Haemodynamic improvements after peritoneovenous shunting in nephrogenic ascites

A patient being treated by regular hemodyalisis for end-stage renal failure had nephrogenic ascites. Despite attempts at fluid removal by ultrafiltration, progressive hypotension and low cardiac output eventually reduced fistula flow so much that haemodylasis became almost impossible. The insertion of a peritoneovenus shunt resulted in reduction of ascites and 78 percent increase in cardiac output, with consequent correction of hypotension and improvement of fistula flow. Peritoneovenous shunting is a simple and beneficial form of treatment for nephrogenic ascites that does not respond to fluid removal by dialysis (Summary)

Oxygen transport in sickle cell anemia

Oxygen transport and delivery in sickle cell anemia are discussed in terms of hemodynamics and blood oxygen affinity. The current concepts of the regulation of the hematocrit value by the oxygen pressure on the venous side of the renal capillary are reviewed, and the concept of 'anemia' redifined. The marked right shift in the oxygen dissociation curve of sickle cell anemia blood is analyzed in terms of the sickling process, the hemolytic anemia, and increase in 2.3 diphosphoglycerate. The clinical implications of this right shift in perpetuating sickling are discussed in the light of its possible correction by treatment with sodium cyanate (AU)

Haemodynamic studies in eleven patients before and during peritoneoscopy - abstract

The peritoneoscopy was performed under general anaesthesia in 9 cases and under local anaesthesia in 2 patients. Dye dilution studies and measurements of arterial blood pressure and pulse rate were done at 4 stages: 1. with patient awake 2. with patient anaesthetized (did not apply in local anaesthesia) 3. immediately after peritoneal insufflation of nitrous oxide, and 4. during the peritoneoscopy. With peritoneal insufflation there was a fall in cardiac output, mainly due to a reduction in stroke volume. There was also an increase in the circulation time. Most patients reponded to these changes in venous return by an increase in systemic vascular resistance and pulse pressure, with variable changes in mean arterial pressure, stroke work decreased following peritoneal insufflation. This indicates that the fall in stroke volume caused no compensatory rise in mean arterial pressure. Most patients showed a reversal of these changes during the next 10 to 15 minutes while peritoneoscopy was in progress (AU)

Haemodynamic and spatial patterns of the hepatic vascular system

A brief review of the accepted morphology of the liver relevant to hepatic haemodynamics is given, with a critical account of the methods previously used to study the parameters of hepatic circulation and of the results of such investigations. The theoretical basis of the method to be used in the experiments on the hepatic vascular bed is given. The conditions under which this theory is valid, in a real vascular system, are carefully examined. The method of preparing an isolated perfused canine liver and of recording indicator-dilution curves is described, emphasis being placed on practical considerations. Results of experiments on the pressure-flow relationships in the liver are presented to demonstrate the viability of the presentation. The concept of hepatic vascular 'spaces' and the method of their circulation from the indicator-dilution curves are described in detail. The results of the investigation into the variation of the hepatic vascular 'spaces' with flow rates are presented and the analysis of the variations in term of a regression line, are explained. On the basis of these results a three compartment model of the hepatic vascular system is proposed and the anatomical and theoretical significance of the model is examined. Further considerations of the model suggest certain lines of investigation:- (a) Functional differences between liver regions supplied by the portal vein and hepatic artery. (b) The effect of reversal of the venous circulation through the liver. Both these aspects are investigated and analysed in terms of the proposed model. The correspondence between the model and the accepted anatomy of the liver is examined. Finally the results are considered in comparision with those obtained by other methods and possible extensions of the present work are suggested (AU)