The Physiologic Basis for Clinical Edema

Little, Robert C.; Ginsburg, J

doi:10.1001/archinte.144.8.1661

Cited by 18 publications

(15 citation statements)

References 10 publications

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“…At its onset, CRPS‐I is often characterized by significant regional edema that is sometimes described as “exaggerated”[20–22]. Edema develops due to the extravasation and accumulation of plasma in the interstitial space [23]. In the early stage of CRPS‐I, there is plasma extravasation [20], increased density of perfused vessels, and higher capillary filtration capacity (an index of microvascular permeability) [24,25].…”

Section: A Hypothesis For the Pathogenesis Crps‐imentioning

confidence: 99%

A Hypothesis for the Cause of Complex Regional Pain Syndrome-Type I (Reflex Sympathetic Dystrophy): Pain Due to Deep-Tissue Microvascular Pathology

Coderre¹,

Bennett²

2010

Pain Med

125

123

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Complex regional pain syndrome-type I (CRPS-I; reflex sympathetic dystrophy) is a chronic pain condition that usually follows a deep-tissue injury such as fracture or sprain. The cause of the pain is unknown. We have developed an animal model (chronic post-ischemia pain) that creates CRPS-I-like symptomatology. The model is produced by occluding the blood flow to one hind paw for 3 hours under general anesthesia. Following reperfusion, the treated hind paw exhibits an initial phase of hyperemia and edema. This is followed by mechano-hyperalgesia, mechano-allodynia, and cold-allodynia that lasted for at least 1 month. Light microscopic analyses and electron microscopic analyses of the nerves at the site of the tourniquet show that the majority of these animals have no sign of injury to myelinated or unmyelinated axons. However, electron microscopy shows that the ischemia-reperfusion injury produces a microvascular injury, slow-flow/no-reflow, in the capillaries of the hind paw muscle and digital nerves. We propose that the slow-flow/no-reflow phenomenon initiates and maintains deep-tissue ischemia and inflammation, leading to the activation of muscle nociceptors, and the ectopic activation of sensory afferent axons due to endoneurial ischemia and inflammation. These data, and a large body of clinical evidence, suggest that in at least a subset of CRPS-I patients, the fundamental cause of the abnormal pain sensations is ischemia and inflammation due to microvascular pathology in deep tissues, leading to a combination of inflammatory and neuropathic pain processes. Moreover, we suggest a unifying idea that relates the pathogenesis of CRPS-I to that of CRPS-II. Lastly, our hypothesis suggests that the role of the sympathetic nervous system in CRPS-I is a factor that is not fundamentally causative, but may have an important contributory role in early-stage disease.

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Section: A Hypothesis For the Pathogenesis Crps‐imentioning

confidence: 99%

A Hypothesis for the Cause of Complex Regional Pain Syndrome-Type I (Reflex Sympathetic Dystrophy): Pain Due to Deep-Tissue Microvascular Pathology

Coderre¹,

Bennett²

2010

Pain Med

125

123

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“…Critical illness frequently results in marked fluid shifts as a result of altered capillary permeability or perturbations of the oncotic and hydrostatic forces (Starling forces) [32–34]. Disease states such as inflammation, infection, sepsis, liver cirrhosis, renal failure, and congestive heart failure can lead to increased capillary permeability due to direct injury or in response to the inflammatory cascade.…”

Section: Effect Of Critical Illness On Pharmacokineticsmentioning

confidence: 99%

Clinical Pharmacology Studies in Critically Ill Children

et al. 2016

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Developmental and physiological changes in children contribute to variation in drug disposition with age. Additionally, critically ill children suffer from various life-threatening conditions that can lead to pathophysiological alterations that further affect pharmacokinetics (PK). Some factors that can alter PK in this patient population include variability in tissue distribution caused by protein binding changes and fluid shifts, altered drug elimination due to organ dysfunction, and use of medical interventions that can affect drug disposition (e.g., extracorporeal membrane oxygenation and continuous renal replacement therapy). Performing clinical studies in critically ill children is challenging because there is large inter-subject variability in the severity and time course of organ dysfunction; some critical illnesses are rare, which can affect subject enrollment; and critically ill children usually have multiple organ failure, necessitating careful selection of a study design. As a result, drug dosing in critically ill children is often based on extrapolations from adults or non-critically ill children. Dedicated clinical studies in critically ill children are urgently needed to identify optimal dosing of drugs in this population. This review will summarize the effect of critical illness on pediatric PK, the challenges associated with performing studies in this vulnerable subpopulation, and the clinical PK studies performed to date for commonly used drugs.

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“…According to Eurostat data 1 , in 2018, the total waste generated in the European Union amounted to more than 2.3 billion metric tons, of which, about 180 million tons (10.6%) was represented by waste stemming from manufacturing activities. For these reasons, the management of industrial waste and by-products is a growing field of research, which requires to define the optimization of sustainable manufacturing and waste generation 2 .…”

mentioning

confidence: 99%

Formation and hydration of eco-friendly cement using industrial wastes as raw materials

Baltakys

Dambrauskas

Rubinaite

et al. 2021

Sci Rep

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In this work, the optimal conditions of the synthesis of eco-friendly cement by using industrial wastes as well as the peculiarities of its early stage hydration were investigated. The eco-friendly cement was synthesized within the 1000–1250 °C temperature range when the targeted composition was 60% of belite, 20% of ye’elimite, and 20% of brownmillerite. It was determined that the optimal sintering temperature for eco-friendly cement is 1100 °C because the primary compounds were fully reacted, and hydraulic active compounds were dominant in the products. Microcalorimetry analysis was performed for the investigation of early stage hydration. The best results of hydration were obtained with the eco-friendly cement which was produced by using mixtures with silica gel waste: three exothermic reactions were observed in the heat evolution curve, while the cumulative heat was equal to 264 J/g after 72 h. Additionally, the sequence of compounds formation during the first day of hydration was analyzed. It was determined that the composition of the initial mixture impacts the hydration rate of synthetic eco-friendly cement; however, it did not affect the mineralogical composition of the hydration products. These results were confirmed by XRD, STA, and SEM analysis.

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The Physiologic Basis for Clinical Edema

Cited by 18 publications

References 10 publications

A Hypothesis for the Cause of Complex Regional Pain Syndrome-Type I (Reflex Sympathetic Dystrophy): Pain Due to Deep-Tissue Microvascular Pathology

A Hypothesis for the Cause of Complex Regional Pain Syndrome-Type I (Reflex Sympathetic Dystrophy): Pain Due to Deep-Tissue Microvascular Pathology

Clinical Pharmacology Studies in Critically Ill Children

Formation and hydration of eco-friendly cement using industrial wastes as raw materials

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