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Cooling Strangulated Intestine Before and Following Release of an Obstruction Protects From Ischemia/Reperfusion Injury

Cooling Strangulated Intestine Before and Following Release of an Obstruction Protects From... Abstract Objective: To evaluate whether cooling of ischemic intestine before and immediately after the release of the obstruction is more advantageous than is warming in an isolated ileal loop rat model. Design: Prospective randomized experimental trials. Setting: Laboratory. Materials: Male Sabra rats. Interventions: An isolated loop of ileum was created in rats and constantly perfused with warmed normal saline (37°C). Intestinal ischemia was caused by clamping of the superior mesenteric artery for 15 minutes. Cooling of the isolated ileal loop to 32°C by the application of cold saline was done for the last half of the ischemic period and continued during the first 10 minutes of reperfusion. The intestine was warmed to 37°C for the next 20 minutes of reperfusion. Main Outcome Measures: The chromium 51—labeled ethylenediaminetetraacetic acid (51Cr-EDTA) plasma-to-lumen clearance rate was used for the evaluation of intestinal mucosal injury. Multiple intestinal samples were harvested at the end of the reperfusion period, and the histological features were evaluated. Results: The51Cr-EDTA plasma-to-lumen clearance rates were significantly lower (P<.001) in the rats in which cooling of the ischemic intestine was performed in comparison with the control group, indicating reduced intestinal mucosal injury in all three 10-minute reperfusion periods. Cooling also significantly changed the resultant histological damage to the intestinal mucosa exerted by ischemia (P<.001). Conclusion: Cooling of the ischemic intestine before the release of the obstruction and for a short period during reperfusion provides significant protection from ischemia/ reperfusion injury compared with the traditional method of warming the ischemic intestine.Arch Surg. 1997;132:406-409 References 1. Amoury RA. Necrotizing enterocolitis: a continuing problem in the neonate . World J Surg . 1993:17:363-373.Crossref 2. Haglund U. Gut ischaemia . Gut . 1994;35( (suppl) ):S73-S76.Crossref 3. Jrvinen O, Laurikka J, Salenius JP, Tarkka M. Acute intestinal ischaemia: a review of 214 cases . Ann Chir Gynaecol . 1994;83:22-25. 4. Scholz FJ. Ischemic bowel disease . Radiol Clin North Am . 1993:31:1197-1218. 5. Zimmerman BJ, Granger DN. Reperfusion injury . Surg Clin North Am . 1992; 72:65-83. 6. Dietrich WD, Alonso O, Busto R, Globus MY, Ginsberg MD. Post-traumatic brain hypothermia reduces histopathological damage following concussive brain injury in the rat . Acta Neuropathol (Berl) . 1994;87:250-258.Crossref 7. Ginsberg MD, Globus MY, Dietrich WD, Busto R. Temperature modulation of ischemic brain injury: synthesis of recent advances . Prog Brain Res . 1993;96: 13-22. 8. Dietrich WD. The importance of brain temperature in cerebral injury . J Neurotrauma . 1992;9( (suppl) ):S475-S485. 9. Ginsberg MD. Sternau LL, Globus MY, Dietrich WD, Busto R. Therapeutic modulation of brain temperature: relevance to ischemic brain injury . Cerebrovasc Brain Metab Rev . 1992;4:189-225. 10. Green EJ, Dietrich WD, van Dijk F, et al. Protective effects of brain hypothermia on behavior and histopathology following global cerebral ischemia in rats . Brain Res . 1992;580:197-204.Crossref 11. Petrasek PF, Homer VS, Walker PM. Determinants of ischemic injury to skeletal muscle . J Vasc Surg . 1994;19:623-631.Crossref 12. Zhang JX, Wolf MB. Effect of cold on ischemia: reperfusion-induced microvascular permeability increase in cat skeletal muscle . Cryobiology . 1994;31:94-100.Crossref 13. Skjeldal S, Torvik A, Nordsletten L, et al. Local hypothermia during ischemia or reperfusion in skeletal muscles . Res Exp Med (Berl) . 1993;193:73-80.Crossref 14. Kelly MJ, Wheatley R, Smith JH, Thomas WE. Cooling prevents ischaemic testicular damage after spermatic cord clamping in rats . Int J Androl . 1987;10: 721-726.Crossref 15. Mitsudo S, Brandt LJ. Pathology of intestinal ischemia . Surg Clin North Am . 1992;72:43-63. 16. Udassin R, Ariel I, Haskel Y, Kitrossky N, Chevion M. Salicylate as an in vivo free radical trap: studies on ischemic insult to the rat intestine . Free Radic Biol Med . 1991;10:1-6.Crossref 17. Caplan MS, MacKendrick W. Necrotizing enterocolitis: a review of pathogenetic mechanisms and implications for prevention . Pediatr Pathol . 1993;13: 357-369.Crossref 18. Jaile JC, Levin T, Wung JT, Abramson SJ, Ruzal SC, Berdon WE. Necrotizing enterocolitis in infancy . Surg Clin North Am . 1992;72:261-276. 19. Busto R, Dietrich WD, Globus MY, Ginsberg MD. The importance of brain temperature in cerebral ischemic injury . Stroke . 1989;20:1113-1114.Crossref 20. Jurkovich GJ, Pitt RM, Curreri PW, Granger DN. Hypothermia prevents increased capillary permeability following ischemia-reperfusion injury . J Surg Res . 1988;44:514-521.Crossref 21. Morikawa E, Ginsberg MD, Dietrich WD, et al. The significance of brain temperature in focal cerebral ischemia: histopathological consequences of middle cerebral artery occlusion in the rat . J Cereb Blood Flow Metab . 1992:12:380-389.Crossref 22. Shuaib A, Sochocka E, Code W, Hertz L. Hypothermia protects astrocytes during ischemia in cell culture . Neurosci Lett . 1992;146:69-71.Crossref 23. Busto R, Dietrich WD, Globus MY, Valdes I, Scheinberg P, Ginsberg MD. Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury . J Cereb Blood Flow Metab . 1987;7:729-738.Crossref 24. Busto R, Dietrich WD, Globus MY, Ginsberg MD. Postischemic moderate hypothermia inhibits CA1 hippocampal ischemic neuronal injury . Neurosci Lett . 1989;101:299-304.Crossref 25. Wright JG, Belkin M, Hobson Rd. Hypothermia and controlled reperfusion: two non-pharmacologic methods which diminish ischemia-reperfusion injury in skeletal muscle . Microcirc Endothelium Lymphatics . 1989;5:315-334. 26. Villarreal D, Grisham MB, Granger DN. Nitric oxide donors improve gut function after prolonged hypothermic ischemia . Transplantation . 1995;59:685-689.Crossref 27. Chen H, Xu D, Qi S, Aboujaoude M, Senechal J. Daloze P. 21-Aminosteroid lipid peroxidation inhibitor U74389G protects the small bowel in the rat against warm and cold ischemia damage . Transplant Proc . 1994;26:1483-1484. 28. Hossain MA, Hamamoto I, Todo S, Maeba T, Tanaka S. Comparison of warm and cold ischemia of the canine small intestine . Eur Surg Res . 1995;27:234-240.Crossref 29. Grisham MB, Benoit JN, Granger DN. Assessment of leukocyte involvement during ischemia and reperfusion of intestine . Methods Enzymol . 1990:186: 729-742. 30. Crissinger KD, Kvietys PR, Granger DN. Pathophysiology of gastrointestinal mucosal permeability . J Intern Med Suppl . 1990;732:145-154.Crossref 31. Parks DA, Bulkley GB, Granger DN, Hamilton SR, McCord JM. Ischemic injury in the cat small intestine: role of superoxide radicals . Gastroenterology . 1982; 82:9-15. 32. Velasquez OR, Tso P, Crissinger KD. Fatty acid-induced injury in developing piglet intestine: effect of degree of saturation and carbon chain length . Pediatr Res . 1993;33:543-547.Crossref 33. Rippe B, Grega GJ. Effects of isoprenaline and cooling on histamine induced changes of capillary permeability in the rat hindquarter vascular bed . Acta Physiol Scand . 1978;103:252-262.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Cooling Strangulated Intestine Before and Following Release of an Obstruction Protects From Ischemia/Reperfusion Injury

Archives of Surgery , Volume 132 (4) – Apr 1, 1997

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1997.01430280080012
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To evaluate whether cooling of ischemic intestine before and immediately after the release of the obstruction is more advantageous than is warming in an isolated ileal loop rat model. Design: Prospective randomized experimental trials. Setting: Laboratory. Materials: Male Sabra rats. Interventions: An isolated loop of ileum was created in rats and constantly perfused with warmed normal saline (37°C). Intestinal ischemia was caused by clamping of the superior mesenteric artery for 15 minutes. Cooling of the isolated ileal loop to 32°C by the application of cold saline was done for the last half of the ischemic period and continued during the first 10 minutes of reperfusion. The intestine was warmed to 37°C for the next 20 minutes of reperfusion. Main Outcome Measures: The chromium 51—labeled ethylenediaminetetraacetic acid (51Cr-EDTA) plasma-to-lumen clearance rate was used for the evaluation of intestinal mucosal injury. Multiple intestinal samples were harvested at the end of the reperfusion period, and the histological features were evaluated. Results: The51Cr-EDTA plasma-to-lumen clearance rates were significantly lower (P<.001) in the rats in which cooling of the ischemic intestine was performed in comparison with the control group, indicating reduced intestinal mucosal injury in all three 10-minute reperfusion periods. Cooling also significantly changed the resultant histological damage to the intestinal mucosa exerted by ischemia (P<.001). Conclusion: Cooling of the ischemic intestine before the release of the obstruction and for a short period during reperfusion provides significant protection from ischemia/ reperfusion injury compared with the traditional method of warming the ischemic intestine.Arch Surg. 1997;132:406-409 References 1. Amoury RA. Necrotizing enterocolitis: a continuing problem in the neonate . World J Surg . 1993:17:363-373.Crossref 2. Haglund U. Gut ischaemia . Gut . 1994;35( (suppl) ):S73-S76.Crossref 3. Jrvinen O, Laurikka J, Salenius JP, Tarkka M. Acute intestinal ischaemia: a review of 214 cases . Ann Chir Gynaecol . 1994;83:22-25. 4. Scholz FJ. Ischemic bowel disease . Radiol Clin North Am . 1993:31:1197-1218. 5. Zimmerman BJ, Granger DN. Reperfusion injury . Surg Clin North Am . 1992; 72:65-83. 6. Dietrich WD, Alonso O, Busto R, Globus MY, Ginsberg MD. Post-traumatic brain hypothermia reduces histopathological damage following concussive brain injury in the rat . Acta Neuropathol (Berl) . 1994;87:250-258.Crossref 7. Ginsberg MD, Globus MY, Dietrich WD, Busto R. Temperature modulation of ischemic brain injury: synthesis of recent advances . Prog Brain Res . 1993;96: 13-22. 8. Dietrich WD. The importance of brain temperature in cerebral injury . J Neurotrauma . 1992;9( (suppl) ):S475-S485. 9. Ginsberg MD. Sternau LL, Globus MY, Dietrich WD, Busto R. Therapeutic modulation of brain temperature: relevance to ischemic brain injury . Cerebrovasc Brain Metab Rev . 1992;4:189-225. 10. Green EJ, Dietrich WD, van Dijk F, et al. Protective effects of brain hypothermia on behavior and histopathology following global cerebral ischemia in rats . Brain Res . 1992;580:197-204.Crossref 11. Petrasek PF, Homer VS, Walker PM. Determinants of ischemic injury to skeletal muscle . J Vasc Surg . 1994;19:623-631.Crossref 12. Zhang JX, Wolf MB. Effect of cold on ischemia: reperfusion-induced microvascular permeability increase in cat skeletal muscle . Cryobiology . 1994;31:94-100.Crossref 13. Skjeldal S, Torvik A, Nordsletten L, et al. Local hypothermia during ischemia or reperfusion in skeletal muscles . Res Exp Med (Berl) . 1993;193:73-80.Crossref 14. Kelly MJ, Wheatley R, Smith JH, Thomas WE. Cooling prevents ischaemic testicular damage after spermatic cord clamping in rats . Int J Androl . 1987;10: 721-726.Crossref 15. Mitsudo S, Brandt LJ. Pathology of intestinal ischemia . Surg Clin North Am . 1992;72:43-63. 16. Udassin R, Ariel I, Haskel Y, Kitrossky N, Chevion M. Salicylate as an in vivo free radical trap: studies on ischemic insult to the rat intestine . Free Radic Biol Med . 1991;10:1-6.Crossref 17. Caplan MS, MacKendrick W. Necrotizing enterocolitis: a review of pathogenetic mechanisms and implications for prevention . Pediatr Pathol . 1993;13: 357-369.Crossref 18. Jaile JC, Levin T, Wung JT, Abramson SJ, Ruzal SC, Berdon WE. Necrotizing enterocolitis in infancy . Surg Clin North Am . 1992;72:261-276. 19. Busto R, Dietrich WD, Globus MY, Ginsberg MD. The importance of brain temperature in cerebral ischemic injury . Stroke . 1989;20:1113-1114.Crossref 20. Jurkovich GJ, Pitt RM, Curreri PW, Granger DN. Hypothermia prevents increased capillary permeability following ischemia-reperfusion injury . J Surg Res . 1988;44:514-521.Crossref 21. Morikawa E, Ginsberg MD, Dietrich WD, et al. The significance of brain temperature in focal cerebral ischemia: histopathological consequences of middle cerebral artery occlusion in the rat . J Cereb Blood Flow Metab . 1992:12:380-389.Crossref 22. Shuaib A, Sochocka E, Code W, Hertz L. Hypothermia protects astrocytes during ischemia in cell culture . Neurosci Lett . 1992;146:69-71.Crossref 23. Busto R, Dietrich WD, Globus MY, Valdes I, Scheinberg P, Ginsberg MD. Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury . J Cereb Blood Flow Metab . 1987;7:729-738.Crossref 24. Busto R, Dietrich WD, Globus MY, Ginsberg MD. Postischemic moderate hypothermia inhibits CA1 hippocampal ischemic neuronal injury . Neurosci Lett . 1989;101:299-304.Crossref 25. Wright JG, Belkin M, Hobson Rd. Hypothermia and controlled reperfusion: two non-pharmacologic methods which diminish ischemia-reperfusion injury in skeletal muscle . Microcirc Endothelium Lymphatics . 1989;5:315-334. 26. Villarreal D, Grisham MB, Granger DN. Nitric oxide donors improve gut function after prolonged hypothermic ischemia . Transplantation . 1995;59:685-689.Crossref 27. Chen H, Xu D, Qi S, Aboujaoude M, Senechal J. Daloze P. 21-Aminosteroid lipid peroxidation inhibitor U74389G protects the small bowel in the rat against warm and cold ischemia damage . Transplant Proc . 1994;26:1483-1484. 28. Hossain MA, Hamamoto I, Todo S, Maeba T, Tanaka S. Comparison of warm and cold ischemia of the canine small intestine . Eur Surg Res . 1995;27:234-240.Crossref 29. Grisham MB, Benoit JN, Granger DN. Assessment of leukocyte involvement during ischemia and reperfusion of intestine . Methods Enzymol . 1990:186: 729-742. 30. Crissinger KD, Kvietys PR, Granger DN. Pathophysiology of gastrointestinal mucosal permeability . J Intern Med Suppl . 1990;732:145-154.Crossref 31. Parks DA, Bulkley GB, Granger DN, Hamilton SR, McCord JM. Ischemic injury in the cat small intestine: role of superoxide radicals . Gastroenterology . 1982; 82:9-15. 32. Velasquez OR, Tso P, Crissinger KD. Fatty acid-induced injury in developing piglet intestine: effect of degree of saturation and carbon chain length . Pediatr Res . 1993;33:543-547.Crossref 33. Rippe B, Grega GJ. Effects of isoprenaline and cooling on histamine induced changes of capillary permeability in the rat hindquarter vascular bed . Acta Physiol Scand . 1978;103:252-262.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Apr 1, 1997

References

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