Biomedical subjects

A N Salt

Publications and source records attributed to A N Salt.

At least 19 recordsLinked to original sources

PubMed2001

Quantification of solute entry into cochlear perilymph through the round window membrane.

The administration of drugs to the inner ear via the round window membrane is becoming more widely used for both clinical and experimental purposes. The actual drug levels achieved in different regions of the inner ear by this method have not been established. The present study has made use of simulations of solute movements in the cochlear fluids to describe the distribution of a marker solute in the guinea pig cochlear fluid spaces. Simulation parameters were derived from experimental measurements using a marker ion, trimethylphenylammonium (TMPA). The distribution of this ion in the cochlea was monitored without volume disturbance using TMPA-selective microelectrodes sealed into the first and second turns of scala tympani (ST). TMPA was applied to perilymph by irrigation of the intact round window membrane with 2 mM solution. At the end of a 90 min application period, TMPA in the first turn, 1.4 mm from the base of ST, reached an average concentration of 330 microM (standard deviation (S.D.) 147 microM, n = 8). TMPA in the second turn, 7.5 mm from the base of ST reached a concentration of 15 microM (S.D. 33 microM, n = 5). The measured time courses of TMPA concentration change were interpreted using the Washington University Cochlear Fluids Simulator (V 1.4), a public-domain program available on the internet at http ://oto.wustl.edu/cochlea/. Simulations with parameters producing concentration time courses comparable to those measured were: (1) round window permeability: 1.9 x 10(-80 cm/s; (2) ST clearance half-time: 60 min; (3) longitudinal perilymph flow rate: 4.4 nl/min, directed from base to apex. Solute concentrations in apical regions of the cochlea were found to be determined primarily by the rate at which the solute diffuses, balanced by the rate of clearance of the solute from perilymph. Longitudinal perilymph flow was not an important factor in solute distribution unless the bony otic capsule was perforated, which rapidly caused substantial changes to solute distribution. This study demonstrates the basic processes by which substances are distributed in the cochlea and provides a foundation to understand how other applied substances will be distributed in the ear.

Animals↗

PubMed2001

Quantitative anatomy of the round window and cochlear aqueduct in guinea pigs.

In order to analyze the entry of solutes through the round window membrane, a quantitative description of round window anatomy in relationship to scala tympani is required. High-resolution magnetic resonance microscopy was used to visualize the fluid spaces and tissues of the inner ear in three dimensions in isolated, fixed specimens from guinea pigs. Each specimen was represented as consecutive serial slices, with a voxel size of approximately 25 microm(3). The round window membrane, and its relationship to the terminal portion of scala tympani in the basal turn, was quantified in six specimens. In each image slice, the round window membrane and scala tympani were identified and segmented. The total surface area of the round window membrane averaged 1.18 mm(2) (S.D. 0.08, n=6). The length and variation of cross-sectional area as a function of distance for the cochlear aqueduct was determined in five specimens. The cochlear aqueduct was shown to enter scala tympani at the medial limit of the round window membrane, which corresponded to a distance of approximately 1 mm from the end of the scala when measured along its mid-point. These data are of value in simulating drug and other solute movements in the cochlear fluids and have been incorporated into a public-domain simulation program available at http://oto.wustl.edu/cochlea/.

Animals↗

PubMed2001

Regulation of endolymphatic fluid volume.

Direct measurements of the dispersal of markers in endolymph have failed to support previously established hypotheses of endolymph homeostasis, specifically longitudinal flow, radial flow, and dynamic flow theories. Rather, they suggest that in the normal state endolymph is maintained without a significant involvement of volume flow at all. Ions appear to be transported into and out of the endolymphatic space in a similar manner to that for a single cell, with each ion transport process contributing to the electrolyte pool. In abnormal volume states, however, longitudinal volume flow of endolymph may contribute to homeostasis. Procedures that enlarge the endolymphatic space result in endolymph flow toward the base of the cochlea, contributing to the removal of electrolytes and volume. Similarly, procedures that decrease cochlear endolymph volume induce apically directed flow in the cochlea, contributing to the addition of electrolytes and volume to the endolymphatic space. The endolymphatic sac responds to endolymph volume disturbance, showing op posite responses to volume increases and decreases. Although evidence is still limited, the endolymphatic sac appears to act as a "bidirectional overflow" system. While volume disturbances originating from out-of-balance transport processes anywhere in the labyrinth may be corrected by the sac, dysfunction of the sac itself is likely to have a substantial effect on endolymph status.

Animals↗

PubMed2000

Ionic and potential changes of the endolymphatic sac induced by endolymph volume changes.

The endolymphatic sac (ES) is believed to be the locus for endolymph volume regulation in the inner ear. It has recently been shown that induced endolymph volume changes in the cochlea result in anatomical changes in the ES, suggesting that function of the sac varies according to endolymph volume status. In the present study we have recorded luminal concentrations of K(+) and Na(+) from the ES and the endolymphatic sac potential (ESP) during cochlear endolymph volume changes. ES recordings were made by an extradural approach, thereby preserving normal cerebrospinal fluid resting pressure. Cochlear endolymph volume changes were generated by performing injections or withdrawals through a pipette inserted into endolymph by a round window approach. The pre-treatment concentrations of K(+) and Na(+) in the ES were found to be 8.4 mM (S.D. 3.3, n=8) and 128. 6 mM (S.D. 18.4, n=10) respectively, and the mean ESP was 14.4 mV (S. D. 5.2, n=18). Endolymphatic injections were found to produce a sustained increase in the K(+) content of the ES by an average of 19. 9 mM and to decrease Na(+) by 30.7 mM measured 50 min after the start of injection. The time for K(+) increase to occur was found to correlate with the injected volume, with larger injected volumes producing a more rapid increase. Endolymphatic withdrawals were found to induce a slow decline in endolymphatic K(+) by an average of 3.4 mM measured at 50 min after withdrawal, although no significant change of Na(+) was detected. Volume-induced ESP changes were highly variable. Injections produced a small increase in the mean ESP and withdrawals produced a small decrease but neither change was statistically significant and some animals showed potential changes in the opposite direction. These data show that a change in cochlear endolymph volume status results in a physiologic response of the ES which is sustained for a considerable period. If the ES plays a part in the restoration of normal endolymph volume, this process appears to proceed slowly, based on the prolonged time courses of ionic changes observed.

Animals↗

PubMed1999

Morphological changes of the endolymphatic sac induced by microinjection of artificial endolymph into the cochlea.

Morphological changes of the endolymphatic sac were analyzed in guinea pigs following microinjection of artificial endolymph into the cochlea or withdrawal of a quantity of native endolymph. Injections were performed into the second turn of scala media with a micro-pump at a rate of 60-100 nl/min, lasting for a period of 4, 7. 5, 15 or 18 min. In withdrawal experiments, endolymph was aspirated from the second cochlear turn over a period of 8 min. For each procedure the contralateral (non-treated) ear served as a histological control. Following artificial endolymph injections of 7. 5 min or more there was an almost total absence of the normal intraluminal homogeneous substance (HS) on the injected side. Our observations suggest that the disappearance of the HS occurs by both enzymatic and macrophagic activity. After endolymphatic withdrawals the ES was found to contain increased amounts of HS. The results could suggest that the volume of fluid in the ES, and hence the volume of the entire membranous labyrinth, may be regulated by a dynamic relationship between active secretion and enzymatic degradation of a lumen-expanding substance that is intimately related to the intraluminal macrophages. The exact mechanism governing these regulatory systems, and their relationship to ion and water movements across the epithelium of the sac, remain to be elucidated.

Animals↗

PubMed1999

Cochlear fluid space dimensions for six species derived from reconstructions of three-dimensional magnetic resonance images.

OBJECTIVES: To establish the dimensions and volumes of the cochlear fluid spaces. STUDY DESIGN: Fluid space volumes, lengths, and cross-sectional areas were derived for the cochleas from six species: human, guinea pig, bat, rat, mouse, and gerbil. METHODS: Three-dimensional reconstructions of the fluid spaces were made from magnetic resonance microscopy (MRM) images. Consecutive serial slices composed of isotropic voxels (25 microm3) representing the entire volume of fixed, isolated cochleas were obtained. The boundaries delineating the fluid spaces, including Reissner's membrane, were resolved for all specimens, except for the human, in which Reissner's membrane was not consistently resolved. Three-dimensional reconstructions of the endolymphatic and perilymphatic fluid spaces were generated. Fluid space length and variation of cross-sectional area with distance were derived by an algorithm that followed the midpoint of the space along the length of the spiral. The total volume of each fluid space was derived from a voxel count for each specimen. RESULTS: Length, volume, and cross-sectional areas are provided for six species. In all cases, the length of the endolymphatic fluid space was consistently longer than that of either perilymphatic scala, primarily as a result of a greater radius of curvature. For guinea pig specimens, the measured volumes of the fluid spaces were considerably lower than those suggested by previous reports based on histological data. CONCLUSIONS: The quantification of cochlear fluid spaces provided by this study will enable the more accurate calculation of drug and other solute movements in fluids of the inner ear during experimental or clinical manipulations.

Animals↗

PubMed1999

Longitudinal endolymph movements and endocochlear potential changes induced by stimulation at infrasonic frequencies.

The inner ear is continually exposed to pressure fluctuations in the infrasonic frequency range (< 20 Hz) from external and internal body sources. The cochlea is generally regarded to be insensitive to such stimulation. The effects of stimulation at infrasonic frequencies (0.1 to 10 Hz) on endocochlear potential (EP) and endolymph movements in the guinea pig cochlea were studied. Stimuli were applied directly to the perilymph of scala tympani or scala vestibuli of the cochlea via a fluid-filled pipette. Stimuli, especially those near 1 Hz, elicited large EP changes which under some conditions exceeded 20 mV in amplitude and were equivalent to a cochlear microphonic (CM) response. Accompanying the electrical responses was a cyclical, longitudinal displacement of the endolymph. The amplitude and phase of the CM varied according to which perilymphatic scala the stimuli were applied to and whether a perforation was made in the opposing perilymphatic scala. Spontaneously occurring middle ear muscle contractions were also found to induce EP deflections and longitudinal endolymph movements comparable to those generated by perilymphatic injections. These findings suggest that cochlear fluid movements induced by pressure fluctuations at infrasonic frequencies could play a role in fluid homeostasis in the normal state and in fluid disturbances in pathological states.

Animals↗

PubMed1998

Longitudinal endolymph movements induced by perilymphatic injections.

Endolymph movements and endocochlear potential (EP) changes were measured during disturbances of perilymphatic pressure. induced by injecting artificial perilymph into scala tympani (ST) or scala vestibuli (SV) of the guinea pig cochlea. Injections were performed either with or without an outlet made in the opposite perilymphatic scala. Injections into ST without an outlet induced large pressure changes but virtually no endolymph movement or EP change. Injection at the same rate into ST with an outlet in SV produced smaller pressure changes which were accompanied by a basally-directed displacement of endolymph and significant EP changes. The magnitude of endolymph displacements and EP changes varied as a function of injection rate. Injections into SV, either with or without an outlet in ST, produced apically-directed endolymph displacement and EP changes. For the SV injections without an outlet, the cochlear aqueduct and round window are likely to provide an outlet and compliance, permitting flow along the perilymphatic scalae to occur even when no ST outlet was provided. We conclude that endolymph movements are not dependent on the absolute pressure of the perilymph, but instead occur when small, sustained pressure gradients are present across the cochlear partition, corresponding to times when perilymph flow is induced. This study demonstrates that in the normal. sealed cochlea, endolymph and EP are insensitive to fluid injections into ST, but are sensitive to fluid injections into SV. Endolymph movements are therefore unlikely to be generated by cerebrospinal fluid pressure fluctuations (such as those produced by respiration, posture changes, coughing, sneezing, etc) which are transmitted to ST by the cochlear aqueduct.

Animals↗

PubMed1997

Longitudinal endolymph flow associated with acute volume increase in the guinea pig cochlea.

Endolymph volume disturbances were induced by microinjections of artificial endolymph into the second turn of the guinea pig cochlea at rates less than 60 nl/min. Induced longitudinal movements and area changes of endolymph were quantified in the basal turn using an ionic flow marker technique. Tetramethylammonium (TMA) was used as a flow marker by iontophoresing it into endolymph in micromolar amounts. TMA movements in the apical and basal directions were monitored by ion-selective electrodes. Changes in endolymph flow and cross-sectional area of scala media were derived using a mathematical model to interpret the recorded tracer time courses. The model was validated by performing comparable volume injections and flow measurements in fine-diameter plastic tubes. The rate of flow of endolymph measured prior to injection was close to zero, in agreement with prior studies. Based on the injection of different volumes into endolymph over a 15 min period, we found that injection of up to 80 nl of artificial endolymph into the second turn would not induce flow in the basal turn. However, above this amount, flow towards the base increased at a rate which correlated with the injected volume, with endolymph moving basally by a distance of 0.0067 mm/nl of artificial endolymph injected. Flow rates measured in the third turn, on the apical side of the injection were far lower and showed characteristics consistent with there being no outlet at the apex. These results suggest that small volume disturbances are corrected locally in the cochlea, but larger disturbances produce a longitudinal flow of endolymph out of the cochlea which represents a significant mechanism contributing to homeostasis. It can be concluded that structures outside the cochlea, such as the endolymphatic sac, do play a role in the correction of endolymph volume disturbances. Although the maintenance of endolymph composition is dominated by local ion transport mechanisms, the capacity of these local mechanisms to maintain normal endolymph volume appears to be limited.

Animals↗

PubMed1997

Quantitative differences in endolymphatic calcium and endocochlear potential between pigmented and albino guinea pigs.

A number of previous studies have suggested that melanin may play a role in Ca2+ homeostasis of endolymph. In the present study, endolymph Ca2+ levels and endocochlear potential (EP) were measured in all four cochlear turns of pigmented or albino guinea pigs. Auditory sensitivity was also evaluated using cochlear action potential (AP) thresholds. In pigmented animals we found that endolymph Ca2+ tended to increase from base to apex of the cochlea, while EP systematically decreased towards the apex. In contrast, no significant Ca2+ gradient was found in albinos and the EP decline was far less. As a result, the apical turn of albino animals had significantly lower Ca2+ and significantly higher EP than in pigmented animals. AP thresholds pooled across all test frequencies were significantly lower in albino animals although no differences at individual frequencies reached significance. Even after correction for EP differences, the endolymph Ca2+ levels in albino animals were significantly lower than in pigmented ones. These results confirm that there are significant physiologic differences between pigmented and albino animals, which are a likely consequence of the absence of melanin in the albino cochlea. They are consistent with the involvement of melanin in the active transport of Ca2+ into endolymph.

Acoustic Stimulation↗

PubMed1997

Fixation-induced shrinkage of Reissner's membrane and its potential influence on the assessment of endolymph volume.

The quantification of endolymph volume by histological techniques or by magnetic resonance (MR) microscopy requires the inner ear to be first treated with chemical fixatives. If the fixative induces soft-tissue shrinkage, it would tend to return a distended Reissner's membrane towards a straight position, since this membrane is anchored to bone at its medial and lateral edges. The goal of this study was to determine the degree of Reissner's membrane shrinkage induced by different fixation protocols to establish methods which minimize tissue shrinkage. Fragments of fresh Reissner's membrane were dissected from isolated cochleae in an artificial perilymph. Specimens were viewed with an inverted microscope during infusion of fixatives, and changes recorded on video tape. Size changes of the specimen were quantified, usually over a 20 min period. Heidenhain-Susa, a fixative which is widely used in histological studies of hydropic cochleae, caused substantial shrinkage of Reissner's membrane, decreasing the length of specimens by an average of 15.1%. Other fixation procedures induced far less shrinkage. The use of 3.1% glutaraldehyde in Hanks' balanced salt solution produced a mean length decrease of only 0.3%. The inclusion in the fixation medium of 4.5% mercuric chloride, corresponding to the concentration which is present in Heidenhain-Susa and which acts to increase the contrast of Reissner's membrane in MR microscopy, contributes significantly to specimen shrinkage. We can conclude that the degree of endolymphatic hydrops may be underestimated in specimens fixed with media containing high levels of mercuric chloride.

Animals↗

PubMed1995

Detection and quantification of endolymphatic hydrops in the guinea pig cochlea by magnetic resonance microscopy.

Three-dimensional magnetic resonance microscopy (MRM) was used to study normal and hydropic cochleae of the guinea pig. With this technique consecutive serial slices representing the entire volume of isolated, fixed cochleae were obtained. The voxels (volume elements) making up the contiguous slices were isotropic (25 microns 3) and in each slice the boundaries of scala media, including the position of Reissner's membrane, were clearly delineated. Three-dimensional reconstructions of the endolymphatic and perilymphatic scale were generated. Custom software was developed to quantify cross-sectional area (CSA) of all scalae. In the normal cochlea all 3 scalae, including scala media, showed a gradual decrease in CSA from base to apex. Marked differences existed between our findings and previously reported cochlear dimensions, especially for the perilymphatic scalae in the basal turn. In hydropic cochleae the scala media was enlarged to a varying extent in different turns and marked changes in the degree of distension of Reissner's membrane occurred along the cochlea. MRM and subsequent computer analysis of the isotropic data provide excellent methods for imaging and quantifying the fluid spaces of normal and hydropic cochleae.

Animals↗

PubMed1995

Endolymph volume changes during osmotic dehydration measured by two marker techniques.

The processes underlying endolymph volume regulation during osmotic disturbances were investigated in vivo using ionic volume markers. The markers utilized were tetramethylammonium (TMA+) or hexafluoroarsenate (AsF6-). Both ions were used in concentrations low enough not to be toxic, but readily detectable by ion-selective microelectrodes (typically < 1 mM). Two marker techniques were developed. In one, termed the 'perfused volume marker' (PVM) method, the marker was loaded into endolymph throughout the cochlea by perfusion of the perilymphatic space. Concentration changes of the marker were measured with a double-barreled ion-selective microelectrode. These recordings were insensitive to longitudinal movements of endolymph. The second technique, termed the 'iontophoresed volume marker' (IVM) method, utilized a localized, iontophoretic injection of marker into endolymph. In this method, marker changes were recorded from two ion-selective electrodes, one placed basal and one placed apical to the injection site. These data were used to compute changes in cross-sectional area and longitudinal movements of endolymph. Changes in endolymph volume were induced by perfusion of the perilymphatic space with hypertonic media. The endolymph potassium increase produced by osmotic dehydration was of similar magnitude and time course to that of a volume marker loaded by the PVM method. Using the IVM method, it was shown that these concentration increases arose by two distinct processes. One component was the area decrease of scala media. A second component was a small apically directed movement of endolymph during dehydration, thereby concentrating the available electrolytes within a smaller volume. This latter component was estimated to contribute approximately one third of the electrolyte increase during dehydration. Both the present and previous studies show that in the undisturbed state, longitudinal endolymph movements are extremely small and cannot make a significant contribution to ionic homeostasis. However, when endolymph volume is disturbed, longitudinal movements contribute to the electrolyte changes and are part of the compensation process. This study provides the first direct evidence supporting the long-standing hypotheses that local, radial homeostasis and longitudinal volume corrections both occur in the mammalian cochlea.

Animals↗

PubMed1995

Comparison of endolymph cross-sectional area measured histologically with that measured in vivo with an ionic volume marker.

In order to establish how endolymph volume is regulated, it is essential to be able to measure endolymph volume or cross-sectional area in vivo. We have developed methods to accomplish this by injecting the volume marker ion hexafluoroarsenate (AsF6) into endolymph by iontophoresis. For an injection at a constant rate, the endolymph concentration is inversely dependent on the cross-sectional area of the scala into which injection occurred. Marker concentrations were monitored by inserting ion-selective microelectrodes into endolymph near the injection site. In a previous study we quantified the degree of hydrops in animals following ablation of the endolymphatic sac. In the present study we validated the technique by comparing the endolymphatic cross-sectional area measured in vivo with AsF6 with that measured by established histologic procedures. The correlation between the two measures was good, with a coefficient of .903, although the area measured histologically was a little lower than that measured in vivo.

Animals↗

PubMed1994

Endolymph calcium increases with time after surgical induction of hydrops in guinea-pigs.

The ionized Ca2+ concentration in cochlear endolymph is normally extremely low. Previous studies have shown that endolymph Ca2+ levels become elevated when measured at long intervals after endolymphatic hydrops is surgically induced. The present study was designed to investigate how rapidly endolymph Ca2+ increases following endolymphatic duct ablation. Hydropic animals were tested at either 4 days, 4 weeks, 8 weeks or 16 weeks after surgery. In each animal endolymph Ca2+ and endocochlear potentials were measured in all four cochlear turns using double-barreled Ca(2+)-sensitive electrodes. Cochlear sensitivity was assessed using compound action potential thresholds. Our results confirm that hydropic animals show an elevation of endolymph Ca2+ and a reduction of EP which is initially small, but becomes more pronounced at longer times after surgery. At 16 weeks endolymph Ca2+ was increased by an average factor of 20 in the basal turn and 7.5 in the fourth turn. These findings suggest that endolymph Ca2+ changes may not be the primary factor responsible for hydrops generation, but probably contribute to cochlear dysfunction in later phases of hydrops. For some experimental groups, the elevation of AP threshold was more closely correlated with endolymph Ca2+ level than it was with endolymph volume. Endolymph Ca2+ changes must therefore be considered in order to account for dysfunction in the hydropic cochlea.

Action Potentials↗

PubMed1994

Time course of endolymph volume increase in experimental hydrops measured in vivo with an ionic volume marker.

A new method has been developed to measure the cross-sectional area (CSA) of scala media in the living cochlea. The method has some advantages over histological methods, in which tissues may shrink or move during processing. In the present study, scala media CSA was measured in the second turn of guinea-pig cochleas in which endolymphatic hydrops was induced surgically. The area measurement method used an iontophoretic injection of a volume marker into scala media, during which the concentration of marker in endolymph was monitored with an ion-selective microelectrode. The measured marker concentration was inversely proportional to the CSA of endolymph. The marker we used was the anion arsenic hexafluoride (AsF6-), which was almost ideal for the purpose as it was retained well in endolymph. Area was measured in normal animals and in hydropic animals at times from 4 days to 16 weeks after endolymphatic duct obstruction. The results showed that hydrops develops within days of ablation of the endolymphatic duct. The degree of hydrops was compared with electrophysiological measures of function, including the endocochlear potential, action potential thresholds and the amplitudes of the cochlear microphonic, summating potential and action potentials. In the initial stages of hydrops development, electrophysiological changes were small. In contrast, there were marked functional changes between 8 and 16 weeks, when endolymph volume was no longer increasing. If the same is true for dysfunction in the ears of patients with Ménière's Disease, then it may not be possible to restore normal function simply by alleviating the hydrops.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustic Stimulation↗

PubMed1993

Accumulation of potassium in scala vestibuli perilymph of the mammalian cochlea.

Movements of potassium (K+) were monitored during perfusion of either the scala tympani (ST) or the scala vestibuli (SV) of the guinea pig cochlea with a solution containing 15 mmol/LK+. A highly asymmetric clearance of K+ was observed, with K+ rapidly being taken up from the ST and allowed to accumulate in the SV. Under some conditions the SV K+ concentration could exceed that in the perfused ST. These observations are believed to result from the distortion of passive K+ diffusion by the high circulating current of K+ that is part of the transduction process. Calculations are presented to demonstrate that circulating fluxes are of sufficient magnitude to generate the results observed. The high rate of circulating K+ current is probably also responsible for the difference in physiologic K+ concentration between the ST and SV, in which the ST perilymph K+ concentration is typically found to be half that of the SV. A clearance of K+ from the ST and its eventual accumulation in the SV could play a role in how the ear responds to abnormal ion concentrations, such as may occur in Meniere's disease. It is proposed that an accumulation of K+ in the SV would result in vestibular dysfunction that might contribute to the vestibular symptoms of the disease.

Animals↗

PubMed1992

Tetramethylammonium for in vivo marking of the cross-sectional area of the scala media in the guinea pig cochlea.

A physiologic technique was developed to measure endolymphatic cross-sectional area in vivo using tetramethylammonium (TMA) as a volume marker. The technique was evaluated in guinea pigs as an animal model. In the method, the cochlea was exposed surgically and TMA was injected into endolymph of the second turn at a constant rate by iontophoresis. The concentration of TMA was monitored during and after the injection using ion-selective electrodes. Cross-section estimates derived from the TMA concentration measurements were compared in normal animals and animals in which endolymphatic hydrops had been induced by ablation of the endolymphatic duct and sac 8 weeks earlier. The method demonstrated a mean increase in cross-sectional area of 258% in the hydropic group. Individually measured area values were compared with action potential threshold shifts and the magnitude of the endocochlear potential (EP). Hydropic animals typically showed an increase in threshold to 2 kHz stimuli and a decrease in EP. However, the degree of threshold shift or EP decrease did not correlate well with the degree of hydrops present.

Animals↗