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Some flow visualization and laser-Doppler-velocity measurements in a true-to-scale elastic model of a human aortic arch--a new model technique.

Flow studies were done in an elastic true-to-scale silicone rubber model of an aortic arch to study further hemodynamic influences on atherosclerosis. The model was prepared from a cast of a young woman. A revised model technique was used. The model had a compliance similar to that of the human aortic arch. Velocity measurements were done in the model with a two component laser-Doppler-anemometer in steady and pulsatile flow using a calcium chloride solution with a viscosity of eta = 3.18 mPas and density of rho = 1.28 kg/m3 at 20 degrees C. The time average Reynolds numbers over a whole cycle in the ascending aorta was Re = 1350. The Womersley parameter for pulsatile flow was a = 20. The pulse wave velocity in the ascending aorta was about c = 5.4 m/sec. The secondary flow behavior was discussed for steady and pulsatile flow. Reverse flows were found, especially along the inner radius of the aortic arch in the descending aorta in steady and pulsatile flow and also in small areas of the ascending aorta and at the branches of the aortic arch. The formation of atherosclerotic plaques at preferred local flow regions is discussed.

Aorta, Thoracic↗

Abnormalities of cutaneous microcirculation in atopic eczematics.

There are signs of abnormal microcirculation in atopics, yet reliable methods for its non-invasive measurement are scarce so far. Since the phenomenon of dermographism (D) elicited by blunt stroking of the skin reflects the functional response of cutaneous vessels to pressure, we studied the haemodynamics of D using laser-Doppler microfluxometry (LDF) and infrared thermography (IR-TH) in patients with atopic eczema (n = 23) and in healthy controls (n = 21) under standardized investigative conditions. Only in-patients not treated with corticoids were selected. LDF values showed a marked reduction in the intensity of hyperaemia in the patients as compared with the controls, according to the visual degree of the dermographic blanching effect (white, delayed white, indifferent; pink). A reduction of the radiating skin temperature vis-à-vis the controls was measured by IR-TH. These results yield evidence that dermographic pallor of atopic skin depends on the strength of local vasoconstriction, possibly including altered blood flow in cutaneous shunt vessels.

Adolescent↗

Alterations of skin microcirculatory rhythmic oscillations in different positions of the lower extremity.

Microcirculatory vasomotion is considered to be an important mechanism promoting and facilitating the transfer of blood cells through skin capillaries. Since skin vulnerability of the leg is closely associated with gravitational factors and skin micro-circulation, we investigated by a laser Doppler apparatus influence of postural changes on skin blood flow oscillations in lower limbs of healthy volunteers. Our data show a marked decrease in microcirculatory oscillation amplitudes at a frequency 7.6 (+/- 0.6) min-1 after lowering the leg. This could be reversed by the application of compressive bandage. Our study points toward a potentially important mechanism of microcirculatory impairment during orthostasis.

Adult↗

Comparison of heated-probe laser Doppler and transcutaneous oxygen measurements for predicting outcome of ischemic wounds.

Transcutaneous oxygen (TcPO2) measurement has proven to be an accurate means of predicting healing of ischemic wounds. This study compares the ability of TcPO2 and laser Doppler, modified by the addition of a heated probe (LDHP), to assess wound outcome. TcPO2 and LDHP measurements were made at the same site for 80 wounds, which consisted of 51 amputations (25 above knee, 6 below knee, 20 forefoot) and 29 ulcerations. Healing was defined as complete wound closure. Failure to heal was defined by the necessity for proximal amputation in 22 wounds (6 amputations, 16 ulcers). Outcome criteria were chosen to maximize accuracy and either positive or negative predictive values. Criteria with the greatest accuracy and positive predictive value for wound healing were > or = 11 mmHg for TcPO2 and > or = 50 mv for LDHP range. Criteria with the most appropriate accuracy and negative predictive value for wound failure were < 5 mmHg for TcPO2 and < 35 mv LDHP range. All wounds whose LDHP range was < 35 mv failed to heal, whereas some wounds with a TcPO2 of 0-1 mmHg healed successfully. An absolute prediction of wound healing (100% specificity and negative predictive value) was offered when either LDHP range was > or = 125 mv or TcPO2 was > or = 33 mmHg, although accuracy of either measurement at this criteria was unacceptable for more general application. We conclude that TcPO2 or LDHP will assess wound outcome with similar overall accuracy, although each test may be better for predicting a specific outcome.

Aged↗

Cutaneous circulation in Raynaud's phenomenon during emotional stress. A morphological and functional study using capillaroscopy and laser-Doppler.

In order to assess the effects of emotional stress on the cutaneous microcirculation in patients suffering from Raynaud's phenomenon (RP) a group of 18 patients with this pathology and 16 healthy control subjects underwent an "arithmetical test". The microcirculatory response was examined using a laser Doppler apparatus. The results obtained showed a constantly reduced flow during mental stress in normal subjects; in the RP group it was possible to observe: a first subgroup with a reduced flow similar to that seen in normal subjects, and a second subgroup with a paradoxically increased flow. It is likely that the normal vasoconstrictor response is the expression of the functional impairment of the microcirculation alone (primary RP), whereas vasodilatation in response to mental stress is a sign, of the organic development of the disease right from an early stage.

Female↗

Evaluation by captopril renal scintigraphy and echo-Doppler flowmetry of hypertensive patients at high risk for renal artery stenosis.

Sixty-three hypertensive patients with probability of obstructive renal artery disease underwent both Captopril renal scintigraphy (CRS) and echo-Doppler flowmetry (EDF) before undergoing renal angiography. Angiography revealed renal artery stenosis (RAS) in 42 patients (unilaterally in 26 and bilaterally in 16). The sensitivity and specificity in the identification of RAS > or = 50% were 90% and 94%, respectively for Captopril renography, and 85% and 78% for echo-Doppler flowmetry. Captopril renography correctly identified stenoses greater than 50%, which is usually held to be the limit of hemodynamic significance. While the Doppler examination was more sensitive than Captopril renography (sensitivity 79% versus 64%) in the detection of all degrees of RAS, less information on the functional significance of RAS was provided. Both CRS and EDF could be usefully employed to assess kidney perfusion, but their appropriate clinical use must take into account inherent differences between the two techniques.

Adolescent↗

[Effects of biomicrosphere on the cochlear blood flow, blood pressure and heart rate in guinea pigs].

Cochlear blood flow (CBF) in guinea pigs was measured by Laser Doppler flowmeter and biomicrosphere method. The effects of dosages of biomicrospheres and time factor on the CBF, blood pressure and heart rate were observed. The findings suggest that 9 x 10(6). 10.5 x 10(6) biomicrospheres may be most suitable for measuring CBF with biomicrosphere method, and some physiological parameters of the guinea pig must be taken down within 2-10 minutes after microsphere injection.

Animals↗

Intraoperative and postoperative monitoring of microsurgical free tissue transfers.

Numerous techniques have been described for monitoring the postoperative viability of microsurgical free tissue transfers, and their sensitivity and reliability continue to be evaluated in animal experiments and clinical trials. Relative advantages and disadvantages of these various postoperative monitoring techniques are discussed. The concept of intraoperative monitoring of the microsurgical anastomoses during closure and inset of a free flap is introduced because many free flaps may fail on the operating table, but this only becomes clinically apparent several hours later in the early postoperative period.

Animals↗

[The effects of intracoronary injection of nitroglycerin on the coronary circulation: evaluation using a Doppler catheter].

To evaluate the effects of intracoronary injection of nitroglycerin (NTG) on the coronary circulation, we measured the flow velocity of the coronary artery using a Doppler catheter. The Doppler catheter was introduced into the region proximal to the left anterior descending artery (LAD) via an 8F guide catheter positioned at the orifice of the left coronary artery. We measured the flow velocity at a point of 3 mm distal to the catheter tip. One mg (2 ml) of NTG was injected via the 8F guide catheter for 10 sec, followed by injection of 3 ml of normal saline. Then the increasing rate of the diastolic coronary flow velocity in the LAD was calculated. Five ml of iopamidol (dye) was also injected for comparison. The subjects consisted of 14 normal persons (G-N), and 12 patients with angina pectoris accompanying critical stenoses of the LAD, who had no ECG changes or no abnormalities by left ventriculography. The subjects with angina pectoris were subclassified as 90% stenoses (G-A: 5 patients), and 99% stenoses (G-B: 7 patients) in the LAD. 1. After intracoronary injection of NTG, the aortic pressure dropped to various degrees in G-N. In 7 of the normal subjects, who had less than a 20% aortic pressure drop, the increased diastolic flow velocity was more rapid than the control diastolic flow velocity 30 sec after the peak velocity.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗

[Clinical and instrumental evaluation of erectile impotence: a proposal of a diagnostic protocol].

There has been increasing interest in recent years in patients complaining of erectile dysfunction. This has prompted research and the development of diagnostic procedures aimed at allowing increasingly rapid characterization of the type of impotence involved (psychogenic or organic) and thus the most effective treatment. In this preliminary study, we present our study methodology in patients with erectile dysfunction, emphasising in particular the diagnostic procedures best suited to revealing the presence of an organic cause in the pathogenesis of impotence.

Erectile Dysfunction↗

An experimental study on direct revascularization of bronchial circulation by microvascular anastomosis.

The effects of direct revascularization of the bronchial artery after bronchoplasty were estimated by laser Doppler velocimetry and india ink injection in dogs. Bronchoplastic surgery at the right main bronchus was performed in all dogs, and the bronchial artery was reconstructed using the internal thoracic artery in the reconstruction group. The mucosal blood flow was measured at the distal side of the anastomosis. India ink was injected into the aorta in the nonreconstruction group and into the internal thoracic artery in the reconstruction group. The peripheral blood flow had diminished immediately after surgeries to 59% of the baseline value and took 14 days to recover to the baseline value in the nonreconstruction group. However, in the reconstruction group, the blood flow recovered at once to 78% of the baseline value and had returned to that value in 5 days. Statistically significant differences were noted between the groups from just after operation to day 7. India ink data confirmed these findings. In the nonreconstruction group, no ink was observed in the peripheral bronchial vessels on day 3; it was noted in part of the vessels on day 7 and in most on day 14. On the other hand, a relatively large number of vessels were stained just after operation in the reconstruction group. Thus reconstruction of the bronchial artery by means of the anastomosis with the internal thoracic artery can be said to be a useful and effective method for preventing airway ischemia.

Anastomosis, Surgical↗

[Preliminary study on the variability of the fetal cerebral velocimetry in various vessels of the Circle of Willis].

The authors have tried to analyse in a small series, the possibility as well as the variability of blood flow velocity waveforms in the different vessels of the circle of willis using colour Doppler. Fourteen patients were assessed. The 14 fetuses were of normal growth and/or had normal umbilical arterial blood flow velocity waveforms as well as normal uterine blood flow. The mean term at the time of examination was 23.8 +/- 2.9 standard deviation with the extremes going from 28.5 standard deviation to 40.5. The examinations were carried out using colour Doppler (Acuson) machine by the abdominal route with a 3.5-5 MHz bi-frequency sound. The vessels that were explored were the middle cerebral artery (CM), posterior cerebral artery (CP), the internal carotid artery (CI), the anterior cerebral artery (CA) in the region of the circle of Willis. CM and CA were able to be recorded in 100% of the cases, CP and CI in 93% of cases (13 out of 14 cases). The difference between he mean index (D/S, D = residual velocity in the diastole, S = maximum velocity in the systole) in each of these vessels was not statistically significant. In 3 out of 16 measurements (19%) the CP index was considered to be pathological while the index in the other vessels was normal, or when a different form of measurement was carried out in the region of CP, it was normal. This was also the case once for CA, but never for CM or CI.(ABSTRACT TRUNCATED AT 250 WORDS)

Artifacts↗

Adenosine triphosphate-magnesium chloride in radiation injury.

Although adenosine triphosphate-magnesium chloride (ATP-MgCl2) has demonstrated cytoprotective effects in a variety of adverse pathophysiologic conditions, its ability to alter radiation injury is unknown. The purpose of this study, therefore, was to assess the effects of ATP-MgCl2 on colorectal radiation injury after preoperative pelvic radiotherapy. Mixed-breed pigs (n = 36) received 4250 cGy preoperative external-beam pelvic radiotherapy (350 cGy fractions three times per week for 4 weeks). During radiotherapy, animals were randomly assigned to one of three treatment groups: (1) intravenous infusions of normal saline during radiotherapy, (2) intravenous ATP-MgCl2 (30 mumol/kg) during radiotherapy, or (3) intravenous ATP-MgCl2 (60 mumol/kg) during each radiotherapy session. After completion of radiotherapy and a 4-week rest period, animals underwent colorectal resection by either the two-layer hand-sewn (n = 18) or stapled end-to-end anastomosis technique (n = 18). Laser Doppler velocimetric readings were obtained to assess mural colonic blood flow after completion of anastomosis. A second laparotomy on postoperative day 5 or 11 was done to examine the following anastomotic parameters: (1) repeat laser Doppler velocimetry, (2) gross inflammatory scoring, (3) bursting pressure, (4) preoperative barium enema to identify leak or stenosis, (5) analysis of anastomotic hydroxyproline content, and (6) incidence of cutaneous injury in the radiation portals. ATP-MgCl2 administered intravenously at 60 mumol/kg led to (1) diminished colorectal seromuscular ischemia evidenced by laser Doppler velocimetric readings, (2) decreased skin and subcutaneous tissue injury in the treatment portals, (3) significantly decreased perianastomotic inflammatory reaction, and (4) increased early hydroxyproline content. There was no significant difference in the incidence of leakage or stenosis between the study groups, nor was the anastomotic bursting strength significantly different between the treatment groups. Therefore the administration of ATP-MgCl2 (60 mumol/kg) appears to offer significant cytoprotection from preoperative pelvic radiation therapy.

Adenosine Triphosphate↗

[Analysis of optic nerve head circulation in diabetics using a laser Doppler technique].

The authors measured the red blood cell speed distributions in the capillaries of the optic nerve head using a laser Doppler technique. We calculated the widths of Doppler-broadened frequency spectra of laser light scattered from temporal sites on the optic nerve head in 34 Type I diabetic patients (mean age, 29.5 years; 12 patients having no retinopathy; 22 having background retinopathy) and in 29 age- and sex-matched normal controls. Doppler broadening proportional to the red blood speed was 763 +/- 113 Hz (mean +/- SD) in the diabetics and 912 +/- 167 Hz in the controls. The difference was statistically significant. Mean blood pressure and intraocular pressure in the diabetics were not significantly different compared to controls. Our finding of abnormally low capillary blood speeds suggests that pathologic alterations occur in the microvasculature of the optic nerve head in the early stages of diabetic retinopathy.

Adult↗

Hypertrophic scar: an interruption in the remodeling of repair--a laser Doppler blood flow study.

Soft-tissue dermal loss does not regenerate; instead, it is replaced with scar. The extent of scarring is directly related to the severity of tissue loss (in terms of volume and depth). Commonly, an acute dermal loss will heal with excessive scar, hypertrophic scar. A hypertrophic scar is elevated but is contained within the boundaries of the initial injury. Hypertrophic scars have a reddish appearance, indicating an elevated local circulation. A laser Doppler blood flow monitor was employed to measure blood flow changes in healed wounds. It was speculated that local circulation in a developing hypertrophic scar would be elevated. Patients with recently healed wound sites were monitored and exhibited an average blood flow reading of 365 +/- 325 mV (n = 131). This average value, ranging from 98 to 1450 mV, was 18 times greater than the average reading from normal skin, which was 43 +/- 13 mV (n = 212). Blood flow declined to 32 +/- 21 mV (n = 7) at 16 to 18 weeks (74 percent of normal skin values) in healed wounds that developed normal scar. However, a closed wound that developed into a hypertrophic scar had a blood flow reading of 148 +/- 78 mV (n = 59) at 16 to 18 weeks. This value was three times greater than in normal skin and four times greater than in normal scar. At 38 to 50 weeks postinjury, hypertrophic scar remained elevated (102 +/- 34 mV; n = 10). Hypertrophic scars sustain an elevated blood flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Effects of the Berlin Heart biventricular assist device on microvascular responses in pre-transplant patients.

Microcirculatory forearm cutaneous blood flow was monitored continuously and noninvasively by laser doppler flow-metry (LDF) in 15 patients treated with the Berlin Heart biventricular assist device system (BVAD) for end-stage heart failure under stable hemodynamic states (BVAD pts, n = 10) and norepinephrine therapy (BVAD nor pts, n = 5). Ten healthy human subjects served as controls (C). Cutaneous blood flow was measured before, during, and after external brachial artery occlusion to evaluate the post-occlusive reactive hyperemia (PORH) as a standardized response. To examine microvascular responses to macrohemodynamic changes, the cardiac output (CO) was decreased by a 20% reduction in BVAD pump rate. No significant differences in baseline LDF measurements (in millivolts) were observed among the three groups (C, 470.7 mV +/- 177.3; BVAD pts, 328.0 mV +/- 122.7; BVAD nor pts, 360.0 mV +/- 160.0). After cuff pressure release (1 min later), a significant (p < 0.004) three-fold to four-fold blood flow increase (PORH) occurred in each group (C, 1113.6 mV +/- 469.2; BVAD pts, 813.0 mV +/- 190.1; BVAD nor pts, 498.0 mV +/- 191.8). The difference in PORH between the BVAD pts and BVAD nor pts was significant (p < 0.01), and the time to peak PORH values was different (p < 0.05) among the three groups (C, 22.2 s +/- 10.7; BVAD pts, 11.3 s +/- 12.5; BVAD nor pts, 7.0 s +/- 5.8). A markedly delayed return to baseline occurred in the BVAD pts. The 20% reduction in BVAD pump rate decreased CO significantly (p < 0.05) and increased (p < 0.01) systemic vascular resistance (SVR).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗