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L-lactate after embolization of the superior mesenteric artery

Acosta, Stefan; Nilsson, Torbjorn K.; Malina, Janne and Malina, Martin LU (2007) In Journal of Surgical Research 143(2). p.320-328
Abstract
Background. Plasma markers for intestinal ischemia have not proven to be accurate. The value of L-lactate is unclear. Experimental models based on open surgery confound the effects of surgical trauma with that of ischemia. The aim was to create an endovascular model for acute superior mesenteric artery thromboembolism, and then to study L-lactate and lactate dehydrogenase (LD) activity in plasma and peritoneal fluid in pigs with extensive, high-grade intestinal ischemia. Materials and methods. Nine pigs underwent full superior mesenteric artery embolization with 4 h of intended intestinal ischemia, whereas six were control animals. Sampling of central venous and arterial blood was performed throughout the experiment, ending with laparotomy... (More)
Background. Plasma markers for intestinal ischemia have not proven to be accurate. The value of L-lactate is unclear. Experimental models based on open surgery confound the effects of surgical trauma with that of ischemia. The aim was to create an endovascular model for acute superior mesenteric artery thromboembolism, and then to study L-lactate and lactate dehydrogenase (LD) activity in plasma and peritoneal fluid in pigs with extensive, high-grade intestinal ischemia. Materials and methods. Nine pigs underwent full superior mesenteric artery embolization with 4 h of intended intestinal ischemia, whereas six were control animals. Sampling of central venous and arterial blood was performed throughout the experiment, ending with laparotomy to collect peritoneal fluid and segmental intestinal biopsies. A pathologist, blinded to the performed interventions, graded the ischemic lesions. Results. There were no differences in plasma L-lactate (P = 0.61) or LD activity levels (P = 0.69), measured at different time points from baseline to end of study, between animals with extensive, high-grade intestinal ischemia and sham. Intraperitoneal L-Lactate (P = 0.005) and LD activity (P = 0.018) levels were elevated compared with sham. There were differences in grades of ischemia in the duodenum (P = 0.003), small intestine (P < 0.001), proximal (P < 0.001), and sigmoid (P = 0.032) colon between experimental animals and sham. The grade of small bowel ischemia (n = 15) correlated to intraperitoneal fluid L-lactate (r = 0.80; P < 0.001) and LD activity levels (r = 0.72; P = 0.003). Conclusions. This endovascular study in a porcine model showed that L-lactate and LD activity levels in peritoneal fluid, not in plasma, reflect intestinal ischemia. The study suggests that plasma L-lactate not is a useful early marker in patients with suspicion of intestinal ischemia. (c) 2007 Elsevier Inc. All rights reserved. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
lactate, intestinal ischemia, animal model, superior mesenteric artery, endovascular study, dehydrogenase
in
Journal of Surgical Research
volume
143
issue
2
pages
320 - 328
publisher
Elsevier
external identifiers
  • wos:000251281200020
  • scopus:36049020973
ISSN
1095-8673
DOI
10.1016/j.jss.2007.02.003
language
English
LU publication?
yes
id
5b79a8cf-893f-427f-bf8b-a66b44f1075a (old id 968587)
date added to LUP
2008-01-29 09:54:45
date last changed
2017-05-14 04:16:55
@article{5b79a8cf-893f-427f-bf8b-a66b44f1075a,
  abstract     = {Background. Plasma markers for intestinal ischemia have not proven to be accurate. The value of L-lactate is unclear. Experimental models based on open surgery confound the effects of surgical trauma with that of ischemia. The aim was to create an endovascular model for acute superior mesenteric artery thromboembolism, and then to study L-lactate and lactate dehydrogenase (LD) activity in plasma and peritoneal fluid in pigs with extensive, high-grade intestinal ischemia. Materials and methods. Nine pigs underwent full superior mesenteric artery embolization with 4 h of intended intestinal ischemia, whereas six were control animals. Sampling of central venous and arterial blood was performed throughout the experiment, ending with laparotomy to collect peritoneal fluid and segmental intestinal biopsies. A pathologist, blinded to the performed interventions, graded the ischemic lesions. Results. There were no differences in plasma L-lactate (P = 0.61) or LD activity levels (P = 0.69), measured at different time points from baseline to end of study, between animals with extensive, high-grade intestinal ischemia and sham. Intraperitoneal L-Lactate (P = 0.005) and LD activity (P = 0.018) levels were elevated compared with sham. There were differences in grades of ischemia in the duodenum (P = 0.003), small intestine (P &lt; 0.001), proximal (P &lt; 0.001), and sigmoid (P = 0.032) colon between experimental animals and sham. The grade of small bowel ischemia (n = 15) correlated to intraperitoneal fluid L-lactate (r = 0.80; P &lt; 0.001) and LD activity levels (r = 0.72; P = 0.003). Conclusions. This endovascular study in a porcine model showed that L-lactate and LD activity levels in peritoneal fluid, not in plasma, reflect intestinal ischemia. The study suggests that plasma L-lactate not is a useful early marker in patients with suspicion of intestinal ischemia. (c) 2007 Elsevier Inc. All rights reserved.},
  author       = {Acosta, Stefan and Nilsson, Torbjorn K. and Malina, Janne and Malina, Martin},
  issn         = {1095-8673},
  keyword      = {lactate,intestinal ischemia,animal model,superior mesenteric artery,endovascular study,dehydrogenase},
  language     = {eng},
  number       = {2},
  pages        = {320--328},
  publisher    = {Elsevier},
  series       = {Journal of Surgical Research},
  title        = {L-lactate after embolization of the superior mesenteric artery},
  url          = {http://dx.doi.org/10.1016/j.jss.2007.02.003},
  volume       = {143},
  year         = {2007},
}