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PubMed1994

[Selective vascular occlusion by repetitive short laser pulse].

The occlusion of arterioles and venules (30 microns in diameter) by means of repeated dye laser pulses (577 nm, 160 microseconds, 0.5 Hz) was studied in the hamster cheek pouch model. Microscopically visible changes during and after irradiation were recorded and monitored by a video system. The energy necessary per pulse for vessel occlusion with a single pulse (arterioles 5 J/cm2, venules 3.5 J/cm2) can be lowered more than 50% with 100 pulses (1.8 J/cm2, 1.2 J/cm2). Rupture of vessels, which regularly occurs with a single pulse, can be totally avoided with 100 repetitive laser pulses. Investigations of the temperature dependence of the occlusion rate of arterioles showed different interaction mechanisms with one pulse and 100 pulses (mechanical and thermal respectively). Light and electron microscopic investigations supported this concept of selective occlusion using repeated short laser pulses. Possible clinical applications are portwine stains of the eyelid, neovascularisation on the cornea and subretinal neovascularisation.

Animals↗
PubMed1994

[Volume pulse wave and respiratory diseases].

We always record the volume pulse wave and oxygen saturation by using a pulse oximeter. The volume pulse wave fluctuation was induced by respiration; we have used this phenomenon to diagnose or assess respiratory diseases. First, differential diagnosis of sleep disorders, that is, central apnea, obstructive apnea, and respiration in upper airway resistance, by using only a pulse oximeter. Second, we used this phenomenon to evaluate dyspnea. When a big volume pulse wave fluctuation exists, most patients feel dyspnea, if they are awake and alert. Then, we monitored coughs by recording the volume pulse wave. Due to the pleural pressure change induced by the cough, the volume pulse wave reveals a characteristic form. This form changes with the intensity of the cough. Then we can evaluate the frequency and intensity of the cough. For recording the volume pulse wave, the pulse oximeter will be widely applicable in respiratory diseases.

Asthma↗
PubMed1998

Use-dependent decline of paired-pulse facilitation at Aplysia sensory neuron synapses suggests a distinct vesicle pool or release mechanism.

We have characterized paired-pulse facilitation at Aplysia sensory neuron-to-motoneuron synapses. This simple form of very short-term synaptic plasticity displayed an unusual feature: it decreased dramatically with repeated testing. Synaptic depression at these synapses and this use-dependent decrease in paired-pulse facilitation occurred independently of each other. Paired-pulse facilitation was inversely correlated with the size of the initial synaptic connection and was absent at stronger synapses. The use-dependent decrease in paired-pulse facilitation occurred at the same rate at large synapses as at small synapses, although the initial paired-pulse facilitation at large synapses was substantially smaller. Rates of synaptic depression were also independent of initial synaptic strength. Paired-pulse facilitation was blocked by presynaptic EGTA injection, but not by postsynaptic EGTA or BAPTA injection. These results indicate that presynaptic Ca2+ influx plays a critical role in paired-pulse facilitation. However, the persistence of the decrease in paired-pulse facilitation for longer than 15 min suggests that Ca2+ from the first paired action potential produces facilitation via a modulatory mechanism rather than by summating with Ca2+ influx during the second paired action potential in activating the Ca2+ binding sites that initiate exocytosis. This modulatory mechanism may not involve protein phosphorylation because paired-pulse facilitation was unaffected by the protein kinase inhibitors H7 and KN-62. These findings further suggest that release by the second paired action potential occurs at sites distinct from those that mediate release by the first action potential.

Action Potentials↗
PubMed1989

The synthesis of soft pulses with a specified frequency response.

We propose a new approach to synthesizing shaped pulses, by first synthesizing a hard pulse sequence and then converting it to a soft pulse. In previous papers, we developed a new approach to synthesizing hard pulse sequences by exactly inverting the Bloch equation, which yields the optimal frequency response. These results can now be applied to shaped pulses. Specifically, one can specify (1) the total duration of the pulse, (2) the frequency range it is desired to perturb, (3) the perturbation desired and, (4) the frequency range it is desired not to perturb. One can then synthesize a shaped pulse which has the desired effect with the least possible error. This enables us to obtain very sharp inversion and pi/2 pulses.

Algorithms↗
PubMed1975

[Changes of pulse rate caused by sonic bomms during sleep (author's transl)].

In two experimental series (19 resp. 53 nights, 2 different persons in each series, test-time 10.30 p.m. to 3.00 a.m.) pulse rate after sonic booms had been recorded during sleep. In the first 3 nights the subjects slept undisturbed by noise. In the following 11 resp. 30 nights sonic booms were applied alternately 2 or 4 times. In the main series after 10 more nights without any noise 4 nights with 8 and 16 sonic booms alternately followed. The last 6 undisturbed nights in both series were used as comparison phase. The interval between two sonic booms was 40 min in nights with 2 booms, 20 min in nights with 4 sonic booms and in the nights with 8 and 16 sonic booms 8.6 resp. 4.6 min. Sound level of the sonic booms ranged from 0.48 mbar to 1.45 mbar, 1 mbar [83.5 dB (A)] in the average. The first sonic boom was applied if one of the two subjects had entered the deepest stage of sleep. Sonic booms induced a biphasic reaction in pulse rate. After an initial increase in frequency with a maximum in the 4th sec pulse rate decreased below the value before sonic boom; it was followed by a slow increase towards the baseline value. This reaction was analysed with special regard to the following factors: 1. Intensity. Due to very fast increase of noise intensity there was no significant correlation between the intensity of sonic boom and the pulse reaction. 2. Exogenic variables. There is no significant connection between postboom pulse rate and noiseless time before the sonic boom, the duration of the test series and the ambient temperature. 3. Endogenic variables. No correlation could be found between the stage of sleep and the reaction. On the contrary a very significant correlation was found between the maximum of postboom increase of pulse rate and the pulse rate before boom. With increasing pulse rate the extent of reaction becomes smaller.

Aircraft↗
PubMed1994

The piezoelectric pulse sensor device: a prospective evaluation.

The goal of this prospective study of the piezoelectric pulse sensor device was to determine its technical applications and its ability to detect lower extremity occlusive arterial disease. Ten extremities (five volunteers) were evaluated to assess the ability to place the sensor in the correct anatomic position on a foot without a palpable pulse during cuff occlusion so that pulsatile flow would be detected following cuff deflation; its sensitivity as an end-point detector for pulsatile perfusion; and whether there is a linear qualitative pulse wave response with increasing perfusion pressures. Forty extremities (20 patients) with suspected occlusive arterial disease were studied to evaluate its capability of detecting perfusion as compared with the presence of a palpable pulse, an audible Doppler signal, and a foot volume waveform. The placement of the sensor on 10 normal limbs with temporary arterial occlusion resulted in a recordable waveform following cuff deflation in 100% of the dorsalis pedis arteries and in 10% of the posterior tibial arteries. The piezoelectric pulse sensor was as sensitive for detecting pulsatile perfusion as an audible Doppler signal and demonstrated a linear change in the waveform's amplitude and shape with incremental changes in perfusion pressure. In the 40 extremities with ankle/brachial indices ranging from 0.00 to 1.35, there was uniform agreement between pulse volume and Pulse Check waveforms. The piezoelectric pulse sensor is a sensitive method for monitoring lower extremity arterial perfusion when supplied by the dorsalis pedis artery; however, it is inadequate for the posterior tibial artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Arterial Occlusive Diseases↗
PubMed1982

Rate of rise of the carotid pulse. An investigation of observer error in a common clinical measurement.

Bedside estimation of the rate of rise of the carotid pulse is a standard clinical observation whose reliability has not been determined. To ascertain interobserver agreement (primary objective) and compare the velocity of rise of the carotid displacement (not pressure) pulse (supplementary objective), three blinded observers evaluated, ranked and palpated the velocity of rise of carotid pulse as "unremarkable," "slow" or "rapid" in 20 consecutive patients. The relative rate of rise of the recorded carotid pulse was represented by the angle between baseline and the initial carotid peak at a standard paper speed of 100 mm/s. Chi-square analyses yielded no significant interobserver agreements (probability [p] 0.22 to 0.51). There was also no correlation of observers' ranking of rise of carotid pulse with the ranking from independent measurement of the recorded pulse rise velocity (p = 0.10 to 0.99). Observer agreement was unanimous only four times and even in these instances was consistent with the recorded carotid pulse rise velocity only once. The results suggest that unbiased observers cannot reliably discriminate slow from "normal" velocity of rise of carotid pulse.

Adult↗
PubMed1984

Use of the indirect axillary pulse tracing for noninvasive determination of ejection time, upstroke time, and left ventricular wall stress throughout ejection in infants and young children.

The use of indirect axillary pulse tracings was investigated as an alternative method to record the carotid pulse in infants and young children. Simultaneous high-speed recordings of ascending aortic pressure and indirect axillary pulse tracings with noninvasive peripheral blood pressures were recorded in 30 young children (aged 1 day to 48 months, median 9 months) during cardiac catheterization. In 15 patients, simultaneous left ventricular (LV) M-mode echocardiograms and phonocardiograms were also performed. Systolic ejection time (SET) and the half-time of the pulse upstroke determined by both methods were compared. Computer analysis of digitized echocardiographic and pulse tracing data was used to generate plots of LV wall stress throughout ejection. Values for wall stress derived from calibrated indirect axillary pulse tracings were compared with those derived from central aortic pressure. SET calculated from axillary tracings was within 5% of the aortic value in 91% of cases, with a mean error for all subjects of -1 +/- 3%. The half-time of the pulse upstroke was within 15% of the aortic value in 91% of cases, with a mean error for all subjects of 6 +/- 12%. LV wall stress was compared at the onset of ejection, peak wall stress, midsystole, and endsystole for each patient, and 98% of values calculated from axillary data were within 10% of the wall stress values calculated from aortic pressure measurements. Thus, indirect axillary pulse tracings provide an excellent representation of the aortic pressure contour and can be used for accurate calculation of SET.(ABSTRACT TRUNCATED AT 250 WORDS)

Axillary Artery↗
PubMed1982

Pulse pressure-III. Prognostic significance in four Chicago epidemiologic studies.

This report, the third in a series on pulse pressure and pure systolic hypertension, examines the associations between blood pressure and the cardiovascular diseases and coronary heart disease, both cross-sectionally and prospectively, utilizing data from four Chicago epidemiologic studies, in an effort to determine whether or not a widened pulse pressure, or pure systolic hypertension, is an independent risk factor. In these analyses, blood pressure is divided into two components, one related to level and the other to pulse pressure, with pulse pressure redefined so that the association between pulse pressure and the prevalence of ECG abnormalities or mortality, indicates whether the endpoint is more strongly related to systolic or diastolic blood pressure. In these studies, blood pressure level is significantly related to both ECG abnormalities and mortality. In the cross-sectional analyses, pulse pressure is generally positively related to the prevalence of ECG abnormalities, indicating a stronger association for systolic blood pressure, and thus a possible association with pure systolic hypertension. However, in the prospective analyses, pulse pressure is generally not related to mortality, indicating an equal association with mortality for systolic and diastolic blood pressure in these studies. Thus, although the cross-sectional analyses generally support the hypothesis that a widened pulse pressure, or pure systolic hypertension, is an independent risk factor for the cardiovascular diseases and coronary heart disease, the prospective analyses do not.

Adolescent↗
PubMedDate not supplied

Do pulse checks delay semiautomatic defibrillation by EMT-defibrillators?

Advanced cardiac life support (ACLS) guidelines from the American Heart Association (AHA) now recommend not checking for a pulse between the initial three defibrillations for pulseless patients in ventricular tachycardia or fibrillation. The AHA asserts that checking for a pulse needlessly delays defibrillation. This study was undertaken to determine if pulse checks delay defibrillation by EMT-Defibrillators (EMT-Ds) using a semiautomatic defibrillator (SAED). Twenty-seven EMT-Ds demonstrated delivery of three successive defibrillations during two test scenarios: once with and once without pulse checks after the first and second defibrillations. The time from the first to third defibrillation was recorded. The mean time to deliver the defibrillations was 60.2 +/- 6.2 seconds with pulse checks and 57.5 +/- 4.6 seconds without pulse checks. The difference, 2.7 +/- 5.9 seconds, was statistically significant (P = 0.026). Pulse checks by EMT-Ds do delay administration of defibrillations, but consideration should be given to reinstating pulse checks as a part of the AHA guidelines, since this delay is of questionable clinical significance.

Electric Countershock↗
PubMed2005

Oxygen pulse during exercise is related to resting systolic and diastolic left ventricular function in older persons with mild hypertension.

BACKGROUND: The mechanisms responsible for impaired cardiovascular hemodynamics during exercise among persons with milder forms of hypertension are not well documented. We examined the relationship of oxygen pulse during exercise, a correlate of stroke volume, with echocardiographic indices of resting left ventricular function to determine whether abnormal contractility and relaxation are related to abnormal cardiovascular dynamics during exercise among such persons. METHODS: Subjects were 44 men and 55 women ages 55 to 75 years with mild hypertension but who were otherwise healthy. Resting left ventricular systolic and diastolic functions were assessed with 2-dimensional Doppler echocardiography and tissue Doppler imaging. Oxygen pulse (millimeters per beat) at rest and during multistage treadmill testing was derived from measurements of oxygen consumption and heart rate. The slope of oxygen pulse between successive exercise stages was calculated. RESULTS: After a steep rise in oxygen pulse from rest to stage 1 of exercise, a markedly diminished oxygen pulse slope was seen between subsequent exercise stages. In stepwise regression analysis, the increase in the slope of oxygen pulse from rest to stage 1 was explained by a greater lean body mass (57%, P < .001) and a larger left atrial size (2%, P < .001). After exercise stage 1, the increase in the slope of oxygen pulse was explained by sex (24%, P < .001), higher mitral E/A ratio (6%, P < .001), and higher mitral annular systolic velocity (6%, P < .001). CONCLUSIONS: These results suggest that a blunted oxygen pulse response to exercise among older persons with milder forms of hypertension may reflect impaired left ventricular stroke volume changes during exercise secondary to subtle abnormalities in both systolic and diastolic left ventricular functions.

Aged↗
PubMed2006

Predictive values of triage temperature and pulse for antibiotic administration and hospital admission in elderly patients with potential infection.

To determine how well triage temperature and pulse abnormalities in elderly patients with potential infections predict antibiotic administration and hospital admission. Data from the National Hospital Ambulatory Care Survey (2001-2002), a sample of US emergency departments, were used. Patients (>or=65 years) with a reason for visit suggesting potential infection were included. Of 10,586 patients 65 years or older, 32% had reasons for visit suggesting potential infection. The negative predictive value for predicting intensive care unit admission (n = 154) for triage hyperthermia (temperature >or=38 degrees C) was 96% (95% confidence interval, 95%-96%); hypothermia (temperature <or=36 degrees C), 95% (95%-96%); pulse higher than 90, 97% (96%-98%); both pulse higher than 90 and hypothermia or hyperthermia, 96% (95%-96%); and either pulse higher than 90 or hypothermia or hyperthermia, 96% (95%-97%). The negative predictive value for the combined outcome of hospital admission and antibiotic administration (n = 432) for hyperthermia was 90% (88%-91%); hypothermia, 87% (86%-88%); pulse higher than 90, 90% (89%-92%); for both pulse higher than 90 and hypothermia or hyperthermia, 89% (88%-90%); and for either pulse higher than 90 or hypothermia or hyperthermia, 91% (90%-93%). Although the absence of pulse and temperature abnormalities in elderly patients with potential infection is predictive of not being admitted to the intensive care unit and the combined outcome of admission and hospitalization, this information should not be used alone to determine the presence or absence of a potentially time-sensitive infection.

Aged↗
PubMedDate not supplied

Effect of high-dose intravenous steroid pulse therapy followed by 3-month oral steroid therapy for Graves' ophthalmopathy.

PURPOSE: To evaluate the effect of high-dose intravenous steroid pulse therapy followed by 3-month oral steroid therapy for Graves' ophthalmopathy. METHODS: We selected 41 Japanese patients (age range, 21-76 years; mean = 49 years) who had active Graves' ophthalmopathy among 205 consecutive patients examined at Sapporo Medical University Hospital between 1997 and 1999. In a prospective study, we investigated the effect on the 41 patients of high-dose intravenous methylprednisolone pulse therapy (1 g/day x 3 days x 3 times) followed by 3-month oral prednisone therapy. Coronal computed tomography (CT) of the orbit, exophthalmometry and monocular fixation field measured by Goldmann perimetry were carried out before the steroid pulse therapy, and 1 and 6 months after the steroid pulse therapy. The maximum coronal section area of the rectus muscle in each eye was measured using an orbital CT image. RESULTS: Extraocular muscle hypertrophy was significantly reduced 1 and 6 months after the pulse therapy (paired t-test, P <.01), and was not significantly different between 1 and 6 months after the pulse therapy. Proptosis was not significantly reduced by the pulse therapy. Monocular fixation fields were measured in 34 patients with diplopia, and limitation of eye movements was improved in 15 patients (44%) by the pulse therapy. In the other patients, improvement of the limitation was not detectable by the test of the monocular fixation field. CONCLUSIONS: The treatment in this study is effective for extraocular muscle hypertrophy, and relapse was minimum within 6 months. However, this treatment has limited effect on limitation of eye movements and less effect on proptosis.

Administration, Oral↗
PubMed1994

Adverse effect of helicopter flight on the ability to palpate carotid pulses.

STUDY OBJECTIVE: To determine if the air medical helicopter environment compromises the ability to palpate carotid pulses. DESIGN: Using a carotid pulse model, flight nurses were tested for their ability to palpate the simulated carotid pulse at normal (120/80 mm Hg) and low (80/60 mm Hg) blood pressures on the ground and during helicopter flight. SETTING: Palpation tests were performed during flight in an MBB BO-105 twin-turbine engine, single-rotor air medical helicopter; control palpation tests were performed on the ground. TYPE OF PARTICIPANTS: Ten flight nurses. MEASUREMENTS AND MAIN RESULTS: Tracings of pulsatile pressure from the carotid pulse model verified its ability to simulate a wide range of arterial pressures. Analyses of variance for repeated measures, including polynomial contrasts, were performed to compare the number of correct detections of the presence or absence of pulse pressures in flight with the number of correct detections in the two control conditions for both carotid pulse pressures. The mean in-flight number of correct detections was lower than both the preflight and postflight control tests, which were themselves nearly equal, at each simulated carotid pulse pressure. The quadratic terms for both the 120/80 mm Hg trial (F1,14 = 9.28; P = .0087) and the 80/60 mm Hg trial (F1,18 = 5.69; P = .0283) were statistically significant. CONCLUSION: Factors associated with transport of patients in an MBB BO-105 helicopter impair the ability of flight nurses to detect carotid pulses in a simulated physiologic model.

Aircraft↗
PubMed2002

Evaluation of a new method for the carotid pulse check in cardiopulmonary resuscitation.

BACKGROUND: The ability to determine the presence or absence of a central pulse remains a key skill in cardiopulmonary resuscitation (CPR) for healthcare providers, despite studies showing that they perform this poorly. The aim of this study was to evaluate a modified technique for palpation of the carotid pulse. METHODS: Sixty seven undergraduate dental students were taught the standard method of carotid pulse detection during a basic life support session and were also taught a modified method. Each student was asked to palpate the carotid pulse of a volunteer in two positions (neck neutral and neck extended) with the volunteer on the floor and on a trolley. The time taken to identify the pulse was measured and the scenarios compared. RESULTS: The time to detect the carotid pulse was reduced in three of the four scenarios (floor, neck extended P=0.0053, trolley neck neutral P=0.0070, trolley neck extended P=0.0024). The final scenario (floor, neck neutral) showed no improvement (P=0.36). CONCLUSION: The new method of carotid pulse palpation results in a more rapid determination of the carotid pulse when it is present in all positions except with the neck neutral on the floor. This will only be clinically significant if trauma is suspected.

Adult↗
PubMed1996

Pulse wave numerical analysis.

The general deterioration of the arterial system is well recognized but not easily measured. Leg pulse waves, generated by the electric impedance plethysmograph, would seem to be a promising method. This study is a mathematical analysis of these pulse waves from the legs. The data were taken from a previous study by the same authors. That study analyzed the pulse waves using a frequency analysis (Fourier) and a lumped component model of the circulatory system. Blood pressure became clinically very meaningful when a number could be assigned to it. This study is being done to determine if a numerical value could be assigned to different types of pulse waves. If this can be done it would furnish a new tool for analyzing the peripheral circulation and peripheral atherosclerosis. This would offer another method for analyzing therapeutic endeavors that affect the circulatory system. These pulse waves were from a rather homogeneous group of generally healthy white males. The subjects were arranged according to age: ages 5-11, ages 19-24, 36-45, ages 55-62, and ages 74-91. This present analysis involves an advanced mathematical analysis done by a computer. The first graph (4a)--sine amplitude vs age--showed a sloping line which intersects the abscissa at about age 100. The second graph (4b)--notch (of the downstroke of the pulse wave) vs age--showed a sloping line intersecting the age line at about age 100. Thus, these calculations suggest that the untreated circulatory system is programmed to have a functional death at about age 100. The two methods used, one involving mathematical calculations and one involving graphic measurements, showed that a number can be put on the pulse wave. The higher the number, theoretically the better the circulation. Then if a treatment scheme can substantially raise the patient's pulse wave number, it might be expected to increase the longevity of their circulatory system.

Adolescent↗
PubMed1987

Palpation of the femoral and popliteal pulses: a study of the accuracy as assessed by agreement between multiple observers.

Six vascular surgeons independently examined 44 legs in patients with suspected peripheral arterial disease. Each surgeon recorded whether the femoral and popliteal pulses were present or absent, and if thought to be present, whether they were normal or reduced in amplitude. Interobserver agreement was determined by calculating both observed agreement (Po) and agreement after correction for chance (kappa-k). The results were calculated both for each possible pair of surgeons and as an overall value for all possible pairs combined. Agreement as to whether pulses were present or absent was significantly better than expected by chance but was only moderately good (overall kappa for femoral pulse = 0.53, and overall kappa for popliteal pulse = 0.52). More often than not, agreement as to whether the pulses were normal or reduced was no better than expected by chance (overall kappa for femoral pulse = 0.15, and overall kappa for popliteal pulse = 0.01). For each assessment, agreement was no better for the more experienced than the less experienced pairs of surgeons. The results indicate that more objective methods than pulse palpation are required to determine whether there is significant disease in the aorto-iliac and femoro-popliteal arterial segments.

Arterial Occlusive Diseases↗
PubMed2002

Determinants of brachial artery mean 24 h pulse pressure in individuals with Type II diabetes mellitus and untreated mild hypertension.

Brachial artery pulse pressure is a predictor of (cardiovascular) morbidity, but its determinants in individuals with Type II diabetes and untreated mild hypertension have not been elucidated. We therefore cross-sectionally investigated determinants of brachial artery mean 24 h pulse pressure in 60 individuals (40 males; age, mean +/- S.D., 57.8 +/- 7.5 years) with Type II diabetes [median diabetes duration (interquartile range), 6.3 (3.6-10.1) years] and untreated mild hypertension [sitting blood pressure >140/90 mmHg and <190/120 mmHg (mean of two consecutive auscultatory office measurements after 5 min of rest)]. We measured (1) three potential determinants reflecting different aspects of central artery stiffness [the overall systemic arterial compliance, the aortic augmentation index and 1/(regional carotido-femoral transit time)], (2) structural and functional changes of the circulatory system often observed in Type II diabetes, and (3) diabetes-associated metabolic variables. After adjustment for age, gender and mean arterial pressure, brachial artery pulse pressure was associated with autonomic function [standardized regression coefficient (beta), -0.27 (P=0.01)], blood pressure decline during sleep [standardized beta, -0.32 (P=0.002)], fasting glucose concentration [standardized beta, 0.26 (P=0.01)], HbA(1c) concentration [standardized beta, 0.27 (P=0.003)] and diabetes duration [standardized beta, 0.28 (P=0.002)] in linear regression analyses. In a combined multivariate model, brachial artery pulse pressure was independently determined by gender [1=male, 2=female; standardized beta, 0.24 (P=0.01)], diabetes duration [standardized beta, 0.18 (P=0.03)], mean arterial pressure [standardized beta, 0.32 (P=0.002)], systemic arterial compliance [standardized beta, -0.23 (P=0.02)] and fasting glucose concentration [standardized beta, 0.20 (P=0.02)]. Aortic augmentation index and 1/(carotido-femoral transit time) were not independently associated with pulse pressure. In conclusion, in individuals with Type II diabetes and untreated mild hypertension, brachial artery pulse pressure is determined mainly by proximal aortic stiffness in a way which is not strongly influenced by peripheral pulse wave reflection. Approx. 60% of the variance in brachial artery pulse pressure could be explained by potentially modifiable determinants.

Adult↗