Disturbance Of Blood Supply Research Articles

Clinical observation on effect of yangjing decoction in promoting follicular growth

To investigate the effect of Yangjing Decoction (YJD, a Chinese prescription of replenishing Kidney essence) in promoting follicular growth and its influence on blood supply of ovary and uterus. Twenty-two cases with secondary amenorrhea and 4 cases of infertility with infrequent menstruation caused by follicle maldevelopment were treated with YJD. The blood supply of ovary and uterus in 7 cases was measured by colour Doppler before and after treatment. Of the 116 therapeutic cycles in 26 cases, there were 69 menstrual cycles (59.48%), 37 follicular maturation cycles (31.90%), 21 ovulation cycles (18.10%), and the follicular maturation rate was 84.62%, The disturbance in blood supply of ovary and uterus was improved remarkably along with follicular development by YJD in 7 cases. YJD could improve follicular development and blood supply of ovary and uterus.

Concentration of vascular endothelial growth factor within the subretinal space and vitreous fluid in rhegmatogenous retinal detachment

To determine the increased production and release of vascular endothelial growth factor (VEGF) from the retina in the eye with non-angiogenic retinal detachment in which relative blood supply disturbance may be present, the concentration of VEGF in subretinal fluid and vitreous fluid collected from the eyes was investigated by enzyme linked immunospecific assay. The average concentration of VEGF was 0.5 +/- 1.1 ng/ml (mean +/- standard deviation) in nine samples of vitreous fluid collected from proliferative retinal detachment, and was 1.2 +/- 1.2 ng/ml in eleven samples of subretinal fluid from rhegmatogenous retinal detachment. The concentration of VEGF in six samples of vitreous fluid from angiogenic diabetic eyes (5.0 +/- 2.8 ng/ml) was significantly higher than in the samples from eyes with retinal detachment. The results suggest that the relative ischemic insult to the detached retina increases the release of VEGF into the vitreous cavity and subretinal space. The increased concentration of VEGF does not induce remarkable angiogenesis since the concentration is lower than the biological threshold, or the effect is modulated by inhibitors.

Transcutaneous Oxygen Tension and Doppler Ankle Pressure During Upper and Lower Body Exercise in Patients with Peripheral Arterial Occlusive Disease

The effects of upper and lower body exercise on blood supply to the lower extremities were investigated in patients with peripheral arterial occlusive disease (PAOD) by measurements of transcutaneous oxygen tension (tcPO2) and Doppler ankle pressure (DAP). Twenty patients with PAOD (PAOD group) and 10 subjects without PAOD (control group) performed treadmill test (TT), recumbent cycle ergometry (CE), and rowing ergometry (RE) with a fixed seat. The tcPO2 was registered on the calf and DAP was measured at the end of each step of CE and RE. The walking distance in TT of the control group was not limited (> 1000 m), whereas that of the PAOD group was 161 m in median. In the control group there was no significant difference of performance between CE (125 +/- 33 W) and RE (111 +/- 24 W), whereas in the PAOD group, performance was lower in CE (72 +/- 31 W) than in RE (102 +/- 28 W) (P < 0.01). DAP of controls increased during both CE (136 to 165 mmHg) and RE (170 to 213 mmHg), whereas the DAP of the PAOD group decreased during CE (from 85 to 44 mmHg) and remained relatively constant during RE (113 to 101 mmHg). In controls, tcPO2 did not distinctly change during TT (70 to 66 mmHg) and increased during CE (58 to 73 mmHg) and RE (69 to 82 mmHg), whereas in the PAOD group, tcPO2 decreased during TT (66 to 33 mmHg) and CE (50 to 22 mmHg) and remained almost unchanged in RE (64 to 60 mmHg). A hyperbolic relationship was found between tcPO2 and DAP. In conclusion, during upper body exercise, blood supply to the lower extremities in patients with PAOD was not affected, whereas lower body exercise led to exhaustion of the functional reserve of blood supply. Because of a hyperbolic relationship between tcPO2 and DAP, tcPO2 remained relatively constant if blood supply was sufficient, but in disturbed blood supply a small change of DAP was accompanied by a great change of tcPO2. Therefore, in critical ischemia the change of tcPO2 was more sensitive than that of DAP.

Role of angiogenesis in patients with cerebral ischemic stroke.

Stroke is one of the most common causes of mortality and morbidity in the Western world. It results from the occlusion of a cerebral artery followed by severe disturbances in blood supply through microvessels to brain tissue. Despite an extensive literature its pathophysiology is poorly understood, and this has severely impeded the logical development of therapy. Brains were obtained from 10 patients aged 46 to 85 years with survival times of 5 to 92 days after their stroke. Infarcted areas and representative control tissues from the contralateral uninvolved brain hemisphere were collected. Microvessel density was measured microscopically. A total of 6520 microvessels were scored in 10,801 areas. The level of activation of the endothelial cells was studied by immunohistochemistry using three monoclonal antibodies, viz, E-9, raised against activated endothelial cells; IG11, recognizing vascular cell adhesion molecule-1; and anti-proliferating cell nuclear antigen. Angiogenic activity in tissue extracts was examined using an in vivo chicken chorioallantoic membrane assay. There was a statistically significant increase in the number of microvessels (Wilcoxon log-rank test; P < or = .01) in 9 of 10 infarcted brain tissues when compared with their contralateral normal hemisphere. In these patients the higher blood vessel counts correlated with longer survival, as ascertained by Spearman's p analysis (P < .02). The number of microvessels filled with blood cells was significantly lower in the infarcted hemispheres (P < .01). In contrast, statistically significant increased numbers of empty microvessels occurred in infarcted tissues compared with the contralateral hemisphere. Monoclonal antibody E-9 reacted weakly with normal-brain vascular endothelial cells; anti-proliferating cell nuclear antigen and IG11 were virtually negative. All three antibodies strongly stained the blood vessels of stroke tissues. The stroke tissues contained angiogenic activity, as shown by the induction of new blood vessels in a chorioallantoic membrane assay. We have shown that stroke causes active angiogenesis that is more developed in the penumbra. Further experiments are needed to determine if this angiogenesis has beneficial effect.

Pathophysiology of ischemia in patients with coronary artery disease

C ORONARY atherosclerosis is characterized by subintimal thickening that leads to plaque formation and stenosis.’ During the progression of this pathology in the large epicardial arteries, episodes of transient myocardial ischemia occur and each event is characterized by a reversible decrease in regional myocardial oxygen concentration that characteristically effects a segment of the left ventricle.2 This leads to the failure of systolic and diastolic muscle function, varying degrees of left ventricular failure, and profound metabolic disturbances. This functional expression of coronary artery disease can be induced by provoking disturbances in coronary blood supply and/or increases in myocardial demand for oxygen (ie, during exercise); ischemia also occurs during the activities of everyday life and it can precede damaging clinical events such as acute myocardial infarction, pulmonary edema, and sudden death.?,’ Transient myocardial ischemia in patients with obstructive coronary artery disease occurs in many different clinical syndromes (eg, chronic stable angina, unstable angina, and after myocardial infarction) and its presence always indicates the increased risk of adverse coronary events.2-7 In the majority of patients with ischemia and proven coronary artery disease, there are atherosclerotic stenoses that severely reduce crosssectional area in a segment of at least one epicardial artery. In these circumstances, standardized exercise protocols can provoke and reproduce ischemia and angina at a reproducible level of exercise. These clinical features have nurtured the belief that coronary blood supply is fixed and myocardial demand increases to cause ischemia. Although this concept is useful when considering the benefits of beta-adrenoreceptor blocking drugs, coronary angioplasty and by-pass graft surgery, these therapies probably do not address the disturbed biology of developing atherosclerotic lesions. Clinical studies of transient myocardial ischemia during daily life,8*9 studies of regional myocardial blood flow before and during ischemia”‘-I5 and studies of coronary vasomotion during cardiac catheterization all highlight the active role of the diseased epicardial arteries in causing transient ischemia.16-r9 An enhanced understanding of the biology of atherosclerotic stenoses has clarified pathophysiological mechanisms of myocardial ischemia and has suggested new directions in the development of therapies aimed at physical regression of coronary atherosclerosis and the control of constriction and thrombosis.20.2i This article will focus on transient myocardial ischemia by examining new clinical characteristics and pathogenic mechanisms rather than simply evaluating diagnostic techniques. It will discuss new clinical information about the biology of atherosclerosis and stenoses in relation to the occurrence of ischemia and adverse clinical outcomes. New insights from basic research will only be discussed as they provide fresh directions for clinical research. This paper will focus on transient ischemia rather than myocardial infarction or sudden death and will try to explore the relationship between coronary atherosclerosis, coronary vasoconstriction, and thrombosis as these problems occur in patients.

Osteonekrose des proximalen Femurs

Aseptic bone necroses are localised osseous lesions that occur in certain bones and bony sections at a certain age and can usually be diagnosed by radiology. These "idiopathic" bone necroses are usually ascribed to local disturbances of blood supply, but this has not been verified in all the cases. In a male patient of 55 years of age an extensive aseptic bone necrosis had developed at an unusual site, in the proximal part of the right femur (including the femoral head, femoral neck and the proximal part of the shoft), possibly due to hyperuricaemia or chronic alcoholism. Differential diagnostic deliberations are described, and possibilities are shown to arrive at a definite diagnosis of this unusual case.

Effect of tumour necrosis factor and lipid A on functional and structural vascular volume in solid murine tumours

Effects of recombinant tumour necrosis factor (TNF) on functional and structural vascular volumes in solid murine Meth A tumours were investigated by injection of Hoechst 33342 and staining for the vascular basement membrane component laminin, respectively. Systemic injection of 3 x 10(4) U TNF caused an initial increase in functional volume in the tumour, but a strong decrease from 1 to 48 h after treatment. Early effects of intralesional treatment were more moderate. Systemic injection of 10(4) U TNF or 0.3 or 3 micrograms lipid A caused a fall in functional volume at 4 h, but a recovery was seen at 24 h. This recovery did not occur after treatment with a combination of 10(4) U TNF and 0.3 micrograms lipid A. Structural vascular volume was not markedly reduced until 24 h after treatment with the high doses of the separate agents and the combination. All effects appeared generally more prominent in the tumour centre than in the borders. Data suggest that TNF induces initially an active hyperaemia that rapidly converts to passive hyperaemia. A prolonged disturbance of tumour blood supply is probably necessary for therapeutic activity. Breakdown of laminin in the vascular basement membrane may be a cause of loss of vascular integrity.

Association of ganglioneuroblastoma with syringomyelia: Case report

The association of a syndrome of a degenerative nature such as syringomyelia and a neuroblastoma can be of clinical interest. We will describe the case of a young female suffering from a retroperitoneal neuroblastoma and secondary development of syringomyelia. The possible pathogenetic link between these two pathologies will be discussed. Firstly, the dysontogenetic interpretation will be underlined. Other hypotheses will concentrate on the presence of tumors within the cord, which tend to cavitate, and furthermore, on the association between the edema and some diseases such as neoplasma, traumas, and on arachnoiditis as a major pathogenetic factor in syringomyelia. The existence of a possible link between arachnoiditis and the radiotherapy received by the patient after the surgical excision of the retroperitoneal neuroblastoma, will be discussed. Lastly a further pathogenetic hypothesis will be pointed out: an intramedullary softening due to disturbed blood supply, caused by the extramedullary neoplasm.

Magnetic resonance imaging of renal transplants: initial experience

Magnetic resonance imaging (MRI) was used in 45 renal transplant investigations (38 patients) using a Picker 0.15 T resistive system and a localized surface coil. An attempt was made to define optimal sequences in the evaluation of both normal and pathological transplants. Three sequences were found to be of value; a T1 weighted sequence (IR2180/700/40) to assess corticomedullary differentiation and its loss in acute rejection and acute tubular necrosis, a T2 weighted sequence (SE2000/80) for assessment of renal vessels and disturbances in blood supply, and a STIR (short tau inversion recovery) sequence (IR800/100/40) to define further the distended collecting system in obstruction and the presence of any perirenal collection. Encouraging results have been obtained, particularly in cases of acute rejection. It is suggested that the MRI scan is a useful screening test in cases of clinical doubt and may even obviate biopsy in some cases.

Scintimetry in transient synovitis of the hip in the child.

Fifty-five consecutive children presenting with transient synovitis of the hip were examined with 99mTc-MDP scintigraphy and pin-hole collimator technique. Quantitative assessment was performed along a profile of interest across the hip joint. The criteria for the normal scintimetric pattern in the child's hip were established and the pathologic pattern of uptake in the acute phase, as well as in the follow-up after synovitis, was described. A decrease in isotope uptake in the proximal femoral epiphysis was observed in 13 children. This was correlated with a reduced uptake in the growth-plate, indicating a disturbance of blood supply to these regions. A characteristic pattern of isotope uptake with duration of symptoms was observed: a decrease in uptake during the first week followed by rebound hyperemia within 1 month. One child developed osteonecrosis (Legg-Calvé-Perthes disease).

Efeect of pyrrolidone-2 on the cerebral circulation

The ability of cyclic GABA derivative--pyrrolidone-2--to increase markedly cerebral blood flow both normally and in conditions of cerebral blood supply disturbances produced by unilateral 20-min ligation of a common carotid artery has been demonstrated. When pyrrolidone-2 administration accompanied bicuculline infusion (0.1 mg/kg) it did not provoke significant changes in the blood flow. Besides, bicuculline markedly weakened pyrrolidone-2 ability to relax the isolated grafts of cerebral arteries.

口こう粘膜の創傷治ゆに関する実験的研究

The rate of epithelialization on intraoral operative wounds was studied with special reference to the influence of blood supply disturbance on mucosa surrounding wound and of the nature of wound surface. A standardized wound was made on the rat hard palate and after various surgical treatments the epithelial extension from the wound edge was observed.Results1) Epithelial extension depended mainly on migration of the epithelial cell.2) The disturbance of blood supply to the surrounding mucosa prolonged the lag period, then the extension started. This factor did not infleunce the rate of epithelialization thereafter.3) In the groups in which the deep portion of the lamina propria was preserved on the wound surface, the rate of epithelialization was 0.19-0.21 mm/day. This value was similar to that reported previously about open skin wounds.Saliva eased dehydration of the connective tissue surface of wounds but did not accelerate epithelialization.4) In the groups in which the palatal bone was exposed to the wound surface, epithelialization was very slow because proliferation of the connective tissue was needed for the epithelial extension. But once the wound surface was covered with a new connective tissue, rate increased to half the level of the groups with the intact deep portion of the lamina propria preserved.5) When the deep portion of the lamina propria, which was suffering from blood supply disturbance, was left on the wound surface, the rate of epithelialization was half the level of groups with the intact deep portion of the lamina propria preserved.6) Edema and inflammation in the wound connective tissue decreased the rate of epithelialization.7) From these findings, it can be stated that the nature of the wound surface is a very important factor which influences epithelialization of intraoral operative wounds. To increase the rate of epithelialization, it is effective to preserve the intact lamina propria in the wound and secondarily to accelerate proliferation of the granulation tissue. It is also effective to prevent inflammation of the connective tissue in the wound.

Subclavian Steal Syndrome. Correction by Transthoracic or Extraanatomic Repair

Proximal subclavian artery stenosis may cause severe disturbances of cere bral blood supply well known as subclavian steal syndrome. On the other hand subclavian artery stenosis may produce problems of the perfusion of the arm. But in the presence of a well established collateral circula tion with reversal flow in the ipsilateral vertebral artery the reduced perfusion of the arm in the presence of proximal subclavian artery stenosis seldom re quires operative treatment.

Experimental Fixation of Femoral Osteotomies by Cerclage with Nylon Straps

Following the successful experience of Partridge in the fixation of human femoral fractures by nylon-strap cerclage, this research in 23 mature dogs was performed to compare nylon-strap with wire-loop cerclage for healing periods of up to 12 weeks. Supplemented by intramedullary fixation with Steinmann pins, long oblique femoral osteotomies were fixed in one femur of each dog by nylon straps and in the other femur by wire loops, at separate operations. The nylon straps were all secured at the same tension by a special "gun." The wire loops were all secured at the same tension by the Rhinelander tightener-twister. Half of the nylon straps had "bumps" along the inner surface, which were added by Partridge in an effort to circumvent the microvascular disturbance reported with Parham bands. On examination by microangiography and correlated histology, all of the osteotomies, regardless of the type of fixation, showed good progress toward osseous union. After fixation by wire cerclage no loss of position or disturbance of blood supply was noted. After fixation by nylon straps slight (clinically insignificant) longitudinal displacement, attributed to slight lengthening of the straps, with consequent loosening was noted in all cases. This loosening was considered advantageous because it appeared to be responsible for the unexpected lack of impairment of the vascularization of the underlying cortical bone by any of the straps. The bumps on the undersurface of some of the straps were, thus, of no vascular advantage, and their presence made accurate fixation of the ostectomy fragments more difficult on the small bones. These studies support the value of fixation by plain nylon straps and show their advantage over straps with bumps for fixation of long oblique single osteotomies of bones the size of the canine femur.

Effect of early postnatal division of the postganglionic nerves on the development of principal cells and small intensely fluorescent cells in the rat superior cervical ganglion.

The three main postganglionic nerve branches of the superior cervical ganglion were divided on one side in 3--4-day-old rats. Five, 10, 20 and 60 days after the operation, the number of principal cells and small intensely fluorescent (SIF) cells, and the ganglion volume were estimated from a complete series of sections through each ganglion, in which catecholamines were histochemically demonstrated by formaldehyde-induced fluorescence. As compared with the contralateral, intact ganglion, the operated ganglion showed a rapid loss of principal cell bodies to about 1/20th of the control value, and the normally large postnatal increase in the volume of the ganglion failed to take place in the operated ganglion. Sham operation experiments showed that these changes were due to nerve division rather than disturbed blood supply and manipulation. The number of SIF cells increased in the intact ganglia from about 200 cells/ganglion at birth and reached the adult value, about 600 cells/ganglion by the 23rd postnatal day. An essentially similar postnatal increase in Sif cell number occurred in the experimental ganglia in spite of the marked loss of principal cells. The relative number of SIF cells increased from less than 1% of all cells (SIF cells and principal cells) in the control ganglia to over 10% in the operated ganglia, in which large aggregates of SIF cells formed 20 and 60 days after nerve division. It is concluded that different sets of developmental rules may apply to the SIF cells and the principal cells.

Surgical treatment of chronic occlusive disease of the enteric visceral branches of the abdominal aorta. Experience with 119 operations.

Whenever abdominal circulatory disorders are caused by obstruction of the abdominal aortic visceral branches, adequate blood flow may be restored only by surgical intervention. With the development of symptoms suggesting inadequate collateral circulation and disturbance of splanchnic blood supply, operation is indicated. The choice of operation depends on the nature and the cause of the disease and the type of occlusion. With intravascular obstruction, correction of blood flow may be achieved by a reconstructive procedure. In many patients with extravascular compression of the celiac artery, adequate flow is restored by simple external decompression. The present communication is based on experience with 119 operations, 102 reconstructive and 17 decompressive. Of the 102 reconstructive procedures, 94 were complex with one-stage revascularization of several arteries. Transaortic endarterectomy as described in our method of choice although with widespread lesions resection and replacement is preferred. A thoracolumbar approach is the most expedient incision for reconstruction. The results obtained provide evidence for the effectiveness of surgical treatment of chronic occlusive disease of the visceral branches of the abdominal aorta.

Effects of low doses of ochratoxin A after intratesticular injection in the rat.

The toxic effect of various doses of ochratoxin A on the rat testis was investigated after a single intratesticular injection. At time of sacrifice (day 10) degenerating changes occur in the testicular tissues: seminiferous tubules dilatation, cytolysis of the seminiferous epithelium, hyperplasia of the interstitial tissue, vascular thrombosis. The relations between the blood supply disturbances and the observed lesions are discussed.

Changes in the dentition of the guinea pig following total section of the inferior alveolar nerve and vessels.

The inferior alveolar nerve was cut or the vessels entering the mandibular canal were damaged in 39 guinea pigs at 10 days of age. Possible changes in the incisors were recorded during a 100-day observation period whereafter the animals were killed and the skulls freed of soft tissues; at this time, 35 skulls were found suitable for further examination. The changes in the mandibular incisors on the operated side became observable 30-40 days post-operatively as discolourization, a 'trauma line' around the tooth, narrowing of the tooth or total loss of it's visible part. In the guinea pigs with the nerve cut (group A), such signs of maldevelopment were seen in 5 out of 19 animals, whereas the corresponding figure for the animals with the damaged vessels (group B) was 14/16. All incisors in group A and 13 out of 14 in group B recovered from the state of maldevelopment; one animal in group B showed complete loss of the incisor. The molar region was examined only from the cleaned skulls. In group A, the first molar was deformed in two animals; in group B, seven animals displayed either maldevelopment of the first molar or the first and second molar or complete loss of the first molar. No malformation of the third molar was observed. With two exceptions, the deformation or loss of molars occurred in combination with incisor maldevelopment. The malformations were considered to result from a disturbed blood supply. In group A, the dental changes may perhaps be ascribed to a short-term interference with the blood supply during the operation. The variable results in group B seem to imply that the mandibular teeth receive at least part of their blood supply from vessels besides those entering the mandibular canal. The innervation appears to have a subordinate role in the restoring of the morphology of continuously erupting teeth.

Electrical activity of muscle motor units with disturbed blood supply

Electrical activity of muscle motor units was studied by concentric needle electrodes in human subjects with normal and impaired circulation of the lower limbs. Shortening of the duration of motor unit action potentials of muscles (gastrocnemius, extensor hallucis brevis) was found when the blood supply to these muscles was disturbed, indicating a myogenic nature of the changes arising in skeletal muscles with an inadequate blood supply.

Minimal internal fixation of tibial fractures.

Flexible wire and small pins cause minimal disturbance of osseous blood supply, and introduce minimal foreign material into the wound. Supplemental support by a plaster cast or by traction is required, but the external support can generally be discontinued early for joint mobilization. Several simple auxillary fixation devices extend the usefulness of wire fixation. Removal of metal is not required. Many common fractures of the tibia are amenable to this method of minimal internal fixation. In the diaphysis, long oblique fractures are the most suitable for this application; the firmness of their fixation by cerclage is augmented by muscle pull. Rotation is effectively controlled by a plate which is L-shaped in cross section, and is held in position by cerclage. In the metaphysis, articular fractures of the knee and ankle are securely fixed by a flattened loop of wire and two washers (wire-washer set), supplemented sometimes by pins or hand-made staples. Two pins alone provide excellent fixation of the medial malleolus. A single pin, or a single wire loop through drill holes, may be sufficient to impart stability to an unstable tibial fracture. A key-type graft of iliac bone, maintained by crossed wire loops through cortical drill holes, is effective in the tibial diaphysis. Autogenous iliac cancellous chips provide minimal and effective internal fixation for an infected ununited fracture of the tibia. The surgical instrument most important for making wire fixation highly successful is a tightener-twister which protects wire loops from excessive strain during application, and permits twisting at a predetermined and therefore reproducible tension. Other special and ordinary instruments are valuable assets.