[Relations between disorders of the intestinal-hepatic basin hemodynamics and absorption function in hemorrhage]

Chronic dog experiments showed that blood loss of 30 ml/kg or an intravenous injection of 1 microgram/kg norepinephrine did not markedly change small intestinal absorption. Blood supply to the liver was maintained at the expense of restricted portal circulation. Adaptation in blood loss seems to support arterial blood supply to the liver and absorbing epithelium of the small intestine to warrant their resistance to circulatory hypoxia and to promote their functional activity.

The effect of haemorrhage on erythropoietin concentration in the mature ovine fetus

This study examines the response in plasma erythropoietin values to haemorrhage of 20% of the estimated blood volume in chronically cannulated ovine fetuses, of gestational ages 128-144 days. Blood samples were collected at 0, 2, 4, 6 and 24h with respect to the haemorrhage. In 5 control experiments there was no significant change in plasma erythropoietin concentration, across this time period, values being 6.1 +/- 2.3 and 6.4 +/- 2.4 mU/ml at 0 and 24h respectively. Values are mean +/- SEM. Haemorrhage reduced the haematocrit and haemoglobin values, significantly, to 83 +/- 6% and 85 +/- 4% (n = 5) of the initial value, respectively, but did not cause a statistically significant increase in plasma erythropoietin concentrations (7.2 +/- 2.4 and 20.7 +/- 8.2 mU/ml; P = 0.131). A larger degree of haemorrhage, in four fetuses reduced the haematocrit to 64 +/- 2.8% of initial, over 24-54h and increased erythropoietin values very significantly (from 11.9 +/- 3.6 to 91 +/- 8.3 mU/ml; P = 0.001).

Oxygen supply dependency in the critically ill--a continuing conundrum

There was little dispute that endotoxin treatment of experimental animals could recreate the O2 extraction defect that had been observed in critically ill patients. The remaining question was whether or not this necessarily signified pervasive tissue hypoxia. Some limitation to O2 diffusion in the tissues had been postulated because of known effects of endotoxin that ultimately result in damage to endothelium. We were unable to alter the critical DO2 or 0(2)ER in endotoxic dogs by manipulating the arterial PO2. This tended to rule against there being a diffusion limitation created by the endotoxin as a result of endothelial disruption or microvascular dysfunction. The results of the DCA and dopexamine experiments served to remind us that arterial lactate measurements may or may not indicate widespread tissue hypoxia. Sepsis, as emulated by endotoxin infusions, is also a metabolic disease that can cause inactivation of PDH and thus cause lactacidosis without tissue hypoxia. Regional measurements of lactate flux indicated that gut was hypoxic in spite of DO2 above critical because of maldistribution of blood flow between muscularis and mucosa. The questions persist of how much tissue hypoxia is caused by sepsis or endotoxin when DO2 is supported at supposedly adequate levels and whether there are marked regional differences. Such questions still await answers. Newer technological advances that permit assessment of tissue oxygenation by noninvasive methods, such as near infrared spectrophotometry or nuclear magnetic resonance measurement of tissue energy potential, may soon be feasible in critically ill patients. This kind of information will be of vast importance in designing the most effective therapeutic regimen.

Bleeding stress and metabolic changes in the crab Scylla tranquebarica (Fabricius)

In the crab scylla tranquebarica, bleeding stress is characterized by changes in proteins, lactic acid and water content of muscles, hepatopancreas and haemolymph. Proteins seemed to be involved in energy expenditure and internal osmotic balance. Lactate levels increased, suggesting a shift in aerobic metabolism. Water content fell.

Fluid restitution and shift of blood volume in anesthetized rabbits subject to cyclic hemorrhage

We investigated the effect of a 10% cyclic blood volume change with a period of 2 or 4 min to study the short-term control of blood volume. In experiments with pentobarbital-anesthetized rabbits, the blood density variation over a 2-min cycle is 0.94 +/- 0.04 (SE) g/l, and the plasma density variation is 0.17 +/- 0.04 g/l. The plasma density variation could result from a fluid restitution from the extravascular space (with a density 1,005 g/l), with a volume equal to 14% of the withdrawn blood volume. This restitution cannot account, however, for the entire observed density change in arterial blood. Because of the Fahraeus effect in microvascular flow, a shift in blood volume from the microvasculature is another mechanism that could lead to a decrease in the density of arterial blood. An analysis of the blood and plasma density variations indicates that a blood volume (49% of the shed volume) is shifted from the micro- to macrocirculation. This volume compensation by fluid restitution and volume shift acts to minimize the effect of hemorrhage on the filling of the venous system. We found that the blood density waveform parallels the change in blood volume. When the blood volume change reverses its direction, the density change also reverses direction with a time delay less than 8 s. The blood density variations are not altered by bilateral vagotomy or its combination with hexamethonium (a sympathetic ganglionic blocker). These observations of anesthetized rabbits indicate that the short-term compensation is primarily due to the volume shift from the microcirculation and is not regulated by humoral or neural mechanisms but by local mechanisms such as autoregulation and the passive response due to changes in microvascular pressure.

Acute volaemic changes modify the gastroduodenal resistance to the flow of saline in anaesthetized dogs

The effect of acute and sequential volaemic changes on the gastroduodenal flow of saline was assessed in 23 anaesthetized dogs following two different experimental protocols. Hypervolaemia, by i.v. infusion of saline, induced a gradual decrease on gastroduodenal flow which amounted to 76% below control values (P less than 0.001) when volaemic expansion attained 5% of body weight. This effect was volume dependent (17% increase on gastroduodenal flow per volume of infused saline equivalent to 0.5% of body weight, P less than 0.001), lasted for at least 90 minutes after infusion was completed and was also obtained by expanding previously bled animals. Hypovolaemia due to bleeding was followed by an increase on gastroduodenal flow of about 88% above control values (P less than 0.05) when haemorrhage was equal to 3% of body weight. This effect was also volume dependent (23% increase on gastroduodenal flow per volume of blood shed equivalent to a 0.5% of body weight, P less than 0.01) and was reversed after blood volume was restored. These modifications in the resistance of the gastroduodenal segment to the flow of liquid due to acute volaemic changes suggest that the extracellular fluid volume modulates the contractile activity of the gastroduodenal portion of the gut possibly to set a gastroduodenal handling of liquid adequate to cope with volaemic imbalances.

Effect of controlled hemorrhage on tissue and serum cefazolin clearance

Effects of blood loss on tissue and serum antibiotic levels were investigated in 30 New Zealand white rabbits. Studies were conducted over a 3.5-hr period after intravenous administration of cefazolin, 30 mg/kg, in control animals (Groups I and IV, n = 5 each) and animals having 50% (Groups II and V, n = 5 each) or 100% (Groups III and VI, n = 5 each) of their blood volume removed and replaced with either Ringer's solution (Groups I, II, and III) or rabbit whole blood (Groups IV, V, and VI) sufficient to maintain central venous pressures at baseline levels. Periodic samples of retroperitoneal fat, iliac artery, and serum were assayed for cefazolin concentration by disc diffusion. Decreased tissue antibiotic levels were observed in animals undergoing 100% blood replacement (Groups III and VI) compared to controls (Groups I and IV) in both fat (P less than or equal to 0.01) and artery (P less than or equal to 0.01) at 90 min. Decreased antibiotic serum half-life accompanying hemorrhage existed when comparing Group II to I (P less than or equal to 0.05), Group III to I (P less than or equal to 0.01), and Group IV to V (P less than or equal to 0.01). The increased antibiotic clearance related to blood loss in this study justifies reassessment of intraoperative dosing intervals. More frequent dosing may be required to maintain stable tissue and serum antibiotic levels during substantial operative hemorrhage.

Diltiazem restores IL-2, IL-3, IL-6, and IFN-gamma synthesis and decreases host susceptibility to sepsis following hemorrhage

Various beneficial effects of calcium channel blockers on cell and organ function following endotoxic shock, organ ischemia, and reperfusion have been reported; however, it is not known whether these agents have any salutary or deleterious effects on immune responses after low-flow conditions. Therefore, the aim of this study was to determine (a) the effect of hemorrhage on lymphocyte IL-2, IL-3, IL-6, and IFN-gamma synthesis, and (b) whether diltiazem has any salutary or adverse effects on these parameters when administered following hemorrhage and resuscitation. To study this, C3H/HeN mice were bled to a mean blood pressure of 35 mm Hg, maintained at that level for 60 min, and resuscitated with shed blood plus twice that volume of Ringer's lactate. Immediately following resuscitation mice received either diltiazem (2400, 800, or 400 micrograms/kg body wt), or an equivalent volume of saline. The mice were sacrificed 24 hr later, splenic lymphocytes were obtained, and their capacity to produce lymphokines was assessed. The results indicated that in the vehicle-treated animals, hemorrhage significantly decreased (P less than 0.05) IL-2, IL-3, IL-6, and IFN-gamma synthesis by 82 +/- 19%, 64 +/- 28%, 71 +/- 11%, and 86 +/- 14%, respectively. However, diltiazem (400 but not 2400 micrograms/kg) treatment after hemorrhage restored lymphocyte capacity to produce IL-2, IL-3, IL-6, and IFN-gamma (P less than 0.05). Additional groups of animals were subjected to sepsis by cecal ligation and puncture 3 days following hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of cerebral ischemia on hypotension-induced increase in plasma vasopressin and hepatic glycogen concentration in the rat

The effect of cerebral ischemia on the vasopressin response to hemorrhagic hypotension and on the hepatic and muscular glycogen mobilization was studied in rats. The addition of cerebral ischemia to the hemorrhage required withdrawal of significantly more blood to lower mean arterial pressure (MAP) to 50 mmHg but not if combined with ganglionic blockade. The increase in plasma vasopressin concentration during hypotension was not significantly different in rats with and without concurrent cerebral ischemia. Ganglionic blockade blunted the vasopressin response. Thus cerebral ischemia in fact attenuated the vasopressin response to hemorrhage. One hour after the insult, the hormone concentration in rats exposed to combined cerebral ischemia and hemorrhagic hypotension without ganglionic blockade was still above control levels and higher than in all other groups. Concomitantly the hepatic but not the muscular glycogen concentration in these rats was significantly lower than in the other groups.

[Acute hemorrhagic cystitis following chlordimeform poisoning ]

A 19-year-old and a 50-year-old man who together had cleaned a water-tank as part of their duties in a tank protection and cleaning firm developed that same evening lower abdominal pain, dysuria and haematuria. Cystoscopy revealed haemorrhagic cystitis in both patients, a finding confirmed by bladder mucosa biopsy. 4-chlor-2 methylaniline (concentration less than 1 mg/l) was found in hydrolysed serum of both. This metabolite of the pesticide chlordimeform was also found in the urine of the 51-year-old patient (16 mg/l). The haematuria regressed within two days of the patients having increased their fluid intake. Dysuria improved within a week. It is likely that chlordimeform had previously been transported in the water-tank. In case of haemorrhagic cystitis possibly caused by occupational or other poisoning, serum and urine should always be obtained for toxicological tests.

Eicosanoids regulate tumor necrosis factor synthesis after hemorrhage in vitro and in vivo

The aim of this investigation was to determine whether PGE2 regulates TNF release in vitro and in vivo following hemorrhage. To study this, C3H/HeN mice were bled to a mean blood pressure (BP) of 35 mm Hg, maintained for 60 minutes, and then resuscitated. For in vitro studies, peritoneal (pM phi) and splenic (sM phi) macrophages obtained at 2 hours and 24 hours after hemorrhage were stimulated with LPS for 24 or 48 hours with or without ibuprofen (IBU). For in vivo studies, M phi were harvested 24 hours following hemorrhage with and without IBU treatment and stimulated with LPS for 48 hours. The decreased TNF release by pM phi but not sM phi from hemorrhaged mice was restored by IBU in vitro. IBU treatment in vivo significantly enhanced TNF release by pM phi compared with untreated hemorrhaged animals, while TNF release by sM phi was only slightly increased. These data indicate a major role of PGE2 in the regulation of TNF release by pM phi following hemorrhage.

[The effect of acute fatal blood loss on post-resuscitation changes in heart phospholipids and prevention of them]

Acute lethal hemorrhage and resuscitation led to a decrease in content of phosphatidyl-choline, -ethanolamine, -serine and cardiolipin but increased lysophosphatidyl choline in rat heart muscle. Within the first week catabolism of phospholipids predominated, maximal rate of which was detected at the end of the first day. Within the subsequent three days phospholipid composition of cardiomyocyte membranes was gradually normalized. Qualitative and quantitative alterations in the membranes phospholipid composition with frequency of heart rhythm impairments, with increased consumption of glucose by functioning heart as well as with amount of enzymes, liberated from isolated isometrically contracting heart into coronary circulation. Preadministration of gamma-hydroxybutyric acid, guthimine, inderal, ionol and isophthine enabled to decrease or even to normalize the cardiomyocyte membranes phospholipid composition.

[Serum acid phosphatase activity in rats with hypoxia of different etiologies]

Experiments on male rats have shown that the acid phosphatase activity increases in all the types of hypoxia (circulatory-hemic, hemic and hypoxic), in blood serum. An increase in the activity of this enzyme distinctly correlates with hypoxia gravity. A supposition is advanced that the blood enzyme level of lysosomal hydrolases can reflect the functional state of the lysosomal apparatus in cells of the organism.

Renal O2 consumption during progressive hemorrhage

Most mammalian tissues regulate O2 utilization such that O2 consumption (VO2) is relatively constant at O2 delivery (DO2) higher than a critical value (DO2c). We studied the relationship between VO2 and DO2 of kidney and whole body during graded progressive exsanguination. The relationship between whole body VO2 and DO2 was biphasic, and whole body VO2 decreased by 5.6 +/- 14.4% (P = NS) from the initial value to the value nearest whole body DO2c. Kidney DO2 decreased in direct proportion to whole body DO2 such that the average R2 value describing the linear regression of kidney DO2 vs. whole body DO2 was 0.94 +/- 0.02. The relationship between kidney, like whole body, VO2 and DO2 appeared biphasic; however, kidney VO2 decreased by 63.3 +/- 10.4% (P less than 0.0001) from the initial value to the value nearest kidney DO2c. Renal O2 extraction ratio was relatively constant over a wide range of kidney DO2, whereas whole body O2 extraction ratio increased progressively at all whole body DO2 values as whole body DO2 decreased. However, final values of O2 extraction ratio were indistinguishable for whole body (0.86 +/- 0.1) and kidney (0.86 +/- 0.06) (P = NS). We conclude that the pattern of kidney and whole body VO2 response to decreasing DO2 differs during hemorrhage, particularly in the range of DO2 normally associated with tissue wellness.

[The negative effect of enkephalins on kidney energetics in rats with hemorrhages]

Content of adenine nucleotides, lactic and pyruvic acids, glucose and fructose-6-phosphate was studied in kidney of rats with hemorrhage constituting 3% of body mass after intravenous administration at a dose of 100 mg/kg of agonists of mu-opiate receptors DAGO and delta-opiate receptors DADL and dalargin. Stimulation of both these types of receptors amplifies the kidney ischemia developed after hemorrhage, which was expressed as increased decomposition of ATP, decrease in energetic charge of the adenine nucleotide system (DAGO) and increase in content of AMP (DADL, dalargin).

Flow redistribution during progressive hemorrhage is a determinant of critical O2 delivery

O2 consumption (VO2) of anesthetized whole mammals is independent of O2 delivery (DO2) until DO2 declines to a critical value (DO2c). Below this value, VO2 becomes O2 supply dependent. We assessed the influence of whole body DO2 redistribution among organs with respect to the commencement of O2 supply dependency. We measured DO2, VO2, and DO2c of whole body, liver, intestine, kidney, and remaining carcass in eight mongrel dogs during graded progressive hemorrhage. Whole body DO2 was redistributed such that the organ-to-whole body DO2 ratio declined for liver and kidney and increased for carcass. We then created a mathematical model wherein each organ-to-whole body DO2 ratio remained approximately constant at all values of whole body DO2 and assigned organ VO2 to predicted organ DO2 by interpolation and extrapolation of observed VO2-DO2 plots. The model predicted that O2 supply dependency without redistribution would have commenced at a higher value of whole body DO2 for whole body (8.11 +/- 0.89 vs. 6.98 +/- 1.16 ml.kg-1.min-1, P less than 0.05) and carcass (6.83 +/- 1.16 vs. 5.06 +/- 1.15 ml.kg-1.min-1, P less than 0.01) and at a lower value of whole body DO2 for liver (6.33 +/- 1.86 vs. 7.59 +/- 1.95, ml.kg-1.min-1, P less than 0.02) and kidney (1.25 +/- 0.64 vs. 4.54 +/- 1.29 ml.kg-1.min-1, P less than 0.01). We conclude that redistribution of whole body DO2 among organs facilitates whole body O2 regulation.

Total parenteral nutrition increases mortality after hemorrhage

OBJECTIVES

To determine the effect of total parenteral nutrition (TPN) and different enteral feeding formulas on survival and liver function following hemorrhage in rats.

DESIGN

Prospective randomized controlled study.

SETTING

Laboratory of a large university-affiliated medical school.

SUBJECTS

Sixty-seven male Sprague-Dawley rats weighing 350 to 450 g.

INTERVENTIONS

Jugular and gastroduodenal feeding catheters were inserted in animals 1 day before hemorrhage, and animals were started on one of six different fluid or nutritional regimens: TPN, iv saline, an enteral amino acid-based formula (AA) (Vivonex-TEN), an enteral peptide-based formula (PEP) (Reabilan-HN), an enteral intact-protein based formula (PRO) (Osmolite-HN), or enteral saline. A catheter was inserted in the tail artery and animals were hemorrhaged 5 mL/kg at baseline and 1 hr later. Animals were returned to their cages and observed for survival. Liver function was determined by measuring circulating bile acid levels at baseline and 24 hr after hemorrhage.

MEASUREMENTS AND MAIN RESULTS

Mortality was significantly increased in animals receiving TPN (63%) and AA (24%). Mortality was 13% in animals receiving PRO and 0% in animals receiving PEP and saline. Liver function deteriorated in all animals after hemorrhage except the PEP group.

CONCLUSIONS

TPN and AA increased mortality in animals after hemorrhage. PEP was associated with zero mortality and protection of liver function after hemorrhage.

Heart and brain nucleotide pools during hemorrhage and resuscitation

Sequential 31P nuclear magnetic resonance (NMR) spectra were measured in adult dogs to determine the relationship between cardiac function and myocardial intracellular pH (pHi) and phosphorylated energy metabolites during 2 h of hemorrhagic shock. Simultaneous measurements of coronary blood flow (radioactive microspheres), arterial and coronary sinus pH, blood gases, and oxygen content were performed. In addition, changes in brain NMR spectra were correlated with changes in cerebral blood flow during shock. Two hurs of hypovolemic shock resulted in significant decreases in phosphocreatine (PCr), PCr-to-ATP ratio, and pHi, whereas Pi rose significantly relative to baseline values. Return of shed blood and crystalloid fluid resuscitation improved cerebral and coronary perfusion and returned cardiac contractile function to near baseline values. We conclude that severe and sustained hemorrhagic shock produced significant alterations in brain and heart phosphorylated metabolites as well as significant intracellular acidosis; however, these changes in energy metabolites were reversible with adequate fluid resuscitation from shock.

Instantaneous restoration of regional organ blood flow after severe hemorrhage: effect of small-volume resuscitation with hypertonic-hyperoncotic solutions

The acute effects of small-volume infusion of hypertonic-hyperoncotic solutions on central hemodynamics, regional organ blood flow (RBF; 15-microns-diameter radiolabeled microspheres), and respiratory function following severe hemorrhage (MAP = 40 mm Hg for 45 min, approx 50% blood loss) were analyzed in anesthetized beagles. Treatment regimens used were: 10% Dextran 60 in 7.2% NaCl (HHS); 10% Dextran 60 in 0.9% NaCl (HDS); or 7.2% NaCl (HSS) alone, administered over 2 min in a volume equivalent to 10% of the blood loss (4 ml/kg iv). Within 5 min, cardiac output reached (HSS, HDS) or even exceeded prehemorrhage values (HHS), and MAP increased to 56% (HDS)-74% (HHS) of baseline. At the same time, RBF in kidneys (all groups), pancreas (HHS, HSS) and gastric mucosa (HHS) was completely restored, while flow in myocardium, brain, skeletal muscle, adrenal glands (all groups), and small intestine and colon (HHS) rose even above baseline values (P less than 0.05). Fractional blood flow (percentage of cardiac output) favored heart and brain in all three groups. These effects tended to persist for at least 30 min. Respiratory function was not affected by either of the three solutions, and no adverse effects were noted. Small-volume resuscitation with 7.2% saline/10% Dextran 60 provides instantaneous restitution of regional organ blood flow; it appears to result in a more uniform circulatory response than 7.2% saline or 10% Dextran 60 alone and might ensure improved organ perfusion during evacuation of patients from the accident site.

Thermal nociception potentiates the release of ACTH and norepinephrine by blood loss

Neuroendocrine and autonomic responses were assessed in chloralose-anesthetized cats after nociceptor activation and after acute blood loss, two of the sensory components that accompany injury. Plasma adrenocorticotropic hormone (ACTH), catecholamines (peripheral and adrenal), and cardiovascular responses were examined after corneal thermal stimulation (52 degrees C), after hemorrhage (10 ml/kg), and after simultaneous presentation of these two stimuli. Corneal heat during hemorrhage evoked an exaggerated increase in plasma ACTH (+185 +/- 76 pg/ml, P less than 0.01) and in peripheral plasma norepinephrine (+0.41 +/- 0.11 ng/ml, P less than 0.01) compared with the responses seen after either stimulus alone. A peripheral origin of norepinephrine was indicated, since the adrenal secretion of catecholamines increased similarly after all stimuli. Extracellular levels of norepinephrine, collected by push-pull perfusion, within raphe pallidus increased after corneal heat but not after blood loss and did not reflect the interaction between these two stimuli. Results indicated that physiological stimulation of nociceptive and cardiovascular receptors interact to potentiate the release of ACTH and norepinephrine into peripheral blood, effects that were not predicted from the responses to either sensory input alone.

Tissue penetration of cefotaxime in normal pigs and pigs with haemorrhagic pancreatitis

This study was designed to evaluate the tissue penetration of cefotaxime in normal pigs and pigs with haemorrhagic pancreatitis. Serum, peritoneal fluid, bile, gallbladder wall and pancreatic tissue concentrations of cefotaxime in these groups of pigs exceeded the MIC90 for susceptible species of Gram-negative aerobic bacteria. Cefotaxime penetration into pancreatic tissue and peritoneal fluid was increased from 2% to 2.6% and 73% to 89%, respectively, in pigs with pancreatitis in comparison with normal pigs. These increases however, were not statistically significant.

Cerebral metabolic and hormonal activations during hemorrhage in sinoaortic-denervated rats

Denervation of sinoaortic baroreceptors in normovolemic rats selectively increases glucose utilization in the median eminence and pituitary neural lobe and enhances secretion of vasopressin and oxytocin. Hemorrhage in denervated animals increases further glucose metabolism in these structures and stimulates the release of both neurohypophysial hormones with preferentially a greater effect on vasopressin. Similar increases in glucose metabolism in these structures with a greater release of vasopressin are observed in sham-operated animals during hemorrhage. Absence of high-pressure receptors, therefore, does not modify the preferential release of vasopressin during hypovolemia. Hemorrhage also increases glucose utilization in the paraventricular and supraoptic nuclei, area postrema, and subfornical organ in sham-operated and denervated rats but only after a 20% blood reduction. The results indicate that decreased inputs from low-pressure receptors during hemorrhage increase the activity of the hypothalamoneurohypophysial system after small reductions in blood volume and that the activity of this system is tonically inhibited by baroreceptors. The activities of structures responsive to circulating angiotensin II (subfornical organ and area postrema) are stimulated by larger reductions in blood volume and their metabolic activities are not tonically influenced by high-pressure receptors.

Immunoprotective effect of a calcium channel blocker on macrophage antigen presentation function, major histocompatability class II antigen expression, and interleukin-1 synthesis after hemorrhage

Hemorrhage induces a severe suppression of the immune system resulting in increased susceptibility to sepsis. Although studies indicate beneficial effects of calcium channel blockers on cell and organ functions after low-flow conditions, it remains unknown whether such agents have any effects on different immune responses after hemorrhage. To study this, C3H/HeN mice were bled to a mean blood pressure of 35 mm Hg and were maintained for 60 minutes, followed by resuscitation with their own shed blood and adequate fluid. The mice received either the water-soluble calcium channel blocker diltiazem (400 or 2400 micrograms/kg body weight) or saline solution (vehicle). Peritoneal macrophages were obtained by lavage 24 hours later. Antigen presentation was measured by coculturing peritoneal macrophages with the D10.G4.1 helper T-lymphocyte clone. Immune associated antigen (Ia) expression was determined by direct immunofluorescence. Interleukin (IL)-1, 6, and tumor necrosis factor-alpha (TNF) levels in peritoneal macrophage supernatants were measured by use of cytokine-specific cellular assays. Hemorrhage caused a significant decrease in peritoneal macrophage antigen presentation function, Ia expression, and IL-1 and IL-6 synthesis in the vehicle-treated group, whereas TNF levels were increased. However, both doses of diltiazem significantly improved peritoneal macrophage antigen presentation, Ia expression, and IL-1 synthesis. IL-6 synthesis was only increased with high doses of diltiazem, whereas both diltiazem doses decreased TNF production. These results indicate that the calcium channel blocker diltiazem can markedly improve macrophage functions after hemorrhage. The use of diltiazem might offer a new therapeutic modality in the treatment of immunosuppression and in decreasing the susceptibility to sepsis after hemorrhagic shock.

[Current findings in the regulation of formation of corticoliberin, pro-opiomelanocortin and ACTH as well as the efficacy of these compounds]

A survey is given on the regulation of the formation of corticoliberin and of pro-opiomelanocortin and of ACTH, respectively, and on the significance of these compounds. The formation of pro-opiomelanocortin is furthered by corticoliberin, vasopressin, oxytocin and angiotensin II. Receptors for the binding of corticoliberin appear in numerous parts of the central nervous system. In various diseases the content of corticoliberin in the plasma and in certain tissues is changed. The inhibition of the ACTH secretion by glucocorticosteroids takes place via a decrease of the formation of corticoliberin and by a reduction of the equipment of the corticotrophic cells with receptors for its binding. The secretion of corticoliberin and of ACTH, respectively, is increased by loads, by hypoglycaemia, by blood losses, by hypoxia and by infections. In the glucocorticosteroid receptors there are 2 types with different affinity to cortisol and corticosterone.

Pancreatic glucagon secretion during a short period of hemorrhage in anesthetized dogs

Glucagon has been implicated in the hormonal metabolic response to hemorrhage. However, evidence for this has been obtained largely from observations of circulating plasma glucagon concentration. A clear increase in the pancreatic glucagon secretion remains to be demonstrated. Plasma concentrations of pancreatic immunoreactive glucagon (IRG) and insulin (IRI) were determined in portal venous and aortic blood, and plasma glucose in aortic blood. Dogs were bled (approximately 15 mL/kg) until aortic systolic blood pressure dropped to approximately 50% (70.5 +/- 8.1 mmHg, n = 7) (1 mmHg = 133.32 Pa) of its control value (135 +/- 7.1 mmHg, n = 7), and the hemorrhagic hypotension was maintained for 10 min. The net portal venous IRG delivery rate rose significantly and continued to increase during the hemorrhagic hypotension despite a significant fall in the portal venous blood flow. Aortic IRG increased significantly along with the increase in portal venous IRG delivery rate (r = 0.838, n = 42, p less than 0.01). The portal venous delivery rate of IRI decreased significantly in response to hemorrhage. The aortic IRG/IRI concentration ratio increased significantly during the hemorrhage-induced hypotension. Aortic glucose concentration increased significantly 5 min after hemorrhage and continued to rise until the end of the hemorrhagic hypotension. The present study demonstrates that the secretion of pancreatic glucagon actually increases during the early phase of hemorrhage. The results also indicate that the increase in aortic IRG during the hemorrhagic hypotension is due to the increased pancreatic glucagon secretion. It is suggested that the pancreatic glucagon may be involved in the early hyperglycemic response to hemorrhage.