potentiates intestinal Intermittent ischemia reperfusion injury Elizabeth T. Clark, MD, and Bruce L. Gewertz, MD, Chicago, Ill.
|
|
- Logan Ashley Wells
- 5 years ago
- Views:
Transcription
1 Intermittent ischemia reperfusion injury potentiates intestinal Elizabeth T. Clark, MD, and Bruce L. Gewertz, MD, Chicago, Ill. We hypothesized that even brief periods of reperfusion interjected between ischemic episodes would increase tissue injury. Studies were performed in a rat small intestine preparation in which metabolic, hemodynamic, and histologic responses to ischemia have been well characterized. Animals were subjected to a total of 30 or 45 minutes of complete intestinal ischemia. Flow interruption was continuous (C, single episode) or intermittent (I, two or three episodes of 15-minute ischemia separated by 5 minutes of reperfusion). In some experiments 5-minute reperfusions were performed with arterial blood depleted of leukocytes (IL). This additional perturbation was included to determine the role of neutrophils that have been strongly implicated in reperfusion injury. In all three protocols histologic sections were obtained after each ischemic insult and after I hour of reperfusion with arterial blood. Villous histology was graded in a blinded fashion with I = normal and 5 = severe injury. No significant differences were found between groups in immediate postischemic histologies before reperfusion. After 1 hour of reperfusion, intermittent episodes of ischemia were associated with significantly worse histologic injury than that seen with comparable durations of continuous ischemia (30 min: I, vs C, ; 45 min: I, vs C, ). However, if5-minute reperfusions were with leukopenic blood, this effect was markedly reduced (30 min IL, ; 45 min IL, ). Even short periods of reperfusion during an ischemic insult greatly increased mucosal injury. This likely resulted from increased access of leukocytes to ischemic tissues during the brief reperfusion periods, since decreasing leukocyte availability by transiently reperfusing with leukopenic blood attenuated the damage. Maneuvers designed to limit leukocyte adherence to endothelial cells should be considered in the treatment of intestinal ischemia, particularly in patients at risk for repeated episodes of flow interruption. (J VAsc SURe 1991;13:601-6.) It is now well accepted that much of the tissue injury associated with an ischemic episode is due to reperfusion phenomena that begin only when blood flow is restored.~ The mechanism of injury involves, at least in part, the generation of oxygen-derived free radical species, which destabilize cellular membranes. 2-4 This improved understanding of ischemia and reperfusion in animal models has suggested new strategies to the vascular surgeon treating ischemic syndromes. These have included the use of free radical scavengers and intentional restriction of the initial bolus of oxygenated blood when flow is first restored. Unfortunately, treatment protocols are Supported by American Heart Association grant No (Dr. Gewertz) and National Institutes of Health Grant No. T32H (Dr. Clark). Presented at the Fourteenth Annual Meeting of the Midwestern Vascular Surgical Society, Toledo, Ohio, Sept , Reprint requests: Bruce L. Gewertz, MD, University of Chicago, Department of Surgery, 5841 S. Maryland Ave., Box 129, Chicago, IL /6/28207 largely based on experimental preparations subjected to single episodes of ischemia. Such models may not approximate the clinical situation; in practice ischemic insults often recur exposing an organ to multiple cycles of ischemia and reperfusion. We addressed this concern in a series of experiments that more closely parallel the clinical setting. We hypothesized that even brief periods of reperfusion interjected between ischemic episodes would increase tissue injury. Studies were performed in a rat small intestine preparation in which metabolic, hemodynamic, and histologic responses to ischemia have been well characterized. This organ was selected since multiple episodes of mesenteric ischemia are often encountered in clinical practice especially in the nonocclusive variant of the syndrome. Animals were subjected to a total of 30 or 45 minutes of complete intestinal ischemia. Flow interruption was continuous (single episode) or intermittent (two or three episodes of 15 minutes ofischemia separated by 5 minutes of reperfusion). In some 601
2 602 Clark and Gewertz Journalof VASCULAR SURGERY RECOROEH / \ A-vox I/ ~ l -,,, RESERVOtR IA WATER BATt4 Fig. 1. Experiments were performed in denervated autoperfused rat intestinal preparations. experiments 5-minute reperfusions were performed with arterial blood depleted of leukocytes. This additional intervention was included to determine the role of neutrophils which have been strongly implicated in reperfusion injury. METHODS Animal care and experimentation described below complied with the "Principles of Laboratory Animal Care" and the "Guide for Care and Use of Laboratory Animals" (NIH publication No , revised 1985). Experimental model. The intestinal preparation is a modification of that previously described by Anzueto et al. s and Kim and Gewertz 6 (Fig. 1). Male Wistar rats weighing 400 to 600 gm (retired breeders, Harlan Sprague-Dawley) were anesthetized by ether inhalation augmented by intraperitoneal injection of sodium pentobarbital (50 mg/ml at 0.1 ml/100 gm). The trachea was intubated with 1.67 mm ID PE 240 tubing (Becton Dickinson Primary Care Diagnostic, Sparks, Md.), and supplemental oxygen was supplied at a rate of 4 L/min. Surgical excision of the duodenum, pancreas, and colon was followed by bilateral ligation of the renal arteries and veins. Periadventitial stripping of the superior me- senteric artery (SMA) was performed to ensure denervation. The small intestine was wrapped in saline-soaked gauze and cellophane to minimize evaporative losses. Temperature was controlled at 37 C with an intermittent thermistor controlled incandescent lamp. Direct cannulation of the right femoral artery allowed continuous monitoring of systemic arterial pressure. After systemic heparinization (100 units heparin/100 gm body weight), an extracorporeal circuit was created to route blood from the right internal carotid artery and superior mesenteric vein (PE190 tubing, 1.19 mm ID) through a continuous A-~rO2 difference analyzer (AVOX Systems, Inc., San Antonio, Texas). Small intestine blood flow was controlled by cannulation of the SMA and use of an infusion pump (Gilson minipuls II; Medical Electronics, Middleton, Wis.) at 6.0 ml/min (calculated to provide 70 to 80 ml/min/100 gm intestine). All extracorporeal blood was collected in a reservoir, pumped through a 37 C water bath, and returned to the rat via the right femoral vein. When indicated, SMA occlusion was produced by cessation of pump perfusion. Protocol. Animals (n = 25) were allowed to stabilize for 1 hour after preparation. Sham animals (n -- 3) were observed for 3 hours without ischemic
3 Volume 13 Number 5 May 1991 Intestinal reperfusion injury potentiated by intermittant ischemia 603 SHAM (N=3) 30 MIN. ISCHEMIA 45 MIN. ISCHEMIA CONTINUOUS INTERMITTENT INT. & LEUKOPENIC CONTLNUOUS INTERMITTENT INT. & LEUKOPEN~C (N=4) (N=4) (N=3) (n=4) (n=4) (n=3) Fig. 2. Animals (n = 25) were subjected to either continuous or intermittent ischemia. Intermittent reperfusion (5 minutes) was performed with either native arterial blood or leukopenic arterial blood. Grade 1 Grade 2 6racte 3 Gracle 4 6ra~e 5 Fig. 3. Histologic grading system. Epithelial morphologic characteristics of individual intestinal sections were evaluated in a blinded manner by use of a modification of the Chiu system. insult to establish the stability of the preparation and to document baseline mesenteric vascular resistance (MVR) and oxygen consumption (VO2) (MVR at time 0, 0.87 _ at 3 hours; ~ro _ at time 0, 3.59 _ at 3 hours). In rats with continuous ischemia (C), intestines were subject to either 30 minutes (n = 4) or 45 minutes (n -- 4) of complete flow interruption as a single episode. Fourteen other rats experienced intermittent ischemia presented as two or three episodes of 15 minutes of flow interruption (total ischemia 30 or 45 minutes) separated by 5 minutes of reperfusion. These short intervals of reperfusion were performed with either native arterial blood (I, n--8) or leukopenic blood (IL, n = 6). Leukopenia (white blood cell cotmt <500/mm 3) was achieved by centtifugation of blood and removal of the buffy coat and confirmed by the absence of white blood cells on peripheral smear. Once the above treatment protocols were completed, the intestines in all animals were reperfused for 1 hour with native arterial blood (Fig. 2). Histologic sections were obtained after each ischemic insult and after 1 hour of reperfusion. After the experiments rats were killed by exsanguination. Intestinal sections were weighed and fixed in 10% neutral buffered formalin. Histologic evaluation was performed in a blinded manner by use of a modification of the system of Chiu et al.7; this grading system considers both villous height and epithelial morphology. Photomicrographs of the histologic grading system are depicted in Fig. 3. Data analysis. All values are reported as mean _+ SEM. Intestinal blood flow is normalized to 100 gm gut weight stripped of mesentery. Oxygen consumption (VO2) was calculated as the product of A-VO 2 difference and intestinal blood flow. Mesenteric vascular resistance was calculated as the difference between mean arterial pressure and mesenteric venous pressure divided by intestinal blood flow. Statistical analysis was performed with t tests between groups, and significance was assumed for p < 0.05.
4 604 Clark and Gewertz Journal of VASCULAR SURGERY I HR. REPERFUSION uj O < o u 0.,J 0 I- \\x\ \N\\ x\\\ \xx\,'x\'~ SHAM C I IL C I IL 30 MIN, 45 MIN, Fig. 4. Intermittent ischemia (I) significantly increased histologic damage as compared to a continuous (C) insult. This effect was attenuated if 5-minute reperfusions were with leukopenic blood (/L). Table I. Mesenteric vascular resistance (MVR, mmhg/ml/min 100 gin) in continuous (C), intermittent (I), and intermittent leukopenic (IL) groups before ischemia and after 1 hour of reperfusion Before ischemia Reperfmion 30 minutes of ischemia Continuous Intermittent Intermittent leukopenic minutes of ischemia Continuous _+ 0.0l Intermittent Intermittent leukopenic _ RESULTS In all groups and ischemic intervals, histologic injury was not prominent until after the 1-hour reperfusion period. Immediate postischemic histologies were different from baseline (p < 0.05 all groups), but no differences were found between groups (30 minutes: C, 2.1 _+ 0.2; I, ; IL, ; 45 minutes: C, 2.7 _+ 0.3; I, ; IL, ). Intermittent episodes of ischemia resulted in significantly worse histologic injury than comparable intervals of continuous ischemia (Fig. 4). For example, 30 minutes of continuous ischemia followed by 1 hour of reperfusion (C) yielded a histologic grade of , whereas 30 minutes of intermittent ischemia (two 15-minute periods, I) resulted in a grade of (p < 0.05). The eventual injury after intermittent ischemia was attenuated by leukopenic reperfusion during the 5-minute intervals. In the 30-minute flow interruptions, limiting access of leukocytes to the intestine during the 5-minute reperfusions (IL) decreased the eventual injury score to (not different from C). Similar results were seen in the 45-minute ischemia groups (C, ; I, ; IL, )~. Since intestinal blood flow was controlled with an infusion pump at 6.0 ml/min, hemodynamic changes are most appropriately monitored by variations in mesenteric vascular resistance. Mean mesenteric vascular resistance in all experimental groups is displayed in Table I. No statistically significant differences were found in MVR between any groups. VO2 ( ml/min/100 gm at baseline) was predictably depressed after 1 hour of reperfusion in all experimental groups. These values did not vary significantly within total ischemia groups (30 minutes: C, ; I, ; IL, ; 45 minutes C, ; I, ; IL, ), although 45 minutes of total ischemia, regardless of temporal sequence, resulted in more severe depression of VO2 than 30 minutes of total ischemia.
5 Volume 13 Number 5 May 1991 Intestinal reperfusion injury potentiated by intermittant ischemia 605 DISCUSSION These data demonstrate that multiple episodes of intestinal ischemia interrupted by brief periods of perfusion are associated with increased mucosal injury as compared to comparable continuous ischemic insults. This phenomenon has been previously investigated in myocardial preparations. Geft et al.8 used a canine model and showed that brief ischemic insults that singly would not cause irreversible cellular injury resulted in myocardial necrosis when repeated. Evidence of necrosis was established by increased creatinine kinase release and confirmed by light and electron microscopy. Subramanian et al.9 observed that intermittent global ischemia of the isolated perfused heart (three 20-minute periods of ischemia each followed by 10 minutes ofreperfusion) resulted in increased levels of malondialdehyde (an indicator of free radical formation) as compared to controls. Repeated ischemia-reperfusion injury also adversely affected recovery of cardiac function. Gorlach et al. performed biopsies on 40 patients undergoing coronary artery bypass grafting who were randomized to intermittent ischemia rather than cardioplegic arrest during operation.i Biopsies of those undergoing intermittent ischemia showed unexpectedly severe myocardial damage with excessive intracellular edema and ultrastructural derangements. Given the role of leukocytes as mediator of the ischemia-reperfusion phenomenon in other organs, we hypothesized that mucosal injury could be attenuated by the use of leukopenic reperfusate between ischemic episodes. Lucchesi et al. 11 showed that leukopenia produced by administration of polymorphonuclear cell (PMN) antisera reduced myocardial infarct size by 43% in a canine model. On histologic examination infarcts in control animals had substantial PMN infiltration, which was virtually absent in leukopenic dogs. Engler et al.12 used leukoplaque filters to produce leukopenia and compared control and leukopenic myocardial preparations after 1 hour of ischemia and 1 hour of reperfusion. Leukocyte depletion prevented excessive tissue edema, ventricular dysrhythmias, and a "no reflow phenomena" as a result of leukocyte "plugging" of capillaries. Korthuis et al.ls examined the role of leukocytes in ischemia-reperfusion injury of skeletal muscle using the well-characterized isolated canine gracilis preparation. Reperfusion with blood depleted of leukocytes prevented the increased microvascular permeability and capillary resistance seen in control preparations. In work more directly related to our experiments, Hernandez et al. 14 investigated the effects of leukocyte depletion on the generation of ischemiareperfusion injury in a feline model of intestinal ischemia. Systemic treatments included either antineutrophil serum or monoclonal antibody to endothelial receptors responsible for neutrophil adherence. Both neutrophil depletion and prevention of adherence significantly attenuated the increased microvascular permeability associated with 1 hour of ischemia-reperfusion. Our data would strongly support the importance of neutrophils in ischemia-reperfusion. Neutrophil binding to endothelium results in cellular activation and the production of free oxygen radicals and associated toxins. Binding is mediated by the CD 11/CD 18 complex on the neutrophil surface and is stimulated by various chemotactic peptides and lipid mediators. The subsequent release of proteases and the production of free oxygen radicals results in lipid peroxidation, hyaluronic acid degradation, and damage to critical cellular membranes. Our data show that these adverse neutrophil effects are evident even if activated leukocytes are reintroduced to ischemic tissues for relatively brief periods of time (5 minutes) in between periods of total blood flow interruption. The clinical implications of this work extend most directly to (1) the syndrome of "nonocclusive" mesenteric ischemia, where multiple flow interruptions are common, (2) the practice of temporary flow restorations during reconstructive procedures for visceral or extremity ischemia, and (3) low cardiac output states with intermittent left ventricular dysfunction. In such settings thought should be given to decreasing the leukocyte concentration in the initial reperfusate. This could be accomplished with blood filters, PMN antisera, or monoclonal antibodies to endothelial receptor sites. Although not used clinically at this time, these measures should be available in the near future given recent technologic advances. Based on our current understanding of reperfusion phenomena, these extra measures may decrease microvascular injury and improve outcome. The authors thank Mrs. Eileen M. Wayte for manuscript preparation. REFERENCES 1. Parks DA, Granger DN. Contributions of ischemia and reperfusion to mucosal lesion formation. Am J Physiol 1986;250:G Granger DN, Rutili G, McCord JM. Superoxide radicals in feline intestinal ischemia. Gastroenterology 1981;81: Granger DN, Hollwarth ME, Parks DA. Ischemia reperfusion
6 606 Clark and Gewertz Journal of VASCULAR SURGERY injury: role of oxygen-derived free radicals. Acta Physiol Scan Suppl 1986;548: Parks DA, Granger DN. Ischemia reperfusion injury: a radical view. Hepatology 1988;3: Anzueto L, Benoit JN, Granger DN. A rat model for studying the intestinal circulation. Am J Physiol 1984;246: Kim EH, Gewertz BL. Chronic digitalis administration alters mesenteric vascular reactivity. J VASC SUV, G 1987;5: Chiu CJ, McArdle AH, Brown R, et al. Intestinal mucosal lesions in low-flow states. Arch Surg 1970;101: Geft IL, Fishbein MC, Ninomiya K, et al. Intermittent brief periods of ischemia have a cumulative effect and may cause myocardial necrosis. Circulation 1982;66: Subramanian R, Plehn S, Noonan J, et al. Free radical mediated damage during myocardial ischemia and reperfusion and protection by carnitine esters. J Cardiol 1987;76: Gorlach G, Sheld HH, Mulch J, et al. Ultrastructure of the human myocardium after intermittent ischemia compared to cardioplegia. Adv Exp Med Biol 1986;194: Romson J, Hook B, Kunkel S, et al. Reduction of the extent of ischemic myocardial injury by neutrophil depletion in the dog. Circulation 1983;67: Engler RL, Daldgren MD, Morris D, et al. Role ofleukocytes in response to acute myocardial ischemia and reflow in dogs. Am J Physiol 1986;251:H Korthuis RJ, Grisham MB, Granger DN. Leukocyte depletion attenuates vascular injury in postischemic skeletal muscle. Am J Physiol 1988;254:H Hernandez LA, Grisham MB, Twohig B, et al. Role of neutrophils in ischemia-reperfusion-induced microvascular injury. Am J Physiol 1987;253:H Submitted Oct. 9, 1990; accepted Jan. 29, BOUND VOLUMES AVAILABLE TO SUBSCRIBERS Bound volumes of the JOURNAL OF VaSCt3L~ StJR~ERY for 1991 are available to subscribers only. They may be purchased from the publisher at a cost of $59.00 for domestic, $79.13 for Canadian, and $75.00 for international subscribers for Vol. 13 (January to June) and Vol. 14 (July to December). Price includes shipping charges. Each bound volume contains a subject and author index, and all advertising is removed. Copies are shipped within 60 days after publication of the last issue in the volume. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Payment must accompany all orders. Contact Subscription Services, Mosby-Year Book, Inc., Westline Industrial Drive, St. Louis, MO , USA. In the United States call toll free: (800) , ext In Missouri call collect: (314) , ext Subscriptions must be in force to qualify. Bound volumes are not available in place of a regular JOURNAL subscription.
E and the heart: Possible role as antioxidant. Acta Vitaminol. Enzymol. 5: 11-22, ) Jolly, S. R., Kane, W. J., Bailie, M. B. et al.
1) Ferrari, R., Visoli, O., Guarnieri, C. et al.: Vitamin E and the heart: Possible role as antioxidant. Acta Vitaminol. Enzymol. 5: 11-22, 1983. 2) Jolly, S. R., Kane, W. J., Bailie, M. B. et al.: Canine
More informationReperfusion Effects After Cardiac Ischemia
Reperfusion Effects After Cardiac Ischemia Dave Milzman, MD, FACEP Professor and Assistant Dean for Clinical Research Georgetown University School of Medicine Research Director, Depts of Trauma and Emerg
More informationMEDIASTINAL LYMPH NODE METASTASIS IN PATIENTS WITH CLINICAL STAGE I PERIPHERAL NON-SMALL-CELL LUNG CANCER
MEDIASTINAL LYMPH NODE METASTASIS IN PATIENTS WITH CLINICAL STAGE I PERIPHERAL NON-SMALL-CELL LUNG CANCER Tsuneyo Takizawa, MD a Masanori Terashima, MD a Teruaki Koike, MD a Hideki Akamatsu, MD a Yuzo
More informationPotassium Efflux from Myocardial Cells Induced by Defibrillator Shock
Purdue University Purdue e-pubs Weldon School of Biomedical Engineering Faculty Publications Weldon School of Biomedical Engineering 1986 Potassium Efflux from Myocardial Cells Induced by Defibrillator
More informationIschemia of lower extremity icd 10
Ischemia of lower extremity icd 10 ICD-10-CM Code(s). ICD-9-CM. Diabetic chronic TEENney disease (E08.22, E09. 22, E10.22, E11.22, E13.22). Hypertensive. I83.001 Varicose veins of unspecified lower extremity
More informationAttenuation of renal reperfusion injury in rats by the 21-aminosteroid U74006F
Attenuation of renal reperfusion injury in rats by the 21-aminosteroid U74006F Jeffrey J. Stanley, BS, John R. Goldblum, MD, Thomas S. Frank, MD, Gerald B. Zelenock, MD, and Louis G. D'Alecy, DMD, PhD,
More informationIschemia of lower extremity icd 10
Ischemia of lower extremity icd 10 This is the 2018 version of the ICD-10- CM diagnosis code I73.89 equina claudication; Intermittent claudication; Ischemia of left lower extremity; Ischemia of. ICD-10-CM
More informationCrush Injury. Professeur D. MATHIEU. Medicine
Crush Injury Professeur D. MATHIEU Department of Critical Care and Hyperbaric Medicine University Hospital of Lille - France Definitions Crush Injury An injury sustained when a body part is subjected to
More informationTHE EFFECT OF ASCORBIC ACID ON RENAL FUNCTION IN DOGS WITH ISCHEMIA REPERFUSION INJURY
Nigerian Veterinary Journal 2010 Vol 31(1):66-70 THE EFFECT OF ASCORBIC ACID ON RENAL FUNCTION IN DOGS WITH ISCHEMIA REPERFUSION INJURY KISANI 1 A.I* and AKINRIMADE 2 J.F 1 Department of Veterinary Surgery
More informationIrreversible shock can defined as last phase of shock where despite correcting the initial insult leading to shock and restoring circulation there is
R. Siebert Irreversible shock can defined as last phase of shock where despite correcting the initial insult leading to shock and restoring circulation there is a progressive decline in blood pressure
More informationDemonstration of Uneven. the infusion on myocardial temperature was insufficient
Demonstration of Uneven in Patients with Coronary Lesions Rolf Ekroth, M.D., HAkan erggren, M.D., Goran Sudow, M.D., Josef Wojciechowski, M.D., o F. Zackrisson, M.D., and Goran William-Olsson, M.D. ASTRACT
More informationMWLCEMS SYSTEM Continuing Education Packet Management of the Acute MI Patient
MWLCEMS SYSTEM Continuing Education Packet Management of the Acute MI Patient In this CE we will discuss the patient presenting with an acute ST-Elevation Myocardial Infarction (STEMI) Definition: Myocardial
More informationIn the name of GOD. Animal models of cardiovascular diseases: myocardial infarction & hypertension
In the name of GOD Animal models of cardiovascular diseases: myocardial infarction & hypertension 44 Presentation outline: Cardiovascular diseases Acute myocardial infarction Animal models for myocardial
More informationMESENTERIC ISCHEMIA THE FORGOTTEN DIAGNOSIS. Richard M. Gore, MD North Shore University Health System University of Chicago Evanston, Illinois
MESENTERIC ISCHEMIA THE FORGOTTEN DIAGNOSIS Richard M. Gore, MD North Shore University Health System University of Chicago Evanston, Illinois SCBT/MR 2010 San Diego, California March 8, 2010 16:00-16:10
More informationIntra-operative Effects of Cardiac Surgery Influence on Post-operative care. Richard A Perryman
Intra-operative Effects of Cardiac Surgery Influence on Post-operative care Richard A Perryman Intra-operative Effects of Cardiac Surgery Cardiopulmonary Bypass Hypothermia Cannulation events Myocardial
More informationIschemic Postconditioning During Primary Percutaneous Coronary Intervention Mechanisms and Clinical Application Jian Liu, MD FACC FESC FSCAI Chief Phy
Ischemic Postconditioning During Primary Percutaneous Coronary Intervention Mechanisms and Clinical Application Jian Liu, MD FACC FESC FSCAI Chief Physician, Professor of Medicine Department of Cardiology,
More informationComparison of Flow Differences amoiig Venous Cannulas
Comparison of Flow Differences amoiig Venous Cannulas Edward V. Bennett, Jr., MD., John G. Fewel, M.S., Jose Ybarra, B.S., Frederick L. Grover, M.D., and J. Kent Trinkle, M.D. ABSTRACT The efficiency of
More informationDiagnosis and Management of Acute Myocardial Infarction
Diagnosis and Management of Acute Myocardial Infarction Acute Myocardial Infarction (AMI) occurs as a result of prolonged myocardial ischemia Atherosclerosis leads to endothelial rupture or erosion that
More informationEffect of Nerve Stimulation on Precapillary Sphincters, Oxygen Extraction, and Hemodynamics in the Intestines of Cats
32 Effect of Nerve Stimulation on Precapillary Sphincters, Oxygen Extraction, and Hemodynamics in the Intestines of Cats W. WAYNE LAUTT AND SHEILA A. GRAHAM SUMMARY The effect of stimulation of the nerves
More informationAcute heart failure: ECMO Cardiology & Vascular Medicine 2012
Acute heart failure: ECMO Cardiology & Vascular Medicine 2012 Lucia Jewbali cardiologist-intensivist 14 beds/8 ICU beds Acute coronary syndromes Heart failure/ Cardiogenic shock Post cardiotomy Heart
More informationSpecial circulations, Coronary, Pulmonary. Faisal I. Mohammed, MD,PhD
Special circulations, Coronary, Pulmonary Faisal I. Mohammed, MD,PhD 1 Objectives Describe the control of blood flow to different circulations (Skeletal muscles, pulmonary and coronary) Point out special
More informationHeart transplantation is the gold standard treatment for
Organ Care System for Heart Procurement and Strategies to Reduce Primary Graft Failure After Heart Transplant Masaki Tsukashita, MD, PhD, and Yoshifumi Naka, MD, PhD Primary graft failure is a rare, but
More informationshehab Moh Tarek ... ManarHajeer
3 shehab Moh Tarek... ManarHajeer In the previous lecture we discussed the accumulation of oxygen- derived free radicals as a mechanism of cell injury, we covered their production and their pathologic
More informationAssoc. Prof. Dr. Aslı Korkmaz* and Prof. Dr. Dürdane Kolankaya**
The possible protective effects of some flavonoids that found honey by experimental ischemia/reperfusion (I/R) induced nitrosative damage in kidney of male rats Assoc. Prof. Dr. Aslı Korkmaz* and Prof.
More informationCHRONIC HEART FAILURE : WHAT ELSE COULD WE OFFER TO OUR PATIENTS? Cardiac Rehabilitation Society of Thailand
CHRONIC HEART FAILURE : WHAT ELSE COULD WE OFFER TO OUR PATIENTS? Cardiac Rehabilitation Society of Thailand ENHANCED EXTERNAL COUNTER PULSATION Piyanuj Ruckpanich, MD. Cardiac Rehabilitation Center Perfect
More informationBlockage of Arginine Vasopressin Receptor 2 Reduces Increase in Pulmonary Vascular Resistance in Ovine Sepsis Model
Blockage of Arginine Vasopressin Receptor 2 Reduces Increase in Pulmonary Vascular Resistance in Ovine Sepsis Model Ernesto Lopez MD 1 Osamu Fujiwara MD 1, Baigalmaa Enkhtaivan MD 1, Jose Rojas PhD 2,
More informationPentoxifylline Reduces Coronary Leukocyte Accumulation Early in Reperfusion After Cold Ischemia
Pentoxifylline Reduces Coronary Leukocyte Accumulation Early in Reperfusion After Cold Ischemia Stephen C. Gale, MD, Jason Y. Hokama, PhD, Leslie S. Ritter, PhD, Grace D. Gorman, BS, Jack G. Copeland,
More informationEffects of myocardial infarction on catheter defibrillation threshold
Purdue University Purdue e-pubs Weldon School of Biomedical Engineering Faculty Publications Weldon School of Biomedical Engineering 1983 Effects of myocardial infarction on catheter defibrillation threshold
More informationPhiladelphia College of Osteopathic Medicine Annual Progress Report: 2011 Formula Grant
Philadelphia College of Osteopathic Medicine Annual Progress Report: 2011 Formula Grant Reporting Period January 1, 2012 June 30, 2012 Formula Grant Overview The Philadelphia College of Osteopathic Medicine
More informationExam 3 Study Guide. 4) The process whereby the binding of antibodies to antigens causes RBCs to clump is called:
Exam 3 Study Guide 1) Where does hematopoiesis produce new red blood cells: 2) Which of the following is a blood clotting disorder: 3) Treatment of hemophilia often involves: 4) The process whereby the
More informationPreparation of Animals for Live Animal Imaging
Preparation of Animals for Live Animal Imaging George A. Tanner, Ph.D. Department of Cellular and Integrative Physiology Indiana University School of Medicine Ideal Condition of Rats during Experiments:
More informationCitation Acta medica Nagasakiensia. 1984, 29
NAOSITE: Nagasaki University's Ac Title Author(s) Efficacy of Coenzyme Q10 Administra Aortic Stenosis and Pacemaker Induc Igarashi, Katsuro Citation Acta medica Nagasakiensia. 1984, 29 Issue Date 1984-10-25
More informationMinimally Invasive Aortic Surgery With Emphasis On Technical Aspects, Extracorporeal Circulation Management And Cardioplegic Techniques
Minimally Invasive Aortic Surgery With Emphasis On Technical Aspects, Extracorporeal Circulation Management And Cardioplegic Techniques Konstadinos A Plestis, MD System Chief of Cardiothoracic and Vascular
More information(Received 22 July 1957) It is now generally accepted that the unequal distribution of ions between cells
190 J. Physiol. (I958) I40, I90-200 THE EFFECT OF ALTERATIONS OF PLASMA SODIUM ON THE SODIUM AND POTASSIUM CONTENT OF MUSCLE IN THE RAT By F. 0. DOSEKUN AND D. MENDEL From the Department of Physiology,
More informationΒ' Πανεπιστημιακή Καρδιολογική Κλινική, ΑΤΤΙΚΟ Νοσοκομείο
«Η απομακρυσμένη ισχαιμική προπόνηση βελτιώνει την αρτηριακή λειτουργία, ενεργοποιεί την έκφραση καρδιοπροστατευτικών mirnas και ελαττώνει το oξειδωτικό στρες σε ασθενείς με STEMI» Δημήτριος Βλαστός, Ιγνάτιος
More informationAcute coronary syndrome. Dr LM Murray Chemical Pathology Block SA
Acute coronary syndrome Dr LM Murray Chemical Pathology Block SA13-2014 Acute myocardial infarction (MI) MI is still the leading cause of death in many countries It is characterized by severe chest pain,
More informationEnhanced CABG is in Your Hands
An Intraoperative Treatment for Preserving Vascular Grafts Enhanced CABG is in Your Hands Intraoperative Graft Damage is the Principal Cause of Vein Graft Failure (VGF) The durability and patency of vein
More informationReperfusion Injury: How Can We Reduce It?
MI/CAD: Practical Question in Management of AMI Patients Reperfusion Injury: How Can We Reduce It? Hyun-Jai Cho, M.D., Ph.D Cardiovascular Center & Department of Internal Medicine Seoul National University
More informationHemodynamic Monitoring and Circulatory Assist Devices
Hemodynamic Monitoring and Circulatory Assist Devices Speaker: Jana Ogden Learning Unit 2: Hemodynamic Monitoring and Circulatory Assist Devices Hemodynamic monitoring refers to the measurement of pressure,
More informationDoes Antiinflammatory Therapy Attenuate the Lung Injury Caused by Ischemia/Reperfusion of the Lower Extremities in the Rabbit
ISPUB.COM The Internet Journal of Thoracic and Cardiovascular Surgery Volume 3 Number 2 Does Antiinflammatory Therapy Attenuate the Lung Injury Caused by Ischemia/Reperfusion of the Lower Extremities in
More informationMYOCARDIAL REPERFUSION
ALLOPURINOL IMPROVES MYOCARDIAL REPERFUSION INJURY IN A XANTHINE OXIDASE FREE MODEL Steven B. Hopson, MD, Robert M. Lust, PhD, You Su Sun, MD, Richard S. Zeri, MD, Ron F. Morrison, Masaki Otaki, MD, and
More informationAmeliorating Reperfusion Injury During Resuscitation from Cardiac Arrest
Ameliorating Reperfusion Injury During Resuscitation from Cardiac Arrest Scott T. Youngquist, MD, MSc Associate Professor, Emergency Medicine University of Utah School of Medicine Medical Director, Salt
More informationBridging With Percutaneous Devices: Tandem Heart and Impella
Bridging With Percutaneous Devices: Tandem Heart and Impella DAVID A. BARAN, MD, FACC, FSCAI SYSTEM DIRECTOR, ADVANCED HEART FAILURE, TX AND MCS SENTARA HEART HOSPITAL NORFOLK, VA PROFESSOR OF MEDICINE
More informationUniversity of Groningen. Impaired Organ Perfusion Morariu, Aurora
University of Groningen Impaired Organ Perfusion Morariu, Aurora IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document
More informationA clinically applicable method for long-term salvage of postischemic skeletal muscle
A clinically applicable method for long-term salvage of postischemic skeletal muscle Barry Rubin, MD, CM, Jacques Tittley, MD, FRCS(C), Gordon Chang, MSc, Phi), Andrew Smith, MD, Shinta Liauw, MSc, Alexander
More informationVenous Ulcers. A Little Basic Science. An Aggressive Prescription to Aid Healing. Why do venous ulcers occur? Ambulatory venous hypertension!
UCSF Vascular Symposium April 26-28, 2012 San Francisco, California True statements about the management of venous ulcers include: An Aggressive Prescription to Aid Healing Anthony J. Comerota, MD, FACS,
More informationDifficult Scenarios for Myocardial Protection SAHA Gil Bolotin M.D., Ph.D. Rambam Medical Center, Haifa, Israel
Difficult Scenarios for Myocardial Protection SAHA 2017 Gil Bolotin M.D., Ph.D. Rambam Medical Center, Haifa, Israel Difficult Scenarios for Myocardial Protection Stone Heart Nightmare Nightmare of the
More informationWhat would be the response of the sympathetic system to this patient s decrease in arterial pressure?
CASE 51 A 62-year-old man undergoes surgery to correct a herniated disc in his spine. The patient is thought to have an uncomplicated surgery until he complains of extreme abdominal distention and pain
More informationThe Effect of Acute Coronary Artery Occlusion during Cardioplegic Arrest
The Effect of Acute Coronary Artery Occlusion during Cardioplegic Arrest and Reperfusion on Myocardial Preservation John H. Rousou, M.D., Richard M. Engelman, M.D., William A. Dobbs, Ph.D., and Mooideen
More informationEACTS Adult Cardiac Database
EACTS Adult Cardiac Database Quality Improvement Programme List of changes to Version 2.0, 13 th Dec 2018, compared to version 1.0, 1 st May 2014. INTRODUCTORY NOTES This document s purpose is to list
More informationNational Imaging Associates, Inc. Clinical guidelines CARDIAC CATHETERIZATION -LEFT HEART CATHETERIZATION. Original Date: October 2015 Page 1 of 5
National Imaging Associates, Inc. Clinical guidelines CARDIAC CATHETERIZATION -LEFT HEART CATHETERIZATION CPT Codes: 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461 LCD ID Number:
More informationNeutrophil-Mediated Microvascular. Skeletal Muscle
1436 Neutrophil-Mediated Microvascular Dysfunction in Postischemic Canine Skeletal Muscle Role of Granulocyte Adherence Donna L. Carden, J. Keith Smith, and Ronald J. Korthuis Downloaded from http://ahajournals.org
More informationCoagulative Necrosis of Myocardium. Dr Rodney Itaki Division of Pathology
Coagulative Necrosis of Myocardium Dr Rodney Itaki Division of Pathology Coagulative Necrosis Gross pathology: 3 day old infarct: Yellow necrosis surrounded by hyperemic borders. Arrow points to a transmural
More informationControl of blood tissue blood flow. Faisal I. Mohammed, MD,PhD
Control of blood tissue blood flow Faisal I. Mohammed, MD,PhD 1 Objectives List factors that affect tissue blood flow. Describe the vasodilator and oxygen demand theories. Point out the mechanisms of autoregulation.
More informationCCAS CPB Workshop Curriculum Outline Perfusion: What you might not know
CCAS CPB Workshop Curriculum Outline Perfusion: What you might not know Scott Lawson, CCP Carrie Striker, CCP Disclosure: Nothing to disclose Objectives: * Demonstrate how the cardiopulmonary bypass machine
More informationRationale for Prophylactic Support During Percutaneous Coronary Intervention
Rationale for Prophylactic Support During Percutaneous Coronary Intervention Navin K. Kapur, MD, FACC, FSCAI Assistant Director, Interventional Cardiology Director, Interventional Research Laboratories
More informationAcute type A aortic dissection (Type I, proximal, ascending)
Acute Type A Aortic Dissection R. Morton Bolman, III, MD Acute type A aortic dissection (Type I, proximal, ascending) is a true surgical emergency. It is estimated that patients suffering this calamity
More informationFastTest. You ve read the book now test yourself
FastTest You ve read the book...... now test yourself To ensure you have learned the key points that will improve your patient care, read the authors questions below. The answers will refer you back to
More informationOpen fenestration for complicated acute aortic B dissection
Art of Operative Techniques Open fenestration for complicated acute aortic B dissection Santi Trimarchi 1, Sara Segreti 1, Viviana Grassi 1, Chiara Lomazzi 1, Marta Cova 1, Gabriele Piffaretti 2, Vincenzo
More informationMyocardial Infarction
Myocardial Infarction MI = heart attack Defined as necrosis of heart muscle resulting from ischemia. A very significant cause of death worldwide. of these deaths, 33% -50% die before they can reach the
More informationGinkgo biloba extract postconditioning reduces myocardial ischemia reperfusion injury
Ginkgo biloba extract postconditioning reduces myocardial ischemia reperfusion injury K. Ran 1, D.-L. Yang 1, Y.-T. Chang 1, K.-M. Duan 2, Y.-W. Ou 2, H.-P. Wang 3 and Z.-J. Li 1 1 Department of Anesthesiology,
More informationThinking outside of the box Perfusion management and myocardial protection strategy for a patient with sickle cell disease
Thinking outside of the box Perfusion management and myocardial protection strategy for a patient with sickle cell disease Shane Buel MS, RRT 1 Nicole Michaud MS CCP PBMT 1 Rashid Ahmad MD 2 1 Vanderbilt
More informationYes No Unknown. Major Infection Information
Rehospitalization Intervention Check any that occurred during this hospitalization. Pacemaker without ICD ICD Atrial arrhythmia ablation Ventricular arrhythmia ablation Cardioversion CABG (coronary artery
More informationMesenchymal Stem Cells to Repair Vascular Damage after Chemotherapy: Past, Present and Future
Mesenchymal Stem Cells to Repair Vascular Damage after Chemotherapy: Past, Present and Future Cell Therapy 2014 Las Vegas, NV, USA Sulaiman Al-Hashmi, PhD Sultan Qaboos University Oman What are MSCs? Stem
More informationClinical Study Decrease of Total Antioxidative Capacity in Developed Low Cardiac Output Syndrome
Oxidative Medicine and Cellular Longevity Volume 202, Article ID 35630, 4 pages doi:0.55/202/35630 Clinical Study Decrease of Total Antioxidative Capacity in Developed Low Cardiac Output Syndrome Alper
More informationJavier Marquez Graciani, MD Attending Dr F. Joglar
Javier Marquez Graciani, MD Attending Dr F. Joglar MI is the leading single-organ cause of early and late mortality. Huber and associates- - Multisystem organ failure (MSOF) caused more deaths (57%) than
More informationWhen the learner has completed this module, she/he will be able to:
Thrombolytics and Myocardial Infarction WWW.RN.ORG Reviewed September 2017, Expires September 2019 Provider Information and Specifics available on our Website Unauthorized Distribution Prohibited 2017
More informationPRODUCTION OF FATAL ENDOTOXIC SHOCK BY VASOACTIVE SUBSTANCES
GASTROENTEROLOGY 64: 285-291, 1973 Copyright 1973 by The Williams & Wilkins Co. Vol. 64, No.2 Printed in U.S.A. PRODUCTION OF FATAL ENDOTOXIC SHOCK BY VASOACTIVE SUBSTANCES PETER CUEVAS, M.D" F,A,C,S"
More informationIschemic Heart Disease
Ischemic Heart Disease Dr Rodney Itaki Lecturer Division of Pathology University of Papua New Guinea School of Medicine & Health Sciences Division of Pathology General Consideration Results from partial
More informationImaging of Coronary Artery Disease: II
Acta Radiológica Portuguesa, Vol.XIX, nº 74, pág. 45-51, Abr.-Jun., 2007 Imaging of Coronary Artery Disease: II Jean Jeudy University of Maryland School of Medicine Department of Diagnostic Radiology Armed
More informationHeart disease remains the leading cause of morbidity and mortality in industrialized nations. It accounts for nearly 40% of all deaths in the United
Heart disease remains the leading cause of morbidity and mortality in industrialized nations. It accounts for nearly 40% of all deaths in the United States, totaling about 750,000 individuals annually
More informationUsing the Ch6diak-Higashi Marker
A Study of the Origin of Pulmonary Macrophages Using the Ch6diak-Higashi Marker Kent J. Johnson, MD, Peter A. Ward, MD, Gary Striker, MD, and Robin Kunkel, MS Using bone marrow reconstitution techniques
More informationMaster Eudipharm 2012 Introductory Module, Principles of Discovery of Medicine and Development Planning. Nathan Mewton, MD, PhD. September 26 th 2012
Master Eudipharm 2012 Introductory Module, Principles of Discovery of Medicine and Development Planning * Nathan Mewton, MD, PhD. September 26 th 2012 *A little bit of History *Rabies a viral disease that
More informationPhysiological Response to Hypovolemic Shock Dr Khwaja Mohammed Amir MD Assistant Professor(Physiology) Objectives At the end of the session the
Physiological Response to Hypovolemic Shock Dr Khwaja Mohammed Amir MD Assistant Professor(Physiology) Objectives At the end of the session the students should be able to: List causes of shock including
More informationSupplementary material 1. Definitions of study endpoints (extracted from the Endpoint Validation Committee Charter) 1.
Rationale, design, and baseline characteristics of the SIGNIFY trial: a randomized, double-blind, placebo-controlled trial of ivabradine in patients with stable coronary artery disease without clinical
More informationAdult Extracorporeal Life Support (ECLS)
Adult Extracorporeal Life Support (ECLS) Steven Scott, M.D., F.A.C.S. Piedmont Heart Institute Cardiothoracic Surgery Disclosures None ECMO = ECLS A technique of life support that involves a continuous
More informationNabeel R. Obeid Mentors: Erin A. Booth and Dr. Benedict R. Lucchesi
Cardioprotective Action of Selective Estrogen-receptor Agonists against Myocardial Ischemia and Reperfusion Injury Nabeel R. Obeid Mentors: Erin A. Booth and Dr. Benedict R. Lucchesi Abstract Cell death
More informationNo-reflow Phenomenon in Patients with Acute Myocardial Infarction: Its Pathophysiology and Clinical Implications
No-reflow Phenomenon in Patients with Acute Myocardial Infarction: Its Pathophysiology and Clinical Implications * 164 Ito Acta Med. Okayama Vol. 63, No. 4 Normal case Anterior MI Fig. 3 Myocardial contrast
More informationDO 2 > VO 2. The amount of oxygen delivered is a product of cardiac output (L/min) and the amount of oxygen in the arterial blood (ml/dl).
Shock (Part 1): Review and Diagnostic Approach Jeffrey M. Todd, DVM, DACVECC University of Minnesota, St. Paul, MN Overview Shock is the clinical presentation of inadequate oxygen utilization, typically
More informationMechanisms of Cell Injury
Causes of Cell Injury 1- oxygen deprivation (anoxia) 2- physical agents 3- chemical agents 4- infections agents 5- immunologic reactions 6- genetic defects 7- nutritional imbalances Mechanisms of Cell
More informationAcute arterial embolism
Acute arterial embolism Definition Thrombus come from heart or blood vessel or other embolus such as tumor,air gas or fat flow with blood stream and occlude distal limb or visceral arteries which causes
More informationIndex. Note: Page numbers of article titles are in boldface type
Index Note: Page numbers of article titles are in boldface type A Acute coronary syndrome, perioperative oxygen in, 599 600 Acute lung injury (ALI). See Lung injury and Acute respiratory distress syndrome.
More informationFurther Studies on the Effect of Arteriovenous Fistulas and Elevations of Sinus Pressure
Further Studies on the Effect of Arteriovenous Fistulas and Elevations of Sinus Pressure on Mortality Rates Following Acute Coronary Occlusions By GEORGE SMITH, F.R.C.S., JAMES DEMMING, MORTON ELEFF, AND
More informationSolution for cardiac perfusion in viaflex plastic container
CARDIOPLEGIA SOLUTION A Solution for cardiac perfusion in viaflex plastic container DESCRIPTION Cardioplegia Solution A is a sterile, non-pyrogenic solution in a Viaflex bag. It is used to induce cardiac
More informationCONSEQUENCES OF MYOCARDIAL ISCHEMIA
Página 1 de 8 CONSEQUENCES OF MYOCARDIAL ISCHEMIA Part of "46 - Coronary Blood Flow and Myocardial Ischemia" Metabolic Consequences During ischemia, several metabolic changes occur. Adenosine triphosphate
More informationCVICU EXAM. Mrs. Jennings is a 71-year-old post-op CABG x5 with an IABP in her left femoral artery
CVICU EXAM 1111 North 3rd Street Mrs. Jennings is a 71-year-old post-op CABG x5 with an IABP in her left femoral artery 1. Nursing standards for a patient on an IABP device include: a. Know results of
More informationIntroduction. Acute sodium overload produces renal tubulointerstitial inflammation in normal rats
Acute sodium overload produces renal tubulointerstitial inflammation in normal rats MI Roson, et al. Kidney International (2006) Introduction Present by Kanya Bunnan and Wiraporn paebua Tubular sodium
More informationAcute myocardial ischemia followed by reperfusion
Vascular Endothelial Growth Factor Attenuates Myocardial Ischemia-Reperfusion Injury Zhengyu Luo, MD, Maurizio Diaco, MD, Toyoaki Murohara, MD, Napoleone Ferrara, MD, Jeffrey M. Isner, MD, and James F.
More informationUniversity of Groningen. Acute kidney injury after cardiac surgery Loef, Berthus Gerard
University of Groningen Acute kidney injury after cardiac surgery Loef, Berthus Gerard IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it.
More informationHemodynamic Disorders, Thrombosis, and Shock. Richard A. McPherson, M.D.
Hemodynamic Disorders, Thrombosis, and Shock Richard A. McPherson, M.D. Edema The accumulation of abnormal amounts of fluid in intercellular spaces of body cavities. Inflammation and release of mediators
More informationMechanical Bleeding Complications During Heart Surgery
Mechanical Bleeding Complications During Heart Surgery Arthur C. Beall, Jr., M.D., Kenneth L. Mattox, M.D., Mary Martin, R.N., C.C.P., Bonnie Cromack, C.C.P., and Gary Cornelius, C.C.P. * Potential for
More informationComplete Recovery of Perfusion Abnormalities in a Cardiac Arrest Patient Treated with Hypothermia: Results of Cerebral Perfusion MR Imaging
pissn 2384-1095 eissn 2384-1109 imri 2018;22:56-60 https://doi.org/10.13104/imri.2018.22.1.56 Complete Recovery of Perfusion Abnormalities in a Cardiac Arrest Patient Treated with Hypothermia: Results
More informationTransit Time Heterogeneity in Canine Small Intestine: Significance for Oxygen Transport
Transit Time Heterogeneity in Canine Small Intestine: Significance for Oxygen Transport Heidi V. Connolly,* Leigh A. Maginniss, and Paul T. Schumacker *Department of Pediatrics, The University of Chicago,
More informationOriginal Article. Introduction
Original Article The Effects of Na Movement on Surgical Myocardial Protection: The Role of the Na + -H + Exchange System and Na-Channel in the Development of Ischemia and Reperfusion Injury Ke-Xiang Liu,
More informationA,kCetazolamide lowers intraocular pressure
Ocular and systemic effects of acetazolamide in nephrectomized rabbits Zvi Friedman,* Theodore Krupin, and Bernard Becker The effects of acetazolamide on intraocular pressure (IOP) were studied on rabbits
More informationBIOCHEMICAL INVESTIGATIONS IN THE DIAGNOSTICS OF CARDIOVASCULAR DISORDERS. As. MARUSHCHAK M.I.
BIOCHEMICAL INVESTIGATIONS IN THE DIAGNOSTICS OF CARDIOVASCULAR DISORDERS As. MARUSHCHAK M.I. Heart attack symptoms Acute MI Measurement of cardiac enzyme levels Measure cardiac enzyme levels at regular
More informationEffects of Amiodarone in a Swine Model of Nortryptiline Toxicity
Toxicology Investigations Effects of Amiodarone in a Swine Model of Nortryptiline Toxicity Fermin Barrueto, Jr., MD a, Indira Murr, MD b, Andrew Meltzer, MD a, Kori Brewer, PhD b, and William Meggs, MD,
More informationThe average potassium content during the last 5. solids. This average decrease of 2.2 meq. per 100. initial potassium content of the arteries.
THE EFFECT OF NOR-EPINEPHRINE ON THE ELECTROLYTE COMPOSITION OF ARTERIAL SMOOTH MUSCLE' By LOUIS TOBIAN 2 AND ADACIE FOX (From the Departments of Pharmacology and Internal Medicine, Southwesters Medical
More informationThe Coronary Baroreflex in Humans
The Journal of The American Society of Extra-Corporeal Technology The Coronary Baroreflex in Humans K. Kincaid, BSc(Hon);* M. Ward, HNC;* U. Nair, FRCS;* R. Hainsworth, Prof; M. Drinkhill, PhD *Yorkshire
More informationclearing activity is produced and destroyed in the rat. Both the
THE SITES AT WHICH PLASMA CLEARING ACTIVITY IS PRODUCED AND DESTROYED IN THE RAT. By G. H. JEFFRIES. From the Sir William Dunn School of Pathology, Oxford. (Received for publication 25th June 1954.) CLEARING
More information