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[Ultrasonographic evaluation of thyroid tissue perfusion in patients with Graves-Basedow disease as preparation for surgery].

The aim of this work was to asses the usefulness of a new colour Doppler ultrasonography technique, namely power Doppler (PD), in the management of thyroid tissue perfusion in patients with Graves' disease before surgery. Forty six patients with Graves' disease treated conventionally with Lugol's solution before the operation were examined with power-Doppler scanner. The distribution of the vascular patterns of both lobes was analysed by computer program. Results were compared with bleeding during surgery subjectively and objectively. The analysis of power-Doppler thyroid perfusion showed significantly higher values of blood flow in patients suffering from Graves disease when compared with control group. Pre-operative preparation with Lugol's iodine decreases parenchymal blood flow. Auscultation of vascular murmur over the gland fading after Lugol's treatment does not always reflect parenchymal high value of blood flow measured by density of microvessels.

Adolescent↗

Multicompartment analysis of blood flow and tissue perfusion employing D2O as a freely diffusible tracer: a novel deuterium NMR technique demonstrated via application with murine RIF-1 tumors.

Deuterium NMR is employed in concert with multicompartment kinetic analysis for measurement of tissue blood flow and perfusion through a bolus administration of D2O as a freely diffusible tracer. The traditional single-compartment and two-compartment in-parallel flow models with no tracer recirculation are briefly discussed. The two-compartment in-series flow model with recirculation is developed to account for reflow of the stable (slowly excreted) deuterium tracer. With this model a monoexponential tracer washout curve is predicted. The rate of blood flow and tissue perfusion is readily extracted by three-parameter monoexponential analysis of the residue decay curve. A three-compartment model with recirculation, incorporating one compartment in-series with two compartments in-parallel, is developed for analysis of biexponential tracer washout curves. With this model the flow rates through the two in-parallel compartments (i.e., fast and slow) and the volume fractions of these two compartments are obtained by five-parameter biexponential analysis of the residue decay curve. Application of these multicompartment tracer-recirculation flow models is demonstrated with in situ determinations of murine RIF-1 tumor blood flow and tissue perfusion. The blood flow rates determined by deuterium NMR and analyzed by the multicompartment flow models agree well with those determined by others using radiolabels. A companion article (S.-G. Kim and J.J.H. Ackerman, Cancer Res. 48, 3449-3453, 1988) discusses in more depth the practical aspects of applying these multicompartment models to tumor blood flow measurement.

Animals↗

Gender dimorphic tissue perfusion response after acute hemorrhage and resuscitation: role of vascular endothelial cell function.

Proestrous female rodents are protected from the deleterious effects of trauma-hemorrhage that are observed in males. We hypothesized that the gender dimorphic outcome after trauma-hemorrhage might be related to gender differences in endothelial function and organ perfusion under such conditions. Male and cycle-matched proestrous female Sprague-Dawley rats underwent a midline laparotomy, hemorrhagic shock (40 mmHg for approximately 90 min), and resuscitation (Ringer lactate, 4x shed blood volume over 60 min). Various parameters were measured 2 h after completion of resuscitation. In the first set of animals, the left ventricle was cannulated and heart performance (maximal rate of left ventricular pressure increase) as well as cardiac output and organ perfusion rates were determined with (85)Sr microspheres. In the second set of animals, aortic vessel rings were harvested and relaxation in response to acetylcholine and nitroglycerin was measured. In the third set of animals, in situ isolated small intestine was perfused to measure the response of the splanchnic vessel bed to acetylcholine and nitroglycerin. After trauma-hemorrhage and resuscitation, females maintained cardiac output and demonstrated increased splanchnic and cardiac perfusion compared with males. Moreover, female intestines did not manifest the endothelial dysfunction that was observed in male intestines after hemorrhagic shock. We conclude that proestrous females show improved endothelial function and tissue perfusion patterns after hemorrhagic shock and that this gender-specific response might be a potential mechanism contributing to the beneficial effects of the proestrus stage under such conditions.

Acetylcholine↗

Effect of hemodilution on tissue perfusion and blood coagulation during radical hysterectomy.

OBJECTIVE: The goal of this study was to evaluate the safety of hemodilution on global and splanchnic perfusion and blood coagulation during radical hysterectomy. METHODS: A pulmonary artery catheter and a gastric tonometry catheter were placed in 16 patients with cervical carcinoma. Global perfusion indices, splanchnic perfusion index, and coagulation tests were obtained. Blood was removed to achieve a hemoglobin measurement of 8-9 9 g/dL. Three more measurements were repeated after hemodilution, at the end of surgery, and after the retransfusion of blood. Analysis of variance was used to determine statistical significance. RESULTS: Sixteen patients with cervical carcinoma had 1.0 +/- 0.3 L (mean +/- SD) of blood removed and had a blood loss of 0.8 +/- 0.7 L. Hemodiluted preoperative hemoglobin was 8.7 +/- 1 g/dL. All of the global perfusion indices, except for arterial pH and oxygen consumption, decreased after hemodilution and recovered with the retransfusion of blood (P < or = 0.004). Splanchnic perfusion and coagulation tests were unchanged (P > or = 0.1). Major complication was pulmonary edema in one patient. CONCLUSION: Hemodilution during radical hysterectomy, in this select group of patients, does not appear to compromise tissue perfusion or coagulation.

Adult↗

Is hypertension a tissue perfusion disorder? Implications for renal and myocardial perfusion.

Structural alterations in the microcirculation form a major link between hypertension and target organ damage. More than 60% of the overall peripheral resistance of the circulatory system arises at the level of the microcirculation. The primary function of the microcirculation is to supply oxygen and nutrients to tissues. In hypertension, remodelling of the microvascular vessels occurs, leading to an early, functional then anatomical reduction in the number of arterioles or capillaries in a given vascular bed. Such changes have been seen in the structure and density of the microvasculature of different target organs such as the myocardium and the kidneys. In hypertension, capillary rarefaction induces an increase in blood pressure, a relative decrease in tissue perfusion and an increased cardiovascular risk. Recent in-vivo non-invasive techniques for exploring the human microcirculation have allowed the detection of myocardial and renal microvascular impairment in hypertensive patients. In comparative therapeutic studies, antihypertensive drugs have been shown to have different capacities for preventing or reversing changes to the microvasculature of affected organs.

Adrenergic beta-Antagonists↗

Accuracy of PET in predicting functional recovery after revascularisation in patients with chronic ischaemic dysfunction: head-to-head comparison between blood flow, glucose utilisation and water-perfusable tissue fraction.

Accurate prediction of improvement in left ventricular ejection fraction (LVEF) after revascularisation is critical in the therapeutic decision-making process in patients with chronic ischaemic dysfunction. Positron emission tomography (PET) allows non-invasive evaluation of myocardial blood flow (MBF), metabolic rate of glucose (MRG, absolute and relative) and the water-perfusable tissue fraction (PTF). Each of these indices has been proposed for the prediction of functional recovery. Their relative merits, however, are unknown, because a direct head-to-head comparison of their predictive accuracy in the same patients has not been performed. In this study, MBF, MRG (absolute and relative) and PTF were evaluated in 34 patients with severe ischaemic LV dysfunction (LVEF 32%+/-9%). MBF and PTF were determined by oxygen-15 labelled water PET, and MRG (absolute and relative) was determined by fluorine-18 fluorodeoxyglucose (FDG) PET during hyperinsulinaemic euglycaemic clamp. LVEF was measured by radionuclide ventriculography before and 4-6 months after surgery. Sensitivities of MBF, PTF, absolute MRG and relative MRG in predicting improvement in LVEF were 80%, 80%, 90% and 100%, respectively. Their specificities were 54%, 67%, 71% and 71%, respectively. The lowest specificity was obtained for MBF, an intermediate specificity was obtained for PTF and the highest specificities were obtained with FDG PET using absolute and relative MRG. It is concluded that metabolic imaging is superior to perfusion-based indexes for assessment of the potential for functional recovery after revascularisation.

Adult↗

Epinephrine induces tissue perfusion deficit in porcine endotoxin shock: evaluation by regional CO(2) content gradients and lactate-to-pyruvate ratios.

Epinephrine is widely used as a vasoconstrictor or inotrope in shock, although it may typically induce or augment lactic acidosis. Ongoing debate addresses the question of whether hyperlactatemia per se is a sign of tissue perfusion deficit or aerobic glycolysis. We wanted to test the hypothesis that epinephrine has selective detrimental effects on visceral perfusion and metabolism. We performed rigorous regional venous blood gas analyses as well as intraperitoneal microdialysis. We used a mathematical model to calculate regional arteriovenous CO(2) content gradients and estimated the magnitude of the Haldane effect in a porcine model of prolonged hypotensive shock induced by endotoxin infusion (mean arterial blood pressure < 60 mmHg). Subsequently, vasopressors (epinephrine or norepinephrine) were administered and adjusted to maintain systemic mean arterial pressure > 70 mmHg for 4 h. Epinephrine caused systemic hyperlactatemia and acidosis. Importantly, both systemic and regional venous lactate-to-pyruvate ratios increased. Epinephrine was associated with decreasing portal blood flow despite apparently maintained total splanchnic blood flow. Epinephrine increased gastric venous-to-arterial Pco(2) gradients and CO(2) content gradients with decreasing magnitude of the Haldane effect, and the regional gastric respiratory quotient remained higher after epinephrine as opposed to norepinephrine infusion. In addition, epinephrine induced intraperitoneal lactate and glycerol release. We did not observe these adverse hemodynamic or metabolic changes related to norepinephrine with the same arterial pressure goal. We conclude that high CO(2) content gradients with decreasing magnitude of the Haldane effect pinpoint the most pronounced perfusion deficiency to the gastric wall when epinephrine, as opposed to norepinephrine, is used in experimental endotoxin shock.

Adrenergic Agonists↗

Dexamethasone treatment during hemorrhagic shock: blood pressure, tissue perfusion, and plasma enzymes.

In a study to determine beneficial effects of dexamethazone (5 mg/kg) during hemorrhagic shock, perfusion (as measured by radioactive microspheres) and plasma enzymes were measured. Hemorrhagic shock (mean arterial blood pressure, MABP, of 50 mm of Hg) was induced in dogs and then the dogs were isolated from the shed-blood reservoir and were allowed to compensate their MABP. Hemodynamic changes, tissue perfusion, and plasma enzymes were measured at different intervals of time in nontreated and dexamethasone-treated dogs. Beneficial effects were increased MABP, improved blood flow to the lungs, gastrointestinal tract, and kidneys, and less cell damage as indicated by amounts of plasma enzymes released from damaged tissues. These effects favor the maintenance of the homeostatic state and, in turn, a greater chance for survival of the dog.

Alanine Transaminase↗

Preparation of sterile xenon-133 in saline for tissue perfusion studies.

A simple, inexpensive method of obtaining Xe-133 in sterile saline is presented. The method uses commercial xenon ampules supplied for pulmonary ventilation studies. As much as 10% of the gas activity can be recovered per aliquot by cooling the saline to 4 degrees C. The specific activities obtained are adequate for most tissue perfusion studies.

Methods↗

[Significance of tissue perfusion disorders and disseminated intravascular blood coagulation in the pathogenesis of post-resuscitation disease in patients with massive hemorrhage and severe multiple trauma].

A total of 198 patients with massive blood loss and grave combined injury treated at the intensive care ward were monitored for 5 days. This paper presents data on the blood content of peripheral tissues assessed by rheovasography and the time course of coagulating characteristics of the blood and fibrinolysis. Despite the stabilization of arterial pressure in the first hours of treatment, disorders of tissue perfusion persisted for 5 days. Signs of disseminated intravascular coagulation were detected as soon as after 6 h in the presence of expressed progressing thrombinemia, decelerated fibrinolysis in the blood plasma, thrombocytopenia, and consumption of some blood clotting factors. According to our data, disseminated intravascular blood coagulation in the microvessels is possible after 12 h and reaches its maximum on day 2 of treatment; it persisted over the entire follow-up (5 days) period and was associated with clinically manifest involvement of the functions of parenchymatous organs and systems starting from the end of the first or beginning of the second day of treatment.

Acute Disease↗

Delayed contrast enhancement and perfusable tissue index in hypertrophic cardiomyopathy: comparison between cardiac MRI and PET.

UNLABELLED: Delayed contrast enhancement (DCE) visualized by cardiac MRI (CMR) is a common feature in patients with hypertrophic cardiomyopathy (HCM), presumed to be related to myocardial fibrosis. The pathophysiologic basis of hyperenhancement in this patient group, however, remains unclear as limited histologic comparisons are available. The present study compares the perfusable tissue index (PTI), an alternative marker of myocardial fibrosis obtained by PET, with DCE-CMR in HCM. METHODS: Twenty-one patients with asymmetric septal HCM, 12 chronic myocardial infarction (MI) patients, and 6 age-matched healthy control subjects were studied with DCE-CMR and PET. PET was performed using (15)O-labeled water and carbon monoxide to obtain the PTI. RESULTS: No hyperenhancement was observed in control subjects and the PTI was within normal limits (1.10 +/- 0.07 [mean +/- SD]). In MI patients, the extent of hyperenhancement (25% +/- 16% [mean +/- SD]) was inversely related to the decrease in the PTI (0.94 +/- 0.12; r = -0.65, P < 0.05). Average hyperenhancement in HCM was 14% +/- 12%, predominantly located in the interventricular septum. The PTI in the hypertrophied interventricular septum, however, was not reduced (1.12 +/- 0.13). Furthermore, in contrast to MI patients, there was a modest positive correlation between the extent of DCE and the PTI in HCM (r = 0.45, P < 0.05). CONCLUSION: DCE in the hypertrophied septum of HCM patients is not accompanied by a decline in the PTI, and there is a positive correlation between the extent of DCE and the PTI. These results suggest that hyperenhancement may not be caused solely by fibrotic replacement scarring in this patient group. Other pathologic changes associated with HCM may also cause gadolinium-diethylenetriaminepentaacetic acid hyperenhancement.

Adult↗

Adipose tissue perfusion and fatty acid release in exercising rats.

Arterial concentrations of free fatty acids (FFA), glycerol and lactate were measured in male Wistar rats before, during and after 30 minutes exercise on a treadmill. The arterial concentration of glycerol increased 120% and lactate 340% during exercise, but fell immediately upon its termination. The arterial concentration of FFA increased only 20% during the exercise, but was followed by a sharp rise in the recovery period. Maximum FFA concentration was found after 6 minutes of recovery, reaching 70% above the preexercise level, whereafter plasma FFA fell. Using radioactivity labelled microspheres it was found that the fraction of cardiac output reaching adipose tissue after 10 min of exercise was reduced by 30-90% in relation to the resting value. After 3 min recovery, however, the fractional distribution to the same tissue was in average 300% above the value measured 3 min before termination of exercise. It is concluded that the increase in plasma FFA observed during the early recovery period is caused by increased FFA release from adipose tissue, as a consequence of increased adipose tissue perfusion in the recovery period.

Adipose Tissue↗

Myocardial tissue perfusion determined by particulate and diffusible tracers during ischaemia: what is measured?

OBJECTIVE: Myocardial perfusion can be determined by many techniques which can be broadly divided into those employing particulate tracers and those employing diffusible tracers. The most commonly used particulate tracer is radioactive microspheres. However, as with other particulate tracers, they only determine convective transport from pre-capillary arterioles. If convective transport is the limiting factor in solute exchange, then particulate tracers will give comparable measurements to diffusible tracer techniques. However, if solute transport becomes diffusion-limited or alternative pathways of convective transport become more important, which may occur during regional ischaemia, perfusion visualised with clearance techniques using diffusible tracers may be greater than that determined with particulate tracers. This study set out to investigate this possibility in the rabbit myocardium under normal and ischaemic conditions. METHODS: A pentobarbitone-anaesthetised rabbit model of regional ischaemia was used. Ischaemia of the apical region was induced by ligation of the large left ventricular branch of the circumflex artery. Tissue perfusion was determined by radioactive microspheres (n = 5) and the clearance of hydrogen, which was detected voltammetrically by platinum microelectrodes (n = 5). Measurements were made prior to and following coronary ligation and the ischaemic region was demarcated using the particulate tracer monastral blue. The exchange of diffusible solutes was visualised using digital fluorescence microscopy on histological sections of tissue following systemic administration of the fluorophore Evans blue labelled albumin (n = 4). RESULTS: Coronary ligation produced an ischaemic zone occupying 50 +/- 13% of the left ventricle. In ischaemic tissue, flow determined by microspheres fell to 3.9 +/- 4.1% of its pre-ligation value, but solute exchange fell only to 22 +/- 10% (adjusted for changes in the partition coefficient of H2 during ischaemia, P < 0.05). Perfusion measured by microspheres and hydrogen clearance was unchanged in the non-ischaemic area during coronary ligation. There was preferential uptake of Evans blue albumin towards the endocardial surface in the ischaemic region and areas of local uptake through the ventricular wall, which were possibly associated with vessels. CONCLUSION: This work demonstrates that under normal physiological conditions nutrient supply is determined by pre-capillary delivery. However, during ischaemia diffusive transport plays an increasingly important role. The alternative pathways for solute exchange are likely to have an important influence on the rate and extent of myocardial necrosis during coronary occlusion.

Animals↗

[Compromised tissue perfusion for defective microcirculation in children].

After a brief review of the anatomic and physiological features of the microcirculatory system, the Authors describe a new interpretation of skin edema in acute diffuse infantile glomerulonephritis, in Henoch-Schönlein's purpura, in epidemic parotitis and in Kawasaki's disease. They attribute the cellular swelling typical of elastic oedema of these diseases to respiratory deficiency due to reduced tissue perfusion following insufficient circulation in real capillaries. The ensuring drop in energy is rapidly resolved by use of very small doses of a calcium antagonist, chloropromazine, which also affects hemorheology. The Authors refer to works which regard the microcirculatory hypothesis in encephalic pathology (similar to that arising in subjects who live at high altitudes where oxygen is scarce), in cranial trauma and in psychic depression. The Authors describe the surprising find, following a fortuitous observation, that in certain forms of hepato-splenomegaly--among which a case of splenomegaly with hepato-megaly and initial cirrhosis--three hours after the administration of doses of chloropromazine ranging from 0.5 to 1.0 mg/kg, the liver and spleen considerably reduced in volume, followed by the patients' ensuing excellent general conditions and functionality of their organs. The article then references many other Authors who in the course of time have acknowledged the fact that hypoxia stimulates proliferation, even of osteoblasts. Mention is made of the fact that many medications and therapeutic measures may cause vasoconstriction at microcirculatory system level, similarly to several antineoplastic drugs, X-rays, hyperbaric oxygen treatment, as well as traumas, low environmental temperatures and surgical operations. For this reason, in order to contrast vasoconstriction in many pathological conditions and in certain therapies, the Authors suggest the addition of the use of calcium antagonists to usual therapy. This conclusion is reached in consideration of the fundamental fact that the energy deficiency arising in the hypoperfused tissue areas allow an accumulation of amino acids, mainly deriving from protein disgregation, used with a low consumption of energy to synthesize a great number of simplified proteins. Final reference is made to the concept expressed on hypoxia and simplified structural proliferation in an article published in "Medical Hypotheses" of 1995 referring to neoplastic promotion.

Acute Disease↗

Dosimetry in isolation perfusion of the limbs by assessment of perfused tissue volume and grading of toxic tissue reactions.

The optimal single dosage of melphalan in isolation perfusion of the limbs for malignant melanoma was assessed. For this purpose a method to determine the volume of the isolated region in the individual patient and a grading system for the reaction of the normal tissues were introduced. A strictly standardized pharmacosurgical routine was developed that permitted an analysis of the correlation between dosage and the grade of toxic reaction in 90 perfusions. The optimal dosage of a cytostatic drug was considered to be the highest amount tolerated at an acceptable risk. Melphalan at 10 mg/l perfused tissue was determined as the likely optimum. This dose provoked remarkably little variation in toxicity, all reactions falling within a safe range. No exception to the applicability of this dosage was encountered.

Arm↗

Direct intramuscular gene transfer of naked DNA encoding vascular endothelial growth factor augments collateral development and tissue perfusion.

BACKGROUND: Striated muscle has been shown to be capable of taking up and expressing foreign genes transferred in the form of naked plasmid DNA, although typically with a low level of gene expression. In the case of genes that encode secreted proteins, however, low transfection efficiency may not preclude bio-activity of the secreted gene product. Accordingly, we investigated the hypothesis that intramuscular (IM) gene therapy with naked plasmid DNA encoding vascular endothelial growth factor (VEGF) could augment collateral development and tissue perfusion in an animal model of hindlimb ischemia. METHODS AND RESULTS: Ten days after ischemia was induced in one rabbit hindlimb, 500 micrograms of phVEGF165, or the reporter gene LacZ, was injected IM into the ischemic hindlimb muscles. Thirty days later, angiographically recognizable collateral vessels and histologically identifiable capillaries were increased in VEGF transfectants compared with controls. This augmented vascularity improved perfusion to the ischemic limb, documented by a superior calf blood pressure ratio for phVEGF165 (0.85 +/- 0.05) versus controls (0.64 +/- 0.05, P < .01), improved blood flow in the ischemic limb (measured with an intra-arterial Doppler wire) at rest (phVEGF165 = 21.3 +/- 3.9 mL/min, control = 14.6 +/- 1.6 mL/min, P < .01) and after a vasodilator (phVEGF165 = 54.2 +/- 12.0 mL/min, control = 37.3 +/- 8.9 mL/min, P < .01) and increased microspheres in the adductor (phVEGF165 = 4.3 +/- 1.6 mL.min-1.100 g of tissue-1, control = 2.9 +/- 1.2 mL.min-1.100 g of tissue-1, P < .05) and gastrocnemius (phVEGF165 = 3.9 +/- 1.0 mL.min-1.100 g of tissue-1, control = 2.8 +/- 1.4 mL.min-1.100 g of tissue-1, P < .05) muscles of the ischemic limb. CONCLUSIONS: Ischemic skeletal muscle represents a promising target for gene therapy with naked plasmid DNA. IM transfection of genes encoding angiogenic cytokines, particularly those that are naturally secreted by intact cells, may constitute an alternative treatment strategy for patients with extensive peripheral vascular disease in whom the use of intravascular catheter-based gene transfer is compromised and/or prohibited.

Animals↗

Reduced brain tissue perfusion in TGF-beta 1 transgenic mice showing Alzheimer's disease-like cerebrovascular abnormalities.

We have studied the functional repercussions of cerebrovascular abnormalities in transgenic mice overexpressing TGF-beta1. These mice develop Alzheimer's disease-like vascular and meningeal alterations without parenchymal degeneration. Autoradiographic cerebral blood flow measurements in 9-month-old TGF-beta1 mice compared to non-transgenic littermates provided evidence of reduced tissue perfusion, most prominent in limbic regions. A highly significant inverse correlation was found between the density of thioflavin-S-positive blood vessels and blood flow in the hippocampus and the cortex. An inverse correlation was likewise found between meningeal staining and blood flow in thalamic nuclei and regions of high blood flow. Thus, the vascular abnormalities were associated locally with reduced perfusion rate and more widely with limitation in the blood flow. These chronic changes may be related to fibrillar and soluble A beta peptides, the amount of which was almost doubled in the brains of TGF-beta1 mice. Comparison with previous results of cerebral glucose utilization in TGF-beta1 mice shows that reduced utilization preferentially occurred in regions with a high metabolic rate and a relatively low blood flow, suggesting that the metabolic needs are not met by blood supply in these regions.

Alzheimer Disease↗

Was isolation of Veillonella from spinal osteomyelitis possible due to poor tissue perfusion?

From a needle biopsy of the body of the 12th thoracic vertebra in a 74-year-old man with spinal osteomyelitis a Veillonella parvula was isolated. The significance of this bacterium as lactic acid indicator has been considered and discussed. Since this strictly anaerobic bacterium mainly uses lactic acid for energy generation, lactic acid must continuously and sufficiently have been produced in or near to the vertebrate body to permit outgrowth of this bacterium. Since neither microbial infections nor tumours could be demonstrated, we finally hypothesised that in this patient poor tissue perfusion has been the primary cause of lactic acid production.

Aged↗