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At least 1,603 records · Page 89Linked to original sources
PubMed1996

The accuracy of magnetic resonance phase velocity measurements in stenotic flow.

Nuclear magnetic resonance (MR) can be used to measure velocities in fluid flow using the technique of phase velocity mapping. Advantages of MR velocimetry include the simultaneous mapping of the entire flow field through a non-contacting, magnetic window. The phase velocity mapping technique assumes that velocity is constant over the measurement time (typically around 10 ms). For many fluid flows, this assumption is not valid. The current study showed that MR phase velocity measurements of velocity through stenotic flow can be in error by over 100% immediately upstream and downstream of the stenosis throat and by 20% far downstream of the throat in comparison with laser Doppler anemometer measurements taken at the same location. Highly turbulent flow also led to significant errors in velocity measurement. These errors can be attributed to several sources including low signal-to-noise ratio, additional phase shifts due to non-constant velocities, and non-stationary transit-time effects. Velocity measurement errors could be reduced to under 30% at all measurement locations through the use of MR sequences with high signal-to-noise ratios, low echo times, and thick slices.

Arterial Occlusive Diseases↗
PubMed1996

A microstructural flow analysis within a bileaflet mechanical heart valve hinge.

BACKGROUND AND AIMS OF THE STUDY: During recent clinical trials, the Medtronic Parallel bileaflet heart valve was found to have an unacceptable thrombosis complication rate. As patient- and material-related factors proved negative causes for this outcome, it was hypothesized that the flow fields within the valve's hinge pocket contributed to the thrombus formation. METHODS: A microstructural flow analysis within the hinge pocket is presented which uses the techniques of flow visualization, computational fluid dynamics (CFD), and laser Doppler velocimetry (LDV). The application of these techniques towards solving this problem has become possible through (i) the ability to manufacture dimensionally correct 1-X transparent heart valve housings, (ii) advances in CFD technology, and (iii) advances in LDV measurement techniques. RESULTS: This analysis showed that a vortex was present at the hinge pocket's inflow channel during forward flow and degenerated to a disturbed three-dimensional structure during reverse flow with zones of turbulent shear stress large enough to cause blood cell damage. In addition, multiple zones of flow stagnation and disturbed flow existed along the leaflet's pivot throughout the entire cardiac cycle. It was felt that these complex fluid structures created conditions which resulted in the formation of thrombus within the hinges of the Medtronic Parallel valve. These findings were supported by limited clinical explant data which illustrated early thrombus formation within the Parallel valve's hinge pocket at sites predicted by the analysis. CONCLUSIONS: This study provides, for the first time, an understanding of the detailed flow structures within the hinges of a mechanical heart valve and demonstrates an analysis technique by which future mechanical heart valve designs may be assessed for the potential of thrombus formation within the valve's hinge regions.

Computer Simulation↗
PubMed1996

Influence of healing on the disturbed blood flow regulation in venous ulcers.

Cutaneous blood flow regulation is disturbed in severe chronic venous insufficiency (CVI). The feedback system between the transmural pressure in the postcapillary venules and the precapillary resistance regulating arterioles has gone awry. The upregulated control system causes "luxus"-hyperperfusion. In this study laser Doppler fluxmetry was performed in 6 patients' florid venous ulcers (U) and later in the former ulcer area after healing (H) and in the inner ankle area of 12 healthy volunteers (C). Laser Doppler flux (LDF) changes were measured with the leg elevated and lowered as well as after arterial and during venous occlusion. The results proved a diminished (p < 0.01) flux increase with the leg elevated (U: LDF = -9%, H: LDF = 3.1%, C: LDF = 80%) and after arterial occlusion (U: LDF = 1.3%, H: LDF = 0%; C: 189.6%) in severe CVI both in florid ulcers and after healing. The ability to reduce flux when transmural pressures were increased remained. Leg lowering reduced flux by 46.4% in ulcers and by 36.8% after healing. This postural response to high transmural pressures, however, seemed weakened compared to controls, where LDF decreased by 65.8%. Our findings suggest that the postural feedback system remains disturbed and upregulated even after a venous ulcer has healed.

Adult↗
PubMed1996

[Influence of hemodialysis on changes in cerebral artery blood flow velocity in patients with chronic renal failure].

The effect of hemodialysis on the cerebral circulation have been inadequately studied. Because of repeatability, safety and non-invasiveness transcranial Doppler sonography is well suited for evaluation of cerebral circulation and for estimation of cerebral blood flow during hemodialysis as well. The aim of our study was to find out whether hemodialysis affects the velocity of blood flow in extra- and intracranial arteries and in what way. 41 patients aged 18-71 (mean 43.9 +/- 13) years suffering from chronic renal failure made up the investigation group. We investigated 17 men and 24 women. Doppler examination was done to each dialized patient immediately before and then 120 and 240 minutes after the onset of hemodialysis. We used pulsed wave Doppler (TC2-64B, EME). Mean blood flow velocities were obtained from extracranial (CCA, ICA, ECA) and intracranial vessels (MCA, ACA, PCA). Simultaneously the series of biochemical blood parameters and arterial blood pressure were monitored. On the basis of investigation results the following conclusion have been drawn: Hemodialysis significantly affects on changes of blood flow velocities in extra-an intracranial arteries. Above mentioned changes consist in decrease of blood flow velocity in both CCA, left ICA, both MCA and PCA and right ACA.

Adolescent↗
PubMed1996

Multimodal monitoring and assessment of cerebral haemodynamic reserve after severe head injury.

This article contains an overview of selected clinical techniques employed for neurointensive care monitoring and testing of cerebral autoregulation of patients following severe head injury. Multiple modalities are used for monitoring of cerebral haemodynamic reserve, including intracranial pressure, cerebral perfusion pressure (CPP), blood flow velocity (FV) in the middle cerebral artery (MCA), jugular bulb oxygen saturation, laser-Doppler cortical flowmetry, near infrared spectroscopy of cerebral cortex, tissue oxygenation, and microdialysis. Large volumes of information demand specialised computer support for sensible interpretation and filtration of artifacts. Methods of testing of cerebral autoregulatory reserve based on transcranial Doppler ultrasonography are reviewed. Repetitive or continuous assessment is important in practice as autoregulatory reserve may fluctuate in time. Static and dynamic rates of autoregulation show sensitivity to carbon dioxide-induced vasodilatation, but fail to correlate with outcome following head injury. The carotid artery compression test, useful for assessment of patients after subarachnoid haemorrhage, has yet to prove its usefulness in head injury. Continuous waveform analysis of MCA FV and CPP correlates with coma score after resuscitation and outcome and hence may be considered as a robust method for the assessment of autoregulation in ventilated head trauma patients.

Cerebrovascular Circulation↗
PubMedDate not supplied

Laser Doppler perfusion imaging of proximal interphalangeal joints in patients with rheumatoid arthritis.

OBJECTIVE: A non-invasive imaging technique (laser Doppler perfusion imaging-LDI) based on measurement of backscattered Doppler-broadened near infra-red laser radiation was used to provide two-dimensional images of perfusion over the proximal interphalangeal (PIP) joints of a group of normal subjects compared to a group of patients with rheumatoid arthritis (RA). RESULTS: Some PIP joints of the RA group showed areas of increased perfusion whereas normal subjects showed much less variation in perfusion between joints. These hyperaemic areas arose from the underlying joint, as scans taken with a less penetrating red laser did not show such areas. CONCLUSION: Apart from its obvious dermatological uses, LDI could be employed to image hyperaemia associated with a variety of inflammatory conditions affecting subcutaneous structures.

Adult↗
PubMed1996

Measurement of optic nerve head circulation: comparison of laser speckle and hydrogen clearance methods.

Microcirculation in the optic nerve head (ONH) in the ocular fundus was measured noninvasively using the recently developed laser speckle circulation analyzer. Results were compared with capillary blood flow (CBF) measurements made by the hydrogen clearance method. The ONH blood flow of six normal rabbits was measured simultaneously by both methods. Inhalation of 10% carbon dioxide (CO2) increased the CBF by 22% (hydrogen clearance method). Intravenous injection of endothelin-1 (ET-1) (10(-10) mol/kg) decreased the CBF by 19%. Significant correlations were found between the NB (normalized blur) value by the laser speckle method and CBF (r = 0.38, P < 0.05, n = 30) and also between the relative change of NB and CBF (r = 0.92, P < 0.01, n = 30) in the ONH. This indicates that evaluation of the NB change in the ONH is as accurate with the laser speckle method as with the hydrogen clearance method, giving a basis for the clinical application of the laser speckle method of measuring ONH circulation.

Administration, Inhalation↗
PubMedDate not supplied

[Comparative hydrodynamic evaluation of variants of the cavopulmonary anastomosis].

An analysis of the range of postoperative complications following cavapulmonary anastomosis reveals a number of medical engineering problems in surgery techniques. The severity of the surgery due to the nonphysiological rearrangement of blood circulation makes it necessary to search for the most optimal types of anastomosis in terms of the hemo- and hydrodynamics of circulation. To optimize the performance of cavapulmonary anastomosis, namely to define the mutual localization and orientation of the implanted anastomoses against the axes of inflow and outflow, hemo- and hydrodynamic studies were made by Doppler laser anemometry. From the hydrodynamic point of view, the findings indicate the most optimal type of cavapulmonary anastomosis-cruciform anastomosis by displacing 0.5 d from the outflow axis at an angle of 60ë5 degrees.

Anastomosis, Surgical↗
PubMed1996

Role of AT1 receptors in the central control of sympathetic vasomotor function.

1. In a number of species, high concentrations of angiotensin II (AngII) receptors have been found in the rostral ventrolateral medulla (RVLM) in the hindbrain, which is an important region involved in the modulation of sympathetic vasomotor tone. The present review describes studies in which the contribution of angiotensin receptors in the brainstem to cardiovascular regulation, in particular sympathetic vasomotor reflexes, has been examined in conscious and anaesthetized rabbits. 2. In conscious rabbits, fourth ventricular infusions of AngII produced dose-dependent pressor responses as does 400 times less than equipressor intravenous doses. Chronic baroreceptor denervation increased the sensitivity to AngII by 1000-fold. Administration of prazosin i.v. blocked the pressor response, suggesting that the mechanism involved sympathetic vasoconstriction. 3. The pattern of haemodynamic changes in response to AngII injected into the fourth ventricle (4V) involved decreased total peripheral conductance and mesenteric conductance, but a rise in hindlimb conductance. Sinoaortic denervation changed the hindlimb fall in conductance to an increase, suggesting that muscle vasomotor pathways were particularly inhibited by baroreceptor feedback mechanisms. 4. In anaesthetized rabbits, infusion of AngII into the RVLM increased blood pressure and transiently increased resting renal sympathetic nerve activity. The renal sympathetic baroreflex curves were shifted to the right and the upper plateau of the sympathetic reflex increase was markedly increased. 5. The pressor actions of 4V AngII were blocked by administration of a peptide antagonist injected into the RVLM or by the angiotensin AT1 antagonist losartan injected into the 4V. These results suggest that mainly AT1 receptors are involved and that the RVLM is a likely candidate site for the modulation of the renal sympathetic baroreflex. 6. Losartan administration into the 4V in conscious rabbits increased resting renal sympathetic tone and enhanced renal sympathetic baroreflex and chemoreflexes. 7. Our studies suggest that there are sympathoexcitatory AT1 receptors in the RVLM accessible to AngII from the cerebrospinal fluid. In addition, an AT1 receptor pathway normally inhibits the sympathoexcitation produced by baroreceptor unloading or chemoreceptor activation. The effect of losartan suggests that there is greater tonic activity within the sympathoinhibitory pathways. These two actions suggest that angiotensin receptors in the brainstem modulate sympathetic responses to specific afferent inputs, thus forming part of a potentially important mechanism for the integration of characteristic autonomic response patterns.

Analysis of Variance↗
PubMed1996

[The new laser Doppler velocimetry for the measurement of retinal circulation and its clinical application].

We developed a new laser Doppler instrument to measure retinal blood flow. This instrument is equipped with an eye tracking system, which maintains the laser beam on the retinal vessel, thus enabling the measurement of patients with poor visual acuity and poor fixation. In diabetic patients even those without retinopathy, the retinal blood flow decreased compared to the control subjects. This was mainly the result of decreased retinal blood speed and no significant change in the arterial diameter. In diabetic patients requiring panretinal photocoagulation, we studied the regional changes in retinal blood flow following superior or inferior half fundus argon laser treatment, which produced a significant retinal blood flow decrease only in the treated area. We also studied the retinal circulatory changes in retinal branch vessel occlusion. In retinal branch view occlusion, the blood flow in arteries supplying the affected lesion showed 80-90% decrease compared to the arteries supplying the unaffected region. In retinal branch artery occlusion, the retinal blood flow in occluded arteries showed 40-50% decrease compared to the non-occluded arteries. In one patient with retinal branch vein occlusion in whom we measured the retinal blood flow over 18 months, the blood flow increased with the development of collateral vessels. The results showed that retinal circulatory abnormalities can be also evaluated quantitatively during the course of retinal vascular occlusive disease by our newly developed laser Doppler instrument, which proved that this instrument is a clinically very useful tool.

Adult↗
PubMed1996

[Macro- and microcirculation study in diabetic patients].

In diabetics, vascular examination may consider great and medium arteries and microcirculation. The aim of this study is correlation between stenosis in carotid and femoral bifurcation, ultrasound biopsy, and laser-Doppler measurements of distal microcirculation in diabetics. During a six month period, we have examined 90 diabetics in the diabetological service of the Civita Castellana Hospital (Viterbo, Italy), asymptomatic for any vascular distal, cerebral or coronary disease. Subjects were 49 +/- 20 years old with 15 +/- 5 years of diabetes; glycosilate haemoglobin was 7% (mean). 70% of diabetics (62% type I, 38% type II) had an altered veno-arteriolar reflex and 30% of these an ultrasound biopsy value of more than 25. These data demonstrate that most diabetic subjects develop an early, preclinical neuropathy that is directly proportional to the arterial wall condition.

Adult↗
PubMed1996

Postocclusive reactive hyperemia estimating peripheral vascular resistance: a noninvasive method to predict outcome of infrainguinal vascular reconstructions?

OBJECTIVE: The peripheral vascular resistance is an important factor determining the outcome of infrainguinal revascularizations. When measured intraoperatively, it correlates to graft patency, but to select patients to surgery a preoperative, preferably noninvasive, method is necessary. The aim of the present study is to test if parameters recorded during postocclusive reactive hyperemia can be used for that purpose. EXPERIMENTAL DESIGN: This prospective study compares patients with occluded grafts within 30 days postoperatively to patients with patent grafts. SETTING: University Hospital. PATIENTS: Thirty patients with critical ischemia scheduled for infrainguinal bypass surgery. MEASURES: Correlations between intraoperatively measured peripheral resistance and preoperatively recorded parameters of postocclusive reactive hyperemia. The ability of the values to predict outcome. RESULTS: Peripheral resistance correlated significantly to two parameters during postocclusive reactive hyperemia recorded after thigh occlusion, flux reappearance time (r=0.47, p=0.01) and time to peak flux (r=0.41, p=0.03). Intraoperative peripheral resistance predicted graft occlusion at 30 days with a 90% accuracy, while parameters obtained during reactive hyperemia, only tended to predict adverse outcome. CONCLUSIONS: Several parameters during reactive hyperemia show weak correlation to intraoperatively measured peripheral resistance, but none was able to accurately predict graft failure. Further studies are needed to evaluate its capability for patient selection.

Aged↗
PubMed1992

[Microcirculatory changes in mitral prolapse as an expression of a systemic change in the connective tissue].

Many authors hypothesize that mitral valve prolapse (MVP) can be, in most cases, only a clinical sign of a primitive and systemic disorder of the connective tissue, like in Marfan Syndrome (MS). In our previous works we supported the presence of morphological and functional alterations of the microcirculation in patients affected by MS. In order to characterize a possible common denominator between these pathologies we have studied the cutaneous microcirculation in a group of patients affected by MVP, divided into 2 groups: anatomic MVP (MVP) and MVP syndrome (MVPS). The morphologic parameters have been investigated by nailfold capillaroscopy while digital laser-Doppler was used to study skin flowmetry. The results have been compared with a control group. Capillaroscopic remarkers showed an architecturally disorganized microvasculature with aspects related to a reduced compactness of the microvasculature unit with a significatively higher score compared with controls (7.3 +/- 2.9 vs 3.6 +/- 1 p less than 0.0005). Laser-Doppler flowmetry showed a significatively reduced rest flow; ischemic test showed: spike time 48.9 +/- 36.9 vs 15.3 +/- 7.7 s (p less than 0.0005), hyperemic acme 6.6 +/- 2.7 vs 12.5 +/- 8.4 UP (p less than 0.002); % increase 32.1 +/- 20.2 vs 51.5 +/- 15.4 (p less than 0.002). Thermic test showed a significatively higher thermic acme 8.7 +/- 4.2 vs 12.6 +/- 9.11 UP (p less than 0.05). These results appeared to be correlated with stage pathology as it was observed a severe microvasculature disorders in MVPS. Therefore we suppose that a phenotypic continuum may exist between MS and MVP.

Adult↗
PubMed1994

Effects of neural blockade and general anesthesia on the laser-Doppler skin blood flow waves recorded from the finger or toe.

Effects of neural blockade and general anesthesia on the basic wave (BW) and the reflex wave (RW) among the laser-Doppler (L-D) skin blood flow waves recorded on the finger or toe were studied in 2 volunteers and 42 patients. The BW was continuous, rhythmic and independent of respiratory movements. The RW, which was induced by a deep inspiration or a snapping sound, was a transient marked reduction in blood flow. The BW was almost flattened and the RW was no longer induced at the finger under complete wrist block (n = 2), or under cervical or upper thoracic epidural anesthesia extended caudally over T7 (n = 2). On the other hand, the BW was still detected with reducing frequency and the RW could be provoked with one exception at the finger on the side with a sympathetic ganglion block at the C6 vertebral level (n = 14). The BW and RW at the toe were retained under lumbar subdural anesthesia (n = 6) as well. However, under the combination of lumbar subdural anesthesia and lower thoracic epidural anesthesia extending rostrally over T4 (n = 6), both the BW and the RW disappeared at the toe. In the course of deepening nitrous oxide/enflurane anesthesia (n = 10), the BW gradually reduced in frequency until it was almost flattened, and it became difficult to provoke the RW. L-D flowmetry of the finger or toe could be a useful clinical measure for detecting the presence or absence of sympathetic function controlling cutaneous vasomotion.

Adult↗
PubMed1982

Current status of noninvasive tests in the diagnosis of peripheral arterial disease.

In this review of the current status of the vascular laboratory, the major emphasis has been upon those tests that have become well-established and documented, including resting pressure, pulse volume measurements, velocity studies, and three stress measurements--exercise ankle pressure, postocclusive reactive hyperemia, and the toe pulse reappearance time. Additional technology that may have application to peripheral arterial disease includes photoplethysmography, transcutaneous oxygen tension, laser-Doppler velocimetry, fluorescein angiography, infrared thermography, and transcutaneous electromagnetic flowmetry. These techniques, which are currently in development and experimental trial, were not discussed but are likely to provide significant additional information. The future role of the vascular diagnostic laboratory in the area of peripheral arterial occlusive disease appears clear. It has already become a standard resource of the community hospital and tertiary referral center. Its functions will become more and more generally accepted with time as newly graduating physicians who have been exposed to this technology enter the practice of medicine. It should permit obtaining an evaluation of all patients at the expert level, aid in the education of all physicians concerned with peripheral arterial disease, and play an important part in guaranteeing a higher level of patient care than has heretofore been available.

Arterial Occlusive Diseases↗
PubMed1988

Partitional measurement of capillary and arteriovenous anastomotic blood flow in the human finger by laser-Doppler-flowmeter.

This study was made to see whether changes in blood flow through the capillaries and arteriovenous anastomoses (AVA's) of the human finger can be measured by noninvasive flowmetry. Total finger blood flow (FBF) was measured by venous occlusion plethysmography; blood flow was measured by a laser-Doppler flowmeter (ADVANCE, ALF-2100, Tokyo, Japan) using probes with optic fiber separations of 0.3 mm (LDF-0.3) and 0.7 mm (LDF-0.7). The maximum sensitivities for LDF-0.3 and LDF-0.7 were at depths of 0.8 and 1.2 mm from the tissue surface respectively. Two series of experiments were performed on separate days. In the first series the test hand was immersed in a water bath whose temperature (Tw) was 25 degrees C at an ambient temperature (Ta) of 25 degrees C. Tw was raised to 35 degrees C (local hand warming), which was then followed by an increase in Ta to 35 degrees C (whole body warming). FBF, LDF-0.3, and LDF-0.7 increased during these thermal stimulations. However, the relationship of FBF to LDF-0.3 showed two different regression lines. In contrast, the relationship of FBF to LDF-0.7 showed a single regression line. In the second series, with Ta at 35 degrees C, the test hand was immersed in a water bath at Tw 35 degrees C. Tw was then raised every 10 min by 2 degrees C steps from 35 to 41 degrees C. At Tw 39-41 degrees C, FBF and LDF-0.7 in the test hand were significantly decreased compared with those at Tw 35 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Selective vasodilators redistribute intestinal blood flow and depress oxygen uptake.

In this paper we report the effects of adenosine and isoproterenol on intestinal oxygen consumption. Using the recently developed technique of laser-Doppler velocimetry (LDV), we also studied the effects of these two agents on regional blood flow in the canine intestinal mucosa and muscularis. In isolated gut loops perfused at constant blood flow, both vasodilators depressed O2 uptake, but isoproterenol increased rubidium extraction while adenosine depressed rubidium extraction. Under constant pressure perfusion both dilators depressed O2 uptake but increased total flow. Isoproterenol increased the capillary filtration coefficient (Kf), but adenosine depressed Kf. LDV flowmetry showed adenosine increased muscularis flow and depressed mucosal flow. Both LDV flowmetry and radioactive microspheres showed isoproterenol increased mucosal but depressed muscularis flow. Our data indicate that the deleterious effects of isoproterenol and adenosine in depressing intestinal oxygen uptake can be explained by the ability of these agents to selectively vasodilate one of the regional circulations within the gut wall and by a "vascular steal" mechanism to reduce blood flow in the other vascular bed not as sensitive to the agent in question. The reduction in the regional blood flow thus depresses the O2 consumption of the gut as a whole. By comparing our regional laser-Doppler blood flow data with a simple analog model, we show that the seemingly paradoxical effect of vasodilators in depressing a regional blood flow while increasing total perfusion is explicable by a "vascular steal" mechanism.

Adenosine↗