RESUMO
La isquemia mesentérica aguda (IMA) es una emergencia médico-quirúrgica poco frecuente con alta morbimortalidad. Corresponde a una interrupción brusca del aporte sanguíneo a un segmento del intestino, produciendo isquemia, daño celular, necrosis intestinal y eventualmente la muerte. La principal etiología de este cuadro es la oclusión arterial de tipo embólica, seguida por la trombótica, no oclusiva y trombótica venosa. Es una patología infrecuente con una incidencia baja, de 12 por 100.000 habitantes en series internacionales. Su principal síntoma es el dolor abdominal tipo cólico de comienzo brusco, vómitos y diarrea, esta última sucediendo posteriormente. En el examen físico se pueden constatar signos de shock y distensión abdominal. Ante la sospecha, los pacientes hemodinámicamente inestables deben ser llevados urgentemente a laparotomía exploradora, y en aquellos estables, se debe solicitar un Angio-TC para confirmar el diagnóstico y planificar el tratamiento. Existen dos métodos para tratar esta patología: la cirugía abierta y la cirugía endovascular o mínimamente invasiva. Finalmente, con el avance de estos nuevos métodos, la tasa de mortalidad ha disminuido, significativamente, en la última década.
Acute mesenteric ischemia (AMI) is a rare medical-surgical emergency that must be treated early due to its high morbidity and mortality. It corresponds to a sudden interruption of the blood supply to a segment of the intestine, producing ischemia, cell damage, intestinal necrosis and eventually death if it is not treated. The main etiology of this condition is embolic-type arterial occlusion, followed by thrombotic, nonocclusive, and venous thrombotic. It is an infrequent pathology with a low incidence of 12 per 100,000 inhabitants in international series. During the information collection, no data was found on the Chilean population since before 1983. Its main symptom is colicky abdominal pain with a sudden onset, vomiting and diarrhea that begins after the pain. On physical examination, signs of shock and abdominal distention may be noted. Hemodynamically unstable patients should be urgently taken to exploratory laparotomy as soon as the condition is suspected, and in stable patients, an angio-CT should be requested to confirm the diagnosis and plan treatment. There are two methods to treat this pathology, open surgery and endovascular or minimally invasive surgery. The form of therapy depends on the preoperative or intraoperative findings and the type of etiology. Finally, with the advancement of these new methods, the mortality rate has decreased in the last decade.
RESUMO
Resumen La isquemia mesentérica aguda se asocia a una mortalidad de entre el 50 y el 100%, la causa más rara de esta es la trombosis venosa de los vasos mesentéricos (5%) y portal (1%). Las manifestaciones clínicas son diversas, siendo el dolor abdominal el principal síntoma. La tomografía computarizada con contraste intravenoso en fase portal es la imagen más precisa para el diagnóstico. El tratamiento en fase aguda se basa en anticoagulación, fluidos intravenosos, antibióticos profilácticos, descanso intestinal y descompresión. La laparotomía de control de daños, incluida la resección intestinal y el abdomen abierto, pueden estar justificados en última instancia para pacientes con necrosis intestinal y sepsis. Caso clínico: Hombre de 35 años, sin antecedentes de importancia, solo tabaquismo desde hace 15 años. Refirió que 5 días previos comenzó a presentar dolor en el epigastrio tipo cólico, de intensidad moderada, posteriormente refirió que el dolor se generalizó y aumentó de intensidad, acompañado de náusea, vómito, intolerancia a la vía oral y alza térmica. Al examen físico tuvo datos de respuesta inflamatoria sistémica, estaba consciente y orientado, con abdomen doloroso a la palpación superficial y profunda a nivel generalizado, pero acentuado en el flanco derecho, rebote positivo con resistencia, timpanismo generalizado, peristalsis ausente. Se ingresó a quirófano a laparotomía exploradora, encontrando lesión a intestinal isquémica-necrótica a 190-240 cm del ángulo de Treitz, y 400 cc de líquido hemático; se realizó resección de la parte intestinal afectada, con entero-enteroanastomosis término-terminal manual. Se envió pieza a patología, y se reportó un proceso inflamatorio agudo con necrosis transmural y congestión vascular. Ante estos hallazgos se realizó angiotomografía abdominal que reportó defecto de llenado en la vena mesentérica superior, secundario a trombosis que se extendía hasta la confluencia y la vena porta. Conclusión: La trombosis venosa mesentérica y portal es una patología muy infrecuente en pacientes jóvenes sin factores de riesgo en los que se presenta dolor abdominal. El diagnóstico es complejo debido a que los datos clínicos y de laboratorio son poco específicos. Sin embargo, debemos tenerla en cuenta en el diagnóstico diferencial de etiologías de dolor abdominal.
Abstract Acute Mesenteric Ischemia is associated with a mortality rate between 50% and 100%; the rarest cause of this is venous thrombosis of the mesenteric (5%) and portal (1%) vessels. The clinical manifestations are diverse, with abdominal pain being the main symptom. Computed tomography with intravenous contrast in the portal phase is the most accurate image for diagnosis. Treatment in the acute phase is based on anticoagulation, intravenous fluids, prophylactic antibiotics, intestinal rest, and decompression. Damage control laparotomy, including bowel resection and open abdomen, may ultimately be warranted for patients with bowel necrosis and sepsis. Clinical case: 35-year-old man, with no significant history, only smoking for 15 years. For 5 days before, he reported crampy epigastric pain of moderate intensity. He subsequently reported that the pain became generalized and increased in intensity, accompanied by nausea, vomiting, oral intolerance, and temperature rise. The physical examination showed signs of a systemic inflammatory response, conscious and oriented, abdomen painful on superficial and deep palpation at a generalized level but accentuated on the right flank, positive rebound with resistance, generalized tympanism, absent peristalsis. The operating room was entered for exploratory laparotomy, finding an ischemic-necrotic intestinal lesion at 190 - 240 cm from the angle of Treitz, and 400cc of blood fluid. Resection of the affected intestinal part is performed, with entire manual terminal end anastomosis. The specimen was sent to pathology, reporting an acute inflammatory process with transmural necrosis and vascular congestion. Given these findings, abdominal CT angiography was performed, which reported a filling defect in the superior mesenteric vein, secondary to thrombosis that extended to the confluence and the portal vein. Conclusion: Mesenteric and portal venous thrombosis is a very rare pathology in young patients without risk factors in whom abdominal pain occurs. The diagnosis is complex because the clinical and laboratory data are not very specific. However, we must take it into account in the differential diagnosis of abdominal pain etiologies.
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It is important to investigate fast and accurate equine colic syndrome diagnostic forms. Lactate results from anaerobic glycolysis; high levels of it may indicate intestinal disorders with tissue hypoperfusion and hypoxia. The current study aims at investigating whether blood and peritoneal lactate values observed when horses with colic syndrome were hospitalized, were associated with condition type, therapeutic referral, and survival rates. Retrospective analysis was applied to 498 medical records of animals with colic syndrome, at EQUIVET Hospital -SP; 89 cases were herein selected. Based on logistic regression, peritoneal lactate played a more significant part than blood in variables like obstruction type and survival rates. Surgical cases comprised 52.8% of analyzed animals; strangulation changes, 26%; and overall survival, 62.9%. Mean blood and peritoneal lactate level in animals showing strangulation changes reached 5.11 and 7.33mmol/L, whereas non-strangulation cases recorded 3.54 and 3.06mmol/L, respectively. On the other hand, mean blood and peritoneal lactate level recorded for survivors reached 3.43 and 2.42mmol/L, whereas non-survivors recorded 4.84 and 7.13mmol/L, respectively. We concluded that peritoneal lactate measured when horses with colic syndrome were hospitalized was a predictor of condition type, and of animal survival and prognosis. However, blood and peritoneal lactate measurements did not contribute to therapeutic referral.
O estudo de formas diagnósticas rápidas e precisas é importante na síndrome cólica equina. O lactato, produto da glicólise anaeróbica, quando elevado, pode indicar afecções intestinais com hipoperfusão e hipóxia. O objetivo deste estudo foi verificar se os valores de lactato sanguíneo e peritoneal, na admissão de equinos com síndrome cólica, estão relacionados com o tipo de afecção, com o encaminhamento terapêutico e a sobrevida. Uma análise retrospectiva foi realizada em 498 atendimentos em síndrome cólica, no Hospital EQUIVET-SP, quando 89 casos foram selecionados. A regressão logística indicou que o lactato peritoneal obteve maior significância comparado ao sanguíneo, nas variáveis tipo de obstrução e sobrevida. Casos cirúrgicos foram 52,8%; alterações estrangulativas, 26%; e sobrevivência geral, 62,9%. Em alterações estrangulativas, a média do lactato sanguíneo e peritoneal foi de 5,11 e 7,33mmol/L; em não estrangulativos, 3,54 e 3,06mmol/L. Já os sobreviventes obtiveram 3,43 e 2,42mmol/L, e os não sobreviventes 4,84 e 7,13mmol/L, respectivamente. Conclui-se que a mensuração do lactato peritoneal na admissão de cavalos com cólica foi considerada um preditor do tipo de afecção, bem como da sobrevida e do prognóstico. Porém, as mensurações de lactato sanguíneo e peritoneal não auxiliaram no encaminhamento terapêutico.
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Animais , Prognóstico , Cólica/veterinária , Ácido Láctico , Doenças dos CavalosRESUMO
AIMS: The lung is an important target organ damage in intestinal ischemia/reperfusion (II/R), but mechanisms involved in II/R-induced pulmonary artery (PA) dysfunction, as well as its treatment, are not clear. The present study aimed to investigate the mechanisms involved in the II/R-induced PA dysfunction and a possible protective role of acute simvastatin pretreatment. MAIN METHODS: Male Wistar rats were subjected to occlusion of the superior mesenteric artery for 45 min followed by 2 h reperfusion (II/R) or sham-operated surgery (sham). In some rats, simvastatin (20 mg/kg, oral gavage) was administrated 1 h before II/R. KEY FINDINGS: II/R reduced acetylcholine-induced relaxation and phenylephrine-induced contraction of PA segments, which were prevented by acute simvastatin pretreatment in vivo or restored by inducible nitric oxide synthase (iNOS) inhibition in situ with 1400 W. Elevated reactive oxygen species (ROS) levels and higher nuclear translocation of nuclear factor kappa B (NFκB) subunit p65 were observed in PA of II/R rats and prevented by simvastatin. Moreover, simvastatin increased superoxide dismutase (SOD) activity and endothelial nitric oxide synthase (eNOS) expression in PA of the II/R group as well as prevented the increased levels of interleukin (IL)-1ß and IL-6 in lung explants following II/R. SIGNIFICANCE: The study suggests that pretreatment with a single dose of simvastatin prevents the II/R-induced increase of inflammatory factors and oxidative stress, as well as PA endothelial dysfunction and adrenergic hyporreactivity. Therefore, acute simvastatin administration could be therapeutic for pulmonary vascular disease in patients suffering from intestinal ischemic events.
Assuntos
Enteropatias , Isquemia Mesentérica , Traumatismo por Reperfusão , Animais , Enteropatias/tratamento farmacológico , Enteropatias/prevenção & controle , Isquemia , Masculino , Óxido Nítrico Sintase Tipo II/metabolismo , Artéria Pulmonar/metabolismo , Ratos , Ratos Wistar , Reperfusão , Traumatismo por Reperfusão/tratamento farmacológico , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/prevenção & controle , Sinvastatina/farmacologiaRESUMO
Resumen Los miomas uterinos, también conocidos como fibromas o leiomiomas, son los tumores uterinos benignos más prevalentes. Afectan a las mujeres principalmente durante sus años reproductivos y se diagnostican hasta en un 70% de las mujeres blancas y en más del 80% de las mujeres de ascendencia africana durante su vida, con una prevalencia durante el embarazo del 2% al 10%. Pueden ser asintomáticos hasta en un 70% de las pacientes, y se estima que pueden ocurrir complicaciones en aproximadamente una de cada 10 mujeres embarazadas. Se han asociado a complicaciones y resultados adversos del embarazo, según su tamaño y ubicación en el útero, y pueden manifestarse de diferentes formas. Presentamos el caso de una mujer de 30 años, con embarazo en el tercer trimestre, quien consultó por dolor abdominal, con ecografías obstétricas durante su control prenatal que reportaban miomatosis uterina, quien presentó isquemia intestinal por un vólvulo de intestino delgado versus compresión extrínseca.
Abstract Uterine fibroids, also known as fibroids or leiomyomas, are the most prevalent benign uterine tumors, affecting women mainly during their reproductive years and are diagnosed in up to 70% of white women and more than 80% of women of African descent during their lifetime, with a prevalence during pregnancy of 2% to 10%; they may be asymptomatic in up to 70% of patients, and it is estimated that complications may occur in approximately one in 10 pregnant women. They have been associated with complications and adverse pregnancy outcomes, depending on their size and location in the uterus, they can manifest in different ways. We present the case of a 30-year-old woman, pregnant in the third trimester, who consulted for abdominal pain, with obstetric ultrasound scans during her prenatal check-up reporting uterine myomatosis, who presented intestinal ischemia due to small bowel volvulus versus extrinsic compression.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Neoplasias Uterinas/complicações , Intestinos/irrigação sanguínea , Isquemia/complicações , Leiomioma/complicações , Complicações Neoplásicas na Gravidez , Volvo Intestinal/etiologiaRESUMO
OBJECTIVE: Acute mesenteric ischemia (AMI) is a surgical emergency for which delays in treatment have been closely associated with high morbidity and mortality. Although the duration of ischemia as a determinant of outcomes for AMI is well known, the objective of this study was to identify hospital-based determinants of delayed revascularization and their effects on postoperative morbidity and mortality in AMI. METHODS: All patients who underwent any surgery for AMI from a multi-center hospital system between 2010 and 2020 were divided into two groups based on timeliness of mesenteric revascularization after presentation. Early revascularization (ER) was defined as having both vascular consultation ≤12 hours of presentation and vascular surgery performed at the patient's initial operation. Delayed revascularization (DR) was defined as having either delays to vascular consultation or vascular surgery. A retrospective review of demographic and postoperative data was performed. The effect of DR on major postoperative outcomes, including 30-day and 2-year mortality, total length of bowel resection, and development of short bowel syndrome, were analyzed. Effects of delayed vascular consultation alone, delayed vascular surgery alone, no revascularization during admission, and admitting service on outcomes were also examined on subgroup analyses. RESULTS: A total of 212 patients were analyzed. Ninety-nine patients received ER, whereas the remaining 113 patients experienced a DR after hospital presentation. Among the DR group, 55 patients (25.9%) had delayed vascular consultation, whereas vascular surgery was deferred until after the initial operation in 37 patients (17.4%). Fifty-one patients (24.0%) were never revascularized during admission. DR was a significant predictor of 30-day (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.4-4.9; P = .03) and 2-year mortality (hazard ratio, 1.55, 95% CI, 1.0-2.3; P = .04). DR was also independently associated with increased bowel resection length (OR, 7.47; P < .01) and postoperative short bowel syndrome (OR, 2.4; P = .03) on multivariate analyses. When examined separately on subgroup analysis, both delayed vascular consultation (OR, 3.38; P = .03) and vascular surgery (OR, 4.31; P < .01) independently increased risk of 30-day mortality. Hospital discharge after AMI without mesenteric revascularization was associated with increased risk of short bowel syndrome (OR, 2.94; P < .01) and late mortality (hazard ratio, 1.60; P = .04). CONCLUSIONS: Delayed vascular consultation and vascular surgery are both significant hospital-based determinants of postoperative mortality and short bowel syndrome in patients with AMI. Timing-based management protocols that emphasize routine evaluation by a vascular surgeon and early, definitive mesenteric revascularization should be established and widely adopted for all patients with clinically suspected AMI at presentation.
Assuntos
Isquemia Mesentérica , Oclusão Vascular Mesentérica , Síndrome do Intestino Curto , Hospitais , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/cirurgia , Oclusão Vascular Mesentérica/complicações , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/cirurgia , Estudos Retrospectivos , Fatores de Risco , Síndrome do Intestino Curto/complicações , Síndrome do Intestino Curto/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos VascularesRESUMO
Abstract Intestinal ischemia/reperfusion (I/R) causes barrier impairment and bacterial influx. This study explored the protective effects of anisodamine hydrobromide (AH) on intestinal I/R injury caused by cardiopulmonary resuscitation (CPR) after cardiac arrest (CA). After successful CPR, minipigs were randomly divided into two groups (n = 8): saline and AH (4 mg/kg), and then treated with saline or AH via central venous injection, respectively. The same procedures without ventricular fibrillation initiation were conducted in the Sham group (n = 8). Levels of interferon gamma (IFN-γ) and interleukin 4 (IL-4) were measured at different time points (0, 0.5, 1, 2, 4, and 6 h) in serum and 6 h in gut associated lymphoid tissues (GALTs) after the return of spontaneous circulation (ROSC) to evaluate changes in the proportion of T-helper type 1 (Th1) and T-helper type 2 (Th2). Moreover, the positive culture rates of GALTs were examined to evaluate bacterial translocation. AH treatment markedly alleviated aberrant arterial blood gas and hemodynamics as well as intestinal macroscopic and morphological changes after CPR. Moreover, AH treatment significantly increased IFN-γ and decreased IL-4 in both serum and GALTs. Furthermore, AH treatment dramatically decreased positive bacterial growth in GALTs. AH treatment mitigated immunosuppression caused by intestinal I/R and protected the intestinal immune barrier against bacterial translocation, thereby reducing the risk of secondary intestinal infection
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Animais , Masculino , Suínos/classificação , Porco Miniatura/classificação , Traumatismo por Reperfusão/complicações , Isquemia/patologia , Fibrilação Ventricular/tratamento farmacológico , Ferimentos e Lesões/complicações , Reperfusão/instrumentação , Reanimação Cardiopulmonar/classificaçãoRESUMO
AIM: The purpose of the study was to evaluate the effect of oral administration of n-3 polyunsaturated fatty acids in experimental ischemic enteritis in rats. METHODS: Forty Wistar rats were submitted to control narrowing of the superior mesenteric artery and were divided in two groups: N3 polyunsaturated fatty acids, which received a high-molecular polymer solution of artificial total enteral nutrition enriched with n-3 fatty acids and CONTROL which received a high-molecular polymer solution of artificial total enteral nutrition. RESULTS: Reduction of the animals' body weight was observed in both groups, but there was no difference between the two groups. Regarding the level of cytokines interleukin (IL)-1b, IL-6, and tumor necrosis factor a (TNF-a) there was no statistically significant difference between the two groups. Ischemic lesions to the small bowel mucosa were observed in both groups. A statistically significant difference in the extent of intestinal lesions was observed between the two groups with the animals that received enteral nutrition enriched with n-3 fatty acid developing fewer lesions. CONCLUSION: Enteral nutrition enriched with n-3 polyunsaturated fatty acids reduces the mucosal lesions caused by mesenteric ischemia compared to standard enteral nutrition, by modifying the local, but not the systemic, immune, and inflammatory response.
OBJETIVO: El propósito del estudio fue evaluar el efecto de la administración oral de ácidos grasos poliinsaturados n-3 en enteritis isquémica experimental en ratas. MÉTODOS: 40 ratas Wistar fueron sometidas a un estrechamiento controlado de la arteria mesentérica superior y se dividieron en dos grupos: N3PUFA, que recibieron una solución de polímero de alto peso molecular de nutrición enteral total artificial enriquecida con ácidos grasos n-3 y CONTROL que recibió un alto -Solución de polímero molecular de nutrición enteral total artificial. RESULTADOS: Se observó una reducción del peso corporal de los animales en ambos grupos, pero no hubo diferencias entre los dos grupos. Con respecto al nivel de citocinas IL-1b, IL-6 y TNF-a, no hubo diferencia estadísticamente significativa entre los dos grupos. Se observaron lesiones isquémicas de la mucosa del intestino delgado en ambos grupos. Se observó una diferencia estadísticamente significativa en la extensión de las lesiones intestinales entre los dos grupos y los animales que recibieron nutrición enteral enriquecida con ácido graso n-3 desarrollaron menos lesiones. CONCLUSIÓN: La nutrición enteral enriquecida con ácidos grasos poliinsaturados n-3 reduce las lesiones mucosas causadas por isquemia mesentérica en comparación con la nutrición enteral estándar, al modificar la respuesta local, pero no sistémica, inmunitaria e inflamatoria.
Assuntos
Enterite , Ácidos Graxos Ômega-3 , Isquemia Mesentérica , Administração Oral , Animais , Enterite/tratamento farmacológico , Enterite/etiologia , Ácidos Graxos Ômega-3/farmacologia , Mucosa Intestinal , Ratos , Ratos WistarRESUMO
Intestinal ischemia is a vascular emergency that arises when blood flow to the intestine is compromised. Reperfusion is necessary to restore intestinal function but might lead to local and systemic inflammatory responses and bacterial translocation, with consequent multiple organ dysfunction syndrome (MODS). During reperfusion occurs production of reactive oxygen species. These species contribute to intestinal injury through direct toxicity or activation of inflammatory pathways. Fullerol is a nanacomposite which has been shown to act as reactive oxygen species and reactive nitrogen species (RNS) scavengers. Thus, our aim was to evaluate whether Fullerol confer anti-inflammatory activity during intestinal ischemia and reperfusion (IIR). Intestinal ischemia was induced by total occlusion of the superior mesenteric artery. Groups were treated with vehicle or Fullerol 10 min before reperfusion. Mice were euthanized after 6 h of reperfusion, and small intestines were collected for evaluation of plasma extravasation, leukocyte influx, cytokine production and histological damage. Bacterial translocation to the peritoneal cavity and reactive oxygen and nitrogen species production by lamina propria cells were also evaluated. Our results showed that treatment with Fullerol inhibited bacterial translocation to the peritoneal cavity, delayed and decreased the lethality rates and diminished neutrophil influx and intestinal injury induced by IIR. Reduced severity of reperfusion injury in Fullerol-treated mice was associated with blunted reactive oxygen and nitrogen species production in leukocytes isolated from gut lamina propria and decreased production of pro-inflammatory mediators. Thus, the present study shows that Fullerol is a potential therapy to treat inflammatory bowel disorders associated with bacterial translocation, such as IIR.
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Anti-Inflamatórios/farmacologia , Antioxidantes/farmacologia , Fulerenos/farmacologia , Intestinos/irrigação sanguínea , Intestinos/efeitos dos fármacos , Isquemia Mesentérica/tratamento farmacológico , Nanocompostos , Traumatismo por Reperfusão/prevenção & controle , Animais , Translocação Bacteriana/efeitos dos fármacos , Citocinas/metabolismo , Modelos Animais de Doenças , Mediadores da Inflamação/metabolismo , Intestinos/microbiologia , Intestinos/patologia , Masculino , Isquemia Mesentérica/metabolismo , Isquemia Mesentérica/microbiologia , Isquemia Mesentérica/patologia , Camundongos Endogâmicos C57BL , Infiltração de Neutrófilos/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Permeabilidade , Espécies Reativas de Nitrogênio/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/microbiologia , Traumatismo por Reperfusão/patologia , Índice de Gravidade de DoençaRESUMO
Acute lung injury induced by intestinal ischemia/reperfusion (I/R) is a relevant clinical condition. Acetylcholine (ACh) and the α7 nicotinic ACh receptor (nAChRα-7) are involved in the control of inflammation. Mice with reduced levels of the vesicular ACh transporter (VAChT), a protein responsible for controlling ACh release, were used to test the involvement of cholinergic signaling in lung inflammation due to intestinal I/R. Female mice with reduced levels of VAChT (VAChT-KDHOM) or wild-type littermate controls (WT) were submitted to intestinal I/R followed by 2 h of reperfusion. Mortality, vascular permeability, and recruitment of inflammatory cells into the lung were investigated. Parts of mice were submitted to ovariectomy (OVx) to study the effect of sex hormones or treated with PNU-282,987 (nAChRα-7 agonist). A total of 43.4% of VAChT-KDHOM-I/R mice died in the reperfusion period compared to 5.2% of WT I/R mice. The I/R increased lung inflammation in both genotypes. In VAChT-KDHOM mice, I/R increased vascular permeability and decreased the release of cytokines in the lung compared to WT I/R mice. Ovariectomy reduced lung inflammation and permeability compared to non-OVx, but it did not avoid mortality in VAChT-KDHOM-I/R mice. PNU treatment reduced lung permeability, increased the release of proinflammatory cytokines and the myeloperoxidase activity in the lungs, and prevented the increased mortality observed in VAChT-KDHOM mice. Cholinergic signaling is an important component of the lung protector response against intestinal I/R injury. Decreased cholinergic signaling seems to increase pulmonary edema and dysfunctional cytokine release that increased mortality, which can be prevented by increasing activation of nAChRα-7.
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Intestinos/metabolismo , Edema Pulmonar/metabolismo , Edema Pulmonar/mortalidade , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/mortalidade , Proteínas Vesiculares de Transporte de Acetilcolina/metabolismo , Animais , Feminino , Mediadores da Inflamação/metabolismo , Intestinos/irrigação sanguínea , Camundongos , Camundongos Transgênicos , Ovariectomia/efeitos adversos , Ovariectomia/mortalidadeRESUMO
OBJECTIVES: The current study compared the impact of pretreatment with melatonin and N-acetylcysteine (NAC) on the prevention of rat lung damage following intestinal ischemia-reperfusion (iIR). METHODS: Twenty-eight Wistar rats were subjected to intestinal ischemia induced by a 60 min occlusion of the superior mesenteric artery, followed by reperfusion for 120 min. Animals were divided into the following groups (n=7 per group): sham, only abdominal incision; SS+iIR, pretreated with saline solution and iIR; NAC+iIR, pretreated with NAC (20 mg/kg) and iIR; MEL+iIR, pretreated with melatonin (20 mg/kg) and iIR. Oxidative stress and inflammatory mediators were measured and histological analyses were performed in the lung tissues. RESULTS: Data showed a reduction in malondialdehyde (MDA), myeloperoxidase (MPO), and TNF-alpha in the animals pretreated with NAC or MEL when compared to those treated with SS+iIR (p<0.05). An increase in superoxide dismutase (SOD) levels in the NAC- and MEL-pretreated animals as compared to the SS+iIR group (34±8 U/g of tissue; p<0.05) was also observed. TNF-α levels were lower in the MEL+iIR group (91±5 pg/mL) than in the NAC+iIR group (101±6 pg/mL). Histological analysis demonstrated a higher lung lesion score in the SS+iIR group than in the pretreated groups. CONCLUSION: Both agents individually provided tissue protective effect against intestinal IR-induced lung injury, but melatonin was more effective in ameliorating the parameters analyzed in this study.
Assuntos
Animais , Ratos , Traumatismo por Reperfusão/prevenção & controle , Lesão Pulmonar Aguda/etiologia , Lesão Pulmonar Aguda/prevenção & controle , Melatonina/uso terapêutico , Acetilcisteína/uso terapêutico , Reperfusão , Ratos Wistar , IsquemiaRESUMO
Resumen: La trombosis mesentérica representa una urgencia vascular condicionada por la interrupción abrupta del flujo sanguíneo, ya sea arterial o venoso; el cuadro clínico puede ser inespecífico, lo cual puede representar un reto diagnóstico. De acuerdo con su etiología vascular, se requiere un enfoque terapéutico diferente. Si hay sospecha clínica o signos de peritonitis, el diagnóstico por imagen puede apoyar a identificar la patología presentada. En esta ocasión, se presenta caso clínico de una paciente de 84 años que acude al servicio de urgencias por dolor abdominal generalizado, que condujo a la realización de un estudio de imagen diagnóstico para confirmar tal hallazgo.
Abstract: Mesenteric thrombosis represents a vascular urgency caused by the abrupt interruption of blood flow, whether arterial or venous; clinical presentation can be nonspecific, which can represent a diagnostic challenge. According to its vascular etiology, a different therapeutic approach is required. If there is clinical suspicion or signs of peritonitis, the imaging diagnosis can support to identify the presented pathology. On this occasion, there is a clinical case of an 84-year-old patient who goes to the emergency department for generalized abdominal pain, which led to a diagnostic imaging study, to confirm this finding.
RESUMO
Despite the development of modern medicine, alternative medicine, which has not lost its timeliness, remains attractive for the treatment of various diseases. Glabridin, a major flavonoid of Glycyrrhiza glabra, is known for its antioxidant and anti-inflammatory activity. The aim of this study was: 1) to determine the possible protective role of glabridin against ischemia/reperfusion (I/R) injury of the intestine; 2) to evaluate the in vitrocontractile responses of ileum smooth muscles to acetylcholine after an intestinal I/R; and 3) to explain the underlying molecular mechanism of its effect. Rats were assigned to groups of six rats each; 1) I/R, 2) gla10, 3) gla20, 4) gla40, 5) N5-[imino(nitroamino)methyl]-L-ornithine, methyl ester monohydrochloride (L-NAME)+gla40, and 6) Sham group. The healing effect of glabridin was abolished by L-NAME. Glabridin did not cause contractility of the smooth muscles to acetylcholine-induced contractile responses in intestinal I/R. Yet, it increased to spontaneous basal activity.
A pesar del desarrollo de la medicina moderna, la medicina alternativa, sin perder su vigencia, sigue siendo atractiva para el tratamiento de varias enfermedades. Glabradina, el flavonoide mayoritario de Glycyrrhiza glabra, es conocido por su actividad antioxidante y antiinflamatoria. Los propósitos de este estudio fueron: 1) Determinar el posible rol protector de glabradina ante daños intestinales por isquemia/reperfusion (I/R) 2) Evaluar in vitrolas respuestas de contracción de los músculos lisos del ileum ante acetilcolina después de I/R intestinal; y 3) Explicar el mecanismo molecular subyacente de este efecto. Se asignaron grupos de seis ratas: 1) I/R, 2) gla10, 3) gla20, 4) gla40, 5) N5-[imino(nitroamino)metil]-L-ornithina, metil ester monohidrochloruro (L-NAME)+gla40, y 6) Grupo testigo. El efecto curativo de glabridina fue abolido por L-NAME. Glabridina no causó contracción en el músculo liso como respuesta acetilcolina-inducida I/R. Además, incrementa la actividad basal expontánea.
Assuntos
Animais , Ratos , Fenóis/administração & dosagem , Traumatismo por Reperfusão/tratamento farmacológico , AMP Cíclico/metabolismo , Glycyrrhiza , Isoflavonas/administração & dosagem , Fenóis/farmacologia , Ratos Wistar , AMP Cíclico/análise , GMP Cíclico/metabolismo , Estresse Oxidativo/efeitos dos fármacos , NG-Nitroarginina Metil Éster , Íleo/efeitos dos fármacos , Íleo/química , Isoflavonas/farmacologia , Malondialdeído/análise , Músculo Liso/efeitos dos fármacosRESUMO
The present study aimed to establish a methodology capable to cause intestinal ischemia and reperfusion injuries, to perform clamping of the jejunal segment of the extramural peri-intestinal marginal artery branch. For this, 37, 10-week-old male New Zealand breed rabbits were used. One rabbit was used to establish the anatomic references for the procedure and was not part of the six experimental groups; the rest were allocated into six experimental groups: Sham group, negative control, subjected only to midline celiotomy; group I1H undergoing vascular occlusion for an hour; group I2H submitted to vascular occlusion for two hours; group I1H/R2H undergoing vascular occlusion for one hour followed by two hours of reperfusion; group I2H/R1H undergoing vascular occlusion for two hours, followed by reperfusion for one hour, and group I2H/R5H undergoing vascular occlusion for two hours followed by reperfusion for five hours. The rabbits were evaluated for the macroscopic aspects (color and peristalsis) of the jejunal segment, as well as the histological aspect, checking for presence or absence of mucosal destruction, edema, hemorrhaging, lymphatic vessel dilatation, and the presence of polymorphonuclear cells. It was observed that the macroscopic and histopathological lesions accentuated in larger employed ischemia and reperfusion times. Rabbits subjected to ischemia for two hours followed by reperfusion for five hours (I2H/R5H) made up the experimental group which was easily reproducible and showed moderate intestinal injury, different from the other groups.(AU)
O presente estudo objetivou estabelecer uma metodologia capaz de causar lesões de isquemia e reperfusão intestinal, realizando clipagem de um ramo de artéria marginal peri-intestinal extramural em segmento jejunal. Para tal foram utilizados 37 coelhos da raça Nova Zelândia, machos, de 10 semanas de idade, alocados em seis grupos experimentais: grupo Sham, controle negativo, submetido apenas a celiotomia mediana; grupo I1H submetido à oclusão vascular por uma hora; grupo I2H submetido a oclusão vascular por duas horas; grupo I1H/R2H submetido a oclusão vascular por uma hora, seguida de reperfusão por duas horas; grupo I2H/R1H submetido a oclusão vascular por duas horas, seguida de reperfusão por uma hora e grupo I2H/R5H submetido a oclusão vascular por duas horas seguida de reperfusão por cincos horas. Os animais foram avaliados quanto o aspecto macroscópico (coloração e peristaltismo) do segmento jejunal e quanto ao aspecto histopatológico, verificando presença ou ausência de destruição de mucosa, edema, hemorragia, dilatação de vasos linfáticos e presença de polimorfonucleares. Observou-se que as lesões macroscópicas e histopatológicas se acentuaram nos maiores tempos de isquemia e reperfusão empregados. Os animais submetidos à isquemia durante duas horas, seguida de reperfusão por cinco horas (I2H/R5H) compuseram o grupo experimental de fácil reprodução e foram os que apresentaram uma lesão intestinal moderada, diferentes dos demais grupos.(AU)
Assuntos
Animais , Coelhos , Coelhos/lesões , Traumatismo por Reperfusão/veterinária , Isquemia/diagnósticoRESUMO
The present study aimed to establish a methodology capable to cause intestinal ischemia and reperfusion injuries, to perform clamping of the jejunal segment of the extramural peri-intestinal marginal artery branch. For this, 37, 10-week-old male New Zealand breed rabbits were used. One rabbit was used to establish the anatomic references for the procedure and was not part of the six experimental groups; the rest were allocated into six experimental groups: Sham group, negative control, subjected only to midline celiotomy; group I1H undergoing vascular occlusion for an hour; group I2H submitted to vascular occlusion for two hours; group I1H/R2H undergoing vascular occlusion for one hour followed by two hours of reperfusion; group I2H/R1H undergoing vascular occlusion for two hours, followed by reperfusion for one hour, and group I2H/R5H undergoing vascular occlusion for two hours followed by reperfusion for five hours. The rabbits were evaluated for the macroscopic aspects (color and peristalsis) of the jejunal segment, as well as the histological aspect, checking for presence or absence of mucosal destruction, edema, hemorrhaging, lymphatic vessel dilatation, and the presence of polymorphonuclear cells. It was observed that the macroscopic and histopathological lesions accentuated in larger employed ischemia and reperfusion times. Rabbits subjected to ischemia for two hours followed by reperfusion for five hours (I2H/R5H) made up the experimental group which was easily reproducible and showed moderate intestinal injury, different from the other groups.(AU)
O presente estudo objetivou estabelecer uma metodologia capaz de causar lesões de isquemia e reperfusão intestinal, realizando clipagem de um ramo de artéria marginal peri-intestinal extramural em segmento jejunal. Para tal foram utilizados 37 coelhos da raça Nova Zelândia, machos, de 10 semanas de idade, alocados em seis grupos experimentais: grupo Sham, controle negativo, submetido apenas a celiotomia mediana; grupo I1H submetido à oclusão vascular por uma hora; grupo I2H submetido a oclusão vascular por duas horas; grupo I1H/R2H submetido a oclusão vascular por uma hora, seguida de reperfusão por duas horas; grupo I2H/R1H submetido a oclusão vascular por duas horas, seguida de reperfusão por uma hora e grupo I2H/R5H submetido a oclusão vascular por duas horas seguida de reperfusão por cincos horas. Os animais foram avaliados quanto o aspecto macroscópico (coloração e peristaltismo) do segmento jejunal e quanto ao aspecto histopatológico, verificando presença ou ausência de destruição de mucosa, edema, hemorragia, dilatação de vasos linfáticos e presença de polimorfonucleares. Observou-se que as lesões macroscópicas e histopatológicas se acentuaram nos maiores tempos de isquemia e reperfusão empregados. Os animais submetidos à isquemia durante duas horas, seguida de reperfusão por cinco horas (I2H/R5H) compuseram o grupo experimental de fácil reprodução e foram os que apresentaram uma lesão intestinal moderada, diferentes dos demais grupos.(AU)
Assuntos
Animais , Coelhos , Coelhos/lesões , Traumatismo por Reperfusão/veterinária , Isquemia/diagnósticoRESUMO
BACKGROUND: Intestinal ischemia reperfusion is a common clinical condition that causes functional impairment. Once tight junctions are damaged, barrier function is compromised, and the intestines become a source for entry of bacterial and inflammatory mediators into the circulation, leading to systemic inflammatory response syndrome, multiple organ failure, and death. It is possible that diazoxide could protect the intestines against ischemia reperfusion. The aim of this study is to determine whether diazoxide can provide protection in a rat model of intestinal ischemia reperfusion. METHODS: A total of 32 adult male specific pathogen-free Wistar rats were randomized into three groups: a control group, n = 6; a saline group, n = 13; and a diazoxide group, n = 13. The saline and diazoxide groups underwent clamping of the superior mesenteric artery for 1 h, with samples in all the groups being collected 12 h later. RESULTS: Intestinal histology showed greater damage in the intestinal ischemia reperfusion groups. mRNA expression of zonula occludens-1 and occludin (tight junction proteins) and interleukin-6 and cyclooxygenase-2 was the highest in the Saline group. The Diazoxide group showed a reduction in aspartate aminotransferase serum levels compared with the other groups. CONCLUSIONS: Increased expression of zonula occludens-1, occludin, and cyclooxygenase-2 suggested a greater regenerative effort because of more severe lesions in the saline group. In addition, increased expression of interleukin-6 in the saline group was suggestive of inflammation, indicating that diazoxide had protective effects in the diazoxide group. Reduced aspartate aminotransferase in the diazoxide group suggested liver protection. Diazoxide protects the intestines and liver from intestinal ischemia reperfusion lesions in rats.
Assuntos
Diazóxido/farmacologia , Isquemia Mesentérica/tratamento farmacológico , Substâncias Protetoras/farmacologia , Traumatismo por Reperfusão/tratamento farmacológico , Animais , Aspartato Aminotransferases/sangue , Ciclo-Oxigenase 2/metabolismo , Diazóxido/uso terapêutico , Modelos Animais de Doenças , Coração/efeitos dos fármacos , Humanos , Interleucina-6/metabolismo , Mucosa Intestinal/irrigação sanguínea , Mucosa Intestinal/efeitos dos fármacos , Mucosa Intestinal/patologia , Fígado/efeitos dos fármacos , Fígado/patologia , Masculino , Artéria Mesentérica Superior/cirurgia , Isquemia Mesentérica/etiologia , Isquemia Mesentérica/patologia , Miocárdio/patologia , Ocludina/metabolismo , Substâncias Protetoras/uso terapêutico , Distribuição Aleatória , Ratos , Ratos Wistar , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/patologia , Organismos Livres de Patógenos Específicos , Junções Íntimas/metabolismo , Resultado do Tratamento , Proteína da Zônula de Oclusão-1/metabolismoRESUMO
The present study aimed to evaluate the efficacy of mesenchymal stem cell (MSC) infusion, derived from adipose tissue, on reduction of local and remote tissue damage caused by the event of experimental intestinal I/R in New Zealand breed rabbits. For obtaining, characterization, and cultivation of MSC derived from adipose tissue (MSC-Adp), 3 juvenile animals (four months old) were used. The cells were considered to be viable for therapy after the fourth passage (in vitro phase). For the in vivo stage, 24 young adult animals (six months old) were used, weighing approximately 3.5 kg, in which were randomly divided into two groups, called: IR treated with MSC (I2H/R5H MSC 3D; I2H/R5H MSC 7D); IR treated with PBS (I2H/R5H PBS 3D; I2H/R5H PBS 7D). The animals were anesthetized and submitted to pre-retro-umbilical midline celiotomy. The extramural peri-intestinal marginal artery was located and clamped (predetermined and standardized region) with the aid of a vascular clip, promoting a 2 hour blood flow interruption. After this period, blood flow was reestablished, inhalatory anesthesia was suspended, and the animals awaken. After 5 hours of reperfusion, the treatments were performed by intravenous infusion according to the experimental groups. The animals were evaluated 72 hours and seven days after the treatment as for the macroscopic appearance (color and peristaltism) of the jejunal segment, and by histological evaluation of the ischemic segment for the presence or absence of destruction of the intestinal mucosa, edema, bleeding, dilation of lymph vessels, and presence of polymorphonuclear inflammatory cells, both in the mucosa and submucosa. The observed results revealed that the groups treated with MSC-Adp obtained smaller mucosal and submucosal lesions when compared to the groups treated with PBS. Also, MSC-Adp treated groups obtained controlled inflammatory response and higher mitotic rate, outcomes related to the therapeutic potential of MSC. Infusion of stem cells attenuated the lesions caused by intestinal I/R in both MSC groups when compared to the group treated with PBS.(AU)
O presente estudo teve como principal objetivo avaliar a eficácia da infusão células tronco mesenquimais (CTM) derivada de tecido adiposo sobre diminuição das lesões teciduais locais e remotas, causadas pelo evento de I/R intestinal experimental, em coelhos da raça Nova Zelândia. Para obtenção, cultivo e caracterização das CTM provenientes de tecido adiposo (ADCTM) foram utilizados 3 animais jovens. As células foram consideradas viáveis para terapia a partir da quarta passagem (fase in vitro). Para etapa in vivo foram utilizados 24 animais, adulto-jovens, pesando aproximadamente 3,5kg, divididos aleatoriamente em dois grupos experimentais, denominados IR Tratado com CTM (I2H/R5H CTM 3D; I2H/R5H CTM 7D); IR Tratado PBS (I2H/R5H PBS 3D; I2H/R5H PBS 7D). Os animais foram anestesiados e submetidos à celiotomia mediana pré-retroumbilical. A artéria marginal peri-intestinal extramural foi localizada e clampeada (região predeterminada e padronizada) com auxílio de um clipe vascular, promovendo uma interrupção do fluxo sanguíneo durante 2 horas. Após esse período, o fluxo sanguíneo foi restabelecido, a anestesia inalatória suspendida e os animais despertados. Após 5 horas de reperfusão realizou-se os tratamentos por infusão endovenosa, conforme grupos experimentais. Os animais foram avaliados 72 horas e sete dias após o tratamento quanto ao aspecto macroscópico (coloração e peristaltismo) do segmento jejunal e por meio de avaliação histológica do segmento isquemiado quanto à presença ou ausência de destruição de mucosa intestinal, edema, hemorragia, dilatação de vasos linfáticos e presença de células inflamatórias polimorfornucleares, tanto em mucosa quanto submucosa. Os resultados observados revelaram que os grupos tratados com ADCTM obtiveram menores lesões em mucosa e submucosa quando comprados aos grupos tratados com PBS. Ainda os grupos tratados com ADCTM obtiveram resposta inflamatória controlada e maior taxa mitótica, resultados relacionados ao potencial terapêutico das CTM.(AU)
Assuntos
Animais , Coelhos , Coelhos/anatomia & histologia , Coelhos/genética , Coelhos/lesões , Infusões Intravenosas/veterinária , Transplante de Células-Tronco Mesenquimais/estatística & dados numéricos , Isquemia/veterináriaRESUMO
The present study aimed to evaluate the efficacy of mesenchymal stem cell (MSC) infusion, derived from adipose tissue, on reduction of local and remote tissue damage caused by the event of experimental intestinal I/R in New Zealand breed rabbits. For obtaining, characterization, and cultivation of MSC derived from adipose tissue (MSC-Adp), 3 juvenile animals (four months old) were used. The cells were considered to be viable for therapy after the fourth passage (in vitro phase). For the in vivo stage, 24 young adult animals (six months old) were used, weighing approximately 3.5 kg, in which were randomly divided into two groups, called: IR treated with MSC (I2H/R5H MSC 3D; I2H/R5H MSC 7D); IR treated with PBS (I2H/R5H PBS 3D; I2H/R5H PBS 7D). The animals were anesthetized and submitted to pre-retro-umbilical midline celiotomy. The extramural peri-intestinal marginal artery was located and clamped (predetermined and standardized region) with the aid of a vascular clip, promoting a 2 hour blood flow interruption. After this period, blood flow was reestablished, inhalatory anesthesia was suspended, and the animals awaken. After 5 hours of reperfusion, the treatments were performed by intravenous infusion according to the experimental groups. The animals were evaluated 72 hours and seven days after the treatment as for the macroscopic appearance (color and peristaltism) of the jejunal segment, and by histological evaluation of the ischemic segment for the presence or absence of destruction of the intestinal mucosa, edema, bleeding, dilation of lymph vessels, and presence of polymorphonuclear inflammatory cells, both in the mucosa and submucosa. The observed results revealed that the groups treated with MSC-Adp obtained smaller mucosal and submucosal lesions when compared to the groups treated with PBS...(AU)
O presente estudo teve como principal objetivo avaliar a eficácia da infusão células tronco mesenquimais (CTM) derivada de tecido adiposo sobre diminuição das lesões teciduais locais e remotas, causadas pelo evento de I/R intestinal experimental, em coelhos da raça Nova Zelândia. Para obtenção, cultivo e caracterização das CTM provenientes de tecido adiposo (ADCTM) foram utilizados 3 animais jovens. As células foram consideradas viáveis para terapia a partir da quarta passagem (fase in vitro). Para etapa in vivo foram utilizados 24 animais, adulto-jovens, pesando aproximadamente 3,5kg, divididos aleatoriamente em dois grupos experimentais, denominados IR Tratado com CTM (I2H/R5H CTM 3D; I2H/R5H CTM 7D); IR Tratado PBS (I2H/R5H PBS 3D; I2H/R5H PBS 7D). Os animais foram anestesiados e submetidos à celiotomia mediana pré-retroumbilical. A artéria marginal peri-intestinal extramural foi localizada e clampeada (região predeterminada e padronizada) com auxílio de um clipe vascular, promovendo uma interrupção do fluxo sanguíneo durante 2 horas. Após esse período, o fluxo sanguíneo foi restabelecido, a anestesia inalatória suspendida e os animais despertados. Após 5 horas de reperfusão realizou-se os tratamentos por infusão endovenosa, conforme grupos experimentais. Os animais foram avaliados 72 horas e sete dias após o tratamento quanto ao aspecto macroscópico (coloração e peristaltismo) do segmento jejunal e por meio de avaliação histológica do segmento isquemiado quanto à presença ou ausência de destruição de mucosa intestinal, edema, hemorragia, dilatação de vasos linfáticos e presença de células inflamatórias polimorfornucleares, tanto em mucosa quanto submucosa. Os resultados observados revelaram que os grupos tratados com ADCTM obtiveram menores lesões em mucosa e submucosa quando comprados aos grupos tratados com PBS...(AU)
Assuntos
Animais , Coelhos , Coelhos/anatomia & histologia , Coelhos/genética , Coelhos/lesões , Infusões Intravenosas/veterinária , Transplante de Células-Tronco Mesenquimais , Isquemia/veterináriaRESUMO
Portograma aéreo o portograma de aire (PA), se define como la presencia de aire en el sistema venoso portomesentérico. Neumatosis intestinal (NI) se define como la presencia de aire en la pared intestinal, independiente de su causa o localización. La principal etiología de estas alteraciones es la isquemia intestinal aguda y en general, se consideran predictores de perforación intestinal y de mal pronóstico. Un pequeño grupo de pacientes con PA y/o NI pueden evolucionar sin complicaciones e incluso cursan sin manifestaciones clínicas. Presentamos el caso de una paciente con antecedente quirúrgico inmediato de gastrectomía total y reconstrucción en Y de Roux, que evidenció en tomografía computarizada (TC) de abdomen de control PA y NI, sin alteraciones clínicas significativas asociadas.
Hepatic portal venous gas (HPVG) is defined as the presence of air in the portal venous system. Pneumatosis intestinalis (PI) is defined as the presence of air within the bowel wall, regardless of its cause or location. Its main etiology is the intestinal ischemia and are generally considered predictors of intestinal perforation and wrong prognosis. A small group of patients with HPVG and PI may have a different clinical course, without complications and clinical manifestations. We report the case of a patient with immediate surgical history of total gastrectomy and Roux-en-Y reconstruction, which showed in computed tomography (CT) of the abdomen HPVG and PI, without associated clinically significant changes.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Embolia Aérea/diagnóstico por imagem , Pneumatose Cistoide Intestinal/etiologia , Tomografia Computadorizada por Raios X , Achados Incidentais , Embolia Aérea/etiologia , Gastrectomia/efeitos adversosRESUMO
RATIONAL: Acute lung injury (ALI) is a common complication after intestinal ischemia and reperfusion (I/R) injury that can lead to acute respiratory distress syndrome (ARDS). We have previously demonstrated that females are protected against lung damage induced by intestinal I/R through an estrogen mediated mechanism. OBJECTIVES: To investigate the effect of obesity on ALI induced by intestinal I/R in female mice. METHODS: C57Bl/6 female mice were fed with a standard low-fat diet (SD) or a high-fat diet (HFD) for 9 weeks. Intestinal I/R injury was induced by a 45â¯min occlusion of the mesenteric artery followed by 2 and 24â¯h of reperfusion. RESULTS: Significant increase in lung myeloperoxidase expression (MPO) and neutrophil numbers of SD and HFD mice occurred at 2â¯h and 24â¯h of reperfusion. Furthermore, HFD mice presented a significant increase in lung eosinophil peroxidase (EPO) expression and eosinophil numbers compared to SD mice. Lung wet/dry weight ratio was significantly greater in HFD mice at 2 and 24â¯h of reperfusion, accompanied by a significant increase in the expression of inducible NO in the lung tissue and a significant decrease in arterial oxygen saturation at 24â¯h of reperfusion relative to SD mice. CONCLUSION: Obesity predisposes female mice to increased pulmonary oedema and deterioration in gas exchange, which is accompanied by an increase in iNOS expression in the lung.