Influence of Ergotamine Tartrate Upon Peripheral Blood-Flow in Subjects with Liver Disease

Abramson, David I.; Lichtman, S. S.; Oppenheimer, B. S.

doi:10.3181/00379727-37-9532

Cited by 14 publications

(3 citation statements)

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“…The site of the presumed vasodilatation remains in question, although clinical evidence favors the skin (cutaneous spider angiomata, palmar erythema, warm hands, clubbing of fingers), and the finding of decreased hepatic and splanchnic blood flow in Laennec's cirrhosis (7) would tend to eliminate the splanchnic vascular bed. Indeed, plethysmographic evidence of increased cutaneous blood flow in patients with hepatic disease has been reported (8).…”

Section: Discussionmentioning

confidence: 99%

The Hemodynamic Response to Exercise in Patients With Laennec's Cirrhosis 1

Abelmann¹,

Kowalski²,

McNeely³

1955

J. Clin. Invest.

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Section: Discussionmentioning

confidence: 99%

The Hemodynamic Response to Exercise in Patients With Laennec's Cirrhosis 1

Abelmann¹,

Kowalski²,

McNeely³

1955

J. Clin. Invest.

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“…These findings suggest an increased cerebrovascular sensitivity to noradrenaline in the obstructive jaundice following bile duct ligation. Circulatory disturbances have been demonstrated in liver dysfunction, but the majority of the abnormalities described relate to a decreased peripheral resistance and abnormal cardiac output (Abramson and Lichtman, 1937;Kontos, Shapiro, Mauck, and Patterson, 1964;Martini and Hagemann, 1956;Huston and Puchner, 1957). In a recent study of renal blood flow in baboons with surgically induced obstructive jaundice, Bloom et al (1974) have shown that there is an increased vascular sensitivity to noradrenaline in this organ.…”

Section: Discussionmentioning

confidence: 99%

Modification of the cerebrovascular response to noradrenaline by bile duct ligation.

Bloom¹,

Eidelman²,

McCalden³

1975

Gut

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SUMMARY The effects of intracarotid infusions of noradrenaline on the cerebral vasculature were studied in seven baboons with bile duct ligation. Infusion of 8 ,ug and 16 Mg/min of noradrenaline resulted in a significant decrease in cerebral blood flow in the jaundiced animals. In normal baboons, these doses produced cerebrovascular dilatation. These results indicate that there is an increased cerebrovascular sensitivity to noradrenaline in the obstructive jaundice which follows bile duct ligation. It is postulated that noradrenaline smooth muscle uptake mechanisms are disturbed allowing a greater concentration of the amine at the receptor sites.Recent studies in the baboon have indicated that there is an increased renovascular sensitivity to noradrenaline with bile duct ligation (Bloom, Bomzon, Rosendorff, and Scriven, 1974). Similarly, experiments on an isolated artery preparation have shownpotentiationofthepressoreffectsofnoradrenaline by plasma obtained from these baboons (Bloom, McCalden, and Rosendorff, 1975a). These results suggest that there is a heightened pressor response to circulating catecholamines in the obstructive jaundice following bile duct ligation.The present study was evolved to examine the possibility that a similar hypersensitivity to noradrenaline exists in the cerebral vascular bed in baboons with duct ligation. This may elucidate some of the unexplained symptoms of cerebral dysfunction in hepatic disease (Sherlock, 1968 mg/kg pentobarbitone sodium (Nembutal, Abbott). The animals were then intubated and anaesthesia was maintained with a 3:2 mixture of oxygen and nitrous oxide with similar quantities of barbiturate given to each group as required. A catheter was introduced into the femoral artery to measure intraarterial blood pressure via an electromanometer (Statham P23AA) and to enable arterial blood sampling for determinations of PaCO2, PaO2 and pH on an Instrumentation Laboratories' blood gas analyser (IL 313). The right carotid bifurcation was exposed and a fine catheter was inserted into the lingual artery until its tip just entered the external carotid artery. The external carotid artery and all its remaining branches were then ligated. Cerebral blood flows were measured by an intracarotid '33xenon washout technique. A bolus of 30 ,Ci of 133xenon in 0.2 ml of saline was injected into the lingual catheter and was washed retrograde down the external carotid artery into the internal carotid.The cerebral uptake and clearance of 133Xe was monitored using a 5-cm diameter sodium iodide detector mounted posteriorly over the parietal region. A high degree of collimation was used to exclude the possible radiation arising from noncerebral orbital tissues. This was confirmed by the absence of a third flow component (extracranial perfusion) in the clearance curves. After the initial peak of activity the clearance data were recorded for at least 15 min in digital form with a Nuclear Enterprises' data logging system. When exceptionally slow flows were found this record was extended to 20 minutes...

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“…A hyperdynamic circulation is often found in patients with liver disease (Kontos, Shapiro, Page Mauck, and Patterson, 1964;Murray, Dawson, and Sherlock, 1958) and increased blood flow to the hand has been demonstrated in cirrhosis (Abramson and Lichtman, 1937;Martini and Hagemann, 1956). As it is generally accepted that blood flow to the hand is almost entirely cutaneous (Kontos et al, 1964), skin blood flow would appear to be increased in liver disease.…”

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confidence: 99%

Skeletal muscle blood flow and neurovascular reactivity in liver disease

Lunzer¹,

Newman²,

Sherlock³

1973

Gut

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SUMMARY There was no significant difference in forearm muscle blood flow, measured by the clearance of 133Xenon when 38 patients with liver disease were compared with 38 normal subjects. Patients with a clinically hyperdynamic circulation, finger clubbing, and previous portocaval anastomoses were included in the study.The changes in forearm skeletal muscle blood flow and pulse rate caused by a head-up tilt of 70 degrees were measured in 15 patients with chronic liver disease and 15 age-matched controls. Head-up tilting resulted in significantly less peripheral vasoconstriction and tachycardia in the group with liver disease than in the control group.These results suggest an impairment of baroreceptor-mediated sympathetic reactivity in liver disease. Such a defect might explain the relative rarity of hypertension in patients with cirrhosis.A hyperdynamic circulation is often found in patients with liver disease (Kontos, Shapiro, Page Mauck, and Patterson, 1964;Murray, Dawson, and Sherlock, 1958) and increased blood flow to the hand has been demonstrated in cirrhosis (Abramson and Lichtman, 1937;Martini and Hagemann, 1956). As it is generally accepted that blood flow to the hand is almost entirely cutaneous (Kontos et al, 1964), skin blood flow would appear to be increased in liver disease.The major components of forearm blood flow in normal subjects at rest are those to skin and skeletal muscle (Cooper, Edholm, and Mottram, 1955). Kontos et a! (1964) have presented indirect evidence that in some patients with cirrhosis there are increases in both muscle and skin blood flow whereas in others only one of these two components is increased. However, there has been no direct evaluation of skeletal muscle blood flow in liver disease.The factors responsible for the circulatory changes of liver disease are unknown, many unsuccessful attempts having been made to identify a humoral vasodilator substance. We have investigated neurovascular responsiveness in patients with chronic liver disease in order to determine a possible alter- Received for publication 8 February 1973 native explanation for these circulatory changes. Head-up tilting from the horizontal position is a powerful stimulus to the baroreceptors in the low pressure vascular compartments in the chest. Firing of these baroreceptors results in reflex vasoconstriction of blood vessels in the forearm and a concomitant tachycardia. These reflexes are transmitted via the sympathetic nervous system. MethodsSkeletal muscle blood flow was measured using the technique of Lassen (Lassen, Lindbjerg, and Munck, 1964). All subjects were supine and had neither eaten nor smoked for at least two hours. Studies were performed at room temperature (23-26°C).133Xenon gas, 150-250 ,Ci, dissolved in not more than 0.15 ml of saline was injected directly into the brachioradialis muscle. The injection was given over a 15-second period and the needle left in situ for a further 15 seconds. At least 15 minutes was allowed to elapse before recording was commenced.The clearance of xenon w...

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Influence of Ergotamine Tartrate Upon Peripheral Blood-Flow in Subjects with Liver Disease

Cited by 14 publications

References 0 publications

The Hemodynamic Response to Exercise in Patients With Laennec's Cirrhosis 1

The Hemodynamic Response to Exercise in Patients With Laennec's Cirrhosis 1

Modification of the cerebrovascular response to noradrenaline by bile duct ligation.

Skeletal muscle blood flow and neurovascular reactivity in liver disease

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