Eero Gullichsen

Renal oxygenation in endotoxin shock in dogs.

Renal hemodynamics and oxygen metabolism were studied in eight adult beagle dogs during shock induced with an iv infusion of Escherichia coli endotoxin. Renal blood flow (RBF) and renal cortical PO2 decreased profoundly during the 15-min endotoxin infusion. RBF increased sharply immediately after cessation of infusion, but soon declined and remained depressed throughout the rest of the 4-h experiment. The renal cortical PO2 remained depressed for approximately 2 h and then gradually increased toward the baseline level. Endotoxin infusion was followed by an increased renal PvO2 and a decreased renal arteriovenous oxygen difference. Renal oxygen consumption declined abruptly during endotoxin infusion, but increased toward the end of the experiment. These results suggest impaired tissue oxygenation and possibly increased oxygen shunting in the kidney during endotoxin shock.

Leg tissue perfusion in simple tibial shaft fractures treated with unreamed and reamed nailing.

BACKGROUND To compare the effects of unreamed and reamed intramedullary nailing on tibialis posterior, dorsalis pedis, and sum (tibialis posterior plus dorsalis pedis) distal arterial peak pulses. Additionally, leg skin temperature and transcutaneous oxygen tension were measured in patients with low energy, closed tibial shaft fractures. METHODS The patients were randomized to unreamed and reamed groups, and intramedullary nailing without or with reaming was performed under spinal anesthesia. The measurements were carried out before the operation and on 5 postoperative days. RESULTS In the unreamed group, the only significant difference between contralateral and nailed legs was in raised leg skin temperature (p = 0.0001). In the reamed group, tibialis posterior distal arterial peak pulses and transcutaneous oxygen tension remained at a significantly lower level and leg skin temperature at a significantly higher level, respectively, in the nailed legs after the operation when compared with contralateral legs (p = 0.0026, p = 0.0001, and p = 0.0001, respectively). There were no statistical differences between preoperative and postoperative values in the measured parameters in both groups. Additionally, there were no intergroup changes in the measured parameters in the injured legs. CONCLUSION The present study suggests that altered distal arterial pulsations, decreased transcutaneous oxymetry values, and thermal reaction are not due to differences in nailing method but caused by a manifestation of the trauma mechanism of the tibial shaft fracture. The potentially negative effects of reaming to soft tissue perfusion parameters could not be established.

Group II phospholipase A2 in serum after knee surgery and intramedullary nailing of tibial shaft fracture

This prospective study investigates the effect of injury and surgery of cartilage and bone on serum group II phospholipase A2 (PLA2-II) and C-reactive protein (CRP) levels. Serum concentrations of PLA2-II and CRP were measured before and after the operation in nine patients with closed tibial shaft fractures treated by nailing, 11 patients with fractures of lateral tibial plateau treated by bone grafting, and 19 patients with ruptured anterior cruciate ligament treated by reconstruction. The postoperative PLA2-II and CRP values were statistically significantly higher than the pre-operative values in the tibial plateau fracture and ligament rupture groups, whereas the increase in the PLA2-II values in the tibial fracture group was not statistically significant. The highest values of both parameters were found on the second postoperative day. The changes in the PLA2-II and CRP values were parallel in the lateral condyle fracture and in anterior cruciate ligament rupture groups. PLA2-II behaves as an acute phase reactant in the serum of patients undergoing acute and elective knee surgery.

Similar central hemodynamics and oxygenation in reamed and unreamed intramedullary nailing of tibial fractures.

BACKGROUND Reamed intramedullary nailing of a long bone fracture is considered to be of crucial importance in the genesis of pulmonary disturbances. Use of unreamed nailing technique has been encouraged to avoid temporary deterioration in lung functions. METHODS Central hemodynamic changes were recorded in 20 healthy adults with a unilateral simple tibial fracture undergoing reamed or unreamed intramedullary nailing. The patients were cannulated with a pulmonary artery catheter. Intramedullary nailing was performed during general anesthesia. Pre- and immediate postoperative hemodynamic variables were compared. RESULTS Unchanged cardiac performance but pathologically altered pulmonary vascular tone were unrelated to the type of nailing technique. Increased oxygen consumption was observed as well. CONCLUSION Changes in cardiac and pulmonary hemodynamics are already present after the trauma and before the intramedullary nailing procedure.

Central hemodynamics during reamed Intramedullary nailing of unilateral tibial fractures

BACKGROUND Intramedullary nailing of a long-bone fracture results in intravasation of bone marrow contents into the right atrium and pulmonary vascular bed and, therefore, may alter cardiac and pulmonary hemodynamics. METHODS Central hemodynamic changes were recorded in 12 healthy adults with a unilateral simple tibial fracture undergoing intramedullary nailing. The patients were cannulated with a pulmonary artery catheter. Reamed intramedullary nailing was performed during general anesthesia. Preoperative and immediate postoperative hemodynamic variables were compared and intraoperative changes studied. RESULTS During the operation, the right ventricular preload as represented by central venous pressure and the right ventricular afterload as presented by mean pulmonary arterial pressure increased significantly. Preoperative and postoperative arterial oxygen tension values demonstrated hypoxia. Abnormal pulmonary shunting and increased oxygen consumption were observed as well. CONCLUSION Changes in cardiac and pulmonary hemodynamics are already present after the trauma and before the reamed intramedullary nailing procedure.

Splanchnic and peripheral tissue perfusion in experimental fat embolism

OBJECTIVE To investigate the acute effects of experimental fat embolism on splanchnic and peripheral perfusion and oxygenation in pigs. DESIGN Randomized, controlled trial. SETTING Animal laboratory. SUBJECTS Eighteen domestic pigs, weighing 25 to 31 kg. INTERVENTIONS The 18 pigs were randomized to either the fat embolism or control groups. Nine anesthetized and mechanically ventilated pigs were intracavally infused with a 10% allogeneic bone marrow suspension at a dose of 100 mg/kg over 5 mins (the fat embolism group); nine control pigs received normal saline in the same volume and speed (control group). MEASUREMENTS AND MAIN RESULTS Mean pulmonary arterial pressure, pulmonary vascular resistance, and pulmonary shunt increased, and PaO2 decreased immediately after the bone marrow suspension infusion. In the fat embolism animals, oxygen delivery decreased, oxygen content difference widened, and total oxygen consumption remained high, indicating enhanced oxygen extraction. Further, superior mesenteric artery blood flow and mesenteric oxygen delivery decreased, while intramucosal pH in the small bowel was stable. Subcutaneous PO2 decreased in both groups, whereas transcutaneous PO2 decreased only in the animals receiving bone marrow suspension. Skin red cell flux showed no significant changes. CONCLUSIONS The present model of fat embolism results in significant impairment in systemic oxygenation. Despite this fact, the intestinal oxygenation remains unaffected probably due to sufficient compensatory mechanisms. Transcutaneous PO2 measurements may provide a useful index for early detection of fat embolism.

The effect of unreamed and reamed intramedullary nailing on the urinary excretion of prostacyclin and thromboxane A2 metabolites in patients with tibial shaft fractures.

OBJECTIVE To compare the effects of unreamed and reamed intramedullary nailing on the systemic production of prostacyclin and thromboxane A2 as assessed, respectively, by determinations of urinary 2,3-dinor-6-ketoprostaglandin F1alpha and 11-dehydrothromboxane B2 excretion. METHODS Ten otherwise healthy patients with closed and simple tibial shaft fractures were treated with unreamed intramedullary nailing, and 10 otherwise healthy patients with closed and simple tibial shaft fractures were treated with reamed intramedullary nailing. Urine was collected preoperatively and during the next 5 postoperative days. The samples were stored at -70 degrees C until assayed at the end of the study. RESULTS In the unreamed group, urinary 2,3-dinor-6-ketoprostaglandin F1alpha and 11-dehydrothromboxane B2 excretion remained stable and at a significantly lower levels compared with the reamed group during the entire study period (p < 0.021). In the reamed group, the alteration in urinary 2,3-dinor-6-ketoprostaglandin F1alpha excretion preoperatively and on the first postoperative day was nearly significant (p=0.075), and the increase in urinary 11-dehydrothromboxane B2 excretion was significant (p=0.020). The proportional increase compared with baseline, however, was 1.6 times greater for 11-dehydrothromboxane B2 than for 2,3-dinor-6-ketoprostaglandin F1alpha. CONCLUSION Only reamed intramedullary nailing elevates urinary 2,3-dinor-6-ketoprostaglandin F1alpha and 11-dehydrothromboxane B2 concentrations and their ratio (thromboxane A2/prostacyclin production) in patients with simple tibial shaft fractures.

Renal carnitine concentration decreases in endotoxic dogs.

Background and MethodsRenal cortical and serum carnitine concentrations were studied in seven anesthetized beagle dogs in which acute circulatory collapse was induced by an iv injection of Escherichia coli endotoxin, 0.5 mg/kg given over 15 mins. Four controls received normal saline. ResultsThe endotoxin injection resulted in cardiac depression, renal hypoperfusion, acidosis with a decrease in urinary output, and hematuria. Arterial and renal venous free carnitine concentrations increased significantly in endotoxemia during the 5-hr experiment, but remained low and unchanged in the controls. Circulating acyl-carnitine concentrations underwent no essential changes in either group. Total, free, and acyl-carnitine concentrations decreased in endotoxic renal tissue. ConclusionsThese data suggest that endotoxemia decreases carnitine concentrations in the renal cortex, but increases free carnitine concentrations in the circulation.