Baroreceptorii sinocarotidieni i aortici sunt stimulai de modificrile presiunii

arteriale sistemice. Creterea presiunii arteriale sistemice (sau compresiunea

carotidelor deasupra bifurcaiei) mrete frecvena impulsurilor pn la un
anumit nivel, proporional cu creterea presiunii. Aceste impulsuri determin
un reflex depresor care are ca finalitate: scderea debitului cardiac (prin
scderea frecvenei i a contractilitii cardiace) i scderea rezistenei
periferice vasculare.
Scderea presiunii arteriale (sau compresia pe carotida comun) stimuleaz
baroreceptorii sinocarotidieni i aortici, determinnd un efect opus,
caracterizat prin tahicardie, vasoconstricie, creterea presiunii i a debitului
cardiac - reflex presor

Inulin Clearance
Inulin is an inert polyfructose sugar that is completely filtered by the glomerulus and is
neither secreted nor reabsorbed by the renal tubules. The volume of plasma cleared of
inulin (mL/min) represents the GFR. Inulin clearance is measured identically to PAH
clearance, and an indwelling intravenous cannula and urinary catheter must be in place.
After an intravenous loading dose of 30 to 50 mg/kg, a continuous infusion of inulin is given
to establish a steady-state plasma concentration of 15 to 20 mg/dL. The bladder is usually
flushed with air to eliminate any pooled urine. Then, a very carefully timed urine collection is
made, which can be as short as 30 minutes. It is generally accepted that inulin clearance
(CIN) provides the most accurate available determination of GFR (i.e., it represents the gold
standard):

where UIN is urinary inulin in mg/dL, PIN is plasma inulin in mg/dL, and V is urine flow rate
in mL/min. This relationship also implies that the renal excretion of inulin (urinary inulin times
urine flow rate) is determined solely by the GFR and the plasma inulin concentration:

Although inulin clearance is the standard measure of GFR in experimental situations, it is
seldom used clinically because its accurate measurement is laborious and requires
meticulous attention to detail. The inulin assay is timeconsuming, and inulin itself is in short
supply because of lack of demand. Inulin meets all the criteria of an ideal filtration marker,
but large changes in blood glucose during the test may interfere with its measurement, and
its accuracy in reflecting GFR cannot be directly assessed, only inferred. The predicted
variability of inulin clearance is 20 percent when measurements are compared at two
different times in the same individual and 40 percent when measurements are compared
between two individuals.
11

Normal values for inulin clearance are 110 to 140 mL/min/1.73m
2
(males) and 95 to 125
mL/min/1.37m
2
(females).

Angiography or arteriography is a medical imaging technique used to visualize the inside,
or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins and
the heart chambers. This is traditionally done by injecting a radio-opaquecontrast agent into the
blood vessel and imaging using X-ray based techniques such as fluoroscopy.
The word itself comes from the Greek words angeion, "vessel", and graphein, "to write" or "record".
The film or image of the blood vessels is called an angiograph, or more commonly, an angiogram.
Though the word itself can describe both an arteriogram and avenogram, in its everyday usage,
the terms angiogram and arteriogram are often used synonymously, whereas the term venogram is
used more precisely.
[1]

The term angiography is strictly defined as based on projectional radiography; however, the term
has been applied to newer vascular imaging techniques such as CT angiography and MR
angiography. The term isotope angiography has also been used, although this more correctly is
referred to as isotope perfusion scanning.
Depending on the type of angiogram, access to the blood vessels is gained most commonly through
the femoral artery, to look at the left side of the heart and at the arterial system; or
the jugular or femoral vein, to look at the right side of the heart and at the venous system. Using a
system of guide wires and catheters, a type of contrast agent (which shows up by absorbing the x-
rays), is added to the blood to make it visible on the x-ray images.
The X-ray images taken may either be still images, displayed on an image intensifier or film, or
motion images. For all structures except the heart, the images are usually taken using a technique
called digital subtraction angiography or DSA. Images in this case are usually taken at 2 - 3 frames
per second, which allows the interventional radiologist to evaluate the flow of the blood through a
vessel or vessels. This technique "subtracts" the bones and other organs so only the vessels filled
with contrast agent can be seen. The heart images are taken at 15-30 frames per second, not using
a subtraction technique. Because DSA requires the patient to remain motionless, it cannot be used
on the heart. Both these techniques enable the interventional radiologist or cardiologist to
see stenosis (blockages or narrowings) inside the vessel which may be inhibiting the flow of blood
and causing pain.
3.1 Coronary angiography
3.2 Microangiography
3.3 Neuro-vascular angiography
3.4 Peripheral angiography
3.5 Post mortem CT angiography for medicolegal cases

Metoda cu izotopi radioactivi:
Explorarea cu izotopi radioactivi ofer date asupra timpului de circulaie a sngelui prin
artere. Pentru determinare se folosete: Na
24
, I
131
, K
42
. substanele radioactive se pot introduce pe
cale general (arterial sau venoas) sau local (catunat, muscular).
Plasarea controlului se face n puncte speciale n funcie de segmentul de circuit arterial la
care se refer determinare.
Datele obinute se apreciaz:
prin determinarea procentului de descretere a radioactivitii pe minut
prin determinarea timpului necesar reducerii numrului de impulsuri la jumtate din valoare
iniial
Valoarea timpului de circulaie depinde de:
volum sanguin
debitul circulator
vscozitatea sngelui
rezistena periferic
Explorarea radioizotopica a cordului (S.Cotul - 14, 11, 37) Explorarea cu radioizotopi
furnizeaza clinicianului informatii morfofunctionale complexe asupra miocardului si a
performantei ventriculare. Examinarile au caracter neinvaziv, pot fi efectuate si in conditii de
ambulator. Ele se bazeaza pe administrarea i.v. a unor radiotrasori cu tropism pentru
miocard (201Thalium) sau de markeri" ai spatiului endocatar (99mTc). Instrumentul utilizat
este camera de scintilatie computerizata, cu programe specializate pentru cord.
Performantele tehnice actuale, confera acestei investigatii neinvazive un grad inalt de
precizie, rezultatele sunt cantificabile si reproductile. Ea poate inlocui in unele situatii
cataterismul cardiac si angiocardiografia de contrast.
Se utilizeaza urmatoarele tipuri de explorari radioizotopice:
1. Scintigrafia miocardului in repaus (SMR)
2. Scintigrafia miocardului in efort (SME)
3. Scintigrafia miocardului dupa persantin (SMP)
4. Scintigrafia secventiala a catatilor (angiocardiografia radioizotopica).
In present, cea mai folosita metoda este ecografia Doppler, al carei principiu
este urmatorul: frecventa (f) unui fascicul de ultrasunete reflectat de hematiile aflate in miscare
este diferita de frecventa initiala (f0), diferenta dintre cele doua fiind semnalul Doppler (f),
care poate fi ascultat sau inregistrat grafic. Amplitudinea semnalului Doppler depinde de
frecventa initiala, de viteza de deplasare a hematiilor (v), viteza de propagare a ultrasunetelor
(c) si de unghiul dintre directia de deplasare a hematiilor si fasciculul de ultrasunete : f= 2 x f0
x
v x cos/c.