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Biomedical subjects

H Unruh

Publications and source records attributed to H Unruh.

At least 19 recordsLinked to original sources

The biophysics of asthmatic airway smooth muscle.

It is clear that significant advances have been made in the understanding of the physiology, biochemistry and molecular biology of airway smooth muscle (ASM) contraction and how the knowledge obtained from these approaches may be used to elucidate the pathogenesis of asthma. Not to belittle other theories of smooth muscle contraction extant in the field, perhaps the most outstanding development has been the formulation of plasticity theory. This may radically alter our understanding of smooth muscle contraction. Its message is that while shortening velocity and capacity are linear functions of length, active force is length independent. These changes are explained by the ability of thick filament protein to depolymerize at short lengths and to increase numbers of contractile units in series at lengths greater than optimal length or L(ref). Other advances are represented by the report that the major part of ASM shortening is complete within the initial first 20% of contraction time, that the nature and history of loading determine the extent of shortening and that these findings can be explained by the finding that the crossbridges are cycling four times faster than in the remaining time. Another unexpected finding is that late in the course of isotonic relaxation the muscle undergoes spontaneous activation which delays relaxation and smoothes it out; speculatively this could minimize turbulence of airflow. On the applied front evidence now shows the shortening ability of bronchial smooth muscle of human subjects of asthma is significantly increased. Measurements also indicate that increased smooth muscle myosin light chain kinase content, via increased actomyosin ATPase activity could be responsible for the changes in contractility.

Adaptation, Physiological↗

Role of autacoids in cardiovascular colapse in anaphylactic shock in anaesthetized dogs.

OBJECTIVE: In anaphylactic shock (AS), the relative effects of the autacoids including histamine, prostaglandins (prost), and leukotrienes (leuk) on causing cardiovascular collapse and the extent to which receptor blocking agents and pathway inhibitors may prevent this collapse are not clear. METHODS: In randomized design, we investigated whether blockade of histamine H1, H2, and H3 receptors or inhibition of the cyclooxygenase (cyclo) and lipoxygenase pathways (lipox) prevented AS in ragweed sensitized dogs. Seven dogs were studied under pentobarbital anesthesia in which the treatment studies were approximately 2 weeks apart. RESULTS: During H1 receptor blockade, the decreases in blood pressure and cardiac output otherwise observed in AS were attenuated (P < 0.05) and the release of prost, thromboxanes, and leuk were reduced as compared with nontreatment studies. Cyclo inhibition also attenuated cardiovascular collapse and mediator release in AS, but the other treatments showed no effects. CONCLUSION: H1 receptor blockade and cyclo may attenuate cardiovascular shock in AS. These agents inhibit autacoid release from mast cells in addition to any specific receptor blocking and pathway inhibition effects.

Analysis of Variance↗

Histamine H3 receptor blockade improves cardiac function in canine anaphylaxis.

In anaphylactic shock (AS), the relative effects of the autacoids including histamine, prostaglandins, and leukotrienes on causing cardiovascular collapse and the extent to which receptor blocking agents and pathway inhibitors may prevent this collapse are not clear. In a ragweed model of anaphylaxis, we examined whether pretreatment with H1, H2, H3 receptor blockers, and cyclooxygenase and leukotriene pathway inhibitors was useful in preventing the depression in left ventricular (LV) contractility known to occur in this model. The dose of allergen was varied to produce similar degrees of shock between treatments. The animals were studied under pentobarbital anesthesia in which the treatment studies were approximately 3 wk apart. LV volumes were measured by sonomicrometric techniques. During challenge, mean arterial blood pressure (Pa), cardiac output (Q), and LV end-diastolic pressure (LVEDP) decreased approximately 50% compared with preshock values in all treatments. Histamine H3 receptor blockade was associated with higher heart rates (HR) and higher stroke work (SW) (p < 0.05) as compared with the other treatment studies. We conclude that histamine H3 activation by inhibiting adrenergic neural norepinephrine release contributes to cardiovascular collapse in AS.

Anaphylaxis↗

Effect of bolus epinephrine on systemic hemodynamics in canine anaphylactic shock.

OBJECTIVE: Epinephrine (Epi) is considered to be the drug of choice for anaphylactic shock (AS). However, the benefit of this drug on improving systemic hemodynamics in AS has never been shown. We used a canine ragweed model of AS to determine if an intravenous bolus of Epi hastened the recovery of hemodynamics and modified mediator release (Med) compared with no treatment (NT). METHODS: In one protocol (n = 8), the effects on hemodynamics of two intravenous doses of Epi (0.01 and 0.025 mg/kg) were examined for 3 h postshock in respective studies approximately three weeks apart under pentobarbital anesthesia in the same animal. In five other dogs, left ventricular (LV) mechanics were additionally determined by sonomicrometric techniques to determine changes in contractility as defined by the preload recruitable stroke-work (SW) relationship. RESULTS: Compared with NT values, Epi treatments produced only transient increases in mean arterial pressure (MAP) and cardiac output (CO) post-challenge. By 20 min postshock, CO in the Epi studies were generally lower (p < 0.05) and BP was not different from NT values. With Epi treatment, SW was reduced for a given LV end-diastolic volume compared with the control study. Epi treatments also caused relatively higher plasma thromboxane B2 concentrations postshock. CONCLUSION: Our findings indicate that, when given immediately postshock, bolus-Epi did not hasten recovery and caused impairment in LV mechanics in canine AS.

Adrenergic alpha-Agonists↗

Effects of anaphylaxis mediators on partitioned pulmonary vascular resistance during ragweed shock in dogs.

We examined the effect of anaphylactic shock on the longitudinal distribution of pulmonary vascular resistance (PVR) in ragweed-sensitized dogs in which PVR was partitioned into an upstream arterial component (Rus) and a downstream venous and capillary component (Rds). We also assessed whether Rus and Rds would be reduced by pretreatment with histamine H1- and H2-receptor blocking agents and with cyclooxygenase and lipoxygenase pathway inhibitors. Anesthetized animals were examined on separate occasions 3 wk apart in which one of the treatments was randomly given. The pulmonary arterial occlusion technique was used to determine segmental pressure drops. During ragweed challenge, PVR increased approximately 4 times compared with the preshock value (3.04 vs. 12. 07 mmHg . l-1 . min; P < 0.05). Although both Rus and Rds increased postshock, the greatest relative increase occurred in Rds. None of the treatments reduced partitioned resistances compared with no treatment. Our results show that, under conditions of anaphylactic shock, increases in Rus and Rds could not be ascribed to release of histamine or products of the cyclooxygenase and lipoxygenase pathways.

Allergens↗

Placement of left double-lumen endobronchial tubes with or without a stylet.

PURPOSE: This study was designed to determine if leaving a stylet in the left Bronch-Cath endobronchial tube (DLT) for the entire intubating procedure improves the accuracy of placement on the initial attempt, without introducing complications. METHODS: Sixty ASA 1-3 patients were randomized to one of two groups. In Group 1 (n = 30), the stylet was retained for the entire intubation procedure and in Group 2 (n = 30), the stylet was removed once the bronchial cuff had passed the vocal cords. In both groups, the DLT was turned 110 degrees counterclockwise and advanced until resistance was encountered. Placement was assessed by auscultation and fibreoptic bronchoscopy (FOB). After surgery, the DLT was replaced by a single-lumen endotracheal tube. The thoracic surgeon (blinded to the method of intubation, and using a FOB) assessed the appearance of the tracheobronchial mucosa. RESULTS: The two groups were similar with respect to sex, height, weight, DLT size, surgeon and expertise of the laryngoscopist. When the stylet was retained, the DLT was correctly placed 60% of the time compared with 17%, if the stylet was removed, (P = 0.001). Seven out of 30 DLTs in Group 2 were initially placed into the right mainstem bronchus, (P = 0.005). The average time to confirmation of correct tube placement by FOB was increased in Group 2, (P = 0.01). Although the observed incidence of left bronchial, mucosal petechiae and erythema was greater in Group 2, this was not statistically significant, (P = 0.063). CONCLUSION: Retaining the stylet for the entire intubation procedure allows for a more rapid, accurate placement of the DLT without increasing the incidence of tracheobronchial mucosa injury.

Bronchi↗

TGF-beta 1, but not TGF-beta 2 or TGF-beta 3, is differentially present in epithelial cells of advanced pulmonary fibrosis: an immunohistochemical study.

Although it is recognized that three isoforms of transforming growth factor-beta (TGF-beta) exist in mammals, their expression, distribution, and function in injury and repair are not well characterized. Using immunohistochemistry and antibodies to synthetic peptides of TGF-beta 1, TGF-beta 2, and TGF-beta 3, we determined the distribution of TGF-beta isoforms in lung sections with acute and chronic lesions of idiopathic pulmonary fibrosis (IPF), chronic asbestosis and hypersensitivity pneumonitis, as well as non-specific pneumonitis. In lung sections with advanced pulmonary fibrosis and honeycombing, irrespective of the diagnosis, TGF-beta 1 was prominently expressed in epithelial cells and macrophages and was found to be associated with the extracellular matrix. In lungs with early lesions of IPF and only inflammatory changes, TGF-beta 1 was present in alveolar macrophages but TGF-beta 1 was not present in epithelial cells. Small amounts of matrix-associated TGF-beta 1 were present subepithelially in areas of lung sections from patients with IPF with minimal inflammation and no fibrosis. In normal lungs with no evidence of inflammation or fibrosis TGF-beta 1 was not seen in alveolar macrophages, epithelial cells, or extracellularly. TGF-beta 2 and TGF-beta 3 were expressed in alveolar macrophages, epithelial cells, and smooth muscle cells of vessels and bronchi of normal lungs and lungs with both inflammatory and fibrotic changes. Our findings suggest that while TGF-beta 2 and TGF-beta 3 are ubiquitously expressed in the lung, TGF-beta 1 is expressed in epithelial cells of fibrotic lungs where the presence of TGF-beta 1 is not disease-specific but an indication of the chronicity of the injury.

Adult↗

Left ventricular systolic performance is depressed in chronic pulmonary emphysema in dogs.

The effect of chronic right ventricular (RV) pressure overload on left ventricular (LV) systolic function in chronic obstructive lung disease is unclear. To examine LV systolic performance in pulmonary emphysema, a chronic canine model was developed in which pulmonary artery pressure could be elevated to a level found in human disease. Severe emphysema was produced by the repeated instillations of the enzyme papain into the lung. Sonomicrometry was used to assess LV dimensions along the septal-lateral, apex-base, and anterior-posterior orthogonal axes of the LV. With the animal conscious, measurements of LV systolic function were obtained over a wide range of LV circumferential end-ejection stresses at baseline and after 1 yr of emphysema (post-1-yr study). In the emphysema group (n = 5), the results showed that at the post-1-yr study, measurements of LV ejection fraction, mean velocity of circumferential shortening, and rate of anterior-posterior dimensional shortening were reduced compared with those obtained at the baseline study. In the emphysema group, end-systolic volume was increased for a given end-systolic pressure or stress at the post-1-yr study compared with baseline values, while fractional shortening measured along the three axes was decreased. There were no similar changes in systolic parameters in control groups. We conclude that chronic RV pressure overload may cause an impairment in LV systolic performance in chronic emphysema.

Analysis of Variance↗

Altered left ventricular chamber stiffness and isovolumic relaxation in dogs with chronic pulmonary hypertension caused by emphysema.

BACKGROUND: In chronic obstructive lung disease, a right to left ventricular septal shift that occurs as a consequence of right ventricular pressure overload is the usual mechanism given to explain a decrease in left ventricular (LV) diastolic performance. The purpose of the present study was to examine the extent to which this mechanism could account for a decrease in LV diastolic function in a canine model in which pulmonary artery pressure was elevated to a level found in human disease. METHODS AND RESULTS: Severe emphysema was produced in dogs by repeated instillations of the enzyme papain into the lung. To assess LV diastolic function, we used sonomicrometry, in which three pairs of subendocardial crystal transducers were implanted along the three orthogonal axes of the LV. LV end-diastolic dimensions and pressure-strain relations along the three axes, as well as the time constant of LV isovolumic relaxation (T), were measured before (baseline) and after 1 year of emphysema (post-1-year study). The results showed that after 1 year of pulmonary hypertension, LV pressure-strain relations were decreased along the septal-lateral and anterior-posterior axes, but a right to left ventricular septal shift was not detected. The relation of average midwall circumferential stress to midwall circumferential strain was used to describe the intrinsic compliance of the LV. The results showed that myocardial stiffness increased in emphysema but that chamber volume was not reduced. At the post-1-year study, T was abnormally increased in the emphysema group in response to augmented preload and afterload compared with preemphysema measurements. CONCLUSIONS: We conclude that mechanisms other than ventricular interdependence may be operative in leading to altered LV diastolic filling in chronic emphysema.

Analysis of Variance↗

Diagnostic algorithm for acute superior vena caval obstruction (SVCO).

Acute SVCO presents a serious diagnostic and therapeutic dilemma to the thoracic surgeon. It is highly desirable to obtain a definitive tissue diagnosis but this requirement must be balanced against the risks inherent in invasive diagnostic procedures in these oft-times critically ill patients. In the past 5 years we have developed an algorithm that has been used successfully in 18 patients presenting with acute SVCO. The decision tree consists of scalene node biopsy, bronchoscopy and mediastinoscopy with categorization into low and high risk groups in the latter. The gender distribution of the 18 patients was 12 male and 6 female with the ages being 58.3 +/- 16.3 and 64.2 +/- 11.2 years respectively. The duration of symptoms range from 1.5 to 12 weeks and averaged 4.5 +/- 3.2 weeks. Two patients had palpable scalene nodes which were positive at biopsy. Bronchoscopy was positive in 5 out of 11 examinations. In 5 instances it was not done. Twelve patients underwent various forms of mediastinal biopsy and one underwent sternotomy. Seven patients requiring mediastinoscopy were judged to be high risk as defined by severe airway and vascular obstruction. Perioperative difficulties occurred in two patients due to cardiorespiratory factors associated with the obstruction. Both patients were undergoing cervical mediastinoscopy under general anesthesia and no difficulties were encountered in high risk patients when local anesthesia was used to perform anterior mediastinotomy. Five patients that were considered low risk all underwent uncomplicated procedures under general anesthesia. Thirteen patients proved to have bronchogenic carcinoma and a specific tissue diagnosis was obtained in 12. The undetermined diagnosis was in a patient who had prior radiotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

Aneurysmal bone cyst of the upper thoracic spine. An operative approach through a manubrial sternotomy.

Surgical access to T-1 and T-2 vertebral bodies through standard cervical approaches may be difficult and extensive in patients with short necks or high sterna. Adequate exposure of this area can be achieved in children, using a partial manubrial sternotomy and retraction of the manubrial halves. This procedure was successfully performed in a 14-year-old girl whose T-1 vertebra had been completely replaced by a large aneurysmal bone cyst that had produced major paraparesis. A two-stage anteroposterior excision and spinal fusion resulted in complete restoration of neurologic function, eradication of the cyst, and stabilization of the cervicothoracic spine. The limited manubrial split approach to lesions in the T-1 and T-2 vertebrae is recommended.

Adolescent↗

Surface to nuclear distances in human bronchial epithelium: relationships to penetration by Rn daughters.

Lung cancer in U miners is thought to be related to the inhalation of particulate Rn daughters. Since the depth of penetration by alpha particles is short, the thickness of the epithelium lining the bronchial tree may be a critical factor in the development of cancers at specific sites in the lung. The objectives of the study were to measure the thickness of the epithelium at all levels of the human bronchial tree, to determine the distances of epithelial nuclei from the mucociliary surface, and to compare these parameters in smokers and nonsmokers. Twenty-nine surgically removed specimens were examined; 26 were from smokers. No significant differences were found between smokers and nonsmokers, allowing us to treat the 29 cases as a homogeneous group. With progressive divisions of the bronchi, the epithelium decreases in thickness, and distances of nuclei from the surface are also less in the peripheral bronchi. Allowing for artefacts of tissue preparation, the mean distance from the mucociliary surface to the underlying nuclei varies between 17 and 38 microns.

Aged↗

Left ventricular contractility is depressed in IgE-mediated anaphylactic shock in dogs.

To determine whether myocardial dysfunction contributes to vascular collapse in anaphylactic shock, we examined left ventricular (LV) contractility, coronary blood flow, and myocardial lactate metabolism during antigen challenge in eight dogs that were sensitized to ragweed pollen extract (anaphylaxis group). Findings in the anaphylaxis group were contrasted to those in another group of dogs in which mean blood pressure was decreased to the same extent by arteriolar vasodilation with nitroprusside. The animals were examined under nonhypoxic conditions while anesthetized and ventilated. LV mechanics were examined with subendocardial crystals placed primarily along the anterior-posterior minor axis of the LV. During antigen challenge, a depression in LV contractility was observed in the anaphylaxis group as assessed by fractional dimensional shortening, stroke volume, and the slope of the end-systolic pressure-dimension relationship. During anaphylaxis, moreover, coronary vasodilation rather than coronary vasoconstriction was observed, and evidence of myocardial ischemia as assessed by altered myocardial lactate metabolism was not found. Our results indicate that depressed LV contractility occurs in anaphylactic shock. The results further suggest that the mechanism may be due to a direct effect of mediators of anaphylaxis on the myocardium to produce systolic dysfunction.

Anaphylaxis↗

Vascular properties of canine lungs perfused with Eurocollins solution and prostacyclin.

Although Eurocollins solution (ECS) is commonly used for lung preservation, its vascular effects and their time course and response to pharmacological interventions are not well understood. The effect of 4 degrees C ECS on the pulmonary circulation was assessed in excised canine left lower lobes. The roles of static oxygen inflation and prostacyclin infusion during ECS perfusion were also examined. The lobes were divided into five groups: time control (A), ECS with oxygen (B), ECS without oxygen (C), ECS with glycine buffer (D), and ECS with prostacyclin (E); group D was the control for E. Eurocollins solution had no effect on gas exchange but had a marked effect on the pulmonary circulation. Vascular conductance decreased from 22.6 to 18.9 mL/min/cm H2O and from 21.3 to 14.1 mL/min/cm H2O with average vascular closure increasing by 1.2 and 2.1 cm H2O in groups B and C, respectively. The decreased vascular conductance and increased vascular closure was associated with a reduction in vascular compliance from 1.63 to 1.25 mL/cm H2O. When prostacyclin was added to ECS, the reduction in vascular closure was much less and was associated with a decrease in vascular closure and no loss of vascular compliance. Eurocollins solution increases pressure cost for perfusion by causing both vascular obstruction and increased tone, especially when oxygen is not provided. This is significantly overcome by addition of prostacyclin infusion during ECS perfusion.

Animals↗

Management of empyema thoracis.

Over a 5-year period, 65 adult patients with empyema thoracis were treated. The cause of the empyema was postpneumonic in 52%, postresectional in 24%, a complication of minor surgical procedures in 14%, posttraumatic in 5%, and the result of miscellaneous causes in 5%. In the postpneumonic group, infection resulted from a single aerobic organism in 41%, multiple aerobic organisms in 9%, single anaerobic organisms in 12%, and mixed aerobic-anaerobic organisms in 18%. Peptostreptococcus, Streptococcus viridans, Staphylococcus epidermidis, Peptococcus, Staphylococcus aureus, and diphtheroids were the most common organisms, accounting for 55% of bacterial isolates. All 34 patients with postpneumonic empyema were initially treated with drainage, which was successful in two thirds. The remainder, 12 patients, ultimately required thoracotomy. Decortication was combined with intrathoracic transposition of extrathoracic skeletal muscles in 9 patients. There was no reoperation or recurrence of infection, and thoracoplasty was avoided; residual spaces were filled by the transposed muscle.

Adult↗