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Jessica in the Well: Ischemia and Reperfusion Injury-Reply

Paul J. Benke, MD, PhD
JAMA. 1988;259(24):3559. doi:10.1001/jama.1988.03720240020018.
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In Reply.  —Jessica's physicians are to be congratulated for the successful outcome of a difficult situation. But I still must quibble about the treatment of reperfusion injury, because the subject is important and has wide clinical application.Skeletal muscle is like cardiac muscle, where considerable evidence demonstrates free-radical species contribute to postischemic injury.1,2 Reduced oxygen concentration alone decreases the extent of skeletal-muscle necrosis following prolonged experimental skeletal-muscle ischemia.3 Damage is further reduced in skeletal muscle when free-radical scavengers are added to reduced oxygen delivery at the time of reperfusion.3 Nevertheless, it has not yet been possible to demonstrate that free-radical scavengers play a therapeutic role in the reduction of damage after heart attacks in man, possibly because the ischemia is too long or because scavengers are administered too late, after free-radical species have dissipated. It is likely that this was the case with Jessica. Some time, not


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