Positive inotropic response to inosine in the in situ canine heart

Effects of inosine on left ventricular contractile force, circumflex blood flow, heart rate, and arterial pressure were investigated in mongrel dogs. Infusion of 50 ml of 10, 25, or 50 mM inosine into the right atrium over 5 min produced arterial blood inosine concentrations of 20-120 microM. Infusion of inosine concentrations of 10 mM or greater produced statistically significant increases in contractile force and circumflex blood flow (P less than 0.05). The increases in contractile force and circumflex blood flow caused by 50 inosine were approximately 40% and 110%, respectively. No statistically significant increases in heart rate or arterial pressure were observed during infusion of inosine at any concentration. Administration of propranolol (2 mg/kg) in no way altered the effects of inosine on contractile force or circumflex blood flow. Thus, the present study suggests that inosine in concentrations which may be produced in the myocardium during stressful conditions causes a substantial effect on the inotropic state of the heart and that the effects of inosine are not mediated through adrenergic mechanisms.

The predisposition to infection following hemorrhagic shock

Subsequent life threatening gram-negative infection in patients successfully resuscitated from hemorrhagic shock is becoming increasingly common. Following hemorrhagic shock and resuscitation, Sprague-Dawley rats were given Escherichia coli intraperitoneally to simulate the clinical setting in which peritoneal contamination and hypovolemic shock occur concurrently. A sublethal dosage of bacteria resulted in a 100 per cent mortality. This suggests that hemorrhagic shock, even when treated promptly and effectively, predisposes to infection.

Delineation of critical factors in the treatment of pancreatic trauma

An analysis of 100 patients sustaining multiple injury and pancreatic trauma was completed. Sixteen patients with penetrating injury died within the first 24 hours, 14 of whom died intraoperatively from major hepatic and/or retroperitoneal venous injury. Eighty-four patients survived long enough to permit evaluation of treatment. There was no statistically significant relationship between mode (p = 0.3) or anatomic area (p = 0.5) of injury and death. However, death was more common in the presence of duct injury (p less than 0.0001). Thirty-nine patients were determined to have duct injury and 45 did not. These two groups were equivalent, with the exception of a higher incidence of concomitant bowel injury (p less than 0.05) in those with duct violation. Combined sump and Penrose drainage was found to be adequate treatment of both proximal and distal nonductal injury with no significant difference in mortality or morbidity rates (p = 0.5). Resection of distal ductal injuries as opposed to drainage alone resulted in significantly lower morbidity and mortality rates (p less than 0.05), comparable to those of drained nonductal injuries. No conclusions could be made relevant to proximal duct injuries, except that drainage alone is inadequate. Seventeen (20 percent) of the 84 patients evaluated died. Pancreatic related mortality rate was 17 percent (14 patients). Two of 23 patients with blunt injury (9 percent) and 12 of 61 patients with penetrating injury (20 percent died). Gram-negative sepsis (82 percent) was the most common cause of death (p less than 0.01), and sepsis was correlated with the presence of pancreatic duct (p less than 0.0001) and bowel (p less than 0.001) injury.

Anti-liver antibody in rabbits infected with Schistosoma japonicum

Anti-liver antibody has been demonstrated in the sera of Schistosoma japonicum-infected rabbits. By the 8th week after exposure to cercariae, perceptible levels of autoantibody were present and appeared to be direct predominantly determinants located in the cell membrane of the hepatocyte.

Post-traumatic intestinal obstruction

The roentgenographic and pathologic findings in three patients with delayed post-traumatic intestinal obstruction are described. The pertinent literature also is reviewed to delineate the variable pathophysiology of the clinical phenomenon. As a result of the increasing incidence of blunt trauma in our society, the problem of occult intra-abdominal injury resulting in subsequent clinical disease always should be considered in the differential diagnosis of patients presenting later with intestinal complaints. Once considered, routine roentgenologic evaluation usually is diagnostic, and arteriographic evaluation should be considered if the diagnosis is strongly suspected in the face of normal contrast studies. If intestinal obstruction is diagnosed, operative treatment is indicated, simple, and effective.

Acute changes in high energy phosphates, nucleotide derivatives, and contractile force in ischaemic and nonischaemic canine myocardium following coronary occlusion

Studies of ischaemic myocardium following occlusion of coronary arterial branches revealed a substantial decline in creatine phosphate, adenosine triphosphate, and total adenine nucleotide contents over 40 min. Contents of nucleotide breakdown derivatives increased significantly but transiently. Contractile force declined rapidly and stabilized at a low level. In nonischaemic muscle following occlusion creatine phosphate, adenosine triphosphate, and total nucleotide contents declined rapidly, although not to the degree seen in ischaemic muscle. Contents of derivatives increased only slightly. Contractile force increased.

The surgical treatment of carcinoma of the colon and rectum: an index of quality care and sociologic and geographic distribution

A comparative experience of 474 patients with primary carcinoma of the colon and rectum has been evaluated in several hospital settings, with particular respect to patient populations, geographic distribution, and surgical characteristics. The differences and similarities are interpreted with caution but may provide a format by which significant objective determinants become the basis for subsequent assessment of quality care in an illness which is prevalent and amenable to relatively standardized operative management. No difference in quality of medical care provided was detectable across the sociologic and geographic boundaries studied. Notable increases in extent of neoplasm and severity of co-existent illness in the urban, "indigent" population adversely influenced both short and long-term mortality rates.

Effect of ischemia and infarction on regional content of adenine nucleotides and derivatives in canine left ventricle

Samples of myocardium from four areas of ischemic and infarcted canine ventricle were examined over a 20-day period for content of the three adenine nucleotides as well as inosine, hypoxanthine, adenosine, and inosine monophosphate. The adenosine triphosphate (ATP) content of central and peripheral areas within the infarct fell to 11% and 8% of control, respectively, 1 day after coronary occlusion. The total adenine nucleotide (TAN) content in these areas fell to 17% of control and showed no significant recovery during the period of study. In the functional myocardium immediately surrounding the infarct the ATP content was depressed to 58% control after 1 day, and the TAN content was also depressed. In the healthy myocardium near the apex, the ATP content was significantly depressed only at the 3-day sample period. Adenine nucleotide derivatives were detected only at 30 min in the central ischemic area. The absence of the nucleoside and nucleobase compounds formed during adenine nucleotide degradation is attributed to their high membrane diffusibility. Loss of these compounds is considered a contributing factor in the prolonged depression of adenine nucleotide content in both ischemic and non-ischemic regions.

The examination of some vinyl acetate/olefin copolymers by pyrolysis gas chromatography mass spectrometry

A study of the thermal degradation of some vinyl acetate/olefin copolymers reveals that side chain scissions at the backbone and scissions within the side chains themselves yield fragments which are apparently characteristic of the parent olefin.

The cause of post-traumatic pulmonary insufficiency in man

Respiratory failure in man most frequently follows sepsis. A sign of occult sepsis may be pulmonary failure. Shock and its necessary fluid therapy may predispose to a brief requirement for ventilatory assistance. Shock and multiple injury predispase to sepsis. Mechanical ventilation with intubation has adverse effects upon the lung as well as beneficial effects of the patient. The most important adverse effect is pneumonia.

Pancreatic abscess

Successful management of pancreatic abscess necessitates early diagnosis and prompt external surgical drainage. The infection is predominantly gram-negative and polymicrobic. Roentgenographic contrast studies are of particular diagnostic value. Prompt recognition and external drainage are associated most frequently with recovery. Multiple system organ failure is the typical pattern of death and should alert one to the possibility of occult sepsis, secondary to pancreatic abscess.