Back
 JBM  Vol.7 No.2 , February 2019
Uterine Reperfusion Ischemia and Use of Elastic Tourniquet
Abstract: Introduction: In humans, it has not been established that the use of elastic tourniquet (ET) during myomectomies, whose delivery times do not exceed 90 minutes, which is responsible for ischemia reperfusion (I/R) systemic. Objectives: To study the plasma variations of markers of I/R during myomectomies performed with ET, whose exposure time does not exceed 90 minutes. Population and methods: Plasma créatinin phosphokinase kinase (CPK) and gluthatione peroxydase (GPX) levels of patients with ET myoma (M + G +, n = 19), taken before, during and after exposure, were compared to those of women operated on myoma without tourniquet (M + G -, n = 15), carriers of unoperated myomas (M + G0, n = 20) and controls (M0G0, n = 18). The duration of exposure of the ET was determined, and perioperative variations of GPX, Ca2+, K+ and CPK between M + G + and others groups were analyzed (p < 0.005). Results: The average duration of exposure of the ET was 51.56 ± 14.12 [30 - 88] min. In M + G +, prior to insertion, CPK was 71.64, GPX 3.537, Ca2+ 3.000, K+ 3.934, and did not vary from those of M + G - (CPK = 59.354, GPX = 3.205, Ca2+ = 2.525, K+ = 3.788), M + G0 (CPK = 71.640, GPX = 2.759, Ca2+ = 3.004, K+ = 3.934) and M0G0 (CPK = 57.2, GPX = 2.306, Ca2+ = 2.879, K+ = 3.705). Conversely, during the posture (CPK = 95.665, GPX = 3.645, Ca2+ = 3.642, K+ = 4.757) and after the release of the ET (CPK = 135.443, GPX = 3.694, Ca2+ = 3.892, K+ = 5.322), these rates were higher among the M + G + compared to the M + G0 and M0G0, but did not differ from those of the M + G - during (CPK = 91.270, GPX = 3.413, Ca2+ = 3.068, K+ = 4.257) and after release (CPK = 137.776, GPX = 3.632, Ca2+ = 3.148, K+ = 5.075). Conclusion: The plasmatic concentration of ischemia (CPK, K+) and reperfusion (GPX, Ca2+) biomarkers does not differ between M + G + and M + G -, but is elevated relatively to controls (M0G0), but also to M + G0’s group. These results show that, for exposure times not exceeding 90 minutes, the elastic tourniquet is probably not the cause of the increase in plasma I/R markers observed in M + G + women. Moreover, these data suggest that the variations of the markers observed during the different surgical stages within each of the two groups of women M + G + and M + G - compared to those of the controls (M0G0) and unoperated myomas (M + G0) are due essentially to the surgical act.
Cite this paper: Nnang Essone, J. , Ovono Abessolo, F. , Tsagoulela, A. , Edjo Nkhilli, G. , Assoumou, P. , Bang Ntamack, J. , Anyunzok, E. , Minkobame, U. , Meye, J. , Ngou Milama, E. (2019) Uterine Reperfusion Ischemia and Use of Elastic Tourniquet. Journal of Biosciences and Medicines, 7, 98-119. doi: 10.4236/jbm.2019.72009.
References

[1]   Debnath, J. and Nath, L.K. (2014) A Review on Pathophysiology of Ischemic Reperfusion Injury of Heart and Ameliorating Role of Flavonoids and Polyphenols. Journal of Medicinal Plant Research, 8, 607-614.
https://doi.org/10.5897/JMPR2014.5360

[2]   Wang, H.L., Cao, C.Y. and Hui, L.Q. (2016) A Study of Myocardial Ischemia Model Induced by Left Coronary Artery Ligation in Rats. World Journal of Cardiovascular Diseases, 6, 133-142.
https://doi.org/10.4236/wjcd.2016.65014

[3]   Hanouz, J.L., Gerard, J.L. and Plaud, B. (2009) Ischémie-Reperfusion. In: Martin, C., Riou, B. and Vallet, B., Eds., Physiologie Humaine Appliquée, 2éd, Arnette wolterskluwer France, Paris, 217-227.

[4]   Neri, M., Riezzo, I., Pascale, N., Pomara, C. and Turillazzi, E. (2017). Ischemia/Reperfusion Injury Following Acute Myocardial Infarction: A Critical Issue for Clinicians and Forensic Pathologists. Mediators of Inflammation, 2017, 1-14.
https://doi.org/10.1155/2017/7018393

[5]   Fernández-Jiménez, R., García-Prieto, J., Sánchez-González, J., et al. (2015) Pathophysiology Underlying the Bimodal Edema Phenomenon after Myocardial Ischemia/Reperfusion. Journal of the American College of Cardiology, 66, 816-828.
https://doi.org/10.1016/j.jacc.2015.06.023

[6]   Feng, H.B., Wang, H.L., Zhao, Y., Zheng, Z.N. and Jin, S. (2016) Gradual Clamping Reduced Ischemia-Reperfusion Injury in an Isolated Rat Heart Model. World Journal of Cardiovascular Surgery, 6, 79-86.
https://doi.org/10.4236/wjcs.2016.66013

[7]   Yunus, O.A., Serap, A., Sadik, S., Zafer, K. and Ozlem, B.O. (2015) Remifentanil Protects Uterus against Ischemia-Reperfusion Injury in Rats. Acta Chirurgica Brasileira, 30, 756-761.
https://doi.org/10.1590/S0102-865020150110000006

[8]   Coquerel, D. and Tamion, F. (2011) Ischémie-Reperfusion Myocardique-Aspects Physiopathologiques. Journal de Réanimation, 20, 267-273.
https://doi.org/10.1007/s13546-010-0102-5

[9]   Hashimoto, N. (2015) Protective Effect of Ischemic Preconditioning on Hepatic Ischemia-Reperfusion Injury in Rats. Open Access Library Journal, 2, e1306-e1312.
https://doi.org/10.4236/oalib.1101306

[10]   Elsharawy, M.A., Elsaid, A. and Elsharawi, I. (2014) Reperfusion of Delayed Acute Occlusive Limb Ischemia. Is It Worthwhile. World Journal of Cardiovascular Diseases, 4, 580-585.
https://doi.org/10.4236/wjcd.2014.412070

[11]   Zhang, D., Lou, W., Chen, G., Yin, X. and Gu, J. (2013) Endovascular Treatment Options of Acute Limb Ischemia. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 2, 39-43.
https://doi.org/10.4236/ijmpcero.2013.21006

[12]   Estèbe, J.P., Davies, J.M. and Richebe, P. (2011) The Pneumatic Tourniquet. Mechanical, Ischaemia-Reperfusion and Systemic Effects. European Journal of Anaesthesiology, 28, 404-411.
https://doi.org/10.1097/EJA.0b013e328346d5a9

[13]   Tran, T.P., Huiyin, Tu., Iraklis, I. and Pipinos, B. (2011) Tourniquet-Induced Acute Ischemia-Reperfusion Injury in Mouse Skeletal Muscles Involvement of Superoxide. European Journal of Pharmacology, 650, 328-334.
https://doi.org/10.1016/j.ejphar.2010.10.037

[14]   Byron, E., Efstathios, K., Marina, P., Anastasios, G., Christodoulou, et al. (2012) Cuff Width Increases the Serum Biochemical Markers of Tourniquet-Induced Skeletal Muscle Ischemia in Rabbits. Science Journal, 35, e1245-e1250.

[15]   Oragui, E., Parsons, A., White, T., Longo, U.G. and Khan, W.S. (2011) Tourniquet Use in Upper Limb Surgery. Hand, 6, 165-173.
https://doi.org/10.1007/s11552-010-9312-6

[16]   Omar, H., Elhamid, B.A., Rady, A. and Khaled, S. (2017) The Effect of Different Regional Blocks Combined FemoralSciatic, Spinal and Epidural Blocks on the Different Side Effects of Arterial Tourniquet in Patients Undergoing Lower Limb Orthopedic Surgeries. Open Journal of Anesthesiology, 7, 88-97.
https://doi.org/10.4236/ojanes.2017.74009

[17]   Ai, R.A., Yapca, O.E. and Gumusburun, N. (2017) A Randomized Trial Comparing Triple versus Single Uterine Tourniquet in Open Myomectomy. Gynecologic and Obstetric Investigation, 82, 547-552.
https://doi.org/10.1159/000468932

[18]   Parker, W.H. and Sharp, T.H. (2017) Technics to Reduce Blood Loss during Abdominal or Laparoscopic Myomectomy.
https://uptodate.com

[19]   Kongnyuy, E.J. and Wiysonge, C.S. (2014) Interventions to Reduce Haemorrhage during Myomectomy for Fibroid. Cochrane Database of Systematic Reviews, No. 11, CD005355.
http://www.Cochrane.com
https://doi.org/10.1002/14651858.CD005355.pub5


[20]   Vilos, G.A. and Allaire, C. (2015) The Management of Uterine Leiomyomas. Journal of Obstetrics and Gynaecology Canada, 37, 157-178.
https://doi.org/10.1016/S1701-2163(15)30338-8

[21]   Taylor, A., Sharma, M. and Tsirkas, P. (2005) Reducing Blood Loss at Open Myomectomy Using Triple Tourniquets. Arandomised Controlled Trial. BJOG, 112, 340-345.
https://doi.org/10.1111/j.1471-0528.2004.00430.x

[22]   Adesina, K.T., Owolabi, B.O. and Raji, H.O. (2017) Abdominal Myomectomy. A Retrospective Review of Determinants and Outcomes of Complications at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Malawi Medical Journal, 29, 38-42.
https://doi.org/10.4314/mmj.v29i1.8

[23]   Lansac, J. and Descamps, P. (2011) La pratique chirurgicale en gynécologie obstétrique. In: Carlan, L., Bourlier, P. and Brétagnol, F., Eds., Chirurgie par voie abdomidale, 3ème Edition, Elsevier Masson, Paris, 142-148.

[24]   Pundir, J., Walawalkar, R., Seshadri, S., Khalaf, Y. and El-Toukhy, T. (2013) Perioperative Morbidity Associated with Abdominal Myomectomy Compared with Total Abdominal Hysterectomy for Uterine Fibroids. Journal of Obstetrics and Gynaecology, 33, 655-662.
https://doi.org/10.3109/01443615.2013.816661

[25]   Ikechebelu, J.I., Ezeama, C.O. and Obiechina, N.J. (2010) The Use of Tourniquet to Reduce Blood Loss at Myomectomy. Nigerian Journal of Clinical Practice, 13, 154-158.

[26]   Thalamkandathil, N. (2016) Laparoscopic Myomectomy—A Three Year Experience. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 5, 3560-3562.
https://doi.org/10.18203/2320-1770.ijrcog20163444

[27]   Migahed, L., Himaya, E. and Antaki, R. (2014) Variation of Anti-Mullerian Hormone Levels Following Myomectomy by Laparotomy. Fertility and Sterility, 102, e299.
https://doi.org/10.1016/j.fertnstert.2014.07.1018

[28]   Balsak, D. (2015) Effects of Melatonin on Ischemia-Reperfusion Injury in Rat Ovary. Histopathologic and Immunohisto Chemical Study. Open Journal of Obstetrics and Gynecology, 5, 639-645.
https://doi.org/10.4236/ojog.2015.511090

[29]   Lee, C., Chang, C.C. and Kuo, Y.-T. (2005) Color Doppler Evaluation of Blood Flow Changes in Leiomyomas after Utérine Artery Ligation. International Journal of Gynecology & Obstetrics, 90, 44-45.
https://doi.org/10.1016/j.ijgo.2005.02.024

[30]   Kun-Min, C., Ming-Jer, C., Ming-Huei, L., Yuan-Der, H. and Chin-San, C. (2012) Fertility and Pregnancy Outcomes after Uterine Artery Occlusion with or without Myomectomy. Journal of Obstetrics and Gynaecology, 51, 331-335.

[31]   Lin, H.M. (2006) Comparaison of Clinical Outcomes and Spectral Doppler Indice of Uterin and Ovarian Stromal Arteries in Women Undergoing Myomectomy with or without Hypogastrique Arterial Ligation. Ultrasound in Obstetrics & Gynecology, 28, 813-836.

[32]   Kisu, I., Umene, K., Adachi, M., Emoto, K., Nogami, Y., et al. (2017) Allowable Warm Ischemic Time and Morphological and Biochemical Changes in Uterine Ischemia/Reperfusion Injury in Cynomolgus Macaque: A Basic Study for Uterus Transplantation. Human Reproduction, 32, 2026-2035.
https://doi.org/10.1093/humrep/dex250

[33]   Gauthier, T., Piver, P., Marquet, P., Couquet, C. and Aubard, Y. (2013) Transplantation utérine. Expérimentations animales. mt Médecine de la Reproduction. Gynécologie Endocrinologie, 15, 157-164.

[34]   Yang, W., Cheng, Z. and Dai, H. (2014) Calcium Concentration Response to Uterine Ischemia. A Comparison of Uterine Fibroid Cells and Adjacent Normal Myometrial Cells. European Journal Of Obstetrics Gynecology And Reproductive Biology, 174, 123-127.
https://doi.org/10.1016/j.ejogrb.2013.12.013

[35]   Scheurig-Muenkler, C., Wagner, M., Franiel, T., Hamm, B. and Kroencke, T.J. (2010) Effect of Uterine Artery Embolization on Uterine and Leiomyoma Perfusion: Evidence of Transient Myometrial Ischemia on Magnetic Resonance Imaging. Journal of Vascular and Interventional Radiology, 21, 1347-1353.
https://doi.org/10.1016/j.jvir.2010.05.008

[36]   Cheng, Z.P., Tao, X., Gong, J., Dai, H. and Hu, L.P. (2009) Early-Stage Morphological Observations of Myoma and Myometrium after Laparoscopic Uterine Artery Occlusion Treatment. European Journal of Obstetrics Gynecology and Reproductive Biology, 145, 113-116.
https://doi.org/10.1016/j.ejogrb.2009.03.027

[37]   Brännström, M. and Wranning, C.A. (2010) Experimental Uterus Transplantation. Human Reproduction Update, 16, 329-345.
https://doi.org/10.1093/humupd/dmp049

[38]   Rakesh, S., Meenakshi, S. and Chaitali, M. (2011) Laparoscopic Myomectomy Whith Uterine Artery Ligation. Review Article and Comparative Analysis. Journal of Gynecological Endoscopy and Surgery, 2, 3-10.

[39]   Banu, N.S., Gaze, D.C., Bruce, H., Collinson, P.O., Belli, A.M., et al. (2007) Markers of Muscle Ischemia, Necrosis, and Inflammation Following Uterine Artery Embolization in the Treatment of Symptomatic Uterine Fibroids. American Journal of Obstetrics and Gynecology, 196, 213-215.

[40]   Shue, S., Radeva, M. and Falcone, T. (2018) Comparison of Long-Term Fertility Outcomes after Myomectomy. Relationship with Number of Myomas Removed. Journal of Minimally Invasive Gynecology, 25, 1002-1008.

[41]   World Medical Association (2013) Declaration of Helsinki. Ethical Principals for Medical Research Involving Human Being Subjects. Helsinki.
http://www.wma.net/fr/

[42]   Dieusaert, P. (2015) Guide pratique des analyses médicales. 6ème Edition, Maloine France, Paris, 1573 p.

[43]   Elabsciences.
http://www.elabscience.com/

[44]   American Society of Anesthesiology and Canadian Anesthesiology Society (2018) Guidelines to the Practice of Anesthesia. Canadian Journal of Anesthesia, 65, 76-104.

[45]   Snežana, P., Todorović, A., Stojiljković, V., Gavrilović, L., Popović, N., et al. (2015) Antioxidant Status in Women with Uterine Leiomyoma Relation with Sex Hormones. Anais da academia brasileira de ciências, 87, 1771-1782.

[46]   Santulli, P., Borghese, B., Lemaréchal, H., Leconte, M., Millischer, A.E., et al. (2013) Increased Serum Oxidative Stress Markers in Women with Uterine Leiomyoma. PLoS ONE, 8, e72069.

[47]   Arsalani-Zadeh, R., Ullah, S., Khan, S. and Macfie, J. (2011) Oxydative Stress in Laparoscopic versus Open Abdominal Surgery. Systematic Review. Journal of Surgical Research, 169, 59-68.
https://doi.org/10.1016/j.jss.2011.01.038

[48]   Farimani Sanoee, M., Alizamir, T., Faramarzi, S., Saidijam, M., Yadegarazari, R., et al. (2014) Effect of Myomectomy on Endometrial Glutathione Peroxidase 3 (GPx3) and Glycodelin mRNA Expression at the Time of the Implantation Window. Iranian Biomedical Journal, 18, 60-66.

[49]   Fan, Z., Lu, J.-M., Yan, J.-J. and Gong, H. (2017) Effects of Dexmedetomidine on Inflammatory Response and Oxidative Stress in Laparoscopic Hysterectomy Patients. Journal of Hainan Medical University, 23, 57-60.

[50]   Marrocco, I., Altieri, F. and Peluso, I. (2017) Measurement and Clinical Significance of Biomarkers of Oxidative Stress in Humans. Oxidative Medicine and Cellular Longevity, 2017, Article ID: 6501046.

[51]   Van der Spuy, L. (2012) Complications of the Arterial Tourniquet. Southern African Journal of Anaesthesia and Analgesia, 18, 14-18.

[52]   Cibiera, M., Włodarczyk, M., Wrzosek, M., Męczekalski, B., Nowicka, G., et al. (2017) Role of Transforming Growth Factor β in Uterine Fibroid Biology. International Journal of Molecular Sciences, 18, e2435.

[53]   Guo, J., Zheng, L., Chen, L., Luo, N., Yang, W., et al. (2015) Lipopolysaccharide Activated TLR4/NF-κB Signaling Pathway of Fibroblasts from Uterine Fibroids. International Journal of Clinical and Experimental Pathology, 8, 10014-10025.

[54]   Zheng, F., Feng, C., Isabell, G.E. and Ewelina, B. (2014) Stromal Fibroblast Activation and Uterine Fibroids. Oncology Letters, 8, 479-486.
https://doi.org/10.3892/ol.2014.2225

[55]   Wu, R., Feng, J., Yang, Y., Dai, C., Lu, A., et al. (2017) Significance of Serum Total Oxidant/Antioxidant Status in Patients with Colorectal Cancer. PLoS ONE, 12, e0170003.

[56]   Al-Khyatt, W., Thomas, J.D., Humes, D.J. and Lobo, D.N. (2013) Intestinal Ischemia Following Laparoscopic Surgery. A Case Series. Journal of Medical Case Reports, 7, 1-25.
https://doi.org/10.1186/1752-1947-7-25

[57]   Oksuzoglu, A. (2015) Comparison of Tissue Trauma after Abdominal, Vaginal and Total Laparoscopic Hysterectomy. Ginekologia Polska, 86, 268-273.
https://doi.org/10.17772/gp/2072

[58]   Tsompos, C., Panoulis, C., Toutouzas, K., Triantafyllou, A., Zografos, G., et al. (2016) The Effect of the Antioxidant Drug “U-74389g” on Uterus Congestion during Ischemia Reperfusion Injury in Rats. Journal of Reproductive Medicine, Gynaecology & Obstetrics, 1, 001.

[59]   Nassif, J. (2009) Traitement opératoire des fibromes utérins. mt Médecine de la Reproduction, Gynécologie Endocrinologie, 11, 164-169.

[60]   De Bruijn, A.M., Lohle, P.N., Huirne, J.A., De Vries, J., Twisk, M., QUESTA-Trial Group, et al. (2018) Uterine Artery Embolization versus Hysterectomy in the Treatment of Symptomatic Adenomyosis. Protocol for the Randomized QUESTA Trial. JMIR Research Protocols, 7, e47-e53.

[61]   Bechev, B. and Magunska, N. (2014) Factors Affecting Duration of the Laparoscopic Myomectomy. Akusherstvo i Ginekologiia, 53, 21-25.

[62]   Adachi, M., Kisu, I., Nagai, T., Emoto, K., Banno, K., et al. (2016) Evaluation of Allowable Time and Histopathological Changes in Warm Ischemia of the Uterus in Cynomolgus Monkey as a Model for Uterus Transplantation. Acta Obstetricia et Gynecologica Scandinavica, 95, 991-998.

 
 
Top