Calman Kc

INCREASED VASCULAR PERMEABILITY: A MAJOR CAUSE OF HYPOALBUMINAEMIA IN DISEASE AND INJURY

The rate of loss of albumin to the tissue spaces (measured as transcapillary escape rate) rose by more than 300% in patients with septic shock, and the average increase within 7 h of cardiac surgery was 100%. The transcapillary escape rate in cachectic cancer patients was twice that of a group of healthy individuals. The rate of loss of albumin to the tissue spaces is normally 5%/h, which is more than 10 times the rates of synthesis and catabolism, and these large rate increases indicate that increased vascular permeability is an important cause of the lowered concentration of albumin commonly seen in acute and chronic disease.

REVERSAL OF ACUTE CLINICAL AND EXPERIMENTAL ORGAN REJECTION USING LARGE DOSES OF INTRAVENOUS PREDNISOLONE

Abstract The ability of single large (1 g.) doses of intravenous prednisolone to reverse rejection episodes has been investigated clinically and experimentally. Sixteen renal-transplant recipients have been treated in this way. The oral dose of prednisone was not increased during these episodes and no additional treatment was given. This therapy reversed 86% of rejection crises without any toxic effects. One patient has died from infection, 1 month after transplantation. Using the heterotopic rat-heart-transplant model the ability of intravenous prednisolone, antilymphocyte serum (A.L.S.), intraperitoneal prednisolone, and azathioprine to reverse rejection in recipients immunosuppressed with a single dose of A.L.S. at the time of transplantation were compared. Intravenous prednisolone was the only successful agent and prolonged survival by 9±3 days.