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At least 19 recordsLinked to original sources

PubMed2002

The hemodynamically unstable patient in the intensive care unit: hemodynamic vs. transesophageal echocardiographic monitoring.

OBJECTIVE: Transesophageal echocardiography is a diagnostic and monitoring modality. The objectives of our study were to compare the diagnoses obtained with continuous transesophageal echocardiography and hemodynamic monitoring in the intensive care unit, to determine interobserver variability of diagnosis obtained with both modalities, and to evaluate its impact. DESIGN: Prospective cohort study. SETTING: Surgical intensive care unit. PATIENTS: Consecutive hemodynamically unstable patients after cardiac surgery. INTERVENTIONS: At admission, unstable patients were monitored during 4 hrs with transesophageal echocardiography and standard hemodynamic monitoring. The critical care physician evaluated the patients based on all information except the transesophageal echocardiography at 0, 2, and 4 hrs and formulated a hypothesis on the most likely cause of hemodynamic instability. Transesophageal echocardiography information was provided after each evaluation. To evaluate interobserver variability, all the hemodynamic and echocardiographic information was gathered, randomized, and evaluated by five clinicians for the hemodynamic data and five echocardiographers for the transesophageal echocardiography data. The evaluators were blinded to all other information. Kappa statistics were used to evaluate agreement. Impact of transesophageal echocardiography was assessed retrospectively by using the Deutsch scale. RESULTS: Twenty patients qualified for the study. The agreement between the hemodynamic and echocardiographic diagnosis showed a kappa at admission, 2 hrs, and 4 hrs of 0.33, 0.47, and 0.28. The interobserver agreement for the initial diagnosis (p =.014) and between all evaluators (p <.001) was significantly higher in the echocardiographic compared with the hemodynamic group. The transesophageal echocardiographic information was considered retrospectively to be essential in 34% and valuable in 34% of cases. CONCLUSIONS: These observations support the belief that transesophageal echocardiographic monitoring in the intensive care unit is associated with higher interobserver agreement in diagnosing and excluding significant causes of hemodynamic instability for postoperative cardiac surgical patients.

Adult↗

PubMed2003

Central hemodynamic responses during serial exercise tests in heart failure patients using implantable hemodynamic monitors.

INTRODUCTION: Exercise testing is commonly used in patients with congestive heart failure for diagnostic and prognostic purposes. Such testing may be even more valuable if invasive hemodynamics are acquired. However, this will make the test more complex and expensive and only provides information from isolated moments. We studied serial exercise tests in heart failure patients with implanted hemodynamic monitors allowing recording of central hemodynamics. METHODS: Twenty-one NYHA Class II-III heart failure patients underwent maximal exercise tests and submaximal bike or 6-min hall walk tests to quantify their hemodynamic responses and to study the feasibility of conducting exercise tests in patients with such devices. RESULTS: Patients were followed for 2-3 years with serial exercise tests. During maximal tests (n=70), heart rate increased by 52+/-19 bpm while S(v)O(2) decreased by 35+/-10% saturation units. RV systolic and diastolic pressure increased 29+/-11 and 11+/-6 mmHg, respectively, while pulmonary artery diastolic pressure increased 21+/-8 mmHg. Submaximal bike (n=196) and hall walk tests (n=172) resulted in S(v)O(2) changes of 80 and 91% of the maximal tests, while RV pressures ranged from 72 to 79% of maximal responses. CONCLUSIONS: An added potential value of implantable hemodynamic monitors in heart failure patients may be to quantitatively determine the true hemodynamic profile during standard non-invasive clinical exercise tests and to compare that to hemodynamic effects of regular exercise during daily living. It would be of interest to study whether such information could improve the ability to predict changes in a patient's clinical condition and to improve tailoring patient management.

Adult↗

PubMed1998

Engineering analysis of penile hemodynamic and structural-dynamic relationships: Part III--Clinical considerations of penile hemodynamic and rigidity erectile responses.

PURPOSE: The extent to which hemodynamic erectile responses predict penile buckling forces has not previously been analytically investigated. An engineering study was performed to compare hemodynamic data with penile buckling force values. METHODS: Dynamic infusion pharmacocavernosometry studies in 21 impotent patients (age 43, range 24-62 y) were accomplished to obtain information during penile erection concerning hemodynamic values, penile buckling forces and their determinants: intracavernosal pressure, erectile tissue mechanical properties and penile geometry. RESULTS: In the 21 patients, discrepancies existed in several patients who demonstrated normal hemodynamic values (low flow-to-maintain and high equilibrium intracavernosal pressures) but elevated cavernosal compliance values and diminished penile buckling forces. There was poor correlation between cavernosal compliance and equilibrium intracavernosal pressure (r = -0.36); better correlation between compliance and expandability (r = -0.72) and best correlation between dimensionless compliance and the dimensionless product of expandability with equilibrium pressure (r = -0.88). These data implied that cavernosal compliance was dependent on multiple factors, not only equilibrium intracavernosal pressure. CONCLUSIONS: Hemodynamic indices which correlate with intracavernosal pressure alone do not predict penile buckling forces since the latter are dependent not only on intracavernosal pressure but also on penile geometry and erectile tissue properties. The most relevant tissue property in predicting adequate penile buckling forces is cavernosal expandability. A new impotence classification system and diagnostic algorithm based on the determinants of penile rigidity and not exclusively on hemodynamic responses in proposed.

Adult↗

PubMed1987

The effect of hemodynamically significant carotid artery disease on the hemodynamic status of the cerebral circulation.

Although the presence of a hemodynamically significant carotid artery lesion is commonly used as an indicator of impaired cerebral circulation, the effect of such lesions on cerebral perfusion pressure and cerebral blood flow has never been determined accurately. We used positron emission tomography (PET) to study 19 patients with unilateral hemodynamically significant carotid artery disease (greater than 66% diameter reduction) and no evidence of cerebral infarction. According to PET measurements in the cerebral hemisphere distal to the lesion, 7 patients had normal cerebral hemodynamics, 8 had reduced perfusion pressure with normal blood flow, and 4 had reduced blood flow. Neither the percent stenosis nor the residual lumen diameter in the carotid artery was a reliable indicator of the hemodynamic status of the cerebral circulation. However, a significant relationship was found between the PET measurements of cerebral hemodynamics and the arteriographic circulation pattern (p = 0.006). The role of hemodynamic factors in the pathogenesis and treatment of cerebrovascular disease cannot be determined from the severity of carotid artery disease alone.

Aged↗

PubMed1988

N-allylnormetazocine: hemodynamic actions and inhibition of leucine-enkephalin hemodynamic activity in conscious dogs.

The hemodynamic actions of dl-, d-, and l-N-allylnormetazocine (NANM) were examined. dl-NANM significantly increased heart rate and systemic arterial pressure in a dose-dependent manner. Naloxone (1 mg/kg) inhibited the hemodynamic actions of 0.5 mg/kg dl-NANM. At a dose of 0.25 mg/kg, l-NANM, but not d-NANM, significantly increased heart rate and mean arterial pressure. The effects of l-NANM were blocked by naloxone but not by naloxone-methylbromide, indicating that the opiate effects are mediated by receptors located in the central nervous system. At a higher dose (0.5 mg/kg), d-NANM consistently produced small increases in heart rate and blood pressure which were statistically significant. The hemodynamic actions of Leu-enkephalin were inhibited by pretreatment with dl-NANM and l-NANM but not d-NANM. These results indicate that NANM has opiate hemodynamic activity which resides with the levorotary isomer. Dextrorotary isomer activity is nonopiate or possibly nonspecific. Furthermore, there appears to be a inhibitory interaction between NANM-opiate and enkephalin hemodynamic actions. This suggests that NANM-opiate receptors may be involved in modulation of the hemodynamic response to circulating enkephalins.

Animals↗

PubMed2003

Timing of hemodynamic pressure measurements on derived hemodynamic parameters.

The purpose of this study was to examine the difference between hemodynamic pressures and parameters obtained pre- compared to post-thermodilution CO measurements. A repeated measures within subject design was conducted with a cardiac surgical cohort. Three measures of hemodynamic pressures and parameters were determined pre- and post-CO measurements (Set 1) and repeated in 30 minutes (Set 2). The sequence was duplicated in four hours (Sets 3 and 4). Hemodynamic pressures lower pre-CO were PAS at Sets 1 and 3, and SBP, DBP, and MAP at Set 3. Hemodynamic parameters lower pre-CO were PVRI at Set 1 and SVRI at Set 3. These pre-post CO differences did not vary by greater than 10%. As the CO injectate volume had minimal effect, hemodynamic pressures may be obtained pre- or post-CO to derive hemodynamic parameters.

Adult↗

PubMed2002

[Application of methods for hemodynamic monitoring in critical cardiac pathology (an experimental model for assessment of hemodynamics)].

Hemodynamic assessment of critically compromised patients with cardiac pathology is one of the goals of recent diagnostics and treatment strategies. Different methods for assessment of hemodynamics are applied in clinical practice. However, applied methods (invasive and noninvasive) have specific advantages and disadvantages. These are discussed in the article. First experience of experimental model for assessment of hemodynamics in laboratory conditions is analyzed in the article. In the year 2002 it was explored a possibility to use standard procedure to evaluate hemodynamics for laboratory animals in Kaunas University of Medicine. It were selected 6 laboratory animals of different weight and sex. 7 measurements of hemodynamics were performed. Standard methodics was successfully applied in the experimental model. Results, method limitations and recommendations for further studies are presented in the article.

Animals↗

PubMed1987

Hemodynamic evaluation of isosorbide dinitrate in alcoholic cirrhosis. Pharmacokinetic-hemodynamic interactions.

Isosorbide dinitrate, a long-acting organic nitrate, has been shown to decrease portal pressure in the experimental animal and humans. We conducted a double-blind randomized hemodynamic evaluation of the effects of placebo and 10 mg and 20 mg isosorbide dinitrate in stable individuals with alcoholic cirrhosis. Baseline values for all three groups were similar. Isosorbide dinitrate resulted in a peak reduction of the hepatic venous gradient of 24.7% +/- 3.0%, with significantly decreased values 4 h after the administration of the 20-mg dose. A reduction of arterial pressure and cardiac index (peak decrease of 25.7% +/- 1.5%) was well tolerated by 13 of 15 patients. Changes in mean arterial pressure were not predictive of modifications in the hepatic vein wedge pressure. There was no relation between the area under the plasma isosorbide dinitrate concentration curve and hemodynamic changes. Levels of isosorbide-5-mononitrate, a vasoactive metabolite, were detectable for an 8-h period. Isosorbide dinitrate significantly reduced portal pressure in stable cirrhotics, in association with systemic hemodynamic changes. Thus, titration of isosorbide dinitrate is required to maximize hemodynamic benefits in individual patients. As the decrease in portal pressure is more predictable than the effect of previously tested pharmacologic agents, isosorbide dinitrate should be evaluated for its efficacy in the management of portal hypertension.

Blood Pressure↗

PubMed1989

Overview of hemodynamic and non-hemodynamic factors associated with left ventricular hypertrophy.

The role of the heart in hypertension has finally emerged as a major issue of cardiovascular concern by the clinician, physiologist, pharmacologist, biochemist, and molecular biologist. This discussion provides an overview of the present state of knowledge and current areas of investigation in this active area of broad interest. Generally, these relate to: the active participation of the heart (e.g. hemodynamic, humoral, autocrine/paracrine); the adaptive response of the heart (i.e. hemodynamic); non-hemodynamic relationships (vis-a-vis, age, race, gender, humoral, coexistent disease); and current thoughts on mechanisms of so-called regression of left ventricular hypertrophy. Several antihypertensive classes of compounds are characterized by decreasing cardiac mass and left ventricular wall thicknesses. The angiotensin converting enzyme inhibitors are included among these agents; their physiological effects in producing "regression" are under active study as are the mechanisms responsible for these changes. These concerns are no longer of incidental or theoretical interest but have major impact on selection of antihypertensive therapy and the management of the patient with hypertension. Thus, the heart may participate actively in the pathogenesis and maintenance of the disease; it adapts to the vascular disease hemodynamically; but in this regard the response has both positive beneficial concerns as well as negative implications as an independent risk factor. These latter concerns should be explored in great depth before conclusions are made with respect to the long-term implications of antihypertensive therapy on the heart.

Antihypertensive Agents↗

PubMed1995

Mechanism of hemodynamic improvement by dual-chamber pacing for severe left ventricular dysfunction: an acute Doppler and catheterization hemodynamic study.

OBJECTIVES: This study was undertaken to determine the mechanism by which improvement in hemodynamic variables may occur with dual-chamber pacing in patients with severe left ventricular dysfunction. BACKGROUND: Dual-chamber pacing has recently been proposed as a therapeutic alternative for the relief of symptoms in patients with dilated cardiomyopathy. METHODS: Fifteen patients with severe left ventricular systolic dysfunction were studied acutely during atrioventricular (AV) sequential pacing at various AV intervals (60, 100, 120, 140, 180 and 240 ms) with use of combined Doppler velocity curves and pressures obtained by high fidelity manometer-tipped catheters and thermodilution cardiac output. RESULTS: Neither cardiac output nor mean left atrial pressure was significantly different when hemodynamic variables in the baseline state were compared with those during AV sequential pacing at the various AV intervals in all patients. The patients were classified into two groups. In group I (eight patients with PR intervals > 200 ms on the rest 12-lead electrocardiogram), cardiac output was significantly increased when AV sequential pacing at the optimal AV interval to output was compared with that at the baseline state (3.0 +/- 1.0 vs. 3.9 +/- 0.43 liters/min, p = 0.005) because timing of mechanical atrial and ventricular synchrony was optimized. In addition, left ventricular end-diastolic pressure and duration of diastolic filling were increased, and diastolic mitral regurgitation was abolished. In group II (seven patients who had normal AV conduction at rest), cardiac output during AV pacing decreased from the baseline value without change in the diastolic filling period. CONCLUSIONS: Dual-chamber pacing may improve acute hemodynamic variables in selected patients with dilated cardiomyopathy, mainly by optimization of the timing of mechanical atrial and ventricular synchrony. Reestablishment of the optimal diastolic filling period and abolition of diastolic mitral regurgitation may also contribute to hemodynamic improvement.

Aged↗

PubMed1999

The hemodynamic effects of long-term ACE inhibition with fosinopril in patients with heart failure. Fosinopril Hemodynamics Study Group.

The objective of this study was to evaluate the hemodynamic and clinical effects of fosinopril in patients with heart failure. This was a prospective, multicenter, double-blind, randomized, parallel-group study. Patients 18 to 80 years of age who were receiving diuretics with a systolic blood pressure (SBP) > or = 90 mm Hg, New York Heart Association (NYHA) functional class II-IV, left ventricular ejection fraction < or = 40%, pulmonary capillary wedge pressure (PCWP) > or = 18 mm Hg, and a cardiac index (CI) < or = 2.6 L/min/m(2) were eligible. A total of 179 patients were randomized to a single, double-blind oral dose of placebo or fosinopril at 1, 20, or 40 mg, and hemodynamic monitoring was performed for 24 hours postdose; 155 patients with SBP > or = 90 mm Hg were re-randomized to 10 weeks of double-blind fosinopril at 1, 20, or 40 mg once daily. Hemodynamic monitoring was repeated at the last visit, beginning at 24 hours postdose (trough) and continuing for 12 hours thereafter. Significant decreases in preload (PCWP) and afterload (mean arterial blood pressure [MABP] and systemic vascular resistance [SVR]) were evident 3 to 4 hours after a single dose of fosinopril at 20 and 40 mg and continuing for up to 8 to 12 hours postdose for PCWP and SVR and for up to 24 hours postdose for MABP (P < or = .05 v placebo and baseline). Sustained decreases in PCWP, MABP, SVR, and heart rate and increases in CI and stroke volume index were observed after 10 weeks of treatment with fosinopril at 20 and 40 mg once daily (P < or = .05 v 1 mg group for PCWP and MABP at most time points and P < or = .05 v baseline for other parameters at most time points). Dose-related trends toward reduced supplemental diuretic use (P = .027) and reduced symptoms of dyspnea (P = .008) were observed with the 20-mg and 40-mg fosinopril dose groups. Once daily administration of fosinopril at 20 and 40 mg was safe and well tolerated, provided a sustained beneficial hemodynamic effect, improved left ventricular performance, and reduced symptoms of dyspnea, resulting in a reduced need for supplemental diuretic therapy.

Adult↗

PubMed1995

Application of transcranial Doppler sonography to evaluate cerebral hemodynamics in carotid artery disease. Comparative analysis of different hemodynamic variables.

BACKGROUND AND PURPOSE: Transcranial Doppler sonography in combination with manipulation of cerebral resistance vessels is widely used to screen patients with suspected intracranial hemodynamic disturbances. Maximal flow velocity (Vmax), mean flow velocity (Vmean), cerebral pulsatility index (CPi), and cerebral resistance index (CRi) have all been used to describe cerebral hemodynamics. The present study examined CO2 reactivity of the above hemodynamic variables with respect to its variability between different age groups and its capability to discriminate between normal and abnormal findings. METHODS: Absolute and relative CO2 reactivity of Vmax, Vmean, CRi, and CPi were determined in both hemispheres in 30 young and 37 elderly control subjects and in 245 consecutive patients with strictly unilateral symptomatic (n = 101) or asymptomatic (n = 144) carotid artery disease (> 80% stenosis or occlusion). RESULTS: Hemispheric reactivities of Vmean, CRi, and CPi were significantly age dependent. Hemispheric Vmax reactivity and interhemispheric differences of individual reactivities (except absolute CPi reactivity) did not vary with age and could therefore be used to define normal values. Patient classification according to these values revealed different frequencies of subjects with pathological findings (3% for hemispheric Vmax reactivity, 5% to 7% for interhemispheric differences of Vmax or Vmean reactivity, 39% and 45% for interhemispheric differences of relative CRi and CPi reactivity, respectively). CONCLUSIONS: Hemispheric reactivities are less suitable to evaluate cerebral hemodynamics than interhemispheric differences, since most of the latter do not vary with age. However, interhemispheric differences vary with respect to their discriminatory power. Power is low for interhemispheric differences of Vmax and Vmean reactivity, since the corresponding frequencies of abnormal findings do not differ from the 5% frequency expected in the reference population (reference range defined as mean +/- 2 SD). With respect to the discriminatory power, interhemispheric differences of relative CRi and CPi reactivity may be superior to other parameters.

Adult↗

PubMed1992

Hemodynamic observations following orthotopic cardiac transplantation: hemodynamic responses to upright exercise at 1 year.

Central hemodynamic responses during upright exercise were studied at 1 year in 40 orthotopic cardiac transplant recipients. Hemodynamic responses were characterized by slow rise in heart rate and blunted peak exercise heart rate response, a significant early increase in stroke index followed by a plateau phase, and a steady increase in ventricular filling pressures and pulmonary artery pressure. In spite of exclusive utilization of the Frank-Starling mechanism to augment cardiac output during early exercise, the pressure responses were comparable to those reported in normal subjects. Our observations also indicate that similarly to normal subjects, the heart rate response plays an important role in the cardiac output achieved at maximum exercise. Although patients with younger donor hearts achieved a more favorable maximum heart rate, the other hemodynamic parameters showed no correlation with the donor heart age. Thus, no hemodynamic disadvantage of older donor hearts could be demonstrated. These data provide further enlightenment regarding the mechanisms of the well-preserved functional capacity noted in these patients.

Adult↗

PubMed1998

Systemic hemodynamic, neurohormonal, and renal effects of a steady-state infusion of human brain natriuretic peptide in patients with hemodynamically decompensated heart failure.

BACKGROUND: Human brain natriuretic peptide (hBNP) is a promising agent for the treatment of decompensated cardiac failure. However, the systemic hemodynamic, neurohormonal, and renal effects of hBNP have been incompletely studied in human heart failure. METHODS AND RESULTS: The effects of a continuous 4-hour infusion of hBNP were determined in 16 decompensated heart failure patients in an invasive, randomized, double-blind, placebo-controlled study. Patients were evaluated during three 4-hour study periods: baseline, treatment (placebo [n = 4] versus hBNP 0.025 or 0.05 microgram/kg/min [n = 12]), and post-treatment. Urinary volume losses were replaced hourly to separate the vasodilatory and diuretic effects of hBNP. Two patients in the hBNP group were excluded from the analysis because of adverse events. hBNP significantly (P < .001) reduced right atrial pressure and pulmonary capillary wedge pressure by approximately 30% and 40%, respectively. hBNP also significantly lowered systemic vascular resistance from 1722 +/- 139 to 1101 +/- 83 dynes.s.cm-5 (P < .05). These unloading effects of hBNP produced a 28% increase in cardiac index (P < .05) with no change in heart rate. Compared to placebo, hBNP decreased plasma norepinephrine and aldosterone. Renal hemodynamics were unaffected by hBNP; however, most patients were resistant to its natriuretic effect. CONCLUSIONS: 1) The predominant hemodynamic effects of hBNP were a decrease in cardiac preload and systemic vascular resistance. 2) hBNP also improved cardiac output without increasing heart rate. 3) Plasma norepinephrine and aldosterone levels decreased during hBNP infusion. 4) hBNP is pharmacologically active and has potential in the therapy for decompensated heart failure.

Adult↗

PubMed1997

Hemodynamic performance of the St. Jude Medical Hemodynamic Plus valve.

The hemodynamic performance of the St. Jude Medical Hemodynamic Plus valve (HP) for a small aortic annulus was compared to that of the standard St. Jude Medical valve (SJM). Doppler echocardiographic parameters were evaluated in patients undergoing aortic valve replacement with either a 19 mm HP (HP19, n = 7), a 21 mm HP (HP21, n = 8), a 19 mm SJM (SJM19, n = 16), or a 21 mm SJM (SJM21, n = 34). The peak and mean pressure gradients and peak flow velocity were significantly (p < 0.05) lower in both patients with the HP21 and those with the HP19 than patients with the SJM21 and those with the SJM19, respectively. The echocardiographic parameters of the patients with the HP19 corresponded closely to those of patients with the SJM21. The left ventricular mass index regressed markedly in patients with the HP19 during the late postoperative period. The results suggested that the hemodynamic performances of certain sizes of the HP were superior to those of the same size SJMs and were considered to be equivalent to those of the next size larger SJM.

Adolescent↗

PubMed1995

Losartan in heart failure. Hemodynamic effects and tolerability. Losartan Hemodynamic Study Group.

BACKGROUND: The aim of the present study was to assess the short- and long-term effects of multiple doses of the angiotensin II receptor antagonist losartan in heart failure. METHODS AND RESULTS: A multicenter, placebo-controlled, oral, multidose (2.5, 10, 25, and 50 mg losartan once daily) double-blind comparison in patients with symptomatic heart failure and impaired left ventricular function (ejection fraction < 40%). Invasive 24-hour hemodynamic assessment was performed after the first dose and after 12 weeks of treatment. Clinical status and tolerability of treatment with losartan over the 12-week period were also evaluated. One hundred fifty-four patients were enrolled, of which 134 met the protocol criterion of baseline pulmonary capillary wedge pressure > or = 13 mm Hg. During short-term administration, systemic vascular resistance (SVR) (largest reduction against placebo of 197 dyne.s-1.cm-5 at 4 hours) and blood pressure fell significantly with 50 mg, lesser decreases were seen with 25 mg, and no discernible effects were seen with 2.5 and 10 mg. After 12 weeks of treatment, similar effects were seen on SVR and blood pressure (maximal fall in SVR against placebo, 318 dyne.s-1.cm-5 at 5 hours with 50 mg). In addition, pulmonary capillary wedge pressure fell with 2.5, 25, and 50 mg (largest reduction against placebo of 6.3 mm Hg at 6 hours with 50 mg), cardiac index rose with 25 and 50 mg, and heart rate was lower with all active treatment groups. Active treatment was well tolerated, and excess cough was not reported. CONCLUSIONS: This study showed that oral losartan administered to patients with symptomatic heart failure resulted in beneficial hemodynamic effects with short-term administration, with additional beneficial hemodynamic effects seen after 12 weeks of therapy. Clear effects were seen with both 25 and 50 mg, with the greatest effect seen with 50 mg.

Aged↗

PubMed2003

Continuous cardiac output and hemodynamic monitoring: high temporal correlation between plasma TNF-alpha and hemodynamic changes during a sepsis-like state in cancer immunotherapy.

Through continuous cardiac output monitoring, we investigated the temporal relationship between hemodynamic changes and plasma cytokines in a cancer patient who developed collateral sepsis to immunotherapy. A 52-year-old male with metastatic renal cell carcinoma received interleukin-2 (IL-2) infusion completing 72 h of administration. The patient developed 3 sepsis-like states including systemic inflammatory response syndrome (SIRS), shock, and multiple organ dysfunction syndrome (MODS). Hemodynamic parameters including systemic vascular resistance index (SVRI), left ventricular stroke work index (LVSWI) and cardiac index (CI) were measured over 60 h. Peripheral blood was drawn when SVRI dropped 20% in the patient and plasma cytokines including TNF-alpha, IL-6 and IL-1beta were measured using ELISA. After 60 h of immunotherapy, the patient showed a 63.4% decrease in SVRI, 54.5% decrease in LVSWI and 65.4% increase in CI. The evaluation of systemic cytokines revealed different kinetic patterns: (i) a sustained increase in TNF-alpha levels through all 3 sepsis-like states; (ii) IL-6 increased preferentially during SIRS and shock, while up/down-responses were found during MODS; (iii) IL-1beta was undetectable during the entire study period. A high temporal relationship between hemodynamic changes and plasma TNF-alpha, but not IL-6, was found. Although there are factors other than cytokines that can alter vascular resistance, this finding could represent an approach to evaluate the course of hemodynamia and probably the systemic cytokine expression after IL-2 administration in renal cancer.

Antineoplastic Agents↗

PubMed1991

[Tumor hemodynamics in hepatic nodules associated with liver cirrhosis: relationship between cancer progression and tumor hemodynamic change].

Tumor hemodynamics including arterial vascularity (AV) and portal perfusion (PP) were evaluated in histologically confirmed 55 hepatic nodules associated with cirrhosis using ultrasonographic (US) angiography during intraarterial carbon dioxide microbubbles injection and CT during arterial portography. Tumor hemodynamic patterns were classified into 6 types as follows: Type I (n = 10): PP (+), AV (hypo); Type I' (n = 2): PP (+), AV (iso); Type II (n = 5): PP (-), AV (hypo); Type III (n = 8): PP (-), AV (iso); Type IV (n = 25): PP (-), AV (hyper), Type V (n = 5): PP (partially +), AV (vascular spot in hypovascular). Eight nodules of Type I were diagnosed as benign nodules histologically including adenomatous hyperplasia (AH) (n = 6) and regenerative nodule (n = 2). Hundred percent (5/5) of Type II and 88% (7/8) of Type III nodules were well-differentiated HCC, in contrast to 8% (2/25) of Type IV nodules, typical HCCs. Fatty metamorphosis was observed in 75% (6/8) of Type III nodules, in contrast to 16% (4/25) of typical (classical) HCC nodules (Type IV). We concluded that at the malignant transformation from AH to HCC, reduction of portal blood flow in the nodule precedes the initiation of the increase of the arterial tumor vessel. Moreover, early stage HCC could exhibit hypovascular (Type I, II), isovascular (Type III), or vascular spot in hypovascular pattern (Type V) compared with a typical HCC (Type IV). It was also suggested that the more mature as a neoplasms the HCC becomes, the more the arterial tumor vessel in the nodule increases and fatty metamorphosis of well-differentiated HCC is highly related with tumor hemodynamic condition, i.e., hypoperfusion state from both arterial and portal vessel.

Carcinoma, Hepatocellular↗