Prevalence and effects of cardiac rehabilitation on depression in the elderly with coronary heart disease

Stellate ganglion block (SGB) is considered to increase blood flow to the governing area, but recent studies have shown the decrease of common carotid arterial blood flow in the unblocked side following SGB. We investigated the influence of SGB on bilateral cerebral blood flow and oxygenation using a regional oxygen saturation (rSO2) monitor, TOS-96 (TOSTEC, Japan). The changes of blood volume (hemoglobin index: Hb I) and rSO2 were measured in twenty adult patients who underwent SGB at the transverse process of the C 6 vertebra. Prior to the investigation, two sensors were calibrated and placed on either side of each patient's forehead in order to see the difference. There were significant increases in rSO2 and Hb I in the blocked side and decreases in rSO2 and Hb I in the contralateral side. These results suggest that blood flow in the blocked side following SGB increases with decreased blood flow in the unblocked side. Patients with cerebral vascular disease undergoing SGB might be at risk of a decrease in cerebral blood flow in the unblocked area.     

Study of the relation between cardiac function and the tonus of resistant vessels in experimental disorder of coronary circulation

Muscle blood flow was studied in 28 patients after Blalock-Taussig anastomosis using the radioactive xenon clearance method. Insignificant differences in blood flow between the arms were found at rest, but there was a highly significant lowering of the peak blood flow on the operated side. Peak blood flow values in the first years after the anastomosis were close to the values in obliterative artery disease. The difference in maximum blood flow became less apparent beyond the first 5 years after the operation. A prolonged time of onset and duration of hyperemia after ischemic exercise were observed on the side of the operation. Statistically significant differences in circumference and length between the arms were measured and a lower strength of contraction of the affected hand was demonstrated. Abnormally low blood supply to muscles is thought to be responsible for the anatomical changes in the operated extremity.     

Blood supply of wrist and forearm after exclusion of radial vascular fascicle of all length from blood stream

The arm and forearm are commonly used in plastic and reconstructive surgery as a donor site for harvesting free microsurgical revascularized autografts, which include not only soft tissues, but when necessary, a fragment of radial bone as well. The radial autograft is taken together with radial vascular bundle, the radial artery is so being excluded from participation in hand and forearm blood flow. Until now there are no common opinion of expedient reconstruction of the radial artery because there are no evidence of visible blood flow disturbances in the hand. There are no convincing data on the functional status of the hand in long-term postoperative period and on the ways and degree of compensation of circulation. It is very important that evaluation of the ways and degree of blood flow compensation may play a great part in the problem of hand replantation, that is to determine the influence of the extent of blood flow restoration not only on hand viability, but on the long-term functional outcome as well. This investigation has revealed impaired blood supply and metabolism in hand soft tissues and bones by using the forearm as a donor site for taking free microsurgical revascularized autografts by radionuclide and ultrasound methods.     

Effects of air pollution on symptoms and peak expiratory flow measurements in subjects with obstructive airways disease

In preterm neonates, intraventricular haemorrhage is linked to the dysfunction of cerebral autoregulation (AR). We aimed at tracing the critical closing pressure (CCP) in order to quantify AR and to reveal its inner workings. In an observational study, 10 preterm neonates (median, range: ga 28 weeks, 25 to 32 weeks; bw 1070, 685 to 1730 g; age 2d, 1 to 7 d) were continuously Doppler traced (a. carotis interna) for > 10 min. Systemic blood pressure (BP, a. umbilicalis, a. radialis, a. temporalis) was recorded simultaneously (> 1200 cardiac cycles each). Systolic BP was on average 11 mmHg above CCP. There was a striking parallel between both variables, even in cases of sudden spontaneous BP fluctuations > 30% (r = 0.72, 0.41 to 0.99), while systolic cerebral blood flow velocity remained largely unaffected (r = -0.15, -0.75 to 0.53), indicating a properly functioning AR. CCP was 28 mmHg, 14 to 38 mmHg. Based on our data, a physiological model of AR is developed, integrating anatomy, metabolic and neuronal pathways with former physiologic findings--including low frequency cycling of cerebral blood flow velocity. Tracing of CCP is thought to have the potential to identify infants with impaired AR. Since this method is noninvasive and independent of angle of insonation (thus rendering it uncritical in probe fixation), it is a promising tool for sustained monitoring of cerebral haemadynamics in the clinical setting.     

Effect of spinal sympathetic blockade upon postural changes of blood flow in human peripheral tissues

The effect of head-up tilt upon subcutaneous and skeletal muscle blood flow in the crus was studied before and during epidural blockade in 10 subjects. Relative changes in blood flow were estimated by the local 133Xe washout technique. In subcutaneous tissue head-up tilt induced a decrease in blood flow of about 40% and there was no difference in the vascular response to head-up tilt before and during epidural blockade. In skeletal muscle tissue essentially the same was found as head-up tilt decreased blood flow by about 26% the response being uninfluenced by epidural blockade. In 3 patients local nervous blockade was induced by Lidocaine in 133Xe labelled subcutaneous tissue on one side. During epidural blockade and tilt blood flow increased by 12% whereas blood flow decreased by 30% on the control side. Thus epidural blockade had no influence on the vasoconstrictor response in subcutaneous tissue and skeletal muscle to head-up tilt whereas local blockade was able to prevent the response. Local mechanisms including the local veno-arteriolar reflex appear to play an important role for the observed maintenance of arterial blood pressure in the tilted position during central sympathetic blockade.     

Local nervous mechanism in regulation of blood flow in human subcutaneous tissue

The effect of local venous stasis upon blood flow in human subcutaneous adipose tissue on the distal part of the forearm was investigated in three healthy subjects and two chronically sympathectomized patients suffering from manual hyperhidrosis. The area under study was separated into two parts by means of a lead shield exerting a pressure of about 360 mmHg on the skin. The effect of venous stasis of about 40 mmHg on one side of the shield upon blood flow measured simultaneously on both sides of the shield by the local 133Xenon washout technique was investigated. During venous stasis on one side of the shield, blood flow decreased about 40% on both sides. The vasoconstrictor impulse could be transmitted over a distance of about 1-2 cm. The phenomenon was unaffected by nerve blockade induced 3 cm proximally, medially, and laterally to the area by infiltration the skin with lidocaine. Thus a vasoconstrictor impulse could be transmitted from the side of stasis to the non stasis side of the lead shield. The transmission was not affected by phentolamine but was blocked by lidocaine and chronic sympathetic denervation. The vasoconstrictor impulse elicited during venous stasis is therefore most likely transmitted by means of a local nervous mechanism involving sympathetic adrenergic vasoconstrictor fibres.     

Effect of Ca-antagonists on pulmonary blood flow during single-lung ventilation in the dog

Experiments were conducted in 21 adult mongrel dogs to clarify the effects of Ca-antagonist (nifedipine sublingual administration 2.5 mg or 5 mg, or nicardipine intravenous administration 30 micrograms/kg or 60 micrograms/kg) on pulmonary blood flow under the condition of collapsed lung on the side of thoracotomy. Under anesthesia, an endotracheal tube with a movable blocker was used to intubate the trachea and the thoracotomized lung was collapsed. Subsequently, a Ca-antagonist was given and the ratio of the left main pulmonary artery/ascending thoracic aorta blood flow was used as an index of hypoxic pulmonary vasoconstriction (HPV). The following results were obtained. 1. Ca-antagonist administration under lung-collapse on the thoracotomy side resulted in inhibition of HPV of the collapsed lung, whereas, arterial blood oxygen tension (PaO2) remained in the acceptable range. 2. The maintenance of the lowered PaO2 within the acceptable range may have been due to the increase in cardiac output and the elevation of mixed venous blood oxygen tension resulting from Ca-antagonist administration, as well as the residual HPV even after administration of the Ca-antagonist.     

Nitric oxide modulation of retinal, choroidal, and anterior uveal blood flow in newborn piglets

The purpose of the present study was to investigate the role of nitric oxide (NO) in modulating the resting vascular tone of the choroidal and anterior uveal circulations and the autoregulatory gain of the retina. Blood flow (ml/min/100 gm dry weight) to tissues was determined in 23 anesthetized piglets (3-4 kg) using radiolabelled microspheres. Ocular Perfusion Pressure (OPP) was defined as mean arterial pressure minus intraocular pressure (IOP) which was manipulated hydrostatically by cannulation of the anterior eye chamber. The OPP was decreased during intravenous infusion (30 mg/kg/hr) of either the NO-synthase inhibitor L-NAME or the inactive enantiomer D-NAME. Blood flows were determined at OPP of 60, 50, 40, 30, and 20 mmHg following initial ocular blood flow measurements. Mean initial choroidal and anterior uveal blood flows with L-NAME showed a 47+/-12% and a 43+/-6% reduction (p <.001), respectively. Mean choroidal blood flows were significantly reduced (p<.01) in the L-NAME treated animals at an OPP of 60 and 50 when compared to D-NAME. Uveal blood flows were linearly correlated with OPP in the L-NAME and D-NAME treated groups. Uveal blood flow was greater following exogenous administration of L-arginine (180 mg/kg). Mean initial retinal blood flow did not differ significantly in either group. Retinal blood flow with L-NAME was reduced at OPP of 60 mmHg and below compared to D-NAME (p<.05). The degree of compensation in the autoregulatory gain of the retinal vasculature was reduced in the presence of L-NAME at an OPP of 50 mmHg and below compared to D-NAME. These data support the hypothesis that NO may be a primary mediator in maintaining resting vascular tone to the choroid and anterior uvea in vivo and that NO blockade reduces the degree of compensation in the autoregulatory gain of the retinal vasculature within a specific range of ocular perfusion pressures.     

Blockade of radiocontrast-induced nephrotoxicity by the endothelin receptor antagonist, SB 209670

The effect of the novel nonpeptide endothelin (ET) receptor antagonist, (+/-)-SB 209670, on the renal effects of the high osmolar tri-iodinated ionic contrast media, Hypaque, was evaluated in anesthetized dogs in the presence or absence of the cyclooxygenase inhibitor, indomethacin (10 mg/kg, i.v.). Hypaque alone (5 ml/kg, i.v.) resulted in a marked diuresis and natriuresis but little change in either renal blood flow or renal vascular resistance. When the ET receptor antagonist, (+/-)-SB 209670, was infused into the renal artery at a dose that inhibited ET-induced renal vasoconstriction, Hypaque resulted in a significant increase in renal blood flow and decrease in renal vascular resistance. In the presence of indomethacin, Hypaque caused a significant increase in renal vascular resistance which was abolished by (+/-)-SB 209670. The data indicate that the radiocontrast media, Hypaque, can cause renal vasoconstriction which may be mediated by ET.     

The effects of the HIV-1 envelope protein gp120 on the production of nitric oxide and proinflammatory cytokines in mixed glial cell cultures

Previous studies showed that intracarotid artery perfusion of biotinylated vasoactive intestinal peptide analog (bio-VIPa) coupled to a blood-brain barrier (BBB) drug delivery vector, OX26/avidin, causes an increase in brain blood flow by 65% in N2O-anesthetized rats. OX26 is a murine monoclonal antibody to the rat transferrin receptor and undergoes receptor-mediated transport through the BBB in vivo. The present investigation examined the central nervous system effects of bio-VIPa after conventional i.v. injection to conscious rats. The VIPa was monobiotinylated (bio) with an-XX-noncleavable (amide) linker, and the bio-XX-VIPa conjugated to OX26/streptavidin (SA) maintained affinity for the VIP receptor in radioreceptor assays. Brain uptake of the bio-XX-VIPa coupled to the OX26/SA vector after i.v. injection was at least 10-fold higher than that of the free bio-XX-VIPa, because of both an increased plasma area under the concentration curve and BBB permeability-surface area product. Administration of the free bio-XX-VIPa increased salivary gland blood flow by 350%, but had no effect on brain blood flow. By contrast, bio-XX-VIPa/OX26-SA conjugate at equal doses (20 micrograms/kg) after i.v. injection increased brain blood flow by 60% in conscious rats, but had no effect on salivary gland blood flow. In summary, the use of the BBB peptide drug delivery system targeted the drug to the central nervous system, and optimized the therapeutic index of the VIPa by enhancing cerebral blood flow and by attenuating side effects in peripheral organs such as salivary gland.     

Local reflex in microcirculation in human cutaneous tissue

Blood flow in cutaneous tissue measured by the local 133Xenon washout technique decreased about 35 per cent during venous stasis of 40 mmHg in three normal subjects. The response was unaffected by block of the nerve three cm proximally to the labeled area. When the tissue was infiltrated with lidocaine or with phentolamine, blood flow remained constant, indicating that the decrease in blood flow is due to an arteriolar vasoconstrictor response to increase in venous transmural pressure. Local venous stasis elicited a vasoconstrictor response in an adjoining area not affected by the stasis. The response was blocked by lidocaine applied to the side of stasis. In 2 chronically sympathectomized patients, the vasoconstrictor response was abolished in the denervated limbs but present on the non-operated side (1 patient with unilateral sympathectomy). The results indicate that the vasoconstrictor response to an increase in venous transmural pressure is due to a local nervous mechanism involving sympathetic adrenergic fibres, most likely a sympathetic axon reflex.     

Identification of eosinophils in lysed whole blood using side scatter and CD16 negativity

The identification of eosinophils in lysed whole blood by flow cytometry can be problematic, since these cells overlap significantly with the neutrophil cluster on forward scatter versus side scatter plots of whole blood samples. Current methods can be time-consuming when running multiple samples or may compromise yield in the interests of greater accuracy. The use of eosinophil purification techniques prior to FACS analysis or sorting as a way of ensuring purity may have unpredictable effects on eosinophil activation, leading to questionable data interpretation. Here we describe a simple, single-step method for definition of eosinophils utilizing their high side scatter and CD16 fluorescence negativity to differentiate them from neutrophils. The purity of the neutrophil and eosinophil populations sorted with this gate is close to 100% regardless of the peripheral blood eosinophil count, while the population obtained by sorting on a plot of FSC/SSC was a mixture of eosinophils and neutrophils. We suggest this method as a simple, reproducible, and accurate way of defining eosinophils by flow cytometry for analysis or sorting.     

Blood flow analysis for the secondary impeller of an IVAS heart pump

The rotodynamic heart pump (IVAS), designed by the Cleveland Clinic Foundation, includes a secondary flow path along the journal bearing, through a secondary impeller, and over the rotor outer surface. The flow behaviors of the blood through the journal bearing and the secondary impeller are investigated by a computational fluid dynamics method that solves the 3-dimensional Navier-Stokes equations using a new solution algorithm. Results of the analyses include: 1) the blood flow patterns within the journal bearing, 2) the effect of the non-uniform bearing clearance on the flow patterns of the impeller cavity, 3) the flow patterns around a secondary impeller blade that include effects of tip clearance and the gap between the blade and the inner or outer side wall, 4) effects of the blade angles on the secondary impeller performance, and 5) the shear stress distribution.     

Acute cholecystitis in choledocholithiasis and stricture of the ampulla of Vater

The central haemodynamics and regional lung function were measured in the sitting position before and after infusion of prostaglandin F2alpha (PGF2alpha) in seven healthy women in the first trimester of pregnancy. The dosage level of PGF2alpha was: 100mug/min for 10 minutes followed by 300mug/min for 5 minutes. The pulmonary arterial pressure, wedge pressure, and cardiac output were measured by means of a flow direct Swan-Ganz catheter introduced through an antecubital vein. The regional perfusion of the lungs was determined, in the sitting position, by external counting over the chest following intravenous injection of Xe133. The thoracic impedance was measured with the Minnesota Impedance Cardiograph Model 304A and the impedance was considered as an expression of the thoracic fluid volume. A significant redistribution of the pulmonary blood flow after PGF2alpha administration was found, ie an increase in the apical blood flow and a reduction in the basal blood flow. Further, the point of maximal blood flow moved in direction of the apex. A significant increase in both arterial [1.92-2.76 kPa (14.4-20.7 mmHg)] and wedge pressures [0.56-0.83 kPa (4.2-6.2 mmHg)] was found at the highest dosage level, whereas no changes were seen in the cardiac output and thoracic impedance. The findings indicate vasoconstriction of the arterial and possibly on the venous side of the pulmonary vascular bed during PGF2alpha infusion.     

The internal thoracic artery of poor quality: was cardiac massage a cause of ITA stenosis?

The case of stenotic left internal thoracic artery (LITA), with a very rare and interesting histological findings is reported. The patient, a 65-year-old man, fell into shock, due to acute myocardial infarction and received cardiopulmonary resuscitation at home immediately. Three months later, patient underwent coronary artery bypass grafting. The LITA was dissected from the chest wall with a tissue pedicle by usual manner. However, it was abandoned to use for grafting, because of extremely poor blood flow even after balloon dilatation was noticed. Histological study revealed a significant granulation of LITA media, led to severe stenosis of LITA lumen on it's portion. On other side, either proximal and distal portion of LITA remained intact. It seems that this unusual histological change of LITA media developed after LITA over stretching due to cardiac massage during cardiopulmonary resuscitation. If patient, scheduled for coronary bypass surgery, has in a personal history the presence of cardiac massage, traffic accident, some contact sport or any other chest trauma, it is recommended to perform LITA angiography preoperatively, if an intention to use the LITA for coronary artery bypass grafting exists.     

Shear stress in cerebral arteries supplying arteriovenous malformations

Arteries supplying cerebral arteriovenous malformations (AVMs) are known to dilate with time. These changes are reversible, and the feeders have been shown to slowly decrease in calibre after removal of the AMV. There is evidence that arteries alter their internal diameters in response to sustained changes of blood flow so that shear stress is kept constant. This implies that blood flow-induced shear stress might be the driving force for remodelling of the cerebral vascular network in the presence of an AVM, and for reversion of these changes after radical operation. The objective of this study is to examine the hypothesis that the shear stress in cerebral arteries supplying AMVs is of the same magnitude as in arteries supplying normal brain tissue in spite of larger blood flow rate. Fifteen patients with supratentorial cerebral AVMs admitted for endovascular treatment were examined with transcranial Doppler ultrasound in the distal Willisian vessels. Vessel calibres were measured in angiograms with magnification correction. Shear stress was estimated assuming a constant value for blood viscosity. Corresponding arteries in the cerebral hemisphere with AVM and in the contralateral one were compared in pairs. Thirty-four pairs of homonymous arteries were studied. The arteries on the AVM side presented larger calibres, higher axial blood flow velocities, lower pulsatility index and larger blood flow rates than the contralateral side. There was a clear positive correlation between blood flow velocities and vessel calibres. The estimates of shear stress did not differ significantly in corresponding arteries of both hemispheres (p = 0.18). The results indicate a precise adjustment of cerebral arterial calibre and blood flow-induced shear stress that presumably induces the progressive dilation of AVM feeders, and the slow regression of the vessel calibres to average dimensions after removal of the lesion. Each vessel seems to remodel itself in response to long-term changes in blood flow rate so that the vessel calibre is reshaped to maintain a constant level of wall shear stress.     

A model for research on cochlear hypoxia

The vessels emerging from one side of the basilar artery are supplied exclusively by the homolateral vertebral artery. Since blood flow is laminar through the vertebrobasilar system, mixing between two sides does not normally occur. Based on this fact, an experimental model for research on cochlear hypoxia is proposed and described. The animal's own blood flow in the vertebral artery is completely replaced by a stream of poorly oxygenated blood injected retrogradely through the ipsilateral axillary artery. In this way, the territory supplied by the vessels emerging from this side of the basilar artery, including the ear, is rendered hypoxic. The changes in the cochlear action potentials induced by the reduced oxygen supply are recorded by a chronically implanted electrode and analyzed.     

Combined treatment of patients with affected extracranial segment of the internal carotid artery

The results of examination of 84 patients with extracranial a. carotis externa affection were analysed. In 36 patients the combined treatment was conducted, including surgical intervention and postoperative therapy course.     

Perfusion-MRI in cerebral infarct

PURPOSE: To investigate the hemodynamic changes in patients with acute cerebral stroke by perfusion MRI. MATERIAL AND METHODS: In 12 patients with acute stroke in the territory of the middle cerebral artery, perfusion MRI was performed. Peak time, mean transit time, regional cerebral blood volume and regional cerebral blood flow were calculated in the infarction, the peri-infarction area and the contralateral hemisphere. RESULTS: In the infarction the mean blood flow was 29 ml/100 g/min, compared to about 40 ml/100 g/min in the peri-infarction area and the contralateral hemisphere. In two patients increased cortical blood flow was found in the infarction due to luxury perfusion. The cerebral blood volume was reduced in the infarction, but significantly increased, to 7.3 ml/100 g, in the peri-infarction tissue. CONCLUSION: Perfusion MRI allows one to differentiate various patterns of perfusion disorders in patients with acute cerebral stroke. The resulting data may be helpful in describing the pathophysiologic mechanisms of compensation.     

Evaluation of a regional oxygen saturation catheter for monitoring SjvO2 in head injured patients

Exercise in the water offers several physiological advantages to the pregnant woman. The hydrostatic force of water pushes extravascular fluid into the vascular spaces, producing an increase in central blood volume that may lead to increased uterine blood flow. This force is proportional to the depth of immersion. The increase in blood volume is proportional to the woman's edema. A marked diuresis and natriuresis accompanies the fluid shifts. The buoyancy of water supports the pregnant women. Water is thermoregulating. Studies of pregnant women exercising in the water have shown less fetal heart rate changes in the water than on land in response to exertion. Pregnant women's heart rates and blood pressures during water exercise are lower than on land exercise, reflecting the immersion-induced increase in circulating blood volume. The physiology of water exercise offers some compensation for the physiological changes of exercise on land that may beneficially affect pregnancy.