Liver glutathione level influences myocardial reperfusion injury following liver ischemia-reperfusion.

BACKGROUND: N-acetyl-L-cysteine (NAC) both replenishes reduced glutathione (GSH) and mitigates reperfusion injury. We hypothesized that liver content of GSH could affect remote myocardial reperfusion injury following liver ischemia-reperfusion. MATERIAL AND METHODS: Following stabilization (30 min), isolated rat livers (6/group) were perfused with Krebs-Henseleit solution (two control groups) or made globally ischemic (two ischemia groups) for 120 min. Paired livers + paced hearts (Langendorff preparation) were then reperfused for 15 min after which the hearts were recirculated alone for 50 min. NAC was added to Krebs (2 mM) that perfused livers during stabilization and reperfusion phases in one control and one ischemia group. RESULTS: GSH levels in the two control liver groups were identical (30.1 +/- 5.7 [SD] nmol/mg protein), and similar to that of the ischemia + NAC livers (28.6 +/- 2.8) but 2-fold that of the ischemia + 0 livers (15.8 +/- 2.4 nmol/mg protein, p<0.05). While hearts paired with control livers maintained unchanged their myocardial velocity of contraction, the contraction in the ischemia + NAC-paired hearts reduced, but was better than in the ischemia + 0-paired hearts (71 +/- 8% vs. 41 +/- 6% off baseline, p<0.05). Coronary flow also decreased dissimilarly in the two ischemia-associated groups of heart: 72 +/- 9% (ischemia + NAC) vs. 46 +/- 7% (ischemia + 0, p<0.05). Xanthine oxidase in the ischemia + 0 livers was 7.5-folds higher than in the ischemia-treated livers. CONCLUSIONS: NAC treatment of ischemia-reperfused livers, associated with GSH replenishment, prevents remote myocardial reperfusion injury. The role of NAC and GSH in reducing liver-associated oxidative burst propagation is discussed.

Role of the molecular adsorbent recycling system (MARS) in the treatment of patients with acute exacerbation of chronic liver failure.

OBJECTIVE: To test the efficacy of the molecular adsorbent recycling system (MARS) in patients with acute exacerbation of chronic liver disease. DESIGN: A prospective case analysis. SETTING: A university-affiliated tertiary medical center. PATIENTS AND METHODS: We applied MARS to treat a consecutive series of eight patients with acute exacerbation of chronic liver disease. RESULTS: The overall survival rate was 62.5%. All patients demonstrated improvement with regard to their degree of encephalopathy. In three patients, intracranial pressure and jugular bulb oxygen saturation decreased and cerebral perfusion pressure increased after treatment institution. Patients' hyperdynamic state was attenuated, as demonstrated by elevation of systemic vascular resistance, mean arterial pressure, and parallel reduction in cardiac index. A prompt reduction in serum ammonia, bilirubin, and lactate levels was observed. There were no complications during the treatment period. CONCLUSIONS: Applying MARS treatments to patients with acute exacerbation of chronic liver disease can detoxify blood, improve cerebral circulation, and reduce brain edema, as reflected by the reduction in intracranial pressure and jugular bulb oxygen saturation values in our patients. A partial reversal of the characteristic hyperdynamic circulation was also achieved. Despite our encouraging results, further testing is needed to determine the reliability of the system.

[Groin pain in sport].

Pain syndromes in the groin are common in people involved in sports such as soccer, handball etc. Approximately 2.5% of all sport related injuries are in the pelvic area. Soft tissue injuries are the most common cause for groin pain in athletes. The majority of conditions will gradually disappear with rest and symptomatic treatment. Symptoms are often vague and diffuse. Therefore, high index of suspicion, thorough knowledge of the anatomy and multidisciplinary approach is needed for diagnosing and treating. Early diagnosis will reduce morbidity. Managing chronic pain is difficult. Groin injuries are some of the most challenging injuries in the field of sports medicine.

Total hip arthroplasty revision using the press-fit CLS Spotorno cementless stem. Twenty-four hips followed between 1987 and 1998.

A retrospective study of uncemented femoral revision for loosening after total hip arthroplasty was conducted for the period 1987-1998. The study included 24 hips in 22 patients (7 men, 15 women). The revision procedure consisted of the replacement of the loose hip prosthesis using the CLS (Protek) press-fit stem. Patients were followed for a mean duration of 4.5 years. The mean interval between the primary operation and the revision was 10 years (range 2-16 years). Using the Merle D'Aubigné hip score and radiographic findings, a favorable outcome was noted in 20 hips. We suggest that the femoral revision procedure using the uncemented Spotorno stem is a very useful method of correction of loosening after total hip replacement.

Work values and organizational commitment.

Dubin, Champoux and Porter (1975) found a strong relationship between central life interests of workers and their commitment to the organization. This paper extends their findings by investigating the relationship between work values, defined as the Protestant Ethic of the worker, and commitment to the organization. A distinction is made between moral and calculative commitment, and it is shown that work values are related more to moral than calculative involvement.