raffinose and Emergencies

Organ shortage limits the number of transplantations, and donor deterioration may precede and often prevent conventional organ preservation. This study evaluates in situ perfusion as a bedside method for cardiac allograft procurement in a large animal model.. Thirty Landrace pigs (42 +/- 7 kg) were studied. The hearts in the conventional group underwent cardioplegic arrest with University of Wisconsin solution and sodium-hydrogen exchange inhibitor cariporide as an additive; they were explanted and stored on ice before transplantation. In the in situ group, one catheter was placed in the ascending aorta and another in the right atrium. After disconnection from the ventilator, hypoxia caused circulatory arrest. The aorta was endoclamped, and in situ perfusion of the aortic root was maintained with University of Wisconsin solution and cariporide. After explantation, hearts were stored on ice for 120 min. All hearts were implanted according to the Shumway technique. Ventricular pressure and cardiac output were monitored online, and troponin-I was measured intermittently. Two hours after weaning from extracorporal circulation, the animals were killed and histology was performed.. Catheters were placed through introducers within 5 min. Functional recovery and histology were comparable between the two techniques. Troponin-I increased in both groups during reperfusion but at a faster rate in the in situ technique (P <0.01).. In situ perfusion may be suitable for cardiac transplants when donor deterioration requires urgent organ preservation. Catheters can be placed at bedside and modified to achieve multi-organ protection through additional perfusion of the abdominal aorta.

Topics: Adenosine; Allopurinol; Animals; Cardioplegic Solutions; Catheterization; Emergencies; Glutathione; Guanidines; Heart; Heart Transplantation; Humans; In Vitro Techniques; Insulin; Models, Animal; Organ Preservation; Organ Preservation Solutions; Perfusion; Raffinose; Sulfones; Sus scrofa; Tissue and Organ Procurement; Tissue Donors

Hemoglobin-based oxygen carriers hold promise for the treatment of acute anemia.. We report a patient with severe dysfunctional uterine bleeding. During her hospitalization, her lowest hemoglobin level was 3.1 g/dL, with a hematocrit of 9.3%. An investigational product, o-raffinose cross-linked human hemoglobin solution (hemoglobin raffimer), was infused along with ongoing high-dose recombinant human erythropoietin and estrogen. The time until the patient's own hematopoiesis provided sufficient red blood cell mass was successfully managed by reducing oxygen demand and providing multiple hemoglobin-based oxygen carrier infusions. After hemoglobin-based oxygen carrier administration, transient pulmonary hypertension and fever were noted. She was discharged after corrective surgery 7 days after hemoglobin-based oxygen carrier administration with a hemoglobin level of 7.8 g/dL.. The hemoglobin level-based oxygen carrier improved oxygen delivery and permitted uterine corrective surgery.

Topics: Adult; Anemia; Emergencies; Female; Hematocrit; Hemoglobins; Humans; Hypertension, Pulmonary; Jehovah's Witnesses; Menorrhagia; Raffinose

Topics: Adenosine; Allopurinol; Elective Surgical Procedures; Emergencies; Female; Glutathione; Humans; Hypertonic Solutions; Insulin; Ischemia; Liver; Liver Transplantation; Male; Organ Preservation; Organ Preservation Solutions; Postoperative Complications; Probability; Prognosis; Raffinose; Renal Insufficiency; Retrospective Studies; Risk Factors; Time Factors