Flow measurement at the pump head of centrifugal pumps: comparison of ultrasonic transit time and ultrasonic Doppler systems.

Determination of blood flow is essential for monitoring rotary blood pumps. However, accurate measurement directly adjacent to the pump housing is difficult because of the highly irregular flow profiles near the fast spinning rotor. Therefore, a specially adapted flow probe based on the ultrasound transit time (USTT) principle was designed to evaluate the flow in centrifugal blood pumps. The probe can be directly mounted at the housing and creates 2 crossed measuring ultrasound beams. The mean value, Qm, of the 2 output signals corresponds to the blood flow and the difference, Qd, correlates to the vorticity of the flow profile in the pump outflow tract. In vitro measurements obtained an accuracy for mean flow values of better than +/-0.6 L/min in extreme working points and for vorticity values even as high as Qd = 3.5 L/min. Because of vorticity, however, the output signal contained considerable noise, and that required the application of a 10 Hz filter. Positioning of the ultrasound (US) beams parallel to the axial direction of the pump was superior to radial positioning. Additional measurement of the flow profile demonstrated that a large vorticity occurred (up to Qd equal to 3.5 L/min), and this vorticity was highly dependent upon the afterload of the pump. In vivo experiments demonstrated the reliability of the method. We concluded that USTT flow measurement can determine blood flow immediately adjacent to the pump housing with sufficient accuracy, and these measurements are superior to those from US-Doppler systems (which cannot handle the vorticity accurately enough) and electromagnetic devices (which lack zero stability).

Minnesota ALG. Safe and effective immunosuppression for cardiac transplantation.

Fifty-six patients undergoing orthotopic cardiac transplantation were given Minnesota ALG prophylactically or therapeutically for acute cardiac rejection. During a follow-up period of 0-28 months (mean follow-up period, 11.9 months), the actuarial survival for the entire group was 96% and 86% at 30 days and 1 year, respectively. Actuarial freedom from rejection was 60% and 28% at 30 days and 1 year, respectively. All but seven rejection episodes responded to initial steroid pulses or a modification of a maintenance cyclosporine and azathioprine regimen. The seven failures were rescued with further Minnesota ALG therapy. Few serious hematologic or allergic reactions to Minnesota ALG were observed, and no new malignancies occurred during the follow-up period. We conclude that Minnesota ALG is safe and effective in cardiac transplantation.

Prevention of early postoperative renal dysfunction in cardiac transplantation.

Fifty six patients undergoing cardiac transplantation were immunosuppressed with a multi-drug induction regimen in which Cs administration was delayed postoperatively until satisfactory hemodynamics and renal function were achieved. The advantage of this approach is the absence of acute renal dysfunction in the early postoperative period. This immunosuppressive regimen was well tolerated and without significant detrimental effects on patient survival, graft rejection, or infection.

Validation of thermal techniques for measurement of pelvic organ blood flows in the nonpregnant sheep: comparison with transit-time ultrasonic and microsphere measurements of blood flow.

Data obtained from a thermal system capable of measuring changes in organ temperature as well as tissue thermal clearance in the uterus and vagina have been compared with blood flow measured continuously with a transit-time ultrasound volume-flow sensor placed around the common internal iliac artery and intermittently with radioactive microspheres in the chronically instrumented nonpregnant sheep. Temperature changes in both the uterus and the vagina correlated well with blood flow changes measured by both techniques after intravenous administration of estradiol or norepinephrine. Thermal clearance did not correlate well with blood flow in the vagina or uterus. These methods may have value in the investigation of blood flow patterns in various clinical situations such as the pelvic pain syndrome and early pregnancy.

Retropulsion-propulsion in equine large colon.

The circular and longitudinal muscle coats of equine "midcolon" were found to be directly electrically coupled. They appear to act in concert, in healthy animals, as a pacemaker in the area of the large colon pelvic flexure, for retropulsive-propulsive myoelectrical events. The retropulsive events keep the cecum and right ventral and left ventral divisions of the colon filled, imposing a delay time for fermentation of cellulose and for bacterial protein synthesis. Point-to-point involvement of adjacent colon sections was slowed by cooling the intestinal contents with no adverse clinical signs. Diminution of the blood flow to this regulatory area was achieved in 12 weanling foals (raised parasite-free) by parasitic cranial mesenteric arteritis, using Strongylus vulgaris larvae. Four of the 12 developed clinical signs of abdominal pain, but on necropsy 3 of these 4 had no gross lesions in the gastrointestinal tract. Dissociation of the left ventral and left dorsal colon divisions, as regards intraluminal pressure events and their antecedent myoelectrical action potentials, was induced in 7 of 8 adult animals given an acaricide which under field conditions is associated with progressive large colon obstruction and colic.