Fluorophotometric evaluation of capillary permeability in gram-negative shock.

We developed a new method by which capillary permeability changes secondary to gram-negative sepsis can be easily monitored. In a preliminary trial, ten dogs were injected intravenously with live Escherichia coli. Progressive extravasation of fluorescein from the retinal capillary bed was demonstrated by retinal angiography, thus indicating "capillary leak." In a subsequent trial, fluorophotometry facilitated direct quantitation of this leak. Three control and three septic dogs underwent continuous hemodynamic and physiologic monitoring. Hourly retinal fluorophotometric measurements were recorded. The control group demonstrated no capillary leak nor any change in hemodynamic and physiologic status. In the septic group, there was a dramatic increase in extravascular fluorescein concentration two to four hours after E coli infusion, correlating well with hemodynamic and physiologic parameters typical of gram-negative shock.

Hepatobiliary scanning in the diagnosis of acute cholecystitis.

Two hundred seventy-one consecutive hepatobiliary scans (HBS) using technetium Tc 99m iprofenin (Pipida [Sn]) were obtained to evaluate abdominal pain. The material (5 to 10 mCi) was injected and standard anterior and lateral scintographic images were obtained during a one-hour period. An abnormal scan was defined as one in which the gallbladder failed to be seen by one hour with adequate visualization of the biliary tree and proximal gastrointestinal tract. The accuracy of this method was evaluated on the basis of surgical pathology obtained in 117 patients. Of the 76 patients undergoing surgery with an abnormal HBS, 75 had acute cholecystitis, yielding a test accuracy of 98.7%. A normal scan reliably excluded the possibility of acute cholecystitis (100%). Hepatobiliary scanning is presently the most accurate and rapid modality in the diagnosis of acute cholecystitis.