The effects of soman poisoning in combination with hypovolemic shock.

Hemorrhage is a cause of death in both combat and civilian injuries. The specific objectives of this research were: (1) to determine the pathophysiologic effects of combined injuries from sublethal amounts of an organophosphate (soman) along with hypovolemic shock, and (2) to determine the efficacy of atropine sulfate and pralidoxime (2-PAM) therapy for organophosphate poisoning when combined injuries occur. Four groups of six beagle dogs/group were used: Group V/H, vehicle administration followed by hemorrhage; Group S/H, soman administration followed by hemorrhage; Group S/A/H, soman followed by antidote (atropine and 2-PAM) and then hemorrhage; and Group S, soman only. Acetylcholinesterase (AChE) activity, hemodynamic parameters, regional blood flow, plasma enzyme, and hematological changes were monitored. Soman rapidly decreased AChE activity in RBCs, plasma, and brain tissue. Treatment with atropine and 2-PAM resulted in only slight reactivation of AChE; they helped maintain blood gases, cortisol, plasma enzymes, inspiratory volume, and blood pressure nearer baseline values. The effects of combined injuries appear to be greater than those of either injury alone. This was indicated by increased plasma lactate, plasma enzymes indicative of tissue damage (aspartate amine transferase and creatine kinase), and increased lethality in dogs subjected to both soman and hemorrhage (5/12 died). All dogs subjected to only one insult survived the 6-hr experiment.

Endotoxin-induced hemodynamic and prostaglandin changes in ponies: effects of flunixin meglumine, dexamethasone, and prednisolone.

Shock was induced in four groups of anesthetized ponies with an intravenous injection of Escherichia coli endotoxin [125 micrograms/kg]. Five minutes after endotoxin injection, the ponies were given no treatment (group A), flunixin meglumine (FM:1.1 mg/kg) (group B), dexamethasone (2 mg/kg) (group C), or prednisolone (10 mg/kg) (group D). Additionally, FM was given every 3 hours, and the steroids were given at 3, 9, and 24 hours following endotoxin. Hemodynamic measurements were made during the 4-hour anesthetic period. Blood samples were collected for the analysis of prostaglandins, blood chemicals, and enzymes until death. Microspheres labeled with one of four radionuclides were used to determine regional blood flow at 0, 0.1, 1, and 2 hours after endotoxin was given. Plasma levels of both thromboxane and prostaglandin I2 increased from less than 1 ng/ml to between 3 and 5 ng/ml following the injection of endotoxin. The elevated thromboxane corresponded with high pulmonary arterial pressure [between 35 and 55 mm Hg] and low mean systemic arterial pressure (between 40 and 65 mm Hg) during the first 5-10 minutes following endotoxin. Increased concentrations of prostaglandin I2 were temporally related to systemic arterial hypotension, which occurred 1-2 hours following endotoxin in all groups except group B. The rise of prostaglandin I2 and hypotension were not observed in the flunixin meglumine-treated ponies. Dexamethasone was less effective, and prednisolone was ineffective in preventing the synthesis of prostaglandin I2 and the accompanying hemodynamic changes that occurred during the first 2 hours following endotoxin. This is probably due to the fact that steroids require a longer period of time before prostaglandin synthesis is reduced. Although not statistically significant, increased survival trends were observed in ponies treated with flunixin meglumine.

Improvement in glucose tolerance of diabetic dogs after implantation of neonatal pancreatic fragments.

Minced neonatal pancreatic tissue from 3-6 canine littermates was placed in the peritoneal cavity of five alloxan diabetic dogs without separation of endocrine and exocrine tissue. Fasting blood glucose levels declined from a preimplant level of 211 +/- 57 mg/dl to 111 +/- 6 mg/dl. The maximum blood glucose following a glucose challenge declined from 387 +/- 26 mg/dl to 175 +/- 37 mg/dl. These levels were slightly higher than the 92 +/- 6 mg/dl fasting and 140 +/- 34 mg/dl maximum obtained in control dogs. Insulin levels before implant ranged from 6 to 11 microU/ml and showed no response to a glucose challenge. Insulin responses to a glucose challenge after implant were variable. Three of the dogs showed some hyperinsulinemia without hypoglycemia. Another dog showed a delayed insulin response of normal magnitude. Improvement in glucose tolerance lasted for 2-6 weeks. These results indicate that neonatal tissue can survive and function within the peritoneal cavity. It was not necessary to obtain isolated islets to achieve hormone secretion. However, additional purification may be needed to decrease the side effects of acinar enzymes.

Effects of flunixin meglumine on blood pressure and fluid compartment volume changes in ponies given endotoxin.

A study was conducted to determine whether body fluids undergo a net shift from one compartment to another during endotoxin-induced shock in the pony, and whether flunixin meglumine alters these endotoxin-induced changes in the volumes of body fluid compartments. Total blood, RBC, and plasma volumes were determined, using 51Cr-labeled RBC and PCV that were corrected for trapped plasma. Total body water was measured by distribution of 3HOH. Arterial blood pressure was measured directly, using a blood pressure transducer. Treatment (flunixin meglumine, 1.1 mg/kg of body weight) was given to 6 of the 12 ponies 1 minute before an IV injection of Escherichia coli endotoxin (100 micrograms/kg of body weight, LD100). The PCV and RBC volume increased in both groups; however, the hemoconcentration was less in flunixin meglumine-treated ponies. In nontreated ponies, total blood volume and plasma volume decreased significantly during the first hour after endotoxin administration. In treated ponies, total blood volume did not vary significantly, and plasma volume decreased only slightly. In both groups, the increase in PCV was apparently due to splenic contraction, which increased the number of circulating RBC. Hemoconcentration was further increased in nontreated ponies by the loss of plasma into the interstitial space. Flunixin meglumine reduced plasma loss, minimized hemoconcentration, and maintained normal blood volume. Total body water remained constant in treated and nontreated ponies.

Endotoxin-induced hemodynamic changes in dogs: role of thromboxane and prostaglandin I2.

Plasma concentrations of thromboxane and prostaglandin I2 (PGI2) before and after IV injection of endotoxin and resulting hemodynamic changes were evaluated. Effects of flunixin meglumine on plasma concentrations of these prostaglandins and the related hemodynamic changes were also determined. Shock was induced in 2 groups of anesthetized dogs. Four dogs were given endotoxin only and 4 dogs were given endotoxin and then were treated with flunixin meglumine. Arterial blood pressure (BP), cardiac output (CO), and heart rate were measured, and blood samples were collected at postendotoxin hours (PEH) 0, 0.1, 0.25, 0.5, 1, 2, 3, and 4. Plasma thromboxane and PGI2 concentrations were increased in canine endotoxic shock. Thromboxane concentration was highest early in shock, and appeared to be associated with an initial decrease in BP and CO. The increased concentration of PGI2 was associated with systemic hypotension at PEH 1 to 2. Treatment of dogs with flunixin meglumine at PEH 0.07 prevented further increase of thromboxane and blocked the release of PGI2, resulting in an increased CO, BP, and tissue aerobic metabolism.

Effects of naloxone on endotoxin-induced changes in ponies.

The value of naloxone (1 mg/kg of body weight/hr for 4 hrs), a beta-endorphin antagonist, was assessed in the management of endotoxin-induced shock in ponies. Three groups of 5 ponies each were used: controls, ponies given Escherichia coli endotoxin put untreated, and ponies given endotoxin and then treated with naloxone. Endotoxin-induced changes in hemodynamics, blood chemical values, regional blood flow, plasma enzymes, and energy supplies were measured at selected times during the first 6 hours after endotoxin was given. There was no evidence that beta-endorphins released during shock were responsible for the hemodynamic changes, blood flow changes, plasma enzyme changes, or energy deficits, because naloxone, at this dosage level, did not prevent these endotoxin-induced changes.

Metabolism of estrogens in the gastrointestinal tract of swine. I. Instilled estradiol.

One minute after instillation of 14C-estradiol-17 beta (14C-E2 17 beta) into selected sections of the gastrointestinal tract of swine, radioactive estradiol metabolites were present in blood collected from the portal and jugular veins. Ether was used to extract free but not conjugated estrogens. The percentage of plasma radioactivity that was ether extractable (EE) was low in portal plasma and even lower in jugular plasma following instillation of 14C-E2 17 beta into the stomach, ileum and colon. EE radioactivity was not detectable in either portal or jugular plasma when estradiol was instilled into the duodenum or jejunum. Therefore, estrogens were conjugated either in the lumen of the gastrointestinal tract or as they crossed the intestinal mucosa. The liver played only a minor role in conjugation of these steroids, since the estrogen metabolites present in portal plasma were very similar to those in jugular plasma, and metabolites in the urine were similar to those in plasma. The principal estrogen conjugate found in both portal and jugular plasma, regardless of the gastrointestinal section into which 14C-E2 17 beta was instilled, was estrone glucuronide. There was no uniform metabolic pattern observed in the metabolites of estradiol that remained in the lumen of each gastrointestinal section; however, many metabolic transformations occurred. We concluded that almost all estrogens absorbed were metabolized during the absorption process. The liver was active only in the metabolism of estrogens that escaped conjugation in the intestinal mucosa.

Metabolism of estrogens in the gastrointestinal tract of swine. II. Orally administered estradiol-17 beta-D-glucuronide.

Studies were conducted to determine the absorption and metabolic fate of orally administered 3H-estradiol-17 beta-glucuronide (3H-E2-G) in swine. Xylazine-tranquilized female pigs (5 to 6 wk old) were given .04, .4 or 4 mumol 3H-E2-G via stomach tube, and blood samples were collected from previously implanted jugular cannulas for 12 or 72 h. The entire gastrointestinal tract was removed from gilts euthanatized 12 h post-treatment, and free and conjugated estrogens were isolated from plasma and intestinal chyme by diethyl ether extraction and adsorption to Amberlite XAD-2 resin columns. After preparative thin layer chromatography of the conjugate fractions, the conjugates were cleaved by enzyme hydrolysis, solvolysis or acid hydrolysis. The freed estrogens were identified by thin layer chromatography. Plasma radioactivity peaked between 6 and 8 h after administration of the conjugate. None of the radioactivity in plasma was ether extractable. There was evidence for a decrease in absorption rate of radioactive estrogen in the high dosage group. The pattern of metabolites and urinary excretion or orally administered 3H-E2-G was similar to that reported for 14C-E2, except for the greater proportion of polar metabolites and delayed absorption, probably reflecting the need for the conjugate to be hydrolyzed first. The greater proportion of polar metabolites found in this study may have been due to the longer treatment period rather than the administration of the conjugated form of estradiol.

Thromboxane, prostaglandin I2 (epoprostenol), and the hemodynamic changes in equine endotoxin shock.

This study had 2 objectives: (i) to correlate plasma thromboxane and prostaglandin I2 (epoprostenol) concentrations with hemodynamic changes occurring in equine endotoxin shock, and (ii) to determine the effects of flunixin meglumine on plasma concentrations of these prostaglandins relative to hemodynamic changes. Shock was induced in 2 groups, each of 4 anesthetized ponies, and in a 3rd group of 2 ponies. Group A ponies were given endotoxin only (and were not treated), and group B ponies were given endotoxin and then treated with flunixin meglumine. Group C ponies were treated with flunixin meglumine 5 minutes before they were fiven endotoxin. Arterial, pulmonary arterial, and central venous pressures were measured and blood samples were collected at 0, 0.1, 0.25, 0.5, 1, 1, 3, and 4 hours after ponies were given the endotoxin. The plasma thromboxane and prostaglandin I2 concentrations were increased in equine endotoxic shock. Increased thromboxane concentration was associated with the high pulmonary arterial and central venous pressures and low arterial blood pressure in the minutes immediately after the ponies were given endotoxin. The increased prostaglandin I2 concentration was associated with systemic hypotension at 1 to 2 hours after endotoxin. Treatment of ponies with flunixin meglumine after endotoxin was given (group B) prevented the prostaglandin I2 rise and the associated hypotension. Treatment with fluixin meglumine before endotoxin was given prevented the increase of the plasma thromboxane and prostaglandin I2 values, along with the associated hemodynamic changes.

Endotoxin-induced change in hemograms, plasma enzymes, and blood chemical values in anesthetized ponies: effects of flunixin meglumine.

A study was made of flunixin meglumine (FM), an analgesic agent with antiprostaglandin activity, in the management of endotoxin-induced changes in ponies. Three groups of 5 ponies each were used: A--controls, B--nontreated ponies with endotoxin-induced shock, and C--ponies with endotoxin-induced shock treated with FM. Shock was induced in anesthetized ponies with IV injections of Escherichia coli endotoxin. Disruption of glucose homeostasis, insulin levels, hemograms, aerobic metabolism, and cell damage as indicated by plasma enzymes were observed. Treatment with FM (5 minutes) after shock was induced did not prevent general tissue damage as indicated by plasma enzymes, but separation of creatine phosphokinase into its 3 isoenzymes revealed a significant increase in the amount of the creatine phosphokinase isoenzyme bb in group B ponies, but not in FM-treated ponies (group C). The source of this isoenzyme is believed to be brain tissue. Acidosis as indicated by lactic acid and venous pH was less in FM-treated ponies than in nontreated (group B) ponies. Blood glucose and insulin concentrations changed in both groups B and C (endotoxin-induced shock), but the patterns of change were different. The only effect of FM on hematologic values was a significant decrease in blood platelet counts. The results of these experiments indicate that FM improved cellular metabolism and reduced brain damage. These effects were believed to be the result of the maintenance of mean arterial blood pressure and enhanced perfusion of vital organs by preventing extensive vasodilation in the gastrointestinal tract.

Endotoxin-induced hemodynamic changes in ponies: effects of flunixin meglumine.

A study was made of flunixin meglumine, an analgesic agent with antiinflammatory and antiprostaglandin activity, for the management of endotoxin-induced cardiovascular derangements. Three groups of 5 ponies each were used: controls--group 1; given endotoxin but not treated--group 2; and given endotoxin and treated with flunixin meglumine--group 3. Shock was induced in anesthetized ponies with IV injection of Escherichia coli endotoxin. Hemodynamic changes were monitored, and regional blood flow was determined at 4 different times, using microspheres labeled with 1 of 4 nuclides. There were extensive vasodilation and decreased blood return to the heart of group 2 ponies, as indicated by decreased mean arterial blood pressure and central venous pressure and by increased heart rate and cardiac output. Blood flow, as determined by radioactive microspheres, to gastrointestinal regions, skeletal muscle, and skin was increased and that to the CNS was decreased. Treatment with flunixin meglumine (group 3 ponies) exerted selective microvascular actions which helped to reverse endotoxin-induced changes. This included the maintenance of mean arterial blood pressure and the enhanced perfusion of vital organs (eg, brain and heart) by preventing extensive vasodilation in the gastrointestinal tract.

Effect of the proteinase inhibitor aprotinin in the management of hemorrhagic shock in the dog.

Aprotinin, a proteinase inhibitor, was evaluated as a pharmacologic aid in dogs subjected to lethal hemorrhagic shock. Survival time, hemodynamic changes, and plasma enzyme analysis were measured as criteria for drug effects. Mixed-breed dogs (n = 14) were divided into 2 groups of 7 each: nontreated dogs in shock (group 1) and aprotinin-treated dogs in shock (group 2). One of 7 dogs in group 1 and 2 of 7 dogs in group 2 survived. Survival time, for the remaining dogs in group 1 (190 min, n = 6) and group 2 (188 min, n = 5) were not significantly different. There was no significant difference in mean arterial pressure, mean pulmonary arterial pressure, cardiac output, or left ventricle systolic pressure associated with aprotinin treatment at any time after hemorrhagic shock. There was no significant difference in plasma lactic acid, aspartate aminotransferase, alanine aminotransferase, creatine phosphokinase, alpha-amylase, and beta-glucuronidase associated with treatment at any time; however, there were significant (P less than 0.05) increases with time. The gastrointestinal tract was the site of most obvious lesions found at necropsy. Lesions varied considerably in extent and severity without apparent correlation to the treatment regimen. These experiments did not show beneficial effects of aprotinin in dogs subjected to hemorrhagic shock, but neither did they completely rule out some valuable actions that may have been obscured by the type of model used.

Dexamethasone treatment during hemorrhagic shock: blood pressure, tissue perfusion, and plasma enzymes.

In a study to determine beneficial effects of dexamethazone (5 mg/kg) during hemorrhagic shock, perfusion (as measured by radioactive microspheres) and plasma enzymes were measured. Hemorrhagic shock (mean arterial blood pressure, MABP, of 50 mm of Hg) was induced in dogs and then the dogs were isolated from the shed-blood reservoir and were allowed to compensate their MABP. Hemodynamic changes, tissue perfusion, and plasma enzymes were measured at different intervals of time in nontreated and dexamethasone-treated dogs. Beneficial effects were increased MABP, improved blood flow to the lungs, gastrointestinal tract, and kidneys, and less cell damage as indicated by amounts of plasma enzymes released from damaged tissues. These effects favor the maintenance of the homeostatic state and, in turn, a greater chance for survival of the dog.

Dexamethasone treatment during hemorrhagic shock: effects independent of increased blood pressure.

Effects of dexamethasone (5 mg/kg of body weight) on organ blood flow, enzyme release, and hemodynamics were studied in dogs with hemorrhagic shock to determine if the consequences observed were due to increased mean arterial blood pressure (MABP) or intrinsic effects of dexamethasone. Hemorrhage was induced in anesthetized dogs until the MABP was 50 mm of Hg and then the dogs were treated with dexamethasone or an equal volume of saline solution. Dogs remained connected to the blood reservoir during the entire experiment and MABP was maintained at 50 mm of Hg in the treated and control groups of dogs. Beneficial actions of dexamethasone treatment independent of increased MABP were observed. Increased survival rate, differential blood flow to some organs, and less tissue damage occurred as a result of dexamethasone treatment and were independent of increased MABP.

Caliber spectra of fibers in the fasciculus gracilis of the cat cervical spinal cord: a quantitative electron microscopic study.

In order to obtain a better understanding of the microscopic structure of the cat fasciculus gracilis, entire cross-sections of the fasciculus were examined with the electron microscope. Twenty-five thousand, two hundred and eighty-four fibers were encountered in one fasciculus. The fiber caliber spectra obtained from the study show that the fasciculus gracilis at cervical level has a unique fiber distribution pattern. The fiber diameters range from less than 1 mu to 15 mu, however, 97 percent of fibers have diameters less than 8 mu; and the majority of the fibers are in the 2-5 mu range.