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Four cases of Takayasu's arteritis in association with pregnancy are described. These patients are at high risk of pregnancy hypertension. Measurement of the blood pressure in the arms may be impossible or unreliable and is often more accurately obtained in the legs.

Cardiopulmonary function was assessed in healthy cats given a xylazine-ketamine hydrochloride combination intramuscularly. Cardiac output, heart rate, stroke volume and cardiac index were significantly decreased. Systolic, diastolic and mean arterial blood pressure were also significantly decreased. Systemic vascular resistance and central venous pressure were significantly increased. Blood gas values remained stable. In conclusion, significant cardiovascular depression was noted in normal cats given the xylazine-ketamine combination at the dosages listed.

In translating this to nursing, shared governance systems can be used to effectively implement transformational philosophies. The process is not easy; it does, however, offer new hope for realizing the maximum potential of nursing services within organizations and for effectively meeting the challenges presented by the complex changes occurring in our world. Part 2 of this series will address specific strategies for operationalizing transforming principles in a nursing organization.

A standardised behaviour rating scale, the Shortened Stockton Rating Scale, was completed by care staff for each of 903 residents in old people's homes. In an attempt to validate the four subscales suggested by the authors of the published scale, the data were subjected to factor analysis. The results indicate the existence of three factors reflecting physical, mental, and social impairment. They offer only partial support for the published subscales and the need for such scales to be validated on the intended target population is discussed.

When oxidative metabolism is inhibited in heart muscle, developed tension often increases slightly before decreasing below control. We have examined the possible mechanisms underlying these changes in developed tension in two series of experiments. In the first series of experiments, the photoprotein aequorin was used to monitor intracellular free [Ca2+] [( Ca2+]i) in papillary muscles during inhibition of oxidative phosphorylation, using either cyanide or hypoxia. The observed changes of developed tension were independent of changes in [Ca2+]i. It was therefore possible that these changes of tension were due to changes of intracellular pH (pHi). We tested this idea in a second series of experiments, using 31P nuclear magnetic resonance to monitor pHi, [ATP], and phosphocreatine concentration [( PCr]) in Langendorff-perfused ferret hearts. During the application of cyanide, pHi increased transiently before decreasing to below control. [PCr] decreased throughout this period, but [ATP] did not change. It is concluded that the observed changes of pHi could account for most of the observed changes of developed tension. It is suggested that the initial increase of pHi is due to PCr breakdown and the subsequent decrease of pHi to accelerated anaerobic glycolysis.

This article addresses issues concerning the relationships among nursing, a nascent "men's health" movement, and the established "women's health" movement. Suggestions are made in regard to the potential positive contributions of a men's health movement that recognizes masculinity as a social reality while aiding men with health problems from a holistic nursing perspective.

1. Measurements have been made of tension development in papillary muscles isolated from the right ventricles of young cats. In some cases membrane potentials have also been recorded, using micro electrodes. 2. Regular contractions at a stimulation rate of 20 min(-1) (the 'standard' rate used in this study) had the following characteristics (30 degrees C): peak tension developed, about 43mN mm(-2); time to peak tension and time to 80% repolarization of the cell membrane, about 400 ms. 3. The corresponding figures for the first contraction after a rest of several minutes (rested state contraction) were: tension developed, about 4mN mm(-2); time to peak tension and time to 80% repolarization of the cell membrane, about 560 ms. Sometimes there was also an early peak in the mechanical response, about 250 ms after stimulation. 4. The time course with which tension development declined when the muscle was allowed to rest was examined under various conditions. It was found to decline more slowly when the muscle was potentiated by raising the bathing Ca2+ concentration and by stimulation at rates above 20 min(-1). 5. Tension development in rested state contractions was found to depend on the Ca2+ and Na+ concentrations in the bathing solution. The full effect of a change in either could be produced by exposing the resting muscle to the altered ionic conditions. 6. These experimental findings have been interpreted in terms of a simple model of the calcium movements involved in excitation-contraction coupling in the myocardial cell.

Shortening of the cardiac action potential during ischemia and anoxia is likely to contribute to the decline in contractility that occurs under such conditions. It has been hypothesized that a decrease in the intracellular ATP concentration ([ATP]i) underlies the changes in the action potential. The recently discovered potassium channel activated at low ATP concentrations might provide the link between action potential shortening and low [ATP]i. However, it has yet to be shown that [ATP]i falls to the range required for channel activation at the time when action potential shortening occurs. We have measured action potentials and [ATP]i simultaneously in isolated ferret hearts during inhibition of both oxidative phosphorylation and anaerobic glycolysis (metabolic blockade). Metabolic blockade caused a rapid decline in cardiac contractility, accompanied by a rapid fall in action potential duration. [ATP]i fell only slightly and remained well above the range where activation of the ATP-sensitive K+ channel would be expected to occur. Moreover, reintroduction of glucose to the perfusate led to a substantial recovery in both contraction and in action potential duration, again in the absence of any great change in [ATP]i. These results suggest that the action potential shortening observed in metabolic blockade cannot be explained by the simple hypothesis of K+ channel opening as a consequence of a decrease in bulk [ATP]i unless the Km for suppression of channel activity by ATP is very much higher in intact cells than in any of the patch configurations studied. An alternative explanation is that the channel may be regulated under these conditions by mechanisms other than a change in [ATP]i.

A retrospective study of 50 patients admitted to the Peninsula Maternity Hospital, Cape Town, with a diastolic blood pressure of 90 mmHg was carried out. Proteinuria and a serum urate level of 0,36 mmol/l or more were found to be risk factors in this group. It is suggested that these patients can be managed as outpatients if no proteinuria is present and the serum urate level is less than 0,36 mmol/l; they should be trained to test urine at home and should be followed up on a weekly basis. A small prospective study showed that home urine testing was both workable and satisfactory.

A model has been developed to describe the delivery of insulin from a controlled release micropump (CRM). Basal delivery was provided by diffusion due to a concentration difference driving force across the CRM. This was modelled by considering the CRM to be a series of one-dimensional steady-state diffusion resistances. This delivery model was used to size prototypes and identify the piston, foam and the pump outlet as the controlling resistances to basal insulin transport. Augmented delivery by the CRM was achieved by repeated compression of a foam disk by a mild steel piston which was driven by a solenoid (tested voltage range 0-173 V DC; 5 msec "on" time; frequency 20-40 min-1). The increased delivery was attributed to the combination of mixing inside the pump barrel and displacement of barrel contents into the downstream reservoir. This action was approximated by a three-compartment model, which considered the CRM to consist of a well-mixed upstream reservoir and pump barrel (with a downstream reservoir) separated by two resistances: a constant upstream membrane resistance, (KmAm)-1, and a variable downstream mixing rate resistance, (Qd)-1. A least squares fit of the model to experimental data showed Qd to increase with the cube of the force on the piston and linearly with the compression frequency. In agreement with experimental results, the model predicted the upstream membrane to be rate controlling only at augmented pump resistances close to the value (KmAm)-1. These models were used to design an improved prototype (VIII) which is now being evaluated in vivo in pancreatectomized dogs for its efficacy in restoring and sustaining normoglycemia.

1. Ferret ventricular muscles were skinned by prolonged application of Triton X-100. Aequorin was allowed to diffuse into the myoplasmic space and the resulting light emission was used to monitor the myoplasmic [Ca2+]. The muscle was then activated with a lightly buffered Ca2+ solution and the changes in myoplasmic [Ca2+] and tension in response to length changes were investigated. 2. A sudden reduction in muscle length led to a rapid increase in myoplasmic [Ca2+] to a new level which was maintained as long as muscle length was reduced and which was reversed when the muscle was stretched back to the control length. The rate of increase of [Ca2+] when the muscle length was reduced was greater than the rate of decrease in [Ca2+] when the muscle was stretched. 3. Increasing the concentration of EGTA in the activating solution, so as to increase its Ca2+-buffering capacity, eliminated the changes in myoplasmic [Ca2+] in response to a length change but had little effect on developed tension. 4. On stretching the muscle there was a slow component of recovery of tension with a time course broadly similar to the rate of decrease of myoplasmic [Ca2+]. The time course of tension redevelopment and of the accompanying reduction in myoplasmic [Ca2+] both decreased to a similar extent when the [Ca2+] used to activate the muscle was increased. 5. Step reductions of length of increasing amplitude caused increases in myoplasmic [Ca2+] which were larger in proportion to the size of the step. 6. Step reductions of length of equal size but from different starting lengths caused changes in myoplasmic [Ca2+] the amplitude of which correlated with the change in tension rather than the change in length. 7. The increase in myoplasmic [Ca2+] when muscle length is reduced suggests that Ca2+ is released from a site in the muscle, probably troponin C. The time course and magnitude of the changes in myoplasmic [Ca2+] correlate more closely with the changes in developed tension than muscle length.

The connection between writing and thinking has been radically reconceptualized in recent years. Whereas the previous view saw writing as recording thought, the new perspective sees writing as developing thinking. The change in views about writing is discussed and implications of the "Writing to Learn" paradigm for instructional and curricular issues in nursing are explored.

The calcium-sensitive photoprotein aequorin was micro-injected into cells of rat, ferret, rabbit and cat papillary muscles. Aequorin light emission is a function of free intracellular calcium concentration. The changes in intracellular calcium concentration [( Ca2+]i) and tension accompanying changes of pH have been studied. When the solution perfusing the papillary muscle was changed from Tyrode solution equilibrated with 5% CO2 to Tyrode solution equilibrated with 15% CO2, developed tension showed a rapid fall followed by a slower rise to a steady state which was less than the control. However the calcium transient associated with each contraction increased monophasically to a new steady state. When the external pH was held constant during exposure to 15% CO2 (by increasing the [HCO3-]), the initial fall of tension was reduced and the slow recovery of tension was greater than when CO2 alone was changed. The amplitude of the calcium transient increased monophasically to a new steady state which was greater than control, but less than when [CO2] alone was increased. If [HCO3-] was decreased while maintaining [CO2] at 5%, there was a slow monophasic decline in developed tension, and a small increase in peak light. Alkaloses produced by changing the [HCO3-]/[CO2] ratio produced similar results but the changes observed were in the opposite direction to those described above. The effects of changes of pHo can be explained if pHi affects tension by two mechanisms. The first mechanism, which is responsible for the rapid change in tension, is not associated with a change in [Ca2+]i. The second mechanism leads to a slower and smaller change in tension, in the opposite direction to the first, and is due to a change in the intracellular calcium transient.

A cell is described that has enabled isolated Langendorff-perfused ferret hearts to be studied in a Bruker WM200 widebore superconducting nuclear magnetic resonance (NMR) spectrometer. Left ventricular pressure was monitored with a latex balloon catheter, and the hearts were paced with a stimulator triggered from the spectrometer's central computer, enabling gated studies to be performed. Suitable radiofrequency filtering for the pacing leads is described. Phosphorus (31P) NMR was used to determine internal pH and the concentration of phosphorylated metabolites under resting conditions. The perfusion rate is shown to affect the phosphocreatine/ATP ratio at low flow rates, but the removal of phosphate from the perfusate is shown not to affect metabolite levels or the internal pH. The time resolution of the method is assessed and its potential for monitoring transient effects illustrated by studies of the effects of acetylcholine and cyanide-induced anoxia. The cardiac gated 31P NMR experiment is discussed and four spectra, corresponding to mid- and end systole and mid- and end diastolic are presented. No effects of cycling of high-energy phosphates are evident in these results.

Nursing leaders know change is not easy: it produces varying degrees of chaos and ambiguity. Maintaining control and traditional structure to minimize either chaos or ambiguity, however, does not achieve the final goal: organizational transformation and effective responses to changes in the environment and the organization. Given our current environment and its demands, we must remember that superficial changes will not address the fundamental problems. Transforming philosophies are relevant and needed in organizations. Transformation requires a shift in our perspectives, our attitudes, and our beliefs. Shared governance is one strategy for assisting in transforming nursing organizations. By sharing power and control with staff, leaders can effectively help to empower the whole and provide leadership that is visionary and creative. The end result of this transformation is meaningful collaboration and a humane, quality nursing system responsive to client needs.

The effects of saffan on cardiopulmonary function were evaluated in eight healthy adult cats. Measured values were cardiac output by thermodilution, heart rate by electrocardiogram, arterial blood gases, respiratory rate and systolic, diastolic and mean arterial blood pressures by arterial catheterization. Calculated values included cardiac index, stroke volume and systemic vascular resistance. Statistical analysis employed paired t-tests comparing pre saffan anesthetic induction and post saffan anesthetic parameters over a 120 minute time sequence. Thirty min after saffan induction, significant depression in cardiac output was evident while stroke volume was significantly depressed at 45 and 60 min, systolic blood pressure at 15 min and respiratory rate at 5, 10 and 15 min. No significant changes occurred in cardiac index, heart rate, arterial blood gases, diastolic and mean arterial blood pressure or systemic vascular resistance. It was concluded that saffan causes significant depression of cardiopulmonary function in normal adult cats.

Bioluminescent indicators have found many uses in, for example, the detection of ATP and free calcium levels. However, such probes often emit only very low levels of light and it is important to optimize the efficiency of the system used to detect this light. We describe some of the problems encountered in using photomultiplier tubes for detecting low levels of light, and some ways of overcoming these problems. We have developed a versatile photomultiplier light detection system which is both efficient and physically small. This system is described and details of its fabrication are given.

Cardiopulmonary function was assessed in healthy cats premedicated with intramuscular acepromazine, meperidine, atropine combination (premix), followed by induction and maintenance with intravenous thiopental for 30 min. Cardiac output by thermodilution, heart rate, blood pressure and blood gas analysis were evaluated over 120 min. A minor degree of respiratory depression was noted in the cats. Cardiac index (cardiac output/kg) was significantly depressed following thiopental induction and for the entire 120 min studied. Stroke volume was significantly reduced after premix administration and for 90 min posthiopental induction. No significant change in heart rate, systemic vascular resistance or blood pressure was observed. Significant cardiovascular depression was produced by the premedicant, and this persisted following thiopental anesthesia.

Calcium sensitive photoprotein aequorin was micro-injected into the cells of cat and rat ventricular cardiac muscles. Light and tension were recorded from the injected muscle in order to clarify the relation between the intracellular Ca++ transient and relaxation. The time course of the falling phase of the light signal and the time course of the relaxation were measured under the various conditions, i.e., changes of stimulation frequency, [Ca++] o, and the administration of adrenaline and caffeine. High stimulation frequency accelerated the time course of the fall of light and the relaxation of tension. Caffeine prolonged the relaxation of tension and the falling phase of light. The time course of relaxation did not change substantially but the falling phase time course of the light was accelerated by increase of [Ca++] o and adrenaline. These results confirm that a fall in [Ca++] i always precedes relaxation but suggest that the decrease of [Ca++] i is not always the rate limiting step of the relaxation in the mammalian cardiac muscle.

The relation between muscle length or sarcomere length and developed tension for lengths up to the optimal for contraction (Lmax) is much steeper in cardiac muscle than in skeletal muscle. The steepness of the cardiac length--tension relation arises because the degree of activation of the cardiac myofibrils by calcium increases as muscle length is increased. Two processes contribute to this length-dependence of activation: (i) the calcium sensitivity of the myofibrils increases with muscle length and (ii) the amount of calcium supplied to the myofibrils during systole increases with muscle length. Of these two, the change in calcium sensitivity is the most clearly defined and is responsible for a large part of the rapid change in developed tension when muscle length is altered. It is likely that this change in calcium sensitivity is due to a change in the affinity of troponin for calcium but the underlying mechanism has not been identified. There is good evidence that changes in the calcium supply to the myofibrils can account for the slow changes in tension that follow an alteration in length; there may also be rapid changes in calcium supply but this is less clearly established at present.

The Ca2+ -sensitive bioluminescent protein aequorin was microinjected into cells of frog atrial trabeculae to study intracellular calcium transients associated with excitation-contraction coupling. The amplitude of the aequorin signal increased with extracellular Ca2+ concentration and stimulus frequency, but decreased with stretch. Isoprenaline and acetylstrophanthidin both increased the amplitude, but had strikingly different effects on the time course of the signal.

Stabilised human serum 500 ml was infused intravenously over 90 minutes in 14 hypertensive women in late pregnancy, and the haemodynamic changes were investigated and compared with those in 7 similar women who were not treated. There was a significant mean increase of 1,85 l in plasma volume, a decrease in diastolic and systolic blood pressure, and an increase in central venous pressure (CVP), pulse pressure and pulse rate in the treated group at 2 hours but not in the control group. After 24 hours most of the observations were not significantly different from the pretreatment levels except the CVP and pulse rate measurements which were still significantly raised. The CVP measurements in the hypertensive women before treatment were relatively low compared with those reported in normal women in late pregnancy. It is suggested that there may be an under-filling of the circulation in pregnancy hypertension and that plasma volume expansion may have an important therapeutic effect by increasing cardiac output and renal and uterine blood flow.

The response of the heart to disease can be detected by assessing myocardial electrical activity. The electrocardiograph is a useful diagnostic tool which is widely available to the veterinary clinician. However, interpretation of the tracing often requires considerable experience.Regularly, electrocardiograms (ECG) of clinical cases will appear in this column. Each tracing will be preceeded by the history and the pertinent ancillary data. Interpretation and discussion of the ECG will follow. The purpose of this column is to present clinicians with examples of common electrocardiographic abnormalities.

1. In this study we have investigated the effects of a novel inotropic agent, pimobendan (UDCG 115-BS), on skinned and intact ventricular muscle from ferrets. 2. Pimobendan (20 or 100 mumol/l) increased tension at a given free [Ca2+] when applied to skinned ventricular muscle, i.e. it increased the Ca2+ sensitivity of the myofibrils. 3. Tension and intracellular free Ca2+ [( Ca2+]i) were measured simultaneously in intact papillary muscles using the aequorin technique. When 25 mumol/l pimobendan was added to the superfusing solution, a slowly developing positive ionotropic effect was produced, which was accompanied by an increase in the size of the systolic rise in [Ca2+]i (Ca2+ transients) with a similar time course. 4. In order to determine whether pimobendan increased the Ca2+ sensitivity of myofibrils in an intact papillary muscle, we compared the increase in Ca2+ transients and tension observed in response to changes in extracellular [Ca2+] with those observed in response to pimobendan. The result of this comparison was that in intact muscle pimobendan caused no apparent increase in myofibrillar Ca2+ sensitivity. 5. Pimobendan caused an abbreviation of the time course of the Ca2+ transients, but the twitch was slightly prolonged. 6. When isoprenaline was added to the superfusing solution, a positive inotropic effect was produced, which was accompanied by a marked increase in the size of the Ca2+ transients. Isoprenaline caused an abbreviation of the time course of both the Ca2+ transients and the twitch. When the Ca2+ sensitivity of the intact myofibrils was determined as described above, isoprenaline caused a desensitization. Pimobendan produced a sensitization when compared with isoprenaline. 7. These results are consistent with the hypothesis that pimobendan produces an inotropic effect in isolated cardiac muscle which is mediated both by an increase in Ca2+ sensitivity and by an increase in adenosine 3':5'-cyclic monophosphate due to its phosphodiesterase-inhibiting activity. Such a combination of activities may be particularly advantageous for an inotropic agent.

The influence of Aspergillus niger broth rheology, bioreactor geometry, and superficial gas velocity on the volumetric liquid phase oxygen transfer coefficient (k(L)a(L)), riser gas holdup (epsilon(GR)), and circulating liquid velocity (u(LR)) was studied in a bubble column (BC) and two external-circulation-loop airlift (ECLAL) bioreactors. The results are compared to those of previous studies on homogeneous fluids and in particular with a recent study on non-Newtonian carboxymethylcellulose (CMC) solutions conducted in the same contactors used for the A. niger fermentations. As expected from the CMC-based studies, in the heterogeneous broths of A. niger epsilon(GR), k(L)a(L), and u(LR) decreased with increasing broth apparent viscosity; epsilon(GR) and k(L)a(L) decreased with increasing downcomer-to-riser cross-sectional area ratio, A(d)/A(r), whereas u(LR) increased with increasing A(d)/A(r). Gas holdup data in the airlift fermentations of A. niger were well predicted by the CMC-based correlation. However, the CMC-based correlations produced conservative estimations of k(L)a(L) and overestimates of u(LR) compared to the observed values in the A. niger broths.

1. The calcium-sensitive photoprotein aequorin was micro-injected into cells of rat and cat ventricular muscles. The resulting light emission is a function of intracellular free calcium concentration ([Ca2+]i). The transient increases in [Ca2+]i that accompany contraction were monitored. 2. After an increase in muscle length, the developed tension increased immediately and then showed a slow increase over a period of minutes. The peak [Ca2+]i in each contraction was initially unchanged after an increase in muscle length but then showed a slow increase with a time course similar to that of the slow tension change. 3. As a consequence of these slow changes, the shape of the tension-length relation depends on the procedure used to determine it and this change in shape can be attributed to changes in activation. 4. Immediately after an increase in muscle length the calcium transient was abbreviated. 5. When a quick release was performed during a contraction, a short-lived increase in the [Ca2+]i was observed following the release. 6. The two previous observations can both be explained if the binding constant of troponin for calcium is a function of developed tension.

The prevalence of gross and/or histological cardiac lesions was found to be much greater in Doberman pinscher dogs (16/26 or 62%) than in non-Doberman dogs (124/417 or 30%). At least some of the affected Dobermans were unrelated. Middle aged (mean age 4.7 yr) Dobermans of both sexes (11 M:5F) were affected. Four of the Dobermans with heart lesions had congestive cardiomyopathy; three of these four had congestive heart failure and the other one died suddenly. Prominent gross lesions were ventricular dilation and atrioventricular valvular endocardiosis. Histological lesions noted were prominent myocardial fibrosis, myofiber degeneration with fatty replacement, myofiber vacuolation and arterial intimal cushion formation. A spectrum of myocardial disease exists in Dobermans and clinically overt congestive cardiomyopathy represents one end of this spectrum.

Isolated cardiac tissue from the ferret was repeatedly exposed to anoxia while perfused with glucose-containing Tyrode solution. In one series of experiments, papillary muscles were injected with aequorin to measure intracellular Ca2+. On the first exposure to anoxia, the Ca2+ transients often increased, but on subsequent exposures this increase disappeared and eventually the Ca2+ transients declined on exposure to anoxia. This decline in the Ca2+ transients could be converted back to an increase by a 1 h exposure to an elevated (x5) glucose concentration. Exposure of aerobic muscles to 10 mM lactic acid caused a similar increase in the Ca2+ transients to that seen in early exposures to anoxia. In a second series of experiments, performed on Langendorff-perfused hearts, measurements were made of glycogen concentration preceding, and lactate production during, exposures to anoxia. At a constant level of glucose, glycogen concentration and lactate production were found to decline on repeated exposures to anoxia, and both were increased after a period of elevated glucose and reduced stimulation frequency. These results suggest that the response of the Ca2+ transients to anoxia is dependent on the metabolic status of the muscle. The increase in the Ca2+ transients during an early exposure to anoxia may be a consequence of lactic acid production due to accelerated glycolysis. Repeated exposures to anoxia reduce glycogen concentration and lactate production and this reduces the rise in the Ca2+ transients.

Light emission from the calcium-sensitive bioluminescent protein aequorin was measured at calcium ion concentrations of 10(-9) to 10(-2) molar. At very low Ca2+ concentations, light emission is independent of calcium ion concentration. The maximum slope of the log-log plot of light as a function of calcium ion concentration is about 2.5. The complete relation is well described by a two-state model involving three calcium-binding sites.