39 research outputs found
Metastaza malignog ameloblastoma na vratu - radioloŔka i patohistoloŔka dilema
Introduction. Ameloblastomas are odontogenic epithelial, locally invasive tumors of slow growth and mostly of benign behavior. Their frequency is low (they account for 1% of all head and neck tumors and about 11% of tumors of dental origin). Malignant variations of ameloblastoma are malignant ameloblastoma and ameloblastic carcinoma. They constitute less than 1% of all ameloblastomas. We presented a case of malignant ameloblastoma of the mandible with neck metastasis. Case report. A patient, aged 72, presented with the following symptoms: pain in the lower jaw, swelling in the left submandibular area and difficult mouth opening. The patient was admitted to the Department of Oral and Maxillofacial Surgery, Clinical Center of Montenegro, two months after he had noticed the symptoms. Panoramic radiography (OPG) showed that both jaws were partially toothless with terminal stage of periodontitis of the remaining teeth. Also, OPG showed sharply limited semicircular defect in the retromolar region and along the front edge of the mandible rami. Conventional histopathologic examination of the neck masses showed malignant ameloblastoma which contained central fields of squamous differentiation. Immunoreactivity of several markers was determined using immunohistochemical analyses. After these diagnostic methods a definite histopathology diagnosis was made: Ameloblastoma metastaticum in textus fibroadiposus regio colli (typus acanthomatosus). Conclusion. It is not possible to distinguish conventional, ie intraosseous, ameloblastoma from malignant ameloblastoma according to histopathologic features. It is necessary to pay special attention, especially in elderly patients, and to carry out further clinical, radiological and pathohistological diagnostic procedures, such as immunohistochemical analysis. A timely and correct diagnosis and treatment of malignant ameloblastoma require a multidisciplinary approach.Uvod. Ameloblastomi su odontogeni epitelni tumori, lokalno invazivni, sporog rasta, i u veÄini sluÄajeva pokazuju benigno ponaÅ”anje. Veoma su rijetki. Njihova uÄestalost je 1% u grupi tumora glave i vrata, kao i 11% kod tumora koji potiÄu od zubnih tkiva. Maligne varijante ameloblastoma su maligni ameloblastom i ameloblastiÄki karcinom. Oni Äine manje od 1% svih ameloblastoma. U radu je prikazan bolesnik sa malignim ameloblastomom donje vilice sa metastazom na vratu. Prikaz bolesnika. Prve subjektivne tegobe bolesnika, starog 72 godine, manifestovale su se kao bolovi u predelu donje vilice, otok u podviliÄnom predelu sa leve strane i otežano otvaranje usta. Bolesnik je primljen u Odeljenje oralne i maksilofacijalne hirurgije KliniÄkog centra Crne Gore dva meseca nakon Å”to je primetio prve tegobe. Ortopantomografski snimak pokazao je suptotalnu bezubost obeju vilica sa terminalnim stadijumom parodontopatije na preostalim zubima. U retromolarnoj regiji i duž prednje ivice ramusa donje vilice, uoÄen je jasno ograniÄen polukružni defekt. Biopsija promene na vratu pokazala je metastazu malignog ameloblastoma, sa prisutnim centralnim poljima skvamozne diferencijacije. Imunohistohemijskom analizom odreÄivana je imunoreaktivnost viÅ”e markera. Nakon ovih dijagnostiÄkih metoda postavljena je definitivna patohistoloÅ”ka dijagnoza: Ameloblastoma metastaticum in textus fibroadiposus regio colli (typus acanthomatosus). ZakljuÄak. Na osnovu histopatoloÅ”kog nalaza nije moguÄe razlikovati konvencionalni, tj. intraosealni, ameloblastom od malignog ameloblastoma. Zbog toga je potrebno obratiti posebnu pažnju, naro Äito kod bolesnika starijeg životnog doba, i sprovesti sve dodatne kliniÄke, radioloÅ”ke i histopatoloÅ”ke, ali i imunohistohemijske dijagnostiÄke procedure. Za postavljanje blagovremene i taÄne dijagnoze, kao i sprovoÄenje adekvatnog terapijskog tretmana malignog ameloblastoma, neophodan je multidisciplinarni pristup
Novi oralni antikoagulantni lekovi kod atrijalne fibrilacije i akutnog koronarnog sindroma
After an acute coronary syndrome, patients remain at risk of recurrent ischemic events despite the use of antiplatelet therapy. In order to reduce the risk of recurrent ischemia in the treatment of patients with acute coronary syndromes, standard oral anticoagulants, such as vitamin K antagonists, have been introduced. These drugs have an important role in preventing stroke and systemic embolism in patients with atrial fibrillation. Vitamin K antagonists (e.g., warfarin) reduce the risk of recurrent cardioĀvascular events and stroke but increase the risk of bleeding. In addition, the traditional anticoagulants have other significant drawbacks. Therefore, modulation of the coagulation process represents an important target in the development of new oral anticoagulants today. The new oral anticoagulants selectively target thrombin (dabigatran etexilate) or factor Xa (rivaroxaban, apixaban, edoxaban). Unlike traditional anticoagulants, these drugs have rapid onset of action and a relatively wide therapeutic range, do not require routine prothrombin time (PT) monitoring and have low potential for food and drug interaction. Dabigatran etexilate and rivaroxaban have been already approved in many countries for the prevention of stroke and systemic embolism in patients with atrial fibrillation. The third phase of clinical studies in which rivaroxaban was investigated in patients with acute coronary syndrome has been successfully completed. .Nakon akutnog koronarnog sindroma, kod bolesnika postoji poveÄan rizik od rekurentnih ishemiÄnih dogaÄaja, uprkos primeni antiagregacione terapije. U cilju smanjenja rizika od rekurentne ishemije, u terapiju visokoriziÄnih bolesnika sa akutnim koronarnim sindromom uvode se standardni oralni antikoagulansi, kao Å”to su antagonisti vitamina K. Ovi lekovi imaju važnu ulogu u prevenciji moždanog udara i sistemskog embolizma kod bolesnika sa atrijalnom fibrilacijom. Antagonisti vitamina K (varfarin) smanjuju rizik od nastanka ponovnih kardiovaskularnih dogaÄaja i moždanog udara, ali poveÄavaju rizik od krvarenja. Pored toga, antagonisti vitamina K poseduju i druge, znaÄajne nedostatke, tako da modulacija procesa koagulacije danas predstavlja znaÄajnu metu za razvoj novih oralnih antikoagulanasa. Novi oralni antikoagulansi deluju selektivno na trombin (dabigatran eteksilat) ili na faktor koagulacije Xa (rivaroksaban, apiksaban, edoksaban). Za razliku od standardnih antikoagulanasa, imaju brz poÄetak dejstva i relativno veliku terapijsku Å”irinu, ne zahtevaju laboratorijsku kontrolu protrombinskog vremena (PT) i retko stupaju u interakcije sa hranom i lekovima. Dabigatran eteksilat i rivaroksaban su veÄ registrovani u mnogim zemljama za prevenciju moždanog udara i sistemskog embolizma kod bolesnika sa atrijalnom fibrilacijom. TreÄa faza kliniÄke studije u okviru koje je ispitivan rivaroksaban kod bolesnika sa akutnim koronarnim sindromom uspeÅ”no je zavrÅ”ena.
Novi antikoagulantni lekovi
Anticoagulants are effective agents for the prevention and treatment of thrombosis and thromboembolic complications, which represent a common cause of morbidity and mortality. Despite their clinical efficiency, traditional anticoagulants are all associated with significant drawbacks. As a result, modulation of the coagulation process represents an important target in the development of new oral and parenteral anticoagulants today. The new oral anticoagulants selectively target thrombin (ximelagatran, dabigatran etexilate) or factor Xa (rivaroxaban, apixaban, edoxaban). Unlike the traditional anticoagulants, vitamin K antagonists, these drugs have rapid onset of action and a relatively wide therapeutic range, do not require routine prothrombin time (PT) monitoring and have low potential for food and drug interaction. The new parenteral anticoagulants achieve their effects through indirect (semuloparin, idrabiotaparinux) or direct inhibition of factor Xa (otamixaban), as well as through inhibition of coagulation factor IXa (RB006). The main characteristics of these agents are a rapid onset of action and a predictable anticoagulant effect, whereby the most of them can be rapidly neutralized by an adequate antidote.Antikoagulantni lekovi su delotvorni u prevenciji i leÄenju tromboze i tromboembolijskih komplikacija, koje su Äest uzrok morbiditeta i mortaliteta. Ipak, uprkos kliniÄkoj delotvornosti, standardni antikoagulansi poseduju znaÄajne nedostatke. Zbog toga, modulacija procesa koagulacije danas predstavlja znaÄajnu metu za razvoj novih, oralnih i parenteralnih, antikoagulanasa. Novi oralni antikoagulansi deluju selektivno na trombin (ksimelagatran, dabigatran eteksilat) ili na faktor koagulacije Xa (rivaroksaban, apiksaban, edoksaban). Za razliku od standardnih antikoagulanasa, antagonista vitamina K, imaju brz poÄetak dejstva i relativno veliku terapijsku Å”irinu, ne zahtevaju laboratorijsku kontrolu protrombinskog vremena (PT), i retko stupaju u interakcije sa hranom i lekovima. Novi parenteralni antikoagulansi svoje antikoagulantno dejstvo ostvaruju indirektnom (semuloparin, idrabiotaparinuks) ili direktnom inhibicijom faktora Xa (otamiksaban), kao i inhibicijom faktora koagulacije IXa (RB006). Glavne karakteristike ovih lekova su brz poÄetak dejstva i predvidljiv antikoagulantni efekat, a kod veÄine je moguÄe postiÄi brzu neutralizaciju adekvatnim antidotom
Direktni oralni antikoagulantni lekovi u profilaksi i terapiji tromboembolijskih bolesti
More than 50 years ago, vitamin K antagonists were the only available oral anticoagulants. Since their application involves a number of limitations, it was necessary to develop new oral anticoagulant drugs and introduce them into clinical practice. These drugs have many advantages over vitamin K antagonists, including rapid onset/offset, a small number of interactions with other drugs and food, simplified dosing and predictable pharmacokinetics, eliminating the need for daily laboratory monitoring. In addition, new oral anticoagulant drugs act selectively on a single coagulation factor. Currently, the following drugs are approved for use: direct thrombin inhibitor, dabigatran etexilate, direct factor Xa inhibitor, rivaroxaban, apixaban and edoxaban. Dabigatran etexilate and apixaban are approved for the primary prevention of venous thromboembolism in adult patients undergoing elective surgery of total hip or knee replacement, while in addition to these anticoagulants edoxaban is approved for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation. For the treatment and prevention of recurrent deep vein thrombosis dabigatran etexilate, rivaroxaban and edoxaban are approved. In addition, rivaroxaban is approved for the secondary prevention of atherothrombotic events in patients with acute coronary syndrome.ViÅ”e od 50 godina, antagonisti vitamina K bili su jedini dostupni oralni antikoagulantni lekovi. S obzirom na to da njihova primena podrazumeva brojna ograniÄenja, bilo je neophodno razviti i uvesti u kliniÄku praksu nove oralne antikoagulantne lekove. Ovi lekovi imaju brojne prednosti u poreÄenju s antagonistima vitamina K, koje ukljuÄuju brz poÄetak i prestanak dejstva, mali broj interakcija s drugim lekovima i hranom, pojednostavljen naÄin doziranja, kao i predvidivu farmakokinetiku, Äime se eliminiÅ”e potreba za svakodnevnim laboratorijskim praÄenjem. Osim toga, novi oralni antikoagulantni lekovi deluju selektivno samo na jedan faktor koagulacije. Trenutno su odobreni za upotrebu direktni inhibitor trombina, dabigatran eteksilat, kao i direktni inhibitori faktora Xa, rivaroksaban, edoksaban i apiksaban. Dabigatran eteksilat i apiksaban odobreni su za primarnu prevenciju venske tromboembolije kod odraslih pacijenata koji se podvrgavaju elektivnom hirurÅ”kom zahvatu totalne zamene kuka ili kolena, dok je za prevenciju moždanog udara i sistemske embolije kod odraslih pacijenata sa nevalvularnom atrijalnom fibrilacijom, pored navedenih antikoagulantnih lekova, odobren i edoksaban. Za terapiju i prevenciju rekurentne duboke venske tromboze odobreni su dabigatran eteksilat, rivaroksaban i edoksaban. Osim toga, rivaroksaban je odobren i za sekundarnu prevenciju aterotrombotiÄkih dogaÄaja nakon akutnog koronarnog sindroma
Mechanisms of endothelium-dependent vasorelaxation induced by procyanidin B2 in venous bypass graft
Cardioprotective abilities of procyanidins, might, at least in part, attribute to their vasodilator properties. The present study was undertaken to assess the vasorelaxant effect of procyanidin B2 on isolated human saphenous vein (HSV) and its underlying mechanisms. Procyanidin B2 relaxed phenylephrine-induced contraction of HSV rings in concentration-dependent manner. The relaxation was dependent on the presence of endothelium and was strongly affected by l-NAME, hydroxocobalamin or ODQ, the inhibitors of NO/cGMP pathway. Indomethacin significantly affected only the relaxation produced by the highest concentrations of procyanidin B2. Apamin and TRAM-34 combination, in the presence of l-NAME and indomethacin, did not additionally decreased procyanidin B2-induced relaxation. In the presence of K+ channel blockers, relaxation induced by procyanidin B2 was partially attenuated by 4-aminopyridine, significantly inhibited by glibenclamide and almost abolished by iberiotoxin. Procyanidin B2 also relaxed the contractions induced by phenylephrine or caffeine in Ca2+-free solution. Finally, nifedipine slightly, while thapsigargin strongly antagonized HSV relaxation. Our results indicate that procyanidin B2 induces endothelium-dependent relaxation of HSV, which results primarily from stimulation of NO production, as well K+ channels opening, especially BKCa, and partially KATP and KV. Regulation of the intracellular Ca2+ release and inhibition of Ca2+ influx probably cont
Tromboliza okludiranog femoropoplitealnog grafta lokalno primenjenim humanim plazminom
Introduction Acute lower limb ischemia results from thrombosis or embolization of diseased native artery or previously implanted bypass graft. When this occurs, several options are available to restore blood flow: catheter-directed thrombolysis, mechanical thrombectomy or open surgery. Fundamental reasons to apply percutaneous interventions are avoiding open procedures in high risk patients, and avoiding difficult dissection through scar tissue. Case Outline A 67-year-old male was admitted at our Institution for critical limb ischemia. After performed angiography the diagnosis of occluded femoropopliteal graft was established. Occlusion was resolved by catheter-directed thrombolysis with plasmin. Culprit lesions were treated by angioplasty. Conclusion Our patient underwent a successful thrombolysis of occluded femoropopliteal graft with locally-delivered human plasmin.Uvod Ishemija donjih ekstremiteta je posledica tromboze ili embolizacije obolele nativne arterije ili implantiranog grafta. Postoji nekoliko naÄina leÄenja ishemije: tromboliza kateterom, mehaniÄka trombektomija i hirurÅ”ko leÄenje. Osnovni razlozi za primenu perkutanih intervencija jeste izbegavanje klasiÄnog hirurÅ”kog leÄenja kod bolesnika s visokim rizikom, kao i izbegavanje preparisanja krvnog suda u ožiljku. Prikaz bolesnika MuÅ”karac star 67 godina primljen je u bolnicu zbog kritiÄne ishemije donjih ekstremiteta. Po uÄinjenoj angiografiji dijagnostikovana je tromboza femoropoplitealnog grafta. Okluzija je reÅ”ena primenom plazmina uz upotrebu intraarterijskog katetera. Stenoze koje su otkrivene posle trombolize leÄene su angioplastikom. ZakljuÄak Trombolizom uz primenu plazmina i intraarterijskog katetera uspeÅ”no je izleÄena okluzija femoropoplitealnog grafta
Novi lekovi u terapiji dislipidemija
Dyslipidemia is the leading risk factor for the development of atherosclerosis and associated consequences, such as coronary heart disease, ischemic cerebrovascular and peripheral vascular disease. These diseases are the major cause of mortality in the world and in Europe as well, where they are responsible for around 45% of all deaths. Treatment of dyslipidemia includes the use of statins, ezetimibe, fibrates, niacin, bile acids sequestrants and omega-3 fatty acids. Although statins play the major role in dyslipidemia treatment by reducing the risk of cardiovascular (CV) events by 30%, there is a need for additional new drugs that reduce the residual risk even more. PCSK9 inhibitors, apolipoprotein B (apoB) synthesis inhibitors, MTP inhibitors and CETP inhibitors are already approved for the specific indications, or are in the advanced stages of clinical investigation. Two PCSK9 inhibitors, alirocumab and evolocumab are approved for use in combination with statins for the treatment of heterozygous familial hypercholesterolemia (FH), but also in patients with clinical atherosclerotic CV diseases who require additional low-density lipoprotein cholesterol (LDL-C) level reduction. In addition, evolocumab is approved for use in patients with homozygous FH. Mipomersen, apoB synthesis inhibitor, lomitapide, and oral MTP inhibitor are currently approved in the treatment of patients with homozygous FH as an adjunct to the maximum tolerated doses of statins and other lipid-lowering drugs. Although the new lipid-lowering agents produce significant LDL-C level reduction, more clinical studies are necessary to confirm their efficacy and safety in dyslipidemia treatment.Dislipidemije su vodeÄi faktor rizika za razvoj ateroskleroze i njenih posledica, kao Å”to su koronarna bolest srca, ishemiÄna cerebrovaskularna i periferna vaskularna bolest. Ove bolesti su glavni uzrok mortaliteta, kako u svetu tako i u Evropi, gde su odgovorne za 45% ukupne smrtnosti. Terapija dislipidemija ukljuÄuje primenu: statina, ezetimiba, fibrata, niacina, smola koje vezuju žuÄne kiseline i omega-3 masnih kiselina. Od pomenutih lekova, vodeÄu ulogu u terapiji dislipidemija imaju statini. Treba istaÄi da uprkos primeni statina, koji redukuju rizik od pojave kardiovaskularnih (KV) dogaÄaja za oko 30%, joÅ” uvek ostaje tzv. rezidualni rizik za nastanak KV dogaÄaja, Å”to ukazuje da su potrebni novi lekovi koji Äe dalje redukovati rezidualni rizik. Novi lekovi u terapiji dislipidemija ukljuÄuju PCSK9 inhibitore, inhibitore sinteze apolipoproteina B (apoB), MTP inhibitore i CETP inhibitore, koji su ili veÄ odobreni za primenu u odreÄenim indikacijama, ili se nalaze u odmaklim fazama kliniÄkog ispitivanja. Alirokumab i evolokumab, dva PCSK9 inhibitora, odobrena su za primenu, u kombinaciji sa statinima, u terapiji heterozigotne familijarne hiperholesterolemije (FH), kao i kod bolesnika sa kliniÄkim aterosklerotiÄnim KV bolestima koji zahtevaju dodatnu redukciju nivoa lipoproteina male gustine (low-density lipoprotein cholesterol, LDL-C). Pored toga, evolokumab je odobren za primenu kod bolesnika sa homozigotnom FH. Mipomersen, inhibitor sinteze apoB, i lomitapid, oralni MTP inhibitor, su, odobreni za primenu samo kod bolesnika sa homozigotnom FH kao dodatak maksimalnoj toleriÅ”uÄoj dozi statina i drugih hipolipemika. Iako novi hipolipemici znaÄajno redukuju nivo LDL-C, neophodno je sprovesti studije, duže i sa veÄim brojem ispitanika, koje Äe potvrditi njihovu efikasnost i bezbednost i time omoguÄiti njihovu Å”iru primenu u terapiji dislipidemija
Mehanizam vazorelaksacije humane vene safene izazvane procijanidinom B2
Findings from epidemiological studies indicate that polyphenols, widespread in
human diet and with numerous biological activities, act cardioprotectively. Procyanidins are
subclass of polyphenols with high content in commonly consumed foods and beverages, such
as grapes, tea, chocolate, nuts and apples. Cardioprotective abilities of procyanidins, might, at
least partly, attribute to their vasodilator properties. Since exact mechanisms of procyanidin
B2-induced vasorelaxation are unknown, our study aimed to investigate relaxant effect of
procyanidin B2 on isolated human saphenous vein (HSV) and its underlying mechanisms.
Discarded segments of HSV were collected from patients undergoing bypass surgery and
studied in organ baths. Procyanidin B2 caused concentration-dependent relaxation of HSV
precontracted by phenylephrine. The relaxation was strongly affected by inhibitors of
NO/cGMP pathway, L-NAME, hydroxocobalamin and ODQ. Indomethacin, a cyclooxygenase
inhibitor, significantly reduced only relaxation produced by the highest concentrations of
procyanidin B2. Combination of apamin and TRAM-34, selective blockers of small- and
intermediate-conductance Ca 2+ -activated K+ (KCa ) channels (SKCa and IK Ca ), in the presence of
L-NAME and indomethacin, did not additionally affect procyanidin B2-induced relaxation.
Additionally, relaxation induced by procyanidin B2 was partially attenuated by 4-
aminopyridine, predominant blocker of voltage-gated K+ (KV) channels, significantly
inhibited by glibenclamide, selective ATP-sensitive K+ (KATP) channels inhibitor, and almost
abolished by iberiotoxin, highly selective blocker of large-conductance KCa (BKCa ). Our results
revealed that procyanidin B2 acts as a potent vasodilator on isolated human venous graft.
Mechanism of this relaxation of HSV probably involves stimulation of NO production, as well
K+ channels opening, especially BK Ca , and partially KATP and KVNalazi epidemioloŔkih studija ukazuju da polifenoli, Ŕiroko rasprostranjeni u ljudskoj
ishrani i sa brojnim bioloŔkim aktivnostima, deluju kardioprotektivno. Procijanidini su
podklasa polifenola sa visokim sadržajem u Äesto konzumiranoj hrani i piÄima, kao Å”to su
grožÄe, Äaj, Äokolada, oraÅ”asti plodovi i jabuke. Kardioprotektivno delovanje procijanidina
može se, bar delimiÄno, pripisati njihovim vazodilatatornim svojstvima. S obzirom da taÄni
mehanizmi pomoÄu kojih procijanidin B2 izaziva vazorelaksaciju nisu poznati, cilj naÅ”e
studije bio je da istražimo relaksantni efekat procijanidina B2 na izolovanoj humanoj veni
safeni (HSV) i njegove osnovne mehanizme.NeiskoriÅ”Äeni segmenti HSV su uzimani od
pacijenata u toku bajpas operacija i ispitivani u kupatilu za izolovane organe. Procijanidin B2
izazvao je koncentracijski-zavisnu relaksaciju HSV prekontrahovane fenilefrinom. Na
relaksaciju su snažno uticali inhibitori NO/cGMP puta, L-NAME, hidroksokobalamin i ODQ.
Indometacin, inhibitor ciklooksigenaze, znaÄajno je umanjio samo relaksaciju izazivanu
najveÄim koncentracijama procijanidina B2. Kombinacija apamina i TRAM-34, selektivnih
blokatora Ca 2+ -zavisnih K+ (KCa ) kanala male i srednje provodljivosti (SKCa i IK Ca ), u prisustvu
L-NAME i indometacina, nije dodatno uticala na relaksaciju uzrokovanu procijanidinom B2.
Osim toga, procijanidinom B2 izazvana relaksacija bila je delimiÄno umanjena 4-
aminopiridinom, dominantnim blokatorom voltažno-zavisnih K+ (KV) kanala, znaÄajno
inhibirana glibenklamidom, selektivnim inhibitorom ATP-zavisnih K+ (KATP) kanala, i skoro
potpuno blokirana iberiotoksinom, selektivnim blokatorom K Ca velike provodljivosti (BK Ca).
NaÅ”i rezultati pokazuju da procijanidin B2 deluje kao moÄni vazodilatator na izolovanom
humanom venskom graftu. Mehanizam ove relaksacije HSV verovatno ukljuÄuje stimulaciju
proizvodnje NO, kao i otvaranje K+ kanala, posebno BK Ca , i delimiÄno KATP i KVVIII Kongres farmaceuta Srbije sa meÄunarodnim uÄeÅ”Äem, 12-15.10.2022. Beogra
Nicorandil directly and cyclic GMP-dependently opens K+ channels in human bypass grafts
As we previously demonstrated the role of different K+ channels in the action of nicorandil on human saphenous vein (HSV) and human internal mammary artery (HIMA), this study aimed to analyse the contribution of the cGMP pathway in nicorandil-induced vasorelaxation and to determine the involvement of cGMP in the K+ channel-activating effect of nicorandil. An inhibitor of soluble guanylate cyclase (GC), ODQ, significantly inhibited nicorandil-induced relaxation, while ODQ plus glibenclamide, a selective ATP-sensitive K+ (KATP) channel inhibitor, produced a further inhibition of both vessels. In HSV, ODQ in combination with 4-aminopyridine, a blocker of voltage-gated K+ (K-V) channels, did not modify the concentration-response to nicorandil compared with ODQ, whereas in HIMA, ODQ plus iberiotoxin, a selective blocker of large-conductance Ca2+-activated K+ (BKCa) channels, produced greater inhibition than ODQ alone. We showed that the cGMP pathway plays a significant role in the vasorelaxant effect of nicorandil on HSV and HIMA. It seems that nicorandil directly opens KATP channels in both vessels and BKCa channels in HIMA, although it is possible that stimulation of GC contributes to KATP channels activation in HIMA. Contrary, the activation of K-V channels in HSV is probably due to GC activation and increased levels of cGMP
Significance and specificity of vascular anastomosis in liver transplantation: Our experience
Introduction Transplantation is the method of choice in the treatment of terminal liver diseases with acute and structural damage of liver tissue and congenital liver diseases. Objective The aim of our study was to determine specificity and significance of vascular anastomosis in liver transplantation by postoperative evaluation of vascular anastomosis function. Method The study included 16 patients with 16 liver transplantations and one re-do liver transplantation. In all patients, preoperative angiography and postoperative duplex sonographic and angiographic evaluation of vascular anastomosis were performed. Results Preoperative angiographic evaluation did not reveal anomalies in liver blood vessels of transplant candidates. In one patient, we identified and angiographically confirmed stenosis on anastomosis of the hepatic artery on the 7th postoperative day. In another patient, we had artificial thrombosis of the hepatic artery branch due to the liver biopsy. Conclusion The successful performance of vascular anastomosis in liver transplantation is significant for adequate liver graft perfusion, good postoperative graft function and overall outcome of the liver transplantation