Decrease of red blood cell filterability seen in intensive care I. The correlation of low erythrocyte filterability with mortality and its return to normal values in critically ill patients under parenteral nutrition.

Damage to the internal viscosity of red cell is correlated with changes in the surface area to volume ratio and to prelytic phenomena. Considerable changes in shape were noticed in red cells from shocked dogs and some critically ill patients in blood smear or fresh preparation, or after in vitro treatment with colloidal plasma substitutes or glucose, and so erythrocyte filterability was investigated in critically ill patients, given or not given parenteral nutrition. The results revealed an increase of the erythrocyte filtration time (EFT 1/2) in more than 50% of the critically ill patients and less alteration in critically ill patients given total parenteral nutrition, the mortality being half as great. The return of increased EFT 1/2 to normal values occurred after 3-12 days of total parenteral nutrition in 6 patients investigated. A death rate twice as great was seen in patients with high EFT 1/2 as compared to the 27.7% mortality in patients with normal EFT 1/2, its correlation with increased filtration time being significant, r = 0.81 greater than 3 Sr, y = 1.291x + 27.44, n = 47.

Intrahematic crystallization of hemoglobin related to blood preservation with acid citrate dextrose and shock.

In 480 investigations and 40 samples of blood stored liquid with acid citrate dextrose, under adequate conditions for morphological study, many crenated cells of echinocyte types II-III were observed. In 17 samples of blood within 17-21 days of preservation 80-100% crenated red cells were observed including spherocytes. The filterability test performed with significant differences of P < 0.001. In 45 critically ill patients filterability was increased by more than 50%, P < 0.001. Some samples of stored blood appear anisotropic in polarized light microscopy, proving internal crystallization of hemoglobin, the only compound in the blood from some patients in shock and following massive transfusion of 3.5-4 liters. The phenomenon, undoubtedly could give evidence for the participation of internal crystallization of hemoglobin in the late stages of transformation of red cells into crenated shape with two possible factors being incriminated: the participation of membrane or crystallization of Hb. Anisotropic, birefringent, red cells indicate great modification in the specific viscosity of erythrocytes in above conditions. The data are in keeping with the findings of Taube, Massuda and Shoemaker (1973) who suggested that changes in the viscosity of the blood in traumatized patients may be related to alterations in the internal viscosity of the red cell.

Parenteral nutrition in toxic septic states.

An analysis is made of two groups each of 20 patients with toxic septic states and hypercatabolic renal failure, who were given parenteral nutrition for at least 3 days. Each group was divided into two subgroups, given glucose, 13--20 and 20--27 kcal. 24 h--1 kg--1 body weight; the second subgroup was also given nitrogen-containing infusions of 0.05--0.12 or 0.12--0.17 g of N 24--1/kg--1 body weight, the total calorie intake amounting to 23--28 and 28--33 kcal. 24 h--1 kg--1 respectively, with nitrogen amounting to 150--400 kcal./g. A mean daily decrease of blood urea of 9.2 mg/100 ml was recorded, together with a positive catabolism in the series given nitrogen, and a rise of 0.8 mg/100 ml with negative catabolic index in the series fed with glucose (P less than 0.01); there were similar nitrogen losses in both the series, corrected by catabolism formula. The results demonstrated a decreased rate of catabolism in patients fed with a diet containing nitrogenous compounds.

[Intraperitoneal and intragastric administration of Norartrinal in severe digestive hemorrhages]. / Administrarea intraperitoneala si intragastrica de Norartrinal în hemoragiile digestive grave.

A total of 23 successful treatments are described, in severe haemorrhages of the upper intestinal tract, which were either primitive (ulcer, gastritis), or secondary (due to stress), in seriously ill patients, by administration of 4 g of Norartrinal intragastrically or intraperitoneally. The absence of adverse reactions, that have been looked for at anatomo-pathological investigations and during surgery, as well as the good results recorded in patients in whom the classical treatment did not result in satisfactory results, recommend this method especially in limit cases.

[Limits of hemodilution in the treatment of hemorrhagic shock]. / Limitele hemodilutiei în tratamentul socului hemoragic

Clinical analysis of 168 cases of hemorrhagic shock of the 230 cases of hemorrhage and injuries admitted to the 2nd Surgical Clinic of Timisora between 1970 and 1973, showed that the administration of blood substitutes (crystalloid and colloid solutions) may be extended with good results in the management of hemorrhagic shock up to a hematocrit of 20%, respectively 7 g Hb. This treatment implies a careful selection of the cases, based upon objective criteria (listed in the text), so that the none administration of blood should not involve any risks. Even in the cases in which blood tranfusion is indispensable, hemodilution reduces to a great extent the amount of blood required.

[Decreased catabolism after toxico-septic aggression by administration of injectable amino acids]. / Scaderea catabolismului dupa agresiunea toxico-septica prin administrarea de aminoacizi injectabili.

Two comparative lots were established, of 48 and 44 patients respectively with toxico-septic syndromes, renal failure of the hypercatabolic type, that had received parenteral food for a period of between 3 and 11 days. The first group received only glucose while the second also had injectable aminoacids. In the first group was noted a daily rate of blood urea variation (r) of 1,65 mg% and a good nitrogen elimination. In the second group was noted an r of --8,13mg% (pless than 0,001) and a more rapid improvement of the clinical condition. Next to the fall in the absolute nitrogen elimination (p greater than 0,05), the nitrogen balance, computed at 36% incorporation of the administered nitrogen, was significantly improved in the second group (p greater than 0,01), demonstrating the lowering of the metabolic rate under perfusion with aminoacids.