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Selective central perfusion

Ryan C Shelstad, Justin G Reeves, Katsuhiro Yamanaka, T Brett Reece
We review the operative techniques of aortic arch replacement. Aortic arch replacement presents several formidable challenges, as it requires arresting the circulation to the body and replacement of the brachiocephalic vessels with special consideration for protecting the central nervous system. Perfusion strategies, selective antegrade cerebral perfusion, and operative graft selection are key elements in aortic arch replacement surgery. Standard approaches include the island technique, the branched graft technique, and the "Spielvogel" trifurcated graft technique-each having its own advantages...
October 7, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
Ramon Francisco Barajas, Soonmee Cha
Metastatic cancer to the central nervous system is primarily deposited by hematogenous spread in various anatomically distinct regions: calvarial, pachymeningeal, leptomeningeal, and brain parenchyma. A patient's overall clinical status and the information needed to make treatment decisions are the primary considerations in initial imaging modality selection. Contrast-enhanced MR imaging is the preferred imaging modality. Morphologic MR imaging is limited to delineating anatomic deraignment of tissues. Dynamic susceptibility contrast-enhanced perfusion and diffusion-weighted physiology-based MR imaging sequences have been developed that complement morphologic MR imaging by providing additional diagnostic information...
November 2016: Neuroimaging Clinics of North America
Xiuling Shang, Kaiyu Wang, Jingqing Xu, Shurong Gong, Yong Ye, Kaihua Chen, Fayang Lian, Wei Chen, Rongguo Yu
Purpose. This study was aimed at investigating the effect of esmolol on tissue perfusion and the clinical prognosis of patients with severe sepsis. Materials and Methods. One hundred fifty-one patients with severe sepsis were selected and divided into the esmolol group (n = 75) or the control group (n = 76), who received conventional antiseptic shock treatment. The esmolol group received a continuous infusion of esmolol via a central venous catheter, and their heart rate (HR) was maintained at 70-100 bpm over 72 hours...
2016: BioMed Research International
Levi Bassin, David Bell
The key to aortic surgery is protection of the brain, heart, spinal cord, and viscera. For operations involving the aortic arch, the focus is on cerebral protection, while for pathology involving the descending thoracic aorta, the focus is on spinal protection. Optimal cerebral and spinal protection requires an extensive knowledge of the operative steps and an understanding of the cardiopulmonary bypass modalities that are possible. A bloodless field is required when operating on the aorta. As a result, periods of ischemia to the central nervous system and end-organ viscera are often unavoidable...
September 2016: Best Practice & Research. Clinical Anaesthesiology
Christoph Englert, Anne-Kristin Trützschler, Martin Raasch, Tanja Bus, Philipp Borchers, Alexander S Mosig, Anja Traeger, Ulrich S Schubert
The targeted drug delivery to the central nervous system represents one of the major challenges in pharmaceutical formulations since it is strictly limited through the highly selective blood-brain barrier (BBB). l-Glutathione (GSH), a tripeptide and well-known antioxidant, has been studied in the last years as potential candidate to facilitate the receptor-mediated transcytosis of nanocarriers. We thus tested whether GSH decoration of a positively charged polymer, poly(ethylene imine), with this vector enables the transport of genetic material and, simultaneously, the passage through the BBB...
November 10, 2016: Journal of Controlled Release: Official Journal of the Controlled Release Society
Sylvain Auvity, Hélène Chapy, Sébastien Goutal, Fabien Caillé, Benoit Hosten, Maria Smirnova, Xavier Declèves, Nicolas Tournier, Salvatore Cisternino
Diphenhydramine, a sedative histamine H1-receptor (H1R) antagonist, was evaluated as a probe to measure drug/H(+)-antiporter function at the blood-brain barrier. In situ brain perfusion experiments in mice and rats showed that diphenhydramine transport at the blood-brain barrier was saturable, following Michaelis-Menten kinetics with a Km = 2.99 mM and Vmax = 179.5 nmol s(-1) g(-1) In the pharmacological plasma concentration range the carrier-mediated component accounted for 77% of diphenhydramine influx while passive diffusion accounted for only 23%...
August 3, 2016: Journal of Cerebral Blood Flow and Metabolism
Na Zhao, Jin Xu, Balwinder Singh, Xuerong Yu, Taixiang Wu, Yuguang Huang
BACKGROUND: Cardiac complications are not uncommon in patients undergoing non-cardiac surgery, especially in patients with coronary artery disease (CAD) or at high risk of CAD. Perioperative cardiac complications can lead to mortality and morbidity, as well as higher costs for patient care. Nitrates, which are among the most commonly used cardiovascular drugs, perform the function of decreasing cardiac preload while improving cardiac blood perfusion. Sometimes, nitrates are administered to patients undergoing non-cardiac surgery to reduce the incidence of cardiac complications, especially for patients with CAD...
2016: Cochrane Database of Systematic Reviews
Rolando Claure-Del Granado, Ravindra L Mehta
BACKGROUND: Fluid overload is frequently found in acute kidney injury patients in critical care units. Recent studies have shown the relationship of fluid overload with adverse outcomes; hence, manage and optimization of fluid balance becomes a central component of the management of critically ill patients. DISCUSSION: In critically ill patients, in order to restore cardiac output, systemic blood pressure and renal perfusion an adequate fluid resuscitation is essential...
August 2, 2016: BMC Nephrology
Martin Raasch, Knut Rennert, Tobias Jahn, Claudia Gärtner, Gilbert Schönfelder, Otmar Huber, Andrea E M Seiler, Alexander S Mosig
The development of therapeutic substances to treat diseases of the central nervous system is hampered by the tightness and selectivity of the blood-brain barrier. Moreover, testing of potential drugs is time-consuming and cost-intensive. Here, we established a new microfluidically supported, biochip-based model of the brain endothelial barrier in combination with brain cortical spheroids suitable to detect effects of neuroinflammation upon disruption of the endothelial layer in response to inflammatory signals...
July 2016: Biomicrofluidics
Simon Bourcier, Claire Pichereau, Pierre-Yves Boelle, Safaa Nemlaghi, Vincent Dubée, Gabriel Lejour, Jean-Luc Baudel, Arnaud Galbois, Jean-Rémi Lavillegrand, Naïke Bigé, Jalel Tahiri, Guillaume Leblanc, Eric Maury, Bertrand Guidet, Hafid Ait-Oufella
BACKGROUND: Microcirculatory disorders leading to tissue hypoperfusion play a central role in the pathophysiology of organ failure in severe sepsis and septic shock. As microcirculatory disorders have been identified as strong predictive factors of unfavourable outcome, there is a need to develop accurate parameters at the bedside to evaluate tissue perfusion. We evaluated whether different body temperature gradients could relate to sepsis severity and could predict outcome in critically ill patients with severe sepsis and septic shock...
December 2016: Annals of Intensive Care
V P Erichev, Yu V Mazurova, Tszin Dan
UNLABELLED: Many factors exist that are associated with higher risk of glaucoma progression. Arterial hypotension, low perfusion pressure, vasospastic syndrome, diabetes mellitus, myopia, etc. increase the need for neuroprotective therapy, which is aimed at stabilizing the pathological process and creating favorable conditions for maintaining visual functions. The aim of this study was to assess the therapeutic efficacy of Gliatilin as part of the complex treatment of progressive glaucomatous optic neuropathy...
March 2016: Vestnik Oftalmologii
Ida M Ki Moore, Carrie J Merkle, Howard Byrne, Adam Ross, Ashley M Hawkins, Sara S Ameli, David W Montgomery
Central nervous system (CNS)-directed treatment for acute lymphoblastic leukemia, used to prevent disease recurrence in the brain, is essential for survival. Systemic and intrathecal methotrexate, commonly used for CNS-directed treatment, have been associated with cognitive problems during and after treatment. The cortex, hippocampus, and caudate putamen, important brain regions for learning and memory, may be involved in methotrexate-induced brain injury. Objectives of this study were to (1) quantify neuronal degeneration in selected regions of the cortex, hippocampus, and caudate putamen and (2) measure changes in the expression of genes with known roles in oxidant defense, apoptosis/inflammation, and protection from injury...
October 2016: Biological Research for Nursing
Shahin Hajibandeh, Shahab Hajibandeh, Stavros A Antoniou, Francesco Torella, George A Antoniou
BACKGROUND: Controversy exists as to whether revascularisation of the left subclavian artery (LSA) confers improved outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR). Even though preemptive revascularisation of the LSA has theoretical advantages, including a reduced risk of ischaemic damage to vital organs, such as the brain and the spinal cord, it is not without risks. Current practice guidelines recommend routine revascularisation of the LSA in patients undergoing elective TEVAR where achievement of a proximal seal necessitates coverage of the LSA, and in patients who have an anatomy that compromises perfusion to critical organs...
2016: Cochrane Database of Systematic Reviews
Carmen Sircuta, Alexandra Lazar, Leonard Azamfirei, Mária Baranyi, E Sylvester Vizi, Zoltán Borbély
Because local anesthetics are known to inhibit both sodium and potassium channels, and anesthetic properties have been attributed to the former effect, we compared their effects with those of tetrodotoxin (TTX), a selective Na(+) channel inhibitor with anesthetic activity, and 4-aminopyridine (4-AP), a selective potassium channel blocker with convulsive activity, on transmitter release during rest and in response to field (axonal) stimulation using the microvolume perfusion method and isolated prefrontal cortex and spinal cord slice preparations loaded with the radioactive transmitters [(3)H]dopamine ([(3)H]DA) and [(3)H]noradrenaline ([(3)H]NA)...
June 2016: Brain Research Bulletin
Ahmed Mukhtar, Hany Dabbous
Splanchnic circulation is the primary mechanism that regulates volumes of circulating blood and systemic blood pressure in patients with cirrhosis accompanied by portal hypertension. Recently, interest has been expressed in modulating splanchnic circulation in patients with liver cirrhosis, because this capability might produce beneficial effects in cirrhotic patients undergoing a liver transplant. Pharmacologic modulation of splanchnic circulation by use of vasoconstrictors might minimize venous congestion, replenish central blood flow, and thus optimize management of blood volume during a liver transplant operation...
January 28, 2016: World Journal of Gastroenterology: WJG
Arturo Consoli, Tommy Andersson, Ake Holmberg, Luca Verganti, Andrea Saletti, Stefano Vallone, Andrea Zini, Alfonso Cerase, Daniele Romano, Sandra Bracco, Svetlana Lorenzano, Enrico Fainardi, Salvatore Mangiafico
BACKGROUND: The purpose of this study was to evaluate the correlation between a novel angiographic score for collaterals and CT perfusion (CTP) parameters in patients undergoing endovascular treatment for acute ischemic stroke (AIS). METHODS: 103 patients (mean age 66.7±12.7; 48.5% men) with AIS in the anterior circulation territory, imaged with non-contrast CT, CT angiography, and CTP, admitted within 8 h from symptom onset and treated with any endovascular approach, were retrospectively included in the study...
January 22, 2016: Journal of Neurointerventional Surgery
Pedro M Baptista, Emma C Moran, Dipen Vyas, Maria H Ribeiro, Anthony Atala, Jessica L Sparks, Shay Soker
OBJECTIVE: Modeling of human liver development, especially cellular organization and the mechanisms underlying it, is fundamental for studying liver organogenesis and congenital diseases, yet there are no reliable models that mimic these processes ex vivo. DESIGN: Using an organ engineering approach and relevant cell lines, we designed a perfusion system that delivers discrete mechanical forces inside an acellular liver extracellular matrix scaffold to study the effects of mechanical stimulation in hepatic tissue organization...
March 2016: Tissue Engineering. Part C, Methods
Daniele Linardi, Giuseppe Faggian, Alessio Rungatscher
Surgery for complex aortic pathologies, such as acute dissections and aneurysms involving the aortic arch, remains one of the most technically and strategically challenging intervention in aortic surgery, requiring thorough understanding not only of cardiovascular physiology but also of neurophysiology (cerebral and spinal cord), and is still associated with significant mortality and morbidity. The introduction of deep hypothermia in the mid 1970s, allowing defined periods of circulatory arrest, has made possible the advent of modern aortic surgery requiring prolonged ischemic tolerance of central nervous system...
March 2016: Therapeutic Hypothermia and Temperature Management
Rika Yoshimatsu, Takuji Yamagami, Masaki Ishikawa, Kenji Kajiwara, Hiroshi Aikata, Kazuaki Chayama, Kazuo Awai
PURPOSE: To evaluate changes in imaging findings on CT during hepatic arteriography (CTHA) and CT during arterial portography (CTAP) by balloon occlusion of the treated artery and their relationship with iodized oil accumulation in the tumor during balloon-occluded transcatheter arterial chemoembolization (B-TACE). METHODS: Both B-TACE and angiography-assisted CT were performed for 27 hepatocellular carcinomas. Tumor enhancement on selective CTHA with/without balloon occlusion and iodized oil accumulation after B-TACE were evaluated...
June 2016: Cardiovascular and Interventional Radiology
Sundeep Mangla, Jae H Choi, Frank C Barone, Carol Novotney, Jenny Libien, Erwin Lin, John Pile-Spellman
BACKGROUND: The choice of an animal model for cerebrovascular research is often determined by the disease subtype to be studied (e.g. ischemic stroke, hemorrhage, trauma), as well as the nature of the intervention to be tested (i.e. medical device or pharmaceutical). Many initial studies are performed in smaller animals, as they are cost-effective and their encephalic vasculature closely models that of humans. Non-human primates are also utilized when confirmation or validation is required on higher levels and to test larger devices...
2015: BMC Research Notes
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