Gender Effect on Oral Volume Capacity

Studies have shown anatomical and functional differences between men and women with respect to the mouth, pharynx, upper esophageal sphincter, and esophagus. The aim of this investigation was to analyze the influence of gender, body mass index (BMI), age, and orofacial anthropometric measurements on the intraoral maximum volume capacity for liquid. The investigation included asymptomatic subjects, 56 females and 44 males, aged 19-53 years. The volunteers sucked water through a straw up to the maximum tolerated oral volume, which was greater in men (71.2 +/- A 15.0 ml) than in women (55.4 +/- A 13.4 ml). Age, BMI, height, and number of teeth had no influence on the intraoral tolerated volume. Anthropometric orofacial measurements were greater in men than in women. In individuals with height between 1.66 and 1.89 m, anthropometric orofacial measurements were greater in men than in women, and the tolerated intraoral volume was greater in men than in women. There was a positive correlation between orofacial measurements and intraoral maximum volume. In conclusion, men have the capacity to place a larger volume of water inside their mouth than women. This observation is associated with higher anthropometric orofacial measures, but not with age, number of teeth, height, or BMI.

Effects of overinflation on procollagen type III expression in experimental acute lung injury

Abstract Introduction In acute lung injury (ALI), elevation of procollagen type III (PC III) occurs early and has an adverse impact on outcome. We examined whether different high-inflation strategies of mechanical ventilation (MV) in oleic acid (OA) ALI alter regional expression of PC III. Methods We designed an experimental, randomized, and controlled protocol in which rats were allocated to two control groups (no injury, recruited [alveolar recruitment maneuver after tracheotomy without MV; n = 4 rats] and control [n = 5 rats]) or four injured groups (one exposed to OA only [n = 10 rats] and three OA-injured and ventilated). The three OA-injured groups were ventilated for 1 hour according to the following strategies: LVHP-S (low volume-high positive end-expiratory pressure [PEEP], supine; n = 10 rats, tidal volume [VT] = 8 ml/kg, PEEP = 12 cm H2O), HVLP-S (high volume-low PEEP, supine; n = 10 rats, VT = 20 ml/kg, PEEP = 5 cm H2O), and HVLP-P (high volume-low PEEP, prone; n = 10 rats). Northern blot analysis for PC III and interleukin-1-beta (IL-1β) and polymorphonuclear infiltration index (PMI) counting were performed in nondependent and dependent regions. Regional differences between groups were assessed by two-way analysis of variance after logarithmic transformation and post hoc tests. Results A significant interaction for group and region effects was observed for PC III (p = 0.012) with higher expression in the nondependent region for HVLP-S and LVHP-S, intermediate for OA and HVLP-P, and lower for control (group effect, p < 0.00001, partial η2 = 0.767; region effect, p = 0.0007, partial η2 = 0.091). We found high expression of IL-1β (group effect, p < 0.00001, partial η2 = 0.944) in the OA, HVLP-S, and HVLP-P groups without regional differences (p = 0.16). PMI behaved similarly (group effect, p < 0.00001, partial η2 = 0.832). Conclusion PC III expression is higher in nondependent regions and in ventilatory strategies that caused overdistension. This response was partially attenuated by prone positioning.

Lung function monitoring in patients with duchenne muscular dystrophy on steroid therapy

Background Duchenne muscular dystrophy (DMD) is a sex-linked inherited muscle disease characterized by a progressive loss in muscle strength and respiratory muscle involvement. After 12 years of age, lung function declines at a rate of 6 % to 10.7 % per year in patients with DMD. Steroid therapy has been proposed to delay the loss of motor function and also the respiratory involvement. Method In 21 patients with DMD aged between seven and 16 years, the forced vital capacity (FVC) and the forced expiratory volume in one second (FEV1) were evaluated at three different times during a period of two years. Results We observed in this period of evaluation the maintenance of the FVC and the FEV1 in this group of patients independently of chronological age, age at onset of steroid therapy, and walking capacity. Conclusion The steroid therapy has the potential to stabilize or delay the loss of lung function in DMD patients even if they are non-ambulant or older than 10 years, and in those in whom the medication was started after 7 years of age.

Biphasic positive airway pressure minimizes biological impact on lung tissue in mild acute lung injury independent of etiology

Abstract Introduction Biphasic positive airway pressure (BIVENT) is a partial support mode that employs pressure-controlled, time-cycled ventilation set at two levels of continuous positive airway pressure with unrestricted spontaneous breathing. BIVENT can modulate inspiratory effort by modifying the frequency of controlled breaths. Nevertheless, the optimal amount of inspiratory effort to improve respiratory function while minimizing ventilator-associated lung injury during partial ventilatory assistance has not been determined. Furthermore, it is unclear whether the effects of partial ventilatory support depend on acute lung injury (ALI) etiology. This study aimed to investigate the impact of spontaneous and time-cycled control breaths during BIVENT on the lung and diaphragm in experimental pulmonary (p) and extrapulmonary (exp) ALI. Methods This was a prospective, randomized, controlled experimental study of 60 adult male Wistar rats. Mild ALI was induced by Escherichia coli lipopolysaccharide either intratracheally (ALIp) or intraperitoneally (ALIexp). After 24 hours, animals were anesthetized and further randomized as follows: (1) pressure-controlled ventilation (PCV) with tidal volume (Vt) = 6 ml/kg, respiratory rate = 100 breaths/min, PEEP = 5 cmH2O, and inspiratory-to-expiratory ratio (I:E) = 1:2; or (2) BIVENT with three spontaneous and time-cycled control breath modes (100, 75, and 50 breaths/min). BIVENT was set with two levels of CPAP (Phigh = 10 cmH2O and Plow = 5 cmH2O). Inspiratory time was kept constant (Thigh = 0.3 s). Results BIVENT was associated with reduced markers of inflammation, apoptosis, fibrogenesis, and epithelial and endothelial cell damage in lung tissue in both ALI models when compared to PCV. The inspiratory effort during spontaneous breaths increased during BIVENT-50 in both ALI models. In ALIp, alveolar collapse was higher in BIVENT-100 than PCV, but decreased during BIVENT-50, and diaphragmatic injury was lower during BIVENT-50 compared to PCV and BIVENT-100. In ALIexp, alveolar collapse during BIVENT-100 and BIVENT-75 was comparable to PCV, while decreasing with BIVENT-50, and diaphragmatic injury increased during BIVENT-50. Conclusions In mild ALI, BIVENT had a lower biological impact on lung tissue compared to PCV. In contrast, the response of atelectasis and diaphragmatic injury to BIVENT differed according to the rate of spontaneous/controlled breaths and ALI etiology.

Weiterentwicklung einer Produktionsanlage und der Speicherungs- bzw. Transportkonzepte für hochpolarisiertes 3He

Der Bedarf an hyperpolarisiertem 3He in Medizin und physikalischer Grundlagenforschung ist in den letzten ca. 10-15 Jahren sowohl in Bezug auf die zu Verfügung stehende Menge, als auch auf den benötigten Grad der Kernspinpolarisation stetig gestiegen. Gleichzeitig mußten Lösungen für die polarisationserhaltende Speicherung und den Transport gefunden werden, die je nach Anwendung anzupassen waren. Als Ergebnis kann mit dieser Arbeit ein in sich geschlossenes Gesamtkonzept vorgestellt werden, daß sowohl die entsprechenden Mengen für klinische Anwendungen, als auch höchste Polarisation für physikalische Grundlagenfor-schung zur Verfügung stellen kann. Verschiedene unabhängige Polarimetriemethoden zeigten in sich konsistente Ergebnisse und konnten, neben ihrer eigenen Weiterentwicklung, zu einer verläßlichen Charakterisierung des neuen Systems und auch der Transportzellen und –boxen eingesetzt werden. Die Polarisation wird mittels „Metastabilem Optischen Pumpen“ bei einem Druck von 1 mbar erzeugt. Dabei werden ohne Gasfluß Werte von P = 84% erreicht. Im Flußbetrieb sinkt die erreichbare Polarisation auf P ≈ 77%. Das 3He kann dann weitgehend ohne Polarisationsver-luste auf mehrere bar komprimiert und zu den jeweiligen Experimenten transportiert werden. Durch konsequente Weiterentwicklung der vorgestellten Polarisationseinheit an fast allen Komponenten kann somit jetzt bei einem Fluß von 0,8 barl/h eine Polarisation von Pmax = 77% am Auslaß der Apparatur erreicht werden. Diese skaliert linear mit dem Fluß, sodaß bei 3 barl/h die Polarisation immer noch bei ca. 60% liegt. Dabei waren die im Rahmen dieser Arbeit durchgeführten Verbesserungen an den Lasern, der Optik, der Kompressionseinheit, dem Zwischenspeicher und der Gasreinigung wesentlich für das Erreichen dieser Polarisatio-nen. Neben dem Einsatz eines neuen Faserlasersystems ist die hohe Gasreinheit und die lang-lebige Kompressionseinheit ein Schlüssel für diese Leistungsfähigkeit. Seit Herbst 2001 er-zeugte das System bereits über 2000 barl hochpolarisiertes 3He und ermöglichte damit zahl-reiche interdisziplinäre Experimente und Untersuchungen. Durch Verbesserungen an als Prototypen bereits vorhandenen Transportboxen und durch weitgehende Unterdrückung der Wandrelaxation in den Transportgefäßen aufgrund neuer Erkenntnisse über deren Ursachen stellen auch polarisationserhaltende Transporte über große Strecken kein Problem mehr dar. In unbeschichteten 1 Liter Kolben aus Aluminosilikatglä-sern werden nun problemlos Speicherzeiten von T1 > 200h erreicht. Im Rahmen des europäi-schen Forschungsprojektes „Polarized Helium to Image the Lung“ wurden während 19 Liefe-rungen 70barl 3He nach Sheffield (UK) und bei 13 Transporten 100 barl nach Kopenhagen (DK) per Flugzeug transportiert. Zusammenfassend konnte gezeigt werden, daß die Problematik der Kernspinpolarisationser-zeugung von 3He, die Speicherung, der Transport und die Verwendung des polarisierten Ga-ses in klinischer Diagnostik und physikalischen Grundlagenexperimenten weitgehend gelöst ist und das Gesamtkonzept die Voraussetzungen für allgemeine Anwendungen auf diesen Gebieten geschaffen hat.

Über das Vermessen tubulärer Strukturen in der Computertomographie

Die chronisch obstruktive Lungenerkrankung (engl. chronic obstructive pulmonary disease, COPD) ist ein Überbegriff für Erkrankungen, die zu Husten, Auswurf und Dyspnoe (Atemnot) in Ruhe oder Belastung führen - zu diesen werden die chronische Bronchitis und das Lungenemphysem gezählt. Das Fortschreiten der COPD ist eng verknüpft mit der Zunahme des Volumens der Wände kleiner Luftwege (Bronchien). Die hochauflösende Computertomographie (CT) gilt bei der Untersuchung der Morphologie der Lunge als Goldstandard (beste und zuverlässigste Methode in der Diagnostik). Möchte man Bronchien, eine in Annäherung tubuläre Struktur, in CT-Bildern vermessen, so stellt die geringe Größe der Bronchien im Vergleich zum Auflösungsvermögen eines klinischen Computertomographen ein großes Problem dar. In dieser Arbeit wird gezeigt wie aus konventionellen Röntgenaufnahmen CT-Bilder berechnet werden, wo die mathematischen und physikalischen Fehlerquellen im Bildentstehungsprozess liegen und wie man ein CT-System mittels Interpretation als lineares verschiebungsinvariantes System (engl. linear shift invariant systems, LSI System) mathematisch greifbar macht. Basierend auf der linearen Systemtheorie werden Möglichkeiten zur Beschreibung des Auflösungsvermögens bildgebender Verfahren hergeleitet. Es wird gezeigt wie man den Tracheobronchialbaum aus einem CT-Datensatz stabil segmentiert und mittels eines topologieerhaltenden 3-dimensionalen Skelettierungsalgorithmus in eine Skelettdarstellung und anschließend in einen kreisfreien Graphen überführt. Basierend auf der linearen System Theorie wird eine neue, vielversprechende, integral-basierte Methodik (IBM) zum Vermessen kleiner Strukturen in CT-Bildern vorgestellt. Zum Validieren der IBM-Resultate wurden verschiedene Messungen an einem Phantom, bestehend aus 10 unterschiedlichen Silikon Schläuchen, durchgeführt. Mit Hilfe der Skelett- und Graphendarstellung ist ein Vermessen des kompletten segmentierten Tracheobronchialbaums im 3-dimensionalen Raum möglich. Für 8 zweifach gescannte Schweine konnte eine gute Reproduzierbarkeit der IBM-Resultate nachgewiesen werden. In einer weiteren, mit IBM durchgeführten Studie konnte gezeigt werden, dass die durchschnittliche prozentuale Bronchialwandstärke in CT-Datensätzen von 16 Rauchern signifikant höher ist, als in Datensätzen von 15 Nichtrauchern. IBM läßt sich möglicherweise auch für Wanddickenbestimmungen bei Problemstellungen aus anderen Arbeitsgebieten benutzen - kann zumindest als Ideengeber dienen. Ein Artikel mit der Beschreibung der entwickelten Methodik und der damit erzielten Studienergebnisse wurde zur Publikation im Journal IEEE Transactions on Medical Imaging angenommen.

Nuclear charge radii of light isotopes based on frequency comb measurements

Optical frequency comb technology has been used in this work for the first time to investigate the nuclear structure of light radioactive isotopes. Therefore, three laser systems were stabilized with different techniques to accurately known optical frequencies and used in two specialized experiments. Absolute transition frequency measurements of lithium and beryllium isotopes were performed with accuracy on the order of 10^(−10). Such a high accuracy is required for the light elements since the nuclear volume effect has only a 10^(−9) contribution to the total transition frequency. For beryllium, the isotope shift was determined with an accuracy that is sufficient to extract information about the proton distribution inside the nucleus. A Doppler-free two-photon spectroscopy on the stable lithium isotopes (6,7)^Li was performed in order to determine the absolute frequency of the 2S → 3S transition. The achieved relative accuracy of 2×10^(−10) is improved by one order of magnitude compared to previous measurements. The results provide an opportunity to determine the nuclear charge radius of the stable and short-lived isotopes in a pure optical way but this requires an improvement of the theoretical calculations by two orders of magnitude. The second experiment presented here was performed at ISOLDE/CERN, where the absolute transition frequencies of the D1 and D2 lines in beryllium ions for the isotopes (7,9,10,11)^Be were measured with an accuracy of about 1 MHz. Therefore, an advanced collinear laser spectroscopy technique involving two counter-propagating frequency-stabilized laser beams with a known absolute frequency was developed. The extracted isotope shifts were combined with recent accurate mass shift calculations and the root-mean square nuclear charge radii of (7,10)^Be and the one-neutron halo nucleus 11^Be were determined. Obtained charge radii are decreasing from 7^Be to 10^Be and increasing again for 11^Be. While the monotone decrease can be explained by a nucleon clustering inside the nucleus, the pronounced increase between 10^Be and 11^Be can be interpreted as a combination of two contributions: the center-of-mass motion of the 10^Be core and a change of intrinsic structure of the core. To disentangle these two contributions, the results from nuclear reaction measurements were used and indicate that the center-of-mass motion is the dominant effect. Additionally, the splitting isotope shift, i.e. the difference in the isotope shifts between the D1 and D2 fine structure transitions, was determined. This shows a good consistency with the theoretical calculations and provides a valuable check of the beryllium experiment.

Entwicklung und Anwendung eines Beatmungssystems zur Untersuchung der Lungenfeinstruktur mittels He-3-Magnetresonanztomographie

Im Rahmen meiner Dissertation wurde ein 3He-Applikationssystem für die in-vivo 3He-Magnetresonanztomographie der Lunge von Ratten entwickelt. Im Gegensatz zu anderen bisher entwickelten MR-kompatiblen Beatmungsgeräten wurde in diesem Applikationssystem erstmals der polarisationserhaltende ³He-Langzeitspeicher im Streufeld des Tomographen integriert. Bei der 3He-Applikation wird das 3He-Gas automatisch aus dem Langzeitspeicher außerhalb des Magneten zum Tier in den Tomographen geleitet. Die Kernspin-Polarisationsverluste, die beim 3He-Transfer zum Tier in den Tomographen auftreten, betragen etwa 1% (rel.) und sind vernachlässigbar gering. Das Beatmungssystem wurde zusammen mit der MRT-Bildgebungssequenz COMSPIRA an mehr als 200 Tieren erfolgreich getestet. Die MRT-Aufnahmen fanden hauptsächlich an einem 0,47 T Niederfeldtomographen bei der Firma Boehringer-Ingelheim Pharma in Biberach statt. Es wurden sowohl morphologische Aufnahmen der Rattenlunge gemacht als auch der „Apparent Diffusion Coefficient“ (ADC) gemessen. Die relative Streuung der ADC-Werte innerhalb einer Gruppe von Tieren ähnlichen Alters und Gewichts betrug dabei 5%. Bei Wiederholungsmessungen an ein und demselben Tier verringerte sich die relative Streuung auf 1%. Diese Werte unterstreichen die hohe Reproduzierbarkeit des Beatmungssystems sowie des gesamten Messverfahrens. Weiterhin wurde ein Verfahren vorgestellt, das den experimentell bestimmten ADC unabhängig von dem Mischungsverhältnis zwischen dem applizierten 3He und der Atemluft in der Lunge macht. Dies kann erreicht werden, indem das hp 3He mit dem chemisch inerten und ungiftigen Gas SF6 in einem definierten Verhältnis gemischt wird und anschließend dem Tier appliziert wird. Zuletzt wurde der ADC von emphysematischen Rattenlungen und von gesunden Rattenlungen gemessen. Die Ergebnisse zeigten einen signifikant kleineren ADC innerhalb der Gruppe der erkrankten Tiere. Diese Dissertation wurde durch die Boehringer-Ingelheim Pharma GmbH & Co. KG unterstützt.

Effectiveness of nitric oxide during spontaneous breathing in experimental lung injury

Inhaled nitric oxide (iNO) improves gas exchange in about 60% of patients with acute respiratory distress syndrome (ARDS). Recruitment of atelectatic lung areas may improve responsiveness and preservation of spontaneous breathing (SB) may cause recruitment. Accordingly, preservation of SB may improve effectiveness of iNO. To test this hypothesis, iNO was evaluated in experimental acute lung injury (ALI) during SB. In 24 pigs with ALI, effects of 10 ppm iNO were evaluated during controlled mechanical ventilation (CMV) and SB in random order. Preservation of SB was provided by 4 different modes: Unassisted SB was enabled by biphasic positive airway pressure (BIPAP), moderate inspiratory assist was provided by pressure support (PS) and volume-assured pressure support (VAPS), maximum assist was ensured by assist control (A/C). Statistical analysis did not reveal gas exchange improvements due to SB alone. Significant gas exchange improvements due to iNO were only achieved during unassisted SB with BIPAP (P <.05) but not during CMV or assisted SB. The authors conclude that effectiveness of iNO may be improved by unassisted SB during BIPAP but not by assisted SB. Thus combined iNO and unassisted SB is possibly most effective to improve gas exchange in severe hypoxemic ARDS.

Sonographic Assessment of Fetal Cardiac Function: Indirect Measurements of Fetal Cardiac Function, Newer Techniques and Clinical Applications

Noninvasive blood flow measurements based on Doppler ultrasound studies are the main clinical tool for studying the cardiovascular status of fetuses at risk for circulatory compromise. Usually, qualitative analysis of peripheral arteries and in particular clinical situations such as severe growth restriction or volume overload also of venous vessels close to the heart or of flow patterns in the heart is being used to gauge the level of compensation in a fetus. However, quantitative assessment of the driving force of the fetal circulation, the cardiac output remains an elusive goal in fetal medicine. This article reviews the methods for direct and indirect assessment of cardiac function and explains new clinical applications. Part 1 of this review describes the concept of cardiac function and cardiac output and the techniques that have been used to quantify output. Part 2 summarizes the use of arterial and venous Doppler studies in the fetus and gives a detailed description of indirect measurements of cardiac function (like indices derived from the duration of segments of the cardiac cycle) with current examples of their application.

Impact of aerobic exercise capacity and procedure-related factors in lung cancer surgery

Over the past decades, major progress in patient selection, surgical techniques and anaesthetic management have largely contributed to improved outcome in lung cancer surgery. The purpose of this study was to identify predictors of post-operative cardiopulmonary morbidity in patients with a forced expiratory volume in 1 s <80% predicted, who underwent cardiopulmonary exercise testing (CPET). In this observational study, 210 consecutive patients with lung cancer underwent CPET with completed data over a 9-yr period (2001-2009). Cardiopulmonary complications occurred in 46 (22%) patients, including four (1.9%) deaths. On logistic regression analysis, peak oxygen uptake (peak V'(O₂) and anaesthesia duration were independent risk factors of both cardiovascular and pulmonary complications; age and the extent of lung resection were additional predictors of cardiovascular complications, whereas tidal volume during one-lung ventilation was a predictor of pulmonary complications. Compared with patients with peak V'(O₂) >17 mL·kg⁻¹·min⁻¹, those with a peak V'(O₂) <10 mL·kg⁻¹·min⁻¹ had a four-fold higher incidence of cardiac and pulmonary morbidity. Our data support the use of pre-operative CPET and the application of an intra-operative protective ventilation strategy. Further studies should evaluate whether pre-operative physical training can improve post-operative outcome.

Long-term course of lung clearance index between infancy and school-age in cystic fibrosis subjects

Multiple breath washout (MBW) measurements have recently been shown to be sensitive for detection of early cystic fibrosis (CF) lung disease, with the lung clearance index (LCI) being the most common measure for ventilation inhomogeneity. The aim of this observational study was to describe the longitudinal course of LCI from time of clinical diagnosis during infancy to school-age in eleven children with CF. Elevated LCI during infancy was present in seven subjects, especially in those with later clinical diagnosis. Tracking of LCI at follow-up was evident only in the four most severe cases. We provide the first longitudinal data describing the long-term course of LCI in a small group of infants with CF. Our findings support the clinical usefulness of MBW measurements to detect and monitor early lung disease in children with CF already present shortly after clinical diagnosis.

Ground-based and airborne in-situ measurements of the Eyjafjallajökull volcanic aerosol plume in Switzerland in spring 2010

The volcanic aerosol plume resulting from the Eyjafjallajökull eruption in Iceland in April and May 2010 was detected in clear layers above Switzerland during two periods (17–19 April 2010 and 16–19 May 2010). In-situ measurements of the airborne volcanic plume were performed both within ground-based monitoring networks and with a research aircraft up to an altitude of 6000 m a.s.l. The wide range of aerosol and gas phase parameters studied at the high altitude research station Jungfraujoch (3580 m a.s.l.) allowed for an in-depth characterization of the detected volcanic aerosol. Both the data from the Jungfraujoch and the aircraft vertical profiles showed a consistent volcanic ash mode in the aerosol volume size distribution with a mean optical diameter around 3 ± 0.3 μm. These particles were found to have an average chemical composition very similar to the trachyandesite-like composition of rock samples collected near the volcano. Furthermore, chemical processing of volcanic sulfur dioxide into sulfate clearly contributed to the accumulation mode of the aerosol at the Jungfraujoch. The combination of these in-situ data and plume dispersion modeling results showed that a significant portion of the first volcanic aerosol plume reaching Switzerland on 17 April 2010 did not reach the Jungfraujoch directly, but was first dispersed and diluted in the planetary boundary layer. The maximum PM10 mass concentrations at the Jungfraujoch reached 30 μgm−3 and 70 μgm−3 (for 10-min mean values) duri ng the April and May episode, respectively. Even low-altitude monitoring stations registered up to 45 μgm−3 of volcanic ash related PM10 (Basel, Northwestern Switzerland, 18/19 April 2010). The flights with the research aircraft on 17 April 2010 showed one order of magnitude higher number concentrations over the northern Swiss plateau compared to the Jungfraujoch, and a mass concentration of 320 (200–520) μgm−3 on 18 May 2010 over the northwestern Swiss plateau. The presented data significantly contributed to the time-critical assessment of the local ash layer properties during the initial eruption phase. Furthermore, dispersion models benefited from the detailed information on the volcanic aerosol size distribution and its chemical composition.

Myocardial blood volume and coronary resistance during and after coronary angioplasty

Animal experiments have shown that the coronary circulation is pressure distensible, i.e., myocardial blood volume (MBV) increases with perfusion pressure. In humans, however, corresponding measurements are lacking so far. We sought to quantify parameters reflecting coronary distensibility such as MBV and coronary resistance (CR) during and after coronary angioplasty. Thirty patients with stable coronary artery disease underwent simultaneous coronary perfusion pressure assessment and myocardial contrast echocardiography (MCE) of 37 coronary arteries and their territories during and after angioplasty. MCE yielded MBV and myocardial blood flow (MBF; in ml · min(-1) · g(-1)). Complete data sets were obtained in 32 coronary arteries and their territories from 26 patients. During angioplasty, perfusion pressure, i.e., coronary occlusive pressure, and MBV varied between 9 and 57 mmHg (26.9 ± 11.9 mmHg) and between 1.2 and 14.5 ml/100 g (6.7 ± 3.7 ml/100 g), respectively. After successful angioplasty, perfusion pressure and MBV increased significantly (P < 0.001 for both) and varied between 64 and 118 mmHg (93.5 ± 12.8 mmHg) and between 3.7 and 17.3 ml/100 g (9.8 ± 3.4 ml/100 g), respectively. Mean MBF increased from 31 ± 20 ml · min(-1) · g(-1) during coronary occlusion, reflecting collateral flow, to 121 ± 33 ml · min(-1) · g(-1) (P < 0.01), whereas mean CR, i.e., the ratio of perfusion pressure and MBF, decreased by 20% (P < 0.001). In conclusion, the human coronary circulation is pressure distensible. MCE allows for the quantification of CR and MBV in humans.

Influence of fluid and volume state on PaO(2) oscillations in mechanically ventilated pigs

ABSTRACT Varying pulmonary shunt fractions during the respiratory cycle cause oxygen oscillations during mechanical ventilation. In artificially damaged lungs, cyclical recruitment of atelectasis is responsible for varying shunt according to published evidence. We introduce a complimentary hypothesis that cyclically varying shunt in healthy lungs is caused by cyclical redistribution of pulmonary perfusion. Administration of crystalloid or colloid infusions would decrease oxygen oscillations if our hypothesis was right. Therefore, n = 14 mechanically ventilated healthy pigs were investigated in 2 groups: crystalloid (fluid) versus no-fluid administration. Additional volume interventions (colloid infusion, blood withdrawal) were carried out in each pig. Intra-aortal PaO(2) oscillations were recorded using fluorescence quenching technique. Phase shift of oxygen oscillations during altered inspiratory to expiratory (I:E) ventilation ratio and electrical impedance tomography (EIT) served as control methods to exclude that recruitment of atelectasis is responsible for oxygen oscillations. In hypovolemia relevant oxygen oscillations could be recorded. Fluid and volume state changed PaO(2) oscillations according to our hypothesis. Fluid administration led to a mean decline of 105.3 mmHg of the PaO(2) oscillations amplitude (P < 0.001). The difference of the amplitudes between colloid administration and blood withdrawal was 62.4 mmHg in pigs not having received fluids (P = 0.0059). Fluid and volume state also changed the oscillation phase during altered I:E ratio. EIT excluded changes of regional ventilation (i.e., recruitment of atelectasis) to be responsible for these oscillations. In healthy pigs, cyclical redistribution of pulmonary perfusion can explain the size of respiratory-dependent PaO(2) oscillations.