ABSTRACT
FUNDAMENTO: A injeção de células-tronco no contexto do infarto agudo do miocárdio (IAM) tem sido testada quase exclusivamente pela via anterógrada intra-arterial coronariana (IAC). A via retrógrada intravenosa coronariana (IVC) pode ser uma via adicional. OBJETIVO: Comparar o padrão de distribuição e retenção celular nas vias anterógrada e retrógrada. Investigar o papel da obstrução microvascular pela ressonância magnética na retenção de células pelo tecido cardíaco após a injeção de células mononucleares da medula óssea (CMMO) no IAM. MÉTODOS: Estudo prospectivo, aberto, randomizado. Foram incluídos pacientes com IAM que apresentassem: (1) reperfusão mecânica ou química com sucesso em até 24 horas do início dos sintomas e (2) infarto acometendo mais de 10 por cento da área do ventrículo esquerdo (VE) pela cintilografia miocárdica. Cem milhões de CMMO foram injetadas na artéria relacionada ao infarto pela via IAC ou veia, pela via IVC. Um por cento das células injetadas foi marcado com Tc99m-hexametil-propileno-amina-oxima(99mTc-HMPAO). A distribuição das células foi avaliada 4 e 24 horas após a injeção da cintilografia miocárdica. Ressonância magnética cardíaca foi realizada antes da injeção de células. RESULTADOS: Trinta pacientes foram distribuídos aleatoriamente em três grupos. Não houve eventos adversos graves relacionados ao procedimento. A retenção precoce e tardia das células marcadas foi maior no grupo IAC do que no grupo IVC, independentemente da presença de obstrução da microcirculação. CONCLUSÃO: A injeção pela abordagem retrógrada mostrou-se viável e segura. A retenção de células pelo tecido cardíaco foi maior pela via anterógrada. Mais estudos são necessários para confirmar esses achados.
BACKGROUND: The injection of stem cells in the context of acute myocardial infarction (AMI) has been tested almost exclusively by anterograde intra-arterial coronary (IAC) delivery. The retrograde intravenous coronary (IVC) delivery may be an additional route. OBJECTIVE: To compare the cell distribution and retention pattern in the anterograde and retrograde routes. To investigate the role of microvascular obstruction by magnetic resonance imaging in cell retention by cardiac tissue after the injection of bone marrow mononuclear cells (BMMC) in AMI. METHODS: This was a prospective, open label, randomized study. Patients with AMI who presented: (1) successful chemical or mechanical reperfusion within 24 hours of symptom onset and (2) infarction involving more than 10 percent of the left ventricle (LV) at the myocardial scintigraphy were included in the study. One hundred million BMMC were injected into the infarction-related artery through IAC route, or vein through the IVC route. One percent of the injected cells were labeled with 99mTc-hexamethyl-propylene-amine-oxime (99mTc-HMPAO). Cell distribution was evaluated at 4 and 24 hours after the myocardial scintigraphy injection. Cardiac magnetic resonance imaging was performed before cell injection. RESULTS: Thirty patients were randomized into three groups. There were no serious adverse events related to the procedure. The early and late retention of labeled cells was higher in the IAC group than in IVC group, regardless of the presence of microcirculation obstruction. CONCLUSION: The injection using the retrograde approach was feasible and safe. Cell retention by cardiac tissue was higher using the anterograde approach. More studies are needed to confirm these findings.
Subject(s)
Female , Humans , Male , Middle Aged , Bone Marrow Transplantation/methods , Coronary Vessels/physiopathology , Microcirculation/physiology , Myocardial Infarction/surgery , Stem Cell Transplantation/methods , Bone Marrow Transplantation/adverse effects , Coronary Vessels , Injections, Intra-Arterial/methods , Myocardial Infarction/physiopathology , Myocardial Infarction , Prospective Studies , Radiopharmaceuticals , Statistics, Nonparametric , Stem Cell Transplantation/adverse effectsABSTRACT
The objective of this study is to describe the cranial and caudal mesenteric arteries in 10 opossuns after Neoprene latex injection. The cranial mesenteric artery arises from the abdominal aorta, caudally to the celiac trunk, originating the caudal duodenal pancreatic artery, middle and right colic, jejunal and ileocecocolic arteries. The caudal mesenteric artery arises from the aorta, cranially to the external iliac arteries, originating the cranial rectal and left colic arteries.
El objetivo de este estudio fue describir las arterias mesentéricas craneal y caudal de 10 zorrillos después de la inyección de látex Neoprene. La arteria mesentérica craneal tiene origen en la aorta abdominal, caudalmente al tronco celíaco y da origen a las arterias: pacreáticoduodenal caudal, cólica media derecha, yeyunales e ileocecocólica. La arteria mesentérica caudal con origen en la aorta, cranealmente a las arterias ilíacas externas, da origen a las arterias rectal craneal y cólica izquierda.
Subject(s)
Adult , Mesenteric Arteries/anatomy & histology , Mesenteric Arteries , Mesenteric Arteries/embryology , Mephitidae/anatomy & histology , Mephitidae/embryology , Aorta, Abdominal/anatomy & histology , Aorta, Abdominal , Aorta/anatomy & histology , Aorta , Dissection/methods , Dissection/veterinary , Injections, Intra-Arterial/methods , Injections, Intra-Arterial/veterinaryABSTRACT
Any evolution in surgical procedure must seek to improve established results, minimize previous complications, and maximize applicability to the general patient population. Arthroscopic examination and treatment of selected shoulder disorders have undoubtedly earned a permanent role in the practice of orthopaedic surgery, with an exciting and expanding future. The current study was designed to evaluate the clinical value of a post-arthroscopic local analgesic method using a single intra-articular injected dose of a mixture of 20mg [4 ml] tenoxicam, 20mg [0.5 ml] triamcinolone acetonide, 0.2% [10 ml] ropivacaine, and 0.5 ml of a 1: 1000 epinephrine solution, in an attempt to achieve a pain-free post-operative period to allow for early rehabilitation. The study was conducted in 76 patients, mostly were young active men, all underwent shoulder arthroscopic surgery for diagnostic and therapeutic purposes. Visual analogue scale [VAS] scores as regards pain intensity and relief were taken before surgery and then, at recovery, 1, 2, 4, 8, 24 hours postoperatively. In addition, patients were assessed for quality of sleep and for daily living. The physiotherapist's opinions about the analgesia provided were also recorded as indicated by the patient's ability to participate in the immediate post-operative mobilization programs. The results revealed a significant benefit as it offered an immediate post-operative pain relief, high therapist compliance, and good patient satisfaction. In addition, the incidence of adverse actions was negligible