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PubMed1967

Regional myocardial blood flow.

A method is described which measures the local effectiveness of the myocardial circulation, expressed as a clearance constant. Uniform clearance constants have been demonstrated in the normal canine and human myocardium. A distinct difference in clearance constants has been demonstrated between the normal canine myocardium and areas of naturally occurring disease. Heterogeneous clearance constants have been found in a majority of human subjects with coronary artery disease-the lowest rates being noted in areas of fibrous aneurysm.

Aneurysm↗
PubMed1968

Effect of hemorrhage and retransfusion on intrarenal distribution of blood flow in dogs.

Distribution of intrarenal blood flow was studied in 12 dogs anesthetized with Nembutal. Medullary blood flow was estimated by local clearance of hydrogen gas from the outer medulla measured polarographically with needleshaped platinum electrodes, and by local clearance of (85)Kr and mean transit time of (32)P-labeled erythrocytes measured with a small semiconductor detector placed in the outer medulla. Cortical blood flow was estimated from cortical red cell transit time and from total renal blood flow measured by electromagnetic flowmeter. Bleeding to a mean arterial pressure of 50-65 mm Hg in the course of 8-20 min reduced cortical and medullary blood flow on the average to the same extent. In half of the experiments both cortical and medullary blood flow were reduced proportionately less than mean arterial pressure during the first half hour of bleeding. Maintenance of mean arterial pressure at 50-65 mm Hg in all cases led to progressive reduction of both cortical and medullary blood flow, out of proportion to the reduction of arterial pressure. A two step bleeding procedure used in two experiments also led to uniform reduction of renal blood flow. Reinfusion of blood after 2-3 hr of hypotension increased total renal blood flow to an average of 82% and outer medullary hydrogen clearance to an average of 92% of control values. All dogs survived the experiment without evidence of renal failure. It is concluded that hemorrhagic hypotension in dogs leads to a progressive and fairly uniform rise in renal vascular resistance, without any selective hemodynamic response in the juxtamedullary circulation.

Anesthesia↗
PubMed1970

Effect of retransfusion after hemorrhagic hypotension on intrarenal distribution of blood flow in dogs.

Hemorrhagic hypotension in anesthetized dogs produces a marked decrease of the cortical blood flow, whereas the medullary blood flow is well preserved. These animals were maintained at blood pressures of 50 mm Hg during a 3 hr period after which their blood pressures were restored by the reinfusion of blood or dextran, or both. In the first group of animals, the reinfusion of blood reestablished the blood pressure to control values, but the cortical blood flow was still nonuniformly decreased whereas the medullary blood flow appeared to be increased. In the second group of animals, phenoxybenzamine failed to protect the kidney completely since after blood reinfusion, the same anomalies described for the preceding group were found in 7 out of 10 dogs. The animals of the third group were reinfused with 50% of the shed blood and 10 ml/kg of a 10 g/100 ml solution of low molecular weight dextran. The modifications of the intrarenal distribution of the blood flow were less marked in this group although the blood flow rate of the inner cortex and the outer medulla was always elevated under these conditions. The reinfusion of low molecular weight dextran alone (20 ml/kg of a 10 g/100 ml solution) restored the blood pressure to levels slightly lower than those observed under control conditions but reestablished a normal pattern of intrarenal blood flow. The reinfusion of high molecular weight dextran was inefficient in correcting completely the anomalies of the renal blood flow. Mechanisms such as the increased sympathetic tone, the liberation of angiotensin, and the intravascular cellular aggregation could possibly account for the persisting anomalies of the renal circulation after reinfusion and are discussed.

Animals↗
PubMed1971

Relationship between renin and intrarenal hemodynamics in hemorrhagic hypotension.

In order to investigate the possible role of the renin-angiotensin system in the regulation of intrarenal hemodynamics in hemorrhagic hypotension (HH), seven mongrel dogs have been studied under the following conditions: (a) Control, (b) HH (mean arterial pressure 70 mm Hg), and (c) HH + alpha adrenergic blockade by phenoxybenzamine (HH + POB). The following parameters were obtained for the right kidney: Intrarenal distribution of blood flow and local blood flow rates ((133)Xe washout technique); total renal blood flow (RBF) on the basis of the clearance and extraction ratio of PAH and the arterial hematocrit; plasma renin concentrations in the renal artery and vein by the method of Boucher and his associates; and renin release into the renal circulation. Alpha adrenergic blockade reverted the typical redistribution of intrarenal blood flow observed under HH. In hemorrhage, arterial and venous renin concentrations increased by a factor of 3.4 and 4.8 respectively. A further small increase was observed during HH + POB with the respective factors increasing to 4.8 and 5.3, as compared with control values. The renin release into the circulation increased by a factor of 1.2 in HH and 4.0 in HH + POB. Whereas in HH there seemed to be a relationship between increased renin concentrations or renin release, and the redistribution of blood flow, no such correlation was found during alpha-adrenergic blockade. From these observations it is concluded that renin alone is unable to maintain the typical redistribution of RBF seen during hemorrhage. Circumstantial evidence points to a permissive role of the renin-angiotensin system in the pathogenesis of the patchy cortical hypoperfusion caused by sympathoadrenergic mechanisms during hemorrhagic hypotension.

Angiotensin II↗
PubMed1972

Improvement in myocardial function and coronary blood flow in ischemic myocardium after mannitol.

The purpose of this study was to evaluate the effect of hyperosmolality on the performance of, and the collateral blood flow to, ischemic myocardium. The myocardial response to mannitol, a hyperosmolar agent which remains extracellular, was evaluated in anesthetized dogs. Mannitol was infused into the aortic roots of 31 isovolumic hearts and of 15 dogs on right heart bypass, before and during ischemia. Myocardial ischemia was produced by temporary ligation of either the proximal or mid-left anterior descending coronary artery. Mannitol significantly improved the depressed ventricular function curves which occurred with left anterior descending coronary artery occlusion. Mannitol also significantly lessened the S-T segment elevation (epicardial electrocardiogram) occurring during myocardial ischemia in the isovolumic hearts and this reduction was associated with significant increases in total coronary blood flow (P < 0.005) and with increased collateral coronary blood flow to the ischemia area (P < 0.005).THUS, INCREASES IN SERUM OSMOLALITY PRODUCED BY MANNITOL RESULT IN THE FOLLOWING BENEFICIAL CHANGES DURING MYOCARDIAL ISCHEMIA: (a) improved myocardial function, (b) reduced S-T segment elevation, (c) increased total coronary blood flow, and (d) increased collateral coronary blood flow.

Animals↗
PubMed1974

Measurement of diaphragmatic blood flow and oxygen consumption in the dog by the Kety-Schmidt technique.

To assess energy expenditure of the diaphragm directly, a method was devised for percutaneous catheterization of the left inferior phrenic vein in dogs. Necropsy studies, including retrograde injection of india ink and measurement of radioactivity in diaphragmatic muscle strips, suggested that the territory drained by the inferior phrenic vein was uniformly perfused, and that there were no major anastomoses between this bed and adjacent ones. Diaphragmatic blood flow ( Q di) was calculated from the integrated diaphragmatic arteriovenous difference of (85)Kr by the Kety-Schmidt technique. Diaphragmatic oxygen consumption ( Vo(2) di) was determined as the product of Q di and the diaphragmatic arteriovenous oxygen content difference [(A-V)O(2) di]. When lightly anesthetized dogs breathed quietly, Q di was 22+/-SD 6 ml/min/100 g, (A-V)O(2) di was 6.1+/-SD 2.5 ml/100 ml, and VO(2) di averaged 1.2+/-SD 0.3 ml/min/100 g. This represented 1.0+/-SD 0.2% of total body oxygen consumption. VO(2) di remained relatively constant during quiet breathing, whereas Q di varied directly with cardiac output and reciprocally with (A-V)O(2) di. The oxygen consumption of the noncontracting diaphragm was 60+/-SD 20% of the level measured during quiet breathing. The energy expended by the diaphragm to support simple hyperventilation was small. A 100% increase in minute ventilation, induced by inhalation of 5% CO(2) in 21% or 14% O(2), increased Q di 13%, (A-V)O(2) di 19%, and VO(2) di 40%. The diaphragm consumed 0.13+/-SD 0.09 ml O(2) for each additional liter of ventilation. In four dogs, pneumonia appeared to increase VO(2) both by increasing minute ventilation and by increasing the energy cost per liter of ventilation.

Animals↗
PubMed1982

Regional lung ventilation in ankylosing spondylitis.

Patients with ankylosing spondylitis (AS) sometimes develop apical lung fibrosis and cavitation. It has been suggested that one causative factor is reduced apical ventilation due to rigidity of the thoracic cage. We measured regional ventilation in 27 patients with AS and 18 normal volunteers. Twelve patients (Group A) had chest expansion greater than 2 cm, twelve (Group B) had chest expansion of 2 cm or less and three (Group C) had apical lung lesions on chest radiographs; patients in Groups A and B had no radiographic lung lesions. Ventilation per unit volume (VE/VA min-1) was calculated from 81Krm washout curves. The ratio of upper zone to lower zone ventilation (VR) was calculated. VR in Group A (0.74 +/- 0.11) and group B (0.75 +/- 0.12) was not significantly different from VR in controls (0.76 +/- 0.08). There was no significant correlation between VR and FVC, FEV1 or maximal chest expansion. In patients with apical fibrosis only the radiographically abnormal areas had reduced ventilation. Patients with AS do not underventilate the upper zones of the lungs except in the presence of radiographically visible fibrosis.

Adult↗
PubMed1991

Evaluation of 99Tcm Technegas ventilation scintigraphy in the diagnosis of pulmonary embolism.

In the diagnosis of pulmonary embolism, perfusion lung scintigraphy offers high sensitivity but low specificity. The specificity can be significantly increased by the use of combined ventilation and perfusion studies. Most aspects of perfusion lung scintigraphy are uniformly accepted but the technique of ventilation imaging varies from centre to centre. This study describes a new technique for the performance of ventilation scintigraphy using a suspension of ultrafine carbon particles labelled with 99Tcm ("Technegas"). The technique combines the ready availability of 99Tcm and its optimal imaging properties with an easily administered radiopharmaceutical of particle size sufficiently small to deposit in the alveoli. Of 63 patients studied by conventional perfusion scintigraphy plus Technegas ventilation scintigraphy, images of diagnostic quality were obtained in all. 31 of these patients also had a ventilation study using 81Krm gas and in only one instance did the two methods of ventilation imaging lead to differing interpretations. We conclude that high quality diagnostic images may be obtained using this new technique, which can be made available on both a routine and an emergency basis, thus improving the service provided for patients suspected of having pulmonary embolism.

Adult↗
PubMed2000

An inspiring case.

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Bronchial Fistula↗