Cardiovascular alterations such as increased heart rate, high cardiac output, reduced systemic vascular resistance, and in most of the cases, increased contractility parameters have been recognized in patients with advanced liver disease. Some investigators define a cirrhotic cardiomyopathy as a hyperdynamic failure of the heart. Consequently, in patients with cirrhosis, the risk of developing further circulatory deterioration may be increased in situations which stress the cardiovascular system. After opening a portocaval shunt, it is expected that a large amount of blood will be distributed from the splanchnic to the pulmonary circulation and put a strain on the heart. This two-dimensional echocardiographic study was made in 30 patients with cirrhosis and in 20 patients who were chronically treated (range: 16 to 156 months) with portasystemic shunt for prevention of hemorrhage from esophageal variceal bleeding. Patients with portasystemic shunts revealed a change in hemodynamic pattern. There was a significant increase in the left ventricular end-diastolic volume index and also a slight increase in the left ventricular end-systolic index. Cardiac output remained high despite a significant decrease in heart rate due to an elevated left ventricular stroke volume index. The parameters of systolic ventricular performance were normal. In contrast to the acute opening of the portacaval shunt, the chronic shunt volume put no strain of clinical significance on the heart.

Adult↗

PubMedDate not supplied

Transjugular intrahepatic portosystemic shunting (TIPS) with balloon-expandable and self-expanding stents: technical and clinical aspects after 3 1/2 years' experience.

PURPOSE: To evaluate prospectively our experience with transjugular intrahepatic portosystemic shunt (TIPS) using four different metallic stents. METHODS: Between November 1991 and April 1995, 57 patients (41 men and 16 women; age 35-72 years, mean 54 years) underwent the TIPS procedure. Techniques for portal vein localization before and during TIPS were fluoroscopy, computed tomography (CT) studies, wedged hepatic venography, arterial portography, and ultrasound. After predilation we deployed balloon-expandable (n = 48) and self-expanding (n = 45) metallic stents. Fifteen patients underwent variceal embolization. Initial follow-up angiograms (mean 6.9 months, range 3-24 months) were obtained in 39 of these patients. RESULTS: Fifty-three patients (93%) had successful TIPS placement. The mean decrease in portal pressure was 42.7%. Besides fluoroscopy, the most helpful techniques for portal vein localization were venography and CT. Residual stenosis (n = 1) and late shortening (n = 4) of Wallstents resulted in shunt dysfunction. The technical problems encountered with the Palmaz stent resulted from its lack of flexibility. We combined balloon-expandable and self-expanding stents in 12 patients. The 30-day and late follow-up (mean 11.9 months) percutaneous reintervention rates were 11.3% and 64.2%, respectively. There were no clinically significant complications related to the TIPS insertions. CONCLUSION: An ideal stent does not exist for TIPS, and the authors recommend combining a Palmaz stent with a flexible self-expanding stent.

Adult↗

PubMedDate not supplied

Radioanalytical studies of fallout 63Ni.

Fallout of Nickel-63 (T1/2 = 100 a) produced in small amounts at nuclear weapon tests following the neutron activation of weapon construction material was investigated by studying carpets of lichen collected during 1961 to 1988 at the Lake Rogen district in central Sweden (62.3 degrees N, 12.4 degrees E). The maximal level of 63Ni in the lichen carpet, which occurred in 1964, was about 0.6 Bq kg-1, dry weight, and decreased to 0.1 Bq kg-1 in 1988. The deposition pattern for 63Ni was similar to other fallout radionuclides such as 137Cs, 90Sr and 239 + 240Pu. The concentrations of stable Ni were relatively constant at 0.5 to 1.0 microgram g-1 throughout the years resulting in, for example, a specific activity (63Ni/stable Ni) of 0.5 Bq mg-1 in 1964 and 0.1 Bq mg-1 in 1988. The total area content of 63Ni was estimated to be 1.0 Bq m-2 and the activity ratio 63Ni/60Co was estimated to be 0.03 in 1966. The Chernobyl accident in April 1986 did not significantly increase the levels of 63Ni. For the measurement of these extremely low-levels of 63Ni, 200 g of dry material (about 1 kg fresh) were ashed and leached with aqua regia after hydroxides had been precipitated with ammonia, leaving Ni in the aqueous phase. Nickel was extracted as a dimethylglyoxime complex by chloroform and back-extracted with HCl. Finally, Ni was electroplated onto copper discs from an ammonium sulfate medium at high pH. The radiochemical yield was determined by atomic absorption spectrometry of stable Ni before and after electrodeposition.(ABSTRACT TRUNCATED AT 250 WORDS)

Nickel↗

PubMedDate not supplied

Determination of the 243 Cm/244 Cm ratio alpha spectrometry and spectral deconvolution in environmental samples exposed to discharges from the nuclear fuel cycle.

The presence of curium nuclides in irradiated nuclear fuel is well known, as is their occurrence in environmental materials exposed to liquid waste discharges from reprocessing plants and to fallout following the Chernobyl accident. Knowledge of the 242 Cm/244 Cm and 243 Cm/244 Cm atom ratios can be a useful tool for characterizing a source-term and assessing the burn-up history of nuclear fuel. Here, a practical technique, based on high-resolution alpha spectrometry and spectral deconvolution, is described by which the 243, 244 Cm multiplet can be resolved at the low activities typical of most environmental samples. The resulting 243 Cm/244 Cm ratio is then used to correct for any interference by 243 Cm in the 242 Cm window. The technique has been applied to the determination of the 243 Cm/244 Cm ratio in samples of seabed sediment collected near the Sellafield outfall, riverine sediment sampled downstream of the Mayak reprocessing plant and soil and lichen from within the Chernobyl exclusion zone. Near Sellafield, the 243 Cm/244 Cm ratio was found to be < 2%, while near Mayak and Chernobyl it was considerably higher, being approximately 6-8%.

Americium↗

PubMedDate not supplied

Status and trends of Ontario's Sydenham River ecosystem in relation to aquatic species at risk.

The Sydenham River in southwestern Ontario is located in the Mixedwood Plains Ecozone, which supports the greatest diversity of flora and fauna in Canada. The river historically supported a rich aquatic community that included 80 fishes and 34 species of freshwater mussels. Fourteen aquatic species native to the river (8 fishes, 5 mussels and 1 turtle) have been designated as endangered, threatened, or of special concern by the Committee on the Status of Species at Risk in Canada (COSEWIC). A multi-agency Recovery Team was formed in 1999 to ensure the continued survival of these and other rare species in the river. The Sydenham River Recovery Team is the first in Canada to adopt an ecosystem approach to recovery planning for aquatic species. Information on land use patterns, water quality trends, the physical condition of the river, and the distributions of aquatic species at risk was synthesized to gain an understanding of the overall health of the river and its major anthropogenic stresses. Seven of the species at risk have declined in distribution or abundance, and three may be extirpated. The main threat to fishes and mussels is heavy loadings of sediment, nutrients, and possibly pesticides to the river via tile drainage and overland runoff from agricultural lands. A strategy that incorporates four overall approaches (management, stewardship, research and monitoring, and awareness and outreach) was developed to recover and protect this globally significant freshwater ecosystem.

Animals↗