Microcirculation

List of ContributorsPreface 1 Introduction Text ReferencesI 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 α-Adrenergic Receptors in Microvessels Venular Size and Reactivity β-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 ReferencesIII 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 ReferencesIndex