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Case ReportPractice

Reperfusion injury after Vandenbos procedure in the primary care office

Daphne Cheung and Jeremy Rezmovitz
Canadian Family Physician December 2018; 64 (12) 903-905;
Daphne Cheung
Medical student at the University of Toronto in Ontario.
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Jeremy Rezmovitz
Family physician in the Department of Family and Community Medicine at Sunnybrook Health Sciences Centre and Assistant Professor in the Department of Family and Community Medicine at the University of Toronto.
MSc MD CCFP
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  • For correspondence: jrezmovitz@gmail.com
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    Figure 1.

    Appearance and course of resolution of reperfusion injury to the right great toe before and after the Vandenbos procedure:A) Before the procedure, B) postoperative day 2, C) postoperative day 4, D) postoperative day 19, E) postoperative day 28, and F) postoperative day 37.

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    Table 1.

    Proposed theories for the pathophysiology of reperfusion injury

    PROPOSED THEORYDESCRIPTION
    Oxidative stress3,5,6During ischemia, there is increased production of free radicals by local tissues and damaged mitochondria. On reperfusion, free radicals accumulate and destroy tissue because cellular antioxidants have been depleted
    Intracellular calcium overload3,5ATP is depleted during ischemia. Consequently, function of membrane sodium-potassium ATPase pumps is compromised, leading to electrolyte disturbances and cell swelling. Intracellular hypercalcemia triggers pro-apoptotic signaling pathways that are further exacerbated when ATP supply is restored during reperfusion
    Inflammation3,7Macrophages and damaged tissue secrete cytokines that promote neutrophilic recruitment. During reperfusion, this leads to accelerated neutrophilic extravasation of healthy tissue
    Complement activation therapy3–5When ischemic tissue is reperfused, immunoglobulin M antibodies that were deposited onto ischemic tissues bind to complement proteins, upregulating local inflammation. Organ dysfunction and systemic inflammatory response syndrome have been reported in cases of major surgery or traumatic injury4
    • ATP—adenosine triphosphate, ATPase—adenosine triphosphatase.

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Canadian Family Physician: 64 (12)
Canadian Family Physician
Vol. 64, Issue 12
1 Dec 2018
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Reperfusion injury after Vandenbos procedure in the primary care office
Daphne Cheung, Jeremy Rezmovitz
Canadian Family Physician Dec 2018, 64 (12) 903-905;

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Daphne Cheung, Jeremy Rezmovitz
Canadian Family Physician Dec 2018, 64 (12) 903-905;
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