Howard A. Frank

THE BACTERIAL FACTOR IN TRAUMATIC SHOCK

IN a standardized preparation of hemorrhagic shock we have repeatedly demonstrated that over 80 per cent of animals recover promptly and completely if the blood lost is returned after ninety minute...

External Mechanical Cardiac Stimulation

TEMPORARY cardiac stimulation in the emergency resuscitation from cardiac arrest and in other less urgent conditions is generally applied by way of a pervenous endocardial electrode and an external...

The Effect of Transcutaneous Electrical Nerve Stimulation on Pain after Thoracotomy

The effect of postoperative transcutaneous electrical nerve stimulation (TENS) was evaluated in 24 patients in two randomly selected groups who underwent thoracotomy. The patients in one group received TENS through periincisional electrodes, and the remaining patients were treated with sham stimulator setups. The stimulators remained in place for 48 hours after operation. Subjective pain scores, duration of stay in the recovery room, tolerance to chest physical therapy, complaints of nausea, time to end of mechanical ventilation, and narcotic requirements were evaluated. Patients in the TENS group had significantly lower pain scores during the first 24 hours postoperatively (p = 0.014), shorter recovery room stays (p = 0.013), and better tolerance of chest physical therapy on both day 1 (p = 0.018) and day 2 (p = 0.006). No respiratory complications occurred in either group.

Advances in Pacemaker Technology

This volume records the proceedings of an International Symposium on Advances in Pacemaker Technology held at Erlangen, Germany, in September 1974. The individual presentations are grouped under headings that include the principles of electrical stimulation of the heart, technical and clinical experiences with cardiac pacing and with the monitoring of pacing systems, theoretical and practical aspects of cardiac electrodes, longevity considerations in power sources, and clinical experience with long-life pacemakers. The 34 contributors are nearly half from the United States and half from Germany, with three or four from Hungary and the USSR. The strength of the symposium lies in its rather successful effort to present the physiological and the engineering problems and experiences in juxtaposition, not in summary, but mainly as primary data, with useful lists of references independently presented by each author. The papers are sophisticated and in the technical language of the two areas, with a fair

Studies of collateral vascular responses. I. Effects of selective occlusions of major trunks within an extensively anastomosing arterial system.

They are seen to have a tortuous or a spiral shape in many tissues. The largest collaterals will usually have developed from small bridging pathways recognizable in that vascular bed before occlusion. When previously invisible or insignificant collaterals become evident, they are likely to take the form of arcades connecting lateral branches of the occluded artery, above and below the occlusion, or else of widened junction points connecting the fine ramifications of the occluded artery with those of adjacent arterial systems. The classical body of information on collateral pathways has been gained for the most part from observations of late or final stages in their development. In the latter half of the 19th century two main theories of mechanism of development of collaterals were expressed; one emphasizes mechanical, hydrodynamic factors, whereas the other directs major attention to the influence of biochemical changes arising from inadequate tissue blood flow (for references see QuiringI7). Holman’sl8 subsequent extensive studies of arterial obstruction and arteriovenous fistulas demon-

TRAUMATIC SHOCK. V. A STUDY OF THE EFFECT OF OXYGEN ON HEMORRHAGIC SHOCK

The accumulating evidence from our studies of the plasma volume in hemorrhagic shock agrees with that of Gregersen (1) and of Evans (2), to the effect that there is no further loss of plasma from the circulation after the initial loss caused by the bleeding. Radioactive plasma proteins in the tissues of the dog in hemorrhagic shock are not found in greater concentration than in the unshocked dog. The irreversibility of hemorrhagic shock therefore cannot be explained by the theory of increased capillary permeability. Venous anoxemia is one of the outspoken pathological phenomena in shock. It appears early, and the associated tissue anoxia, if prolonged sufficiently, might be considered responsible for the development of irreversibility because of irretrievable damage to vital structures. In that case, the prevention or amelioration of venous anoxemia might exert a beneficial therapeutic effect. Indeed, several recent reports (3, 4) claim such an effect from the administration of pure oxygen. The data given are not convincing, because the anoxemia was only partially corrected and the benefit derived consisted of temporary elevation of blood pressure or a prolofigation of survival time by a few hours. A more definitive judgment as to the value of oxygen and the importance of venous anoxemia would require the prevention or complete correction of venous anoxemia. Only if a resulting change from the usual trend of events in shock is observed, can a therapeutic benefit from oxygen be claimed. This communication presents experimental data showing that the usual trend of events in hemorrhagic shock is in no way influenced by oxygen so given as to prevent the occurrence of or restore to normal an already lowered venous oxygen.

Transfusion therapy guided by blood volume determinations

Abstract Data are presented to demonstrate the accuracy and convenience of a new instrument for rapid, semiautomatic blood volume determination by radioactive tracer dilution and the usefulness of such determinations for guiding transfusion therapy in surgical patients.

Adaptations of collateral arterial pathways. An in vivo microangiographic study in the rabbit's ear.

that the vascular changes developed in consequence of altered pressure gradients and flow patterns produced by the ligatures. In the current work we (1) measured the pressure fall-off in the two asymmetric limbs of the above system, (2) altered pressure gradients -till further by an additional ligature, and observed the subsequent vascular changes, and, 13) compared these vascular responses with those following intraluminal obstruction of an equivalent arcade. 1. By direct cannulation of the arterial system at the three relevant points and recording pres-

Achalasia of the Esophagus Complicated by Varices and Massive Hemorrhage

MASSIVE and life-threatening hemorrhage from the esophagus was encountered in two patients with achalasia. Since bleeding of major clinical proportions has rarely been mentioned as a complication o...

Epithelial Dna Synthesis Within Skin Grafts Undergoing Rejection1

SUMMARY Rabbits carrying skin allografts and autografts were killed at daily intervals up to 8 days after grafting, 2 hours after they were given an i.v. dose of tritiated thymidine. Counts of labelled epithelial cells in autoradiographs of grafts revealed a progressive increase in the rate of DNA synthesis in allografted skin, as the rejection process progressed, when compared to autografted skin in the same rabbit. It is possible that at concentrations below those that cause cell destruction the infiltrating lymphoid cells and/or transplantation antibody may produce epithelial cell proliferation.