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PubMed1998

Incidence and pattern of varicocele recurrence after laparoscopic ligation of the internal spermatic vein with preservation of the testicular artery.

OBJECTIVES: To determine the incidence and pattern of recurrence of varicocele after laparoscopic internal spermatic vein ligation with testicular artery preservation. METHODS: In a prospective study, 16 patients who underwent 20 laparoscopic varix ligation were evaluated postoperatively for recurrence by clinical physical examination and percutaneous spermatic venography. RESULTS: No significant complications were encountered with the surgical or radiological procedure. Clinical recurrence was detected by physical examination in 20% of cases, while percutaneous spermatic venography detected recurrence in 45% of cases. The sensitivity and specificity of clinical physical examination for detecting varicocele recurrence was 33% and 90.9%, respectively with an accuracy rate of 65%. Recurrences were through parallel collaterals or medial transverse collaterals in 88.8% and 11.2%, respectively. Parallel collaterals joined the spermatic vein in mid or high retroperitoneum in seven patients while it joined the renal vein in one patient. There were no low retroperitoneal parallel collaterals. CONCLUSIONS: Laparoscopic ligation of internal spermatic vein with preservation of testicular artery is a procedure that is associated with low morbidity and quick recovery. It is able to achieve its surgical objective in only 55% of cases, however. Such information should be taken into consideration during patient counselling when selecting the operative technique of choice for varicocele ligation.

Adult↗
PubMed1989

Structure-function relationships in rat brainstem subnucleus interpolaris: IV. Projection neurons.

In a companion paper (Jacquin et al., '89), the structure and function of local circuit (LC) neurons in spinal trigeminal (V) subnucleus interpolaris (Sp Vi) were described. The present report provides similar data for 44 projection neurons in Sp Vi. Of these, 25 thalamic, 16 cerebellar, 2 superior collicular, and 1 inferior olivary projecting neurons were studied. The majority responded to vibrissa(e) deflection, and all except 4 of these had multivibrissae receptive fields. The remainder were responsive to either guard hair deflection or indentation of glabrous skin. Latencies to V ganglion shocks were suggestive of monosynaptic activation from the periphery. Sp Vi projection neurons were topographically organized in a manner consistent with that of their primary afferent inputs. Nonvibrissa sensitive cells had diverse morphologies. Morphometric analyses of the more heavily sampled thalamic and cerebellar projecting, vibrissa(e)-sensitive cells indicated the following. (1) As compared to LC neurons, projection neurons had bigger receptive fields, cell bodies, dendritic trees, and axons; less circular dendritic trees; a greater preponderance of spiny dendrites and fewer axon collaterals in Sp Vi. (2) Dendritic tree extent correlated significantly with receptive field size, thus suggesting that dendritic tree size is one mechanism contributing to receptive field size in vibrissae-sensitive projection neurons. (3) V thalamic cells had significantly bigger receptive fields and dendritic trees, and also give off more local axon collaterals, than V cerebellar neurons. Collicular and inferior olivary projecting neurons shared structural and functional attributes with other Sp Vi long-range projecting cells. Structure-function relationships exist for vibrissa-sensitive projection neurons in Sp Vi. The relevant parameters correlating with projection neuron morphology are receptive field size and projection status, whereas for Sp Vi LC neurons the relevant correlative parameter is peripheral receptor association.

Action Potentials↗
PubMed2002

Screening for intracranial stenosis with transcranial Doppler: the accuracy of mean flow velocity thresholds.

BACKGROUND: Patients with 50% intracranial arterial stenosis may require more intensive therapies for stroke prevention. Transcranial Doppler (TCD) is a convenient noninvasive screen for intracranial stenosis. The accuracy of different mean flow velocity (MFV) thresholds for determining the degree of stenosis remains uncertain. METHODS: The authors prospectively compared the accuracy of TCD criteria and MFV thresholds to magnetic resonance, computed tomography, and digital subtraction angiography in patients with symptoms of recent or remote stroke or transient ischemic attack. Stenosis on angiography was measured as 0%, < 50%, or > or = 50% diameter reduction. RESULTS: Of 136 consecutive patients, 33 (24%) had distal internal carotid artery (ICA), middle cerebral artery (MCA), posterior cerebral artery, or basilar artery stenosis on angiography (14 patients [10%] were excluded due to incomplete TCD examinations, mainly from a lack of temporal windows). TCD showed 31 true-positive, 9 false-positive, 2 false-negative, and 94 true-negative studies. For all vessels, TCD had a sensitivity of 93.9% (confidence interval [CI] = 89%-98%), a specificity of 91.2% (CI = 87%-96%), a positive predictive value (PPV) of 77.5%, and a negative predictive value (NPV) of 97.9%. The trade-off in sensitivity and specificity for MCA MFV thresholds was as follows: MFV > or = 80 cm/s had a sensitivity of 100%, a specificity of 96.9% (CI = 94%-99%), a PPV of 84%, and an NPV of 100%. MFV > or = 100 cm/s had a sensitivity of 100%, a specificity of 97.9% (CI = 96%-99%), a PPV of 88.8%, and an NPV of 94.9%. MFV > or = 120 cm/s had a sensitivity of 68.7% (CI = 61%-78%), a specificity of 100%, a PPV of 100%, and an NPV of 94.9%. Reasons for false-positive findings include collateralization of flow in the presence of proximal ICA stenosis and prestenotic to stenotic MCA velocity ratios of 1: < or = 2. CONCLUSION: TCD is both sensitive and specific in identifying > or = 50% intracranial arterial stenosis. A MFV threshold cutoff of 100 cm/s has an optimal sensitivity and specificity trade-off for > or = 50% MCA stenosis. To help avoid false-positive results, a prestenotic to stenotic MCA velocity ratio of 1: > or = 2 should be used in addition to the MFV threshold.

Aged↗
PubMed2004

Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow.

BACKGROUND: Comminuted radial head fractures associated with an injury of the medial collateral ligament can be treated with a radial head implant. We hypothesized that lengthening and shortening of the radial neck would alter the kinematics and the pressure through the radiocapitellar joint in the medial collateral ligament-deficient elbow. METHODS: The effects of lengthening (2.5 and 5 mm) and shortening (2.5 and 5 mm) of the radial neck were assessed in six human cadaveric upper extremities in which the medial collateral ligament had been surgically released. The three-dimensional spatial orientation of the ulna was recorded during simulated active motion from extension to flexion. Total varus-valgus laxity and ulnar rotation were measured. Radiocapitellar joint pressure was assessed with use of pressure-sensitive film. RESULTS: Radial neck lengthening or shortening of >/=2.5 mm significantly changed the kinematics in the medial collateral ligament-deficient elbow. Lengthening caused a significant decrease (p < 0.05) in varus-valgus laxity and ulnar rotation (p < 0.05), with the ulna tracking in varus and external rotation. Shortening caused a significant increase in varus-valgus laxity (p < 0.05) and ulnar rotation (p < 0.05), with the ulna tracking in valgus and internal rotation. The pressure on the radiocapitellar joint was significantly increased after 2.5 mm of lengthening. CONCLUSIONS: This study suggests that accurate restoration of radial length is important and that axial understuffing or overstuffing of the radiohumeral joint by >/=2.5 mm alters both elbow kinematics and radiocapitellar pressure. CLINICAL RELEVANCE: This in vitro cadaver study indicates that a radial head replacement should be performed with the same level of concern for accuracy and reproducibility of component position and orientation as is appropriate with any other prosthesis.

Aged↗
PubMed2000

Spleno-renal shunt blood flow is an accurate index of collateral circulation in different models of portal hypertension and after pharmacological changes in rats.

BACKGROUND/AIMS: Recently, we developed a new method to measure collateral blood flow in rats: splenorenal shunt (SRS) blood flow (BF). The aims were to evaluate the reproducibility of SRSBF measurement in different models of portal hypertension, and to investigate the ability of SRSBF to disclose pharmacological changes. METHODS: Hemodynamics were determined in anesthetized rats with secondary biliary, CCl4 or DMNA cirrhosis and portal vein ligation (PVL) under baseline and pharmacological (octreotide, vapreotide) conditions. The main measurements performed were: SRSBF by the transit time ultrasound (TTU) method and % portosystemic shunts (PSS) by the microsphere method. RESULTS: SRSBF was 6 to 10 times higher in portal hypertensive rats and was similar in the different models of cirrhosis but was higher in portal vein ligated rats than in cirrhotic rats (1.1+/-0.7 vs 0.6+/-0.7 ml x min(-1) x 100 g(-1), p=0.01). SRSBF was correlated with mesenteric %PSS (r=0.61, p<0.01), splenic %PSS (r=0.54, p<0.05), portal pressure (r= 0.32, p<0.05) and the area of liver fibrosis (r=0.33, p<0.05). Octreotide significantly decreased SRSBF (-23+/-20%, p<0.01 vs placebo: -6+/-8%, NS). Vapreotide significantly decreased SRSBF but not mesenteric or splenic %PSS compared to placebo. The variations in SRSBF (-26+/-32%) and in splenic %PSS (0+/-15%) with vapreotide were significantly different (p<0.05) and not correlated (r=-0.1, NS). CONCLUSIONS: Determination of SRSBF by TTU is an accurate way to measure collateral blood flow in different models of intra- and extra-hepatic portal hypertension in rats. Its sensitivity provides accurate measurement of pharmacological changes, unlike the traditional estimation of %PSS by the microsphere method.

Animals↗
PubMed1998

Tissue effects of subclinical diode laser treatment of the retina.

OBJECTIVE: To determine whether consistent tissue effects are obtained when laser lesions are produced with a commercially available diode laser that are near the limit of clinical detection at the time of treatment. METHODS: Continuous-wave or micropulse diode laser was used to produce clinically undetectable (subthreshold) or barely detectable (threshold) retinal lesions in pigmented rabbits. Tissue effects at intervals after treatment were determined in retinal pigment epithelial (RPE) whole mounts by fluorescence microscopy, and in sections of retina and RPE by light and electron microscopy. RESULTS: Continuous-wave and micropulse laser lesions that were originally clinically undetectable were detectable as zones of pigment mottling after 5 days. By microscopy, compaction and/or swelling was seen in the outer retina, and cells in the RPE monolayer became heterogeneous in size, shape, and pigmentation, but the tissue responses in the outer retina and RPE were variable even within and among lesions in the same eye. CONCLUSIONS: Subthreshold energies used to create both continuous-wave and micropulse laser lesions produced variable effects on the RPE and the overlying neurosensory retina. It appears that, near the minimum effective dose of laser irradiation, individual RPE cell heterogeneity becomes detectable as variability in sensitivity to laser injury. CLINICAL RELEVANCE: As laser energy is reduced to limit collateral tissue damage in clinical applications, it may be difficult to generate reproducible lesions because of heterogeneity among individual cells.

Animals↗
PubMed2003

Remote thermometry to avoid complications in radiofrequency ablation.

Percutaneous image-guided radiofrequency ablation (RFA) of tumors has the potential risk for thermal damage to nearby normal collateral tissues. Thus, the goal of creating a sufficient area of tumor necrosis must be weighed against the risk for injury to collateral tissues. In this study, remote thermistors were used to monitor temperatures near collateral structures during tumor RFA. Four unique cases are described. When temperature-sensitive structures are near the target lesion, remote thermometry could further increase the safety of this evolving minimally invasive procedure.

Aged↗
PubMed1995

Methylmercury acts at multiple sites to block hippocampal synaptic transmission.

To explore the mechanisms by which methylmercury (MeHg) blocks central synaptic transmission, intracellular recordings of action potentials and resting membrane potentials were made in CA1 neurons of rat hippocampal slices. At 4 to 100 microM, MeHg blocked action potentials in a concentration- and time-dependent manner. MeHg also depolarized Ca1 neuronal membranes. However, this effect occurred more slowly than block of action potentials because the resting membrane potentials remained unchanged when threshold stimulation-evoked action potentials were blocked. Thus, MeHg may initially alter the threshold level of neuronal membrane excitability and subsequently depolarize the membrane leading to block of synaptic transmission. To identify potential sites of action of MeHg, effects of MeHg on the responses of CA1 neurons to orthodromic stimulation of Schaffer collaterals, antidromic stimulation of the alveus, direct injection of current at cell soma and iontophoretic application of glutamate were compared. At 20 and 100 microM, MeHg blocked action potentials evoked by stimulation of Schaffer collaterals and by current injection at the cell soma at similar times. In contrast, action potentials evoked by stimulation of the alveus were blocked more rapidly by 100 microM MeHg than were action potentials evoked by current injection at CA1 neuronal soma. MeHg also blocked the responses of CA1 neurons to iontophoresis of glutamate, but time to block of these responses was slower than block of the corresponding orthodromically-evoked responses by stimulation of Schaffer collaterals. Compared to excitatory postsynaptic potentials, inhibitory postsynaptic potentials appeared to be more sensitive to MeHg, because block of inhibitory postsynaptic potentials occurred before block of excitatory postsynaptic potentials.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1998

[Changes in spatio-temporal patterns after long-term potentiation (LTP) in mouse hippocampal slices and effects of trichloroethylene on LTP].

Spatio-temporal patterns of neuronal activity after the induction of long-term potentiation (LTP) in mouse hippocampal slices were studied with the use of a real-time high-resolution optical recording system. The slices were stained with voltage-sensitive dye and then high-frequency pulses (tetanus) were delivered to Schaffer collaterals of CA3 at the stratum radiatum of CA1. Optical signals as well as field potential in response to test pulses were potentiated after tetanus. The area of response measured by optical recording was slightly but significantly enlarged after tetanus, suggesting that the propagation of optical responses from CA1 towards the subiculum was enlarged. It was suggested that a great increase in neuronal activity was elicited at CA1 and the subiculum after LTP. These changes of spatio-temporal patterns of neuronal activity may contribute to learning and memory. The effect of trichloroethylene (TCE) on LTP was studied with the use of both electrical and optical and recording. The hippocampus from mice injected with 300 mg/kg or 1000 mg/kg TCE was sliced 24 hours after TCE-administration. Test pulses were delivered to Schaffer collaterals every 30 sec and the field potential from the stratum pyramidale of CA1 was recorded. At 40 min after the application of tetanus, population spikes (PS) were potentiated in all groups, but the post/pre ratio of PS was smaller in TCE groups than in the control. Optical recording was also carried out in 1000 mg/kg TCE-injected mice. At 40 min after tetanus, the optical signal response to the test pulse was potentiated in both TCE and control groups, but the post/pre ratio of the optical signals was smaller in TCE than in the control. No significant difference was detected in the increase in the neuronal response area between TCE and the control. It was suggested that TCE depressed the LTP, whereas the increase in the area after tetanus meant that a good amount of neuronal activity was still potentiated.

Animals↗
PubMed2002

Spinal cord blood supply in patients with thoracoabdominal aortic aneurysms.

OBJECTIVE: In patients with thoracoabdominal aortic aneurysms (TAAAs), the blood supply to the spinal cord is highly variable and unpredictable because of obstructed intercostal and lumbar arteries. This study was performed for the prospective documentation of patent segmental arteries during TAAA repair and the assessment of their functional contribution to the spinal cord blood supply. METHODS: TAAA repair was performed in 184 consecutive patients (68 with type I aneurysm, 91 with type II, and 25 with type III) according to a protocol that included left heart bypass grafting, cerebrospinal fluid drainage, and the monitoring of motor-evoked potentials (MEPs). Patent intercostal and lumbar arteries were documented, and all reattached, selectively grafted, and oversewn segmental arteries were noted. MEP amplitude that decreased to less than 25% of baseline was considered an indication of critical spinal cord ischemia and prompted spinal cord revascularization. RESULTS: Adequate MEP levels were encountered in 183 of 184 patients. One patient had early paraplegia (absent MEPs), two patients had delayed paraplegia develop, and two patients had temporary paraparesis, which accounted for an overall neurologic deficit of 2.7%. The median total number of patent intercostal and lumbar arteries in type I, II, and III aneurysms was three, five, and five, respectively. In eight of 68 type I cases, no segmental arteries were seen between the fifth thoracic vertebrae (T5) and the first lumbar vertebrae (L1) and MEP levels remained adequate because of distal aortic perfusion. In 18 of 91 type II cases, the aortic segment T5 to L1 did not contain patent arteries, and in six of these patients, the segment L1 to L5 did not have lumbar arteries either. In the latter patients, MEP levels depended on the pelvic circulation provided with the left heart bypass graft. In the other 12 of 91 type II cases, the only patent arteries were the lumbar arteries between L3 and L5. The loss of MEPs could be corrected with the reattachment of these arteries. In seven of 25 type III cases, the MEP levels also depended on lumbar arteries L3 to L5 and in three of 25 cases, no segmental arteries were available and MEP levels recovered after the reperfusion of the pelvic circulation. With the combination of the findings of type II and III cases, spinal cord perfusion was directed by lower lumbar arteries in 16% of the cases (19 of 116) and pelvic circulation in 8% of the cases (nine of 116). CONCLUSION: In patients with TAAA, most intercostal and lumbar arteries are occluded and spinal cord perfusion depends on an eminent collateral network, which includes lumbar arteries and pelvic circulation. The monitoring of MEPs is a sensitive technique for the assessment of spinal cord ischemia and the identification of segmental arteries that critically contribute to spinal cord perfusion. Surgical strategies on the basis of this technique reduced the incidence rate of neurologic deficit to less than 3%.

Adult↗
PubMed1992

Importance of intraluminal pressure on hemodynamics and vasoconstriction responses of stenotic arteries.

BACKGROUND: Clinical and morphological studies clearly indicate that most human coronary artery stenoses are capable of vasomotion. Variable ischemic thresholds, ischemia unrelated to work load, and variant angina further show the presence and importance of vasoconstriction in coronary artery stenosis. Despite the importance of vasoconstriction, the effect of intraluminal pressure on the hemodynamic response to vasoconstrictors has not yet been examined. Intraluminal pressure is a primary determinant of vessel size and the force opposing vasoconstriction. Accordingly, we examined the effects of intraluminal pressure on the hemodynamic response to norepinephrine (NE)-induced vasoconstriction. METHODS AND RESULTS: In canine carotid arteries perfused with physiological salt solution, pressures at the proximal and distal ends of the artery, as well as flow, were continuously recorded. We altered intraluminal pressure using three diverse interventions: changes in perfusion pressure, decreasing distal resistance, and collaterals. In normal, nonstenotic arteries, NE decreased the external vessel diameter but did not reduce flow. Perfusion pressure changes did not affect the ED50 of the NE-diameter relation. After an intraluminal stenosis was created, NE-induced constriction decreased flow. The threshold concentration of NE needed to decrease flow decreased as the perfusion pressure decreased (38.5 +/- 17.9, 2.3 +/- 1.3, and 0.12 +/- 0.1 x 10(-7) mol/l for 125, 100, and 75 mm Hg of perfusion pressure, respectively; p less than 0.05). Lowering distal resistance decreased stenotic pressure and decreased the threshold NE concentration from 5.4 +/- 1.9 to 0.34 +/- 0.2 x 10(-7) mol/l (p less than 0.05), and increasing stenotic pressure with collaterals increased the threshold NE concentration from 2.6 +/- 1.4 to 7.5 +/- 4.6 x 10(-7) mol/l (p less than 0.05). CONCLUSIONS: In stenotic arteries, interventions that lowered the intraluminal pressure decreased the threshold NE concentration needed to decrease flow, and interventions that raised the intraluminal pressure increased the threshold NE concentration. This pressure-dependent constrictor sensitivity affects the vasomotor tone and is important in pathophysiology of ischemia occurring with hypotension (low perfusion pressure) or mild increase in myocardial oxygen demand (low distal arteriolar resistance). The results also suggest that collaterals, by maintaining stenotic pressure, could decrease the constrictor sensitivity and prevent ischemia.

Animals↗
PubMed1982

Renal scintigraphy versus renal vein renin activity for identifying and treating renovascular hypertension.

This paper compares renal scintigraphy (RS) with renal vein renin activity (RVRA), intravenous pyelography (IVP), and peripheral plasma renin activity (pPRA) in a population of hypertensive subjects with suspect renovascular hypertension (RVH), of whom 30 underwent surgery, in order to evaluate (a) screening ability of RS for RVH, and (b) surgical prognosis of RS for RVH. RS agreed with arteriographic findings of arterial stenosis in 91% of patients and proved more sensitive as a screening test than IVP and pPRA. The false-negative rate of RS was 9% and the false-positive rate was 10%. In the patients who underwent surgery RS was positive in 89% and RVRA in 85% of those who benefited from surgery. In this series false-negatives for RS occurred only in the presence of extensive collateral circulation, where RVRA also gave the same result. In patients who had been operated on, the sensitivity and specificity of RS, compared to RVRA, were very high. Our work supports the view that RS is a good screening test in RVH; moreover, it seems to be as accurate as RVRA as a surgical prognostic method for curable RVH.

Adolescent↗
PubMedDate not supplied

The origin of right inferior phrenic artery on multidetector row helical CT.

The origin of the right inferior phrenic artery (RIPA) was assessed in 216 patients using arterial-phase, contrast-enhanced multidetector row helical computed tomography (CT) and that of 26 patients was confirmed by angiography. One hundred and eighty patients showed the origin of the RIPA in aorta, the celiac artery, the right renal artery or the left gastric artery on CT. The sensitivity of CT was 92%. Multidetector row helical CT provides valuable anatomical information for angiographer.

Aged↗
PubMed2005

Contrast-enhanced magnetic resonance angiography of the lower extremities: standard-dose vs. high-dose gadodiamide injection.

PURPOSE: To compare the efficacy and safety of two different doses (0.1 and 0.3 mmol/kg of body weight [BW]) of gadodiamide for contrast-enhanced magnetic resonance angiography (ce-MRA) of the lower extremities with intraarterial digital subtraction angiography (IA-DSA). MATERIALS AND METHODS: A total of 30 patients with peripheral arterial occlusive disease underwent IA-DSA and ce-MRA from the aortic bifurcation down to the ankle. Patients were randomized to receive a total dose of 0.1 or 0.3 mmol/kg of BW gadodiamide (Omniscan, Amersham Buchler), administered intravenously as a series of three automatic bolus injections. Ce-MRA was performed with a 1.5-T system using a body phased-array coil, centered stepwise over the calf, thigh, and pelvic region. A fast T1-weighted, three-dimensional gradient-echo sequence was obtained before and after injection of the allocated dose. IA-DSA was performed using the Seldinger technique and a femoral approach. The vessels under investigation were divided into 31 segments, and ce-MRA and IA-DSA image sets were evaluated in a double-blind fashion for the presence of stenosis, presence of collateral vessels, vessel delineation, and overall image quality. Both dose groups were compared with regard to contrast index (CI) and signal- and contrast-to-noise ratios (SNR, CNR). The occurrence of adverse events or side effects was also documented. Sensitivity, specificity, and accuracy were calculated in relation to the results of stenosis grading. RESULTS: A total of 26 patients were entered in the efficacy evaluation, while all 30 patients were included in the safety assessment. The sensitivity, specificity, and accuracy for the 0.1 and 0.3 mmol/kg dose groups were 78.8%/93.0%/88.9% vs. 60.2.%/91.5%/83.2%, respectively. The detection of collaterals was similar to IA-DSA for the 0.3 mmol/kg dose group (30.2% vs. 27.4%), but was lower in the 0.1 mmol/kg dose group (27.3% vs. 12.3%). The high-dose gadodiamide injection proved to be superior to the 0.1 mmol/kg dose group with regard to vessel delineation and overall image quality (P = 0.007 and P = 0.002, respectively). The difference between the two dose groups regarding CI, SNR, and CNR was significant (P = 0.0001), in favor of the 0.3 mmol/kg dose group. No adverse events were observed in any of the patients. CONCLUSION: Ce-MRA with gadodiamide is safe and efficacious. Comparison of two different doses with IA-DSA as the standard of reference showed that the 0.3 mmol/kg dose is superior to the standard 0.1 mmol/kg dose with respect to contrast enhancement, vessel delineation, image quality, and detection of collaterals. However, the 0.1 mmol/kg dose was superior to the high dose in the grading of stenosis.

Aged↗
PubMed2005

[Value of low dose dobutamine real-time myocardial contrast echocardiography in the assessment of coronary artery disease].

OBJECTIVE: To evaluate the value of quantitative real-time myocardial contrast echocardiography (RT-MCE) combined with low dose dobutamine stress test in the detection of coronary artery disease (CAD), and to assess the contribution of collateral blood flow (CBF) to myocardial perfusion. METHODS: Twenty-six hospitalized patients referred for coronary angiography and subsequent revascularization underwent routine echocardiography, RT-MCE at baseline and after low dose dobutamine administration. The images of RT-MCE were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve by using the QLab software. RESULTS: At baseline, both beta and A x beta (but not A) were decreased with the increase of severity of coronary stenosis (P < 0.01). Under dobutamine stress, A, beta and A x beta values were decreased with the increase of severity of coronary stenosis (P < 0.01), Graded decreasing in the reserves of A, beta and A x beta were observed with increasing coronary stenosis severity (P < 0.01). Furthermore, significant differences in beta, A x beta, and WMS were observed between segments with CBF and those without. CONCLUSION: Quantitative RT-MCE in conjunction with dobutamine stress can be used as a sensitive measure to identify and stratify CAD as well as to assess the contribution of collateral blood flow.

Adult↗
PubMed1994

Transcranial Doppler detection of vertebrobasilar vasospasm following subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Transcranial Doppler sonography is of established value in the detection and monitoring of middle cerebral artery vasospasm. Little information exists on the utility of transcranial Doppler for detection of posterior circulation vasospasm. METHODS: Cerebral angiography and conventional hand-held transcranial Doppler sonography were compared to determine sensitivity and specificity of transcranial Doppler for detection of vertebral and basilar artery vasospasm. RESULTS: Of 59 consecutive subarachnoid hemorrhage patients with transcranial Doppler angiogram correlations, 42 underwent posterior circulation angiography to evaluate 64 vertebral arteries and 42 basilar arteries during the period of risk for vasospasm and had technically adequate transcranial Doppler examinations within 24 hours of the angiogram. A mean flow velocity of 60 cm/s and above was indicative of both vertebral and basilar artery vasospasm. For the vertebral artery, there were 7 true-positive test results, 42 true-negatives, 6 false-positives (unknown cause in 3, increased collateral flow in 1, adjacent vessel vasospasm in 1, hyperperfusion in 1), and 9 false-negatives (anatomic in 7, operator error in 2). Sensitivity was 44% and specificity was 87.5%. For the basilar artery, there were 10 true-positives, 23 true-negatives, 6 false-positives (unknown cause in 4, hyperemia/hyperperfusion in 1, increased collateral flow in 1), and 3 false-negatives (operator error in 2, tortuous vessel course in 1). Sensitivity was 76.9% and specificity was 79.3%. When the diagnostic criterion was changed to > or = 80 cm/s (vertebral artery) and > or = 95 cm/s (basilar artery), all false-positive results were eliminated (specificity and positive predictive value, 100%). CONCLUSIONS: Our data suggest that transcranial Doppler has good specificity for the detection of vertebral artery vasospasm and good sensitivity and specificity for the detection of basilar artery vasospasm. Transcranial Doppler is highly specific (100%) for vertebral and basilar artery vasospasm when flow velocities are > or = 80 and > or = 95 cm/s, respectively.

Adult↗
PubMed1996

Computer modeling of cerebral blood flow following internal carotid artery occlusion.

It is difficult to predict the adequacy of the collateral blood flow in patients who undergo internal carotid artery occlusion. In order to address this difficulty, the authors have created a computer model of the cerebral circulation. This model features individualized simulations of the Circle of Willis and its afferent and efferent branches which can predict changes in flow that will occur during internal carotid artery occlusion. Analysis of the flow predictions suggests that in patients with a symmetric Circle of Willis the anterior communicating artery is the major conduit of collateral blood supply. In patients with a small anterior communicating artery, the posterior communicating arteries become more important as sources of collateral flow, but they cannot supply as much flow as in the case of a normal anterior communicating artery. Sensitivity studies show that changes in the dimensions of each artery affect the flow throughout the system, such that the arteries in the cerebral circulation must be analyzed as a network rather than as isolated elements. This computer model of the cerebral circulation may help clinicians predict the adequacy of collateral blood supply in patients who undergo internal carotid artery occlusion.

Carotid Arteries↗
PubMed1975

The morphology of the Limulus visual system. VI. Connectivity in the ocellus.

An ocellus of the horseshoe crab, Limulus polyphemus, has been serially sectioned for light and electron microscopy, its sensory cells have been indexed, and the interconnections of a third of these traced. The ocellus contains 155 retinula cells and 26 arhabdomeric cells, which are secondary sensory neurons. Of these, 55 retinula cells constitute 7 quasi-ommatidial assemblages, each innervated by at least one and a total of 9 arhabdomeric cells. When known electrotonic coupling patterns are compared with gap-junctional connections, retinula cells sensitive to visible or ultraviolet light can be tentatively identified. Retinula cell axons contribute collaterals to a synaptic plexus, in which the arhabdomeric cells apparently do not participate.

Animals↗