Marcello Barros

Postoperative Evolution of Inflammatory Response in a Model of Suprarenal Aortic Cross-clamping with and without Hemorrhagic Shock. Systemic and Local Reactions

Surgery of the abdominal aorta generates a systemic inflammatory response (SIR), a source of operative morbidity-mortality. In the present work we attempted to evaluate the evolution of SIR in an experimental model that simulates elective and urgent surgery on the abdominal aorta. Fifteen mini-pigs divided into three groups were used. The animals were subjected to suprarenal aortic/iliac clamping and bypass with a Dacron-collagen prosthetic graft. Groups were as follows: (1) sham (only aortic dissection); (2) clamping and bypass; (3) hemorrhage of 40%, pre-clamping, and bypass. Determinations included (1) tumor necrosis factor-alpha (TNF-α) interleukin (IL)-1β, IL-6, IL-10, interferon-gamma; (2) myeloperoxidase (MPO), superoxide anion (SOA), superoxide dismutase (SOD), and malondialdehyde (MDA); (3) nitrites; (4) iNOS, (5) cell adhesion molecules (ICAM-1, VCAM-1) at 24 hours, 48 hours, and on day 7; and (6) NFκB at 48 hours. Our results point to an increase in all inflammatory variables, corroborated by their molecular regulators such as the expression of CAMs, iNOS, and NFκB. The alterations tended to normalize by day 7, after reperfusion. The results point to the great importance of SIR at all levels (molecular, nuclear, cellular, and systemic) in situations such as elective and urgent abdominal aorta surgery and the role that control of this response could represent for the future of vascular surgery.

P- and E-selectin blockade can control bacterial translocation and modulate systemic inflammatory response.

Bacterial translocation is an important phenomenon in clinical medicine and leads to an increase in patient morbidity and mortality by multiple organ failure. The selectin family plays an important role in the pathogenesis of inflammation, causing an increase in leukocyte-endothelium interactions and inducing a greater leukocytes migration. This study considered the effect of a sulfo derivative of Sialyl-Lewis(X), GM 1998-016, that will block the P- and E-selectins interaction with a ligand, the Sialyl-Lewis(X), valuing the modulation of the systemic inflammatory response and the induced translocation. Seventy-five Wistar male rats were injected intraperitoneally with Zymosan A and treated with different doses of GM 1998-016 according to study groups. Measurements of values of qualitative and quantitative microbiology, neutrophil infiltration (myeloperoxidase), oxygen free radicals (superoxide anion, superoxide dismutase, catalase, and gluthatione peroxidase), and cytokines (tumor necrosis factor-alpha and interleukin-1beta) were taken at different times after Zymosan administration. A significant decrease of bacterial translocation, both local (MLN) and systemic (p < .05), was observed, with a decrease in the neutrophil infiltration (p < .001), the oxygen free radicals production (p < .01) and the studied cytokines (p < .01). In conclusion, GM 1998-016 showed a protective effect in an in vivo experimental model of bacterial translocation, downregulating the inflammatory response and the leukocyte-endothelium interactions.

Nitric oxide prevents the bacterial translocation and inhibits the systemic inflammatory response produced by implantation of a vascular prosthesis followed by Zymosan A

Abstract.Objective and design: To evaluate the beneficial effects of exogenous NO and its levels of action in a model of SIRS/Bacterial Translocation (BT) induced by two sequential insults.Material or subjects: Eighty-six Wistar rats were submitted to different treatments and their tissue and blood samples were accessed at the end of the experiment.Treatment: Nitric Oxide was compared to Gentamicin as the tested guideline for our study.Methods: Dacron graft implantation (first insult) and subsequent administration of Zymosan A® (second insult) were performed in Wistar rats. The animals were divided into 6 groups: I) No manipulation (BASAL); II) Laparotomy (L) + mineral oil (SHAM); III) L + Graft-Zymosan (GZ) (CONTROL); IV) L + GZ + Antibiotic (A) (ASSAY I); V) L + GZ + NO (ASSAY II) and VI) L + GZ + A + NO (ASSAY III). Determinations: Survival, Bacterial Translocation, myeloperoxidase (MPO), Cytokines (TNF-α, IL-1β, IFN-γ), Oxygen Free Radical (OFR) SOA and detoxifying enzymes (SOD, Superoxide Dismutase, CAT, Catalase and GPX, Glutathione Peroxidase), Cell Adhesion Molecules, CAMs (ICAM-1, VCAM-1 and PECAM-1) and Nuclear Transcription Factor, NFκB.Results: The model established induced a mortality rate of 20% and generated BT in all samples. It also significantly increased all variables, with P < 0.001 for MPO and all Cytokines; P < 0.01 for all OFR, and P < 0.05 for CAMs and for NFκB. Treatment with A reduced mortality to 0%, significantly decreased BT, MPO, Cytokines and OFR (P < 0.05), but did not reduce CAMs or NFκB. NO, either alone or associated, reduced mortality to 0% and abolished BT, significantly decreasing nearly all the variables studied (P < 0.001 for MPO and all Cytokines; P < 0.01 for OFR, and P < 0.05 for CAMs and for NFκB).Conclusions: The exogenous administration of NO before the two sequential insults prevented BT and controlled SIRS peripherally and at both cellular and transcriptional level in a lasting manner. In contrast, antibiotic treatment only exerted its action at peripheral level. The association of both treatments did not provide any important advantages.

Self-administered versus interview-based questionnaires among patients with intermittent claudication: Do they give different results? A cross-sectional study

CONTEXT AND OBJECTIVE Many clinical investigations use generic and/or specific questionnaires to obtain information about participants and patients. There is disagreement about whether the administration method can affect the results. The aim here was to determine whether, among patients with intermittent claudication (IC), there are differences in the Walking Impairment Questionnaire (WIQ) and European Quality of Life-5 Dimension (EQ-5D) scores with regard to: 1) the questionnaire administration method (self-administration versus face-to-face interview); and 2) the type of interviewer (vascular surgeon, VS, versus general practitioner, GP). DESIGN AND SETTING Cross-sectional observational multicenter epidemiological study carried out within the Spanish National Health Service. METHODS 1,641 evaluable patients with IC firstly completed the WIQ and EQ-5D questionnaires and then were interviewed by their doctor on the same day. Pearson correlations and Chi-square tests were used. RESULTS There was a strong correlation (r > 0.800; P < 0.001) between the two methods of administering the WIQ and EQ-5D questionnaires, and between the VS and GP groups. Likewise, there was a high level of concordance (P > 0.05) between the different dimensions of the WIQ-distance and EQ-5D (self-administration versus face-to-face) in the VS and GP groups. CONCLUSION There was no difference between the different methods of administering the WIQ and EQ-5D questionnaires, among the patients with IC. Similarly, the two types of interviewers (VS or GP) were equally valid. Therefore, it seems unnecessary to expend effort to administer these questionnaires by interview, in studies on IC.

Pseudo-aneurisma femoral micótico após onze anos de cateterismo

The authors report the unusual case of a 52-year-old mountain climber that presented with pain and swelling in his right thigh which revealed to be a ruptured mycotic pseudoaneurysm with no history of recent trauma or other apparent cause. The patient reported a past history of myocardial infarction 11 years before, with the performing of two femoral catheterisms for coronary angiography. He denied any episode of fever or diagnosis of bacteraemia at that time or later, nor any other complaint during these 11 years. The rarity of the case, the appearance of this extremely late complication together with the patients kind of sportive activity prompted us to publish the case.