Prostacyclin (epoprostenol): its effect on canine splanchnic blood flow during hemorrhagic shock.

Prostacyclin (epoprostenol, prostaglandin I2) is a vasodilator of the splanchnic circulation during normotensive states. To confirm the persistence of its effects after hemorrhagic shock, six anesthetized, previously splenectomized, adult mongrel dogs were subjected to hemorrhagic shock using a modified Wigger's technique in which a mean arterial pressure of 30 mm Hg was maintained until 25% of the shed blood spontaneously returned. The animals were randomly resuscitated with normal saline solution or a similar volume of saline solution containing prostacyclin.

Capabilities and limitations of pulsed Doppler sonography in carotid imaging.

Pulsed Doppler ultrasonic imaging of the extracranial carotid arteries was performed in 118 patients (226 arteries) in whom selective contrast arteriograms were available for comparison to ultrasonic images. Specificity for the detection of normal and stenosis less than 50% was 84%, whereas sensitivity for detecting stenosis greater than 50% and occlusion of the internal carotid arteries was 89%. Overall accuracy was 85%.

Below-knee bypass for limb salvage. Comparison of autogenous saphenous vein, polytetrafluoroethylene, and composite dacron-autogenous vein grafts.

Autogenous saphenous vein was used preferentially for 92 below-knee bypass procedures (44 femoral-distal popliteal and 48 femoral-distal tibial or peroneal) performed for limb salvage in 87 adult male patients during a 30-month period of study. When a saphenous vein was unavailable or of unsuitable length or diameter, we randomly used expanded polytetrafluoroethylene (PTFE) and composite Dacron-autogenous vein (DV) grafts. With good run-off, all grafts have remained patent.

Comparison of pulsed Doppler and real-time B-mode echo arteriography for noninvasive imaging of the extracranial carotid arteries.

Accuracy and clinical applications of noninvasive imaging of the extracranial carotid arteries were compared using pulsed Doppler and real-time B-mode ultrasonography. During the period December, 1977, to February, 1979, 530 ultrasonograms (265 patients) were performed. Angiographic correlations were available in 90 patients (172 arteries) using the pulsed Doppler technique, and both techniques were employed in 43 patients (84 arteries).

Operative confirmation of Doppler ultrasound in evaluation of intestinal ischemia.

The prediction at operation of viability of ischemic intestine frequently is difficult and has resulted in recommendations for reoperation to assess intestine of questionable viability. This report describes the use of the Doppler ultrasonic flowmeter in three patients with ischemic intestine caused by acute superior mesenteric arterial thrombosis. Reliability of the Doppler technique was confirmed at second-look operations in each patient.

Arteriovenous malformations of the cecum: operative localization by Doppler ultrasound.

The Doppler ultrasonic flowmeter was used for operative localization of an arteriovenous malformation of the cecum in a patient with recurrent large intestinal bleeding. Application of the technique permitted operative confirmation of the diagnosis in an other wise normal appearing cecum.

Atherosclerotic aneurysms of the subclavian artery.

The case reports of three adult men, in whom four atherosclerotic aneurysms of otherwise normal subclavian arteries were detected in the absence of thoracic outlet syndrome or a history of trauma, are detailed. Two patients complained of supraclavicular discomfort--one having a history suggestive of peripheral arterial emboli and the other was asymptomatic. These aneurysms can be resected safely using a supraclavicular incision with resection of the medial clavicle.

Determination of intestinal viability by Doppler ultrasound.

The Doppler ultrasonic flowmeter was used to determine intestinal serosal and mesenteric blood flows in 130 patients who underwent abdominal aortic vascular procedures and in 14 patients who underwent general surgical procedures. Temporary occlusion of the inferior mesenteric artery (IMA) during aortic surgery resulted in the absence or marked diminution of collateral blood flow over the left side of the colon in eight patients. One patient had the flow in the IMA preserved by proper placement of an end-to-side aortofemoral Dacron prosthesis, whereas the other seven patients underwent replantation of the IMA into the Dacron prosthesis.

Vena caval interruption in pulmonary hypertensive canines.

Massive pulmonary embolism regularly causes a reduction in systemic arterial pressure. This is accompanied by an increase in pulmonary arterial pressure. If right heart strain is sufficient, peripheral venous pressures also rise.

Acute hemodynamic effects of lumbar sympathectomy.

Lumbar sympathectomy increases total limb blood flow after aortofemoral bypass in a high percentage of cases. This was true in eleven of fourteen extremities (78.6 per cent) in our series even though no specific selection criteria for entry into the study, other than the need for aortofemoral bypass, were used: that is, patients were entered into the study irrespective of preoperative ankle/arm pressure indexes or results of hyperemia testing.

A prospective randomized study of three expanded polytetrafluoroethylene (PTFE) grafts as small arterial substitutes.

A prospective, double-blind, randomized study was performed to determine the relative patency rate of polytetrafluoroethylene (PTFE) grafts, Gore-Tex, Impra, and a Surgikos prototype PTFE graft. The 48 grafts (40 x 4 mm) replaced excised segments of femoral arteries in adult mongrel dogs, whose mean weight was 20.6 +/- 0.

Primate mesenteric blood flow. Effects of vasopressin and its route of delivery.

The effects of vasopressin on blood flow in the superior mesenteric artery and on mean arterial pressure and portal venous pressure were measured in 7 rhesus monkeys. Vasopressin was injected, as either a bolus, or infused both intravenously and intraarterially to assess the influence of the route of administration upon hemodynamic responses. Dose-dependent decreases in superior mesenteric arterial flow were observed during both intraarterial and intravenous injections of vasopressin.