Capillary permeability in traumatic shock

Engel, D.; Forrai, E.

doi:10.1113/jphysiol.1943.sp004022

Cited by 10 publications

(4 citation statements)

References 8 publications

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“…Actual determinations have shown that the reduction in blood volume which accompanies both tourniquet and traumatic shock can be accounted for entirely by the quantity of fluid lost in the injured area (40,17,12). The bulk of evidence now favors the view, that, in these forms of shock, increased capillary permeability and loss of fluid are local rather than widespread (41,40,34).…”

Section: Resultsmentioning

confidence: 90%

Fluid Loss in Rats With Tourniquet Shock 1

Koletsky

Gustafson²

1946

J. Clin. Invest.

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Release of a high unilateral tourniquet producing complete interruption of blood flow to a hind limb of the rat for about 5 hours almost invariably results in fatal shock. The development of shock is accompanied by progressive edema of the limb. The main object of the following experiments was to determine the magnitude and the rapidity of the fluid loss in the injured extremity. METHODSAdult white male rats weighing about 150 to 300 grams were used. These were anesthetized with sodium pentobarbital, given intraperitoneally in dosage of 25 to 35 mgm. per kgm. of body weight (0.3 to 0.4 ml. of a 2 per cent solution). Circulation in the left lower extremity was then entirely occluded by 2 tightly wound rubber band tourniquets. The first was placed around the knee in order to obtain extension of the leg. This facilitated the application of the second tourniquet, which was placed as high as possible in the groin, anchorage being obtained over a redundant segment of skin drawn down beneath the rubber band.Constriction was maintained for 5 hours and 10 minutes, at the end of which time the rats were alert and showed complete outward recovery from the anesthesia. The animals were then sacrificed by decapitation, either without release of tourniquet, or at fixed time intervals after release, i.e., 15 minutes, 30 minutes, and 1, 2 and 3 hours. The experiments were performed with small groups of rats sacrificed at different periods by random selection, until there was a total of 20 rats for each time interval.In each group there were 1 or more control rats which developed shock after removal of tourniquet and went on to death. Since these yielded only little blood at the time of death, an additional group of 11 rats was sacrificed at 5 to 6 hours following removal of constriction, in order to obtain sufficiEnt blood for chemical determinations. In 18 rats sacrificed by ether at various intervals after tourniquet release, the figures for fluid loss were of the same order as those obtained from decapitated animals.There were a few deaths apparently due to anesthesia. In addition, several rats which chewed their leg before or after removal of tourniquet were discarded. Food and water were withheld for a period of about 10 hours be-1 Aided by a grant from the Elisabeth Severance Prentiss Foundation.fore anesthesia was given, and also during the course ot the experiments. The latter were performed at room temperature during the summer and autumn seasons.The amount of fluid lost in the leg following removal of tourniquet was determined by the method of bisection (1, 2). An anterior midline incision was made from sternum to symphysis pubis and follow.ed by evisceration. A similar posterior midline incision extended down across the base of the tail. The spine was then transected at about the level of the first or second lumbar vertebra, and the lower extremities separated by bilateral paravertebral incisions passing through the hip joints.The difference in weight between the normal and the edematous extremity gave the gain in wei...

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Section: Resultsmentioning

confidence: 90%

Fluid Loss in Rats With Tourniquet Shock 1

Koletsky

Gustafson²

1946

J. Clin. Invest.

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“…In an extensive clinical study (129,130) , hemodilution was found most commonly in those patients with shock due to skeletal trauma or hemorrhage, while hemoconcentration was found most commonly in those in shock from extensive burns or abdominal wounds. Other experimental evidence has been presented also to demonstrate that the increase in capillary permeability observed in traumatic shock is confined to the area of injury (131,132).…”

Section: Body Fluid Changes In Shock and Allied Conditionsmentioning

confidence: 96%

Water Metabolism

McQuarrie¹

1945

Annu. Rev. Physiol.

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The literature of the current year contains an unusu. ally large number of reports dealing with the special problems which have arisen from the necessities of war waged on a global scale. Signifi cant additions have been made to our knowledge regarding the disturbances in fluid balance which result from such conditions as (a) extensive burns, (b) severe hemorrhage, (c) traumatic shock, (d) water and salt deprivation, and (e) exposure to extreme changes in environmental temperature and humidity� These receive special attention in the present review. Related topics, such as blood sub stitutes, renal secretion, and the special roles of proteins, electro lytes, and endocrine secretions, are dealt with as they relate to water metabolism. The general problem has been considered in two previous volumes of this publication (1,2). WATER DEPRIVATION AND DEHYDRATIONMuch of the older literature dealing with water deprivation has emphasized the effects of salt deficiency, because the usual situa tion in clinical medicine in which the subject is deprived of water is one of fasting or one in which the salt intake is deficient. Warfare on sea or land not infrequently subjects men to a',shortage of drink ing water while food is plentiful. Studies (3) have been made on men under conditions simulating the latter situation, in that they abstained from drinking water for three or four days while taking a "dry" diet which was adequate in protein, salt, and calories.There was no reduction in total plasma volume. The sodium of the serum rose while the potassium fell. The amount of urea produced by the body during the period of dehydration increased. The ex-. cretion of minerals did not keep pace with that of water, and the osmotic pressure of the plasma and of the whole body rose. This increase in osmotic pressure in dehydration may be the cause of death. Some potassium was lost from the cells, which contributed water to the extracellular compartment. The same authors (4) confirmed the findings of previous investigators (5) to the effect that the body may lose as much as 10 per cent of its weight from water deprivation without any appreciable reduction in blood 127 Annu. Rev. Physiol. 1945.7:127-162. Downloaded from www.annualreviews.org Access provided by Michigan State University Library on 02/19/15. For personal use only.Quick links to online content Further ANNUAL REVIEWS 128 McQUARRIE volume. No significant reduction in blood pressure or glomerular 'filtration rate is demonstrable during dehydration produced in this manner. Changes which characterize the urine of dehydration are due, therefore, to tubular activity alone. The effect of varying salt intake during water deprivation was found to be that of in creased plasma, which always led to a rise in urine volume, the ' , extra w�ter coming from tissue fluids (6) . On rehydration in stages, the subjects of the latter study who had been deprived of water for some' days on a diet containing five to fifteen grams of sodium chloride, showed a fall in urine volume when given some what l...

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“…

The purpose of this paper is to draw practical conclusions from recent experiments (Engel and Forrai, 1943 ;Engel, 1943) and to propose regional sympathetic block as a preventive and curative method in cases of extensive crush injuries. Though my proposal is based on animal experiments there is enough clinical evidence to support my views.

The result of the experimental work can briefly be summarized as follows: In " traumatic shock" the rate of filtration through the capillaries in tissue adjacent to trauma, and probably also in the traumatized tissue itself, is greatly increased in the first 1 to 5 hours following trauma, and reduced afterwards.

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confidence: 99%

“…The purpose of this paper is to draw practical conclusions from recent experiments (Engel and Forrai, 1943 ;Engel, 1943) and to propose regional sympathetic block as a preventive and curative method in cases of extensive crush injuries. Though my proposal is based on animal experiments there is enough clinical evidence to support my views.…”

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confidence: 99%