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Jessica in the Well: Ischemia and Reperfusion Injury

Jefferson C. Davis, MD, MPH
JAMA. 1988;259(24):3558. doi:10.1001/jama.1988.03720240020016.
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To the Editor.  —In his letter, Dr Benke1 expressed his opinion that hyperbaric oxygen should not be used for ischemie injuries because of increased xanthine oxidase activity, which might generate excess free radicals during the period of reperfusion. The references he cited show the presence of large amounts of xanthine dehydrogenase available for conversion to xanthine oxidase, which uses molecular oxygen to produce superoxide radical during reperfusion of ischemic intestine, heart, brain, kidney, and possibly free-skin-flap transfer in rats. Fortunately, skeletal muscle is spared from this free-radical formation found in other tissues.2 Experimental data on early use of hyperbaric oxygen for traumatized postischemic skeletal muscle have clearly demonstrated reduction of muscle necrosis3 and reduction of edema.4-6 The absence of damage due to reperfusion formation of free radicals in skeletal muscle is in accord with the observation that while measurable amounts of xanthine dehydrogenase exist in skeletal


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