G P Novelli

Azienda Ospedaliero Universitaria Careggi, Firenzuola, Tuscany, Italy

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Publications (118)307.66 Total impact

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    ABSTRACT: In this double-blinded, randomized controlled trial, we compared the clinical advantages and disadvantages of patient-controlled-analgesia (PCA) with continuous infusion (CI) with tramadol alone versus a combination of tramadol plus ketorolac in the management of postoperative pain after major abdominal surgery. Sixty adult patients were randomly assigned to 2 groups. Group T, was given 10 mg/mL tramadol and Group TK was given 1.50 mg/mL ketorolac plus 5 mg/mL tramadol. After an i.v. loading dose of 0.07 mL/kg, the demand bolus injection was set at 0.2 mL, with a lockout interval of 30 min, and a continuous background i.v. infusion was set at 1.5 mL/h. Data of PCA demand, dose delivered and total analgesic consumption were retrieved from the computer memory bank of PCA device. Visual analogue scale at rest, sedation score and the occurrence of adverse effects were assessed every 3 h for 18 h. No significant differences were found with regard to pain scores and side effects. Patients in Group TK were significantly more alert. We concluded that the combination of ketorolac plus tramadol in the same PCA device was an effective and safe treatment for postoperative analgesia in abdominal surgery.
    Minerva anestesiologica 01/2006; 72(1-2):59-67. · 2.82 Impact Factor
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    ABSTRACT: To define the best strategy to reduce Compound A production in Sevoflurane low-flow anaesthesia by experiments in vitro and in vivo of different absorbers and different anaesthesia machines. In vitro Compound A has been measured at 45 degrees C in vitro following Sevoflurane interactions with potassium hydroxide, sodium hydroxide, soda lime, Dragersorb 800 Plus and Amsorb, a new absorber that does not contain sodium or potassium hydroxide. In vivo Compound A concentration in the anaesthesia circuit (inspiratory branch) has been measured using an indirect sampling method through absorber vials (SKC) with active coal granules, during low flows (500 ml/min) general anaesthesia using soda lime, Dragersorb 800 Plus or Amsorb as absorber. Compound A was also measured during low flows (500 ml/min) general anaesthesia using as carbon dioxide absorber soda lime with different anaesthesia machines. In vitro at 45 degrees C Compound A concentration with soda lime and Dragersorb 800 Plus was about 10 times higher than with Amsorb. In vivo the Compound A concentrations in the inspiratory branch of the circuit were lower in the group with Amsorb. The Compound A production is minimal with Amsorb as carbon dioxide absorber.
    Acta Anaesthesiologica Scandinavica 10/2002; 46(8):1017-20. · 2.36 Impact Factor
  • R Casali, G Buti, Q Cantini, G P Novelli
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    ABSTRACT: Numerous publications have analysed the hemodynamic effects of "small volume resuscitation" during the initial phases of hemorrhagic shock. Nevertheless nowadays the information about microcirculatory effects are poor. The aim of this study was to estimate the change of tissue perfusion in hypovolemic rats, before and after infusion of Ringer's lactate (RL), hypertonic saline solution (HS) or blood. Mesocecal microcirculation was visualized by intravital microscopy during 30 minutes of hemorrhagic hypovolemia (MAP, mean arterial pressure of 40 mmHg) and subsequent reinfusion period. Rats were resuscitated with RL (shed volume), HS (one-seventh of the shed volume), or blood (shed volume). The perfusion was estimated through speed of red blood cells. Moreover MAP, pH and B.E. was measured. Thirty minutes after hemorrhage a very important decrease of capillary flow was noticed and in lesser quantity, of the flow in arterioles and venules. The RL infusion did not cause measureable changes of microcirculatory blood flows. The HS infusion caused an improvement in the flow of arterioles and venules but not in capillaries. The blood infusion caused a progressive improvement in the flow of arterioles, venules and capillaries, however at slightly lower values than previous hemorrhage. Neither RL nor HS seem as efficient as blood to restore the microcirculatory blood flow in the mesocecum of the rats submitted to hemorrhagic hypovolemia.
    Minerva anestesiologica 01/2002; 68(1-2):17-24. · 2.82 Impact Factor
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    ABSTRACT: The so called stop-flow operation is based on locoregional perfusion with an antiblastic hypoxic solution of the region invaded by malignant tissue. Cardiocirculatory complications are common, mainly consisting of reduction of cardiac index, increase of arterial pulmonary pressure, systemic vascular resistance and heart rate. Sevoflurane has been used for its stable hemodynamic profile to reduce cardiocirculatory troubles. Six patients were submitted to stop-flow operation. General anaesthesia was performed with Sevoflurane 1 MAC in Air/O2. The following parameters were recorded: nitroglycerin infusion m order to maintain the position of the balloon of the catheters, arterial oxygen saturation, end-tidal carbon dioxide, mean arterial pressure, central venous pressure, arterial pulmonary pressure, heart rate and mixed oxygen venous saturation; recordings were performed before stop-flow (T1), during stop-flow (T2) and 10' after reperfusion (T3). Before stop-flow (T1) all the parameters were normal. At T2 heart rate, cardiac index and pulmonary capillary wedge pressure increased whilst mean arterial pressure, systemic vascular resistance and pulmonary vascular resistance decreased. Ten minutes after the end of perfusion (T3) absence of variations in systemic vascular resistance, in pulmonary vascular resistance, in pulmonary capillary wedge pressure, in cardiac index and in mixed oxygen venous saturation were noticed. Heart rate and central venous pressure showed a tendency to decrease. The hemodynamic profile during stop-flow appears to be stable with general anaesthesia with Sevoflurane.
    Minerva anestesiologica 01/2002; 67(12):849-53. · 2.82 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the discharge rate of children undergoing ophthalmic surgery of medium length (69-120') in a day-hospital regime under general anesthesia with orotracheal intubation and using Sevoflurane as the only anesthetic agent. Experimental protocol: prospective study. Setting: the study was carried out in the operating theatre of the Ophthalmic Clinic at Florence University. Patients: 58 pediatric patients aged 2-10 years, ASA I-II, 13-34 kg. Operations: correction of strabismus, cataract, glaucoma, palpebral ptosis and intubation of lacrimal tracts. Parameters measure: Any signs of reactivity in the airways to Sevoflurane on induction or reawakening (cough, bronchospasm, laryngospasm and psychomotor agitation), hemodynamic variables (heart rate and NIBP); reawakening time (from turning off the vaporiser to extubation), discharge time from recovery room (SatO2 > or = 97% in ambient atmosphere), discharge time from hospital (stable vital signs, response to simple and complex commands). The mean reawakening time was 7 min, discharge time from the recovery room was 20 min, discharge time from the hospital 80% after four hours, 100% after six hours. No respiratory and/or cardiovascular complications were reported nor psychomotor agitation. General anesthesia with Sevoflurane and Atracurium was found to be a realistic and reliable technique in pediatric ophthalmic surgery of medium length performed in day hospital.
    Minerva anestesiologica 12/2000; 66(11):807-10. · 2.82 Impact Factor
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    ABSTRACT: To evaluate whether microalbuminuria increases in post-operative patients developing sepsis, and whether it is correlated to the sepsis severity score (SOFA) and the PaO2/FIO2 ratio. Prospective study. University intensive care unit. Fifty-five postoperative ASA II-III patients admitted to the ICU after major abdominal or vascular surgery. None. Urine collection and measurement of microalbuminuria and urinary creatinine on admission and again as soon as sepsis developed or at the end of the study (72 h after admission). Results are expressed as the microalbuminuria/creatinine ratio (MACR). The MACR significantly increased as soon as sepsis (defined according to the ACPP/SCCM Consensus Conference) appeared. The MACR positively correlated to the SOFA score, but had no relation to the PaO2/FIO2 ratio. Patients not developing sepsis did not show any increase in the MACR during the study period. Post-operative patients developing sepsis, unlike those with an uncomplicated postoperative evolution, showed an increase in glomerular permeability which was revealed by MACR. The increase in the MACR was positively correlated to the increase in SOFA score, while it had no relation to the PaO2/FIO2 ratio.
    Intensive Care Medicine 10/2000; 26(9):1364-8. · 5.54 Impact Factor
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    ABSTRACT: Both the hyperproduction of oxygen free radicals (OFR) and the weakening of natural scavenging mechanisms have been implicated as contributors to multiple organ failure in septic shock. This study examined whether the antioxidants glutathione (GSH) and N-acetyl-L-cysteine (NAC) play a protective role against damage by OFR in early septic shock. We randomly entered 30 patients with septic shock into one of three groups within 24 h of diagnosis. All of the patients received septic shock therapy, including parenteral nutrition, antibiotics, and volume-expanding and inotropic agents. One group (Group B) also received 70 mg/kg/d of intravenous GSH, and a second group (Group C), 70 mg/kg/d of intravenous GSH and 75 mg/kg/d of intravenous NAC. The protection against OFR damage was evaluated by measuring expired ethane, plasma malondialdehyde, erythrocyte deformability, complement activation, and clinical scores at admission and on Days 3 and 5 of treatment. A significant decrease in peroxidative indexes was observed at Day 5 in Group B as compared with both the control group and basal values. The decrease in peroxidative indexes was even more marked in Group C. Clinical scores in this group were also significantly improved. In conclusion, the administration of high doses of NAC added to GSH significantly decreased the peroxidative stress of patients with septic shock.
    American Journal of Respiratory and Critical Care Medicine 07/2000; 161(6):1907-11. · 11.04 Impact Factor
  • R Casali, A Lepri, Q Cantini, S Landi, G P Novelli
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    ABSTRACT: To compare morphine and tramadol in the treatment of postoperative pain (POP), using a system of Patient Controlled Analgesia (PCA). Experimental design: Randomised comparative study on 88 patients, undergoing general major surgical operations (gastrectomy, colectomy and hemicolectomy). Patients: PCA i.v.: group M treated with morphine (at a dilution of 1 mg/ml) and group T with tramadol (at a dilution of 10 mg/ml). Loading dose: 0.05 mg/kg for the group treated with morphine and 0.5 mg/kg for the group treated with tramadol. Baseline infusion: 1.5 ml/h. Bolus on demand: 0.2 ml every 30 minutes. At T0, after 1 hour, 3 and 18 hours assessment of pain intensity, level of sedation, respiratory and cardiocirculatory parameters. After 18 hours assessment of the amount of drug administered, the number of boluses requested and given and any side effects. Statistical analysis: ANOVA test, Student "t", chi 2. A statistically significant reduction in POP was found after 1 hour, 3 and 18 hours with no significant differences between the two groups. No statistically significant differences in cardiocirculatory or respiratory parameters or level of sedation were found. Few side effects were observed. Tramadol determines pain relief similar to morphine, with the advantage that it does not lead to abuse, tolerance or addiction.
    Minerva anestesiologica 04/2000; 66(3):147-52. · 2.82 Impact Factor
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    ABSTRACT: A 54-year-old patient who had been treated by haemodialysis for the past 10 years complained of symptoms of restless legs syndrome over the past 7 years. All treatments were ineffective. Gabapentin 400 mg was administered just after dialysis and provided relief of symptoms. Three weeks later the symptoms reappeared 24 h after dialysis. The dosage was increased to 500 mg just after dialysis and then a second capsule of 400 mg was added the day after dialysis. After one year of therapy the patient reported complete relief of symptoms. This result was unexpected because gabapentin, according to its pharmacokinetics, would be expected to be effective even if administered only once. It might be possible to explain the result if an unknown extrarenal breakdown of the drug is involved.
    The Pain Clinic 02/2000; 12(1):61-63.
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    ABSTRACT: This study investigates the effects of N-acetylcysteine (NAC) and rutin on the lung oxidative burden of patients with early adult respiratory distress syndrome (ARDS). The protection was evaluated by measuring expired ethane and malondialdehyde (MDA), and oxidized (GSSG) and reduced glutathione (GSH) in the epithelial lining fluid of 36 patients who developed ARDS less than 24 hours before enrollment in the study. The patients were randomly assigned to 3 groups, receiving 250 mL 5% dextrose in water (group 1), NAC 50 mg/kg body weight in 5% dextrose (group 2), and NAC 50 mg/kg + rutin 5 mg/kg in 5% dextrose (group 3). Ethane and MDA concentrations were significantly reduced in the treatment groups after day 6. GSH was 30% increased in the treatment groups. No significant variations were observed in the control group until day 9. The trial confirms that NAC and rutin are efficient in protecting the lungs of patients with ARDS.
    Shock 02/2000; 13(1):14-8. · 2.61 Impact Factor
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    ABSTRACT: The molecular response to endotoxins includes the molecular responses to light, oxygen and heat which may be regarded as parts of a single ancestral stress. Laboratory data suggest that a) light stress provokes molecular responses that are also caused by oxidative stress and endotoxins; b) heat stress activates heat shock proteins, as do oxidative stress and endotoxins; the former protect against oxidative stress, heat stress and endotoxins; c) oxidative stress activates antioxidant enzymes like endotoxin; these protect against endotoxins; d) endotoxin-related stress activates the molecular responses to all the aforesaid primordial stresses. Many laboratory findings prompt us to conclude that the molecular response to endotoxemia and sepsis is an archetypal response common to all forms of primordial stress.
    Minerva anestesiologica 12/1999; 65(11):759-67; discussion 768. · 2.82 Impact Factor
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    ABSTRACT: Diprifusor TCI is a newly developed target-controlled system for the infusion of propofol. Purpose of this study is to evaluate the acceptability, efficacy and safety of Diprifusor TCI in comparison with the manually controlled technique. This multicentre, randomised, parallel group study was carried out in 160 patients undergoing surgical procedures of 10 min to 4 h duration in 8 centres. In each centre 20 male or female patients, aged > or = 18 years, ASA I-III were randomised to treatment with either Diprifusor TCI (TCI group--80 patients) or manually controlled infusion (MI group--80 patients). Assessments included hemodynamics; adverse events, including accidents, actual or possible; recovery times; anesthetist ratings of quality of induction and maintenance, and of ease of control and use of technique. Ratings were summed up in a global quality score (study end-point). Induction doses were significantly lower (median values 1.4 vs 1.9 mg/kg) and maintenance infusion rate significantly higher (median values 10.2 vs 8.8 mg/kg/h) in the TCI group; anesthetists ratings obtained maximum scores in most patients of either group, but more frequently in the TCI group, with significant differences for ease of control (good 91.2% TCI vs 74.7% IM; adequate 8.8 vs 21.5%; poor 0 vs 3.8%), and of use of technique (good 91.2% TCI vs 60.8% IM; adequate 8.8 vs 39.2%); the global quality score showed a significant advantage for the TCI system (median value 12 vs 11). The TCI technique is effective and safe, and has a better acceptability than the manually controlled infusion technique.
    Minerva anestesiologica 10/1999; 65(10):701-9. · 2.82 Impact Factor
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    ABSTRACT: Latex allergy has become a real problem among both surgical staff (paramedics and physicians) and patients especially pediatric patients with urogenital malformations and spina bifida. Latex allergy is produced from both natural molecules which compose the substance produced from Hevea brasiliensis (rubber tree) and industrial additives contents in latex devices. Diagnosis of latex allergy may be carried out through a preoperative Prik-test. A characteristic of latex allergy reaction is the starting of symptoms (more than 15 minutes after allergen contact). Pathophysiology of latex allergy is the same of all allergic reactions; it is an antigen-antibody reaction and type I or II reaction may occur. There are a lot of devices that surgeons and anesthesists use in the operative theatre and that should not be used in presence of a patient with latex allergy. Guaranteed latex-free devices should always be present in store.
    Minerva anestesiologica 04/1999; 65(3):101-7. · 2.82 Impact Factor
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    ABSTRACT: The present study was undertaken to evaluate the impact of a new procedure for eliciting informed consent by patients undergoing minor surgical procedures, in which the choice between general anaesthesia (GA) and regional anaesthesia (RA) was possible. In this prospective study, two randomly selected groups of patients were compared: study group (SG), 52 patients, received from the nurse before the preoperative interview, a list of seven questions, which they were invited to ask the anaesthetist; while the control group (CG), 73 patients, did not receive any suggested questions. There were two end points: the proportion that chose RA and the number of questions actually addressed to the doctor at the preanaesthetic interview. Psychological aspects were taken into account by collecting the Hospital Anxiety and Depression (HAD) scale before the preanaesthetic interview. Satisfaction with the interview was recorded using a telephone questionnaire 2 weeks after the operation. The results from the two groups were compared by calculating the odds ratio according to Mantel-Haenszel and by logistic analysis. Altogether, 71.2% of the patients chose RA without any difference between the groups. The average number of questions asked by each SG patient was higher than for the CG (1.67 vs. 0.96). The satisfaction level was similar in the two groups. Our list of questions was designed to facilitate patient autonomy. It offered an aid to those requesting more information and assisted communication. The method did not change the proportion who chose a specific kind of anaesthesia, but does seem to improve patient participation in the decision-making process.
    European Journal of Anaesthesiology 04/1999; 16(3):160-5. · 2.79 Impact Factor
  • European Journal of Anaesthesiology 10/1998; 15(5):517-9. · 2.79 Impact Factor
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    ABSTRACT: To highlight the intervention sequence of cells and their products (RO degree and NO) involved in the pathogenesis of lung injury caused by the instillation of endotoxin in rats. An experimental comparative study in rats. The experiments were performed using intratracheal instillation of endotoxin in rats (5 mg/kg in 0.125 ml of saline solution). Untreated rats or those instilled with saline solution alone formed the control group. All animals were sacrificed 12, 24 and 48 hours after instillation and the following studies were performed on both lungs: 1) morphological study (optical and electronic); 2) assay of lung MDA; 3) NADPH-diaphorase evaluation using a histochemical method. Lung damage evolves gradually over 48 hours. After the first 12 hours, neutrophil granulocytes were present in the lung capillaries together with monocytes; monocytes were also present in the interstitium. During the following hours, monocytes differentiated into macrophages and, once activated, the granulocytes passed into the interstitium. The parenchyma appears to be extensively altered. Tissular MDA gradually increases until it reaches a maximum level (p < 0.01 vs basal) at 48 hours. Positivity for NADPH-d in macrophage and/or fibroblastic cells was evident after 24 hours and increased after 48 hours. Acute lung injury caused by endotoxin involves both NO and RO degree. Their production is related to different cell types and follows slightly different kinetic.
    Minerva anestesiologica 06/1998; 64(6):281-7. · 2.82 Impact Factor
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    ABSTRACT: Seventy patients (40 male, 30 female), mean (SD) age 60.8 +/- 13.7 years were treated with parenteral morphine (10 mg/1 ml ampul) or tramadol (100 mg/2 ml ampul) to verify their analgesic effects in pain following abdominal surgery. The multicenter trial followed an open, controlled experimental design between patients, randomized within the centers. The drugs were given by intramuscular injection, as requested by patients, starting in the postoperative period when pain was more than 70 mm, assessed on a visual analog scale. Patients were allowed up to six ampuls of tramadol or morphine in the 24-h trial but in the first 4 h, if they asked for supplementary analgesic, only diclofenac (75 mg in a 3-ml ampul) was allowed. Both test drugs gave rapid and constant pain relief. After the first dose, pain intensity was reduced 36.2% with tramadol, and 51% with morphine; the pain-free interval was similar for both treatments. The quality of sleep and the number of hours of sleep the night after surgery were similar for both groups. Tramadol was tolerated better, giving rise to no untoward reactions; with morphine there was one case of mild respiratory depression. In abdominal surgery, therefore, tramadol given by intramuscular injection has postoperative analgesic activity similar to morphine, but is better tolerated.
    Drugs under experimental and clinical research 02/1998; 24(1):9-16.
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    ABSTRACT: In the last years the interest for Informed Consent (IC) in anaesthesia has been growing and it has been debated on the adequate explanations in order to obtain a consent. The purpose of the present study was to assess patients' desire for information about anaesthesia. In this prospective study a form has been given to consecutive patients waiting for surgical operation in general surgery or ear nose throat surgery and able to read and write, to inform them about the necessity of General Anaesthesia (GA); they were asked to complete a questionnaire concerning their desire for information about the following six items concerning anaesthesia: "the duration of anaesthesia"; "what type of pain will I have when I come round, and what pain-killers will I be given"; "details on the various types of anaesthesia, how and where will I be anaesthetized"; "what are the most common complications of general anaesthesia"; "where and how will I come round from general anaesthesia"; "what is artificial respiration in general anaesthesia". 107 patients participated in the study, 24 of whom were undergoing surgery for malignant cancer and 83 for benign non-oncological diseases. More than two-thirds of patients expressed their wish to receive information, and the trend of desire to know was inversely related to age (p < 0.05). There was no significant statistical difference in the desire to know according either to sex or to the kind of disease (benign or malignant). The demand for information about pain was particularly high (85%), also in the older group of patients. The results and the difficulties for obtaining IC are debated. The growth of patients' desire for information about anaesthesia is an aspect of the evolving doctor-patient relationship in Italy. Efforts should be directed at improving reciprocal communication.
    Minerva anestesiologica 01/1998; 64(1-2):5-11. · 2.82 Impact Factor
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    ABSTRACT: The aim of the study was to verify the therapeutic response of vancomycin in methicillin-resistant staphylococcus infection (MRSA/ MRCNS) administered according to two different methods (intermittent infusion vs. continuous infusion). Experimental plan: retrospective study; study environment: university hospital, two intensive care units. Twenty-five critically ill patients submitted to antibiotic treatment with vancomycin for infection from MRSA/MRCNS were studied. The patients, who were classified according to SAPS II scores, were divided into two groups: group A (n = 14): dose of vancomycin of 0.5 g x 4/day and group B (n = 11): dose of 2 g/day of vancomycin administered in a continuous infusion. Before the antibiotic therapy was started (T1) and prior to its end (T2), the following parameters were evaluated: degree of impairment of the main organs and systems by means of sepsis-related organ failure assessment score (SOFA) and count of the white blood cells (WBC). The length of the hospital stay during intensive care was calculated for both groups (statistics: Student t test). No significant differences were found in the SAPS II scores and in the length of the hospital stay. In a comparison of the T1 and T2 results, we noted that patients of group A had no variations in the SOFA scores (4.84 +/- 2.48 vs. 4 +/- 3.9) and in the WBC mean values (12,415 +/- 5,099 vs. 12,841 +/- 6,864 cells/mm3). In contrast, in the patients of group B, we noted significant variations (p < 0.05) in the mean values of the SOFA scores (6.62 +/- 2.2 vs. 4.37 +/- 3.5) and in the mean values relative to the WBC count (17,242 +/- 12,842 vs. 10,757 +/- 3,610 cells/mm3). In critically ill patients suffering from MRSA/MRCNS infection, vancomycin administration in continuous infusions improved organ function and leukocyte response, but did not seem to modify the overall evolution of the disease.
    Chemotherapy 01/1998; 44(1):63-8. · 2.07 Impact Factor
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    ABSTRACT: Neutrophil accumulation and the consequent production of oxygen-derived free radicals are involved in the pathogenesis of Ischemia-Reperfusion syndrome. In this study we investigated whether a treatment with Vitamin E, which has antioxidant properties, could attenuate the tissue damage by interfering with the influx of neutrophils within the ischemic and reperfused human skeletal muscle. To this purpose, patients undergoing aortic cross-clamping during the surgical repair of aortic abdominal aneurysm were studied as a model of ischemia-reperfusion of the lower limb muscles. Muscle biopsies from the right femoral quadriceps of patients not receiving and receiving Vitamin E pretreatment before surgery were taken: a) after the induction of anaesthesia, as control samples, and b) after a period of ischemia followed by 30 min of reperfusion. The tissue samples were either routinely processed for morphological study and immunohistochemical analysis to detect an altered expression of specific endothelial adhesion proteins, such as E-selectin and ICAM-1. The results obtained showed that Vitamin E administration was able to prevent the accumulation of neutrophils within the ischemic and reperfused muscle. This beneficial effect of Vitamin E was due to its ability to hinder the expression of E-selectin and ICAM-1, molecules known to increase the adhesiveness of endothelium to circulating neutrophils. After treatment with Vitamin E a marked attenuation of the reperfusion injury was also evident. In conclusion, Vitamin E treatment may be considered a valuable tool for protection against the ischemia-reperfusion damage of human skeletal muscle.
    Histology and histopathology 08/1997; 12(3):663-9. · 2.28 Impact Factor