losartan-potassium and Shock

Topics: Acute Lung Injury; Adult; Anemia; Blood Preservation; Blood Specimen Collection; Brain Injuries; Critical Illness; Erythrocyte Transfusion; Erythropoietin; Hemorrhage; Humans; Myocardial Ischemia; Nervous System Diseases; Sepsis; Shock; Stroke; Subarachnoid Hemorrhage

In forensic pathology, while classical morphology remains a core procedure to investigate deaths, a spectrum of ancillary procedures has been developed and incorporated to detail the pathology. Among them, postmortem biochemistry is important to investigate the systemic pathophysiological changes involved in the dying process that cannot be detected by morphology. In addition, recent advances in molecular biology have provided a procedure to investigate genetic bases of diseases that might present with sudden death, which is called 'molecular autopsy'. Meanwhile, the practical application of RNA analyses to postmortem investigation has not been accepted due to rapid decay after death; however, recent experimental and practical studies using real-time reverse transcription-PCR have suggested that the relative quantification of mRNA transcripts can be applied in molecular pathology for postmortem investigation of deaths, which may be called 'advanced molecular autopsy'. In a broad sense, forensic molecular pathology implies applied medical sciences to investigate the genetic basis of diseases, and the pathophysiology of diseases and traumas leading to death at a biological molecular level in the context of forensic pathology. The possible applications include analyses of local pathology, including tissue injury, ischemia/hypoxia and inflammation at the site of insult or specific tissue damage from intoxication, systemic responses to violence or environmental hazards, disorders due to intoxication, and systemic pathophysiology of fatal process involving major life-support organs. A review of previous studies suggests that systematic postmortem quantitative analysis of mRNA transcripts can be established from multi-faceted aspects of molecular biology and incorporated into death investigations in forensic pathology, to support and reinforce morphological evidence.

Topics: Aging; Animals; Asphyxia; Biomarkers; Erythropoietin; Forensic Pathology; Gene Expression; Glucose Transporter Type 1; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Hypoxia-Ischemia, Brain; Immunohistochemistry; Postmortem Changes; Pulmonary Surfactant-Associated Proteins; Respiratory Insufficiency; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Shock; Specimen Handling; Vascular Endothelial Growth Factor A; Violence; Wounds and Injuries

High energy trauma is often responsible for acute bleeding. Long bone and pelvis fractures are correlated with increased blood loss. Hypovolaemia could become a life threatening complication especially in elderly patients because of the reduced physiological response. Furthermore it could compromise the course of associated morbidities. Haemorrage is also associated in both comminuted fractures and osteoporosis. An increased intraoperative bleeding often occurs when a prolonged surgical time is required to obtain an appropriate ostheosynthesis. The final consequence of a mayor bleeding is hypovolaemic shock. The reduced oxygen tension of the tissue may be responsible for heart attack, arrhythmia, stroke, multi organ deficiency. For these reasons, it is important to immediately recognize and correct all potential bleeding in order to avoid complications.

Topics: Blood Loss, Surgical; Blood Transfusion; Erythropoietin; Hematinics; Humans; Orthopedics; Shock; Wounds and Injuries

Because of the firm refusal of transfusion of blood and blood components by Jehovah's Witnesses, the management of Jehovah's Witness patients with severe bleeding is often complicated by medical, ethical, and legal concerns. Because of a rapidly growing and worldwide membership, physicians working in hospitals should be prepared to manage these patients. Appropriate management of a Jehovah's Witness patient with severe bleeding entails understanding of the legal and ethical issues involved, and meticulous medical management, including treatment of hypovolemic shock, local hemostatic interventions, and administration of prohemostatic agents, when appropriate. In addition, high-dose recombinant erythropoietin in combination with supplemental iron may enhance the speed of hemoglobin synthesis.

Topics: Acute Disease; Adult; Antifibrinolytic Agents; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Transfusion; Contraindications; Emergencies; Erythropoietin; Hemorrhage; Hemostatic Techniques; Humans; Informed Consent; Jehovah's Witnesses; Phlebotomy; Recombinant Proteins; Shock; Treatment Refusal; Unconsciousness; Vitamin K

Erythropoietin (EPO), already known as the stimulating hormone for erythropoiesis, has shown different and interesting pleiotropic actions. It does not only affect erythroid cells, but also myeloid cells, lymphocytes and megakaryocytes. This hormone can also enhance phagocytic function of the polymorphonuclear cells and reduce the activation of macrophages, thus modulating the inflammatory process.Moreover, hematopoietic and endothelial cells probably have the same cellular origin, and the discovery of erythropoietin receptors (EPO-R) also on mesangial and myocardial cells, smooth muscle fibrocells and neurons has prompted the study of the non-erythropoietic functions of this hormone.The interaction between EPO and VEGF may be of particular importance in neovascularization and wound healing. Different studies have demonstrated that EPO has an important direct hemodynamic and vasoactive action, which does not depend exclusively on any increase in hematocrit and viscosity. Moreover EPO showed protective effects on myocardial cells against apoptosis induced by ischemia/repefusion injury, but it could negatively affect pulmonary hypertension in patient with chronic cor pulmonale.This review aims to stress the importance of the increasing interest in EPO applications and the necessity of further studies to gain a deeper knowledge of this hormone and its pleiotropic and complex actions.

Topics: Anemia; Angiogenesis Modulating Agents; Clinical Trials as Topic; Erythropoietin; Humans; Hypoxia; Shock; Vascular Endothelial Growth Factor A

Topics: Anemia; Animals; Blood Pressure; Blood Substitutes; Blood Transfusion; Christianity; Erythropoietin; Ethics, Nursing; Female; Humans; Middle Aged; Religion and Medicine; Severity of Illness Index; Shock; United States; Wounds and Injuries

Topics: Animals; Aspirin; Blood Coagulation; Blood Platelets; Blood Preservation; Blood Transfusion; Chromium Radioisotopes; Cyclic AMP; Dimethyl Sulfoxide; Erythrocytes; Erythropoiesis; Erythropoietin; Hematocrit; Hemolysis; Humans; Hypertension; Kidney; Osmotic Fragility; Platelet Adhesiveness; Prostaglandins; Receptors, Cell Surface; Shock

Topics: Animals; Anti-Inflammatory Agents; Antioxidants; Apoptosis; Darbepoetin alfa; Erythropoietin; Humans; Multiple Organ Failure; Oxidative Stress; Recombinant Proteins; Shock; Time Factors

Erythropoietin protects many organs against the tissue injury and dysfunction caused by ischaemia/reperfusion and excessive inflammation. This editorial comment discusses the effects of erythropoietin in preclinical models of septic shock, endotoxemia, hemorrhagic shock, spinal cord trauma and zymosan-induced multiple organ failure.

Topics: Animals; Disease Models, Animal; Dose-Response Relationship, Drug; Endotoxemia; Erythropoietin; Mice; Multiple Organ Failure; Shock; Shock, Hemorrhagic; Shock, Septic; Spinal Cord Injuries; Treatment Outcome; Zymosan

Erythropoietin is a potent stimulator of erythroid progenitor cells, and its expression is enhanced by hypoxia. In the present study, we investigated the effects of erythropoietin (1000 IU/kg subcutaneously) on the development of nonseptic shock caused by zymosan.. Prospective, randomized study.. University-based research laboratory.. Male CD mice.. Mice received either intraperitoneally zymosan (500 mg/kg, administered intraperitoneally as a suspension in saline) or vehicle (0.25 mL/mouse saline). Erythropoietin was administered at the dose of 1000 IU/kg subcutaneously, 1 and 6 hrs after zymosan administration. Organ failure and systemic inflammation in mice was assessed 18 hrs after administration of zymosan and/or erythropoietin.. Treatment of mice with erythropoietin (1000 IU/kg subcutaneously, 1 and 6 hrs after zymosan administration) attenuated the peritoneal exudation and the migration of polymorphonuclear cells caused by zymosan. Erythropoietin also attenuated the lung, liver, and pancreatic injury and renal dysfunction caused by zymosan as well as the increase in myeloperoxidase activity caused by zymosan in the lung and intestine. Immunohistochemical analysis for nitrotyrosine and poly(ADP-ribose) revealed positive staining in lung and intestine tissues obtained from zymosan-treated mice. The degree of staining for nitrotyrosine and poly(ADP-ribose) was markedly reduced in tissue sections obtained from zymosan-treated mice, which received erythropoietin. In addition, administration of zymosan caused severe illness in the mice characterized by a systemic toxicity, significant loss of body weight, and a 70% mortality rate at the end of observation period (7 days). Treatment with erythropoietin significantly reduced the development of systemic toxicity, the loss in body weight, and the mortality caused by zymosan.. This study provides evidence, for the first time, that erythropoietin attenuates the degree of zymosan-induced nonseptic shock in mice.

Topics: Animals; Erythropoietin; Male; Mice; Shock; Zymosan

Previous studies in rodents from different kinds of shock models and isolated vessel models indicate that erythropoietin (EPO) has haemodynamic effects through interaction with sympathetic stimuli. This has relevance to the recently described non-haematopoietic effects of EPO, e.g. tissue protective effects. Studies describing the acute effects on integrated physiological haemodynamic variables in larger animal models are scarce though.. To examine the acute effects of EPO on standard physiological haemodynamic parameters as well as a possible synergistic effect of a sympathetic agonist (dopamine) and EPO on these parameters. RESULTS AND DESIGN: A porcine model was applied. Invasive haemodynamic variables were recorded at baseline, during 2 h after EPO injection and with addition of dopamine. Significant changes were only seen with addition of dopamine. Thus cardiac output increased only significantly in control group (21% versus 4%, P<0.05), and accordingly a decline in systemic vascular resistance was only seen in the control group (19% versus 5%, P< 0.05) with addition of dopamine. Pulmonary vascular resistance increased in EPO group (42% versus unchanged, P<0.05). There was a trend towards increase in left ventricular contractility as measured by slope of the pressure-volume relation (E(max)) in EPO group with addition of dopamine.. Erythropoietin has small but significant haemodynamic effects on the response to a sympathetic agonist in the present minimal invasive porcine model.

Topics: Animals; Cardiac Output; Disease Models, Animal; Dopamine; Erythropoietin; Humans; Models, Cardiovascular; Models, Genetic; Models, Statistical; Oxygen; Oxygen Consumption; Shock; Swine; Systole; Time Factors

1. We investigated the effects of recombinant human erythropoietin (rh-EPO) in splanchnic artery occlusion (SAO) shock. Sham operated animals were used as controls. Survival rate, mean arterial blood pressure (MAP), serum Tumor Necrosis Factor (TNF-alpha), plasma nitrite/nitrate concentrations, red blood cell (RBC) count, blood haemoglobin (Hb), the responsiveness of aortic rings to phenylephrine (PE, 1 nM-10 microM) and the activity of inducible nitric oxide synthase (iNOS) were studied. 2. SAO shocked rats had a decreased survival rate (0% at 4 h of reperfusion, while sham shocked rats survived more than 4 h), enhanced serum TNF-alpha concentrations, increased plasma nitrite/nitrate levels (60+/-9.5 microM; sham shocked rats= 2+/-0.4 microM), decreased MAP, unchanged RBC count and blood Hb and enhanced iNOS activity in the aorta. Moreover aortic rings from shocked rats showed a marked hyporeactivity to PE. 3. Rh-EPO (25, 50 and 100 U 100 g(-1), 5 min following the onset of reperfusion) increased survival rate (70% at 4 h of reperfusion with the highest dose), reduced plasma nitrite/nitrate concentrations (10.3+/-3.3 microM), increased MAP, did not change RBC count and blood Hb, and inhibited iNOS activity in thoracic aortae. Furthermore rh-EPO, either in vivo or in vitro (10 U for 1 h in the organ bath), restored to control values the hyporeactivity to PE. Finally rh-EPO inhibited the activity of iNOS in peritoneal macrophages activated with endotoxin. 4. Our data suggest that rh-EPO protects against SAO shock by inhibiting iNOS activity.

Topics: Animals; Aorta, Thoracic; Blood Pressure; Constriction, Pathologic; Enzyme Inhibitors; Erythrocyte Count; Erythropoietin; Humans; In Vitro Techniques; Male; Muscle Contraction; Muscle, Smooth, Vascular; Nitric Oxide; Nitric Oxide Synthase; Nitric Oxide Synthase Type II; Rats; Rats, Sprague-Dawley; Recombinant Proteins; Shock; Splanchnic Circulation; Survival Analysis; Tumor Necrosis Factor-alpha

Topics: Dobutamine; Dopamine; Erythropoietin; Fatal Outcome; Female; Hemodynamics; Humans; Male; Middle Aged; Pulmonary Artery; Recombinant Proteins; Shock; Vascular Resistance