Equine coronary hemodynamics during brief coronary occlusions at three levels of collateral function.

Adult-grade ponies were surgically instrumented with a Doppler flow probe and pneumatic cuff occluder on the left anterior descending coronary artery (LAD), sonomicrometry crystals and intraventricular micromanometer in the left ventricle, and catheters in the left atrium, anterior interventricular vein, and, in some animals, the LAD. Conscious-animal studies were begun 2 wk after surgery. Measured variables included regional left ventricular systolic function, end-diastolic wall thickness, oxygen extraction, lactate extraction, and hydrogen ion release. Changes in collateral perfusion were deduced from changes in these variables. Serial data were obtained during a 3-min LAD occlusion before stimulation of collateral function by the intermittent coronary occlusion method and during a 10-min LAD occlusion after 14 +/- 2 and 27 +/- 2 days of stimulation. Hemodynamic interpretation of data was based on a model of the equine coronary circulation consisting of collateral and arteriolar resistances in series. It was concluded that 1) chronic stimulation of collateral function leads to the emergence of a time-dependent reduction in total collateral resistance during acute coronary occlusion; 2) with enhancement of collateral function, the major resistance controlling collateral blood flow shifts from the collateral circulation to the recipient vessel arterioles; and 3) at a certain level of enhanced collateral function, coronary occlusion results in a triphasic blood flow response in collateral-dependent myocardium consisting of early hypoperfusion, transient hyperperfusion, and late autoregulated perfusion. This study demonstrates that chronic stimulation of collateral function is accompanied by specific alterations in coronary hemodynamics during acute coronary occlusion that hasten the recovery of ischemic myocardium.

Effective written communication in biomedical sciences.

The written word is the biomedical scientist's most important and most enduring communication tool. Nevertheless, the development of writing skills receives little attention in most scientific disciplines and the ability to conduct research is often viewed as more important than the ability to communicate the results of that research. Consequently, many scientists lack the writing skills necessary to effectively convey essential aspects of their research. In this paper, we will discuss the importance of good writing skills, give examples of common mistakes that are made in biomedical science writing and offer suggestions on how to improve written communication.

Cardiac cycle length variability in ponies at rest and during exercise.

We evaluated cardiac cycle length variability in ponies at rest and during strenuous exercise with and without premedication with atropine. In the absence of premedication, cardiac cycle length at rest was 1,112 +/- 53 ms, the individual cardiac cycle length standard deviation (SDCL) was 75 +/- 23 ms, and the individual cycle length coefficient of variation (CVCL) was 6.32 +/- 1.62. Exercise significantly decreased (P < 0.05) all three indexes (290 +/- 9 ms, 5 +/- 1 ms, and 1.65 +/- 0.20, respectively). Atropine premedication significantly reduced resting cardiac cycle length (685 +/- 46 ms), SDCL (10 +/- 2 ms), and CVCL (1.45 +/- 0.19) compared with nonpremedicated values. Cardiac cycle length was significantly decreased by exercise after atropine premedication, but no statistically significant changes occurred in SDCL or CVCL. Thus, although considerable cardiac cycle length variability exists in nonpremedicated ponies at rest, it is nearly completely abolished by strenuous exercise. The absence of significant differences between the indexes of variability during exercise without premedication, at rest after atropine, and during exercise after atropine indicates that cardiac cycle length variability in the pony is mediated primarily through activity of the parasympathetic system.

Distribution of coronary collateral blood flow at different levels of collateral growth in conscious ponies.

Coronary collateral growth was stimulated in chronically instrumented conscious ponies by a previously validated intermittent coronary occlusion method. Changes in regional myocardial function (sonomicrometry) and reactive hyperemia (Doppler method) were used to monitor collateral growth and to program measurements of regional myocardial blood flow (microsphere method). A serial analysis of the transmural and lateral distributions of collateral blood flow was performed at the native and three superimposed levels of collateral growth. Results in nine animals undergoing an average of 553 +/- 188 brief coronary occlusions over 68 +/- 18 days demonstrated that as collateral conductance increased, the perfusion field within the ischemic region increased from the epicardium to the endocardium but not from the lateral edges to the center of the ischemic region. The findings are consistent with an analog model consisting of interarterial collaterals whose collective resistance is in series with arteriolar resistance of the recipient artery. No special protection of deeper myocardial layers by a subendocardial plexus or intramural collaterals was noted. Instead, the findings suggest that coronary extravascular compressive forces play a more important role than the transmural location of collaterals in determining the volume and spatial distribution of collateral blood flow during collateral growth in the pony.

Disuse inhibition of newly functional coronary collateral circulation in ponies.

We evaluated the loss of coronary collateral function in the absence of stimulation (disuse inhibition) by doubling the interval between successive left anterior descending coronary artery (LAD) occlusions in ponies in which collateral function initially had been enhanced by 2-min occlusions at 30-min intervals. Before collateralization, occlusion caused segment systolic shortening, velocity of shortening, and stroke work index in the LAD-dependent left ventricular apex to decrease, whereas heart rate and left ventricular end-diastolic pressure increased. After 476 +/- 102 occlusions, segment function recovered to preocclusion levels and hemodynamics were unchanged during occlusion. Occlusion did not elicit sustained functional deterioration until the occlusion interval was greater than or equal to 32 h. During the occlusion after the 128-h interval, segment systolic shortening, velocity of shortening, and stroke work index were reduced 69 +/- 8, 38 +/- 9, and 46 +/- 13%, respectively. Percent recovery of systolic shortening during successive occlusions declined exponentially (T1/e = 102.0 +/- 17.3 h). Thus, in ponies collateral function progressively declines when the occlusion interval is greater than or equal to 32 h, but complete inhibition does not occur even after 128 h without occlusion. This indicates that collateral function in ponies can be maintained by occlusions that are far less frequent than those needed for initial collateral development. The long time constant of collateral disuse inhibition suggests that equine collaterals are quite resistant to the effects of occlusion cessation and differ from canine collaterals in that respect.

Mathematical modelling of post-exercise heart rate recovery in ponies.

Using a recently developed nonlinear algorithm which identifies reference points on left ventricular pressure waveforms and other waveforms, we analyzed heart rate recovery in ponies after strenuous treadmill exercise. Each pony performed exercise tests with and without premedication with atropine methyl nitrate. Resting and exercise heart rates were 54 +/- 3 and 209 +/- 6 beats/min, respectively, without premedication and 85 +/- 8 and 212 +/- 5 beats/min, respectively, following atropine premedication. Post-exercise heart rate recovery without premedication was best described by a biexponential curve with a rapid initial period (duration = 55 +/- 6 sec, Tl/e = 15 +/- 2 sec) and a slower secondary period (duration = 267 +/- 5 sec, Tl/e = 455 +/- 78 sec). After atropine premedication, heart rate recovery followed a monoexponential curve (Tl/e = 174 +/- 46 sec) in 4 ponies, but remained biexponential (Part 1 duration = 74 sec, Tl/e = 20 sec; Part 2 duration = 243 sec, Tl/e = 342 sec) in the other ponies. The calculated time required for heart rate to return to resting levels after atropine premedication was 11.3 +/- 2.2 min, compared to 26.3 +/- 3.9 min without premedication. However, without premedication, only 6.6 +/- 1.6 min were required to reach the post-atropine resting heart rate, indicating that the time difference was due to the higher resting heart rate after atropine premedication. Thus, heart rate recovery in the non-premedicated pony follows a biexponential curve similar to that observed in other species.(ABSTRACT TRUNCATED AT 250 WORDS)

Myocardial blood flow, metabolism, and function with repeated brief coronary occlusions in conscious ponies.

Studies were performed in the conscious pony instrumented with a Doppler flow probe and hydraulic occluder on the left anterior descending coronary artery (LAD), sonomicrometry crystals and intraventricular micromanometer in the left ventricle, and catheters in the left atrium and anterior interventricular vein. Two-minute LAD occlusions were performed every 30 min continuously or during working hours. Data on release of catabolites (potassium, hydrogen ions, and lactate) and norepinephrine from the initially dysfunctional region were obtained periodically during a regimen of 445 +/- 56 occlusions in six animals. Regional myocardial blood flow was measured (microsphere method) before and after an occlusion regimen in four animals. Marked release of catabolites and norepinephrine from the initially dysfunctional region was noted in association with early occlusions when myocardial segment function was severely reduced. With further occlusions, release of these substances decreased while segment function improved. Blood flow was markedly decreased in the initially dysfunctional region during an early occlusion but was at the control level during a later occlusion. Although the metabolic findings are consistent with protection due to "ischemic preconditioning" and no increase in collateral perfusion, the inverse relationship noted between catabolite release and segment function is best explained by flow-dependent mechanisms. These results, together with the myocardial blood flow data, serve to validate a previous assumption that protection against regional myocardial dysfunction under these conditions is due to increased collateral perfusion.

Digital signal analysis of cardiac events in horses and ponies.

We have developed a digital signal analysis technique which can be used to evaluate various cardiac events in ponies and horses at rest and during exercise. The algorithm is designed to identify R-wave peaks on the surface electrocardiogram, consistent reference points on the left ventricular pressure waveform and the initiation of the QRS complex on the epicardial electrogram. We have used the technique to evaluate data from 10 horses and ponies at rest, during strenuous exercise and during experimentally-induced coronary artery occlusion. The technique provided rapid and accurate beat-by-beat evaluation of data, even with relatively noisy signals and under conditions in which the waveform configurations were not consistent. The benefits afforded by this technique make it especially useful for extracting information which previously was difficult or impossible to obtain using more conventional methods of analysis.

Nonlinear algorithm for identification of a fiducial marker for various cardiac events.

We report on a nonlinear algorithm which identifies R-wave peaks on the surface electrocardiogram, consistent reference points on the left ventricular pressure waveform and the initiation of the QRS complex on the epicardial electrogram. The algorithm has been used to evaluate data from horses, ponies, dogs and humans at rest and during exercise. It permits rapid, accurate evaluation of data on a beat-by-beat basis even with noisy signals and varying waveform configurations. The algorithm facilitates the acquisition of detailed information previously difficult or impossible to obtain by more conventional methods of analysis.

Left ventricular function and haemodynamics in ponies during exercise and recovery.

Myocardial and haemodynamic responses to strenuous treadmill exercise were monitored with chronically implanted instrumentation in seven physically untrained ponies. In two other ponies, haemodynamics were monitored using a conventional catheter technique. During exercise (mean +/- sem heart rate = 203 +/- 3 beats/min), left ventricular peak systolic ahd end-diastolic blood pressure significantly increased from 125 +/- 2 to 208 +/- 6 mmHg and from 29 +/- 1 to 58 +/- 3 mmHg, respectively (P less than 0.05). Peak positive first derivative of left ventricular pressure (dP/dt) was also increased significantly, (1397 +/- 144 to 6016 +/- 325 mmHg/sec), as were myocardial segment velocity of shortening during systole (dL/dtsys) and stroke work (193 and 109 per cent, respectively). Paradoxically, segment systolic shortening was reduced significantly (P less than 0.05) with respect to resting control values for 10 mins after cessation of exercise, with the maximal reduction of 22 per cent occurring at 2 mins post exercise. In addition, left ventricular segment stroke work decreased significantly to 67 per cent of resting control value at 2 mins post exercise. This study demonstrates that analysis of regional myocardial performance in conjunction with haemodynamic data permits a detailed description of cardiac events during and immediately following exercise, facilitating definition of changes which are not readily reflected by haemodynamics. Based on these findings, the authors conclude that untrained ponies may readily complete short bouts of near-maximal exercise, yet experience significantly diminished left ventricular function in the immediate post exercise period.

Early osteonecrosis of the femoral head: detection in high-risk patients with MR imaging.

To determine whether magnetic resonance (MR) imaging can demonstrate the early stages of osteonecrosis that are not detectable radiographically, the authors compared radiologic findings with histologic results in seven patients at high risk for osteonecrosis of the femoral head. Radiography and MR imaging were performed, and proximal femoral intramedullary pressures were measured in all patients, even if results from imaging studies were normal. If the pressures were elevated, core decompression with biopsy was performed. Seven patients had elevated pressures in 11 hips. Of 11 hips from which biopsy specimens were taken, all had histologic evidence of osteonecrosis. However, in only five were the MR imaging findings consistent with osteonecrosis. In the remaining six hips with osteonecrosis, MR imaging findings were normal. Sensitivity of MR imaging in detection of osteonecrosis was 46%. The authors conclude that normal MR imaging results in high-risk patients do not rule out the presence of osteonecrosis.

Ischaemia induced development of functional coronary collateral circulation in ponies.

The response of coronary collaterals in nine ponies subjected to repeated reversible occlusions (2 min duration, 30 min interval) of the left anterior descending coronary artery was studied at rest. Each pony was instrumented with a Doppler flowmeter and hydraulic cuff occluder around the left anterior descending coronary artery, left ventricular subendocardial sonomicrometers, and a left ventricular micromanometer. Initial occlusions increased end diastolic myocardial segment length by 3% and decreased segment systolic shortening, stroke work, and velocity of shortening by 103%, 95%, and 79% respectively in the left ventricular apex. Left ventricular systolic and end diastolic pressure, peak positive dP/dt, and heart rate were not significantly changed by occlusion. After 421(70) (mean(SEM)) occlusions no sustained alterations in myocardial segment function occurred in response to occlusion. Thus the presence of a subendocardial plexus did not protect against a severe loss of myocardial segment function when the ponies were initially subjected to occlusions of the left anterior descending coronary artery. However, repeated reversible occlusions enhanced coronary collateral blood flow such that it was adequate to maintain left ventricular function in the absence of left anterior descending coronary artery flow. It is concluded that the pony is highly suitable for use in studies of coronary collateral circulation because of its coronary anatomical similarity to man and its capacity to develop functional collateralisation.

Left ventricular hypertrophy in chronically hypertensive ponies.

Systemic arterial hypertension is associated with equine laminitis, a disease precipitated by gross over-ingestion of carbohydrates. We examined the hearts from nine chronically hypertensive (161 +/- 11/99 +/- 6 mmHg) laminitic ponies and nine normotensive (128 +/- 2/76 +/- 3 mmHg) ponies postmortem for signs of left ventricular hypertrophy. The hypertensive ponies had hearts which were significantly larger (7.77 +/- 0.26 g/kg bodyweight (BW) vs. 5.67 +/- 0.22 g/kg BW), as well as increased combined left ventricle and septum weight (4.99 +/- 0.21 g/kg BW vs. 3.67 +/- 0.20 g/kg BW) and left ventricular free wall weight (3.71 +/- 0.23 g/kg BW vs. 2.62 +/- 0.19 g/kg BW) (p less than 0.05). The right ventricular free wall weights were not significantly different. Mean left ventricular free wall thickness was increased significantly in the hypertensive ponies compared to the normotensive group (26.1 +/- 0.4 mm and 22.5 +/- 1 mm, respectively), but neither septal nor right ventricular free wall thickness was different. These findings demonstrate that left ventricular hypertrophy accompanies equine laminitis-induced hypertension.

Upper gastrointestinal endoscopy--how far does the endoscope go?

Two adult-size endoscopes (Olympus GIF-K2 and ACMI TX-8) were compared for extent of duodenal intubation by the endoscopist's estimate of location and x-ray position in 55 patients. The endoscopes were not different in duodenal position when separately analyzed for the endoscopist's estimate or x-ray location. Combining the results for both endoscopes showed the endoscopist's estimate to differ significantly from x-ray location in 47% of patients (p = 0.02). When incorrect, the endoscopist overestimated 62% of the time and underestimated 38% of the time. X-ray evaluation of insertion depth confirmed that the second portion of the duodenum was reached in 96%, third portion in 51%, and fourth portion or beyond in 38% of patients. We conclude that fluoroscopic confirmation may be necessary when endoscopically assessing distal duodenal segments for pathology.

Inhalation anesthesia in adult cattle.

An inhalation technique was used for anesthesia during ileal cannulation in five adult cows. Following sedation with intravenous acepromazine, anesthesia was induced intravenously with thiopental sodium in 5% glyceryl guaiacolate solution. Endotracheal intubation was performed and anesthesia maintained with halothane in oxygen via a circle system with a precision vaporizer. In all cases, induction was smooth and no difficulties were experienced during the maintenance of anesthesia. Total anesthesia time was 1.5 to 2.5 hours. Following completion of the surgical procedure, which was performed with the animal in left lateral recumbency, each cow was rolled to a sternal position and supported, if necessary. The endotracheal tube was left in place, with oxygen administration continued, until the animal was able to swallow. Recoveries were rapid and all animals were ambulatory within 30 minutes after completion of the surgery. The only post-operative complication due to anesthesia was transient mouth soreness in two cases, attributed to the use of a mouth speculum during intubation.

Mediastinal impressions on the dilated esophagus.

This article explores how the mediastinum accommodates a significantly dilated esophagus, using achalasia as an anatomic model. This accommodation introduces the concepts of vascular tethering and the paratracheal esophagus as part of a unifying theory of "the path of least resistance." Practical examples demonstrate the importance of understanding these concepts in any disease involving esophageal dilatation.

Comparison of Golytely lavage with standard diet/cathartic preparation for double-contrast barium enema.

In a two-part study, two groups of 100 outpatients each were randomly assigned a colon preparation. In part 1, a standard 1-day diet/cathartic combination was compared with Golytely. In part 2, diet/cathartics was compared with Golytely plus Dulcolax (bisacodyl). The standard preparation provided good or excellent feces removal in 81 (80%) of 101 subjects. Golytely alone was successful in only 21 (53%) of 40 patients, but Golytely followed by Dulcolax achieved good or excellent feces removal in 31 (82%) of 38. Degraded mucosal coating with Golytely alone, due to excessive fluid retention, was also corrected by the addition of Dulcolax. Golytely alone is not an adequate method of colon cleansing for double-contrast barium enema, but Golytely plus Dulcolax is as effective as the standard preparation.

Arterial oxygen and carbon dioxide tensions in conscious laterally recumbent ponies.

Six adult ponies were trained calmly to assume and maintain left lateral recumbency without the use of sedative or immobilising agents. During a 30 min recumbent period, pHa, arterial oxygen and carbon dioxide tensions (PaO2 and PaCO2) and heart and respiratory rates were monitored at regular intervals to evaluate ventilatory response. Overall, there were no statistically significant differences found between mean control and recumbent or final standing values. When lightweight ponies were compared to heavyweight ponies, only mean PaO2 at 10 mins recumbency was different. This information supports the hypothesis that ventilation impairment during the first 30 mins of equine general anesthesia is primarily drug-mediated, rather than initiated by recumbency per se.

Digital radiology in trauma using small-dose exposure.

The microdose radiology system produces a large-field examination within thirty seconds on a video monitor. This video image can be manipulated in the same manner as a computed tomography (CT) scan. The system was installed at the Maryland Institute for Emergency Services (MIEMS) to examine severely injured patients. No major abnormalities were overlooked during the examination of these patients. The microdose system is useful in providing extensive radiologic information immediately applicable to the care of massively traumatized patients.