Increasing survival of dogs subjected to hemorrhagic shock by administration of fructose 1-6 diphosphate.

Previous reports from this laboratory described animal experiments in which intravenous administration of fructose 1-6 diphosphate (FDP) at the onset of hypovolemia, toxemia, and trauma effected improvement in hemodynamic and metabolic parameters, attenuation of tissue damage, and a significant increase in survival. The obvious question remained: Would this agent be as effective if administered after the onset of the shock syndrome? Thus 72 anesthetized dogs were subjected to normotensive hemorrhagic shock and were subsequently treated with FDP at 30 minutes, 1 hour, 90 minutes, and 2 hours after exsanguination. Analysis of the results (as compared with vehicle-treated controls) revealed evidence of improved cardiac output and arterial pressure (p less than 0.02), conservation of effective circulatory volume, better oxygen utilization, and a significant increase in survival (p less than 0.0001). These results, in conjunction with earlier experimental and recent clinical data, indicate that the therapeutic effect of FDP in ischemic and hypoperfusion states is in part metabolically mediated by the augmentation of carbohydrate utilization. Prevention of tissue injury is in part due to the inhibition of generation of oxygen-derived free radicals by neutrophils.

Comparison between selective distal splenorenal shunt and small diameter H-graft portosystemic shunt.

Although most commonly performed portal decompressive procedures control bleeding effectively, postoperative morbidity and mortality remains a serious problem in these patients. Both distal splenorenal shunts (DSRS) and small-diameter portacaval H-grafts (PCHG) are reported to produce decreased rates of postoperative encephalopathy. We prospectively evaluated 69 patients in whom 27 PCHG and 45 DSRS were performed over a seven-year interval. There were no significant preoperative differences between these groups. Operative mortality was 12.9% overall. DSRS was associated with decreased intraoperative blood transfusions and operative time. Postoperatively, DSRS was associated with significantly less encephalopathy, other postoperative complications, and ascites. Recurrent variceal bleeding was seen in three patients treated with PCHG and two patients with DSRS. We conclude that both DSRS and PCHG are effective in preventing recurrent variceal bleeding, but DSRS remains our procedure of choice because of its decreased rates of postoperative complications.