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Biomedical subjects

G A Mook

Publications and source records attributed to G A Mook.

7 recordsLinked to original sources

Respiration and measurement of cardiac output by thermodilution and central or peripheral dye dilution.

Cardiac output as measured by indicator dilution methods during artificial ventilation shows differences up to +/- 35%. We studied the influence of spontaneous breathing on measurement of cardiac output by thermodilution (TD) and central (CDD) and peripheral dye dilution (PDD) in seven anesthetized dogs. Injection of indicator was timed at one of five chosen moments in a respiratory cycle. The indicator for TD was also used as solvent for indocyanine green. Results were normalized by the value obtained with injection at inspiratory onset. Results of the central dilution methods showed a slight but not significant difference between values measured with injection at 25 and 75% of the respiratory cycle: 105.7 and 98.0%, respectively, (TD) and 102.3 and 97.2% (CDD). Mean cardiac output determined by TD, CDD, or PDD was not significantly different. We conclude that 1) a reasonable estimate of cardiac output may be obtained by means of a single indicator-dilution curve and 2) the choice of the dilution method may be determined by practical considerations.

Animals

A fiberoptic reflection densitometer with cardiac output calculator.

A catheter-tip densitometer for indocyanine green is described consisting of a cardiac catheter containing optical fibers, an incandescent light source, a light detection unit and a processing unit. Half of the optical fibers guide the light to the blood at the tip of the catheter, the other half the back-scattered (reflected) light to the detection unit. In the detection unit the light is measured by two silicium barrier layer photocells after it has been split into two beams by a beam splitter. In the measuring channel the light passes an 800 nm filter before reaching the photocell. When fiberoptic catheters with glass fibers are employed, the other channel, used for compensation of non-specific effects such as blood flow variations, contains no filter, thus measuring light in a broad spectral band. It is shown that in this way compensation of flow effects may be about two times better than when a 920 nm filter is used. When using plastic optical fibers a 950 nm filter must be used, because above lambda = 850 nm plastic fibers transmit only a band around that wavelength (950 nm). At zero dye concentration the densitometer output or ratio of compensating and measuring photocell output R/R800 is almost insensitive to changes in haemoglobin concentration. When the blood contains dye, however, the influence of haemoglobin concentration is considerable. The densitometer output R/R800 is linearly related to dye concentration up to 50 mg . 1-1, the output R920/R800 up to 30 mg . 1(-1). The output R/R800 decreases with decreasing oxygen saturation; the slope of the calibration line, however, appears to be unaffected. The processing unit also contains an analog cardiac output calculator consisting of an integrator and a divider. Central dye dilution curves recorded from the pulmonary artery after injection of dye into the right atrium or a caval vein come down to the baseline. At this moment the reading of a digital voltmeter displaying the divider output calibrated in 1 . min-1 can be held and the reading taken.

Animals

Spectrophotometric determination of oxygen saturation of blood independent of the presence of indocyanine green.

The strong absorbance of indocyanine green in a broad band around lambda = 800 nm invalidates the usual spectrophotometric two-wavelength methods for measuring oxygen saturation operating in the red and near infrared region. By proper wavelength selection, however, the effect of the dye can be eliminated. With the two-wavelength method utilising lambda = 660 and 860 nm oxygen saturation is measured virtually independent of the presence of indocyanine green.

Animals

A fiberoptic reflection oximeter.

A catheter tip oximeter is described consisting of a cardiac catheter containing optical fibers, and incandescent light source, a light detection unit and a processing unit. Half of the optical fibers guide the light to the blood at the tip of the catheter, the other half the backscattered (reflected) light to the detection unit. The detection unit contains a dichroic mirror, transmitting most of the light with lambda less than 800 nm and reflecting most of the light with lambda greater than 900 nm, thus splitting the light into two beams. These pass through interference filters with nominal wavelengths of 640 and 920 nm respectively, and are focused on silicium barrier layer photocells. The photocell signals are amplified and fed into a divider giving the ratio of measuring (R640) and compensating (R920) photocell output. The relationship between log R640/R920 and oxygen saturation is represented by a slightly curved line. The relation may be linearized by subtracting a constant voltage from the divided output before taking the logarithm. The slope of the calibration line is dependent on the total haemoglobin concentration. Nonetheless an average calibration line can be used between 70 and 100% oxygen saturation. For 78 measurements of pig blood samples in this range (haemoglobin concentration between 96 and 161 g.1(-1)), the standard deviation of the difference between the fiberoptic oximeter and a Radiometer OSM1 oxygen saturation meter was 1.9% saturation, for 152 samples over the entire saturation range the standard deviation of the difference was 3.1% saturation. The influence of the flow velocity of blood on the light reflection depends on wavelength as well as on oxygen saturation. Therefore, complete compensation for the flow effect is not possible by simple means.

Animals

Light-absorbing properties, stability, and spectral stabilization of indocyanine green.

The absorption spectrum of indocyanine green depends on the nature of the solvent medium and on the dye concentration. Binding to plasma proteins causes the principal peaks in the absorption spectrum to shift about 25 nm toward the higher wavelengths. The much greater influence on the spectrum of the dye concentration results from progressive aggregate formation with increasing concentration. Indocyanine green solutions therefore do not follow Lambert-Beer's law above 15 mg-I-1 (in plasma). Indocyanine green solutions in plasma and concentrated (1,000 mg-I-1) solutions in distilled water are stable for at least 4 h. In long-term experiments the optical density of indocyanine green solutions in plasma as well as in distilled water generally diminishes, even in the dark. On the 7th day a new absorption maximum starts to appear at gamma=900 nm, possibly caused by further aggregate formation leading to much larger particles. Spectral stabilization after injection of a concentrated solution into the blood is most rapid when the dye is dissolved in distilled water. Spectral stabilization slows down with decreasing temperature. As rapid spectral stabilization is essential in quantitative dye dilution studies, the practice of adding a albumin and/or isotonic saline solution to the injectate should be discontinued. When a 10 g-1(-1) aqueous solution of indocyanine green is used, spectral stabilization takes less than 1.5 a (at 37 degrees C), which is sufficiently fast for almost any application.

Blood

Value of systolic time intervals in assessing severity of congenital aortic stenosis in children.

Simultaneous recordings have been made of electrocardiogram, phonocardiogram, carotid pulse tracing, left ventricular pressure, and aortic pressure in 27 children with aortic valve stenosis and 3 children with membranous subaortic stenosis. Peak systolic pressure difference ranged from 10 to 110 mmHg (1.3 to 14.6 kPa). None of the patients had congestive heart failure and cardiac output was in the normal range in all. Total electromechanical systole, left ventricular ejection time, and pre-ejection time were corrected for heart rate, age, and sex. Mild stenosis (peak systolic pressure difference less than or equal to 50 mmHg (6.7 kPa)) was present in 18, severe stenosis (peak systolic pressure difference greater than 50 mmHg) in 12 patients. The externally measured pre-ejection time and ejection time proved to be nearly equal to the corresponding intervals measured internally; from these data it is concluded that pre-ejection time and ejection time in children with aortic stenosis can be measured reliably by non-invasive methods. Mean values for corrected total electromechanical systole and ejection time were prolonged, but the corrected pre-ejection time did not differ from the normal value. When corrected time intervals were plotted against severity of the aortic stenosis as expressed by the peak systolic pressure difference or the aortic valve orifice index, a wide scatter was found. It is concluded that a normal ejection time is strong evidence against a peak systolic pressure difference of more than 50 mmHg (6.7 kPa) or an aortic valve orifice index less than 0.70 cm2 per m2 BSA. A prolonged ejection time, however, may occur in mild as well as in severe stenosis. Total electromechanical systole and pre-ejection time have no value in predicting the severity of aortic stenosis in children.

Adolescent