Absence of pulmonary edema during peritonitis and shock in rats.

We evaluated the development of pulmonary edema early in the course of peritonitis and shock in rats. Peritonitis was established by cecal ligation and perforation. In a preliminary experiment, sepsis was induced in five animals and five animals served as sham-operated controls. Lungs harvested for gravimetric analysis at 6 hours revealed no significant difference in wet-dry/dry (W-D/D) ratios. In a second experiment, 15 rats were randomized to three groups: septic animals, septic animals infused with 5% albumin, and sham-operated animals. Thermodilution cardiac output and arterial blood gases were sequentially measured over a 6-hour interval. At 6 hours, the lungs were harvested for gravimetric analysis. Lung W-D/D and arterial oxygenation were not significantly different between the three groups. The W-D/D was 3.46 +/- 0.10 in sham-operated rats, 3.37 +/- 0.12 in septic rats, and 3.88 +/- 0.27 in albumin-infused septic rats. The alveolar-arterial oxygen difference at 6 hours was 10 +/- 2 mm Hg in sham-operated rats, 7 +/- 1 mm Hg in septic rats, and 13 +/- 6 mm Hg in albumin-infused septic rats. These data suggest that overt pulmonary edema and arterial hypoxemia may not occur early in septic shock when fluid infusion is not excessive.

Extramarital relationships: a reapraisal.

Extramarital relationships may not always disturb marital interaction, but on the contrary, marriages may have more permanence because many individuals find an answer to unmet needs in such relationships. In addition, a factor that rarely is mentioned in our society, which has vestiges of a puritanical ethic, is that an extramarital relationship can be an enjoyable experience for the individuals in and of itself. In a democratic society, which values choice, perhaps extramarital relationships can be undertaken if the individuals involved recognize: (1) the consequences of discovery, which may result in a threat to the solidarity of the marriage(s) involved; (2) the possibility that individuals so involved ultimately may wish to leave their own mates; and (3) that such a relationship may strengthen, not destroy, the unity of marriage.