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Notley SR, Mitchell D, Taylor NAS. A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 2: physiological measurements. Eur J Appl Physiol 2023; 123:2587-2685. [PMID: 37796291 DOI: 10.1007/s00421-023-05284-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/14/2023] [Indexed: 10/06/2023]
Abstract
In this, the second of four historical reviews on human thermoregulation during exercise, we examine the research techniques developed by our forebears. We emphasise calorimetry and thermometry, and measurements of vasomotor and sudomotor function. Since its first human use (1899), direct calorimetry has provided the foundation for modern respirometric methods for quantifying metabolic rate, and remains the most precise index of whole-body heat exchange and storage. Its alternative, biophysical modelling, relies upon many, often dubious assumptions. Thermometry, used for >300 y to assess deep-body temperatures, provides only an instantaneous snapshot of the thermal status of tissues in contact with any thermometer. Seemingly unbeknownst to some, thermal time delays at some surrogate sites preclude valid measurements during non-steady state conditions. To assess cutaneous blood flow, immersion plethysmography was introduced (1875), followed by strain-gauge plethysmography (1949) and then laser-Doppler velocimetry (1964). Those techniques allow only local flow measurements, which may not reflect whole-body blood flows. Sudomotor function has been estimated from body-mass losses since the 1600s, but using mass losses to assess evaporation rates requires precise measures of non-evaporated sweat, which are rarely obtained. Hygrometric methods provide data for local sweat rates, but not local evaporation rates, and most local sweat rates cannot be extrapolated to reflect whole-body sweating. The objective of these methodological overviews and critiques is to provide a deeper understanding of how modern measurement techniques were developed, their underlying assumptions, and the strengths and weaknesses of the measurements used for humans exercising and working in thermally challenging conditions.
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Affiliation(s)
- Sean R Notley
- Defence Science and Technology Group, Department of Defence, Melbourne, Australia
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Duncan Mitchell
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Nigel A S Taylor
- College of Human Ecology, Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea.
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WINSOR T. Influence of Peripheral Arterial Disease On the Initial Changes in Digital Volume During Reactive Hyperemia. Angiology 2016; 2:243-55. [PMID: 14857365 DOI: 10.1177/000331975100200402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Affiliation(s)
| | | | - Hensel
- Physiologisches Institut der Universität Heidelberg Germany
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Caldwell JN, Taylor NAS. Water-displacement plethysmography: a technique for the simultaneous thermal manipulation and measurement of whole-hand and whole-foot blood flows. Physiol Meas 2014; 35:1781-95. [DOI: 10.1088/0967-3334/35/9/1781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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STRANDELL T, WAHREN J. Circulation in the Calf at Rest, after Arterial Occlusion and after Exercise in Normal Subjects and in Patients with Intermittent Claudication. ACTA ACUST UNITED AC 2009; 173:99-105. [PMID: 13984534 DOI: 10.1111/j.0954-6820.1963.tb16510.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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WINSOR T. Simplified determination of arterial insufficiency; plethysmographic observation of reactive hyperemia following fifteen minute arterial occlusion at the ankle. Circulation 2004; 3:830-6. [PMID: 14848932 DOI: 10.1161/01.cir.3.6.830] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reactive hyperemia following 15 minute arterial occlusion at the ankle was studied in plethysmographic tracings using the venous occlusion technic. The resulting curves present an essentially different pattern in normal subjects and patients with various types of peripheral arterial disease. Several characteristic features can be distinguished, notably the level of highest blood flow after release of arterial occlusion, the time required until the highest blood flow is reached, and the degree of secondary vasoconstriction. Evaluation of these factors permits an estimate of the therapeutic value of lumbar sympathectomy.
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Mayrovitz HN, Sims N. Effects of ankle-to-knee external pressures on skin blood perfusion under and distal to compression. Adv Skin Wound Care 2003; 16:198-202. [PMID: 12897676 DOI: 10.1097/00129334-200307000-00013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the effects of select leg compression pressures on blood perfusion in the skin overlying bone and the skin distal to the leg compression. DESIGN Blood perfusion of skin overlying the tibia and the foot dorsum was simultaneously measured in 12 healthy subjects using laser Doppler. Each subject's calf was compressed from ankle to knee with an air cast that applied external pressure, ranging from 0 to 40 mm Hg in 10 mm Hg increments. All measurements were initiated after a 20-minute rest interval and were recorded with each subject in a supine position. SETTING University research center. RESULTS The main findings show that compression causes a significant decrease in skin blood perfusion (SBF) at both sites, with greater reductions in SBF occurring with increased compression pressure. Greater SBF reductions occurred at the foot than at the directly compressed tibia site. Thus, at the highest pressure (40 mm Hg), the foot SBF reduction (61.6% +/- 13.7%) was greater than at the directly compressed tibial site (33.3% +/- 0.3%), both of which were significantly less than baseline (P <.01). CONCLUSIONS The present findings and considerable related evidence indicate that lower extremity external compression, within the range of commonly used therapeutic levels, reduces SBF by an amount that depends on the magnitude of the compression pressures. The quantitative difference between the effect of compression on SBF within the compression area, and distal to it, is likely a result of the way that the compression affects arteriolar and venous resistance to blood flow at the 2 sites. From a clinical perspective, it would seem prudent to anticipate that sub-bandage and distal SBF would be negatively affected by compression, with greater effects likely in tissue distal to compression.
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Affiliation(s)
- Harvey N Mayrovitz
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
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Irwin ST, Gilmore J, McGrann S, Hood J, Allen JA. Blood flow in diabetics with foot lesions due to 'small vessel disease'. Br J Surg 1988; 75:1201-6. [PMID: 3233470 DOI: 10.1002/bjs.1800751219] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Blood flow was measured in the feet and toes of 23 diabetics, 7 controls and 6 non-diabetic neuropathic controls, using venous occlusion plethysmography. All of the diabetics showed a characteristic flow abnormality with mild hyperperfusion of the foot at rest but impaired peak flow following arterial occlusion. When the diabetics were subdivided into those with 'small vessel disease', those with neuropathic ulceration and those with neuropathy but no ulceration, the groups had remarkably comparable blood flows, except that peak great toe blood flow was rather lower in small vessel disease. In small vessel disease, the combination of high resting blood flow and elevated foot venous oxygen saturation suggests that the hyperperfusion is due to arteriovenous shunting. It seems likely that the toe lesions ascribed to small vessel disease were in fact manifestations of severe diabetic neuropathy. The term small vessel disease should be avoided in the context of diabetic foot lesions.
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Affiliation(s)
- S T Irwin
- Department of Surgery, Queen's University of Belfast, UK
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Abstract
A short historical note on plethysmography is given and the development of the modern computerized pneumoplethysmograph is described. The computer-aided pneumoplethysmogram (CAP), with proper programming, makes possible numerous computations that give new, useful, and rapid information about the patient. New applications of the CAP will quickly develop and the data collected will be quickly analyzed and displayed.
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Francis TJ, McCaig RH. Comparative plethysmography; evidence for a hydrostatic effect on foot blood flow. EUROPEAN JOURNAL OF APPLIED PHYSIOLOGY AND OCCUPATIONAL PHYSIOLOGY 1985; 54:404-12. [PMID: 4065127 DOI: 10.1007/bf02337185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Blood flow in the right foot of 11 subjects was measured simultaneously by a strain gauge placed around the mid metatarsal circumference of the foot and a water displacement plethysmograph in which the foot was resting. A close linear correlation (r = 0.88) between the results of the two methods existed over a wide range of blood flows. It was apparent however that blood flow at the mid metatarsal region of the foot was only about 30% of the total foot blood flow measured by the plethysmograph. The likely cause of this finding is the varying proportion of bone to soft tissue along the length of the foot. It was observed that the strain gauge estimates of blood flow increased two to three fold when the plethysmograph was emptied, an effect that was abolished by refilling the plethysmograph. These changes were highly statistically significant (P less than 0.01) in all ten subjects in whom this comparison was made. The application of progressively increasing hydrostatic pressure in a further 4 subjects demonstrated that the reduction in blood flow was proportional to the pressure applied. Explanations for this effect based upon small temperature and pressure changes altering strain gauge performance are excluded. Three mechanisms are proposed, based upon an increase in venous leakage, a reduction in arterial inflow and the consequence of increased capillary filling occurring as a result of hydrostatic pressure within the plethysmograph.
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Norton JA, Burt ME, Brennan MF. Capacitance plethysmography: validation in an ex vivo human limb model. J Surg Res 1982; 32:127-9. [PMID: 7057629 DOI: 10.1016/0022-4804(82)90079-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Rutlen DL, Wackers FJ, Zaret BL. Radionuclide assessment of peripheral intravascular capacity: a technique to measure intravascular volume changes in the capacitance circulation in man. Circulation 1981; 64:146-52. [PMID: 6786793 DOI: 10.1161/01.cir.64.1.146] [Citation(s) in RCA: 123] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Changes in the capacitance vasculature influence venous return and cardiac performance, so an understanding of the effects of pathophysiologic states on the human capacitance vasculature is necessary to understand integrated cardiovascular function in man. Techniques available to assess the capacitance vasculature in man, however, have limitations. We performed radionuclide imaging of the calf or forearm in 51 patients whose erythrocytes had been labeled in vivo with technetium-99m, basing our approach on the principle that counts from the radiolabeled intravascular space are proportional to blood volume. Two-minute or 15 second count acquisitions were obtained from the calf in 42 patients. Counts obtained at rest demonstrated little variation. With veno-occlusion at 15 and 30 mm Hg, counts increased 8 +/- 1% (+/- SEM) (p less than 0.001) and 28 +/- 2% (p less than 0.001), respectively. After 0.4 mg of sublingual nitroglycerin, counts increased 9 +/- 1% (p less than 0.001). With leg elevation, counts decreased 34 +/- 4% (p less than 0.001). Response patterns were similar with 2-minute and 15-second acquisitions. In nine patients who underwent forearm imaging (2-minute acquisitions), counts increased 14 +/- 2% (p less than 0.001) and 26 +/- 4% (p less than 0.001) at 15- and 30-mm Hg veno-occlusion and 15 +/- 3% (p less than 0.001) after nitroglycerin. Volume displacements, recorded simultaneously with a fluid-filled plethysmograph about the contralateral forearm, correlated linearly in all nine patients. Thus, gamma camera imaging of the radiolabeled peripheral intravascular space provides a quantitative and reliable assessment of peripheral vascular capacity in man. The technique could be used in conjunction with gated cardiac imaging in order to assess the interactions of peripheral vascular capacity and ventricular performance.
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Cristini G, Meduri R, Garbini GC, Giovannini A. A new method for determining the blood quantity in the eye in a unit of time. ALBRECHT VON GRAEFES ARCHIV FUR KLINISCHE UND EXPERIMENTELLE OPHTHALMOLOGIE. ALBRECHT VON GRAEFE'S ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY 1975; 197:1-11. [PMID: 1081845 DOI: 10.1007/bf00506635] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The principles of rheography with "infinite time constant" are utilized. After applying a suction cup electrode mechanism, by gradual increases of the vacuum, ocular pressure rises above venous pressure, and without modification of arterial inflow, the venous outflow is blocked; in consequence an increase of blood accumulation in the interior of the eye occurs. The electrical impedance variation, as a result of the latter, gives the recorded tracing a "slow" rising curve, that maintains the same pulse morphology. After being analyzed and elaborated on with certain mathematical formulae, this curve makes it possible to calculate the blood flow in the eye in a unit of time. Statistics on normal patients of various ages are reported.
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Englund NE, Hallböök T, Ling L, Vang J. Skin and muscle blood flow during regional perfusion with hyperthermal perfusate. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1974; 8:77-9. [PMID: 4857527 DOI: 10.3109/14017437409129068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Raman ER, Vanhuyse VJ, Jageneau AH. Comparison of plethysmographic and electromagnetic flow measurements. Phys Med Biol 1973; 18:704-11. [PMID: 4271311 DOI: 10.1088/0031-9155/18/5/309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Fronek A, Johansen KH, Dilley RB, Bernstein EF. Noninvasive physiologic tests in the diagnosis and characterization of peripheral arterial occlusive disease. Am J Surg 1973; 126:205-14. [PMID: 4721544 DOI: 10.1016/s0002-9610(73)80154-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Ledingham IM, McArdle CS, Parratt JR. Proceedings: Comparison of a coronary vasodilator drug (carbochromen) and a cardiac stimulant (oxyfedrin) on blood flow and oxygen extraction in experimental myocardial infarcts. Br J Pharmacol 1972; 44:323P-324P. [PMID: 4668599 PMCID: PMC1666074 DOI: 10.1111/j.1476-5381.1972.tb07273.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Stevens AE. Improved thigh sphygmomanometer cuff. Lancet 1966; 1:1355. [PMID: 4160753 DOI: 10.1016/s0140-6736(66)92142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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STEENBURG RW, THOMASSON BH. Radiation plethysmograph. J Surg Res 1965; 5:41-8. [PMID: 14228622 DOI: 10.1016/s0022-4804(65)80058-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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GRAF K. Zur Methodik der venösen Okklusionsplethysmografie. Die Wirkung distaler Gefässokklusion auf die Durchblutung im Unterarm. ACTA ACUST UNITED AC 1964; 60:70-89. [PMID: 14131832 DOI: 10.1111/j.1748-1716.1964.tb02870.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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GRAF K. Auswertung und Messfehler okklusions-plethysmografischer Durchblutungsregistrierungen. ACTA ACUST UNITED AC 1964; 60:120-35. [PMID: 14131820 DOI: 10.1111/j.1748-1716.1964.tb02875.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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MACKAY IF, WALKER RL. An investigation to devise a technique for the production of maximal flows of blood in the arm. Am Heart J 1963; 66:509-16. [PMID: 14068374 DOI: 10.1016/0002-8703(63)90383-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Die Fingerdurchblutung in Abh�ngigkeit vom wirksamen arteriellen Mitteldruck. Pflugers Arch 1960. [DOI: 10.1007/bf00420019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Chronic venous insufficiency may be complicated by ulceration of the skin of the involved extremity. The ulcers appear to be caused by the prolonged elevation of venous pressure in the leg and the resultant edema. A device is described that counterbalances exactly the elevated pressure in the veins of the leg, regardless of the position of the patient. This hydrostatic pressure stocking prevents formation of edema without interfering with the flow of blood through the tissues. The use of this device in the treatment of ulcers due to chronic venous insufficiency is also described.
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COFFMAN JD, WOOD JE, WILKINS RW. Effect of cooling and of smoking tobacco upon the blood flow of reactive hyperemia of the foot. Circulation 1958; 18:177-82. [PMID: 13561488 DOI: 10.1161/01.cir.18.2.177] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tobacco smoking and body cooling have been shown to decrease the "resting" blood flow to the foot. The present study was designed to determine whether either of these 2 stimuli also affects the increased blood flow that follows a period of ischemia (reactive hyperemia). Blood flows to the foot were measured in subjects with and without vascular disease by the venous occlusion, water plethysmographic method in a warm and a cool environment before and during smoking. Patients with bilaterally and unilaterally sympathectomized limbs were also studied to determine the mechanism of the observed responses.
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Abstract
The experimental evidence reported here supports the validity of venous occlusion plethysmography.
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M�ller EA, Heising A. Die Armdurchblutung nach Arbeit der Unterarmmuskeln. Eur J Appl Physiol 1953. [DOI: 10.1007/bf00934145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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BARNETT AJ. VENOUS OCCLUSION PLETHYSMOGRAPHY: II. AN AID TO THE DIAGNOSIS AND MANAGEMENT OF PERIPHERAL VASCULAR DISEASE. Med J Aust 1951; 2:458-64. [PMID: 14890177 DOI: 10.5694/j.1326-5377.1951.tb74526.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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KONDO B, WINSOR T. Five-minute arterial occlusion technique for the determination of vascular insufficiency. Am Heart J 1950; 39:99-110, illust. [PMID: 15399488 DOI: 10.1016/0002-8703(50)90013-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Scheinberg P, Dennis E, Robertson R, Stead E. The relation between arterial pressure and blood flow in the foot. Am Heart J 1948; 35:409-20. [DOI: 10.1016/0002-8703(48)90117-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kondo B, Katz L, Meyer J, Malinow M. The plethysmographic measurement of blood flow through the forepaw during experimental shock. Am Heart J 1947; 33:207-17. [DOI: 10.1016/0002-8703(47)90006-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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