Reduction of atherosclerotic nanoplaque formation and size by Ginkgo biloba (EGb 761) in cardiovascular high-risk patients

Coating a silica surface with the isolated lipoprotein receptor proteoheparan sulfate (HS-PG) from arterial endothelium and vascular matrices and adding both the atherogenic VLDL/IDL/LDL lipid fraction in its native composition and Ca(2+) ions, we could observe in vitro the earliest stages of atherosclerotic plaque development by ellipsometric techniques (patent EP 0 946 876). This so-called nanoplaque formation is represented by the ternary aggregational complex of the HS-PG receptor, lipoprotein particles and calcium ions. The model was validated in several clinical studies on statins in cardiovascular high-risk patients. In eight patients who had undergone an aortocoronary bypass operation, the reduction of atherosclerotic nanoplaque formation amounted to 11.9+/-2.5% (p<0.0078) and of nanoplaque size to 24.4+/-8.1% (p<0.0234), respectively, after a 2-month therapy with Ginkgo biloba extract (2x 120 mg daily, EGb 761). Additionally, superoxide dismutase (SOD) activity was upregulated by 15.7+/-7.0% (p<0.0391), the quotient oxLDL/LDL lowered by 17.0+/-5.5% (p<0.0234) and lipoprotein(a) concentration decreased by 23.4+/-7.9% (p<0.0234) in the patients' blood. The concentration of the vasodilating substances cAMP and cGMP was augmented by 37.5+/-9.1% (p<0.0078) and 27.7+/-8.3% (p<0.0156), respectively. A multiple regression analysis between the patients' VLDL/IDL/LDL lipoprotein fraction applied in the ellipsometry measurements as well as the further risk factors oxLDL/LDL and Lp(a) on the one hand and changes in nanoplaque formation on the other hand reveals a basis for a mechanistic explanation of nanoplaque reduction under ginkgo treatment. The atherosclerosis inhibiting effect is possibly due to an upregulation in the body's own radical scavenging enzymes and an attenuation of the risk factors oxLDL/LDL and Lp(a).

Catheter Directed Thrombolysis for Treatment of Ilio-femoral Deep Venous Thrombosis is Durable, Preserves Venous Valve Function and May Prevent Chronic Venous Insufficiency

OBJECTIVES

To investigate the results of catheter directed thrombolysis offered to patients with acute femoro-iliac deep venous thrombosis (DVT).

DESIGN

Retrospective analysis of all patients treated with this modality at Gentofte Hospital until December 2003.

MATERIAL

Forty-five consecutive patients treated between June 1999 and December 2003 with a median age of 31 years. All patients had femoro-iliac DVT with an average anamnesis of 6 days.

METHODS

All patients were treated by catheter directed infusion of alteplase into the popliteal vein. After thrombolysis residual venous stenoses were treated by percutaneous balloon angioplasty (PTA) and stenting. Patients were followed with color-duplex scanning for assessment of venous patency and reflux.

RESULTS

Forty-two of 45 (93%) of cases were treated successfully with reopening of the thrombosed vein segments. In 30 of 45 cases a residual stenosis was treated by PTA and stenting. Only one serious complication was observed: Compartment syndrome of the forearm where arterial punctures had been taken. After an average of 24 months follow-up were no cases of re-thrombosis among the 42 patients discharged with open veins. Only two of 41 with presumed normal venous valve function prior to DVT developed reflux during follow-up.

CONCLUSION

In this selected patient group, catheter directed thrombolysis seems effective in treating acute DVT, it appears durable and preserves venous valve function in the majority. The method needs to be tested in a randomised controlled trial.

Quantification of feto-maternal haemorrhage (FMH) by flow cytometry: anti-fetal haemoglobin labelling potentially underestimates massive FMH in comparison to labelling with anti-D

Many centres now routinely use flow cytometry to quantify feto-maternal haemorrhage (FMH). However, which flow cytometric method is the most accurate in quantifying FMH is currently unknown. An audit of clinical results in which FMH had been estimated by both directly conjugated monoclonal anti-D and anti-fetal haemoglobin (HbF) labelling suggested that the anti-HbF labelling method may underestimate massive FMH in comparison to labelling with anti-D. Subsequent to this audit, 46 samples of adult D-negative blood were spiked with varying amounts of D-positive cord blood (0.05-10% fetal cells per sample), and the number of fetal cells present was quantified by both labelling methods. The percentage of fetal cells detected by anti-D was not significantly different to the estimated percentage of fetal cells added to each sample (P = 0.636). However, anti-HbF labelling significantly underestimated the percentage of fetal cells present (P = 0.0001). In comparison to anti-D, the percentage of fetal cells detected by anti-HbF was also significantly lower (P < 0.0001). The difference in fetal cell detection between anti-D and anti-HbF labelling was only apparent in the spiked samples containing > or =1% fetal cells per sample. In samples containing < or =0.6% fetal cells, no significant difference in the detection of fetal cells between anti-D and anti-HbF labelling was observed (P = 0.11). To allow adequate immunoprophylaxis in D-negative mothers with massive FMH, we recommend that anti-D labelling should be used in the routine flow cytometric estimation of FMH.

Frequency dependent changes in mechanosensitivity of rat knee joint afferents after antidromic saphenous nerve stimulation

The aim of the present study was to examine the effect of electrical saphenous nerve stimulation (14 V, 1-10 Hz) on the mechanosensitivity of rat knee joint afferents. The responses to passive joint rotations at defined torque were recorded from slowly conducting knee joint afferent nerve fibres (0.6-20.0 m/s). After repeated nerve stimulation with 1 Hz, the mechanosensitivity of about 79% of the units was significantly affected. The effects were most prominent at a torque close to the mechanical threshold. In about 46% of the examined nerve fibres a significant increase was obtained, whereas about 33% reduced their mechanosensitivity. The sensitisation was prevented by an application of 5 microM phentolamine, an alpha-adrenergic receptor blocker, together with a neuropeptide Y receptor blocker. An inhibition of N-type Ca(2+) channels by an application of 1 microM omega-conotoxin GVIA caused comparable changes of the mechanosensitivity during the electrical stimulation. Electrical nerve stimulation with higher frequencies resulted in a further reduction of the mean response to joint rotations. After stimulation with 10 Hz, there was a nearly complete loss of mechanosensitivity.In conclusion, antidromic electrical nerve stimulation leads to a frequency dependent transient decrease of the mechanosensitivity. A sensitisation was only obtained at 1 Hz, but this effect may be based on the influence of sympathetic nerve fibres.

Cortical projection of the rat knee joint innervation and its processing in the somatosensory areas SI and SII

In recent years the rat knee joint has become an important model for the study of nociception of deep tissues. In contrast to the cortical processing of superficial pain, the knowledge about the processing of deep pain evoked by noxious stimuli in tissues such as tendons, bone, and joint is sparse. To obtain a basis for further functional studies, the projections of the knee joint in the cerebral cortex were determined. Cortical surface potentials evoked by electrical stimulation of the posterior articular nerve were recorded by a platinum ball electrode. Evoked activity was found in the primary somatosensory area SI in an area of about 3 x 3 mm on the contralateral side. Its center was located about 3 mm caudal to the bregma and about 3 mm lateral to the superior sagittal sinus. A small projection in SII was found on the lateral side of the cortex about 6 mm lateral from SI. This area had a size of about 1 x 1 mm, and the amplitudes of the potentials were smaller but had similar latencies to those in SI. An additional projection with small potentials and longer latencies was observed in SI on the ipsilateral side. Cooling of the contralateral SI revealed deprivation of the ipsilateral evoked potentials in SI whereas the potentials in SII remained unchanged. These data indicate that information from the knee joint is processed in parallel in SI and SII on the contralateral side and that there is an additional serial processing in SI on the ipsilateral side.

Histological demonstration of voltage dependent calcium channels on calcitonin gene-related peptide-immunoreactive nerve fibres in the mouse knee joint

The afferent (excitability) and efferent functions (release of neuropeptides) of primary afferent nerve fibres are based on Ca(2+)-influx. The aim of the present study was to examine the presence of L- and N-type Ca(2+)-channels at sensory nerve fibres in the mouse knee joint capsule. Specific fluorescent labelled channel blockers and antisera against these channel subtypes were combined with an immunohistochemical staining for calcitonin gene-related peptide (CGRP), a neuropeptide that is widely distributed in primary afferents. There was a nearly complete colocalisation of CGRP immunoreactivity and the binding of omega-conotoxin GVIA (toxin VIA of Conus geographus or BODIPY-verapamil (BODIPY(R) FL verapamil, hydrochloride) demonstrating the presence of N-type and L-type Ca(2+)-channels, respectively. These data were further confirmed by identical results obtained after an immunohistochemical demonstration of the two channel subtypes at the peptidergic nerve fibres.

Angioplasty for the treatment of buttock claudication caused by internal iliac artery stenoses

A case of buttock claudication due to isolated internal iliac artery stenoses is presented. Although ankle systolic pressure at rest was within normal limits and distal pulses were palpable, an angiogram demonstrated severe stenoses. A computed tomography scan showed no spinal stenosis. The patient was successfully treated with angioplasty. This diagnosis may be elusive if ankle pressure or distal pulses are normal, thereby directing the clinician's suspicion away from vascular pathology.

Neuropeptide Y changes the excitability of fine afferent units in the rat knee joint

1. The aim of the present study was to examine the effects of the sympathetic co-transmitter Neuropeptide Y on primary afferent nerve fibres of the rat knee joint. The responses to passive joint rotations at defined torque were recorded from 41 slowly conducting afferent nerve fibres (0.9 - 18.8 m s(-1)) innervating the knee joint capsule. 2. About 70% of the joint afferents were significantly affected in their mechanosensitivity by topical application of Neuropeptide Y. Significant effects occurred at a concentration of 10 nM. 3. Decreased mechanosensitivity was observed in about 40% of nerve fibres, whereas 30% of the units increased the mechanosensitivity. In addition, in about 35% of the fibres resting activity was induced or increased. Neither the conduction velocity nor the mechanical threshold of the units correlated with the described effects of Neuropeptide Y. 4. NPY(13--36), a specific Y2-receptor agonist, only modulated the mechanosensitivity, with no effect on the resting activity. The effects on the mechanosensitivity were similar to Neuropeptide Y, i.e. increase and decrease of the response. 5. Studies with the Y1-agonist (Leu(31), Pro(34))-NPY showed that activation of the Y1-receptor predominantly resulted in an enhanced mechanosensitivity and an induction or increase of a resting activity. The opposite effect was observed by application of BIBP 3226 BS, a Y1-receptor antagonist. 6. In conclusion, these data indicate that Neuropeptide Y affects the excitability of sensory nerve fibre endings.

Responses of fine primary afferent nerve fibres innervating the rat knee joint to defined torque

In total 23 rat knee joint afferent units with conduction velocities of 1.2-17 m/s were recorded extracellularly during inward and outward joint rotations of defined torque using a newly developed torque-meter. There was not a linear relation between the torque and the obtained angle of the joint. The mechanical thresholds of the units ranged from 10 to 60 mNm. During 10 s of stimulation with 60 mNm they responded with 12-300 action potentials. Two mechanosensitive nerve fibres could not be activated via knee joint rotation at any torque at all. The units could be classified according to their response pattern during stimulation: (1) phasic-tonic response behaviour; (2) constant discharge rate; (3) delayed onset of activity. In conclusion, the novel torque-meter allows a precise characterisation of the mechanical threshold and the corresponding response of fine afferent joint units during knee joint rotation.

Galanin influences the mechanosensitivity of sensory endings in the rat knee joint

The aim of the present study was to examine the effect of galanin on group III and IV afferent nerve fibres (n = 53) innervating normal and acutely inflamed knee joints in rats. They responded to local mechanical stimulation, movements of the joint and i.a. injections of KCl close to the joint. Single i.a. bolus injections of galanin (0.1 mM, 0.2 mL) caused no direct responses of the units. In normal and acutely inflamed joints, about half of the units did not change the responses to knee joint rotation. A significant reduction of the responses to noxious movements was found in approximately 40% of the units reaching a mean value of 57% in normal joints and 70% in inflamed joints compared with control movements. In approximately 10% the responses increased to 143% in normal joints and 120% in inflamed joints. Injection of a galanin receptor antagonist (M35) doubled the responses to noxious movements in 36% of the units in normal joints and reduced it in 18% to 86% of the control movements, indicating a tonic release and influence on the mechanosensitivity of a proportion of primary afferents by galanin. In conclusion, these data further support the hypothesis that the mechanosensitivity of fine afferent nerve fibres is regulated by a mixture of different substances being released into the innervated tissue. Besides the action of several pro-inflammatory peptides there seems to exist a tonic inhibitory system.

The control of mandible movements in the ant Odontomachus

Ants use their mandibles to manipulate many different objects including food, brood and nestmates. Different tasks require the modification of mandibular force and speed. Besides normal mandible movements the trap-jaw ant Odontomachus features a particularly fast mandible reflex during which both mandibles close synchronously within 3 ms. The mandibular muscles that govern mandible performance are controlled by four opener and eight closer motor neurons. During slow mandible movements different motor units can be activated successively, and fine tuning is assisted by co-activation of the antagonistic muscles. Fast and powerful movements are generated by the additional activation of two particular motor units which also contribute to the mandible strike. The trap-jaw reflex is triggered by a fast trigger muscle which is derived from the mandible closer. Intracellular recording reveals that trigger motor neurons can generate regular as well as particularly large postsynaptic potentials, which might be passively propagated over the short distance to the trigger muscle. The trigger motor neurons are dye-coupled and receive input from both sides of the body without delay, which ensures the synchronous release of both mandibles.

Effect and outcome of balloon angioplasty and stenting of the iliac arteries evaluated by intravascular ultrasound

OBJECTIVES

To document the mechanism of percutaneous transluminal angioplasty (PTA) and stenting of the iliac arteries, and to relate the effect to patency.

MATERIALS AND METHODS

Thirty-seven stenotic iliac arteries were examined by intravascular ultrasound (IVUS) and arteriography before and after PTA, and after stent deployment (n = 16). The patients were followed prospectively by duplex scanning at 3, 6, 12, 18 and 24 months after the intervention.

RESULTS

The effect of PTA was established by both compression and stretching with the major contribution arising from stretching. There were differences in the effect of PTA dependent on plaque morphology: in homogeneous eccentric lesions, stretching contributed significantly more than compression to the luminal gain, while stretching and compression contributed equally in concentric or heterogeneous plaques. Stenting of the arteries had no effect on the free luminal area as measured by IVUS. The primary 1-year patency rate was 72%. The patency was related to the free luminal area and diameter and the heterogenicity of the plaque as evaluated by IVUS. The arteriographic measurements did not have any predictive value.

CONCLUSION

IVUS was able to document the effect of PTA and stenting in the iliac arteries, and predict the outcome. The luminal gain and reduction in degree of stenosis seemed to be accomplished primarily by stretching of the arteries and to a lesser extent by plaque compression. Stenting did not change the IVUS measurements. Patency was related to the size of the free lumen and the heterogenicity of the plaque.

Quantification of iliac artery stenoses: a methodological comparative study between intravascular ultrasound, arteriography and duplex scanning

Two morphological methods for quantifying the degree of stenoses in the iliac arteries, intravascular ultrasound (IVUS) and arteriography, were compared with duplex scanning, a method of evaluating the haemodynamic importance of the stenosis. A total of 38 patients, 20 women and 18 men, median age 66 y, admitted for either PTA (n=18) or femoro-femoral crossover bypass surgery (n=20), were examined by IVUS, single plane arteriography and duplex scanning. The predictive value, sensitivity, specificity and kappa value of IVUS were higher than the corresponding values for arteriography. Logistic regression analysis found that IVUS had a predictive value (p=0.0003) for diagnosing significant stenosis as defined by duplex scanning, but arteriography did not (p=0.1). However, this difference in usefulness as predictors did not reach significance. The agreement between arteriography and IVUS was relatively good. The conclusion is that IVUS seems to be superior to single-plane arteriography in predicting hemodynamically significant stenoses as defined by duplex scanning.

Mandible muscle fibers in ants: fast or powerful?

Ants use their mandibles for catching prey, cracking seeds, cutting leaves, or for the construction of nests and the tender care of brood. The functional morphology of the mandibles reflect the species' adaptations to particular foraging habits and social life. The versatility and specialization of the mandibles depend directly on the design and physiology of the mandible closer muscles and their component fibers. A comparative video analysis of the closing movements of ant mandibles revealed that the maximal velocity varies considerably among species. The speed is correlated with the morphology of the mandible closer muscle, the largest muscle in ants. It is composed of two morphologically very distinct fiber types: long fibers with short sarcomeres (sarcomere length approximately 2 microM) showing all the structural attributes of fast muscle fibers, and shorter fibers with longer sarcomeres (sarcomere length approximately 5 microM) exhibiting the characteristics of slow and powerful fibers. Ants with fast-moving mandibles have a very high proportion of fast closer fibers, whereas the muscles of ants that cannot perform fast mandible movements have only a few or no fast fibers at all. Fast fibers always attach directly to the solid apodeme, while slow fibers often attach to thin apodeme threads. We suppose that the latter kind of fiber attachment is disadvantageous for fast contracting fibers but helps the ants to make better use of the space in the head capsule.

Importance of diastolic velocities in the detection of celiac and mesenteric artery disease by duplex ultrasound

PURPOSE

To assess the predictive value of ultrasound duplex scanning in the detection of superior mesenteric artery (SMA) and celiac artery (CA) occlusive disease.

METHODS

Thirty-nine patients in whom mesenteric ischemia was suspected were examined with duplex scan and arteriography.

RESULTS

Duplex scan visualized both vessels in all examined patients. An absent Doppler signal from an adequately visualized SMA or CA was a pathognomonic sign for total occlusion of the arteries. Elevated diastolic velocities (peak diastolic velocity > 70 cm/sec for SMA and > 100 cm/sec for CA) were accurate predictors of arteriographically confirmed stenoses > or = 50%. Increased blood velocity was occasionally observed in a thyrotoxic patient with malabsorption-induced weight loss and abdominal pain but arteriographically-normal SMA. Further examinations of hyperthyroid patients showed systematic elevation of peak systolic velocity in the SMA greater than 300 cm/sec but normal diastolic velocities and resistivity indexes.

CONCLUSION

Duplex ultrasound is a highly selective and specific method for detection of SMA and CA occlusive disease. The most accurate predictors of the disease were increased diastolic velocities, which in contrast to peak systolic velocity also correctly classified thyrotoxic patients. The method can be used before arteriographic evaluation as a screening examination of patients in whom mesenteric ischemia is suspected.

Prediction of outcome after femoropopliteal balloon angioplasty by intravascular ultrasound

OBJECTIVE

To evaluate intravascular ultrasound (IVUS) as a control procedure after femoropopliteal percutaneous transluminal angioplasty (PTA), and compare it with arteriography.

DESIGN

Descriptive study.

MATERIAL

Arteriographic and intravascular ultrasound data obtained from 18 patients (20 limbs) undergoing PTA of the superficial femoral or popliteal artery. The degree of stenosis, the diameter and area of the lumen and the morphological changes in the plaque were related to the short-term patency of the intervention, as evaluated by duplex scan and ankle branchial index.

RESULTS

Fifteen arteries remained patent. Two occlusions and two stenoses developed during the first 3 months after the intervention and one occlusion occurred after 1 year. The following IVUS parameters were related to a favourable patency: presence of calcification; dissection or plaque rupture and residual stenosis of less than 70%. The arteriographically determined diameter reduction did not show predictive value.

CONCLUSION

This study shows that in contrast to arteriography, IVUS revealed parameters predictive for patency following PTA.

Changes in superior mesenteric artery Doppler waveform during reduction of cardiac stroke volume and hypotension

Influence of stroke volume reduction and hypotension on the superior mesenteric artery (SMA) Doppler waveform was evaluated during head-up tilt-induced central hypovolemia in 11 healthy volunteers. During normotensive reduction in stroke volume, peak systolic velocity (pV), mean velocity, pulsatility and resistivity indices decreased, while diastolic velocities increased. During hypotension, a further decrease in pV was accompanied by maintained elevation of diastolic velocities and reduction in pulsatility and resistivity indices. Power of backscattered Doppler wave was elevated throughout the hypovolemia. Alterations in pV and pulsatility indices were closely related to changes in stroke volume, and a negative correlation was found between diastolic velocities and stroke volume. regression analysis showed no significant relation between variations in velocity parameters and blood pressure. Results of the study indicate that alterations in stroke volume induce consequential changes in the SMA Doppler waveform. These changes originate from both direct influence of stroke volume and/or pressure on blood flow velocity, and alterations in SMA peripheral resistance that follow variations in stroke volume. Presented interdependencies should be taken into consideration while studying mesenteric physiology with the use of Doppler technique and while interpreting the duplex results in patients suffering from diseases that may influence flow velocity and mimic or obscure Doppler effects of the SMA stenosis.

Acute and chronic effects of winter swimming on LH, FSH, prolactin, growth hormone, TSH, cortisol, serum glucose and insulin

The present investigation is based on a 2.5 months selbstversuch (self-experiment) of the authors, between October 21 1992, and January 6 1993. 11 healthy students, five females and six males, age 24 to 29 years, and their teachers underwent regular winter swimming at least once a week, for 2 to 10 minutes, at the natural water temperature (6.8 degrees C (October 1992) to 2.0 degrees C (January 1993)) in the southern Baltic Sea. Blood samples were drawn before and 30 and 60 minutes after the cold bath, both at the first and the last day of the swimming season. TSH increased from 0.96 mU/l to 1.42 mU/l (p < 0.01) in the untrained, and from 0.93 mU/l to 1.43 mU/l (p < 0.01) in the cold-trained persons, and decreased thereafter (p < 0.01). Similar changes occurred in cortisol serum concentrations, though psychological stress seemed to interfere with cold stress. Cortisol increased from 99 ng/ml to 133 ng/ml in the untrained, and from 101 ng/ml to 137 ng/ml (p < 0.05) in the cold-trained persons within 30 minutes after cold water immersion, and decreased thereafter (p < 0.01). There were mild decreases in prolactin serum levels after cold stress, whereas FSH, LH and growth hormone remained unaltered. There was a mild initial elevation of serum glucose after cold stress (plus 12 mg/dl, (p < 0.01)) which disappeared after training. There were long term training effects besides the effects on glucose: Basal prolactin levels increased by almost the factor two, and insulin serum levels dropped by almost 50%.(ABSTRACT TRUNCATED AT 250 WORDS)

A lupus anticoagulant neutralization procedure using the patient's own platelets

An auto platelet neutralization procedure (APNP) which assists identification of lupus anticoagulants (LA) is described. Patient platelet-rich plasma is frozen then thawed (PRPF) and an activated partial thromboplastin time (aPTT) is performed on both platelet-poor plasma and PRPF. The degree of correction between the two plasmas is calculated and the percentage APNP is obtained. A lupus anticoagulant was suspected if a sample had a prolonged aPTT and at least two out of three of the following characteristics: (1) aPTT resistant to correction with equal parts normal plasma, (2) prolonged kaolin clotting time mixing test (delta KCT), (3) prolonged dilute Russell's Viper Venom Time that did not correct with normal plasma (DRVVR). Ten normal volunteers had mean (+/- SD) APNP of 7.7 +/- 4.3%. Fifty LA negative patients with normal aPTT, delta KCT and DRVVR, had a mean APNP of 10.0 +/- 6.3%. Twenty-eight patients suspected as LA positive had APNP > 25% with a mean of 39.0 +/- 7.5%. Twenty-one patients with prolonged aPTT attributed to factor deficiency had APNP < 25% with a mean of 6.3 +/- 12.0%. LA was also suspected in two other patients with prolonged aPTT that did not meet the above criterion but had APNP > 25%. In three patients with normal aPTT, LA was suspected and APNP ranged from 21 to 28%. An intermediate APNP range of 20-25% may be suggestive of LA in patients with normal aPTT. The APNP did not appear to be effected by platelet count in the samples tested unless the platelet count in PRP was less than 175 x 10(9)/1.(ABSTRACT TRUNCATED AT 250 WORDS)

Duplex ultrasonography of superior mesenteric artery: interobserver variability

The aim of this study was to evaluate the interobserver variability during duplex ultrasonographic investigation of the SMA. Eleven healthy volunteers were examined twice under the same conditions by two independent observers. Three basic Doppler wave parameters were assessed for the SMA: pV, edV, and rT. The tD was recorded for SMA and abdominal aorta (AotD) with B-mode imaging. The interobserver variability was very low for all parameters: pV = 13.5 cm/s; edV = 3.4 cm/s; rT = 0.01 s; tD = 0.3 mm; AotD = 0.5 mm, with corresponding 95% confidence intervals as follows: pV = 19 cm/s; edV = 4.7 cm/s; rT = 0.015 s; tD = 0.4 mm; and AotD = 0.75 mm. Coefficients of variation also showed very low dispersion for results obtained. Under the appropriate standard conditions for duplex sonographic examination of the mesenteric artery, assessments of basic Doppler wave parameters do not differ significantly between independent investigators. Reliable evaluation of B-mode distances can be obtained by replication of measurements.