1
|
Tewkesbury DH, Pollard LR, Green HD, Horsley A, Kenna D, Jones AM. When is Burkholderia cepacia complex truly eradicated in adults with cystic fibrosis? A 20-year follow up study. J Cyst Fibros 2024; 23:87-90. [PMID: 37775444 DOI: 10.1016/j.jcf.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Burkholderia cepacia complex (BCC) infection in cystic fibrosis (CF) is associated with increased morbidity and mortality. Current UK guidance recommends segregation of people with CF according to infection status. To date there is no universally agreed consensus on the number of negative samples or time interval since last isolation of BCC for eradication to be deemed successful. METHODS All cases of new BCC isolation at Manchester Adult Cystic Fibrosis Centre were followed-up between May 2002-May 2022. The number of subsequent positive and negative sputum samples for BCC were recorded, as well as eradication treatment received. Eradication was deemed successful if there were ≥3 negative sputum samples and no further positive sputum samples for the same species and strain ≥12 months until the end of follow-up. RESULTS Of 46 new BCC isolation, 25 were successfully eradicated and 21 resulted in chronic infection. 5 (16.7%) cases with exclusively negative sputum samples 6-12 months after initial isolation had subsequent samples that were culture-positive for BCC and 3 (10.7%) cases with exclusively negative sputum samples after 12-24 months had subsequent culture-positive samples. Cases where BCC was eradicated had a greater median number of days of eradication treatment (42, IQR 21-63) compared to those in whom BCC isolation resulted in chronic infection (28, IQR 14-42), p = 0.04. CONCLUSIONS A cautious approach to segregation should be maintained after new isolation of BCC in CF, as some individuals with ≥3 negative samples 12-24 months after initial isolation had subsequent sputum samples culture-positive for BCC.
Collapse
Affiliation(s)
- Daniel H Tewkesbury
- Manchester University NHS Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
| | | | - Heather D Green
- Manchester University NHS Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
| | - Alexander Horsley
- Manchester University NHS Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
| | - Dervla Kenna
- UK Health Security Agency, Colindale, United Kingdom
| | - Andrew M Jones
- Manchester University NHS Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom.
| |
Collapse
|
2
|
Green HD, Jones AM. Managing Pulmonary Infection in Adults With Cystic Fibrosis: Adult Cystic Fibrosis Series. Chest 2022; 162:66-75. [PMID: 35167860 DOI: 10.1016/j.chest.2022.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 12/17/2022] Open
Abstract
Cystic fibrosis (CF) is characterized by chronic airway infection and progressive respiratory decline. Historically, a narrow spectrum of bacterial pathogens was believed to comprise the bulk of respiratory infections in CF, with Haemophilus influenzae and Staphylococcus aureus dominating childhood infections, and Pseudomonas aeruginosa or, less commonly, a member of the Burkholderia cepacia complex becoming the dominant infecting organism in adulthood. Today, the landscape is changing for airway infection in CF. The prevalence of "less typical" gram-negative bacterial infections are rising due to a number of factors: the CF population is aging; new therapies are being introduced; antibiotic usage is increasing; diagnostic tests are evolving; and taxonomic changes are being made as new bacterial species are being discovered. Less is known about the clinical relevance and evidence for treatment strategies for many of the other lower prevalence organisms that are encountered in CF. The aim of this article was to discuss the current evidence and recommended strategies for treating airway infection in CF, focusing on bacterial infections.
Collapse
Affiliation(s)
- Heather D Green
- Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Manchester, England
| | - Andrew M Jones
- Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Manchester, England; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, England.
| |
Collapse
|
3
|
Rautemaa V, Green HD, Jones AM, Rautemaa-Richardson R. High level of β-(1,3)- d -glucan antigenaemia in cystic fibrosis in the absence of invasive fungal disease. Diagn Microbiol Infect Dis 2017. [DOI: 10.1016/j.diagmicrobio.2017.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
4
|
Green HD, Bright-Thomas RJ, Mutton KJ, Guiver M, Jones AM. Increased prevalence of Pneumocystis jirovecii colonisation in acute pulmonary exacerbations of cystic fibrosis. J Infect 2016; 73:1-7. [PMID: 27189843 DOI: 10.1016/j.jinf.2016.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/06/2016] [Accepted: 05/08/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study examined the prevalence of Pneumocystis jirovecii in the sputum of adults with cystic fibrosis during clinical stability and acute pulmonary exacerbation. METHODS This was a prospective, longitudinal observational study of patients attending the Manchester Adult Cystic Fibrosis Centre. Sputum samples were analysed for P. jirovecii DNA using PCR at enrolment and up to 5 follow-up visits. Patients were classified as stable or exacerbating using a modified Fuch's pulmonary exacerbation score. RESULTS 226 samples were tested from 111 patients. P. jirovecii was more likely to be detected in samples at acute pulmonary exacerbation (7/76 (9.2%)) compared with stable visits (3/150 (2%)), p = 0.03. P. jirovecii was detected less frequently if patients had received co-trimoxazole within 3 months of sample collection (0% versus 29.7%, p = 0.03). CONCLUSIONS Prevalence of P. jirovecii in stable patients is low, but P. jirovecii is detected in approximately 1 in 10 patients experiencing an acute pulmonary exacerbation.
Collapse
Affiliation(s)
- Heather D Green
- Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK; University of Manchester, Institute of Inflammation and Repair, UK.
| | - Rowland J Bright-Thomas
- Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK; University of Manchester, Institute of Inflammation and Repair, UK
| | - Ken J Mutton
- University of Manchester, Institute of Inflammation and Repair, UK; Central Manchester University Hospitals NHS Trust, Clinical Virology Department and PHE Public Health Laboratory, Clinical Sciences Building, Manchester Royal Infirmary, Manchester, M13 9WL, UK
| | - Malcolm Guiver
- Central Manchester University Hospitals NHS Trust, Clinical Virology Department and PHE Public Health Laboratory, Clinical Sciences Building, Manchester Royal Infirmary, Manchester, M13 9WL, UK
| | - Andrew M Jones
- Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK; University of Manchester, Institute of Inflammation and Repair, UK
| |
Collapse
|
5
|
Green HD, Bright-Thomas R, Kenna D, Jones AM. P275 Prevalence and Strain Typing Results Of Gram-negative Emerging Bacterial Pathogens in Patients Attending a Large UK Adult CF Centre. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
6
|
Abstract
The use of non-prescribed anabolic agents amongst non-athletes is increasing with young, adult males with cystic fibrosis (CF) in the highest risk demographic. There is evidence that anabolic agents increase weight and muscle mass in adults with a variety of catabolic conditions but there is no evidence for their use in hormone sufficient adults with CF. We report a case of anabolic agent use in a male adult with CF and review the clinical features of anabolic agent use with a focus on adults with CF.
Collapse
Affiliation(s)
- Heather D Green
- Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, England; Institution of Inflammation and Repair, University of Manchester.
| | - Peter J Barry
- Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, England
| | - Andrew M Jones
- Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, England; Institution of Inflammation and Repair, University of Manchester
| |
Collapse
|
7
|
|
8
|
|
9
|
Abstract
From August 1992 to January 1995, 24 patients with 26 supracondylar femoral fractures were treated with a retrograde intramedullary nail. There were 22 patients with 24 nails available for review. Eight fractures were open and 13 were intraarticular fractures. There were a significant number of associated injuries. The average followup interval was 18 months (range, 4-36 months). All fractures healed by 4 months, (average, 3 months). Only 1 patient required bone grafting. There were no implant failures or superficial or deep infections. One malunion occurred. Average knee range of motion was 104 degrees. A previously described rating scale was used to evaluate function. There were 4 excellent, 16 good, 2 fair, and 2 poor results. The supracondylar nail provides rigid internal fixation for rapid healing and comparable functional outcomes to lateral fixation devices with significantly less soft tissue dissection.
Collapse
Affiliation(s)
- R E Gellman
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | | | | | | |
Collapse
|
10
|
Abstract
The use of different types of antithrombotic prophylactics in various clinical settings was examined. A standardized questionnaire was mailed to 5000 randomly selected practicing orthopaedic surgeons that detailed practice profile, surgical case type and frequency, method of thromboembolism prophylaxis used, incidence of morbidity, and type of screening used. Twenty-one percent (n = 1046) of surgeons surveyed returned the questionnaire. Four of 5 surgeons performing elective hip arthroplasty used some form of thromboembolic prophylaxis for all of their patients, 13% used prophylaxis only for patients considered to be at high risk, and 3% of respondents never used prophylaxis. The rates of prophylactic use for patients undergoing elective knee arthroplasty were similar. A considerably lower rate of routine prophylactic use was seen among surgeons performing surgery for pelvic and lower extremity trauma. Except for cases involving neurologic compromise, most patients undergoing either elective or traumatic spinal surgery were not given prophylaxis. Low dose warfarin alone was the most commonly used prophylaxis modality. A comparison of the results of the current survey with those of past surveys showed that the use of aspirin has fallen. The use of routine pharmacologic prophylaxis against thromboembolism in hip and knee arthroplasty has become the standard of care in the United States. Among patients undergoing surgery for hip fracture and other lower extremity trauma, however, prophylaxis remains underused.
Collapse
Affiliation(s)
- G V Janku
- University of California at San Francisco, CA, USA
| | | | | |
Collapse
|
11
|
Abstract
Gorham's disease (disappearing bone disease, massive osteolysis, idiopathic osteolysis, essential osteolysis, progressive atrophy of bone, spontaneous absorption of bone, phantom bone, hemangiomatosis/lymphangiomatosis of bone, progressive osteolysis) is an extremely rare occurrence. There are fewer than 150 reported cases in the literature. This disorder can be characterized by spontaneous or posttraumatic progressive resorption of bone. The etiology is still very speculative, the prognosis unpredictable, and any effective therapy still unknown. This paper presents a review of the literature and two case reports of suspected Gorham's disease of the bones of the foot.
Collapse
Affiliation(s)
- H D Green
- British Columbia, Canada, Vancouver Hospital
| | | | | |
Collapse
|
12
|
Paiement GD, Hymes RA, LaDouceur MS, Gosselin RA, Green HD. Postoperative infections in asymptomatic HIV-seropositive orthopedic trauma patients. J Trauma 1994; 37:545-50; discussion 550-1. [PMID: 7932883 DOI: 10.1097/00005373-199410000-00005] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In a retrospective study of 476 surgical orthopedic trauma patients, we compared postoperative infection rates between individuals seropositive for the human immunodeficiency virus (HIV) and with no associated clinical symptoms with HIV-seronegative patients. Overall, the surgical postoperative infection rate was 16.7% in seropositive patients and 5.4% in the seronegative group (Chi-square, p = 0.035). When open fractures were considered separately, the seropositive group had a 55.6% infection rate compared with 11.3% in the seronegative group (Fisher's exact test, p = 0.004). Similarly, seropositive patients also had significantly increased rates of postoperative non-wound infections and complications (Chi-square p < 0.001). Asymptomatic HIV-seropositive orthopedic trauma patients are at significantly higher risk for postoperative infections than their seronegative counterparts. For HIV-seropositive patients with open fractures, this risk is especially pronounced.
Collapse
Affiliation(s)
- G D Paiement
- Department of Orthopedic Surgery University of California, San Francisco General Hospital 94110
| | | | | | | | | |
Collapse
|
13
|
Green SA, Green HD. The influence of radiographic projection on the appearance of deformities. Orthop Clin North Am 1994; 25:467-75. [PMID: 8028887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In a series of 100 malunions and nonunions, the authors found, on average, that the worst deformity visualized radiographically underestimated the true deformity by 14% (range of 0% to 41.4%). By recomputing the analysis as though four views (anteroposterior, lateral, both 45% obliques) had been obtained, the visualization error was reduced from 14% to 2.5%. The authors recommended either obtaining the aforementioned four views when planning a complex deformity correction, or, better yet, obtain the radiographic projection that shows each deformity in profile.
Collapse
Affiliation(s)
- S A Green
- Problem Fracture Service, Rancho Los Amigos Medical Center, Downey, California
| | | |
Collapse
|
14
|
Green HD. Maintaining an effective and efficient dental practice: a formula for success S = A17 + C5. J Wis Dent Assoc 1985; 61:654-5, 657, 659. [PMID: 3863967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
15
|
Farrar DJ, Bond MG, Sawyer JK, Green HD. Pulse wave velocity and morphological changes associated with early atherosclerosis progression in the aortas of cynomolgus monkeys. Cardiovasc Res 1984; 18:107-18. [PMID: 6697337 DOI: 10.1093/cvr/18.2.107] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
To determine the time course of changes in arterial stiffness and corresponding morphology during atherosclerosis progression, we determined pulse wave velocity (PWV) in cynomolgus monkeys fed atherogenic (test) and control diets over an 18-month period. At 6-month intervals, thoracic and abdominal aortic PWVs were determined with a pressure transducer retracted down the aorta in 5 cm increments. Iliac artery PWV was determined from the abdominal aortic pressure to a noninvasive femoral pulse. Groups of individual cardiac cycles, triggered by the ECGs, were sampled on a computer and the velocities (PWV) of the pulse wave fronts were calculated. There was no significant difference between groups until 18 months when test animal PWVs in the thoracic (7.44 +/- 0.83 m X s-1) and abdominal (8.52 +/- 0.67 m X s-1) aorta were significantly greater than those of controls (5.02 +/- 0.51 and 6.24 +/- 0.53 m X s-1, respectively), indicating increased arterial stiffness. There was no change in iliac PWV, 10.96 +/- 0.74 m X s-1 for 18-month test compared with 9.44 +/- 0.89 m X s-1 for controls. Constant infusion of nitroprusside and noradrenaline lowered and raised blood pressure and PWV in all groups, and PWV changes due to drug-induced pressure changes were greater in atherosclerotic than in control arteries. Systolic pressure of 18-month test and pulse pressure of 12- and 18-month test groups were significantly greater than controls under all drug conditions, also indicating increased vessel stiffness. Morphometric evaluation of histological aortic cross sections revealed early, noncomplicated atherosclerosis showing gradual increases in the ratio of intimal to medial cross-sectional area in the thoracic (1.24 +/- 0.30 after 18 months) and abdominal (1.70 +/- 0.42 after 18 months) aortas, compared with control ratios of essentially zero. The fraction of the internal elastic lamina covered with atherosclerotic lesions, and maximal intimal thickness also showed significant increases during the test diet period. These data show that early atherosclerosis resulted in aortic but not iliac stiffening which was detected by increased PWV before development of significant stenotic lesions.
Collapse
|
16
|
Farrar DJ, Green HD, Wagner WD, Bond MG. Reduction in pulse wave velocity and improvement of aortic distensibility accompanying regression of atherosclerosis in the rhesus monkey. Circ Res 1980; 47:425-32. [PMID: 7408125 DOI: 10.1161/01.res.47.3.425] [Citation(s) in RCA: 75] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
17
|
Abstract
Pulsatile haemodynamics associated with graded degrees of experimentally produced stenosis were studied in the canine femoral artery. Invasively determined pulsatile blood flow and noninvasively determined blood velocity with Doppler ultrasound were measured an average of 1.3 and 2.3 cm proximal to the stenosis, respectively. Pulsatile blood pressure was measured 0.6 cm proximal and 3.7 cm distal to the stenosis. With increasing severity of stenosis there were progressive increases in the femoral artery hydraulic input impedance moduli and in the ratio of the impedance moduli to the zero harmonic impedance (or total resistance). This resulted in: a) a progressive reduction in the Fourier harmonic moduli and pulsewave amplitudes of flow, velocity, and distal pressure; b) a progressive increase in the fifth-seventh proximal pressure harmonic moduli; but c) little change in mean proximal pressure or its first 4 harmonic moduli. The data confirm the well known phenomena of a 'critical stenosis' in that there is little decrease in resting mean blood flow until there is a 70 to 80 stenosis (area reduction). Also the oscillatory portions of the femoral artery data were more sensitive to the changes in stenosis than were the nonoscillatory parameters, which confirms previously reported findings from the thoracic aorta. However, the femoral artery haemodynamics exhibited a greater amount of frequency dependent behaviour than the thoracic aorta which is probably the result of a more complex interaction of reflections from the stenosis and from the periphery in the femoral artery than in the thoracic aorta. The sensitive changes in oscillatory haemodynamics may provide a useful basis for noninvasive and invasive physiological assessment of human peripheral atherosclerotic stenosis and of experimental stenosis in animals.
Collapse
|
18
|
Malindzak GS, Kosinski EJ, Green HD, Yarborough GW. The role of coronary adrenergic receptors in the response to nitroglycerine and the regulation of large and small vessel resistance. Arch Int Pharmacodyn Ther 1978; 235:299-316. [PMID: 104677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The role of coronary adrenergic receptors in response to nitroglycerine and in the regulation of large and small coronary vascular resistance was evaluated in two separate studies involving fifteen anesthetized mongrel dog preparations, before and after alpha- and beta-adrenergic blockade, respectively. Coronary blood flow (CBF) was measured through the left anterior descending (LAD) coronary artery by a non-cannulating electromagnetic flow probe. Pressure catheters were inserted into the arch of the aorta and into a distal apical branch of the LAD coronary artery to measure, respectively, aortic pressure (coronary perfusion pressure (PA), peripheral coronary pressure )PC), and coronary artery pressure gradient (PG = PA -PC). End-diastolic resistances to flow were computed as: (a) large coronary end-diastolic resistance (RL = PG/CBF), and (B) small coronary end-diastolic resistance (RS = PC/CBF). Nitroglycerine (NG) alone increased RL to approximately 180--220% of control and reduced RS to about 60% of control, respectively. Following pharmacologic blockade with propranolol (PRO), NG increased RL to about 180% of control and reduced RS to about 60% of control. Following alpha blockade with phenoxybenzamine (PBZ), NG decreased RL to about 78% of control and decreased RS to about 56% of control. It is concluded that while the overall effect of NG on the coronary vascular resistance is one of vasodilation, RL appears to be increased transiently and RS transiently decreased. Alpha adrenergic blockade appears to abolish this response. The increase in RL in response to NG appears to be associated with the systemic hypotensive effect in response to NG. It is proposed that the observed increase in RL is produced by the increase in cardiac sympathetic nerve activity which is initiated by the systemic hypotensive effect of NG.
Collapse
|
19
|
Malindzak GS, Kosinski EJ, Green HD, Yarborough GW. The effects of adrenergic stimulation on conductive and resistive segments of the coronary vascular bed. J Pharmacol Exp Ther 1978; 206:248-58. [PMID: 682109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
20
|
Farrar DJ, Green HD, Bond MG, Wagner WD, Gobbeé RA. Aortic pulse wave velocity, elasticity, and composition in a nonhuman primate model of atherosclerosis. Circ Res 1978; 43:52-62. [PMID: 95906 DOI: 10.1161/01.res.43.1.52] [Citation(s) in RCA: 92] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aortic pulse wave velocity was determined in Macaca fascicularis monkeys fed either atherogenic or control diets for 36 months. The foot-to-foot velocity and apparent phase velocities of the second through seventh Fourier harmonics at a given diastolic pressure in the atherosclerotic monkeys were 1.5 to 2.0 times the values for the control animals. More than 80% of the aortic intimal surface of the atherosclerotic monkeys was covered with fibrous or fatty plaque, which approximately doubled wall thickness and wall thickness to radius ratio. Angiochemical evaluations showed no difference in collagen or elastin concentration (as a fraction of lipid and mineral-free dried aorta), but the atherosclerotic aortas were 1.5 to 2.0 times that of control in collagen and elastin content (defined as the absolute quantity beneath a square centimeter of intimal surface). Total cholesterol and calcium concentrations in the atherosclerotic aortas were more than 10 times the values for the control aortas. The static circumferential distensibility of the excised atherosclerotic aortas was significantly less than control, but there was no difference in incremental (Young's) modulus of elasticity. The in vitro pressure-strain elastic modulus of the atherosclerotic aortas was more than twice that of control, which was predicted from the enhanced wave velocity. The significantly increased stiffness of the atherosclerotic arteries appeared to be due mainly to the increased wall thickness caused by the atherosclerotic plaques rather than to material changes described by Young's modulus. Extensive medial damage, however, also was present and could have had a major influence on stiffness. Atherosclerosis therefore can result in increased aortic stiffening, detectable by pulse wave velocity, even if there is no change in the overall Young's modulus of elasticity.
Collapse
|
21
|
Hutchins PM, Thurstone FL, Green HD, Schmid HE. A mathematical model of transient adjustments during renal autoregulation. Med Res Eng 1977; 12:12-5. [PMID: 886925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
22
|
Abstract
The mucosal microcirculation in innervated and denervated small intestine was studied using anesthetized rats. Denervation did not cause significant (P greater than 0.05) diameter changes in the precapillary vasculature; however, venules did constrict significantly. These results indicate minimum neural control in the precapillary vasculature during the resting state. The innervated precapillary vasculature constricted during both the carotid occlusion reflex and hemorrhagic hypotension. The diameter of the denervated precapillary vasculature was unchanged during the carotid occlusion reflex and dilated during hemorrhage. The responses of innervated and denervated precapillary vasculatures were attributed to increased neural activity and autoregulatory mechanisms, respectively. Neither innervated nor denervated venules responded during the carotid occlusion reflex. During hemorrhage, however, innervated venules constricted and denervated vessels dilated. The vasoconstriction of the innervated vasculature during hemorrhage contributed to a stoppage of blood and epithelial detachment; these responses did not occur in the dilated, denervated vasculature. Therefore, neural vasoconstriction, qualitatively similar to that in normal animals during the baroreceptor reflex, is a contributing cause to the vascular and tissue impairment in the intestinal mucosa during hemorrhage.
Collapse
|
23
|
|
24
|
Abstract
Livedo reticularis and peripheral edema often have been observed in patients receiving amantadine hydrochloride, suggesting alterations in the responsiveness of peripheral vessels. To investigate this possibility, five patients with Parkinson's disease who had either livedo reticularis or peripheral edema while being treated with amantadine (100 mg twice daily) were evaluated before and after the drug was discontinued. Finger and toe temperatures were significantly lower when patients received the drug than when it was discontinued, and plethysmographic studies showed increased flow in the lower limbs in three patients when the drug was stopped. It is concluded that amantadine therapy may be associated with peripheral vasoconstriction in some patients.
Collapse
|
25
|
|
26
|
Malindzak GS, Green HD, Rapela CE, Gobbeé RA. Computer simulation of equations for indicator-concentration curves in parabolic flow model. Ann Biomed Eng 1972; 1:44-55. [PMID: 4588439 DOI: 10.1007/bf02363417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
27
|
Malindzak GS, Van Dyke AH, Green HD, Meredith JH. Alpha and beta adrenergic receptors in the coronary vascular bed. Arch Int Pharmacodyn Ther 1972; 197:112-22. [PMID: 4402326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
28
|
Malindzak GS, Miller RD, Green HD. Coronary vasodilation and adrenergic receptors. Arch Int Pharmacodyn Ther 1972; 195:87-98. [PMID: 4622069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
29
|
|
30
|
Malindzak GS, Green HD. Numerical analysis of indicator concentration curves. Med Res Eng 1971; 10:14-6. [PMID: 4931091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
31
|
|
32
|
|
33
|
|
34
|
Conrad MC, Green HD, Yopp JD. Quantitative evaluation of vascular status of patients with peripheral vascular disease. Methods for storage and retrieval of clinical and laboratory data. Comput Biomed Res 1968; 1:301-14. [PMID: 5696974 DOI: 10.1016/0010-4809(68)90062-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
35
|
Rapela CE, Green HD. Autoregulation of cerebral blood flow during hypercarbia and during hyprcarbia and controlled (H+). Scand J Clin Lab Invest Suppl 1968; 102:V:C. [PMID: 5707558 DOI: 10.3109/00365516809168984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
36
|
Allen GD, Ward RJ, Green HD, Perrin EB. Reversal of apnea following artificial ventilation under anesthesia. Anesth Analg 1967; 46:690-7. [PMID: 6070160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
37
|
Abstract
Cerebral venous outflow was measured in anesthetized dogs at the confluence of the sagittal and straight sinuses, with the lateral sinuses occluded. Denervation of the carotid bifurcation increased systemic arterial pressure (+25.8;
SE
±7.7 mm Hg) and decreased cerebral vascular conductance (-0.018;
SE
±0.005 ml/min · mm Hg); stimulation of the carotid sinus nerve decreased systemic arterial pressure and increased cerebral vascular conductance. Graded constrictions of the common carotid arteries induced transient responses of the cerebral blood flow that were characteristic of an autoregulatory process. Plots of the steady-state pressures and flows during the decreases of perfusion pressure were concave toward the pressure axis, were similar before and after denervation of the carotid bifurcation, and were indicative of autoregulation.
We conclude that pressoreceptors in the carotid bifurcation or other pressoreceptors in systemic vessels upstream from the carotid bifurcation are not necessary for the control of the "tone" of the cerebral vasculature or in the mechanism of the autoregulation of cerebral blood flow.
Collapse
|
38
|
Green HD. Discussion of "Intestinal vascular responses to naturally occurring vasoactive substances". Gastroenterology 1967; 52:451-3. [PMID: 6020114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
|
39
|
|
40
|
Green HD. The peripheral circulation during shock. Calif Med 1965; 103:318. [PMID: 5834282 PMCID: PMC1516080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
41
|
|