Measurement of pulsatile limb and finger blood flow by electrical impedance plethysmography: Criteria for the diagnosis of abnormal flow

The range of pulsatile arm and finger blood flow, measured by electrical impedance plethysmography, has been investigated in a hospital ward. The range of absolute blood flows, in ml min⁻¹, was found to be too wide to be used as a standard for identifying single blood flow readings as being abnormal. A blood flow ratio was calculated by dividing the blood flow in the right forearm or middle finger by the blood flow in the left forearm or middle finger. This ratio was found to have a clearly defined range. A blood flow in a unilaterally injured or otherwise abnormal arm or finger was considered to be significantly altered if the blood flow ratio fell outside the previously defined normal range. The diagnosis of significantly altered arm and finger blood flow from abnormalities in the blood flow ratio was tested in a series of experiments, in which artificial changes in upper limb flow were created by high elevation of the right hand. The ratio was measured in 11 patients with unilateral upper limb injuries and in 3 patients who required an urgent assessment of the upper limb circulation. Abnormalities in the ratio were identified in 12 out of 18 subjects after high elevation of the hand and in 8 out of the 14 patients.     

Correction of the stomach blood flow as a mechanism of anti-ulcer effects of short proline-containing peptides

Intraperitoneal administration of the PGP did not change basal mucosal blood flow, whereas the PG and GP significantly decreased it. Ethanol and Indomethacin caused a rapid and stable decrease in the blood flow. Administration of the PGP prior to ethanol abolished this effect. Injections of the PGP and PG following Indomethacin administration prevented reduction of the mucosal blood flow. Administration of the GP did not change the blood flow decrease induced with Indomethacin. The mucosal blood flow correction seems to be one of the possible mechanisms of the PGP and PG antiulcer effect. The effect seems to be realised through a change in the CNS activity.     

Measurement of skin blood flow in delayed deltopectoral flaps, using local clearance of 133Xenon.

A study was made to determine the skin blood flow at the deltoid region in 89 cases, and the regional blood flow of delayed deltopectoral flaps, using the local clearance of 133Xe. The change in the skin blood flow, before and after a delay procedure of the deltopectoral flap, was measured in 27 patients--and the following results were obtained. (1) There was a linear tendency to a decreasing flow, one found to be statistically significant, with increasing age of the patient. (2) A significant correlation was found between the skin blood flow and the blood flow of the subcutaneous tissue. (3) The blood flow after we raised one side of a deltopectoral flap and lined it with a split-skin graft was higher than that found after a U-shaped undermining and not lining a flap. (4) The rate of successful transfer of a deltopectoral flap was found to be low when the 133Xe clearance rate was less than 0.07.     

Comparing subjective and objective assessments of the severity of vibration induced white finger

The present staging of the disease severity of vibration induced white finger (VWF) is based on the patients' symptoms. Forty patients, with a history of VWF, with disease severity stage III or stage IV, on the Taylor-Pelmear scale, were investigated. Total, reactive hyperaemic blood flow to the hands was measured using an isotope limb blood flow (ILBF) technique. Skin blood flow patterns were assessed using a cold provocation test, followed by thermographic assessment of hand rewarming. Thermographic abnormalities were detected in 39 patients (97%). Decreased post-occlusive, reactive hyperaemic blood flow occurred in 29 patients (73%). There was no difference in skin blood flow patterns or in total hand blood flow between the stage III and stage IV groups. Reduction of postocclusive reactive hyperaemic blood flow may be indicative of occlusive lesions of the digital vessels. We conclude that the classification of the severity of VWF using subjective assessment, needs to be augmented by objective evidence of altered blood flow.     

Simultaneous determinations of uterine blood flow and plasma concentrations of placental lactogen in late-pregnant goats

Blood flow in the middle uterine artery was measured with electromagnetic blood flow probes, and placental lactogen in jugular and uterine venous plasma was estimated as total lactogenic activity using a radioreceptor assay. There was no circadian variation in uterine arterial blood flow in late pregnancy (Days 105-124) and the pattern of blood flow varied between goats. Blood flow was quite stable for periods of up to 40 min although at other times a rapid fall (by up to 90%) was followed by a gradual recovery. These spontaneous changes lasting up to 30 min could not be consistently related to postural or behavioural changes. Acute decreases of about the same duration could also be induced by administration of adrenaline. In the short-term there was no association between uterine blood flow and total lactogenic activity in the peripheral circulation during spontaneous or adrenaline-induced depression of blood flow. More limited short-term observations on total lactogenic activity in the uterine vein also failed to show a relationship with blood flow in the uterine artery.     

A microsphere study on the effects of somatostatin and secretin on regional blood flow in anesthetized dogs

The endogenous peptides somatostatin and secretin are effective in the therapy of upper gastrointestinal tract bleeding and acute pancreatitis. The clinical effects may be partly brought about by changes in the regional blood flow. To evaluate the effects of somatostatin (50 and 100 μg/min over 6–8 min) and secretin (0.1 and 0.5 U · kg^?1 · min^?1 over 3–5 min) on tissue blood flow, particularly of the gastrointestinal tract, the tracer microsphere reference sample method was used in anesthetized dogs.Infusion of somatostatin significantly diminished gastric and pancreatic blood flow whereas no changes of duodenal and ileal blood flow could be obtained. Blood flow through spleen, kidneys and adrenal glands was increased but no changes were observed in the blood flow of other tissues. Cardiac hemodynamics remained unchanged.Secretin increased the blood flow of the duodenum, the kidneys and the adrenal glands and diminished gastric blood flow without changing pancreatic, ileal, hepatic, pulmonary and muscle blood flow. Cerebral, pituitary and myocardial blood flow was increased by a higher dose of secretin. It also evoked a slight but significant positive ino- and chronotropic effect. Since secretin and somatostatin differ in their respective effects on gastrointestinal blood flow it is suggested that the previously reported beneficial effects of both peptides on upper gastrointestinal bleeding cannot solely be attributed to changes in regional blood flow.     

The correlation of skin blood flow with age, total cholesterol, hematocrit, blood pressure, and hemoglobin

Normal skin blood flow at the deltoid region in 55 men whose ages ranged from 20 to 72 years was measured by the xenon-133 clearance method. In addition, the correlation of skin blood flow with age, systolic blood pressure, total cholesterol, hematocrit, hemoglobin, and total protein was analyzed by multiple regression analysis. The following results were obtained. Normal skin blood flow was found to decrease with increase in age, total cholesterol, and systolic blood pressure and showed a tendency to increase with elevation in hematocrit and hemoglobin values. Of the six parameters examined in the present study, the parameter that showed the strongest correlation with skin blood flow at the deltoid region was age, followed in decreasing order by total cholesterol, hematocrit, systolic blood pressure, and hemoglobin. It could therefore be concluded that age is the most reliable factor in clinically estimating skin blood flow. Furthermore, inasmuch as total cholesterol, hematocrit, systolic blood pressure and hemoglobin values also were correlated with skin blood flow, these values also should be taken in account in the synthetic evaluation of skin blood flow. It was skin blood flow at the deltoid region that was strongly correlated with age. This was followed by systolic blood pressure, hematocrit, and hemoglobin. Total cholesterol showed a weak correlation with age, but total protein did not demonstrate any correlation with skin blood flow and age. The results of the present study show that skin blood flow would be poor in the elderly and in patients with arteriosclerosis, hypertension, and anemia. Since it is suggested that the wound-healing process is delayed in such patients, utmost care should be exercised in treating their wounds.     

A semi-empirical model for flow of blood and other particulate suspensions through narrow tubes

A semi-empirical model applicable to the flow of blood and other particulate suspensions through narrow tubes has been developed. It envisages a central core of blood surrounded by a wall layer of reduced hematocrit. With the help of this model the wall layer thickness and extent of plug flow may be calculated using pressure drop, flow rate and hematocrit reduction data. It has been found from the available data in the literature that for a given sample of blood the extent of plug flow increases with decreasing tube diameter. Also for a flow through a given tube it increases with hematocrit. The wall layer thickness is found to decrease with increase in blood hematocrit. A comparison between the results of rigid particulate suspensions and blood reveals that the thicker wall layer and smaller plug flow radius in the case of blood may be attributed to the deformability of the erythrocytes.     

Hepatic blood flow: accuracy of estimation from galactose clearances in cats

Experiments were carried out to determine the accuracy and validity of estimations of hepatic blood flow from clearance data during infusions of galactose in anesthetized cats. Clearance calculations were compared directly with the measured hepatic blood flows using a hepatic venous long-circuit technique. This technique allowed direct measurement and alteration of hepatic blood flow and collection of arterial and mixed hepatic venous blood samples without depletion of the animal's blood volume. It was found that infusions of galactose could not be used to estimate accurately hepatic blood flow. Infusion rate could not be used as an estimate of hepatic or splanchnic uptake owing to substantial and variable extrasplanchnic uptake. As a result, estimated hepatic flows allowing for incomplete extraction overestimated the true flow. On the other hand, extraction was less than 100%. This caused systemic galactose clearance to underestimate hepatic blood flow. These errors could cancel each other giving an apparently good estimate of hepatic flow from systemic galactose clearance. This agreement was fortuitous and occurred only at a specific dose and blood flow. We conclude that in the absence of independent measurements of both extrasplanchnic uptake and splanchnic extraction of galactose, systemic galactose clearance is not a reliable measure of hepatic blood flow in anesthetized cats. Until proved otherwise, it seems likely that this is also true in humans.     

Effect of hyperthermia on tumor blood flow

Differences in blood perfusion rates between tumors and normal tissue can be utilized to selectively heat many solid tumors. Blood flow in normal tissues is considerably increased at temperatures commonly applied during localized hyperthermia. In contrast, tumor blood flow may respond to localized heat typically in two different blood flow patterns: Flow may either decrease continuously with increasing exposure time and/or temperature or flow may exhibit a transient increase followed by a decline. A decrease in blood flow at high thermal doses can be observed in most of the tumors, whereas an increase in flow at low thermal doses seems to occur less frequently. The inhibition of blood flow at high thermal doses may lead to physiological changes in the microenvironment of the cancer cells that increase the cell killing effect of hyperthermia. Flow increases at low thermal doses can enhance the efficiency of other treatment modalities, such as irradiation or the administration of antiproliferate drugs.     

The initiation of blood flow and flow induced events in early vascular development

Within a day of gastrulation, the embryonic heart begins to beat and creates blood flow in the developing cardiovascular system. The onset of blood flow completely changes the environment in which the cardiovascular system is forming. Flow provides physiological feedback such that the developing network adapts to cue provided by the flow. Targeted inactivation of genes that alter early blood fluid dynamics induce secondary defects in the heart and vasculature and therefore proper blood flow is known to be essential for vascular development. Though hemodynamics, or blood fluid dynamics, are known to activate signaling pathways in the mature cardiovascular system in pathologies ranging from artherosclerosis to angiogenesis, the role in development has not been as intensively studied. The question arises how blood vessels in the embryos, which initially lack cells types such as smooth muscle cells, differ in their response to mechanical signals from blood flow as compared to the more mature cardiovascular system. Many genes known to be regulated by hemodynamics in the adult are important for developmental angiogenesis. Therefore the onset of blood flow is of primary importance to vascular development. This review will focus on how blood flow initiates and the effects of the mechanical signals created by blood flow on cardiovascular development.     

Estimation of rat muscle blood flow by microdialysis probes perfused with ethanol, [14C]ethanol, and 3H2O.

We used the perfused rat hindquarter to evaluate whether the microdialysis ethanol technique can be used to qualitatively estimate nutritive skeletal muscle blood flow. Four microdialysis probes were inserted in different hindlimb muscles in each of 16 rats. Hindquarters were perfused at blood flow rates ranging from 0 to 21 ml. 100 g-1. min-1. The microdialysis probes were perfused at 2 microliter/min with perfusate containing ethanol, [14C]ethanol, and 3H2O. Within and between experiments outflow-to-inflow ratios (o/i) generally varied inversely with blood flow. When a low flow or no flow was maintained in hindquarters, o/i ratios first increased with time (for at least 60 min) and then leveled off. The long time constant impaired detection of rapid oscillations in blood flow, especially at low blood flow rates. Contractions per se apparently decreased o/i ratios independent of blood flow. Ethanol and [14C]ethanol o/i ratios did not differ. 3H2O o/i paralleled ethanol and [14C]ethanol o/i ratios but it was significantly lower. In conclusion, differences in skeletal muscle blood flow can be detected by the microdialysis technique. However, the slow changes in o/i, in particular at low blood flow rates, limit the usefulness of the technique for measuring dynamic changes in blood flow; caution must also be exerted during muscle contractions. 3H2O and [14C]ethanol are good alternatives to ethanol in the determination of blood flow by microdialysis.     

Redistribution of blood flow after thermal injury and hemorrhagic shock

Diminished mucosal mass and a diminished rate of DNA synthesis by the intestinal mucosa have been identified in the rat after thermal injury. Because these changes may be associated with ischemia, the distribution of intestinal blood flow was studied after a thermal injury and compared with the blood flow distribution after hemorrhagic shock. For the thermal injury, anesthetized animals received a standardized 20% body surface area, full-thickness injury and were given intraperitoneal saline resuscitation. By the use of 46Sc- or 141Ce-labeled microspheres, no changes in intestinal and hepatic blood flow occurred after thermal injury. In contrast, a marked redistribution of blood flow was identified after hemorrhagic shock in which a decrease in arterial blood flow was identified to the stomach and to the small and large intestine. Although clinical shock was not present, the cardiac output decreased to a comparable degree in the hemorrhagic shock and the thermal injury. These studies indicate that although physiological changes in intestinal mucosa can be demonstrated after burn injury, these changes are not due to decreases in mesenteric arterial blood flow.     

Effect of glomerulopressin on ovarian blood flow in dogs.

The present study showed that glomerulopressin decreased ovarian blood flow in normal dogs and that this effect could be inhibited by treatment with indomethacin. In addition diabetic dogs had a high plasma level of glomerulopressin and a low ovarian blood flow that was shown to increase after treatment with indomethacin. This suggests that the low ovarian blood flow in diabetis might be due to a prostaglandin synthesizing effect of glomerulopressin.     

Effects of local heat on blood flow in infected and normal hands

Changes in response to heat in the dermal, subcutaneous, and muscle blood flow in the hands of 10 patients with hand infections were studied using 133Xe and recording of clearance data. A further 15 normal hands were studied in a similar manner. The application of topical heat to normal hands resulted in a decrease in the dermal blood flow (p less than 0.001), an increase in the subcutaneous blood flow (p less than 0.05), and perhaps an increase in the intramuscular flow (p less than 0.1). This suggests that surface heat promotes a shunting of the blood from the skin to deeper tissue layers. In infected hands, the blood flow was found to be significantly increased threefold in the intradermal circulation (p less than 0.01) and eightfold in the subcutaneous circulation (p less than 0.03) when compared to controls. In contrast to normal hands, in the infected hands, the blood flow decreased in all three compartments by 50 percent following application of heat. The blood flow of the normal hand in patients with infection did not respond to heat in the normal pattern. We conclude that the application of local heat to normal tissues results in shunting of blood flow from superficial tissues such as dermis to deeper ones such as subcutaneous fat and muscle. In infected tissues, the blood flow was found to be much higher than normal; however, the traditional belief in the improvement in blood flow by the application of heat was not confirmed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Arteriovenous shunting and regional blood flow in myocutaneous island flaps: an experimental study in pigs

In eight pigs, total blood flow, regional capillary blood flow distribution, and arteriovenous (AV) shunting were studied during the first 4 postoperative hours after elevation of a myocutaneous rectus abdominis island flap. Capillary blood flow and AV shunting were measured using radioactive microspheres before flap creation and 1 and 4 hours after surgery. Total blood flow, measured continuously as venous outflow, increased in the first postoperative hour (p less than 0.05). Elevation of the flap caused a slight decrease in skin capillary blood flow (p less than 0.05), whereas muscular capillary blood flow increased (p less than 0.01). AV shunting accounted for 50 percent of the total flap blood flow, whereas it was negligible in the abdominal wall prior to flap elevation. Thus stalk blood flow, skin appearance, and skin temperature may be poor indicators of nutritional capillary perfusion. However, the clinical and nutritional consequences of these findings remain to be established.     

Stabilization of pressure drop in the feeder arteries of rats as affected by an increase in blood flow

The dependence of the pressure drop (PD) along conducting vessels between the aorta and the distal end of a. saphena on the blood flow in the artery has been studied in rats. The PD was shown to react to rapid blood flow increase from 0.6 to 1.2 ml/min, with a drastic upstroke followed by a gradual decrease to the initial value within 20 s. When the blood flow was returned to the initial level the PD was recovered during 40 s. A rapid flow increase from 0.1 to 1.0 ml/min in 3 s was accompanied by proportional changes in PD. However, a slow blood flow increase from 0.1 to 1.5 ml/min in 600 s did not induce any marked changes in PD in the range of the blood flow from 0.5 to 1.5 ml/min. The observed stabilization of PD may be attributed to the property of conducting arteries to increase their internal diameter in response to blood flow increase.     

The Cardiovascular Control of Heat Exchange: Consequences of Body Size

For blood flow to be an effective agent for the control of heatexchange, it must occur in a region of the body where conductionresistance in the tissues is relatively high, and in an environmentwhere external resistance to heat exchange is relatively low.If either of these conditions is not met, control of heat exchangeby blood flow is not possible. Very small reptiles should notbe able to control heat exchange by blood flow in any environment,unless they control blood flow specifically to appendages. Verylarge reptiles should be able to control heat exchange by bloodflow only under certain conditions, such as in water, very highwinds, or intense radiative heating. Otherwise, they shouldhave little control. An optimum body size should exist for areptile's ability to control heat exchange using blood flow.In air, this optimum body size for alligators appears to beabout 5 kg. Theoretically, the optimum size should be substantiallylarger than 5 kg for reptiles heating and cooling in water.     

Effect of injectable or inhalational anesthetics and of neuroleptic, neuroleptanalgesic, and sedative agents on tumor blood flow

Among other parameters, varying blood flow values may be responsible for tumor-to-tumor variabilities in the radiobiologically hypoxic cell fraction of experimental rodent tumors. To test whether changes in tumor blood flow may be caused by anesthetic agents often used in radiobiology, the effect of injectable and inhalational anesthetics and of neuroleptic, neuroleptanalgesic, and sedative agents on blood flow in subcutaneous DS-carcinosarcomas implanted in Sprague-Dawley rats has been investigated using the 85Kr clearance technique. In conscious rats, 20-100 min after animal instrumentation mean blood flow is 0.62 +/- 0.17 ml/g/min (mean +/- SD) in 0.75 +/- 0.15 g tumors at a mean arterial blood pressure of 125 +/- 12 mm Hg. In animals receiving thiobutabarbital, chloral hydrate, or methoxyflurane tumor blood flow is somewhat higher than that measured in conscious rats. Tumor blood flow in animals receiving etomidate, ketamine-xylazine, fentanyl-fluanisone, or urethane is significantly lower than that in the thiobutabarbital group and somewhat lower than in the conscious animals. Blood flow values observed with midazolam, ketamine-midazolam, fentanyl-droperidol, droperidol, diazepam, and pentobarbital are similar to those measured in conscious rats. Virtually no flow alterations with time are detectable in conscious rats and with most of the drugs used. In animals anesthetized with urethane or methoxyflurane, tumor blood flow increases and tumor vascular resistance diminishes slightly with time.     

Particulate nature of blood determines macroscopic rheology: a 2-D lattice Boltzmann analysis

Historically, predicting macroscopic blood flow characteristics such as viscosity has been an empirical process due to the difficulty in rigorously including the particulate nature of blood in a mathematical representation of blood rheology. Using a two-dimensional lattice Boltzmann approach, we have simulated the flow of red blood cells in a blood vessel to estimate flow resistance at various hematocrits and vessel diameters. By including white blood cells (WBCs) in the flow, we also calculate the increase in resistance due to white cell rolling and adhesion. The model considers the blood as a suspension of particles in plasma, accounting for cell-cell and cell-wall interactions to predict macroscopic blood rheology. The model is able to reproduce the Fahraeus-Lindqvist effect, i.e., the increase in relative apparent viscosity as tube size increases, and the Fahraeus effect, i.e., tube hematocrit is lower than discharge hematocrit. In addition, the model allows direct assessment of the effect of WBCs on blood flow in the microvasculature, reproducing the dramatic increases in flow resistance as WBCs enter short capillary segments. This powerful and flexible model can be used to predict blood flow properties in any vessel geometry and with any blood composition.