Venous air embolism in swine: transport of gas bubbles through the pulmonary circulation

The assumption that the lung is an effective filter for gas bubbles is of importance for certain occupations (e.g., divers, astronauts) as well as in the accomplishment of several medical procedures. The filtering capacity was tested in pigs by use of continuous air infusion into the right ventricle and a transesophageal echocardiographic transducer for detection of air in the left atrium. Twenty pigs, anesthetized with pentobarbital sodium and mechanically ventilated, were divided into groups that received air at infusion rates of 0.05 (group 1a, n = 7), 0.10 (group 2, n = 6), and 0.20 (group 3, n = 5) ml.kg-1.min-1. Two pigs served as controls. The breakthrough incidence was 0, 67, and 100%, respectively. Group 1a received a second infusion of 0.10 ml.kg-1.min-1 (group 1b, n = 7), and spillover of bubbles occurred in only 14% of these pigs. Infusion of gas caused a maximum increase in mean pulmonary arterial pressure (PAP) of 129 +/- 9% to 39.2 +/- 1.3 (SE) mmHg, with no significant difference between the groups. Breakthrough was observed only in animals with a dramatic reduction in mean arterial pressure and a PAP that returned to almost-normal values at spillover time. Our results suggest that the threshold value for breakthrough of air bubbles in pigs is reduced compared with that in dogs. The hemodynamic consequences at a given infusion rate are, however, greatly enhanced.     

TEE monitoring for RA-horizontal paradoxical arterial air embolism during sitting-position surgery

A 36-year-old woman suffered meningioma in her right cerebellopontine angle. Air embolisms often complicate sitting-position surgeries. Because TEE guides the localization of central venous catheters and promptly locates air embolisms promptly enough for effective treatment, TEE is an effective monitoring method for sitting-position surgeries.     

Alpha-adrenergic agents have little effect during air embolism lung injury in awake sheep

Since it is not clear whether alpha-adrenergic receptors can modulate lung microvascular liquid and protein leakiness, we studied the effects of alpha-adrenergic receptor stimulation or blockade on lung filtration under base-line conditions and during the acute lung injury caused by a 4-h infusion of venous air emboli in six unanesthetized, chronically instrumented sheep with lung lymph fistulas. During the experiments we continuously infused the alpha-adrenergic receptor agonist phenylephrine hydrochloride (1.0 microgram X kg-1 X min-1 iv) or the alpha-adrenergic receptor antagonist phentolamine mesylate (1.0 mg X kg-1 X min-1 iv), and we measured pulmonary vascular pressures, cardiac output, lung lymph flow, and the lymph-to-plasma protein concentration ratio. During air embolism, alpha-receptor stimulation increased pulmonary vascular resistance and decreased lung lymph flow by 25%; alpha-receptor blockade had the opposite effects. During recovery, neither agent significantly affected pulmonary hemodynamics or lymph flow. Our results indicate that alpha-adrenergic receptors are active during air embolism and modulate pulmonary filtration by causing arteriolar constriction, which reduces the surface area or the perfusion pressure in the pulmonary microvascular bed. They may also affect venous smooth muscle tone. We found no evidence that alpha-adrenergic receptors modulate lung microvascular liquid or protein leakiness directly.     

Ret signalling integrates a craniofacial muscle module during development

An appropriate organisation of muscles is crucial for their function, yet it is not known how functionally related muscles are coordinated with each other during development. In this study, we show that the development of a subset of functionally related head muscles in the zebrafish is regulated by Ret tyrosine kinase signalling. Three genes in the Ret pathway (gfra3, artemin2 and ret) are required specifically for the development of muscles attaching to the opercular bone (gill cover), but not other adjacent muscles. In animals lacking Ret or Gfra3 function, myogenic gene expression is reduced in forming opercular muscles, but not in non-opercular muscles derived from the same muscle anlagen. These animals have a normal skeleton with small or missing opercular muscles and tightly closed mouths. Myogenic defects correlate with a highly restricted expression of artn2, gfra3 and ret in mesenchymal cells in and around the forming opercular muscles. ret(+) cells become restricted to the forming opercular muscles and a loss of Ret signalling results in reductions of only these, but not adjacent, muscles, revealing a specific role of Ret in a subset of head muscles. We propose that Ret signalling regulates myogenesis in head muscles in a modular manner and that this is achieved by restricting Ret function to a subset of muscle precursors.     

Clinical evaluation of an air embolism detection device

The clinical evaluation of the Sarns Air-Bubble Detector System in over 4,000 assorted operative procedures using cardiopulmonary bypass is described in this report. The system is designed to produce an alarm when a bolus of air enters the circuit. False alarms caused by electrical static within the operating room can be eliminated with a filter incorporated into the electrical circuit.     

Keratan sulfate expression during avian craniofacial morphogenesis

Summary Using the monoclonal antibody MZ15 in immunocytochemical and ultrastructural studies we have been able to determine the spatiotemporal pattern of keratan sulfate (KS) distribution during quail craniofacial morphogenesis. KS-containing proteoglycans are found associated with invaginating placodes (olfactory, lens and otic), in developing pronephric tubules, notochord, pharynx and endocardium, and display developmental regulation. The appearance of such proteoglycans (PGs) during placode morphogenesis is particularly striking and we suggest that they may be an important component of the extracellular matrix which has been previously implicated in mediating the morphogenetic interactions and cell movements occurring at these sites. The otic vesicle during stage 18–22 displays a notable asymmetric distribution of KS-containing PGs. The role that these molecules may play and the reasons for this regionalization are, as yet, unclear but it is conceivable that the distribution of proteoglycans at this stage reflects subsequent differentiative events during otocyst development. Furthermore, our ultrastructural observations indicate that over the developmental period studied (H & H stages 8–22) keratan sulfate exists in at least two proteoglycan forms. Some spatiotemporal correlation has been found to exist between the distributions of KS-containing PGs and type II collagen as previously reported by Thorogood et al. (1986). We suggest that the proteoglycan detected at such sites is cartilage-specific proteoglycan and that it plays an important role, together with type II collagen, in the “signalling” mechanism which specifies the subsequent pattern of the chondrocranium. It is proposed that this interaction at epithelio-mesenchymal interfaces in the developing head parallels the matrix-mediated tissue interaction between notochord and somites which results in the formation of the cartilaginous primordia of the vertebrae from the sclerotomes as reported by Lash and Vasan (1978).     

The craniofacial air sac system of Mesozoic birds (Aves)

Birds are characterized by pneumatization of their skeletons by epithelial diverticula from larger, air—filled cavities. The diverticula—or 'air sacs'—that invade the postcranium result from outgrowths of the lungs; postcranial pneumaticity has been very well studied. Much more poorly understood are the air sacs that pneumatize the skull. Study of craniofacial pneumaticity in modern birds (Neornithes) indicates the presence of two separate systems: nasal pneumaticity and tympanic pneumaticity. The lacrimal and maxillary bones are pneumatized by diverticula of the main paranasal cavity, the antorbital sinus. There are five tympanic diverticula in neornithines that pneumatic the quadrate, articulare and the bones of the braincase. The pneumatic features of the following six genera of Mesozoic birds are examined: Archaeopteryx, Enaliornis, Baptornis, Parahesperornis, Hesperornis and Ichthyornis. Despite the 'archaic' aspect of most of these birds, many of the pneumatic features of neornithines are found in Mesozoic birds and are considered primitive for Aves. The phylogenetic levels at which most of the avian pneumatic features arose within Archosauria are uncertain. Until the phylogenetic levels at which homologous pneumatic features arose are determined, it is unwise to use most pneumatic characters in the discussion of avian origins. Within avian phylogeny, Ornithurae and Neornithes are well–supported by pneumatic synapomorphies. There is a trend towards reduction of craniofacial pneumaticity within Hesperornithiformes. Within Neornithes, four derived pneumatic characters suggest that the Palaeognathae (ratites and tinamous) is monophyletic.