Arterial hypertension and neurofibromatosis: renal artery stenosis and coarctation of abdominal aorta.

A 10-year-old girl had arterial hypertension, generalized neurofibromatosis, coarctation of the abdominal aorta and multiple stenoses at the origin of each renal artery. After resection of the stenotic areas and reimplantation of the renal arteries in the aorta, her arterial pressure decreased substantially. However, hypertension recurred and radiologic follow-up 4 1/2 years later showed distinct progression of the coarctation and renewed stenosis of all renal arteries at their origin. The stenotic areas showed eccentric intimal proliferation, frequently bulging into the lumen, with small nodular aggregates of smooth muscle cells and proliferation of fibrous tissue containing spindle-shaped nuclei in a palisading pattern. Hypertension associated with neurofibromatotic vascular disease has been described in 47 other patients in the literature. These patients have been young (mean age, 14 years) and predominantly male. In contrast to fibromuscular dysplasia, in which 95% of all stenoses are found in the distal two thirds of the renal arteries, in vascular neurofibromatosis more than 50% of the stenoses are found at the origin.     

Arterial imaging with computerized fluoroscopy

Computerized fluoroscopy (CF) allows visualization of any segment of the arterial vascular system with intravenous injection of small volumes of standard iodinated contrast media. Because it avoids the risk of arterial puncture and the need for hospitalization, this technique is safer and more economical than standard arteriography. Because of these advantages, CF is likely to expand the role of arteriography in the clinical management of vascular disease. Computerized arteriographic imaging requires an intravenous power injection of 40 to 60 cc of iodinated contrast media. Immediately after injection, six to ten fluoroscopic images (1/15 sec duration) are obtained at 1.5-sec intervals. The first image serves as a mask from which subsequent images are serially subtracted by means of a digital video image processor. The sequence of different images is contrast enhanced and stored on a video disk. Video images are converted to hard copy arteriography with a standard multiformat camera. Technical failures (<5%) may result from patient motion, inadequate peripheral venous access, or extravasation of contrast media. Nearly 600 computerized intravenous arteriograms have been performed in 240 patients with peripheral vascular disease. Qualitative com-parisons with standard arteriograms suggest a close correlation between these two imaging techniques. Computerized fluoroscopy allows the identification of atheromatous plaque ulceration, stenoses, occlusions, and aneurysms. This method has been used to visualize the aortic arch and its branches, the cervical and intracranial vessels, the abdominal aorta, and arteries of the extremities. Computerized fluoroscopy has great potential as a method for safe, simple diagnostic screening and assessment of the postoperative patient.     

Effect of atriopeptin on the adrenergic mechanism regulating blood vessel tonus

The direct action of atriopeptin on the cell regulation mechanism of the smooth muscle in isolated segments of the portal vein, aorta, pancreatic and cerebral arteries have been studied. It was found that atriopeptin induce the direct relaxation of the smooth muscle in the main vessels only (aorta, portal vein). In the cerebral and pancreatic arteries atriopeptin stops norepinephrine-induced contractions. The data obtained show that the action of the atriopeptin is mediated by Na+-K+ pump activation of smooth muscle cells and restricts vasoconstriction of catecholamine effect.     

Chronic occlusions in patients with coronary heart disease: results of recanalization

The paper analyzes the results of endovascular treatment in 298 patients with chronic occlusions or subtotal stenoses of coronary arteries. The authors show that balloon coronary angioplasty for chronic coronary occlusions is an effective and relatively safe techniques of myocardial revascularization. Successful endovascularization has been achieved in 68.1% of patients with chronic coronary occlusions and in 97.5% of those with subtotal coronary stenoses. The results show a high incidence of restenosis and asymptomatic reocclusion.     

Constrictor reaction to transmural electric stimulation of the isolated femoral artery and its branches in chronic arterial hypotension

Chronic regional arterial hypotension in the hind limbs of rats was produced by narrowing of the abdominal aorta. 14-19 days later the femoral artery and its main branches were isolated and perfused in vitro with oxygenated Krebs' solution. It was shown that constrictor responses to transmural electrical stimulation decreased 14-30 days after the constriction of the aorta, however, 90 days after the operation the responses were identical to those in the control. Guanethidine (1.10(-5) mol/l) decreased significantly the responses to stimulation in all the cases, while phentolamine (3.5.10(-5) mol/l) inhibited completely those reactions. The constriction of femoral arteries in response to noradrenaline infusion was the same in control and hypotensive vessels.     

Ischemic Heart Disease: Precarious Coronary Lesions and Prognosis

Coronary arteriograms in 113 patients whose cases were followed for 2 to 12 years were analyzed in an attempt to discover why in some patients with angina pectoris there are long stable clinical courses and in others the courses proceed rapidly to death. It was found that patients with completed coronary occlusions, usually with distal portions reconstituted by collateral, had favorable prognoses with prolonged longevity. Patients with multiple high grade narrowings of the coronary arteries, on the other hand, had poor prognoses with high attrition rates. The more stenotic lesions present in the coronary arteries, the higher the attrition rates. Completed coronary occlusions, therefore, have been classified as nonprecarious while local coronary stenoses greater than 50 percent of the lumen diameter have been classified as degrees of precariousness according to the number of lesions present.When compared with classification by number of diseased vessels and by arteriographic score of Friesinger, the nonprecarious cases had better prognoses than the precarious.     

Endothelin in the splanchnic vascular bed of DOCA-salt hypertensive rats

Vascular capacitance is reduced by endothelin-1 (ET-1) in deoxycorticosterone (DOCA)-salt hypertensive rats. This may contribute to hypertension development. Because the splanchnic blood vessels (especially veins) are important in determining vascular capacitance, we tested the hypothesis that ET-1 levels in the splanchnic vasculature are elevated in hypertensive DOCA-salt compared with normotensive rats. Tissue ET-1 content was measured by ELISA in aorta, vena cava, superior mesenteric artery and vein, and small mesenteric arteries and veins from normotensive sham-operated (sham) and 4-wk DOCA-salt rats. We also determined ET-1 concentration in aortic and portal venous blood (draining the nonhepatic splanchnic organs) in anesthetized and conscious sham and DOCA-salt rats before and after acute blockade of ETB receptor-mediated plasma clearance of ET-1. Results showed a higher ET-1 content in veins than in arteries of similar size. However, ET-1 content was similar in vessels from sham and DOCA-salt rats, except in aorta and superior mesenteric artery, where ET-1 content was greater in DOCA-salt rats. ET-1 concentration was significantly higher in portal venous than in aortic blood, indicating net nonhepatic splanchnic release (nNHSR) of ET-1. However, nNHSR of ET-1 was similar in sham and DOCA-salt rats. Although nNHSR of ET-1 increased significantly after ETB receptor blockade in sham rats, it was completely unchanged in DOCA-salt rats. These data suggest that, despite the absence of ETB receptor-mediated plasma clearance of ET-1, neither the venous peptide content nor the net release of ET-1 is increased in the splanchnic vasculature of DOCA-salt rats. These results argue against the hypothesis that increased venomotor tone in DOCA-salt hypertension is caused by increased ET-1 concentration around splanchnic venous smooth muscle cells.     

慢性阻断血管紧张素Ⅱ1型受体不能完全防止模拟失重大鼠血管的适应性结构变化

我们以前的工作提示,在模拟失重所引起的血管区域特异性适应变化中,局部肾素．血管紧张素系统（local reninangiotensin system,L-RAS）可能发挥关键调控作用。本文以losartan慢性阻断血管紧张素Ⅱ1型受体（angiotensin Ⅱtypelreceptor,AT1R）,观察模拟失重是否仍能引起血管的这种适应性改变,并检测大血管管壁L-RAS主要成分的表达是否也发生相应变化。以尾部悬吊大鼠模型模拟失重的生理影响。制作基底动脉、胫前动脉、颈总动脉和腹主动脉的HE染色切片,在光学显微镜下进行形态观测：用免疫组织化学技米测量颈总动脉和腹主动脉壁的血管紧张素原（angiotensinogen,AGT）及AT-R的表达变化。结果表明：4周模拟失重引起大鼠基底动脉中膜和颈总动脉管壁各平滑肌肌层肥厚,而胫前动脉和腹主动脉则发生萎缩性改变;给予losartan4周引起上述4种血管皆发生萎缩性变化;阻断AT1R,模拟失重仍然能引起基底动脉、颈总动脉发生相对肥厚性改变和腹主动脉萎缩加重。4周模拟失重还引起颈总动脉壁中AGT和AT1R表达上调,而腹主动脉壁及血管周围组织中AGT和AT1R表达下调;给予losartan4周仅引起腹主动脉壁中AGT和AT1R表达减少;阻断AT1R,模拟失重使腹主动脉壁AT1R表达进一步减少。结果提示,4周模拟失重引起大鼠脑、颈部与后身大、中动脉血管的形态结构改变和L-RAS主要成分表达发生上调或下调,血管L-RAS在其中可能发挥关键性调控作用;但在慢性阻断AT1R的条件下,其它调控机制仍可能在脑血管适应性调节中发挥一定作用。     

Distribution of stress and strain along the porcine aorta and coronary arterial tree

The existence of a homeostatic state of stresses and strains has been axiomatic in the cardiovascular system. The objective of this study was to determine the distribution of circumferential stress and strain along the aorta and throughout the coronary arterial tree to test this hypothesis. Silicone elastomer was perfused through the porcine aorta and coronary arterial tree to cast the arteries at physiological pressure. The loaded and zero-stress dimensions of the vessels were measured. The aorta (1.8 cm) and its secondary branches were considered down to 1.5 mm diameter. The left anterior descending artery (4.5 mm) and its branches down to 10 microm were also measured. The Cauchy mean circumferential stress and midwall stretch ratio were calculated. Our results show that the stretch ratio and Cauchy stress were lower in the thoracic than in the abdominal aorta and its secondary branches. The opening angle (theta) and midwall stretch ratio (lambda) showed a linear variation with order number (n) as follows: theta = 10.2n + 63.4 (R(2) = 0.989) and lambda = 4.47 x 10(-2)n + 1.1 (R(2) = 0.995). Finally, the stretch ratio and stress varied between 1.2 and 1.6 and between 10 and 150 kPa, respectively, along the aorta and left anterior descending arterial tree. The relative uniformity of strain (50% variation) from the proximal aorta to a 10-microm arteriole implies that the vascular system closely regulates the degree of deformation. This suggests a homeostasis of strain in the cardiovascular system, which has important implications for mechanotransduction and for vascular growth and remodeling.     

The shifting of the aortic origin of the brachial arteries in the metamorphosing eel Anguilla anguilla (L.), with remarks on the shifting mechanisms in arterial junctions in general

In silver eels the arteries supplying the pectoral girdles and fins, arise from a common trunk which branches off from the dorsal aspect of the dorsal aorta, while the origin of this trunk is found at the ventral aspect of the aorta in the leptocephalus larva. The rearrangement of the origin of this trunk is mainly accomplished during metamorphosis, and is related to the rearrangement of the junction of the epibranchial arteries and the aorta. The processes of remodelling the wall of the vessels involved in these rearrangements are discussed against the background of data on similar remodelling, accompanying the rearrangement of arterial junctions during the development of higher vertebrates.     

Development of atherosclerotic lesions in cholesterol-loaded rabbits.

To examine both of the target vessels and the optimal time of their endothelial denudation to study vascular restenosis after balloon injury in cholesterol-loaded rabbits, we made 36 atherosclerotic rabbits by feeding a hypercholesterol diet, and histologically examined the onset time and the development of atherosclerosis. Atheromatous changes were observed first after the 5th week in the thoracic aorta from the start of the diet, and then extended to the abdominal aorta, coronary artery with time. The atherosclerotic lesions in the thoracic aorta and the proximal portion of the coronary artery showed high-grade concentric intimal thickening with luminal stenosis. The abdominal aortic lesion mildly progressed. In the renal, carotid and femoral arteries, in contrast, slight atheroscleromatous changes developed during the diet period. These results suggest that the thoracic and abdominal aortas and the coronary artery would be suitable as target vessels to study vascular restenosis after balloon injury, and the endothelial denudation of these vessels should be performed between the 8th and 15th week in this diet protocol for an accurate analysis.     

Congenital venous hypoplasia in the liver of rats.

Narrowed and rudimentary portal vein branches were observed in the livers of specified-pathogen-free rats which, at the age of 6-11 weeks, showed poor condition and reatrded growth. At autopsy abdominal venous distension and congestion suggestive of portal hypertension and collateral circulation appeared to have developed. The cause of the observations and their significance in view of the use of the rats are unknown.     

Modelling the circle of Willis to assess the effects of anatomical variations and occlusions on cerebral flows

Blood flow in the circle of Willis (CoW) is modelled using the 1-D equations of pressure and flow wave propagation in compliant vessels. The model starts at the left ventricle and includes the largest arteries that supply the CoW. Based on published physiological data, it is able to capture the main features of pulse wave propagation along the aorta, at the brachiocephalic bifurcation and throughout the cerebral arteries. The collateral ability of the complete CoW and its most frequent anatomical variations is studied in normal conditions and after occlusion of a carotid or vertebral artery (VA). Our results suggest that the system does not require collateral pathways through the communicating arteries to adequately perfuse the brain of normal subjects. The communicating arteries become important in cases of missing or occluded vessels, the anterior communicating artery (ACoA) being a more critical collateral pathway than the posterior communicating arteries (PCoAs) if an internal carotid artery (ICA) is occluded. Occlusions of the VAs proved to be far less critical than occlusions of the ICAs. The worst scenario in terms of reduction in the mean cerebral outflows is a CoW without the first segment of an anterior cerebral artery combined with an occlusion of the contralateral ICA. Furthermore, in patients without any severe occlusion of a carotid or VA, the direction of flow measured at the communicating arteries corresponds to the side of the CoW with an absent or occluded artery. Finally, we study the effect of partial occlusions of the communicating arteries on the cerebral flows, which again confirms that the ACoA is a more important collateral pathway than the PCoAs if an ICA is occluded.     

Impaired agonist-dependent myosin phosphorylation and decreased RhoA in rat portal hypertensive mesenteric vasculature

The purpose of the present study was to examine the effects of portal hypertension on agonist-induced myosin phosphorylation and RhoA expression in vascular smooth muscle. A possible link to cAMP-dependent events was also examined. Portal hypertension was produced by stenosis of the portal vein. Vessel segments were treated with or without 50 microM of the PKA inhibitor Rp-cAMPS for 30 min and subsequently stimulated with 10(-4) M phenylephrine. Myosin regulatory light-chain phosphorylation was detected by immunoblotting. Total RNA from first-order mesenteric arteries and portal veins was isolated and amplified by RT-PCR using RhoA and GAPDH primers. RhoA protein expression was also measured in first-order mesenteric arteries using Western blot analysis. Myosin phosphorylation in maximally stimulated first-order mesenteric arteries was significantly lower in portal hypertensive animals (19.9 +/- 2.86%) when compared with sham-operated control (43.8 +/- 3.53%). Inhibition of PKA selectively increased myosin phosphorylation to 34.7 +/- 4.18%. Rp-cAMPS did not affect the phosphorylation of the portal veins or superior mesenteric arteries. RhoA mRNA and membrane-associated RhoA protein expression in portal hypertensive first-order mesenteric arteries were significantly lower when compared with controls. Acute inhibition of PKA had no effect on RhoA mRNA expression. However, it restored membrane-associated RhoA protein expression in portal hypertensive vessels to control levels. The results suggest that reductions in membrane-associated RhoA expression, which appear to be regulated by cAMP-dependent events, lead to reduced myosin phosphorylation and may underlie the reduced vasoconstrictor effectiveness in the resistance vasculature of portal hypertensive intestine.     

The vascular territories of the superior epigastric and the deep inferior epigastric systems

The vascular territories of the superior and the deep inferior epigastric arteries were investigated by dye injection, dissection, and barium radiographic studies. By these means it was established that the deep inferior epigastric artery was more significant than the superior epigastric artery in supplying the skin of the anterior abdominal wall. Segmental branches of the deep epigastric system pass upward and outward into the neurovascular plane of the lateral abdominal wall, where they anastomose with the terminal branches of the lower six intercostal arteries and the ascending branch of the deep circumflex iliac artery. The anastomoses consist of multiple narrow "choke" vessels. Similar connections are seen between the superior and the deep inferior epigastric arteries within the rectus abdominis muscle well above the level of the umbilicus. Many perforating arteries emerge through the anterior rectus sheath, but the highest concentration of major perforators is in the paraumbilical area. These vessels are terminal branches of the deep inferior epigastric artery. They feed into a subcutaneous vascular network that radiates from the umbilicus like the spokes of a wheel. Once again, choke connections exist with adjacent territories: inferiorly with the superficial inferior epigastric artery, inferolaterally with the superficial circumflex iliac artery, and superiorly with the superficial superior epigastric artery. The dominant connections, however, are superolaterally with the lateral cutaneous branches of the intercostal arteries. For breast reconstruction, it would appear that prior ligation of the deep inferior epigastric artery would be of advantage when elevating the lower abdominal skin on a superiorly based rectus abdominis musculocutaneous flap. The vascularity of this flap would be further increased by positioning some part of the skin paddle over the dense pack of large paraumbilical perforators. Based on these anatomic studies, the relative merits of the superior and deep inferior epigastric arteries with respect to local and distant tissue transfer using various elements of the abdominal wall are discussed in detail.     

Development of the neural apparatus of blood vessels in the common frog in ontogenesis

The neural apparatus of the aorta, abdominal vein, ischiatic, femoral, pulmonary and caudal vessels has been studied histochemically in tadpoles (the 30th-50th stages of development) and in 1-year-old animals. It has been stated for the first time that in the frog, a representative of the Amphibia class, like in mammals and birds, formation of the adrenergic apparatus in various vessels does not take place simultaneously. For instance, the first adrenergic fibers in the hind limb vessels appear much earlier than in other arteries and veins. The process of the adrenergic innervation development and its completion in vessels of various areas is taking its course differently. In the aorta and in the abdominal vein the formation of the adrenergic plexus develops as increasing density and amount of the mediator in the adrenergic fibers and is completed with maturation in an adult animal. In contrast to these vessels, maturation of the adrenergic apparatus in the hind limb arteries and veins takes place during a shorter interval and is completed at the end of metamorphosis AchE-containing fibers are revealed in tadpoles, as well as in a mature frog only in the aortal arc and in the pulmonary artery. In these vessels the development of cholinergic innervation leaves behind that of the adrenergic innervation, as it does in the vessels of Mammalia, and the human subject.     

Reversible decrease of portal venous flow in cirrhotic patients: a positive side effect of sorafenib

Portal hypertension, the most important complication with cirrhosis of the liver, is a serious disease. Sorafenib, a tyrosine kinase inhibitor is validated in advanced hepatocellular carcinoma. Because angiogenesis is a pathological hallmark of portal hypertension, the goal of our study was to determine the effect of sorafenib on portal venous flow and portosystemic collateral circulation in patients receiving sorafenib therapy for advanced hepatocellular carcinoma. Porto-collateral circulations were evaluated using a magnetic resonance technique prior sorafenib therapy, and at day 30. All patients under sorafenib therapy had a decrease in portal venous flow of at least 36%. In contrast, no specific change was observed in the azygos vein or the abdominal aorta. No portal venous flow modification was observed in the control group. Sorafenib is the first anti-angiogenic therapy to demonstrate a beneficial and reversible decrease of portal venous flow among cirrhotic patients.     

Embryonic vascular development: immunohistochemical identification of the origin and subsequent morphogenesis of the major vessel primordia in quail embryos

The development of the embryonic vasculature is examined here using a monoclonal antibody, QH-1, capable of labelling the presumptive endothelial cells of Japanese quail embryos. Antibody labelling is first seen within the embryo proper at the 1-somite stage. Scattered labelling of single cells appears ventral to the somites and at the lateral edges of the anterior intestinal portal. The dorsal aorta soon forms a continuous cord at the ventrolateral edge of the somites and continues into the head to fuse with the ventral aorta forming the first aortic arch by the 6-somite stage. The rudiments of the endocardium fuse at the midline above the anterior intestinal portal by the 3-somite stage and the ventral aorta extends craniad. Intersomitic arteries begin to sprout off of the dorsal aorta at the 7-somite stage. The posterior cardinal vein forms from single cells which segregate from somatic mesoderm at the 7-somite stage to form a loose plexus which moves mediad and wraps around the developing Wolffian duct in later stages. These studies suggest two modes of origin of embryonic blood vessels. The dorsal aortae and cardinal veins apparently arise in situ by the local segregation of presumptive endothelial cells from the mesoderm. The intersomitic arteries, vertebral arteries and cephalic vasculature arise by sprouts from these early vessel rudiments. There also seems to be some cell migration in the morphogenesis of endocardium, ventral aorta and aortic arches. The extent of presumptive endothelial migration in these cases, however, needs to be clarified by microsurgical intervention.     

The blood supply of the stomach

156 abdominal preparations were explored by arteriography, corrosion and dissection. The stomach is vascularized by four well-anastomosed main arteries: the arteria gastrica dextra and sinistra and the arteria gastroepiploica dextra and sinistra. Other important vessels include: the arteria gastroduodenalis, the arteriae gastricae breves for the upper half of the greater curvature, a posterior gastric artery (36%), an accessory left gastric artery (12%) and an arteria supraduodenalis. The main vessels give rise to some very specific collaterals, e.g. the omental arteries that may form an omental arcade (44%), supra- and infra-pyloric branches, retroduodenal branches, rami cardiaci, esophagei and tuberales and an accessory left hepatic artery. The gastroduodenal artery always arises at a fixed point.