Longitudinal and shear mode ultrasound propagation in human skull bone

Recent studies have attempted to dispel the idea of the longitudinal mode being the only significant mode of ultrasound energy transport through the skull bone. The inclusion of shear waves in propagation models has been largely ignored because of an assumption that shear mode conversions from the skull interfaces to the surrounding media rendered the resulting acoustic field insignificant in amplitude and overly distorted. Experimental investigations with isotropic phantom materials and ex vivo human skulls demonstrated that, in certain cases, a shear mode propagation scenario not only can be less distorted, but at times allowed for a substantial (as much as 36% of the longitudinal pressure amplitude) transmission of energy. The phase speed of 1.0-MHz shear mode propagation through ex vivo human skull specimens has been measured to be nearly half of that of the longitudinal mode (shear sound speed = 1500 +/- 140 m/s, longitudinal sound speed = 2820 +/- 40 m/s), demonstrating that a closer match in impedance can be achieved between the skull and surrounding soft tissues with shear mode transmission. By comparing propagation model results with measurements of transcranial ultrasound transmission obtained by a radiation force method, the attenuation coefficient for the longitudinal mode of propagation was determined to between 14 Np/m and 70 Np/m for the frequency range studied, while the same for shear waves was found to be between 94 Np/m and 213 Np/m. This study was performed within the frequency range of 0.2 to 0.9 MHz.     

Cardiac autonomic responses to standing up and cognitive task in overtrained athletes

This study compared the autonomic responses to an active orthostatic test and Stroop Color Word Test (Stroop) as well as cognitive performance in Stroop in twelve severely overtrained (OA, 6 men and 6 women) and twelve control athletes (CA, 6 men and 6 women). RR-intervals were recorded during the orthostatic test, the Stroop, and a relaxation period succeeding the Stroop. Low frequency power during standing in the orthostatic test was lower in OA than in CA (1322 +/- 955 ms2 vs. 2262 +/- 1029 ms2, p = 0.030, respectively). During Stroop, OA had higher relative total power (50 +/- 47 % vs. 19 +/- 14 % of the individual total power during supine rest after awakening, p = 0.028, respectively) and high frequency power (38.5 +/- 9.4 % vs. 13.5 +/- 2.3 % of the individual high frequency power during supine rest after awakening, p = 0.035, respectively) than CA. In the Stroop, OA made more mistakes than CA (9.7 +/- 6.5 % vs. 5.4 +/- 3.0 %, p = 0.045). The increase in absolute total power from the Stroop to relaxation correlated negatively with the amount of mistakes in the Stroop (r = - 0.588, p = 0.003). Thus, cardiac autonomic modulation during orthostatic task and responses to cognitive task and to relaxation, as well as the cognitive performance were attenuated in severe overtraining.     

The feasibility of interstitial ultrasound hyperthermia.

One of the most promising ways to increase the efficacy of brachytherapy is to combine it with hyperthermia. In this paper, the feasibility of using ultrasound transducers as interstitial hyperthermia sources was investigated. The ultrasound output of eight cylindrical transducers (diameter 1 mm and length 25 mm) was studied. It was found that many of these transducers were able to generate between 2 and 3 W of acoustic energy at the frequency of 9.5 MHz. The ultrasound field emitted radially was well collimated and extended the full length of the transducer. In vitro perfused liver and kidney experiments showed that an array of four transducers placed in brachytherapy catheters up to a maximum spacing of 20 mm in a square pattern could induce therapeutic temperatures. Also, the effect of flow rate into the organs and catheter cooling were investigated. These results showed that interstitial ultrasound sources are potentially the most promising way of generating therapeutic temperatures through standard interstitial radiation therapy catheters.     

Plasma atrial natriuretic factor during ethanol ingestion in volume-loaded subjects.

The present study was designed to test whether ethanol ingestion affects plasma atrial natriuretic factor (ANF) concentration in healthy volunteers. On the basis of previous studies showing that ethanol induces a diuretic response and a decrease in atrial size (atrial distension), it was hypothesized that ethanol intake might be associated with a decrease in plasma ANF level. To somewhat increase plasma ANF level, the subjects were slightly loaded with water before the trial. As compared with juice, ethanol, 1 g/kg within 1 hr, increased urine output [405 +/- 37 (mean +/- SEM) ml/hr vs. 197 +/- 20 ml/hr, P less than 0.001]. Left atrial size decreased similarly (P less than 0.001) with both drinks. Plasma ANF concentration did not change with either ethanol or juice during the 3-hr study period. No changes were observed in plasma arginine vasopressin concentration and plasma renin activity. Our results are in conflict with previous reports in fasted subjects showing significant changes in plasma concentrations of the same hormones. Thus, the basal fluid balance seems to be crucial to the hormonal response to ethanol. The plasma concentrations of the hormones measured in this study do not directly explain the diuretic response to ethanol observed in slightly volume-loaded subjects.     

Effects of physical parameters on high temperature ultrasound hyperthermia

The purpose of this research was to investigate the feasibility of inducing perfusion independent, predictable therapeutic thermal dose using high power ultrasonic pulses. Computer simulations were used to study the effects of blood perfusion, tissue properties, transducer characteristics, and treatment geometry on the temperature elevation and thermal dose delivered by short ultrasonic pulses. Experiments were conducted in vitro and in vivo to investigate the effects of blood perfusion changes. Results show that short pulse lengths (less than or equal to 2 s) and small focal diameters (approximately 3 mm) give temperature elevations and thermal doses which are nearly perfusion independent. Normal fluctuations in tissue properties should not have a significant effect on the treatment provided that proper choice of transducer is made for each individual application.     

Design of ultrasonic transducers for local hyperthermia

Computer simulations of the interdependence of different pairs of the parameters of spherically focusing ultrasonic transducers were performed, taking the ultrasonic attenuation in biological tissue into consideration. The maximum distance and gain of the last intensity maximum were calculated with different frequencies between 0.3 and 5 MHz and frequencies around 1 MHz were found to be most useful for hyperthermia. The relationships between the distance of the last axial maximum and the radius of curvature, as well as between the intensity gain and radius of curvature with different diameters of ultrasonic transducers operating with a frequency of 1 MHz were calculated. Also the effect of thermal conduction on the temperature distribution was discussed.     

Hemodynamic effects of alpha-human atrial natriuretic peptide in healthy volunteers

The hemodynamic effects of synthetic alpha-human atrial natriuretic peptide (alpha-hANP) were evaluated in a double-blind, placebo-controlled study with echocardiography and systolic time intervals in 11 healthy volunteers. During an infusion of alpha-hANP for 30 min, when plasma ANP concentration increased to a peak level of approximately 300 pg/ml, an increase occurred in diuresis (+174%, p less than 0.01 vs. placebo) and natriuresis (+148%, p less than 0.05). Heart rate increased (+10%, p less than 0.05), but the mean arterial pressure remained unchanged. The left ventricular end-diastolic diameter was reduced (-3%, p less than 0.01), as was the left ventricular end-systolic diameter (-11%, p less than 0.001). Total peripheral resistance (-12%, p less than 0.05) and midsystolic circumferential wall stress (-16%, p less than 0.05) decreased, while cardiac output increased (+15%, p less than 0.05), as did fractional shortening (+15%, p less than 0.001). Within 30 min postinfusion, all differences between the ANP and placebo treatments had disappeared. No significant difference between the treatments was observed in preejection period or preejection period/left ventricular ejection time ratio. In conclusion, when administered as a short infusion, alpha-hANP causes peripheral arterial vasodilation and thus, by reducing left ventricular afterload, improves the pump function of the heart. Venous vasodilating effect of alpha-hANP may contribute to the decrease in left ventricular preload, but a diuresis-induced reduction in circulating intravascular volume may also be influenced.     

The CDRH helix. A phase I clinical trial

Seventeen patients have been given regional hyperthermia treatments using the Center for Devices and Radiologic Health (CDRH) Helix, a resonant helical coil unit. Most of these patients had large, clinically advanced tumors, whose mean volume exceeded 1000 cc. Mean maximum, minimum, and average temperatures were 40.6, 38.6, and 39.6 degrees C, respectively, for all sites combined. The pelvic heating capabilities of the CDRH Helix and the BSD-1000 annular phased array were compared, and generally were equivalent. Although the Helix could be used in a wider variety of locations, and was more comfortable and easier to use than the BSD-1000 annular phased array, neither device was particularly effective in generating clinically useful temperatures; the Helix is currently under investigation for use in regional-systemic hyperthermia in combination with antineoplastic drugs and biologic response modifiers.     

Resonance frequency of microbubbles in small blood vessels: a numerical study

Microbubbles are currently used as ultrasound contrast agents. Their potential therapeutic applications are also under investigation. This work is designed to provide some insight into the mechanisms of energy absorption and deposition by a preformed gas bubble in the microvasculature to optimize its efficacy. In the linear regime, the most favourable condition for the transfer of energy from an ultrasonic field to a gas bubble occurs when the centre frequency of the ultrasonic field equals the resonance frequency of the bubble. The resonance frequency of gas microbubbles has been investigated up to now mainly in unbounded liquids; however when bubbles are confined in small regions, their resonance frequency is strongly affected by the surrounding boundaries. A parametric study on how the resonance frequency of microbubbles in blood vessels is affected by the bubble radius, vessel radius and the bubble position in the vessel is presented. The resonance frequency decreases below its free value with decreasing vessel radius for vessels smaller than 200-300 microm depending on the bubble size. This model suggests the possibility of using ultrasound in a range of frequencies that are, in general, lower than the ones used now for therapeutic and diagnostic applications of ultrasound (a few MHz). When microbubbles oscillate at their resonance frequency they absorb and therefore emit more energy. This energy may allow specific blood vessels to be targeted for both diagnostic and therapeutic applications of ultrasound.     

Postdischarge symptoms after ambulatory surgery: first-week incidence, intensity, and risk factors

Minor sequelae, such as pain, nausea, and drowsiness, often occur in surgical outpatients in the immediate postdischarge period. In this prospective, observational study was defined the daily incidence and intensity of several symptoms during the first week after surgery and determined predictive factors of minor morbidity. In two similar mixed ambulatory surgery units, 3910 patients received a questionnaire to grade daily the intensity of predefined symptoms on a 4-point scale. Multinomial logistic regression was used to analyze risk factors, with adults and children as separate groups. Of these patients, 2754 (70%) responded. Patients experienced numerous minor sequelae during the first week after ambulatory surgery. Symptoms were common (up to 86% of all patients) on the initial days after surgery and were still reported by 24% of adults on the postoperative Day 7. In adults, pain was the most common symptom and, in comparison with other symptoms, was more often moderate or severe. Drowsiness was most common in children. Younger adults, older children, and women were more prone to experience minor morbidity. Longer duration of surgery led to increased likelihood of pain and nausea in all patients and increased the risk of several other symptoms in adults.