Cardiac output (CO) and the distribution of blood flow were studied in chronically catheterized conscious rats during sustained (4 days) sepsis. Septicemia was induced by intraperitoneal administration of a pooled fecal inoculum, and tissue blood flow and CO were determined daily with 15-micron radioactive microspheres. Mean arterial blood pressure (MABP, 113 +/- 2 mmHg), CO (244.5 +/- 11.4 ml X min-1 X kg-1), and total peripheral resistance (TPR, 1.36 +/- 0.07 mmHg X ml-1 X min) were stable in control rats over the 4 days postinoculation. Septic animals showed a consistent tachycardia with MABP significantly reduced only on days 3 and 4 (86 +/- 4 mmHg). A hyperdynamic response to sepsis was indicated by an elevated CO (27%) and similarly reduced TPR on day 2. The calculated stroke volume averaged 0.22 +/- 0.01 ml/beat and did not vary over time or between the two groups. There was a 40-70% increase in blood flow to the heart, spleen, adrenal glands, and small intestine, and a greater than sixfold increase in hepatic arterial blood flow. The sustained elevation of coronary blood flow, observed in septic animals, was independent of myocardial work and is consistent with impaired myocardial function. Pancreas, stomach, and skeletal muscle blood flow was consistently compromised (24, 39, and 52%, respectively) during sepsis. Blood flow in other organs remained unchanged over time. Sepsis-induced changes in the fractional distribution of blood flow to various organs were similar to those described for absolute flow. (ABSTRACT TRUNCATED AT 250 WORDS)

Myocardial blood flow was analyzed by radioisotope-labeled microspheres and ultrafast computed tomography (CT) in 16 closed-chest, anesthetized dogs. The first set of 10 dogs had CT and microsphere measurements before and after chromonar-induced increases in myocardial blood flow. A second set of six dogs had flows measured at control and during temporary reductions in regional flow produced by balloon cuff occlusion of the left anterior descending coronary artery. All dogs had four-slice, 20-instance CT scans after injection of a medium bolus (0.35 ml/kg) of contrast medium into a femoral vein simultaneous with injection of microspheres into the left atrium. CT myocardial flow was calculated as the change in myocardial CT numbers divided by the area from a blood pool time-density curve. A wide range of myocardial blood flows was produced as determined by microspheres (0 to 6.7 ml/min/g). Global flow of the first set of dogs was shown to have excellent correlation (r = .95, n = 17) for a limited range (.4 < X < 1.4 ml/min/g) of flows. Regional flows of these measurements demonstrated less correlation (r = .63, n = 110) but extended the range of flow to 1.7 ml/min/g. At higher flows (> 2.5 ml/min/g) the correlation for global and regional flows was not significantly different than zero. Regional ischemic flow correlation extended the linear range of flow to 0 ml/min/g (r = .62, n = 17). These results show that CT can measure myocardial blood flow over a limited but clinically relevant range of flows defined as slightly above normal to ischemic. These results indicate that another preparation of CT flow measurement must be sought for quantification of myocardial perfusion values significantly above normal. Circulation 76, No. 6, 1262-1273 MEASUREMENT of myocardial blood flow in man has been evaluated by the combination of cardiac imaging methods and a variety of indicators. This approach has been limited in the heart by the lack of an imaging modality that could acquire images with high temporal and spatial resolution and accurately measure the concentration of an indicator in the myocardium. Currently, the only clinically available method of measuring absolute myocardial blood flow is xenon

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The objective of this article is to provide health care of hepatitis C among injection drug users. (HEPATOLOGY providers, patients, and the general public with a respon-1997; 26(Suppl 1):2S-10S.) sible assessment of current available methods to diagnose, treat, and manage hepatitis C. A non-Federal, nonadvocate, 12-member panel representing the fields of The hepatitis C virus (HCV) is one of six viruses (A, B, C, D, E, and G) that together account for the majority of general internal medicine, hepatology, gastroenterology, infectious diseases, medical ethics, transfusion medicine, cases of viral hepatitis. According to the National Health and Nutrition Examination Survey of 1988 to 1994 and other epidemiology, biostatistics, and the public participated. In addition, 25 experts from these same fields presented population-based surveys, estimates of the incidence and prevalence of HCV infection have been made. Nearly four data to the panel and a conference audience of 1,600. The literature was searched through Medline, and an ex-million Americans are infected with hepatitis C. The infection is more common in minority populations (3.2% of blacks tensive bibliography of references was provided to the panel and the conference audience. Experts prepared ab-and 2.1% of Mexican-Americans) than in non-Hispanic whites (1.5%). The incidence of hepatitis C infection appears stracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anec-to be declining since its peak in 1989. Currently, approximately 30,000 acute new infections are estimated to occur dotal experience. The panel, answering predefined questions, developed their conclusions based on the sci-each year, approximately 25% to 30% of which are diagnosed.Hepatitis C accounts for 20% of all cases of acute hepatitis. entific evidence presented in open forum and the scientific literature. The panel composed a draft statement Currently, hepatitis C is responsible for an estimated 8,000to 10,000 deaths annually, and without effective intervention that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel re-that number is postulated to triple in the next 10 to 20 years.Hepatitis C is now the leading reason for liver transplantation solved conflicting recommendations and released a revised statement at the end of the conference. The panel in the United States.The switch from commercial to volunteer blood donors finalized the revisions within a few weeks after conference. Hepatitis C is a common infection with variable and the development of a diagnostic blood test for hepatitis B in the early 1970s led to screening of blood donors and course that can lead to chronic hepatitis, cirrhosis, and hepatocellular carcinoma. The course of illness may be reduced from 30% to 10% the incidence of hepatitis after multiple transfusions. The remainder of these transfusionadversely affected by various factors, especially alcohol consumption. Therefore, more than one drink per day is ass...