Sample records for renal hemodynamic parameters

  1. Obesity and renal hemodynamics

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.


    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile

  2. Obesity and renal hemodynamics

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.


    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile inde

  3. Pre-interventional prognostic value of renal endocrine, hemodynamic and arteriographic parameters in hypertensive patients with uni- and bilateral renal artery stenosis

    Arlart, I.P.; Bargon, G.


    In order to improve pre-interventional prognosis of blood pressure normalization, in patients with angiographically proven uni- (n=75) and bilateral (n=38) renal artery stenosis, (RAS) evaluation of renal venous and peripheral renin activity including stimulative procedures and Saralasin-infusion-test was carried out. In addition selective renal arteriographic, hemodynamic and pharmacodynamic (133 xe-washout) investigations were performed. The data were correlated with operative results concerning response of blood pressure to surgical treatment in 54 patients with uni- and 30 patients with bilateral RAS. Our results suggest that a postoperative normalization of blood-pressure can only be expected if pre-interventional selective arteriograms reveal a normal vascular tree accompanied with normal cortical flow rates of both kidneys in uni- and bilateral RAS. Selective renin determinations, stimulative procedures of the renin-angiotensin system and application of angiotensin antagonists are only of value for selection of patients.

  4. Prognostic value of renal hemodynamic characteristics in patients with proliferative lupus nephritis

    Martens, Henk A.; Bijl, Marc; Kallenberg, Cees G. M.


    Background/Aim: Previous studies showed that renal hemodynamic parameters, especially the filtration fraction ( FF), are decreased in patients with active lupus nephritis ( LN). In this study, we evaluate the prognostic value of renal hemodynamic function tests on the renal outcome in patients with

  5. Relationship Between Serum Uric Acid Levels and Intrarenal Hemodynamic Parameters

    Hideki Uedono


    Full Text Available Background/Aims: Hyperuricemia has been reported to affect renal hemodynamics in rat models. We evaluate the relationship between serum uric acid and intrarenal hemodynamic parameters in humans, utilizing the plasma clearance of para-aminohippurate (CPAH and inulin (Cin. Methods: Renal and glomerular hemodynamics were assessed by simultaneous measurement of CPAH and Cin in 58 subjects. Of these, 19 subjects were planned to provide a kidney for transplantation; 26 had diabetes without proteinuria; and 13 had mild proteinuria. Renal and glomerular hemodynamics were calculated using Gomez`s formulae. Results: Cin was more than 60 ml/min/1.73m2 in all subjects. Serum uric acid levels correlated significantly with vascular resistance at the afferent arteriole (Ra (r = 0.354, p = 0.006 but not with that of the efferent arteriole (Re. Serum uric acid levels (β = 0.581, p = a after adjustment for several confounders (R2 = 0.518, p = Conclusions: These findings suggest, for the first time in humans, that higher serum uric acid levels are associated significantly with Ra in subjects with Cin > 60 ml/min/1.73m2. The increase in Ra in subjects with higher uric acid levels may be related to dysfunction of glomerular perfusion.

  6. Acute effects of ferumoxytol on regulation of renal hemodynamics and oxygenation

    Cantow, Kathleen; Pohlmann, Andreas; Flemming, Bert; Ferrara, Fabienne; Waiczies, Sonia; Grosenick, Dirk; Niendorf, Thoralf; Seeliger, Erdmann


    The superparamagnetic iron oxide nanoparticle ferumoxytol is increasingly used as intravascular contrast agent in magnetic resonance imaging (MRI). This study details the impact of ferumoxytol on regulation of renal hemodynamics and oxygenation. In 10 anesthetized rats, a single intravenous injection of isotonic saline (used as volume control) was followed by three consecutive injections of ferumoxytol to achieve cumulative doses of 6, 10, and 41 mg Fe/kg body mass. Arterial blood pressure, renal blood flow, renal cortical and medullary perfusion and oxygen tension were continuously measured. Regulation of renal hemodynamics and oxygenation was characterized by dedicated interventions: brief periods of suprarenal aortic occlusion, hypoxia, and hyperoxia. None of the three doses of ferumoxytol resulted in significant changes in any of the measured parameters as compared to saline. Ferumoxytol did not significantly alter regulation of renal hemodynamics and oxygenation as studied by aortic occlusion and hypoxia. The only significant effect of ferumoxytol at the highest dose was a blunting of the hyperoxia-induced increase in arterial pressure. Taken together, ferumoxytol has only marginal effects on the regulation of renal hemodynamics and oxygenation. This makes ferumoxytol a prime candidate as contrast agent for renal MRI including the assessment of renal blood volume fraction. PMID:27436132

  7. Renal parameter estimates in unrestrained dogs

    Rader, R. D.; Stevens, C. M.


    A mathematical formulation has been developed to describe the hemodynamic parameters of a conceptualized kidney model. The model was developed by considering regional pressure drops and regional storage capacities within the renal vasculature. Estimation of renal artery compliance, pre- and postglomerular resistance, and glomerular filtration pressure is feasible by considering mean levels and time derivatives of abdominal aortic pressure and renal artery flow. Changes in the smooth muscle tone of the renal vessels induced by exogenous angiotensin amide, acetylcholine, and by the anaesthetic agent halothane were estimated by use of the model. By employing totally implanted telemetry, the technique was applied on unrestrained dogs to measure renal resistive and compliant parameters while the dogs were being subjected to obedience training, to avoidance reaction, and to unrestrained caging.

  8. Monitoring of renal hemodynamics during acute hemorrhagic shock with Doppler ultrasonic imaging: an experimental study

    Rui-hong LIU


    Full Text Available Objective To evaluate the value of color Doppler flow imaging (CDFI and pulsed-wave Doppler (PWD in monitoring renal hemodynamics in rabbits with acute hemorrhagic shock. Methods The experimental model of acute hemorrhagic shock was reproduced in 16 normal New Zealand white rabbits by controlled exsanguination which was divided into 4 different grades: normal (100% MAP, mild (70% MAP, moderate (50% MAP, and severe (40% MAP. The right kidney of the experimental animal was examined by gray-scale ultrasound (2DUS, CDFI and PWD. The structure of the right kidney was observed with 2DUS. CDFI was used to monitor the change in right renal hemodynamics along with the progression of shock. The hemodynamic parameters of main renal artery (MRA, segmental renal artery (SRA and interlobar renal artery (IRA were measured by PWD, including the peak systolic velocity (Vmax, minimum diastolic velocity (Vmin and resistive index (RI. Results The animal model of hemorrhagic shock was successfully reproduced in 16 healthy New Zealand rabbits, of which 14 rabbits survived at the end of the experiment, and 2 died of severe shock. The mean arterial pressure (MAP declined, while the respiratory rate and heart rate increased as the circulation changed from normal to severe shock (P<0.05. Observation of the right renal structure by 2DUS revealed no obvious changes after bleeding in different degrees. CDFI showed a gradually reduced distribution of blood flow in renal hemodynamics along with the progression of hemorrhagic shock. Vmax and Vmin declined gradually, while RI intensity increased as the hemorrhagic shock progressed from minor to severe. There was statistically significant difference in RI intensity between different grades of shock (P<005. Conclusion CDFI and PWD can quantitatively assess the renal hemodynamics during acute hemorrhagic shock, so it can be used as a noninvasive monitoring tool in the diagnosis and treatment of hemorrhagic shock. DOI: 10

  9. Valuation of color Doppler ultrasound in monitoring hemodynamic parameters following renal transplantation%彩色多普勒超声在肾移植后监测中的应用



    背景:超声检查已经成为了肾移植后的常规检查及监测方法.目的:探讨彩色多普勒超声在肾移植后监测的应用价值.方法:对61 例同种异体肾移植后患者采用彩色多普勒超声进行检测,其中移植肾正常组35 例,急性排斥反应组22 例,慢性排斥反应组4 例.对所有患者进行常规超声探查,结合彩色多普勒及能量多普勒观察移植肾的观察移植肾结构、血流灌注情况,测量各级血管的血流参数.结果与结论:急性排斥反应组移植肾较功能正常组明显肿大,彩色多普勒显像、多普勒能量图显示肾实质血流信号减少,舒张期明显,各级动脉阻力指数和搏动指数明显增高;慢性排斥反应组移植肾体积较功能正常组明显减小,彩色多普勒显像、多普勒能量图显示肾动脉内径明显缩小,动脉阻力指数和搏动指数明显升高.提示,应用超声能早期无创的观察移植肾的血流灌注情况,测量移植肾各级血管的血流参数能敏感的反应移植肾的功能状况.%BACKGROUND: Ultrasound examination has been a routine examination and monitoring method following renal transplantation.OBJECTIVE: To investigate the value of color Doppler ultrasound in monitoring hemodynamic parameters of the transplanted kidney.METHODS: Sixty-one patients of allograft renal transplantation were divided into 3 groups of which 35 patients in normal group,22 in acute rejection group, and 4 in chronic rejection group. Conventional ultrasound examination combined with color Doppler flow image (CDFI) and power Doppler image (PDI) was performed with each objects to observe construction, blood perfusion and measure the hemodynamic parameters of various vessels in transplanted kidney.RESULTS AND CONCLUSION: Swelling, renal parenchyma thickening and echo enhancement were demonstrated in acute rejection group. The bound between cortex and medullary substance was blurring. CDFI and PDI indicated that the blood

  10. Does lower limb exercise worsen renal artery hemodynamics in patients with abdominal aortic aneurysm?

    Anqiang Sun

    Full Text Available Renal artery stenosis (RAS and renal complications emerge in some patients after endovascular aneurysm repair (EVAR to treat abdominal aorta aneurysm (AAA. The mechanisms for the causes of these problems are not clear. We hypothesized that for EVAR patients, lower limb exercise could negatively influence the physiology of the renal artery and the renal function, by decreasing the blood flow velocity and changing the hemodynamics in the renal arteries. To evaluate this hypothesis, pre- and post-operative models of the abdominal aorta were reconstructed based on CT images. The hemodynamic environment was numerically simulated under rest and lower limb exercise conditions. The results revealed that in the renal arteries, lower limb exercise decreased the wall shear stress (WSS, increased the oscillatory shear index (OSI and increased the relative residence time (RRT. EVAR further enhanced these effects. Because these parameters are related to artery stenosis and atherosclerosis, this preliminary study concluded that lower limb exercise may increase the potential risk of inducing renal artery stenosis and renal complications for AAA patients. This finding could help elucidate the mechanism of renal artery stenosis and renal complications after EVAR and warn us to reconsider the management and nursing care of AAA patients.

  11. Renal Function and Hemodynamic Study in Obese Zucker Rats

    Park, Sung Kwang; Kang, Sung Kyew


    Objectives To investigate the renal function and hemodynamic changes in obesity and hyperinsulinemia which are characteristics of type II diabetes. Methods Studies were carried out in two groups of female Zucker rats. Group 1 rats were obese Zucker rats with hereditary insulin resistance. Group 2 rats were lean Zucker rats and served as controls. In comparison with lean Zucker rats, obese Zucker rats exhibited hyperinsulinemia but normoglycemia. Micropuncture studies and morphologic studies w...

  12. Comparative effects of enalapril and nifedipine on renal hemodynamics in hypertensive renal allograft recipients.

    Abu-Romeh, S H; el-Khatib, D; Rashid, A; Patel, M; Osman, N; Fayyad, M; Scheikhoni, A; Higazi, A S


    The comparative effects of enalapril (E) and nifedipine (N) on renal hemodynamics were assessed in twenty-two moderately hypertensive, cadaveric renal transplant patients who were maintaining stable renal function. Fourteen patients were on cyclosporin (CSA) and eight were receiving azathioprine with prednisolone (AZA). In each patient effective renal plasma flow (ERPF) was determined four times, first baseline, second with E, third as another baseline after a washout period, and fourth with N; and renal vascular resistance (RVR) was derived in each. ERPF and RVR were significantly compromised in the CSA group (202 +/- 55 ml/min and 65 +/- 18 mmHg/ml/min) compared to the AZA group (302 +/- 99 and 43 +/- 15 respectively). During E therapy, RVR further increased in the CSA group to 82 +/- 37 while it decreased in the AZA group to 31 +/- 7 (both changes were significant when compared to their respective baseline values). N, on the other hand, only significantly lowered RVR in the AZA group. Furthermore, two patients, one from each group, developed acute reversible renal failure shortly after E therapy. However, both agents were effective in lowering blood pressure to a comparable degree in both groups. In conclusion, our data showed a somewhat less favourable renal hemodynamic response to short-term enalapril therapy in hypertensive renal transplant patients maintained on CSA. However, the significance of such hemodynamic changes for long-term renal function remains uncertain.

  13. [Determining the aortic and renal hemodynamic effects of propofol on rabbits using Doppler ultrasonography].

    Apan, Alpaslan; Karadeniz Bilgili, M Yasemin; Cağlayan, Fatma


    The hemodynamic effects of propofol-fentanyl anesthesia were known to reduce arterial pressure and heart rate. We aimed to determine the effects of propofol-fentanyl anesthesia on renal artery blood flow and aorta by using Doppler ultrasonography on an animal model. The study was conducted on 8 male New Zaeland White strain rabbits. The initial aortic and renal hemodynamic measurements were determined on animals using ketamin anesthesia. Later the right femoral arteries were cannulated for determining arterial blood pressure and pulse oximetry was followed from the ear. Propofol 5-7 mg/kg with fentanyl 1-2 microg/kg was injected via the ear vein. Doppler parameters (RI, RI, Vmax, Vmin) of the renal artery and aorta were determined after the anesthesia. According to the basal measurements, arterial blood pressure and breath rates declined significantly (27% and 53% respectively, p<0.05); however there were no statistical alteration of aortic and renal artery Doppler parameters. Anesthesia induced by propofol-fentanyl did not induce a statistically significant difference in Doppler parameters obtained from the renal artery and aorta. It is clinically important to know that determining the changes in RI and PI during the postoperative period is not related to the propofol-fentanyl anesthesia.

  14. Impact of Iodinated Contrast on Renal Function and Hemodynamics in Rats with Chronic Hyperglycemia and Chronic Kidney Disease.

    Fernandes, Sheila Marques; Martins, Daniel Malisani; da Fonseca, Cassiane Dezoti; Watanabe, Mirian; Vattimo, Maria de Fátima Fernandes


    Iodinated contrast (IC) is clinically used in diagnostic and interventional procedures, but its use can result in contrast-induced acute kidney injury (CI-AKI). Chronic kidney disease (CKD) and chronic hyperglycemia (CH) are important predisposing factors to CI-AKI. The aim of this study was to investigate the impact of iodinated contrast on the renal function and hemodynamics in rats with chronic hyperglycemia and chronic kidney disease. A total of 30 rats were divided into six groups; Sham: control of chronic renal disease; Citrate: control of chronic hyperglycemia (CH); Nx5/6: rats with 5/6 nephrectomy; Chronic Hyperglycemia: rats receiving Streptozotocin 65 mg/kg; Nx5/6 + IC: rats Nx5/6 received 6 mL/kg of IC; CH + IC: Chronic hyperglycemia rats receiving 6 mL/kg of IC. Renal function (inulin clearance; urinary neutrophil gelatinase-associated lipocalin, NGAL) and hemodynamics (arterial blood pressure; renal blood flow; renal vascular resistance) were evaluated. Iodinated contrast significantly increased urinary NGAL and reduced inulin clearance, while the hemodynamics parameters showed changes in arterial blood pressure, renal blood flow, and renal vascular resistance in both CKD and CH groups. The results suggest that the iodinated contrast in risk factors models has important impact on renal function and hemodynamics. NGAL was confirmed to play a role of highlight in diagnosis of CI-AKI.

  15. Tempol improves renal hemodynamics and pressure natriuresis in hyperthyroid rats.

    Moreno, Juan Manuel; Rodríguez Gómez, Isabel; Wangensteen, Rosemary; Alvarez-Guerra, Miriam; de Dios Luna, Juan; García-Estañ, Joaquín; Vargas, Félix


    Hyperthyroidism in rats is associated with increased oxidative stress. These animals also show abnormal renal hemodynamics and an attenuated pressure-diuresis-natriuresis (PDN) response. We analyzed the role of oxidative stress as a mediator of these alterations by examining acute effects of tempol, a superoxide dismutase mimetic. The effects of increasing bolus doses of tempol (25-150 micromol/kg) on mean arterial pressure (MAP), renal vascular resistance (RVR), and cortical (CBF) and medullary (MBF) blood flow were studied in control and thyroxine (T4)-treated rats. In another experiment, tempol was infused at 150 to analyze its effects on the glomerular filtration rate (GFR) and on PDN response in these animals. Tempol dose dependently decreased MAP and RVR and increased CBF and MBF in control and T4-treated rats, but the T4 group showed a greater responsiveness to tempol in all of these variables. The highest dose of tempol decreased RVR by 13.5 +/- 2.1 and 5.5 +/- 1.2 in hyperthyroid (P natriuresis (T4+tempol: 0.17 +/- 0.05; T4: 0.09 +/- 0.03 microeq.min(-1).g(-1).mmHg(-1); P < 0.05) and reduced 8-isoprostane excretion in hyperthyroid rats. These results show that antioxidant treatment with tempol improves renal hemodynamic variables and PDN response in hyperthyroid rats, indicating the participation of an increased oxidative stress in these mechanisms.

  16. Renal hemodynamics in hypertensive renal allograft recipients: effects of calcium antagonists and ACE inhibitors.

    Grekas, D; Dioudis, C; Kalevrosoglou, I; Alivanis, P; Derveniotis, V; Tourkantonis, A


    Hypertension present in more than 50% of successfully renal transplanted patients and its prevalence has slightly increased since the introduction of cyclosporine A. Twenty patients, 9 women and 11 men aged from 30 to 58 years, with stable cadaveric renal allograft function and moderate to severe hypertension, were included in the study. Renal artery graft stenosis causing hypertension were excluded. All patients were given triple drug immunosuppressive treatment with methylprednisolone, azathioprine and cyclosporine A (CsA) and their hypertension was treated with a nifedipine dose of 20 mg twice daily. To evaluate the effect of ACE inhibitors on renal hemodynamics and hypertension, a 4 mg/daily dose of perindopril was added to the above regimen for two months. Effective renal plasma flow (ERPF) decreased from 208 +/- 54 to 168 +/- 61 ml/min and renal vascular resistance (RVR) increased from 75 +/- 12 to 88 +/- 17 mm Hg/ml/min (P nifedipine. It is suggested that the combination of both antihypertensive agents was more effective than monotherapy with nifedipine in controlling blood pressure, but less favorable on the renal hemodynamic response in hypertensive renal transplant patients who were maintained on CsA.

  17. Role of vascular potassium channels in the regulation of renal hemodynamics

    Sørensen, Charlotte Mehlin; Braunstein, Thomas Hartig; von Holstein-Rathlou, Niels-Henrik


    of one or more classes of K+ channels will lead to a change in hemodynamic resistance and therefore of renal blood flow and glomerular filtration pressure. Through these effects, the activity of renal vascular K+ channels influences renal salt and water excretion, fluid homeostasis, and ultimately blood...

  18. The effect of Cratylia floribunda lectin on renal hemodynamics and ion transport

    Alexandre Havt


    Full Text Available Lectins have been described as glycoproteins that reversibly and specifically bind to carbohydrates. Legume lectins isolated from the subtribe Diocleinae (Canavalia, Dioclea andCratylia are structurally homologous with respect to their primary structures. The Diocleinae lectins of Canavalia brasiliensis, Dioclea guianensis andCanavalia ensiformis have been shown to distinctly alter physiological parameters in isolated rat kidneys. Thus, the aim of this study was to investigate the effect of Cratylia floribunda lectin (CFL on renal hemodynamics and ion transport in rats. In isolated perfused kidneys, CFL (10 mg/mL, n=5 increased RPP, RVR and decreased %TK+, but did not change urinary flow, glomerular filtration rate, sodium or chloride tubular transport. In isolated perfused mesenteric bed, CFL (3 and 10 mg/mL/min; n=4 did not alter tissue basal tonus or tissue contraction by phenylephrine (1 mM/mL/min. In conclusion, the seed lectin of Cratylia floribunda increased renal hemodynamic parameters showing a kaliuretic effect. This effect could be of tubular origin, rather than a result from haemodynamic alterations.

  19. Renal Function and Hemodynamic Study in Obese Zucker Rats

    Park, Sung Kwang; Kang, Sung Kyew


    Objectives To investigate the renal function and hemodynamic changes in obesity and hyperinsulinemia which are characteristics of type II diabetes. Methods Studies were carried out in two groups of female Zucker rats. Group 1 rats were obese Zucker rats with hereditary insulin resistance. Group 2 rats were lean Zucker rats and served as controls. In comparison with lean Zucker rats, obese Zucker rats exhibited hyperinsulinemia but normoglycemia. Micropuncture studies and morphologic studies were performed in these rats. Results Functional studies showed that obese Zucker rats exhibited increases in kidney weight and GFR(obese Zucker, 1.23±.07)ml/min; lean Zucker, 0.93±.03ml/min). Micropuncture studies revealed that the increase in GFR in obese Zucker rats was attributable to the increases in the single nephron plasma flow rate and glomerular transcapillary hydraulic pressure. The glomerular ultrafiltration coefficient was the same in both groups. Morphologic studies revealed that the increase in GFR in obese Zucker rats was associated with an increase in glomerular volume. Conclusions These results suggest that obesity and hyperinsulinemia, which are the characteristics of type II diabetes, can be associated with glomerular hyperfiltration and glomerular capillary hypertension. PMID:7626557

  20. The Influence of Age on Hemodynamic Parameters During Rest and Exercise in Healthy Individuals

    Wolsk, Emil; Bakkestrøm, Rine; Thomsen, Jacob H


    . Participants had hemodynamic parameters measured using right heart catheterization during rest, passive leg raise, and incremental exercise. RESULTS: During rest, all hemodynamic parameters were similar between age groups, apart from blood pressure. During leg raise and incremental exercise...

  1. Effect of increased protein intake on renal acid load and renal hemodynamic responses

    Teunissen-Beekman, Karianna F.M.; Dopheide, Janneke; Geleijnse, Marianne; Bakker, Stephan J.L.; Brink, Elizabeth J.; Leeuw, de Peter W.; Baak, van Marleen A.


    Increased protein intake versus maltodextrin intake for 4 weeks lowers blood pressure. Concerns exist that high-protein diets reduce renal function. Effects of acute and 4-week protein intake versus maltodextrin intake on renal acid load, glomerular filtration rate and related parameters were com

  2. Effect of increased protein intake on renal acid load and renal hemodynamic responses

    Teunissen-Beekman, Karianna F M; Dopheide, Janneke; Geleijnse, Johanna M; Bakker, Stephan J L; Brink, Elizabeth J; de Leeuw, Peter W; van Baak, Marleen A


    Increased protein intake versus maltodextrin intake for 4 weeks lowers blood pressure. Concerns exist that high-protein diets reduce renal function. Effects of acute and 4-week protein intake versus maltodextrin intake on renal acid load, glomerular filtration rate and related parameters were compar

  3. Correlative study on blood perfusion and hemodynamics parameters observed by ultrasonography and serum creatinine levels in patients with renal transplantation%超声观察移植肾血流灌注及动力学参数与血清肌酐水平的相关性研究

    李晓萌; 李博慧; 朱军; 赵洋; 曹晔; 杜巍


    Objective To study the correlation of blood perfusion and hemodynamics parameters observed by ultrasonography and serum creatinine (SCr) levels in patients with renal transplantation. Methods One hundred and twenty-six patients who were after renal transplantation 1 year were enrolled in this study. They were divided into normal renal function group (30 cases) and abnormal renal function group (96 cases) according to serum creatinine level. The morphology,size and structure of transplanted kidney were observed by two-dimensional ultrasound. The renal arterial blood flow perfusion was observed by color Doppler flow imaging. The spectral pattern was observed by PW Doppler. The systolic maximum velocity ( Vp ), Diastolic minimum velocity ( Vmin ) , mean velocity ( Vmean ), resistance index ( RI) and pulsatility index ( PI) of main renal artery and interlobar artery were measured. Results The ultrasonic manifestations of normal renal function group showed uniform echo in transplantation renal cortex, internal structure was clear, the renal blood vessels distributed as "branch-like" , abundant blood flow signal was found.Spectrum showed consistent forward blood flow with low resistance in whole cardiac cycle. There were 96 cases of medullary edema in abnormal renal function group, 30 cases of those showed enhancement solid echo and regular edge. Compared with normal renal function group, Vp, Vmin and Vmean of main renal artery and interlobar artery in abnormal renal function group were decreased, RI and PI were increased (P <0.05). Conclusion The blood perfusion and hemodynamics parameters observed by ultrasonography can provide a imaging evidence for function change of transplanted kidney.%目的 超声观察移植肾血流灌注及动力学参数与血清肌酐水平的相关性研究.方法 选取肾移植术后1年的126例患者,根据血清肌酐水平分为肾功能正常组30 例及异常组96 例.二维超声观察移植肾形态、大小、结构,彩色多普

  4. Assessment of hemodynamic parameters of uterus during physiological pregnancy

    Chekhonatskaya M.L.; Petrosyan N.O.


    The aim of the article is to analysis of the hemodynamic parameters of the uterus and cervix during the second and third trimesters of pregnancy. Material and methods. It was conducted dynamic ultrasound in 240 women with physiological course for singleton pregnancies in the period from 12 weeks of gestation until term labor. Results. For the second trimester of pregnancy redistribution of total uterine blood flow in the direction of increasing blood flow in more of the body than the cervix h...

  5. Assessment of hemodynamic parameters of uterus during physiological pregnancy

    Chekhonatskaya M.L.


    Full Text Available The aim of the article is to analysis of the hemodynamic parameters of the uterus and cervix during the second and third trimesters of pregnancy. Material and methods. It was conducted dynamic ultrasound in 240 women with physiological course for singleton pregnancies in the period from 12 weeks of gestation until term labor. Results. For the second trimester of pregnancy redistribution of total uterine blood flow in the direction of increasing blood flow in more of the body than the cervix has been considered to be typical. From the third trimester of pregnancy until term labor a significant increase of blood supply to the cervix has been found; there has been a tendency to increase the capacity of the vascular channel and the reduction in peripheral resistance vessels of cervix. Conclusions. Early detection of disorders of uterine and cervical hemodynamics allows to predict the occurrence of various pathological conditions.

  6. Evaluation of the hemodynamic impact of continuous renal replacement therapy in healthy dogs.

    Shimokawa Miyama, Takako; Itamoto, Kazuhito; Yoshioka, Chihiro; Minami, Koji; Okawa, Takumi; Fujisaki, Yuka; Hiraoka, Hiroko; Mizuno, Takuya; Okuda, Masaru


    We performed continuous renal replacement therapy (CRRT) on clinically healthy dogs to evaluate the effects of CRRT on hemodynamics. Heart rate, arterial blood pressure, and central venous pressure of the dogs (n=6) were recorded during the procedure, which was performed under general anesthesia. Throughout the CRRT, heart rate and arterial blood pressure were stable. Central venous pressure increased after CRRT termination but returned to the basal level within 30 min. In this study, hemodynamic alterations, including hypotension, hypertension, and arrhythmias, were not observed during CRRT. These observations suggest that the CRRT protocol used in the present study can be safely applied to clinical cases with acute renal failure.

  7. Renal Heme Oxygenase-1 Induction with Hemin Augments Renal Hemodynamics, Renal Autoregulation, and Excretory Function

    Fady T. Botros


    Full Text Available Heme oxygenases (HO-1; HO-2 catalyze conversion of heme to free iron, carbon monoxide, and biliverdin/bilirubin. To determine the effects of renal HO-1 induction on blood pressure and renal function, normal control rats (n=7 and hemin-treated rats (n=6 were studied. Renal clearance studies were performed on anesthetized rats to assess renal function; renal blood flow (RBF was measured using a transonic flow probe placed around the left renal artery. Hemin treatment significantly induced renal HO-1. Mean arterial pressure and heart rate were not different (115±5 mmHg versus 112±4 mmHg and 331±16 versus 346±10 bpm. However, RBF was significantly higher (9.1±0.8 versus 7.0±0.5 mL/min/g, P<0.05, and renal vascular resistance was significantly lower (13.0±0.9 versus 16.6±1.4 [mmHg/(mL/min/g], P<0.05. Likewise, glomerular filtration rate was significantly elevated (1.4±0.2 versus 1.0±0.1 mL/min/g, P<0.05, and urine flow and sodium excretion were also higher (18.9±3.9 versus 8.2±1.0 μL/min/g, P<0.05 and 1.9±0.6 versus 0.2±0.1 μmol/min/g, P<0.05, resp.. The plateau of the autoregulation relationship was elevated, and renal vascular responses to acute angiotensin II infusion were attenuated in hemin-treated rats reflecting the vasodilatory effect of HO-1 induction. We conclude that renal HO-1 induction augments renal function which may contribute to the antihypertensive effects of HO-1 induction observed in hypertension models.

  8. Effect of naringin on hemodynamic changes and left ventricular function in renal artery occluded renovascular hypertension in rats

    Asjad Visnagri


    Full Text Available Background: Renal artery occlusion (RAO induced hypertension is a major health problem associated with structural and functional variations of the renal and cardiac vasculature. Naringin a flavanone glycoside derived possesses metal-chelating, antioxidant and free radical scavenging properties. Objective: The objective of this study was to investigate the antihypertensive activity of naringin in RAO induced hypertension in rats.Material and Methods: Male Wistar rats (180-200 g were divided into five groups Sham, RAO, naringin (20, 40 and 80 mg/kg. Animals were pretreated with naringin (20, 40 and 80 mg/kg p.o for 4 weeks. On the last day of the experiment, left renal artery was occluded with renal bulldog clamp for 4 h. After assessment of hemodynamic and left ventricular function various biochemical (superoxide dismutase [SOD], glutathione [GSH] and malondialdehyde [MDA] and histological parameters were determined in the kidney. Results: RAO group significantly (P < 0.001 increased hemodynamic parameters at 15, 30 and 45 min of clamp removal. Naringin (40 and 80 mg/kg treated groups showed a significant decrease in hemodynamic parameters at 15 min. after clamp removal that remained sustained for 60 min. Naringin (40 and 80 mg/kg treated groups showed significant improvement in left ventricular function at 15, 30 and 45 min after clamp removal. Alteration in level of SOD, GSH and MDA was significantly restored by naringin (40 and 80 mg/kg treatment. It also reduced histological aberration induced in kidney by RAO. Conclusion: It is concluded that the antihypertensive activity of naringin may result through inhibition of oxidative stress.

  9. Effect of inhibition of converting enzyme on renal hemodynamics and sodium management in polycystic kidney disease.

    Torres, V E; Wilson, D M; Burnett, J C; Johnson, C M; Offord, K P


    We compared the tubular transport of sodium and the erythrocyte sodium-lithium countertransport activity in hypertensive patients with autosomal dominant polycystic kidney disease (ADPKD) and in normotensive control subjects. In addition, we assessed the effects of inhibition of converting enzyme on renal hemodynamics and sodium excretion in hypertensive patients with ADPKD to provide information on mechanisms responsible for the increased renal vascular resistance and filtration fraction and the adjustment of the pressure-natriuresis relationship during saline expansion, observed in patients with ADPKD, hypertension, and preserved renal function. In comparison with normotensive control subjects, the hypertensive patients with ADPKD had lower renal plasma flows, higher renal vascular resistances and filtration fractions, and similar proximal and distal fractional reabsorptions of sodium. The administration of enalapril resulted in significant increases in the renal plasma flow and significant reductions in mean arterial pressure, renal vascular resistance, and filtration fraction, but the glomerular filtration rate remained unchanged. Despite the significant reduction in mean arterial pressure during inhibition of converting enzyme, the distal fractional reabsorption of sodium decreased while the total fractional excretion of sodium remained unchanged or increased slightly. No significant differences were detected between the normotensive control subjects and the hypertensive patients with ADPKD in erythrocyte sodium-lithium countertransport activity, plasma renin activity, plasma aldosterone concentration, or atrial natriuretic factor. These results suggest that the renal renin-angiotensin system plays a central role in the alterations in renal hemodynamics and sodium management associated with the development of hypertension in ADPKD.

  10. Tube-Load Model Parameter Estimation for Monitoring Arterial Hemodynamics

    Guanqun eZhang


    Full Text Available A useful model of the arterial system is the uniform, lossless tube with parametric load. This tube-load model is able to account for wave propagation and reflection (unlike lumped-parameter models such as the Windkessel while being defined by only a few parameters (unlike comprehensive distributed-parameter models. As a result, the parameters may be readily estimated by accurate fitting of the model to available arterial pressure and flow waveforms so as to permit improved monitoring of arterial hemodynamics. In this paper, we review tube-load model parameter estimation techniques that have appeared in the literature for monitoring wave reflection, large artery compliance, pulse transit time, and central aortic pressure. We begin by motivating the use of the tube-load model for parameter estimation. We then describe the tube-load model, its assumptions and validity, and approaches for estimating its parameters. We next summarize the various techniques and their experimental results while highlighting their advantages over conventional techniques. We conclude the review by suggesting future research directions and describing potential applications.

  11. Tube-Load Model Parameter Estimation for Monitoring Arterial Hemodynamics

    Zhang, Guanqun; Hahn, Jin-Oh; Mukkamala, Ramakrishna


    A useful model of the arterial system is the uniform, lossless tube with parametric load. This tube-load model is able to account for wave propagation and reflection (unlike lumped-parameter models such as the Windkessel) while being defined by only a few parameters (unlike comprehensive distributed-parameter models). As a result, the parameters may be readily estimated by accurate fitting of the model to available arterial pressure and flow waveforms so as to permit improved monitoring of arterial hemodynamics. In this paper, we review tube-load model parameter estimation techniques that have appeared in the literature for monitoring wave reflection, large artery compliance, pulse transit time, and central aortic pressure. We begin by motivating the use of the tube-load model for parameter estimation. We then describe the tube-load model, its assumptions and validity, and approaches for estimating its parameters. We next summarize the various techniques and their experimental results while highlighting their advantages over conventional techniques. We conclude the review by suggesting future research directions and describing potential applications. PMID:22053157

  12. Effect of elevated interstitial pressure on the renal cortical hemodynamics.

    Källskog, O; Wolgast, M


    The influence of renal interstitial pressure on the resistance pattern within the superficial cortical vasculature has been investigated from determinations of 1) the glomerular blood flow eith a modified microsphere technique and 2) the intravascular hydrostatic pressures. Interstitial pressure was monitored via a 50 mum PVC-catheter placed into the subcapsular interstitial space. Two conditions were analyzed viz. a) elevation of uretheral pressure to 20 mm Hg and b) venous stasis to 10-15 mm Hg. Both conditions produced an increase in the interstitial pressure from 1-2 mm Hg to about 5 mm Hg as well as an increased hilar lymph flow and protein flow of about the same size. The vascular reactions were different, however. Uretheral stasis (but not the stasis of a single nephron) produced a decreased resistance in the afferent arteriolae with a concomitant increae in the pressures in the glomerular capillaries, and the peritobular capillary network. In contrast, venous stasis produced only small changes in the parameters studied but for the obvious rise in the peritubular capillary pressure. The results suggest that factors other than the interstitial pressure are governing the afferent vascular tone; the tubular wall tension might be one of these factors.

  13. Hemodynamic parameters change earlier than tissue oxygen tension in hemorrhage.

    Pestel, Gunther J; Fukui, Kimiko; Kimberger, Oliver; Hager, Helmut; Kurz, Andrea; Hiltebrand, Luzius B


    Untreated hypovolemia results in impaired outcome. This study tests our hypothesis whether general hemodynamic parameters detect acute blood loss earlier than monitoring parameters of regional tissue beds. Eight pigs (23-25 kg) were anesthetized and mechanically ventilated. A pulmonary artery catheter and an arterial catheter were inserted. Tissue oxygen tension was measured with Clark-type electrodes in the jejunal and colonic wall, in the liver, and subcutaneously. Jejunal microcirculation was assessed by laser Doppler flowmetry (LDF). Intravascular volume was optimized using difference in pulse pressure (dPP) to keep dPP below 13%. Sixty minutes after preparation, baseline measurements were taken. At first, 5% of total blood volume was withdrawn, followed by another 5% increment, and then in 10% increments until death. After withdrawal of 5% of estimated blood volume, dPP increased from 6.1% +/- 3.0% to 20.8% +/- 2.7% (P < 0.01). Mean arterial pressure (MAP), mean pulmonary artery pressure (PAP) and pulmonary artery occlusion pressure (PAOP) decreased with a blood loss of 10% (P < 0.01). Cardiac output (CO) changed after a blood loss of 20% (P < 0.05). Tissue oxygen tension in central organs, and blood flow in the jejunal muscularis decreased (P < 0.05) after a blood loss of 20%. Tissue oxygen tension in the skin, and jejunal mucosa blood flow decreased (P < 0.05) after a blood loss of 40% and 50%, respectively. In this hemorrhagic pig model systemic hemodynamic parameters were more sensitive to detect acute hypovolemia than tissue oxygen tension measurements or jejunal LDF measurements. Acute blood loss was detected first by dPP. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  14. Effect of increased protein intake on renal acid load and renal hemodynamic responses.

    Teunissen-Beekman, Karianna F M; Dopheide, Janneke; Geleijnse, Johanna M; Bakker, Stephan J L; Brink, Elizabeth J; de Leeuw, Peter W; van Baak, Marleen A


    Increased protein intake versus maltodextrin intake for 4 weeks lowers blood pressure. Concerns exist that high-protein diets reduce renal function. Effects of acute and 4-week protein intake versus maltodextrin intake on renal acid load, glomerular filtration rate and related parameters were compared in this study. Seventy-nine overweight individuals with untreated elevated blood pressure and normal kidney function were randomized to consume a mix of protein isolates (60 g/day) or maltodextrin (60 g/day) for 4 weeks in energy balance. Twenty-four-hour urinary potential renal acid load (uPRAL) was compared between groups. A subgroup (maltodextrin N = 27, protein mix N = 25) participated in extra test days investigating fasting levels and postprandial effects of meals supplemented with a moderate protein- or maltodextrin-load on glomerular filtration rate, effective renal plasma flow, plasma renin, aldosterone, pH, and bicarbonate. uPRAL was significantly higher in the protein group after 4 weeks (P ≤ 0.001). Postprandial filtration fraction decreased further after the protein-supplemented breakfast than after the maltodextrin-supplemented breakfast after 4 weeks of supplementation (P ≤ 0.001). Fasting and postprandial levels of glomerular filtration rate, effective renal plasma flow, renin, aldosterone, angiotensin-converting enzyme, pH and bicarbonate did not differ between groups. In conclusion, 4 weeks on an increased protein diet (25% of energy intake) increased renal acid load, but did not affect renal function. Postprandial changes, except for filtration fraction, also did not differ between groups. These data suggest that a moderate increase in protein intake by consumption of a protein mix for 4 weeks causes no (undesirable) effects on kidney function in overweight and obese individuals with normal kidney function.

  15. Hemodynamic evaluation of uterine artery and renal artery in preeclampsia patients and its relationship with endothelial function and invasive function

    Ping-Feng Shu; Peng Wang


    Objective:To study the hemodynamic condition of uterine artery and renal artery in preeclampsia patients and its relationship with endothelial function and invasive function. Methods:Preeclampsia puerperas were enrolled in observation group of the research, including 20 cases each with mild preeclampsia, moderate preeclampsia and severe preeclampsia; healthy puerperas were enrolled in control group. Then color Doppler ultrasound was used to detect hemodynamic parameters of uterine spiral artery and bilateral renal interlobar artery, enzyme-linked immunosorbent assay was used to detect endothelial function indexes in serum, and PCR was used to detect invasive function parameters in placenta.Results: S/D, PI and RI of uterine spiral artery and bilateral renal interlobar artery in mild, moderate and severe preeclampsia patients were all higher than those of control group; the more severe the preeclampsia condition was, the higher the S/D, PI and RI of uterine spiral artery and bilateral renal interlobar artery were; mRNA contents of Cst L, Cst D and MMP-9 in placenta of mild, moderate and severe preeclampsia patients were lower than those of control group, and mRNA contents of RECK as well as serum sFlt-1, sEng, AT1-AA and AngII contents were higher than those of control group; the more severe the disease degree was, the lower the mRNA contents of Cst L, Cst D, and MMP-9 were, the higher the mRNA contents of RECK as well as serum sFlt-1, sEng, AT1-AA and AngII contents were.Conclusion:Resistance of uterine artery and renal artery in preeclampsia patients increases, and it is closely related to endothelial dysfunction and invasive function loss.

  16. Renal hemodynamic and neurohumoral responses to urapidil in hypertensive man

    de Leeuw, P.W.; van Es, P.N.; de Bruyn, H.A.; Birkenhaeger, W.H.D.


    In order to evaluate the acute effects of urapidil on renal vascular tone and on pressor systems we performed a randomized placebo-controlled crossover study in 8 patients with uncomplicated essential hypertension. Each subject received, on two separate days one week apart, an intravenous injection of either placebo or urapidil (25 mg, to be increased to 50 mg if blood pressure did not fall within 5 minutes). Before and following this injection we measured blood pressure and heart rate (Dinamap), renal plasma flow (/sup 125/I-hippuran), renin, angiotensin II, aldosterone, and catecholamines. The results show that urapidil, when compared to placebo, significantly reduced blood pressure, while increasing heart rate, renal blood flow, noradrenaline and adrenaline. Dopamine levels, on the other hand, were suppressed. While renin and angiotensin II were only mildly stimulated, aldosterone levels increased markedly. It is concluded that urapidil, given intravenously, has an immediate blood pressure lowering effect associated with a fall in renal vascular tone and an increase in renal perfusion. As a consequence both the sympathetic system and the renin-angiotensin system are stimulated, although the latter only to a mild degree. The rise in aldosterone may be related to withdrawal of dopaminergic tone.


    I. G. Fomina


    Full Text Available Aim. To study parameters of a renal hemodynamic and the general glomerular filtration rate (GGFR and their correlations with cardiovascular risk factors (RF in patient with arterial hypertension (AH.Material and methods. 102 patients with AH (35 men and 67 women of 40-60 y.o. were involved in the study. 20 persons (10 men and 10 women with normal blood pressure (BP were included in control group. Dynamic renal angioscintigraphy was used for an estimation of a renal hemodynamic and GGFR.Results. Hypertensive women had lower renal blood flow and GGFR than these in men (p<0,000. Renal hemodynamics and GGFR in men and women did not differ in control group. Positive correlation  r=0,61; p<0,05 between GGFR and a tobacco smoking was found in hypertensive men as well as negative correlation (r=-0,41; p<0,005 between GGFR and body mass index (BMI in women.Conclusion. Renal blood flow and GGFR are lower in hypertensive women than these in men. Positive correlation between GGFR and tobacco smoking and negative correlation between GGFR and BMI were found in men and women respectively.

  18. N-acetylcysteine improves renal hemodynamics in rats with cisplatin-induced nephrotoxicity.

    Abdelrahman, Aly M; Al Salam, Suhail; AlMahruqi, Ahmed S; Al husseni, Ishaq S; Mansour, Mohamed A; Ali, Badreldin H


    This work investigated the effect of N-acetylcysteine (NAC), on renal hemodynamics in cisplatin (CP)-induced nephrotoxicity in Wistar-Kyoto (WKY) rats. The animals were divided into four groups (n = 5 or 6). The first and second groups received normal saline (control) and intraperitoneal (i.p.) N-acetylcysteine (500 mg kg(-1) per day for 9 days), respectively. The third and fourth groups were given a single intraperitoneal (i.p.) injection of CP (5 mg kg(-1)) and an i.p. injection of CP (5 mg kg(-1)) together with i.p. NAC (500 mg kg(-1) per day for 9 days), respectively. At the end of the experiment, rats were anesthetized and blood pressure and renal blood flow were monitored, followed by intravenous (i.v.) injection of norepinephrine (NE) for measurement of renal vasoconstrictor responses. CP caused a significant reduction in renal blood flow but did not affect NE-induced renal vasoconstriction. In addition, CP significantly increased plasma concentrations of urea and creatinine and urinary N-acetyl-beta-D-glucosaminidase (NAG) activity and kidney relative weight. CP decreased body weight and creatinine clearance. Histopathologically, CP caused remarkable renal damage compared with control. NAC alone did not produce any significant change in any of the variables measured. However, NAC significantly ameliorated CP-induced hemodynamic, biochemical and histopathological changes. The concentration of platinum in the kidneys of CP ? NAC treated rats was less than in CP-treated rats by 37%. The results show that administration of i.p. NAC (500 mg kg(-1) per day for 9 days) reversed the renal hemodynamic changes as well as the biochemical and histopathological indices of CP-induced nephrotoxicity in WKY rats.

  19. Staging of hemodynamic parameters during development of experimental arterial hypertension in rabbits.

    Frolov, V A; Blagonravov, M L; Zotov, A K; Zotova, T J


    The study analyzed changes in parameters of the central and intracardiac hemodynamics during the development of experimental arterial hypertension, which were assessed as the adaptive in nature. The development of hypertension demonstrated staging of the adaptive processes. The development of the adaptive responses was characterized by changes in the magnitude and probabilistic distribution of the hemodynamic parameters.

  20. Acute effect of cisplatin on renal hemodynamics and tubular function in dog kidneys

    Daugaard, G; Abildgaard, U; Holstein-Rathlou, N H


    The present study was designed to investigate the early hemodynamic and tubular effects of cisplatin administration on dogs. To localize the nephrotoxic actions of cisplatin, we have taken advantage of the lithium clearance method. After infusion of 5 mg of cisplatin per kg, an immediate and sign.......56 +/- 0.04 and from 4.76 +/- 0.32 mmol/min to 3.92 +/- 0.23 mmol/min, respectively. The results show that administration of cisplatin causes an acute, mainly proximal tubular impairment in dogs without alterations in renal hemodynamics......./min) and fractional lithium clearance (from 0.31 +/- 0.03 to 0.44 +/- 0.04) was seen. This occurred without measurable changes in glomerular filtration rate and renal blood flow. The calculated fractional as well as absolute rates of proximal reabsorption of sodium decreased significantly from 0.68 +/- 0.03 to 0...

  1. Evaluation of Hemodynamic Parameters as Predictors of Glaucoma Progression

    Ingrida Januleviciene


    Full Text Available Purpose. To evaluate hemodynamic parameters as possible predictors for glaucoma progression. Methods. An 18-month randomized double-masked cohort study including 30 open-angle glaucoma patients receiving fixed-combination treatment with Dorzolamide/Timolol (DTFC or Latanoprost/Timolol (LTFC (n=15 per group was performed. Intraocular pressure (IOP, arterial blood pressure (BP, ocular and diastolic perfusion pressures (OPP, DPP, color Doppler imaging, pulsatile ocular blood flow analysis, scanning laser polarimetry, and Humphrey visual field evaluations were included. Results. Both treatments showed statistically similar IOP reduction. Six patients in DTFC and 7 in LTFC group met glaucoma progression criteria. DTFC group had higher OPP, DPP, and lower vascular resistivity indices as compared to the LTFC. Progressing patients had higher nerve fiber index, lower systolic BP, OPP, DPP, higher ophthalmic and central retinal artery vascular resistance, and lower pulse volume (P<.05; t-test. Conclusions. Structural changes consistent with glaucoma progression correlate with non-IOP-dependent risk factors.

  2. Ansys Fluent versus Sim Vascular for 4-D patient-specific computational hemodynamics in renal arteries

    Mumbaraddi, Avinash; Yu, Huidan (Whitney); Sawchuk, Alan; Dalsing, Michael


    The objective of this clinical-need driven research is to investigate the effect of renal artery stenosis (RAS) on the blood flow and wall shear stress in renal arteries through 4-D patient-specific computational hemodynamics (PSCH) and search for possible critical RASs that significantly alter the pressure gradient across the stenosis by manually varying the size of RAS from 50% to 95%. The identification of the critical RAS is important to understand the contribution of RAS to the overall renal resistance thus appropriate clinical therapy can be determined in order to reduce the hypertension. Clinical CT angiographic data together with Doppler Ultra sound images of an anonymous patient are used serving as the required inputs of the PSCH. To validate the PSCH, we use both Ansys Fluent and Sim Vascular and compare velocity, pressure, and wall-shear stress under identical conditions. Renal Imaging Technology Development Program (RITDP) Grant.

  3. The effect of high-dose nifedipine on renal hemodynamics of cyclosporine-treated renal allograft recipients.

    Chagnac, A; Zevin, D; Ori, Y; Korzets, A; Hirsh, J; Levi, J


    Cyclosporine has been shown to reduce renal perfusion and to decrease glomerular filtration rate. Experimental studies suggest that nifedipine might reverse this renal vasoconstrictive effect of cyclosporine. We studied renal hemodynamics of 5 cyclosporine-treated renal transplant recipients before and after 2 weeks of therapy with high-dose nifedipine (up to 120 mg/day). Pretreatment GFR and renal plasma flow (RPF) were decreased. Following administration of nifedipine, RPF increased by 18% (P less than 0.01), while GFR did not change. Filtration fraction decreased by 10.5% (P less than 0.01). Mean arterial pressure declined from 111 +/- 5 to 96 +/- 3 mmHg (P less than 0.01). Renal vascular resistance dropped by 25% (P less than 0.01). Calculated postglomerular plasma flow increased by 20.5% (P less than 0.01). Urinary albumin excretion rate was unaffected. Cyclosporine whole blood levels were unchanged. The increase in RPF and in postglomerular plasma flow suggests that high-dose nifedipine might lessen cyclosporine-induced glomerular and interstitial ischemia in renal allograft recipients.

  4. Hemodynamic and neurochemical determinates of renal function in chronic heart failure.

    Gilbert, Cameron; Cherney, David Z I; Parker, Andrea B; Mak, Susanna; Floras, John S; Al-Hesayen, Abdul; Parker, John D


    Abnormal renal function is common in acute and chronic congestive heart failure (CHF) and is related to the severity of congestion. However, treatment of congestion often leads to worsening renal function. Our objective was to explore basal determinants of renal function and their response to hemodynamic interventions. Thirty-seven patients without CHF and 59 patients with chronic CHF (ejection fraction; 23 ± 8%) underwent right heart catheterization, measurements of glomerular filtration rate (GFR; inulin) and renal plasma flow (RPF; para-aminohippurate), and radiotracer estimates of renal sympathetic activity. A subset (26 without, 36 with CHF) underwent acute pharmacological intervention with dobutamine or nitroprusside. We explored the relationship between baseline and drug-induced hemodynamic changes and changes in renal function. In CHF, there was an inverse relationship among right atrial mean pressure (RAM) pressure, RPF, and GFR. By contrast, mean arterial pressure (MAP), cardiac index (CI), and measures of renal sympathetic activity were not significant predictors. In those with CHF there was also an inverse relationship among the drug-induced changes in RAM as well as pulmonary artery mean pressure and the change in GFR. Changes in MAP and CI did not predict the change in GFR in those with CHF. Baseline values and changes in RAM pressure did not correlate with GFR in those without CHF. In the CHF group there was a positive correlation between RAM pressure and renal sympathetic activity. There was also an inverse relationship among RAM pressure, GFR, and RPF in patients with chronic CHF. The observation that acute reductions in RAM pressure is associated with an increase in GFR in patients with CHF has important clinical implications.

  5. The Gomez' equations and renal hemodynamic function in kidney disease research.

    Bjornstad, Petter; Škrtić, Marko; Lytvyn, Yuliya; Maahs, David M; Johnson, Richard J; Cherney, David Z I


    Diabetic kidney disease (DKD) remains the leading cause of end-stage renal disease. A major challenge in preventing DKD is the difficulty in identifying high-risk patients at an early, pre-clinical stage. Albuminuria and eGFR as measures of renal function in DKD research and clinical practice are limited by regression of one-third of patients with microalbuminuria to normoalbuminuria and eGFR is biased and imprecise in the normal-elevated range. Moreover, existing methods that are used to assess renal function do not give detailed insight into the location of the renal hemodynamic effects of pharmacological agents at the segmental level. To gain additional information about the intrarenal circulation in-vivo in humans, mathematical equations were developed by Gomez et al in the 1950s. These equations used measurements of GFR, renal blood flow (RBF), effective renal plasma flow (ERPF), renal vascular resistance (RVR), hematocrit and serum protein to calculate afferent and efferent arteriolar resistances, glomerular hydrostatic pressure and filtration pressure. Although indirect and based on physiological assumptions, these techniques have the potential to improve researchers' ability to identify early pre-clinical changes in renal hemodynamic function in patients with a variety of conditions including DKD, thereby offering tremendous potential in mechanistic human research studies. In this review, we focus on the application of Gomez' equations and summarize the potential and limitations of this technique in DKD research. We also summarize illustrative data derived from Gomez' equations in patients with type 1 (T1D) and type 2 diabetes (T2D) and hypertension.

  6. Effect of nitrendipine on renal function and on hormonal parameters after intravascular iopromide

    Madsen, J K; Jensen, J W; Sandermann, J


    . Renal tubular function was estimated from the clearance of lithium. Hormones were measured by radioimmunoassays. RESULTS: Arteriography with iopromide did not change renal function. No differences between the nitrendipine and placebo groups were found in renal hemodynamics, tubular sodium handling...

  7. The use of terlipressin during living donor liver transplantation: Effects on systemic and splanchnic hemodynamics and renal function.

    Mukhtar, Ahmed; Salah, Maged; Aboulfetouh, Fawzia; Obayah, Gihan; Samy, Maha; Hassanien, Azza; Bahaa, Mohamed; Abdelaal, Amr; Fathy, Mohamed; Saeed, Hany; Rady, Mohamed; Mostafa, Ibrahim; El-Meteini, Mahmoud


    To assess the effect of the intraoperative use of terlipressin on splanchnic hemodynamics and postoperative renal function in patients undergoing liver transplantation. Open-label, prospective, randomized study. Single-center study. Thirty patients who underwent elective, living-donor liver transplantation with portal pressure >20 mm Hg. Patients were assigned randomly to one of two equal groups. The control group received saline, whereas the treatment group (TP group) received an initial bolus dose of terlipressin (1 mg over 30 mins) followed immediately by a continuous infusion of 2 μg·kg(-1)·h(-1) for 48 hrs. Portal pressure and gas exchange (radial artery, portal vein, and hepatic vein, blood gas analyses, and lactate concentration) were assessed at baseline (after ligation of the hepatic artery) and 2 hrs after drug administration. Systemic hemodynamic data and calculated tissue oxygenation parameters were compared throughout the procedure. Renal function was assessed by measurement of serum cystatin C after induction of anesthesia and on the first 2 days postoperatively. After the infusion of terlipressin, portal venous pressure decreased significantly from 26.3 ± 3.3 to 21.3 ± 3.6 mm Hg (p Portal and hepatic base excess, and the level of serum lactate, did not differ between the two groups. The serum levels of both cystatin C and creatinine were significantly higher in the control group than in the TP group on postoperative day 2. Perioperative use of terlipressin abrogates the early postoperative decline in renal function of patients who have chronic liver disease and undergo liver transplantation without any detrimental effect on hepatosplanchnic gas exchange and lactate metabolism.

  8. A Pilot Study to Evaluate Renal Hemodynamics in Cirrhosis by Simultaneous Glomerular Filtration Rate, Renal Plasma Flow, Renal Resistive Indices and Biomarkers Measurements

    Mindikoglu, Ayse L.; Dowling, Thomas C.; Wong-You-Cheong, Jade J.; Christenson, Robert H.; Magder, Laurence S.; Hutson, William R.; Seliger, Stephen L.; Weir, Matthew R.


    Background Renal hemodynamic measurements are complicated to perform in patients with cirrhosis; yet they provide the best measure of risk to predict hepatorenal syndrome (HRS). Currently, there are no established biomarkers of altered renal hemodynamics in cirrhosis validated by measured renal hemodynamics. Methods In this pilot study, simultaneous measurements of glomerular filtration rate (GFR), renal plasma flow (RPF), renal resistive indices and biomarkers were performed to evaluate renal hemodynamic alterations in 10 patients with cirrhosis (3 patients without ascites, 5 with diuretic sensitive and 2 diuretic refractory ascites). Results Patients with diuretic refractory ascites had the lowest mean GFR (36.5 ml/min/1.73m2) and RPF (133.6 ml/min/1.73m2) when compared to those without ascites (GFR=82.9 ml/min/1.73m2, RPF=229.9 ml/min/1.73m2) and with diuretic-sensitive ascites (GFR=82.3 ml/min/1.73m2, RPF=344.1 ml/min/1.73m2). A higher mean filtration fraction (FF= GFR/RPF=0.36) was noted among those without ascites compared to those with ascites. Higher FF in patients without ascites is most likely secondary to the vasoconstriction in the efferent glomerular arterioles (normal FF≃0.20). In general, renal resistive indices were inversely related to FF. While patients with ascites had lower FF and higher right kidney main and arcuate artery resistive indices, those without ascites had higher FF and lower right kidney main and arcuate artery resistive indices. While cystatin C and beta-2 microglobulin performed better compared to Cr in estimating RPF; beta-trace protein, beta-2 microglobulin, SDMA, and (SDMA+ADMA) performed better in estimating right kidney arcuate artery resistive index. Conclusion The results of this pilot study showed that identification of non-invasive biomarkers of reduced RPF and increased renal resistive indices can identify cirrhotics at risk for HRS at a stage more amenable to therapeutic intervention, and reduce mortality from kidney

  9. Diagnostic value of color Doppler ultrasound measurement of renal hemodynamic parameters for early pre-diction of the degree of diabetic renal damage in patients with diabetic nephropathy%彩色多普勒超声测量肾血流动力学参数对早期预测糖尿病肾病肾损害程度的诊断价值



    目的:探讨彩色多普勒超声测量肾血流动力学参数对早期预测糖尿病肾病(DN)肾损害程度的诊断价值。方法选取我院2013年1月至2015年12月收治的150例糖尿病肾病患者作为研究对象,根据24 h尿蛋白定量的不同分为3组,即尿蛋白正常组36例、早期DN组52例和临床期DN组62例,同时选取50名健康成人作为对照组。分别检查各组彩色多普勒超声,比较各组肾脏大小及血流成像。结果临床期DN组的肾脏主肾动脉(MRA)、肾窦部段动脉(SRA)、肾椎体叶间动脉(IRA)各取样点的Vsmax 均明显低于对照组(P<0.05),早期DN组仅IRA这一取样点的Vsmax明显低于对照组(P<0.01),但随着肾损害程度的加重,各取样点的Vsmax均逐渐降低。 DN组中尿蛋白正常组、早期DN组以及临床期DN组3组的MRA、SRA、IRA各取样点的Vdmin均明显低于对照组(P<0.01)。 DN组中尿蛋白正常组、早期DN组以及临床期DN组3组的MRA、SRA、I-RA各取样点的RI均明显高于对照组(P<0.05)。临床期DN组肾脏体积明显小于其余3组(P<0.01)。结论彩色多普勒超声测量肾血流动力学参数可有效反映出糖尿病肾病肾脏损害程度,对糖尿病肾病的早期诊断具有重要价值。%Objective To explore the diagnostic value of Color Doppler ultrasound measurement of renal hemodynamic parameters for the degree of diabetic renal damage in patients with diabetic nephropathy (DN). Methods One hundred and fifty cases with diabetic nephropathy (DN) in our hospital from January 2013 to December 2015 were selected as the research objects. They were divided into three groups, which were normal group with urinary pro-tein of normal level(36 cases), early DN group (52 cases) and clinical stage DN group(62 cases) according to the 24h urine protein quantity. At the same time, 50 cases of healthy adults were chosen as the control group. Patients in each group

  10. Knockdown of parathyroid hormone related protein in smooth muscle cells alters renal hemodynamics but not blood pressure.

    Raison, Denis; Coquard, Catherine; Hochane, Mazène; Steger, Jacques; Massfelder, Thierry; Moulin, Bruno; Karaplis, Andrew C; Metzger, Daniel; Chambon, Pierre; Helwig, Jean-Jacques; Barthelmebs, Mariette


    Parathyroid hormone-related protein (PTHrP) belongs to vasoactive factors that regulate blood pressure and renal hemodynamics both by reducing vascular tone and raising renin release. PTHrP is expressed in systemic and renal vasculature. Here, we wanted to assess the contribution of vascular smooth muscle cell endogenous PTHrP to the regulation of cardiovascular and renal functions. We generated a mouse strain (SMA-CreERT2/PTHrPL2/L2 or premutant PTHrPSM-/-), which allows temporally controlled, smooth muscle-targeted PTHrP knockdown in adult mice. Tamoxifen treatment induced efficient recombination of PTHrP-floxed alleles and decreased PTHrP expression in vascular and visceral smooth muscle cells of PTHrPSM-/- mice. Blood pressure remained unchanged in PTHrPSM-/- mice, but plasma renin concentration and creatinine clearance were reduced. Renal hemodynamics were further analyzed during clearance measurements in anesthetized mice. Conditional knockdown of PTHrP decreased renal plasma flow and glomerular filtration rate with concomitant reduction in filtration fraction. Similar measurements were repeated during acute saline volume expansion. Saline volume expansion induced a rise in renal plasma flow and reduced filtration fraction; both were blunted in PTHrPSM-/- mice leading to impaired diuresis. These findings show that endogenous vascular smooth muscle PTHrP controls renal hemodynamics under basal conditions, and it is an essential factor in renal vasodilation elicited by saline volume expansion.

  11. Diagnostics Of Renal Hemodynamics Disturbance In Children And Teenagers With Chronic Constipation, Encopresis And Their Correction

    A.L. Malykh


    Full Text Available The article gives the detailed issue of results of complex inspection of 90 children and teenagers aged 4-17 with problems of chronic constipation, incontinence and encopresis. Ultrasonic screening has shown various pathology in the functional condition of arterial renal vessels. The method of biological feedback has been considered as prospective method of treatment excluding medication of bladder and small bowel dysfunction. The efficiency of the method was marked at combination of encopresis and incontinence. The purpose of the present research was the study of renal hemodynamics disturbances and working out methods of their correction. The examination included ultrasonic investigation, electromyography and uroflowmetry. The study of functional condition of anterior abdominal wall muscles and pelvic floor muscles was performed by means of «Miomed - 938». All patients received complex therapy on the basis of which the method of biological feedback was used

  12. Acute effect of calcium blocker on renal hemodynamics in diabetic spontaneously hypertensive rat.

    Kaizu, K; Ling, Q Y; Uriu, K; Ikeda, M; Eto, S


    This study was done to examine the acute effect of a calcium channel blocker on renal hemodynamics in the diabetic spontaneously hypertensive rat (SHR). Streptozotocin was used to induce diabetes, and barnidipine (B) was used as a calcium blocker. Renal blood flow (RBF) and glomerular filtration rate (GFR) were measured by a clearance method with paraaminohypurate (PAH) and inulin, respectively. Rats were divided into two groups: nondiabetic SHR, N-SHR; diabetic SHR, DM-SHR. B increased RBF in N-SHR (7.44 +/- 1.99 versus 8.50 +/- 1.97 mL/min/ while there was no change in DM-SHR. B reduced renovascular resistance (RVR) in DM-SHR and N-SHR. B increased GFR in N-SHR (1.15 +/- 0.24 versus 1.34 +/- 0.25 mL/min/, in spite of no changes in DM-SHR. B did not modify filtration fraction (FF) in both groups. These results indicate (1) in SHR, B exerts beneficial effects on hypertensive renal damage by reducing mean arterial pressure (MAP), RVR, RBF, and GFR; (2) in diabetic SHR, B is less effective in restoring renal hyperfiltration in spite of reducing RVR.

  13. Metabolic and Hormonal Determinants of Glomerular Filtration Rate and Renal Hemodynamics in Severely Obese Individuals

    Edoardo Vitolo


    Full Text Available Objective: Renal function is often compromised in severe obesity. A true measurement of glomerular filtration rate (GFR is unusual, and how estimation formulae (EstForm perform in such individuals is unclear. We characterized renal function and hemodynamics in severely obese individuals, assessing the reliability of EstForm. Methods: We measured GFR (mGFR by iohexol plasma clearance, renal plasma flow (RPF by 123I-ortho-iodo-hippurate, basal and stimulated vascular renal indices, endothelium-dependent and -independent vasodilation using flow-mediated dilation (FMD as well as metabolic and hormonal profile in morbid, otherwise healthy, obese subjects. Results: Compared with mGFR, the better performing EstForm was CKD-EPI (5.3 ml/min/1.73 m2 bias by Bland-Altman analysis. mGFR was directly related with RPF, total and incremental glucose AUC, and inversely with PTH and h8 cortisol. Patients with mGFR below the median shown significantly higher PTH and lower vitamin D3. Basal or dynamic renal resistive index, FMD, pulse wave velocity were not related with mGFR. In an adjusted regression model, renal diameter and plasma flow remained related with mGFR (R2 = 0.67, accounting for 15% and 21% of mGFR variance, respectively. Conclusions: CKD-EPI formula should be preferred in morbid obesity; glucose increments during oral glucose tolerance test correlate with hyperfiltration; RPF and diameter are independent determinants of mGFR; slightly high PTH values, frequent in obesity, might influence mGFR.

  14. Computer simulations in comparison with in vivo measurements of nifedipine-induced changes in renal allograft hemodynamics.

    Merkus, J W; van Asten, W N; Hilbrands, L B; Hoitsma, A J; Koene, R A; Skotnicki, S H


    Analysis of Doppler spectrum waveforms is increasingly used in the differential diagnosis of human renal allograft dysfunction. The physiologic interpretation of changes in Doppler spectra obtained from renal allografts, however, remains a major problem. Computer simulation models of the renal circulation may provide insight into the physiologic mechanisms responsible for changes in Doppler spectrum characteristics. The results of measurements of renal allograft hemodynamics with both determinations of PAH clearance and Doppler spectrum analysis in 11 kidney allograft recipients were explained physiologically using a computer simulation model of kidney allograft hemodynamics. Using PAH clearance and blood pressure measurements a significant decrease in RVR was found (from 0.32 +/- 0.17 to 0.20 +/- 0.07 mm Hg x min/ml, P nifedipine. The Doppler spectrum waveform obtained from interlobar renal arteries showed a decrease in the RI (from 0.60 +/- 0.04 to 0.56 +/- 0.06; P < 0.05) and Tmax (from 133 +/- 32 to 98 +/- 32 ms; P < 0.05). The user-designed simulation model of renal hemodynamics showed comparable changes of the waveform when, in the model, the analogs of blood pressure, impedance of the artery, and the impedance of the peripheral vascular bed were altered proportionally.

  15. Renal hemodynamic effects of candesartan in normal and impaired renal function in humans

    Buter, H; Navis, G; deZeeuw, D; deJong, PE


    The effects of angiotensin II type I receptor antagonist candesartan cilexitil, 8 mg once daily, were studied after single dose and after five days treatment in 17 hypertensive patients [median mean arterial pressure (MAP) 118 mm Hg, range 84 to 134] with renal function impairment of different sever

  16. Effects of hypoproteinemia on renal hemodynamics, arterial pressure, and fluid volume

    Manning, R.D. Jr.


    The effects of long-term hypoproteinemia on renal hemodynamics, arterial pressure, and fluid volume were studied in eight conscious dogs over a 34-day period. Plasma protein concentration (PPC) was decreased by daily plasmapheresis, and the effects of decreasing and increasing sodium intake were measured. By the 12th day of plasmapheresis PPC had decreased to 2.5 g/dl from a control value of 7.2 g/dl, mean arterial pressure had decreased to 78% of control, glomerular filtration rate (GFR) was 75.2% of control, and urinary sodium excretion was decreased. By day 18 of plasmapheresis, estimated renal plasma flow (ERPF) was decreased to 60% of control due to the decreased arterial pressure and an increase in renal vascular resistance. GFR and ERPF were determined from the total clearance of (/sup 125/I)iothalamate and (/sup 131/I)iodohippurate. Also, plasma renin activity and plasma aldosterone concentration were both increased, and the relationship between mean arterial pressure and urinary sodium excretion was distinctly shifted to the left along the arterial pressure axis. In contradistinction to acute experiments, chronic hypoproteinemia results in decreases in GFR, ERPF, and urinary sodium excretion and has marked effects on both fluid volume and arterial pressure regulation.

  17. Renal Hemodynamic Effects of Serelaxin in Patients With Chronic Heart Failure A Randomized, Placebo-Controlled Study

    Voors, Adriaan A.; Dahlke, Marion; Meyer, Sven; Stepinska, Janina; Gottlieb, Stephen S.; Jones, Andrew; Zhang, Yiming; Laurent, Didier; Slart, Riemer H. J. A.; Navis, Gerjan J.


    Background-Serelaxin is a promising therapy for acute heart failure. The renal hemodynamic effects of serelaxin in patients with chronic heart failure are unknown. Methods and Results-In this double-blind, randomized, placebo-controlled, multicenter study, patients with New York Heart Association Cl

  18. Hemodynamics in Transplant Renal Artery Stenosis and its Alteration after Stent Implantation Based on a Patient-specific Computational Fluid Dynamics Model.

    Wang, Hong-Yang; Liu, Long-Shan; Cao, Hai-Ming; Li, Jun; Deng, Rong-Hai; Fu, Qian; Zhang, Huan-Xi; Fei, Ji-Guang; Wang, Chang-Xi

    Accumulating studies on computational fluid dynamics (CFD) support the involvement of hemodynamic factors in artery stenosis. Based on a patient-specific CFD model, the present study aimed to investigate the hemodynamic characteristics of transplant renal artery stenosis (TRAS) and its alteration after stent treatment. Computed tomography angiography (CTA) data of kidney transplant recipients in a single transplant center from April 2013 to November 2014 were reviewed. The three-dimensional geometry of transplant renal artery (TRA) was reconstructed from the qualified CTA images and categorized into three groups: the normal, stenotic, and stented groups. Hemodynamic parameters including pressure distribution, velocity, wall shear stress (WSS), and mass flow rate (MFR) were extracted. The data of hemodynamic parameters were expressed as median (interquartile range), and Mann-Whitney U-test was used for analysis. Totally, 6 normal, 12 stenotic, and 6 stented TRAs were included in the analysis. TRAS presented nonuniform pressure distribution, adverse pressure gradient across stenosis throat, flow vortex, and a separation zone at downstream stenosis. Stenotic arteries had higher maximal velocity and maximal WSS (2.94 [2.14, 3.30] vs. 1.06 [0.89, 1.15] m/s, 256.5 [149.8, 349.4] vs. 41.7 [37.8, 45.3] Pa at end diastole, P= 0.001; 3.25 [2.67, 3.56] vs. 1.65 [1.18, 1.72] m/s, 281.3 [184.3, 364.7] vs. 65.8 [61.2, 71.9] Pa at peak systole, P= 0.001) and lower minimal WSS and MFRs (0.07 [0.03, 0.13] vs. 0.52 [0.45, 0.67] Pa, 1.5 [1.0, 3.0] vs. 11.0 [8.0, 11.3] g/s at end diastole, P= 0.001; 0.08 [0.03, 0.19] vs. 0.70 [0.60, 0.81] Pa, 2.0 [1.3, 3.3] vs. 16.5 [13.0, 20.3] g/s at peak systole, P= 0.001) as compared to normal arteries. Stent implantation ameliorated all the alterations of the above hemodynamic factors except low WSS. Hemodynamic factors were significantly changed in severe TRAS. Stent implantation can restore or ameliorate deleterious change of hemodynamic

  19. Joint state and parameter estimation of the hemodynamic model by particle smoother expectation maximization method

    Aslan, Serdar; Taylan Cemgil, Ali; Akın, Ata


    Objective. In this paper, we aimed for the robust estimation of the parameters and states of the hemodynamic model by using blood oxygen level dependent signal. Approach. In the fMRI literature, there are only a few successful methods that are able to make a joint estimation of the states and parameters of the hemodynamic model. In this paper, we implemented a maximum likelihood based method called the particle smoother expectation maximization (PSEM) algorithm for the joint state and parameter estimation. Main results. Former sequential Monte Carlo methods were only reliable in the hemodynamic state estimates. They were claimed to outperform the local linearization (LL) filter and the extended Kalman filter (EKF). The PSEM algorithm is compared with the most successful method called square-root cubature Kalman smoother (SCKS) for both state and parameter estimation. SCKS was found to be better than the dynamic expectation maximization (DEM) algorithm, which was shown to be a better estimator than EKF, LL and particle filters. Significance. PSEM was more accurate than SCKS for both the state and the parameter estimation. Hence, PSEM seems to be the most accurate method for the system identification and state estimation for the hemodynamic model inversion literature. This paper do not compare its results with Tikhonov-regularized Newton—CKF (TNF-CKF), a recent robust method which works in filtering sense.

  20. Effects of endothelin on hemodynamics, prostaglandins, blood coagulation and renal function.

    Schulz, E; Ruschitzka, F; Lueders, S; Heydenbluth, R; Schrader, J; Müller, G A


    The interaction of the endogenous vasoconstrictors endothelin (ET), angiotensin II (Ang II) and catecholamines with the kallikrein-kinin-, prostaglandin and renin-aldosterone systems in the pathogenesis of acute renal failure (ARF) is still to be defined. In 18 anesthesized pigs the influence of i.v. bolus applications of ET (2 micrograms/kg), Ang II (10 micrograms/kg) and norepinephrine (NE; 20 micrograms/kg) on hemodynamics, plasmatic coagulation and fibrinolysis system, prostaglandins and renal function was studied. ET induced a biphasic change in blood pressure, starting with an initial short-lasting reduction followed by a long-lasting elevation of systolic and diastolic blood pressure. Endothelin bolus resulted in a significant increase of 6-keto-PGF1 alpha, PGE2 and TXB2 plasma levels (P PKK) and factor VIII activity at the beginning. Finally a pronounced decrease of ATIII, FM and PKK occurred, indicating a consumptive coagulopathy. At the end of the experiment, elevated plasma renin activity and pCO2, significantly decreased creatinine clearance, blood pH, pO2, base excess, HCO3-, oxygen saturation (P < 0.01), a distinct glomerular proteinuria, and a final anuria were observated. These results reveal that ET activates the plasmatic coagulation system and induces an ARF accompanied by impairment of pulmonary function.(ABSTRACT TRUNCATED AT 250 WORDS)


    詹锋; 黄烈城


    Objective The renal hemodynamic alteration was sequentially studied in dogs with ascites due to portal hypertension.Methods The model of portal hypertension was established by the constriction of hepatic vein. Effective renal plasma flow (ERPF), systemic blood pressure, urinary excretion of sodium were measured. Eighteen dogs were studied until the ascites occurred.Results The ascites was generally detected between the sixth day and the eighth day after the portal hypertension occurred, the average being the seventh day. Mean artery pressure (MAP) and renal vascular resistance (RVR) were firstly changed after the portal vein pressure increased. MAP fell 17% (130.37mmHg±16.2 mmHg before the portal hypertension, 108.32 mmHg±10.47 mmHg after the portal hypertension on the 1st day, p<0.001) and RVR increased by 31% (0.38 mmHg. ml-1. min-1±0.09 mmHg. ml-1. min-1 before the portal hypertension, 0.5 mmHg. ml-1. min-1±0.15mmHg. ml-1. min-1 after the portal hypertension, P<0.05) after the portal hypertension occurred on the 2nd day, thereafter, MAP decreased and RVR increased continually. ERPF also fell in the forepart, but there was only significant difference in the appearance of ascites (P<0.05). Urinary excretion of sodium gradually fell after portal hypertension and reached the lowest value on the 7th day, and there was statistical significance from the 2nd day (59.86 mmol/min±25.96 mmol/min before portal hypertension, 31.95 mmol/min±18.79mmol/min after the portal hypertension on the 2nd day, p<0.05).Conclusion Our research indicates that the hemodynamics has been changed before the ascites occurred. The earliest change occurs in MAP and RVR, but no marked change is found in ERPF.

  2. Fenestrated Stent Graft Repair of Abdominal Aortic Aneurysm: Hemodynamic Analysis of the Effect of Fenestrated Stents on the Renal Arteries

    Sun, Zhonghua; Chaichana, Thanapong [Curtin University of Technology, Perth (Australia)


    We wanted to investigate the hemodynamic effect of fenestrated stents on the renal arteries with using a fluid structure interaction method. Two representative patients who each had abdominal aortic aneurysm that was treated with fenestrated stent grafts were selected for the study. 3D realistic aorta models for the main artery branches and aneurysm were generated based on the multislice CT scans from two patients with different aortic geometries. The simulated fenestrated stents were designed and modelled based on the 3D intraluminal appearance, and these were placed inside the renal artery with an intra-aortic protrusion of 5.0-7.0 mm to reflect the actual patients' treatment. The stent wire thickness was simulated with a diameter of 0.4 mm and hemodynamic analysis was performed at different cardiac cycles. Our results showed that the effect of the fenestrated stent wires on the renal blood flow was minimal because the flow velocity was not significantly affected when compared to that calculated at pre-stent graft implantation, and this was despite the presence of recirculation patterns at the proximal part of the renal arteries. The wall pressure was found to be significantly decreased after fenestration, yet no significant change of the wall shear stress was noticed at post-fenestration, although the wall shear stress was shown to decrease slightly at the proximal aneurysm necks. Our analysis demonstrates that the hemodynamic effect of fenestrated renal stents on the renal arteries is insignificant. Further studies are needed to investigate the effect of different lengths of stent protrusion with variable stent thicknesses on the renal blood flow, and this is valuable for understanding the long-term outcomes of fenestrated repair.

  3. Helical CT study of cerebral perfusion and related hemodynamic parameters

    Cenic, Aleksa; Lee, Ting-Yim; Craen, Rosemary A.; Gelb, Adrian W.


    A convenient method for assessing cerebral perfusion and related functional parameters has been developed using a third generation slip-ring CT scanner. Dynamic contrast- enhanced scanning at the same level was employed to image the cerebral circulation at the rate of 1 image per second. Using data acquired with this non-helical mode of scanning, we have developed a method for the simultaneous in-vivo determination of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT). These measurements are given in the same physiological units as positron emission tomography. In order to obtain accurate measurements of these parameters, methods were also developed to correct for recirculation and partial volume averaging in imaging small blood vessels. We have used 6 New Zealand white rabbits in our studies. For each rabbit, up to 3 CT measurements of CBF, CBV, and MTT were made at normocapnia under isoflurane anesthesia. Coronal sections through the brain were imaged while simultaneously imaging either a brain artery or the ear artery. Images were acquired for 1 minute as Isovue 300 was injected intravenously. In the acquired CT images, regions of interest in brain parenchyma and an artery were drawn. For each region of interest, the mean CT number in pre-contrast images was subtracted from the mean in post-contrast images to calculate the contrast concentration curves for the brain regions Q(t) and the arterial region Ca(t). Using a robust deconvolution method, the MTT was determined. CBV was then determined from the ratio of the areas of Q(t) and Ca(t). Finally, CBF was calculated from the Central Volume Principle. The mean regional CBF, CBV and MTT values were 73.3 +/- 5.1 ml/min/100g, 1.93 +/- 0.12 ml/100g and 1.80 +/- 0.18 s respectively. IN order to validate our CT CBF measurements, we also measured CBF using the well- established technique of microspheres with each CT study. The feasibility of our CT method to measure CBF accurately was

  4. A computer-based matrix for rapid calculation of pulmonary hemodynamic parameters in congenital heart disease

    Lopes Antonio


    Full Text Available Background : In patients with congenital heart disease undergoing cardiac catheterization for hemodynamic purposes, parameter estimation by the indirect Fick method using a single predicted value of oxygen consumption has been a matter of criticism. Objective : We developed a computer-based routine for rapid estimation of replicate hemodynamic parameters using multiple predicted values of oxygen consumption. Materials and Methods : Using Microsoft ® Excel facilities, we constructed a matrix containing 5 models (equations for prediction of oxygen consumption, and all additional formulas needed to obtain replicate estimates of hemodynamic parameters. Results : By entering data from 65 patients with ventricular septal defects, aged 1 month to 8 years, it was possible to obtain multiple predictions for oxygen consumption, with clear between-age groups ( P < .001 and between-methods ( P < .001 differences. Using these predictions in the individual patient, it was possible to obtain the upper and lower limits of a likely range for any given parameter, which made estimation more realistic. Conclusion : The organized matrix allows for rapid obtainment of replicate parameter estimates, without error due to exhaustive calculations.

  5. Effects of angiotensin-converting enzyme inhibition on altered renal hemodynamics induced by low protein diet in the rat.

    Fernández-Repollet, E; Tapia, E; Martínez-Maldonado, M


    We assessed the role of angiotensin II in mediating the alterations in renal hemodynamics known to result from low protein feeding to normal rats by examining the effect of the angiotensin-converting enzyme (ACE) inhibitor captopril. 2 wk of low protein (6% casein) diet resulted in decreased glomerular filtration rate (normal protein [NP], 1.82 +/- 0.17 vs. low protein [LP], 0.76 +/- 0.01 ml/min; P less than 0.05) and renal plasma flow (NP, 6.7 +/- 0.2 vs. LP, 3.3 +/- 0.3 ml/min; P less than ...

  6. Dynamic Measurement of Hemodynamic Parameters and Cardiac Preload in Adults with Dengue: A Prospective Observational Study.

    Vipa Thanachartwet

    Full Text Available Few previous studies have monitored hemodynamic parameters to determine the physiological process of dengue or examined inferior vena cava (IVC parameters to assess cardiac preload during the clinical phase of dengue. From January 2013 to July 2015, we prospectively studied 162 hospitalized adults with confirmed dengue viral infection using non-invasive cardiac output monitoring and bedside ultrasonography to determine changes in hemodynamic and IVC parameters and identify the types of circulatory shock that occur in patients with dengue. Of 162 patients with dengue, 17 (10.5% experienced dengue shock and 145 (89.5% did not. In patients with shock, the mean arterial pressure was significantly lower on day 6 after fever onset (P = 0.045 and the pulse pressure was significantly lower between days 4 and 7 (P50% between days 4 and 5 (P<0.05. Hypovolemic shock was observed in 9 (52.9% patients and cardiogenic shock in 8 (47.1%, with a median (interquartile range time to shock onset of 6.0 (5.0-6.5 days after fever onset, which was the median day of defervescence. Intravascular hypovolemia occurred before defervescence, whereas myocardial dysfunction occurred on the day of defervescence until 2 weeks after fever onset. Hypovolemic shock and cardiogenic shock each occurred in approximately half of the patients with dengue shock. Therefore, dynamic measures to estimate changes in hemodynamic parameters and preload should be monitored to ensure adequate fluid therapy among patients with dengue, particularly patients with dengue shock.

  7. Renal dysfunction and state of metabolic and hemodynamic factors in patients with arterial hypertension

    Klochkov V.A.


    Full Text Available The aim of the investigation is to carry out comparative evaluation of metabolic and hemodynamic indices in patients with arterial hypertension (AH and renal dysfunction; to study the interrelation between arterial blood pressure level normalization and the presence or lack of microalbuminuria (MAU in the morning urine portion of patients with AH after therapy with antihypertensive preparations (APs of various groups. Methods. 121 persons have been investigated, 91 out — patients of both sexes, aged 33-55, with the diagnosis of arterial hypertension of stage II risk III, who have been taking Perindopril, Telmisartan and Bisoprolol for3 months. The control of arterial pressure level, biochemical analysis of metabolic indices and morning urine portion test for microalbuminuria has been carried out. Results. MAU has been revealed in 17,6% patients, occurring more frequently in men than in women. Microalbuminuria is accompanied by reliable decrease of total and ionized calcium and magnesium concentrations, an increase of potassium level in blood plasma, increase of cholesterol, triglycerides, glucose and levels. Patients with AH and renal dysfunction reliably demonstrate higher levels of systolic and diastolic arterial pressure in the morning and evening hours, their normalization effect after APs intake is significantly interconnected with MAU presence. Conclusion. In patients with AH and MAU the main risk factors of cardio-vascular diseases development are more expressed. Microalbuminuria is a risk factor in patients with arterial hypertension and may influence on the basic blood electrolyte balance. While carrying out antihypertensive therapy the presence of MAU should be taken into consideration

  8. Joint state and parameter estimation for a class of cascade systems: Application to a hemodynamic model

    Zayane, Chadia


    In this paper, we address a special case of state and parameter estimation, where the system can be put on a cascade form allowing to estimate the state components and the set of unknown parameters separately. Inspired by the nonlinear Balloon hemodynamic model for functional Magnetic Resonance Imaging problem, we propose a hierarchical approach. The system is divided into two subsystems in cascade. The state and input are first estimated from a noisy measured signal using an adaptive observer. The obtained input is then used to estimate the parameters of a linear system using the modulating functions method. Some numerical results are presented to illustrate the efficiency of the proposed method.

  9. Phosphodiesterase-5 inhibition preserves renal hemodynamics and function in mice with diabetic kidney disease by modulating miR-22 and BMP7

    Pofi, Riccardo; Fiore, Daniela; De Gaetano, Rita; Panio, Giuseppe; Gianfrilli, Daniele; Pozza, Carlotta; Barbagallo, Federica; Xiang, Yang Kevin; Giannakakis, Konstantinos; Morano, Susanna; Lenzi, Andrea; Naro, Fabio; Isidori, Andrea M.; Venneri, Mary Anna


    Diabetic Nephropathy (DN) is the leading cause of end-stage renal disease. Preclinical and experimental studies show that PDE5 inhibitors (PDE5is) exert protective effects in DN improving perivascular inflammation. Using a mouse model of diabetic kidney injury we investigated the protective proprieties of PDE5is on renal hemodynamics and the molecular mechanisms involved. PDE5i treatment prevented the development of DN-related hypertension (P < 0.001), the increase of urine albumin creatinine ratio (P < 0.01), the fall in glomerular filtration rate (P < 0.001), and improved renal resistive index (P < 0.001) and kidney microcirculation. Moreover PDE5i attenuated the rise of nephropathy biomarkers, soluble urokinase-type plasminogen activator receptor, suPAR and neutrophil gelatinase-associated lipocalin, NGAL. In treated animals, blood vessel perfusion was improved and vascular leakage reduced, suggesting preserved renal endothelium integrity, as confirmed by higher capillary density, number of CD31+ cells and pericyte coverage. Analysis of the mechanisms involved revealed the induction of bone morphogenetic protein-7 (BMP7) expression, a critical regulator of angiogenesis and kidney homeostasis, through a PDE5i-dependent downregulation of miR-22. In conclusion PDE5i slows the progression of DN in mice, improving hemodynamic parameters and vessel integrity. Regulation of miR-22/BMP7, an unknown mechanism of PDE5is in nephrovascular protection, might represent a novel therapeutic option for treatment of diabetic complications. PMID:28294194

  10. Effects of AV-delay optimization on hemodynamic parameters in patients with VDD pacemakers.

    Krychtiuk, Konstantin A; Nürnberg, Michael; Volker, Romana; Pachinger, Linda; Jarai, Rudolf; Freynhofer, Matthias K; Wojta, Johann; Huber, Kurt; Weiss, Thomas W


    Atrioventricular (AV) delay optimization improves hemodynamics and clinical parameters in patients treated with cardiac resynchronization therapy and dual-chamber-pacemakers (PM). However, data on optimizing AV delay in patients treated with VDD-PMs are scarce. We, therefore, investigated the acute and chronic effects of AV delay optimization on hemodynamics in patients treated with VDD-PMs due to AV-conduction disturbances. In this prospective, single-center interventional trial, we included 64 patients (38 men, 26 women, median age: 77 (70-82) years) with implanted VDD-PM. AV-delay optimization was performed using a formula based on the surface electrocardiogram (ECG). Hemodynamic parameters (stroke volume (SV), cardiac output (CO), heart rate (HR), and blood pressure (BP)) were measured at baseline and follow-up after 3 months using impedance cardiography. Using an ECG formula for AV-delay optimization, the AV interval was decreased from 180 (180-180) to 75 (75-100) ms. At baseline, AV-delay optimization led to a significant increase of both SV (71.3 ± 15.8 vs. 55.3 ± 12.7 ml, p AV delay vs. nominal AV interval, respectively) and CO (5.1 ± 1.4 vs. 3.9 ± 1.0 l/min, p AV-delay optimization in patients treated with VDD-PMs exhibits immediate beneficial effects on hemodynamic parameters that are sustained for 3 months.

  11. Trandolapril, but not verapamil nor their association, restores the physiological renal hemodynamic response to adrenergic activation in essential hypertension.

    Lambertucci, Lorella; Di Serio, Claudia; Castellani, Sergio; Torrini, Monica; Lotti, Elena; Cristofari, Claudia; Masotti, Giulio; Marchionni, Niccolò; Ungar, Andrea


    The purpose of this study was to evaluate the effects of antihypertensive drugs on renal hemodynamics in hypertensive patients during an adrenergic activation by mental stress (MS), which induces renal vasoconstriction in healthy subjects. Renal hemodynamics was assessed twice in 30 middle-aged essential hypertensive patients (57±6 years)-after 15 days of pharmacological wash-out and after 15 days of treatment with Trandolapril (T, 4 mg, n=10), Verapamil (V, 240 mg, n=10), or both (T 2 mg+V 180 mg, n=10). Each experiment consisted of 4 30-min periods (baseline, MS, recovery I and II). Renal hemodynamics was evaluated with effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) from plasminogen activator inhibitor and inulin clearance, respectively. MS increased blood pressure (BP) to a similar extent before and after each treatment. Before treatment, the increasing BP was not associated with any modification of ERPF in the 3 groups. Renal vascular resistances (RVR) markedly increased during MS (+23% in the T group, +21.6% in the V group, and +32.9% in the T+V group); GFR remained constant during the whole experiment. After treatment, ERPF decreased significantly during MS in the T group (-15%, P<0.05) and in the V group (-11.7%, p<0.01); in the T+V group, ERPF modifications were not statistically significant (P=0.07). In the T group, ERPF reverted to baseline values at the end of the stimulus, whereas in the V group, renal vasoconstriction was more prolonged. Only in hypertensive patients treated with 4 mg of T, RVR reverted to baseline during the recovery I, whereas in the V group, RVR remained elevated for the whole experiment. No modifications of GFR were observed in all groups. The kidney of hypertensive patients cannot react to a sympathetic stimulus with the physiological vasoconstriction. A short-term antihypertensive treatment with 4 mg of T restores the physiological renal response to adrenergic activation.

  12. Multivariate spatial Gaussian mixture modeling for statistical clustering of hemodynamic parameters in functional MRI

    Fouque, A.L.; Ciuciu, Ph.; Risser, L. [NeuroSpin/CEA, F-91191 Gif-sur-Yvette (France); Fouque, A.L.; Ciuciu, Ph.; Risser, L. [IFR 49, Institut d' Imagerie Neurofonctionnelle, Paris (France)


    In this paper, a novel statistical parcellation of intra-subject functional MRI (fMRI) data is proposed. The key idea is to identify functionally homogenous regions of interest from their hemodynamic parameters. To this end, a non-parametric voxel-based estimation of hemodynamic response function is performed as a prerequisite. Then, the extracted hemodynamic features are entered as the input data of a Multivariate Spatial Gaussian Mixture Model (MSGMM) to be fitted. The goal of the spatial aspect is to favor the recovery of connected components in the mixture. Our statistical clustering approach is original in the sense that it extends existing works done on univariate spatially regularized Gaussian mixtures. A specific Gibbs sampler is derived to account for different covariance structures in the feature space. On realistic artificial fMRI datasets, it is shown that our algorithm is helpful for identifying a parsimonious functional parcellation required in the context of joint detection estimation of brain activity. This allows us to overcome the classical assumption of spatial stationarity of the BOLD signal model. (authors)

  13. Efficiency of Physical Therapy for Improving Hemodynamic Parameters in Young Obese Patients

    Iuliana GHERGHEL


    Full Text Available Aim: The paper aims to demonstrate the efficiency of an individualized exercise training protocol on preventing cardiovascular complications, by improving hemodynamic parameters and body composition of young obese patiens. Material and method: The group included 35 subjects from which 21 female and 14 male with age between 18 and 25 years and the period of the study was 9 months of which 6 of training. At the beginning and at the end of training, subjects were assessed in regard to body composition and hemodynamic parameters. To design an individualized exercise training program, testing and monitoring protocol was based on using of some modern methods among which: cardiopulmonary exercise testing and bioimedance body composition analyses. Statistical analysis was performed by using paired t test. Value of the coefficient p under 0.05 was considered statistically significant. Results: Training programs performed during 6 months have brought significant improvements in the following parameters: body mass index, resting heart rate, systolic blood presure and dyastolic blood pressure, allong with maximal blood presure in effort. Conclusions: The concept of individual intervals training brought improvements of targeted parameters, causing weight loss but also improvements of cardiovascular risk.

  14. Label-free determination of hemodynamic parameters in the microcirculaton with third harmonic generation microscopy.

    Steffen Dietzel

    Full Text Available Determination of blood flow velocity and related hemodynamic parameters is an important aspect of physiological studies which in many settings requires fluorescent labeling. Here we show that Third Harmonic Generation (THG microscopy is a suitable tool for label-free intravital investigations of the microcirculation in widely-used physiological model systems. THG microscopy is a non-fluorescent multi-photon scanning technique combining the advantages of label-free imaging with restriction of signal generation to a focal spot. Blood flow was visualized and its velocity was measured in adult mouse cremaster muscle vessels, non-invasively in mouse ear vessels and in Xenopus tadpoles. In arterioles, THG line scanning allowed determination of the flow pulse velocity curve and hence the heart rate. By relocating the scan line we obtained velocity profiles through vessel diameters, allowing shear rate calculations. The cell free layer containing the glycocalyx was also visualized. Comparison of the current microscopic resolution with theoretical, diffraction limited resolution let us conclude that an about sixty-fold THG signal intensity increase may be possible with future improved optics, optimized for 1200-1300 nm excitation. THG microscopy is compatible with simultaneous two-photon excited fluorescence detection. It thus also provides the opportunity to determine important hemodynamic parameters in parallel to common fluorescent observations without additional label.

  15. Systemic arterial and venous determinants of renal hemodynamics in congestive heart failure.

    Braam, Branko; Cupples, William A; Joles, Jaap A; Gaillard, Carlo


    Heart and kidney interactions are fascinating, in the sense that failure of the one organ strongly affects the function of the other. In this review paper, we analyze how principal driving forces for glomerular filtration and renal blood flow are changed in heart failure. Moreover, renal autoregulation and modulation of neurohumoral factors, which can both have repercussions on renal function, are analyzed. Two paradigms seem to apply. One is that the renin-angiotensin system (RAS), the sympathetic nervous system (SNS), and extracellular volume control are the three main determinants of renal function in heart failure. The other is that the classical paradigm to analyze renal dysfunction that is widely applied in nephrology also applies to the pathophysiology of heart failure: pre-renal, intra-renal, and post-renal alterations together determine glomerular filtration. At variance with the classical paradigm is that the most important post-renal factor in heart failure seems renal venous hypertension that, by increasing renal tubular pressure, decreases GFR. When different pharmacological strategies to inhibit the RAS and SNS and to assist renal volume control are considered, there is a painful lack in knowledge about how widely applied drugs affect primary driving forces for ultrafiltration, renal autoregulation, and neurohumoral control. We call for more clinical physiological studies.

  16. The Influence of Age on Hemodynamic Parameters During Rest and Exercise in Healthy Individuals

    Wolsk, Emil; Bakkestrøm, Rine; Thomsen, Jacob H


    The authors sought to obtain hemodynamic estimates across a wide age span and in both sexes for future reference and compare these estimates with current guideline diagnostic hemodynamic thresholds...

  17. Hemodynamic Measurement Using Four-Dimensional Phase-Contrast MRI: Quantification of Hemodynamic Parameters and Clinical Applications

    Ha, Hojin [POSTECH Biotech Center, Pohang University of Science and Technology, Pohang 37673 (Korea, Republic of); Kim, Guk Bae [Asan Institute of Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505 (Korea, Republic of); Kweon, Jihoon [Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505 (Korea, Republic of); Lee, Sang Joon [POSTECH Biotech Center, Pohang University of Science and Technology, Pohang 37673 (Korea, Republic of); Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang 37673 (Korea, Republic of); Kim, Young-Hak [Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505 (Korea, Republic of); Lee, Deok Hee; Yang, Dong Hyun [Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505 (Korea, Republic of); Kim, Namkug [Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505 (Korea, Republic of); Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505 (Korea, Republic of)


    Recent improvements have been made to the use of time-resolved, three-dimensional phase-contrast (PC) magnetic resonance imaging (MRI), which is also named four-dimensional (4D) PC-MRI or 4D flow MRI, in the investigation of spatial and temporal variations in hemodynamic features in cardiovascular blood flow. The present article reviews the principle and analytical procedures of 4D PC-MRI. Various fluid dynamic biomarkers for possible clinical usage are also described, including wall shear stress, turbulent kinetic energy, and relative pressure. Lastly, this article provides an overview of the clinical applications of 4D PC-MRI in various cardiovascular regions.

  18. Hemodynamic measurement using four-dimensional phase-contrast MRI: Quantification of hemodynamic parameters and clinical applications

    Ha, Ho Jin; Lee, Sang Joon [POSTECH Biotech Center, Pohang University of Science and Technology, Pohang (Korea, Republic of); Kim, Guk Bae; Kweon, Ji Hoon; Kim, Young Hak; Lee, Deok Hee; Yang, Dong Hyun; KIm, Nam Kug [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)


    Recent improvements have been made to the use of time-resolved, three-dimensional phase-contrast (PC) magnetic resonance imaging (MRI), which is also named four-dimensional (4D) PC-MRI or 4D flow MRI, in the investigation of spatial and temporal variations in hemodynamic features in cardiovascular blood flow. The present article reviews the principle and analytical procedures of 4D PC-MRI. Various fluid dynamic biomarkers for possible clinical usage are also described, including wall shear stress, turbulent kinetic energy, and relative pressure. Lastly, this article provides an overview of the clinical applications of 4D PC-MRI in various cardiovascular regions.

  19. [Duplex scanning of hemodynamic parameters of the celiac trunk and superior mesenteric artery in healthy volunteers].

    Kuntsevich, G I; Shilenok, D V


    The possibility of studying the hemodynamics in the visceral arteries of the abdominal aorta by duplex scanning was demonstrated. The results of examination of 30 healthy persons are discussed. Characteristic features of the blood flow spectrogram of the celiac trunk and superior mesenteric artery were revealed. According to the spectrogram, the flow of blood in the celiac trunk is characterized by rapidly increasing peak systolic rate and slowly diminishing diastolic rate to approximately 1/3 of the maximal value of systole. The character of the blood flow in the superior mesenteric artery is distinguished by a lesser peak systolic rate and the presence of a short-lived reverse rate before the sloping diastolic curve. Normal values of the blood flow volume rate were determined, it was 649 +/- 25.4 ml/min in the celiac trunk and 395 +/- 20.5 ml/min in the superior mesenteric artery. Among the advantages of the duplex scanning method are noninvasiveness and safety and the possibility of dynamic study of the hemodynamic parameters.

  20. Recovery from renal ischemia-reperfusion injury is associated with altered renal hemodynamics, blunted pressure natriuresis, and sodium-sensitive hypertension.

    Pechman, Kimberly R; De Miguel, Carmen; Lund, Hayley; Leonard, Ellen C; Basile, David P; Mattson, David L


    The present studies evaluated intrarenal hemodynamics, pressure natriuresis, and arterial blood pressure in rats following recovery from renal ischemia-reperfusion (I/R) injury. Acute I/R injury, induced by 40 min of bilateral renal arterial occlusion, resulted in an increase in plasma creatinine that resolved within a week. Following 5 wk of recovery on a 0.4% NaCl diet, the pressure-natriuresis response was assessed in anesthetized rats in which the kidney was denervated and extrarenal hormones were administered intravenously. Increasing renal perfusion pressure (RPP) from 107 to 141 mmHg resulted in a fourfold increase in urine flow and sodium excretion in sham control rats. In comparison, pressure diuresis and natriuresis were significantly attenuated in post-I/R rats. In sham rats, glomerular filtration rate (GFR) averaged 1.6 +/- 0.2 mlxmin(-1)xg kidney weight(-1) and renal blood flow (RBF) averaged 7.8 +/- 0.7 mlxmin(-1)xg kidney weight(-1) at RPP of 129 mmHg. Renal cortical blood flow, measured by laser-Doppler flowmetry, was well autoregulated whereas medullary blood flow and renal interstitial hydrostatic pressure increased directly with elevated RPP in sham rats. In contrast, GFR and RBF were significantly reduced whereas medullary perfusion and interstitial pressure demonstrated an attenuated response to RPP in post-I/R rats. Further experiments demonstrated that conscious I/R rats develop hypertension when sodium intake is increased. The present data indicate that the pressure-natriuretic-diuretic response in I/R rats is blunted because of a decrease in GFR and RBF and the depressed pressure-dependent increase in medullary blood flow and interstitial pressure.

  1. Renal hemodynamics and oxygenation in transient renal artery occluded rats evaluated with iron-oxide particles and oxygenation-sensitive imaging

    Pedersen, Michael [Aarhus Univ. Hospital (Denmark). MR Research Centre; Aarhus Univ. (Denmark). Inst. of Experimental Clinical Medicine; Univ. Victor Segalen Bordeaux 2 (France). Lab. Imagerie Moleculaire et Fonctionnelle: de la physiologie a la therapie CNRS UMR 5231; Laustsen, Christoffer [Aarhus Univ. Hospital (Denmark). MR Research Centre; Perot, Vincent; Grenier, Nicolas [Hopital Pellegrin, CHU Bordeaux (France). Service d' Imagerie Diagnostique et Therapeutique de l' Adulte; Basseau, Fabrice; Moonen, Chrit [Univ. Victor Segalen Bordeaux 2 (France). Lab. Imagerie Moleculaire et Fonctionnelle: de la physiologie a la therapie CNRS UMR 5231


    Mild or severe renal arterial occlusion is a phenomenon occasionally observed in daily clinical practice, potentially leading to renal ischemia and a general impairment of renal function. Secondly, closing the blood flow to the kidneys can also occur during kidney transplantation procedures. However, the exact physiological effects of these conditions on renal blood perfusion as well as the renal oxygen handling are poorly understood. The objectives of this study were therefore to measure the lateral changes of renal blood perfusion in rats subjected to transient unilateral arterial occlusion (RAS), and in addition, to measure the consequences on the intrarenal oxygenation. Experimental studies were performed using sixteen adolescent rats. The left renal artery was exposed through a flank incision and acute RAS for 45 min was achieved by placing a ligature around the renal artery. MRI was performed 3 days after the surgical procedure, where a blood oxygenation sensitive sequence (BOLD MRI) was performed, followed by a perfusion-weighted imaging sequence using a single bolus of the iron-oxide nanoparticle Sinerem. The renal oxygenation of blood was indirectly measured by the BOLD-parameter R2{sup *}, and perfusion measures include relative renal blood flow, relative renal blood volume and mean transit time. Histopathologic changes through the outer stripe of the outer medulla showing typical histopathologic findings of ischemia. This study demonstrated that rats with transient renal arterial stenosis (for 45 min) showed a reduction in intrarenal oxygenation and intrarenal blood flow three days after the surgical procedure. A decreased R2{sup *} was measured within the ipsilateral medulla in parallel with a decreased medullary blood flow, is probably related to a lower reabsorption load within the ipsilateral kidney. MRI may therefore be a promising tool in long-term evaluation of RAS. (orig.)

  2. Relationship Between Cerebral Oxygenation and Hemodynamic and Oxygen Transport Parameters in Surgery for Acquired Heart Diseases

    A. I. Lenkin


    Full Text Available Objective: to evaluate the relationship between cerebral oxygenation and hemodynamic and oxygen transport parameters in surgical correction of concomitant acquired heart diseases. Subjects and methods. Informed consent was received from 40 patients who required surgery because of concomitant (two or more acquired heart defects. During procedure, perioperative monitoring of oxygen transport and cerebral oxygenation was performed with the aid of PiCCO2 monitor (Pulsion Medical Systems, Germany and a Fore-Sight cerebral oximeter (CASMED, USA. Anesthesia was maintained with propofol and fen-tanyl, by monitoring the depth of anesthesia. Early postoperative intensive therapy was based on the protocol for early targeted correction of hemodynamic disorders. Oxygen transport and cerebral oxygenation parameters were estimated intraopera-tively and within 24 postoperative hours. A statistical analysis including evaluation of Spearman correlations was performed with the aid of SPSS 15.0. Results. During perfusion, there was a relationship between cerebral oximetry values and hemat-ocrit levels, and oxygen partial pressure in the venous blood. Furthermore, a negative correlation between cerebral oximetry values and blood lactate levels was found 30 minutes after initiation of extracorporeal circulation (EC. During the study, there was a positive correlation between cerebral oxygenation and values of cardiac index, central venous saturation, and oxygen delivery index. There was a negative relationship between cerebral oxygenation and extravascular lung water at the beginning of surgery and a correlation between cerebral oximetry values and oxygenation index by the end of the first 24 postoperative hours. Conclusion. The cerebral oxygenation values correlate -with the main determinants of oxygen transport during EC and after cardiac surgical procedures. Cerebral oximetry may be used in early targeted therapy for the surgical correction of acquired combined

  3. Sympathetic nervous activity and renal and systemic hemodynamics in cirrhosis: plasma norepinephrine concentration, hepatic extraction, and renal release

    Ring-Larsen, H; Hesse, B; Henriksen, Jens Henrik Sahl


    Systemic and renal neurovascular reactivity was investigated in eight patients with cirrhosis and in eight control subjects with fatty liver during postural changes. In the supine position, mean renal blood flow averaged 1.51 and 2.97 ml per gm per min in patients and controls, respectively (p less...... 60 degrees head-up tilt, the increase in NE was similar in both groups. In another 10 patients with cirrhosis in recumbency, the splanchnic arterial-hepatic venous extraction of NE averaged 0.43 (p less than 0.01), and the hepatic clearance of NE averaged 315 ml per min which is of the same order...... be responsible for renal vasoconstriction in these patients. However, systemic and renal neurovascular reactivity seems to be maintained even at an advanced stage of the disease....

  4. Quantitative scintigraphic parameters for the assessment of renal transplant patients

    El Maghraby, T.A.F.; Eck-Smit, B.L.F. van; Pauwels, E.K.J. [Department of Radiology, Division of Nuclear Medicine, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden (Netherlands); Fijter, J.W. de [Department of Nephrology, Leiden University Medical Centre, Leiden (Netherlands)


    Radionuclide renal diagnostic studies play an important role in assessing renal allograft function especially in the early post transplant period. In the last two decades various quantitative parameters have been derived from the radionuclide renogram to facilitate and confirm the changes in perfusion and/or function of the kidney allograft. In this review article we discuss the quantitative parameters that have been used to assess graft condition with emphasis on the early post-operative period. These quantitative methods were divided into parameters used for assessing renal graft perfusion and parameters used for evaluating parenchymal function. The blood flow in renal transplants can be quantified by measuring (a) the rate of activity appearance in the kidney graft; (b) the ratio of the integral activity under the transplanted kidney and arterial curves e.g. Hilson's perfusion index and Kircher's kidney/aortic ratio; (c) calculating the renal vascular transit time by deconvolution analysis. The literature overview on these parameters showed us that they have some practical disadvantages of requiring high quality bolus injection and numerical variations related to changes in the site and size of regions of interest. In addition, the perfusion parameter values suffer from significant overlap when various graft pathologies coexist. Quantitative evaluation of the graft parenchymal extraction and excretion was assessed by parameters derived from {sup 123}I/{sup 131}I-OIH,{sup 99m}Tc-DTPA or {sup 99m}Tc-MAG3 renograms. We review in this article a number of parenchymal parameters which include (1) plasma clearance methods like glomerular filtration rate (GFR) and effective renal plasma flow (ERPF); (2) renal transit times such as parenchymal mean transit time, T{sub max}, T{sub 1/2}; (3) parenchymal uptake and excretion indices as the accumulation index, graft uptake capacity at 2 and 10 min, excretion index and elimination index. These indices, however, are

  5. Down-regulation of integrin β1 and focal adhesion kinase in renal glomeruli under various hemodynamic conditions.

    Xiaoli Yuan

    Full Text Available Given that integrin β1 is an important component of the connection to maintain glomerular structural integrity, by binding with multiple extracellular matrix proteins and mediating intracellular signaling. Focal adhesion kinase (FAK is the most essential intracellular integrator in the integrin β1-FAK signalling pathway. Here, we investigated the changes of the two molecules and visualized the possible interaction between them under various hemodynamic conditions in podocytes. Mice kidney tissues were prepared using in vivo cryotechnique (IVCT and then were stained and observed using light microscopy, confocal laser scanning microscopy and immunoelectron microscopy. The expression of these molecules were examined by western blot. Under the normal condition, integrin β1 stained continually and evenly at the membrane, and FAK was located in the cytoplasm and nuclei of the podocytes. There were significant colocalized plaques of two molecules. But under acute hypertensive and cardiac arrest conditions, integrin β1 decreased and stained intermittently. Similarly, FAK decreased and appeared uneven. Additionally, FAK translocated to the nuclei of the podocytes. As a result, the colocalization of integrin β1 and FAK reduced obviously under these conditions. Western blot assay showed a consistent result with the immunostaining. Collectively, the abnormal redistribution and decreased expressions of integrin β1 and FAK are important molecular events in regulating the functions of podocytes under abnormal hemodynamic conditions. IVCT could offer considerable advantages for morphological analysis when researching renal diseases.

  6. Renal hemodynamic effects of nabumetone, sulindac, and placebo in patients with osteoarthritis.

    Cangiano, J L; Figueroa, J; Palmer, R


    We assessed the effects of nabumetone, sulindac, and placebo on renal function and renal excretion of vasodilatory prostaglandins in older female patients (age >50 years) with osteoarthritis and normal renal function. Using a prospective, crossover design, we compared the effects of nabumetone 2000 mg/d and sulindac 400 mg/d with placebo on glomerular filtration rate (GFR), renal plasma flow (RPF), and urinary excretion of prostaglandin E2 and 6-keto-prostaglandin F1alpha in 12 patients. Urinary excretion of vasodilatory prostaglandins was not decreased after 14 days of treatment with either nabumetone or sulindac. Likewise, treatment with nabumetone or sulindac did not significantly alter renal function compared with placebo. There were no differences in mean changes in GFR or RPF from baseline after treatment with nabumetone or sulindac compared with placebo. The mean (+/- SD) changes in GFR from baseline were 0%+/-8% in patients receiving nabumetone, -8%+/-15% in patients receiving sulindac, and -7%+/-15% in patients receiving placebo. The results of this study demonstrate that treatment with nabumetone or sulindac caused no deterioration in renal function in older female patients with osteoarthritis and normal renal function.

  7. Renal hemodynamics, tubular function, and response to low-dose dopamine during acute hypoxia in humans

    Olsen, Niels Vidiendal; Hansen, J M; Kanstrup, I L


    , heart rate, and plasma norepinephrine. Effective renal plasma flow (ERPF) decreased at HA by 10% (P sodium clearance (CNa), and urine flow remained unchanged compared with SL. Dopamine at SL and HA increased ERPF by 47% (P

  8. Renal Extraction and Acute Effects of Glucagon-like peptide-1 on Central and Renal Hemodynamics in Healthy Men

    Asmar, Ali; Simonsen, Lene; Asmar, Meena


    catheterization of a renal vein. The subjects remained supine during the experiments. During GLP-1 infusion, the systolic blood pressure and arterial pulse pressure both increased by 5 ± 1 mm Hg (p=0.015 and p=0.002, respectively). Heart rate increased by 5 ± 1 bpm (p=0.005) and cardiac output increased by 18...




    Objective - To compare the antihypertensive, renal haemodynamic and antiproteinuric effect of enalapril and atenolol in patients with proteinuria of non-diabetic origin. Design - Prospective, double blind, randomised 16 week study after a pretreatment period of at least three weeks. Setting - Outpat

  10. Central Body Fat Distribution Associates with Unfavorable Renal Hemodynamics Independent of Body Mass Index

    Kwakernaak, Arjan J.; Zelle, Dorien M.; Bakker, Stephan J. L.; Navis, Gerjan


    Central distribution of body fat is associated with a higher risk of renal disease, but whether it is the distribution pattern or the overall excess weight that underlies this association is not well understood. Here, we studied the association between waist-to-hip ratio (WHR), which reflects centra

  11. Value of three hemodynamic parameters in evaluating volume status under artificial pneumoperitoneum and their correlation

    Xiao-mei LIU


    Full Text Available Objective To explore the value of stroke volume variation (SVV, pulse pressure variation (PPV and pleth variability index (PVI in evaluating the volume status under pneumoperitoneum and their correlation. Methods Twenty-six patients with stomach cancer receiving laparoscopy-assisted radical gastrectomy under general anesthesia were involved in this study. The indexes of SVV, PPV and PVI were monitored continuously after general anesthesia. A volume loading test was performed after pneumoperitoneum, and the hemodynamic parameters were determined before and after fluid infusion (6% HES, 7ml/kg, and the patients were divided into response group (n=16 and non-response group (n=10 according to whether the increase in stroke volume index (ΔSVI was ≥15% or not. The receiver operator characteristic (ROC curves of SVV, PPV and PVI were drawn to evaluate the value of SVV, PPV and PVI in evaluating volume status under artificial pneumoper itoneum and the correlation between them. Results The analysis of ROC curves showed that SVV, PPV and PVI could all be used to estimate the volume status effectively, the area under the curve (AUC of them was 0.978, 0.963 and 0.928 respectively, and there was a significant correlation between the three parameters (SVV and PPV: r=0.921, P<0.01; SVV and PVI: r=0.686, P<0.01; PPV and PVI: r=0.577, P<0.01. Conclusion SVV, PPV and PVI could be used to accurately evaluate the volume status under artificial pneumoperitoneum, and there is a good correlation between them. DOI: 10.11855/j.issn.0577-7402.2014.07.08

  12. 彩色多普勒超声检测高血压病肾动脉血流动力学的临床研究%Color Doppler ultrasonography for detecting renal artery hemodynamics in hypertensive patients

    瞿茹莼; 赵菊芳; 张春侠; 吴英龙; 张俊玲


    目的:探讨彩色多普勒超声检测高血压肾动脉血流动力学的诊断意义。方法收集就诊于江苏省昆山市第六人民医院超声科的临床诊断为高血压的患者96例作为观察组,同时收集该院进行健康体检的患者98例作为对照组,对所有研究对象均采用彩色多普勒超声进行检测,对两组患者的肾脏长径、实质厚度、肾窦厚度、实质厚度/肾窦厚度的比值以及肾窦部的段动脉中段和皮髓交界处的叶间动脉段血流各项参数进行比较。结果观察组患者的肾脏长径、实质厚度、肾窦厚度、实质厚度/肾窦厚度比值均高于对照组(P<0.05),观察组患者肾窦部的段动脉中段的收缩期最大血流速度(Vmax)、舒张期最低血流速度(Vmin)、阻力指数(RI)值低于对照组(P<0.05),观察组对象的叶间动脉段的Vmax、Vmin、RI值低于对照组,差异具有统计学意义(P<0.05)。结论彩色多普勒超声可以检测高血压病肾动脉血流动力学各项参数,可反映继发性肾灌注的改变,为临床诊断高血压病的早期肾功能损害提供了重要依据。%Objective To investigate the diagnostic significance of color Doppler ultrasonography for detecting renal artery hemodynamics of hypertension.Methods The patients with hypertension were chosen as observation group (n=96) and the objects with physical examinations were chosen as control group (n=98) from the Department of Ultrasonography of Sixth People’s Hospital of Kunshan City in Jiangsu Province. All objects were given the detections of color Doppler ultrasonography, and some indexes including renal length, renal parenchymal thickness, thickness of renal sinus and ratio of parenchymal thickness to sinus thickness, and hemodynamic parameters of middle segment of sinus renal artery (SRA) and segment of interlobular renal artery (IRA) at cortex-medulla junction were compared in 2 groups.Results The

  13. Effects of angiotensin Ⅱ receptor antagonist olmesartan on renal hemodynamic variables and vascular structural properties in streptozotocin-induced diabetic rats

    SONG Hui-fen; CHEN Jian-fei; SUN Ning-ling; LI Hong-wei


    Background Diabetic nephropathy is a major cause of renal failure in diabetes mellitus (DM). It has been known that renin-angiotensin system (RAS) blockers have a renal protective effect. This study aimed to investigate whether treatment with angiotensin Ⅱ receptor blocker, olmesartan, could modify renal hemodynamic variables and vascular structural properties, then attenuate renal injury in streptozotocin (STZ)-induced DM rats.Methods DM was induced in male Wistar rats by intraperitoneal administration of STZ. The rats were then randomized to a DM group and an olmesartan treatment (OLM+DM) group. The normal group (non-DM) were administered only citrate buffer. At the end of the 14th week, blood glucose, kidney weight/body weight and urinary protein-to-creatinine ratio were determined. Further, the flow-pressure and pressure-glomerular filtration rate (GFR) relationships were determined for maximally vasodilated, perfused kidneys. From the relationship, 3 indices of vascular structural properties were estimated: slope of flow-pressure (minimal renal vascular resistance, reflecting overall luminal dimensions of preglomerular and postglomerular vasculature), slope of pressure-GFR (glomerular filtration capacity against pressure)and threshold pressure for beginning filtration at pressure-GFR (preglomerular to postglomerular vascular resistance ratio). Kidneys were then perfusion fixed for histological analysis. The renal histopathology was observed by light microscopy.Results The body weight of DM rats was lower than that of non-DM rats. Blood glucose, kidney weight/body weight,urinary protein-to-creatinine ratio were significantly greater in DM rats than in non-DM rats. The parameters such as kidney weight/body weight, urinary protein-to-creatinine ratio in OLM+DM rats had dramatically decreased compared with those in DM rats. However, the treatment with olmesartan had no effect on blood glucose levels. The slope of flow-pressure relationship was greater in DM rats

  14. No effect of dietary fish oil on renal hemodynamics, tubular function, and renal functional reserve in long-term renal transplant recipients.

    Hansen, J M; Løkkegaard, H; Høy, C E; Fogh-Andersen, N; Olsen, N V; Strandgaard, S


    Dietary supplementation with fish oil rich in n-3 polyunsaturated fatty acids has been suggested to protect the kidney against cyclosporin A (CsA) toxicity. This study investigated the effects of a 10-wk dietary supplementation with fish oil on renal function and renal functional reserve in healthy volunteers (N = 9) and two groups of stable long-term kidney-transplanted patients treated with maintenance low-dose CsA (3.0 +/- 0.6 mg/kg; N = 9) or without CsA (N = 9). After an overnight fast, the subjects were water loaded, and clearance studies were performed, postponing morning medication. GFR and effective RPF were measured as the renal clearances of (99mTc)DTPA and (131I)hippuran, respectively. Renal tubular function was evaluated by use of the renal clearance of lithium and the urinary excretion of beta 2-microglobulin. Fish oil did not change baseline values of effective RPF, GFR, lithium clearance, and urinary excretion of beta 2-microglobulin in any of the groups. The infusion of amino acids induced a comparable increase in GFR, lithium clearance, and the urinary excretion rate of beta 2-microglobulin in all three groups with no additional effect of fish oil. Thus, long-term renal transplant recipients treated with a low maintenance dose of CsA had a well-preserved renal functional reserve, and dietary supplementation with fish oil in these patients did not improve renal function.

  15. Safety in intrahospital transportation: evaluation of respiratory and hemodynamic parameters. A prospective cohort study

    Bruno Franco Mazza

    Full Text Available CONTEXT AND OBJECTIVE: Intrahospital transportation of mechanically ventilated patients is a high-risk situation. We aimed to determine whether transfers could be safely performed by using a transportation routine. DESIGN AND SETTING: Prospective cohort study with "before and after" evaluation. METHODS: Mechanically ventilated patients who needed transportation were included. Hemodynamic and respiratory parameters were measured before and after transportation. Statistical analysis consisted of variance analysis and paired Student's t test. Results were considered significant if P 5, FiO2 > 0.4 and vasoactive drug use comprised 42.4%, 24.3%, 21.6% and 33.0% of cases, respectively. Mean duration of transportation was 43.4 ± 18.9 minutes. Complications occurred in 32.4%. There was a significant increase in CO2 (before transportation, 29.6 ± 7.3 and after transportation, 34.9 ± 7.0; P = 0.000; a trend towards improved PO2/FiO2 ratio (before transportation, 318.0 ± 137.0 and after transportation, 356.8 ± 119.9; P = 0.053; increased heart rate (before transportation, 80.9 ± 18.7 and after transportation, 85.5 ± 17.6; P = 0.08; and no significant change in mean arterial blood pressure (P = 0.93. CONCLUSION: These results suggest that intrahospital transportation can be safely performed. Our low incidence of complications was possibly related to both the presence of a multidisciplinary transportation team and proper equipment.

  16. Usefulness of Doppler Parameter in Patients with Renal Transplantation

    Yoon, Yeo Chang; Shin, Byung Seok; Ohm, Joon Young; Ahn, Moon Sang [Chungnam National University Hospital, Daejeon (Korea, Republic of); Park, Mi Hyun [Dept. of Radiology, Dankook University Hospital, Cheonan (Korea, Republic of); Kim, Ho Jun [Dept. of Radiology, Konyang University Hospital, Daejeon (Korea, Republic of)


    The purpose of this study is to assess the usefulness of Doppler parameters in transplanted kidney function. Doppler parameters, including resistive index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end diastolic velocity (EDV) were measured in the interlobar artery of 55 transplant recipients. Patients were grouped according to glomerular filtration rate (GFR): Group A (GFR < 30 ml / min / 1.73 m2, n = 27) and group B (GFR {>=}30 ml / min / 1.73 m2, n = 28). Doppler parameters were compared between groups and correlated with the GFR. GFR (40.1 {+-} 26.9) showed a significant negative correlation with RI (0.69{+-}.08) (p = .002, r = -.414). RI (0.72 vs. 0.67), PI (1.42 vs. 1.23), and EDV (10.5 vs. 15.3) differed significantly between groups (p < .05), however, PSV was not (36.9 vs. 47.1). Patients in group A (n = 11) with a lower RI than the mean had significantly lower PSV (31.7 vs. 45.1; p = .027) and EDV (11.1 vs. 16.7; p .017), compared with such patients in group B (n = 21). Doppler parameters are useful for evaluation of function of transplanted kidney. Even if the RI is normal, PSV and EDV may be used as hemodynamic indicators.

  17. Effect of short-term high-protein compared with normal-protein diets on renal hemodynamics and associated variables in healthy young men.

    Frank, Helga; Graf, Julia; Graf, Juliane; Amann-Gassner, Ulrike; Bratke, Renate; Daniel, Hannelore; Heemann, Uwe; Hauner, Hans


    High-protein diets are effective for weight reduction; however, little is known about the potential adverse renal effects of such diets. The aim of our study was to compare the effect of a high-protein (HP) with a normal-protein (NP) diet on renal hemodynamics and selected clinical-chemical factors. We prospectively studied the effect of an HP diet (2.4 g x kg(-1) x d(-1)) with that of an NP diet (1.2 g x kg(-1) x d(-1)) on the glomerular filtration rate (assessed on the basis of sinistrin-an inulin analog-clearance) and renal plasma flow (para-aminohippuric acid clearance) by using the constant infusion technique. Filtration fraction and renal vascular resistance were calculated. Twenty-four healthy young men followed the 2 diet protocols for 7 d each in a crossover design. They were individually advised by a dietitian to achieve the planned protein intake by selecting normal foods under isocaloric conditions. Serum and urinary variables and renal hemodynamics were measured on day 7 of both diets. The glomerular filtration rate (NP: 125 +/- 5 mL/min; HP: 141 +/- 8 mL/min; P < 0.001) and filtration fraction (NP: 23 +/- 5%; HP: 28 +/- 5%; P < 0.05) increased significantly with the HP diet. Renal plasma flow was not significantly different between the HP (496 +/- 25 mL/min) and NP (507 +/- 18 mL/min) phases. Renal vascular resistance was not significantly different between the NP (94 +/- 6 mm Hg x mL(-1) x min(-1)) and HP (99 +/- 8 mm Hg x mL(-1) x min(-1)) phases. Blood urea nitrogen, serum uric acid, glucagon, natriuresis, urinary albumin, and urea excretion increased significantly with the HP diet. A short-term HP diet alters renal hemodynamics and renal excretion of uric acid, sodium, and albumin. More attention should be paid to the potential adverse renal effects of HP diets.

  18. Characterization of hemodynamics and oxygenation in the renal cortex of rats

    Grosenick, Dirk; Wabnitz, Heidrun; Macdonald, Rainer; Niendorf, Thoralf; Cantow, Kathleen; Flemming, Bert; Arakelyan, Karen; Seeliger, Erdmann


    We have performed a pre-clinical study on 13 rats to investigate the potential of near-infrared spectroscopy for quantification of hemoglobin concentration and oxygen saturation of hemoglobin in the renal cortex of small animals. These measurements were combined with laser-Doppler fluxmetry and a fluorescence quenching technique for quantification of tissue oxygen tension. Hemoglobin concentration and oxygen saturation were determined from experimental data by a Monte Carlo model. The methods were applied to investigate and compare temporal changes during several types of interventions such as arterial and venous occlusions, as well as hyperoxia, hypoxia and hypercapnia induced by different mixtures of the inspired gas.

  19. Hemodynamic parameters of the isolated dog kidney as determined by a frequency response method.

    Sato, T; Shirataka, M; Ikeda, N; Vega, D; Yamashiro, S M; Grodins, F S


    The isolated kidney of the dog was perfused with autologous blood through an oxygenator. Responses of arterial input pressure (PI), venous pressure (PV), and venous flow (UV) were measured during sinusoidal forcing of arterial inflow (UA) at 5 to 1,000 cpm superimposed on a steady-state flow level. Pre- (RA) and postglomerular (REV) resistances, and compliances of artery (CA) and glomeruli (CG) were estimated based on a network model and using the Bode diagram of gains PI/UA, UV/UA. The data were evaluated by the least square method with a digital computer. The mean values of the parameters normalized for the average weight of the kidney (64.5g) were: CA = 0.0027 ml/mmHg, CG = 0.088, RA = 0.45 mmHg . min/ml, and REV = 0.35. Mean arterial pressure (PA) and glomerular pressure (PG) were 111 and 50 mmHg, respectively. The regression lines of PG against PA were significantly different at high and low PA, this being taken as a manifestation of autoregulation of the renal circulation. PG values were less than those given by the classical study of Winton but close to those recently obtained on mutants rats with a direct puncture method by Brenner et al. It is concluded that the present study has given an experimental background with which we may continuously estimate, under more intact conditions, circulatory parameter values by monitoring pressures and flows which respond to external perturbations.


    肖新华; 甘佩珍; 余明炎; 李竞; 韩其蔚


    In this study,we investigated the effect of captopril (CPT) on glomerular filtration rate (GFR),effective renal plasma flow(ERPF),filtration fraction(FF),urinary albumin excretion (UAE) and daily urinary exceretion of thromboxane B2(TXB2) and 6-keto-prostaglandin F1a(6-keto-PGF1a) in 29 normotensive non-insulin-dependent diabetes (NIDDM) patients withour clinically discernible nephropathy.Before treatment,urinsry excretion 6-keto-PGF]a was sienificantly increased (P<0.05) in 29 NIDDM patients compared with 25 health subjects matched for age and sex.The values of GFR and FF were significantly higher (P<0.01 and P<0.005,respectively) in NIDDm than in normal volunters,whereas ERPF was comparable in both groups.Meanwhile we observed that UAE of early NIDDM was increased before treatment.After CPT treatment,GFR,FF,UAE and urinary excretion of 6-keto-PGF1a were significantoly reduce (all P<0.005) compared with those of NIDDM before treatment.These date indicated that CPT is effective in lowering glomerular filtration pressure and ameliorating microalbuminria in the normotensive early NIDDM.

  1. Hemodynamic parameters obtained by transthoracic echocardiography and right heart catheterization: a comparative study in patients with pulmonary hypertension

    TIAN Zhuang; ZENG Xiao-feng; LIU Yong-tai; FANG Quan; NI Chao; CHEN Tai-bo; FANG Li-gang; GAO Peng; JIANG Xiu-chun; LI Meng-tao


    Background Hemodynamic evaluation is crucial for the management of patients with pulmonary hypertention. Clinicians often prefer a rapid and non-invasive method. This study aimed to examine the feasibility of transthoracic echocardiography for the measurements of hemodynamic parameters in patients with pulmonary hypertension.Methods A prospective single-center study was conducted among 42 patients with pulmonary hypertension caused by different diseases. Transthoracic echocardiography and right-heart catheterization were performed within 24 hours. Pulmonary artery systolic, diastolic and mean pressure (PASP, PADP and PAMP), cardiac output (CO), and pulmonary capillary wedge pressure (PCWP) were measured by both methods. A linear correlation and a Bland-Altman analysis were performed to compare the two groups of hemodynamic parameters.Results A good correlation was found between invasive and non-invasive measurements for PASP (r=0.96), PADP (r=0.85), PAMP (r=0.88), CO (r=0.82), and PCWP (r=0.81). Further agreement analysis done by the Bland-Altman method showed that bias and a 95% confidence interval for PASP, PADP, and CO were clinically acceptable while great discrepancies existed for PAMP and PCWP.Conclusions The non-invasive measurements by PASP, PADP, and CO in patients with pulmonary hypertension correlate well with the invasive determinations. Transthoracic echocardiography (TTE) was inappropriate for estimating PCWP and PAMP.

  2. A novel non invasive measurement of hemodynamic parameters: Comparison of single-chamber ventricular and dual-chamber pacemaker

    Ingrid M. Pardede


    Full Text Available We carried out a cross sectional study to analyze hemodynamic parameters of single-chamber ventricular pacemaker compared with dual-chamber pacemaker by using thoracic electrical bioimpedance monitoring method (Physio Flow™ - a novel simple non-invasive measurement. A total of 48 consecutive outpatients comprised of 27 single chamber pacemaker and 21 dual chamber were analyzed. We measured cardiac parameters: heart rate, stroke volume index, cardiac output index, estimated ejection fraction, end diastolic volume, early diastolic function ratio, thoracic fluid index, and systemic parameters: left cardiac work index and systemic vascular resistance index. Baseline characteristic and pacemaker indication were similar in both groups. Cardiac parameters assessment revealed no significant difference between single-chamber pacemaker and dual-chamber pacemaker in heart rate, stroke volume index, cardiac index, estimated ejection fraction, end-diastolic volume, thoracic fluid index. There was significantly higher early diastolic function ratio in single-chamber pacemaker compared to dual-chamber pacemaker: 92% (10.2-187.7% vs. 100.6% (48.7-403.2%; p=0.006. Systemic parameters assessment revealed significantly higher left cardiac work index in single-chamber group than dual-chamber group 4.9 kg.m/m² (2.8-7.6 kg.m/m² vs. 4.3 kg.m/m² (2.9-7.2 kg.m/m²; p=0.004. There was no significant difference on systemic vascular resistance in single-chamber compared to dual-chamber pacemaker. Single-chamber ventricular pacemaker provides similar stroke volume, cardiac output and left cardiac work, compared to dual-chamber pacemaker. A non-invasive hemodynamic measurement using thoracic electrical bioimpedance is feasible for permanent pacemaker outpatients. (Med J Indones 2008; 17: 25-32Keywords: Permanent pacemaker, single chamber, dual chamber, thoracic electrical bioimpedance, hemodynamic parameter

  3. Exogenous L-Arginine Attenuates the Effects of Angiotensin II on Renal Hemodynamics and the Pressure Natriuresis-Diuresis Relationship

    Das, Satarupa; Mattson, David L.


    SUMMARY Administration of exogenous L-Arginine (L-Arg) attenuates Angiotensin II (AngII)-mediated hypertension and kidney disease in rats. The present study assessed renal hemodynamics and pressure-diuresis-natriuresis in anesthetized rats infused with vehicle, AngII (20 ng/kg/min, iv) or AngII + L-Arg (300 µg/kg/min, iv). Increasing renal perfusion pressure (RPP) from approximately 100 to 140 mmHg resulted in a 9–10 fold increase in urine flow and sodium excretion rate in control animals. In comparison, AngII infusion significantly reduced renal blood flow (RBF) and glomerular filtration rate (GFR) by 40–42% and blunted the pressure-dependent increase in urine flow and sodium excretion rate by 54–58% at elevated RPP. Supplementation of L-Arg reversed the vasoconstrictor effects of AngII and restored pressure-dependent diuresis to levels not significantly different from control rats. Experiments in isolated aortic rings were performed to assess L-Arg effects on the vasculature. Dose-dependent contraction to AngII (10−10M to 10−7M) was observed with a maximal force equal to 27±3% of the response to 10−5M phenylephrine. Contraction to 10−7M AngII was blunted by 75±3% with 10−4M L-Arg. The influence of L-Arg to blunt AngII mediated contraction was eliminated by endothelial denudation or incubation with nitric oxide synthase inhibitors. Moreover, the addition of 10−3M cationic or neutral amino acids, which compete with L-Arg for cellular uptake, blocked the effect of L-Arg. Anionic amino acids did not influence the effects of L-Arg on AngII-mediated contraction. These studies indicate that L-Arg blunts AngII-mediated vascular contraction by an endothelial- and NOS-dependent mechanism involving cellular uptake of L-Arg. PMID:24472006

  4. Exogenous L-arginine attenuates the effects of angiotensin II on renal hemodynamics and the pressure natriuresis-diuresis relationship.

    Das, Satarupa; Mattson, David L


    Administration of exogenous L-arginine (L-Arg) attenuates angiotensin-II (AngII)-mediated hypertension and kidney disease in rats. The present study assessed renal hemodynamics and pressure diuresis-natriuresis in anaesthetized rats infused with vehicle, AngII (20 ng/kg per min i.v.) or AngII + L-Arg (300 μg/kg per min i.v.). Experiments in isolated aortic rings were carried out to assess L-Arg effects on the vasculature. Increasing renal perfusion pressure (RPP) from ~100 to 140 mmHg resulted in a nine- to tenfold increase in urine flow and sodium excretion rate in control animals. In comparison, AngII infusion significantly reduced renal blood flow (RBF) and glomerular filtration rate (GFR) by 40-42%, and blunted the pressure-dependent increase in urine flow and sodium excretion rate by 54-58% at elevated RPP. Supplementation of L-Arg reversed the vasoconstrictor effects of AngII and restored pressure-dependent diuresis to levels not significantly different from control rats. Dose-dependent contraction to AngII (10(-10) mol/L to 10(-7) mol/L) was observed with a maximal force equal to 27 ± 3% of the response to 10(-5) mol/L phenylephrine. Contraction to 10(-7) mol/L AngII was blunted by 75 ± 3% with 10(-4) mol/L L-Arg. The influence of L-Arg to blunt AngII-mediated contraction was eliminated by endothelial denudation or incubation with nitric oxide synthase inhibitors. Furthermore, the addition of 10(-3) mol/L cationic or neutral amino acids, which compete with L-Arg for cellular uptake, blocked the effect of L-Arg. Anionic amino acids did not influence the effects of L-Arg on AngII-mediated contraction. These studies show that L-Arg blunts AngII-mediated vascular contraction by an endothelial- and nitric oxide synthase-dependent mechanism involving cellular uptake of L-Arg.

  5. Hemodynamic and glucometabolic factors fail to predict renal function in a random population sample

    Pareek, M.; Nielsen, M.; Olesen, Thomas Bastholm


    indices of beta-cell function (HOMA-2B), insulin sensitivity (HOMA-2S), and insulin resistance (HOMA-2IR)), traditional cardiovascular risk factors (age, sex, smoking status, body mass index, diabetes mellitus, total serum cholesterol), and later renal function determined as serum cystatin C in 238 men......-2006. Results: Mean (+/- s.d.) follow-up time, creatinine, and cystatin C were 28 +/- 1 years, 94 +/- 12 micromoles/L, and 1.220 +/- 0.298 mg/L. Mean estimated glomerular filtration rates at baseline and follow-up were 84 +/- 12 mL/min/1.73m2 and 68 +/- 18 mL/min/1.73m2. In univariate analyses, cystatin C...

  6. Applying dynamic parameters to predict hemodynamic response to volume expansion in spontaneously breathing patients with septic shock.

    Lanspa, Michael J; Grissom, Colin K; Hirshberg, Eliotte L; Jones, Jason P; Brown, Samuel M


    Volume expansion is a mainstay of therapy in septic shock, although its effect is difficult to predict using conventional measurements. Dynamic parameters, which vary with respiratory changes, appear to predict hemodynamic response to fluid challenge in mechanically ventilated, paralyzed patients. Whether they predict response in patients who are free from mechanical ventilation is unknown. We hypothesized that dynamic parameters would be predictive in patients not receiving mechanical ventilation. This is a prospective, observational, pilot study. Patients with early septic shock and who were not receiving mechanical ventilation received 10-mL/kg volume expansion (VE) at their treating physician's discretion after initial resuscitation in the emergency department. We used transthoracic echocardiography to measure vena cava collapsibility index and aortic velocity variation before VE. We used a pulse contour analysis device to measure stroke volume variation (SVV). Cardiac index was measured immediately before and after VE using transthoracic echocardiography. Hemodynamic response was defined as an increase in cardiac index 15% or greater. Fourteen patients received VE, five of whom demonstrated a hemodynamic response. Vena cava collapsibility index and SVV were predictive (area under the curve = 0.83, 0.92, respectively). Optimal thresholds were calculated: vena cava collapsibility index, 15% or greater (positive predictive value, 62%; negative predictive value, 100%; P = 0.03); SVV, 17% or greater (positive predictive value 100%, negative predictive value 82%, P = 0.03). Aortic velocity variation was not predictive. Vena cava collapsibility index and SVV predict hemodynamic response to fluid challenge patients with septic shock who are not mechanically ventilated. Optimal thresholds differ from those described in mechanically ventilated patients.

  7. Applying dynamic parameters to predict hemodynamic response to volume expansion in spontaneously breathing patients with septic shock

    Lanspa, Michael J.; Grissom, Colin K.; Hirshberg, Eliotte L.; Jones, Jason P.; Brown, Samuel M.


    Background Volume expansion is a mainstay of therapy in septic shock, although its effect is difficult to predict using conventional measurements. Dynamic parameters, which vary with respiratory changes, appear to predict hemodynamic response to fluid challenge in mechanically ventilated, paralyzed patients. Whether they predict response in patients who are free from mechanical ventilation is unknown. We hypothesized that dynamic parameters would be predictive in patients not receiving mechanical ventilation. Methods This is a prospective, observational, pilot study. Patients with early septic shock and who were not receiving mechanical ventilation received 10 ml/kg volume expansion (VE) at their treating physician's discretion after initial resuscitation in the emergency department. We used transthoracic echocardiography to measure vena cava collapsibility index (VCCI) and aortic velocity variation (AoVV) prior to VE. We used a pulse contour analysis device to measure stroke volume variation (SVV). Cardiac index was measured immediately before and after VE using transthoracic echocardiography. Hemodynamic response was defined as an increase in cardiac index ≥ 15%. Results 14 patients received VE, 5 of which demonstrated a hemodynamic response. VCCI and SVV were predictive (Area under curve = 0.83, 0.92, respectively). Optimal thresholds were calculated: VCCI ≥ 15% (Positive predictive value, PPV 62%, negative predictive value, NPV 100%, p = 0.03); SVV ≥ 17% (PPV 100%, NPV 82%, p = 0.03). AoVV was not predictive. Conclusions VCCI and SVV predict hemodynamic response to fluid challenge patients with septic shock who are not mechanically ventilated. Optimal thresholds differ from those described in mechanically ventilated patients. PMID:23324885

  8. No effect of dietary fish oil on renal hemodynamics, tubular function, and renal functional reserve in long-term renal transplant recipients

    Hansen, J M; Løkkegaard, H; Høy, Carl-Erik


    volunteers (N = 9) and two groups of stable long-term kidney-transplanted patients treated with maintenance low-dose CsA (3.0 +/- 0.6 mg/kg; N = 9) or without CsA (N = 9). After an overnight fast, the subjects were water loaded, and clearance studies were performed, postponing morning medication. GFR...... and effective RPF were measured as the renal clearances of (99mTc)DTPA and (131I)hippuran, respectively. Renal tubular function was evaluated by use of the renal clearance of lithium and the urinary excretion of beta 2-microglobulin. Fish oil did not change baseline values of effective RPF, GFR, lithium...

  9. The Effects of a Multiflavonoid Supplement on Vascular and Hemodynamic Parameters following Acute Exercise

    Rebecca M. Kappus


    Full Text Available Antioxidants can decrease oxidative stress and combined with acute exercise they may lead to further decreases in blood pressure. The purpose of this study was to investigate the effects of 2 weeks of antioxidant supplementation on vascular distensibility and cardiovascular hemodynamics during postexercise hypotension. Methods. Twenty young subjects were randomized to placebo (=10 or antioxidant supplementation (=10 for two weeks. Antioxidant status, vascular distensibility, and hemodynamics were obtained before, immediately, and 30 minutes after an acute bout of aerobic exercise both before and after supplementation. Results. Two weeks of antioxidant supplementation resulted in a greater systolic blood pressure (SBP decrease during postexercise hypotension (PEH and significant decreases in augmentation index versus placebo (12.5% versus 3.5%, resp.. Also ferric-reducing ability of plasma (FRAP increased significantly (interaction P = 0.024 after supplementation. Conclusion. Supplementation showed an additive effect on PEH associated with increased FRAP values and decreases in systolic blood pressure and augmentation index.

  10. Assessment of Renal Hemodynamics and Oxygenation by Simultaneous Magnetic Resonance Imaging (MRI) and Quantitative Invasive Physiological Measurements.

    Cantow, Kathleen; Arakelyan, Karen; Seeliger, Erdmann; Niendorf, Thoralf; Pohlmann, Andreas


    In vivo assessment of renal perfusion and oxygenation under (patho)physiological conditions by means of noninvasive diagnostic imaging is conceptually appealing. Blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) and quantitative parametric mapping of the magnetic resonance (MR) relaxation times T 2* and T 2 are thought to provide surrogates of renal tissue oxygenation. The validity and efficacy of this technique for quantitative characterization of local tissue oxygenation and its changes under different functional conditions have not been systematically examined yet and remain to be established. For this purpose, the development of an integrative multimodality approaches is essential. Here we describe an integrated hybrid approach (MR-PHYSIOL) that combines established quantitative physiological measurements with T 2* (T 2) mapping and MR-based kidney size measurements. Standardized reversible (patho)physiologically relevant interventions, such as brief periods of aortic occlusion, hypoxia, and hyperoxia, are used for detailing the relation between the MR-PHYSIOL parameters, in particular between renal T 2* and tissue oxygenation.

  11. [Study of the effect of colloidal solution of silver nanoparticles on parameters of cardio- and hemo-dynamics in rabbits].

    Pryskoka, A O


    Metal nanoparticles and silver nanoparticles in particular are extensively studied recently considering their prominent antimicrobial properties. Nevertheless, their toxicity aspects and probable side effects remain not well studied. In this article the results of study of the influence of silver nanoparticles onto a cardiovascular system in an in vivo experiment were provided, changes in parameters of cardio- and hemodynamics were defined, and the principles of such influence were identified. Dose-dependent effect of these nanoparticles was established when administered in dose of 4.3 mg/kg three times and 20 mg/kg once.

  12. Application effect of hyperbaric oxygen in the patients with optic atrophy and influence for the hemodynamic parameters

    Kun Zhang


    Full Text Available AIM: To observe the application effect of hyperbaric oxygen in the patients with optic atrophy and influence degree for the hemodynamic parameters.METHODS: Fifty patients with optic atrophy in our hospital from January 2012 to January 2014 were objected, they were randomly divided into control group(conventional optic atrophy treatment groupand observation group(conventional treatment and hyperbaric oxygen treatment group, each group was 25 cases. Statistical analysis of two group before and after treatment eyesight, vision acuity, visual field defect and ophthalmic artery, central retinal artery blood flow parameters were undergone.RESULTS: The sight, visual field sensitivity and field vision defect of observation group were all better than those of control group at first, second and third course after the treatment, arteriae ophthalmica and arteriae centralis retinae EDV and PSV were all higher than those of control group, PI and RI were all lower than those of control group were all significant differences(PCONCLUSION: The application effect of hyperbaric oxygen in the patients with optic atrophy is better, and the influence of treatment method for the ocular hemodynamic parameters are more active.

  13. Short-term renal hemodynamic effects of tolvaptan in subjects with autosomal dominant polycystic kidney disease at various stages of chronic kidney disease.

    Boertien, Wendy E; Meijer, Esther; de Jong, Paul E; Bakker, Stephan J L; Czerwiec, Frank S; Struck, Joachim; Oberdhan, Dorothee; Shoaf, Susan E; Krasa, Holly B; Gansevoort, Ron T


    Vasopressin V2-receptor antagonists may delay disease progression in ADPKD. Trials with V2-receptor antagonists have been performed predominantly in patients with an estimated creatinine clearance of 60 ml/min or more. Here we determined renal hemodynamic effects of the V2-receptor antagonist tolvaptan in 27 patients with ADPKD at various stages of chronic kidney disease: group A: >60, group B: 30-60, and group C: chronic kidney disease stages 1 through 4, but minor GFR drops may be observed in individual patients.

  14. Goal directed hemodynamic therapy based in esophageal Doppler flow parameters: A systematic review, meta-analysis and trial sequential analysis.

    Ripollés-Melchor, J; Casans-Francés, R; Espinosa, A; Abad-Gurumeta, A; Feldheiser, A; López-Timoneda, F; Calvo-Vecino, J M


    Numerous studies have compared perioperative esophageal doppler monitoring (EDM) guided intravascular volume replacement strategies with conventional clinical volume replacement in surgical patients. The use of the EDM within hemodynamic algorithms is called 'goal directed hemodynamic therapy' (GDHT). Meta-analysis of the effects of EDM guided GDHT in adult non-cardiac surgery on postoperative complications and mortality using PRISMA methodology. A systematic search was performed in Medline, PubMed, EMBASE, and the Cochrane Library (last update, March 2015). Randomized clinical trials (RCTs) in which perioperative GDHT was compared to other fluid management. Overall complications. Mortality; number of patients with complications; cardiac, renal and infectious complications; incidence of ileus. Studies were subjected to quantifiable analysis, pre-defined subgroup analysis (stratified by surgery, type of comparator and risk); pre-defined sensitivity analysis and trial sequential analysis (TSA). Fifty six RCTs were initially identified, 15 fulfilling the inclusion criteria, including 1,368 patients. A significant reduction was observed in overall complications associated with GDHT compared to other fluid therapy (RR=0.75; 95%CI: 0.63-0.89; P=0.0009) in colorectal, urological and high-risk surgery compared to conventional fluid therapy. No differences were found in secondary outcomes, neither in other subgroups. The impact on preventing the development of complications in patients using EDM is high, causing a relative risk reduction (RRR) of 50% for a number needed to treat (NNT)=6. GDHT guided by EDM decreases postoperative complications, especially in patients undergoing colorectal surgery and high-risk surgery. However, no differences versus restrictive fluid therapy and in intermediate-risk patients were found. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Comparison of neostigmine and sugammadex for hemodynamic parameters in cardiac patients undergoing noncardiac surgery.

    Kizilay, Deniz; Dal, Didem; Saracoglu, Kemal T; Eti, Zeynep; Gogus, Fevzi Y


    The aim of this study is to compare the hemodynamic effects of neostigmine-atropine combination and sugammadex in patients with cardiac problems undergoing noncardiac surgery. Prospective randomized study. In the operating room. Ninety patients with a class 2 or 3 cardiovascular disease according to the New York Heart Association classification and aged between 18 and 75 years undergoing noncardiac surgery were randomized. Group N (n = 45) received 0.03 mg/kg IV neostigmine when T2 appeared as measured with a nerve muscle stimulator. When heart rate was 5 beats/min (±10 beats/min) lower than the heart rate before administration of the medication, 0.5 mg IV atropine sulfate was given. Group S (n = 45) received 3 mg/kg IV sugammadex when T2 appeared as measured with a nerve muscle stimulator. Heart rate, mean systolic and diastolic blood pressures, and electrocardiographic alterations including the QTc (QT Fredericia and QT Bazett) were recorded. There were no significant differences between and within the groups in terms of QTc values. Sugammadex group had a significant decrease on heart rate 1 minute after the medication when compared to the measurement before the medication (P Sugammadex group had lower systolic, diastolic, and mean blood pressures and heart rate when compared to neostigmine group (P sugammadex might be preferred as it provides more hemodynamic stability compared to neostigmine-atropine combination to reverse rocuronium-induced neuromuscular blockage in cardiac patients undergoing noncardiac surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Computer simulation of Cerebral Arteriovenous Malformation—validation analysis of hemodynamics parameters

    Mehta, Shashi Bhushan; Ramachandra, Manjunath


    Problem The purpose of this work is to provide some validation methods for evaluating the hemodynamic assessment of Cerebral Arteriovenous Malformation (CAVM). This article emphasizes the importance of validating noninvasive measurements for CAVM patients, which are designed using lumped models for complex vessel structure. Methods The validation of the hemodynamics assessment is based on invasive clinical measurements and cross-validation techniques with the Philips proprietary validated software’s Qflow and 2D Perfursion. Results The modeling results are validated for 30 CAVM patients for 150 vessel locations. Mean flow, diameter, and pressure were compared between modeling results and with clinical/cross validation measurements, using an independent two-tailed Student t test. Exponential regression analysis was used to assess the relationship between blood flow, vessel diameter, and pressure between them. Univariate analysis is used to assess the relationship between vessel diameter, vessel cross-sectional area, AVM volume, AVM pressure, and AVM flow results were performed with linear or exponential regression. Discussion Modeling results were compared with clinical measurements from vessel locations of cerebral regions. Also, the model is cross validated with Philips proprietary validated software’s Qflow and 2D Perfursion. Our results shows that modeling results and clinical results are nearly matching with a small deviation. Conclusion In this article, we have validated our modeling results with clinical measurements. The new approach for cross-validation is proposed by demonstrating the accuracy of our results with a validated product in a clinical environment. PMID:28149675

  17. Penile vascular diagnostic categorization using penile duplex Doppler ultrasound: Differences in vascular hemodynamics parameters by differences in anatomic sampling location

    Fabio Pezzoni


    Full Text Available Objectives. In 2013 the International Society for Sexual Medicine(ISSM published the guidelines regarding the standard operating procedure (SOP for penile duplex Doppler ultrasound (PDDU. Although ISSM-SOP have given important strides in reducing interobserver variability in PDDU by procedural protocol and parameters these guidelines do not address the anatomic location along the penis at which hemodynamic measurements have to be done. In our opinion a “double sampling” may be interesting to detect the arteriogenic or venogenic nature of the erectile dysfunction (ED. In particular sampling measurements at the “crus” (at the level of the peno-scrotal junction may be significative for detection of veno-occlusive dysfunction (VOD,whereas an evaluation at “mid penis” (1/2 distance between peno-scrotal junction and coronal sulcus, may be useful to diagnose an arterial insufficiency (AI. Material and Methods. We evalued 90 men, mean age 56.3, affected with ED of medium degree, responder to PDE5-I that urdergone to PDDU and also responder after pharmacologic intracavernosal injection (PIIof prostaglandin E1 20 mcg, with rigid erection and normal maintenance. We moreover evalued 90 men in youthful age (mean 35.2, in absence of vascular risk factors, no responder to PDE5-I that undergone to PDDU by PII at high dosage (bimix: prostaglandin E1 20 mcg, papaverine 20 mg. Results. In the first pool the sampling at “mid penis” resulted significative for arterial insuffciency (AI in 81% (73, in presence of normal or borderline end diastolic velocity (EDV. Sampling at the “crus” resulted negative for VOD in 90% (81. In the second pool, 66.6% (60 resulted responder with rigid erection and normal maintenance in presence of normal hemodynamic parameters: peak systolic velocity (PSV and end diastolic velocity (EDV both at the “crus” and at “mid penis” sampling. 33.4% (30 responded with a semirigid erection and manifested a constant

  18. Nephrectomy elicits impact of age and BMI on renal hemodynamics : Lower postdonation reserve capacity in older or overweight kidney donors

    Rook, M.; Bosma, R. J.; van Son, W. J.; Hofker, H. S.; van der Heide, J. J. Homan; ter Wee, P. M.; Ploeg, R. J.; Navis, G. J.


    Renal functional reserve could be relevant for the maintenance of renal function after kidney donation. Low-dose dopamine induces renal vasodilation with a rise in glomerular filtration rate (GFR) in healthy subjects and is thought to be a reflection of reserve capacity (RC). Older age and higher bo

  19. A hemodynamic-based dimensionless parameter for predicting rupture of intracranial aneurysms

    Asgharzadeh, Hafez; Varble, Nicole; Meng, Hui; Borazjani, Iman


    Rupture of an intracranial aneurysm (IA) is a disease with high rates of mortality. Given the risk associated with the aneurysm surgery, quantifying the likelihood of aneurysm rupture is essential. There are many risk factors that could be implicated in the rupture of an aneurysm. However, the hemodynamic factors are believed to be the most influential ones. Here, we carry out three-dimensional high resolution simulations on human subjects IAs to test a dimensionless number, denoted as An number, to classify the flow mode. An number is defined as the ratio of the time takes the parent artery flow transports through the expansion region to the time required for vortex formation. Furthermore, we investigate the correlation of IA flow mode and WSS/OSI on the human subject IAs. Finally, we test if An number can distinguish ruptured from unruptured IAs on a database containing 204 human subjects IAs. This work was supported by National Institute Of Health (NIH) Grant R03EB014860 and the Center of Computational Research (CCR) of University at Buffalo.

  20. Effects of Reiki on Post-cesarean Delivery Pain, Anxiety, and Hemodynamic Parameters: A Randomized, Controlled Clinical Trial.

    Midilli, Tulay Sagkal; Eser, Ismet


    The aim of this study was to investigate the effect of Reiki on pain, anxiety, and hemodynamic parameters on postoperative days 1 and 2 in patients who had undergone cesarean delivery. The design of this study was a randomized, controlled clinical trial. The study took place between February and July 2011 in the Obstetrical Unit at Odemis Public Hospital in Izmir, Turkey. Ninety patients equalized by age and number of births were randomly assigned to either a Reiki group or a control group (a rest without treatment). Treatment applied to both groups in the first 24 and 48 hours after delivery for a total of 30 minutes to 10 identified regions of the body for 3 minutes each. Reiki was applied for 2 days once a day (in the first 24 and 48 hours) within 4-8 hours of the administration of standard analgesic, which was administered intravenously by a nurse. A visual analog scale and the State Anxiety Inventory were used to measure pain and anxiety. Hemodynamic parameters, including blood pressure (systolic and diastolic), pulse and breathing rates, and analgesic requirements also were recorded. Statistically significant differences in pain intensity (p = .000), anxiety value (p = .000), and breathing rate (p = .000) measured over time were found between the two groups. There was a statistically significant difference between the two groups in the time (p = .000) and number (p = .000) of analgesics needed after Reiki application and a rest without treatment. Results showed that Reiki application reduced the intensity of pain, the value of anxiety, and the breathing rate, as well as the need for and number of analgesics. However, it did not affect blood pressure or pulse rate. Reiki application as a nursing intervention is recommended as a pain and anxiety-relieving method in women after cesarean delivery.

  1. Serial measurement of Doppler hepatic hemodynamic parameters for the diagnosis of acute rejection after live donor liver transplantation.

    Sugimoto, Hiroyuki; Kato, Koichi; Hirota, Masashi; Takeda, Shin; Kamei, Hideya; Nakamura, Taro; Kiuchi, Tetsuya; Nakao, Akimasa


    To elucidate the role of Doppler hepatic hemodynamic parameters as surrogate markers of acute rejection (AR) after live donor liver transplantation (LDLT), serial Doppler measurements were prospectively performed during the first 2 weeks after LDLT to compare the longitudinal hepatic hemodynamic changes between patients with histologically proven AR and patients without histologically proven AR. Forty-six patients that had undergone adult-to-adult LDLT using a right lobe graft were enrolled in this study. The portal venous maximum velocity (PVV; cm/second), portal venous flow volume, hepatic arterial peak systolic velocity, hepatic arterial pulsatility index, hepatic venous maximum velocity, hepatic venous pulsatility index, and splenic arterial pulsatility index were measured. Fourteen patients were diagnosed by biopsy to have clinically relevant AR. Markedly increased PVV was seen soon after surgery and gradually decreased in both patients with clinically relevant AR and patients without clinically relevant AR. This serial change of decreasing PVV was significantly greater in patients with clinically relevant AR (P patients with clinically relevant AR was significantly lower than that in patients without clinically relevant AR (PVV on postoperative day 6: 35.6 +/- 21.3 versus 58.3 +/- 27.1 cm/second, respectively, P = 0.0080). A PVV cutoff value of 20.2 cm/second demonstrated the best accuracy for predicting clinically relevant AR. The sensitivity and specificity for predicting clinically relevant AR were 92.9% and 87.1%, respectively. The area under the curve was 0.94. In conclusion, serial Doppler measurement of hepatic parameters in LDLT is useful for the diagnosis of clinically relevant AR. Clinically relevant AR should therefore be suspected when a marked unexpected decrease in the PVV is observed.

  2. Influence of cardiac hemodynamic parameters on coronary artery opacification with 64-slice computed tomography

    Husmann, Lars; Alkadhi, Hatem; Boehm, Thomas; Leschka, Sebastian; Desbiolles, Lotus; Marincek, Borut [University Hospital of Zurich, Department of Medical Radiology, Institute of Diagnostic Radiology, Zurich (Switzerland); Schepis, Tiziano; Koepfli, Pascal; Wildermuth, Simon [University Hospital of Zurich, Cardiovascular Center, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital of Zurich, Cardiovascular Center, Zurich (Switzerland); University of Zurich, Center for Integrative Human Physiology, Zurich (Switzerland)


    The purpose of this study was to evaluate the influence of ejection fraction (EF), stroke volume (SV), heart rate, and cardiac output (CO) on coronary artery opacification with 64-slice computed tomography (CT). Sixty patients underwent, retrospectively, electrocardiography-gated 64-slice CT coronary angiography. Left ventricular EF, SV, and CO were calculated with semi-automated software. Attenuation values were measured and contrast-to-noise ratios (CNRs) were calculated in the proximal right coronary artery (RCA) and left main artery (LMA). Mean EF during scanning was 61.5{+-}12.4%, SV was 63.2{+-}15.6 ml, heart rate was 62.5{+-}11.8 beats per minute (bpm), and CO was 3.88{+-}1.06 l/min. There was no significant correlation between the EF and heart rate and the attenuation and CNR in either coronary artery. A significant negative correlation was found in both arteries between SV and attenuation (RCA r=-0.26, P<0.05; LMA r=-0.34, P<0.01) and between SV and CNR (RCA r=-0.26, P<0.05; LMA r=-0.26, P<0.05). Similarly, a significant negative correlation was found between the CO and attenuation (RCA r=-0.42, P<0.05; LMA r=-0.56, P<0.001) and between the CO and CNR (RCA r=-0.39, P<0.05; LMA r=-0.44, P<0.001). The actual hemodynamic status of the patient influences the coronary artery opacification with 64-slice CT, in that vessel opacification decreases as SV and CO increase. (orig.)

  3. Hemodynamic Parameters of Low-Flow Isoflurane and Low-Flow Sevoflurane Anesthesia During Controlled Ventilation With Laryngeal Mask Airway

    Negargar, Sohrab; Peirovifar, Ali; Mahmoodpoor, Ata; Parish, Masoud; Golzari, Samad EJ; Molseqi, Haniye; Negargar, Soheil


    Background: Nowadays laryngeal mask airway (LMA) is popular as one of the best choices for airway management. Low-flow anesthesia has some advantages like lower pollution, hemodynamic stability and cost effectiveness. Volatile anesthetics are widely used for anesthesia maintenance during operations. Sevoflurane has more hemodynamic stability compared to isoflurane, but there are few studies comparing the hemodynamic stabilities of these two anesthetics during controlled low flow anesthesia wi...

  4. Influence of sevoflurane on hemodynamic parameters in low flow anesthesia applied

    Özer Debre


    Full Text Available Objective: In this study, it was aimed to investigate the hemodynamic effects of sevoflurane in low flow anesthesia (LFA without nitrous oxide. Methods: A total of 40 ASA I-II patients aged between 18-70 years were included in this study. Patients were randomly allocated to two groups. Group 1 (LFA with nitrous oxide was applied preoxygenation with 10 L/min 100% O2 for 2 min. After preoxygenation, 4-7 mg/kg pentothal, 0.1 mg/kg vecuronium bromide and 1 μg/kg fentanyl were applied respectively via intravenous route. Endotracheal intubation was applied 3 min later after induction. 4 L/min (50% O2-50% N2O normal flow had been applied within the first 10 min of the operation following intubation, it was switched to 1 L/min (50% O2-50% N2O low flow. Sevoflurane concentration was set as 0.8-1 MAK so as to keep mean blood pressure (MBP within ± 20% limits. In Group 2 (LFA without nitrous oxide all procedure was the same with Group I except that air was used instead of N2O. Heart rate (HR, MAP, SPO2 and ETCO2 values were recorded just after intubation and following 15, 30, 45 and 60. min and switched to 4 L/min of normal flow 15 min before termination of the operation. Results: There were no significant differences between the groups from measurement after induction to 60 min measurement in terms of systolic blood pressure (SBP and ETCO2. Values in Group I were found greater than those in Group II at 15 min measurement in terms of diastolic blood pressure (DBP, MAP and HR (p<0,05. No complications were encountered in patients. Conclusion: We concluded that preferring LFA techniques applied without N2O, with sevoflurane is beneficial if proper conditions are provided. J Clin Exp Invest 2014; 5 (1: 12-17

  5. Hemodynamics, functional state of endothelium and renal function, platelets depending on the body mass index in patients with chronic heart failure and preserved systolic function

    Kushnir Yu.


    Full Text Available The aim of the study was to evaluate hemodynamics, endothelium function of kidneys and platelets depending on the body mass index (BMI in patients with chronic heart failure (CHF and preserved systolic function. 42 patients (mean age - 76,690,83 years with CHF II-III FC NYHA with preserved systolic function (LVEF>45% were enrolled. Echocardiography was performed, endothelial function, serum creatinine levels and microalbuminuria were determined in patients. BMI and glomerulation filtration rate were calculated by formulas. The morphological and functional status of platelets was estimated by electronic microscopy. It was defined that increased BMI in patients with CHF and preserved systolic function determines the structural and functional changes of the myocardium and leads to the endothelial and renal functional changes. An increased risk of thrombogenesis was established in patients with overweight and obesity.

  6. Role of No in the Regulation of Systemic and Renal Hemodynamics Following Hemorrhagic Shock in the Rate


    suprapubic incision for urine sampling. The right internal jugular vein was cannulated with two PE-50 catheters. Inulin , PAH and pentobarbital sodium...aortic arch (10). Glomerular filtration rate (GFR) and effective renal plasma flow were determined by the renal clearance of inulin -carboxyl...Carboxyl-14C] and aminohippuric acid P-[glycyl-2-3H] respectively (New England Nuclear, Boston, MA). The 14C- inulin was infused at a rate of 0.06uCi/min

  7. Fetal Hemodynamic Parameters in Low Risk Pregnancies: Doppler Velocimetry of Uterine, Umbilical, and Middle Cerebral Artery

    C. O. Figueira


    Full Text Available Objective. To elaborate curves of longitudinal reference intervals of pulsatility index (PI and systolic velocity (SV for uterine (UtA, umbilical (UA, and middle cerebral arteries (MCA, in low risk pregnancies. Methods. Doppler velocimetric measurements of PI and SV from 63 low risk pregnant women between 16 and 41 weeks of gestational age. Means (±SD for intervals of gestational age and percentiles 5, 50, and 95 were calculated for each parameter. The Intraclass Correlation Coefficients (ICC were also estimated for assessing intra- and intervariability of measurements. Results. Mean PI of UtA showed decreasing values during pregnancy, but no regular pattern was identified for mean SV. For UA, PI decreased and SV increased along gestation. MCA presented PI increasing values until 32–35 weeks. SV showed higher levels with increasing gestation. High ICC values indicated good reproducibility. Conclusions. Reference intervals for the assessment of SV and PI of UtA, UA, and MCA were established. These reference intervals showed how a normal pregnancy is expected to progress regarding these Doppler velocimetric parameters and are useful to follow high risk pregnancies. The comparison between results using different curves may provide insights about the best patterns to be used.

  8. Assessment of baseline hemodynamic parameters within infarct progression areas in acute stroke patients using perfusion-weighted MRI

    Ritzenthaler, Thomas; Cho, Tae-Hee; Derex, Laurent; Nighoghossian, Norbert [Hospices Civils de Lyon, Cerebrovascular Unit, Hopital Neurologique Pierre Wertheimer, Bron (France); Claude Bernard Lyon 1 University, Creatis-LRMN, UMR 5520-Inserm 630, Lyon (France); Wiart, Marlene; Berthezene, Yves [Claude Bernard Lyon 1 University, Creatis-LRMN, UMR 5520-Inserm 630, Lyon (France); Berthiller, Julien [Hospices Civils de Lyon, Pole Information Medicale Evaluation Recherche, Lyon (France); Universite Lyon 1, Lyon (France); Oestergaard, Leif [University of Aarhus, Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus (Denmark); Hermier, Marc [Hospices Civils de Lyon, Neuroradiology Department, Hopital Neurologique Pierre Wertheimer, Lyon (France)


    The value of perfusion MRI for identifying the tissue at risk has been questioned. Our objective was to assess baseline perfusion-weighted imaging parameters within infarct progression areas. Patients with anterior circulation stroke without early reperfusion were included from a prospective MRI database. Sequential MRI examinations were performed on admission, 2-3 h (H2), 2-3 days (D2), and between 15 and 30 days after the initial MRI. Maps of baseline time-to-peak (TTP), mean transit time (MTT), cerebral blood volume (CBV), and cerebral blood flow (CBF) were calculated. Lesion extension areas were defined as pixels showing de novo lesions between each MRI and were generated by subtracting successive lesion masks: V{sub 0}, baseline diffusion-weighted imaging (DWI) lesion; V{sub 1}, lesion extension between baseline and H2 DWI; V{sub 2}, lesion extension from H2 to D2 DWI; and V{sub 3}, lesion extension from D2 DWI to final FLAIR. Repeated measures analysis was used to compare hemodynamic parameters within the baseline diffusion lesion and subsequent lesion extension areas. Thirty-two patients were included. Baseline perfusion parameters were significantly more impaired within the acute DWI lesion compared to lesion extension areas (TTP, p<0.0001; MTT, p<0.0001; CBF p<0.0001; CBV, p<0.0001). A significant decrease in MTT (p = 0.01) and TTP (p = 0.01) was found within successive lesion growth areas. A decreasing gradient of severity for TTP and MTT was observed within successive infarct growth areas. (orig.)

  9. Influence of stenosis on hemodynamic parameters in the realistic left coronary artery under hyperemic conditions.

    Kamangar, Sarfaraz; Badruddin, Irfan Anjum; Badarudin, A; Nik-Ghazali, N; Govindaraju, Kalimuthu; Salman Ahmed, N J; Yunus Khan, T M


    The current study investigates the hyperemic flow effects on heamodynamics parameters such as velocity, wall shear stress in 3D coronary artery models with and without stenosis. The hyperemic flow is used to evaluate the functional significance of stenosis in the current era. Patients CT scan data of having healthy and coronary artery disease was chosen for the reconstruction of 3D coronary artery models. The diseased 3D models of coronary artery shows a narrowing of >50% lumen area. Computational fluid dynamics was performed to simulate the hyperemic flow condition. The results showed that the recirculation zone was observed immediate to the stenosis and highest wall shear stress was observed across the stenosis. The decrease in pressure was found downstream to the stenosis as compared to the coronary artery without stenosis. Our analysis provides an insight into the distribution of wall shear stress and pressure drop, thus improving our understanding of hyperemic flow effect under both conditions.

  10. The hemodynamic effect of calcium ion concentration in the infusate during predilution hemofiltration in chronic renal failure

    Karamperis, N.; Sloth, E.; Jensen, Jens Dam


    BACKGROUND: It is the prevailing view that convective dialysis techniques stabilize blood pressure. Calcium concentration in the substitution fluid may be important in this respect. The aim of this study is to investigate the influence of calcium ion concentration in the substitution fluid...... on hemodynamic stability during predilution hemofiltration (HF). METHODS: We conducted a randomized, crossover, blinded, controlled trial with 12 stable long-term hemodialysis patients without diabetes. Each patient was randomly assigned to substitution fluid with a calcium ion (iCa) concentration of 2.5 m...

  11. Endothelin-like action of Pausinystalia yohimbe aqueous extract on vascular and renal regional hemodynamics in Sprague Dawley rats.

    Ajayi, A A; Newaz, M; Hercule, H; Saleh, M; Bode, C O; Oyekan, A O


    The bark of the African tree Pausinystalia yohimbe has been used as a food additive with aphrodisiac and penile erection enhancing properties. The effect of an aqueous extract of P. yohimbe (CCD-X) on renal circulation was assessed in order to test the hypothesis that it possesses additional effects on nitric oxide production and/or endothelin-1 (ET-1)-like actions. In vivo studies with CCD-X in Sprague Dawley rats demonstrated a dose-dependent (1-1000 ng/kg) increase in mean blood pressure (p < 0.001) and an increase in medullary blood flow (MBF) (p < 0.001). Both the pressor action and renal medullary vasodilation were blocked by endothelinA (ETA) receptor antagonist BMS182874 and endothelinB (ETB) receptor antagonist BQ788 in combination. L-Nomega-nitro-l-arginine methyl ester (L-NAME; 10 mg/kg) also inhibited the increase in MBF induced by CCD-X. In vitro studies in isolated perfused kidney and in pressurized renal microvessels confirmed the dose-dependent vasoconstrictor action of this extract. ETA receptor antagonist BQ610 and ETB receptor antagonist BQ788 separately and significantly attenuated the renal vasoconstrictor actions of the extract (p < 0.001 ANOVA). These preliminary observations indicate that, in addition to the alpha-adrenergic antagonist actions that characterize yohimbine, CCD-X possesses endothelin-like actions and affects nitric oxide (NO) production in renal circulation. These findings suggest a strong possibility of post-receptor cross-talk between alpha2-adrenoceptors and endothelin, as well as a direct effect of alpha2-adrenoceptors on renal NO production.

  12. Effects of low-dose dopamine on renal and systemic hemodynamics during incremental norepinephrine infusion in healthy volunteers

    Hoogenberg, K; Smit, AJ; Girbes, ARJ


    Objectives: To assess the effects of low-dose dopamine on norepinephrine induced renal and systemic vasoconstriction in normotensive healthy subjects. Design: On separate days, either a low-dose dopamine (4 mu g/kg/min) or a placebo (5% glucose) infusion was added in a single, blinded, randomized or

  13. Effects of a human recombinant alkaline phosphatase on renal hemodynamics, oxygenation and inflammation in two models of acute kidney injury

    Peters, Esther; Ergin, Bülent; Kandil, Asli; Gurel-Gurevin, Ebru; van Elsas, Andrea; Masereeuw, Rosalinde; Pickkers, Peter; Ince, Can


    Two small clinical trials indicated that administration of bovine intestinal alkaline phosphatase (AP) improves renal function in critically ill patients with sepsis-associated acute kidney injury (AKI), for which the mechanism of action is not completely understood. Here, we investigated the

  14. A Novel Index Using Ankle Hemodynamic Parameters to Assess the Severity of Peripheral Arterial Disease: A Pilot Study

    Tanno, Jun; Gatate, Yodo; Kasai, Takatoshi; Nakano, Shintaro; Senbonmatsu, Takaaki; Sato, Osamu; Ichioka, Shigeru; Kuro-o, Makoto; Nishimura, Shigeyuki


    In peripheral arterial disease (PAD) of the lower extremities, the presence of flow-limiting stenoses can be objectively detected by the ankle-brachial index (ABI). However, the severity of ischemic symptoms is not necessarily associated with the ABI value. Atherosclerotic plaque in lower extremity PAD induces ankle arterial stiffness and reduces ankle vascular resistance, which may decrease ankle blood flow and cause ischemic symptoms. We hypothesized that the ankle hemodynamic index (AHI), defined as the ratio of ankle arterial stiffness to ankle vascular resistance, could be used to assess the blood supply deficiency in a diseased lower limb in patients with PAD. The 85 consecutive patients with PAD who were retrospectively analyzed in this study had Rutherford grade 1 to grade 6 ischemia diagnosed as PAD and significant stenotic lesions (>50% diameter stenosis) of the lower extremity on contrast angiography. The AHI was calculated as the product of the ankle pulse pressure and the ratio of heart rate to ankle mean arterial pressure (ankle pulse pressure × heart rate/ankle mean arterial pressure). The Rutherford grade was significantly correlated with the AHI (r = 0.50, P < 0.001), but not with the ABI (r = 0.07, P = 0.52). Multiple ordinal regression analysis showed that anemia (odds ratio 0.66, P = 0.002) and AHI (odds ratio 1.04, P = 0.02) were independently associated with Rutherford grade. Our study shows that AHI, a novel parameter based on the ABI measurement, is well correlated with ischemic symptoms, and may be a useful means to assess the arterial blood supply of the lower extremities of patients with PAD. PMID:27760183

  15. [The changes of hemodynamic parameters, pathology and c-kit mRNA expression in myocardium after acute myocardial infarction in rats].

    Chen, Shiqian; Long, Weifu; Wu, Wenchao; Jiang, Congxun; Liu, Xiaojing; Li, Liang


    This study was aimed to investigate the changes of hemodynamic parameters, pathology and c kit mRNA expression in myocardium after acute myocardial infarctionin (AMI) in rats, and to elucidate the relationship between these three kinds of changes. Sixty six adult male SD rats were randomly divided into normal group, Sham groups and ligation groups. The rat model of AMI was set up by ligating the left anterior descending artery. Hemodynamic parameters, pathological changes and c kit mRNA expression in myocardiam were examined. The results revealed that there were no statistically significant differences in hemodynamic parameters between normal group and Sham groups. Compared with the normal group, all ligation groups exhibited significantly decreased left ventricular systolic pressure (LVSP) and +/-dp/dtmax (Pinfarct zone at 3rd day group after ligation, and granulation tissue infiltrated into the infarct zone at 14th day group after ligation. In all five time points groups after ligation, the levels of c-kit mRNA expression were 0.99 fold, 1.06 fold, 1.46 fold, 1.91 fold and 2.67 fold, respectively, compared with Sham groups. The results suggest that cardiac stem cells in myocardium might contribute to the role of regenerating myocardium via self proliferation after acute myocardial infarction, but further investigation is still needed.

  16. eGFR is a reliable preoperative renal function parameter in patients with gastric cancer

    Takayuki; Kosuge; Tokihiko; Sawada; Yoshimi; Iwasaki; Junji; Kita; Mitsugi; Shimoda; Nobumi; Tagaya; Keiichi; Kubota


    AIM: To evaluate the validity of the estimated glomerular filtration rate (eGFR) as a preoperative renal function parameter in patients with gastric cancer. METHODS: A retrospective study was conducted in 147 patients with gastric cancer. Preoperative creatinine clearance (Ccr), eGFR, and preand postoperative serum creatinine (sCr) data were examined. Preoperative Ccr and eGFR were then compared for their reliability in predicting postoperative renal dysfunction. RESULTS: Among 110 patients with normal preo...

  17. Effects of thrombin inhibition with melagatran on renal hemodynamics and function and liver integrity during early endotoxemia

    Nitescu, Nicoletta; Grimberg, Elisabeth; Ricksten, Sven-Erik


    in thiobutabarbital-anesthetized rats by an intravenous bolus dose of lipopolysaccharide (LPS; 6 mg/kg). Sham-Saline, LPS-Saline, and LPS-Melagatran study groups received isotonic saline or melagatran immediately before (0.75 micromol/kg iv) and continuously during (0.75 iv) 4.5 h of endotoxemia....... Kidney function, renal blood flow (RBF), and intrarenal cortical and outer medullary perfusion (OMLDF) measured by laser-Doppler flowmetry were analyzed throughout. Markers of liver injury and tumor necrosis factor (TNF)-alpha were measured in plasma after 4.5 h of endotoxemia. In addition, liver....... Melagatran did not diminish histological abnormalities in the liver or the elevated hepatic gene expression of TNF-alpha, intercellular adhesion molecule-1, and inducible nitric oxide synthase in endotoxemic rats. In summary, thrombin inhibition with melagatran preserved renal OMLDF, attenuated liver...

  18. Quantitative assessment of cerebral hemodynamic parameters by QUASAR arterial spin labeling in Alzheimer's disease and cognitively normal Elderly adults at 3-tesla.

    Mak, Henry K F; Chan, Queenie; Zhang, Zhipeng; Petersen, Esben T; Qiu, Deqiang; Zhang, Linda; Yau, Kelvin K W; Chu, Leung-Wing; Golay, Xavier


    QUASAR arterial spin labeling (ASL) was used to investigate the role of vascular impairment in Alzheimer's disease (AD). We hypothesized that the hemodynamic parameters monitoring cerebrovascular integrity, i.e., cerebral blood flow (CBF), arterial blood volume (aBV), and arterial transit time (aTT), would be affected. 13 AD patients and 15 healthy control (HC) subjects underwent 3T MRI scanning. Two separate blood flow acquisitions were obtained with 1 slice overlap for whole brain coverage. CBF, aBV, and aTT maps were calculated using in-house software. Preprocessing and statistical analyses were performed on SPM5. Region-of-interest (ROI) studies of ten selected cerebral regions were also conducted. There were significant differences in mini mental status exam (MMSE) (AD: 16.3 ± 4.55, HC: 28.5 ± 2.00) and Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) scores (AD: 25.25 ± 9.64, HC: 5.51 ± 2.62) between the 2 groups (p QUASAR ASL, we found patterns of regional hemodynamic impairment typical of moderate AD, suggesting underlying vascular abnormality. As potential biomarkers, these hemodynamic parameters could differentiate patients from volunteers, and possibly indicate the conversion from healthy aging to mild cognitive impairment to AD.

  19. Hemodynamics and the parameters of the heart mass in the dog after inhalation of submicron /sup 239/Pu dioxide

    Kalmykova, Z.I.; Buldakov, Z.I.; Kharunzhin, V.V.

    The growth of the right heart mass was mainly registered in dogs after inhalation of different quantities of /sup 239/Pu submicron dioxide. This was correlated with the value of /sup 239/Pu deposited in the lungs and associated with the systemic hemodynamic disorders.

  20. Coefficient of variation: a powerful Doppler ultrasonographic parameter for detection of renal artery stenosis.

    Eibenberger, K; Schima, H; Trubel, W; Temel, T; Schmidt, C; Scherer, R; Windberger, U; Dock, W; Grabenwöger, F


    The aim of our study was to objectively compare the effectiveness of various Doppler parameters in the diagnosis of renal artery stenosis. In three sheep, variable degrees of renal artery stenosis were induced and renal segmental arteries were investigated using pulsed Doppler sonography. In each animal the standard deviation of the instantaneous peak velocity within one cardiac cycle normalized by the mean peak velocity (coefficient of variation) had significantly higher normalized regression coefficients (k* = -0.215, average of three animals) when compared to resistive index (k* = -0.090) and acceleration index (k* = -0.069). In each individual animal, coefficient of variation detected lower pressure gradients (6.3 mm Hg, average value) than did resistive index (13.4 mm Hg) or acceleration index (17.3 mm Hg). The coefficient of variation may detect the presence of pressure gradients in renal artery stenosis more accurately than acceleration index or resistive index.

  1. Clinical analysis of abnormal renal hemodynamics in hypertensive patients with early renal injury%高血压早期肾损害肾内血流动力学异常临床分析

    蓝翔; 季乃军; 童丽军; 陈东海; 雷建明; 章春来


    目的 对高血压合并早期肾损害患者的肾内动脉血流动力学异常状况进行分析. 方法 随机选择我院200例原发性高血压患者为观察组, 按照既定的标准将其划分无早期肾损害患者100例和早期肾损害患者100例,另外选择100名身体健康的志愿者作为对照组.利用彩超多普勒技术对MRA(主肾动脉)、SRA(叶段动脉)、IRA (叶间动脉)的Vs(收缩期峰速度)、Vd(舒张期末速度)、Vm(平均血流速度)、AT(血流峰速加速时间)、PI(脉冲指数)以及RI(阻力指数)等血流参数进行测定,取两肾的平均值为最总结果. 结果 观察组患者的MRA(主肾动脉)、SRA(叶段动脉)、IRA(叶间动脉)的Vs(收缩期峰速度)、Vd(舒张期末速度)、Vm(平均血流速度)均较对照组低(P0.05);早期肾损害组和无早期肾损害组的组内比较结果为SRA(叶段动脉)、IRA(叶间动脉)的Vs(收缩期峰速度)、Vd(舒张期末速度)、Vm(平均血流速度)降低,AT(血流峰速加速时间)延长,PI(脉冲指数)以及RI(阻力指数)增高(P均0.05). Compared with the group without early renal injury, the group with early renal injury had significantly lower Vs, Vd, and Vm in the SRA and IRA, a significantly prolonged AT, and significantly higher PI and RI (all P<0.05). Conclusion The patients with primary hypertension have abnormal renal hemodynamics in the early stage of renal injury.

  2. Assessment of various parameters in the estimation of differential renal function using technetium-99m mercaptoacetyltriglycine

    Lythgoe, M.F.; Gordon, I.; Khader, Z.; Smith, T.; Anderson, P.J. [Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London (United Kingdom)


    Differential renal function (DRF) is an important parameter that should be assessed from virtually every dynamic renogram. With the introduction of technetium-99m mercaptoacetyltriglycine ({sup 99m}Tc-MAG3), a tracer with a high renal extraction, the estimation of DRF might hopefully become accurate and reproducible both between observers in the same institution and also between institutions. The aim of this study was to assess the effect of different parameters on the estimation of DRF. To this end we investigated two groups of children: group A, comprising 35 children with a single kidney (27 of whom had poor renal function), and group B, comprising 20 children with two kidneys and normal global function who also had an associated {sup 99m}Tc-dimercaptosuccinic acid scan ({sup 99m}Tc-DMSA). The variables assessed for their effect on the estimation of DRF were: different operators, the choice of renal regions of interest (ROIs), the applied background subtraction, and six different techniques for analysis of the renogram. The six techniques were based on: linear regression of the slopes in the Rutland-Patlak plot, matrix deconvolution, differential method, integral method, linear regression of the slope of the renograms, and the area under the curve of the renogram. The estimation of DRF was less dependent upon both observer and method in patients with two normally functioning kidneys than in patients with a single kidney. The inter-observer comparison among children in either group was not dependent on either ROI or background subtraction. However, in patients with poor renal function the method of choice for the estimation of DRF was dependent on background subtraction, though not ROI. In children with two kidneys and normal renal function, the estimation of DRF from the 24 techniques gave similar results. Methods that produced DRF values closest to expected results, from either group of children, were the Rutland-Patlak plot and matrix deconvolution methods


    Valluri Satya


    Full Text Available The clinical pattern of malaria has changed worldwide including India in last decade. Earlier cerebral malaria was the predominant manifestation of severe malaria, whereas now the combination of jaundice and renal failure are more common. Severe haemorrhage is seen in upto 5% of patients with severe malaria. Studies on renal and hepatic dys function in Plasmodium falciparum malaria are a plenty, but there is a paucity of studies correlating haemorrheological abnormalities with hepatic and renal dysfunction in Plasmodium falciparum malaria. METHODS : 100 patients of malaria with positive periph eral blood smear for plasmodium falciparum , out of which 50 cases with AKI and Hepatic failure during the period January 2012 - June 2013. I n department of general medicine, Government General Hospital, Kakinada. GROUP A : Comprising 50 consecutive adult pat ients of all age groups and both genders who had jaundice or renal failure or both at the time of admission. GROUP B: comprising 50 consecutive cases of plasmodium falciparum malaria and had no complications. RESULTS: In group A patients all parameters are significantly raised as compared to group B patients. CONCLUSION: 10% of patients had clinically overt bleeding manifestations, this indicates subclinical haemorrheological dysfunction in patients suffering from falciparum malaria with hepatic and renal d ysfunction, high incidence of subclinical DIC, evidenced by prolonged aPTT (56%, low total platelet count (58%, and PT (20%. An observational, screening, analytical prospective study. 100 cases of PF positive complicated and uncomplicated cases during t he period - January 2012 - June 2013

  4. Immunologic, hemodynamic, and adrenal incompetence in cirrhosis

    Risør, Louise Madeleine; Bendtsen, Flemming; Møller, Søren


    dysfunction, but is not responsive to volume expansion. Recent research indicates that development of hepatic nephropathy represents a continuous spectrum of functional and structural dysfunction and may be precipitated by the inherent immunologic, adrenal, and hemodynamic incompetence in cirrhosis. New...... research explores several new markers of renal dysfunction that may replace serum creatinine in the future and give new insight on the hepatic nephropathy. Our understanding of the pathophysiological mechanisms causing the immunologic, adrenal, and hemodynamic incompetence, and the impact on renal...

  5. Comparison of hemodynamic, biochemical and hematological parameters of healthy pregnant women in the third trimester of pregnancy and the active labor phase

    Flisser Ana


    Full Text Available Abstract Background Pregnancy is accompanied by several hemodynamic, biochemical and hematological changes which revert to normal values after labor. The mean values of these parameters have been reported for developed countries, but not for Mexican women. Furthermore, labor constitutes a stress situation, in which these factors may be altered. It is known that serologic increase of heat shock protein (Hsp 70 is associated with abnormal pregnancies, presenting very low level in normal pregnant women. Nevertheless, there are no studies where these measurements are compared in healthy pregnant women at their third trimester of pregnancy (3TP and the active labor phase (ActLP. Methods Seventy five healthy Mexican pregnant women were included. Hemodynamic, biochemical and hematological parameters were obtained in all cases, and serum Hsp70 levels were measured in a sample of 15 women at 3TP and at ActLP. Results Significant differences were found in most analysis performed and in Hsp70 concentration at 3TP as compared to ActLP, however all were within normal range in both conditions, supporting that only in pathological pregnancies Hsp70 is drastically increased. Conclusion Results obtained indicate that 3TP and ActLP have clinical similarities in normal pregnancies, therefore if abnormalities are found during 3TP, precautions should be taken before ActLP.

  6. Correlation between Dynamic Spiral-CT Enhancement Parameters and Tumor Angiogenesis in Renal Cell Carcinomas

    Jinhong Wang; Weixia Chen; Xiuhui Zhang; Pengqiu Min; Rongbo Liu; Hengxuan Yang


    OBJECTIVE To prospectively investigate the correlation between the enhancement parameters of a dynamic-CT (D-CT) scan for renal cell carcinomas (RCC) and the carcinoma tissue microvessel density (MVD) in renal cell carcinomas (RCC).METHODS Twenty-four cases of renal cell carcinoma verifyied by histopathology were scanned via dynamic-CT, followed by a whole kidney scan. Enhancement parameters were derived as follows .The slope of the contrast media uptake curve (S), area under the curve(AR), the density difference before and after tissue enhancement (△HU) and tissue blood ratio (TBR) were calculated for all lesions. Time-density curve types were ranked from the lowest to the highest of the slope of the contrast media uptake curve (S) as type A, B and C. Pathologic slides corresponding to the CT imagings were subjected to CD34 monoclonal antibodies, then were evaluated with an image analyzer to count hot spots of MVD. By using the Spearman rank correlation tests, statistical analysis was performed to determine the strength of the relationship between enhancement parameters and MVD determinations.RESULTS The carcinoma tissue MVD showed a direct correlation with the enhancement parameters of D-CT (r=0.54, r=0.62, r=0.55, r=0.64, r=0.44,P< 0.05). Moreover the S, △HU, TBR and type curves all demonstrated a strong correlation with the MVD. By analyzing the various enhancement parameters of the time-density curves, the relationship between the enhancement CT parameters corresponding to the tumor's MVD was identified.CONCLUSION A dynamic spiral-CT scan may be a helpful method as a measurement of tumor angiogenesis in vivo in RCC.

  7. MR imaging of renal cortical tumours: qualitative and quantitative chemical shift imaging parameters.

    Karlo, Christoph A; Donati, Olivio F; Burger, Irene A; Zheng, Junting; Moskowitz, Chaya S; Hricak, Hedvig; Akin, Oguz


    To assess qualitative and quantitative chemical shift MRI parameters of renal cortical tumours. A total of 251 consecutive patients underwent 1.5-T MRI before nephrectomy. Two readers (R1, R2) independently evaluated all tumours visually for a decrease in signal intensity (SI) on opposed- compared with in-phase chemical shift images. In addition, SI was measured on in- and opposed-phase images (SI(IP), SI(OP)) and the chemical shift index was calculated as a measure of percentage SI change. Histopathology served as the standard of reference. A visual decrease in SI was identified significantly more often in clear cell renal cell carcinoma (RCCs) (R1, 73 %; R2, 64 %) and angiomyolipomas (both, 80 %) than in oncocytomas (29 %, 12 %), papillary (29 %, 17 %) and chromophobe RCCs (13 %, 9 %; all, P chemical shift index was significantly greater in clear cell RCC and angiomyolipoma than in the other histological subtypes (both, P analysis (concordance correlation coefficient, 0.80). A decrease in SI on opposed-phase chemical shift images is not an identifying feature of clear cell RCCs or angiomyolipomas, but can also be observed in oncocytomas, papillary and chromophobe RCCs. After excluding angiomyolipomas, a decrease in SI of more than 25 % was diagnostic for clear cell RCCs. • Chemical shift MRI offers new information about fat within renal tumours. • Opposed-phase signal decrease can be observed in all renal cortical tumours. • A greater than 25 % decrease in signal appears to be diagnostic for clear cell RCCs.

  8. Renal function parameters of Thai vegans compared with non-vegans.

    Wiwanitkit, Viroj


    In Asia, vegetarianism is a well-established eating behavior. It appears that the adoption of a vegan diet leads to a lessening of several health risk factors. Although vegetarianism has some notable effects on the hematological system, the effect on the nephrological system has not been well clarified. The pattern of renal function parameters was studied in 25 Thai vegans compared with 25 non-vegetarians. Of the studied parameters, it was found that urine protein was significantly different (p vegans and controls. Vegans had significantly lower urine protein level.

  9. The quantification of hemodynamic parameters downstream of a Gianturco Zenith stent wire using newtonian and non-newtonian analog fluids in a pulsatile flow environment.

    Walker, Andrew M; Johnston, Clifton R; Rival, David E


    Although deployed in the vasculature to expand vessel diameter and improve blood flow, protruding stent struts can create complex flow environments associated with flow separation and oscillating shear gradients. Given the association between magnitude and direction of wall shear stress (WSS) and endothelial phenotype expression, accurate representation of stent-induced flow patterns is critical if we are to predict sites susceptible to intimal hyperplasia. Despite the number of stents approved for clinical use, quantification on the alteration of hemodynamic flow parameters associated with the Gianturco Z-stent is limited in the literature. In using experimental and computational models to quantify strut-induced flow, the majority of past work has assumed blood or representative analogs to behave as Newtonian fluids. However, recent studies have challenged the validity of this assumption. We present here the experimental quantification of flow through a Gianturco Z-stent wire in representative Newtonian and non-Newtonian blood analog environments using particle image velocimetry (PIV). Fluid analogs were circulated through a closed flow loop at physiologically appropriate flow rates whereupon PIV snapshots were acquired downstream of the wire housed in an acrylic tube with a diameter characteristic of the carotid artery. Hemodynamic parameters including WSS, oscillatory shear index (OSI), and Reynolds shear stresses (RSS) were measured. Our findings show that the introduction of the stent wire altered downstream hemodynamic parameters through a reduction in WSS and increases in OSI and RSS from nonstented flow. The Newtonian analog solution of glycerol and water underestimated WSS while increasing the spatial coverage of flow reversal and oscillatory shear compared to a non-Newtonian fluid of glycerol, water, and xanthan gum. Peak RSS were increased with the Newtonian fluid, although peak values were similar upon a doubling of flow rate. The introduction of the

  10. A comparative analysis of the dependences of the hemodynamic parameters on changes in ROI's position in perfusion CT scans

    Choi, Yong-Seok; Cho, Jae-Hwan; Namgung, Jang-Sun; Kim, Hyo-Jin; Yoon, Dae-Young; Lee, Han-Joo


    This study performed a comparative analysis of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and mean time-to-peak (TTP) obtained by changing the region of interest's (ROI) anatomical positions, during CT brain perfusion. We acquired axial source images of perfusion CT from 20 patients undergoing CT perfusion exams due to brain trauma. Subsequently, the CBV, CBF, MTT, and TTP values were calculated through data-processing of the perfusion CT images. The color scales for the CBV, CBF, MTT, and TTP maps were obtained using the image data. Anterior cerebral artery (ACA) was taken as the standard ROI for the calculations of the perfusion values. Differences in the hemodynamic average values were compared in a quantitative analysis by placing ROI and the dividing axial images into proximal, middle, and distal segments anatomically. By performing the qualitative analysis using a blind test, we observed changes in the sensory characteristics by using the color scales of the CBV, CBF, and MTT maps in the proximal, middle, and distal segments. According to the qualitative analysis, no differences were found in CBV, CBF, MTT, and TTP values of the proximal, middle, and distal segments and no changes were detected in the color scales of the the CBV, CBF, MTT, and TTP maps in the proximal, middle, and distal segments. We anticipate that the results of the study will useful in assessing brain trauma patients using by perfusion imaging.

  11. Study of psychosocial parameters related to the survival rate of renal transplantation in children.

    Mongeau, J G; Clermont, M J; Robitaille, P; Plante, A; Jéquier, J C; Godbout, C; Guertin, M C; Beaulieu, M A; Sarrazin, F


    The purpose of the present study was to assess the effect of intelligence, schooling, psychomotor, emotional, and social status on renal graft survival in children. Sixty-two cadaver renal transplant recipients were evaluated retrospectively and the influence of sex, age, weight, and the use of cyclosporin A (CyA) on the success rate of the graft from 1 to 5 years later was analyzed. Psychological and social scores were devised and included as factors predictive of survival of the graft. Univariate analysis showed that the following variables predicted renal graft survival: the use of CyA (P = 0.0002), pre-transplant dialysis (P = 0.04), weight at the time of transplantation (P = 0.072), and psychological scores (P = 0.064). Association analysis demonstrated that pre-transplantation dialysis was only a chance association and therefore the parameter was discarded. Multivariate analysis showed that the predictive parameters were the use of CyA, sex, weight in kilograms, and the psychological score. An equation was then derived from variables that predict the probability that a specific patient's graft will survive more than t months. This equation is the estimated survival distribution function and is as follow: S (t) = Exp {-Exp[-(0.8882x1 - 1.827x2 + 0.037x3 - 0.1746x4) + ln t - 4.7862]} where S (t) = the survival at t months post transplantation, x1 = sex (male 1, female 2), x2 = CyA (yes 1, no 2), x3 = weight in kilograms, and x4 = psychological score. The major impact of psychological factors on renal graft survival was surprising.

  12. α1B-Adrenoceptors mediate adrenergically-induced renal vasoconstrictions in rats with renal impairment

    Md Abdul Hye KHAN; Munavvar Abdul SATTAR; Nor Azizan ABDULLAH; Edward James JOHNS


    Aim: This study examined whether α1B-adrenoceptors are involved in mediating adrenergically-induced renal vasoconstrictor responses in rats with pathophysi-ological and normal physiological states. Methods: Male Wistar Kyoto and spon-taneously hypertensive rats were induced with acute renal failure or experimental early diabetic nephropathy by cisplatin or streptozotocin, respectively. Cisplatin-induced renal failure was confirmed by impaired renal function and pronounced tubular damage. Experimental early diabetic nephropathy was confirmed by hyperglycemia, changes in physiological parameters, and renal function. The hemodynamic study was conducted on anesthetized rats after 7 d of cisplatin (renal failure) and 4 weeks of streptozotocin (experimental early diabetic nephropathy). Results: In the rats with renal failure and experimental early dia-betic nephropathy, there were marked reductions in their baseline renal blood flow (P0.05) in the renal failure and experimental early diabetic nephropathy rats, respectively, as compared to their non-renal failure and non-diabetic nephropathy controls. In the rats with renal impairment, chloroethylclonidine caused either accentuation or attenuation (all P0.05). Conclusion: This study demonstrated the presence of functional α1B-adrenoceptors that mediated the adrenergically-induced renal vaso-constrictions in rats with renal impairment, but not in rats with normal renal function.

  13. Efeitos hemodinâmicos e renais da injeção de doses elevadas de clonidina no espaço peridural do cão Efectos hemodinámicos y renales de la inyección de dosis elevadas de clonidina en el espacio peridural del perro Hemodynamic and renal effects of high epidural clonidine doses in dogs

    Nilson Camargo Roso


    érmino de M1, la clonidina o la solución fisiológica fue administrada en el espacio peridural. Después de un período de 20 minutos en M2 y en seguida en el M3. RESULTADOS: La clonidina en la dosis de 10 µ en el espacio peridural del perro promovió alteraciones significativas, con disminuciones de la frecuencia cardiaca y del débito cardíaco y aumento de la relación depuración de para-aminohipurato de sodio/débito cardíaco. CONCLUSIONES: En las condiciones realizadas y en las dosis empleadas, se puede concluir que la clonidina no promovió alteración de la función renal, pero disminuyó valores hemodinámicos (frecuencia y débitos cardíacos.BACKGROUND AND OBJECTIVES: There are no studies reporting renal effects promoted by high epidural clonidine doses. This study aimed at evaluating hemodynamic and renal effects of high epidural clonidine doses in dogs. METHODS: This double-blind randomized study involved 20 animals anesthetized with sodium thiopental and fentanyl, which were distributed in two groups: Group 1 or placebo (n = 10, receiving 0.2 saline, and Group 2 or clonidine (n = 10, receiving 0.2 of a solution with 50 µg.mL-1 clonidine in the epidural space. The following hemodynamic parameters were evaluated: heart rate (HR: beat.min-1; mean blood pressure (MBP: mmHg; pulmonary capillary wedge pressure (PCWP: mmHg; cardiac output (CO: L.min-1; and systolic volume (SV: mL. The following renal function parameters were also evaluated: renal blood flow (RBF mL.min-1; renal vascular resistance (RVR: mmHg.mL-1; urinary minute volume (UMV: mL.min-1; creatinine clearance (C Cr: mL.min-1; para-aminohippurate clearance (C PAH: mL.min-1; filtration fraction (FF; sodium clearance (C NA: mL.min-1; potassium clearance (C K: mL.min-1; sodium fractional excretion (FE NA: %; sodium urinary excretion (U NA V: µEq.min-1; potassium urinary excretion (U K V: µEq.min-1. Experiment consisted of three 20-minute moments. Data were collected at 10 minutes

  14. Parameter estimation in a stochastic model of the tubuloglomerular feedback mechanism in a rat nephron

    Ditlevsen, Susanne; Yip, Kay-Pong; Holstein-Rathlou, N.-H.


    A key parameter in the understanding of renal hemodynamics is the gain of the feedback function in the tubuloglomerular feedback mechanism. A dynamic model of autoregulation of renal blood flow and glomerular filtration rate has been extended to include a stochastic differential equations model o...

  15. Exercise hemodynamics during extended continuous flow left ventricular assist device support: the response of systemic cardiovascular parameters and pump performance.

    Martina, Jerson; de Jonge, Nicolaas; Rutten, Marcel; Kirkels, J Hans; Klöpping, Corinne; Rodermans, Ben; Sukkel, Eveline; Hulstein, Nelienke; Mol, Bas; Lahpor, Jaap


    Patients on continuous flow left ventricular assist devices (cf-LVADs) are able to return to an active lifestyle and perform all sorts of physical activities. This study aims to evaluate exercise hemodynamics in patients with a HeartMate II cf-LVAD (HM II). Thirty (30) patients underwent a bicycle exercise test. Along with exercise capacity, systemic cardiovascular responses and pump performance were evaluated at 6 and 12 months after HM II implantation. From rest to maximum exercise, heart rate increased from 87 ± 14 to 140 ± 32 beats/minute (bpm) (P<0.01), while systolic arterial blood pressure increased from 93 ± 12 to 116 ± 21 mm Hg (P<0.01). Total cardiac output (TCO) increased from 4.1 ± 1.1 to 8.5 ± 2.8 L/min (P<0.01) while pump flow increased less, from 5.1 ± 0.7 to 6.4 ± 0.6 L/min (P<0.01). Systemic vascular resistance (SVR) decreased from 1776 ± 750 to 1013 ± 83 dynes.s/cm(5) (P<0.001) and showed the strongest correlation with TCO (r= -0.72; P<0.01). Exercise capacity was affected by older age, while blood pressure increased significantly in men compared with women. Exercise capacity remained consistent at 6 and 12 months after HM II implantation, 51% ± 13% and 52% ± 13% of predicted VO2 max for normal subjects corrected for age and gender. In conclusion, pump flow of the HM II may contribute partially to TCO during exercise, while SVR was the strongest determinant of TCO.

  16. N-nitrosodimethylamine (NDMA, Liver Function Enzymes, Renal Function Parameters and Oxidative Stress Parameters: A Review

    Usunobun Usunomena


    Full Text Available The aim of this study is to review a procarcinogen, the N-Nitrosodimethylamine (NDMA, liver and kidney functional enzymes (in assessing action of toxicants such as NDMA as well as oxidative stress parameters (in assessing the extent of free radical damage and scavenging. Catalase and hydro peroxidase enzymes convert hydrogen peroxide and hydro peroxides to non-radical forms and functions as natural antioxidant in human body. Enzymes like Superoxide Dismutase (SOD and Catalase (CAT and compounds such as tocopherol and ascorbic acid can protect organisms against free radical damage. Lipid peroxidation is a mechanism generally recognized as being the most important in the pathogenesis of liver injury by a number of toxic compounds including NDMA.

  17. Influência da técnica anestésica nas alterações hemodinâmicas no transplante renal: estudo retrospectivo Influencia de la técnica anestésica en las alteraciones hemodinámicas en el transplante renal: estudio retrospectivo Influence of the anesthetic technique on the hemodynamic changes in renal transplantation: a retrospective study

    Eunice Sizue Hirata


    cuenta los datos demográficos, los exámenes laboratoriales preoperatorios, técnicas y agentes anestésicos, hidratación, parámetros hemodinámicos, el uso de aminas vasoactivas, la presencia de diuresis y complicaciones intraoperatorias, con análisis comparativo entre los subgrupos formados conforme a la técnica anestésica empleada. Se usaron en el análisis estadístico el test t de Student (paramétricos, Mann-Whitney (no paramétricos, test del Cui-cuadrado y Exacto de Fisher para la comparación de proporciones y análisis multivariada. RESULTADOS: Se estudiaron 92 pacientes, 59 con anestesia general (AG y 33 anestesia general asociada a la epidural (AG + Peri, 42 recibieron riñones de donantes vivos y 50 de fallecidos. No hubo diferencia (p BACKGROUND AND OBJECTIVES: The success of renal transplantation (Tx depends on the type of donor, length of cold ischemia, and hemodynamic parameters on reperfusion. The objective of this study was to analyze the anesthetic technique, the incidence of cardiovascular changes, and the presence of postoperative diuresis of Tx performed at UNICAMP. METHODS: Renal transplantation of adults performed from January 2005 and April 2006 were evaluated retrospectively. Demographic data, preoperative laboratorial exams, anesthetic techniques and agents, hydration, hemodynamic parameters, use of vasoactive amines, presence of a diuresis, and intraoperative complications were evaluated, and comparative analysis between the subgroups, formed according to the anesthetic technique, was undertaken. The Student t test (parametric, Mann-Whitney test (non-parametric, Chi-square test and Fisher Exact test for comparison of proportions and multivariate analysis were used. RESULTS: Ninety-two patients were evaluated; 59 underwent general anesthesia (GA and 33 underwent general anesthesia associated with epidural block (GA + Epi; 42 patients received live-donor transplants and 50 from dead donors. Most preoperative parameters analyzed did not

  18. Selenium status indices, laboratory data, and selected biochemical parameters in end-stage renal disease patients.

    Zagrodzki, Pawel; Bartoń, Henryk; Walas, Stanisław; Fołta, Maria; Stompór, Tomasz; Janusz-Grzybowska, Eve; Drozdz, Maciej; Sułowicz, Władysław


    We investigated the relations between selenium status (SeS) parameters, indexes of nutrition, erythropoiesis, and uremic toxemia, serum electrolytes, and other biochemical markers in end-stage renal disease (ESRD) patients, as no multivariate statistical analysis concerning all of these parameters was performed so far. SeS was evaluated by plasma Se concentration (plSe) and glutathione peroxidase (plGSHPx) activity in 69 uremic patients treated with hemodialysis (HD) and 40 healthy controls. The hierarchical multivariate partial least squares model (PLS2) was employed to establish data structure and correlations between parameters investigated. plSe and plGSHPx activity were significantly lower in patients when compared with controls (p=0.000). plSe was positively associated with indexes of erythropoiesis and nutritional status, as well as serum electrolytes and parameters of uremic toxemia. plGSHPx was inversely dependent on the pair of parameters: intact parathyroid hormone (iPTH) and aluminum plasma concentration (Al). We conclude that (1) ESRD strongly decreases selenium status and (2) the PLS2 approach revealed the existence of significant interactions among plSe, plGSHPx, and selected biochemical parameters or groups of such parameters; some of these associations need further studies to be clarified.

  19. Compliant model of a coupled sequential coronary arterial bypass graft: effects of vessel wall elasticity and non-Newtonian rheology on blood flow regime and hemodynamic parameters distribution.

    Kabinejadian, Foad; Ghista, Dhanjoo N


    We have recently developed a novel design for coronary arterial bypass surgical grafting, consisting of coupled sequential side-to-side and end-to-side anastomoses. This design has been shown to have beneficial blood flow patterns and wall shear stress distributions which may improve the patency of the CABG, as compared to the conventional end-to-side anastomosis. In our preliminary computational simulation of blood flow of this coupled sequential anastomoses design, the graft and the artery were adopted to be rigid vessels and the blood was assumed to be a Newtonian fluid. Therefore, the present study has been carried out in order to (i) investigate the effects of wall compliance and non-Newtonian rheology on the local flow field and hemodynamic parameters distribution, and (ii) verify the advantages of the CABG coupled sequential anastomoses design over the conventional end-to-side configuration in a more realistic bio-mechanical condition. For this purpose, a two-way fluid-structure interaction analysis has been carried out. A finite volume method is applied to solve the three-dimensional, time-dependent, laminar flow of the incompressible, non-Newtonian fluid; the vessel wall is modeled as a linearly elastic, geometrically non-linear shell structure. In an iteratively coupled approach the transient shell equations and the governing fluid equations are solved numerically. The simulation results indicate a diameter variation ratio of up to 4% and 5% in the graft and the coronary artery, respectively. The velocity patterns and qualitative distribution of wall shear stress parameters in the distensible model do not change significantly compared to the rigid-wall model, despite quite large side-wall deformations in the anastomotic regions. However, less flow separation and reversed flow is observed in the distensible models. The wall compliance reduces the time-averaged wall shear stress up to 32% (on the heel of the conventional end-to-side model) and somewhat


    Shkrobot, S; Sokhor, N; Milevska-Vovchuk, L; Yasniy, O; Shkrobot, L


    The aim of the research is to study the peculiarities of cardiac morphometric parameters, the parameters of central hemodynamics and their impact on the course of hemodynamic ischemic stroke in acute period. 116 patients were performed Echo-Doppler-cardiography in acute period of hemodynamic ischemic stroke in order to evaluate cardiac morphometric parameters. These patients were also performed transcranial duplex scanning. The results established that among significant clinical factors that influence the course of the acute period of hemodynamic ischemic stroke the most important are: the size of the focus, the level of consciousness on the 1st day, primary systolic arterial pressure, age of the patient. Hemodynamic ischemic stroke occurs on the background of changes of cardiac morphometric parameters and the disorders of the central hemodynamics. There is a close connection between the severity of hemodynamic ischemic stroke on the 7th and 14th day with the ejection fraction, the size of left atrium, the thickness of posterior wall of left ventricle, final diastolic size of left ventricle. The interrelation between the parameters of cerebral hemodynamics and cardiac morphometric parameters was established. cardiac morphometric parameters and parameters of central hemodynamics can be predictors of the course of hemodynamic ischemic stroke in acute period.

  1. Changes of the electrical heart field and hemodynamic parameters in the 34th to 40th weeks of pregnancy and after delivery.

    Lechmanová, M; Parízek, A; Halaska, M; Slavícek, J; Kittnar, O


    We have studied changes of the electrical heart field resulting from the changed spatial position of the heart during the last period of pregnancy in healthy women. This was suggested to be a good model of electrocardiographic changes that could be found on patients suffering from obesity. The measured parameters of the electrical heart field were compared with hemodynamic parameters before and after delivery in the group of non-obese women with physiological pregnancy and in a group of healthy non-obese and non-pregnant women. Several significant changes of the electrical heart field were detected in the late pregnancy: increased heart rate, shortening of A-V conductance, prolongation of QT interval normalised for the heart rate and changes in the ventricular depolarisation and repolarisation patterns. Some of these changes are not fully restored in 4 days after delivery. Moreover, we have found an increased pump function of the left ventricle accompanied by decreased peripheral resistance in the group of pregnant women. Increased pump function was partially restored after delivery, peripheral resistance was not only restored, but it overshot to increased values. Persisting elevated heart rate with increased peripheral resistance suggested increased sympathetic activity after birth. Only some changes of electrical heart field could be explained by changed spatial arrangement of the chest organs during pregnancy and they must be considered in a complex consequence with changes in regulatory mechanisms.




    The stimulatory effects of growth hormone (GH) and glucagon on renal function are well known, but it is uncertain whether these hormones are involved in the increase in renal function, characteristic of type 1 (insulin-dependent) diabetes mellitus. Therefore, the circulatory levels of GH and glucago

  3. [Change of ambulatory blood pressure-related parameters for different levels of renal function in resistant hypertension].

    Kong, Yu; Li, Hang; Yu, Zhenqiu; Yang, Geng


    To explore the predictive values of ambulatory blood pressure-related parameters for moderate renal impairment in resistant hypertension (RH). The clinical data were retrospectively analyzed for 401 hospitalized patients with hypertension at our hospital from October 2010 to October 2013. They were divided into RH (n = 263) and non-RH (n = 138). The modified estimating equation of glomerular filtration rate (GFR) for Chinese patients was used to assess renal functions. The standardization of moderate renal impairment was when GFR below 60 ml · min⁻¹ · 1.73 m⁻². The ambulatory blood pressure-related parameters were obtained by 24 h ambulatory blood pressure monitoring. The important prediction of these parameters for moderate renal impairment was accessed by receiver operating characteristic (ROC) curve. And the related risk factors for renal function impairment were tested by multiple stepwise Logistic regression analysis. Ambulatory arterial stiffness index (AASI), 24 h mean pulse pressure (24 hPP), sleeptime relative systolic blood pressure (SBP) decline and 24 h systolic blood pressure (24 hSBP) had important predictive values for moderate renal impairment in RH. GFR was significantly lower in those with AASI ≥ 0.485, 24 hPP ≥ 47.5 mmHg, sleeptime relative SBP decline ≤ -1.75% and 24 hSBP ≥ 130.5 mmHg (P resistant hypertension.

  4. Hemodynamic and neural responses to renal denervation of the nerve to the clipped kidney by cryoablation in two-kidney, one-clip hypertensive rats.

    Rossi, Noreen F; Pajewski, Russell; Chen, Haiping; Littrup, Peter J; Maliszewska-Scislo, Maria


    Renal artery stenosis is increasing in prevalence. Angioplasty plus stenting has not proven to be better than medical management. There has been a reluctance to use available denervation methodologies in this condition. We studied conscious, chronically instrumented, two-kidney, one-clip (2K-1C) Goldblatt rats, a model of renovascular hypertension, to test the hypothesis that renal denervation by cryoablation (cryo-DNX) of the renal nerve to the clipped kidney decreases mean arterial pressure (MAP), plasma and tissue ANG II, and contralateral renal sympathetic nerve activity (RSNA). Five-week-old male Sprague-Dawley rats underwent sham (ShC) or right renal artery clipping (2K-1C), placement of telemetry transmitters, and pair-feeding with a 0.4% NaCl diet. After 6 wk, rats were randomly assigned to cryo-DNX or sham cryotreatment (sham DNX) of the renal nerve to the clipped kidney. MAP was elevated in 2K-1C and decreased significantly in both ShC cryo-DNX and 2K-1C cryo-DNX. Tissue norepinephrine was ∼85% lower in cryo-DNX kidneys. Plasma ANG II was higher in 2K-1C sham DNX but not in 2K-1C cryo-DNX vs ShC. Renal tissue ANG II in the clipped kidney decreased after cryo-DNX. Baseline integrated RSNA of the unclipped kidney was threefold higher in 2K-1C versus ShC and decreased in 2K-1C cryo-DNX to values similar to ShC. Maximum reflex response of RSNA to baroreceptor unloading in 2K-1C was lower after cryo-DNX. Thus, denervation by cryoablation of the renal nerve to the clipped kidney decreases not only MAP but also plasma and renal tissue ANG II levels and RSNA to the contralateral kidney in conscious, freely moving 2K-1C rats.

  5. Glucagon-like peptide-1 does not have acute effects on central or renal hemodynamics in patients with type 2 diabetes without nephropathy

    Asmar, Ali; Simonsen, Lene; Asmar, Meena


    effects of GLP-1 in patients with type 2 diabetes under fixed sodium intake. During a 3-hour infusion of GLP-1 (1.5 pmol kg(-1) min(-1)) or saline, intra-arterial blood pressure and heart rate were measured continuously, concomitantly with cardiac output estimated by pulse contour analysis. Renal plasma...... flow, glomerular filtration rate, and uptake/release of hormones and ions were measured using Fick's Principle after catheterization of a renal vein. Urine collection was conducted throughout the experiments at voluntary voiding, and patients remained supine during the experiments. During the GLP-1...... infusion, systolic and diastolic blood pressure and cardiac output remained unchanged, whereas heart rate increased significantly. Arterio-venous gradients for GLP-1 exceeded glomerular filtrations significantly, but renal plasma flow and glomerular filtration rate as well as renal sodium and lithium...

  6. Prematurity and Related Biochemical Outcomes: Study of Bone Mineralization and Renal Function Parameters in Preterm Infants

    Sarika Singh Chauhan


    phosphorus levels were found to be significantly decreased, and serum ALP, creatinine, and electrolytes were found to be significantly increased (<0.001 at 28–30 weeks as compared to controls, but serum calcium and phosphorous levels were found to be insignificantly decreased, whereas serum ALP activities were found to be insignificantly increased at 28–30 weeks as compared to 30–32 weeks of gestational age in preterm babies. It can be concluded that high serum ALP activity and low serum calcium and phosphorus levels are associated with preterm babies. A significant difference in the mean values of these renal function parameters was also obtained, except for serum sodium and potassium.

  7. The PhysioFlow thoracic impedancemeter is not valid for the measurements of cardiac hemodynamic parameters in chronic anemic patients.

    Pascal Bogui

    Full Text Available The aim of the present study was to test the validity of the transthoracic electrical bioimpedance method PhysioFlow® to measure stroke volume in patients with chronic anemia. Stroke volume index (SVI, as well as cardiac index (CI obtained by transthoracic electrical bioimpedance method and doppler echocardiography were compared in healthy subjects (n = 25 and patients with chronic anemia (i.e. mainly with sickle cell anemia; n = 32, at rest. While doppler echocardiography was able to detect difference in SVI between the two populations, the Physioflow® failed to detect any difference. Bland & Altman analyses have demonstrated no interchangeability between the two methods to assess CI and SVI in anemic patients and healthy subjects. While doppler echocardiography displayed a good concordance for SVI results with those obtained in the literature for anemic patients, the Physioflow® did not. Finally, in contrast to doppler echocardiography: 1 the CI obtained with the Physioflow® was not correlated with the hemoglobin level and 2 the stroke volume determined by the Physioflow® was highly influenced by body surface area. In conclusion, our findings indicate that the Physioflow® device is inaccurate for the measurement of SVI and CI in patients with chronic anemia and has a poor accuracy for the measurement of these parameters in African healthy subjects.

  8. Oxidative damage parameters in renal tissues of aged and young rats based on gender

    Uzun D


    Full Text Available Duygu Uzun,1 Gülcan Güntas Korkmaz,2 Mustafa Erinç Sitar,3 Tamer Cebe,4 Karolin Yanar,3 Ufuk Çakatay,3 Seval Aydin3 1Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey; 2Kirklareli University, School of Health, Kirklareli, Turkey; 3Istanbul University, Cerrahpasa Faculty of Medicine, Department of Medical Biochemistry, Istanbul, Turkey; 4Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey Purpose: Aging is characterized by a gradual functional decrease of all systems including the kidneys. Growing evidence links altered lipid protein redox-homeostasis with renal dysfunction. The effect of sexual dimorphism on the lipid protein redox-homeostasis mechanisms in the aging kidney is obscure. In the current study, we aimed to investigate redox homeostasis as it related to sexual dimorphism on protein oxidation and lipid peroxidation parameters, as protein carbonyl (PCO, total thiol (T-SH, advanced oxidation protein products (AOPP, malondialdehyde, glutathione (GSH, and superoxide dismutase (SOD activity, as potential aging biomarkers, which may contribute to an analysis of the free radical theory of aging. Materials and methods: The study was carried out with 16 naturally aged rats (24 months old; eight males and eight females and their corresponding young rat groups as controls (6 months old; eight males and eight females. All of the aforementioned parameters (PCO, T-SH, AOPP, MDA, GSH, SOD were measured manually instead of automated devices or ELISA kits. Results: PCO, AOPP, and malondialdehyde levels in aged rats were significantly higher in the older rat group than in the younger rat group, whereas SOD activities were significantly lower in old rats. T-SH levels were not significantly different in male groups; however, T-SH levels were lower in the aged female group than in the young female control group. In addition, GSH levels were significantly different between the aged rat group and the corresponding

  9. Renal hemodynamic and morphological changes after 7 and 28 days of leptin treatment: the participation of angiotensin II via the AT1 receptor.

    Thieme, Karina; Oliveira-Souza, Maria


    The role of hyperleptinemia in cardiovascular diseases is well known; however, in the renal tissue, the exact site of leptin's action has not been established. This study was conducted to assess the effect of leptin treatment for 7 and 28 days on renal function and morphology and the participation of angiotensin II (Ang II), through its AT1 receptor. Rats were divided into four groups: sham, losartan (10 mg/kg/day, s.c.), leptin (0.5 mg/kg/day for the 7 days group and 0.25 mg/kg/day for the 28 days group) and leptin plus losartan. Plasma leptin, Ang II and endothelin 1 (ET-1) levels were measured using an enzymatic immuno assay. The systolic blood pressure (SBP) was evaluated using the tail-cuff method. The renal plasma flow (RPF) and the glomerular filtration rate (GFR) were determined by p-aminohippuric acid and inulin clearance, respectively. Urinary Na+ and K+ levels were also analyzed. Renal morphological analyses, desmin and ED-1 immunostaining were performed. Proteinuria was analyzed by silver staining. mRNA expression of renin-angiotensin system (RAS) components, TNF-α and collagen type III was analyzed by quantitative PCR. Our results showed that leptin treatment increased Ang II plasma levels and progressively increased the SBP, achieving a pre-hypertension state. Rats treated with leptin 7 days showed a normal RPF and GFR, but increased filtration fraction (FF) and natriuresis. However, rats treated with leptin for 28 showed a decrease in the RPF, an increase in the FF and no changes in the GFR or tubular function. Leptin treatment-induced renal injury was demonstrated by: glomerular hypertrophy, increased desmin staining, macrophage infiltration in the renal tissue, TNF-α and collagen type III mRNA expression and proteinuria. In conclusion, our study demonstrated the progressive renal morphological changes in experimental hyperleptinemia and the interaction between leptin and the RAS on these effects.

  10. Comparison of Ultrasound Corticomedullary Strain with Doppler Parameters in Assessment of Renal Allograft Interstitial Fibrosis/Tubular Atrophy.

    Gao, Jing; Rubin, Jonathan M; Weitzel, William; Lee, Jun; Dadhania, Darshana; Kapur, Sandip; Min, Robert


    To compare the capability of ultrasound strain and Doppler parameters in the assessment of renal allograft interstitial fibrosis/tubular atrophy (IF/TA), we prospectively measured ultrasound corticomedullary strain (strain) and intra-renal artery Doppler end-diastolic velocity (EDV), peak systolic velocity (PSV) and resistive index (RI) in 45 renal transplant recipients before their kidney biopsies. We used 2-D speckle tracking to estimate strain, the deformation ratio of renal cortex to medulla produced by external compression using the ultrasound transducer. We also measured Doppler EDV, PSV and RI at the renal allograft inter-lobar artery. Using the Banff scoring system for renal allograft IF/TA, 45 patients were divided into the following groups: group 1 with ≤5% (n = 12) cortical IF/TA; group 2 with 6%-25% (n = 12); group 3 with 26%-50% (n = 11); and group 4 with >50% (n = 10). We performed receiver operating characteristic curve analysis to test the accuracy of these ultrasound parameters and duration of transplantation in determining >26% cortical IF/TA. In our results, strain was statistically significant in all paired groups (all p 26%, including 26%-50% and >50%) and low-grade (≤25%, including 0.05). The areas under the receiver operating characteristic curve for strain, EDV, PSV, RI and duration of transplantation in determining >26% cortical IF/TA were 0.99, 0.94, 0.88, 0.52 and 0.92, respectively. Our results suggest that corticomedullary strain seems to be superior to Doppler parameters and duration of transplantation in assessment of renal allograft cortical IF/TA.

  11. Improvement in cerebral hemodynamic parameters and outcomes after superficial temporal artery-middle cerebral artery bypass in patients with severe stenoocclusive disease of the intracranial internal carotid or middle cerebral arteries.

    Low, Shiong Wen; Teo, Kejia; Lwin, Sein; Yeo, Leonard L L; Paliwal, Prakash R; Ahmad, Aftab; Sinha, Arvind K; Teoh, Hock Luen; Wong, Lily Y H; Chong, Vincent F; Seet, Raymond C S; Chan, Bernard P L; Yeo, Tseng Tsai; Chou, Ning; Sharma, Vijay K


    Both the older and the recent extracranial-intracranial (EC-IC) bypass trials for symptomatic carotid occlusion failed to demonstrate a reduction in stroke recurrence. However, the role of superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in patients with symptomatic intracranial stenoocclusive disease has been rarely evaluated. The authors evaluated serial changes in various cerebral hemodynamic parameters in patients with severe stenoocclusive disease of the intracranial internal carotid artery (ICA) or middle cerebral artery (MCA) and impaired cerebral vasodilatory reserve (CVR), treated by STA-MCA bypass surgery or medical treatment. Patients with severe stenoocclusive disease of the intracranial ICA or MCA underwent transcranial Doppler (TCD) ultrasonography and CVR assessment using the breath-holding index (BHI). Patients with impaired BHI (hemodynamic parameters and reduction in stroke recurrence.

  12. Implications of the Hemodynamic Optimization Approach Guided by Right Heart Catheterization in Patients with Severe Heart Failure

    Luís E. Rohde


    Full Text Available OBJECTIVE: To report the hemodynamic and functional responses obtained with clinical optimization guided by hemodynamic parameters in patients with severe and refractory heart failure. METHODS: Invasive hemodynamic monitoring using right heart catheterization aimed to reach low filling pressures and peripheral resistance. Frequent adjustments of intravenous diuretics and vasodilators were performed according to the hemodynamic measurements. RESULTS: We assessed 19 patients (age = 48±12 years and ejection fraction = 21±5% with severe heart failure. The intravenous use of diuretics and vasodilators reduced by 12 mm Hg (relative reduction of 43% pulmonary artery occlusion pressure (P<0.001, with a concomitant increment of 6 mL per beat in stroke volume (relative increment of 24%, P<0.001. We observed significant associations between pulmonary artery occlusion pressure and mean pulmonary artery pressure (r=0.76; P<0.001 and central venous pressure (r=0.63; P<0.001. After clinical optimization, improvement in functional class occurred (P< 0.001, with a tendency towards improvement in ejection fraction and no impairment to renal function. CONCLUSION: Optimization guided by hemodynamic parameters in patients with refractory heart failure provides a significant improvement in the hemodynamic profile with concomitant improvement in functional class. This study emphasizes that adjustments in blood volume result in imme-diate benefits for patients with severe heart failure.

  13. 超声对肝豆状核变性患者肾脏血流动力学变化的诊断价值%Detection of renal hemodynamics in patients with hepatolenticular degeneration by color Doppler ultrasound

    韦玉国; 胡文彬; 程楠; 许亚娟; 韩丽; 韩咏竹; 杨任民


    Objective To investigate the diagnostic value of color Doppler ultrasound for renal hemodynamic changes in hepatolenticular degeneration(HLD) patients. Methods Thirty healthy volunteers were served as control group, 61 patients with HLD were divided into HLD nephropathy group (group A) and HLD group with no changes in renal echo (group B) . Their master renal arteries (MRA),segmental renal arteries(SRA)and interlobular renal arteries(IRA)were detected by color Doppler ultrasound. The display rate of the arteries were calculated, the peak systolic velocity (PSV) and resistant index (RI)were measured. Results The display rate of MRA, SRA and IRA in control group and group B was 100%. The display rate of MRA, SRA and IRA in group A was 100%, 84.3% and 71.8%, respectively. Compared with control group, the PSV of MRA, SRA and IRA was decreased in group A and B, RI was increased. These differences had statistical significance (P < 0.05). Conclusion The renal hemodynamics has significant changes in HLD patients.%目的探讨彩色多普勒超声对肝豆状核变性(HLD)患者肾脏血流动力学改变的诊断价值。方法30例体检健康者为对照组,61例HLD患者分为肾脏回声改变组(A组)和肾脏回声无改变组(B组),彩色多普勒超声检测其三级肾动脉(肾主动脉、段间动脉、叶间动脉),计算三级动脉的显示率,测量收缩期最大血流速度和阻力指数。结果对照组和B组肾主动脉、段间动脉及叶间动脉显示率均为100%。A组肾主动脉显示率为100%,段间动脉显示率为84.3%,叶间动脉显示率为71.8%。与对照组比较,A组和B组的肾主动脉、肾段间动脉及叶间动脉血流速度减慢,阻力指数增高,差异均有统计学意义(P<0.05)。结论 HLD患者肾脏血管血流动力学状态可发生明显改变。

  14. 颈脊髓损伤血液动力学变化%Changes of hemodynamic parameters in acute cervical spinal cord injury

    赵昌松; 张强; 蔡娟; 袁征; 高峥嵘; 权学民; 陈小龙


    [Objective]To evaluate the relationship between the severity of cervical spinal cord injury ( SCI) and hemodynamic parameters changes. [Method]Blood pressure(BP)and heart rate(HR)were taken once daily during the first 7 days in hospital persist warding the electrocardiogram. The mean value of the hemodynamic parameters were choosen as statistic data. The neurologic clinical status of patients was assessed according to the American Spinal Injury Association ( ASIA) impairment scale. Severe complete SCI( Frankel grade A) was determined in 31 patients of these patients,frankel B in 19 patients,Frankel C/D in 28 patients. The mean patient age w4s 36. 5 years( range of 16 - 78 ) . [ Result] The occurrence of hypotension and brad-ycardia revealed a statistically significant difference among Frankel A,Frankel B and C/D(P<0.05). [Conclusion] Dysfunction of cardiovascular system usually develops in patients with cervical SCI, the main clinical presentations are hypotension and bradycardia. Detailed evaluation of autonomic dysfunctions following SCI cardiovascular instability can improve our understanding of the complicated of clinical presentations and possible neurological impairment.%[目的]探讨颈脊髓损伤的严重性(Franke1分级)与患者血液动力学变化的关系.[方法]颈脊髓损伤患者入院后进行连续7d心电监护测量血压、心率取平均值,并作为统计参数.患者神经功能根据美国脊髓损伤协会(American Spinal Injury Association,ASIA)损伤系统分级法,其中Franke1 A 31例,Franke1 B 19例,Franke1 C/D 28例.患者平均年龄36.5岁(16 ~ 78岁),平均随访时间30个月(12~ 60个月).[结果]Franke1 A组出现低血压和心动过缓病例和Franke1 B,Franke1 C/D组比较,有显著差异性(P<0.05).[结论]颈脊髓损伤后可引起植物神经系统功能障碍,常发生心血管功能紊乱,临床表现为低血压、心动过缓.详细评价颈脊髓损伤后自主神经功能紊乱所致的心血管功能

  15. Magnesium lithospermate B ameliorates renal cortical microperfusion in rats

    Chun-guang CHEN; Yi-ping WANG


    Aim: To investigate the effects of magnesium lithospermate B (MLB) isolated from Salviae miltiorrhizae on renal microcirculation, and renal and systemic hemodynamics in Sprague-Dawley rats. Methods: MLB (10, 30, and 60 mg/kg) was injected intravenously and renal blood flow (RBF), renal cortical microperfusion (RCM), and systemic hemodynamic function parameters including heart rate (HR),mean arterial pressure (MAP), left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), and maximal velocity of pressure increase (dp/dtmax) were measured for 45 min after administration. Results: Intravenous MLB at doses of 10, 30, and 60 mg/kg increased RCM significantly, but had no obvious effects on RBF or systemic hemodynamics. The effect of MLB on RCM reached its peak 15 min after injection and returned to baseline after 45 min. Up to60 mg/kg MLB increased RCM by 62.4%±20.2% (changes from baseline, P<0.01),whereas RBF (3.7%±9.7% vs baseline) and renal vascular resistance (-1.4%±9.1%vs baseline) did not obviously change. Conclusion: These results indicate that MLB ameliorates renal microcirculation in a dose-dependent manner, which may be related to the renoprotective effects of MLB.

  16. Renal Fractional Excretion of Sodium in Relation to Arterial Blood Gas and Spirometric Parameters in Chronic Obstructive Pulmonary Disease

    Fariba Rezaeetalab


    Full Text Available Introduction: Arterial gas derangement could change urinary sodium excretion in Chronic Obstructive Pulmonary Disease (COPD patients.There are very few and conflicting data in regards to the measurement of fractional excretion of sodium in COPD patients. The main aim of this study was to assess the relationship between renal fractional excretion of sodium(FeNa with arterial blood gas and spirometric parameters in COPD. Materials and Methods: This study was a cross-sectional study performed on 40 consecutive stable COPD outpatients in 2 main general hospitals (Emam Reza, Ghaem in Mashhad/Iran between 2011 and 2012. We investigated the relationship of renal FeNa with arterial blood gas parameters including HCO3, PH, PaCO2 and PaO2, and spirometric parameters. Analysis was done by SPSS v16 with a statistically meaningful p value of less than 0.05. Results: Mean age was 65.97±10.77 SD years and female to male ratio was 0.26. A renal FeNa of less than 1% was presented in 27% patients. There was a significant, positive relationship between renal FeNa and PaO2 (P=0.005, r=0.456. The correlations between PaCO2, HCO3, PH and spirometric parameters were not seen (P>0.05, but there was a significant relationship between Urine Na and PaO2. Outstanding, it seems likely that kidneys of COPD patients are responsible for sodium retaining state particularly in the presence of hypoxemia. Conclusion: This study indicates that in COPD patients, PaO2 but not PaCO2 is related to renal FeNa which shows the probable role of hypoxemia on sodium output in COPD patients. However, some caution is needed for interpretation of the probable role of hypercapnia on sodium retention in COPD.

  17. Renogram and deconvolution parameters in diagnosis of renal artery stenosis. Variants of background subtraction and analysis techniques

    Kempi, V. [Dept. of Clinical Physiology, Sjukhuset, Oestersund (Sweden)


    Aim: Multivariate statistical methods can be used for objective analysis. The emphasis is on analysing renal function parameters together, not one at a time. The aim is to identify curve parameters useful in making predictions in kidneys with and without renal artery stenosis (RAS). Patients, methods: 68 patients with resistant hypertension were subjected to captopril renography with {sup 99m}Tc-DTPA. Variants of background areas and background subtraction methods were employed. A correction was applied for loss of renal parenchyma. Parameters from time-activity curves and retention curves from deconvolution were calculated. Renal angiography established the presence or absence of RAS. Logistic regression analysis, using age- and kidney size-adjusted models, was performed to assess the capability of renography and deconvolution to differentiate between kidneys with and without RAS. Results: Discrimination between normal kidneys and RAS was achieved by deconvolution and by renography. Deconvolution was the method of first rank with a sensitivity of 87% and a specificity of 98%. For separation of RAS and kidneys with parenchymal insufficiency deconvolution was the method of first rank with a sensitivity of 80% and specificity of 89%, whereas renography produced poor results. Conclusion: The best performance with {sup 99m}Tc-DTPA was based on normalised background subtraction using a rectangular area between the kidneys. Deconvolution produced the most favourable results in the separation of kidneys with and without RAS. For separation of RAS and kidneys with parenchymal insufficiency conventional renography produced poor results. Conceptually, the results of a logistic regression analysis of renal function parameters may raise possibilities in the field of computer-aided diagnosis. (orig.)

  18. Renal Fractional Excretion of Sodium in Relation to Arterial Blood Gas and Spirometric Parameters in Chronic Obstructive Pulmonary Disease

    Fariba Rezaeetalab


    Full Text Available Introduction: Arterial gas derangement could change urinary sodium excretion in Chronic Obstructive Pulmonary Disease (COPD patients.There are very few and conflicting data in regards to the measurement of fractional excretion of sodium in COPD patients. The main aim of this study was to assess the relationship between renal fractional excretion of sodium(FeNa with arterial blood gas and spirometric parameters in COPD. Materials and Methods: This study was a cross-sectional study performed on 40 consecutive stable COPD outpatients in 2 main general hospitals (Emam Reza, Ghaem in Mashhad/Iran between 2011 and 2012. We investigated the relationship of renal FeNa with arterial blood gas parameters including HCO3, PH, PaCO2 and PaO2, and spirometric parameters. Analysis was done by SPSS v16 with a statistically meaningful p value of less than 0.05. Results: Mean age was 65.97±10.77 SD years and female to male ratio was 0.26. A renal FeNa of less than 1% was presented in 27% patients. There was a significant, positive relationship between renal FeNa and PaO2 (P=0.005, r=0.456. The correlations between PaCO2, HCO3, PH and spirometric parameters were not seen (P>0.05, but there was a significant relationship between Urine Na and PaO2. Outstanding, it seems likely that kidneys of COPD patients are responsible for sodium retaining state particularly in the presence of hypoxemia. Conclusion: This study indicates that in COPD patients, PaO2 but not PaCO2 is related to renal FeNa which shows the probable role of hypoxemia on sodium output in COPD patients. However, some caution is needed for interpretation of the probable role of hypercapnia on sodium retention in COPD.

  19. RASSF1A protein expression and correlation with clinicopathological parameters in renal cell carcinoma

    Machtens Stefan


    Full Text Available Abstract Background Epigenetic silencing of RAS association family 1A (RASSF1A tumor suppressor gene occurs in various histological subtypes of renal cell carcinoma (RCC but RASSF1A protein expression in clear cell RCC as well as a possible correlation with clinicopathological parameters of patients has not been analyzed at yet. Methods 318 primary clear cell carcinomas were analyzed using tissue microarray analysis and immunohistochemistry. Survival analysis was carried out for 187 patients considering a follow-up period of 2–240 month. Results Expression of RASSF1A was found to be significantly decreased in tumoral cells when compared to normal tubular epithelial cells. RASSF1A immunopositivity was significantly associated with pT stage, group stage and histological grade of tumors and showed a tendency for impaired survival in Kaplan-Meier analysis. Conclusion While most tumors demonstrate a loss of RASSF1A protein, a subset of tumors was identified to exhibit substantial RASSF1A protein expression and show increased tumor progression. Thus RCC tumorigenesis without depletion of RASSF1A may be associated with an adverse clinical outcome.

  20. Polycystic Ovary Syndrome: The Correlation Between Renal Doppler Ultrasound and Laboratory Parameters

    Elif Karadeli


    Full Text Available Aim: To investigate whether there is alteration both right and left kidney lenght, parenchymal thickness, renal arterial,venous blood flow measurements in normotensive reproductive age women with polycystic ovary syndrome (PCOS. Material and Method: Forty women with PCOS according to Rotterdam criteria and thirty-six healthy volunteers women were included in our study. Hormonal, biochemical analysis, renal Doppler ultrasonography were performed and were investigated in terms of both left and right renal lenght, parenchymal thickness, peak systolic velocity (PSV, resistive index (RI, venous impedance index (VI, metabolic characteristics having insulin resistance, impaired glucose tolerance, serum lipid concentration. The student t test and pearson corelation test were used for statistical analysis.Results: The measurements for kidneys were not different between women with PCOS and healthy women. The peak systolic velocity of mean renal artery was lower in PCOS group. The mean renal venous impedance also was higher in PCOS group than control group. The mean renal resistive index was slightly higher in PCOS but not statistical significant. In bivariate corelation analyse including all patients, it was seen that BMI, WHR, level of serum fasting glucose, insulin, LDL, trigliserides were positively related with mean renal length and mean parenchymal thickness measurements. Discussion: We found that there was alterations kidney blood flow in normotensive reproductive age women with PCOS. This findings may indicate results of long term renal and cardiovascular complications of PCOS.

  1. Efeitos do pneumoperitônio sobre a hemodinâmica e função renais de cães ventilados com volume e pressão controlados Efectos del pneumoperitonio sobre la hemodinámica y función renal de perros ventilados con volumen y presión controlados Effects of pneumoperitoneum on renal hemodynamics and function of dogs under volume and pressure-controlled ventilation

    Armando Vieira de Almeida


    hemodynamics and function changes in dogs under volume and pressure controlled ventilation. METHODS: This study involved 16 dogs anesthetized with sodium thiopental and fentanyl, which were divided in two groups: Group 1: volume controlled; and Group 2: pressure controlled, both submitted to 10 and 15 mmHg pneumoperitoneum. The following parameters were evaluated: renal blood flow, renal vascular resistance, sodium para-aminohippurate clearance, plasma sodium, plasma potassium, plasma osmolality, creatinine clearance, filtration fraction, urinary volume, urinary clearance, osmolar clearance, free water clearance, sodium clearance, sodium urinary excretion, sodium fractional excretion, potassium clearance, potassium urinary excretion and potassium fractional excretion. Data were collected in 4 moments: M1 before pneumoperitoneum, M2, 30 minutes after 10 mmHg pneumoperitoneum, M3, 30 minutes after 15 mmHg pneumoperitoneum, M4, 30 minutes after pneumoperitoneum deflation. RESULTS: Sodium para-aminohippurate and creatinine clearance remained constant for both groups throughout the experiment. Plasma sodium and potassium were not changed. There has been potassium clearance and fractional excretion decrease as from M2 in both groups. CONCLUSIONS: Ventilatory modes have not promoted renal hemodynamic differences between groups. Pneumoperitoneum, by compressing renal parenchyma, may have determined changes in potassium reabsorption and/or secretion.

  2. Age Features of Structural and Hemodynamic Parameters of Great Vessels of the Neck in Non-Alcoholic Fatty Liver Disease and Overweight

    V.I. Bulda


    Violation of the structure and hemodynamics of the main vessels of the neck, detected during the complex duplex examination, is the result of direct impact of NAFLD (steatosis and increased body weight and leads to the development of cardiovascular risk, mainly in groups of middle-aged and elderly patients.

  3. Effects of Polygonatum on Hemodynamics of Rats with Chronic Renal Failure%中药制黄精对慢性肾衰大鼠血液动力学的影响

    傅晓骏; 傅志慧


    Objective: To observe the polygonatum effects on hemodynamics of rats with chronic renal failure, thus exploring the mechanism of protective effect on kidney of rats with diabetic nephropathy. Method ;Take 21 clean level SD male rats and divide them into the sham operation group and the model group, through the 5/6 nephrectomy manufacturing method to make the chronic renal failure( CRF) animal model. Two weeks later,blood sample was taken from tail veins, serum creatinine determination(Scr)and urea nitrogen( BUN) values were tested. According to the Scr value, the model rats were randomly divided into pathological group, polygonatum group and the sham operation group. 8 weeks after feeding or treatment, he rats were sacrificed, then hemoglobin ( Hb ) , red blood cell ( RBC ) , white blood cell ( WBC ) , serum creatinine (Cr) , blood urea nitrogen ( BUN ) ,24 hours urine protein quantity ( Pro ) ,endothelin(ET) ,calcitonin gene related peptide(CGRP) ,angiotensin I( AT - I) ,angiotensin II( AT - II) ,TXB2 and 6 - Keto - PGF1 were determined. Results :The kidney function and the routine blood test result in polygonatum group were obviously improved. Compared with pathological group, polygonatum group could improve the anemia condition, reduce the white blood cells (P <0. 05) and rise the Hb as well as red blood cells(P <0. 01) ;levels of AT - II and ET in serum could be obviously decreased and 6 - Keto - PGFla level be increased. Conclusion ;The polygonatum can improve hemodynamics of kidney of chronic renal failure rats so as to significantly improve renal function.%目的:观察制黄精对慢性肾衰大鼠血液动力学的影响,从而探讨其对糖尿病肾病大鼠肾脏的保护作用机制.方法:取清洁级SD雄性大鼠21只,随机分为假手术组及模型组,通过5/6肾切除法制造慢性肾功能衰竭(CRF)动物模型,术后2周行大鼠断尾采血,测定血清肌酐(Scr)、尿素氮(BUN)值,根据Scr随机分为病理组、制黄精组,并

  4. The effect of atorvastatin on renal hemodynamics of the elder patients with hypertensive nephropathy%阿托伐他汀对老年高血压肾病患者血流动力学的影响

    王屹; 姜学中


    Objective:To observe the effect of atorvastatin on renal function and hemodynamics in elderly hypertensive patients. Methods; Fifty-six elderly hypertensive patients with hypertensive nephropathy were randomly divided into atorvastatin group(n = 29) and control group (n - 27), atorvastatin group was treated with atorvastatin for six months. The variation of blood pressure, low density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT), creatine kinase (CK), creatinine, estimated glomerular filtration rate (eGFR), 24-hour urinary protein quantitation were examined, and the renal hemodynamics were observed by colour Doppler ultrasound before and after treatment. Results:LDL-C in atorvastatin group decreased significantly after 1 month or 6 months of treatment(P 0.05), however, the difference was significant between two groups(P< 0.05). No significant difference was found in the peak systolic velocity (PSV) of bilateral renal artery (RA), segmental renal artery(SRA), leaves renal artery (IRA) in two groups before and after treatment. In the atorvastatin group, end-diastolic minimum flow (EDV) increased and resistance index (RI) of RA, SRA and IRA decreased significantly after 6 months of treatment (P< 0.05), significant difference was found between two groups (P< 0.05), especially for the difference of RA(P < 0.01). Conclusion: Atorvastatin have protective effect on renal in patients with hypertensive nephropathy. Reducing renal arteries resistance, improving renal vascular structure may be one of the renal protective mechanisms.%目的:观察阿托伐他汀对老年高血压肾病患者肾脏血流动力学及肾功能的影响.方法:选择56例老年高血压肾病患者随机给予常规治疗(对照组)及常规+阿托伐他汀治疗(阿托伐他汀组),治疗前和治疗1、6个月时查诊室血压、低密度脂蛋白胆固醇( LDL-C)、丙氨酸氨基转移酶(AlT)、肌酸激酶(CK)、血肌酐、24h尿蛋白定量,并估算肾小球滤

  5. Effects of mild hypothemia on hemodynamics of systemic and renal of dog with septic shock%亚低温对感染性休克犬全身及肾脏血流动力学的影响

    刘思伯; 刘金洁; 高恺; 崔嵩; 周恒杰; 刘国梁; 张祎超; 杨荣利


    Objectives To explore the effects of mild hypothemia on hemodynamics of systemic and renal of dog with septic shock.Methods 40 healthy dogs were randomly and evenly divided into the normal temperature non-infected group (NTNS), normal temperature infected group (NTS), hypothermia noninfected group (MHNS) and hypothermia infected group (MHS).NTS and MHS were pumped through the femoral vein of Escherichia coli (E.coli 1 × 109 cfu/ml) by 0.5 ml · kg-1 · h-1 , producting septic shock model with high-power cycle.Combining with blood pump devices and low temperature thermostat bath, the MHNS and MHS implemented extracorporeal blood cooling method to maintain the blood in temperature (33 ± 1) ℃.0, 24, 48, 72 h point, tested specimens from femoral vein for renal function.In the 0-72 h.Pulse indicates the continuous cardiac output monitor (PiCCO) monitored systemic hemodynamics on each time point.In the 0-72 h, color Doppler ultrasound (CDFI) measured renal hemodynamic on each time point.Results There was an increase of SBP (P <0.05), SVR [(2 415 ±651) dyn · s · cm-5vs (1 613 ± 223) dyn · s · cm-5 ,p =0.01] and RI (P =0.04) in the M HS group comparing with the NTS group from 24 to 72 h.CO [(3.58 ±0.44) L/min vs (4.18 ±0.60) L/min,P =0.04], HR and PSV was decreased in the MHS group.BUN [(8.6 ± 1.6) mmol/L vs (21.2 ±4.8) mmol/L,P <0.01] and Scr [(167.6 ±31.2) μmol/L vs (383.8 ±35.2) μmol/L,P <0.01] was decreased in MHS group comparing with the NTS group.There was a positively correlation between CO and PSV in the canine model of septic shock (P <0.01);and CO was negatively correlated with RI (P < 0.01).Conclusions In this canine model of septic shock, hypothermia can stable systemic and renal hemodynamics, and improve kidney function.%目的 观察亚低温对感染性休克所致急性肾损伤(AKI)肾功能、全身及肾脏血流动力学的影响.方法 将40只健康犬数字表法随机均分为常温非感染组(NTNS) 10

  6. Evaluation of lipid parameters and bioindices in patients with different stages of chronic renal failure

    Čabarkapa Velibor


    Full Text Available Background/Aim. Cardiovascular morbidity and mortality are markedly increased in chronic renal failure (CRF. The aim of this study was to evaluate lipid parameters and bioindices in patients with different stages of CRF. Methods. In 46 hemodialysed (HD, 50 CRF patients with II, III and IV stage of CRF (non-HD and 48 control subjects triglycerides (TG, total cholesterol (C, HDL-C, urea, creatinine, creatinuria (standard biochemical methods, apolipoprotein (apo AI, apo B, lipoprotein(a, cystatin C (immunoturbidimetric method were evaluated, and LDL-C, non-HDL-C, LDLC/ HDL-C, non-HDL-/HDL-C, TG/HDL-C, and new bioindices, LTI (lipid tetrad index, logLTI, LPI (lipid pentad index, logLPI, AIP (atherogenic index of plasma, and creatinine clearance were calculated. Results. There were significant differences in the levels of TG, HDL-C, LDL-C, non- HDL-C, total C and apo A-I between the HD and non-HD patients, and the HD patients and the controls. LTI and LPI were significantly higher in the HD and non-HD patients compared to the controls (p < 0.05, without a good separation by the Box-Whisker plots. The values of TG/HDL-C ratio and AIP were significantly higher in the HD and non- HD-patients compared to the controls (p < 0.05, and significantly higher in the HD compared to non-HD patients (p < 0.05. AIP > 0.11 was found in 71.7% of the HD, 56% of non-HD and 31.3% of the controls. Conclusion. Among lipid parameters and indices, AIP and TG/HDL-C ratio are most suitable for evaluation of lipid disturbances in different stages of CRF. In addition to, non-HDL-/HDL-C, and apoB/A-I ratios, apo A-I, HDL-C and TG are important markers in HD patients. Non-HDL-C is not a suitable marker. LTI and LPI need to be further investigated.

  7. Effect of NO synthase inhibitor 2-amino-5,6-dihydro-4H-1,3-thiazine on endotoxin-induced changes in hemodynamic parameters and respiration in rats.

    Proskuryakov, S Ya; Filimonova, M V; Verkhovskii, Yu G; Konoplyannikov, A G; Mandrugin, A A; Fedoseev, V M; Skvortsov, V G


    We studied the effect of NO synthase inhibitor 2-amino-5,6-dihydro-4H-1,3-thiazine (2-ADT) on the cardiovascular system in rats with endotoxic shock. Blood pressure, heart rate, and respiratory rate were recorded. E. coli lipopolysaccharide decreased blood pressure and heart rate. 2-ADT in a dose of 5 mg/kg normalized these hemodynamic parameters. The normalizing effect of 2-ADT decreased with increasing the dose of this preparation. 2-ADT in high doses (10, 20, and 30 mg/kg) and repeated injections of the preparation caused death of experimental animals.

  8. Research about the influence of alprostadil for the renal blood flow parameters and fibrosis indexes of patients with diabetic nephropathy

    Li Ling; Guo-Juan Lao; Li-Bo Chen; Diao-Zhu Lin


    Objective:To observe the curative effects of alprostadil on diabetes nephropathy and its influences on the renal blood flow parameters and fibrosis indexes of patients.Methods:Eighty cases of patients with diabetic nephropathy who were treated in our hospital from May 2013 to September 2014 were randomly selected as the research objects and were divided into the control group and the observation group. Each group had 40 cases. Patients of the control group were treated by routine therapy, while patients of the observation group were treated with alprostadil on the basis of routine therapy. The fasting blood glucose, renal function-related indexes, serum creatinine, blood urea nitrogen, urinary albumin excretion rate and fibrosis markers, matrix metalloproteinase-9 (MMP-9), hyaluronic acid (HA), laminin (LN),Ⅲ procollagen (PCⅢ) and typeⅣ collagen (ⅣC) of the two groups before and after treatments were respectively tested, and the peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI) and pulsatility index (PI) of renal artery segment were tested by color doppler ultrasound.Results:After 14 and 28 d of treatments, the blood urea nitrogen, urinary albumin excretion rate of the observation group were all significantly lower than those of the control group; the PSV and EDV were all significantly faster than those of the control group; RI and PI were all observably lower than those of the control group and the serum levels of MMP-9, HA, LN, PCⅢ, andⅣC were also prominently lower than those of the control group. Conclusions:Alprostadil can effectively slow the development of fibrosis and protect the renal function of patients with diabetic nephropathy by improving renal blood supply for them.

  9. Deferasirox effect on renal haemodynamic parameters in patients with transfusion-dependent β thalassaemia.

    Piga, Antonio; Fracchia, Silvia; Lai, Maria E; Cappellini, Maria Domenica; Hirschberg, Raimund; Habr, Dany; Wegener, Antje; Bouillaud, Emmanuel; Forni, Gian Luca


    Some patients with β thalassaemia experience non-progressive creatinine increases with deferasirox, mostly within normal limits; the mechanisms involved are not fully elucidated. The effects of deferasirox on renal haemodynamics, including glomerular filtration rate (GFR) and renal plasma flow (RPF), were investigated in a Phase I, open-label study in β thalassaemia major patients with iron overload. Patients received deferasirox 30 mg/kg/d up to Week 8, followed by a 2-week washout period, and extended treatment up to Week 104 with a 4-week washout period. In the short-term study (n = 11), mean GFR and RPF declined from baseline to Week 8 (mean [%] change:-9·2 [-9·5%] and -105·7 ml/min [-17·8%], respectively). A similar pattern was observed during the long-term study (n = 5); mean GFR and RPF decreased up to Week 52 (-19·1 [-17·7%] and -155·6 ml/min [-26·1%]), with similar change at Week 104 (-18·4 [-17·2%] and -115·9 ml/min [-19·6%]). Measures returned to baseline values after each washout. Serum creatinine and creatinine clearance followed a similar pattern. Effects of deferasirox on renal haemodynamics were mild and reversible for up to 2 years of treatment, with no progressive worsening of renal function over time. NCT00560820.

  10. Serum beta-2-Microglobulin level: A parameter for early diagnosis of renal allograft rejection

    Rezai A


    Full Text Available For monitoring of renal transplant function, serum B2m was evaluated in 23 recipients. According to clinical diagnosis the patients were in four groups: 1 Successful renal transplant; the mean concentration of SB2m pretransplantation was 73.1±26.1 mg/L but decreased to nearly normal level (4.43±1.17 mg/L within 24-48h and then reached to 3.1 mg/L duting 20 days after transplantation. 2 Renal dysfunction (except rejection; the maximum changes of SB2m was 1.1 mg/L/day and no significant changes of SB2m were found between this group and group 1. 3 Accelerated and acute rejection; during immunological rejection crisis, SB2m level increased and after response to antirejection therapy decreased. The daily changes of SB2m allowed to diffrentiate renal dysfunction fom rejection in 84% of cases. Moreover according to SB2m fluctuation levels, SB2m had a prognostic pattern for acute rejection due to significant differences between the level of SB2m on the day of clinical diagnosis of rejection and 4 days previously (P<0.025, and also 2 days before rejection (P<0.025, while this pattern was not found for serum creatinin and BUN.

  11. 血管内超声测量血流动力学参数的研究进展%Progresses of intravascular ultrasound in measurement of hemodynamic parameters



    Intravascular ultrasound (IVUS) can record the morphology of vessel wall,lumen and plaque,composition of plaques and even wall functional features in vivo.Detecting hemodynamic parameters of coronary arteries,including elastic modulus of vessel wall and wall shear stress and strain,etc.,from intracoronary ultrasound images is important for diagnosing coronary heart diseases and planning the treatment.The progresses of quantitative measurement of hemodynamic parameters of coronary arteries from IVUS images were reviewed in this article.%血管内超声显像可在活体中观察血管壁、管腔及斑块形态、性质,甚至斑块成分和管壁功能状态,由此获得的冠状动脉的血流动力学参数(包括管壁的弹性模量和血管壁应力-应变分布等)对于正确诊断冠心病、制定最佳诊疗方案具有重要意义.本文就近年来血管内超声在冠状动脉血流动力学参数测量中的应用进行综述.

  12. Tacrolimus in combination with FTY720--an analysis of renal and blood parameters.

    Gallo, Ana Paula; Silva, Lea Bueno Lucas; Franco, Marcello; Burdmann, Emmanuel Almeida; Bueno, Valquiria


    Calcineurin inhibitors (CNIs) are routinely used in immunosuppressive therapy and both Cyclosporine (CsA) and Tacrolimus (FK506) show similar efficacies to prevent rejection and death within the first year after organ transplantation. However, their use is limited by side effects such as kidney damage, hypertension, onset of diabetes and hyperlipidemia. It is a consensus that compared with CsA, FK506 causes less changes in blood pressures, serum lipids and renal function. Nevertheless, FK506 use is associated with a higher incidence of post-transplant diabetes mellitus (PTDM). FTY720 is a new compound that has shown a protective effect in animal models with respect to rejection in transplantation, ischemia-reperfusion injury, autoimmune diseases and tumor development. FTY720 acts by altering lymphocytes homing from blood to peripheral lymphoid organs. In mice, FTY720 administered in combination with CsA during 21 days has prolonged skin allograft survival without causing significant renal changes. In a model of CsA-induced chronic nephropathy in rats, FTY720 administration prevented renal injury suggesting benefit from using a combination of these drugs. In a canine kidney allograft model, FTY720 in combination with low doses of CsA or FK506 showed an addictive anti-rejection effect without causing critical adverse effects. We therefore, investigated whether 21 days of FTY720 administration in association with FK506 could prevent renal damage and development of diabetes in mice. Mice receiving FK506 alone or FTY720 + FK506 during 21 days showed changes in kidney function and structure besides an increase in blood glucose and lymphopenia. The FTY720 + FK506 combination requires further investigation with an aim toward understanding the mechanisms involved with respect to side effects.

  13. [Renal angiomyolipoma rupture as a cause of lumbar pain: report of one case].

    Cifuentes, Melissa; Calleja, Félix; Hola, José; Daviú, Antonio; Jara, Danilo; Vallejos, Humberto


    Renal angiomyolipoma is a benign tumor formed by smooth muscle, adipose tissue and blood vessels. It is commonly found incidentally and its clinical manifestations are pain and abdominal mass or spontaneous tumor rupture with retroperitoneal bleeding. The clinical presentation of a hemorrhagic shock secondary to a retroperitoneal hematoma is uncommon. We report a 40 year-old male who presented to the emergency room with lumbar pain and deterioration of hemodynamic parameters. The CT scan showed a left renal injury associated to an expansive retroperitoneal process. The abdominal exploration, vascular control of the renal pedicle and nephrectomy allowed a successful outcome.

  14. Effect of polyethylene oxide on renal hemodynamics in rabbits with endotoxin shock%聚环氧乙烷对内毒素休克兔肾血流动力学的影响

    方琴; 胡振华; 陈仲清; 段星星; 陈辉; 傅卫军; 魏红云


    Objective To investigate the effect of polyethylene oxide (PEO) on renal blood flow and its renoprotective effect in rabbits with endotoxin sepsis.Methods Twenty normal New Zealand white rabbits were randomly divided into normal saline (NS) group and PEO group (n=10),and endotoxin shock was induced by an intravenous injection of 0.6 mg/kg lipopolysaccharide.Resuscitation was performed when the blood pressure of the rabbits showed a 30% decline,using NS (in NS group) or the mixture of equal volumes of NS and 20 ng/g PEO (in PEO group) perfused at the rate of 5 ml/kg per hour.Before and during shock and at 1 h after resuscitation,the renal hemodynamics was monitored by ultrasound and the venous blood was extracted to examine the renal functions.The heart rate and arterial blood pressure were monitored throughout the experiment.Results The rabbits in both groups showed a significantly lower renal artery blood flow velocity during the shock (P<0.05) with significantly increased pulsatility index (PI) and resistance index (RI) compared with those before the shock.One hour after resuscitation,the blood flow velocity in the renal arteries at all levels and the tertiary veins were reduced in NS group without obvious reduction of the PI and RI; in PEO group,the blood flow velocities in the renal arteries increased significantly compared to those before shock (P<0.05),and the PI and RI of the tertiary arteries were significantly lower than those in NS group (P<0.05).In both groups,BUN and Cr increased during endotoxin shock stage,and 1 h after resuscitation,PEO group showed significantly lower BUN and Cr levels than NS group (P<0.05).Conclusion A small dose of PEO can significantly promote renal perfusion in rabbits with septic shock,thus offering renoprotective effect against early damage in septicopyemia and septic shock.%目的 应用超声监测内毒素休克新西兰免肾血流,观察聚环氧乙烷(PEO)对内毒素休克免肾血流的影响

  15. Telomere length in relation to immunological parameters in patients with renal cell carcinoma.

    Ulrika Svenson

    Full Text Available Over the last decade, telomere length (TL has gained attention as a potential biomarker in cancer disease. We previously reported that long blood TL was associated with a poorer outcome in patients with breast cancer and renal cell carcinoma. Based on these findings, we hypothesized that certain immunological components may have an impact on TL dynamics in cancer patients. One aim of the present study was to investigate a possible association between serum cytokines and TL of peripheral blood cells, tumors and corresponding kidney cortex, in patients with clear cell renal cell carcinoma. For this purpose, a multiplex cytokine assay was used. Correlation analysis revealed significant positive correlations between tumor TL and peripheral levels of three cytokines (IL-7, IL-8 and IL-10. In a parallel patient group with various kidney tumors, TL was investigated in whole blood and in immune cell subsets in relation to peripheral levels of regulatory T cells (Tregs. A significant positive association was found between whole blood TL and Treg levels. However, the strongest correlation was found between Tregs and TL of the T lymphocyte fraction. Thus, patients with higher Treg levels displayed longer T cell telomeres, which might reflect a suppressed immune system with fewer cell divisions and hence less telomere shortening. These results are in line with our earlier observation that long blood TL is an unfavorable prognostic factor for cancer-specific survival. In summary, we here show that immunological components are associated with TL in patients with renal cell carcinoma, providing further insight into the field of telomere biology in cancer.

  16. Systemic and splanchnic hemodynamic changes after liver transplantation for cirrhosis: a long-term prospective study.

    Piscaglia, F; Zironi, G; Gaiani, S; Mazziotti, A; Cavallari, A; Gramantieri, L; Valgimigli, M; Bolondi, L


    The effect of orthotopic liver transplantation (OLT) on the systemic and splanchnic hemodynamic alterations of cirrhosis is still largely unknown. The aim of this study was to prospectively investigate the long-term changes induced by OLT on several hemodynamic parameters. In 28 patients undergoing OLT for cirrhosis, the following parameters were measured before surgery and subsequently at 6-month intervals (mean follow-up period, 17 months): cardiac index, mean arterial pressure (MAP), heart rate, total peripheral resistance (TPR), portal vein flow velocity and flow volume, spleen size, and Doppler ultrasound resistance or pulsatility indexes (RI or PI) in the: 1) interlobular renal, 2) superior mesenteric, 3) splenic, and 4) hepatic arteries. The same parameters were measured in 10 healthy controls. After OLT, cardiac index and heart rate significantly decreased (P Spleen size decreased significantly, but persisted to be larger than in controls. In conclusion, systemic, renal, and most, but interestingly not all, splanchnic circulatory alterations of cirrhosis are restored to normal after OLT.

  17. Comparison of Effects of Separate and Combined Sugammadex and Lipid Emulsion Administration on Hemodynamic Parameters and Survival in a Rat Model of Verapamil Toxicity.

    Tulgar, Serkan; Kose, Halil Cihan; Demir Piroglu, Isılay; Karakilic, Evvah; Ates, Nagihan Gozde; Demir, Ahmet; Gergerli, Ruken; Guven, Selin; Piroglu, Mustafa Devrim


    Toxicity of calcium channel blockers leads to high patient mortality and there is no effective antidote. The benefit of using 20% lipid emulsion and sugammadex has been reported. The present study measured the effect of sugammadex and 20% lipid emulsion on hemodynamics and survival in a rat model of verapamil toxicity. In this single-blinded randomized control study, rats were separated into 4 groups of 7 rats each: Sugammadex (S), Sugammadex plus 20% lipid emulsion (SL), 20% lipid emulsion (L), and control (C). Heart rates and mean arterial pressures were monitored and noted each minute until death. Average time to death was 21.0±9.57 minutes for group C, 35.57±10.61 minutes for group S, 37.14±16.6 minutes for group L and 49.86±27.56 minutes for group SL. Time to death was significantly longer in other groups than in the control group (psugammadex and lipid emulsion had a positive effect on survival in patients with calcium channel blocker toxicity. Sugammadex and intralipid increased survival in a rat model of verapamil toxicity. The combination of both drugs may decrease cardiotoxicity. Sugammadex alone or combined with 20% lipid emulsion reduce the need for inotropic agents. The mechanism requires clarification with larger studies.

  18. The importance of hemodynamic monitoring in mitrocuspid surgery

    Dobrić Biljana J.; Petrović Jasna S.; Radovanović Ninoslav D.


    Introduction. Untreated mitral valve disease is associated with marked hemodynamic disorders, low ejection fraction (EF) and poor perfusion. The study aimed to explore the importance of hemodynamic monitoring in intraoperative evaluation and treatment of these patients. Material and methods. This prospective study included 85 patients: group I: 41 patients, EF<40%; group II: 44 patients, EF>40%. Hemodynamic parameters were recorded after initation of anesthesia (1), after sternotomy (2)...

  19. The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters.

    Delahunt, Brett; Cheville, John C; Martignoni, Guido; Humphrey, Peter A; Magi-Galluzzi, Cristina; McKenney, Jesse; Egevad, Lars; Algaba, Ferran; Moch, Holger; Grignon, David J; Montironi, Rodolfo; Srigley, John R


    The International Society of Urological Pathology 2012 Consensus Conference made recommendations regarding classification, prognostic factors, staging, and immunohistochemical and molecular assessment of adult renal tumors. Issues relating to prognostic factors were coordinated by a workgroup who identified tumor morphotype, sarcomatoid/rhabdoid differentiation, tumor necrosis, grading, and microvascular invasion as potential prognostic parameters. There was consensus that the main morphotypes of renal cell carcinoma (RCC) were of prognostic significance, that subtyping of papillary RCC (types 1 and 2) provided additional prognostic information, and that clear cell tubulopapillary RCC was associated with a more favorable outcome. For tumors showing sarcomatoid or rhabdoid differentiation, there was consensus that a minimum proportion of tumor was not required for diagnostic purposes. It was also agreed upon that the underlying subtype of carcinoma should be reported. For sarcomatoid carcinoma, it was further agreed upon that if the underlying carcinoma subtype was absent the tumor should be classified as a grade 4 unclassified carcinoma with a sarcomatoid component. Tumor necrosis was considered to have prognostic significance, with assessment based on macroscopic and microscopic examination of the tumor. It was recommended that for clear cell RCC the amount of necrosis should be quantified. There was consensus that nucleolar prominence defined grades 1 to 3 of clear cell and papillary RCCs, whereas extreme nuclear pleomorphism or sarcomatoid and/or rhabdoid differentiation defined grade 4 tumors. It was agreed upon that chromophobe RCC should not be graded. There was consensus that microvascular invasion should not be included as a staging criterion for RCC.

  20. A re-appraisal of volume status and renal function impairment in chronic heart failure : combined effects of pre-renal failure and venous congestion on renal function

    Sinkeler, Steef J.; Damman, Kevin; van Veldhuisen, Dirk J.; Hillege, Hans; Navis, Gerjan


    The association between cardiac failure and renal function impairment has gained wide recognition over the last decade. Both structural damage in the form of systemic atherosclerosis and (patho) physiological hemodynamic changes may explain this association. As regards hemodynamic factors, renal imp

  1. Central Hemodynamics and Microcirculation in Critical Conditions

    A. A. Kosovskikh


    Full Text Available Objective: to compare central hemodynamic and microcirculatory changes in critical conditions caused by different factors and to reveal their possible differences for a further differentiated approach to intensive therapy. Subjects and methods. The study covered 16 subjects with severe concomitant injury (mean age 41.96±2.83 years and 19 patients with general purulent peritonitis (mean age 45.34±2.16 years. Their follow-up was 7 days. The central hemodynamics was estimated by transpulmonary thermodilution using a Pulsion PiCCO Plus system (Pulsion Medical Systems, Germany. The microcirculatory bed was evaluated by cutaneous laser Doppler flowmetry using a LAKK-02 capillary blood flow laser analyzer (LAZMA Research-and-Production Association, Russian Federation. Results. The pattern of central hemodynamic and microcirculatory disorders varies with the trigger that has led to a critical condition. Central hemodynamics should be stabilized to ensure the average level of tissue perfusion in victims with severe concomitant injury. In general purulent peritonitis, microcirculatory disorders may persist even if the macrohemodynamic parameters are normal. Conclusion. The macrohemodynamic and microcirculatory differences obtained during the study suggest that a complex of intensive therapy should be differentiated and, if the latter is used, it is necessary not only to be based on the central hemodynamics, but also to take into consideration functional changes in microcirculation. Key words: severe concomitant injury, general purulent peritonitis, micro-circulation, central hemodynamics, type of circulation.


    N. A. Gorban


    Full Text Available Tumor cell proliferation and angiogenesis are essential factors for tumor growth, progression, and metastasis.Objective: to assess the relationship between the values of proliferative activity and the morphometric parameters of intratumoral microvessels in metastatic and localized carcinomas of the kidney.Materials and methods. Surgical specimens taken from 54 patients (32 men and 22 women aged 26 to 69 years (mean age 55 ± 1.5 years with the verified diagnosis of clear-cell renal cell carcinoma (RCC were studied.Conclusion. Proliferative activity and angioarchitectonics are an important biological characteristic of a tumor of unequal clinical value in RCC. Metastatic carcinoma has a higher proliferative activity and a low tumor vascularization than those of localized carcinoma.

  3. Optical monitoring of kidney oxygenation and hemodynamics using a miniaturized near-infrared sensor

    Shadgan, Babak; Macnab, Andrew; Nigro, Mark; Nguan, Christopher


    Background: Following human renal allograft transplant primary graft dysfunction can occur early in the postoperative period as a result of acute tubular necrosis, acute rejection, drug toxicity, and vascular complications. Successful treatment of graft dysfunction requires early detection and accurate diagnosis so that disease-specific medical and/or surgical intervention can be provided promptly. However, current diagnostic methods are not sensitive or specific enough, so that identifying the cause of graft dysfunction is problematic and often delayed. Near-infrared spectroscopy (NIRS) is an established optical method that monitors changes in tissue hemodynamics and oxygenation in real time. We report the feasibility of directly monitoring kidney the kidney in an animal model using NIRS to detect renal ischemia and hypoxia. Methods: In an anesthetized pig, a customized continuous wave spatially resolved (SR) NIRS sensor was fixed directly to the surface of the surgically exposed kidney. Changes in the concentration of oxygenated (O2Hb) deoxygenated (HHb) and total hemoglobin (THb) were monitored before, during and after renal artery clamping and reperfusion, and the resulting fluctuations in chromophore concentration from baseline used to measure variations in renal perfusion and oxygenation. Results: On clamping the renal artery THb and O2Hb concentrations declined progressively while HHb rose. With reperfusion after releasing the artery clamp O2Hb and THb rose while HHb fell with all parameters returning to its baseline. This pattern was similar in all three trials. Conclusion: This pilot study indicates that a miniaturized NIRS sensor applied directly to the surface of a kidney in an animal model can detect the onset of renal ischemia and tissue hypoxia. With modification, our NIRS-based method may contribute to early detection of renal vascular complications and graft dysfunction following renal transplant.

  4. Parameter estimation of feedback gain in a stochastic model of renal hemodynamics: differences between spontaneously hypertensive and Sprague-Dawley rats

    Ditlevsen, Susanne; Yip, Kay-Pong; Marsh, Donald J;


    Proximal tubular pressure shows periodic self-sustained oscillations in normotensive rats but highly irregular fluctuations in spontaneously hypertensive rats (SHR). Although we have suggested that the irregular fluctuations in SHR represent low-dimensional deterministic chaos in tubuloglomerular...

  5. Intrarenal hemodynamics and impaired tubular functions in patients with systemic lupus erythematosus

    A N Maksudova; Liya Aleksandrovna Khusnutdinova; I G Salikhov


    Objective. To identify intrarenal hemodynamic disorders in patients with systemic lupus erythematosus (SLE), to assess their prognostic role, and to reveal an association between tubular dysfunction and intraglomerular hemodynamics. Subjects and methods. Twenty-nine SLE patients, 86.2% of them were diagnosed as having a renal lesion, were examined. The levels of ethanolamine, uric acid, calcium, and phosphorus were determined in their daily urine and serum; the renal functional reserve (RF...

  6. The Effect of Neuraxial Anesthesia on Maternal Cerebral Hemodynamics

    Postma, Ineke R.; van Veen, Teelkien R.; Mears, Scott L.; Zeeman, Gerda G.; Haeri, Sina; Belfort, Michael A.


    Objective Neuraxial anesthesia is known to reduce sympathetic tone and mean arterial pressure. Effects on cerebral hemodynamics in pregnancy are not well known. We hypothesize that cerebral hemodynamic parameters will change with respect to baseline following regional analgesia/anesthesia. Study

  7. The Effect of Neuraxial Anesthesia on Maternal Cerebral Hemodynamics

    Postma, Ineke R.; van Veen, Teelkien R.; Mears, Scott L.; Zeeman, Gerda G.; Haeri, Sina; Belfort, Michael A.


    Objective Neuraxial anesthesia is known to reduce sympathetic tone and mean arterial pressure. Effects on cerebral hemodynamics in pregnancy are not well known. We hypothesize that cerebral hemodynamic parameters will change with respect to baseline following regional analgesia/anesthesia. Study Des

  8. Classification of Atrial Septal Defect and Ventricular Septal Defect with Documented Hemodynamic Parameters via Cardiac Catheterization by Genetic Algorithms and Multi-Layered Artificial Neural Network

    Mustafa Yıldız


    Full Text Available Introduction: We aimed to develop a classification method to discriminate ventricular septal defect and atrial septal defect by using severalhemodynamic parameters.Patients and Methods: Forty three patients (30 atrial septal defect, 13 ventricular septal defect; 26 female, 17 male with documentedhemodynamic parameters via cardiac catheterization are included to study. Such parameters as blood pressure values of different areas,gender, age and Qp/Qs ratios are used for classification. Parameters, we used in classification are determined by divergence analysismethod. Those parameters are; i pulmonary artery diastolic pressure, ii Qp/Qs ratio, iii right atrium pressure, iv age, v pulmonary arterysystolic pressure, vi left ventricular sistolic pressure, vii aorta mean pressure, viii left ventricular diastolic pressure, ix aorta diastolicpressure, x aorta systolic pressure. Those parameters detected from our study population, are uploaded to multi-layered artificial neuralnetwork and the network was trained by genetic algorithm.Results: Trained cluster consists of 14 factors (7 atrial septal defect and 7 ventricular septal defect. Overall success ratio is 79.2%, andwith a proper instruction of artificial neural network this ratio increases up to 89%.Conclusion: Parameters, belonging to artificial neural network, which are needed to be detected by the investigator in classical methods,can easily be detected with the help of genetic algorithms. During the instruction of artificial neural network by genetic algorithms, boththe topology of network and factors of network can be determined. During the test stage, elements, not included in instruction cluster, areassumed as in test cluster, and as a result of this study, we observed that multi-layered artificial neural network can be instructed properly,and neural network is a successful method for aimed classification.

  9. Changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization at admission to ICU and the relation to outcome.

    Conti-Patara, Andreza; de Araújo Caldeira, Juliana; de Mattos-Junior, Ewaldo; de Carvalho, Haley da Silva; Reinoldes, Adriane; Pedron, Bruno Gregnanin; Patara, Marcelo; Francisco Talib, Mariana Semião; Faustino, Marcelo; de Oliveira, Clair Motos; Cortopassi, Silvia Renata Gaido


    To evaluate the changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization in the ICU and their relation to outcome. Prospective observational study. ICU of a veterinary university medical center. Thirty dogs with severe sepsis or septic shock caused by pyometra who underwent surgery and were admitted to the ICU. Severe sepsis was defined as the presence of sepsis and sepsis-induced dysfunction of one or more organs. Septic shock was defined as the presence of severe sepsis plus hypotension not reversed with fluid resuscitation. After the presumptive diagnosis of sepsis secondary to pyometra, blood samples were collected and clinical findings were recorded. Volume resuscitation with 0.9% saline solution and antimicrobial therapy were initiated. Following abdominal ultrasonography and confirmation of increased uterine volume, dogs underwent corrective surgery. After surgery, the animals were admitted to the ICU, where resuscitation was guided by the clinical parameters, central venous oxygen saturation (ScvO(2)), lactate, and base deficit. Between survivors and nonsurvivors it was observed that the ScvO(2), lactate, and base deficit on ICU admission were each related independently to death (P = 0.001, P = 0.030, and P dogs with severe sepsis and septic shock; animals with a higher ScvO(2) and lower base deficit at admission to the ICU have a lower probability of death. © Veterinary Emergency and Critical Care Society 2012.

  10. Prognostic value of selected echocardiographic, impedance cardiographic, and hemodynamic parameters determined during right heart catheterization in patients qualified for heart transplantation.

    Gilewski, Wojciech; Pietrzak, Jarosław; Banach, Joanna; Bujak, Robert; Błażejewski, Jan; Karasek, Danuta; Wołowiec, Łukasz; Sinkiewicz, Władysław


    The aim of the study was to verify prognostic value of selected echocardiographic (UKG), impedance cardiography (ICG), and right heart catheterization (RHC) parameters in systolic heart failure (HF). UKG, ICG, and RHC were performed in 46 patients with chronic HF with ejection fraction 13 mm [area under curve (AUC), 0.791], right atrial (RA) >5.2 cm (AUC 0.710) and ventricular dimension (RVD) >3.5 cm (AUC 0.717), tricuspid annular plane systolic excursion (TAPSE)  24 mmHg; AUC 0.773) turned out to be the most accurate single predictors of worse outcome. Prognostic value of non-invasive parameters was improved due to the use of their composite measures: IVC% × TAPSE (2.4 mmHg/mm; AUC 0.800), IVC% × SBP (>2097% mmHg; AUC 0.826), and RA × IVCinsp/S'RV (>11.8 cm s; AUC 0.839). In conclusion, composite measures based on non-invasive parameters, such as IVC%/TAPSE, RVSP/TAPSE and RA × IVCinsp/S'RV, may provide equally accurate prognosis as the invasive examination. PCWP and CI determined during RHC were the best individual predictors of the composite endpoint. In addition, echocardiographic parameters: RVD, RA, IVC, TAPSE, and S'RV are accurate predictors of the unfavorable outcome.

  11. Hemodynamic Profiling in Complicated Pregnancies

    J.M.J. Cornette (Jérôme)


    textabstractIn order to permit a successful pregnancy outcome, the cardiovascular system must undergo substantial changes. This thesis addresses the hemodynamics in several pregnancy complications. A general overview of normal hemodynamic adaptation to pregnancy is provided . Several techniques of

  12. Precise measurement of renal filtration and vascular parameters using a two-compartment model for dynamic contrast-enhanced MRI of the kidney gives realistic normal values

    Tofts, Paul S. [Brighton and Sussex Medical School, Falmer, Sussex (United Kingdom); UCL Institute of Neurology, London (United Kingdom); Cutajar, Marica [Brighton and Sussex Medical School, Falmer, Sussex (United Kingdom); UCL Institute of Child Health, London (United Kingdom); Mendichovszky, Iosif A. [University of Manchester, Imaging Science and Biomedical Engineering, Manchester (United Kingdom); Peters, A.M. [Brighton and Sussex Medical School, Falmer, Sussex (United Kingdom); Gordon, Isky [UCL Institute of Child Health, London (United Kingdom)


    To model the uptake phase of T{sub 1}-weighted DCE-MRI data in normal kidneys and to demonstrate that the fitted physiological parameters correlate with published normal values. The model incorporates delay and broadening of the arterial vascular peak as it appears in the capillary bed, two distinct compartments for renal intravascular and extravascular Gd tracer, and uses a small-vessel haematocrit value of 24%. Four physiological parameters can be estimated: regional filtration K{sup trans} (ml min {sup -1} [ml tissue ]{sup -1}), perfusion F (ml min {sup -1} [100 ml tissue ]{sup -1}), blood volume v{sub b} (%) and mean residence time MRT (s). From these are found the filtration fraction (FF; %) and total GFR (ml min {sup -1}). Fifteen healthy volunteers were imaged twice using oblique coronal slices every 2.5 s to determine the reproducibility. Using parenchymal ROIs, group mean values for renal biomarkers all agreed with published values: K{sup trans}: 0.25; F: 219; v{sub b}: 34; MRT: 5.5; FF: 15; GFR: 115. Nominally cortical ROIs consistently underestimated total filtration (by {proportional_to} 50%). Reproducibility was 7-18%. Sensitivity analysis showed that these fitted parameters are most vulnerable to errors in the fixed parameters kidney T{sub 1}, flip angle, haematocrit and relaxivity. These renal biomarkers can potentially measure renal physiology in diagnosis and treatment. circle Dynamic contrast-enhanced magnetic resonance imaging can measure renal function. circle Filtration and perfusion values in healthy volunteers agree with published normal values. circle Precision measured in healthy volunteers is between 7 and 15%. (orig.)

  13. Activated Charcoal Hemoperfusion in the Treatment of Experimental Amitriptyline Poisoning in Pigs - The Effect on Amitriptyline Plasma Concentration and Hemodynamic Parameters

    Jansen, Tejs; Petersen, Henrik; Malskaer, Cecilie M;


    Coated activated charcoal hemoperfusion (CAC-HP) is a well-known treatment modality. Case reports have revealed conflicting results about the efficacy of CAC-HP in the treatment of amitriptyline (AT) poisoning, and no randomised clinical trials have been identified in the literature. This study...... aimed at quantifying the efficacy of modern CAC-HP as an adjunctive treatment of AT intoxication compared to standard care alone. Fourteen female Danish landrace pigs were randomized to either standard care or standard care plus 4 hr of CAC-HP. The pigs were anaesthetized and vital parameters were...... continuously recorded. Amitriptyline infusion (7.5 mg/kg) was completed in 20 min. Thirty minutes following AT infusion, activated charcoal was instilled orally in both groups. In the intervention group, CAC-HP was initiated 60 min. after AT infusion. Blood and urine samples were collected as were vital...

  14. Peripheral moving-table contrast-enhanced magnetic resonance angiography (CE-MRA) using a prototype 18-channel peripheral vascular coil and scanning parameters optimized to the patient's individual hemodynamics.

    Potthast, Silke; Wilson, Gregory J; Wang, Maisie S; Maki, Jeffrey H


    To demonstrate that with a priori determination of individual patient hemodynamics, peripheral contrast-enhanced magnetic resonance angiography (pCE-MRA) can be customized to maximize signal-to noise ratio (SNR) and avoid venous enhancement. Using a 1.5T MRI scanner and prototype 18-channel peripheral vascular (PV) coil designed for highly accelerated parallel imaging, geometry (g)-factor maps were determined. SNR-maximized protocols considering the two-dimensional sensitivity encoding (2D SENSE) factor, TE, TR, bandwidth (BW), and flip angle (FA) were precalculated and stored. For each exam, a small aortic timing bolus was performed, followed by dynamic three-dimensional (3D)-MRA of the calf. Using this information, the aorta to pedal artery and calf arteriovenous transit times were measured. This enabled estimation of the maximum upper and middle station acquisition duration to allow lower station acquisition to begin prior to venous arrival. The appropriately succinct SNR-optimized protocol for each station was selected and moving-table pCE-MRA was performed using thigh venous compression and high-relaxivity contrast material. The protocol was successfully applied in 15 patients and all imaging demonstrated good SNR without diagnosis-hindering venous enhancement. By knowing each patient's venous enhancement kinetics, scan parameters can be optimized to utilize maximum possible acquisition time. Some time is added for the timing scans, but in return time-resolved calf CE-MRA, maximized SNR, and decreased risk of venous enhancement are gained.

  15. Improved quantification of cerebral hemodynamics using individualized time thresholds for assessment of peak enhancement parameters derived from dynamic susceptibility contrast enhanced magnetic resonance imaging.

    Christian Nasel

    Full Text Available Assessment of cerebral ischemia often employs dynamic susceptibility contrast enhanced magnetic resonance imaging (DSC-MRI with evaluation of various peak enhancement time parameters. All of these parameters use a single time threshold to judge the maximum tolerable peak enhancement delay that is supposed to reliably differentiate sufficient from critical perfusion. As the validity of this single threshold approach still remains unclear, in this study, (1 the definition of a threshold on an individual patient-basis, nevertheless (2 preserving the comparability of the data, was investigated.The histogram of time-to-peak (TTP values derived from DSC-MRI, the so-called TTP-distribution curve (TDC, was modeled using a double-Gaussian model in 61 patients without severe cerebrovascular disease. Particular model-based zf-scores were used to describe the arterial, parenchymal and venous bolus-transit phase as time intervals Ia,p,v. Their durations (delta Ia,p,v, were then considered as maximum TTP-delays of each phase.Mean-R2 for the model-fit was 0.967. Based on the generic zf-scores the proposed bolus transit phases could be differentiated. The Ip-interval reliably depicted the parenchymal bolus-transit phase with durations of 3.4 s-10.1 s (median = 4.3s, where an increase with age was noted (∼30 ms/year.Individual threshold-adjustment seems rational since regular bolus-transit durations in brain parenchyma obtained from the TDC overlap considerably with recommended critical TTP-thresholds of 4 s-8 s. The parenchymal transit time derived from the proposed model may be utilized to individually correct TTP-thresholds, thereby potentially improving the detection of critical perfusion.

  16. Renal vascular effects of calcium channel blockers in hypertension.

    Benstein, J A; Dworkin, L D


    Recent evidence suggests that calcium channel blockers have specific effects on renal hemodynamics in patients with hypertension and may also slow the progression of chronic renal failure. When these agents are studied in vitro, their predominant effect is to reverse afferent arteriolar vasoconstriction induced by catecholamines or angiotensin II. Because efferent resistance may remain high, glomerular filtration rate rises while renal blood flow remains low. The effects in vivo are less consistent. In human hypertension, calcium channel blockers lower renal resistance and may raise both renal blood flow and glomerular filtration rate. In experimental models of chronic renal disease, calcium channel blockers slow the progression of renal damage; however, variable effects on renal hemodynamics have been found. Other factors implicated in the progression of renal damage, including compensatory renal hypertrophy, platelet aggregation, and calcium deposition, may also be favorably influenced by these agents. Recent studies suggest that calcium channel blockers may have similar protective effects in patients with hypertension and chronic renal disease.

  17. Cerebral hemodynamics in migraine

    Hachinski, V C; Olesen, Jes; Norris, J W


    Clinical and angiographic findings in migraine are briefly reviewed in relation to cerebral hemodynamic changes shown by regional cerebral blood flow (rCBF) studies. Three cases of migraine studied by the intracarotid xenon 133 method during attacks are reported. In classic migraine, with typical...

  18. In vivo imaging of tissue scattering parameter and cerebral hemodynamics in rat brain with a digital red-green-blue camera

    Nishidate, Izumi; Mustari, Afrina; Kawauchi, Satoko; Sato, Shunichi; Sato, Manabu; Kokubo, Yasuaki


    We propose a rapid imaging method to monitor the spatial distribution of total hemoglobin concentration (CHbT), the tissue oxygen saturation, and the scattering power b in the expression of μs'=aλ-b as the scattering parameters in cerebral cortex using a digital red-green-blue camera. In the method, the RGB-values are converted into the tristimulus values in CIEXYZ color space which is compatible with the common RGB working spaces. Monte Carlo simulation (MCS) for light transport in tissue is used to specify a relation among the tristimulus XYZ-values and the concentration of oxygenated hemoglobin, that of deoxygenated hemoglobin, and the scattering power b. In the present study, we performed sequential recordings of RGB images of in vivo exposed rat brain during the cortical spreading depolarization evoked by the topical application of KCl. Changes in the total hemoglobin concentration and the tissue oxygen saturation imply the temporary change in cerebral blood flow during CSD. Decrease in the scattering power b was observed before the profound increase in the total hemoglobin concentration, which is indicative of the reversible morphological changes in brain tissue during CSD. The results in this study indicate potential of the method to evaluate the pathophysiological conditions in brain tissue with a digital red-green-blue camera.

  19. Refractory anemia leading to renal hemosiderosis and renal failure

    Sujatha Siddappa; K M Mythri; Kowsalya, R.; Ashish Parekh


    Renal hemosiderosis is a rare cause of renal failure and, as a result, may not be diagnosed unless a detailed history, careful interpretation of blood parameters and renal biopsy with special staining is done. Here, we present a rare case of renal hemosiderosis presenting with renal failure.

  20. Refractory anemia leading to renal hemosiderosis and renal failure

    Sujatha Siddappa


    Full Text Available Renal hemosiderosis is a rare cause of renal failure and, as a result, may not be diagnosed unless a detailed history, careful interpretation of blood parameters and renal biopsy with special staining is done. Here, we present a rare case of renal hemosiderosis presenting with renal failure.

  1. A review of histopathological and immunohistochemical parameters in diagnosis of metastatic renal cell carcinoma with a case of gingival metastasis

    Seema Sikka


    Full Text Available The oral cavity constitutes a site of low prevalence for metastasis of malignant tumors. However, oral metastasis of a renal origin is relatively more common and represents 2% of all cancer deaths. Renal cancer may metastasize to any part of the body, with a 15% risk of metastasis to the head and neck regions, and pose one of the greatest diagnostic challenges in medical sciences. Approximately 25% of patients have a metastatic disease at initial assessment, which is often responsible for initiating the diagnosis in the first place. Here we present a review of literature of renal cell carcinoma along with a case of gingival metastasis.

  2. Physiological responses to environmental factors related to space flight. [hemodynamic and metabolic responses to weightlessness

    Pace, N.


    Physiological base line data are established, and physiological procedures and instrumentation necessary for the automatic measurement of hemodynamic and metabolic parameters during prolonged periods of weightlessness are developed.

  3. The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters

    Delahunt, B.; Cheville, J.C.; Martignoni, G.; Humphrey, P.A.; Magi-Galluzzi, C.; McKenney, J.; Egevad, L.; Algaba, F.; Moch, H.; Grignon, D.J.; Montironi, R.; Srigley, J.R.; Hulsbergen-van de Kaa, C.A.


    The International Society of Urological Pathology 2012 Consensus Conference made recommendations regarding classification, prognostic factors, staging, and immunohistochemical and molecular assessment of adult renal tumors. Issues relating to prognostic factors were coordinated by a workgroup who id

  4. The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters

    Delahunt, B.; Cheville, J.C.; Martignoni, G.; Humphrey, P.A.; Magi-Galluzzi, C.; McKenney, J.; Egevad, L.; Algaba, F.; Moch, H.; Grignon, D.J.; Montironi, R.; Srigley, J.R.; Hulsbergen-van de Kaa, C.A.


    The International Society of Urological Pathology 2012 Consensus Conference made recommendations regarding classification, prognostic factors, staging, and immunohistochemical and molecular assessment of adult renal tumors. Issues relating to prognostic factors were coordinated by a workgroup who id

  5. Acute Renal Failure and Volume Overload Syndrome Secondary to a Femorofemoral Arteriovenous Fistula Angioplasty in a Kidney Transplant Recipient

    Dominique Bertrand


    Full Text Available Experimental and clinical studies analyzing the impact of AVF on cardiovascular and renal parameters, as well as outcomes, in kidney transplant recipients are lacking. On the other hand, it is not known whether AVF ligation after transplantation modifies hemodynamic parameters and kidney function. We report a case of a renal transplant recipient who developed an acute congestive heart failure accompanied by renal failure, which were triggered by femorofemoral AVF angioplasty. Prompt AVF ligation rapidly reversed clinical symptoms and normalized cardiac and renal functions. This paper illustrates the potential deleterious consequences of high-output AVF after kidney transplantation and raises considerations regarding the impact of the fistula on cardiac status and kidney function after kidney transplantation and, consequently, the management AVF after transplantation.

  6. Renal failure


    2005234 Association between serum fetuin-A and clinical outcome in end-stage renal disease patients. WANG Kai(王开), Dept Renal Dis, Renji Hosp Shanghai, 2nd Med Univ, Shanghai 200001. Chin J Nephrol, 2005;21(2):72-75. Objective: To investigate the change of serum fetuin-A level before and after dialysis, and the association of serum fetuin-A level with clinical parameters

  7. Heart function and hemodynamics


    930469 The effects of different ventricular pac-ing rates on cardiac hemodynamics and theirclinical significance.WEI Meng(魏盟),et al.Zhongshan Hosp,Shanghai Med Univ,Shanghai,200032.Shanghai Med J 1993;16(3):125—126.Changes of hemodynamics were investigated in26 patients at ventricular pacing rate of 60 to120,and 160 bpm.Effects of increasing ventricu-lar pacing rate on EF which were determined bygated blood pool scintigraphy were also studiedin another 11 patients.It is concluded that:1)inpatients with normal cardiac function as well asmost patients with cardiac insufficiency,the rela-tion of CO with increasing pacing rate can be il-

  8. Renal function parameters during early and late recovery periods following an all-out 21-km run in trained adolescent runners.

    Tian, Ye; Tong, Tom K; Lippi, Giuseppe; Huang, Chuanye; Shi, Qingde; Nie, Jinlei


    This study investigated the changes in biomarkers of renal function and the corresponding estimated glomerular filtration rate (eGFR) in 10 male adolescent (16.2±0.6 years) trained runners during early and late recovery periods after an all-out 21-km run. Venous blood samples were taken immediately before, and at 2-h, 4-h, and 24-h following the 21-km run. Samples were analyzed for hemoglobin (Hb) and hematocrit (Hct), and serum urea (U), creatinine (Cr), creatine kinase (CK) and lactate dehydrogenase (LDH). U/Cr ratio, eGFR, and plasma volume change (%ΔPV) were calculated based on the associated measured variables. At 2-h and 4-h, there were increases (26%-146%) in U, Cr, U/Cr, CK, and LDH, and decreases (8%-13%) in Hb and Hct, as compared with the corresponding pre-exercise values. The calculated %ΔPV increased by 17% while the eGFR decreased 20% from the corresponding pre-exercise value, respectively. At 24-h, the changes of the blood variables and renal function parameters observed at early recovery period were sustained. Taken together, the findings of this study suggest that mild decline in renal function occurred during the early recovery period following the 21-km run. The decline in renal function did not return to normal during the later recovery period.

  9. Flow-sensitive in-vivo 4D MR imaging at 3T for the analysis of aortic hemodynamics and derived vessel wall parameters; Die Analyse aortaler Haemodynamik und Gefaesswandparameter mittels fluss-sensitiver in-vivo 4D-MRT bei 3 Tesla

    Frydrychowicz, A.; Markl, M.; Stalder, A.F.; Bock, J.; Bley, T.A.; Berger, A.; Russe, M.F.; Hennig, J.; Langer, M. [Freiburg Univ. (Germany). Abt. Roentgendiagnostik; Harloff, A. [Freiburg Univ. (Germany). Abt. Klinische Neurologie und Neurophysiologie; Schlensak, C. [Freiburg Univ. (Germany). Abt. Herz- und Gefaesschirurgie


    Modern phase contrast MR imaging at 3 Tesla allows the depiction of 3D morphology as well as the acquisition of time-resolved blood flow velocities in 3 directions. In combination with state-of-the-art visualization and data processing software, the qualitative and quantitative analysis of hemodynamic changes associated with vascular pathologies is possible. The 4D nature of the acquired data permits free orientation within the vascular system of interest and offers the opportunity to quantify blood flow and derived vessel wall parameters at any desired location within the data volume without being dependent on predefined 2D slices. The technique has the potential of overcoming the limitations of current diagnostic strategies and of implementing new diagnostic parameters. In light of the recent discussions regarding the influence of the wall shear stress and the oscillatory shear index on the genesis of arteriosclerosis and dilatative vascular processes, flow-sensitive 4D MRI may provide the missing diagnostic link. Instead of relying on experience-based parameters such as aneurysm size, new hemodynamic considerations can deepen our understanding of vascular pathologies. This overview reviews the underlying methodology at 3T, the literature on time-resolved 3D MR velocity mapping, and presents case examples. By presenting the pre- and postoperative assessment of hemodynamics in a thoracic aortic aneurysm and the detailed analysis of blood flow in a patient with coarctation we underline the potential of time-resolved 3D phase contrast MR at 3T for hemodynamic assessment of vascular pathologies, especially in the thoracic aorta. (orig.)

  10. Effect of Exercise Therapy on Lipid Parameters in Patients with End-Stage Renal Disease on Hemodialysis

    Gordon, Lorenzo; McGrowder, Donovan A; Pena, Yeiny T; Cabrera, Elsa; Lawrence-Wright, Marilyn


    Background: Dyslipidemia has been established as a well-known traditional risk factor for cardiovascular disease in chronic kidney disease patients. Aim: This study investigated the impact of Hatha yoga exercise on lipid parameters in patients with end-stage renal disease (ESRD) on hemodialysis. Materials and Methods: This prospective randomized study consisted of 33 ESRD patients in the Hatha yoga exercise group that was matched with 35 ESRD patients in the control group. Serum total cholesterol, triglycerides, low-density lipoprotein (LDL)-cholesterol, and high-density lipoprotein (HDL)-cholesterol were determined at baseline (0 month) and after 4 months. Results: Comparing values after 4 months versus baseline in the prehemodialysis Hatha yoga exercise group, there was found a significant decrease in total cholesterol from 5.126 ± 0.092 mmol/l to 4.891 ± 0.072 mmol/l (-4.58%; P = 0.0001), triglycerides from 2.699 ± 0.078 mmol/l to 2.530 ± 0.063 mmol/l (-6.26%; P = 0.0001), LDL-cholesterol from 2.729 ± 0.083 mmol/l to 2.420 ± 0.066 mmol/l (-11.32%; P = 0.0001), and total cholesterol/HDL-cholesterol ratio from 5.593 ± 0.119 mmol/l to 4.907 ± 0.116 mmol/l (-12.26%; P = 0.047). For patients in the Hatha yoga exercise group, 51.5% had normal total cholesterol at 0 month while 70.0% had normal total cholesterol (P < 0.05) after 4 four months and 54.5% of patients had normal LDL-cholesterol at 0 month while 84.9% had normal LDL-cholesterol after 4 months (P < 0.05). Conclusion: These findings suggest that Hatha yoga exercise has preventive and beneficial effects and may be a safe therapeutic modality in ESRD patients. PMID:22923917

  11. Correlation of urinary monocyte chemo-attractant protein-1 with other parameters of renal injury in type-II diabetes mellitus

    Ibrahim Salwa


    Full Text Available Diabetic nephropathy (DN is the leading cause of end-stage renal disease in the western world. Increased number of interstitial macrophages has been observed in biopsies from patients with DN. Monocyte chemo-attractant protein-1 (MCP-1 is the strongest known chemo-tactic factor for monocytes and is upregulated in DN. We examined urinary levels of MCP-1 in patients with type-2 diabetes mellitus (DM to assess its possible correlation with other para-meters of renal injury. The urinary MCP-1 level was assessed in 75 patients with type-2 DM (25 patients each with no microalbuminuria, with macroalbuminuria and, with renal impairment and compared them with matched healthy control subjects. The HbA1c and estimated glomerular fil-tration rate (eGFR derived from the abbreviated Modification of Diet in Renal Disease (MDRD equation were examined in the study groups in relation to the urinary MCP-1. The urinary MCP-1 level was significantly higher in patients with micro and macroalbuminuria (167.41 ± 50.23 and 630.87 ± 318.10 ng/gm creatinine respectively as compared with normoalbuminuric patients and healthy controls (63.85 ± 21.15 and 61.50 ± 24.81 ng/gm creatinine, p< 0.001. MCP-1 correlated positively with urine albumin/creatinine ratio (ACR (r= 0.75, p< 0.001, HbA1c (r= 0.55, p< 0.001 and inversely with eGFR (r=-0.60, p< 0.001. Our findings suggest that hyperglycemia is associated with increased urinary levels of MCP-1 that is closely linked to renal damage as reflected by proteinuria and eGFR levels. Collectively, these findings suggest that MCP-1 is in-volved in the pathogenesis of diabetic nephropathy through its various stages.

  12. Effect of recombinant human B-type natriuretic peptide on renal hemodynamics in a bioengineering model of acute myocardial infarction with heart failure%B型钠尿肽对心力衰竭生物工程模型肾血流动力学的影响

    樊欣娜; 张晶; 蔡丽丽; 杨桂凤; 傅向华


      结果与结论:造模成功后与基线比较,肾动脉管径无变化,肾动脉平均峰值速率明显下降,肾动脉血流量显著降低,肾动脉血管阻力明显升高,跨肾灌注压明显降低。给予重组人B型钠尿肽0.010μg/(kg•min)后可见肾动脉扩张,并随剂量增加,肾动脉直径继续增加。肾动脉平均峰值速率增高,但较基线差异无显著性意义,此后,随剂量增加,肾动脉平均峰值速率逐渐下降。给药后肾动脉血管阻力逐渐下降,呈剂量依赖性。跨肾灌注压随着药物剂量的升高进行性下降,至0.030μg/(kg•min)泵入时显著低于对照组。给予重组人B型钠尿肽后肾动脉血流量逐渐升高,最高点出现在0.020μg/(kg•min)。结果可见急性心肌梗死伴心力衰竭模型应用重组人B型钠尿肽可增加肾灌注,0.020μg/(kg•min)效果最强。%BACKGROUND:The reduction of renal circulation and perfusion, the decline of renal blood flow, wil al cause renal injury. The heart failure concomitant with renal injury can significantly increase the mortality. But there are arguments about the effect of B-type natriuretic peptide (BNP) on the renal function of patients with heart failure, and little evidence is known about the effect of BNP on the renal hemodynamics. OBJECTIVE:To evaluate the effects of different dosages of recombinant human BNP on renal perfusion in bioengineering models of acute myocardial infarction with heart failure. METHODS:Bioengineering model of York pigs of acute myocardial infarction with heart failure was established with the method of occluding anterior descending branch with bal oon and injecting microthrombus. The models were randomized into recombinant human BNP group and control group (n=6). Clinical dose of recombinant human BNP (bolus of 1.5μg/kg fol owed by a continuous infusion of 0.01μg/(kg.min) for 60 minutes, and then a continuous infusion of 0.02 and 0.03μg/(kg.min) for 60

  13. Drug Dosing During Continuous Renal Replacement Therapies

    Thompson, A. Jill


    Continuous renal replacement therapies (CRRT) are used to manage fluid overload and/or renal failure. The continuous nature of the fluid and solute removal has less impact on hemodynamic variables in critically ill patients, making CRRT preferred over intermittent hemodialysis for some patients in the intensive care arena. The impact of CRRT on drug removal is variable depending on the CRRT modality, the ultrafiltrate and dialysate flow rates, the filter, and the patient's residual renal func...

  14. [Effect of somatostatin on the hemodynamic changes induced by acute experimental pancreatitis in the conscious rat].

    Ais, G; Novo, C; Ortega, M; González, A; Jiménez, I; López, J; Romeo, J M


    The aim of this study was to determine the hemodynamic effect of somatostatin, either prophylactically or therapeutically, in shock caused by acute necrohemorragic pancreatitis in conscious rats. For this purpose, radioactive microspheres were used in 3 groups (control pancreatitis, therapeutic somatostatin and prophylactic somatostatin), performing a basal and final hemodynamic study. In the control group, acute necrohemorragic pancreatitis resulted in overwhelming shock with decrease of 55% in cardiac output, 58% in renal blood flow, increase in total peripheral resistances of 342%, and death after 70 min. Therapeutic somatostatin decreased cardiac output by 42%, renal blood flow by 47%, and increased total peripheral resistances by 153%. Prophylactic somatostatin decreased cardiac output by 24%, and renal blooded flow by 28%; it increased peripheral resistances by 146%, and improved survival up to 97 min. In conclusion, therapeutic somatostatin, and particularly prophylactic somatostatin, improved hemodynamic shock after acute necrohemorragic pancreatitis in conscious rats.

  15. [Invasive and minimally invasive hemodynamic monitoring].

    Hansen, Matthias


    Advanced hemodynamic monitoring is necessary for adequate management of high-risk patients or patients with derangement of circulation. Studies demonstrate a benefit of early goal directed therapy in unstable cardiopulmonary situations. In these days we have different possibilities of minimally invasive or invasive hemodynamic monitoring. Minimally invasive measurements like pulse conture analysis or pulse wave analysis being less accurate under some circumstances, however only an artery catheter is needed for cardiac output monitoring. Pulmonary artery, transpulmonary thermodilution and lithium dilution technology have acceptable accuracy in cardiac output measurement. For therapy of unstable circulation there are additionally parameters to obtain. The pulmonary artery catheter is the device with the largest rate of complications, used by a trained crew and with a correct indication, his use is unchained justified.

  16. Single sublethal dose of microcystin-LR is responsible for different alterations in biochemical, histological and physiological renal parameters.

    Lowe, J; Souza-Menezes, J; Freire, D S; Mattos, L J; Castiglione, R C; Barbosa, C M L; Santiago, L; Ferrão, F M; Cardoso, L H D; da Silva, R T; Vieira-Beiral, H J; Vieyra, A; Morales, M M; Azevedo, S M F O; Soares, R M


    Microcystins (MCYSTs) are very stable cyclic peptidic toxins produced by cyanobacteria. Their effects on hepatic tissue have been studied extensively, and they are considered to be a potent hepatotoxin. However, several effects of MCYST on other organs have also been described, but generally in studies using higher doses of MCYST. In the present work, we investigated the effect of a single sublethal dose of MCYST-LR (55 μg/kg) in Wistar rats and analyzed different aspects that influenced renal physiology, including toxin accumulation, excretion, histological morphology, biochemical responses and oxidative damage in the kidney. After 24 h of exposure to MCYST-LR, it was possible to observe an increased glomerular filtration rate (6.28 ± 1.56 vs 2.16 ± 0.48 μl/min per cm(2)) compared with the control group. Increase of interstitial space and collagen deposition corresponded to a fibrotic response to the increased production of reactive oxygen species. The observed decrease of Na(+) reabsorption was due to inhibition of the activity of both Na(+) pumps in proximal tubules cells. We suggested that this modulation is mediated by the effect of MCYST as a phosphatase protein inhibitor that maintains the sustained kinase-mediated regulatory phosphorylation of the ATPases. The observed alteration of Na(+) active transporters lead to damage of renal function, since are involved in regulation of water and solute reabsorption in proximal tubules. The results of this report reinforce the importance of understanding the molecular effects of a single sublethal dose of MCYST-LR, which, in this study, was responsible for macro-alterations found in the renal parenchyma and renal physiology in rats.

  17. Methylene blue treatment for resistant shock following renal transplantation.

    Hershman, Eli; Hadash, Amir; Attias, Ori; Ben-Ari, Josef


    We report a case of a 19-year-old female with a history of hyperoxaluria type 1 and renal failure. The patient presented for a second renal transplantation 17 years after her first combined liver and kidney transplantation. Postoperative shock was highly resistant to fluids and required massive pharmacologic hemodynamic support. Vasoplegic shock was the presumed diagnosis, and methylene blue was utilized as a rescue therapy, with a rapid hemodynamic response and no apparent side effects.

  18. Impact of immune parameters on long-term survival in metastatic renal cell      carcinoma

    Donskov, Frede; Maase, Hans von der


    PURPOSE: The purpose of this study was to evaluate the impact of       immunologic prognostic factors in combination with established clinical       prognostic factors in patients with metastatic renal cell carcinoma       (mRCC). PATIENTS AND METHODS: A total of 120 consecutive patients with    ......PURPOSE: The purpose of this study was to evaluate the impact of       immunologic prognostic factors in combination with established clinical       prognostic factors in patients with metastatic renal cell carcinoma       (mRCC). PATIENTS AND METHODS: A total of 120 consecutive patients...... with estimated       5-year survival rates of 60%, 25%, and 0%, respectively. These findings       were apparent in both our own prognostic model and in an extended Memorial       Sloan-Kettering Cancer Center (New York, NY) prognostic model. CONCLUSION:       This study points on five clinical and three...

  19. Blood pressure, renal biochemical parameters and histopathology in an original rat model of essential hypertension (SHRSP/Kpo strain).

    Kato, Takashi; Mizuguchi, Nobuyuki; Ito, Akihiko


    Hypertensive nephropathy, a consequence of chronic high blood pressure, is increasingly a cause of end-stage renal diseases and its correct management is very important for clinical outcome. Spontaneously hypertensive rat (SHR/Kpo) and stroke-prone SHR (SHRSP/Kpo) strains represent models of human essential hypertension. However, the kidney injuries in SHR/Kpo and SHRSP/Kpo are not well defined. We therefore characterized the renal pathophysiology of SHR/Kpo and SHRSP/Kpo compared with normotensive control (WKY/Kpo) rats. The SHRSP/Kpo exhibited increased systolic blood pressure at 10 weeks of age, and proteinuria and increased blood urea nitrogen (BUN) and serum creatinine levels at 20 weeks. We simultaneously detected mononuclear cell infiltration, tubular injuries, accumulation of extracellular matrix and marked expression of α-SMA in the tubulointerstitium. Additionally, TGF-β1 and CTGF were up-regulated in the kidney of SHRSP/Kpo. We lastly focused on changes in glomerular cells of SHRSP/Kpo. Nestin, a podocyte marker, was detected but decreased slightly in 20-week-old SHRSP/Kpo. PECAM-1 expression was increased in SHRSP/Kpo glomeruli, indicating the thickening of glomerular endothelial cells. Moreover, we found that α-SMA, a myofibroblast marker, was also upregulated in the glomeruli of SHRSP/Kpo at 20 weeks. These findings suggest that SHRSP/Kpo could be a valuable animal model for human hypertensive nephropathy.

  20. Central Hemodynamic Function in Miners with Thermal Injury

    V. V. Moroz


    Full Text Available Objective: to study the specific features of central hemodynamic function in the acute phase of severe thermal injury (STI in miners who had a length of service of 10 years or more. Subjects and methods. A noninvasive study of central hemodynamics was conducted in 33 miners with severe thermal injury (a study group and 34 patients without a length of underground work who had the same condition (a control group. Both groups were matched by age and the nature and severity of thermal injuries. Central hemodynamics was evaluated by the following parameters: mean arterial blood, heart rate, stroke index (SI, cardiac index (CI, cardiac output (CO, specific vascular peripheral resistance (SVPR determined by Cubichek tetrapolar rheography. Results. The study indicated that on posttraumatic days 3—7, as compared with victims without a length of underground service, the miners had more pronounced central hemodynamic changes: decreases in CI, SI, and CO and an increase in SVPR. In the control group, from day 3, the hemodynamic changes were the following: increases in SI, SI, and CO and a decrease in SVPR. In the miners, the above features were attributable to the baseline central hemodynamic function. Conclusion. Thus, unlike the victims without a length of underground service, the miners with severe thermal injury develop more significant and prolonged central hemodynamic disorders. The detected differences during thermal injury are determined by the lowered reserve capacities of the cardiovascular system in miners due to the long-term exposure to poor working conditions, i. e. an underground service length of 10 years or more. Key words: thermal injury, miner, hemodynamics, type of circulation.

  1. Echocardiographic Evaluation of Hemodynamics in Neonates and Children

    Yogen Singh


    Full Text Available Hemodynamic instability and inadequate cardiac performance are common in critically ill children. The clinical assessment of hemodynamic status is reliant upon physical examination supported by the clinical signs such as heart rate, blood pressure, capillary refill time, and measurement of the urine output and serum lactate. Unfortunately, all of these parameters are surrogate markers of cardiovascular well-being and they provide limited direct information regarding the adequacy of blood flow and tissue perfusion. A bedside point-of-care echocardiography can provide real-time hemodynamic information by assessing cardiac function, loading conditions (preload and afterload and cardiac output. The echocardiography has the ability to provide longitudinal functional assessment in real time, which makes it an ideal tool for monitoring hemodynamic assessment in neonates and children. It is indispensable in the management of patients with shock, pulmonary hypertension, and patent ductus arteriosus. The echocardiography is the gold standard diagnostic tool to assess hemodynamic stability in patients with pericardial effusion, cardiac tamponade, and cardiac abnormalities such as congenital heart defects or valvar disorders. The information from echocardiography can be used to provide targeted treatment in intensive care settings such as need of fluid resuscitation versus inotropic support, choosing appropriate inotrope or vasopressor, and in providing specific interventions such as selective pulmonary vasodilators in pulmonary hypertension. The physiological information gathered from echocardiography may help in making timely, accurate, and appropriate diagnosis and providing specific treatment in sick patients. There is no surprise that use of bedside point-of-care echocardiography is rapidly gaining interest among neonatologists and intensivists, and it is now being used in clinical decision making for patients with hemodynamic instability. Like any

  2. Quantitative assessment of renal function with magnetic resonance imaging; Quantitative Erfassung der renalen Funktion mit der Magnetresonanztomographie

    Schoenberg, S.O.; Bock, M.; Aumann, S.; Essig, M.; Floemer, F.; Knopp, M.V.; Kaick, G. van [Deutsches Krebsforschungszentrum Heidelberg (Germany). Abt. Radiologische Diagnostik und Therapie; Just, A. [Heidelberg Univ. (Germany). 1. Physiologisches Inst.


    Aim. To show the potential of various methods in magnetic resonance imaging for the evaluation of renal function. Material and Methods. A combined assessment of renal morphology, renal hemodynamics and function is proposed. Various techniques are explained, including multiphasic 3D gadolinium MR angiography, MR phase-contrast flow measurements, quantitative perfusion measurements with intravascular contrast agents, and MR renography and MR urography. The use of these techniques is demonstrated for renovascular diseases. Results. The combined use of these techniques allows renal artery stenosis to be accurately detected and evaluation of renal blood flow, perfusion, glomerular filtration rate, and renal excretion. Based on true quantitative parameters, the hemodynamic and functional significance of the stenosis can be assessed. Renovascular diseases can be differentiated from renoparenchymal disease. Conclusion. For the assessment of renal function, functional magnetic resonance imaging techniques are an important alternative to nuclear medicine. The predictive value regarding the effect of revascularization is currently under investigation. (orig.) [German] Fragestellung. Verschiedene Methoden der Magnetresonanztomographie zur quantitativen Erfassung der Nierenfunktion sollen aufgezeigt werden. Methodik. Es werden MR-Techniken zur kombinierten Beurteilung der renalen Morphologie, Haemodynamik und Funktion der Niere vorgestellt. Zur Anwendung kommen hierbei die multiphasische 3-D-Gadolinium-MR-Angiographie, die MR-Phasenkontrastflussmessung, die quantitative Perfusionsmessung mit intravasalen Kontrastmitteln sowie die MR-Renographie/MR-Urographie. Die Methoden werden exemplarisch am Beispiel renovaskulaerer Erkrankungen demonstriert. Ergebnisse. Mit den vorgestellten Methoden lassen sich Nierenarterienstenosen akkurat detektieren sowie Aenderungen des renalen Blutflusses, der Nierenperfusion, der Filtrationsleistung sowie der renalen Ausscheidung erfassen. Auf der

  3. Doppler ultrasound in kidney diseases: a key parameter in clinical long-term follow-up.

    Spatola, Leonardo; Andrulli, Simeone


    Doppler ultrasound has been extensively used in detecting reno-vascular diseases, showing to be a non-invasive, safe, low cost and repeatable tool. The Renal Resistive Index (RRI) [(peak systolic velocity - end diastolic velocity)/peak systolic velocity] is a semi-quantitative index derived by Doppler evaluation of renal vascular bed. Normally RRI is in the range of 0.47-0.70, it increases with aging and, usually, it shows a difference between the two kidneys less than 5-8 %. RRI is an important prognostic marker in chronic kidney diseases (CKD), both in diabetic and non-diabetic kidney diseases, because, in longitudinal prospective studies, it significantly correlated with hemodynamic (ABPM, SBP, DBP, pulse pressure) and histopathological parameters (glomerular sclerosis, arteriolosclerosis, interstitial fibrosis/tubular atrophy, interstitial infiltration). In acute kidney injury (AKI) RI is a valid tool in differentiating between pre-renal and renal failure and in predicting renal response to vaso-active agents. In addition a RRI >0.74 can predict the onset of AKI in septic patients. Renal Resistive Index is a useful marker in allograft diseases because it has been widely showed a correlation with histological lesions during worsening of renal function, both in acute rejection and in chronic allograft nephropathy. Recent studies suggest its role in the risk of new onset diabetes after transplantation and it could be one of the parameters to evaluate to shift or withdrawal immunological and/or hypertensive therapy.

  4. Renal Actions of Neutral Endopeptidase Inhibition in Rats with Chronic Heart Failure

    Amr M. Abbas


    Full Text Available Problem statement: We aim to evaluate the effects of acute and chronic inhibition of Neutral EndoPeptidase (NEP, by ONO-9902, on plasma and renal NEP gene expression, hemodynamic and renal parameters in rats with Chronic Heart Failure (CHF following left Coronary Artery Ligation (CAL. Approach: Forty eight male Sprague-Dawley rats (220-240 g were divided into sham and CAL groups. Myocardial infarction was induced by left CAL. All rats were further subdivided into untreated and orally treated with ONO-9902 (300 mg kg-1 day-1 from the 1st to 6th weeks after the operation. At the 1st and 6th weeks after the operation, gene expression of plasma and renal NEP, plasma ANP, cGMP and aldosterone concentrations, urine volume, Na and ANP excretion, creatinine clearance and renal cGMP generation were measured. Results: CAL leads to sodium and water retention, increased renal NEP gene expression, plasma ANP and aldosterone and decreased renal cGMP generation and plasma NEP gene expression. Acute treatment of CAL rats by ONO-9902, at the 1st week after the operation, inhibited plasma and renal NEP gene expression with increased plasma ANP, which caused diuresis, natriuresis and increased renal cGMP generation. Moreover, chronic treatment of those rats by ONO-9902 decreased plasma and renal NEP gene expression, plasma aldosterone, increased plasma ANP but non significantly, and caused diuresis, natriuresis with increased renal cGMP generation. GFR was not significantly changed before or after treatment. Conclusion: Chronic treatment with NEP inhibitor decreases Na and water retention in rats with CHF by enhancing ANP action and suppressing aldosterone secretion. So, ONO-9902 may offer a new therapeutic approach in patients with CHF.

  5. Correlation of Serum and Salivary Biochemical Parameters in end Stage Renal Disease Patients Undergoing Hemodialysis in Pre and Post-Dialysis State.

    Seethalakshmi, C; Koteeswaran, D; Chiranjeevi, V


    The aim of this study is to compare the salivary urea, creatine, sodium, potassium and phosphate in pre dialysis and post dialysis state in end stage renal disease patients and compare with the serum counterpart. The study group was selected from patients undergoing hemodialysis due renal failure of any cause, who are undergoing dialysis for at least one year duration in a private hospital in Chennai. The total number of subjects was 30. The venous blood was collected from the study group just prior to the dialysis and after the dialysis from the venous catheter which is placed for the purpose of hemodialysis. The collected samples were immediately (within 15 min) submitted to the laboratory for the biochemical examination of urea, creatinine, sodium, potassium and phosphate by an automated biochemical analyser. Unstimulated whole saliva was collected by spitting method from study group both before and after dialysis. The collected samples were immediately submitted to the laboratory for the biochemical examination of urea, creatinine, sodium, potassium and phosphate by an automated biochemical analyser. The paired t-test analysis was done in pre and post blood urea, creatinine, potassium and phosphate which was significant with a p-value of dialysis state which also gave a significant reduction in the parameters with a p-value of < 0.0001.




    Background. Dietary fish oil exerts effects on renal hemodynamics and the immune response that may benefit renal-transplant recipients treated with cyclosporine. To evaluate this possibility, we studied the effect of fish oil on renal function, blood pressure, and the incidence of acute rejection ep

  7. 早期液体复苏前后血流动力学参数对脓毒性休克患者短期预后的预测价值研究%Predictive Value of Hemodynamic Parameters Before and After Early Fluid Resuscitation on the Short-term Prognosis of Patients With Septic Shock

    古旭云; 陈炜; 赵磊; 牛素平; 臧学峰


    Objective To assess the early predictive value of hemodynamic parameters before and after early fluid resuscitation on short-term prognosis of patients With septic shock. Methods We made a retrospective analysis on the data of 47 patients With septic shock Who Were admitted into Beijing Shijitan Hospital from January to December in 2013. General data and hemodynamic parameters of monitored by PICCO Were collected,including CI,GEDI,SVRI,ELWI,PVPI before and six hours after early fluid resuscitation. According to survival or death on day 7,the patients Were divided into survival group and death group. The tWo groups Were compared by hemodynamic parameters,and ROC curves Were plotted. The early predictive value of hemodynamic parameters in prognosis Was analyzed. Results ( 1 )Within 7 days after early fluid resuscitation,21 patients died With a mortality rate of 44. 7%. Apart from SVV,the tWo groups Were not significantly different(P >0. 05)in the rest hemodynamic parameters before early fluid resuscitation;the tWo groups Were significantly different(P0.05);而液体复苏后6 h每搏量指数( SVI)、平均动脉压( MAP)、全心射血分数( GEF)、ELWI、PVPI和心功能指数( CFI)比较差异有统计学意义(P<0.05)。(2)血流动力学各指标预测预后的ROC曲线图显示,早期液体复苏后6 h的ELWI预测患者预后结局的AUC最大为0.898,切点值为9.5 ml/kg,在此截点值下灵敏度为76.2%,特异度为92.3%。早期液体复苏后6 h的PVPI预测患者预后结局的 AUC 为0.842,切点值为1.75,在此截点值下灵敏度为66.7%,特异度为96.2%。(3)多因素Logistic回归分析结果显示,早期液体复苏后6 h的ELWI水平对预后判断有统计学意义( P<0.05)。结论 PICCO监测的血流动力学参数PVPI、ELWI、MAP与脓毒性休克患者的预后相关,早期液体复苏后6 h的ELWI水平是评估脓毒性休克患者短期预后的早期独立预测因素。

  8. A re-appraisal of volume status and renal function impairment in chronic heart failure: combined effects of pre-renal failure and venous congestion on renal function.

    Sinkeler, Steef J; Damman, Kevin; van Veldhuisen, Dirk J; Hillege, Hans; Navis, Gerjan


    The association between cardiac failure and renal function impairment has gained wide recognition over the last decade. Both structural damage in the form of systemic atherosclerosis and (patho) physiological hemodynamic changes may explain this association. As regards hemodynamic factors, renal impairment in chronic heart failure is traditionally assumed to be mainly due to a decrease in cardiac output and a subsequent decrease in renal perfusion. This will lead to a decrease in glomerular filtration rate and a compensatory increase in tubular sodium retention. The latter is a physiological renal response aimed at retaining fluids in order to increase cardiac filling pressure and thus renal perfusion. In heart failure, however, larger increases in cardiac filling pressure are needed to restore renal perfusion and thus more volume retention. In this concept, in chronic heart failure, an equilibrium exists where a certain degree of congestion is the price to be paid to maintain adequate renal perfusion and function. Recently, this hypothesis was challenged by new studies, wherein it was found that the association between right-sided cardiac filling pressures and renal function is bimodal, with worse renal function at the highest filling pressures, reflecting a severely congested state. Renal hemodynamic studies suggest that congestion negatively affects renal function in particular in patients in whom renal perfusion is also compromised. Thus, an interplay between cardiac forward failure and backward failure is involved in the renal function impairment in the congestive state, presumably along with other factors. Only few data are available on the impact of intervention in volume status on the cardio-renal interaction. Sparse data in cardiac patients as well as evidence from cohorts with primary renal disease suggest that specific targeting of volume overload may be beneficial for long-term outcome, in spite of a certain further decrease in renal function, at least

  9. The internist and the renal resistive index: truths and doubts.

    Boddi, Maria; Natucci, Fabrizia; Ciani, Elisa


    The renal resistive index (RRI) is measured by Doppler sonography in an intrarenal artery, and is the difference between the peak systolic and end-diastolic blood velocities divided by the peak systolic velocity. The RRI is used for the study of vascular and renal parenchymal renal abnormalities, but growing evidence indicates that it is also a dynamic marker of systemic vascular properties. Renal vascular resistance is only one of several renal (vascular compliance, interstitial and venous pressure), and extrarenal (heart rate, aortic stiffness, pulse pressure) determinants that combine to determine the RRI values, and not the most important one. RRI cannot always be considered a specific marker of renal disease. To summarize from the literature: (1) hydronephrosis, abdominal hypertension, renal vein thrombosis and acute kidney injury are all associated with an acute increase in interstitial and venous pressure that determine RRI values. In all these conditions, RRI is a reliable marker of the severity of renal damage. (2) The hemodynamic impact of renal artery stenosis can be assayed by the RRI decrease in the homolateral kidney by virtue of decreasing pulse pressure. However, renal diseases that often coexist, increase renal vascular stiffness and hide the hemodynamic effect of renal stenosis. (3) In transplant kidney and in chronic renal disease, high RRI values (>0.80) can independently predict renal and clinical outcomes, but systemic (pulse pressure) rather than renal hemodynamic determinants sustain the predictive role of RRI. (4) Higher RRI detects target renal organ damage in hypertension and diabetes when renal function is still preserved, as a marker of systemic atherosclerotic burden. Is this the fact? We attempt to answer.

  10. Clinical monitoring of systemic hemodynamics in critically ill newborns.

    Boode, W.P. de


    Circulatory failure is a major cause of mortality and morbidity in critically ill newborn infants. Since objective measurement of systemic blood flow remains very challenging, neonatal hemodynamics is usually assessed by the interpretation of various clinical and biochemical parameters. An overview

  11. Characteristics of Hemodynamic Disorders in Patients with Severe Traumatic Brain Injury

    Ryta E. Rzheutskaya


    Full Text Available Purpose. To define specific features of central hemodynamic parameter changes in patients with isolated severe traumatic brain injury (STBI and in patients with clinically established brain death and to determine the required course of treatment for their correction. Data and Research Methods. A close study of central hemodynamic parameters was undertaken. The study involved 13 patients with isolated STBI (group STBI and 15 patients with isolated STBI and clinically established brain death (group STBI-BD. The parameters of central hemodynamics were researched applying transpulmonary thermodilution. Results. In the present study, various types of hemodynamic reaction (normodynamic, hyperdynamic, and hypodynamic were identified in patients with isolated STBI in an acute period of traumatic disease. Hyperdynamic type of blood circulation was not observed in patients with isolated STBI and clinically established brain death. Detected hemodynamic disorders led to the correction of the ongoing therapy under the control of central hemodynamic parameters. Conclusions. Monitoring of parameters of central hemodynamics allows to detect the cause of disorders, to timely carry out the required correction, and to coordinate infusion, inotropic, and vasopressor therapy.


    Cerasella Dorina Şincar


    Full Text Available The scope of the study was to evaluate the odontoperiodontal modifications observed in patients with renal pathology in terminal stage, installed as a result of several chronic systemic pathologies, subjected to either dialysis or transplants. Materials and method. The group of patients suffering from IRC included 42 persons (30 men and 12 women, with an average age of 42.6 ± 9.2 years, while the control group was formed of 88 patients (36 men and 52 women, with an average age of 41.3 ± 8.4 years. 28 patients with IRC were treated by HD – hemodialysis, 8 by DPAC – continuous ambulatory peritoneal dialysis, and 6 by CCPD – continuous assisted cycle of peritoneal dialysis. The investigation was developed in the Specialized Policlinics of the „Sf. Apostol Andrei” Urgency Hospital of Galaţi. Results and discussion. The distribution of dialysed patients affected with IRC according to the type of therapy applied is the following: the highest ratio – 59% – is recorded for the patients treated by hemodialysis, followed by those subjected to ambulatory continuous peritoneal dialysis (DPAC and by those with continuous cycle assisted by peritoneal dialysis (CCDP. A statistically significant association was observed between the number of teeth covered by dental plaque or scale and the number of elements with bleeding on probing (r = 0.543, P<0.001 and r = 0.568, P<0.001, respectively. Conclusions: The study shows that the dialysed patients suffering from IRC are more susceptible to periodontal diseases, comparatively with those without IRC, which shows that maintaining of an optimum oral hygiene is essential.

  13. Predictive parameters of arteriovenous fistula functional maturation in a population of patients with end-stage renal disease.

    Khalid Bashar

    Full Text Available With increasing numbers of patients diagnosed with ESRD, arteriovenous fistula (AVF maturation has become a major factor in improving both dialysis related outcomes and quality of life of those patients. Compared to other types of access it has been established that a functional AVF access is the least likely to be associated with thrombosis, infection, hospital admissions, secondary interventions to maintain patency and death.Study of demographic factors implicated in the functional maturation of arteriovenous fistulas. Also, to explore any possible association between preoperative haematological investigations and functional maturation.We performed a retrospective chart review of all patients with ESRD who were referred to the vascular service in the University Hospital of Limerick for creation of vascular access for HD. We included patients with primary AVFs; and excluded those who underwent secondary procedures.Overall AVF functional maturation rate in our study was 53.7% (52/97. Female gender showed significant association with nonmaturation (P = 0.004 and was the only predictor for non-maturation in a logistic regression model (P = 0.011. Patients who had history of renal transplant (P = 0.036, had relatively lower haemoglobin levels (P = 0.01 and were on calcium channel blockers (P = 0.001 showed better functional maturation rates.Female gender was found to be associated with functional non-maturation, while a history kidney transplant, calcium channel-blocker agents and low haemoglobin levels were all associated with successful functional maturation. In view of the conflicting evidence in the literature, large prospective multi-centre registry-based studies with well-defined outcomes are needed.

  14. The clinical spectrum of renal osteodystrophy in 57 chronic hemodialysis patients: a correlation between biochemical parameters and bone pathology findings.

    Chazan, J A; Libbey, N P; London, M R; Pono, L; Abuelo, J G


    Fifty-nine chronic hemodialysis patients who had been on dialysis for an average of 77 months underwent bone biopsies and the pathologic findings were correlated with biochemical and demographic data. All but two had evidence of renal osteodystrophy, 23 with osteitis fibrosa (OF), 19 with osteomalacia and/or adynamic disease (OM/AD), and 15 with mixed osteodystrophy (MOD). Patients in each group were similar with regard to age, sex distribution, duration of dialysis, unstimulated serum aluminum, calcium and phosphorus. Patients with osteitis fibrosa (OF) had statistically higher DFO stimulated aluminum, alkaline phosphatase and PTHC levels than the other two groups although there was marked individual variation. The bone biopsies were also evaluated for the amount of aluminum deposited in the osteoid seam. All 23 of the patients with OF and 11 of the 15 patients with MOD had no, mild, or minimal aluminum deposition but 12 of the 19 patients with OM/AD had moderate to marked aluminum deposition. Patients with minimal to mild aluminum deposition were similar in age, duration of dialysis, sex distribution, unstimulated and DFO stimulated aluminum levels, calcium, phosphorus, alkaline phosphatase to those with moderate to marked deposition but had significantly higher parathormone levels. All patients had been treated in a similar fashion regarding diet, oral phosphate binders and vitamin D; therefore, the observed differences in bone pathology were not readily explicable. However, patients who were found to have osteitis fibrosa and those with minimal to mild aluminum deposition had significantly higher parathormone levels when compared with patients in the other groups at the inception of dialysis.

  15. Bayesian model comparison in nonlinear BOLD fMRI hemodynamics

    Jacobsen, Danjal Jakup; Hansen, Lars Kai; Madsen, Kristoffer Hougaard


    Nonlinear hemodynamic models express the BOLD (blood oxygenation level dependent) signal as a nonlinear, parametric functional of the temporal sequence of local neural activity. Several models have been proposed for both the neural activity and the hemodynamics. We compare two such combined models......: the original balloon model with a square-pulse neural model (Friston, Mechelli, Turner, & Price, 2000) and an extended balloon model with a more sophisticated neural model (Buxton, Uludag, Dubowitz, & Liu, 2004). We learn the parameters of both models using a Bayesian approach, where the distribution...

  16. Non-invasive quantification of hemodynamics in human choriocapillaries

    Yu, Huidan (Whitney); Chen, Rou; An, Senyou; McDonough, James; Gelfand, Bradley; Yao, Jun


    The development of retinal disease is inextricably linked to defects in the choroidal blood supply. However, to date a description of the hemodynamics in the human choroidal circulation is lacking. Through high resolution choroidal vascular network mapped from immunofluorescent labeling and confocal microscopy of human cadaver donor eyes. We noninvasively quantify hemodynamics including velocity, pressure, and wall-shear stress (WSS) in choriocapillaries through mesoscale modeling and GPU-accelerated fast computation. This is the first-ever map of hemodynamic parameters (WSS, pressure, and velocity) in anatomically accurate human choroidal vasculature in health and disease. The pore scale simulation results are used to evaluate porous media models with the same porosity and boundary conditions. School of Medicine, Indiana University.

  17. Upper extremity hemodynamics and sensation with backpack loads.

    Kim, Sae Hoon; Neuschwander, Timothy B; Macias, Brandon R; Bachman, Larry; Hargens, Alan R


    Heavy backpacks are often used in extreme environments, for example by military during combat, therefore completion of tasks quickly and efficiently is of operational relevance. The purpose of this study was to quantify hemodynamic parameters (brachial artery Doppler and microvascular flow by photoplethysmography; tissue oxygenation by near-infrared spectroscopy; arterial oxygen saturation by pulse oximeter) and sensation in upper extremities and hands (Semmes-Weinstein monofilament test and 2-point discrimination test) while wearing a loaded backpack (12 kg) in healthy adults for 10 min. All values were compared to baseline before wearing a backpack. Moderate weight loaded backpack loads significantly decreased upper extremity sensation as well as all macrovascular and microvascular hemodynamic values. Decreased macrovascular and microvascular hemodynamics may produce neurological dysfunction and consequently, probably affect fine motor control of the hands.

  18. Features of Extracranial Hemodynamics in Children with Bronchial Asthma

    S.M. Nedelska


    Full Text Available The paper analyzes the performance of extracranial hemodynamics — volumetric and linear blood flow velocity, the state of peripheral vascular resistance and vascular reactivity at ultrasound Doppler examination of the internal carotid and vertebral arteries of 66 children with bronchial asthma and and 22 healthy children. Development of regional hypoperfusion in vertebrobasilar zone, disorders of the carotid system are proven, but these changes have not led to a decrease in the volumetric blood flow velocity in both internal carotid arteries and the total volume of cerebral blood flow, indicating the compensation of hemodynamic disturbances due to the influence of constant rates in volumetric blood flow in the carotid system. Changes in parameters of extracranial hemodynamics in children with bronchial asthma should be considered as predictor of cerebrovascular complications in this group of patients.

  19. Gut endotoxin restriction improves postoperative hemodynamics in the bile duct-ligated rat.

    Houdijk, A P; van Lambalgen, A A; Thijs, L G; van Leeuwen, P A


    Postoperative hemodynamic disturbances in obstructive jaundice are associated with complications such as shock and renal failure. Gut-derived endotoxemia may underlie these complications. Recently, we have shown that cholestyramine treatment prevents gut-derived endotoxemia in bile duct-ligated (BDL) rats (Houdijk APJ, Boermeester MA, Wesdorp RIC, Hack CE, van Leeuwen PAM: Tumor necrosis factor unresponsiveness following surgery in bile duct-ligated rats. Am J Physiol 271: G980-G986, 1996). The effect of cholestyramine on systemic hemodynamics and organ blood flows after a laparotomy was studied in 2 wk BDL rats using radioactive microspheres. Compared with sham-operated rats, postoperative BDL rats had 1) lower blood pressure (p < .05) and heart rate (p < .001) with higher cardiac output (p < .05), 2) lower splanchnic blood flow (p < .05), 3) lower renal blood flow (p < .01), and 4) higher splanchnic organ and renal-vascular resistances. Cholestyramine treatment in BDL rats prevented the postoperative decrease in blood pressure by increasing cardiac output (p < .01). In addition, cholestyramine maintained splanchnic blood flow at sham levels (p < .05). Furthermore, cholestyramine also prevented the fall in renal blood flow after surgery in BDL rats. Gut endotoxin restriction using cholestyramine treatment maintained normal blood pressure, improved splanchnic blood flow, and completely prevented the fall in renal blood flow in BDL rats. Reducing the gut load of endotoxin in patients with obstructive jaundice scheduled for abdominal surgery may prevent postoperative hemodynamic complications.

  20. Identifying parameters to distinguish non-diabetic renal diseases from diabetic nephropathy in patients with type 2 diabetes mellitus: a meta-analysis.

    Shuang Liang

    Full Text Available BACKGROUND: Renal injuries in patients with diabetes include diabetic nephropathy (DN and non-diabetic renal diseases (NDRD. The value of a clinical diagnosis of DN and NDRD remains inconclusive. We conducted a meta-analysis of the literature to identify predictive factors of NDRD and to compare the clinical characteristics of DN and NDRD for differential diagnosis. METHODS: We searched PubMed (1990 to January 2012, Embase (1990 to February 2009, and CNKI (1990 to January 2012 to identify studies that enrolled patients with DN and NDRD. Then, the quality of the studies was assessed, and data were extracted. The results were summarized as odds ratios (ORs for dichotomous outcomes and weighted mean differences (WMDs for continuous outcomes. RESULTS: Twenty-six relevant studies with 2,322 patients were included. The meta-analysis showed that the absence of diabetic retinopathy (DR predicts NDRD (OR, 0.15; 95% confidence interval [CI], 0.09-0.26, p<0.00001. A shorter duration of diabetes mellitus (DM also predicted NDRD (weighted mean difference, -34.67; 95% CI, -45.23--24.11, p<0.00001. The levels of glycosylated hemoglobin (HbA1C%, blood pressure (BP, and total cholesterol were lower in patients with NDRD, whereas triglycerides and body mass index were higher. Other clinical parameters, including age, 24-h urinary protein excretion, serum creatinine, creatinine clearance, blood urea nitrogen, and glomerular filtration rate were not different between patients with NDRD and DN. CONCLUSIONS: We identified that the absence of DR, shorter duration of DM, lower HbA1C, and lower BP may help to distinguish NDRD from DN in patients with diabetes. This could assist clinicians in making a safe and sound diagnosis and lead to more effective treatments.

  1. Hemodynamic study of hepatocellular car-cinoma nodules by multi-slice spiral computed tomographic perfusion



    Objective To analyze the 64-slice computed tomographic(CT) perfusion parameters of hepatocellular carcinoma(HCC) nodule so as to assess the diagnostic value of hemodynamic changes of HCC nodule by this perfusion

  2. Characteristics of Hemodynamic Disorders in Patients with Severe Traumatic Brain Injury

    Rzheutskaya, Ryta E.


    Purpose. To define specific features of central hemodynamic parameter changes in patients with isolated severe traumatic brain injury (STBI) and in patients with clinically established brain death and to determine the required course of treatment for their correction. Data and Research Methods. A close study of central hemodynamic parameters was undertaken. The study involved 13 patients with isolated STBI (group STBI) and 15 patients with isolated STBI and clinically established brain death ...

  3. Childhood moyamoya disease: hemodynamic MRI

    Tzika, A.A. [Department of Radiology, Children`s Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 (United States); Robertson, R.L. [Department of Radiology, Children`s Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 (United States); Barnes, P.D. [Department of Radiology, Children`s Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 (United States); Vajapeyam, S. [Department of Radiology, Children`s Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 (United States); Burrows, P.E. [Department of Radiology, Children`s Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 (United States); Treves, S.T. [Department of Radiology, Children`s Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 (United States); Scott, R.M. l [Department of Radiology, Children`s Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 (United States)


    Background. Childhood moyamoya disease is a rare progressive cerebrovascular disease. Objective. To evaluate cerebral hemodynamics using dynamic Gd-DTPA-enhanced imaging in children with moyamoya disease. Materials and methods. Eight children (2-11 years of age) with the clinical and angiographic findings typical of moyamoya disease, before and/or after surgical intervention (pial synangiosis), underwent conventional MR imaging (MRI) and hemodynamic MR imaging (HMRI). HMRI used a spoiled gradient-echo with low flip angle (10 deg) and long TE (TR/TE = 24/15 ms) to minimize T 1 effects and emphasize T 2{sup *} weighting. Raw and calculated hemodynamic images were reviewed. Three-dimensional time-of-flight MR angiography (MRA) and perfusion brain single photon emission computed tomography (SPECT) were also performed. Results. Abnormal hemodynamic maps resulting from vascular stenosis or occlusion and basal collaterals were observed in six patient studies. HMRI depicted perfusion dynamics of affected cerebrovascular territories, detected cortical perfusion deficits, and complemented conventional MRI and MRA. HMRI findings were consistent with those of catheter angiography and perfusion SPECT. Conclusion. Our preliminary experience suggests that HMRI may be of value in the preoperative and postoperative evaluation of surgical interventions in moyamoya disease. (orig.). With 4 figs., 3 tabs.

  4. The Renal Renin-Angiotensin System

    Harrison-Bernard, Lisa M.


    The renin-angiotensin system (RAS) is a critical regulator of sodium balance, extracellular fluid volume, vascular resistance, and, ultimately, arterial blood pressure. In the kidney, angiotensin II exerts its effects to conserve salt and water through a combination of the hemodynamic control of renal blood flow and glomerular filtration rate and…

  5. Incidental renal neoplasms

    Rabjerg, Maj; Mikkelsen, Minne Nedergaard; Walter, Steen;


    On the basis of associations between tumor size, pathological stage, histological subtype and tumor grade in incidentally detected renal cell carcinoma vs symptomatic renal cell carcinoma, we discussed the need for a screening program of renal cell carcinoma in Denmark. We analyzed a consecutive...... series of 204 patients with renal tumors in 2011 and 2012. The tumors were classified according to detection mode: symptomatic and incidental and compared to pathological parameters. Eighty-nine patients (44%) were symptomatic, 113 (55%) were incidental. Information was not available in two patients...

  6. Trauma renal Renal trauma

    Gerson Alves Pereira Júnior


    Full Text Available Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration

  7. Investigating the Effect of Oral Consumption of Tear Assafoetida on Hepatic, Renal, Cardiac, and Blood Biochemical Parameters of Rats

    M Esmailidehaj


    Methods: Forty male Wistar rats, with average weighting of 300 grams, were divided into five groups of eight in each. The first group was considered as control group and groups 2-5 as the pretreatment groups that were pre-treatmented by 12.5, 25, 50 and 100 mg/kg tear assafoetida for 30 days, respectively. Then, blood samples were collected for measurement of biochemical parameters of liver (AST, ALT, ALP, kidney (Urea, Cr, cardiac (CPK and blood coagulation (Pt, Ptt. Blood pressures were also recorded through inserting a cannula into the carotid artery. Lead II of electrocardiogram was used to monitor electrical activity of the heart. Data was analyzed by one-way analysis of variance. Results: The plasma level of AST, CPK and Ptt significantly reduced in pretreatment groups with assafoetida (P<0.05. With increasing the dose of assafoetida, plasma urea concentration reduced and plasma Cr concentration and all blood pressures increased insignificantly. Conclusion: The findings of this study suggest that low doses of tear assafoetida (25 mg/kg does not probably have any side effects and even maybe useful for health, but at higher doses (100 mg/kg it may lead to complications. Hence, there is a need for further studies to answer some questions that arose from this study.

  8. Hemodynamic Changes during Epidural Anesthesia with Various Local Anesthetics

    Ye. M. Shifman


    Full Text Available Central hemodynamic stability during gynecological laparoscopic operations remains an important problem of anes-thesiological monitoring. Subjects and methods. Fifty-eight patients who had undergone various gynecological laparoscopic operations were examined. According to the mode of anesthesia, the patients were divided into 2 groups: 1 29 patients who received epidural anesthesia with ropivacaine; 2 29 who had epidural anesthesia using lidocaine. The indices of cardiac performance (stroke volume, stroke index, and cardiac output, blood (diastolic, systolic, and mean pressure, vascular parameters (linear blood flow velocity, total peripheral vascular resistance were determined by volumetric compression oscillometry. Results. The study indicated that all the modes of anesthesia demonstrated the satisfactory condition of the cardiovascular system, but the highest stability of hemodynamic parameters was recorded in the epidural ropivacaine group. In this group, there were steady-state reductions in diastolic, systolic, mean blood pressures, and total vascular peripheral resistance and increases in stroke index, stroke volume, and linear blood flow velocity. Conclusion. Epidural anesthesia using ropivacaine during gynecological surgical endoscopic interventions is the method of analgesia causing minimal hemodynamic disorders. Key words: hemodynamics, epidural anesthesia, laparoscopic gynecological operations.

  9. Renal arteriography

    ... Read More Acute arterial occlusion - kidney Acute kidney failure Aneurysm Atheroembolic renal disease Blood clots Renal cell carcinoma Renal venogram X-ray Review Date 1/5/2016 Updated by: Jason Levy, ...

  10. Contrast-enhanced MR angiography utilizing parallel acquisition techniques in renal artery stenosis detection

    Slanina, Martin, E-mail: slaninajicin@seznam.c [Department of Radiology, Charles University Prague, Medical Faculty and Teaching Hospital in Hradec Kralove, Sokolska 581, Hradec Kralove 500 05 (Czech Republic); Zizka, Jan; Klzo, Ludovit; Lojik, Miroslav [Department of Radiology, Charles University Prague, Medical Faculty and Teaching Hospital in Hradec Kralove, Sokolska 581, Hradec Kralove 500 05 (Czech Republic)


    Significant renal artery stenosis (RAS) is a potentially curable cause of renovascular hypertension and/or renal impairment. It is caused by either atherosclerosis or fibromuscular dysplasia. Correct and timely diagnosis remains a diagnostic challenge. MR angiography (MRA) as a minimally invasive method seems to be suitable for RAS detection, however, its diagnostic value widely differs in the literature (sensitivity 62-100% and specificity 75-100%). The aim of our prospective study was to compare the diagnostic value of contrast-enhanced MRA utilizing parallel acquisition techniques in the detection of significant RAS with digital subtraction angiography (DSA). A total of 78 hypertensive subjects with suspected renal artery stenosis were examined on a 1.5 Tesla MR system using a body array coil. Bolus tracking was used to monitor the arrival of contrast agent to the abdominal aorta. The MRA sequence parameters were as follows: TR 3.7 ms; TE 1.2 ms; flip angle 25{sup o}; acquisition time 18 s; voxel size 1.1 mm x 1.0 mm x 1.1 mm; centric k-space sampling; parallel acquisition technique with acceleration factor of 2 (GRAPPA). Renal artery stenosis of 60% and more was considered hemodynamically significant. The results of MRA were compared to digital subtraction angiography serving as a standard of reference. Sensitivity and specificity of MRA in the detection of hemodynamically significant renal artery stenosis were 90% and 96%, respectively. Prevalence of RAS was 39% in our study population. Contrast-enhanced MRA with high spatial resolution offers sufficient sensitivity and specificity for screening of RAS.

  11. Associations between mercury and hepatic, renal, endocrine, and hematological parameters in Atlantic bottlenose dolphins (Tursiops truncatus) along the eastern coast of Florida and South Carolina.

    Schaefer, Adam M; Stavros, Hui-Chen W; Bossart, Gregory D; Fair, Patricia A; Goldstein, Juli D; Reif, John S


    We evaluated associations between total mercury (Hg) concentrations in blood and skin and endocrine, hepatic, renal, and hematological parameters in free-ranging bottlenose dolphins (Tursiops truncatus). Dolphins in Indian River Lagoon, FL had higher concentrations of Hg in blood (0.67 μg/l wet wt) and skin (7.24 μg/g dry wt) compared with those from Charleston Harbor, SC (0.15 μg/l wet wt, 1.68 μg/g dry wt). An inverse relationship was observed between blood and skin Hg concentrations and total thyroxine, triiodothyronine, absolute numbers of lymphocytes, eosinophils, and platelets. Adrenocorticotropic hormone (ACTH), blood urea nitrogen, and gamma-glutamyl transferase increased with increasing concentrations of Hg in blood and skin; lactate dehydrogenase and neutrophils increased with concentrations in skin only. Hemoglobin and mean corpuscular hemoglobin increased with increasing concentrations of Hg in blood. Selenium was negatively associated with free T4, progesterone, and absolute numbers of monocytes, and positively correlated with absolute numbers of eosinophils and lymphocytes, and mean corpuscular volume. The results suggest the potential for a deleterious effect of Hg in highly exposed dolphins.

  12. Detailing the relation between renal T2* and renal tissue pO2 using an integrated approach of parametric magnetic resonance imaging and invasive physiological measurements.

    Pohlmann, Andreas; Arakelyan, Karen; Hentschel, Jan; Cantow, Kathleen; Flemming, Bert; Ladwig, Mechthild; Waiczies, Sonia; Seeliger, Erdmann; Niendorf, Thoralf


    This study was designed to detail the relation between renal T2* and renal tissue pO2 using an integrated approach that combines parametric magnetic resonance imaging (MRI) and quantitative physiological measurements (MR-PHYSIOL). Experiments were performed in 21 male Wistar rats. In vivo modulation of renal hemodynamics and oxygenation was achieved by brief periods of aortic occlusion, hypoxia, and hyperoxia. Renal perfusion pressure (RPP), renal blood flow (RBF), local cortical and medullary tissue pO2, and blood flux were simultaneously recorded together with T2*, T2 mapping, and magnetic resonance-based kidney size measurements (MR-PHYSIOL). Magnetic resonance imaging was carried out on a 9.4-T small-animal magnetic resonance system. Relative changes in the invasive quantitative parameters were correlated with relative changes in the parameters derived from MRI using Spearman analysis and Pearson analysis. Changes in T2* qualitatively reflected tissue pO2 changes induced by the interventions. T2* versus pO2 Spearman rank correlations were significant for all interventions, yet quantitative translation of T2*/pO2 correlations obtained for one intervention to another intervention proved not appropriate. The closest T2*/pO2 correlation was found for hypoxia and recovery. The interlayer comparison revealed closest T2*/pO2 correlations for the outer medulla and showed that extrapolation of results obtained for one renal layer to other renal layers must be made with due caution. For T2* to RBF relation, significant Spearman correlations were deduced for all renal layers and for all interventions. T2*/RBF correlations for the cortex and outer medulla were even superior to those between T2* and tissue pO2. The closest T2*/RBF correlation occurred during hypoxia and recovery. Close correlations were observed between T2* and kidney size during hypoxia and recovery and for occlusion and recovery. In both cases, kidney size correlated well with renal vascular conductance

  13. Effects of ligustrazine on hemodynamics and contractile function of coronary vascular ring in dogs with renal hypertension%川芎嗪对肾性高血压犬血流动力学及冠状动脉血管环功能的影响

    唐瑭; 陈德森; 刘刚


    目的 观察川芎嗪对肾性高血压犬血流动力学及冠状动脉环舒缩功能的影响.方法 以直接测压法测定犬在给予川芎嗪(0.2g/kg小剂量组和0.6g/kg大剂量组)前及给药后0.5,1,2,4h共5个时间点的左室内压力峰值(LVSP)、左室内压力最大上升速率(+LV dp/dtmax)、平均动脉压(MAP)、脉压(PP).以去甲肾上腺素(NE)和氯化钾(KCl)分别灌流模型组犬离体冠状动脉环,测定川芎嗪对犬冠状动脉环半抑制浓度(IC50),观察川芎嗪对NE及KCl致肾性高血压的冠状动脉环收缩的影响.结果 给药后1,2h 2个时间点测定的川芎嗪有较明显的剂量依赖性地降低肾性高血压犬LVSP、+LV dp/dtmax、MAP的作用;抑制NE和KCl引起的离体冠脉收缩,NE及KCl IC50分别为(1.06±0.65)×10-4mol/L和(1.51±0.26)×10-4mol/L.1×10-4和5×10-4mol/L川芎嗪可使NE引起的内源性钙收缩张力由(1.45±0.18)g分别下降至(0.94±0.42)g和(0.63±0.25)g,外源性钙收缩张力由(2.15±0.47)g降至(1.21±0.42)g和(0.89±0.25)g.结论 川芎嗪对肾性高血压犬有降压作用,并可抑制NE和KCl引起的冠脉收缩,其作用机制与抑制平滑肌细胞电压依赖性钙通道和受体操纵钙通道介导的外钙内流和内钙释放,降低心肌收缩力进而影响心功能有关.%Objective It is to explore the effects of ligustrazine on hemodynamics and contractile function of coronary vascular ring in renal hypertensive dogs. Methods The direct manometric method was used to determine the left intraventricular pressure peak value ( LVSP ), maximum rising rate of left ventricular pressure ( + LV dp/dtmax ), mean arterial pressure ( MAP ) , pulse pressure ( PP ) in canines before giving ligustrazine 0. 2 g/kg or 0. 6 g/kg and after 30 min, 1, 2, 4 h respectively. In norepinephrine( NE ) - and potassium chloride ( KC1 )-induced renal hypertension canines, half inhibitory concentration ( IC50 ) of coronary vascular ring was determined after perfusing

  14. Creatinine clearance as a substitute for the glomerular filtration rate in the assessment of glomerular hemodynamics.

    Okada, N; Imanishi, M; Yoshioka, K; Konishi, Y; Okumura, M; Tanaka, S; Fujii, S


    A method for the clinical assessment of glomerular hemodynamics has been published previously. We here examined whether, when using this method, renal creatinine clearance (Ccr) can be substituted for the glomerular filtration rate (GFR). The study subjects comprised 57 inpatients from Osaka City General Hospital: 30 with type 2 diabetes mellitus and 27 with chronic glomerulonephritis. During the 2-wk study, patients received a high-salt diet for 1 wk and a low-salt diet for 1 wk. Urinary sodium excretion and systemic blood pressure were measured daily. The renal plasma flow, Ccr, and plasma total protein concentration were also evaluated simultaneously on the last day of the high-salt diet. The GFR was also calculated from the fractional renal accumulation of 99mTc-diethylenetriaminepentaacetic acid (DTPA). Glomerular hemodynamics, represented by the glomerular capillary hydraulic pressure and the resistance of afferent and efferent arterioles, were calculated using the renal clearance, the plasma total protein concentration, and the pressure-natriuresis relationship. Values for renal hemodynamics with the Ccr-derived GFR were compared with those from the 99mTc-DTPA-derived GFR. Ccr values of 53 to 169 ml/min correlated with the 99mTc-DTPA-derived clearance of 39 to 179 ml/min (n=57, r=.71, presistances of afferent and efferent arterioles calculated using the Ccr-derived GFR correlated significantly with those calculated using the 99mTc-DTPA-derived GFR (r=.99, p<.001 and r=.99, p<.001, respectively). These results indicate that the Ccr is an accurate representation of the GFR for use in glomerular hemodynamic analysis of the pressure-natriuresis relationship.

  15. Hemodynamic gestational adaptation in bitches

    Vívian Tavares de Almeida; Ricardo Andres Ramirez Uscategui; Priscila Del Aguila da Silva; Michele Lopes Avante; Ana Paula Rodrigues Simões; Wilter Ricardo Russiano Vicente


    ABSTRACT: Throughout pregnancy, maternal hemodynamic adaptation is needed to ensure proper uterine perfusion and fetal development. When the uteroplacental vascular system is formed, starting with reduced resistance to uterine arterial flow, this results in decreased total vascular resistance, an activation of neuroendocrine vasoactive peptides, an increase in circulating blood and changes in the cardiovascular system morphophysiology to respond to the increasing demands of uterine perfusion....

  16. Hemodynamic gestational adaptation in bitches

    Vívian Tavares de Almeida

    Full Text Available ABSTRACT: Throughout pregnancy, maternal hemodynamic adaptation is needed to ensure proper uterine perfusion and fetal development. When the uteroplacental vascular system is formed, starting with reduced resistance to uterine arterial flow, this results in decreased total vascular resistance, an activation of neuroendocrine vasoactive peptides, an increase in circulating blood and changes in the cardiovascular system morphophysiology to respond to the increasing demands of uterine perfusion. There has been considerable study of hemodynamic adaptation in pregnant women and this assessment has become a diagnostic tool for fatal obstetric disorders. However, in bitches the available information in this regard is limited; therefore a parallel was drawn between other species of animals and women, in order to subsidize the paucity of information about this process and facilitate the understanding of maternal-fetal hemodynamic adaptation in pregnant bitches. This review and literature analysis aimed\\ to discuss morphophysiological cardiovascular adaptations during pregnancy and the possible disorders that can affect this process in pregnant female dogs.

  17. Factors Influencing Renal Vasculature during Anesthesia, Trauma, and Oliguric Renal Failure States in Man


    Harrison, J.H.: Intrarenal distribution of blood flow in canine renal allografts treated with immunosuppressive drugs . J. Urol. 101:482-486, 1969...Ethacrynic acid induced a dramatic response, providing that diuretic -induced plasma volume production was prevented. The hemodynamic response to... diuretic phase. Initially, the rapid flow component was small and evanascent, disappearing on some occasions. Diuresis became established when the

  18. Renal function and histology after acute hemorrhage in rats under dexmedetomidine action

    Marangoni, Marco Aurelio [UNESP; Hausch,Alex; Vianna,Pedro Thadeu Galvão; Braz, José Reinaldo Cerqueira [UNESP; Viero, Rosa Marlene [UNESP; Castiglia, Yara Marcondes Machado [UNESP


    PURPOSE: About 50 % of indications for dialysis in acute renal failure are related to problems originated during the perioperative period. Intraoperative hemodynamic changes lead to renal vasoconstriction and hypoperfusion. Previous studies have not defined the dexmedetomidine renal role in hemorrhage situations. This study evaluated the effect of dexmedetomidine on renal function and histology after acute hemorrhage in rats. METHODS: Covered study with 20 Wistars rats, anesthetized with sodi...

  19. D-2-like receptor stimulation decreases effective renal plasma flow and glomerular filtration rate in spontaneously hypertensive rats

    de Vries, PAM; de Jong, PE; de Zeeuw, D; Navis, GJ


    In spontaneously hypertensive rats (SHRs) the dopaminergic D-1-like renal vasodilator response is impaired. The renal vascular response to D-2-like receptor stimulation in vivo is incompletely known. Therefore, renal hemodynamics were studied in conscious SHRs during continuous infusion of D-2-like

  20. Comparison of the hemodynamic effects of etomidate between hypertensive and normotensive patients

    Hayrettin Daşkaya


    Full Text Available Objective: Comparison of the hemodynamic effect of ethomidate induction in normotensive and hypertensive patients. Methods: Forty ASA 1-2 patients were included. After informed consent were obtained, patients were divided into two group; Group H: Hypertensive patients, Group N: Normotensive patients. Fentanile and midazolam were administrated for premedication. Anesthesia induction was performed by etomidate 0.3 mg/kg and rocuronium 0.6 mg/kg. Arterial pressures and heart rates were measured at certain intervals: control, pre-intubation and 1, 3 and 5 min post-intubation. Myoclonic movements and hemodynamic parameters were noted by an anesthetist who was masked to the groups. Results: Hemodynamic parameters were higher in hypertensive patients but were in clinically tolerable limits. Conclusion: No hemodynamic instability was observed in anesthesia induction with ethomidate in neither hypertensive nor normotensive patients. J Clin Exp Invest 2014; 5 (2: 164-168

  1. Pharmacological Modulation of Hemodynamics in Adult Zebrafish In Vivo.

    Daniel Brönnimann

    Full Text Available Hemodynamic parameters in zebrafish receive increasing attention because of their important role in cardiovascular processes such as atherosclerosis, hematopoiesis, sprouting and intussusceptive angiogenesis. To study underlying mechanisms, the precise modulation of parameters like blood flow velocity or shear stress is centrally important. Questions related to blood flow have been addressed in the past in either embryonic or ex vivo-zebrafish models but little information is available for adult animals. Here we describe a pharmacological approach to modulate cardiac and hemodynamic parameters in adult zebrafish in vivo.Adult zebrafish were paralyzed and orally perfused with salt water. The drugs isoprenaline and sodium nitroprusside were directly applied with the perfusate, thus closely resembling the preferred method for drug delivery in zebrafish, namely within the water. Drug effects on the heart and on blood flow in the submental vein were studied using electrocardiograms, in vivo-microscopy and mathematical flow simulations.Under control conditions, heart rate, blood flow velocity and shear stress varied less than ± 5%. Maximal chronotropic effects of isoprenaline were achieved at a concentration of 50 μmol/L, where it increased the heart rate by 22.6 ± 1.3% (n = 4; p < 0.0001. Blood flow velocity and shear stress in the submental vein were not significantly increased. Sodium nitroprusside at 1 mmol/L did not alter the heart rate but increased blood flow velocity by 110.46 ± 19.64% (p = 0.01 and shear stress by 117.96 ± 23.65% (n = 9; p = 0.03.In this study, we demonstrate that cardiac and hemodynamic parameters in adult zebrafish can be efficiently modulated by isoprenaline and sodium nitroprusside. Together with the suitability of the zebrafish for in vivo-microscopy and genetic modifications, the methodology described permits studying biological processes that are dependent on hemodynamic alterations.

  2. Contemporary evaluation and management of renal trauma.

    Chouhan, Jyoti D; Winer, Andrew G; Johnson, Christina; Weiss, Jeffrey P; Hyacinthe, Llewellyn M


    Renal trauma occurs in approximately 1%-5% of all trauma cases. Improvements in imaging and management over the last two decades have caused a shift in the treatment of this clinical condition. A systematic search of PubMed was performed to identify relevant and contemporary articles that referred to the management and evaluation of renal trauma. Computed tomography remains a mainstay of radiological evaluation in hemodynamically stable patients. There is a growing body of literature showing that conservative, non-operative management of renal trauma is safe, even for Grade IV-V renal injuries. If surgical exploration is planned due to other injuries, a conservative approach to the kidney can often be utilized. Follow up imaging may be warranted in certain circumstances. Urinoma, delayed bleeding, and hypertension are complications that require follow up. Appropriate imaging and conservative approaches are a mainstay of current renal trauma management.

  3. Hemodinâmica glomerular renal no roedor Calomys callosus

    Mirian A. Boim


    . This rodent presented a significant number of superficial glomeruli, allowing to evaluate glomerular hemodynamics and renal microcirculation parameters. Despite mean arterial pressure similar to the Munich- Wistar (MW rats, mean glomerular capillary hydraulic pressure was lower in Calomys callosum due to a lower post glomerular resistance in this rodent when compared to MW rats. The mean glomerular plasma flow rate was relatively elevated when compared with single nephron glomerular filtration rate, which in turn blunted the lower intraglomerular hydraulic pressure, and thus increased the single nephron glomerular filtration rate per g/kidney. The present work suggests that despite of the technical difficulties imposed by the reduced size of the Calomys callosus, the study of the renal function and glomerular hemodynamics is possible, establishing therefore, a model for the study such renal function.

  4. Imaging evaluation of the cerebral hemodynamic changes pre and post revascularization by 320 slices CT multiple parameter scan%320排CT头颈联合扫描评价颈动脉血运重建术前后脑血流动力学变化

    毕涛; 于薇; 何楠; 杨琳; 张晓洁; 张兆琪


    Objective;To evaluate the relationship between carotid stenosis and brain perfusion changes before and after revascularization, by 320 slices CT multiple segments and parameter scan. Further analysis was done to find which kind of patient can get more benefit form the carotid artery revascularization. Methods:30 patients that the ultrasound result demonstrated carotid artery stenosis underwent carotid artery revasculariza-tion. All of them studied with 320 CT multiple parameter scan 2 weeks pre and post carotid revascularization. The degree of carotid artery stenosis and CT perfusion( CTP) parameters, include (cerebral blood flow( CBF) , cerebral blood volume (CBV) , mean transit time(MTT) ,time to peak('lTP) and Delay time (Delay) were cal-culated. The relative value were measured. Patients were divided into two groups , Group 1 symmetry bilateral hemisphere CTP, group 2 asymmetry bilateral hemisphere CTP. Results: The relative value ( rTTP, rDelay) changed obviously after carotid artery revascularization, other parameter showed no obvious change. Patients were subdivided into two groups, based on the hemodynamic changes. 12 patients included in the symmetry CTP group, the hemodynamic parameters showed no obviously improvement afler carotid artery revasculariza-tion, 18 patients included in the asymmetry CTP group, the hemodynamic parameters (rCBV, rMTT, rTTP, rDelay) improved obviously after the operation. Conclusion: After the carotid revascularization, the morphology change of carotid artery, and the hemodynamic changes of the blood supply area, can be shown by 320 slices CT multiple parameter scan. Carotid artery stenosis patient with asymmetry CTP can get more benefit from the carotid artery revascularization.%目的:采用320排CT头颈联合多参数扫描模式,对拟行颈动脉血运重建术的患者进行扫描,探讨颈动脉狭窄解除与脑灌注参数改善间的关系,并进一步探讨脑血流动力学改变,对血运重建术前不同类

  5. Morphological and hemodynamic analysis of mirror posterior communicating artery aneurysms.

    Jinyu Xu

    Full Text Available BACKGROUND AND PURPOSE: Hemodynamic factors are commonly believed to play an important role in the pathogenesis, progression, and rupture of cerebral aneurysms. In this study, we aimed to identify significant hemodynamic and morphological parameters that discriminate intracranial aneurysm rupture status using 3-dimensional-angiography and computational fluid dynamics technology. MATERIALS AND METHODS: 3D-DSA was performed in 8 patients with mirror posterior communicating artery aneurysms (Pcom-MANs. Each pair was divided into ruptured and unruptured groups. Five morphological and three hemodynamic parameters were evaluated for significance with respect to rupture. RESULTS: The normalized mean wall shear stress (WSS of the aneurysm sac in the ruptured group was significantly lower than that in the unruptured group (0.52±0.20 versus 0.81±0.21, P = .012. The percentage of the low WSS area in the ruptured group was higher than that in the unruptured group (4.11±4.66% versus 0.02±0.06%, P = .018. The AR was 1.04±0.21 in the ruptured group, which was significantly higher than 0.70±0.17 in the unruptured group (P = .012. By contrast, parameters that had no significant differences between the two groups were OSI (P = .674, aneurysm size (P = .327, size ratio (P = .779, vessel angle (P = 1.000 and aneurysm inclination angle (P = 1.000. CONCLUSIONS: Pcom-MANs may be a useful disease model to investigate possible causes of aneurysm rupture. The ruptured aneurysms manifested lower WSS, higher percentage of low WSS area, and higher AR, compared with the unruptured one. And hemodynamics is as important as morphology in discriminating aneurysm rupture status.

  6. Endogenous nitric oxide synthase inhibitors, arterial hemodynamics, and subclinical vascular disease: the PREVENCION Study.

    Chirinos, Julio A; David, Robert; Bralley, J Alexander; Zea-Díaz, Humberto; Muñoz-Atahualpa, Edgar; Corrales-Medina, Fernando; Cuba-Bustinza, Carolina; Chirinos-Pacheco, Julio; Medina-Lezama, Josefina


    Endogenous NO synthase inhibitors (end-NOSIs) have been associated with cardiovascular risk factors and atherosclerosis. In addition, end-NOSIs may directly cause hypertension through hemodynamic effects. We aimed to examine the association between end-NOSI asymmetrical dimethylarginine (ADMA) and N-guanidino-monomethyl-arginine (NMMA), subclinical atherosclerosis, and arterial hemodynamics. We studied 922 adults participating in a population-based study (PREVENCION Study) and examined the correlation between end-NOSI/L-arginine and arterial hemodynamics, carotid-femoral pulse wave velocity, and carotid intima-media thickness using linear regression. ADMA, NMMA, and L-arginine were found to be differentially associated with various classic cardiovascular risk factors. ADMA and NMMA (but not L-arginine) were significant predictors of carotid intima-media thickness, even after adjustment for cardiovascular risk factors, C-reactive protein, and renal function. In contrast, ADMA and NMMA did not predict carotid-femoral pulse wave velocity, blood pressure, or hemodynamic abnormalities. Higher L-arginine independently predicted systolic hypertension, higher central pulse pressure, incident wave amplitude, central augmented pressure, and lower total arterial compliance but not systemic vascular resistance or cardiac output. We conclude that ADMA and NMMA are differentially associated with cardiovascular risk factors, but both end-NOSIs are independent predictors of carotid atherosclerosis. In contrast, they are not associated with large artery stiffness, hypertension, or hemodynamic abnormalities. Our findings are consistent with a role for asymmetrical arginine methylation in atherosclerosis but not in large artery stiffening, hypertension, or long-term hemodynamic regulation. L-arginine is independently associated with abnormal pulsatile (but not resistive) arterial hemodynamic indices, which may reflect abnormal L-arginine transport, leading to decreased intracellular

  7. Renal Osteodystrophy

    Aynur Metin Terzibaşoğlu


    Full Text Available Chronic renal insufficiency is a functional definition which is characterized by irreversible and progressive decreasing in renal functions. This impairment is in collaboration with glomeruler filtration rate and serum creatinine levels. Besides this, different grades of bone metabolism disorders develop in chronic renal insufficiency. Pathologic changes in bone tissue due to loss of renal paranchyme is interrelated with calcium, phosphorus vitamine-D and parathyroid hormone. Clinically we can see high turnover bone disease, low turnover bone disease, osteomalacia, osteosclerosis and osteoporosis in renal osteodystropy. In this article we aimed to review pathology of bone metabolism disorders due to chronic renal insufficiency, clinic aspects and treatment approaches briefly.

  8. Prediction of Hemodynamic Reactivity during Sevoflurane Remifentanyl Anesthesia for Laparoscopic Cholecystectomy Using Analgesia Nociception Index

    Ali Şefik Köprülü


    Full Text Available Aim: Pneumoperitoneum may cause serious side effects in high-risk patients during laparoscopic cholecystectomy. Perioperative analgesic sufficiency has been measured by the Analgesia Nociception index (ANI in recent years. We examine the possibility of predicting hemodynamic reactivity by observing sudden changes in ANI during operation. Methods: In this retrospective study, recorded hemodynamic parameters (including heart rate, systolic/ diastolic blood pressure values and ANI values, before and after intubation, nasogastric tube application, intraperitoneal gas insufflation, and surgical incision in 31 patients who were applied laparoscopic cholecystectomy were compared by paired t-test. Additionally, an increment or decrement of 20% in ANI and 15% in hemodynamic parameters with respect to basal observation values were called “sudden changes”. Correlation of these parameters with sudden changes in ANI values was examined either. Results: There was a statistically significant difference in parameters after premedication and intubation. After induction, a statistically significant decrement was detected only in heart rate and systolic/diastolic blood pressure values. There was no significant change after nasogastric tube insertion. During pneumoperitoneum and surgical incision, there was no change in heart rate and systolic/diastolic blood pressure values, but a statistically significant decrement was observed in ANI. No correlation was detected between sudden changes in ANI values and hemodynamic parameters. Conclusion: We assume that use of ANI in analgesia evaluation under general anesthesia at perioperative period is suitable, however, it is not reliable in predicting hemodynamic interaction.

  9. Papilledema due to a permanent catheter for renal dialysis and an arteriovenous fistula: a "two hit" hypothesis.

    Simon, Melissa A; Duffis, Ennis J; Curi, Michael A; Turbin, Roger E; Prestigiacomo, Charles J; Frohman, Larry P


    Elevated intracranial pressure in patients with chronic renal failure has several potential causes. Its rare occurrence secondary to the hemodynamic effects of hemodialysis is described and the findings support a multifactorial etiology ("two hits").

  10. Renal protection in cardiovascular surgery [version 1; referees: 2 approved

    Nora Di Tomasso


    Full Text Available Acute kidney injury (AKI is one of the most relevant complications after major surgery and is a predictor of mortality. In Western countries, patients at risk of developing AKI are mainly those undergoing cardiovascular surgical procedures. In this category of patients, AKI depends on a multifactorial etiology, including low ejection fraction, use of contrast media, hemodynamic instability, cardiopulmonary bypass, and bleeding. Despite a growing body of literature, the treatment of renal failure remains mainly supportive (e.g. hemodynamic stability, fluid management, and avoidance of further damage; therefore, the management of patients at risk of AKI should aim at prevention of renal damage. Thus, the present narrative review analyzes the pathophysiology underlying AKI (specifically in high-risk patients, the preoperative risk factors that predispose to renal damage, early biomarkers related to AKI, and the strategies employed for perioperative renal protection. The most recent scientific evidence has been considered, and whenever conflicting data were encountered possible suggestions are provided.




    Although the renal clearance of Tc-99m-MAG3 is about 60% of the I-131-hippurate clearance, Tc-99m-MAG3 clearance may be useful to estimate ERPF. In one study, however, proteinuria seemed to influence the MAG3/hippurate clearance ratio. In order to establish whether proteinuria or serum albumin level

  12. Investigating the relationship between hemodynamic and metabolic parameters in portal triade occlusion following hemorrhagic shock Estudo da relação entre os parâmetros hemodinâmicos e metabólicos na oclusão da tríade portal associada ao choque hemorrágico

    Mauro José Fontelles


    Full Text Available PURPOSE: To determine whether metabolic and hemodynamic parameters are "mathematically" coupled in rats submitted to portal triad occlusion following controlled hemorrhagic shock state. METHODS: Pearson's coefficient (r-value analysis was performed. Differences considered significant at pr>0.50. RESULTS: It was observed that there is a direct proportional relationship to HCO3- with pCO2 (r=0.66, base deficit (r=0.87 and inverse with serum lactate (r=-0.54. pCO2 was directly associated with MAP (r=0.51, and inversely with pH (r=-0.64. Hematocrit was directly associated with HR (r=0.72 and CI (r=0.76, and serum lactated was inversely associated with base deficit (r=-0.61. CONCLUSION: In rats submitted to Pringle's maneuver during 15 minutes following hemorrhagic shock state, there is a mathematical coupling with a very good correlation between several hemodynamic and metabolic variables.OBJETIVO: com a utilização de um modelo experimental, determinar se as alterações hemodinâmicas e metabólicas estão "matematicamente" relacionadas em ratos submetidos a estado de choque hemorrágico controlado seguido de isquemia hepática total. MÉTODOS: O coeficiente de correlação de Pearson (valor r foi utilizado para determinação das fórmulas matemáticas. Diferenças foram consideradas significativas com pr>0.50. RESULTADOS: Encontrou-se uma relação diretamente proporcional para o HCO3- quando comparado com pCO2 (r=0,66 e com o déficit de base (r=0,87; e inversamente proporcional quando comparado com o lactato sérico (r=-0,54. O pCO2 esteve diretamente relacionado com a PAM (r=0,51 e inversamente com o pH (r=-0,64. O hematócrito esteve diretamente associado com a freqüência cardíaca (r=0,72 e, também, com o índice cardíaco (r=0,70. O lactato sérico esteve inversamente associado com o déficit de base (r=-0,61. CONCLUSÃO: Em ratos submetidos ao estado de choque hemorrágico controlado, por 20 minutos, seguido de manobra de Pringle, por

  13. Hemodynamic changes during robotic radical prostatectomy

    Vanlal Darlong


    Full Text Available Background: Effect on hemodynamic changes and experience of robot-assisted laparoscopic radical prostatectomy (RALRP in steep Trendelenburg position (45° with high-pressure CO 2 pneumoperitoneum is very limited. Therefore, we planned this prospective clinical trial to study the effect of steep Tredelenburg position with high-pressure CO 2 pneumoperitoneum on hemodynamic parameters in a patient undergoing RALRP using FloTrac/Vigileo™1.10. Methods: After ethical approval and informed consent, 15 patients scheduled for RALRP were included in the study. In the operation room, after attaching standard monitors, the radial artery was cannulated. Anesthesia was induced with fentanyl (2 μg/kg and thiopentone (4-7 mg/kg, and tracheal intubation was facilitated by vecuronium bromide (0.1 mg/kg. The patient′s right internal jugular vein was cannulated and the Pre Sep™ central venous oximetry catheter was connected to it. Anesthesia was maintained with isoflurane in oxygen and nitrous oxide and intermittent boluses of vecuronium. Intermittent positive-pressure ventilation was provided to maintain normocapnea. After CO 2 pneumoperitoneum, position of the patient was gradually changed to 45° Trendelenburg over 5 min. The robot was then docked and the robot-assisted surgery started. Intraoperative monitoring included central venous pressure (CVP, stroke volume (SV, stroke volume variation (SVV, cardiac output (CO, cardiac index (CI and central venous oxygen saturation (ScvO 2 . Results: After induction of anesthesia, heart rate (HR, SV, CO and CI were decreased significantly from the baseline value (P>0.05. SV, CO and CI further decreased significantly after creating pneumoperitoneum (P>0.05. At the 45° Trendelenburg position, HR, SV, CO and CI were significantly decreased compared with baseline. Thereafter, CO and CI were persistently low throughout the 45° Trendelenburg position (P=0.001. HR at 20 min and 1 h, SV and mean arterial blood pressure

  14. Immediate hemodynamic response to furosemide in patients undergoing chronic hemodialysis.

    Schmieder, R E; Messerli, F H; deCarvalho, J G; Husserl, F E


    To evaluate the effect of furosemide on cardiovascular hemodynamics in patients with end-stage renal failure, we studied ten patients undergoing hemodialysis three times a week. Arterial pressure, heart rate, and cardiac output (indocyanine green dye) were measured in triplicate; total peripheral resistance and central blood volume were calculated by standard formulas. Hemodynamics were determined at baseline and 5, 10, 15, and 30 minutes after intravenous (IV) bolus injection of furosemide 60 mg. Furosemide produced a decrease in central blood volume of -13% +/- 2.2% from pretreatment values (P less than .01) that was most pronounced five minutes after injection, together with a fall in cardiac output (from 6.76 +/- 0.59 to 6.17 +/- 0.52 L/min, P less than .10). Stroke volume decreased with a maximum fall occurring after 15 minutes (from 84 +/- 7 to 79 +/- 7 mL/min, P less than .05), and total peripheral resistance increased (from 15.8 +/- 2.1 to 17.8 +/- 2.3 units, P less than .05) after furosemide. Arterial pressure and heart rate did not change. The decrease in central blood volume reflects a shift of the total blood volume from the cardiopulmonary circulation to the periphery, suggesting dilation of the peripheral venous bed. Thus, even in patients undergoing hemodialysis, furosemide acutely decreases left ventricular preload by venous dilation and should therefore prove to be beneficial in acute volume overload.

  15. Antiangiogenic factors and maternal hemodynamics during intensive hemodialysis in pregnancy.

    Cornelis, Tom; Spaanderman, Marc; Beerenhout, Charles; Perschel, Frank H; Verlohren, Stefan; Schalkwijk, Casper G; van der Sande, Frank M; Kooman, Jeroen P; Hladunewich, Michelle


    We report on a 21-year-old pregnant patient with IgA nephropathy who was initiated on intensive hemodialysis (8 hours of hemodialysis 3 times a week) at a gestational age of 26 weeks on the basis of worsening kidney function resulting in rapidly progressive fatigue and difficulties in metabolic control. Throughout the pregnancy, and while on intensive hemodialysis, 24-hour ambulatory blood pressure control was within the target, and results of weekly 24-hour measurement of central hemodynamics and pulse wave velocity, and of serial levels of circulating (anti-)angiogenic factors were comparable to normal pregnancies. Estimated fetal growth evolved along the 50th percentile, and no polyhydramnios was detected. After induction for a sudden, unexplained increase in blood pressure, she delivered a healthy boy of 2480 g at a gestational age of 36 weeks. This case adds to the expanding literature that supports the use of intensive hemodialysis in pregnant patients with end-stage renal disease and illustrates, for the first time, the potential use of serial (anti-) angiogenic factors and 24-hour measurements of blood pressure and hemodynamic indices in order to facilitate monitoring of these complicated patients.

  16. Role of Hemodynamic Forces in Unruptured Intracranial Aneurysms: An Overview of a Complex Scenario.

    Longo, Marcello; Granata, Francesca; Racchiusa, Sergio; Mormina, Enricomaria; Grasso, Giovanni; Longo, Giuseppe Maria; Garufi, Giada; Salpietro, Francesco M; Alafaci, Concetta


    An understanding of the natural history of unruptured intracranial aneurysms (IAs) has always played a critical role in presurgical or endovascular planning, to avoid possibly fatal events. Size, shape, morphology, and location are known risk factors for rupture of an aneurysm, but morphologic parameters alone may not be sufficient to perform proper rupture risk stratification. We performed a systematic PubMed search and focused on hemodynamics forces that may influence aneurysmal initiation, growth, and rupture. We included 223 studies describing several hemodynamic parameters related to aneurysm natural history. In these studies, different modalities of aneurysm model creation have been used to evaluate flow and to comprehensively analyze the evolution of IAs. Controversy exists about the correlation between these parameters and initiation, growth, rupture risk, or stabilization of the aneurysmal sac. Recent findings have also shown the importance of flow patterns in this process and the relationship between unruptured IA geometry and hemodynamic parameters. The role of hemodynamic forces in evaluation of the natural history of unruptured IAs presents is inherently complex and is still not completely understood. In this complex scenario, although several attempts have been described in the literature, a proper risk rupture stratification and treatment strategy selection based on hemodynamic forces has not yet been created. Further efforts should be made to accomplish this important goal. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Renal perfusion scintiscan

    Renal perfusion scintigraphy; Radionuclide renal perfusion scan; Perfusion scintiscan - renal; Scintiscan - renal perfusion ... supply the kidneys. This is a condition called renal artery stenosis. Significant renal artery stenosis may be ...

  18. Inactivation of extrahepatic vascular Akt improves systemic hemodynamics and sodium excretion in cirrhotic rats.

    Fernández-Varo, G; Melgar-Lesmes, P; Casals, G; Pauta, M; Arroyo, V; Morales-Ruiz, M; Ros, J; Jiménez, W


    Increased activity of the vascular Akt/eNOS signaling pathway is involved in the hemodynamic and renal complications developed by patients and rats with cirrhosis and ascites. This occurs in the setting of impaired Akt/eNOS activity within the cirrhotic liver. Here we assessed the feasibility of selectively inhibiting vascular eNOS without further impairing the intrahepatic activity of this enzyme. Ultimately, we sought to determine whether endothelial transduction of a constitutively inactive mutant of Akt (AA-Akt) improves circulatory function and sodium excretion in cirrhotic rats with ascites. First, we administered recombinant adenoviruses that encode the β-galactosidase gene (β-gal) to 5 control rats and 5 cirrhotic rats with ascites and analyzed their tissue distribution by chemiluminescence. Next, urine samples were obtained from 18 cirrhotic rats with ascites and then the animal randomly received saline or adenoviruses containing the β-gal or the AA-Akt genes. Following a 24-h urine collection period, hemodynamic studies were performed and tissue samples were obtained to analyze Akt and eNOS expressions. No β-gal activity was detected in the liver of cirrhotic rats compared to that of controls. This was paralleled by increased β-gal activity in other territories such as the thoracic aorta. AA-Akt transduction improved systemic hemodynamics, splanchnic perfusion pressure and renal excretory function in comparison with cirrhotic rats transduced with β-gal adenoviruses or receiving saline. Moreover, the AA-Akt transgene did not modify portal pressure. Inactivation of extrahepatic vascular Akt and the concomitant decrease in nitric oxide expression ameliorate systemic hemodynamics and renal excretory function in experimental cirrhosis. Copyright © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  19. Renal replacement therapy in sepsis-induced acute renal failure

    Rajapakse Senaka


    Full Text Available Acute renal failure (ARF is a common complication of sepsis and carries a high mortality. Renal replacement therapy (RRT during the acute stage is the mainstay of therapy. Va-rious modalities of RRT are available. Continuous RRT using convective methods are preferred in sepsis-induced ARF, especially in hemodynamically unstable patients, although clear evidence of benefit over intermittent hemodialysis is still not available. Peritoneal dialysis is clearly inferior, and is not recommended. Early initiation of RRT is probably advantageous, although the optimal timing of dialysis is yet unknown. Higher doses of RRT are more likely to be beneficial. Use of bio-compatible membranes and bicarbonate buffer in the dialysate are preferred. Anticoagulation during dialysis must be carefully adjusted and monitored.

  20. Growth factors and acute renal failure.

    Hirschberg, R; Ding, H


    During acute renal injury, there are alterations in the expression of several growth factors and their receptors in the kidney. The increased expression of several growth factors and/or their receptors at sites of nephron injury suggests important contributions to repair. Exogenous administration of some growth factors, such as IGF-I, EGF and HGF, accelerates recovery of renal function in experimental acute renal failure (ARF). In ARF growth factors act through several mechanisms, which may include altered cell cycle regulation and mitogenesis, differentiation of recovered cells, regulation of apoptosis, improved renal hemodynamics, and others. There is evidence for interactions of growth factors with other growth factors as well as with other genes resulting in complex orchestration of biologic events contributing to recovery from ARF.

  1. Invasive hemodynamic monitoring in the postoperative period of cardiac surgery

    Desanka Dragosavac


    Full Text Available OBJETIVE: To assess the hemodynamic profile of cardiac surgery patients with circulatory instability in the early postoperative period (POP. METHODS: Over a two-year period, 306 patients underwent cardiac surgery. Thirty had hemodynamic instability in the early POP and were monitored with the Swan-Ganz catheter. The following parameters were evaluated: cardiac index (CI, systemic and pulmonary vascular resistance, pulmonary shunt, central venous pressure (CVP, pulmonary capillary wedge pressure (PCWP, oxygen delivery and consumption, use of vasoactive drugs and of circulatory support. RESULTS: Twenty patients had low cardiac index (CI, and 10 had normal or high CI. Systemic vascular resistance was decreased in 11 patients. There was no correlation between oxygen delivery (DO2 and consumption (VO2, p=0.42, and no correlation between CVP and PCWP, p=0.065. Pulmonary vascular resistance was decreased in 15 patients and the pulmonary shunt was increased in 19. Two patients with CI < 2L/min/m² received circulatory support. CONCLUSION: Patients in the POP of cardiac surgery frequently have a mixed shock due to the systemic inflammatory response syndrome (SIRS. Therefore, invasive hemodynamic monitoring is useful in handling blood volume, choice of vasoactive drugs, and indication for circulatory support.




    Full Text Available BACKGROUND: Pneumoperitoneum required for laparoscopic surgeries results in various pathophysiologic changes in the body, especially in the cardiovascular system. Moxonidine is a selective Imidazoline I1-receptor agonist with an I1:α2 affinity ratio of 40:1 to 70:1. Through an action in the Rostral Ventrolateral Medulla (RVLM, where the I1 receptors are situated, it reduces sympathetic outflow and lowers peripheral vascular resistance. BP reduction is not accompanied by any significant change in heart rate or cardiac output. AIMS AND OBJECTIVES: The aim of our study was to evaluate effect of orally administered Moxonidine in attenuating the hemodynamic responses that occur during laparoscopic cholecystectomy. MATERIALS AND METHODS: 50 adult ASA I and II patients scheduled for elective laparoscopic cholecystectomy were selected for this prospective randomized double blinded comparative study. They were randomly allocated to two groups; Moxonidine group and Placebo group. Moxonidine group received oral Moxonidine 0.3 mg at 8 PM the day before surgery and at 8 AM on the day of surgery. Placebo group received a placebo at the same timing as that of the Moxonidine group. RESULTS: When vital parameters were compared significant rise in heart rate, systolic, diastolic and mean blood pressure was noted in the Placebo group following pneumoperitoneum, where as in Moxonidine group the rise was not more than 20% of baseline. CONCLUSION: In conclusion, Moxonidine when administered preoperatively provides perioperative hemodynamic stability in ASA I and II patients undergoing laparoscopic cholecystectomy. It’s other benefits such as absence of reflex tachycardia, preservation of hepatic and renal function makes it a good choice for laparoscopic procedure.

  3. Sub-band denoising and spline curve fitting method for hemodynamic measurement in perfusion MRI

    Lin, Hong-Dun; Huang, Hsiao-Ling; Hsu, Yuan-Yu; Chen, Chi-Chen; Chen, Ing-Yi; Wu, Liang-Chi; Liu, Ren-Shyan; Lin, Kang-Ping


    In clinical research, non-invasive MR perfusion imaging is capable of investigating brain perfusion phenomenon via various hemodynamic measurements, such as cerebral blood volume (CBV), cerebral blood flow (CBF), and mean trasnit time (MTT). These hemodynamic parameters are useful in diagnosing brain disorders such as stroke, infarction and periinfarct ischemia by further semi-quantitative analysis. However, the accuracy of quantitative analysis is usually affected by poor signal-to-noise ratio image quality. In this paper, we propose a hemodynamic measurement method based upon sub-band denoising and spline curve fitting processes to improve image quality for better hemodynamic quantitative analysis results. Ten sets of perfusion MRI data and corresponding PET images were used to validate the performance. For quantitative comparison, we evaluate gray/white matter CBF ratio. As a result, the hemodynamic semi-quantitative analysis result of mean gray to white matter CBF ratio is 2.10 +/- 0.34. The evaluated ratio of brain tissues in perfusion MRI is comparable to PET technique is less than 1-% difference in average. Furthermore, the method features excellent noise reduction and boundary preserving in image processing, and short hemodynamic measurement time.

  4. Computational medical imaging and hemodynamics framework for functional analysis and assessment of cardiovascular structures.

    Wong, Kelvin K L; Wang, Defeng; Ko, Jacky K L; Mazumdar, Jagannath; Le, Thu-Thao; Ghista, Dhanjoo


    Cardiac dysfunction constitutes common cardiovascular health issues in the society, and has been an investigation topic of strong focus by researchers in the medical imaging community. Diagnostic modalities based on echocardiography, magnetic resonance imaging, chest radiography and computed tomography are common techniques that provide cardiovascular structural information to diagnose heart defects. However, functional information of cardiovascular flow, which can in fact be used to support the diagnosis of many cardiovascular diseases with a myriad of hemodynamics performance indicators, remains unexplored to its full potential. Some of these indicators constitute important cardiac functional parameters affecting the cardiovascular abnormalities. With the advancement of computer technology that facilitates high speed computational fluid dynamics, the realization of a support diagnostic platform of hemodynamics quantification and analysis can be achieved. This article reviews the state-of-the-art medical imaging and high fidelity multi-physics computational analyses that together enable reconstruction of cardiovascular structures and hemodynamic flow patterns within them, such as of the left ventricle (LV) and carotid bifurcations. The combined medical imaging and hemodynamic analysis enables us to study the mechanisms of cardiovascular disease-causing dysfunctions, such as how (1) cardiomyopathy causes left ventricular remodeling and loss of contractility leading to heart failure, and (2) modeling of LV construction and simulation of intra-LV hemodynamics can enable us to determine the optimum procedure of surgical ventriculation to restore its contractility and health This combined medical imaging and hemodynamics framework can potentially extend medical knowledge of cardiovascular defects and associated hemodynamic behavior and their surgical restoration, by means of an integrated medical image diagnostics and hemodynamic performance analysis framework.

  5. Evaluation of the relative risk of stroke in patients with hypertension using cerebrovascular hemodynamic accumulative score

    HUANG Jiuyi; WANG Guiqing; GUO Jiping; CAO Yifeng; WANG Yan; YANG Yongju; YU Xuehai


    The relative risk(RR)of stroke in patients with hypertension was evaluated by using synthetic index of cerebrovascular hemodynamics.A total of 7,371 patients with hypertension with ages≥40 years were selected from a population-based cohort study of the risk factors for stroke.The data on the baseline investigation of risk factors,the determination of cerebrovascular hemodynamic parameters (CVHP),and stroke follow-up were analyzed.The RR of stroke in patients with hypertension was evaluated by CVHP scores.Univariate analysis indicated that hypertension,complicated by other risk factors,had significant statistical association with the onset of stroke.RRS for stroke when hypertension complicated with decrease of hemodynamic scores,heart disease,cigarette smoking and alcohol consumption were 4.93(95%CI,3.26-7.45),1.90(95%CI,1.36-2.66),1.99(95%CI,1.42-2.79)and 1.73(95%CI,1.19-2.53)respectively.In multivariate analysis,hemodynamic score,age,sex,cigarette smoking,family history of stroke and systolic blood pressure were selected by the Cox regression for inclusion in the final analysis.Among them,the RR of hemodynamic score was highest.The analysis of doseresponse relationships indicated that when the hemodynamic scores in patients with hypertension were lower than 75 points,the RR of stroke at 75,60,45,30 and 15 points were 2.85,4.43,4.54,5.40 and 9.88,respectively.The risk of stroke in patients with hypertension is closely associated with hemodynamic impairment and the hemodynamic score may be used for quantitative evaluation of relative risks of stroke.

  6. Combined Visualization of Vessel Deformation and Hemodynamics in Cerebral Aneurysms.

    Meuschke, Monique; Voss, Samuel; Beuing, Oliver; Preim, Bernhard; Lawonn, Kai


    We present the first visualization tool that combines patient-specific hemodynamics with information about the vessel wall deformation and wall thickness in cerebral aneurysms. Such aneurysms bear the risk of rupture, whereas their treatment also carries considerable risks for the patient. For the patient-specific rupture risk evaluation and treatment analysis, both morphological and hemodynamic data have to be investigated. Medical researchers emphasize the importance of analyzing correlations between wall properties such as the wall deformation and thickness, and hemodynamic attributes like the Wall Shear Stress and near-wall flow. Our method uses a linked 2.5D and 3D depiction of the aneurysm together with blood flow information that enables the simultaneous exploration of wall characteristics and hemodynamic attributes during the cardiac cycle. We thus offer medical researchers an effective visual exploration tool for aneurysm treatment risk assessment. The 2.5D view serves as an overview that comprises a projection of the vessel surface to a 2D map, providing an occlusion-free surface visualization combined with a glyph-based depiction of the local wall thickness. The 3D view represents the focus upon which the data exploration takes place. To support the time-dependent parameter exploration and expert collaboration, a camera path is calculated automatically, where the user can place landmarks for further exploration of the properties. We developed a GPU-based implementation of our visualizations with a flexible interactive data exploration mechanism. We designed our techniques in collaboration with domain experts, and provide details about the evaluation.

  7. Hemodynamic effects of peri-operative statin therapy in on-pump cardiac surgery patients

    Hinz Jose


    Full Text Available Abstract Background Peri-operative statin therapy in cardiac surgery cases is reported to reduce the rate of mortality, stroke, postoperative atrial fibrillation, and systemic inflammation. Systemic inflammation could affect the hemodynamic parameters and stability. We set out to study the effect of statin therapy on perioperative hemodynamic parameters and its clinical outcome. Methods In a single center study from 2006 to 2007, peri-operative hemodynamic parameters of 478 patients, who underwent cardiac surgery with cardiopulmonary bypass, were measured. Patients were divided into those who received perioperative statin therapy (n = 276; statin group and those who did not receive statin therapy (n = 202; no-statin group. The two groups were compared together using Kolmogorov-Smirnov-Test, Fisher’s-Exact-Test, and Student’s-T-test. A p value  Results There was no significant difference in the preoperative risk factors. Onset of postoperative atrial fibrillation was not affected by statin therapy. Extended hemodynamic measurements revealed no significant difference between the two groups, apart from Systemic Vascular Resistance Index (SVRI . The no-statin group had a significantly higher SVRI (882 ± 206 vs. 1050 ± 501 dyn s/cm5/m2, p = 0.022. Inotropic support was the same in both groups and no significant difference in the mortality rate was noticed. Also, hemodynamic parameters were not affected by different types and doses of statins. Conclusions Perioperative statin therapy for patients undergoing on-pump coronary bypass grafting or valvular surgery, does not affect the hemodynamic parameters and its clinical outcome.

  8. Clinical Implications of Cluster Analysis-Based Classification of Acute Decompensated Heart Failure and Correlation with Bedside Hemodynamic Profiles.

    Ahmad, Tariq; Desai, Nihar; Wilson, Francis; Schulte, Phillip; Dunning, Allison; Jacoby, Daniel; Allen, Larry; Fiuzat, Mona; Rogers, Joseph; Felker, G Michael; O'Connor, Christopher; Patel, Chetan B


    Classification of acute decompensated heart failure (ADHF) is based on subjective criteria that crudely capture disease heterogeneity. Improved phenotyping of the syndrome may help improve therapeutic strategies. To derive cluster analysis-based groupings for patients hospitalized with ADHF, and compare their prognostic performance to hemodynamic classifications derived at the bedside. We performed a cluster analysis on baseline clinical variables and PAC measurements of 172 ADHF patients from the ESCAPE trial. Employing regression techniques, we examined associations between clusters and clinically determined hemodynamic profiles (warm/cold/wet/dry). We assessed association with clinical outcomes using Cox proportional hazards models. Likelihood ratio tests were used to compare the prognostic value of cluster data to that of hemodynamic data. We identified four advanced HF clusters: 1) male Caucasians with ischemic cardiomyopathy, multiple comorbidities, lowest B-type natriuretic peptide (BNP) levels; 2) females with non-ischemic cardiomyopathy, few comorbidities, most favorable hemodynamics; 3) young African American males with non-ischemic cardiomyopathy, most adverse hemodynamics, advanced disease; and 4) older Caucasians with ischemic cardiomyopathy, concomitant renal insufficiency, highest BNP levels. There was no association between clusters and bedside-derived hemodynamic profiles (p = 0.70). For all adverse clinical outcomes, Cluster 4 had the highest risk, and Cluster 2, the lowest. Compared to Cluster 4, Clusters 1-3 had 45-70% lower risk of all-cause mortality. Clusters were significantly associated with clinical outcomes, whereas hemodynamic profiles were not. By clustering patients with similar objective variables, we identified four clinically relevant phenotypes of ADHF patients, with no discernable relationship to hemodynamic profiles, but distinct associations with adverse outcomes. Our analysis suggests that ADHF classification using simultaneous

  9. Prenatal Calcification of the Inferior Vena Cava and Renal Veins in a Normal Neonate

    Daniel Ranch


    Full Text Available Prenatal calcification of the inferior vena cava (IVC and renal veins is a rare condition with unclear etiology and prognosis. It occurs with renal vein thrombosis in utero and is associated with congenital anomalies and abnormal prenatal hemodynamic status. We report a rare case of prenatal IVC and renal vein calcification in a normal neonate without any history of compromised prenatal or perinatal condition, or significant deterioration of kidney function.

  10. Effect of iptakalim hydrochloride on hemodynamics

    Qing-leiZHU; HaiWANG; Wen-binXIAO


    AIM: To study the effect of iptakalim hydrochloride (Ipt) on hemodynamics. METHODS: Effect of Ipt on hemodynamics were studied in anesthetized nomotensive dogs, conscious nomotensive rats (NTR), and stroke prone spontaneously hypertensive rats (SHRsp), respectively. RESULTS: In pentobarbital anesthetized nomotensive dogs, Ipt at doses of 0.125, 0.25, 0.5,1.0, and 2.0 mg/kg iv could dose-dependently decrease blood pressure (BP), with the decrease of systolic BP equivalent

  11. Hemodynamic changes in depressive patients

    MA Ying; LI Hui-chun; ZHENG Lei-lei; YU Hua-liang


    Objective: This study is aimed at exploring the relationship between hemodynamic changes and depressive and anxious symptom in depression patients. Methods: The cardiac function indices including the left stroke index (LSI), ejection fraction (EF), heart rate (HR), diastolic pressure mean (DPM), systolic pressure mean (SPM), left ventricle end-diastolic volume (LVDV), effective circulating volume (ECV), resistance total mean (RTM) and blood flow smooth degree (BFSD) were determined in 65 patients with major depressive disorders and 31 healthy normal controls. The clinical symptoms were assessed with Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA). Results: In patients with depression without anxiety,LSI, EF, LVDV, DPM, SPM, ECV, BFSD were significantly lower than those in controls, while RTM was higher than that in controls. Patients with comorbidity of depression and anxiety showed decreased LVDV, ECV, BFSD, and increased HR in comparison with the controls. The anxiety/somatization factor score positively correlated with LSI, EF, LVDV, but negatively correlated with RTM. There was negative correlation between retardation factor score and DPM, SPM, LVDV. Conclusion: The study indicated that there are noticeable changes in left ventricle preload and afterload, blood pressure, peripheral resistance, and microcirculation in depressive patients, and that the accompanying anxiety makes the changes more complicated.

  12. Numerical simulation of hemodynamic changes during beating-heart surgery : Analysis of the effects of cardiac position alteration in an animal model

    Ferrari, Gianfranco; De Lazzari, Claudio; de Kroon, Thom L.; Elstrodt, Jan M.; Rakhorst, Gerhard; Gu, Y. John


    Hemodynamic instability, mostly due to vertical lifting of the heart, is usually observed during beating-heart surgical procedures. However, some hemodynamic parameters, such as coronary blood flow, are not routinely measured. A digital computer model of the circulation able to simulate and analyze

  13. Changes of choroidal thickness and hemodynamic parameters and their influencing factors in patients with diabetic retinopathy%糖尿病视网膜病变患者脉络膜厚度和血流动力学参数的变化及其影响因素

    徐芳; 赵淼焱; 刘菊


    •AIM: To study the changes of choroidal thickness and hemodynamic parameters in patients with diabetic retinopathy and their influencing factors.•METHODS: From January 2013 to January 2015, 100 patients (100 eyes) with type 2 diabetes were divided into 3 groups:34 patients without diabetic retinopathy ( NDR) , 36 patients with non proliferative diabetic retinopathy ( NPDR) group, and 30 patients with proliferative diabetic retinopathy (PDR). According to the results of OCT, the patients with diabetic retinopathy were divided into 2 groups: diabetic macular edema ( DME ) group ( 28 cases) , and 38 cases without diabetic macular edema. During the same period in our hospital 35 subjects for physical examination were selected as the control group. The hemodynamic parameters of the posterior ciliary artery in different groups of patients at different distance from the center of the macular were compared, analyzing influencing factors.•RESULTS:With the aggravation of diabetic retinopathy, the choroidal thickness in different distance from the center of the macular decreased. The choroidal thickness of NPDR and PDR group were thinner than that of the control group (P0. 05). There was no significant difference in the choroidal thickness between the DME patients and non DME patients (P>0. 05). Pearson correlation analysis showed that there was no significant correlation between choroidal thickness of patients with diabetic retinopathy and diabetic duration, fasting blood glucose, HbA1c, eye axis length, systolic blood pressure and diastolic blood pressure (P>0. 05), but there was a correlation with BCVA (logMAR) (P0.05)。糖尿病视网膜病变合并DME患者和非DME患者距黄斑中心凹不同距离的脉络膜厚度比较,差异无统计学意义( P>0.05)。 Pearson相关性分析显示,糖尿病视网膜病变患者脉络膜厚度与糖尿病病程、空腹血糖、HbA1 c、眼轴长度、收缩压及舒张压均无显著相关性(P>0.05),而与logMAR BCVA

  14. Hemodynamic modelling of BOLD fMRI - A machine learning approach

    Jacobsen, Danjal Jakup


    This Ph.D. thesis concerns the application of machine learning methods to hemodynamic models for BOLD fMRI data. Several such models have been proposed by different researchers, and they have in common a basis in physiological knowledge of the hemodynamic processes involved in the generation...... of the BOLD signal. The BOLD signal is modelled as a non-linear function of underlying, hidden (non-measurable) hemodynamic state variables. The focus of this thesis work has been to develop methods for learning the parameters of such models, both in their traditional formulation, and in a state space...... formulation. In the latter, noise enters at the level of the hidden states, as well as in the BOLD measurements themselves. A framework has been developed to allow approximate posterior distributions of model parameters to be learned from real fMRI data. This is accomplished with Markov chain Monte Carlo...


    A. V. Govorov


    Full Text Available Renal cryoablation is an alternative minimally-invasive method of treatment for localized renal cell carcinoma. The main advantages of this methodology include visualization of the tumor and the forming of "ice ball" in real time, fewer complications compared with other methods of treatment of renal cell carcinoma, as well as the possibility of conducting cryotherapy in patients with concomitant pathology. Compared with other ablative technologies cryoablation has a low rate of repeat sessions and good intermediate oncological results. The studies of long-term oncological and functional results of renal cryoablation are presently under way.

  16. Renal angiomyolipoma

    Holm-Nielsen, P; Sørensen, Flemming Brandt


    lesion. Three cases of renal angiomyolipoma, 2 of which underwent perfusion-fixation, were studied by electron microscopy to clarify the cellular composition of this lesion. In the smooth muscle cells abundant accumulation of glycogen was found, whereas the lipocytes disclosed normal ultrastructural......-specific vesicular structures. These findings suggest a secondary vascular damage, i.e. the thickened vessels may not be a primary, integral part of renal angiomyolipoma. Evidence of a common precursor cell of renal angiomyolipoma was not disclosed. It is concluded that renal angiomyolipoma is a hamartoma composed...

  17. Relaxation oscillation model of hemodynamic parameters in the cerebral vessels

    Cherevko, A. A.; Mikhaylova, A. V.; Chupakhin, A. P.; Ufimtseva, I. V.; Krivoshapkin, A. L.; Orlov, K. Yu


    Simulation of a blood flow under normality as well as under pathology is extremely complex problem of great current interest both from the point of view of fundamental hydrodynamics, and for medical applications. This paper proposes a model of Van der Pol - Duffing nonlinear oscillator equation describing relaxation oscillations of a blood flow in the cerebral vessels. The model is based on the patient-specific clinical experimental data flow obtained during the neurosurgical operations in Meshalkin Novosibirsk Research Institute of Circulation Pathology. The stability of the model is demonstrated through the variations of initial data and coefficients. It is universal and describes pressure and velocity fluctuations in different cerebral vessels (arteries, veins, sinuses), as well as in a laboratory model of carotid bifurcation. Derived equation describes the rheology of the ”blood stream - elastic vessel wall gelatinous brain environment” composite system and represents the state equation of this complex environment.

  18. Values of hemodynamic variation in response to passive leg raising in predicting exercise capacity of heart failure with preserved ejection fraction.

    Zhou, Hong-Lian; Ding, Ling; Mi, Tao; Zheng, Kai; Wu, Xiao-Fen; Wang, Jing; Liu, Meng-Ying; Zhang, Le; Zhang, Cun-Tai; Quan, Xiao-Qing


    In heart failure patients with preserved ejection fraction, their hemodynamic parameters usually change when they are from recumbent to passive leg raising. The authors designed this study to investigate the relationship between hemodynamic parameters measured by impedance cardiography (ICG) and 6-minute walk distance (6MWD) of heart failure with preserved ejection fraction (HFPEF). We recruited 49 subjects with HFPEF in the study, and all the subjects were separated into 2 groups: the patients whose hemodynamic parameters rose after passive leg raising were in group 1 (n = 26) and the patients whose hemodynamic parameters did not rise after passive leg raising were in group 2 (n = 23). Our study then compared the 6MWD, left ventricular ejection fraction, and plasma NT-pro-brain natriuretic peptide between the 2 groups. Group 1 had significantly longer 6MWD than group 2 (515.38 ± 24.97 vs 306.39 ± 20.20 m; P = 0.043). Hemodynamic parameters measured by ICG significantly correlated with 6MWD in both groups. Patients whose hemodynamic parameters rose in response to passive leg raising were more likely to have better exercise capacity. Hemodynamic variation in response to passive leg raising measured by ICG may be more sensitive in predicting exercise capacity of patients with HFPEF.

  19. Renal cancer

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.


    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all acknowle

  20. Renal fallure


    920705 Endothelin and acute renal failure:study on their relationship and possiblemechanisms. LIN Shanyan(林善锬), et al.Renal Res Lab, Huashan Hosp, Shanghai MedUniv, Shanghai, 200040. Natl Med J China 1992;72(4): 201-205. In order to investigate the role of endothelin

  1. Renal cancer.

    Corgna, E.; Betti, M.; Gatta, G.; Roila, F.; Mulder, P.H.M. de


    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  2. Renal cancer

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.


    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  3. Renal failure in patients with left ventricular assist devices.

    Patel, Ami M; Adeseun, Gbemisola A; Ahmed, Irfan; Mitter, Nanhi; Rame, J Eduardo; Rudnick, Michael R


    Implantable left ventricular assist devices (LVADs) are increasingly being used as a bridge to transplantation or as destination therapy in patients with end stage heart failure refractory to conventional medical therapy. A significant number of these patients have associated renal dysfunction before LVAD implantation, which may improve after LVAD placement due to enhanced perfusion. Other patients develop AKI after implantation. LVAD recipients who develop AKI requiring renal replacement therapy in the hospital or who ultimately require long-term outpatient hemodialysis therapy present management challenges with respect to hemodynamics, volume, and dialysis access. This review discusses the mechanics of a continuous-flow LVAD (the HeartMate II), the effects of continuous blood flow on the kidney, renal outcomes of patients after LVAD implantation, dialysis modality selection, vascular access, hemodynamic monitoring during the dialytic procedure, and other issues relevant to caring for these patients.

  4. Arteriovenous fistulas aggravate the hemodynamic effect of vein bypass stenoses

    Nielsen, T G; Djurhuus, C; Pedersen, Erik Morre;


    PURPOSE: The purpose of this study was to assess the impact of arteriovenous fistulas combined with varying degrees of stenosis on distal bypass hemodynamics and Doppler spectral parameters. METHODS: In an in vitro flow model bypass stenoses causing 30%, 55%, and 70% diameter reduction were induced...... 10 cm upstream of a fistula with low outflow resistance. Flow and intraluminal pressure were measured proximal to the stenosis and downstream of the fistula. The waveform parameters peak systolic velocity, end-diastolic velocity, pulsatility index, and pulse rise time were determined from midstream...... Doppler spectra obtained 10 cm downstream of the fistula. All measurements were carried out with open and clamped fistula. RESULTS: At 30% diameter reducing stenosis opening of the fistula induced a 12% systolic pressure drop across the stenosis but had no adverse effect on the Doppler waveform parameters...

  5. [Treatment of acute renal failure--concepts and controversies. 2. Extracorporeal renal replacement and peritoneal dialysis].

    Gabriel, A; Müller, E; Tarnow, J


    Therapy of prolonged acute renal failure regularly requires a renal replacement therapy. This can be achieved by different extracorporal renal replacement therapies (ERRT) or by peritoneal dialysis. ERRT are classified according to the physical principle underlying toxin elimination as hemodialysis (diffusion) and hemofiltration (convection). Another classification refers to intermittent or continuous application modes. Biocompatibility of membranes is judged according to their activation of the complement system. Prospective randomized studies did not consolidate the assumptions about the benefit of particular modalities proposed on theoretical foundations. Mortality, duration and complication rates of acute renal failure are not significantly decreased by use of biocompatible membranes. Continuous modalities are not generally preferable but optimize treatment in hemodynamically unstable patients, in whom they endorse fluid balancing and maintenance of sufficient arterial blood pressure. The use of demanding hemofiltration techniques for cytokine removal should be limited to clinical studies. The effects of ERRT-"intensity" and the best timing for initiation of ERRT have not been evaluated sufficiently. The choice of the ERRT modality is subject to clinical judgement (criterion: hemodynamic situation), practical aspects (criteria: availability of equipment and handling experience), and costs. Prior to their general use new and expensive technical modalities and membrane types should be thoroughly evaluated in studies with regard to outcome-related aspects such as patient survival and preservation of renal function.

  6. Mathematical modelling of transport of a non-diffusible indicator to estimate renal blood supply

    Gelfand, I.N.; Narkevich, V.Y.


    A new method is recommended to interpret the results in radionuclide studies of renal blood flow with the mathematical modelling of transport of a non-diffusible indicator in the blood vessels. The analytic proportions are ascertained between mean transit time of indicator, mean retention time (both at impulse influence and at occurence of any signal at the input) for different forms of transport function, and impulse-shaped retention function of the studied physiological system. By means of external measuring of radioactivity this allows to estimate the mean transit time of the indicator by the studied element of hemodynamics, an index, used in classically physiological studies. The recommended system of physiological indices describes the statistic and dynamic parameters of the vessel network in each kidney adequately. The use of this method showed its efficiency on principle in 7 healthy persons and in 4 patients with clinically manifest kidney diseases. (author).

  7. Acute renal failure in premature neonates

    Doronjski Aleksandra


    Full Text Available Background/Aim. Hemodynamic stress is the leading cause of acute renal failure (ARF in premature neonates. Incidence of ARF in this population is between 8 and 24%. The aim of this study was to determine the frequency of presence of ARF in premature neonates, as well as its impact on their survival. Methods. A retrospective study of 114 premature neonates [(gestational age, GA less than 37 gestation weeks (gw] admitted to the Intensive Care Unit (ICU at the Pediatric Clinic, Institute of Child and Youth Healthcare of Vojvodina in 2007 was conducted. Serum creatinine, urea and bilirubine were determined on the 3rd day of life in 65 newborns who met inclusion criteria. ARF was diagnosed in 16 newborns (n=16/65; 25%. Results. The premature neonates with ARF had significantly lower GA [<28 gw - 8/16 (50% vs. 5/49 (10%; p < 0.05], birth weight (BW (1 265 g vs. 1615 g; p < 0.05 and systolic blood pressure (43.37 mm Hg vs. 52.7 mmHg; p < 0.05 than ones without ARF. Non-olyguric ARF was diagnosed in 62% of newborns with ARF (n=10/16, while the rest had the olyguric type (n = 6/16; 38%. Twenty-five percent of premature neonates with ARF (n = 4/16 died in contrast to 10% of premature neonates without ARF (n = 5/49. ARF was treated conservatively in all but 3 cases when peritoneal dialysis was performed. Renal function has recovered completely in all of the survivors. In order to determine their predictivity in relation to ARF, following parameters were analyzed: GA, BW < 1 500 g, presence of concomitant sepsis and intracranial hemorrhage grade III/IV. BW < 1 500 g demonstrated the highest sensitivity (se 0.75, while GA < 28 gw, sepsis and intracranial hemorrhage grade III/IV showed high specificity (sp = 0.90, 0.89 0.88, respectively. Conclusion. Acute renal failure frequently occurs in population of premature neonates and requires meticulous fluid and electrolyte balance, especially in the case of low birth weight and extreme immaturity.

  8. Hemodynamic Disorders in Severe Brain Injury

    Yu. A. Churlyaev


    Full Text Available This study was undertaken to determine the general regularities of hemodynamic disorders in relation to the severity of brain damage for the subsequent development of pathogenetically warranted methods for their correction in the complex of intensive care for severe brain injury. Studies were made in 67 victims, by using neurophysiological studies (electroencephalography, studies of acoustical stem-evoked potentials and somatosensory stem-evoked potentials, computed tomography and magnetic resonance imaging. Central hemodynamics was studied by a Sirecust 1260 monitoring system using Swan-Ganz catheters and thermodilution. The overall condition of the victims was regarded as very bad. Loss of consciousness was 8-4 scores by the Glasgow coma scale. The studies have indicated that the victims in whose clinical picture the signs of compression of the cerebral hemispheres dominate over those of the latter’s contusion develop a hemodynamic reaction by the normodynamic type. The hyperdynamic type of hemodynamic disorder develops in cerebral hemispheric and diencephalic lesions with a parallel increase in oxygen transport and uptake; and in severe brain injury, lower brain stem damages are accompanied by hemodynamic disorder by the hypodynamic type with a reduction in oxygen transport and uptake.

  9. Normal Doppler velocimetry of renal vasculature in Persian cats.

    Carvalho, Cibele F; Chammas, Maria C


    /s(2). The mean renal-interlobar artery ratio was 1.45±0.57. The RI values obtained in this study were similar to values reported in the literature. Some conditions that lead to a decrease in compliance and to an increase in vascular resistance can affect the Doppler spectral waveforms without changes in RI. To our knowledge, there are no studies that were directed toward to the normal ESA values of the renal vasculature in Persian cats. This study introduced a new ratio between the PSV of the RA and the IA. This index was developed based on the well-known effects of Doppler on the detection of stenosis, regardless of the cause. Further studies are necessary to verify the hemodynamic behavior of this index under pathological conditions in cats as well as the effect of aging, nephropathies and systemic pressure on Doppler velocimetric parameters.

  10. Intraoperative goal directed hemodynamic therapy in noncardiac surgery: a systematic review and meta-analysis

    Javier Ripollés

    Full Text Available Abstract Background: The goal directed hemodynamic therapy is an approach focused on the use of cardiac output and related parameters as end-points for fluids and drugs to optimize tissue perfusion and oxygen delivery. Primary aim: To determine the effects of intraoperative goal directed hemodynamic therapy on postoperative complications rates. Methods: A meta-analysis was carried out of the effects of goal directed hemodynamic therapy in adult noncardiac surgery on postoperative complications and mortality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. A systematic search was performed in Medline PubMed, Embase, and the Cochrane Library (last update, October 2014. Inclusion criteria were randomized clinical trials in which intraoperative goal directed hemodynamic therapy was compared to conventional fluid management in noncardiac surgery. Exclusion criteria were trauma and pediatric surgery studies and that using pulmonary artery catheter. End-points were postoperative complications (primary and mortality (secondary. Those studies that fulfilled the entry criteria were examined in full and subjected to quantifiable analysis, predefined subgroup analysis (stratified by type of monitor, therapy, and hemodynamic goal, and predefined sensitivity analysis. Results: 51 RCTs were initially identified, 24 fulfilling the inclusion criteria. 5 randomized clinical trials were added by manual search, resulting in 29 randomized clinical trials in the final analysis, including 2654 patients. A significant reduction in complications for goal directed hemodynamic therapy was observed (RR: 0.70, 95% CI: 0.62-0.79, p < 0.001. No significant decrease in mortality was achieved (RR: 0.76, 95% CI: 0.45-1.28, p = 0.30. Quality sensitive analyses confirmed the main overall results. Conclusions: Intraoperative goal directed hemodynamic therapy with minimally invasive monitoring decreases postoperative complications in noncardiac

  11. Ecocardiografia-doppler e parâmetros hemodinâmicos em cardiopatias congênitas com hiperfluxo pulmonar Ecocardiografia-doppler y parámetros hemodinámicos en cardiopatías congénitas con hiperflujo pulmonar Doppler echocardiography and hemodynamic parameters in congenital heart disease with increased pulmonary flow

    Zilma Verçosa de Sá Ribeiro


    áficos relacionados al flujo sistólico pulmonar y sistémico y al flujo en la vena pulmonar fueron relacionados a datos hemodinámicos en 30 pacientes consecutivos con defectos septales cardíacos (edad entre 4 meses y 58 años, mediana 2,2 años; presión arterial pulmonar media entre 16 y 93 mmHg. RESULTADOS: Las variables integral velocidad-tiempo del flujo sistólico en la vía de salida del ventrículo derecho (VTIVSVD > 22 cm y del flujo en la vena pulmonar (VTIVP > 20 cm fueron predictivas de niveles RVP/RVS 27 cm y VTIVP > 24 cm, la especificidad fue superior a 0,90 y la razón de chances 2,29 y 4,47 respectivamente. La razón entre los flujos pulmonar y sistémico (Qp/Qs > 2,89 y > 4,0, estimaciones ecocardiográficas fue útil para la predicción de valores Qp/Qs > 3,0 por cateterismo (especificidad de 0,78 y 0,91, razón de chances 1,14 y 2,97, respectivamente. CONCLUSIÓN: En portadores de defectos septales cardíacos, la ecocardiografía-Doppler es capaz de identificar aquellos en situación de aumento de flujo y bajos niveles de resistencia vascular pulmonar.BACKGROUND: The prediction of pulmonary hemodynamic data from non-invasive assessment could exempt some patients with congenital cardiac septal defects from preoperative invasive assessment (catheterization. OBJECTIVE: To determine, in simultaneous assessment, whether data obtained from Doppler echocardiography could predict aspects of pulmonary hemodynamics in such patients. METHODS: Echocardiographic parameters related to systolic and systemic pulmonary flow and pulmonary venous flow were related to hemodynamic data in 30 consecutive patients with cardiac septal defects (aged 4 months to 58 years, median 2.2 years, mean pulmonary artery pressure between 16 and 93 mmHg. RESULTS: The velocity-time integrals of systolic flow in right ventricle outflow tract (VTI RVOT > 22 cm and pulmonary venous flow (VTI VP > 20 cm predicted PVR/SVR 27 cm and VTI PV > 24 cm values, the specificity was higher than 0.90 and odds

  12. 腹腔镜与开放手术在肾上腺嗜铬细胞瘤切除术中血流动力学变化的对比研究%Comparative Study of Hemodynamic Parameters Between Laparoscopic and Open Adrenalectomy for Adrenal Pheochromocytoma

    金亿里; 汪朔; 周长春; 卢大乔; 熊冰; 傅军红


    Objective To study the effects of carbon dioxide pneumoperitoneum and tumor manipulation on the intraoperative hemodynamic parameters in laparoscopy for adrenal pheochromocytoma . Methods We retrospectively analyzed data of 101 patients with pheochromocytoma from April 2004 to May 2013.The group A ( n =49 ) received laparoscopic and the group B ( n =52 ) underwent open surgery .The changes of artery systolic pressure ( SP) , diastolic pressure ( DP) , and heart rate ( HR) in two groups at time points of intubation , pneumoperitoneum establishment/beginning of surgery , mobilizing tumor , after tumor resection , and returning to the recovery room were recorded .The incidence of intraoperative hemodynamic instability ( defined as an intraoperative hypertensive crisis , tachycardia , or hypotension in at least one of three conditions ) , incidence of tachycardia ( HR >100 bpm ) , incidence of hypertensive crisis ( SP >180 mm Hg), incidence of hypotension ( SP 0.05).The incidences of intraoperative hemodynamic instability, tachycardia, hypertensive crisis, and hypotension were not significantly different between the two groups (P>0.05).The group A had shorter operative time [(99.4 ±36.2) min vs.(154.5 ±75.0) min, t=-4.751, P=0.000], less intraoperative blood loss [50 (10-1300) ml vs.300 (50-10 000) ml, Z=-6.529, P=0.000], shorter hospital stay [(5.8 ±1.9) d vs. (10.8 ±4.6) d, t=-7.188, P=0.000] as compared with the group B . Conclusions Carbon dioxide pneumoperitoneum is well tolerated in patients with pheochromocytoma . Laparoscopic adrenalectomy for pheochromocytoma does not increase the risks as compared with open surgery . Having advatages of minimal invasion and quick recovery , laparoscopic adrenalectomy for pheochromocytoma should be considered as the first choice .%目的:探讨气腹和腹腔镜操作对肾上腺嗜铬细胞瘤术中血流动力学的影响。方法回顾性分析2004年4月~2013年5月手术治疗嗜铬细胞瘤101例

  13. The value of color doppler ultrasonography in detecting the hemodynamic changes of renal artery before and after drug treatment in severe preeclampsia pregnant women%彩超评价重度子痫前期孕妇药物治疗前后肾动脉血流动力学变化的应用价值

    陈小聪; 徐立新; 潘高云; 朱张茜; 张红萍


    目的:应用彩色多普勒超声检测妊娠高血压疾病重度子痫前期孕妇药物治疗前后肾动脉血流的参数变化特点,评价其临床应用价值.方法:以正常孕妇100例为对照组,选取经临床确诊的30例重度子痫前期孕妇作为治疗前组,以该病例组药物治疗后作为治疗后组.采用SEQUOIA 512型超声诊断仪、阿洛卡a5型超声诊断仪,探头频率3.5~5.0 MHz,观察各组肾内结构,应用脉冲多普勒测量各组孕妇肾叶间动脉(IRA)收缩期血流峰值流速(PSV)、舒张末期血流流速(EDV)、加速时间(AT)、阻力指数(RI)、PSV/EDV (S/D).结果:治疗前组PSV (28.72±1.21) m/s、EDV (6.78±2.13)m/s明显低于对照组和治疗后组;RI (0.75±0.05),AT (0.10±0.04)s,S/D(3.76±0.22)明显高于对照组和治疗后组,差异有统计学意义(P< 0.05).结论:多普勒超声检查评价重度子痫前期孕妇药物治疗前后肾动脉血流参数变化,重复性强,为临床诊断和治疗重度子痫提供了重要的依据,具有较高的临床应用价值.%Objective: To investigate the characteristics of the parameter changes of renal artery blood flow before and after drug treatment in pregnancy-induced hypertension and severe eclampsism pregnant women by color doppler ultrasonography, and evaluate its clinical application value. Methods: 100 normal pregnant women were selected as the control group. 30 cases of severe eclampsism pregnant women were selected as pretherapy group. The same 30 women in pretherapy group after medical treatment were taken as post-treatment group. Ultrasonography studies were performed with Acuson Sequoia 512 and ALOKA a5 equipment, probe frequency 3.5-5.0 MHz. Observed the inner structures of kidneys of all gravida. Measured the peak systolic velocity (PSV), end diastolic velocity (EDV), acceleration time (AT), resistance index (RI), peak systolic velocity and end-diastolic maximum velocity ratio (S/D) of interlobar renal artery (IRA) of all

  14. Effects of different vasopressors on hemodynamics in patients undergoing orthotopic liver transplantation

    ZHANG Li-ping; LI Min; YANG Lu


    Background The hyperdynamic circulatory state in end-stage liver disease is similar to the hemodynamic state in endotoxic shock. Recent research indicated that proper use of norepinephrine (NE) in patients with endotoxic shock could improve the perfusion of visceral organs and raise the survival rate. In this study, dopamine (DA) or NE combined with DA was infused during the orthotopic liver transplantation (OLT) to observe and compare their effects on hemodynamics, oxygenation, and renal function during different stages of the operation. Methods Thirty American Society of Anesthesiology (ASA) Ⅲ-Ⅳ patients undergoing OLT were randomly divided into group DA and group NE with 15 patients in each group. Vasopressors were infused after induction of anesthesia. DA was infused in group DA; DA and NE in group NE. Data of hemodynamics, oxygenation and renal function were collected after induction, 1 hour in preanhepatic, anhepatic, neohepatic phase and at the end of operation.Results Heart rate(HR) and mean arterial pressure (MAP) of the two groups were stable. In anhepatic phase, central venous pressure(CVP), mean pulmonary arterial pressure(MPAP), pulmonary arterial wedge pressure(PAWP), cardiac output (CO), and cardiac index (CI) decreased, whereas systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI) increased significantly (P<0.05). The hemodynamic variables of group NE were more stable than that of group DA. Pulmonary vascular resistance(PVR), pulmonary vascular resistance index(PVRI), power of hydrogen(pH), and mixed venous oxygen saturation (SvO2) had no significant changes. Oxygen delivery (DO2) and oxygen consumption(VO2) decreased during anhepatic phase (P<0.05), but lactic acid (LAC)increased since anhepatic phase. Blood urea nitrogen (BUN) maintained relatively stable during different phases. Group NE had more urine output (F=4.733, P=0.039). Conclusions During OLT, both DA and NE combined with DA can maintain hemodynamics stable

  15. Serum Endocan Levels Associated with Hypertension and Loss of Renal Function in Pediatric Patients after Two Years from Renal Transplant

    de Souza, Livia Victorino; Oliveira, Vanessa; Laurindo, Aline Oliveira; Huarachı, DelmaRegına Gomes; Nogueira, Paulo Cesar Koch; Feltran, Luciana de Santis; Medina-Pestana, José Osmar


    Endocan is an important biomarker of inflammation and endothelial dysfunction that increases in association with several chronic diseases. Few published data have described the role of endocan in pediatric renal transplant (RT) patients. We evaluated the endocan concentrations in 62 children who underwent renal transplantation and assessed their relationships with the patients' blood pressure and loss of renal function. The endocan levels were significantly elevated in the pediatric RT patients who had hypertension and a loss of renal function. We determined positive correlations between the endocan concentrations and the hemodynamic variables (systolic blood pressure: r = 0.416; P = 0.001; pulse pressure: r = 0.412; P = 0.003). The endocan levels were inversely correlated with the estimated glomerular filtration rate (r = −0.388; P = 0.003). An endocan cutoff concentration of 7.0 ng/mL identified pediatric RT patients who had hypertension and a loss of renal function with 100% sensitivity and 75% specificity. In conclusion, the endocan concentrations were significantly elevated in pediatric RT patients who had both hypertension and a loss of renal function. The correlations between the endocan levels and the hemodynamic variables and the markers of renal function strengthen the hypothesis that it is an important marker of cardiorenal risk. PMID:28083150

  16. Cerebral hemodynamics: concepts of clinical importance

    Edson Bor-Seng-Shu


    Full Text Available Cerebral hemodynamics and metabolism are frequently impaired in a wide range of neurological diseases, including traumatic brain injury and stroke, with several pathophysiological mechanisms of injury. The resultant uncoupling of cerebral blood flow and metabolism can trigger secondary brain lesions, particularly in early phases, consequently worsening the patient's outcome. Cerebral blood flow regulation is influenced by blood gas content, blood viscosity, body temperature, cardiac output, altitude, cerebrovascular autoregulation, and neurovascular coupling, mediated by chemical agents such as nitric oxide (NO, carbon monoxide (CO, eicosanoid products, oxygen-derived free radicals, endothelins, K+, H+, and adenosine. A better understanding of these factors is valuable for the management of neurocritical care patients. The assessment of both cerebral hemodynamics and metabolism in the acute phase of neurocritical care conditions may contribute to a more effective planning of therapeutic strategies for reducing secondary brain lesions. In this review, the authors have discussed concepts of cerebral hemodynamics, considering aspects of clinical importance.

  17. Renal teratogens.

    Morgan, Thomas M; Jones, Deborah P; Cooper, William O


    In utero exposure to certain drugs early in pregnancy may adversely affect nephrogenesis. Exposure to drugs later in pregnancy may affect the renin-angiotensin system, which could have an impact on fetal or neonatal renal function. Reduction in nephron number and renal function could have adverse consequences for the child several years later. Data are limited on the information needed to guide decisions for patients and providers regarding the use of certain drugs in pregnancy. The study of drug nephroteratogenicity has not been systematized, a large, standardized, global approach is needed to evaluate the renal risks of in utero drug exposures.

  18. Dilemma of Renal Disease in Elderly

    El Essawy Abdel


    Full Text Available The aging process results in profound anatomic and functional changes in a number of human body systems. Changes in kidney function with normal aging are the most dramatic of any human organ or organ system. These include anatomical, physiological, hemodynamic and immunological changes. Increased propensities of systemic diseases and exposure to poly-pharmacy of the aged group have an additive deleterious effect. The aforementioned changes have its implications on clinical presentations, management and prognosis of all renal diseases in elderly. Atypical presentation, more frequent and longer course are the characteristics of acute renal failure in this age group. Also, presentation of glomerular diseases, clinical course, prognosis, decision of performing a renal biopsy and use of immunosuppressive drugs in elderly specially those subgroup above 80 years of age are still a big challenges that needs a consensus and standardization.

  19. Hemodynamics of Stent Implantation Procedures in Coronary Bifurcations: an in vitro study

    Brindise, Melissa C; Burzotta, Francesco; Migliavacca, Francesco; Vlachos, Pavlos P


    Stent implantation in coronary bifurcations presents unique challenges and currently there is no universally accepted stent deployment approach. Despite clinical and computational studies, to date, the effect of each stent implantation method on the coronary artery hemodynamics is not well understood. In this study the hemodynamics of stented coronary bifurcations under pulsatile flow conditions were investigated experimentally. Three implantation methods, provisional side branch (PSB), culotte (CUL), and crush (CRU), were investigated using time-resolved particle image velocimetry (PIV) to measure the velocity fields. Subsequently, hemodynamic parameters including wall shear stress (WSS), oscillatory shear index (OSI), and relative residence time (RRT) were calculated and the pressure field through the vessel was non-invasively quantified. The effects of each stented case were evaluated and compared against an un-stented case. CRU provided the lowest compliance mismatch, but demonstrated detrimental stent in...

  20. Metabolic and hemodynamic evaluation of brain metastases from small cell lung cancer with positron emission tomography

    Lassen, U; Andersen, P; Daugaard, G


    for studies of metabolic and hemodynamic features. This study was performed to determine regional cerebral metabolic rate of glucose (rCMRglu), regional cerebral blood flow (rCBF), and regional cerebral blood volume (rCBV) in brain metastases from small cell lung cancer and the surrounding brain. Tumor r......CMRglu, rCBF, and rCBV exerted a broad variability, but were higher than the corresponding values in white matter and higher than or similar to those of gray matter. Tumor rCMRglu and rCBF were highly correlated (P metabolic or hemodynamic parameters...... was not observed. Other methods for noninvasive in vivo analysis of tumor hemodynamics are needed, especially for discrimination between tumor necrosis and hypoxia....

  1. The impact of deformation of an aneurysm model under pulsatile flow on hemodynamic analysis.

    Kawakami, T; Takao, H; Ichikawa, C; Kamiya, K; Murayama, Y; Motosuke, M


    Hemodynamic analysis of cerebral aneurysms has been widely carried out to clarify the mechanisms of their growth and rupture. In several cases, patient-specific aneurysm models made of transparent polymers have been used. Even though periodic changes in aneurysms due to the pulsation of blood flow could be important, the deformation of the model geometry and its effect on hemodynamic evaluation has not been fully investigated. In addition, the fabrication accuracy of aneurysm models has not been evaluated even though it may affect the hemodynamic parameters to be analyzed. In this study, the fabrication accuracy of a silicone aneurysm model was investigated. Additionally, the deformation of the model under pulsatile flow as well as its correlation with flow behavior was evaluated. Consequently, a fabrication method for an aneurysm model with high accuracy was established and the importance of the wall thickness of the model was also specified.

  2. [Hemodynamic evaluation of the patient with microvarices].

    Alvarez Sánchez, J A; Vega Gómez, M E; Rodríguez Lacaba, B; Martínez Griñán, M A


    The present study included 21 lower limbs with micro varicosities, 56 lower limbs with retrograde flow-varicosities (positive Rivlin) and 35 health lower limbs. Technics used for diagnosis were: Doppler ultrasonography and strain gauge plethysmography. We found a higher incidence of valvular failure on the varicose patients with retrograde flow (showing changes on their viscoelastic features of their venous walls). On the contrary, patient with microvaricosities showed an hemodynamics similar to the healty patient: we did not found any difference on the variables analyzed between the two groups. We conclude that the presence of microvaricosities has no influence on the analyzed hemodynamic parametres.

  3. Sarcoidose renal



    Full Text Available Em uma mulher de 62 anos, branca, em avaliação pré-operatória de facectomia, foram detectadas alterações urinárias, tendo sido firmados os diagnósticos de calculose renal esquerda e exclusão renal homolateral. No pré-operatório da nefrectomia foram evidenciados processo pulmonar intersticial bilateral e adenopatia torácica, cuja investigação foi adiada para após a cirurgia. No rim retirado foram detectados granulomas epitelióides não necrotizantes, o mesmo ocorrendo posteriormente em biópsia transbrônquica. A paciente foi tratada com metilprednisolona, com discreta melhora pulmonar, o que não ocorreu com a função renal. O diagnóstico final foi de sarcoidose com envolvimento pulmonar, ganglionar torácico e renal.

  4. Renal failure


    930150 Epidermal growth factor and its recep-tor in the renal tissue of patients with acute re-nal failure and normal persons.LIU Zhihong(刘志红),et al.Jinling Hosp,Nanjing,210002.Natl Med J China 1992;72(10):593-595.Epidermal growth factor(EGF)and its receptor(EGF-R)were identified by immunohis-tochemical method(4 layer PAP)in the renaltissue specimens obtained from 11 normal kid-neys and 17 cases of acute renal failure(ARF).The quantitative EGF and EGF-R in the tissuewere expressed as positive tubules per mm~2.The amount of EGF and EGF-R in renal tissue

  5. Non-hemodynamic predictors of blood pressure in recreational sport ...

    Non-hemodynamic predictors of blood pressure in recreational sport practitioners in ... that regular physical activity is an efficient means to control high blood pressure. ... structures can be effective in managing hemodynamic health problems.

  6. Renal failure


    950351 Serum erythropoietin levels in chronic renalinsufficiency.ZHAI Depei(翟德佩),et al.DeptNephrol.General Hosp,Tianjin Med Univ,Tianjin,300000.Tianjin Med J 1995;23(1):19-21.Patients with chronic renal insufficiency(CRI) areoften associated with anemia.The deficiency of EPOproduction in the kidney is thought to be a key factorin the pathogenesis of renal anemia.Serum erythropoi-

  7. Renal failure


    2008463 Protective effect of recombination rat augmenter of liver regeneration on kidney in acute renal failure rats. TANG Xiaopeng(唐晓鹏), et al. Dept Nephrol, 2nd Affili Hosp Chongqing Med Univ, Chongqing 400010.Chin J Nephrol 2008;24(6):417-421. Objective To investigate the protective effects of recombination rat augmenter of liver regeneration (rrALR) on tubular cell injury and renal dysfunction

  8. Renal Hemangiopericytoma

    İbrahim Halil Bozkurt


    Full Text Available Hemangiopericytoma is an uncommon perivascular tumor originating from pericytes in the pelvis, head and tneck, and the meninges; extremely rarely in the urinary system. We report a case of incidentally detected renal mass in which radiologic evaluation was suggestive of renal cell carcinoma. First, we performed partial nephrectomy, and then, radical nephrectomy because of positive surgical margins and the pathological examination of the surgical specimen that revealed a hemangiopericytoma. No additional treatment was administered.

  9. The effect of continuous hyperthermic peritoneal perfusion in patients with pseudomyxoma peritoneal on respiratory function, hemodynamics and metabolism parameters%术中腹腔内持续热灌注化疗术对腹腔假黏液瘤患者围术期呼吸力学、血流动力学及生化代谢的影响

    杨占民; 郑翔丽; 梁汉生; 陶德强; 付强; 张古月


    Objective To evaluate the effects of continuous hyperthermic peritoneal perfusion (CHPP) on respirato-ry, cardiovascular system and biochemical parameters. Methods Twenty ASAⅠ~Ⅲ patients underwent cytoreductive surgery followed by CHPP were involved. The respiratory function, hemodynamics and biochemical parameters were recorded during the whole procedure. Results The nose temperature (T) increased significantly during CHPP. Respiratory function changed markedly, and PCO2 raise significantly 15 min after CHPP. Heart rate increased during CHPP and re-turned to (92.8 ±12.6) bpm (P< 0.05) after CHPP. During CHPP, the mean artery pressure decreased significantly (P<0.05), meanwhile, CVP also increased significantly, which returned to normal when CHPP was ended. For biochemi-cal metabolism, the blood glucose level changed significantly after CHPP, so it should be necessary to use insulin to con-trol blood glucose level before CHPP. Along with the CHPP, the dosage of insulin increased. After CHPP, the levels of blood glucose began to fall, during CHPP, plasma potassium and sodium ion concentration decreased, pH, BE and HCO 3-also decreased significantly. During CHPP, the increase of HR had good relationship with the change of blood temperature (r=0.976, P<0.05). Conclusion During CHPP, the hemodynamic and biochemical parameters change significantly. It is necessary to monitor and manage during anesthesia to ensure the safety of patients.%目的:观察腹腔内持续热灌注(continuous hyperthermic peritoneal perfusion, CHPP)对腹腔假黏液瘤手术患者呼吸力学、血流动力学及生化指标的影响。方法 ASAⅠ~Ⅲ级择期腹腔假黏液瘤手术患者20例,吻合口缝合完毕后进行CHPP。手术和热化疗过程中进行呼吸力学、血流动力学及生化代谢监测。结果 CHPP过程中颅脑温(鼻咽温)增高明显(P<0.05),CHPP后30 min颅脑温依然显著增高,气道峰压(Ppeak)增高

  10. 普萘洛尔联合5-单硝酸异山梨酯对肝硬化门静脉高压血流动力学参数的影响%The effect of a combined treatment with propranolol and isosorbide-5-mononitrate on hemodynamics parameters in patients with cirrhosis and portal hypertension

    肖华鑫; 王敏; 李健; 田川


    目的 探讨普萘洛尔联合5-单硝酸异山梨酯治疗对肝硬化门静脉高压患者血流动力学参数的影响. 方法 30例肝功能Child-Pugh分级A、B级的肝硬化门静脉高压患者随机分为两组,其中普萘洛尔治疗组15例,普萘洛尔联合5-单硝酸异山梨酯治疗组15例,疗程均为48周.所有患者治疗前后均通过超声多普勒显像仪观察门 静脉血流速度( VFP)和门静脉内径(PVD),并计算门静脉充血指数(PCI). 结果 普萘洛尔组治疗前后VFP分别为(12.01±1.75)cm/s和(10.80±1.32)cm/s,PVD分别为(20.73±1.58)mm和(19.53±1.41)mm,差异均有统计学意义(P<0.05),PCI未显著下降(P>0.05);联合组治疗前VFP、PVD和PCI分别为(11.40±1.55)cm/s、(20.87±1.50)mm和(0.2940±0.4561),治疗后分别为(9.60±1.30)cm/s、(15.87±1.19)mm和(0.2107±0.4220),差异均有统计学意义(P均<0.05);两组比较治疗后的VFP、PVD和PCI差异均有统计学意义(P均<0.05). 结论 普萘洛尔联合5-单硝酸异山梨酯较单用普萘洛尔能更有效地降低肝硬化门静脉高压血流动力学参数,具有预防上消化道出血的作用.%Objective To investigate the effect of a combined treatment with propranolol and isosorbide-5-mononitrate on hemodynamics parameters in patients with cirrhosis and portal hypertension. Methods Thirty patients with cirrhosis and portal hypertension, Child-Pugh A B, were randomly divided into two groups. For 48 weeks, one was given propranolol and the other received combined treatment with propranolol and isosorbide-5-mononitrate. In all patients, the velocity of blood flow in the portal vein (VFP) and the cross sectional area of the portal vein (PVD) were determined with Doppler ultrasonography and the portal vein congestion index (PCI) was calculated. Results The group that received propranolol alone had a VFP of (12. 01 + 1. 75)cm/s before treatment and (10. 80±1.32)cm/s afterwards and a PVD of (20. 73±1.58)mm before treatment and (19

  11. Influence of renal denervation on blood pressure, sodium and water excretion in acute total obstructive apnea in rats

    J.V.M. Franquini


    Full Text Available Obstructive apnea (OA can exert significant effects on renal sympathetic nerve activity (RSNA and hemodynamic parameters. The present study focuses on the modulatory actions of RSNA on OA-induced sodium and water retention. The experiments were performed in renal-denervated rats (D; N = 9, which were compared to sham (S; N = 9 rats. Mean arterial pressure (MAP and heart rate (HR were assessed via an intrafemoral catheter. A catheter was inserted into the bladder for urinary measurements. OA episodes were induced via occlusion of the catheter inserted into the trachea. After an equilibration period, OA was induced for 20 s every 2 min and the changes in urine, MAP, HR and RSNA were recorded. Renal denervation did not alter resting MAP (S: 113 ± 4 vs D: 115 ± 4 mmHg or HR (S: 340 ± 12 vs D: 368 ± 11 bpm. An OA episode resulted in decreased HR and MAP in both groups, but D rats showed exacerbated hypotension and attenuated bradycardia (S: -12 ± 1 mmHg and -16 ± 2 bpm vs D: -16 ± 1 mmHg and 9 ± 2 bpm; P < 0.01. The basal urinary parameters did not change during or after OA in S rats. However, D rats showed significant increases both during and after OA. Renal sympathetic nerve activity in S rats increased (34 ± 9% during apnea episodes. These results indicate that renal denervation induces elevations of sodium content and urine volume and alters bradycardia and hypotension patterns during total OA in unconscious rats.

  12. Stratification of cerebral hemodynamics of child moyamoya disease using CBF SPECT

    Nakagawara, Jyoji; Saito, Norihiro; Osato, Toshiaki; Kamiyama, Kenji; Takeda, Rihei; Nakamura, Hirohiko [Nakamura Memorial Hospital, Sapporo (Japan)


    In order to make sure the stratification of cerebral hemodynamics of child moyamoya disease, we evaluated {sup 123}I-IMP SPECT before and after surgical revascularization. The aim of this paper is to establish the semiquantitative parameters that can be applied to estimate severity of hemodynamic cerebral ischemia instead of quantitative parameters. Quantitative studies using IMP-autoradiography (ARG) method were performed on thirteen patients to measure resting regional cerebral blood flow (rCBF), and vascular reserve (rVR): (Diamox-activated rCBF/resting rCBF-1) x 100%. Semiquantitative parameters were calculated from the ratio of region of interest (ROI) counts in the anterior cerebral artery (ACA) and middle cerebral artery (MCA) territory to the dominant cerebellum counts (ROI/Ce ratio) at resting and Diamox-activated conditions. From the quantitative study, both mean resting rCBF less than 40 ml/100 g/min and rVR less than 10% could indicate stage 2 hemodynamic cerebral ischemia. The prediction of stage 2 ischemia using semiquantitative parameters (resting ROI/Ce ratio less than 0.9 and Diamox-activated ROI/Ce ratio less than 0.85 in the MCA territory) was not statistically different comparison to the diagnosis using quantitative parameters (using Fisher exact test<0.0001, Sensitivity and specificity were 87.5% and 90.9%, respectively). The ROI/Ce ratio can be utilized as simple parameters instead of quantitative parameters. (author)

  13. Effect of food azo dyes tartrazine and carmoisine on biochemical parameters related to renal, hepatic function and oxidative stress biomarkers in young male rats.

    Amin, K A; Abdel Hameid, H; Abd Elsttar, A H


    Tartrazine and carmoisine are an organic azo dyes widely used in food products, drugs and cosmetics. The present study conducted to evaluate the toxic effect of these coloring food additives; on renal, hepatic function, lipid profile, blood glucose, body-weight gain and biomarkers of oxidative stress in tissue. Tartrazine and carmoisine were administered orally in two doses, one low and the other high dose for 30 days followed by serum and tissue sample collection for determination of ALT, AST, ALP, urea, creatinine, total protein, albumin, lipid profile, fasting blood glucose in serum and estimation of GSH, catalase, SOD and MDA in liver tissue in male albino rat. Our data showed a significant increase in ALT, AST, ALP, urea, creatinine total protein and albumin in serum of rats dosed with tartrazine and carmoisine compared to control rats and these significant change were more apparent in high doses than low, GSH, SOD and Catalase were decreased and MDA increased in tissue homogenate in rats consumed high tartrazine and both doses of carmoisine. We concluded that tartrazine and carmoisine affect adversely and alter biochemical markers in vital organs e.g. liver and kidney not only at higher doses but also at low doses.

  14. Ischemic preconditioning protects post-ischemic renal function in anesthetized dogs: role of adenosine and adenine nucleotides

    Fan-zhu LI; Shoji KIMURA; Akira NISHIYAMA; Matlubur RAHMAN; Guo-xing ZHANG; Youichi ABE


    Aim: To investigate the effects of renal ischemic preconditioning (IPC) on both renal hemodynamics and the renal interstitial concentrations of adenosine and adenine nucleotides induced by ischemia-reperfusion injury.Methods: Renal hemodynamics responses to ischemia-reperfusion injury in mongrel dog models were determined with or without multiple brief renal ischemic preconditioning treatments, as well as the adenosine A1 receptor antagonist (KW-3902),respectively.The renal interstitial concentrations of adenosine and adenine nucleotides in response to ischemia-reperfusion injury, either following 1-3 cycles of IPC or not, were measured simultaneously using microdialysis sampling technology.Results: One 10-min IPC, adenosine A1 receptor antagonist (KW3902) also shortened the recovery time of renal blood flow (RBF) and urine flow (UF), as well as mean blood pressure (BP).Advanced renal IPC attenuated the increment of adenosine and adenine nucleotides, as well as recovery time during the 60-min reperfusion which followed the 60-min renal ischemia.All of these recovery times were dependent on the cycles of 10-min IPC.The renal interstitial concentrations of adenosine and adenine nucleotides increased and decreased during renal ischemia and reperfusion, respectively.Conclusion: A significant relativity in dog models exists between the cycles of 10-min renal IPC and the recovery time of BP, UF, and RBF during the 60-min renal reperfusion following 60-min renal ischemia, respectively.Renal IPC can protect against ischemiareperfusion injury and the predominant effect of endogenous adenosine induced by prolonged renal ischemia; renal adenosine A1 receptor activation during the renal ischemia-reperfusion injury is detrimental to renal function.

  15. Endothelin-A receptor blockade slows the progression of renal injury in experimental renovascular disease.

    Kelsen, Silvia; Hall, John E; Chade, Alejandro R


    Endothelin (ET)-1, a potent renal vasoconstrictor with mitogenic properties, is upregulated by ischemia and has been shown to induce renal injury via the ET-A receptor. The potential role of ET-A blockade in chronic renovascular disease (RVD) has not, to our knowledge, been previously reported. We hypothesized that chronic ET-A receptor blockade would preserve renal hemodynamics and slow the progression of injury of the stenotic kidney in experimental RVD. Renal artery stenosis, a major cause of chronic RVD, was induced in 14 pigs and observed for 6 wk. In half of the pigs, chronic ET-A blockade was initiated (RVD+ET-A, 0.75 mg·kg(-1)·day(-1)) at the onset of RVD. Single-kidney renal blood flow, glomerular filtration rate, and perfusion were quantified in vivo after 6 wk using multidetector computer tomography. Renal microvascular density was quantified ex vivo using three-dimensional microcomputer tomography, and growth factors, inflammation, apoptosis, and fibrosis were determined in renal tissue. The degree of stenosis and increase in blood pressure were similar in RVD and RVD+ET-A pigs. Renal hemodynamics, function, and microvascular density were decreased in the stenotic kidney but preserved by ET-A blockade, accompanied by increased renal expression of vascular endothelial growth factor, hepatocyte growth factor, and downstream mediators such as phosphorilated-Akt, angiopoietins, and endothelial nitric oxide synthase. ET-A blockade also reduced renal apoptosis, inflammation, and glomerulosclerosis. This study shows that ET-A blockade slows the progression of renal injury in experimental RVD and preserves renal hemodynamics, function, and microvascular density in the stenotic kidney. These results support a role for ET-1/ET-A as a potential therapeutic target in chronic RVD.

  16. Mathematical simulation of hemodynamical processes and medical technologies

    Tsitsyura, Nadiya; Novyc'kyy, Victor V.; Lushchyk, Ulyana B.


    Vascular pathologies constitute a significant part of human's diseases and their rate tends to increase. Numerous investigations of brain blood flow in a normal condition and in a pathological one has created a new branch of modern medicine -- angioneurology. It combines the information on brain angioarchitecture and on blood supply in a normal condition and in a pathological one. Investigations of a disease's development constitute an important problem of a modern medicine. Cerebrum blood supply is regulated by arterial inflow and venous outflow, but, unfortunately, in the literature available arterial and venous beds are considered separately. This causes an one-sided interpretation of atherosclerotical and discirculatory encefalopathies. As arterial inflow and venous outflow are interrelated, it seems to be expedient to perform a complex estimation of arteriovenous interactions, prove a correlation dependence connection between the beds and find a dependence in a form of mathematical function. The results will be observed clearly in the graphs. There were 139 patients aged from 2 up to 70 examined in the 'Istyna' Scientific Medical Ultrasound Center by means of a Logidop 2 apparatus manufactured by Kranzbuhler, Germany using a technique of cerebral arteries and veins ultrasound location (invented and patented by Ulyana Lushchyk, State Patent of Ukraine N10262 of 19/07/1995). A clinical interpretation of the results obtained was performed. With the help of this technique and ultrasound Dopplerography the blood flow in major head and cervical arteries was investigated. While performing a visual graphic analysis we paid attention to the changes of carotid artery (CA), internal jugular vein (IJV) and supratrochlear artery's (STA) hemodynamical parameters. Generally accepted blood flow parameters: FS -- maximal systolic frequency and FD -- minimal diastolic frequency were measured. The correlation between different combinations of parameters in the vessels mentioned

  17. Emergency intervention therapy for renal vascular injury

    LIU Feng-yong; WANG Mao-qiang; FAN Qing-sheng; WANG Zhi-jun; DUAN Feng; SONG Peng


    Objective: To evaluate the efficacy and safety of the interventional techniques in the treatment of renal vascular injury.Methods: A total of 16 patients with renal vascular injuries were treated by superselective arterial embolization.The renal injuries resulted from renal biopsy in 7 patients,endovascular intervention in 2.percutaneous puncture and pyelostomy in 2.local resection of renal tumor in 1 and trauma in 4.With regards to clinical manifestations,there was hemorrhagic shock in 8 patients,severe flank pain in 14,and hematuria in 14.CT and ultrasonography confmued that 15 Patients had perirenal hematoma.The embolization was performed with microcoils in 13 and standard stainless steel coils in 3 patients,associated with polyvinyl alcohol particles (PVA) in 9,and gelfoam particles in 6 cases.Results: Renal angiogram revealed arteriovenous fistula in renal parenchyma in 9 cases,pseudoaneurysm in 3 and extravasation of contrast media in 4.The arterial embolization was successful in all 16 cases in a single session.The angiography at the end of therapy showed that abnormal vessels had disappeared without other major intrarenal arterial branch occlusion.In 13 patients with hemodynamical compromise,blood loss-related symptoms were immediately relieved after blood transfusion.In 14 patients with severe flank pain,the pain was progressively relieved.Hematuda ceased in 14 patients 2-14 days after the embolization procedures.The renal function was impaired after the procedure in 6 cases,in which preoperative renal insufficiency was exacerbated in 3 and developed new renal dysfunction in 3.2 of whom received hemodialysis.The ultrasonography showed that perirenal hematoma was gradually absorbed within 2.6 mortths after the procedure.A11 patients were followed up in 6-78 months (mean,48 months).Six patients died of primary diseases (5 cases of renal failure and multiple organ failure and 1 case of malignant tumor).Ten patients survived without bleeding and further

  18. Hemodynamic performance and tolerance to physical activity in women with rheumatic heart diseases



    We have studied the parameters of central hemodynamics in relation to the physical activity tolerance in women with rheumatic heart disease. The increase of the depth and severity of the valve apparatus lesions is associated with an increase of functional class of heart failure. In pregnant women with rheumatic heart diseases, the heart failure signs develop on the background of minimal changes of linear and volumetric parameters of the myocardium, which does not exceed the normal limits.

  19. Renal Trauma: The Rugby Factor

    Freeman, Catherine M.; Kelly, Michael E.; Nason, Gregory J.; McGuire, Barry B.; Kilcoyne, Aoife; Ryan, John; Lennon, Gerald; Galvin, David; Quinlan, David; Mulvin, David


    Introduction Renal trauma accounts for 5% of all trauma cases. Rare mechanisms of injuries including sports participation are increasingly common. Rugby-related trauma poses a conundrum for physicians and players due to the absence of clear guidelines and a paucity of evidence. Our series highlights traumatic rugby-related renal injuries in our institution, and emphasize the need for international guidelines on management. Methods A retrospective review of all abdominal traumas between January 2006 and April 2013, specifically assessing for renal related trauma that were secondary to rugby injuries was performed. All patients' demographics, computerized tomography results, hematological and biochemical results and subsequent management were recorded. Results Five male patients presented with rugby-related injuries. Mean age was 21 years old. All patients were hemodynamically stable and managed conservatively in acute setting. One patient was detected to have an unknown pre-existing atrophic kidney that had been subsequently injured, and was booked for an elective nephrectomy an 8-week interval. Conclusion Rugby-related trauma has generated essential attention. This paper serves to highlight this type of injury and the need for defined guidelines on role of imaging and international consensus on timing of return to contact sport, in both professional and amateur settings. PMID:26889132

  20. Prolonged Subcutaneous Administration of Oxytocin Accelerates Angiotensin II-Induced Hypertension and Renal Damage in Male Rats.

    James Phie

    Full Text Available Oxytocin and its receptor are synthesised in the heart and blood vessels but effects of chronic activation of this peripheral oxytocinergic system on cardiovascular function are not known. In acute studies, systemic administration of low dose oxytocin exerted a protective, preconditioning effect in experimental models of myocardial ischemia and infarction. In this study, we investigated the effects of chronic administration of low dose oxytocin following angiotensin II-induced hypertension, cardiac hypertrophy and renal damage. Angiotensin II (40 μg/Kg/h only, oxytocin only (20 or 100 ng/Kg/h, or angiotensin II combined with oxytocin (20 or 100 ng/Kg/h were infused subcutaneously in adult male Sprague-Dawley rats for 28 days. At day 7, oxytocin or angiotensin-II only did not change hemodynamic parameters, but animals that received a combination of oxytocin and angiotensin-II had significantly elevated systolic, diastolic and mean arterial pressure compared to controls (P < 0.01. Hemodynamic changes were accompanied by significant left ventricular cardiac hypertrophy and renal damage at day 28 in animals treated with angiotensin II (P < 0.05 or both oxytocin and angiotensin II, compared to controls (P < 0.01. Prolonged oxytocin administration did not affect plasma concentrations of renin and atrial natriuretic peptide, but was associated with the activation of calcium-dependent protein phosphatase calcineurin, a canonical signalling mechanism in pressure overload-induced cardiovascular disease. These data demonstrate that oxytocin accelerated angiotensin-II induced hypertension and end-organ renal damage, suggesting caution should be exercised in the chronic use of oxytocin in individuals with hypertension.

  1. Identification of pre- and post-treatment markers, clinical, and laboratory parameters associated with outcome in renal cancer patients treated with MVA-5T4

    Robert eAmato


    Full Text Available The recent approvals of immunotherapeutic agents (Sipuleucel-T and Ipilimumab for the treatment of different solid tumors gave a boost to the growing cancer immunotherapy field, even though few immunotherapy studies have demonstrated convincingly that there is a direct link between the predicted mode of action of an immunological compound and therapeutic benefit. MVA-5T4 (Trovax® is a novel vaccine combining the tumor-associated antigen 5T4 to an engineered vector-modified vaccinia Ankara (MVA. MVA helps to express the oncofetal 5T4 antigen and subsequently trigger a tumor-directed immune reaction. The safety and clinical benefit reported in multiple phase I and II clinical trials using MVA-5T4 were encouraging; immune responses were induced in almost all treated patients, and associations between 5T4-specific cellular or humoral responses and clinical benefit were reported in most of the nine phase II trials. In particular, clinical studies conducted in renal cell carcinoma (RCC patients have demonstrated an association between 5T4-specific (but not MVA antibody responses and enhanced survival. This review describes the clinical studies using MVA-5T4 conducted in RCC that convincingly demonstrated that an antigen-specific immune response induced by vaccination is associated with enhanced patient survival and is not simply a function of the general health of patients. We will also provide our expert opinions on possible future better-designed clinical trials based on relevant biomarkers. In addition, various combinations of MVA-5T4 and different and newer immunomodulator agents with promising clinical benefit will be discussed.

  2. Time-course effects of aerobic exercise training on cardiovascular and renal parameters in 2K1C renovascular hypertensive rats

    R.C.A. Maia


    Full Text Available Exercise training (Ex has been recommended for its beneficial effects in hypertensive states. The present study evaluated the time-course effects of Ex without workload on mean arterial pressure (MAP, reflex bradycardia, cardiac and renal histology, and oxidative stress in two-kidney, one-clip (2K1C hypertensive rats. Male Fischer rats (10 weeks old; 150–180 g underwent surgery (2K1C or SHAM and were subsequently divided into a sedentary (SED group and Ex group (swimming 1 h/day, 5 days/week for 2, 4, 6, 8, or 10 weeks. Until week 4, Ex decreased MAP, increased reflex bradycardia, prevented concentric hypertrophy, reduced collagen deposition in the myocardium and kidneys, decreased the level of thiobarbituric acid-reactive substances (TBARS in the left ventricle, and increased the catalase (CAT activity in the left ventricle and both kidneys. From week 6 to week 10, however, MAP and reflex bradycardia in 2K1C Ex rats became similar to those in 2K1C SED rats. Ex effectively reduced heart rate and prevented collagen deposition in the heart and both kidneys up to week 10, and restored the level of TBARS in the left ventricle and clipped kidney and the CAT activity in both kidneys until week 8. Ex without workload for 10 weeks in 2K1C rats provided distinct beneficial effects. The early effects of Ex on cardiovascular function included reversing MAP and reflex bradycardia. The later effects of Ex included preventing structural alterations in the heart and kidney by decreasing oxidative stress and reducing injuries in these organs during hypertension.

  3. Bioimpedance Measurement of Segmental Fluid Volumes and Hemodynamics

    Montgomery, Leslie D.; Wu, Yi-Chang; Ku, Yu-Tsuan E.; Gerth, Wayne A.; DeVincenzi, D. (Technical Monitor)


    Bioimpedance has become a useful tool to measure changes in body fluid compartment volumes. An Electrical Impedance Spectroscopic (EIS) system is described that extends the capabilities of conventional fixed frequency impedance plethysmographic (IPG) methods to allow examination of the redistribution of fluids between the intracellular and extracellular compartments of body segments. The combination of EIS and IPG techniques was evaluated in the human calf, thigh, and torso segments of eight healthy men during 90 minutes of six degree head-down tilt (HDT). After 90 minutes HDT the calf and thigh segments significantly (P < 0.05) lost conductive volume (eight and four percent, respectively) while the torso significantly (P < 0.05) gained volume (approximately three percent). Hemodynamic responses calculated from pulsatile IPG data also showed a segmental pattern consistent with vascular fluid loss from the lower extremities and vascular engorgement in the torso. Lumped-parameter equivalent circuit analyses of EIS data for the calf and thigh indicated that the overall volume decreases in these segments arose from reduced extracellular volume that was not completely balanced by increased intracellular volume. The combined use of IPG and EIS techniques enables noninvasive tracking of multi-segment volumetric and hemodynamic responses to environmental and physiological stresses.

  4. A Liquid-Solid Coupling Hemodynamic Model with Microcirculation Load

    Bai Li


    Full Text Available From the aspect of human circulation system structure, a complete hemodynamic model requires consideration of the influence of microcirculation load effect. This paper selected the seepage in porous media as the simulant of microcirculation load. On the basis of a bi-directional liquid-solid coupling tube model, we built a liquid-solid-porous media seepage coupling model. The simulation parameters accorded with the physiological reality. Inlet condition was set as transient single-pulse velocity, and outlet as free outlet. The pressure in the tube was kept at the state of dynamic stability in the range of 80–120 mmHg. The model was able to simulate the entire propagating process of pulse wave. The pulse wave velocity simulated was 6.25 m/s, which accorded with the physiological reality. The complex pressure wave shape produced by reflections of pressure wave was also observed. After the model changed the cardiac cycle length, the pressure change according with actual human physiology was simulated successfully. The model in this paper is well-developed and reliable. It demonstrates the importance of microcirculation load in hemodynamic model. Moreover the properties of the model provide a possibility for the simulation of dynamic adjustment process of human circulation system, which indicates a promising prospect in clinical application.

  5. Hemodynamic aspects of normal human feto-placental (umbilical) circulation.

    Acharya, Ganesh; Sonesson, Sven-Erik; Flo, Kari; Räsänen, Juha; Odibo, Anthony


    Understanding the changes in normal circulatory dynamics that occur during the course of pregnancy is essential for improving our knowledge of pathophysiological mechanisms associated with feto-placental diseases. The umbilical circulation is the lifeline of the fetus, and it is accessible for noninvasive assessment. However, not all hemodynamic parameters can be reliably measured in utero using currently available technology. Experimental animal studies have been crucial in validating major concepts related to feto-placental circulatory physiology, but caution is required in directly translating the findings of such studies into humans due to species differences. Furthermore, it is important to establish normal reference ranges and take into account gestational age associated changes while interpreting the results of clinical investigation. Therefore, it is necessary to critically evaluate, synthesize and summarize the knowledge available from the studies performed on human pregnancies to be able to appropriately apply them in clinical practice. This narrative review is an attempt to present contemporary concepts on hemodynamics of feto-placental circulation based on human studies. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  6. The pulsatility index and the resistive index in renal arteries. Associations with long-term progression in chronic renal failure

    Petersen, L J; Petersen, J R; Talleruphuus, U


    The pulsatility index (PI) and the resistive index (RI) are used as pulsed-wave Doppler measurements of downstream renal artery resistance. PI and RI have been found to correlate with renal vascular resistance, filtration fraction and effective renal plasma flow in chronic renal failure. The aim...... of the present study was to evaluate the potential relationship between these indices and the rate of decline in renal function, as reflected by changes in different parameters of renal function in patients with chronic renal failure....

  7. The pulsatility index and the resistive index in renal arteries in patients with hypertension and chronic renal failure

    Petersen, L J; Petersen, J R; Ladefoged, S D


    The pulsatility index (PI) and the resistive index (RI) are used as pulsed-wave Doppler measurement of downstream renal artery resistance. Little information is available on their value in chronic renal failure and their correlation to parameters of renal function and haemodynamics. The aim...... was to compare PI and RI of renal arteries in healthy volunteers and in patients with hypertension and chronic renal failure, and furthermore to study the correlation of these indices to measurements of renal haemodynamics and function by standard methods in patients with renal failure and hypertension....

  8. Parâmetros de prática clínica para suporte hemodinâmico a pacientes pediátricos e neonatais em choque séptico Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock

    Joseph A. Carcillo


    (mortalidade de 9% versus 27%. A fisiopatologia do choque e a resposta a terapias variam de acordo com a idade do paciente. Por exemplo, insuficiência cardíaca é uma das causas predominantes de morte entre pacientes neonatais e pediátricos, enquanto insuficiência vascular é causa predominante de morte entre adultos. Agentes inotrópicos, vasodilatadores (crianças, óxido nítrico inalado (neonatos e oxigenação por membrana extracorpórea podem ser contribuições mais importantes para a sobrevivência de populações pediátricas, enquanto vasopressores podem contribuir mais diretamente para a sobrevivência de pacientes adultos. Conclusões: As diretrizes do American College of Critical Care Medicine para o suporte hemodinâmico de pacientes adultos em choque séptico têm pouca aplicação no cuidado de pacientes neonatais ou pediátricos. São necessários estudos para determinar se as diretrizes do American College of Critical Care Medicine para o suporte hemodinâmico de pacientes neonatais ou pediátricos serão implementadas e associadas a uma melhor evolução.Background: the Institute of Medicine has called for the development of clinical guidelines and practice parameters to develop "best practice" and potentially improve patient outcome. Objective: to provide American College of Critical Care Medicine clinical guidelines for hemodynamic support of neonates and children with septic shock. Setting: individual members of the Society of Critical Care Medicine with special interest in neonatal and pediatric septic shock were identified from literature review and general solicitation at Society of Critical Care Medicine Educational and Scientific Symposia (1998-2001. Methods: the MEDLINE literature database was searched with the following age-specific keywords: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, and extracorporeal membrane oxygenation. More than 30 experts graded literature and drafted specific

  9. Outcome of Patients With Metastatic Sarcomatoid Renal Cell Carcinoma: Results From the International Metastatic Renal Cell Carcinoma Database Consortium

    Kyriakopoulos, Christos E; Chittoria, Namita; Choueiri, Toni K


    BACKGROUND: Sarcomatoid renal cell carcinoma is associated with poor prognosis. Data regarding outcome in the targeted therapy era are lacking. PATIENTS AND METHODS: Clinical, prognostic, and treatment parameters in metastatic renal cell carcinoma patients with and without sarcomatoid histology t...

  10. Invasive hemodynamic characterization of heart failure with preserved ejection fraction

    Andersen, Mads Jønsson; Borlaug, Barry A


    Recent hemodynamic studies have advanced our understanding of heart failure with preserved ejection fraction (HFpEF). Despite improved pathophysiologic insight, clinical trials have failed to identify an effective treatment for HFpEF. Invasive hemodynamic assessment can diagnose or exclude HFpEF......, making it invaluable in understanding the basis of the disease. This article reviews the hemodynamic mechanisms underlying HFpEF and how they manifest clinically, discusses invasive hemodynamic assessment as a diagnostic tool, and explores how invasive hemodynamic profiling may allow understanding...

  11. Novel MRI approaches for assessing cerebral hemodynamics in ischemic cerebrovascular disease.

    Donahue, Manus J; Strother, Megan K; Hendrikse, Jeroen


    Changes in cerebral hemodynamics underlie a broad spectrum of ischemic cerebrovascular disorders. An ability to accurately and quantitatively measure hemodynamic (cerebral blood flow and cerebral blood volume) and related metabolic (cerebral metabolic rate of oxygen) parameters is important for understanding healthy brain function and comparative dysfunction in ischemia. Although positron emission tomography, single-photon emission tomography, and gadolinium-MRI approaches are common, more recently MRI approaches that do not require exogenous contrast have been introduced with variable sensitivity for hemodynamic parameters. The ability to obtain hemodynamic measurements with these new approaches is particularly appealing in clinical and research scenarios in which follow-up and longitudinal studies are necessary. The purpose of this review is to outline current state-of-the-art MRI methods for measuring cerebral blood flow, cerebral blood volume, and cerebral metabolic rate of oxygen and provide practical tips to avoid imaging pitfalls. MRI studies of cerebrovascular disease performed without exogenous contrast are synopsized in the context of clinical relevance and methodological strengths and limitations.

  12. Evolution from electrophysiologic to hemodynamic monitoring: the story of left atrial and pulmonary artery pressure monitors

    Deirdre M Mooney


    Full Text Available Heart failure (HF is a costly, challenging and highly prevalent medical condition. Hospitalization for acute decompensation is associated with high morbidity and mortality. Despite application of evidence-based medical therapies and technologies, HF remains a formidable challenge for virtually all healthcare systems. Repeat hospitalizations for acute decompensated HF (ADHF can have major financial impact on institutions and resources. Early and accurate identification of impending ADHF is of paramount importance yet there is limited high quality evidence or infrastructure to guide management in the outpatient setting. Historically, ADHF was identified by physical exam findings or invasive hemodynamic monitoring during a hospital admission; however, advances in medical microelectronics and the advent of device-based diagnostics have enabled long-term ambulatory monitoring of HF patients in the outpatient setting. These monitors have evolved from piggybacking on cardiac implantable electrophysiologic devices to standalone implantable hemodynamic monitors that transduce left atrial or pulmonary artery pressures as surrogate measures of left ventricular filling pressure. As technology evolves, devices will likely continue to miniaturize while their capabilities grow. An important, persistent challenge that remains is developing systems to translate the large volumes of real-time data, particularly data trends, into actionable information that leads to appropriate, safe and timely interventions without overwhelming outpatient cardiology and general medical practices. Future directions for implantable hemodynamic monitors beyond their utility in heart failure may include management of other major chronic diseases such as pulmonary hypertension, end stage renal disease and portal hypertension.

  13. Effects of 4 multitargeted receptor tyrosine kinase inhibitors on regional hemodynamics in conscious, freely moving rats

    Carter, Joanne J.; Fretwell, Laurice V.; Woolard, Jeanette


    VEGF inhibitors, including receptor tyrosine kinase inhibitors, are used as adjunct therapies in a number of cancer treatments. An emerging issue with these drugs is that most cause hypertension. To gain insight into the physiological mechanisms involved, we evaluated their regional hemodynamic effects in conscious rats. Male Sprague Dawley rats (350–450 g) were chronically implanted with pulsed Doppler flow probes (renal and mesenteric arteries, and the descending abdominal aorta) and catheters (jugular vein, peritoneal cavity, and distal abdominal aorta). Regional hemodynamics were measured over 4 d, before and after daily administration of cediranib (3 and 6 mg/kg, 3 and 6 mg/kg/h for 1 h, i.v.), sorafenib (10 and 20 mg/kg, 10 and 20 mg kg/h for 1 h, i.v.), pazopanib (30 and100 mg/kg, i.p.), or vandetanib (12.5 and 25 mg/kg, i.p.). All drugs evoked significant increases (P phentolamine and propranolol (each 1 mg/kg/h), suggesting a need for new strategies to overcome them.—Carter, J. J., Fretwell, L. V., Woolard, J. Effects of 4 multitargeted receptor tyrosine kinase inhibitors on regional hemodynamics in conscious, freely moving rats. PMID:27986807

  14. Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 1): Physiologic and Technical Considerations.

    Chirinos, Julio A


    A better understanding of the pathophysiology of heart failure with a preserved left ventricular ejection fraction (HFpEF) is important. Detailed phenotyping of pulsatile hemodynamics has provided important insights into the pathophysiology of left ventricular remodeling and fibrosis, diastolic dysfunction, microvascular disease, and impaired oxygen delivery to peripheral skeletal muscle, all of which contribute to exercise intolerance, the cardinal feature of HFpEF. Furthermore, arterial pulsatile hemodynamic mechanisms likely contribute to the frequent presence of comorbidities, such as renal failure and dementia, in this population. Our therapeutic approach to HFpEF can be enhanced by clinical phenotyping tools with the potential to "segment" this population into relevant pathophysiologic categories or to identify individuals exhibiting prominent specific abnormalities that can be targeted by pharmacologic interventions. This review describes relevant technical and physiologic aspects regarding the deep phenotyping of arterial hemodynamics in HFpEF. In an accompanying review, the potential of this approach to enhance our clinical and therapeutic approach to HFpEF is discussed.

  15. Pig model of pulmonary embolism: where is the hemodynamic break point?

    Kudlička, J; Mlček, M; Hála, P; Lacko, S; Janák, D; Hrachovina, M; Malík, J; Bělohlávek, J; Neužil, P; Kittnar, O


    Early recognition of collapsing hemodynamics in pulmonary embolism is necessary to avoid cardiac arrest using aggressive medical therapy or mechanical cardiac support. The aim of the study was to identify the maximal acute hemodynamic compensatory steady state. Overall, 40 dynamic obstructions of pulmonary artery were performed and hemodynamic data were collected. Occlusion of only left or right pulmonary artery did not lead to the hemodynamic collapse. When gradually obstructing the bifurcation, the right ventricle end-diastolic area expanded proportionally to pulmonary artery mean pressure from 11.6 (10.1, 14.1) to 17.8 (16.1, 18.8) cm(2) (ppoint of maximal hemodynamic compensatory steady state. Similarly, mean arterial pressure decreased from 96 (87, 101) to 60 (53, 78) mmHg (p<0.0001), central venous pressure increased from 4 (4, 5) to 7 (6, 8) mmHg (p<0.0001), heart rate increased from 92 (88, 97) to 147 (122, 165) /min (p<0.0001), continuous cardiac output dropped from 5.2 (4.7, 5.8) to 4.3 (3.7, 5.0) l/min (p=0.0023), modified shock index increased from 0.99 (0.81, 1.10) to 2.31 (1.99, 2.72), p<0.0001. In conclusion, instead of continuous cardiac output all of the analyzed parameters can sensitively determine the individual maximal compensatory response to obstructive shock. We assume their monitoring can be used to predict the critical phase of the hemodynamic status in routine practice.

  16. Hemodynamic response to treatment of iron deficiency anemia in pulmonary arterial hypertension: longitudinal insights from an implantable hemodynamic monitor.

    Mehmood, Muddassir; Agarwal, Richa; Raina, Amresh; Correa-Jaque, Priscilla; Benza, Raymond L


    Despite new therapeutic options, pulmonary arterial hypertension (PAH) remains a progressive disease associated with substantial morbidity and mortality. As such, additional strategies for monitoring and adjunctive management of this disease are important. A 59-year-old woman with scleroderma-associated PAH received an implantable hemodynamic monitor (IHM) as part of a research protocol at our institution. Pulmonary artery pressures, heart rate, and cardiac output (sensor-based algorithm) were measured on a daily basis, and parameters of right ventricular (RV) performance and afterload were calculated. At the time of IHM implant, the patient had functional class III symptoms, was receiving triple-drug therapy, and had normal hemoglobin levels. Four months after implant, and with further optimization of prostacyclin therapy, she had improvement in her symptoms. However, shortly thereafter, while the patient was receiving stable drug therapy, her case regressed with worsening symptoms, and the patient received a new diagnosis of iron deficiency anemia. Oral iron supplementation resulted in normalization of hemoglobin levels and improvement in the patient's iron profile. A gradual and sustained reduction in pulmonary pressures was noted after initiation of oral iron accompanied by increased RV performance and favorable reduction in RV afterload. The patient had significant symptomatic improvement. Iron deficiency is an underappreciated yet easily treatable risk factor in PAH. Use of IHM in this case longitudinally illustrates the optimization of pulmonary hemodynamics and RV afterload in tandem with clinical improvement achieved by a simple therapy.

  17. Hemodynamic response to treatment of iron deficiency anemia in pulmonary arterial hypertension: longitudinal insights from an implantable hemodynamic monitor


    Abstract Despite new therapeutic options, pulmonary arterial hypertension (PAH) remains a progressive disease associated with substantial morbidity and mortality. As such, additional strategies for monitoring and adjunctive management of this disease are important. A 59-year-old woman with scleroderma-associated PAH received an implantable hemodynamic monitor (IHM) as part of a research protocol at our institution. Pulmonary artery pressures, heart rate, and cardiac output (sensor-based algorithm) were measured on a daily basis, and parameters of right ventricular (RV) performance and afterload were calculated. At the time of IHM implant, the patient had functional class III symptoms, was receiving triple-drug therapy, and had normal hemoglobin levels. Four months after implant, and with further optimization of prostacyclin therapy, she had improvement in her symptoms. However, shortly thereafter, while the patient was receiving stable drug therapy, her case regressed with worsening symptoms, and the patient received a new diagnosis of iron deficiency anemia. Oral iron supplementation resulted in normalization of hemoglobin levels and improvement in the patient’s iron profile. A gradual and sustained reduction in pulmonary pressures was noted after initiation of oral iron accompanied by increased RV performance and favorable reduction in RV afterload. The patient had significant symptomatic improvement. Iron deficiency is an underappreciated yet easily treatable risk factor in PAH. Use of IHM in this case longitudinally illustrates the optimization of pulmonary hemodynamics and RV afterload in tandem with clinical improvement achieved by a simple therapy. PMID:28090307

  18. Relationship of bispectral index to hemodynamic variables and alveolar concentration multiples of sevoflurane in puppies.

    Morgaz, J; Granados, M M; Domínguez, J M; Navarrete, R; Galán, A; Fernández, J A; Gómez-Villamandos, R J


    The relationships between bispectral index (BIS), cardiovascular variables and minimum alveolar concentration (MAC) multiples of sevoflurane in puppies were determined. Five puppies were anesthetized with sevoflurane on two occasions. First, the individual sevoflurane MAC values were determined for each puppy. Secondly, dogs were anesthetized with sevoflurane at each of 5 MAC multiples, 0.75, 1, 1.25, 1.5 and 1.75 MAC administered in random order. Hemodynamic parameters and BIS data were collected for 20min. Somatic stimulus was then applied and the same parameters and data were collected for 6min. Correlation between BIS and end tidal sevoflurane and between BIS and hemodynamic parameters were studied. We found positive significant correlation in both cases. BIS is lower in puppies that in adults at the same alveolar anesthetic concentrations and sevoflurane appears to be a safe anesthetic in puppies.

  19. Venous hemodynamic changes in lower limb venous disease

    Lee, Byung Boong; Nicolaides, Andrew N; Myers, Kenneth


    ). Their aim was to confirm or dispel long-held hemodynamic principles and to provide a comprehensive review of venous hemodynamic concepts underlying the pathophysiology of lower limb venous disorders, their usefulness for investigating patients and the relevant hemodynamic changes associated with various......There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due...... not provide the physiological basis for understanding the hemodynamics of flow, pressure, compliance and resistance. Hemodynamic investigations appear to provide a better correlation with post-treatment clinical outcome and quality of life than ultrasound findings. There is a far better prospect...

  20. Regulation of renal function and blood pressure control by P2 purinoceptors in the kidney.

    Van Beusecum, Justin; Inscho, Edward W


    Kidneys are important regulators of extracellular fluid volume (ECFV) homeostasis. ECFV is a key regulatory component of long-term blood pressure control influenced by controlling tubular sodium transport. In recent decades, renal P2 purinoceptors (P2 receptors) have come to the forefront as a mechanism for regulating ECFV. P2 receptors are broadly distributed in renal tubular and vascular elements where they confer segmental control of renal vascular resistance, autoregulation, and tubular reabsorption. Activation or impairment of renal P2 purinoceptors is implicated in the regulating blood pressure or causing renal pathologies including hypertension. In this brief review, we discuss the role of renal vascular and tubular P2 purinoceptors in the regulation of renal hemodynamics, maintenance of ECFV, regulation of sodium reabsorption and the control of blood pressure.

  1. Arginase inhibition slows the progression of renal failure in rats with renal ablation.

    Sabbatini, Massimo; Pisani, Antonio; Uccello, Francesco; Fuiano, Giorgio; Alfieri, Raffaele; Cesaro, Antonio; Cianciaruso, Bruno; Andreucci, Vittorio E


    Exogenous arginine slows the progression of chronic renal failure (CRF) in remnant rats through a nitric oxide (NO)-dependent mechanism. We tested whether the inhibition of arginase could induce similar results through the increased availability of endogenous arginine. Three groups of remnant rats were studied for 8 wk: 1) untreated rats (REM); 2) remnant rats treated with 1% l-arginine (ARG); and 3) remnant rats administered a Mn(2+)-free diet to inhibit arginase (MNF). Normal rats (NOR) were used as controls. Liver arginase activity was depressed in MNF rats (-35% vs. REM, P renal hemodynamics. Despite the better GFR, proteinuria was decreased in both ARG and MNF rats (-42%, P renal level, arginase activity was only slightly depressed in MNF rats (-18% vs. REM), but intrarenal concentrations of arginine were lower in this latter group (P factors are involved in these modifications.

  2. Study for the effect of hemodynamics for patients'with continuous renal substitute by two kinds of two primers blood methods%两种引血方法对连续性肾脏替代治疗患者血流动力学的影响

    侯春怡; 曾兰芳; 黄敬烨; 马新强


    Objective To investigate the hemodynamic effects between the two methods of CRRT beginning in vasopressor-dependent patients with replacement of CRRT circuits and the blood filters .Method Patients was sur-veyed retrospectively from January 2011 to June 2013 and requires constant CRRT treatment and use of vasoactive drugs noradrenaline dosage>0 .1 μg/(kg · min) .Using method 1:at the end of the current treatment ,according to conventional slower pump speed at start of CRRT (group A) and the method 2:at the end of the current treatment , using double machine operation to start blood pump and retune blood to the patient at the same time .(group B) , Hemodynamics changed between two groups of patients at the beginning of CRRT treatment for 4 hours was ana-lyzed .Result The mean arterial pressure for two groups of patients at the end of the current to the next beginning of CRRT 0 h ,CRRT 1h was significant different (P<0 .005);there was significant difference in norepinephrine dos-age for two groups of patients at the next end of the current blood lead therapeutic treatment 0h ,CRRT1h ,CRRT 2 h .Conclusion For patients with severe hemodynamic instability ,we can use double machine operation to start blood pump and retune blood at the same time during changing tube and filter .It is able to stabilize the patient's vital signs ,reduce the interruption of treatment time ,more conducive to patient safety .%目的:探讨两种CRRT引血方法对血管活性药物依赖且持续CRRT治疗的重症患者更换CRRT管路和滤器时血流动力学的影响。方法回顾性调查2011年1月~2013年6月需要持续CRRT 治疗并使用血管活性药物去甲肾上腺素剂量>0.1μg/(kg · min)的患者,使用方法一:当前治疗结束时,回血后按常规缓慢引血治疗(A组);方法二:当前治疗结束时,按双机一引一回的引血治疗(B组),分析两组病人在CRRT 治疗开始时4 h血流动力学的变化。结果两组患

  3. Morphologic and Hemodynamic Analysis in the Patients with Multiple Intracranial Aneurysms: Ruptured versus Unruptured.

    Linkai Jing

    Full Text Available The authors evaluated the impact of morphologic and hemodynamic factors on multiple intracranial aneurysms and aimed to identify which parameters can be reliable indexes as one aneurysm ruptured, and the others did not.Between June 2011 and May 2014, 69 patients harboring multiple intracranial aneurysms (69 ruptured and 86 unruptured were analyzed from 3D-digital subtraction angiography (DSA images and computational fluid dynamics (CFD. Morphologic and hemodynamic parameters were evaluated for significance with respect to rupture. Receiver operating characteristic (ROC analysis identified area under the curve (AUC and optimal thresholds separating ruptured from unruptured intracranial aneurysms for each parameter. Significant parameters were examined by binary logistic regression analysis to identify independent discriminators.Nine morphologic (size, neck width, surface area, volume, diameter of parent arteries, aspect ratio, size ratio, lateral/bifurcation type and regular/irregular type and 6 hemodynamic (WSSmean, WSSmin, OSI, LSA, flow stability and flow complexity parameters achieved statistical significance (p0.7. By binary logistic regression analysis, large aspect ratio and low WSSmean were the independently significant rupture factors (AUC, 0.924; 95% CI, 0.883-0.965.Large aspect ratio and low WSSmean were independently associated with the rupture status of multiple intracranial aneurysms.

  4. Hemodynamic improvement by right ventricular septal pacing in elderly patients with chronic atrial fibrillation and slow ventricular response

    Wei HUA; Shidong GUO; Shu ZHANG; Fangzheng WANG; Lida ZHI; Hongxia NIU; Xin CHEN


    Background and objectives Right ventricular apical (RVA) pacing has been reported impairing left ventricular (LV)performance. Alternative pacing sites in right ventricle (RV) has been explored to obtain better cardiac function. Our study was designed to compare the hemodynamic effects of right ventricular septal (RVS) pacing with RVA pacing. Methods Ten elderly patients with chronic atrial fibrillation (AF) and long RR interval or slow ventricular response (VR) received VVI pacing. The hemodynamic difference between RVS and RVA pacing were examined by transthoracic echocardiography (TTE). Results Pacing leads were implanted successfully at the RVA and then RVS in all patients without complication. The left ventricular (LV) parameters,measured during RVA pacing including left ventricular ejection fraction (LVEF), FS, stroke volume (SV) and peak E wave velocity (EV) were decreased significantly compared to baseline data, while during RVS pacing, they were significantly better than those during RVA pacing. However, after 3-6 weeks there was no statistical significant difference between pre- and post- RVS pacing.Conclusions The LV hemodynamic parameters during RVA pacing were significantly worse than baseline data. The short term LV hemodynamic parameters of RVS pacing were significantly better than those of RVA pacing; RVS pacing could improve the hemodynamic effect through maintaining normal ventricular activation sequence and biventricular contraction synchrony in patients with chronic AF and slow ventricular response.

  5. Impaired renal vascular response to a D-1-like receptor agonist but not to an ACE inhibitor in conscious spontaneously hypertensive rats

    de Vries, P.A.M.; Navis, Ger Jan; De Jong, P.E.; de Zeeuw, Dick


    The natriuretic response to a dopamine 1-like receptor agonist is blunted in spontaneously hypertensive rats (SHRs). Whether the renal vasodilator response to D-1-like receptor stimulation in SHRs is defective also is unclear. To determine whether the renal hemodynamic response to a D-1-like recepto

  6. Effects of Cardiopulmonary Bypass on Renal Perfusion, Filtration, and Oxygenation in Patients Undergoing Cardiac Surgery.

    Lannemyr, Lukas; Bragadottir, Gudrun; Krumbholz, Vitus; Redfors, Bengt; Sellgren, Johan; Ricksten, Sven-Erik


    Acute kidney injury is a common complication after cardiac surgery with cardiopulmonary bypass. The authors evaluated the effects of normothermic cardiopulmonary bypass on renal blood flow, glomerular filtration rate, renal oxygen consumption, and renal oxygen supply/demand relationship, i.e., renal oxygenation (primary outcome) in patients undergoing cardiac surgery. Eighteen patients with a normal preoperative serum creatinine undergoing cardiac surgery procedures with normothermic cardiopulmonary bypass (2.5 l · min · m) were included after informed consent. Systemic and renal hemodynamic variables were measured by pulmonary artery and renal vein catheters before, during, and after cardiopulmonary bypass. Arterial and renal vein blood samples were taken for measurements of renal oxygen delivery and consumption. Renal oxygenation was estimated from the renal oxygen extraction. Urinary N-acetyl-β-D-glucosaminidase was measured before, during, and after cardiopulmonary bypass. Cardiopulmonary bypass induced a renal vasoconstriction and redistribution of blood flow away from the kidneys, which in combination with hemodilution decreased renal oxygen delivery by 20%, while glomerular filtration rate and renal oxygen consumption were unchanged. Thus, renal oxygen extraction increased by 39 to 45%, indicating a renal oxygen supply/demand mismatch during cardiopulmonary bypass. After weaning from cardiopulmonary bypass, renal oxygenation was further impaired due to hemodilution and an increase in renal oxygen consumption, accompanied by a seven-fold increase in the urinary N-acetyl-β-D-glucosaminidase/creatinine ratio. Cardiopulmonary bypass impairs renal oxygenation due to renal vasoconstriction and hemodilution during and after cardiopulmonary bypass, accompanied by increased release of a tubular injury marker.

  7. Renal Cysts

    ... as “simple” cysts, meaning they have a thin wall and contain water-like fluid. Renal cysts are fairly common in ... simple kidney cysts, meaning they have a thin wall and only water-like fluid inside. They are fairly common in ...

  8. Renal failure


    970363 Effect on serum PTH and 1, 25(OH)2 D3levels of rapid correction of metabolic acidosis in CRFpatients with secondary hyperparathyroidism. YUANQunsheng(袁群生), et al. Renal Div, PUMC Hosp,Beijing, 100730. Chin J Nephrol 1996; 12(6): 328-331.

  9. Emergency management of hemodynamically unstable pelvic fractures

    ZHAO Xiao-gang


    Full Text Available 【Abstract】Pelvic fractures are serious injuries. Death within 24 hours is most often a result of acute blood loss. The emergency management of these patients is challenging and controversial. The key issues in its management are identifying the site(s of hemorrhage and then controlling the bleeding. Management of hemodynamically unstable patients with pelvic fracture requires a multidisci- plinary team. The issues addressed in this management algorithm are diagnostic evaluation, damage control resuscitation, indications for noninvasive pelvic stabilization, preperitoneal pelvic packing and the critical decisions concerning surgical options and angiography. This review article focuses on the recent body of know- ledge on those determinations. Key words: Pelvis; Hemodynamic; Emergencies; Practice management

  10. Biology and hemodynamics of aneurismal vasculopathies

    Pereira, Vitor Mendes, E-mail: [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland); Brina, Olivier, E-mail: [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland); Gonzalez, Ana Marcos, E-mail: [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland); Narata, Ana Paula, E-mail: [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland); Ouared, Rafik, E-mail: [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland); Karl-Olof, Lovblad, E-mail: [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland)


    Aneurysm vasculopathies represents a group of vascular disorders that share a common morphological diagnosis: a vascular dilation, the aneurysm. They can have a same etiology and a different clinical presentation or morphology, or have different etiology and very similar anatomical geometry. The biology of the aneurysm formation is a complex process that will be a result of an endogenous predisposition and epigenetic factors later on including the intracranial hemodynamics. We describe the biology of saccular aneurysms, its growth and rupture, as well as, current concepts of hemodynamics derived from application of computational flow dynamics on patient specific vascular models. Furthermore, we describe different aneurysm phenotypes and its extremely variability on morphological and etiological presentation.

  11. Drug-induced renal injury

    Drugs can cause acute renal failure by causing pre-renal, intrinsic or post-renal toxicity. Pre-renal ... incidence of drug dose adjustment in renal impairment in the SAMJ. ... Fever, haemolytic anaemia, thrombocytopenia, renal impairment and.

  12. Efficient hemodynamic event detection utilizing relational databases and wavelet analysis

    Saeed, M.; Mark, R. G.


    Development of a temporal query framework for time-oriented medical databases has hitherto been a challenging problem. We describe a novel method for the detection of hemodynamic events in multiparameter trends utilizing wavelet coefficients in a MySQL relational database. Storage of the wavelet coefficients allowed for a compact representation of the trends, and provided robust descriptors for the dynamics of the parameter time series. A data model was developed to allow for simplified queries along several dimensions and time scales. Of particular importance, the data model and wavelet framework allowed for queries to be processed with minimal table-join operations. A web-based search engine was developed to allow for user-defined queries. Typical queries required between 0.01 and 0.02 seconds, with at least two orders of magnitude improvement in speed over conventional queries. This powerful and innovative structure will facilitate research on large-scale time-oriented medical databases.

  13. Hemodynamic changes after levothyroxine treatment in subclinical hypothyroidism

    Faber, J; Petersen, L; Wiinberg, N


    was then calculated as MAP/CO. Measurements were performed before and after 60 degrees head-up tilting, and before and after LT(4) substitution. Plasma levels of catecholamines were also measured. In 16 otherwise healthy women with SH (ages 44-74 years; serum TSH in mean 17.1 mU/L (range, 6.8-27), and normal free T(4.......05). These changes were qualitatively similar but quantitatively less pronounced than in 15 women with overt hypothyroidism, also studied. Taking the two groups together (n = 31), pretreatment thyroid function (expressed as either TSH or free T(4) estimate) correlated to CO and SVR as well as the changes induced...... by LT(4) (p changes in hemodynamic parameters of potentially beneficial character. SH and overt hypothyroidism should...

  14. Successful pregnancy in an end-stage renal disease patient on peritoneal dialysis.

    Inal, Salih; Reis, Kadriye Altok; Armağan, Berkan; Oneç, Küşrad; Biri, Aydan


    Among women with chronic kidney disease, successful pregnancy with a surviving infant is rather rare. Although these pregnancies carry higher risk, with the possibility of adverse maternal and fetal outcomes, they can be managed with close monitoring and intense renal replacement therapy. Given the hemodynamic advantages of peritoneal dialysis over hemodialysis in pregnancy, peritoneal dialysis therapy is thought to be a favorable renal replacement option in pregnant patients with chronic kidney disease.

  15. Manejo da insuficiência renal aguda em cães e gatos

    Palumbo,Mariana Isa Poci; Romão, Felipe Gazza [UNESP; Machado, Luiz Henrique Araújo [UNESP


    Acute renal failure (ARF) may be defined as a subtle loss of renal function, leading to accumulation of nitrogenated substances. Several causes may lead to the development of ARF in an animal, including severe shock, intense blood loss, hypotension, dehydration, hypovolemia, deep anesthesia and nephrotoxins. Fluid therapy remains the basis of ARF treatment in animals. Thee therapeutic objective is to normalize fluid balance, solve hemodynamic problems and promote urine production. The objecti...

  16. Renal function and histology after acute hemorrhage in rats under dexmedetomidine action Função e histologia renais após hemorragia aguda em ratos sob ação da dexmedetomidina

    Marco Aurelio Marangoni; Alex Hausch; Pedro Thadeu Galvão Vianna; José Reinaldo Cerqueira Braz; Rosa Marlene Viero; Yara Marcondes Machado Castiglia


    PURPOSE: About 50 % of indications for dialysis in acute renal failure are related to problems originated during the perioperative period. Intraoperative hemodynamic changes lead to renal vasoconstriction and hypoperfusion. Previous studies have not defined the dexmedetomidine renal role in hemorrhage situations. This study evaluated the effect of dexmedetomidine on renal function and histology after acute hemorrhage in rats. METHODS: Covered study with 20 Wistars rats, anesthetized with sodi...

  17. Time-varying modeling of cerebral hemodynamics.

    Marmarelis, Vasilis Z; Shin, Dae C; Orme, Melissa; Rong Zhang


    The scientific and clinical importance of cerebral hemodynamics has generated considerable interest in their quantitative understanding via computational modeling. In particular, two aspects of cerebral hemodynamics, cerebral flow autoregulation (CFA) and CO2 vasomotor reactivity (CVR), have attracted much attention because they are implicated in many important clinical conditions and pathologies (orthostatic intolerance, syncope, hypertension, stroke, vascular dementia, mild cognitive impairment, Alzheimer's disease, and other neurodegenerative diseases with cerebrovascular components). Both CFA and CVR are dynamic physiological processes by which cerebral blood flow is regulated in response to fluctuations in cerebral perfusion pressure and blood CO2 tension. Several modeling studies to date have analyzed beat-to-beat hemodynamic data in order to advance our quantitative understanding of CFA-CVR dynamics. A confounding factor in these studies is the fact that the dynamics of the CFA-CVR processes appear to vary with time (i.e., changes in cerebrovascular characteristics) due to neural, endocrine, and metabolic effects. This paper seeks to address this issue by tracking the changes in linear time-invariant models obtained from short successive segments of data from ten healthy human subjects. The results suggest that systemic variations exist but have stationary statistics and, therefore, the use of time-invariant modeling yields "time-averaged models" of physiological and clinical utility.

  18. Hemodynamic, ventilator, and ECG changes in pediatric patients undergoing extraction

    Y K Sanadhya


    Full Text Available Background: Dental treatment induces pain anxiety and fear. This study was conducted to assess the changes in hemodynamic, ventilator, and electrocardiograph changes during extraction procedure among 12-15-year-old children and compare these changes with anxiety, fear, and pain. Materials and Methods: A purposive sample of 60 patients selected based on inclusion and exclusion criteria underwent study procedure in the dental OPD of a medical college and hospital. The anxiety, fear, and pain were recorded by dental anxiety scale, dental fear scale, and visual analogue scale, respectively, before the start of the procedure. The systolic blood pressure, diastolic blood pressure, heart rate, oxygen saturation, and electrocardiogram changes were monitored during the extraction procedure. The recording was taken four times (preinjection phase, injection, extraction, and postextraction and was analyzed. Results: At the preinjection phase the mean vales were systolic blood pressure (128 ± 11.2, diastolic blood pressure (85.7 ± 6.3, heart rate (79.7 ± 9.3, and oxygen saturation (97.9 ± 5.8. These values increased in injection phases and decreased in extraction phase and the least values were found after 10 min of procedure and this relation was significant for all parameters except oxygen saturation (P = 0.48, NS. ECG abnormalities were seen among 22 patients and were significant before and after injection of Local anesthetic (P = 0.0001, S. Conclusions: Anxiety, fear, and pain have an effect on hemodynamic, ventilator, and cardiovascular parameters during the extraction procedure and hence behavioral management has to be emphasized among children in dental clinics.

  19. Hemodynamic effect of iloprost inhalation and oral sildenafil during acute vasoreactivity test in pulmonary arterial hypertension.

    Sompradeekul, Suree; Wattanasiriphakdee, Siriphan


    The vasoreactivity test is usually performed to identify pulmonary arterial hypertension (PAH) patients who may benefit from long-term calcium channel blocker (CCB). The first and most commonly used agent is intravenous epoprostenol. A few other agents such as intravenous adenosine and inhaled nitric oxide are also used. In Thailand, epoprostenol is not available and the others are costly. Therefore, inhaled iloprost or oral sildenafil may be alternatives to test vasoreactivity. To evaluate the hemodynamic effect and response rate of inhaled iloprost and oral sildenafil during acute vasoreactivity test in PAH patients. In this retrospective descriptive study, the authors recruited patients with idiopathic PAH (IPAH) or PAHassociated with connective tissue disease (PAH-CNT) seen at the Medicine department Siriraj Hospital between January 2005 and December 2011 for whom acute vasoreactivity test was indicated. All patients used 20 microgram of inhaled iloprost via Delphinus® nebulizer for the test. Hemodynamic parameters were recorded before and after iloprost administration. Eight of those patients subsequently had a repeated test using 100 mg of oral sildenafil. Fifteen patients had acute vasoreactivity testing. Eleven patients were IPAH and four were PAH-CNT Using ESC/ERS guidelines criteria for responsiveness to vasoreactivity test, the response rate was 13% (2 out of 15 patients) using inhaled iloprost. Hemodynamic change was seen as early as five minutes after the inhalation and the effect lasted up to 35 minutes. The response rate was 25% (2 out of 8 patients) using oral sildenafil. Hemodynamic change was seen as early as 30 minutes after sildenafil ingestion and lasted up to 480 minutes. Inhaled iloprost can be used for acute vasoreactivity test in Thailand. The hemodynamic parameters should be recorded immediately after iloprost inhalation. Oral sildenafil, however, is not a suitable agent for acute vasoreactivity test due to its extended effect.

  20. Renal failure (chronic)

    Clase, Catherine


    Chronic renal failure is characterised by a gradual and sustained decline in renal clearance or glomerular filtration rate (GFR). Continued progression of renal failure will lead to renal function too low to sustain healthy life. In developed countries, such people will be offered renal replacement therapy in the form of dialysis or renal transplantation. Requirement for dialysis or transplantation is termed end-stage renal disease (ESRD).Diabetes, glomerulonephritis, hypertension, pyelone...

  1. Duplex ultrasound for identifying renal artery stenosis

    Zachrisson, Karin; Herlitz, Hans; Lönn, Lars


    Background Renal artery duplex ultrasound (RADUS) is an established method for diagnosis of renal artery stenosis (RAS), but there is no consensus regarding optimal RADUS criteria. Purpose To define optimal cutoff values for RADUS parameters when screening for RAS using intra-arterial trans...

  2. Combining numerical and clinical methods to assess aortic valve hemodynamics during exercise.

    Bahraseman, Hg; Hassani, K; Khosravi, A; Navidbakhsh, M; Espino, Dm; Fatouraee, N; Kazemi-Saleh, D


    Computational simulations have the potential to aid understanding of cardiovascular hemodynamics under physiological conditions, including exercise. Therefore, blood hemodynamic parameters during different heart rates, rest and exercise have been investigated, using a numerical method. A model was developed for a healthy subject. Using geometrical data acquired by echo-Doppler, a two-dimensional model of the chamber of aortic sinus valsalva and aortic root was created. Systolic ventricular and aortic pressures were applied as boundary conditions computationally. These pressures were the initial physical conditions applied to the model to predict valve deformation and changes in hemodynamics. They were the clinically measured brachial pressures plus differences between brachial, central and left ventricular pressures. Echocardiographic imaging was also used to acquire different ejection times, necessary for pressure waveform equations of blood flow during exercise. A fluid-structure interaction simulation was performed, using an arbitrary Lagrangian-Eulerian mesh. During exercise, peak vorticity increased by 14.8%, peak shear rate by 15.8%, peak cell Reynolds number by 20%, peak leaflet tip velocity increased by 47% and the blood velocity increased by 3% through the leaflets, whereas full opening time decreased by 11%. Our results show that numerical methods can be combined with clinical measurements to provide good estimates of patient-specific hemodynamics at different heart rates.

  3. Correlation between Hemodynamics and Treatment Outcome of Intracranial Aneurysms after Intervention with Flow Diverters

    Paliwal, Nikhil; Damiano, Robert; Davies, Jason; Siddiqui, Adnan; Meng, Hui


    Endovascular intervention by Flow Diverter (FD) - a densely woven stent - occludes an aneurysm by inducing thrombosis in the aneurysm sac and reconstructing the vessel. Hemodynamics plays a vital role in the thrombotic occlusion of aneurysms and eventual treatment outcome. CFD analysis of pre- and post-treatment aneurysms not only provides insight of flow modifications by FD, but also allows investigation of interventional strategies and prediction of their outcome. In this study 80 patient-specific aneurysms treated with FDs were retrospectively studied to evaluate the effect of intervention. Out of these cases, 16 required retreatment and thus are considered as having unfavorable outcome. Clinical FD deployment in these cases was simulated using an efficient virtual stenting workflow. CFD analysis was carried out on both pre- and post-treatment cases, and changes in hemodynamic parameters were calculated. Support vector machine algorithm was used to correlate the hemodynamic changes with outcome. Results show that cases having higher flow reduction into the aneurysmal sac have a better likelihood of occlusion. This suggests that changes in hemodynamics can be potentially used to predict the outcome of different clinical intervention strategies in aneurysms. This work was supported by the National Institutes of Health (R01 NS091075).

  4. Diffuse optical measurements of head and neck tumor hemodynamics for early prediction of chemoradiation therapy outcomes

    Dong, Lixin; Kudrimoti, Mahesh; Irwin, Daniel; Chen, Li; Kumar, Sameera; Shang, Yu; Huang, Chong; Johnson, Ellis L.; Stevens, Scott D.; Shelton, Brent J.; Yu, Guoqiang


    This study used a hybrid near-infrared diffuse optical instrument to monitor tumor hemodynamic responses to chemoradiation therapy for early prediction of treatment outcomes in patients with head and neck cancer. Forty-seven patients were measured once per week to evaluate the hemodynamic status of clinically involved cervical lymph nodes as surrogates for the primary tumor response. Patients were classified into two groups: complete response (CR) (n=29) and incomplete response (IR) (n=18). Tumor hemodynamic responses were found to be associated with clinical outcomes (CR/IR), wherein the associations differed depending on human papillomavirus (HPV-16) status. In HPV-16 positive patients, significantly lower levels in tumor oxygenated hemoglobin concentration ([HbO2]) at weeks 1 to 3, total hemoglobin concentration at week 3, and blood oxygen saturation (StO2) at week 3 were found in the IR group. In HPV-16 negative patients, significantly higher levels in tumor blood flow index and reduced scattering coefficient (μs‧) at week 3 were observed in the IR group. These hemodynamic parameters exhibited significantly high accuracy for early prediction of clinical outcomes, within the first three weeks of therapy, with the areas under the receiver operating characteristic curves (AUCs) ranging from 0.83 to 0.96.

  5. Comparison of hemodynamic effects of lidocaine, prilocaine and mepivacaine solutions without vasoconstrictor in hypertensive patients.

    Ezmek, Bahadir; Arslan, Ahmet; Delilbasi, Cagri; Sencift, Kemal


    Local anesthetic solutions with vasoconstrictors are not contraindicated in hypertensive patients, but due to their hemodynamic effects, local anesthetics without vasoconstrictors are mainly preferred by the clinicians. The aim of this study was to compare hemodynamic effects of three different local anesthetics without vasoconstrictors during tooth extraction in hypertensive patients. Sixty-five mandibular molars and premolars were extracted in 60 hypertensive patients (29 females and 31 males; mean age: 66.95 ± 10.87 years; range: 38 to 86 years old). Inferior alveolar and buccal nerve blocks were performed with 2% lidocaine hydrochloride (HCl), 2% prilocaine HCl or 3% mepivacaine HCl without vasoconstrictor. Hemodynamic parameters namely systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), saturation rate (SR), rate pressure product (RPP) and pressure rate quotient (PRQ) were investigated before and at different intervals after anesthetic injection. The hemodynamic effects of the three agents were similar to each other, although some significance was observed for DBP, MAP, RPP and PRQ values in the lidocaine, prilocaine and mepivacaine groups. Lidocaine, prilocaine and mepivacaine solutions without vasoconstrictor can be safely used in hypertensive patients. It is advisable that dental practitioners select anesthetic solutions for hypertensive patients considering their cardiovascular effects in order to provide patient comfort and safety.

  6. Comparison of hemodynamic effects of lidocaine, prilocaine and mepivacaine solutions without vasoconstrictor in hypertensive patients

    Bahadir Ezmek


    Full Text Available OBJECTIVE: Local anesthetic solutions with vasoconstrictors are not contraindicated in hypertensive patients, but due to their hemodynamic effects, local anesthetics without vasoconstrictors are mainly preferred by the clinicians. The aim of this study was to compare hemodynamic effects of three different local anesthetics without vasoconstrictors during tooth extraction in hypertensive patients. MATERIAL AND METHODS: Sixty-five mandibular molars and premolars were extracted in 60 hypertensive patients (29 females and 31 males; mean age: 66.95 ± 10.87 years; range: 38 to 86 years old. Inferior alveolar and buccal nerve blocks were performed with 2% lidocaine hydrochloride (HCl, 2% prilocaine HCl or 3% mepivacaine HCl without vasoconstrictor. Hemodynamic parameters namely systolic blood pressure (SBP, diastolic blood pressure (DBP, mean arterial pressure (MAP, heart rate (HR, saturation rate (SR, rate pressure product (RPP and pressure rate quotient (PRQ were investigated before and at different intervals after anesthetic injection. RESULTS: The hemodynamic effects of the three agents were similar to each other, although some significance was observed for DBP, MAP, RPP and PRQ values in the lidocaine, prilocaine and mepivacaine groups. CONCLUSION: Lidocaine, prilocaine and mepivacaine solutions without vasoconstrictor can be safely used in hypertensive patients. It is advisable that dental practitioners select anesthetic solutions for hypertensive patients considering their cardiovascular effects in order to provide patient comfort and safety.

  7. Dose Adjustment Strategy of Cyclosporine A in Renal Transplant Patients: Evaluation of Anthropometric Parameters for Dose Adjustment and C0 vs. C2 Monitoring in Japan, 2001-2010

    Kokuhu, Takatoshi; Fukushima, Keizo; Ushigome, Hidetaka; Yoshimura, Norio; Sugioka, Nobuyuki


    The optimal use and monitoring of cyclosporine A (CyA) have remained unclear and the current strategy of CyA treatment requires frequent dose adjustment following an empirical initial dosage adjusted for total body weight (TBW). The primary aim of this study was to evaluate age and anthropometric parameters as predictors for dose adjustment of CyA; and the secondary aim was to compare the usefulness of the concentration at predose (C0) and 2-hour postdose (C2) monitoring. An open-label, non-randomized, retrospective study was performed in 81 renal transplant patients in Japan during 2001-2010. The relationships between the area under the blood concentration-time curve (AUC0-9) of CyA and its C0 or C2 level were assessed with a linear regression analysis model. In addition to age, 7 anthropometric parameters were tested as predictors for AUC0-9 of CyA: TBW, height (HT), body mass index (BMI), body surface area (BSA), ideal body weight (IBW), lean body weight (LBW), and fat free mass (FFM). Correlations between AUC0-9 of CyA and these parameters were also analyzed with a linear regression model. The rank order of the correlation coefficient was C0 > C2 (C0; r=0.6273, C2; r=0.5562). The linear regression analyses between AUC0-9 of CyA and candidate parameters indicated their potential usefulness from the following rank order: IBW > FFM > HT > BSA > LBW > TBW > BMI > Age. In conclusion, after oral administration, C2 monitoring has a large variation and could be at high risk for overdosing. Therefore, after oral dosing of CyA, it was not considered to be a useful approach for single monitoring, but should rather be used with C0 monitoring. The regression analyses between AUC0-9 of CyA and anthropometric parameters indicated that IBW was potentially the superior predictor for dose adjustment of CyA in an empiric strategy using TBW (IBW; r=0.5181, TBW; r=0.3192); however, this finding seems to lack the pharmacokinetic rationale and thus warrants further basic and clinical

  8. Modeling the hemodynamic response in fMRI using smooth FIR filters

    Goutte, Cyril; Nielsen, Finn Årup; Hansen, Lars Kai


    -parametric approach based on finite impulse response (FIR) filters. In order to cope with the increase in the number of degrees of freedom, the authors introduce a Gaussian process prior on the filter parameters. They show how to carry on the analysis by incorporating prior knowledge on the filters, optimizing hyper......Modeling the hemodynamic response in functional magnetic resonance (fMRI) experiments is an important aspect of the analysis of functional neuroimages. This has been done in the past using parametric response function, from a limited family. In this contribution, the authors adopt a semi......-parameters using the evidence framework, or sampling using a Markov Chain Monte Carlo (MCMC) approach. The authors present a comparison of their model with standard hemodynamic response kernels on simulated data, and perform a full analysis of data acquired during an experiment involving visual stimulation....

  9. Midterm evaluation of hemodynamics of the Top Hat supraannular aortic valve

    Aagaard, Jan; Nissen, Henrik; Geha, Alexander S


    The CarboMedics Top Hat supraannular aortic valve provides an orifice-to-annulus ratio of 1:1 in most patients, and enhances patient outcomes. This study compared the midterm echocardiographic parameters of 52 patients undergoing aortic valve replacement with a Top Hat valve with those in other...... measurements were compared in 38 patients with aortic valve stenosis. Hemodynamic data were comparable to those of other studies, but the Top Hat prosthesis implanted was significantly larger (by a mean of 3.29 mm) than the valve size indicated using an intraannular valve sizer in 48 patients. Mean effective...... orifice area improved significantly from 0.73 cm(2) preoperatively to 2.04 cm(2) postoperatively. In patients with preoperative aortic valve stenosis, postoperative mean peak gradient was significantly reduced. The larger orifice-to-annulus ratio of the Top Hat valve improved hemodynamic parameters...




    To establish the effects of alpha-adrenoceptor blockade on dopamine-induced changes in renal hemodynamics and sodium excretion, dopamine dose-response curves were performed without and with pre-treatment with the selective postsynaptic alpha-1-adrenoceptor antagonist prazosin in normal volunteers an

  11. Proteinuria following conversion from azathioprine to sirolimus in renal transplant recipients.

    Akker, J.M. van den; Wetzels, J.F.M.; Hoitsma, A.J.


    Recent studies have reported a significant increase of proteinuria in kidney transplant recipients who were switched from a calcineurin inhibitor (CI) to sirolimus. This has (partly) been ascribed to the hemodynamic renal effects of CI withdrawal. We have evaluated the evolution of proteinuria in re

  12. Structural renal changes in obesity and diabetes.

    Amann, Kerstin; Benz, Kerstin


    Overweight, obesity, and associated diseases represent an emerging problem, not only in Western countries but also in the developing world. They are now characterized as epidemic diseases. Obesity is particularly serious because its incidence in children and adolescents increased dramatically: it is estimated that in the United States every eighth adolescent suffers from obesity, which in the long run may reduce life expectancy in the population. Apart from cardiovascular disease (ie, blood pressure, stroke, and coronary heart disease), kidney diseases also have been shown to be associated with obesity. Epidemiologic studies have indicated that obesity can be a risk factor of chronic kidney disease irrespective of the presence or absence of diabetes, arterial hypertension, and other comorbidities. More evidence is accumulated on the link between chronic kidney disease in obesity and abnormalities in adipokine secretion (hyperleptinemia, lack of adiponectin), activation of the renin-angiotensin system, chronic inflammation, endothelial dysfunction, lipid accumulation, impaired renal hemodynamics, and diminished nephron number related to body mass. In general, obesity is known to aggravate the course of many primary renal diseases such as glomerulonephritides, but also impairs renal function after kidney transplantation. Microalbuminuria, proteinuria, hyperfiltration, and impaired renal function are associated with obesity. Histologically, secondary focal segmental sclerosis has been shown to be caused particularly by obesity. Of practical purpose for clinical nephrology, loss of body weight either by lifestyle modification or bariatric surgery improves albuminuria and hyperfiltration in obese patients, making renal disease in obesity accessible for prevention programs. This review specifically addresses the pathogenesis and morphology of renal functional and particularly structural changes in obesity and associated renal disease such as diabetic nephropathy.

  13. Effect of oleic acid-induced acute lung injury and conventional mechanical ventilation on renal function in piglets

    LIU Ai-jun; LING Feng; LI Zhi-qiang; LI Xiao-feng; LIU Ying-long; DU Jie; HAN Ling


    Background Animal models that demonstrate changes of renal function in response to acute lung injury (ALl) and mechanical ventilation (MV) are few.The present study was performed to examine the effect of ALl induced by oleic acid (OA) in combination with conventional MV strategy on renal function in piglets.Methods Twelve Chinese mini-piglets were randomly divided into two groups:the OA group (n=6),animals were ventilated with a conventional MV strategy of 12 ml/kg and suffered an ALl induced by administration of OA,and the control group (n=6),animals were ventilated with a protective MV strategy of 6 ml/kg and received the same amount of sterile saline.Results Six hours after OA injection a severe lung injury and a mild-moderate degree of renal histopathological injury were seen,while no apparent histological abnormalities were observed in the control group.Although we observed an increase in the plasma concentrations of creatinine and urea after ALl,there was no significant difference compared with the control group.Plasma concentrations of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C increased (5.6±1.3) and (7.4±1.5) times in the OA group compared to baseline values,and were significantly higher than the values in the control group.OA injection in combination with conventional MV strategy resulted in a dramatic aggravation of hemodynamic and blood gas exchange parameters,while these parameters remained stable during the experiment in the control group.The plasma expression of TNF-α and IL-6 in the OA group were significantly higher than that in the control group.Compared with high expression in the lung and renal tissue in the OA group,TNF-α and IL-6 were too low to be detected in the lung and renal tissue in the control group.Conclusions OA injection in combination with conventional MV strategy not only resulted in a severe lung injury but also an apparent renal injury.The potential mechanisms involved a cytokine response of TNF-α and

  14. Renale Osteopathie

    Horn S


    Die renale Osteopathie umfaßt Erkrankungen des Knochens, die bei Patienten mit chronischen Nierenerkrankungen auftreten, wie den sekundären bzw. tertiären Hyperparathyreoidismus, die adynamische Knochenerkrankung und die Osteopathie nach Nierentransplantation. Durch die Identifikation des Kalzium-Sensing-Rezeptors bzw. des Vitamin D-Rezeptors hat sich unser Verständnis der Zusammenhänge in den letzten Jahren erheblich verbessert. Neue Medikamente versprechen effizientere Prophylaxe- und Thera...

  15. Renale Knochenerkrankungen

    Mayer G


    Full Text Available Störungen des Mineral- und Knochenstoffwechsels sind bei fast allen Patienten mit chronischen Nierenerkrankungen anzutreffen. Pathogenetisch spielt eine Neigung zur Phosphatretention bei einer Reduktion der glomerulären Filtrationsrate die zentrale Rolle. Neben typischen, aber sehr variablen Veränderungen der Knochenstruktur (renale Osteopathie besteht auch eine sehr enge Assoziation zwischen diesen Störungen und dem massiv erhöhten kardiovaskulären Risiko der Patienten.

  16. The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury

    Nisenbaum Rosane


    Full Text Available Abstract Background Minimization of hemodynamic instability during renal replacement therapy (RRT in patients with acute kidney injury (AKI is often challenging. We examined the relative hemodynamic tolerability of sustained low efficiency dialysis (SLED and continuous renal replacement therapy (CRRT in critically ill patients with AKI. We also compared the feasibility of SLED administration with that of CRRT and intermittent hemodialysis (IHD. Methods This cohort study encompassed four critical care units within a single university-affiliated medical centre. 77 consecutive critically ill patients with AKI who were treated with CRRT (n = 30, SLED (n = 13 or IHD (n = 34 and completed at least two RRT sessions were included in the study. Overall, 223 RRT sessions were analyzed. Hemodynamic instability during a given session was defined as the composite of a > 20% reduction in mean arterial pressure or any escalation in pressor requirements. Treatment feasibility was evaluated based on the fraction of the prescribed therapy time that was delivered. An interrupted session was designated if Results Hemodynamic instability occurred during 22 (56.4% SLED and 43 (50.0% CRRT sessions (p = 0.51. In a multivariable analysis that accounted for clustering of multiple sessions within the same patient, the odds ratio for hemodynamic instability with SLED was 1.20 (95% CI 0.58-2.47, as compared to CRRT. Session interruption occurred in 16 (16.3, 30 (34.9 and 11 (28.2 of IHD, CRRT and SLED therapies, respectively. Conclusions In critically ill patients with AKI, the administration of SLED is feasible and provides comparable hemodynamic control to CRRT.

  17. Occupational exposure in hemodynamic; Exposicao ocupacional em hemodinamica

    Silva, Amanda J.; Fernandes, Ivani M.; Silva, Paula P. Nou; Sordi, Gian Maria A.A.; Carneiro, Janete C.G.G., E-mail: ajsilva@ipen.b, E-mail: imfernandes@ipen.b, E-mail: ppsilva@ipen.b, E-mail: gmsordi@ipen.b, E-mail: janetegc@ipen.b [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)


    This paper has an objective to perform a radiometric survey at a hemodynamic service. Besides, it was intended to evaluate the effective dose of health professionals and to provide data which can contribute with minimization of exposures during the realization of hemodynamic procedure. The radiometric survey was realized in the real environment of work simulating the conditions of a hemodynamic study with a ionization chamber

  18. 数字化塑型钛网颅骨修补对颅骨缺损患者颅内压、脑血流动力学及神经功能康复的影响%Changes of intracranial pressure, cerebral hemodynamic parameters and neuro-rehabilitation in adult patients after cranioplasty reconstruction with digital shaping titanium mesh

    罗晟; 何永生; 陈隆益; 黄光富


    Objective To investigate the appropriate time of the skull reconstruction of skull defect,and explore the changes of intracmnial pressure,cerebral hemodynamic parameters,clinical symptoms and signs before and after cranioplasty with digital shaping titanium mesh.Methods The clinical data included parameter variations of noninvasive intracranial pressure (ICP),cerebral blood flow velocity,and improvement of skull defect syndrome and cognitive function were retrospectivly analyzed in 69 patients with skull defect received cranioplasty with digital shaping titanium mesh in our hospital from June 2009 to May 2014.The preoperative ICP less than 80 mmH2O was recorded in 53 patients and that more than or equal to 80 mmH2O was recorded in 16 patients.The interval time from the skull defects to cranioplasty was as follows:11 patients were within 3-6 months,25 were in 6-9 months,24 were in 9-12 months,and 9 were more than one year.Results The ICP after cranioplasty was in the normal range,which was statistically different as compared with that before cranioplasty (P<0.05).The mean blood flow velocity two weeks after cranioplasty was improved significantly as compared with that before cranioplasty (P<0.05).All 69 patients were recovered well postoperatively;14 patients with preoperative sensory and movement disorders got improvement of different degrees after cranioplasty;in the four patients with epilepsy,three were seizure-free,and the left one had obviously reduced epileptic seizure;two patients with speech disorders got improvement postoperatively.Skull defect syndrome symptoms in the 54 patients were disappeared.Significant differences of Glasgow outcome scale (GOS) and function independent measurement (FIM) scores were noted between before cranioplasty and three months after cranioplasty (2.48±0.67 vs.3.56±0.35;77.91±10.32 vs.93.78±6.51;P<0.05).The GOS and FIM scores in patients performed cranioplasty at early stage (interval time from the skull defects to

  19. Value of portal hemodynamics and hypersplenism in cirrhosis staging

    Bao-Min Shi; Xiu-Yan Wang; Qing-Ling Mu; Tai-Huang Wu; Jian Xu


    AIM: To determine the correlation between portal hemodynamics and spleen function among different grades of cirrhosis and verify its significance in cirrhosis staging.METHODS: The portal and splenic vein hemodynamics and spleen size were investigated by ultrasonography in consecutive 38 cirrhotic patients with cirrhosis (Child's grades A to C) and 20 normal controls. The differences were compared in portal vein diameter and flow velocity between patients with and without ascites and between patients with mild and severe esophageal varices. The correlation between peripheral blood cell counts and Child's grades was also determined.RESULTS: The portal flow velocity and volume were significantly lower in patients with Child's C (12.25±1.67 cm/s vs 788.59±234 mm/min, respectively) cirrhosis compared to controls (19.55±3.28 cm/s vs 1254.03±410 mm/min,respectively) and those with Child's A (18.5±3.02 cm/s vs1358.48±384 mm/min, respectively) and Child's B (16.0±3.89cm/s vs 1142.23±390 mm/min, respectively)cirrhosis.Patients with ascites had much lower portal flow velocity and volume (13.0±1.72 cm/s vs 1078±533 mm/min) than those without ascites (18.6±2.60 cm/s vs 1394±354 mm/min).There was no statistical difference between patients with mild and severe esophageal varices. The portal vein diameter was not significantly different among the above groups.There were significant differences in splenic vein diameter,flow velocity and white blood cell count, but not in spleen size, red blood cell and platelet counts among the various grades of cirrhosis. The spleen size was negatively correlated with red blood cell and platelet counts (r= -0.620and r = -0.8.34, respectively).CONCLUSION: An optimal system that includes parameters representing the portal hemodynamics and spleen function should be proposed for cirrhosis staging.

  20. [Hemodynamic effects of spinal anaesthesia during caesarian section in pregnant women with hypertensive disorders].

    Kinzhalova, S V; Makarov, R A; Davydova, N S


    To make the comparative analysis of the changes of main parameters of haemodynamic during caesarean section with spinal anaesthesia (SA) in patients with uncomplicated pregnancy and pregnancy with hypertensive disorders. The study included 103 pregnant women undergoing caesarean section under SA. The comparative analysis of the main haemodynamic parameters was performed in patients into three groups: an uncomplicated pregnancy (n = 35); pregnancy with chronic hypertension (n = 33) and pregnancy complicated by severe preeclampsia (n = 35). Heart rate (HR), mean blood pressure (BP), cardiac index (CI) and systemic vascular resistance (SVR) were measured by noninvasive bioimpedans technology. Data were recorded at 5 stages of the study. The data of study demonstrated that haemodynamic stability better if SA is used during caesarean section in women with normal pregnancy. In the group of pregnant women with severe preeclampsia observed the most significant hemodynamic changes: BP and SVR decreased significantly greater at all stages of the operation, whereas the increase SI on the 3rd stage was higher in comparison with the control group. There were significant differences changes in the main hemodynamic parameters between groups at all stages of the study. Results of this survey suggest that hemodynamic response to anaesthesia depends on the initial state of the circulatory system.

  1. Serum Zn/Cu ratio is associated with renal function, glycemic control, and metabolic parameters in Japanese patients with and without type 2 diabetes: A cross-sectional study

    Hidetaka Hamasaki


    Full Text Available Background: Zinc (Zn and copper (Cu may play a pivotal role in the pathogenesis of diabetes and diabetic complications by mediating oxidative stress. Both Zn deficiency and excess of Cu are associated with an increased risk of type 2 diabetes and cardiovascular disease. We aimed to investigate the relationships between serum Zn/Cu ratio and glycemic status, renal function, and metabolic parameters in patients with and without type 2 diabetes.Methods: We conducted a cross-sectional study on 355 subjects (149 type 2 diabetic and 206 non-diabetic in whom serum Zn and Cu levels were measured at the same time. Associations between serum Zn/Cu ratio and clinical data were evaluated using multiple regression analysis. We also evaluated associations between serum Zn/Cu ratio and the prevalence of type 2 diabetes and glycemic control by multivariate logistic regression analysis.Results: Serum Zn/Cu ratio was positively associated with estimated glomerular filtration rate after adjustment for BMI (β = 0.137, P = 0.014. Plasma B-type natriuretic peptide levels were negatively associated with serum Zn/Cu ratio after adjustment for age, sex, and BMI (β = −0.258, P = 0.032. In patients with type 2 diabetes, serum Zn/Cu ratio was negatively associated with plasma HbA1c levels after adjustment for age, sex, and BMI (β = −0.239, P = 0.003. In addition, multivariate logistic regression analysis revealed that the highest quartile of serum Zn/Cu ratio was associated with a reduced risk of poor (HbA1c ≥ 7% glycemic control odds ratio = 0.382; 95% confidence interval (CI, 0.165–0.884; P = 0.025 in patients with type 2 diabetes.Conclusion: Serum Zn/Cu ratio was favorably associated with renal function in all subjects and glycemic control in patients with type 2 diabetes. The Zn/Cu ratio, in addition to the individual serum levels of trace elements, is important for metabolism in humans.

  2. Hemodynamic Changes Caused by Flow Diverters in Rabbit Aneurysm Models: Comparison of Virtual and Realistic FD Deployments Based on Micro-CT Reconstruction.

    Xu, Jinyu; Deng, Benqiang; Fang, Yibin; Yu, Ying; Cheng, Jiyong; Wang, Shengzhang; Wang, Kuizhong; Liu, Jian-Min; Huang, Qinghai


    Adjusting hemodynamics via flow diverter (FD) implantation is emerging as a novel method of treating cerebral aneurysms. However, most previous FD-related hemodynamic studies were based on virtual FD deployment, which may produce different hemodynamic outcomes than realistic (in vivo) FD deployment. We compared hemodynamics between virtual FD and realistic FD deployments in rabbit aneurysm models using computational fluid dynamics (CFD) simulations. FDs were implanted for aneurysms in 14 rabbits. Vascular models based on rabbit-specific angiograms were reconstructed for CFD studies. Real FD configurations were reconstructed based on micro-CT scans after sacrifice, while virtual FD configurations were constructed with SolidWorks software. Hemodynamic parameters before and after FD deployment were analyzed. According to the metal coverage (MC) of implanted FDs calculated based on micro-CT reconstruction, 14 rabbits were divided into two groups (A, MC >35%; B, MC 0.05). The normalized mean WSS in Group A after realistic FD implantation was significantly lower than that of Group B. All parameters in Group B exhibited no significant difference between realistic and virtual FDs. This study confirmed MC-correlated differences in hemodynamic parameters between realistic and virtual FD deployment.

  3. Mining data from hemodynamic simulations via Bayesian emulation

    Nair Prasanth B


    Full Text Available Abstract Background: Arterial geometry variability is inevitable both within and across individuals. To ensure realistic prediction of cardiovascular flows, there is a need for efficient numerical methods that can systematically account for geometric uncertainty. Methods and results: A statistical framework based on Bayesian Gaussian process modeling was proposed for mining data generated from computer simulations. The proposed approach was applied to analyze the influence of geometric parameters on hemodynamics in the human carotid artery bifurcation. A parametric model in conjunction with a design of computer experiments strategy was used for generating a set of observational data that contains the maximum wall shear stress values for a range of probable arterial geometries. The dataset was mined via a Bayesian Gaussian process emulator to estimate: (a the influence of key parameters on the output via sensitivity analysis, (b uncertainty in output as a function of uncertainty in input, and (c which settings of the input parameters result in maximum and minimum values of the output. Finally, potential diagnostic indicators were proposed that can be used to aid the assessment of stroke risk for a given patient's geometry.

  4. Correction of Hemodynamic Disorders in the Complex Surgical Correction of Acquired Cardiac Valvular Defects

    A. I. Lenkin


    Full Text Available Objective: to compare the efficiency of using the values of transpulmonary (PiCCO and prepulmonary (Swan-Ganz catheter thermodilution as guides to targeted therapy for hemodynamic disorders in the surgical correction of mixed cardiac valvular defects. Subjects and methods. The study enrolled 40 patients operated on for acquired cardiac diseases who were randomized to two matched groups. Hemodynamics was monitored by means of a Swan-Ganz catheter in Group 1 and by transpulmonary thermodilution in Group 2. Anesthesia was maintained with propofol and fentanyl. Infusion therapy was performed using crystalloid and colloid solutions. Continuous intravenous infusion of inotropic agents was used when heart failure was developed. Hemodynamic, clinical, and laboratory parameters were estimated intraoperatively and within 24 hours postoperatively. Results. The groups did not differ in the degree of baseline heart failure, the duration of an operation and myocardial ischemia, and the length of extracorporeal circulation. In the PiCCO group, postoperative infusion volume was 33% higher than that in the Swan-Ganz group, which ensured increases in stroke volume and oxygen delivery in the early postoperative period (p<0.05. Respiratory support was 26% shorter in the PiCCO group (p<0.04. Conclusion. After surgical interventions for mixed cardiac defects, the targeted therapy algorithm based on transpulmonary thermodilution provided more steady-state values of hemodynamics and oxygen transport, which was followed by the increased scope of infusion therapy and the shorter length of postoperative mechanical ventilation than that based on hemodynamics being corrected from the values of prepul-monary thermodilution. Key words: transpulmonary thermodilution, targeted therapy, prepulmonary ther-modilution, acquired heart disease.

  5. Hemodynamic changes in a rat parietal cortex after endothelin-1-induced middle cerebral artery occlusion monitored by optical coherence tomography

    Liu, Jian; Ma, Yushu; Dou, Shidan; Wang, Yi; La, Dongsheng; Liu, Jianghong; Ma, Zhenhe


    A blockage of the middle cerebral artery (MCA) on the cortical branch will seriously affect the blood supply of the cerebral cortex. Real-time monitoring of MCA hemodynamic parameters is critical for therapy and rehabilitation. Optical coherence tomography (OCT) is a powerful imaging modality that can produce not only structural images but also functional information on the tissue. We use OCT to detect hemodynamic changes after MCA branch occlusion. We injected a selected dose of endothelin-1 (ET-1) at a depth of 1 mm near the MCA and let the blood vessels follow a process first of occlusion and then of slow reperfusion as realistically as possible to simulate local cerebral ischemia. During this period, we used optical microangiography and Doppler OCT to obtain multiple hemodynamic MCA parameters. The change trend of these parameters from before to after ET-1 injection clearly reflects the dynamic regularity of the MCA. These results show the mechanism of the cerebral ischemia-reperfusion process after a transient middle cerebral artery occlusion and confirm that OCT can be used to monitor hemodynamic parameters.

  6. Application of pharmacokinetics local model to evaluate renal function


    The pharmacokinetics local model was used to evaluate renal function.Some typical kinds of renal function cases, normal or disorder, were selected to be imaged with SPECT and those data measured were treated by the pharmacokinetics local model computer program (PLM).The results indicated that parameters, including peak value, peak time, inflexion time, half-excretion time, and kinetic equation played and importantrole in judging renal function.The fact confirms that local model isvery useful in evaluating renal function.

  7. Lack of Association Between Limb Hemodynamics and Response to Infrapopliteal Endovascular Therapy in Patients With Critical Limb Ischemia.

    Mustapha, J A; Diaz-Sandoval, Larry J; Adams, George; Jaff, Michael R; Beasley, Robert; McGoff, Theresa; Finton, Sara; Miller, Larry E; Ansari, Mohammad; Saab, Fadi


    Non-invasive limb hemodynamics may aid in diagnosis of critical limb ischemia (CLI), although the relationship with disease severity and response to endovascular therapy is unclear. This prospective, single-center study enrolled 100 CLI patients (Rutherford class 4-6) who underwent infrapopliteal endovascular revascularization (175 lesions) in the Peripheral RegIstry of Endovascular Clinical OutcoMEs (PRIME) registry. Hemodynamic measures included ankle-brachial index (ABI), toe-brachial index (TBI), and toe pressure (TP). Procedure success following revascularization was defined as stenosis ≤30%. Hemodynamic success was defined as an increase >0.15 in ABI or TBI relative to baseline. Freedom from amputation was defined as no major or minor amputation during follow-up. Clinical success was defined as a decrease of at least one Rutherford class during follow-up. Treatment success was defined as procedure success, freedom from amputation, and clinical improvement. Median baseline hemodynamic values were 0.90 for ABI, 0.39 for TBI, and 54 mm Hg for TP. Twenty-nine patients (29%) did not meet the common hemodynamic diagnostic criterion for eligibility in CLI trials (ABI ≤0.5, TBI ≤0.5, or TP <50 mm Hg). Main outcomes included 96% procedure success, 95% freedom from amputation, 64% clinical success, and 62% treatment success. There was no relationship between baseline (or with the pretreatment to posttreatment change) limb hemodynamic values and the response to infrapopliteal endovascular therapy. Non-invasive hemodynamic studies may have limited clinical usefulness in patients with CLI. The usefulness of these parameters to confirm eligibility and to assess response to therapy in interventional CLI clinical trials should be re-evaluated.

  8. Hemodynamic significance of internal carotid artery disease

    Schroeder, T


    . Examination of periorbital flow direction or oculoplethysmography could be used as a screening procedure. Negative tests most certainly rule out any severe pressure gradient across the stenosis, irrespective of the luminal reduction. A positive result, on the other hand, should be further quantified since...... cerebral hemodynamics in terms of increased flow through the reconstructed vessel and elimination of pressure gradients. The cerebral blood flow, though remains unchanged in the majority of patients, at least when measured at baseline. Only in those patients with a reduction in perfusion pressure can...

  9. Hemodynamic response to the upright posture.

    Smith, J J; Porth, C M; Erickson, M


    The authors' objective was to review previous studies of immediate (first 30 seconds) and stabilized (30 seconds to 20 minutes) hemodynamic responses of healthy adults to the head-up posture, with particular reference to alteration of such responses in the elderly and the usefulness of such data in the diagnosis of orthostatic hypotension. The immediate response in healthy young adults is characterized by a prompt rise in heart rate, which peaks at about 8 to 15 seconds and then tapers; the arterial pressure and total vascular resistance decrease sharply at 5 to 10 seconds, followed by a rapid rebound and overshoot. Over the first 30 seconds there is a steady parallel decline of thoracic blood volume and stroke volume; there is also an initial surge of cardiac output followed by a steady decrease. During the stabilized response (30 seconds to 20 minutes), the hemodynamic variables are relatively steady, showing average increases in heart rate of about 15 to 30%, in diastolic pressure of 10 to 15%, and in total vascular resistance of 30 to 40%; during the 5th to 20th minutes there are also decreases in thoracic blood volume averaging about 25 to 30%, in cardiac output 15 to 30%, and in pulse pressure about 5 to 10%. It is evident that in normal human subjects, assumption of the upright posture results in profound hemodynamic changes, most of them occurring during the first 30 seconds. In elderly subjects (aged 60-69 years), there are, in the upright posture, lesser increments of heart rate and diastolic pressure, but no significant differences from younger age groups in the response of thoracic blood volume, cardiac output or total vascular resistance. However, beginning at about age 75, there is an increasing incidence of orthostatic hypotension, which averages about 14 to 20% at age 75 and older. The tendency toward orthostatic hypotension in the elderly is due (1) to the structural and functional changes in the circulation itself, (2) to a decline in autonomic

  10. Emergency management of hemodynamically unstable pelvic fractures

    ZHAO Xiao-gang


    Pelvic fractures are serious injuries.Death within 24 hours is most often a result of acute blood loss.The emergency management of these patients is challenging and controversial.The key issues in its management are identifying the site(s) of hemorrhage and then controlling the bleeding.Management of hemodynamically unstable patients with pelvic fracture requires a multidisciplinary team.The issues addressed in this management algorithm are diagnostic evaluation,damage control resuscitation,indications for noninvasive pelvic stabilization,preperitoneal pelvic packing and the critical decisions concerning surgical options and angiography.This review article focuses on the recent body of knowledge on those determinations.

  11. Bilateral Renal Mass-Renal Disorder: Tuberculosis

    Ozlem Tiryaki


    Full Text Available A 30-year-old woman has presented complaining of weakness and fatigue to her primary care physician. The renal sonography is a routine step in the evaluation of new onset renal failure. When the renal masses have been discovered by sonography in this setting, the functional imaging may be critical. We reported a case about bilateral renal masses in a young female patient with tuberculosis and renal insufficiency. Magnetic resonance (MR has revealed the bilateral renal masses in patient, and this patient has been referred to our hospital for further management. The patient’s past medical and surgical history was unremarkable.

  12. Distal renal tubular acidosis

    Renal tubular acidosis - distal; Renal tubular acidosis type I; Type I RTA; RTA - distal; Classical RTA ... excreting it into the urine. Distal renal tubular acidosis (Type I RTA) is caused by a defect ...

  13. Proximal renal tubular acidosis

    Renal tubular acidosis - proximal; Type II RTA; RTA - proximal; Renal tubular acidosis type II ... by alkaline substances, mainly bicarbonate. Proximal renal tubular acidosis (Type II RTA) occurs when bicarbonate is not ...

  14. Toward an Optimal Position for IVC Filters: Computational Modeling of the Impact of Renal Vein Inflow

    Wang, S L; Singer, M A


    The purpose of this report is to evaluate the hemodynamic effects of renal vein inflow and filter position on unoccluded and partially occluded IVC filters using three-dimensional computational fluid dynamics. Three-dimensional models of the TrapEase and Gunther Celect IVC filters, spherical thrombi, and an IVC with renal veins were constructed. Hemodynamics of steady-state flow was examined for unoccluded and partially occluded TrapEase and Gunther Celect IVC filters in varying proximity to the renal veins. Flow past the unoccluded filters demonstrated minimal disruption. Natural regions of stagnant/recirculating flow in the IVC are observed superior to the bilateral renal vein inflows, and high flow velocities and elevated shear stresses are observed in the vicinity of renal inflow. Spherical thrombi induce stagnant and/or recirculating flow downstream of the thrombus. Placement of the TrapEase filter in the suprarenal vein position resulted in a large area of low shear stress/stagnant flow within the filter just downstream of thrombus trapped in the upstream trapping position. Filter position with respect to renal vein inflow influences the hemodynamics of filter trapping. Placement of the TrapEase filter in a suprarenal location may be thrombogenic with redundant areas of stagnant/recirculating flow and low shear stress along the caval wall due to the upstream trapping position and the naturally occurring region of stagnant flow from the renal veins. Infrarenal vein placement of IVC filters in a near juxtarenal position with the downstream cone near the renal vein inflow likely confers increased levels of mechanical lysis of trapped thrombi due to increased shear stress from renal vein inflow.

  15. Dataset for: An efficient multi-stage algorithm for full calibration of the hemodynamic model from BOLD signal responses

    Djellouli, Rabia


    We propose a computational strategy that falls into the category of prediction/correction iterative-type approaches, for calibrating the hemodynamic model introduced by Friston et al. (2000). The proposed method is employed to estimate consecutively the values of the biophysiological system parameters and the external stimulus characteristics of the model. Numerical results corresponding to both synthetic and real functional Magnetic Resonance Imaging (fMRI) measurements for a single stimulus as well as for multiple stimuli are reported to highlight the capability of this computational methodology to fully calibrate the considered hemodynamic model.

  16. An efficient multi-stage algorithm for full calibration of the hemodynamic model from BOLD signal responses

    Zambri, Brian


    We propose a computational strategy that falls into the category of prediction/correction iterative-type approaches, for calibrating the hemodynamic model introduced by Friston et al. (2000). The proposed method is employed to estimate consecutively the values of the biophysiological system parameters and the external stimulus characteristics of the model. Numerical results corresponding to both synthetic and real functional Magnetic Resonance Imaging (fMRI) measurements for a single stimulus as well as for multiple stimuli are reported to highlight the capability of this computational methodology to fully calibrate the considered hemodynamic model. This article is protected by copyright. All rights reserved.

  17. Cerebral Hemodynamics With rTMS in Alcohol Dependence: A Randomized, Sham-Controlled Study.

    Mishra, Biswa Ranjan; Maiti, Rituparna; Nizamie, S Haque


    The authors studied cerebral hemodynamics in alcohol dependence and evaluated their changes with application of high-frequency rTMS. A prospective, single-blind, randomized, parallel-group, sham-controlled clinical study was conducted with patients with alcohol dependence (DSM-IV-TR). The study population comprised 25 subjects each in active rTMS, sham rTMS, and healthy control groups. At baseline, cerebral hemodynamic indices were measured with transcranial Doppler sonography. Subjects in the active rTMS group received 10 sessions of rTMS daily; the sham group was administered sham rTMS with the same parameters. Cerebral hemodynamic parameters were repeated 5 minutes after the last rTMS session. At baseline, mean velocity (MV) of both middle cerebral artery (MCA; R-MCA: p=0.003; L-MCA: p=0.002) and anterior cerebral artery (ACA; R-ACA: p=0.003; L-ACA: p=.001) was significantly reduced. Pulsatility index (PI) of MCA (prTMS group, except L-MCA PI, significant differences were observed in values of MV, PI, and RI of both MCA and ACA following rTMS intervention; such changes were not evident in the sham rTMS group. The changes in mean difference in MV of L-MCA (p=0.006) and L-ACA (p=0.015) were statistically significant in the active rTMS group, in comparison with the sham group. Significant differences were also observed between the two groups postintervention, in RI of L-MCA (p=0.001) and ACA (R-ACA: p=0.010; L-ACA: p=0.015). Alcohol dependence may result in altered cerebral hemodynamic parameters, which can be improved with high-frequency rTMS application.

  18. The normal renal size of Korean children. Radiologic estimation

    Ko, Young Tae; Hyun, Jae Suk; Kim, Young Sun; Kim, Kyung Do [Chungang University College of Medicine, Chinju (Korea, Republic of)


    A nephropathy following urinary tract infection is usually referred to as renal scarring. The main radiologic features are an overall reduction in the size of the kidney, with coarse scar, deformity of calyxes and indentation of the surface. If adequately treated, the progressive renal scarring by urinary tract infection could be prevented. Therefore, the early radiologic detection of renal damage following urinary tract infection or vesicoureteral reflux is great importance for the evaluation of the pathogenesis of renal scarring and for the planning of the therapy. To evaluate the renal damage, we must have the normal data of the kidneys. Many reports discussed the renal size in normal children, but there are no reports in the Korean children. We estimate the renal length, width, several focal parenchymal thicknesses for renal size evaluation and segmental lumbar vertebral length at the intravenous paleography in the normal Korean children. And the linear equations are obtained by the regression analysis between the various renal parameters and segmental vertebral length. Thereafter we make out the nomogram by the obtained equations. The renal length and width are highly correlated to the segmental lumbar vertebral length than various renal parenchymal thicknesses. These results suggest that the renal length and width are reliable parameters for normal renal size evaluation in growing kidney. And then the obtained equations and nomograms might be useful in the diagnosis of parenchymal loss in early scarring and follow-up. (author)

  19. Renal tuberculosis

    Džamić Zoran


    Full Text Available Tuberculosis is still a significant health problem in the world, mostly in developing countries. The special significance lies in immunocompromised patients, particularly those suffering from the HIV. Urogenital tuberculosis is one of the most common forms of extrapulmonary tuberculosis, while the most commonly involved organ is the kidney. Renal tuberculosis occurs by hematogenous dissemination of mycobacterium tuberculosis from a primary tuberculosis foci in the body. Tuberculosis is characterized by the formation of pathognomonic lesions in the tissues - granulomata. These granulomata may heal spontaneously or remain stable for years. In certain circumstances in the body associated with immunosuppression, the disease may be activated. Central caseous necrosis occurs within tuberculoma, leading to formation of cavities that destroy renal parenchyma. The process may gain access to the collecting system, forming the caverns. In this way, infection can be spread distally to renal pelvis, ureter and bladder. Scaring of tissue by tuberculosis process may lead to development of strictures of the urinary tract. The clinical manifestations are presented by nonspecific symptoms and signs, so tuberculosis can often be overlooked. Sterile pyuria is characteristic for urinary tuberculosis. Dysuric complaints, flank pain or hematuria may be presented in patients. Constitutional symptoms of fever, weight loss and night sweats are presented in some severe cases. Diagnosis is made by isolation of mycobacterium tuberculosis in urine samples, by cultures carried out on standard solid media optimized for mycobacterial growth. Different imaging studies are used in diagnostics - IVU, CT and NMR are the most important. Medical therapy is the main modality of tuberculosis treatment. The first line anti-tuberculosis drugs include isoniazid, rifampicin, pyrazinamide and ethambutol. Surgical treatment is required in some cases, to remove severely damaged kidney, if

  20. [Acute renal replacement therapy in pediatrics].

    Gaillot, T; Ozanne, B; Bétrémieux, P; Tirel, O; Ecoffey, C


    In pediatric intensive care unit, the available modalities of acute renal replacement therapy include intermittent hemodialysis, peritoneal dialysis and continuous renal replacement therapies. No prospective studies have evaluated to date the effect of dialysis modality on the outcomes of children. The decision about dialysis modality should therefore be based on local expertise, resources available, and the patient's clinical status. Poor hemodynamic tolerance of intermittent hemodialysis is a common problem in critically ill patients. Moreover, many pediatric intensive care units are not equipped with dedicated water circuit. Peritoneal dialysis, a simple and inexpensive alternative, is the most widely available form of acute renal replacement therapy. However, its efficacy may be limited in critically ill patients. The use of continuous renal replacement therapy permits usually to reach a greater estimated dialysis dose, a better control of fluid balance, and additionally, to provide adequate nutrition. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  1. Drug dosing during continuous renal replacement therapies.

    Thompson, A Jill


    Continuous renal replacement therapies (CRRT) are used to manage fluid overload and/or renal failure. The continuous nature of the fluid and solute removal has less impact on hemodynamic variables in critically ill patients, making CRRT preferred over intermittent hemodialysis for some patients in the intensive care arena. The impact of CRRT on drug removal is variable depending on the CRRT modality, the ultrafiltrate and dialysate flow rates, the filter, and the patient's residual renal function; all of these may change from patient to patient or even in the same patient depending on the clinical status. However, CRRT modalities are generally more efficient than intermittent hemodialysis at drug removal, in some cases approximating or even exceeding normal renal function, resulting in a significant risk of subtherapeutic dosing if conventional hemodialysis dosing recommendations are followed. This annotated bibliography provides a summary of publications analyzing drug removal during CRRT, including CRRT settings and drug clearance values found in each study. Caution is warranted as findings from one study may not be generalizable to all patients due to the many factors that influence drug removal. Serum drug concentrations should be monitored when available, and patient clinical status is exceedingly important for following expected and unexpected responses to drug therapies. Reviews on general drug dosing calculations in CRRT are available elsewhere.

  2. Renale Osteopathie

    Horn S


    Full Text Available Die renale Osteopathie umfaßt Erkrankungen des Knochens, die bei Patienten mit chronischen Nierenerkrankungen auftreten, wie den sekundären bzw. tertiären Hyperparathyreoidismus, die adynamische Knochenerkrankung und die Osteopathie nach Nierentransplantation. Durch die Identifikation des Kalzium-Sensing-Rezeptors bzw. des Vitamin D-Rezeptors hat sich unser Verständnis der Zusammenhänge in den letzten Jahren erheblich verbessert. Neue Medikamente versprechen effizientere Prophylaxe- und Therapiemöglichkeiten. Wir beeinflussen dadurch nicht nur die Morbidität und Lebensqualität, sondern auch die Mortalität unserer Patienten.

  3. Renal disease in pregnancy.

    Thorsen, Martha S; Poole, Judith H


    Anatomic and physiologic adaptations within the renal system during pregnancy are significant. Alterations are seen in renal blood flow and glomerular filtration, resulting in changes in normal renal laboratory values. When these normal renal adaptations are coupled with pregnancy-induced complications or preexisting renal dysfunction, the woman may demonstrate a reduction of renal function leading to an increased risk of perinatal morbidity and mortality. This article will review normal pregnancy adaptations of the renal system and discuss common pregnancy-related renal complications.

  4. Digital subtaction angiography (DSA) in renal-related conditions

    Kim, Dae Ho; Jeong, Seong Wook; Bae, Kwang Soo; Chung, Moo Chan; Kim, Ki Jeong [Soon Chun Hyang University College of Medicine, Asan (Korea, Republic of)


    DSA (Digital Subtraction Angiography) is a valuable diagnostic imaging method in many clinical fields, including renal-related conditions. Sixty four renal DSA examination were performed in 59 patients with renal-related diseases from Jan. 1984 to Dec. 1985. Summary of These were as follows: 1. Intraarterial(IA)-DSA is performed in 6 cases, intravenous(IV)-DSA in 58 cases. In 58 Examinations of IV-DSA, diagnostic image quality is obtained in 51 cases (88%). 2. In investigations of a possible renovascular etiology of hypertension, IV-DSA is a simple, safe, sensitive and accurate method. On screening for evaluation of renovascular hypertension, RSP should be replaced with IV-DSA, because IV-DSA is more sensitive and accurate and can detect not only anatomic change of renal artery but also functional hemodynamic change. 3. IV-DSA is valuable in diseases with morphologic changes of vessels. In characterization of a known renal mass, and evaluation of hematuria, suspected aneurysm and renal trauma, IV-DSA is very useful diagnostic imaging modality. 4. In evaluation of potential renal donors, IV-DSA is an accurate and safe method with 82.4% of accuracy. IV-DSA also is useful in follow-up of allograft recipients. 5. In investigation of diabetic nephropathy, glomerulonephritis, pyelonephritis, IV-DSA is little helpful. 6. The advantages of DSA are well known, particularly post-procedure process using computer program is helpful for obtaining information's of hemodynamic change or time-suquence-curve of density etc. More technical improvement with this modality is required for improvement of the image quality and resolution. And more accumulation of clinical experience is required in order to increase the diagnostic accuracy.

  5. Computed tomography perfusion in living donor liver transplantation: an initial study of normal hemodynamic changes in liver grafts.

    Zhuang, Zhi Guo; Qian, Li Jun; Wang, Bi Xiong; Zhou, Yan; Li, Qi Gen; Xu, Jian Rong; Cheng, Yu Fan


    Hepatic hemodynamic changes in grafts after living donor liver transplantation (LDLT) are complicated. In this study, computed tomography (CT) perfusion parameter values, especially portal vein perfusion (PVP), was retrospectively analyzed in recipients both with and without small-for-size syndrome (SFSS). PVP was significantly higher in non-SFSS recipients on post-operative day (POD) 14 or 28 than in normal donors before donation (p spleen size ratio and PVP on POD 14 in non-SFSS group (r = -0.545, p = 0.002). Furthermore, PVP in the SFSS group was significantly greater than in the non-SFSS group on POD 14 (p = 0.042). In conclusion, we successfully evaluated normal hemodynamic changes in grafts without SFSS by CT perfusion examination. To our knowledge, this is the first study on hemodynamic changes of living donor liver grafts using CT technique.

  6. Cerebral hemodynamic dysfunction in parkinsonian patients

    Mirjana Vladetić


    Full Text Available Aim The purpose of this investigation was to determine the cerebral hemodynamics in patients withparkinsonism and the influence of hemodynamic dysfunction in developing the lacunar infarcts.Methods Fifty patients with the signs of parkinsonism were included in this study. The patients weredevided into two subgroups depending on whether they had vascular parkinsonism (VP (N-22 or idiopathicParkinson disease (N-28. The control group consisted of 30 patients who had ischemic stroke.The conventional transcranial dopler sonography was performed to evaluate the cerebral blood flow.To evaluate the cognitive impairment we performed the mini mental state examination to patients withparkinsonism.Results Patients with vascular parkinsonism have greater cognitive disturbances than patients withParkinson disease. In most of the parkinsonian patients the cerebral blood flow was decreased and themicroangiopathy was present.Conclusion In most patients with parkinsonism, the cerebral blood flow was decreased as a consequenceof microangiopathy. In our opinion, this led to lacunar infarction in VP patients, but can also bea risk factor for developing the same changes in patients with idiopathic Parkinson disease.

  7. Cerebrovascular hemodynamics in patients with cerebral arteriosclerosis

    Jianbo Yang; Changcong Cui; Chengbin Wu


    The present study observed hemodynamic changes in 26 patients with cerebral arteriosclerosis using a cerebral circulation dynamics detector and transcranial Doppler.In patients with cerebral arteriosclerosis the blood supply and flow rate in the bilateral carotid arteries and the blood flow rate in the anterior cerebral and middle cerebral arteries were similar to normal controls, but the cerebral vascular resistance, critical pressure and pulsatility index were increased, and cerebral arterial elasticity and cerebral blood flow autoregulation were decreased.Compared with the lesioned hemisphere of patients with cerebral infarction, the total blood supply and blood flow rate of patients with cerebral arteriosclerosis were higher.Compared with normal subjects, patients with cerebral arteriosclerosis exhibited cognitive disturbances, mainly in short-term memory, attention, abstract capability, and spatial and executive dysfunction.Results showed that cerebral arteriosclerosis does not directly affect the blood supply of a cerebral hemisphere, but affects cognitive function.The increased cerebral vascular resistance and reduced autoregulation of cerebral blood vessels may be important hemodynamic mechanisms of arteriosclerosis-induced cerebral infarction.

  8. Cerebral hemodynamics and functional prognosis in hydrocephalus

    Hirai, Osamu; Nishikawa, Michio; Watanabe, Shu; Yamakawa, Hiroyasu; Kinoshita, Yoshimasa; Uno, Akira; Handa, Hajime (Hamamatsu Rosai Hospital, Shizuoka (Japan))


    The functional outcome of cerebral hemodynamics in the chronic stage of juvenile hydrocephalus was determined using single photon emission computed tomography (SPECT). Five patients including three with aqueductal stenosis, one with post-meningitic hydrocephalus, and one case with hydrocephalus having developed after repair of a huge occipital encephalocele. Early images of cerebral blood flow (CBF) were obtained 25 minutes after intravenous injection of 123-I-iodoamphetamine (IMP), and late images were scanned 3 hours later. Cerebral blood volume (CBV) was also measured using {sup 99m}Tc in three patients. Twenty cases with adult communicating hydrocephalus were also investigated from the point of view of shunt effectiveness. Although there was no remarkable change in the cerebrovascular bed in the juvenile cases, CBF of the remnant brain parenchyma was good irrespective of the degree of ventricular dilatation. There was a periventricular-related IMP uptake in each case; however, it somehow matched the ventricular span. Functional outcome one to 23 years after the initial shunt operation was good in every case, despite multiple shunt revisions. Redistribution on late images had no bearing on clinical states. In adult cases, 8 patients with effective shunting demonstrated a relatively localized periventricular low perfusion, with preoperative increased cerebrospinal fluid (CSF) pressure. On the contrary, 12 patients with no improvement with or without ventricular-reduced IMP uptake, despite low CSF pressure. The present study indicates that periventricular hemodynamics may play an important role in cerebral function compromised by hydrocephalus. (J.P.N.).

  9. Hemodynamic Consequences of Changes in Microvascular Structure.

    Rizzoni, Damiano; Agabiti-Rosei, Claudia; Agabiti-Rosei, Enrico


    In hypertension, an increased media-to-lumen ratio of small resistance arteries might play an important role in the increase of vascular resistance, and may also be an adaptive response to the increased hemodynamic load. The presence of morphological alteration in the microvasculature may be associated to an impaired tissue perfusion and/or to the development of target organ damage. Structural alterations in the microcirculation might represent a predictor of the onset of cardio-cerebrovascular events and hypertension complications. A cross-talk between the small and large artery may exaggerate arterial damage, following a vicious circle. Therefore, in the present review, possible hemodynamic consequences of the presence of microvascular structural alterations will be considered, in terms of their time of onset, role in the development and/or maintenance of high blood pressure values, and interrelationships with structural/mechanical alterations of large conductance arteries. © American Journal of Hypertension, Ltd 2017. All rights reserved. For Permissions, please email:

  10. Hemodynamic forces in a model left ventricle

    Domenichini, Federico; Pedrizzetti, Gianni


    Intraventricular pressure gradients were clinically demonstrated to represent one useful indicator of the left ventricle (LV) function during the development of heart failure. We analyze the fluid dynamics inside a model LV to improve the understanding of the development of hemodynamic forces (i.e., mean pressure gradient) in normal conditions and their modification in the presence of alterations of LV tissue motion. To this aim, the problem is solved numerically and the global force exchanged between blood flow and LV boundaries is computed by volume integration. We also introduce a simplified analytical model, based on global conservation laws, to estimate hemodynamic forces from the knowledge of LV tissue information commonly available in cardiac imaging. Numerical results show that the normal intraventricular gradients feature a deep brief suction at early diastolic filling and a persistent thrust during systolic ejection. In presence of abnormalities of the wall motion, the loss of time synchrony is more relevant than the loss of spatial uniformity in modifying the normal pressure gradient spatiotemporal pattern. The main findings are reproduced in the integral model, which represents a possible easy approach for integrating fluid dynamics evaluations in the clinical examination.

  11. [Acute renal failure in patients with tumour lysis sindrome].

    Poskurica, Mileta; Petrović, Dejan; Poskurica, Mina


    `Hematologic malignancies (leukemia, lymphoma, multiple myeloma, et al.), as well as solid tumours (renal, liver, lung, ovarian, etc.), can lead to acute or chronic renal failure.The most common clinical manifestation is acute renal failure within the tumour lysis syndrome (TLS). It is characterized by specific laboratory and clinical criteria in order to prove that kidney disorders result from cytolysis of tumour cells after chemotherapy regimen given, although on significantly fewer occasions it is likely to occur spontaneously or after radiotherapy. Essentially, failure is the disorder of functionally conserved kidney or of kidney with varying degrees of renal insufficiency, which render the kidney impaired and unable to effectively eliminate the end products of massive cytolysis and to correct the resulting disorders: hyperuricemia, hyperkalemia, hypocalcaemia, hyperphosphatemia, and others. The risk of TLS depends on tumour size, proliferative potential of malignant cells, renal function and the presence of accompanying diseases and disorders. Hydration providing adequate diuresis and administration of urinary suppressants (allopurinol, febuxostat) significantly reduce the risk of developing TLS. If prevention of renal impairment isn't possible, the treatment should be supplemented with hemodynamic monitoring and pharmacological support, with the possible application of recombinant urate-oxidase enzyme (rasburicase). Depending on the severity of azotemia and hydroelectrolytic disorders, application of some of the methods of renal replacement therapy may be considered.

  12. Acute renal failure in patients with tumour lysis sindrome

    Poskurica Mileta


    Full Text Available Hematologic malignancies (leukemia, lymphoma, multiple myeloma, et al., as well as solid tumours (renal, liver, lung, ovarian, etc., can lead to acute or chronic renal failure. The most common clinical manifestation is acute renal failure within the tumour lysis syndrome (TLS. It is characterized by specific laboratory and clinical criteria in order to prove that kidney disorders result from cytolysis of tumour cells after chemotherapy regimen given, although on significantly fewer occasions it is likely to occur spontaneously or after radiotherapy. Essentially, failure is the disorder of functionally conserved kidney or of kidney with varying degrees of renal insufficiency, which render the kidney impaired and unable to effectively eliminate the end products of massive cytolysis and to correct the resulting disorders: hyperuricemia, hyperkalemia, hypocalcaemia, hyperphosphatemia, and others. The risk of TLS depends on tumour size, proliferative potential of malignant cells, renal function and the presence of accompanying diseases and disorders. Hydration providing adequate diuresis and administration of urinary suppressants (allopurinol, febuxostat significantly reduce the risk of developing TLS. If prevention of renal impairment isn’t possible, the treatment should be supplemented with hemodynamic monitoring and pharmacological support, with the possible application of recombinant urate-oxidase enzyme (rasburicase. Depending on the severity of azotemia and hydroelectrolytic disorders, application of some of the methods of renal replacement therapy may be considered.

  13. [Renal protection in intensive care : Myths and facts].

    John, S


    Acute kidney injury (AKI) is a common and severe complication in patients on the intensive care unit with a significant impact on patient mortality, morbidity and costs of care; therefore, renal protective therapy is most important in these severely ill patients. Many renal protective strategies have been postulated during the last decades, which are sometimes still in place as a kind of "myth" but which are not always proven by evidence-based "facts". The aim of this review is therefore to question and compare some of these "myths" with the available "facts". Most important for renal protection is the early identification of patients at risk for AKI or with acute kidney damage before renal function deteriorates further. A stage-based management of AKI comprises more general measures, such as discontinuation of nephrotoxic agents and adjustment of diuretic doses but most importantly early hemodynamic stabilization with crystalloid volume replacement solutions and vasopressors, such as noradrenaline. The aim is to ensure optimal renal perfusion and perfusion pressure. Patients with known arterial hypertension potentially need higher perfusion pressures. Large amounts of hyperchloremic solutions should be avoided. Volume overload and renal vasodilatory substances can also lead to further deterioration of kidney function. There is still no specific pharmacological therapy for renal protection.

  14. Advanced Hemodynamic Management in Patients with Septic Shock

    Huber, Wolfgang; Nierhaus, Axel; Kluge, Stefan; Reuter, Daniel A.; Wagner, Julia Y.


    In patients with sepsis and septic shock, the hemodynamic management in both early and later phases of these “organ dysfunction syndromes” is a key therapeutic component. It needs, however, to be differentiated between “early goal-directed therapy” (EGDT) as proposed for the first 6 hours of emergency department treatment by Rivers et al. in 2001 and “hemodynamic management” using advanced hemodynamic monitoring in the intensive care unit (ICU). Recent large trials demonstrated that nowadays protocolized EGDT does not seem to be superior to “usual care” in terms of a reduction in mortality in emergency department patients with early identified septic shock who promptly receive antibiotic therapy and fluid resuscitation. “Hemodynamic management” comprises (a) making the diagnosis of septic shock as one differential diagnosis of circulatory shock, (b) assessing the hemodynamic status including the identification of therapeutic conflicts, and (c) guiding therapeutic interventions. We propose two algorithms for hemodynamic management using transpulmonary thermodilution-derived variables aiming to optimize the cardiocirculatory and pulmonary status in adult ICU patients with septic shock. The complexity and heterogeneity of patients with septic shock implies that individualized approaches for hemodynamic management are mandatory. Defining individual hemodynamic target values for patients with septic shock in different phases of the disease must be the focus of future studies. PMID:27703980

  15. Hemodynamic Disorders in Explosive Mine Injury: Experimental Study

    V. N Yelsky; G. K. Krivobok; A. N. Talalayenko; A. A. Redko; A. Yu. Kryuk


    The authors have studied hemodynamic features in explosive mine injury in the presence or absence of a preliminary exposure to premorbid mining factors. A combined influence of premorbid mining factors following an explosive mine injury has been ascertained to induce more severe systemic and cerebral hemodynamic disorders than an isolated explosive mine injury.

  16. Non-invasive assessment of maternal hemodynamics in early pregnancy

    van der Graaf, Anne Marijn; Zeeman, Gerda G.; Groen, Henk; Roberts, Claire; Dekker, Gus A.


    Objectives: Non-invasive assessment of maternal hemodynamics in early pregnancy may be promising in evaluating maternal hemodynamic (mal)adaptation to pregnancy. We explored usage of applanation tonometry and Doppler ultrasound for assessment of cardiac output (CO), systemic vascular resistance (SVR

  17. Renal calculus

    Pyrah, Leslie N


    Stone in the urinary tract has fascinated the medical profession from the earliest times and has played an important part in the development of surgery. The earliest major planned operations were for the removal of vesical calculus; renal and ureteric calculi provided the first stimulus for the radiological investigation of the viscera, and the biochemical investigation of the causes of calculus formation has been the training ground for surgeons interested in metabolic disorders. It is therefore no surprise that stone has been the subject of a number of monographs by eminent urologists, but the rapid development of knowledge has made it possible for each one of these authors to produce something new. There is still a technical challenge to the surgeon in the removal of renal calculi, and on this topic we are always glad to have the advice of a master craftsman; but inevitably much of the interest centres on the elucidation of the causes of stone formation and its prevention. Professor Pyrah has had a long an...

  18. ANCA-Associated Glomerulonephritis: Risk Factors for Renal Relapse

    Göçeroğlu, Arda; Berden, Annelies E.; Fiocco, Marta; Floßmann, Oliver; Westman, Kerstin W.; Ferrario, Franco; Gaskin, Gill; Pusey, Charles D.; Hagen, E. Christiaan; Noël, Laure-Hélène; Rasmussen, Niels; Waldherr, Rüdiger; Walsh, Michael; Bruijn, Jan A.; Jayne, David R. W.; Bajema, Ingeborg M.


    Relapse in ANCA-associated vasculitis (AAV) has been studied previously, but there are few studies on renal relapse in particular. Identifying patients at high risk of renal relapse may aid in optimizing clinical management. We investigated which clinical and histological parameters are risk factors for renal relapse in ANCA-associated glomerulonephritis (AAGN). Patients (n = 174) were newly diagnosed and had mild–moderate or severe renal involvement. Data were derived from two trials of the European Vasculitis Society: MEPEX and CYCAZAREM. The Cox regression model was used to identify parameters increasing the instantaneous risk (= rate) of renal relapse (useful for instant clinical decisions). For identifying predictors of renal relapse during follow-up, we used Fine & Gray’s regression model. Competing events were end-stage renal failure and death. The cumulative incidence of renal relapse at 5 years was 9.5% (95% CI: 4.8–14.3%). In the Cox model, sclerotic class AAGN increased the instantaneous risk of renal relapse. In Fine & Gray’s model, the absence of interstitial infiltrates at diagnosis was predictive for renal relapse. In this study we used two different models to identify possible relationships between clinical and histopathological parameters at time of diagnosis of AAV with the risk of experiencing renal relapse. Sclerotic class AAGN increased the instantaneous risk of renal relapse. This association is most likely due to the high proportion of sclerosed glomeruli reducing the compensatory capacity. The absence of interstitial infiltrates increased the risk of renal relapse which is a warning sign that patients with a relatively benign onset of disease may also be prone to renal relapse. Renal relapses occurring in patients with sclerotic class AAGN and renal relapses occurring in patients without interstitial infiltrates were mutually exclusive, which may indicate that they are essentially different. PMID:27973575

  19. Characterization of pulmonary microcirculation according to hemodynamic changes with computed tomography

    Choi, Byoung W.; Choe, Kyu O.; Kim, Hee-Joung; Cho, Bum K.; Chung, Kyung Y.; Kim, Se K.; Kim, Bong K.; Yang, In S.


    The common and important change of pulmonary hemodynamics is represented by increased or decreased pulmonary blood flow (PBF) and increased pulmonary vascular resistance (PVR). We made 3 hemodynamic models in 5 dogs, that is, increased and decreased PBF model and increased PVR model. CT perfusion scan was performed. Perfusion parameters including blood flow (BF), blood volume (BV), mean transit time (MTT), and maximal slope (MS) were analyzed. In normal state, blood flow was affected by gravity and dependent area showed higher BF, BV and lower MS, MTT than non-dependent area. First, decreased PBF model showed no significant change in BV and elongation of MTT. Secondly, increased PBF model showed slightly increased BV and decreased MTT. Thirdly, increased PVR model showed significant decrease of BF, BV, and MS and slight increase of MTT without statistical significance. However, it was noticeable that the distribution of MTT according to gravity in normal lung was completely reversed in increased PVR model. In conclusion, on the basis of our understanding of perfusion characteristic in normal state, we can detect and evaluate the abnormal regional hemodynamic change in lung. Predicting the change of pulmonary vascular resistance should be possible by thorough analysis of CT perfusion parameters.

  20. Heart and aortic baroreceptors: operation in providing hemodynamic processes in cardiovascular system

    Mikhail Y. Rudenko


    Full Text Available Aims Up to the present, ECGs have been classified on the basis of the analysis of the ECG curve shape. But this made impossible to classify many ECG shapes. The most promising methods for the classification must evaluate each of the 10 cardiac cycle phases both by their functions and hemodynamic parameters. The aim hereof is to develop the new classification principles for all possible ECG shape variations. Materials and methods The heart cycle phase analysis method is used to calculate the hemodynamic parameters in each of 10 phases, like the phase-related blood volumes and the level of contraction of the corresponding cardiovascular musculature determining its function dynamics in the cardiac cycle phase structure related to the compensation mechanism for maintaining normal hemodynamics. Results An ECG phase changes periodic table consisting of 10 groups of the actual ECG curves typical for the corresponding pathologies is proposed. Each group contains 4 levels of characteristic phase changes. Conclusion The ECG phase changes periodic table is the first attempt to classify the great variety of the ECG shapes. In this case the proposed system requires further investigations. It has been demonstrated that the theoretical concept of the table is in compliance with practice. Further it is planned to improve characteristics of every group and every level.

  1. [Analysis and computational fluid dynamics simulation of hemodynamic influences caused by splenic vein thrombosis].

    Zhou, Hongyu; Gong, Peiyun; Du, Xuesen; Wang, Meng


    This paper aims to analyze the impact of splenic vein thrombosis (SVT) on the hemodynamic parameters in hepatic portal vein system. Based on computed tomography (CT) images of a patient with portal hypertension and commercial software MIMICS, the patient's portal venous system model was reconstructed. Color Doppler ultrasound method was used to measure the blood flow velocity in portal vein system and then the blood flow velocities were used as the inlet boundary conditions of simulation. By using the computational fluid dynamics (CFD) method, we simulated the changes of hemodynamic parameters in portal venous system with and without splenic vein thrombosis and analyzed the influence of physiological processes. The simulation results reproduced the blood flow process in portal venous system and the results showed that the splenic vein thrombosis caused serious impacts on hemodynamics. When blood flowed through the thrombosis, blood pressure reduced, flow velocity and wall shear stress increased. Flow resistance increased, blood flow velocity slowed down, the pressure gradient and wall shear stress distribution were more uniform in portal vein. The blood supply to liver decreased. Splenic vein thrombosis led to the possibility of forming new thrombosis in portal vein and surroundings.

  2. Acutely altered hemodynamics following venous obstruction in the early chick embryo.

    Stekelenburg-de Vos, Sandra; Ursem, Nicolette T C; Hop, Wim C J; Wladimiroff, Juriy W; Gittenberger-de Groot, Adriana C; Poelmann, Robert E


    In the venous clip model specific cardiac malformations are induced in the chick embryo by obstructing the right lateral vitelline vein with a microclip. Clipping alters venous return and intracardiac laminar blood flow patterns, with secondary effects on the mechanical load of the embryonic myocardium. We investigated the instantaneous effects of clipping the right lateral vitelline vein on hemodynamics in the stage-17 chick embryo. 32 chick embryos HH 17 were subdivided into venous clipped (N=16) and matched control embryos (N=16). Dorsal aortic blood flow velocity was measured with a 20 MHz pulsed Doppler meter. A time series of eight successive measurements per embryo was made starting just before clipping and ending 5h after clipping. Heart rate, peak systolic velocity, time-averaged velocity, peak blood flow, mean blood flow, peak acceleration and stroke volume were determined. All hemodynamic parameters decreased acutely after venous clipping and only three out of seven parameters (heart rate, time-averaged velocity and mean blood flow) showed a recovery to baseline values during the 5h study period. We conclude that the experimental alteration of venous return has major acute effects on hemodynamics in the chick embryo. These effects may be responsible for the observed cardiac malformations after clipping.

  3. [Isradipine-SRO: antihypertensive efficacy, central and peripheral hemodynamic effects in patients with hypertensive disease].

    Podzolkov, V I; Bartieva, D M; Makolkin, V I


    To assess antihypertensive efficacy of isradipine, to study its effects on central and peripheral hemodynamics, and to investigate relationships between state of microcirculation and response to treatment. Isradipine was given for 12 weeks to 30 patients (16 men, 14 women, mean age 50.2+/-9.8 years) with I-II stage mild and moderate hypertension. Twenty four hour blood pressure monitoring, assessment of parameters of central hemodynamics and state of microcirculation were carried out before and after 12 weeks of isradipine administration. Administration of isradipine was associated with improved sense of well-being and significant lowering of 24-hour, diurnal and nocturnal systolic/diastolic blood pressure (by 6.4/12.7, 7.6/9.4, 10.5/13.4%, respectively). Average 24-hour heart rate increased mainly during daytime (by 10.6%). Mean hemodynamic blood pressure was lowered by 16.3% due to reduction of total peripheral vascular resistance. There occurred redistribution of types of microcirculation with increase of proportion of normocirculatory and decrease - of spastic types. Changes of parameters of microcirculation at rest and during functional tests evidenced for resolution of baseline arteriolar spasm, stasis and venous congestion in microcirculatory vascular bed. Patients who responded to isradipine more often had spastic (50%) and congestive (35%) types of microcirculation. Patients with hyperemic type did not respond to isradipine. Most frequent side effect was flushing (23.3%) because of which 2 patients stopped taking the drug.

  4. Comparative Study of the Clonidin and Propranolol Effect in the Prevention of Hemodynamic Changes after Electroconvulsive Therapy

    A. Moradi


    Full Text Available Introduction & Objective: ECT is an inevitable therapy for many of psychiatric patients. During ECT severe hemodynamic changes occur which may cause dangerous cardiovascular complications especially in elderly patients with cardiac disease and may lead to arrhythmia,ischemia and myocardial infarction. The purpose of this study was to show the effect of clonidin and propranolol on the prevention of hemodynamic changes following the ECT.Materials & Methods: This study was a controlled double blind clinical trial which was carried out on 31 patients ASA I, II hospitalized in psychiatry ward of Hamadan Sina hospital who were in need of ECT. In order to increase the accuracy of the study the personal factors on the drug metabolism were omitted and the chosen patients were given ECT three times separately with the interval of 48 hours. Two hours before every ECT clonidin (0.2 mg, propranolol (40 mg and placebo (vitamin c were administered and after each ECT the hemodynamic parameters including systolic blood pressure, diastolic blood pressure, rate pressure product and ECG were measured at certain intervals and recorded on information forms and then analyzed by SPSS 9 soft ware. Results: The result of this study showed that the average changes of hemodynamic parameters in different times occurred in all groups significantly(p<0.001. Following ECT, arrhythmia in control group has been plentiful in comparison with the other two groups, and the changes were statistically meaningful (p=0.001.Conclusion: We concluded that the modifying hemodynamic changes and decrease of arrhythmia taking the drugs in comparison with placebo have been more effective and of the two drugs, propranolol has been more effective on the prevention of hemodynamic changes after ECT.

  5. Central hemodynamics and androgen status in men with coronary heart disease, and androgen deficiency in its correction of prolonged administration of testosterone

    L. M. Gaivoronskaya


    Full Text Available This work was designed to study the dynamic of the central hemodynamic disorders symptoms at men with coronary heart disease, stable angina, obesity and androgen deficiency under replacement short-term therapy by Testosterone undecanoate (TU. The comparative assessment of central hemodynamic indicators and total and sub-scale AMS score at two groups of men who receiving (the main group and not receiving (control group replacement therapy of TU is carried out. Results showed that in the main group, unlike control group the positive tendency in a number of indicators (stroke volume, left ventricular end- diastolic volume, left ventricular end- systolic volume of the central hemodynamic and indicators of the androgenic status is observed. Positive dynamics of some parameters of the central hemodynamic even at short-term replacement therapy of TU indicates the therapeutic potential of testosterone at cardiovascular pathology which full realization may require longer period of testosterone administration.

  6. Cigarette smoking: an important renal risk factor – far beyond carcinogenesis

    Orth SR


    Full Text Available Abstract In recent years, it has become apparent that smoking has a negative impact on renal function, being one of the most important remediable renal risk factors. It has been clearly shown that the risk for high-normal urinary albumin excretion and microalbuminuria is increased in smoking compared to non-smoking subjects of the general population. Data from the Multiple Risk Factor Intervention Trial (MRFIT indicate that at least in males, smoking increases the risk to reach end-stage renal failure. Smoking is particularly "nephrotoxic" in older subjects, subjects with essential hypertension and patients with preexisting renal disease. Of interest, the magnitude of the adverse renal effect of smoking seems to be independent of the underlying renal disease. Death-censored renal graft survival is decreased in smokers, indicating that smoking also damages the renal transplant. Cessation of smoking has been show to reduce the rate of progression of renal failure both in patients with renal disease or a renal transplant. The mechanisms of smoking-induced renal damage are only partly understood and comprise acute hemodynamic (e.g., increase in blood pressure and presumably intraglomerular pressure and chronic effects (e.g., endothelial cell dysfunction. Renal failure per se leads to an increased cardiovascular risk. The latter is further aggravated by smoking. Particularly survival of smokers with diabetes mellitus on hemodialysis is abysmal. In the present review article the current state of knowledge about the renal risks of smoking is reviewed. It is the aim of the article to point out that smoking not only increases the risk of renal cell carcinoma or uroepithelial cell carcinoma, but also the risk of a faster decline of renal function. The latter is a relatively new negative aspect which has not been widely recognized.

  7. Echocardiographic Evaluation of Hemodynamic Changes in Left-Sided Heart Valves in Pregnant Women With Valvular Heart Disease.

    Samiei, Niloufar; Amirsardari, Mandana; Rezaei, Yousef; Parsaee, Mozhgan; Kashfi, Fahimeh; Hantoosh Zadeh, Sedigheh; Beikmohamadi, Somayeh; Fouladi, Masoumeh; Hosseini, Saeid; Peighambari, Mohammad Mehdi; Mohebbi, Ahmad


    Physiologic changes during pregnancy can deteriorate or improve patients' hemodynamic status in the setting of valvular heart disease. There are sparse data regarding the effect of pregnancy on valve hemodynamics in normal pregnant women with known valvular heart disease. In a prospective study from July 2014 to January 2016, a total of 52 normal pregnant women who had mitral stenosis, aortic stenosis, or a history of mitral valve or aortic valve replacements were assessed. All patients underwent echocardiographic examinations and hemodynamic parameters were measured for both the mitral valve and aortic valve at first, second, and third trimesters. The parameters included mean gradient, peak gradient, mean gradient/heart rate, peak gradient/heart rate, pressure halftime, dimensionless velocity index, and valve area. Although most hemodynamic parameters (i.e., mean gradient, peak gradient, mean gradient/heart rate, and peak gradient/heart rate) increased approximately 50% from first to second trimester and first to third trimester (p 0.05). The ratio of changes between trimesters for valve area and dimensionless velocity index were comparable. No clinical decompensations were observed except for 3 and 7 cases of deterioration to functional class II at second and third trimesters, respectively. In conclusion, during a full-term and uncomplicated pregnancy, mitral and aortic valve gradients increase without significant changes in valve area that are more marked between the second and first trimester than between the third and second trimester.

  8. Study of severe scorpion envenoming following subcutaneous venom injection into dogs: Hemodynamic and concentration/effect analysis.

    Elatrous, Souheil; Ouanes-Besbes, Lamia; Ben Sik-Ali, Habiba; Hamouda, Zineb; BenAbdallah, Saoussen; Tilouche, Nejla; Jalloul, Faten; Fkih-Hassen, Mohamed; Dachraoui, Fahmi; Ouanes, Islem; Abroug, Fekri


    To evaluate the dose-effects of Androctonus australis hector (Aah) venom injected subcutaneously on hemodynamics and neurohormonal secretions, 10 anesthetized and ventilated mongrel dogs, were split in two groups (n = 5/group). Subcutaneous injection was done with either 0.2 mg/kg or 0.125 mg/kg of the purified G50 scorpion toxic fraction. Hemodynamic parameters using right heart catheter were recorded and plasma concentrations of catecholamine, troponin, and serum toxic fraction were measured sequentially from baseline to 120 min. We identified the dose of toxic fraction evoking characteristic hemodynamic perturbation of severe envenomation, the time-lapse to envenomation, and the associated plasma level. The injection of 0.125 mg/kg toxic fraction was not associated with significant variations in hemodynamic parameters, whereas the 0.2 mg/kg dose caused envenomation characterized by significant increase in plasma catecholamines, increased pulmonary artery occluded pressure, mean arterial pressure, and systemic vascular resistance (p < 0.05), in association with sustained decline in cardiac output (p < 0.001). Envenomation occurred by the 30th minute, and the corresponding concentration of toxic fraction was 1.14 ng/ml. The current experiment allowed the identification of the sub-lethal dose (0.2 mg/kg) of the toxic fraction of Aah administered by the subcutaneous route. Two parameters with potential clinical relevance were also uncovered: the time-lapse to envenomation and the corresponding concentration of toxic fraction.

  9. Renal effects of DPP-4 inhibitor sitagliptin or GLP-1 receptor agonist liraglutide in overweight patients with type 2 diabetes : A 12-week, randomized, double-blind, placebo-controlled trial

    Tonneijck, Lennart; Smits, Mark M.; Muskiet, Marcel H A; Hoekstra, Trynke; Kramer, Mark H H; Danser, A. H Jan; Ter Wee, Piet M.; Diamant, Michaela; Joles, Jaap A.; Van Raalte, Daniël H.


    OBJECTIVE To investigate effects of dipeptidyl peptidase-4 inhibitor (DPP-4I) sitagliptin or glucagon-like peptide 1 (GLP-1) receptor agonist liraglutide treatment on renal hemodynamics, tubular functions, and markers of renal damage in overweight patients with type 2 diabetes without chronic kidney

  10. Renal effects of DPP-4 inhibitor sitagliptin or GLP-1 receptor agonist liraglutide in overweight patients with type 2 diabetes : A 12-week, randomized, double-blind, placebo-controlled trial

    Tonneijck, Lennart; Smits, Mark M.; Muskiet, Marcel H A; Hoekstra, Trynke; Kramer, Mark H H; Danser, A. H Jan; Ter Wee, Piet M.; Diamant, Michaela; Joles, Jaap A.; Van Raalte, Daniël H.


    OBJECTIVE To investigate effects of dipeptidyl peptidase-4 inhibitor (DPP-4I) sitagliptin or glucagon-like peptide 1 (GLP-1) receptor agonist liraglutide treatment on renal hemodynamics, tubular functions, and markers of renal damage in overweight patients with type 2 diabetes without chronic kidney

  11. Imaging of hemodynamic effects in arthritic joints with dynamic optical tomography

    Hielscher, Andreas H.; Lasker, Joseph M.; Fong, Christopher J.; Dwyer, Edward


    Optical probing of hemodynamics is often employed in areas such as brain, muscular, and breast-cancer imaging. In these studies an external stimulus is applied and changes in relevant physiological parameters, e.g. oxy or deoxyhemoglobin concentrations, are determined. In this work we present the first application of this method for characterizing joint diseases, especially effects of rheumatoid arthritis (RA) in the proximal-interphalangeal (PIP) finger joints. Using a dual-wavelength tomographic imaging system together with previously implemented model-based iterative image reconstruction schemes, we have performed dynamic imaging case studies on a limited number of healthy volunteers and patients diagnosed with RA. Inflating a sphygmomanometer cuff placed around the forearm we elicited a controlled vascular response. We observed pronounced differences between the hemodynamic effect occurring in healthy volunteers and patients affected by RA.

  12. Hemodynamic analysis of intracranial aneurysms using phase-contrast magnetic resonance imaging and computational fluid dynamics

    Zhao, Xuemei; Li, Rui; Chen, Yu; Sia, Sheau Fung; Li, Donghai; Zhang, Yu; Liu, Aihua


    Additional hemodynamic parameters are highly desirable in the clinical management of intracranial aneurysm rupture as static medical images cannot demonstrate the blood flow within aneurysms. There are two ways of obtaining the hemodynamic information—by phase-contrast magnetic resonance imaging (PCMRI) and computational fluid dynamics (CFD). In this paper, we compared PCMRI and CFD in the analysis of a stable patient's specific aneurysm. The results showed that PCMRI and CFD are in good agreement with each other. An additional CFD study of two stable and two ruptured aneurysms revealed that ruptured aneurysms have a higher statistical average blood velocity, wall shear stress, and oscillatory shear index (OSI) within the aneurysm sac compared to those of stable aneurysms. Furthermore, for ruptured aneurysms, the OSI divides the positive and negative wall shear stress divergence at the aneurysm sac.

  13. A Perspective Review on Numerical Simulations of Hemodynamics in Aortic Dissection

    Wan Ab Naim, Wan Naimah; Ganesan, Poo Balan; Hashim, Shahrul Amry


    Aortic dissection, characterized by separation of the layers of the aortic wall, poses a significant challenge for clinicians. While type A aortic dissection patients are normally managed using surgical treatment, optimal treatment strategy for type B aortic dissection remains controversial and requires further evaluation. Although aortic diameter measured by CT angiography has been clinically used as a guideline to predict dilation in aortic dissection, hemodynamic parameters (e.g., pressure and wall shear stress), geometrical factors, and composition of the aorta wall are known to substantially affect disease progression. Due to the limitations of cardiac imaging modalities, numerical simulations have been widely used for the prediction of disease progression and therapeutic outcomes, by providing detailed insights into the hemodynamics. This paper presents a comprehensive review of the existing numerical models developed to investigate reasons behind tear initiation and progression, as well as the effectiveness of various treatment strategies, particularly the stent graft treatment. PMID:24672348

  14. Conventional hemodynamic resuscitation may fail to optimize tissue perfusion: An observational study on the effects of dobutamine, enoximone, and norepinephrine in patients with acute myocardial infarction complicated by cardiogenic shock

    C.A. den Uil (Corstiaan); W.K. Lagrand (Wim); M. van der Ent (Martin); K. Nieman (Koen); A. Struijs (Ard); L.S.D. Jewbali (Lucia); A.A. Constantinescu (Alina); P.E. Spronk (Peter); M.L. Simoons (Maarten)


    textabstractAim: To investigate the effects of inotropic agents on parameters of tissue perfusion in patients with cardiogenic shock. Methods and Results: Thirty patients with cardiogenic shock were included. Patients received dobutamine, enoximone, or norepinephrine. We performed hemodynamic measur

  15. Hemodynamic studies in preeclampsia: implications for management

    W. Visser (Willy)


    textabstractPreeclampsia is a condition unique to pregnancy, characterized by hypertension and proteinuria. Nulliparous pregnancies and those affected by preexisting hypertension, diabetes and renal disease are at increased risk. Preeclampsia may develop during pregnancy, labor or in the early puerp

  16. [Regional cerebral oxygen saturation as a marker of hemodynamic state following cardiac surgery].

    García-Hernández, J A; Aldemira-Liz, A; Martínez-López, A I; Cayuela, A; Charlo-Molina, M T; Cano-Franco, J; Loscertales-Abril, M


    Regional cerebral oxygen saturation (rSO₂) is a measure of the general state of perfusion and oxygenation. We aim to analyze the relationship between this and various hemodynamic and respiratory parameters. Forty-three patients, operated on between October 2011 and July 2012, were included in this prospective observational descriptive study. The following parameters were measured: mean arterial pressure, both arterial and central venous oxygen saturation and partial pressures of oxygen and carbon dioxide, and lactate levels. From these parameters, the oxygenation index and the oxygen extraction ratio were calculated. These measurements were studied to evaluate whether rSO₂ correlated significantly with the other parameters. The average age and weight of the patients were 27.3 months and 9.2 kg, respectively. The rSO₂ correlated positively with both central venous oxygen saturation (r=0.73, P 0.4) between the rSO₂ and central venous oxygen saturation, and between the rSO₂ and oxygen extraction ratio. Regional cerebral oxygen saturation correlates well with hemodynamic parameters - mean arterial pressure, venous saturation, and the tissue oxygen extraction. However, it does not correlate with respiratory parameters. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  17. Hemodynamic challenge to early mobilization after cardiac surgery: A pilot study

    Tiziano Cassina


    Full Text Available Background: Active mobilization is a key component in fast-track surgical strategies. Following major surgery, clinicians are often reluctant to mobilize patients arguing that circulatory homeostasis would be impaired as a result of myocardial stunning, fluid shift, and autonomic dysfunction. Aims: We examined the feasibility and safety of a mobilization protocol 12-24 h after elective cardiac surgery. Setting and Design: This observational study was performed in a tertiary nonacademic cardiovascular Intensive Care Unit. Materials and Methods: Over a 6-month period, we prospectively evaluated the hemodynamic response to a two-staged mobilization procedure in 53 consecutive patients. Before, during, and after the mobilization, hemodynamics parameters were recorded, including the central venous oxygen saturation (ScvO 2 , lactate concentrations, mean arterial pressure (MAP, heart rate (HR, right atrial pressure (RAP, and arterial oxygen saturation (SpO 2 . Any adverse events were documented. Results: All patients successfully completed the mobilization procedure. Compared with the supine position, mobilization induced significant increases in arterial lactate (34.6% [31.6%, 47.6%], P = 0.0022 along with reduction in RAP (−33% [−21%, −45%], P 10% and nine of them (17% required treatment. Hypotensive patients experienced a greater decrease in ScvO 2 (−18 ± 5% vs. −9 ± 4%, P = 0.004 with similar changes in RAP and HR. All hemodynamic parameters, but arterial lactate, recovered baseline values after resuming the horizontal position. Conclusions: Early mobilization after cardiac surgery appears to be a safe procedure as far as it is performed under close hemodynamic and clinical monitoring in an intensive care setting.

  18. Monitoring changes in hemodynamics following optogenetic stimulation

    Frye, Seth

    The brain is composed of billions of neurons, all of which connected through a vast network. After years of study and applications of different technologies and techniques, there are still more questions than answers when it comes to the fundamental functions of the brain. This project aims to provide a new tool which can be used to gain a better understanding of the fundamental mechanisms that govern neurological processes inside the brain. In order for neural networks to operate, blood has to be supplied through neighboring blood vessels. As such, the increase or decrease in the blood supply has been used as an indicator of neural activity. The neural activity and blood supply relationship is known as neural vasculature coupling. Monitoring the hemodynamics is used as an indicator of neurological activity, but the causal relationship is an area of current research. Gaining a better understanding of the coupling of neural activity and the surrounding vasculature provides a more accurate methodology to evaluate regional neural activity. The new optical technology applied in this project provides a set of tools to both stimulate and monitor this coupling relationship. Optogenetics provides the capability of stimulating neural activity using specific wavelengths of light. Essentially this tool allows for the direct stimulation of networks of neurons by simply shining one color of light onto the brain. Optical Coherence Tomography (OCT), another new optical technology applied in this project, can record volumetric images of blood vessels and flow using only infrared light. The combination of the two optical technologies is then capable of stimulating neural activity and monitoring the hemodynamic response inside the brain using only light. As a result of this project we have successfully demonstrated the capability of both stimulating and imaging the brain using new optical technologies. The optical stimulation of neural activity has evoked a direct hemodynamic effect

  19. Biomarkers of Hemodynamic Stress and Aortic Stiffness after STEMI: A Cross-Sectional Analysis

    Sebastian Johannes Reinstadler


    Full Text Available Aim. Increased aortic stiffness might adversely affect cardiac structure, function, and perfusion. Release of biomarkers of hemodynamic stress is thought to be enhanced by these alterations. We aimed to evaluate the association between biomarkers of hemodynamic stress and aortic stiffness assessed at a chronic stage after ST-segment elevation myocardial infarction (STEMI. Methods. Fifty-four patients four months after STEMI were enrolled in this cross-sectional, single-center study. N-terminal pro–B-type natriuretic peptide (NT-proBNP, mid-regional pro–A-type natriuretic peptide (MR-proANP, and mid-regional proadrenomedullin (MR-proADM levels were measured by established assays. Aortic stiffness was assessed by the measurement of pulse wave velocity using phase-contrast cardiovascular magnetic resonance. Results. NT-proBNP, MR-proANP, and MR-proADM concentrations were all correlated with aortic stiffness in univariate analysis (r=0.378, r=0.425, and r=0.532; all P<0.005, resp.. In multiple linear regression analysis, NT-proBNP (β=0.316, P=0.005 and MR-proADM (β=0.284, P<0.020 levels were associated with increased aortic stiffness independently of age, blood pressure, and renal function. NT-proBNP was the strongest predictor for high aortic stiffness (area under the curve: 0.82, 95% CI 0.67–0.96. Conclusion. At a chronic stage after STEMI, concentrations of biomarkers for hemodynamic stress, especially NT-proBNP, are positively correlated with aortic stiffness. These biomarkers might also be useful as predictors of high aortic stiffness after STEMI.

  20. Renal actinomycosis with concomitant renal vein thrombosis.

    Chang, Dong-Suk; Jang, Won Ik; Jung, Ji Yoon; Chung, Sarah; Choi, Dae Eun; Na, Ki-Ryang; Lee, Kang Wook; Shin, Yong-Tai


    Renal actinomycosis is a rare infection caused by fungi of the genus Actinomyces. A 74-year-old male was admitted to our hospital because of gross hematuria with urinary symptoms and intermittent chills. Computed tomography of the abdomen showed thrombosis in the left renal vein and diffuse, heterogeneous enlargement of the left kidney. After nephrectomy, sulfur granules with chronic suppurative inflammation were seen microscopically, and the histopathological diagnosis was renal actinomycosis. Our case is the first report of renal actinomycosis with renal vein thrombosis.

  1. Predictors of nephrectomy in high grade blunt renal trauma patients treated primarily with conservative intent.

    Prasad, Narla Hari; Devraj, Rahul; Chandriah, G Ram; Sagar, S Vidya; Reddy, Ch Ram; Murthy, Pisapati Venkata Lakshmi Narsimha


    There is no consensus on the optimal management of high grade renal trauma. Delayed surgery increases the likelihood of secondary hemorrhage and persistent urinary extravasation, whereas immediate surgery results in high renal loss. Hence, the present study was undertaken to evaluate the predictors of nephrectomy and outcome of high Grade (III-V) renal injury, treated primarily with conservative intent. The records of 55 patients who were admitted to our institute with varying degrees of blunt renal trauma from January 2005 to December 2012 were retrospectively reviewed. Grade III-V renal injury was defined as high grade blunt renal trauma and was present in 44 patients. The factors analyzed to predict emergency intervention were demographic profile, grade of injury, degree of hemodynamic instability, requirement of blood transfusion, need for intervention, mode of intervention, and duration of intensive care unit stay. Rest of the 40 patients with high grade injury (grade 3 and 4)did not require emergency intervention and underwent a trail of conservative management. 7 of the 40 patients with high grade renal injury (grade 3 and 4), who were managed conservatively experienced complications requiring procedural intervention and three required a delayed nephrectomy. Presence of grade V injuries with hemodynamic instability and requirement of more than 10 packed cell units for resuscitation were predictors of nephrectomy. Predictors of complications were urinary extravasation and hemodynamic instability at presentation. Majority of the high grade renal injuries can be successfully managed conservatively. Grade V injuries and the need for more packed cell transfusions during resuscitation predict the need for emergency intervention.

  2. Predictors of nephrectomy in high grade blunt renal trauma patients treated primarily with conservative intent

    Narla Hari Prasad


    Full Text Available Introduction: There is no consensus on the optimal management of high grade renal trauma. Delayed surgery increases the likelihood of secondary hemorrhage and persistent urinary extravasation, whereas immediate surgery results in high renal loss. Hence, the present study was undertaken to evaluate the predictors of nephrectomy and outcome of high Grade (III-V renal injury, treated primarily with conservative intent. Materials and Methods: The records of 55 patients who were admitted to our institute with varying degrees of blunt renal trauma from January 2005 to December 2012 were retrospectively reviewed. Grade III-V renal injury was defined as high grade blunt renal trauma and was present in 44 patients. The factors analyzed to predict emergency intervention were demographic profile, grade of injury, degree of hemodynamic instability, requirement of blood transfusion, need for intervention, mode of intervention, and duration of intensive care unit stay. Results: Rest of the 40 patients with high grade injury (grade 3 and 4 did not require emergency intervention and underwent a trail of conservative management. 7 of the 40 patients with high grade renal injury (grade 3 and 4, who were managed conservatively experienced complications requiring procedural intervention and three required a delayed nephrectomy. Presence of grade V injuries with hemodynamic instability and requirement of more than 10 packed cell units for resuscitation were predictors of nephrectomy. Predictors of complications were urinary extravasation and hemodynamic instability at presentation. Conclusion: Majority of the high grade renal injuries can be successfully managed conservatively. Grade V injuries and the need for more packed cell transfusions during resuscitation predict the need for emergency intervention.


    Soraia Geraldo Rozza Lopes


    Full Text Available El objetivo del estudio fue comprender el significado de espera del trasplante renal para las mujeres en hemodiálisis. Se trata de un estudio cualitativo-interpretativo, realizado con 12 mujeres en hemodiálisis en Florianópolis. Los datos fueron recolectados a través de entrevistas en profundidad en el domicilio. Fue utilizado el software Etnografh 6.0 para la pre-codificación y posterior al análisis interpretativo emergieron dos categorías: “las sombras del momento actual”, que mostró que las dificultades iniciales de la enfermedad están presentes, pero las mujeres pueden hacer frente mejor a la enfermedad y el tratamiento. La segunda categoría, “la luz del trasplante renal”, muestra la esperanza impulsada por la entrada en la lista de espera para un trasplante.

  4. Renal failure


    930564 Dwell times affect the local host de-fence mechanism of peritoneal dialysis patients.WANG Tao(汪涛),et al.Renal Instit,SunYatsen Med Univ,Guangzhou,510080.Chin JNephrol 1993;9(2):75—77.The effect of different intraperitoneal awelltimes on the local host defence in 6 peritonealdialysis patients was studied.A significant de-crease in the number of peritoneal cells,IgG con-centration and the phagoeytosis and bactericidalactivity of macrophages was determined when thedwell time decreased from 12 to 4 hs or form 4 to0.5hs,but the peroxidase activity in macrophagesincreased significantly.All variables,except theperoxidase activity in macrophages,showed nosignificant difference between patients of high or

  5. Traumatismo renal

    Rocha, Sofia Rosa Moura Gomes da


    Introdução: A realização deste trabalho visa a elaboração de uma revisão sistematizada subordinada à temática da traumatologia renal. Objectivos: Os principais objectivos deste trabalho são: apurar a etiologia, definir a classificação, analisar o diagnóstico e expôr o tratamento e as complicações. Desenvolvimento: Os traumatismos são a principal causa de morte antes dos 40 anos. O rim é o órgão do aparelho génito-urinário mais frequentemente atingido. Os traumatismos renais são mais fre...

  6. Modulation of the renal response to ACE inhibition by ACE insertion/deletion polymorphism during hyperglycemia in normotensive, normoalbuminuric type 1 diabetic patients.

    Weekers, Laurent; Bouhanick, Béatrice; Hadjadj, Samy; Gallois, Yves; Roussel, Ronen; Pean, Franck; Ankotche, Amos; Chatellier, Gilles; Alhenc-Gelas, François; Lefebvre, Pierre J; Marre, Michel


    ACE inhibition protects kidney function, but ACE insertion/deletion (I/D) polymorphism affects renal prognosis in type 1 diabetic patients. ACE genotype may influence the renal benefits of ACE inhibition. We studied the impact of ACE I/D polymorphism on the renal hemodynamic changes induced by ACE inhibition in type 1 diabetes. We studied renal hemodynamics (glomerular filtration rate [GFR], effective renal plasma flow [ERPF], filtration fraction [GFR/ERPF], mean arterial pressure [MAP], and total renal resistances [MAP/ERPF]) repeatedly during normoglycemia and then hyperglycemia in 12 normotensive, normoalbuminuric type 1 diabetes and the II genotype (associated with nephroprotection) versus 22 age- and sex-matched subjects with the ACE D allele after three randomly allocated 2- to 6-week periods on placebo, 1.25 mg/day ramipril, and 5 mg/day ramipril in a double-blind, cross-over study. During normoglycemia, the hemodynamic changes induced by ramipril were similar in both genotypes. During hyperglycemia, the changes induced by ramipril were accentuated in the II genotype group and attenuated dose dependently in the D allele group (treatment-genotype interaction P values for ERPF, 0.018; MAP, 0.018; and total renal resistances, 0.055). These results provide a basis to different renal responses to ACE inhibition according to ACE genotype in type 1 diabetes.

  7. Computational Simulations of Inferior Vena Cava (IVC) Filter Placement and Hemodynamics in Patient-Specific Geometries

    Aycock, Kenneth; Sastry, Shankar; Kim, Jibum; Shontz, Suzanne; Campbell, Robert; Manning, Keefe; Lynch, Frank; Craven, Brent


    A computational methodology for simulating inferior vena cava (IVC) filter placement and IVC hemodynamics was developed and tested on two patient-specific IVC geometries: a left-sided IVC, and an IVC with a retroaortic left renal vein. Virtual IVC filter placement was performed with finite element analysis (FEA) using non-linear material models and contact modeling, yielding maximum vein displacements of approximately 10% of the IVC diameters. Blood flow was then simulated using computational fluid dynamics (CFD) with four cases for each patient IVC: 1) an IVC only, 2) an IVC with a placed filter, 3) an IVC with a placed filter and a model embolus, all at resting flow conditions, and 4) an IVC with a placed filter and a model embolus at exercise flow conditions. Significant hemodynamic differences were observed between the two patient IVCs, with the development of a right-sided jet (all cases) and a larger stagnation region (cases 3-4) in the left-sided IVC. These results support further investigation of the effects of IVC filter placement on a patient-specific basis.

  8. Insulin sensitivity and hemodynamic responses to insulin in Wistar-Kyoto and spontaneously hypertensive rats.

    Pître, M; Nadeau, A; Bachelard, H


    The insulin-mediated vasodilator effect has been proposed as an important physiological determinant of insulin action on glucose disposal in normotensive humans. The present study was designed to further examine the acute regional hemodynamic effects of insulin in different vascular beds and to explore the relationships between insulin vascular effects and insulin sensitivity during euglycemic hyperinsulinemic clamps in conscious normotensive Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHR). The rats were instrumented with intravascular catheters and pulsed Doppler flow probes to measure blood pressure, heart rate, and regional blood flows. In WKY rats, the euglycemic infusion of insulin (4 and 16 causes vasodilations in renal and hindquarter vascular beds but no changes in mean blood pressure, heart rate, or superior mesenteric vascular conductance. In contrast, in SHR, the same doses of insulin produce vasoconstrictions in superior mesenteric and hindquarter vascular beds and, at high doses, increase blood pressure. Moreover, at the lower dose of insulin tested, we found a reduction in the insulin sensitivity index in the SHR compared with the WKY rats. The present findings provide further evidence for an association between insulin sensitivity and insulin-mediated hemodynamic responses.

  9. Acute renal failure and severe thrombocytopenia associated with metamizole

    Maria Dolores Redondo-Pachon


    Full Text Available Metamizole or dipyrone is a pyrazolone derivative that belongs to the non-steroidal anti-inflammatory drugs. Its main side-effect is hematological toxicity. Thrombocytopenia due to metamizole is rare and is usually associated with the involvement of the two other blood series. Drug-induced thrombocytopenia is more frequently related to immune mechanisms, and the diag-nosis is still largely made by exclusion of other causes and by correlation of timing of thrombocytopenia with the administration of drug. Metamizole may cause acute renal failure due to hemodynamic renal failure/acute tubular necrosis and/or acute tubulointerstitial nephritis. We report a case of acute renal failure and severe thrombocytopenia after metamizole. As far as we know, this combination of adverse effects from this drug has not been reported previously.

  10. Central and peripheral hemodynamics in exercising humans

    Calbet, J A L; González-Alonso, J; Helge, J W


    In humans, arm exercise is known to elicit larger increases in arterial blood pressure (BP) than leg exercise. However, the precise regulation of regional vascular conductances (VC) for the distribution of cardiac output with exercise intensity remains unknown. Hemodynamic responses were assessed...... during incremental upright arm cranking (AC) and leg pedalling (LP) to exhaustion (Wmax ) in nine males. Systemic VC, peak cardiac output (Qpeak ) (indocyanine green) and stroke volume (SV) were 18%, 23%, and 20% lower during AC than LP. The mean BP, the rate-pressure product and the associated...... perfusion pressure to increase O2 delivery, allowing a similar peak VO2 per kg of muscle mass in both extremities. In summary, despite a lower Qpeak during arm cranking the cardiovascular strain is much higher than during leg pedalling. The adjustments of regional conductances during incremental exercise...

  11. [Myocardial contractility and hemodynamics in hypothyroidism].

    Selivonenko, V G


    The author determined the phasic structure of the systole of the left ventricle by the method of polycardiography and hemodynamics in 20 patients suffering from hypothyrodism. Blood plasma and erythrocyte electrolytes were examined at the same time. Patients with hypothyroidism displayed a phasic syndrome of hypodynamia and a marked correlation between the phase of the synchronous contraction, the period of ejection, the strength of contraction of the left ventricle and the electrolyte content. Sodium and magnesium produced the greatest influence on the phasic structure of the systole; potassium and calcium had a lesser effect. The heart stroke volume diminished; as to the cardiac index, expenditure of the energy of cardiac contractions directed to the maintenance of movement of 1 litre of the minute blood volume; the external work, and the peripheral vascular resistance displayed no significant change.

  12. Red wine, arterial stiffness and central hemodynamics.

    Karatzi, Kalliopi; Papaioannou, Theodore G; Papamichael, Christos; Lekakis, John; Stefanadis, Christodoulos; Zampelas, Antonis


    Red wine is considered to reduce cardiovascular risk and decrease peripheral systolic and diastolic blood pressure. Central aortic pressures are often more sensitive clinical and prognostic factors than peripheral pressures, while arterial stiffness is an independent prognostic factor for cardiovascular events. Great efforts are being made to find natural sources of improving health. In order to clarify the mechanisms under which a widely used drink, like red wine, is affecting heart and vessels, we aimed to review the available data regarding the effects of red wine on arterial stiffness, wave reflections and central blood pressures. The effect of red wine on central hemodynamics has been poorly explored with divergent results. Possible consequences of acute and long-term intake on arterial stiffness, wave reflections and central pressures are not clear. This might make someone skeptical when suggesting the consumption of a glass of red wine, although its cardioprotective actions (when moderately consumed) are already shown from epidemiological studies.

  13. 10.1.Heart function and hemodynamics


    930252 Pathophysiological effects oftranscoronary chemical ablation in dogs.QI Xi-angqian (齐向前),et al.Cardiovasc Instit &Fuwai Hosp,CAMS,Beijing.Chin Cir J 1992;7(6):567—569.This study was designed to evaluate thepathophysiologic changes induced by intracoro-nary ethanol (ICE) in normal dogs.CK—MBactivity,ECG,hemodynamics,myocardialnecrosis size and histologic changes resultingfrom ICE were observed.In anesthetized dogs,0.4~0.6 ml (group A,n=9) and 1.0~1.2 ml(group B,n=9) of 95% ethanol were injectedinto the diagonal branch of the lelt anterior de-

  14. Evaluation of allograft perfusion by radionuclide first-pass study in renal failure following renal transplantation

    Baillet, G.; Ballarin, J.; Urdaneta, N.; Campos, H.; Vernejoul, P. de; Fermanian, J.; Kellershohn, C.; Kreis, H.


    To assess the diagnostic value of indices measured on a first-pass curve, we performed 72 radionuclide renal first-pass studies (RFP) in 21 patients during the early weeks following renal allograft transplantation. The diagnosis was based on standard clinical and biochemical data and on fine needle aspiration biopsy (FNAB) of the transplant. Aortic and renal first-pass curves were filtered using a true low-pass filter and five different indices of renal perfusion were computed, using formulae from the literature. Statistical analysis performed on the aortic and renal indices indicated excellent reproducibility of the isotopic study. Although renal indices presented a rather large scatter, they all discriminated well between normal and rejection. Three indices have a particularly good diagnostic value. In the discrimination between rejection and Acute Tubular Necrosis (ATN), only one index gave satisfying results. The indices, however, indicate that there are probably ATN with an alternation of renal perfusion and rejection episodes where perfusion is almost intact. We conclude that radionuclide first-pass study allows accurate and reproducible quantitation of renal allograft perfusion. The measured parameters are helpful to follow up the course of a post-transplantation renal failure episode and to gain more insight into renal ischemia following transplantation.

  15. Large eddy simulation of powered Fontan hemodynamics.

    Delorme, Y; Anupindi, K; Kerlo, A E; Shetty, D; Rodefeld, M; Chen, J; Frankel, S


    Children born with univentricular heart disease typically must undergo three open heart surgeries within the first 2-3 years of life to eventually establish the Fontan circulation. In that case the single working ventricle pumps oxygenated blood to the body and blood returns to the lungs flowing passively through the Total Cavopulmonary Connection (TCPC) rather than being actively pumped by a subpulmonary ventricle. The TCPC is a direct surgical connection between the superior and inferior vena cava and the left and right pulmonary arteries. We have postulated that a mechanical pump inserted into this circulation providing a 3-5 mmHg pressure augmentation will reestablish bi-ventricular physiology serving as a bridge-to-recovery, bridge-to-transplant or destination therapy as a "biventricular Fontan" circulation. The Viscous Impeller Pump (VIP) has been proposed by our group as such an assist device. It is situated in the center of the 4-way TCPC intersection and spins pulling blood from the vena cavae and pushing it into the pulmonary arteries. We hypothesized that Large Eddy Simulation (LES) using high-order numerical methods are needed to capture unsteady powered and unpowered Fontan hemodynamics. Inclusion of a mechanical pump into the CFD further complicates matters due to the need to account for rotating machinery. In this study, we focus on predictions from an in-house high-order LES code (WenoHemo(TM)) for unpowered and VIP-powered idealized TCPC hemodynamics with quantitative comparisons to Stereoscopic Particle Imaging Velocimetry (SPIV) measurements. Results are presented for both instantaneous flow structures and statistical data. Simulations show good qualitative and quantitative agreement with measured data.

  16. [Renal toxicity of antiviral drugs].

    Frasca', Giovanni M; Balestra, Emilio; Tavio, Marcello; Morroni, Manrico; Manarini, Gloria; Brigante, Fabiana


    Highly effective and powerful antiviral drugs have been introduced into clinical practice in recent years which are associated with an increased incidence of nep