As a non-toxic endogenous antioxidant, the semi-essential amino acid taurine is a potential attenuator of oxidative damage such as that produced by ischaemia-reperfusion injury. Ischaemia-reperfusion injury is a well established if paradoxical phenomenon whereby ischaemic tissue, doomed to necrosis if it is not reperfused, is actually further damaged by oxidative attack when perfusion is restored. This paper is a review of the literature concerning therapeutic strategies in ischaemia-reperfusion injury, including non-pharmacological and pharmacological interventions. There is consistent experimental evidence of an important role of taurine in ischaemia-reperfusion injury, with a clinical role emerging in human trials of taurine administered prior to coronary artery bypass grafting and heart valve surgery.
Introduction: Tissues subjected to prolonged ischaemia are paradoxically further damaged when their perfusion is restored. The mechanisms underlying this ischaemia-reperfusion injury are complex, but oxidative attack is a central feature. Among the therapeutic agents used to attenuate ischaemia-reperfusion injury, endogenous agents such as taurine which form part of the native defence mechanism against oxidative damage are of particular interest.Methods: Using a model of hindlimb ischaemia-reperfusion injury in the rat, taurine solution was administered either into the operated hindlimb, into the systemic circulation, or both. Contraction strengths of gastrocnemius biopsies from the operated and contralateral (control) hindlimbs of each animal were measured.Results: Fast twitch strength was impaired significantly by ischaemia-reperfusion injury, and taurine injected into the operated limb conferred partial protection. A similar trend was observed for tetany, but protection by taurine was not statistically significant for tetanic contraction strength.Conclusion: Preservation of fast twitch strength following ischaemia-reperfusion injury by administration of taurine before ischaemia has clinical potential. However, delivery to the affected tissues during ischaemia presents technical difficulties.
The wide variety of scoring instruments available to assess the injured patient may be divided into three groups: anatomical, physiological and combined systems. Anatomical systems depend on an accurate description of the injuries sustained. Physiological systems measure the effects of injury on the patient's physiological reserves. Combined systems contain elements of both anatomical and physiological scores. Prospectively, scoring systems help in description, triage, treatment decisions and estimating outcome. Retrospective scoring is helpful in audit, in quality control, in comparing treatment methods or centres, and in identifying unexpected outcomes. Limitations may be inherent in the system or may reflect inaccurate or incomplete data collection.
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