Jack H. Bloch

The modern treatment of shock based on physiologic principles

The hemodynamic disturbances resulting from shock due to hemorrhage or endotoxins and the results of several methods of treatment are presented. The experimental data indicate that vasopressors intensify the visceral vasoconstriction, ischemia, and loss of capillary integrity characteristic of severe shock. The benefical effects of corticosteroids or phenoxybenzamine combined with volume replacement are indicated.

PHYSIOLOGY AND THERAPY OF BACTEREMIC SHOCK. EXPERIMENTAL AND CLINICAL OBSERVATIONS.

OR THE past few years we have studied irreversible shock in the dog caused by prolonged hemorrhage, endotoxins or vasopressor agents. The dog has been used exclusively in these studies in an attempt to make a continuing study in one species; although there are many individual differences between the various species of mammals, the general physiologic principles are surprisingly constant among the mammals. Gram-negative bacterial shock or bacteremic shock was first described over 50 years ago in the German literature.’ Much has since been learned about this type of shock; but most important is the fact that the lipopolysaccharide or endotoxin within the cell wall is responsible for the hypotensive effects of these gram-negativ,e bacteria; hence the term endotoxin shock.2 Endotoxin causes shock by its sympathomimetic-like effect resulting in intense vasospasm in small arteries and veins in selected areas of the body, more particularlyin the I-isceral organs of a variety of species of

In vitro preservation of whole organs by hypothermia and hyperbaric oxygenation.

Abstract Canine whole organs (kidney, heart, small bowel) have been successfully preserved for 48 hours in an in vitro viable state by the combination of hypothermia (2 ° to 4 °C) and hyperbaric oxygen up to 7.9 atmospheres absolute. We have presented here the genesis of the method, described its purpose, and detailed the results of individual experiments, as well as citing pertinent historic data. Clinical applications have also been cited in human renal homotransplantation studies.

Experimental preservation of the small bowel

Summary o 1. Canine terminal ileum has been successfully preserved by hypothermia and hyperbaric oxygen for up to forty-eight hours. 2. The importance of whole organ storage for prolonged periods is stressed. 3. The mechanism of action of successful storage by the method described is unknown, but theories are presented. 4. The ultimate goal of these studies is the establishment of whole organ banks.

Peripheral Resistance Changes During Shock in Mana

a Supported by the United States Public Health Service and the Minnesota Heart Association. ° Sterling Winthrop Research Fellow. ° Assistant Professor, Department of Surgery, University of Minnesota Medical School. d Professor, Department of Surgery, University of Minnesota Medical School. Total peripheral resistance (TPR) is used to assess the degree of peripheral vasoconstriction in shock. Although useful, this calculated resistance value may at times be misleading. Both high and low resistance values have been reported in shock. 1-3 High peripheral resistance is usually found in cardiogenic and hemorrhagic shock while low values are often found in gram-negative bacterial or septic shock; yet even in septic shock there is evidence of intense peripheral vasoconstriction in the face of low calculated resistance. Hence, use of the calculated TPR alone as a guide to vasoconstriction can be confusing. Other measurements are necessary to assess vasoconstriction in shock in addition to TPR.

Avoiding the Slippery Knot Syndrome

To the Editor.— The problem of coated and impregnated monofilament suture material becoming untied is not a new one; it has been experienced by the undersigned on two occasions. Since these two misadventures, we have been tying three knots, the last two of which are square, and applying a 3-mm Weck clipped firmly across the ends of the suture adjacent to the knot. The suture is then cut distal to the clip (Fig 2). An alternative method of keeping the knot from becoming untied is to coagulate the suture above the knot with an electrasurgical unit. There are no instances of the knot slipping or coming untied since we have adopted these practices.