Rapidly progressing fatal reperfusion syndrome caused by acute critical ischemia of the lower limb
Rapidly progressing fatal reperfusion syndrome caused by acute critical ischemia of the lower limb
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DOI：
10.1016/j.carpath.2013.02.006
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发表时间：
2013-11-01
影响因子：
3.7
通讯作者：
Lotz, Gabor
中科院分区：
文献类型：
--
作者：
Szijarto, Attila;Turoczi, Zsolt;Lotz, Gabor
下肢动脉手术后缺血再灌注损伤最严重的并发症是再灌注综合征。因此，我们的目的是详细描述肌肉损伤的程度和再灌注综合征相关的远端器官病变，通过一个记录良好的长期肾下主动脉血栓形成的情况。紧急血运重建后，可检测到多器官功能障碍的几种临床体征，包括循环、泌尿、呼吸、胃肠道和止血系统。根据组织学检查，术中肌肉活检显示严重的肌肉损伤。肌纤维的活力进行了评估与一个特殊的硝基蓝四氮唑染色为基础的活力测试由我们的团队开发;所获得的结果表明，在此之前，这是通过常规的组织学方法证实了显着程度的肌肉损伤。彻底的尸检证实了远程器官损伤的存在。病理结果包括急性肾小管坏死、心肌和空肠梗死、缺血性胰腺炎、弥漫性肺泡损伤伴肺透明膜形成和局灶性小叶中心肝坏死。通过使用特殊的染色技术，在肾脏样本中确认了肌红蛋白和脂褐质沉积物的存在。在本文中，我们提出了一个病人谁开发的所有主要并发症后，长期持续的动脉闭塞。我们还介绍了一种新的方法来评估缺血性损伤的程度，这可能是适合在不久的将来快速检测不可逆的肌肉损伤。因此，可以降低该病的死亡率。(C)2013 Elsevier Inc. All rights reserved.
The most severe complication of ischemia-reperfusion injury following lower limb arterial surgery is reperfusion syndrome. Therefore, our aim was to describe the extent of muscle damage and the reperfusion syndrome-related remote organ lesions in detail, through a well-documented case of long-lasting infrarenal aorta thrombosis. After urgent revascularization, several clinical signs of multiple organ dysfunction were detectable, including the circulatory, urinary, respiratory, gastrointestinal, and hemostatic systems. Upon histological examination, intraoperative muscle biopsy showed severe muscle damage. Muscle fiber viability was assessed with a special nitroblue tetrazolium staining-based viability test developed by our team; the obtained results indicated significant degree of muscle damage before this was confirmed by conventional histological methods. Thorough postmortem examination confirmed the presence of remote organ damage. The pathological findings included acute tubular necrosis, myocardial and jejunal infarctions, ischemic pancreatitis, and diffuse alveolar damage with hyaline membrane formation in the lungs and focal centrilobular liver necrosis. By using special staining techniques, the presence of myoglobin and lipofuscin deposits was confirmed in the kidney samples. In this paper, we present a patient who developed all major complications following long-lasting arterial occlusion. We also introduce a novel method to assess the degree of ischemic injury, which may be suitable in the near future for the rapid detection of irreversible muscle injury. Therefore, the mortality of the disease might be reduced. (C) 2013 Elsevier Inc. All rights reserved.