Clarithromycin attenuates the inflammatory response induced by surgical trauma in a guinea pig model.

The effect of clarithromycin on the systemic and local inflammatory responses after surgical trauma was investigated using a guinea pig model. There was no statistically significant difference in the body temperature and respiratory rate of the guinea pigs between the clarithromycin and control groups, although there was a trend towards a lower temperature in the first 36 h after the operation, and a trend towards a lower respiratory rate on day 1 and day 2 (P=0.07 and 0.18, respectively) in the clarithromycin group. The total leukocyte count of both groups of animals increased from day -1 to day 4, and the increase was more marked in the control group (P=0.06 on day 1). The neutrophil and monocyte counts of the two groups of animals also increased after the operation. The neutrophil count of the control group was significantly higher than the clarithromycin group on day 1 and 2 (P<0.05 and 0.01, respectively), and the monocyte count of the control group was significantly higher than the clarithromycin group on day 1 (P<0.005). Moreover, the platelet count of the animals also increased after the operation, and the count in the control group was significantly higher than the clarithromycin group on day 1, 2 and 4 (P<0.05, 0.005 and 0.005, respectively). There was no difference between the haemoglobin concentration, lymphocyte count, eosinophil count and basophil count between the two groups of animals. The number of animals with wound discharge was lower in the clarithromycin group than the control group throughout the post-operative period, but the difference was not statistically significant. None of the animals developed signs of wound infection. The present observation suggests that clarithromycin suppressed both the systemic and local inflammatory response after surgical trauma, and it prompts further animal experiments for delineation of the mechanism of action, as well as clinical trials in major surgical procedures.

Surgical shock presenting as lower limb ischaemic rest pain.

Ischaemic rest pain affecting the lower limb is characteristically constant, severe and distressing. Attention is thereby concentrated on the affected leg and its vascular supply which may distract the attending clinician from a precipitating cause. We present two patients with shock that led to acute onset of ischaemic leg pain.

Pulmonary microembolization in experimental aortic surgery.

Pulmonary dysfunction frequently follows major surgery and has many features identical to "shock lung'. A porcine model of aortic surgery is described in which 111In-labelled platelet kinetics were related to subsequent pulmonary function. In 14 pigs, standardized aortic surgery resulted in reproducible shock and a 50 per cent mortality at 3 days. Cardiac output fell from 2.3 +/- 0.2 to 1.0 +/- 0.1 litres min-1 following removal of the aortic clamp and mean platelet and leucocyte counts fell from 437 +/- 48 to 252 +/- 39 x 10(9) litres-1 and 21.7 +/- 1.5 to 12.9 +/- 1.2 x 10(9) litres-1 respectively (P less than 0.01). Aggregate levels in inferior vena caval blood were maximal at this time and radiolabelled platelets accumulated in the lung with a rise in pulmonary vascular resistance. Alveolar-arterial oxygen difference subsequently increased from initial values of 13.7 +/- 2.0 to 23.4 +/- 3.5 mmHg (P less than 0.01) following resuscitation and to 32.5 +/- 3.4 mmHg at 3 days following surgery (P less than 0.01). This clear sequence suggests that pulmonary platelet microembolization occurs during surgical shock and may be responsible for subsequent pulmonary dysfunction.

Might the aphorism "there is no indication in medicine for a pint of blood" lie behind some of the residual morbidity and mortality of surgery?

Reconsideration of, and some uncertainty about, the risks of whole blood transfusion are stimulating renewed debate around and about transfusion policy. This essay -- 1) considers probable risks of retreating in fright from the approach which has significantly reduced the morbidity and mortality of surgical operations over the last 100 years, so that we may balance them against the known and putative risks of transfusion. 2) questions the universality of the aphorism "There is no indication in medicine for a pint of blood" -- because it presumes and implies that everyone can "tolerate"/not be harmed by/minor blood loss, or minor hypovolaemia from any other cause, and leads surgeons and anaesthetists to aim at "minimising" the degree and duration of hypovolaemia during surgery rather than to prevent it entirely. 3) proposes that circulating volume deficiencies, including small ones, are intrinsically intolerable pathological events to be prevented by a "positive" policy aiming at normovolaemia throughout operative procedures by "priming" patients about to undergo major operations with volume expanders before surgery, minimising their intraoperative blood loss, giving non-blood plasma expanders until dilution threatens significant anaemia, and whole-blood transfusion as a last resort when it does. 4) proposes that averting "minor" short-lived circulating volume depletion might avert the residual "minor" morbidity and mortality caused by venous thrombosis, pulmonary embolism, bronchopneumonia, intestinal ileus, postoperative abdominal distension, wound and anastomotic dehiscence, fat embolism, (alone or in various combinations) and give us a greater (insight into and) control over fluid and electrolyte balance.

[Surgical shock. Acute hypocatecholaminemia and therapeutic indications of an adrenocortical vasopressor sympathicolytic drug mixture. Clinical studies and experimental research]. / Socul operator, Hipocatecolaminemia acuta si indicatiile terapeutice ale amestecului farmacologic simpaticolitic vasopresor adrenocortical. Studii clinice si cercetari experimentale.

In cases with postoperative shock and collapse a constant fall in the concentration of serum cathecholamines was noted. Thus adrenalin was reduced by 77%, noradrenalin by 86.5%, in direct proportion with the fall in the blood pressure, of the pulse amplitude and with the slowing-down (or the arrest) of the microcirculation. The reduction of serum cathecholamines also coincided with a decrease in the amount of buffer bases and of the diuresis. The adrenocortical vasopresor sympathicolithic mixture is indicated in the prolonged arterial hypotension following failure of therapy aimed at filling of the vascular bed associated with the administration of sympathicolytic drugs.

[Pancreatitis following kidney transplantation]. / Pankreatitis nach Nierentransplantation.

Follow-up of 249 recipients of cadaver renal allografts revealed 14 cases of pancreatitis. The minimum follow-up time was 2 1/2 years and the maximum 12 1/2 years. In 9 patients acute pancreatitis occurred within 4 months, 5 died from hemorrhagic-necrotizing disease. Later, 2 lethal cases of abscess-forming pancreatitis, 1 benign acute and 2 chronic forms were observed. The mortality in post-transplant pancreatitis is 7 out of 14, which corresponds to 7% of all fatalities after transplantation. Many different factors contribute to the development of pancreatitis, the most important being steroid medication.