Post-hemorrhagic shock mesenteric lymph is an important contributor to cardiac dysfunction following hemorrhagic shock

PURPOSE: To evaluate whether post-hemorrhagic shock mesenteric lymph (PSML) is involved in cardiac dysfunction induced by hemorrhagic shock. METHODS: The hemorrhagic shock model (40±2 mmHg, 3h) was established in rats of the shock and shock+drainage groups; and PSML drainage was performed from hypotension 1-3h in the shock+drainage rats. Then, the isolated hearts were obtained from the rats for the examination of cardiac function with Langendorff system. Subsequently, the isolated hearts were obtained from normal rats and perfused with PSML or Krebs-Henseleit solution, and the changes of cardiac function were observed. RESULTS: The left ventricular systolic pressure (LVSP) and the maximal rates of LV developed pressure (LVDP) rise and fall (±dP/dt max) in the shock and shock+drainage groups were lower than that of the sham group; otherwise, these indices in the shock+drainage group were higher compared to the shock group. In addition, after isolated hearts obtained from normal rats perfusing with PSML, these cardiac function indices were gradual decline along with the extension of time, such as heart rate, LVSP, ±dP/dt max, etc. CONCLUSION: Post-hemorrhagic shock mesenteric lymph is an important contributor to cardiac dysfunction following hemorrhagic shock. .

Myosin light chain kinase is necessary for post-shock mesenteric lymph drainage enhancement of vascular reactivity and calcium sensitivity in hemorrhagic-shocked rats

Vascular hyporeactivity is an important factor in irreversible shock, and post-shock mesenteric lymph (PSML) blockade improves vascular reactivity after hemorrhagic shock. This study explored the possible involvement of myosin light chain kinase (MLCK) in PSML-mediated vascular hyporeactivity and calcium desensitization. Rats were divided into sham (n=12), shock (n=18), and shock+drainage (n=18) groups. A hemorrhagic shock model (40±2 mmHg, 3 h) was established in the shock and shock+drainage groups. PSML drainage was performed from 1 to 3 h from start of hypotension in shock+drainage rats. Levels of phospho-MLCK (p-MLCK) were determined in superior mesenteric artery (SMA) tissue, and the vascular reactivity to norepinephrine (NE) and sensitivity to Ca2+ were observed in SMA rings in an isolated organ perfusion system. p-MLCK was significantly decreased in the shock group compared with the sham group, but increased in the shock+drainage group compared with the shock group. Substance P (1 nM), an agonist of MLCK, significantly elevated the decreased contractile response of SMA rings to both NE and Ca2+ at various concentrations. Maximum contractility (Emax) in the shock group increased with NE (from 0.179±0.038 to 0.440±0.177 g/mg, P<0.05) and Ca2+ (from 0.515±0.043 to 0.646±0.096 g/mg, P<0.05). ML-7 (0.1 nM), an inhibitor of MLCK, reduced the increased vascular response to NE and Ca2+ at various concentrations in the shock+drainage group (from 0.744±0.187 to 0.570±0.143 g/mg in Emax for NE and from 0.729±0.037 to 0.645±0.056 g/mg in Emax for Ca2+, P<0.05). We conclude that MLCK is an important contributor to PSML drainage, enhancing vascular reactivity and calcium sensitivity in rats with hemorrhagic shock.

Drenaje linfatico manual, como parte del tratamiento en el síndrome del dolor regional complejo tipo I de extremidad superior / Manual lymphatic drainage in the treatment of complex regional pain syndrome type I of upper extremity

Síndrome de Dolor Regional Complejo Tipo -1 (SDRC- 1) constituye un conjunto de manifestaciones clínicas que se caracterizan, por dolor e impotencia funcional. Se relacionan con trastornos vasomotores intensos y prolongados, entre ellos edema y con alteraciones tróficas que afectan a parte o la totalidad de un miembro. El origen traumático es la causa más frecuente de SDRC - 1, aunque también puede desarrollarse a partir de una complicación iatrogénica de un tratamiento quirúrgico o médico. En el SDRC 1 se presenta un funcionamiento alterado del sistema nervioso simpático, lo cual produce una alteración vasomotora que contribuirá a la formación de un edema local de tipo mixto. El Drenaje Linfático Manual (Leduc) podría incorporarse dentro de un plan de tratamiento de esta patología. Con el DLM se pretende disminuir el edema, con lo que se atenuaría parte del dolor que presenta el paciente, ya que se lograría reducir, por un lado el estímulo mecánico que genera una presión anormal en los tejidos blandos de la extremidad afectada y el estímulo químico, causado por la acumulación de metabolitos en estos tejidos. Con esto se podría obtener mejores resultados en el tratamiento del SDRC 1.

The Complex Regional Pain Syndrome Tipe- I (SDRC-I) constitutes a set of clinical manifestations that are characterized, by pain and functional impotence. Theyare related to intense and prolonged vasomotors upheavals, among them edema and with trophics alterations that affect to a part or the totality of a member. The traumatic origin is the most frequent cause of SDRC- 1, although also can be developed from a iatrogenic complication of a surgical or medical treatment. In SDRC- I an altered operation of the likeable nervous system appears, which produces a vasomotor alteration that will contribute to the formation of a local edema of mixed type. The Manual Lymphatic Drainage (Leduc) could be gotten up within a plan of treatment of this pathology. With the DLM it is tried to diminish the edema, with which part of the pain that the patient presents would be attenuated, since it would be reduced, on one hand the mechanical stimulus that generates an abnormal pressure in soft weaves of the affected extremity and the chemical stimulus, caused by the accumulation of metabolitos in these weaves. With this it would be possible to obtain better results in the treatment of SDRC- 1.

The Use of Elastic Adhesive Tape to Promote Lymphatic Flow in the Rabbit Hind Leg

Any method that deforms the skin of the extremities may increase lymphatic flow rate, and may be applied to treat peripheral lymphedema. This study was undertaken to investigate whether or not elastic adhesive tape with passive exercise can increase lymph flow in the rabbit hind leg by effective and periodic skin deformation. Cannulation into a pre-popliteal afferent lymphatic vessel in the lower left leg of 22 male New Zealand White rabbits was performed under a stereomicroscope. After stabilization, lymph was collected at rest or during passive exercise with an electric motor at 60 r.p.m. for 15 minutes and was then measured. Lymph flow rate was calculated and expressed as g/hour. Increase of lymph flow rate due to taping was significant only for passive exercise (p=0.0317). The lymph flow rate increased linearly as the area of tape was increased (p=0.0011), and lymph flow rates were significantly different according to site (p=0.0017). Tape on the anterior aspect of the ankle caused salient deformation and tended to increase the lymph flow rate more so than tape on the dorsum of the foot (p=0.0831). Taping with elastic adhesive tape in passive exercise increased the lymph flow rate in the rabbit hind leg by deforming the skin, which suggests a novel therapeutic method in cases of peripheral lymphedema.