Abnormal bone scanning following intraosseous access

A case of an abnormal bone scan following intraosseous access in a 12-month-old child is presented. Gallium scanning and follow-up showed no signs of possible complicating osteomyelitis. This case report suggests that an abnormal bone scan following intraosseous access is possible and should not be considered diagnostic for osteomyelitis.     

Atriopeptin alters the vasopressin and renin responses elicited by hemorrhage

This study was designed to investigate whether an infusion of atrial peptide is capable of modulating the hormonal and hemodynamic responses elicited by acute hemorrhage. Conscious dogs were bled at a rate of 0.8 ml.kg-1.min-1 until 20 ml of blood/kg body wt had been removed. Two experiments were performed on each dog; in one experiment the animal was given alpha-human atrial natriuretic peptide (alpha-hANP) (50 ng.kg-1.min-1) dissolved in saline; in the other only the saline vehicle was given. Right and left atrial pressures decreased during hemorrhage in all experiments; the absolute decreases were greater when the animals received atriopeptin, but the differences between treatments were statistically significant only for right atrial pressure. Cardiac output decreased (P less than 0.05) and total peripheral resistance increased (P less than 0.05) during hemorrhage when atriopeptin was infused; although these variables showed similar trends when vehicle alone was infused during hemorrhage, no significant changes occurred. Infusion of atrial peptide did not affect the decrease in arterial blood pressure that occurred during hemorrhage. The increase in plasma vasopressin induced by hemorrhage was potentiated, but the increase in plasma renin activity was attenuated when alpha-hANP was infused. Hemorrhage increased circulating aldosterone levels in each experiment, but the response was less pronounced when alpha-hANP was given during the experiment. Intravenous administration of alpha-hANP modulates the hemodynamic responses elicited by hemorrhage, potentiates the rise in plasma vasopressin, and attenuates the rise in plasma renin activity induced by acute blood loss in conscious dogs.     

Stiffening of the femoral head due to inter-trabecular fluid and intraosseous pressure

The mechanical properties of cancellous bone, as measured from bone plug samples have been widely documented. However, few tests have been attempted to explore the effects the intertrabecular contents may have on the load bearing capabilities. In this study, canine femoral heads were subjected to dynamic compressive strain cycles. The femoral heads were tested intact, as well as with disrupted boundary conditions of the continuous, intraosseous fluid space. A significant reduction in mechanical stiffness was observed when the fluid compartment boundary was disrupted by drilling a hole part way into the femoral neck. A finite element model of a typical femoral head showed that the stiffness change was not due to removal of material from the neck, hydraulic effects notwithstanding. Refilling the hole in the neck with saline solution and sealing the boundary restored the stiffness to the intact baseline level. However, an increase in the fluid pressure did not cause a statistically significant increase in the stiffness of the femoral head.     

Increased pulmonary vascular filtration pressure does not alter lung liquid secretion in fetal sheep.

The purpose of this study was to determine whether an increase in pulmonary vascular filtration pressure affects net production of liquid within the lumen of the fetal lung. We studied 14 chronically catheterized fetal lambs [130 +/- 3 (SD) days gestation] before, during, and after a 4-h rapid (500 ml/h) intravenous infusion of isotonic saline. In seven fetuses we measured pulmonary arterial and left atrial pressures, lung lymph flow, and protein osmotic pressures in plasma and lymph. In eight lambs with a chronically implanted tracheal loop cannula, we measured the change in luminal lung liquid volume over time by progressive dilution of tracheally instilled 125I-albumin, which stays within the lung lumen. Saline infusion increased pulmonary vascular pressures by 2-3 mmHg and decreased the plasma-lymph difference in protein osmotic pressure by 1 mmHg. Lung lymph flow increased from 1.9 +/- 0.6 to 3.9 +/- 1.2 (SD) ml/h; net production of luminal lung liquid did not change (12 +/- 5 to 12 +/- 6 ml/h). Thus an increase in net fluid filtration pressure in the pulmonary circulation, which was sufficient to double lung lymph flow, had no significant effect on luminal lung liquid secretion in fetal sheep.     

Intraosseous Vascular Access through the Anterior Mandible – A Cadaver Model Pilot Study

Background

Several insertion sites have been described for intraosseous puncture in cases of emergencies when a conventional vascular access cannot be established. This pilot study has been designed to evaluate the feasibility of the mandibular bone for the use of an intraosseous vascular access in a cadaver model.

Methodology/Principal Findings

17 dentistry and 16 medical students participating in a voluntary course received a short introduction into the method and subsequently used the battery powered EZ-IO system with a 15 mm cannula for a puncture of the anterior mandible in 33 cadavers. The time needed to perform each procedure was evaluated. India ink was injected into the accesses and during the anatomy course cadavers were dissected to retrace the success or failure of the puncture. Dental students needed 25.5±18.9(mean±standard deviation)s and medical students 33±20.4 s for the procedure (p = 0.18). Floor of mouth extravasation occurred in both groups in 3 cases. Success rates were 82 and 75% (p = 0.93).

Conclusions/Significance

Despite floor of mouth extravasation of injected fluid into a mandibular intraosseous access might severely complicate this procedure, the anterior mandible may be helpful as an alternative to other intraosseous and intravenous insertion sites when these are not available in medical emergencies.     

Gastric effects of thyrotropin-releasing hormone microinjected into the dorsal vagal nucleus in cats

We investigated the gastric acid secretory and motility responses to microinjection of thyrotropin-releasing hormone (TRH) into the dorsal motor nucleus of the vagus (DMV) in anesthetized cats. Gastric acid output was collected every 15 min through a gastric cannula after saline flush and titrated to pH 7.0. Antral and corpus contractions were continuously recorded by extraluminal force transducers. TRH dissolved in 200 nl of saline and microinjected unilaterally into the DMV induced a dose-dependent (50-200 ng) increase in gastric acid secretion. The acid secretory response began in the first 15 min collection and lasted 45 min. TRH frequently increased the force of contractions of the antrum and corpus within one minute of microinjection. The minimal effective dose for eliciting increased motility was lower than for inducing acid secretion. These results demonstrate that TRH acts in the DMV of cats to stimulate gastric acid secretion and contractions.     

The influence of exogenous cross-linking and compressive creep loading on intradiscal pressure

This study involves a biomechanical evaluation of a prospective injectable treatment for degenerative discs. The high osmolarity of the non-degenerated nucleus pulposus attracts water contributing to the hydrostatic behavior of the tissue. This intradiscal pressure is known to drop as fluid is exuded from the matrix due to compressive loading. The objective of this study was to compare the changes in intradiscal pressure in control and genipin cross-linked intervertebral discs. Thirty bovine lumbar motion segments were randomly divided into a phosphate-buffered saline control group and a 0.33% genipin group and soaked at room temperature for 2 days. A needle pressure sensor was held in the center of the disc while short-term and static creep compressive loads were applied. The control group demonstrated a 25% higher average intradiscal pressure compared to genipin-treated discs under 750 N compressive load (p=0.029). Depressurization during static compressive creep was 56% higher in the control than in the genipin group (p=0.014). These results suggest cross-linking induced changes in the poroelastic properties of the involved tissues affected the mechanics of compressive load support in the disc with lower levels of nucleus pressure, a corresponding decrease in the elastic expansion of the annulus, and an increased axial compressive loading of the inner and outer annulus tissues. It is possible that concurrent changes in hydraulic permeability and proteoglycan retention known to be associated with genipin cross-linking were also contributors to poroelastic changes. Reduction of peak pressures and moderation of pressure fluctuations could be beneficial relative to discogenic pain.     

Changes of deep cervical lymph flow following the infusion of isotonic, hypotonic, and hypertonic NaCl in rabbit.

Isotonic, hypotonic, or hypertonic saline was infused in anesthetized rabbits in order to test the effects of osmolality in cerebral vessels on lymph flow. The jugular lymph trunk was cannulated by PE tubing in a headward direction. Either a hypo-(100 mosmol), iso-(310 mosmol), or hypertonic (605 mosmol) NaCl solution was infused into the internal carotid artery (ICA) or the right lateral ventricle (RIV). Lymph was continuously collected at slight negative pressure, and measured over a 90 min preinfusion period, as well as during saline infusion and intermittent recovery periods. Mean peak flow rates for the first 30 min infusion of hypertonic saline via ICA and RLV were 5.1 +/- 1.2 and 6.7 +/- 1.6 microliters/min, respectively, or a significant increase of 38% and 40% over those of isotonic saline (3.7 +/- 0.9 microliters/min via ICA; 4.8 +/- 1.0 microliters/min via RLV). Conversely, for hypotonic saline, lymph flow rates were significantly reduced by 19% (2.9 +/- 0.6 microliters/min) and 23% (3.7 +/- 0.7 microliters/min) for the first 30 min infusion via ICA and RLV, respectively. Increases in arterial and intracranial pressures, as well as an enhancement of respiratory movements following hypertonic saline infusion, augmented lymph formation. The results suggest that the observed changes in jugular lymph flow following saline infusion can be correlated to the resulting increase in intracranial pressure and respiratory movements, and changes in the osmolality and blood pressure of cerebral vessels.     

Effect on breathing of acute pressure rise in pulmonary artery and right ventricle

We tested the hypothesis that breathing would be regulated in response to right ventricular and pulmonary arterial pressure changes when secondary events are controlled. Dogs were anesthetized, thoracotomies were performed, and cardiopulmonary bypass perfusion was established. Lungs were inflated to sustained pressures. The left diaphragmatic lobe was retrogradely cannulated and all other lobar arteries were ligated, forming a pulmonary arterial sac that drained to the oxygenator from the cannula and filled from systemic venous return by the beating right ventricle. Right atrial pressure was adjusted to produce sac flows of approximately 400 ml/min. We recorded systemic and pulmonary arterial pressures, sac flow, and the integrated diaphragm electromyogram (DEMG). Resistive loads were imposed on sac outflow by adjusting a clamp. Loaded mean pulmonary arterial pressures ranged from 27 to 70 Torr. Loading increased respiratory frequency without affecting peak DEMG amplitude. Responses did not occur after vagotomy. Effects were quantitatively modest: pressurization to approximately 50 Torr increased frequency approximately 3.4 breaths/min (22%). The magnitude of change was insufficient to explain in intact dogs the ventilatory responses that have been attributed to this reflexogenic unit.     

Passive pericardial constraint protects against stretch-induced vulnerability to atrial fibrillation in rabbits

Atrial fibrillation is more common in conditions with elevated atrial pressure and can be induced experimentally with acute increases in atrial pressure. We examined the effect of increased atrial pressure with and without pericardial constraint to better separate the effects of increased pressure and atrial stretch. In Langendorff-perfused rabbit hearts with intact pericardium, after ligating the pulmonary and caval veins, intra-atrial pressures were increased in a stepwise manner by adjusting the pulmonary outflow cannula. Rapid burst pacing was applied to induce atrial fibrillation at increasing intra-atrial pressures from 0 to 24 cmH(2)O. The atrial refractory period was recorded at each pressure using a single extra stimulus. The protocol was repeated after the pericardium was removed. When the pericardium was intact, atrial stretch was limited by passive constraint, and sustained atrial fibrillation could not be induced despite atrial pressures in excess of 20 cmH(2)O. In contrast, when the pericardium was removed, atrial fibrillation could be reliably induced when atrial pressure exceeded 15 cmH(2)O. This suggests that the electrophysiological effects of acute atrial volume loading rely on atrial stretch rather than increased atrial pressure alone.     

Prostaglandin E1 induces intraosseous hypotension under conditions of normal arterial pressure

The purpose of this study was to investigate the late effects of intravenous infusion of prostaglandin E1 (PGE1) on intraosseous pressure (IOP). PGE1 was infused intravenously at 0, 0.1, 0.3 or 1.0 microg/kg/min over 120 min daily for 5 consecutive days into six rabbits each. On the day after the final infusion, mean (SD) change from baseline in IOP of the tibia was 14.5 (22.6), -10.6 (29.6), -29.8 (22.2) and -6.9 (22.5) percent in the groups infused at 0, 0.1, 0.3 and 1.0 microg/kg/min, respectively, being significantly different between the groups infused at 0 and 0.3 microg/kg/min. The mean change from baseline in mean arterial pressure (MAP) was not significantly different between the four groups. There was no significant correlation between percent changes from baseline in IOP and MAP in all the 24 rabbits from the four groups (r = 0.197, P = 0.362 ). In conclusion, IOP decreases following repeated PGE1 infusion independent of MAP change when the dose is appropriate. CLINICAL RELEVANCE: Intraosseous hypotension induced under conditions of normal arterial pressure contributes to systemic control of intraoperative bleeding from the bone.     

Autonomic nervous system regulation of epicardial coronary vein systolic and diastolic blood velocity as measured by a laser Doppler velocimeter

The velocity of blood in a major epicardial coronary vein accompanying the left anterior descending coronary artery of dogs was measured by means of a 140-micron fiber optic probe connected to a laser Doppler velocimeter. Right atrial pressure, left ventricular intramyocardial and cavity pressures, aortic pressure, as well as peripheral and central coronary venous pressures were compared with the velocity of blood measured in the epicardial coronary vein midway between the sites of the catheters measuring proximal and distal coronary vein pressures. During control conditions, coronary vein velocity was 14-18 cm/s during systole and 1.0-2.1 cm/s during diastole. Right stellate ganglion stimulation, norepinephrine or isoproterenol increased diastolic coronary vein velocity significantly, whereas left stellate ganglion stimulation did not. Average peak systolic velocity was not affected by these interventions. During these positive inotropic interventions, the peak coronary vein velocity usually occurred later in the cardiac cycle than during control conditions. Positive inotropic interventions appeared to decrease coronary vein velocity during systole and increase it during diastole. Left vagosympathetic trunk stimulation decreased diastolic but not systolic coronary vein velocity and usually caused peak coronary vein velocity to occur earlier in the cardiac cycle than during control states. Changes induced by vagosympathetic trunk stimulation usually occurred within one cardiac cycle. It is concluded that coronary vein blood velocity can be influenced by the autonomic nervous system.     

Modeling of the inactivation of Salmonella typhimurium by supercritical carbon dioxide in physiological saline and phosphate-buffered saline

In this study, we used supercritical carbon dioxide (SC-CO(2)) to inactivate Salmonella typhimurium suspended in physiological saline (PS) or phosphate-buffered saline (PBS). The colony forming activity of S. typhimurium was completely lost (i.e., 8-log reduction) under the following condition ranges: pressures of 80-150 bar, temperatures of 35-45 degrees C and 10-50 min treatment times. The microbial inactivation process had three distinct phases and was modeled by the modified Gompertz model. Generally, an increase in pressure at constant temperature, and an increase in temperature at a constant pressure, both enhanced S. typhimurium inactivation. When the cells were suspended in PBS rather than PS, the length of time for the complete inactivation significantly increased. We observed the surface and internal morphological changes of the cells by SEM and TEM, respectively. The extraction of proteinous substances, nucleic acids and outer membrane proteins into the suspension during SC-CO(2) treatment was also observed. Through SDS-PAGE analysis of the total proteins and major outer membrane proteins (OMPs) of SC-CO(2)-treated cells, we found that a substantial amount of the total soluble proteins had converted into insoluble protein.     

Control of scion vigour by kiwifruit rootstocks is correlated with spring root pressure phenology

Root pressure was measured continuously over spring in eight clonal kiwifruit rootstocks selected from seven Actinidia species (A. chrysantha, A. deliciosa, A. eriantha, A. hemsleyana, A. kolomikta, A. macrosperma, A. polygama), using pressure transducers and miniature compression fittings. Rootstocks that promoted scion vigour developed root pressures up to 0.15 MPa before or during scion budburst, whereas those that reduced scion vigour developed root pressure up to 0.05 MPa only after scion shoot expansion. When several seasons were compared, the date of onset of root pressure and the magnitude of pressure achieved were consistent for each rootstock. Root pressure was first recorded between late July and early September in vigour-promoting rootstocks, while scion budburst and initial shoot growth were in late August and early September. Vigour-reducing rootstocks did not develop significant root pressure until October. The date of onset was similar for the grafted rootstock and ungrafted plant of the same clone, but was not clearly related to the timing of shoot growth by the ungrafted plant. In the grafted plants the leaf and xylem water potentials of the scion were more negative, midday turgor was 0.3-0.5 MPa lower, and wilting was sometimes observed in developing shoots growing on low-vigour rootstocks, indicating that water stress was contributing to reductions in growth. Leaf turgor was correlated with average root pressure but not pressure measured during the day, suggesting that root pressure was not supporting transpiration during peak flows and was, instead, indicative of higher root hydraulic conductance. The rapid temporal rise in root pressure observed each spring in the various rootstocks was not accompanied by changes in xylem sap solute potential, but when rootstock clones were compared those that developed higher root pressures had higher sap solute potentials. Xylem sap solute potential varied between rootstocks from -0.07 MPa to -0.15 MPa, while root pressures measured at the same time varied between 0.0 MPa and 0.09 MPa, suggesting that an osmotic mechanism could account for the observed root pressure. Differences in phenology between the rootstocks and scion appeared to account for the rootstock effects on shoot growth, and changes in root pressure provided a useful indication of seasonal changes in root hydraulic properties and solute transport behaviour.     

Long-term infusion of nonphysiologic solutions into brain parenchyma: effects of pH, osmolarity, and flow rate

The effects of long-term (3-day) infusion of nonphysiologic solutions into brain parenchyma were investigated in male Fischer (F344) 344 rats. Two weeks prior to infusion, a guide cannula was placed into the striatum, substantia nigra, or hippocampus. Solutions were infused continually for 3 days at flow rates of 0.03 (129.6 microl total) or 0.10 (432 microl total) microl/min. Four days after infusion, rats were euthanized and the brain was removed and processed for histologic evaluation. Rats that received cannula implants alone had the usual mechanical damage induced by implantation of the cannula. The brain regions that received 0.9% saline, pH 5.0 or pH 9.0 buffer at the two aforementioned flow rates had only minor evidence of tissue damage adjacent to the infusion site that was similar to that attributable to mechanical damage from the cannula implants. Brain tissue infused with distilled water or 1.8% saline also had modest effects of the solutions similar to the usual mechanical damage induced by the infusion cannulae. In contrast, contamination of the infusion sites was seen to induce inflammation. Data from these studies support the hypothesis that nonphysiologic solutions can be used to deliver compounds into brain parenchyma, without the infusion solutions themselves causing excess damage to brain tissue.     

Acute changes of biventricular gene expression in volume and right ventricular pressure overload

OBJECTIVE: We investigated the effects of acute volume and RV pressure overload on biventricular function and gene expression of BNP, pro-inflammatory cytokines (IL-6 and TNF-alpha), iNOS, growth factors (IGF-1, ppET-1), ACE and Ca2+-handling proteins (SERCA2a, phospholamban and calsequestrin). METHODS: Male Wistar rats (n=45) instrumented with pressure tip micromanometers in right (RV) and left ventricular (LV) cavities were assigned to one of three protocols: i) Acute RV pressure overload induced by pulmonary trunk banding in order to double RV peak systolic pressure, during 120 or 360 min; ii) acute volume overload induced by dextran40 infusion (5 ml/h), during 120 or 360 min; iii) Sham. RV and LV samples were collected for mRNA quantification. RESULTS: BNP upregulation was restricted to the overloaded ventricles. TNF-alpha, IL-6, ppET-1, SERCA2a and phospholamban gene activation was higher in volume than in pressure overload. IGF-1 overexpression was similar in both types of overload, but was limited to the RV. TNF-alpha and CSQ mRNA levels were increased in the non-overloaded LV after pulmonary trunk banding. No significant changes were detected in ACE or iNOS expression. RV end-diastolic pressures positively correlated with local expression of BNP, TNF-alpha, IL-6, IGF-1, ppET-1 and SERCA2a, while RV peak systolic pressures correlated only with local expression of IL-6, IGF-1 and ppET-1. CONCLUSIONS: Acute cardiac overload alters myocardial gene expression profile, distinctly in volume and pressure overload. These changes correlate more closely with diastolic than with systolic load. Nonetheless, gene activation is also present in the non-overloaded LV of selectively RV overloaded hearts.     

The relationship between sexual and aggressive behaviour, and pituitary and testicular activity during the seasonal sexual cycle of rams, and the influence of photoperiod

Six adult Soay rams were housed under artificial lighting conditions with alternating 16-week periods of long (16 h light: 8 h darkness) and short days (8L:16D) During long days the rams were reproductively quiescent: the abrupt change from long to short days induced a specific succession of responses in the reproductive system. Plasma LH and FSH levels began to increase after 2-4 weeks, followed almost immediately by a rise in plasma testosterone levels accompanied by growth of the testes. Testicular activity continued to increase during short days and the greatly elevated androgen levels apparent after 5-10 weeks caused changes in the peripheral target organs, including growth of the epididymides, development of the sexual flush on the exposed ventral skin and heightened genital sensitivity. High testosterone levels were also associated with an increase in aggressive (scored by a mechanical device) and sexual (incidence of Flehmen) behavior which was at peak about 1 month after the start of the peak androgen levels. The change to long days was associated with a decrease in plasma gonadotrophin levels within 2 weeks followed by a progressive decline in all reproductive parameters measured. Implantation of a low dose of testosterone (200 mg) during the period of reproductive quiescence induced the development of the sexual flush and an increase in genital tactile sensitivity, although behaviour was not significantly affected. The annual changes in reproductive physiology and behaviour of 12 Soay rams living under natural lighting conditions were recorded for comparison with the experimental situation. The nadir of the sexual cycle was in the spring and early summer, and the sequence of events culminating in the mating season in the autumn was similar to that induced experimentally.     

Immunity of Fischer 344 rats to salt hypertension.

Female Fischer 344 rats sensitized to the development of salt hypertension by unilateral nephrectomy were given water, 1% NaCl solution or 5% sucrose + 1% NaCl solution to drink. Rats on saline alone drank about twice the fluid volume of those on water, whereas those on the sucrose-saline solution drank four to six times as much. No Fischer 344 rats ever developed hypertension, defined as a systolic pressure exceeding 150 mm Hg, during the six months of the study. However, the group on saline averaged slightly higher arterial pressures than those on water on 13 of the 14 occasions that blood pressure was measured, and the average pressure over the entire experimental period was also significantly increased. The rats on sucrose-saline had a group mean blood pressure which was always significantly higher than that of the group on water and usually greater also than that of the group on saline, and the average pressure over the entire experimental period was significantly augmented above that in either of the other groups. Rats on either of the saline solutions also had a slight but significant degree of heart and kidney enlargement, greatest in the sucrose-saline group, which is attributed to the higher pressures developed, even though they remained within the normotensive range.     

Individual variation between general practitioners in labelling of hypertension.

Variation in labelling of hypertension by individual general practitioners was studied during a continuous opportunistic screening programme for hypertension in a single general practice with 12 principals. All the general practitioners agreed to label as hypertensive patients with systolic pressures of greater than or equal to 200 mm Hg or diastolic pressures of greater than or equal to 110 mm Hg on three consecutive readings. The overall number of patients labelled hypertensive at the beginning of the screening programme was 505 and this rose to 801 after five years. There was a large variation in the numbers of patients recorded as hypertensive at the start of the screening period, with numbers ranging from eight to 112 for individual practitioners. The variation persisted during the screening period, with the numbers of patients detected by individual general practitioners ranging from four to 46. The average systolic and diastolic pressures recorded among these patients also varied between doctors, and only 24 out of 187 patients had their high pressures recorded on three occasions and so fully met the criteria for diagnosing hypertension. Clearly, general practitioners are following their own individual criteria in defining hypertension and taking into account factors other than just the measured blood pressure.     

Method for in vivo measurement of intraosseous pressure of the patella]

During the development of degenerative joint disease (osteoarthritis, chondropathy), a diagnostic or even pathogenetic role is attributed to the phenomenon of intraosseous pressure (IOP). Owing to technical problems and a lack of systematic experimental or clinical studies on the control mechanisms of the IOP, the actual importance of this factor is still not known with certainty. Now, a measuring method that enables correct recording of the IOP and standardized on-line processing of the measured signal minimize artefact-related problems. The technique is evaluated for reliability in an in vitro model of the human patella and in a limited clinical study of the IOP in patients undergoing knee surgery for various reasons. Factors such as intra-articular effusion, joint position or changes in intra-articular soft tissue are examined for their influence of the primary signal.