losartan-potassium and Aortic-Aneurysm--Thoracic

Paraplegia remains a significant complication of thoracoabdominal aortic intervention. We previously reported that diazoxide (DZ), enhances the neuroprotective efficacy of erythropoietin (EPO). We hypothesized that DZ and EPO combined treatment attenuates spinal cord ischemic injury through upregulation of nerve growth factor (NGF).. DZ (pretreatment) was given to adult male C57/BL6 mice by oral gavage and EPO (before surgery) was intraperitoneally injected 32 h after administration of DZ. Spinal cords were harvested 0, 2, 4, and 6 h after injection of EPO. NGF expression was analyzed by western blot. After determining the optimal time, NGF expression was compared between DZ (pretreatment) + EPO (before surgery), DZ + PBS, PBS + EPO, and PBS + PBS (ischemic control). Four groups were studied to compare the motor function after ischemia: DZ + EPO (n = 11), ischemic control (n = 9), DZ + EPO + tropomyosin receptor kinase A receptor inhibitor (n = 9), and sham (without cross-clamp, n = 4). Spinal cord ischemia was induced by a 4-min thoracic aortic cross-clamp. Functional scoring (Basso Mouse Score) was done at 12-h intervals until 48 h, and spinal cords were harvested for evaluation of NGF expression and histological changes.. NGF expression was significantly upregulated 4 h after administration of EPO. At 4 h after injection of EPO, NGF expression in the DZ + EPO group was significantly higher than that in the other groups. DZ + EPO significantly preserved motor function compared with all other groups. At 48 h after reperfusion, the level of NGF expression in the DZ + EPO group, was significantly higher than in all other groups.. DZ + EPO attenuates spinal cord ischemic injury through upregulation of NGF. Better understanding of this mechanism may serve to further prevent ischemic complications for aortic intervention.

Topics: Animals; Aortic Aneurysm, Thoracic; Diazoxide; Disease Models, Animal; Drug Synergism; Erythropoietin; Humans; Male; Mice; Nerve Growth Factor; Paraplegia; Recombinant Proteins; Spinal Cord; Spinal Cord Ischemia; Up-Regulation; Vascular Surgical Procedures

Thoraco-abdominal aneurysm repair usually necessitates blood or blood product transfusion which is prohibited in Jehovah's Witnesses. We report the blood conservation strategy used during thoraco-abdominal aneurysm repair in a Jehovah's Witness. This included pre-operative recombinant erythropoietin, per-operative acute normovolaemic haemodilution, cell salvage, aprotinin, restricted heparinisation, left atrial-distal bypass and recombinant factor VIIa. Post-operative haemoglobin levels were maintained, but a left haemothorax necessitated re-thoracotomy on post-operative day 4. Following re-thoracotomy, Hb was 12.0 g.dL(-1) and platelet count 49 x 10(9).L(-1). Recombinant erythropoietin was recommenced. At discharge (day 12), Hb was 10.1 g.d(L-1). The patient remains well at one year. A thoroughly, pre-planned multi-disciplinary blood conservation strategy can be used to undertake high-risk procedures.

Topics: Adult; Anticoagulants; Aortic Aneurysm, Thoracic; Aprotinin; Blood Loss, Surgical; Erythropoietin; Hemodilution; Heparin; Humans; Jehovah's Witnesses; Male; Preoperative Care; Tomography, X-Ray Computed

Topics: Adult; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Blood Transfusion, Autologous; Erythropoietin; Female; Hemodilution; Humans; Jehovah's Witnesses; Preoperative Care

The thromboexclusion technique was used to treat a massive thoracic aneurysm in a Jehovah's witness. Preoperative erythropoietin therapy was used. At operation a Hemashield graft was used to bypass the aneurysm before the mouth was stapled closed. The hemoglobin level fell from 13.5 to 10.6 g/dL.

Topics: Aortic Aneurysm, Thoracic; Aortic Dissection; Blood Vessel Prosthesis; Christianity; Embolization, Therapeutic; Erythropoietin; Humans; Male; Middle Aged; Surgical Staplers