No abstract

The transport equation describing the flow of solute across a membrane has been modified on the basis of theoretical studies calculating the drag of a sphere moving in a viscous liquid undergoing Poiseuille flow inside a cylinder. It is shown that different frictional resistance terms should be introduced to calculate the contributions of diffusion and convection. New sieving equations are derived to calculate r and A,/Ax (respectively, the pore radius and the total area of the pores per unit of path length). These equations provide a better agreement than the older formulas between the calculated and the experimental glomerular sieving coefficients for [6I]polyvinylpyrrolidone (PVP) fractions with a mean equivalent radius between 19 and 37 A. From r and A,/Ax, the mean effective glomerular filtration pressure has been calculated, applying Poiseuille's law. A value of 15.4 mm Hg has been derived from the mean sieving curve obtained from 23 experiments performed on normal anesthetized dogs.In 1951, Pappenheimer et al. developed the so-called "pore theory" to account for the transcapillary transport of uncharged, lipid-insoluble solutes in mammalian muscles (24). According to this theory, convective flow and net diffusion contribute to solute flow across the membrane, in this case the capillary walls, both processes being impeded by the steric hindrance at the entrance of the "pores" (supposed to exist between the cells) and by frictional forces within the pores (20,22,23,25).The solute flow due to diffusion was calculated as D(c -c 2 )AW/Ax X A,/A, where D is the free diffusion coefficient, cl and c 2 , respectively, the solute concentrations in filtrand and filtrate and A,/Ax the pore area freely available to water per unit of length. The term A,/A, describes the restriction to the motion and can be calculated as 1/K 1 X SD where SD = [1 -(a,/r)]2 is the steric hindrance term (a, is the radius of the solute molecules

No abstract

Determination of glomerular intracapillary and transcapillary pressure gradients from sieving data. A biomathematical model is described to calculate the intracapillary and transcapillary glomerular pressure gradients from the sieving coefficients (phi: fractional clearances/GFR) of macromolecules such as polyvinylpyrrolidone (PVP). Two differential equations have been developed. The first one calculates local values for GFR in terms of local values for PGC (intracapillary hydrostatic pressure) and pi (oncotic pressure). The second equation calculates the clearance of PVP equimolecular fractions, the sieving equations previously described (24) being used to derive the concentrations of PVP in the filtrate (c2). Two variants of the second equation have been considered, assuming the filtrate in contact with the membrane either "well stirred" or "unstirred" (constant c2 and local c2 gradient models respectively). Computer simulations have been used to illustrate how the sieving curve is modified when the five parameters on which depends the shape of the curve are changed one by one. The sieving curve relates phi to a(s) (hydrodynamically equivalent molecular radius). The determining parameters are: GFP, the mean effective glomerular filtration pressure, epsilon, the slope of the intracapillary pressure, FF, the filtration fraction, Cp0, the protein concentration in arterial plasma and r, the pore radius which is the only structural parameter involved when one assumes the glomerular membrane crossed by cylindrical pores of uniform size and length. The shape of the sieving curve is modified significantly enough by changing GFP, FF and r within reasonable limits, to make it possible to derive GFP and r from experimental sieving data for macromolecules such as PVP or dextrans.

We studied 40 patients who underwent cavo-tricuspid isthmus ablation for typical counterclockwise atrial flutter with cooled tip catheters between 2001 and 2003. Complete bi-directional isthmus block was created in all patients. A new, three-dimensional (3D), non-fluoroscopic mapping system was used in 20 patients (test group), and conventional fluoroscopy in 20 others (conventional group), using anatomic and electrophysiologic criteria in both groups. We measured the total procedure, ablation procedure, and overall fluoroscopy times, and the total number of radiofrequency (RF) applications delivered in the two groups. The overall fluoroscopy time was shorter in the test group (mean 8.8 minutes, range 2-17 minutes) than the conventional group (29.7 minutes, range 12-57 minutes; P < 0.001). Though the overall procedure time was similar in both groups (92.5 +/- 28.6 minutes vs 106.5 +/- 20.9 minutes; P = 0.067) the ablation duration (25.1 +/- 6.6 minutes versus 43.3 +/- 19.6 minutes; P = 0.0051) and the total RF applications (10.6 +/- 9.4 versus 16.4 +/- 9.4; P = 0.044) were smaller in the test group. The use of a new, 3D non-fluoroscopic mapping system markedly reduced the fluoroscopy exposure during typical atrial flutter ablation. It was also associated with a significant reduction in ablation time and in the number of RF applications. Since atrial flutter ablation is one of the most frequently performed procedures, this system may significantly reduce the overall amount of radiation exposure in high-volume laboratories.

The multidetector 16-slice CT scan with contrast injection accurately evaluates the anatomy of the CTI. The only independent anatomic parameter that predicts a more difficult procedure is the thickness of the CTI.

The addition of proximal irrigation holes at the catheter tip do not facilitate lesion formation during RF ablation, but significantly increases the risk of steam pop. This is probably the consequence of an increase distortion of the temperature feedback.

No abstract