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Pulmonary edema, experimental observations on dogs following acute peripheral blood loss
SELECTED
ABSTRACTS
\i I.3
Excellent control of the hemorrhage was effected by application of a cuff of dry, compressed gela tin sponge, which in turn was surrounded by a sheath of chromic surgical catgut. The sheath was held in place with several snug ligatures of chromic catgut. In sixteen animals thus treated, there was a blowout on the fourth day in one experiment, and on the seventeenth day in another. The authors conclude that this method may well serve as a “secondary line of defense” against blowouts where arterial suture has been performed for a wound in the vessel, and especi;tlly where it has been impossible to carry out a careful suture. IA tP.1,. Eaton,
R. M.: Peripheral
Pulmonary Blood Loss.
Edema,
Experimental
Observations
on Bogs
Following
Acute
J. Thoracic Surg. 16:668 (Dec.), 1947.
In an extensive experimental study, Eaton demonstrated in dogs that acute hemorrhage 01 25 per cent of blood volume from the femoral artery resulted in the following circulatory changes: relative anoxia, increase in capillary permeability, fall in the systemic arterial and venous pressures; a decrease in cardiac output; and early increase in pressure in the pulmonary artery, which was due to an increase in the transudation of fluid into the alveoli. The author demonstrated marked increase in pulmonary moisture and increase in pulmonary lymph flow, a fall in the plasma protein level, and elevation in the hematocrit reading. Many of these changes were temporary, and within a few hours returned to normal. However, pulmonary edema continued for several days and was readily demonstrable microscopically, in spite of the fact that the animals showctf normal behavior. In his discussion, Eaton points out that from a practical point of view acute hemorrhage which occurs at operation and is not balanced immediately by transfusion can be responsil)le in a matter of a few minutes for the changes in the pulmonary circulation just described. Further, pulmonary edema, which is a stagnant alveolar accumulation of high protein value, is an excellent culture media for droplet implantations from the nose and throat and, hence, for the subsequtxn: development of pneumonia. The author studied the use of infusions of saline, plasma, and blood in an attempt to see whether these fluids, given intravenously, would alter the changes found in the lungs. He drmonstrated that intravenous saline markedly aggravated the pulmonary edema, whereas blood .tntl plasma had only slight deleterious effects. LOND. Loeffler,
W.,
Cardiologia
and
Maier,
C.:
Case
of
Felty’s
Syndrome
With
Cyclic
Agranulocytosis.
12:19.5, 1947-1948.
A 24-year-old farmer, following an atypical pneumonia with pleural effusion, developed splenomegaly, enlarged cervical lymph nodes, and a white blood count of 5,000 with 12 per cent polymorphonuclear leucocytes, 20 per cent eosinophiles, 33 per cent monocytes, and 33 per cent lymphocytes. Eight months later he had his first bout of polyarthritis, slight pigmentation of the skin, and a white cell count of 4,600 with 1.5 per cent polymorphonuclear leucoc) yes. 6 per cent esoinophiles, 58 per cent monocytes, and 33 per cent lymphocytes. Subsequently, he had bouts of polyarthritis every twenty-one days, lasting seven days, with a maximum ale pression of the neutrophiles on the third and fourth days of the bout; at times this amounted IO a During the complete agranulocytosis, a concomitant monocytosis, and a persistent eosinophilia. neutropenia the bone marrow showed a shift to the left with promyelocytes predominating during remission the marrow was normal. Two years after onset of this picture a splenectomy Three weeks was performed which was followed by severe arthritis and a temporary leucocytosis. later the neutropenia was as severe as before. The spleen showed a chronic inflammatory hyperplasia with eosinophilia of the pulp and hyperplasia of the lymph follicles. Gradually, the symp toms abated and were further improved by penicillin. At present, five years after onset of sylnp tams, occasional joint pains and fever recur,and’the neutropenia persists. One month after the onset of symptoms an aortic insufficiency was noted. The blood preh sure ranged around 150/7.5. A chest x-ray film showed an aortic configuration of the hpart. X-ray films of the joints were normal.
ABSTRACTS
\i I.3
Excellent control of the hemorrhage was effected by application of a cuff of dry, compressed gela tin sponge, which in turn was surrounded by a sheath of chromic surgical catgut. The sheath was held in place with several snug ligatures of chromic catgut. In sixteen animals thus treated, there was a blowout on the fourth day in one experiment, and on the seventeenth day in another. The authors conclude that this method may well serve as a “secondary line of defense” against blowouts where arterial suture has been performed for a wound in the vessel, and especi;tlly where it has been impossible to carry out a careful suture. IA tP.1,. Eaton,
R. M.: Peripheral
Pulmonary Blood Loss.
Edema,
Experimental
Observations
on Bogs
Following
Acute
J. Thoracic Surg. 16:668 (Dec.), 1947.
In an extensive experimental study, Eaton demonstrated in dogs that acute hemorrhage 01 25 per cent of blood volume from the femoral artery resulted in the following circulatory changes: relative anoxia, increase in capillary permeability, fall in the systemic arterial and venous pressures; a decrease in cardiac output; and early increase in pressure in the pulmonary artery, which was due to an increase in the transudation of fluid into the alveoli. The author demonstrated marked increase in pulmonary moisture and increase in pulmonary lymph flow, a fall in the plasma protein level, and elevation in the hematocrit reading. Many of these changes were temporary, and within a few hours returned to normal. However, pulmonary edema continued for several days and was readily demonstrable microscopically, in spite of the fact that the animals showctf normal behavior. In his discussion, Eaton points out that from a practical point of view acute hemorrhage which occurs at operation and is not balanced immediately by transfusion can be responsil)le in a matter of a few minutes for the changes in the pulmonary circulation just described. Further, pulmonary edema, which is a stagnant alveolar accumulation of high protein value, is an excellent culture media for droplet implantations from the nose and throat and, hence, for the subsequtxn: development of pneumonia. The author studied the use of infusions of saline, plasma, and blood in an attempt to see whether these fluids, given intravenously, would alter the changes found in the lungs. He drmonstrated that intravenous saline markedly aggravated the pulmonary edema, whereas blood .tntl plasma had only slight deleterious effects. LOND. Loeffler,
W.,
Cardiologia
and
Maier,
C.:
Case
of
Felty’s
Syndrome
With
Cyclic
Agranulocytosis.
12:19.5, 1947-1948.
A 24-year-old farmer, following an atypical pneumonia with pleural effusion, developed splenomegaly, enlarged cervical lymph nodes, and a white blood count of 5,000 with 12 per cent polymorphonuclear leucocytes, 20 per cent eosinophiles, 33 per cent monocytes, and 33 per cent lymphocytes. Eight months later he had his first bout of polyarthritis, slight pigmentation of the skin, and a white cell count of 4,600 with 1.5 per cent polymorphonuclear leucoc) yes. 6 per cent esoinophiles, 58 per cent monocytes, and 33 per cent lymphocytes. Subsequently, he had bouts of polyarthritis every twenty-one days, lasting seven days, with a maximum ale pression of the neutrophiles on the third and fourth days of the bout; at times this amounted IO a During the complete agranulocytosis, a concomitant monocytosis, and a persistent eosinophilia. neutropenia the bone marrow showed a shift to the left with promyelocytes predominating during remission the marrow was normal. Two years after onset of this picture a splenectomy Three weeks was performed which was followed by severe arthritis and a temporary leucocytosis. later the neutropenia was as severe as before. The spleen showed a chronic inflammatory hyperplasia with eosinophilia of the pulp and hyperplasia of the lymph follicles. Gradually, the symp toms abated and were further improved by penicillin. At present, five years after onset of sylnp tams, occasional joint pains and fever recur,and’the neutropenia persists. One month after the onset of symptoms an aortic insufficiency was noted. The blood preh sure ranged around 150/7.5. A chest x-ray film showed an aortic configuration of the hpart. X-ray films of the joints were normal.