Microcirculation

Microcirculation: Current Physiologic, Medical, and Surgical Concepts is based primarily on a course and a series of lectures presented at a congress on microcirculation held at the University of California in August 1979. The book gives an overview of the concepts regarding the structure and properties of small vessels, a topic mostly read only in specialized journals. The primary focus of the text is on the function and dysfunction of small blood vessels.
Three major parts comprise the text. Part I discusses the morphology, physiology, and pharmacology of circulation, and Part II presents the dynamics or role of the microcirculation in the study of diabetes. Finally, Part III discusses also the role of microcirculation in disease states, particularly hemoconcentration.
The book will provide much information to researchers and students in the fields of biology, medicine, physiology, and pharmacology.

Contenu

List of Contributors

Preface

1 Introduction

Text

References

I Basic Structure and Function of the Bicrocirculation

2 Anatomy of the Microcirculation

Definition of Term

Functional Considerations

General Considerations

Structural Characteristics of the Microcirculation

Other Types of Blood Vessels within the Microvascular Bed

References

3 Assessment of Capillary Permeability Using Lymphatic Protein Flux: Estimation of the Osmotic Reflection Coefficient

Introduction

Theory Development

Summary

References

4 Capillary Exchanges: Small Solutes

Introduction

The Conventional Approach

The Phenomenological Approach

Summary

References

5 Pharmacology of the Microcirculation

Comparative Size and Ultrastructure of Muscular Microvessels

Density of Adrenergic Innervation

Pharmacologic Evidence Supporting Rich Adrenergic Innervation of Arterioles and Sparsity of Innervation in Muscular Venules

a-Adrenergic Receptors in Microvessels

Venular Size and Reactivity

ß-Adrenergic Receptors in Microvessels

Relative Sensitivity of Muscular Microvessels to Different Constrictor Hormonal and Humoral Agonists and Specificity of Receptors

Dilator Humoral Agonists and Specificity of Dilator Receptors

Direct In Vivo Evidence Implicating Roles for Certain Humoral Substances in Regulation of Blood Flow

Electrophysiology of Arteriolar and Venular Smooth Muscle

Speculation on Mechanisms of Contraction and Relaxation in Arterioles versus Venules

Effects of Anesthetic Agents on Tone and Reactivity of Microvessels

Structure-Activity Studies on Muscular Venules: Microcirculatory Approach to Treatment of Low-Flow States

Conclusions

References

6 Structure and Function of the Sympathetic Nerves in the Pulmonary Vascular Bed of the Dog

Introduction

Methods

Results

Discussion

References

7 The Basement Membrane in the Microvasculature

Introduction

Morphology

Biochemistry

Antigenic Components of Basement Membranes

Origin of Basement Membranes

Turnover

Function

Summary and Conclusions

References

8 Endothelial Metabolism

Introduction

Anatomical Considerations

An Overview of Known Metabolic Activities

Therapeutic Implications

Concluding Remarks

References

II Diabetes Mellitus and the Microcirculation

9 The Dynamics of the Microcirculation as a Tool for the Study of Events in Diabetes

Disturbed Glucose Metabolism in Diabetes

Early Functional Changes in the Microcirculation

Hypoxia as a Factor for Retinal Changes

Impaired Erythrocyte Oxygen Delivery and Functional Microangiopathy

References

10 The Present Status of Basement Membrane Thickening in Diabetes

Introduction

Structure and Function of Capillary Basement Membrane

Frequency and Severity of Capillary Basement Membrane Thickening in Different Types of Diabetes

Pathophysiological Considerations and Pathogenesis of Capillary Basement Membrane Thickening

Relationship of Basement Membrane Thickening to Diabetic Nephropathy, Retinopathy, and Large Vessel Disease

Pathophysiological Consequences and Implications of Capillary Basement Membrane Thickening in Diabetes

References

11 The Microcirculation and Pathology of the Diabetic Retina

Pathology

Vascular Lesions

Pathogenesis

References

12 The Functional and Degenerative Pathology of the Diabetic Kidney

Introduction

Renal Function in Early Diabetes

Anatomic Renal Changes in Early Diabetes

Renal Function in Long-Standing Diabetes

Anatomic Changes in Diabetic Nephropathy

Why Does the Diabetic Kidney Fail?

What is the Sequence of Development of Diabetic Nephropathy?

Treatment Principles in Diabetic Nephropathy

Summary

References

III Hemorheology and Hemodilution

13 Factors Promoting and Preventing the Fluidity of Blood

Introduction

The Concept of Red Cell Fluidity

Disadvantages and Risk Factors of Blood Rheology: Pseudoplastic Behavior in Diseases

Interaction of Vasomotion and Blood Rheology

Abnormal Flow "Properties" in Disease: "Hyperviscosity Syndromes" and Blood Fluidity

Red Cell "Rigidification" ("Sclerocytosis")

References

14 Quantitative Assessment of Microvascular Integrity by Tissue Oxymetry in Patients

Clinical Tissue Oxymetry-Methods, Electrode Technology, Recording Instrumentation, and Data Processing

Recording Instrumentation

Physiological Significance of Tissue PO2

Clinical Tissue Oxymetry

Skeletal Muscle PO2 as a Diagnostic Tool in Intensive Care Medicine

Intraoperative Tissue Oxymetry

Summary

References

15 Hemodilution as a Therapy in Occlusive Vascular Disease of the Limbs

Introduction

Patient Selection, Procedures, and Measurements

Results

Discussion

Conclusion

References

16 Retinal Vascular Occlusions: Hemodilution, a New Therapeutic Concept?

Introduction

Methods

Results

Discussion

References

17 Stabilization of the Circulation by Hemodilution in Elective and Cardiac Surgery

Definition of Hemodilution

Hemodilution versus Hemoconcentration

Oxygen Transport and Tissue Oxygenation

Myocardial Performance, the Limiting Factor in Hemodilution

The Importance of Normovolemia and the Choice of the Diluent

Acute Preoperative Hemodilution in Elective Surgery

Hemodilution in Open Heart Surgery

Summary

References

Index