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Biomedical subjects

R S Reneman

Publications and source records attributed to R S Reneman.

At least 361 records · Page 20Linked to original sources
PubMedDate not supplied

The effect of elevated arterial free fatty acid concentrations on hemodynamics and myocardial metabolism and blood flow during ischemia.

In the present investigation the effect of elevated arterial free fatty acid (FFA) concentrations on regional myocardial blood flow (MBF), myocardial metabolism and hemodynamics during ischemia was studied in anesthetized dogs. Ischemia was induced by stenosis of the left interventricular coronary artery. Mean poststenotic coronary artery pressure was kept constant during ischemia. FFA concentrations were elevated by intravenous injection of heparin (group I), intralipid (group II) or both substances (group III). After elevation of FFA concentrations by heparin alone or together with intralipid, heart rate gradually increased, while aortic pressure tended to decrease. Slight elevation of arterial FFA levels (up to 0.30 mM, group I, and up to 0.53 mM, group II) had no significant effect on total MBF and uptake of glucose, FFA, and oxygen or release of lactate in the ischemic myocardium. However, elevating arterial FFA levels up to 0.81 mM (Group III), significantly decreased total MBF (6%), endo/epicardial blood flow ratio (13%), and oxygen uptake (34%) in the ischemic myocardium and resulted in release of lactate from this area. The release of potassium, inorganic phosphate and H+ as well as plasma CO2 concentration were not influenced. Neither was the uptake of glucose and FFA. These findings suggest that elevated arterial FFA concentrations can decrease MBF and augment lactate production in the ischemic myocardium.

Animals↗
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Blood flow distribution in the left ventricular free wall in open-chest dogs.

The distribution of blood flow in various layers of the normally perfused left ventricular free wall was studied in open-chest dogs, using 15-micrometer radioactive microspheres. The most pronounced variations were found in epicardial blood flow, which was higher near the apex than near the base and lower along the marginal branch of the left circumflex coronary artery than along the left interventricular coronary artery. The variations in endocardial blood flow were less pronounced, while blood flow in the middle layers was about equally distributed. Consequently the endo/epicardial blood flow ratios varied over the left ventricular free wall. Possible causes of the inhomogeneities in blood flow distribution are discussed.

Animals↗
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Limitations of Doppler spectral broadening in the early detection of carotid artery disease due to the size of the sample volume.

In the present study the criteria of spectral broadening used in pulsed Doppler systems to diagnose minor disease in the cervical carotid arteries were evaluated in relation to the size of the sample volume. For this purpose the Doppler audio spectra as recorded in asymptomatic volunteers with an ATL Duplex scanner (relatively large sample volume) and a multi-gate pulsed Doppler system (relatively small sample volume) were compared with each other. The volunteers, randomly selected from the population registers, varied in age from 20-69 yr. Only in the common carotid artery at younger age, were normal spectra recorded, especially with the multi-gate system. In the internal carotid artery the number of spectra, supposed to be associated with low grade stenosis, increased significantly, especially when recorded with the Duplex scanner. More pronounced spectral broadening was found when the spectra were recorded distally in this artery. In the cervical carotid arteries normal spectra were found only when sampled in the middle of the bloodstream. These findings indicate that for the detection of vascular lesions in the cervical carotid arteries at an early stage of the disease on the basis of spectral broadening, small sample volumes and sampling in the centre of the vessel are required.

Adult↗
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Methods to evaluate the sample volume of pulsed Doppler systems.

The spatial resolution of a pulsed Doppler system heavily depends on both the characteristics of the ultrasound transducer and the processing circuitry. The local characteristics of the ultrasound beam give the lateral sample function while the way the signals are processed affects the axial shape of the sample volume. A simple way to explore the size of the sample volume is the employment of a running string target. However, the detected Doppler signals will be the sum of all the Doppler signals returned by the string along its course through the sample volume. Therefore, it will be complicated to separate the axial and lateral contribution to the actual size of the sample volume. A scanning system capable of visualizing the cross-sectional distribution of the ultrasound intensity allows the assessment of the sample sensitivity in lateral direction. A single vibrating point target enables the exploration of both the axial and lateral sampling function. The latter approach is especially suited to evaluate routinely the spatial performance of pulsed Doppler systems in clinical practice.

Humans↗
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Transcutaneous detection of relative changes in artery diameter.

The extent of the excursions of the arterial walls during the cardiac cycle depends on both the compliance of the vessel wall and the local pressure fluctuations. Simultaneous assessment of the relative change in artery diameter in combination with the velocity distribution along the vessel cross section can reveal the cause of loss of distensibility. As will be demonstrated, a multigate pulsed Doppler system with a high spatial resolution can perform simultaneously both functions. The relative change in diameter during the cardiac cycle is obtained by taking the ratio of the distension and the diameter of the artery as observed along the ultrasound beam. It can be shown that this ratio will be angle independent. Statistical and experimental evaluations demonstrate that the system allows the assessment of the relative change in diameter of major peripheral arteries as a continuous function of time with an accuracy of about 0.5%.

Arteries↗
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The anterior and the lateral compartmental syndrome of the leg due to intensive use of muscles.

The anterior and lateral compartmental syndromes of the leg due to intensive use of muscles can be briefly defined as painful circulatory disturbances associated with a pathological increase in total intramuscular pressure. In these syndromes, an acute and a chronic form are distinguished. The acute form takes a progressive course, and the structures within the compartment affected are subject to complete or partial destruction. The chronic form takes an intermittent course. Physical exertion of the lower limbs gives rise to pain in the compartment. Determination of the pressure in the tibialis anteriot muscle and phlebography, both before and after weighted exercise of the muscles of the anterior compartment, were found to be the most valuable diagnostic aids in the chronic syndrome. In the acute syndrome, the compartment affected must be decompressed by fasciotomy as quickly as possible. Since most patients with a chronic syndrome can adequately cope with daily requirements, an operation is not always required. Indications for fasciotomy are presented. The real cause of the increase in total intramuscular pressure is not understood, suggestions concerning the pathogenesis are made, and the mechanism of the circulatory disturbances is discussed.

Acute Disease↗
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Assessment of local differences in intima-media thickness in the human common carotid artery.

Intimal thickening may be focal in nature and is especially found in areas with low shear rate. To be able to study the relation between intima-media thickness (IMT) and wall shear rate appropriately, a method to assess IMT locally is required. It was the aim of the present study to investigate the ability of a recently developed automated method to assess local differences in IMT, if any, in relatively short arterial segments. Therefore, intrasession interlocation differences in IMT were assessed at the posterior wall of the common carotid artery close to the bulb (0 mm) and 10 and 20 mm more upstream in terms of mean difference +/- 2 standard deviations. Prior to this study we investigated the ability of the system to reproducibly assess IMT locally (intersession intralocation) in terms of repeatability coefficient (= 2 standard deviations). The measurements were performed in the common carotid artery 20 mm proximal to the bulb. The study was performed on young and older subjects presumed to be healthy. The intersession intralocation repeatability coefficient was 0.07 mm in the young group and 0.11 mm in the older group. The IMT close to the bulb (0 mm) was significantly larger (+/-0.050-0.065 mm) than that at the other locations in both age groups. We conclude that local IMT can be assessed reproducibly and local differences in wall morphology in short arterial segments can be studied reliably.

Adult↗
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Mean wall shear stress in the femoral arterial bifurcation is low and independent of age at rest.

In elastic arteries, mean wall shear stress appears to be close to 1. 5 Pa, the value predicted by the theory of minimal energy loss. This finding in elastic arteries does not necessarily represent the situation in muscular arteries. Elastic arteries have to store potential energy, while muscular arteries have mainly a conductive function. Therefore, we determined wall shear stress and its age dependency in the common and superficial femoral arteries, 2-3 cm from the flow divider in 54 presumed healthy volunteers between 21 and 74 years of age, using a non-invasive ultrasound system. Prior to the study, the reliability of this system was determined in terms of intrasubject variation. Mean wall shear stress was significantly lower in the common femoral artery (0.35 +/- 0.18 Pa) than in the superficial femoral artery (0.49 +/- 0.15 Pa). In all age categories, peak systolic wall shear stress and the maximal cyclic change in wall shear stress were not significantly different in the common and the superficial femoral arteries. Peak systolic wall shear stress in the common and the superficial femoral arteries was not significantly different from the value previously determined in the common carotid artery, but mean wall shear stress was lower in the common and superficial femoral arteries than in the common carotid artery by a factor of 2-4. In both the common and the superficial femoral arteries, mean, peak systolic and maximal cyclic change in wall shear stress did not change significantly with age, nor did diameter. We conclude that, as compared to elastic arteries, mean wall shear stress is low in the conductive arteries of a resting leg, due to backflow during the first part of the diastolic phase of the cardiac cycle and the absence of flow during the rest of the diastolic phase. Mean wall shear stress is lower in the common than in the superficial femoral artery due to additional reflections from the deep femoral artery.

Adult↗
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Effects of assessment and processing techniques on the shape of arterial pressure-distension loops.

The dynamic mechanical characteristics of the arterial wall, especially its alinearity and viscoelastic behaviour, are revealed by pressure-distension loops, where the change in diameter (distension) of a lumen is plotted as a function of the change in transmural pressure. For linearity, the pressure-distension loop should be closed and straight, while viscous behavior results in an open loop. For a correct interpretation of the loops, it is essential that both distension and pressure are recorded simultaneously at the same location and processed by circuitries having the same frequency characteristics. The present paper aims at quantifying the effect of misalignment in recording position and of mismatch in frequency characteristics by analyzing the distension and pressure waveforms obtained at known locations in a phantom rig under pulsatile conditions with equipment with a validated frequency response. It is concluded that misalignment of only a few millimeters or mismatch in frequency response, even if the cutoff frequencies are far beyond the signal frequencies of interest, strongly affects the shape of the pressure-distension loop. If the forward and reflected pressure wave partially coincide, position misalignment cannot adequately be corrected for. The frequency mismatch, however, can be corrected for by crosswise preprocessing a waveform by a filter with the frequency response of the registration equipment used for the recording of the other waveform. It is important to consider these artifacts in interpreting pressure-distension loops in the clinical situation.

Arteries↗
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Different effects of ageing on elastic and muscular arterial bifurcations in men.

In a previous study we have shown that the wall of the elastic carotid artery bifurcation (CAB) stiffens inhomogeneously with increasing age, the carotid artery bulb being most affected. In the present study the effect of ageing on the elastic properties of the wall and the strain the wall is exposed to along the muscular femoral artery bifurcation (FAB) was investigated using the CAB for comparison. The study was performed with 10 young (aged 20-30 years) and 10 old (50-60 years) presumed healthy volunteers. Distensibility along the bifurcation was determined by measuring noninvasively the maximum relative diameter changes of the artery during systole (peak delta d/d.100%), which is also a measure of strain, at various sites along both bifurcations by means of a vessel wall moving detector system. This system also makes the assessment of (end-diastolic) diameter possible. At all levels along the CAB, the diameter was significantly larger in the old than in the young. In the FAB, the diameter was only significantly larger in the old than in the young in the common and superficial femoral arteries. At all levels in the CAB, peak delta d/d.100% was significantly lower in the old than in the young, the carotid artery bulb being more affected than the common carotid artery (CCA), while in the FAB this parameter was lower in the old than in the young only in the common femoral artery (CFA). Peak delta d/d.100% was similar in the CCA and in the bulb in the young, but significantly higher in the CCA than at all levels in the bulb in the old. In the FAB, in the young peak delta d/d 100% was significantly higher in the CFA than at both levels in the deep and superficial femoral arteries, while in the old no significant differences in peak delta d/d.100% along the FAB could be detected. These findings indicate that the loss of wall elasticity with increasing age is different in the muscular and elastic arterial bifurcations investigated. The homogeneous distribution of wall elasticity in the elastic CAB at a younger age becomes inhomogeneous at an older age, while the opposite is observed in the muscular FAB. The changes in strain the different parts of the bifurcations are exposed to with increasing age are different in the CAB and the FAB. Differences in distensibility along bifurcations will make them deform inhomogeneously during the cardiac cycle.

Adult↗
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Local application of adenosine induces an increase of capillary diameter in skeletal muscle of anesthetized rabbits.

The effects of locally applied adenosine (ADO) and/or femoral artery pressure reduction (induced by complete aorta occlusion) on capillary diameter were investigated in the tenuissimus muscle of anesthetized rabbits. Capillaries were visualized by means of intravital video microscopy. Diameters were measured using an image shearing device. During control femoral artery pressure (median: 83 mm Hg) and without ADO, median capillary diameter was 4.3 microns (range: 3.2-5.3 microns; 27 capillaries in 7 animals). Complete aorta occlusion (median femoral artery pressure: 18 mm Hg) resulted in a reduction of capillary diameter to 3.9 microns (2.7-4.7 microns; p < 0.0001). Subsequent reactive hyperemia resulted in an increase in diameter to 5.2 microns (3.7-6.0 microns; p < 0.0001). Locally applied ADO (10(-4) M) probably led to complete vasodilation of the arterioles, because their diameters did not further increase during reactive hyperemia after complete occlusion. ADO (10(-4) M) induced an increase of control capillary diameter to 5.5 microns (4.1-6.4 microns; median relative increase: 27%; p < 0.0001), resulting in a decrease of capillary resistance by 61%. In the presence of ADO, aorta occlusion resulted in a capillary diameter decrease to 4.7 microns (3.4-6.1 microns); p < 0.0001). Subsequent reactive hyperemia resulted in an increase to maximally 5.6 microns (4.3-6.4 microns; p < 0.0001). This diameter was approximately the same as the control diameter during ADO. During occlusion in the presence of ADO, capillary diameter was significantly larger (11%; p < 0.0001) than during control without ADO. The capillary diameter changes induced by the various interventions were mainly passive, i.e., proportional to capillary transmural pressure changes. However, capillary diameter was larger during aortal occlusion in the presence of ADO than during control femoral artery pressures without ADO, even though capillary pressure was probably higher in the latter case. It is proposed that the prolonged increase in transmural capillary pressure due to ADO may induce changes in capillary wall configuration, leading to larger diameters.

Adenosine↗
PubMedDate not supplied

The usefulness of capillary microscopy, transcutaneous oximetry and laser Doppler fluxmetry in the assessment of the severity of lower limb ischaemia.

TMo date, capillary microscopy, transcutaneous oximetry (tcpO2) and laser Doppler fluxmetry are frequently used in the investigation of skin microcirculation in patients with lower limb ischaemia. The concomitant microcirculatory disturbances may be useful in addition to macrocirculatory parameters to discriminate the different degrees of ischaemic severity. The best ways of application of these methods and the choice of the best parameters to assess ischaemia have been insufficiently investigated. Therefore, skin microcirculation was investigated with the use of these techniques in 130 patients with different stages of lower limb ischaemia, divided according to their ankle-to-brachial pressure index (ABI). Patients were investigated in the sitting and the supine position. Measurements were performed at rest and during reactive hyperaemia following arterial occlusion, and before and after local skin heating. The reactive hyperaemic response using laser Doppler fluxmetry differed in every patient group investigated. Capillary red blood cell velocity was markedly impaired in critically ischaemic patients (ABI < 25%). Transcutaneous oxygen pressure measurements at rest rendered the highest positive predictive value (PV; 87%) to classify patients as having clinically severe ischaemia (Fontaine 3 or 4). Ankle and toe pressure measurements provided a PV value of 78%. Microcirculatory parameters and techniques appear to be useful as an addition to standard macrocirculatory techniques to assess the severity of lower limb ischaemia. This is particularly of importance in patients in whom macrocirculatory parameters are unattainable.

Adult↗
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Oxygen- and pressure-dependent functional capillary density in rabbit tenuissimus muscle.

Perfusion of capillaries was investigated in the tenuissimus muscle of young anesthetized New Zealand White rabbits during control conditions, complete aorta occlusion, and reactive hyperemia at various local oxygen tensions. Capillaries were visualized with bright-field microscopy. The number of capillaries perfused under experimental conditions was compared with that during control conditions. Capillary diameter was measured to assess whether the interventions caused changes in luminal diameter. During control conditions at a local pO2 of about 20 mm Hg, capillary perfusion fluctuates; instantaneous capillary density is smaller than anatomical capillary density. When the aorta is (partially) occluded, capillary perfusion becomes continuous and instantaneous capillary density equals anatomical capillary density. The latter is also observed during the early phase of reactive hyperemia, prior to the reappearance of flowmotion. Capillary diameter is not invariant during these interventions, but decreases by 8% during occlusion and increases by 12% during reactive hyperemia. The concomitant change in perimeter and cross-sectional area should be factored in with functional capillary density, when tissue exchange surface area or volume flow are considered. When during control conditions, the muscle becomes locally (under the microscope lens) exposed to a higher oxygen tension, capillary diameter does not change. However, the relative number of capillaries perfused at complete aorta occlusion is unity at low local oxygen, and diminishes with increasing local oxygen to become 0 at an oxygen tension of about 70 mm Hg. In preparations in which capillary diameter is not invariant under the experimental conditions, functional capillary density can only be used to compare the number of perfused capillaries with the number of capillaries anatomically present. Capillary diameter has to be factored in when tissue perfusion or exchange surface area are considered.

Animals↗
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The influence of adenosine on red blood cell flow cessation in skeletal muscle.

The observed positive correlation between cessation of red blood cell flow in capillaries at low perfusion pressures and the oxygen tension (PO2) in the superfusion solution may be due to oxygen-dependent arteriolar constriction. To test this hypothesis, we investigated capillary flow cessation during aortic occlusion and concomitant changes in diameters of terminal arterioles and capillaries in normal and vasodilated vascular beds of rabbit tenuissimus muscle (n = 15) by means of video intravital microscopy. In the vasodilated bed, arteriolar tone was eliminated by local application of 10(-4) M adenosine (ADO). The PO2 in the superfusate was varied locally, i.e., in the solution between objective lens and muscle surface. At a local PO2 of 40 mm Hg without ADO, flow ceased in about 50% of the capillaries during aortic occlusion while the arterioles dilated to 118% of control (median; p < 0.001). Addition of ADO led to an increase in arteriolar and capillary diameter to 220% (median; p < 0.001) and 121% (median; p < 0.05), respectively. Under ADO, the incidence of capillary flow cessation was reduced (p < 0.05) to about 20%. Elevation of the local PO2 from 40 to 100 mm Hg in the presence of ADO did not lead to a significant change in the incidence of flow cessation, nor to changes in arteriolar or capillary diameter. In the presence of ADO, median arteriolar and capillary diameters during aortic occlusion were 96% (p < 0.001) and 7% (p < 0.05) larger than their control diameters without ADO, respectively. In summary, it is suggested that the incidence of flow cessation may depend on both the arteriolar and the capillary diameter. Of these two factors, capillary diameter may be the most important one, because its changes affect the interaction between red blood cells and the vessel wall in the narrow capillaries, and, hence, the resistance to flow. In the presence of ADO, at elevated local PO2 levels flow cessation still occurs in about 20-30% of the capillaries, suggesting that arteriolar contraction is only in part responsible for the incidence of flow cessation.

Adenosine↗
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Different effects of anesthetics on spontaneous leukocyte rolling in rat skin.

In immunological reactions, leukocytes need to travel from the intravascular space through the vessel wall into the surrounding tissue. The first step in this process is leukocyte rolling, which has often been studied in anesthetized animals. In this study, we investigated the effect of pentobarbital, Hypnorm and both components of the latter, fentanyl and fluanisone, on this primary leukocyte-endothelial cell interaction. Using intravital brightfield video microscopy, observations were made in postcapillary venules in the intact skin of the nailfold of trained conscious Lewis rats. Subsequently, the animals were anesthetized and observations were made in vivo. Leukocyte rolling was significantly elevated after injection of Hypnorm or fentanyl, while pentobarbital and fluanisone had no effect. None of the anesthetics affected leukocyte rolling velocity. Blood flow was significantly increased only after injection of Hypnorm and fluanisone. No correlation existed between the relative changes in leukocyte rolling and concomitant changes in blood flow. The results show that the level of leukocyte rolling can be affected by anesthetics. These changes are probably not mediated by changes in local hemodynamics. Pentobarbital anesthesia does not influence leukocyte rolling. Therefore, pentobarbital is a suitable anesthetic for observation of leukocyte rolling in skin. Hypnorm significantly increases the level of rolling in skin venules. This effect seems to be caused mainly by fentanyl.

Anesthetics↗
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Serum HDL/total cholesterol ratio and blood pressure in asymptomatic atherosclerotic lesions of the cervical carotid arteries in men.

One hundred neurologically asymptomatic male subjects (aged 50-69 years), randomly selected through population registers, were screened for atherosclerotic lesions of the cervical carotid arteries, using a high resolution multi-gate pulsed Doppler system. In 93 subjects serum was assayed for total and HDL cholesterol. Besides, cuff arterial blood pressure measurements were made. Twenty-three of these subjects (Group III) were classified as abnormal according to the Doppler investigation (degree of narrowing less than 50% in 78% of the cases). Seven of these 23 subjects also had a history of ischemic heart disease or intermittent claudication. Of the 70 subjects with a normal Doppler examination 16 had a history of ischemic heart disease and/or intermittent claudication (Group II). The remaining 54 subjects served as controls (Group I). The frequency of asymptomatic atherosclerotic lesions of the cervical carotid arteries in the population under investigation was 23%. The HDL/total cholesterol ratio was lower and the frequency of high blood pressure higher in the Groups II and III than in Group I. The findings in this study support the idea that a low serum HDL/total cholesterol ratio and high blood pressure have a high degree of association with atherosclerotic lesions of the cervical carotid arteries. This association is already apparent at an early stage of the disease, i.e. in asymptomatic subjects with a slight to moderate degree of carotid artery narrowing.

Aged↗