Oscillography and Digital Pulse Plethysmography in Occlusive Disease of the Subclavian Artery and the Brachiocephalic Trunk: A Pre-And Postoperative Study

Patients with occlusive disease of the subclavian artery or brachiocephalic trunk were examined by oscillography (17 cases) and digital pulse plethysmography (19 cases) before and after reconstruction of the occluded vessel. Before surgery the oscillographic amplitudes were significantly lower on the occluded than the contralateral arm, with no difference between the registration levels. Shape analysis of the digital pulse curve recordings gave significant differences in all variables, between the occluded and the contralateral arm, inclination time and RAMP₂₅ being most sensitive. Identical studies repeated up to 6 months after surgery demonstrated a marked increase in oscillometric amplitudes at all levels on the operated side. in the digital pulse-curve recordings the greatest improvement was found in inclination time and RAMP₂₅.     

Carotid Duplex with Contralateral Disease: The Influence of Vertebral Artery Blood Flow

t -tests were used to assess significant changes within groups and independent t-tests were used to compare changes between groups. Sixty-seven patients had a normal VAS and 43 patients had an abnormal VAS. Patients with an abnormal VAS had significantly greater decreases in EDV after contralateral CEA. In the abnormal VAS group, there was a higher incidence (23.2% vs. 16.4%) of ipsilateral overestimation of stenosis by duplex and a greater incidence (20.9% vs. 10.4%) of postoperative decrease in stenosis following contralateral CEA than in the normal VAS group. Patients who underwent CEA for severe stenosis versus moderate stenosis had significant postoperative decreases in ipsilateral PSV, EDV, and ICA/CCA ratio. Severe contralateral stenosis patients with an abnormal VAS had a significant decrease in EDV compared to patients with a normal VAS. Vertebral artery blood flow contributes significantly to the ``hemodynamic effect' of carotid disease identified by duplex.     

Regional Cerebral Blood Flow and Vertebral Angiography at Rest and in Connection with Arm Work in Patients with the “Subclavian Steal Phenomenon”

Vascular anatomy and haemodynamics of the vertebro-basilar system were investigated by means of vertebral angiography as well as rCBF measurements using the ¹³³Xenon clearance method in 12 patients with occlusive disease of the subclavian artery. Prior to the investigation, the occlusive lesions had been demonstrated by aortocervical angiography, which in 9 out of 12 patients showed reversed vertebral blood flow at rest. All selective vertebral angiographies and rCBF measurements were performed at rest and in connection with graded arm exercise. Patients with the subclavian steal phenomenon were found to have a slightly reduced rCBF. After arm exercise, the intracranial flow velocity of contrast medium in the cerebral vessels remained unchanged, while the velocity of the reversed flow of contrast medium in the vertebral artery was increased. Regional cerebral blood flow in the vertebro-basilar system increased during arm exercise, the average increase being about 16%. The augmentation of flow is probably due to activation of neuronal processes within the brain. The magnitude of these flow alterations in healthy individuals is unknown.     

Improvement of Microcirculatory Blood Flow under Epidural Spinal Cord Stimulation in Patients with Nonreconstructible Peripheral Arterial Occlusive Disease

Abstract: Epidural spinal cord stimulation (ESCS) has been suggested as a method to improve microcirculatory blood flow and to reduce the amputation rate in vascular patients. We studied the effects of ESCS on microcirculatory blood flow in 237 patients with nonreconstructible peripheral arterial occlusive disease. Clinical status was classified as Fontaine Stage 3 (ischemic rest pain) in 169 patients and as Fontaine Stage 4 (ulcers/gangrene) in 68 patients. After a mean follow-up period of 31.2 months, major pain relief (<75%) was noticed in patients who retained their limbs. Sixty-four patients underwent major amputation despite ESCS. Clinical improvement was confirmed by the increase in transcutaneous oxygen (TcPo₂).     

Effects of Respiratory Alkalosis and Acidosis on Myocardial Blood Flow and Metabolism in Patients with Coronary Artery Disease

Background: Variation of the arterial carbon dioxide partial pressure (PaCO2) is not uncommon in anesthetic practice. However, little is known about the myocardial consequences of respiratory alkalosis and acidosis, particularly in patients with coronary artery disease. The aim of the current study was to investigate the effects of variation in PaCO (2) on myocardial blood flow (MBF), metabolism, and systemic hemodynamics in patients before elective coronary artery bypass graft surgery.

Methods: In 10 male anesthetized patients, measurements of MBF, myocardial contractility, metabolism, and systemic hemodynamics were made in a randomized sequence at PaCO2 levels of 30, 40, and 50 mmHg, respectively. The MBF was measured using the Kety-Schmidt technique with argon as a tracer. End-diastolic left ventricular pressure and the maximal increase of left ventricular pressure were assessed using a manometer-tipped catheter.

Results: The cardiac index significantly changed with varying PaCO (2) levels (hypocapnia, - 9%; hypercapnia, 13%). This reaction was associated with inverse changes in systemic vascular resistance index levels. The MBF significantly increased by 15% during hypercapnia, whereas no change was found during hypocapnia. Myocardial oxygen and glucose uptake and the maximal increase of left ventricular pressure were not affected by varying Pa (CO)2 levels.     

Timed Loaded Standing: A Measure of Combined Trunk and Arm Endurance Suitable for People with Vertebral Osteoporosis

Chronic back tiredness or fatigue is a common complaint of people who have a history of osteoporotic vertebral fracture. Trunk muscle endurance has not been studied in people with vertebral osteoporosis, partly due to the lack of assessment tools. We developed a measure of combined trunk and arm endurance suitable for people with vertebral osteoporosis, timed loaded standing (TLS). TLS measures the time a person can stand while holding a two-pound dumbbell in each hand with the arms at 90° of shoulder flexion and the elbows extended. Intraclass correlation coefficients (ICCs) for same day inter-trial and six to ten day test-retest reliability were 0.89 (lower bound 95% confidence interval [LB 95% CI] 0.79) and 0.84 (LB 95% CI 0.68), respectively, in a sample of 21 older women with no known osteoporosis. In 127 women with vertebral fractures, the ICC for same day inter-trial reliability was 0.81 (LB 95% CI 0.75). In a sub-sample of 30 of these women with vertebral fractures, the six to ten day test-retest reliability was 0.85 (LB 95% CI 0.75). Moderately strong and statistically significant (p≤0.05) correlations were found between TLS and sixteen of eighteen measures of physical impairment and function. Functional reach distance, gait velocity, MOS-36 Physical Function Subscale, shoulder flexion strength, and six minute walk distance were most strongly associated with TLS time. Women with vertebral fractures who endorsed having back tiredness when standing and working with the arms in front of the body, sitting to rest because of back tiredness or pain, and planning rest periods because of back tiredness or pain had significantly lower TLS times. TLS is a simple, safe physical performance measure of combined trunk and arm endurance that demonstrates acceptable reliability (inter-trial and test- retest) and concurrent validity. Received: 27 October 1999 / Accepted: 4 April 2000     

The Effects of Near-Infrared Spectroscopy on the Neurocognitive Functions in the Patients Undergoing Coronary Artery Bypass Grafting with Asymptomatic Carotid Artery Disease: A Randomized Prospective Study

Purpose: The purpose of this study was to research the use of near-infrared spectroscopy (NIRS) on the neurocognitive functions in the patients undergoing coronary artery bypass grafting (CABG) with asymptomatic carotid artery disease.Methods: The study design was carried out with the participation of 79 patients in a prospective, randomized and double blind control method. The patients were separated into two groups as NIRS (n = 43) and no NIRS (n = 36). A neurocognitive test was applied preoperatively and postoperatively to all patients before discharge. Cognitive functions were evaluated by applying the Montreal Cognitive Assessment test (MoCA).Results: The decrease in the postoperative score of mean MoCA in no NIRS group was statistically significant when compared to preoperatively (p <0.001). Postoperative mean MoCA score was found to be significantly higher in NIRS group (NIRS: 26.8 ± 1.9 vs. no NIRS: 23.6 ± 2.5, p <0.001). It has been determined that there was a moderately positive significant correlation between the increase in the NIRS used patients (%) and increase in the MoCA score of the patients (r = 0.59, p <0.001).Conclusion: Intraoperative NIRS usage in the patients undergoing CABG with carotid artery disease might be useful due to its postoperative positive effects on the cognitive functions.     

Healing of Ulcers on the Feet Correlated with Distal Blood Pressure Measurements in Occlusive Arterial Disease

The frequency of healing in subchronic ulcers in 66 feet in 62 patients with arterial occlusive disease was correlated with the systolic digital blood pressure (SDBP) and the systolic ankle blood pressure (SABP), both measured with a strain gauge, and with the skin perfusion pressure on the heel (SPPH) as measured with a photocell. Thirty—two patients (35 feet with ulcerations) had diabetes mellitus. the treatment was conservative. in 42 feet the ulcers healed after an average period of 5.8 months; in 24 feet major amputation became necessary after an average of 4.3 months. the frequency of healing correlated significantly with the three distal blood pressure parameters investigated, the closest correlation being with the SDBP measured at the final examination, i.e. just after healing of the ulcer or just before an inevitable major amputation. of the 22 cases with SDBP below 20 mmHg only two cases (9 per cent) healed. of the 11 cases with SDBP of 20 to 29 mmHg seven cases (64 per cent) healed and of the 33 cases with SDBP of 30 mmHg or above all cases (100 per cent) healed. There was no significant difference between the 35 diabetic feet and the 31 non—diabetic feet as regards the healing rates, although infection and peripheral neuropathy were frequent in die diabetic group. the data show that the systolic digital blood pressure is a particularly valuable prognostic parameter.     

The Influence of Collateral Flow on the Antegrade and Retrograde Distribution of Cardioplegia in Patients with an Occluded Right Coronary Artery

Background: The predictive value of electrocardiography (ECG) and coronary angiography for cardioplegia distribution in patients with an occluded right coronary artery was evaluated.

Methods: Coronary angiograms and ECGs were evaluated in 15 patients with right coronary artery occlusion. Prediction of antegrade cardioplegia distribution was based on ECG evidence of infarction and coronary collateral flow determined from the angiogram. Antegrade and retrograde delivery of cardioplegia was directly assessed in all patients by myocardial contrast echocardiography. Intraoperative transesophageal echocardiographic images of the right ventricular free wall, the apex, and the intraventricular septum were recorded while 4 ml of Albunex (Mallinckrodt Medical, St. Louis, MO) was injected into antegrade and retrograde cardioplegic catheters during cardioplegia delivery. The observed (myocardial contrast echocardiography) cardioplegia distribution was compared to the predicted cardioplegia distribution. Sensitivity, specificity, positive predictive values, and negative predictive values were calculated.

Results: Eighty seven of 90 (97%) segments were analyzed. Angiography and ECG poorly predicted incomplete cardioplegia distribution. Electrocardiography was a better predictor of inadequate cardioplegia distribution to the right ventricle than was angiography. The negative predicted values of cardioplegia distribution ranged from 20 to 50% for the septum and right ventricle, respectively, with ECG criteria and from 0 to 33% for the septum and apex, respectively, with angiographic criteria. Antegrade cardioplegia delivery was distributed to the right ventricle in 31% of patients, despite 100% occlusion of the right coronary artery; whereas retrograde cardioplegia delivery to the right ventricle occurred 20% of the time.     

Determinants of Coronary Artery Disease in Nondiabetic Hemodialysis Patients: A Matched Case-Control Study

Background/Aims. The aim of this matched case-control study was to evaluate the determinants of coronary artery disease (CAD) other than conventional risk factors in nondiabetic hemodialysis (HD) patients. Methods. Among 312 consecutive patients on regular HD, 26 nondiabetic patients with angiographically defined coronary artery disease (20 men, 6 women; mean age 57.0 ± 13 years) constituted the case group (group 1). A subject group of the same gender, smoking status, and hypertension with similar ages and body mass indexes who had normal electrocardiography and myocardial perfusion scintigraphy served as controls (20 men, 6 women; mean age 54.1±12 years, group 2). Demographics, high sensitivity C-reactive protein (hs-CRP), erythrocytes dimentation rate (ESR), hematocrit-corrected ESR, beta-2 microglobulin, cardiac troponin I, parathyroid hormone, albumin, calcium (Ca), phosphorus (P), Ca × P, and lipid profiles were compared between the groups. Results. Patients in group 1 had higher hs-CRP and troponin I (18.0±12 vs. 7.2±5 mg/L, p < 0.001; 0.36±0.16 vs. 0.22±0.05 ng/mL, p < 0.001, respectively) and lower HDL cholesterol levels than group 2 (37.0±10mg/dL vs. 46.3±17mg/dL, p = 0.02). Backwards stepwise logistic regression analysis revealed that high hs-CRP and troponin I levels (p = 0.03 and p = 0.01) and low HDL cholesterol levels (p = 0.02) were independently related with CAD. Conclusion. According to these results, in nondiabetic patients on regular hemodialysis, high hs-CRP, troponin I levels and low HDL-cholesterol were the determinants of CAD.     

冠心病和风心病患者吸入麻醉药血/气分配系数

测定并比较不同成人心脏病患者的吸入麻醉药血／气分配系数（Ｂ／Ｇ），判断血液成分对Ｂ／Ｇ的影响。方法：健康人、冠心病患者和风湿性心脏病患者各２０例，采静因１０ｍｌ，用两次平衡法测定地氟醚、异氟醚和氟铁Ｂ／Ｇ，并测定红细胞压积、血浆总胆固醇、甘油三酯、白蛋白和球蛋白浓度。结果：冠心病患者地氟醚、异氟醚、和氟烷的Ｂ／Ｇ和血浆甘油三酯浓度均高于健康人和风心病患者；三种吸入麻醉药的Ｂ／Ｇ均与甘油三酯含量有关     

Disturbance of Cerebral Blood Flow Autoregulation in Hypertension is Attributable to Ischaemia Following Subarachnoid Haemorrhage in Rats: A PET Study

The effects of subarachnoid haemorrhage (SAH) on cerebral blood flow (CBF) autoregulation during induced hypertension were studied by positron emission tomography (PET) during chronic vasospasm in anaesthetized Sprague-Dawley rats. SAH was induced by intracisternal injection of autologous blood. In the control animals saline was injected instead. This method produced angiographical vasospasm of major arteries 48 h after injection. During this period, CBF was measured at each side of fronto-parietal and occipital sections using PET with or without induced hypertension. Mean arterial blood pressure (MABP) was increased from 94+/-2.4 to 140+/-0.3 mmHg by the injection of phenylephrine. An autoregulatory index (AI) expressed as delta CBF (%) per 10-mmHg increase in MABP was employed to analyse CBF response. SAH significantly reduced (p<0. 0001) basal CBF (ml/100 g/min) by 26.2% (control 60.0+/-1.9 n=24, SAH 44.3+/-4.5 n=20). A territorial CBF that decreased by 50% or more over the mean control value was used to define ischaemia and was identified in five out of 20 regions (25%) in the SAH group. AI (%/10-mmHg) was 13.5+/-2.4 in the control group (n=24). In the SAH group, AI decreased (p<0.05) to 4.5+/-2.5 in non-ischaemic areas (n=15), while in the ischaemic areas (n=5) AI increased (p<0.05) to 25.2+/-4.1. Since the spastic artery is intrinsically resistant to hypertension, the marked increase in CBF during hypertension can be attributable to ischaemia following SAH.     

The Prostacyclin Analogue Beraprost Sodium Prevents Occlusion of Bypass Grafts in Patients with Lower Extremity Arterial Occlusive Disease: A 20-Year Retrospective Study

Although conventional bypass grafting is commonly used to treat ischemia in lower extremities, graft failure often occurs. This study retrospectively analyzed the factors that affect graft patency to help establish more effective treatment of obstructive arterial disease of the lower limbs. Kaplan-Meier analysis was used to estimate graft patency in 90 legs of 80 patients who underwent femoropopliteal bypass (28 vein grafts and 62 expanded polytetrafluoroethylene grafts) between 1984 and 2003. Patients were randomly selected for graft materials in sequential surgical treatment order. After initial analysis, several risk factors and postoperative medication regimens were analyzed to ascertain any association with graft failure. The overall mean patency period for femoropopliteal bypass was 10.5 ± 0.7 years. Graft occlusion occurred in 20 limbs. Neither the materials composing the grafts nor the position of distal anastmosis had any influence on patency maintenance. Graft occlusion rates were significantly greater in patients with either diabetes (p = 0.0049) or rest pain before surgery (p = 0.0011). Postoperative administration of beraprost sodium significantly increased the patency period (p = 0.0082). Diabetes and rest pain before surgery are important factors for late graft failure after femoropopliteal bypass. Our data also suggest that administration of beraprost sodium increases the graft patency period.