Pulmonary hypertension in dogs with heartworm before and after the adulticide protocol recommended by the American Heartworm Society

Pulmonary hypertension (pH) is a frequent and severe phenomenon in heartworm disease (Dirofilaria immitis). There is a lack of studies assessing the evolution of the proliferative endarteritis and pH caused by D. immitis after the death of the parasites, so this study evaluated the influence that the elimination of the worms exerts over the pulmonary pressure and therefore evolution of the endarteritis, through the evaluation of the Right Pulmonary Artery Distensibility (RPAD) Index and other echocardiographic measurements in 2D mode, M-mode and Doppler echocardiography in 34 dogs naturally infected by D. immitis on day 0, and one month after the last adulticide dose (day 120). pH, based on the determination of the RPAD Index, was present in 68% of the dogs (n=23) on day 0 and on day 120. No significant differences were observed between the RPAD Index between the two measurements, and only significant differences were found in pulmonary deceleration time, ejection time, and left ventricular internal diameter in telediastole when measurements from day 0 and day 120 were compared. There was not any worsening in the development of pH after the elimination of the parasites, independently of the parasite burden. During the adulticide treatment, the death of the worms causes thromboembolism and tends to worsen the vascular damage and presence of pH . It seems that following the adulticide protocol recommended by the American Heartworm Society with the previous elimination of Wolbachia and reduction of microfilariae followed by the stepped death of the worms did not cause a significant aggravation of the pulmonary damage of the treated dogs. Neither is present any significant improvement in the RPAD Index on day 120; probably, more time is needed before appreciating some positive changes after the elimination of the worms and Wolbachia from the vasculature and further studies are necessary.

[The experience with thoracoscopic sympathectomy for the treatment of distal lesions of limb arteries]

The study included 107 patients with distal lesions of limb arteries treated with the use of thoracoscopic sympathectomy. The best results in the early postoperative period were obtained in patients with Raynaud's disease. Modifications introduced into the methods of its treatment permitted to retain effectiveness of sympathectomy till the late postoperative period in 90% of the patients. Surgery for obliterative endarteritis and atherosclerosis was viewed as a possibility to preserve the supporting function of the limb. This purpose was attained in 73.2 and 62.5% of the patients respectively in the early and in 62 and 25% in the late postoperative periods.

[Chronic angiospastic arterial ischemia of limbs in the patients of elderly and senile age]

The experience of examination and treatment of about 3000 patients having chronic arterial ischemia of extremities allowed to determine that such a clinical presentation appears as a result of functional organic diseases of arteries of extremities: arterial vasoconstriction and obliterating disease of arteries (obliterating atherosclerosis, obliterating endoarteritis, diabetic angiopathy). Chronic ischemia of extremities develops from arterial vasoconstriction of central genesis and then obliterating disease of arteries joins the process. The paper is devoted to the first phase of development of chronic arterial ischemia of extremities: vertebragenous angiospastic disease of arteries of extremities and its treatment for patients of middle and old age.

Neonatal infective endarteritis complicating patent ductus arteriosus

Infective endarteritis complicating patent ductus arteriosus (PDA) is a rare occurrence. Most cases are reported in older children and adults, and there are little published data describing this condition in the preterm neonate. We outline the presentation, clinical course, management and outcome of two affected infants born at less than 27 weeks of gestation.

CONCLUSION

This report highlights the importance of a detailed cardiac evaluation in a neonate with persisting bacteraemia. An increasing awareness of neonatal ductal endarteritis combined with the wider availability of more sensitive echocardiography has implications for local neonatal service delivery.

[Evaluation of functional potentials of microcirculation in patients with obliterating diseases of lower limb vessels]

An analysis of the data of laser doppler fluorometry in 136 patients has shown that different obliterating diseases have different typical fluorometric features of changes in microcirculation. Results of the postischemic test are of greater informative value in the noninvasive assessment of the functional state of microcirculation. The significance of the functional tests was particularly increasing in critical ischemia of the lower extremities. The intraoperative determination of the muscle blood flow allowed performing the control of the lower extremity revascularization and determining the optimum level of amputation.

[Use of UV-irradiated autologous blood in the treatment of patients with occlusive vascular diseases of the lower extremities]

Based upon the investigation of the hemogram, biochemical indices of blood and certain instrumental methods of research in patients with a critical form of obliterating diseases of lower extremity vessels, whose treatment included UVI of auto-blood, the authors have shown pronounced clinical efficiency of the method of treatment resulting in the improvement of theological properties of blood, microcirculation in tissues, less pain syndrome and rapid healing of trophic ulcers against the background of better condition of the patient. The method allowed the time of staying at the hospital to be substantially shortened.

[Ergography of crural muscles in the diagnosis of arterial occlusive diseases of the lower extremities]

Under examination there were 280 patients with obliterating diseases of lower extremity arteries using the methods of selective ergometry of musculus gastrocnemius. It was established that initial stages of the disease were characterized by 10-fold decrease of working capacity of leg muscles. With progress of ischemia and longer duration of the disease and simultaneously decreased volume of work the strength of a single muscular contraction dropped, their average and maximum instantaneous power decreased which demonstrates the development of degenerative alterations in muscles. Bilateral lesion of the arteries was diagnosed in 85% of patients with complaints about ischemic pains in one extremity. Selective ergography may be used for diagnosing preclinical forms of the disease and objective evaluation of the results of treatment.

[Blood flow "stealing" phenomenon in the foot as one of the causes of ischemia of the toes]

An examination of 750 patients with chronic ischemia of lower extremities has revealed 12 patients whose foot arteries pulsation could be determined by pulpation. However, by means of angiography of the ischemic lower extremity, ultrasound flowmetry of the foot arterial arch with the use of compression tests these patients were found to have the syndrome of "robbing" the foot bloodflow.

[Plasmapheresis in the treatment of patients with vascular diseases]

The mechanisms of positive effects of plasmapheresis were studied in 52 patients with angiological pathology who were given 135 sessions of plasmapheresis. Most of the patients had obliterating atherosclerosis (28) and endarteritis (16). The clinical effect obtained in 80.7% of the patients with a severe regional ischemia was associated with the improved hemorheology (lower blood viscosity, lower fibrinogen level, higher deformability of erythrocytes), with hypocoagulation and normalization of the correlation of high and low density lipoproteins in atherosclerotic patients. These effects are of relatively long durations, the repeated courses of plasmapheresis within 6-8 months being, as a rule, successful.

[Treatment of occlusive vascular diseases of the lower extremities using the method of autologous transfusion of UV-irradiated blood]

Knott's autotransfusion of UV-irradiated blood was performed in 163 inoperable patients, including 141 patients with obliterating atherosclerosis and 22 patients with endarteritis. Good clinical effect was produced that was particularly apparent in patients with obliterating atherosclerosis. Assessment of the effects of autotransfusion of US-irradiated blood on microcirculation, peripheral circulation, hemostasis and humoral immunity in the two samples confirmed the method's efficiency.

[Diagnostic possibilities of polysegmental occlusive rheoplethysmography in disorders of arterial circulation of the lower extremities]

The method of polysegmentary occlusive rheoplethysmography was used in 90 patients with endarteritis and obliterating atherosclerosis in order to establish the phasic character of blood filling curves, the dependence of the curve prophile on the alterations in blood circulation. It facilitated diagnostics of localization and character of injuries of the arteries, detection of the collateral blood flow and the presence of compensatory vasodilatation or pathological arterio-venous output.

[Functional potentials of the microcirculatory system in patients with thrombo-obliterative arterial diseases of the lower extremities]

Photoangiotensiotonography in the microcirculation system was used in order to study hemodynamic indices and its functional potencies in patients with thrombo-obliterating diseases of the lower extremity arteries. The progress of the disease was established to be followed by a considerable decrease of the main indices of hemodynamics in microvessels and the functional capacity of the microcirculation system.

[Correction of the regional blood flow in obliterating vascular lesions of the legs]

Results of different methods of treatment of 712 patients with obliterating injuries of the lower extremity vessels were followed for the period from 1974 to 1980. Complex conservative therapy was used in 225 patients. Good results were observed in 1/3 of the patients. Operations were fulfilled in 487 patients: 273 lumbar sympathectomies (bilateral in 28%) and 214 reconstruction operation on the arteries. The prognosing of effects of sympathectomies gave positive results in 84.3% of patients. Good remote results after reconstructive operations were observed in 72,5% of patients. The authors emphasize a short-term effect of reconstructive operations below the inguinal ligament.

[Prognosis of the effect of sympathectomy of the extremity in obliterating lesions of the major arteries]

Indices of the central hemodynamics were studied by the method of integral rheography in 76 male patients with obliterating lesions of the lower extremity arteries. The elasticity of the arterial vascular bed in these patients was found to reduce. It proved to be possible not only to estimate the effects of operative desympathization of the lower extremities but also to prognoze its nearest results by the data of temporal chemical desympathization of the lumbar ganglia by novocain or peridural blockade.

[Intraosseous blood pressure in occlusive arterial diseases of the extremities]

The intaosseous blood pressure was studied in 78 patients with occlusion diseases of the extremity arteries. It was established that the intraosseous blood pressure of the 1st stage varied within the range of the lower and upper limits of normal values, that of the 2nd and 3d stages was increased, and at the 4th stage the intraosseous pressure was decreased.

[Capillary blood flow and oxygen consumption in the leg muscles in obliterating endarteritis]

Free oxygen tension (pO2) and tissue blood flow (by the rate of elimination of hydrogen from the tissues after its single inhale) at rest and after functional stresses (oxygen inhalation, walking) were studied polarographically in healthy persons (10), patients with obliterating endarteritis (25) and obliterating atherosclerosis (22). It was shown that the rate of pO2 and capillary blood flow reduction in the tissues and peculiarities of their changes in response to functional stresses aid in establishing the precise differential diagnosis of obliterating endarteritis and atherosclerosis, a stage of the disease and also in evaluating the efficacy of treatment.

[Electrical activity of the motor units of the muscles in blood supply disorders of the latter]

Electrical activity of the motor units in the muscles (m. gastrocnemius and m. extensor hallucis brevis) in normal humans and in the patients with impaired peripheral circulation in the lower limbs was studied with the needle concentric electrodes. A reduction in the muscle action potentials under conditions of their circulation impairment was revealed; this pointed to the myogenic origin of alterations in the skeletal muscles due to the incompetence of their blood circulation.