William R. Cole

Adrenal insufficiency as a complication of the acquired immunodeficiency syndrome.

Excerpt Since the acquired immunodeficiency syndrome was recognized in 1980, various malignancies, infections, and immunologic defects have been found in the affected population. Recently, adrenal ...

Lymph Circulation in Hepatic Cirrhosis: Effect of Portacaval Shunt

Abstract To determine the relative contribution of the liver and extrahepatic portal bed to increased flow of thoracic duct lymph in hepatic cirrhosis, thoracic duct lymph was examined in 84 patien...

Protein Content in Lymph and Edema Fluids in Congestive Heart Failure

Protein content of tissue fluid and lymph is not uniform and depends upon regional differences in capillary permeability modified by changes in capillary filtration pressure. Whereas increased pressure in freely permeable liver sinusoids promotes formation of excess liver and thoracic duct lymph and ascitic fluid high in protein, increased venous pressure in less permeable beds promotes formation of excess lymph and edema fluid progressively lower in protein content. To ascertain the influence of colloid osmotic (oncotic) and hydrostatic pressure on excess lymph and edema formation in congestive heart failure, a disorder characterized by generalized venous hypertension, protein content of lymph (thoracic duct, liver, and small intestine), intracavitary and peripheral edema fluid, and plasma were measured in 42 patients with cardiac failure. In “acute” heart failure, thoracic duct lymph and ascitic fluid have high protein content (85% and 68% of plasma protein respectively) and are derived primarily from the liver, but in “chronic” heart failure protein content of thoracic duct lymph and ascitic fluid are lowered (46% and 40% of plasma protein respectively) by lymph from extrahepatic sites. In both stages, pleural and leg edema fluid are comparatively low in protein content (26 to 44% and 3 to 8% of plasma protein respectively). In congestive heart failure, edema and intracavitary fluid form primarily in response to increased venous pressure which outside the liver is partially counterbalanced by increased effective plasma oncotic pressure.

Thoracic Duct-to-Pulmonary Vein Shunt in the Treatment of Experimental Right Heart Failure

Elevated venous pressure in right heart failure leads not only to an increase in lymph formation but also to progressive resistance in the neck to the return of lymph to the circulation via the thoracic duct. Sequestration of fluid behind the failing heart tends to protect the circulation but at the same time leads to the clinical manifestations of heart failure.The present study was performed on 40 dogs with combined tricuspid insufficiency and pulmonary stenosis. Thoracic duct lymph flow was greatly increased. Pressure was considerably greater in the systemic veins than in the pulmonary vein beyond the right heart obstruction. Lymph flow was substantially enhanced when the thoracic duct was connected to the lower pressure pulmonary veins. Furthermore, direct anastomosis of the thoracic duct to the pulmonary vein resulted in fall in systemic venous pressure, increase in renal excretion of salt and water, and reduction in ascites. These results indicate that alterations in the flow of thoracic duct lymph have important bearing on the manifestations and treatment of right heart failure.

Patterns of distribution of sulfobromophthalein in lymph and blood during obstruction to bile flow

Abstract New questions must be formulated concerning the events in obstructive jaundice; the old controversy as to whether bile regurgitates into lymph or into blood is no longer applicable. Blood as well as lymph transports excess BSP (and presumably bilirubin) from the obstructed liver. The importance of one route over the other depends on the form of the molecule and the duration of bile stasis.

Peritoneal Transudate: A Diagnostic Clue to Portal System Obstruction in Patients With Intra-abdominal Neoplasms or Peritonitis

The protein content of ascitic fluid was determined in 26 patients with intra-abdominal neoplasms or inflammation in whom patency of the portal venous system was evaluated directly at laparotomy or autopsy. Ascitic fluid was high in protein content (respectively 54% and 62% of the plasma level) in both groups except when portal system occlusion was superimposed on the underlying disturbance, in which case ascitic fluid was low in protein content (respectively 8% and 24% of the plasma level). Viewed in the light of observations on the protein content of ascitic fluid in patients with hepatic cirrhosis, these data suggest that, in the absence of marked hypoproteinemia, peritoneal fluid of low protein content signifies marked impairment to portal blood flow into the liver.

Present effect of penicillin on experimental peritonitis in dogs.

Summary These experiments indicate that penicillin remains a remarkably effective antimicrobial agent for the repression of experimental peritonitis in dogs. Providing these conclusions may be transferred to humans, penicillin may remain a drug of considerable importance in the treatment of peritonitis of gastrointestinal origin. Because of its relatively low degree of toxicity, which permits administration of large quantities of the drug, penicillin still closely approximates an ideal antibiotic. These experiments also indicate that an animal without an omentum will withstand peritonitis poorly, even with the administration of a dose of penicillin which would save a significant number of animals in which the omentum had not been removed. These data emphasize the urgency of early surgical correction of abdominal conditions likely to lead to peritonitis, such as intestinal obstruction, appendicitis, and the like, in infants and young children who have not developed a satisfactory omentum, and in adults who have had their omentum resected or effectively removed by adhesions. Surgical removal of the primary lesion would seem to hold the only chance of survival under these circumstances.

Chemoprophylaxis with penicillin. Prevention of infection in devascularized muscle

Abstract Bacterial gangrene in devascularized muscle may be prevented by preliminary treatment with antimicrobial drugs. The subsequent growth of bacteria in the muscle is delayed, the number of species is reduced, and colonization of the muscle by anaerobic bacteria is prevented.