[Features of the morphofunctional response of Peyer's patches in rats during the course of traumatic shock and the early post-shock period]

The reaction of Peyer's patches to trauma manifests in: 1) vascular changes; 2) primary or stressor cells shifts recordable in traumatic shock, characterized by depletion of patch follicles by minor lymphocytes; 3) secondary changes associated with the onset of reparative processes; 4) the increased macrophagal activity detectable during the entire period of the traumatic shock and in the early post-shock period. It is suggested that changes seen may be due to endotoxin that penetrates from the intestine.

Role of the splanchnic visceral organs in development of tolerance to traumatic shock

Tumbling pentobarbital-anesthetized rats (25 mg/kg) in a Noble-Collip drum for 600 revolutions resulted in a severe form of circulatory shock, and all traumatized rats died within 5 hours. However, rats subjected to sublethal tumbling (i.e., conditioning) for 4 days before lethal tumbling developed tolerance to this usually lethal dose of trauma. After the tumbling, untreated nonconditioned rats showed a marked production of the cardiotoxic peptide, myocardial depressant factor (MDF), and depression of reticuloendothelial system (RES) function. Conditioned rats subjected to trauma did not show these changes. Nonconditioned tumbled rats developed severe twisting of the small intestine resulting in a vascular strangulation of the intestine: conditioned rats did not exhibit strangulation after tumbling. To eliminate mesenteric strangulation during tumbling, two methods were employed: 1) a four-baffle drum to prevent torsional twisting of rats in the drum; and 2) emptying the intestinal contents before tumbling in the ordinary two-baffle drum. Both of these procedures eliminated mesenteric strangulation in rats during tumbling, and all rats subjected to either of these procedures survived 5 hours post-trauma. Thus mesenteric strangulation may be a critical factor contributing to lethality in Noble-Collip drum trauma. Post-traumatic splanchnic lysosomal labilization, depression of RES function, and pancreatic MDF formation and its accumulation in the plasma may be direct consequences of the splanchnic ischemia leading to lethal shock. Since conditioned rats did not develop mesenteric ischemia during tumbling, no subsequent detrimental event occurred, and these rats did not develop lethal circulatory shock.

Nonoliguric vasopressin oversecretion in severely burned patients

Eight burn patients with smoke inhalation were studied. High levels of plasma vasopressin and plasma cortisol in the presence of polyuria were observed. Stress and pain seem to be the main factors in the vasopressin oversecretion; the polyuria probably resulted from fluid administration and osmotic diuresis.

Studies on the mechanism of shock. Central serotoninergic neuron activity after trauma in the rat

An attempt has been made to assess the effect of injury (limb ischaemia, scald) on the central serotoninergic system of the rat by studying the effect of these injuries on the tryptophan concentration, the tryptophan hydroxylase activity and the metabolism of serotonin in the hypothalamus, mid-brain and hind-brain. The effects of a serotonin uptake inhibitor and an antagonist on the survival time and mortality rate after limb ischaemia have been examined as well as the effects of central lesions produced by the injection of 5.6- and 5.7-dihydroxytryptamine into a lateral cerebral ventricle and the i.p. injection of (+/-)-4-chloroamphetamine. A few changes indicative of increased activity in the central serotoninergic system were found--an increase in tryptophan hydroxylase activity after 4 h bilateral hind-limb ischaemia, better survival of fed rats pre-treated with 5,6-dihydroxytryptamine--but for the most part the changes were not as great as those produced by starving or exposure to cold. Hence the effect of trauma on this system seems small.

[Long-term observation of pulmonary water and protein extravasation in traumatic-hemorrhagic shock (author's transl)]

Eleven mongrel dogs were observed for 72 h following a standardized traumatic hemorrhagic shock. The decrease of plasma albumin concentration and blood 125-I-albumin activity with a concomitant increase in lung I-albumin content is possibly caused by capillary leakage. A rise in the extravascular lung water content was measured by a gravimetric postmortem method. An in vivo double indicator technique, however, failed to document these findings.

[Metabolic changes in the multiply injured. Biochemical studies in multiply injured patients with reference to the severity of the injury]

Leading physical sign of "trauma-disease" in polytraumatized patients is hypovolemic shock. Changes in metabolism have been described previously. At present there are no reports concerning the time at which these changes occur. The early posttraumatic phase is characterized by normosodiemia and initial transient hypopotassemia, which is based on the renin-angiotensin-mechanism. The metabolic acidosis depending on trauma causes decreased oxygen perfusion of tissue, which possibly is found even before alterations of circulation are detected. Already at the site of the accident hyperglycemia and hyperglucagonemia with normal values of insulin were found. The increase of blood glucose was correlated to the values of adrenalin and to the insulin antagonist glucagon. The catabolism of proteins closely related to the degree of trauma continued as long as 5 days after injury. Analysis of the blood clotting system showed that in the early phase after trauma there are changes in hemostatic potential consisting in hemostatic defect. In several essential points the early posttraumatic phase of metabolism is different from that in a later phase. These facts should be kept in mind if planning therapy.

Protective actions of aprotinin in acute traumatic shock

The effect of the protease inhibitor, aprotinin, was examined in rats during traumatic shock. In sham-operated control rats, intravenous administration of aprotinin (20,000 or 40,000 KIU/kg) showed no immediate changes in the mean arterial blood pressure and heart rate. In rats subjected to Noble-Collip drum trauma, aprotinin at a dose of 20,000 KIU/kg prolonged survival time to 2.1 +/- 0.3 hr (p less than 0.05) and 40,000 KIU/kg prolonged the survival time of rats to a greater extent (3.1 +/- 0.4 hr, p less than 0.001) compared to rats given only its vehicle (1.1 +/- 0.2 hr, mean +/- SE). The improved survival was accompanied by inhibition of the plasma accumulation of the cardiotoxic peptide, myocardial depressant factor (MDF). However, aprotinin showed no inhibitory effect on the plasma accumulation of the lysosomal enzyme, cathepsin D. Aprotinin has a beneficial effect on traumatic shock in rats possibly by its potent inhibitory action on MDF formation.

[Changes in the composition of fatty acids in blood plasma lipids and in various organs in traumatic shock]

The composition of fatty acids of the total lipids of the myocardium, lungs, liver, intestine, adipose tissue, and blood plasma was studied during traumatic shock reproduced in dogs by crush of soft tissues of the hip. The formation of the shock process was accompanied by a rise in the percentage content of linoleic and arachidonic acids in the blood plasma and some organs; a close correlation existed between the linoleic acid content in the adipose tissue and the blood. Oleic acid deficiency was revealed in the lipids of the organs under study.

[Tissue serotonin content and monoamine oxidase activity in shock]

Content of serotonin was increased approximately 3-fold in brain, 8-fold in liver tissue, 15-16-fold in kidney and heart, as compared with control, after traumatic shock caused by crushing of rat soft tissues. At the same time content of serotonin was decreased in lungs by 40% and in intestine -- by 80%. The MAO activity was altered in all the tissues studied. The alterations followed a similar pattern in all the cases: short-term increase, decrease, restoration after completing the compression and persistent decrease in decompressional period.

[Changes in several indices of gas exchange in dogs during the initial stage of Cannon's traumatic shock]

In experiments reproducing traumatic shock according to Cannon on 35 dogs it was shown that metabolic acidosis developed in shock against the background of sharply elevated oxgen consumption at the very beginning of injury, when the arterial pressure exceeds considerably the inital level. In traumatic shock the brain is under the most favourable conditions of gas exchange and the skeletal musculature of the extremities--under the worst ones. It was concluded that in severe trauma, despite the strain of respiratory and cardiovascular system function the tissues of the brain and the skeletal muscles failed to obtain an adequate O2 quantity because of their sharply increases needs in oxygen, as well as of hemodynamic disturbances.

Experimental study of dibutyryl cyclic AMP: its antishock effects observed in traumatic shock rats

Antishock effect of N6, O2-dibutyryl cyclic AMP (DBcAMP) Was investigated in rats subjected to Noble-Collip drum trauma and compared with effects of hydrocortisone and Trasylol. Results obtained are as follows. 1)Hydrocortisone and Trasylol administered 1 hr before initiating drumming improved the survival rate from traumatic shock with concomitant reducton of levels of acid phosphatase and beta-glucuronidase in circulating blood. DBcAMP administered i.p. immediately after trauma also improved the survival rate to the same extent as did Traylol or hydrocortisone, while no inhibitory effects were observed on acid phosphatase and beta-glucuronidase. 2)The rectal temperature fell significantly after suffering trauma, and the rats with greater fall in rectal temperature had poorer chance for survival. The fall in rectal temperature was considerably prevented by DBcAMP in a dose of 0.5 mg/100 g body weight (b.w.). 3)DBcAMP induced a rise in plasma insulin level (IRI) and insulin/glucose ratio (I/G) in shock rats, and the elevation in blood lactate/pyruvate ratio (L/P) and excess lactate otherwise observed after trauma were satisfactorily prevented by DBcAMP administration. It is concluded that the antichock effects of DBcAMP primarily resulted from improvements of the intracellular metabolism induced by its easy passage through the cell membrane and its cAMP like action, while any preventive action was not observed against elevation of lysosomal enzymes in the circulating blood.

Biochemical changes occurring after blunt chest trauma in monkeys

Anesthetized adult female rhesus monkeys were impacted in the middle of the sternum with a 10 kg stunner traveling at a speed of 22-25 mph to simulate an automobile accident. Blodd was obtained at 10 and 60 min following the impact, and approximately 50 values were measured with an autoanalyzer. Blunt chest shock and trauma produced a biochemical, hematologic, and urinary profile which might be used to aid life saving measures.

[The present stand of knowledge in the general treatment of burns: a review (author's transl)]

This review article reports the present stand of knowledge in regard to recent therapeutic developments in the general management of severe burns. Especial emphasis is placed on the importance of parenteral nutrition, qualitatively and quantitatively correct fluid replacement and acidosis phrophylaxis or early, specific treatment of acidosis for survial.