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Three studies are presented demonstrating the reliability of the pressure algometer as an index of myofascial trigger point sensitivity. The first study showed high reliability between and within experimenters when measuring marked trigger point locations. In study 2, significant between experimenter reliability in locating and measuring the same unmarked trigger point locations was shown, while study 3 supported the idea that trigger points are discrete points of focal tenderness within the muscle. The ability to quantify and reliably measure trigger point sensitivity opens the door to a range of clinical and research possibilities for myofascial and related musculoskeletal pain problems.

Isolated lungs from high-altitude rats compared with those from low-altitude rats have blunted hypoxic pressor responses. Because calcium is essential for the hypoxic pressor response and has been shown to be altered in the pulmonary arterial smooth muscle during high-altitude exposure, we wondered whether altered calcium metabolism might account for the blunted response. We attempted to unmask differences between high- and low-altitude rat lungs by altering extracellular calcium. The addition of calcium to the blood perfusate augmented the hypoxic pressure response of high-altitude lungs and depressed that of low-altitude lungs. Calcium addition did not affect pressor responses to angiotensin II, but slowed vasodilation after both angiotensin injection and removal of the hypoxic stimulus. The maximal KCl-induced contraction was blunted in rings of main pulmonary artery from high-altitude rats, but augmented in their aortic rings. Submaximally constricted (40 mM KCl) pulmonary arteries from low- but not high-altitude rats further constricted with calcium addition. Aortic rings exhibited an inverse behavior. Thus, calcium addition augmented the blunted vasopressor response in high-altitude rats lungs, possibly by an effect on lung arteries. The aorta and main pulmonary artery differ in calcium handling.

To evaluate pulmonary vasodilation in a structurally altered pulmonary vascular bed, we gave endothelium-dependent (acetylcholine) and endothelium-independent [sodium nitroprusside, prostaglandin I2 (PGI2)] vasodilators in vivo and to isolated lobar pulmonary arteries from neonatal calves with severe pulmonary hypertension. Acetylcholine, administered by pulmonary artery infusion, decreased pulmonary arterial pressure from 120 +/- 7 to 71 +/- 6 mmHg and total pulmonary resistance from 29.4 +/- 2.6 to 10.4 +/- 0.9 mmHg.l-1.min without changing systemic arterial pressure (90 +/- 5 mmHg). Although both sodium nitroprusside and PGI2 lowered pulmonary arterial pressure to 86 +/- 4 and 96 +/- 4 mmHg, respectively, they also decreased systemic arterial pressure to 65 +/- 4 and 74 +/- 3 mmHg, respectively. Neither sodium nitroprusside nor PGI2 was as effective as acetylcholine at lowering total pulmonary resistance (18.0 +/- 3.6 and 19.1 +/- 2.2 mmHg.l-1.min, respectively). Right-to-left cardiac shunt through the foramen ovale was decreased by acetylcholine from 1.6 +/- 0.4 to 0.1 +/- 0.2 l/min but was not changed by sodium nitroprusside or PGI2. Isolated lobar pulmonary arteries from pulmonary hypertensive calves did not relax in response to acetylcholine, whereas isolated pulmonary arteries from age-matched control calves did relax in response to acetylcholine. Control and pulmonary hypertensive lobar pulmonary arteries relaxed equally well in response to sodium nitroprusside. We concluded that acetylcholine vasodilation was impaired in vitro in isolated lobar pulmonary arteries but was enhanced in vivo in resistance pulmonary arteries in neonatal calves with pulmonary hypertension.

Within days of ascent to high altitude when symptoms of acute mountain sickness (AMS) are common, pulmonary and cerebral edema may also develop. Although peripheral edema of the hands, face or feet may also appear, its association with AMS is unclear. In addition, persons with high altitude pulmonary edema often report an antidiuresis. Hence, altitude sickness appears to result from abnormalities in the handling of body water. To test this hypothesis, we studied 102 men and women who were trekking in the Mount Everest region of Nepal. Most were seen both at low (1377 m) and at high (4243 m) altitude. Severity of AMS was measured by an established Symptom Score derived from a questionnaire and physical examination. Change in body water was inferred from change in body weight in less than 10 days. Peripheral edema was assessed separately by physical examination. AMS Symptom Score correlated directly with weight change; those who remained well lost weight, whereas increasing signs and symptoms of AMS occurred in those with increasing weight gain. The symptomatic subjects also developed peripheral edema and reported decreased urinary output. These findings support the hypothesis that with rapid ascent to high altitude, abnormalities in the handling of body water, with antidiuresis, result in fluid retention (weight gain) manifest as peripheral, pulmonary, and/or cerebral edema.

Rapid ascent to high altitude may cause serious problems for climbers, skiers, and aviators. In contrast, gradual ascent enables humans to function where the unacclimatized cannot. To examine changes in the O2 transport system that produce acclimatization, eight men were taken in a decompression chamber (without other stresses experienced on high mountains) to a simulated altitude of 8,840 m (29,028 ft, ambient PO2 = 43 Torr) in 40 days. Maximal O2 uptake fell to 1.2 l/min, and arterial PO2 and PCO2 were 30 and 11 Torr, respectively, with arterial pH of 7.56. Many sophisticated studies were done: Swan-Ganz catheterization and inert gas diffusion studies at three altitudes showed that normal cardiac function persisted, pulmonary vascular resistance increased and at extreme altitude was not lowered by O2, and pulmonary ventilation-perfusion mismatch increased, though variably. This appears to be an important factor limiting performance at extreme altitude. This paper presents the background, general approach, and a summary of major observations reported in detail in other papers.

Cardiac sarcolemmal (SL) membrane vesicles accumulated Ca in the presence of ATP. The accumulated Ca was released by osmotic shock and by the Ca ionophore A23187, indicating that the Ca had been transported into the vesicle interior. Ca uptake by the SL vesicles was not inhibited by ruthenium red, 2,4-dinitrophenol, carbonyl cyanide m -chlorophenyl hydrazone, of NaN 3 , agents that are known to inhibit mitochondrial Ca transport activity. In contrast to the behavior of cardiac sarcoplasmic reticulum, Ca accumulation by the SL vesicles was not stimulated by oxalate and could not driven by p-nitrophenylphosphate hydrolysis. NaCl inhibited ATP-dependent Ca uptake by the SL vesicles. This effect was shown to be due to a stimulation of Ca efflux by Na, mediated by the sarcolemmal NaCa exchange system. The results provide conclusive evidence for the presence of an ATP-dependent Ca “pump” in the cardiac SL membrane.

Prostaglandins are naturally occurring substances with powerful vasoactive effects that are released from tissues during hypoxia or ischemia. Several workers have suggested that a prostaglandin may help to mediate the pulmonary vascular pressor response to alveolar hypoxia. To investigate this possibility, we have measured the pressor responses to hypoxia before and after prostaglandin synthesis antagonism with meclofenamate in eight anesthetized dogs, two groups of awake calves (n=10 and =5), and nine isolated, perfused rat lungs. In addition, synthesis was inhibited by the use of indomethacin in nine additional dogs. The stability of the pulmonary vascular response to repeated hypoxic challenges was demonstrated in nine other dogs. In each species and with both prostaglandin antagonists, the pulmonary pressorresponses to hypoxia were significantly increased rather than reduced. We conclude that prostaglandins do not mediate the pulmonary vasoconstriction caused by hypoxia. The consistent increase observed suggests that hypoxic vasoconstriction stimulates prostaglandin synthesis, the net effect of which is pulmonary vasodilatation which opposes the constriction.

An active skin-conductance measuring device, utilizing integrated circuit operational amplifiers, is described. The transducer offers accurate measurement despite fluctuations in source voltage. The circuit also provides protection in case of accidental short circuit.

We investigated acute and chronic hypoxic pulmonary pressor responses in two groups of calves, one bred to be susceptible, the other resistant to high-altitude pulmonary hypertension. Twelve 5-mo-old susceptible calves residing at 1,524 m increased their mean pulmonary arterial pressure from 26 +/- 2 (SE) to 55 +/- 4 mmHg during 2 h at a simulated altitude of 4,572 m. In 10 resistant calves pressure increased from 22 +/- 1 to 37 +/- 2 mmHg. Five calves were selected from each group for further study. When 9 mo old, the 5 susceptible calves again showed a greater pressor response to acute hypoxia (27 +/- 1 to 55 +/- 4 mmHg) than did 5 resistant calves (23 +/- 1 to 41 +/- 3 mmHg). When 12 mo old, the 5 susceptible calves also developed a greater increase in pulmonary arterial pressure (21 +/- 2 to 9 +/- 4 mmHg) during 18 days at 4,572 m than did the 5 resistant calves (21 +/- 1 to 64 +/- 4 mmHg). Acute and chronic hypoxic pulmonary pressor responses were highly correlated (r = 0.91; P less than 0.001) indicating that they were probably produced through a common mechanism.

We wondered if inhibition of hypoxic pulmonary vasoconstriction by acetylcholine was mediated by prostaglandin synthesis. In 5 calves at a simulated altitude of 4,570 m, acetylcholine (10 μg/kg/min) decreased mean pulmonary arterial pressure and total pulmonary resistance by 24 ± 2 and 35 ± 3% before and by 21 ± 2 and 27 ± 4% after the administration of meclofenamate (2 mg/kg). Since there was no difference in the effect of acetylcholine before and after meclofenamate, it was concluded that pulmonary vasodilation by activation of muscarinic receptors was not dependant on prostaglandin synthesis.

The administration of monocrotaline to rats causes pulmonary vascular leak within 1 wk followed in 2–3 wk by perivascular proliferation and fatal pulmonary hypertension. Possibly blocking the proliferation might block the pulmonary hypertension, providing insight into its mechanism. Because heparin, given as an antiproliferative agent, reduced hypoxic pulmonary hypertension in mice, it might also block monocrotaline-induced pulmonary hypertension. Alternatively, anticoagulation could worsen the lung injury. We found that heparin (300 and 600 U/kg sc twice daily) inhibited clotting in rats given monocrotaline but did not change the vascular leak, the right ventricular pressure, the right ventricular hypertrophy, the increased medial thickness of the pulmonary arterioles, or the production of a slow-reacting substance of anaphylaxis-like material by the lungs. A nonanticoagulant heparin fragment (2 mg/kg sc twice daily), given to avoid anticoagulation also did not influence the monocrotaline injury. Thus neither anticoagulant nor nonanticoagulant heparin either attenuated or worsened the measured effects of monocrotaline.

Arterial O2 saturation (Sao2) decreases in hypoxia in the transition from rest to moderate exercise, but it is unknown whether other several weeks at high altitude SaO2 in submaximal exercise follows the same time course and pattern as that of ventilatory acclimatization in resting subjects. Ventilatory acclimatization is essentially complete after approximately 1 wk at 4,300 m, such that improvement in submaximal exercise SaO2 would then require other mechanisms. On days 2, 8, and 22 on Pikes Peak (4,300 m), 6 male subjects performed prolonged steady-state cycle exercise at 79% maximal O2 uptake (VO2 max). Resting SaO2 rose from day 1 (78.4 +/- 1.6%) to day 8 (87.5 +/- 1.4%) and then did not increase further by day 20 (86.4 +/- 0.6%). During exercise, SaO2 values (mean of 5-, 15-, and 30-min measurements) were 72.7% (day 2), 78.6% (day 8), and 82.3% (day 22), meaning that all of the increase in resting SaO2 occurred from day 1 to day 8, but exercise SaO2 increased from day 2 to day 8 (5.9%) and then increased further from day 8 to day 22 (3.7%). On day 22, the exercise SaO2 was higher than on day 8 despite an unchanged ventilation and O2 consumption. The increased exercise SaO2 was accompanied by decreased CO2 production. The mechanisms responsible for the increased exercise SaO2 require further investigation.

SYNOPSIS The response of 25 chronic myofascial head and neck pain patients to a systematic musculoskeletal rehabilitation program was examined. The program emphasized the acquisition of self-management skills through a highly structured interdisciplinary format. Physical and cognitive behavioral therapies were aimed at reducing factors which perpetuate myofascial pain. Results immediately following treatment, and at three, six and twelvemonths post-treatment when compared to pretreatment scores, showed highly reliable reductions in self-reports of pain and medication intake.

Introduction: Pulmonary hypertension of unknown origin, also called primary pulmonary hypertension (i.e. there is no associated heart or lung disease), comprises three different pathological entities: (i) pulmonary veno-occlusive disease, (ii) recurrent thromboembolic or thrombotic pulmonary disease and (iii) plexogenic pulmonary hypertension (PPH) [1, 2]. The last-named is characterized by predominant involvement of small pulmonary arteries which has three distinctive characteristics: (i) concentric ‘onion-like’ intimal fibrosis, (ii) fibrinoid necrosis of the wall of some arteries occasionally associated with an organized or organizing thrombus, and (iii) dilated side-branches whose wall is often reduced to a single elastic lamina and is lined interiorly by cellular proliferation showing a ‘plexiform’ arrangement. This review is concerned with primary PPH and drug-induced PPH [3] as opposed to PPH complicating post-tricuspid cardiac shunts, although the actual sequence of events leading to remodelling of pulmonary vessels is better known in the latter than in the former. Since a recent exhaustive review is available [3], we shall concentrate on the role of vasodilatator treatment in PPH and the present understanding of cause(s) of PPH.

We examined the pulmonary vascular reactivity of normotensive rats (NR) and spontaneously hypertensive rats (SHR) to acute and chronic pressor stimuli. In rats kept at low altitude (1,520 m), SHRhad a slight degree of right ventricular hypertrophy, but there was no difference between SHRand NR in either right ventricular systolic pressure or pulmonary artery wall thickness. When compared to blood-perfused lungs from low altitude NR, lungs from low altitude SHR were normoresponsive to acute airway hypoxia, hyporesponsive to intra-arterial angiotensin II, and hyperresponsive to intra-arterial prostaglandin F2α. After exposing rats to simulated high altitude (4-6 weeks at 4,270 m) to induce hypoxic pulmonary hypertension, SHRhad a higher right ventricular systolic pressure, a greater degree of right ventricular hypertrophy, and more pulmonary artery medial thickening than did NR. The results indicate that although the pulmonary vasculature of SHRdoes not become hypertensive spontaneously, it might have an increased tendency to develop hypertension when exposed to an appropriate stimulus, i.e., chronic airway hypoxia.

To determine the effects of high oxygen (O2) tension on pulmonary vascular reactivity, we exposed rats either to 100% O2 for 48 hours or 40% O2 for 3 to 5 weeks. Lungs from all rats were isolated, blood perfused and ventilated, and pressor responses to airway hypoxia and to infused angiotensin II were measured. We found that chronic subtoxic hyperoxia did not augment subsequent hypoxic vasoconstriction, and that 48 hrs of 100% O2 markedly blunted hypoxic vasoconstriction. Meclofenamate restored hypoxic vasoconstriction to control levels in the lungs with blunted responses. Evidence for O2 toxicity in the lungs exposed to 100% O2 included interstitial swelling with alveolar exudates seen by light microscopy, and lung edema by water content calculations. We conclude that 1) chronic subtoxic hyperoxia does not influence subsequent hypoxic vasoconstriction, and 2) a dilator prostaglandin produced in the lung is a potent inhibitor of hypoxic vasoconstriction in O2 toxic lungs.

The presence of pulmonary, cerebral, and/or peripheral edema in acute mountain sickness (AMS) implies a derangement in the body's handling of water. Previously, we demonstrated water retention and increased symptoms of AMS when hypocapnia was prevented in subjects exposed to simulated high altitude. This led us to the hypothesis that upon ascent to high altitude, those persons who fail to increase their ventilation adequately and hence do not become hypocapnic will retain water reflected as weight gain and will develop AMS. To test this hypothesis, we studied in Kathmandu, Nepal (1,377 m) 42 healthy western tourists; all were restudied in Pheriche (4,243 m) within 6 days of exposure to high altitude. Symptoms of AMS were highly correlated (p less than 0.001) with weight change, suggesting that persons becoming symptomatic retained fluid. On going from low to high altitude, those persons who lost weight and remained well increased their resting ventilation, whereas those who gained weight did not (p = 0.03). This relative hypoventilation in the latter group was confirmed by higher values of Pco2 (heated hand vein blood) and lower values of arterial saturation (ear oximeter) at Pheriche. Vital capacity measured in Kathmandu was correlated with arterial saturation at Pheriche (p = 0.02); persons with low vital capacity were more hypoxemic with more symptoms of AMS. We conclude that relative hypoventilation and weight gain appear early in the development of AMS suggesting links between altitude hypoxia, hyperventilation, hypocapnia, and the body's handling of water.

This study was conducted to identify and clarify the actions of pulmonary and systemic H1- and H2-receptors by utilizing specific histamine receptor antagonists. Histamine was infused in anesthetized dogs during control conditions, after H2-receptor blockade with metiamide, after H1-receptor blockade with chlorpheniramine, and after combined H1- and H2-receptor blockade. Histamine infusion, alone, induced marked systemic vasodilatation, pulmonary vasoconstriction, and transient increases in cardiac output and heart rate. H2-receptor blockade prevented the systemic vasocilatation and potentiated the pulmonary vasoconstriction induced by histamine. H1-receptor blockade augmented the systemic vasodilatation, prevented the pulmonary vasoconstriction, and increased the cardiac output and heart rate responses induced by histamine. Thus, H2-receptors appear to mediate the vasocilatation, tachycardia, and increased cardiac output induced by histamine, whereas H1-receptors appear to mediate the vasoconstrictor and the minimal cardiac depressent actions of histamine. Histamine stimulates only H1- and H2-receptors, since combined H1- and H2-receptor antagonism prevented almost all of the cardiovascular actions of histamine.

The site density of the Na2+-Ca2+ exchanger in bovine cardiac sarcolemma was estimated from measurements of the fraction of reconstituted proteoliposomes exhibiting exchange activity. Sarcolemmal vesicles were solubilized with 1% Triton X-100 in the presence of either 100 mM NaCl or 100 mM KCl; after a 20-40-min incubation period on ice, sufficient KCl, NaCl, CaCl2, and soybean phospholipids were added to each extract to give final concentrations of 40 mM NaCl, 120 mM KCl, 0.1 mM CaCl2, and 10 mg/ml phospholipid. These mixtures were then reconstituted into proteoliposomes, and the rate of 45Ca2+ isotopic exchange was measured under equilibrium conditions. Control studies showed that Na+-Ca2+ exchange activity was completely lost if Na+ was not present during solubilization. The difference in 45Ca2+ uptake between vesicles initially solubilized in the presence or absence of NaCl therefore reflected exchange activity and corresponded to 3.1 +/- 0.3% of the total 45Ca2+ uptake by the entire population of vesicles, as measured in the presence of the Ca2+ ionophore A23187. Assuming that each vesicle with exchange activity contained 1 molecule of the Na+-Ca2+ exchange carrier, a site density of 10-20 pmol/mg of protein for the exchanger was calculated. The Vmax for Na+-Ca2+ exchange activity in the proteoliposomes was approximately 20 nmol/mg of protein.s which indicates that the turnover number of the exchange carrier is 1000 s-1 or more. Thus, the Na+-Ca2+ exchanger is a low density, high turnover transport system.

The literature indicates that vasoactive substances released from platelets contribute to the pulmonary pressor response and hypoxemia during pulmonary microembolism. Hence, removal of the platelets or inhibition of their function should reduce these effects. The purpose of this study was, therefore, to investigate the pulmonary effects of experimental embolism with glass beads in dogs rendered thrombocytopenic with platelet antiserum and to compare these effects to the effects in dogs pretreated with sulfinpyrazone (Anturane) or heparin, both substances that affect the function of platelets, probably by inhibiting the release of platelets. In all three groups the pulmonary hypertension was reduced by more than half, and hypoxemia was lessened or abolished. The results of this study indicate the platelets contribute to the effects of pulmonary microembolism and that administration of sulfinpyrazone or heparin reduces the embolism-induced pulmonary hypertension to the same extent as the depletion of platelets. Platelet-inhibiting drugs might therefore be useful prophylactically in human pulmonary microembolism.

We wished to determine whether high pulmonary blood How alters the pulmonary vascular responses to the vasoconstrictors, hypoxia and prostaglandin F2α (PGF2α). Acute or chronic left pulmonary artery (PA) occlusion was performed in dogs in order to create high pulmonary blood How conditions. Right lung pulmonary vascular resistance (PVR) during normoxia was reduced by both acute and chronic left PA occlusion, suggesting passive vasodilatation. Increases in right lung PVR induced by hypoxia (10–15% O2) and PGF2α (0.8–4 μg kg−1min−1) were attenuated both in acute and chronic left PA occluded dogs. Since the reductions in responsiveness were similar with acute and chronic increases in blood flow, the attenuating effect of high blood How was not dependent upon morphologic changes in the vasculature. Pulmonary vascular responsiveness was probably reduced in these animals due to their dilated pulmonary vascular beds, consequent to the increased pulmonary blood How, thereby decreasing the effectiveness of smooth muscle contraction.

In order to determine the relationship between trigger point sensitivity and the referred symptoms of myofascial pain, VAS ratings of referred pain intensity and pressure algometer measures of myofascial trigger point sensitivity were taken pre and post treatment of the muscle containing the trigger point with passive stretch. The results in 20 subjects, experiencing unilateral or bilateral myofascial head and neck pain, showed that myofascial trigger point sensitivity decreases in response to passive stretch as assessed by the pressure algometer, and that trigger point sensitivity and intensity of referred pain are related.

We hypothesized that leukotrienes are involved in hypoxic pulmonary vasoconstriction, since they are pulmonary vasoconstrictors and cells capable of producing leukotrienes are located in the lung near resistance vessels. We investigated in isolated perfused rat lungs whether three structurally unrelated blockers [diethylcarbamazine citrate (DEC), U-60257, and FPL 55712] of leukotriene synthesis or action block hypoxic pulmonary vasoconstriction. DEC blocked ongoing and subsequent hypoxic pressor responses while minimally affecting the angiotensin II pressor response. The inhibition of the hypoxic pressor response by DEC was not affected by cyclooxygenase or H1-receptor blockers. Potassium-induced vasoconstriction, which is dependent on calcium entry, was largely blocked by verapamil but not by DEC, suggesting that DEC was not acting primarily as a calcium-entry blocker. U-60257 blocked the hypoxic pressor response without inhibiting the pressor response to angiotensin II or potassium chloride. FPL 55712, a leukotriene end-organ blocker, in a dose which inhibited vasoconstriction caused by exogenous leukotriene C4, inhibited the pressor response to hypoxia but not to angiotensin II. We conclude that leukotriene inhibitors preferentially inhibit hypoxic pulmonary vasoconstriction in isolated perfused adult rat lungs.

Rat thymocytes can be separated into two subpopulations by centrifugation for 20 minutes at 1,600 g in an 18/26/36% (w/v) discontinuous gradient of bovine serum albumin. Approximately 13% of the cells band at the 18/26% interface (light cells) while the remaining cells band at the 26/36% interface (heavy cells). In vitro and in vivo studies of 3H-thymidine incorporation indicate that the light cells are 2- to 3-fold enriched in the rapidly dividing lymphoblast subpopulation of thymocytes as compared to heavy cells. Light cells transport the non-metabolizable glucose analogue 3-O-methylglucose (3-MeGlc) approximately four times faster than heavy cells. The time course of 3-MeGlc uptake is biphasic for light, heavy and unfractionated thymocytes. While the half-times of the rapid (1 minute) and slow (20-45 minute) phases of uptake are similar for all three types of cells, the contributions of the rapid phase to total uptake are 50% for light cells, 20% for unfractionated thymocytes and 10% for heavy cells. The results show that 3-MeGlc transport activity differs markedly within certain thymocyte subpopulations. The correlation between the contributions of the rapid phase of uptake and the proportion of lymphoblasts in the thymocyte fractions suggests that the lymphoblast and small lymphocyte subpopulations might be responsible for the rapid and slow phase of 3-MeGlc uptake, respectively.

We suggest that hypoxia-induced pulmonary hypertension in the newborn calf is an attractive model for studying the mechanisms underlying alterations in extracellular matrix accumulation which occur in pulmonary vascular disease. Our data support a model (Fig 7) in which the SMC, perhaps as a result of hypoxic and/or pressure-induced vessel wall injury, becomes phenotypically altered. This phenotypically altered SMC generates a factor, termed smooth muscle derived extracellular matrix factor (SMEF), and possibly other factors. SMEF, in turn, stimulates or induces elastin and collagen synthesis in fibroblasts and endothelial cells. SMEF, or an associated activity derived from phenotypically altered smooth muscle cells, also induces elastin receptor expression on the cell surface and affects the chemotactic responsiveness of vascular cells. Thus, the SMC may be able to affect both the secretory and responsive properties of cell types in the vascular wall. The SMC may be critical in the vascular remodeling in pulmonary hypertension. The possible autocrine or paracrine alteration of cellular phenotypes by smooth muscle-derived mediators provides an important new direction for future research into molecular and cellular mechanisms of connective tissue regulation in diseased vessels.

Chronic beta-receptor blockade has been reported to inhibit right ventricular hypertrophy in rats at high altitude. If so, we wanted to determine whether beta-receptor blockade or some other drug action were involved and whether the heart, the lung vessels, or blood alterations were affected. In rats, chronic treatment with DL-propranolol (2 mg/kg ip once daily) reduced right ventricular hypertrophy and polycythemia of chronic high altitude. D-Propranolol and metoprolol did not reduce hypoxia-induced right ventricular hypertrophy or polycythemia. In isolated lungs from low-altitude rats treated chronically with DL-propranolol or with D-propranolol the pressor response to acute hypoxia was blunted. Chronic DL-propranolol blunted the acute hypoxic pressor response and angiotensin II induced vasoconstriction in lungs from high-altitude rats. Two effects of DL-propranolol treatment were seen: 1) blockade of beta 2-adrenergic receptors, which reduced the right ventricular hypertrophy of high altitude through reduction of hematocrit; and 2) a non-beta-effect, which reduced vascular responsiveness to acute hypoxia in the isolated lung preparation.

The pulmonary hypertensive response to chronic hypoxia varies markedly among mammalian species. An explanation for this variability was sought by exposing seven species to hypobaric hypoxia (PB equal to 435 mmHg) for 19-48 days. Control animals were studied at 1,600 m (PB equal to 630 mmHg). The pulmonary hypertension that developed varied in the following order of decreasing severity: calf and pig (severe); rat and rabbit (moderate); sheep, guinea pig, and dog (mild). Right ventricular hypertrophy developed in proportion to the elevation in right ventricular systolic pressure. These interspecies variations in response were not correlated with the degree of arterial hypoxemia, degree of polycythemia, elevation in heart rate, or postnatal age. However, the medial thickness of the small pulmonary arteries in control animals was highly correlated with the development of pulmonary hypertension and right ventricular hypertrophy in hypoxic animals. Thus, the amount of lung vascular smooth muscle inherent within each species is a major determinant of the pulmonary hypertensive response to high altitude and contributes to the interspecies variability in this response.

Pregnancy decreases systemic vascular reactivity but comparatively little is known about the effects of pregnancy on the pulmonary circulation. Pulmonary vascular resistance (PVR) during acute hypoxia was lower (P < 0.01) in eight intact anesthetized pregnant dogs compared to the same animals postpartum. Mean pulmonary arterial pressure (Ppa) and PVR during infusion of prostaglandin (PG) F2 alpha were also reduced during pregnancy. Nonpregnant female dogs (n = 5) treated with estrogen (0.001 mg x kg-1 x da-1) for 2 wk had decreased Ppa (P < 0.01) during acute hypoxia compared to control measurements, but PVR was unchanged during hypoxia and PGF2 alpha infusion. Treatment with progesterone in four dogs had no effect on pulmonary vascular reactivity to hypoxia or PGF2 alpha. Inhibition of circulating PG with meclofenamate in four dogs during pregnancy did not appear to restore pulmonary vascular reactivity. Blunted pulmonary vascular reactivity is suggested by the limited data available for women, but is not seen in pregnant cows. We conclude that pregnancy decreases pulmonary as well as systemic vascular reactivity in the dog, but the mechanism is unclear.

Eight normal subjects were decompressed to barometric pressure (PB) = 240 Torr over 40 days. The ventilation-perfusion (VA/Q) distribution was estimated at rest and during exercise [up to 80–90% maximal O2 uptake (VO2 max)] by the multiple inert gas elimination technique at sea level and PB = 428, 347, 282, and 240 Torr. The dispersion of the blood flow distribution increased by 64% from rest to 281 W, at both sea level and at PB = 428 Torr (heaviest exercise 215 W). At PB = 347 Torr, the increase was 79% (rest to 159 W); at PB = 282 Torr, the increase was 112% (108 W); and at PB = 240 Torr, the increase was 9% (60 W). There was no significant correlation between the dispersion and cardiac output, ventilation, or pulmonary arterial wedge pressure, but there was a correlation between the dispersion and mean pulmonary arterial pressure (r = 0.49, P = 0.02). When abnormal, the VA/Q pattern generally had perfusion in lung units of zero or near zero VA/Q combined with units of normal VA/Q. Alveolar-end-capillary diffusion limitation of O2 uptake (VO2) was observed at VO2 greater than 3 l/min at sea level, greater than 1–2 l/min VO2 at PB = 428 and 347 Torr, and at higher altitudes, at VO2 less than or equal to 1 l/min. These results show variable but increasing VA/Q mismatch with long-term exposure to both altitude and exercise. The VA/Q pattern and relationship to pulmonary arterial pressure are both compatible with alveolar interstitial edema as the primary cause of inequality.

Cerebral blood flow increases at high altitude, but the mechanism of the increase and its role in adaptation to high altitude are unclear. We hypothesized that the hypoxemia at high altitude would increase cerebral blood flow, which would in turn defend O2 delivery to the brain. Noninvasive Doppler ultrasound was used to measure the flow velocities in the internal carotid and the vertebral arteries in six healthy male subjects. Within 2–4 h of arrival on Pikes Peak (4,300 m), velocities in both arteries were slightly and not significantly increased above sea-level values. By 18–44 h a peak increase of 20% was observed (combined P less than 0.025). Subsequently (days 4–12) velocities declined to values similar to those at sea level. At altitude the lowest arterial O2 saturation (SaO2) and the highest end-tidal PCO2 was observed on arrival. By day 4 and thereafter, when the flow velocities had returned toward sea-level values, hemoglobin concentration and SaO2 were increased over initial high-altitude values such that calculated O2 transport values were even higher than those at sea level. Although the cause of the failure for cerebral flow velocity to increase on arrival is not understood, the subsequent increase may act to defend brain O2 transport. With further increase in hemoglobin and SaO2 over time at high altitude, flow velocity returned to sea-level values.

Systemic and pulmonary vascular responses to infusions of histamine, 2-methylhistamine (2-MeH), and 4-methylhistamine (4-MeH) were determined. In dogs, H1-receptor stimulation with 2-MeH induced pulmonary vasoconstriction, and a decrease in cardiac output. H2-receptor stimulation with 4-MeH induced pulmonary and systemic vasodilation, tachycardia, and an increase in cardiac output. In cats, 2-MeH caused slight pulmonary vasoconstriction and 4-MeH caused vasodilation. Both H1- and H2-receptors mediated the systemic vasodilation, tachycardia, and increase in cardiac output observed in cats.

Hypoxia at high altitude could depress cardiac function and decrease exercise capacity. If so, impaired cardiac function should occur with the extreme, chronic hypoxemia of the 40-day simulated climb of Mt. Everest (8,840 m, barometric pressure of 240 Torr, inspiratory O2 pressure of 43 Torr). In the five of eight subjects having resting and exercise measurements at the barometric pressures of 760 Torr (sea level), 347 Torr (6,100 m), 282 Torr (7,620 m), and 240 Torr, heart rate for a given O2 uptake was higher with more severe hypoxia. Slight (6 beats/min) slowing of the heart rate occurred only during exercise at the lowest barometric pressure when arterial blood O2 saturations were less than 50%. O2 breathing reversed hypoxemia but never increased heart rate, suggesting that hypoxic depression of rate, if present, was slight. For a given O2 uptake, cardiac output was maintained. The decrease in stroke volume appeared to reflect decreased ventricular filling (i.e., decreased right atrial and wedge pressures). O2 breathing did not increase stroke volume for a given filling pressure. We concluded that extreme, chronic hypoxemia caused little or no impairment of cardiac rate and pump functions.

SummaryGreater pulmonary vascular resistance increases in response to acute hy-poxia have been observed in the anesthetized dog at 1600-m altitude than in dogs studied at sea level. Consequently, the he-modynamic response to hypoxia was studied in 11 “lowland” dogs flown to Denver and compared to the response of 11 dogs obtained locally. The local “highland” dogs had mean increases in pulmonary arterial pressure and pulmonary vascular resistance during hypoxia of +17 ± 1 mm Hg and + 5.3 ± 0.9 mm Hg/liter/min, respectively, in contrast to the increases of +12 ± 1 mm Hg and +2.8± 0.2 mm Hg/liter/min observed in the lowland dogs. The increase in pulmonary arterial pressure induced by prostaglandin F2a was not significantly different in the two groups. The pulmonary pressor response to hypoxia in seven lowland dogs restudied after 3- to 4-weeks residence at 1600 m was not altered. The difference in responsiveness of the pulmonary vascular bed to hypoxia in the two groups suggests that chronic low-grade hypoxi...

HIGH-ALTITUDE pulmonary edema is an unusual and puzzling illness.1,2 We have seen four patients without a right pulmonary artery, all of whom had high-altitude pulmonary edema at moderate altitudes (2000 to 3000 m) in Colorado. Both of these conditions are so uncommon that their association by chance is highly unlikely. The implications of this association were recognized by Dr. Houston when the first of our four cases was called to his attention by another member of the group. In each of the four patients edema developed in the left lung, which received the entire right ventricular output. This occurrence . . .

Chronic exposure to high altitude reduces maximal O2 uptake (VO2max). At extreme altitudes approaching the summit of Mt. Everest [inspiratory PO2(PIO2) = 43 Torr], mean VO2max have been determined to be 15.3 ml.kg-1.min-1 in two subjects who breathed 14% O2 at 6,300 m on Mt. Everest (West et al., J. Appl. Physiol. 54: 1188–1194, 1983). To provide a more complete description of performance near the limits of human tolerance to chronic hypoxia, we measured VO2max in volunteers in an altitude chamber before, during, and after a 40-day decompression to a barometric pressure (PB) of 240 Torr (PIO2 = 43 Torr). In five of eight subjects studied at sea level and PB of 464, 347, 289, and 240 Torr, VO2max was reduced from 4.13 to 1.17 l/min (49.1–15.3 ml.kg-1.min-1) in agreement with the prior study. Although the range decreased, the rank order among the subjects was preserved. Arterial O2 saturation at maximum effort decreased (46% by ear oximetry), but minute ventilation, respiratory frequency, and tidal volume did not. The highest minute ventilation (201 l/min BTPS) was observed at PB of 464 Torr. Arterial PCO2 in three subjects at PB of 240 Torr, at rest, and with maximum effort, averaged 10.3 and 9.6 Torr, respectively. Sustained hyperventilation was crucial to exercise performance during chronic, severe hypoxemia. VO2max was lower after altitude exposure compared with initial sea level values, indicating that exposure had not improved sea level exercise capacity.

In the bovine fetus, tracheal fluid has pulmonary pressor activity. This tracheal fluid flows cephalad and empties into the amniotic fluid. Pulmonary pressor activity of the bovine amniotic fluid has not been determined. Sterile amniotic fluid obtained during amniocentesis from Jersey calves in the last trimester of gestation was given intravenously (40 to 70 μl/kg) to seven Jersey calves. The aortic pressure showed a transient increase of 10 ± 8 mm Hg within 15 sec and the pulmonary arterial pressure showed an increase of 8 ± 3 m Hg within 1–3 min. Wedge pressure, cardiac output and arterial oxygen tension did not change. Antigen-antibody reactions could not be implicated because pressor responses occurred in calves given compatible fluids. A lipid extract of amniotic fluid caused pulmonary hypertension. Aspirin blocked the effects of amniotic fluid in five experiments, suggesting that prostaglandin precursors might be present. Substances which contribute to the vaso-constriction in the bovine fetal lung may be present in the amniotic fluid.

Leukotriene inhibitors preferentially inhibit the acute pressor response to hypoxia in isolated rat lungs. If leukotrienes are important in hypoxic pulmonary vasoconstriction, then inhibition of their synthesis could prevent the development of chronic hypoxic pulmonary hypertension. We found that diethylcarbamazine (DEC), a leukotriene synthesis blocker, reversibly inhibited acute hypoxic pulmonary vasoconstriction in the awake rat. Rats exposed to chronic hypobaric hypoxia showed pulmonary hypertension and the production of a slow-reacting substance compared with low altitude control rats. The higher of 2 doses of DEC blocked the pulmonary hypertension and the production of slow-reacting substance in all of the hypoxic rats treated. The lower dose of DEC attenuated the pulmonary hypertension in only some of the rats. Changes in weight gain, hematocrit, or generation of prostacyclin did not explain the prevention of the pulmonary hypertension by DEC. We conclude that diethylcarbamazine inhibits acute and chronic pulmonary hypertension in the intact rat.

Acute hypoxia stimulates an increase in ventilation but the resulting hypocapnia limits the magnitude of the increase. Thus the hypoxic ventilatory response is usually measured during isocapnia, but this may not reflect events at high altitude. We hypothesized that the degree of inhibition by hypocapnia might depend on individual ventilatory response to CO2 and thus vary between persons. To test this hypothesis we compared the isocapnic hypoxic ventilatory response (end-tidal PCO2 maintained by CO2 addition) with the response in which CO2 was not added and the end-tidal PCO2 fell to a variable extent (poikilocapnic hypoxia). In 14 healthy persons we found that the poikilocapnic hypoxic ventilatory response was determined by two factors: sensitivity to isocapnic hypoxia acting to increase ventilation and sensitivity to CO2 acting to decrease the hypoxic ventilatory response. The ventilatory response to poikilocapnic hypoxia correlated with but was generally less than the isocapnic hypoxic response. The magnitude of the difference between them related to the hypercapnic response. Further, the results suggested that the CO2 response in the high CO2 range related to ventilatory events in the low CO2 range. Thus the magnitude of ventilatory inhibition by hypocapnia may depend on individual ventilatory responsiveness to CO2.

Ultrasound studies in pulmonary hypertension often show systolic partial closure of the pulmonic valve and early peaking of Doppler pulmonary flow velocity, but these findings are poorly understood. Our initial observations of earlier systolic partial closure with higher pulmonary pressures suggested that this phenomenon might relate to pressure. In 30 patients with documented pulmonary hypertension, the timing of systolic partial closure and the corresponding decrease in Doppler flow velocity related inversely to pulmonary artery pressure at catheterization. Peak flow precedec the systolic velocity decrease and also related inversely to pressure. Since changing flow velocity might reflect a changing driving force across the valve, we examined simultaneous high-fidelity catheter pressure tracings from the right ventricle and pulmonary artery from 24 patients with and without pulmonary hypertension. In 30 studies, a positive right ventricular to pulmonary artery pressure gradient was present early in systole, but the gradient decreased to a minimum value in mid-to-late systole. The timing of this minimum also related inversely to pressure. We conjectured that forces opposing ejection occur earlier in pulmonary hypertension, thereby decreasing the forward driving force and allowing earlier partial systolic closure.

We tested the hypothesis that monocrotaline would activate arachidonic acid metabolism in rats. If activation occurred before the pulmonary hypertension developed, arachidonate metabolites could play a role in the hypertensive monocrotaline injury. We found that 1 wk after monocrotaline administration 6-ketoprostaglandin F1 alpha and leukotriene C4 were increased in lung lavages. At 3 wk when pulmonary hypertension was well developed, lung lavage contained increased 6-ketoprostaglandin F1 alpha and thromboxane B2. In addition, the number and activity of white blood cells in the lavages was increased, and abnormal alveolar macrophages were present. The lung extract contained slow-reacting substances including leukotriene D4. Indomethacin administration inhibited the formation of cyclooxygenase metabolites but did not prevent pulmonary hypertension. Diethylcarbamazine administration reduced the numbers and activity of inflammatory cells, increased pulmonary hypertension, prevented right ventricular hypertrophy, and inhibited the formation of slow-reacting substances. We concluded that arachidonate metabolism was activated before pulmonary hypertension developed, that the inflammatory cells in the alveolus accompanied the hypertensive process, and that diethylcarbamazine attenuated both the monocrotaline-induced inflammatory response and the pulmonary hypertension.

The biofeedback literature affirms the therapeutic efficacy of EMG-biofeedback-assisted relaxation for the treatment of tension headache. However, this form of therapy has failed to focus on the role of cognitive variables in the control and perception of tension headache. The present case study provides a prototype treatment combining cognitive behavior--modification procedures with EMG-biofeedback training to treat a subject with chronic tension headache. Phase I, baseline, involved collecting mean EMG and daily headache activity, emphasizing specification of environmental stressors. Phase II, cognitive skills--training, focused on: (1) identifying negative self-statements (cognitions) related to stressors, and (2) training the subject to replace negative self-statements with coping self-instructions. This treatment resulted in a 33% headache reduction over baseline, with no concomitant changes in frontalis EMG. Phase III, EMG-biofeedback training, resulted in a 38% reduction in mean EMG level and a 66% reduction in mean headache activity when compared to baseline. The results suggest the importance of attending to cognitive factors in the treatment of tension headache.

Isolated lungs lose the vasoconstrictor response to airway hypoxia with time of perfusion. In isolated rat lungs this loss was accelerated by the addition to perfusate of glucose or pyruvate. The addition of 3- O -methyl glucoside (a non-metabolizable glucose analog) or saline (a solvent control) did not change the rate of decline of hypoxic vasoconstriction. An inhibitor for glucose metabolism (2-deoxy-D-glucose) augmented the hypoxic pressor response. Vasoconstrictor responses to angiotensin II and KCl were not affected by any of the additions. There were no differences in perfusate osmolality among groups of lungs. These results suggest that glucose accelerated the decline of hypoxic pulmonary vasoconstriction by a metabolic, not an osmotic, effect. There may be an important link between lung glucose metabolism and the hypoxic pressor response.

Histamine is an important amine within the lung. The purpose of the present study was to evaluate in rats the factors that affect the measurement of lung histamine concentration. We found that the lung content was not clearly altered by pentobarbital anesthesia or by freezing of the lung. Heparin administration and inhalational ether anesthesia appeared to result in elevated lung histamine contents by an unknown mechanism. Pulmonary edema rapidly lowered the histamine content. The histamine content is better related to DNA content than to the amount of protein in the lung.

Eight male volunteers had rest and exercise measurements to determine the mechanisms of oxygen transport during a 40-day chamber, decompression simulating high-altitude exposure equivalent to the summit of Mt Everest. Five subjects completing the study decreased their maximum oxygen uptake by 72%. During maximal or near-maximal exercise, arterial PCO 2 fell as low as 8 mm Hg, defending the alveolar PO 2 and confirming marked hyperventilation. Alveolar-arterial diffusion did not improve and V/Q worsened. Cardiac function was unimpaired. Circulatory oxygen transport resembled that at sea level. The decrease in mixed venous PO 2 was not enough to preserve fractional oxygen utilization "on the summit". The PO 2 gradients from atmosphere to alveolus, alveolus to arterial blood, arterial to venous blood, and from venous (capillary) blood to mitochondria all decreased. However, hyperventilation appeared to be the primary adaptation that defended the maximum oxygen uptake.

Carbonylcyanide m -chlorophenylhydrazone, a well-known uncoupling agent, inhibits lactose and amino acid transport by isolated cytoplasmic membrane vesicles from Escherichia coli and Staphylococcus aureus in the micromolar concentration range and has many of the properties of a typical sulfhydryl reagent. Its inhibitory effects are not alleviated by dilution and washing, but the addition of a number of thiol compounds, dithiothreitol in particular, dramatically blocks and reverses its inhibitory activity. Moreover, incubation of vesicles with this uncoupler diminishes their reactivity towards N -ethylmaleimide, suggesting that the compound blocks sulfhydryl groups in membrane proteins. Neither of these effects are observed with 2,4-dinitrophenol. The results are discussed in terms of chemical and chemiosmotic concepts of energy transduction.

Membrane vesicles isolated from rabbit ventricular tissue rapidly accumulated Ca2+ when an outwardly directed Na+ gradient was formed across the vesicle membrane. Vesicles loaded internally with K+ showed only 10% of the Ca2+ uptake activity observed with Na+-loaded vesicles. Dissipation of the Na+ gradient with the monovalent cation exchange ionophores nigericin or narasin caused a rapid decline in Ca2+ uptake activity. The Ca2+-ionophore A23187 inhibited Ca2+ uptake by Na+-loaded vesicles and enhanced the rate of Ca2+ loss from the vesicles after uptake. Efflux of preaccumulated Ca2+ from the vesicles was stimulated 30-fold by the presence of 50 mM Na+ in the external medium. Na+-dependent uptake and efflux of Ca2+ were both inhibited by La3+. The results indicate that cardiac membrane vesicles exhibit Na+-Ca2+ exchange activity. Fractionation of the vesicles by density gradient centrifugation revealed a close correspondence between Na+-Ca2+ exchange activity and specific ouabain-binding activity among the various fractions. This relationship suggests that the observed Na+-Ca2+ exchange activity derives from the sarcolemmal membranes within the vesicle preparation.

The relative contributions of breathing frequency and tidal volume to the increase in ventilation during acute or prolonged exposure to hypoxia is uncertain. We examined the changes in breathing pattern during hypoxic exposures lasting minutes, hours, and days using data from previous studies. Increased tidal volume accounted for the increased ventilation during 7–10 and 30 min of isocapnic and poikilocapnic (no CO2 added) hypoxic exposures as well as during 7 h of poikilocapnic hypobaric hypoxia (4,800 m). Tidal volume was also a greater overall contributor than frequency to increased ventilation in sea-level residents during 3 days of isocapnic hypobaric hypoxia (4,100–4,600 m) and in Denver (1,600 m) residents during 5 days on Pikes Peak (4,300 m). In sea-level residents during 3 days of poikilocapnic hypobaric hypoxia (3,600–4,300 m) and during 7–8 days on Pikes Peak, increased frequency accounted for the rise in ventilation. Tidal volume thus contributed more than frequency to increasing ventilation during brief hypoxia, whereas the contribution of frequency was increased in prolonged hypoxia involving a 4,300-m altitude ascent and hypocapnia.

Sarcolemmal membrane vesicles isolated from canine ventricular tissue accumulate calcium through the sodium-calcium exchange system when an outwardly directed sodium gradient is generated across the vesicle membrane. Moreover, calcium uptake under these conditions is accompanied by the transient accumulation of the lipophilic cation tetraphenylphosphonium. Since the distribution of tetraphenylphosphonium across biological membranes reflects the magnitude and direction of transmembrane potential differences and the characteristics of the transient accumulation of this cation closely resemble those of sodium-calcium exchange activity, it is concluded that a membrane potential, interior negative, is produced during calcium accumulation through the exchange system. Thus, the operation of the sodium-calcium exchange system generates a current in cardiac membrane vesicles, suggesting that three or more sodium ions exchange for each calcium ion.