentrations of ICAM-1 and p-selectin, as well as ATIII depletion, compared with sham group (P < 0.05). In KET+IR group these alterations were significantly reduced (P < 0.05). DEN group showed ICAM-1 elevations when compared with sham group (P < 0.05), and DEN+IR group showed no difference in any parameter compared with IR group. However, ketamine administration in group DEN+KET+IR had no effect on any parameter when compared with DEN+IR group. CONCLUSIONS: Ketamine was able to diminish alterations induced by I/R. Myenteric plexus ablation with BAC treatment alone had no effects on intestinal I/R injury. However, this procedure abolished ketamine's protective effects. Ketamine seems to require an intact enteric nervous system to exert its protective action.
Asunto(s)
Compuestos de Benzalconio/farmacología , Intestinos/irrigación sanguínea , Ketamina/farmacología , Plexo Mientérico/efectos de los fármacos , Daño por Reperfusión/tratamiento farmacológico , Animales , Antitrombina III/metabolismo , Biomarcadores/sangre , Modelos Animales de Enfermedad , Inmunohistoquímica , Molécula 1 de Adhesión Intercelular/sangre , Molécula 1 de Adhesión Intercelular/metabolismo , Mucosa Intestinal/irrigación sanguínea , Mucosa Intestinal/efectos de los fármacos , Mucosa Intestinal/patología , Precondicionamiento Isquémico/métodos , Masculino , Selectina-P/sangre , Selectina-P/metabolismo , Distribución Aleatoria , Ratas , Ratas Wistar , Valores de Referencia , Daño por Reperfusión/sangre , Daño por Reperfusión/patología , Sensibilidad y EspecificidadRESUMEN
Renal ischemia/reperfusion (I/R) occurs during shock and transplant procedures, greatly affecting outcome. A definitive treatment has not been found. One of the pathophysiological bases of renal I/R injury is the activation of the transcription factor nuclear factor-kappaB (NF-KappaB). We studied the effects of sulfasalazine (SFZ), a NF-kappaB inhibitor, over renal injury in a bilateral renal I/R model in rats. Ten male Wistar rats were subjected to bilateral renal I/R for 45 min followed by 24 h of reperfusion. Half of these received 100 mg/kg SFZ orally before the induction of I/R, while the others received only saline. Five rats served as sham-operated controls. At the end of the reperfusion period, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), blood urea nitrogen (BUN), P-selectin, tumor necrosis factor-alpha (TNF-alpha), intracellular adhesion molecule-1 (ICAM-1), and endothelin-1 (ET-1) concentrations were determined in serum, and renal samples were taken for histological evaluation. After renal I/R, AST, LDH, BUN, TNF-alpha, ICAM-1, and ET-1 serum levels were significantly increased, and tubules were severely damaged on histological analysis, compared to sham controls. SFZ treatment reduced the AST, LDH, BUN, TNF-alpha, and ET-1 elevations, as well as the tubular damage, induced by renal I/R. Serum ICAM-1 and P-selectin were unchanged. These results show that SFZ has a protective effect over renal IR injury. The modulation of adhesion molecules probably does not play a part in these effects, but TNF-alpha and ET-1 modulation could be partly responsible for the effects we observed.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Enfermedades Renales/terapia , Daño por Reperfusión/terapia , Sulfasalazina/uso terapéutico , Animales , Modelos Animales de Enfermedad , Enfermedades Renales/prevención & control , Masculino , FN-kappa B/antagonistas & inhibidores , Ratas , Ratas Wistar , Daño por Reperfusión/prevención & controlRESUMEN
Intestinal ischemia/reperfusion causes severe injury and alters motility. N-methyl-D-aspartate (NMDA) receptor antagonists have been shown to reduce ischemia/reperfusion injury in the nervous system, and in other organs. In this study, we set out to investigate the effects of NMDA receptor antagonists over intestinal ischemia/reperfusion injury. Male Wistar rats were randomly divided into four groups: (1) a control, sham-operated group; (2) an intestinal ischemia/reperfusion group subjected to 45 min ischemia and 1h reperfusion; (3) a group treated with 10 mg/kg ketamine before ischemia/reperfusion; and (4) a group treated with 10 mg/kg memantine before ischemia/reperfusion. Intestinal samples were taken for histological evaluation. Serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), malondialdehyde (MDA), total antioxidant capacity, tumor necrosis factor alpha (TNF-alpha), P-selectin and antithrombin III (ATIII) were measured. Intestinal transit time was determined to evaluate intestinal motility. Fecal pellet output and animal weight were also registered daily for 7 days post-ischemia. After reperfusion, AST, LDH, TNF-alpha and P-selectin levels were elevated, ATIII levels were depleted, and ALT levels were unchanged in serum. Additionally, levels of MDA were increased and total antioxidant capacity was reduced in serum, indicating oxidative stress. Intestinal mucosa showed severe injury. Ketamine, but not memantine, diminished these alterations. Intestinal motility and fecal pellet output were also altered after ischemia/reperfusion. Both drugs abolished the alterations in motility. In conclusion, ketamine's protective effects over ischemia/reperfusion do not appear to be NMDA mediated, but they could be playing a role in protecting the intestine against ischemia-induced functional changes.
Asunto(s)
Intestinos/efectos de los fármacos , Intestinos/patología , Ketamina/farmacología , Memantina/farmacología , Receptores de N-Metil-D-Aspartato/antagonistas & inhibidores , Daño por Reperfusión/prevención & control , Alanina Transaminasa/sangre , Animales , Antioxidantes/metabolismo , Antitrombina III/metabolismo , Aspartato Aminotransferasas/sangre , Biomarcadores/sangre , Peso Corporal/efectos de los fármacos , Heces , Motilidad Gastrointestinal/efectos de los fármacos , Mucosa Intestinal/efectos de los fármacos , Mucosa Intestinal/metabolismo , Mucosa Intestinal/patología , Intestinos/fisiopatología , L-Lactato Deshidrogenasa/sangre , Masculino , Malondialdehído/sangre , Estrés Oxidativo/efectos de los fármacos , Selectina-P/sangre , Ratas , Ratas Wistar , Daño por Reperfusión/sangre , Daño por Reperfusión/patología , Daño por Reperfusión/fisiopatología , Factores de Tiempo , Factor de Necrosis Tumoral alfa/sangreRESUMEN
AIM: To investigate the differences in injury patterns caused by arterial, venous or arteriovenous mesenteric occlusion. METHODS: Male Wistar rats were separated equally into four groups. Occlusion was performed by clamping the superior mesenteric artery (A), the mesenteric vein (V) or both (AV) for 30 min, followed by 60 min of reperfusion. A control group received sham surgery only. Intestinal sections were examined for histological damage and serum tumor necrosis factor-alpha (TNF-alpha), endothelin-1 (ET-1), P-selectin, antithrombin III (ATIII) and soluble intracellular adhesion molecule-1 (ICAM-1) concentrations were measured. RESULTS: All groups showed significant mucosal injury compared to controls. Furthermore, mucosal injury was significantly more severe in the V and AV groups compared to the A group (3.6 +/- 0.55, 3.4 +/- 0.55 and 2 +/- 0.71, respectively P = 0.01). ICAM-1 was similarly elevated in all groups, with no significant differences between the groups. P-selectin levels were significantly elevated in the V and AV groups but not the A group (1.4 +/- 0.5 ng/mL, 2.52 +/- 0.9 ng/mL and 0.02 +/- 0.01 ng/mL, respectively, P = 0.01) and ET-1 was significantly elevated in the A and V groups but not the AV group (0.32 +/- 0.04 pg/mL, 0.36 +/- 0.05 pg/mL and 0.29 +/- 0.03 pg/mL, respectively, P = 0.01) compared to sham controls. ATIII levels were markedly depleted in the V and AV groups, but not in the A group (29.1 +/- 5.2 pg/mL, 31.4 +/- 21.8 pg/mL and 55.8 +/- 35.6 pg/mL, respectively, P = 0.01), compared to controls. Serum TNF-alpha was significantly increased in all groups compared to sham controls (1.32 +/- 0.87 ng/mL, 1.79 +/- 0.20 ng/mL and 4.4 +/- 0.69 ng/mL, for groups A, V and AV, respectively, P = 0.01), with higher values in the AV group. CONCLUSION: Different patterns of response to ischemia/reperfusion are associated with venous, arterial or arteriovenous occlusion. Venous and arteriovenous occlusion was associated with the most severe alterations.