Systemic Blood Supply Research Articles

Fifteen Micrometer Microspheres Reflux Up the Pulmonary Veins during Pulmonary Artery Occlusion

The systemic arterial blood supply to the lung (bronchial blood flow, Q̇ br ) is commonly measured using the reference flow technique by injecting radiolabeled microspheres into the left atrium (LA) and simultaneously collecting a reference blood sample from a large artery such as the aorta. These measurements are often done with the pulmonary artery occluded prior to the time of injection. We have reported previously that left atrial blood refluxes up the pulmonary veins following pulmonary artery (PA) occlusion. We designed this experiment to determine if 15μ microspheres reflux from the LA into the left lung (i) when the left PA is occluded prior to microsphere injection and (ii) when the left PA is open during the injection. We calculated Q̇ br to the left lung after simultaneous left ventricular (LV) and LA injections of different radiolabeled microspheres in anesthetized, closed-chest, prone goats. When the PA was open (but occluded 5 sec after the microsphere injection), Q̇ br calculated from an LA injection differed little from that calculated from an LV injection of microspheres. However, when the PA was occluded prior to injection of the microspheres, Q̇ br calculated from an LA injection was significantly higher than that calculated from an LV injection suggesting that microspheres reflux from the LA to the lung.

Communicating bronchopulmonary foregut malformations: Classification and embryogenesis

Communicating bronchopulmonary foregut malformations (CBPFMs) are characterized by a fistula between an isolated portion of respiratory tissue (ie, a lung, a lung lobe, or a segment) and esophagus or stomach. We combine our 30-year (1959 to 1989) experience of 6 cases with 51 reported patients to propose a CBPFM classification supported by a proposed embryogenesis theory. Group I (16%): anomaly is associated with esophageal atresia and tracheoesophageal fistula. Group II (33%): one lung originates from the lower esophagus. Group III (46%): an isolated anatomic lung lobe or segment communicates with the esophagus or stomach. Group IV (5%): A portion of the normal bronchial system communicates with the esophagus. The portion of the lung served by the communicating bronchus receives systemic blood supply. The right and left lung sacs curve dorsally to embrace the lower esophagus during normal lung development. At this stage a part of the lung bud joins the esophagus. This segment then breaks away from the main pulmonary anlage to form a CBPFM. CBPFMs should be considered in the workup of infants with respiratory distress and/or recurrent pneumonias. Patients with suspected pulmonary sequestration should undergo contrast studies to exclude a gastrointestinal communication.

Changes in Basic Fibroblast Growth Factor Coincident with Estradiol-Induced Hyperplasia of the Anterior Pituitaries of Fischer 344 and Sprague-Dawley Rats*

Adult female Fischer 344 (F344) and Sprague-Dawley (SD) rats were treated with estradiol via Silastic implants for 10 and 20 days. This treatment period in F344 rats is sufficient to produce dramatic hyperplasia of anterior pituitary lactotropes, activation of folliculo-stellate cells (FS) as phagocytes, and reorganization of the blood supply, i.e. hemorrhagic lakes and arteriogenesis from vessels in the adjacent meninges. Estradiol-treated SD rats do not demonstrate a comparable response. We now report intense focal concentrations of cells immunopositive for basic fibroblast growth factor (FGF) in estradiol-treated F344 rats predominantly near the posterolateral edge of the anterior pituitary, a zone rich in gonadotropes and lactotropes. Immunostaining for FGF, by both light and electron microscopy, revealed that the immunopositive cells were gonadotropes, and that the immunoprecipitate was cytosolic and was most abundant in the cytosol facing the capillaries. Immunostaining for extracellular matrix-associated FGF also revealed foci of positivity at the postero-lateral edge. Estradiol-treated SD rats did not reveal comparable localization for FGF. Morphological analysis and immunolocalization of S-100 protein, a marker for FS cells, revealed that the periphery of the anterior pituitary of estradiol-treated F344 rats included numerous disrupted gonadotropes and, furthermore, was largely devoid of FS cells. This zone was more intact in control F344 rats, but lacked FS cells. The peripheral parenchyma of control and estradiol-treated SD rats was intact compared to that of F344 rats and consistently included FS cells. These results suggest that disruptions of gonadotropes at the pituitary periphery may release FGF, which could then stimulate angiogenesis from blood vessels within the adjacent meninges. The resultant systemic blood supply would stimulate lactotrope hypertrophy and hyperplasia. Since FS cells are known phagocytes within the anterior pituitary, their absence from the periphery of F344 rats may intensify or prolong the effect of the peripherally released FGF.

Fleischner lecture. Developmental abnormalities in the systemic blood supply to the lungs.

Developmental abnormalities in the systemic blood supply to the lungs occur in association with congenital heart disease, congenital lung disease, and rarely with apparently normal heart and lungs. Although most of these anomalies are rare, in the aggregate they are relatively common and of special interest to students of chest and heart disease.

Oesophageal lung with systemic arterial blood supply

An adolescent girl with congenital bronchopulmonary-foregut malformation (BPFM) is reported. The patient had a hypoplastic, non-functioning right lung with the main bronchus originating from the oesophagus. The pulmonary artery of the "oesophageal lung" was supplied by systemic circulation from the descending aorta, and the venous flow drained through a hypoplastic right pulmonary artery (RPA) into the large left pulmonary artery (LPA). This case was a rare type of left-to-right shunt and demonstrates that oesophagography, pulmonary angiography and aortography are important in demonstrating the haemodynamics involving this malformation.

Obsessive-compulsive disorder: Its conceptual history in France during the 19th century

Until the 1850s, obsessive-compulsive phenomena were considered to be a variant of the old notion of insanity. Around this time they became a separate disease: first, as a member of the old class of the neuroses; then, briefly, as a variant of the newly formed notion of psychosis; and finally, as a neurosis proper (in the post-1880s sense). These changes reflected theoretical shifts in the definition of the grand psychiatric categories. After 1860, organic causal hypotheses for OCD included dysfunctions of the autonomic nervous system and cortical blood supply. Psychological hypotheses suggested the OCD might result from volitional, intellectual, or emotional impairment, the last of which predominated after 1890. Issues relating OCD to personality types and hereditability were dealt with in terms of the degeneration theory. By the late 1880s, OCD achieved full clinical and nosological definition.

Systemic arterial blood supply to the trachea and lung in sheep.

We studied the systemic arterial blood supply to the trachea and lung in adult sheep. After anesthesia, sheep were exsanguinated and then studied by intra-arterial injection of one of the following materials: saline containing dyes of various colors (n = 24), Microfil (n = 8), or Batson's solution (n = 6). The systemic blood supply to the cervical trachea originated from the two common carotid arteries via three to four small branches (rami tracheales cervicales) on each side. A segment of the thoracic trachea between the thoracic inlet and the origin of the tracheal bronchus (bronchus trachealis) and the bronchial tree of the right cranial lobe (lobus cranialis dexter) were supplied by the tracheal bronchial branch (ramus bronchalis trachealis), which originated from the brachiocephalic trunk (truncus brachiocephalicus). A portion of thoracic trachea between the origin of the tracheal bronchus and the tracheal carina was supplied by the thoracic tracheal branch (ramus trachealis thoracica), arising from the bronchoesophageal artery (arteria bronchoesophagea) or directly from the thoracic aorta. The bronchial branch (ramus bronchalis) originated from the bronchoesophageal artery, and its branches supplied the remainder of the bronchial tree. At 120 cmH2O pressure (n = 8), the bronchial branch contributed approximately 50% and the other two approximately 25% each of the total tracheobronchial blood flow. These three branches also supplied the visceral pleura. Additionally, several small vessels (rami pleurales pulmonales) originated from the esophageal branch (ramus esophagea) of the bronchoesophageal artery, traversed the pulmonary ligaments, and supplied the visceral pleura.

Extralobar sequestration of the lung in children.

Sixteen patients with extralobar sequestration of the lung are reported on. The age at time of diagnosis varied from 21 days to 12 years (mean 3.6 years). Most of the patients presented with respiratory symptoms, such as dyspnoea, pneumonia, coughing attacks, cyanosis and asthmatic symptoms, but diagnosis was made incidentally in 4. Diagnosis was established by chest X-ray in every case. Preoperative angiography and bronchography was carried out in six cases. All 16 patients underwent thoracotomy for removal of the sequestration. Rudimentary bronchial remnants were found in 6 cases. Extralobar sequestration was associated with 12 additional malformations in 10 of the 16 patients. The clinical picture varies considerably and many of the "typical" features, such as systemic arterial blood supply, left lower lobe localization and diaphragmatic defect, are often absent. Diagnosis and treatment are easy.

Scimitar syndrome in childhood

Scimitar syndrome is a rare but well-described constellation of cardiopulmonary anomalies: anomalous pulmonary venous connection of the right lung, hypoplasia of the right lung with dextroposition of the heart, hypoplasia and malformation of the right pulmonary artery (PA) and bronchial trees, and anomalous systemic arterial blood supply to the right lung, arising from the abdominal aorta or its branches. The partial or total anomalous venous connection of the right lung drains into the inferior vena cava or azygous system and is present in all cases. 1–5 Often, this anomalous vessel is visible on a chest radiograph as a curvilinear shadow just above the right diaphragm and resembles a Turkish sword or “scimitar.” This report summarizes our experience with scimitar syndrome in 15 children.

Brachiocephalic artery dilation by percutaneous transluminal angioplasty.

Percutaneous transluminal angioplasty (PTA) was used to dilate stenotic lesions in 38 brachiocephalic arteries in 36 patient. Complete evaluation of the central nervous system blood supply is a prerequisite for the brachiocephalic PTA when cerebral symptoms are present. The femoral artery is the best vascular entry site; use of digital subtraction angiography equipment for arterial mapping is helpful. Balloon diameter should be the same as or slightly wider than the diameter of the normal artery adjacent to the stenotic segment. Spasm was successfully treated with intraarterial injection of nitroglycerin. The only drug therapy consistently used with PTA was aspirin. Complete dilation of the stenosis is the best prevention of thrombotic or embolic complications. In properly selected cases, proximal subclavian artery stenoses can be safely dilated, and the balloon can eventually be placed across the origin of the vertebral artery. Because of potential complications associated with brachiocephalic PTA, indications must be well established, and interventions should not be performed on marginal or asymptomatic stenoses.

Bronchial Omentopexy in Canine Lung Allotransplantation

Impaired bronchial healing has been a major source of morbidity and mortality following clinical lung transplantation. Bronchial ischemia secondary to division of the systemic bronchial blood supply may be an important cause of these complications. Bronchial omentopexy was performed in conjunction with lung allotransplantation in 6 dogs. Revascularization of the distal bronchial circulation through the omental pedicle was demonstrated in all instances by postmortem injection studies done through the celiac artery. Bronchostenosis occurred in 1 dog. No other complications were encountered. In view of the frequency of bronchial anastomotic complications following human lung transplantation, the technique of bronchial omentopexy warrants serious consideration.

Scimitar vein syndrome: Report of nine new cases

Moes CAF, Fowler RS, Trusler GA: Total anomalous pulmonary venous drainage into the azygos vein. Am J Roentgen01 98378, 1966. Neil1 (‘A. Ferencz C, Sahiston DC, Sheldon H: The familiar occurrence of hypoplastic right lung with systemic arterial blood supply and venous drainage. “Scimitar” syndrome. Bull ,Johns Hopkins Hosp 107:1, 1960. Ferencz C. Greco JM, Libi-Sylora M: Variability of pulmonary vascular disease in certain malformations of the heart; In Kidd BSL, Keith JD, editors: 7%~ natural history and progress in treatment of congenital heart defects. Springtield, 111. 1970. Charles C Thomas, p. 300. Kittle CF, Crockett JE: Vena cava bronchovascular syndrome--a triad of anomalies involving the right lung. Anomalous pulmonary vein, abnormal bronchi and systemic pulmonary arteries. Ann Surg 156:222. 1962. Park EA: Defective development of the right lung due to anomalous development of the right pulmonary artery and March, 1994 American Heart Journal

Absent pulmonary artery. A hint to its embryogenesis.

Cardiac catheterization was performed in nine patients with unilateral absence of a pulmonary artery. Aortography revealed a diverticulum of the innominate artery in five of six patients in whom the aortic arch and absent pulmonary artery were on opposite sides. It is suggested that the diverticulum indicates fetal systemic blood supply to the affected lung through the distal part of the sixth aortic arch, which--consisting of ductal tissue--obliterated after birth, leaving the diverticulum where the ductus joins the innominate artery.

Fascicular Block and Acute Myocardial Infarction

PROPER treatment of patients with acute myocardial infarction and fascicular block depends on understanding of the relationship between the ventricular specialized conduction system and its blood supply. In this article, we detail the importance of site of infarction, the type of ECG abnormality, and the clinical status of the patient in formulating a rational treatment program. <h3>VENTRICULAR SPECIALIZED CONDUCTION SYSTEM (VSCS) AND ITS BLOOD SUPPLY</h3> The VSCS begins with the branching portion of the His bundle in which fibers segregate into right and left bundle branches (Fig 1). The right bundle-branch (RBB) is long and slender and terminates into a Purkinje network relatively late in its course. In contrast, the left bundle-branch (LBB) divides early into a left anterior fascicle and a left posterior fascicle.¹Special fibers derived from the left conducting system activate the septum. The blood supply to the His bundle is usually dual,²arising from

The isolated-perfused rabbit oviduct: A simple experimental preparation

A new, simple method to study several physiological parameters in the isolated rabbit oviduct is described in detail. The whole oviduct with its supporting membranes, the ovary and part of the uterine horn, and part of the systemic blood supply were excised and perfused in vitro through cannulated blood vessels with a blood-physiological solution mixture. Autoregulation of the vasculature was demonstrated, suggesting that the preparation was viable and well oxygenated. The frequency of contractions of the ampullary and isthmic parts was decreased by prostaglandin E 2 added to the perfusing solution.

Malformation of bronchopulmonary foregut with systemic and pulmonary arterial blood supply: D. B. Crawford, S. Cole, K. S. Danielson, E. M. Henken, R. M. Maenza, and J. L. Westcott. Chest 73:421–424 (March), 1978

Malformation of bronchopulmonary foregut with systemic and pulmonary arterial blood supply: D. B. Crawford, S. Cole, K. S. Danielson, E. M. Henken, R. M. Maenza, and J. L. Westcott. Chest 73:421–424 (March), 1978

Malformation of Bronchopulmonary Foregut with Systemic and Pulmonary Arterial Blood Supply

A case of congenital malformation of the bronchopulmonary foregut with communication between the esophagus and sequestered lobe is reported in a six-month-old boy. Only 29 similar cases have been reported previously, and this case was especially unusual in that the communication was from the middle portion of the esophagus to a right apical sequestration. Another unusual feature was that the sequestered segment was supplied by four systemic arteries from the thoracic aorta, as well as by branches from the right pulmonary artery. Within the sequestration, there was shunting of blood from the systemic to pulmonary arterties with reversal of flow in the pulmonary arterial branches.

Morphological and topographical variations of the outlet chamber in complex congenital heart disease: an angiocardiographic study.

The outlet chamber of the human heart can show considerable variations in its morphology and topography (relationship to main ventricular chamber), and such variations in anatomy and spacial relationship may be predictive of the associated intracardiac anatomy. Although there is considerable debate about whether the position of the outlet chamber is indicative of the type of bulboventricular loop (whether D- or L-), a right-sided and anterior outlet chamber has different implications than a left-sided, superior, and more posterior positioned one. The inflows into the outlet chamber can vary anatomically, and progressive changes in the calibers of these communications can adversely alter the natural history. One or both of the greak vessels, or neither, or a persistent truncus arteriosus can originate from the outlet chamber, and any significant morphological change in the outlet chamber may or may not adversely affect either the pulmonary or systemic blood supply, or both. Finally, any consideration of the outlet chamber raises important conceptual difference in terminologies. At present, there is not unanimity as to what constitutes either an outlet chamber (as compared to a "small right ventricle" in tricuspid atresia) or a single (primitive) ventricle. Any discussion of the morphological and topographical variations of the outlet chamber must be viewed with respect to the terminology employed.

Intralobar pulmonary sequestration, with special reference to developmental pathology.

SUMMARy _ Observations in 13 patients with intralobar sequestration with or without an aberrant systemic artery were made on a 3-dimensional reconstruction of bronchoalveolar components and afferent and efferent vessels. The location of cartilage or mucous glands in the walls of cystic bronchial components, the shape of these cystic changes, and the developmental state of the broncho­ alveolar structures, which was divided into 4 grades, suggested that the malformed lung developed from the posterior, medial, basal part of the lower lobe in an upward and lateral direction and fused with normally developed lung tissue. In one patient, a fibrous stalk was connected to the esophagus, and in another patient, it was accompanied by an extralobar sequestration. Observations on the relationship between the extent of the sequestered area and the extent of the systemic blood supply showedindependent occurrencesof the malformed lung and the aberrant artery. These findings support the view that intralobar as well as extralobar sequestrations arise from an ac­ cessory bronchopulmonary bud on the foregut. A normal lung supplied by an aberrant artery with or without a pulmonary artery should be excluded from the category of pulmonary sequestration.

Haemodynamic characteristics of systemic arterial blood supply to the lungs.

Haemodynamic characteristics of systemic arterial blood supply to the lungs.