Lethal Reperfusion Injury: Does It Exist and Does It Matter?

Journal of Thrombosis and Thrombolysis -     

Does Reperfusion Injury Exist?

Journal of Thrombosis and Thrombolysis -     

Does Lethal Myocardial Reperfusion Injury Exist?

Journal of Thrombosis and Thrombolysis -     

Does “Lethal Reperfusion Injury” Exist?

Journal of Thrombosis and Thrombolysis -     

Lethal Myocardial Reperfusion Injury: Does it Exist; Should We Treat It?

Journal of Thrombosis and Thrombolysis -     

Does Lethal Reperfusion Injury Exist in Cardiac Surgery?

Journal of Thrombosis and Thrombolysis -     

Existence and Clinical Relevance of Lethal Myocardial “Reperfusion Injury”

Journal of Thrombosis and Thrombolysis -     

Prediabetic Neuropathy: Does It Exist?

It is now increasingly being appreciated that a substantial proportion of subjects with prediabetes may exhibit peripheral neuropathy and/or neuropathic pain. The reverse is also true, inasmuch as examining patients with idiopathic peripheral neuropathy will frequently reveal prediabetes. In the general population, the prevalence of neuropathy in prediabetes is intermediate between overt diabetes and subjects with normoglycemia. This prediabetic neuropathy is, generally, milder in comparison to diabetic neuropathy and mainly affects small fibers mediating sensory function. Hyperglycemia, microangiopathy, dyslipidemia and the metabolic syndrome have been implicated as pathogenic mechanisms. In practice, therapy of prediabetic neuropathy should be addressed towards normoglycemia and correction of cardiovascular risk factors. However, additional work is needed to establish the long-term results of this approach.     

Lethal Reperfusion Injury: Does Anyone Still Care?

Journal of Thrombosis and Thrombolysis -     

Does Family History Have any Relevance to Clinical Practice in Cardiology?

Years ago it was common to include all aspects of the history in the presentation, including the family history. In more recent times when there are multiple admissions of patients with cardiac symptoms (e.g., chest pain), the details of the present illness and any past cardiovascular illnesses are generally presented in detail, but there is a tendency to pay little attention to the family history and it is often neglected. Copyright © 2009 Wiley Periodicals, Inc.     

Statin Rebound or Withdrawal Syndrome: Does It Exist?

Studies in vascular cells in culture and in laboratory animals revealed that statin discontinuation triggers a rebound deterioration of vascular function. Retrospective studies of patients admitted with an acute coronary syndrome revealed that stopping statins during the first days of admission was associated with worse outcomes. In a prospective, randomized controlled trial in patients with a hemispheric ischemic stroke, stopping statins for 3 days was associated with a 4.7-fold increase in the risk of death or dependency, greater neurological deterioration, and a larger infarct volume. Discontinuing statins during the post-operative period following major vascular surgery was associated with a higher incidence of myocardial ischemia, nonfatal myocardial infarction, and cardiovascular death. However, no increase in adverse outcomes was observed in patients with stable chronic coronary artery disease following statin treatment discontinuation. Despite some study limitations, the bulk of the evidence suggests that under conditions of severe acute vascular stress, removal of statins must be contraindicated.     

Lethal “Reperfusion Injury”: Is It a Real Entity?

Journal of Thrombosis and Thrombolysis -     

Does Lethal Reperfusion Injury Interfere with Myocardial Salvage?

Journal of Thrombosis and Thrombolysis -     

Does Lethal Myocardial Reperfusion Injury Exist? A Controversy that is Unlikely to Be Settled in our Lifetime

Journal of Thrombosis and Thrombolysis -     

Lethal Myocardial Reperfusion Injury: Fact or Fiction?

Journal of Thrombosis and Thrombolysis -     

Reperfusion Injury: Idle Curiosity or Therapeutic Vector?

Journal of Thrombosis and Thrombolysis -     

Intracoronary Thermography: Does It Help Us in Clinical Decision Making?

The concept of the "vulnerable" plaque has recently emerged to explain how quiescent atherosclerotic lesions evolve to cause clinical events. The morphologic and immunologic determinants specific for the vulnerable plaque have been reported: a large lipid core (>or=40% plaque volume) composed of free cholesterol crystals, cholesterol esters, and oxidized lipids impregnated with tissue factor; a thin fibrous cap depleted of smooth muscle cells and collagen; an outward (positive) remodeling; inflammatory cell infiltration of fibrous cap and adventitia (mostly monocyte-macrophages, some activated T cells, and mast cells); and increased neovascularity. Despite the large amount of information regarding the morphological characteristics of remote lesions, we lack studies with functional assessment of non-culprit lesions. Coronary thermography is a technique for functional assessment of coronary atherosclerotic plaques. Several catheter designs have been proposed. There are catheters with thermistor(s) and wires with thermal sensors at the distal tip. All designs have several advantages and disadvantages. Despite the current limitations of coronary thermography, we gained important pathophysiological and clinical information regarding the vulnerability of atheromatic plaques. It has been documented both experimentally and clinically that increased heat generation is associated with increased macrophage concentration within the plaque. The correlation between local inflammatory involvement and local heat generation has also been observed with the peripheral inflammatory markers such as C-reactive protein. Whether systemic treatment, with agents such as statins or interventional techniques, such as drug-eluting stents, will have an impact on stabilizing vulnerable plaques need to be determined in future studies. In conclusion, although there are several techniques for evaluating morphologically atheromatic plaques, thermography is a promising method for the functional assessment of vulnerable plaque and has been introduced into clinical practice, with a good predictive value for clinical events in patients with increased temperature in the atherosclerotic plaque.     

REVIEW: Ischemia—Reperfusion Injury of the Intestine and Protective Strategies Against Injury

Ischemia-reperfusion injury of the intestine is a significant problem in abdominal aortic aneurysm surgery, small bowel transplantation, cardiopulmonary bypass, strangulated hernias, and neonatal necrotizing enterocolitis. It can also occur as a consequence of collapse of systemic circulation, as in hypovolemic and septic shock. It is associated with a high morbidity and mortality. This article is a comprehensive review of the current status of the molecular biology and the strategies to prevent ischemia-reperfusion injury of the intestine. Various treatment modalities have successfully been applied to attenuate reperfusion injury in animal models of reperfusion injury of the intestine. Ischemic preconditioning has been found to be the most promising strategy against reperfusion injury during the last few years, appearing to increase the tolerance of the intestine to reperfusion injury. Although ischemic preconditioning has been shown to be beneficial in the human heart and the liver, prospective controlled studies in humans involving ischemic preconditioning of the intestine are lacking. Research focused on the application of novel drugs that can mimic the effects of ischemic preconditioning to manipulate the cellular events during reperfusion injury of the intestine is required.