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Abstract
It has been shown that capillary endothelium serves indispensable functions under
normal physiologic conditions. These include local capillary hyperemia incident to
functional activity of tissue cells, inflammatory hyperemia in response to cellular
injury, the processes of diffusion and osmosis both in the distribution of useful
substances and in the elimination of wastes. Not the least important function of the
endothelial membrane has to do with the mechanism of water balance.
The performance of these functions requires that endothelium be delicately sensitive
to oxygen tension, to the presence of metabolites and cytoplasmic substances. This
very sensitivity renders endothelium a highly vulnerable structure. Its essential
quality of semipermeability and its normal tonus are readily affected by diverse agents.
These include lack of oxygen, the presence of metabolites in abnormal concentration,
products of tissue injury and protein cleavage, bacterial proteins and toxins, venoms,
and various drugs, chemicals, and poisons.
The effects of these and similar agents may cause abnormal permeability of a large
area of endothelium. This produces a characteristic clinical syndrome of circulatory
disturbance, usually called shock or collapse, accompanied by an equally characteristic
group of physiologic disorders. The visceral changes seen at necropsy are those indicative
of capillary damage. Hemoconcentration is an associated phenomenon which is highly
valuable in the recognition of this syndrome in its early stages.
The action of many drugs, chemicals, and poisons is due in part to their effects upon
endothelium. It appears that pharmacologic and toxicologic interpretations may need
revision to include the effects of many agents upon capillary endothelium.
The self-perpetuating quality of this type of circulatory deficiency makes early recognition
essential to successful management. Hemoconcentration is a more useful index than
a decline in arterial blood pressure. The former occurs early and is detectable during
the incipient stages, while the latter is a sign that the mechanism of compensation
has failed.
Efforts to combat shock will be directed logically toward the removal of the cause,
toward the restoration of the lost blood volume and capillary tonus, and toward relieving
anoxia.
Unless the condition that caused the circulatory deficiency is relieved, any efforts
to restore circulatory efficiency will be useless. Transfusions of plasma or serum
are more suitable than whole blood, because they relieve the hemoconcentration by
supplying the same type of fluid which was lost. There is physiologic evidence that
one function of the adrenal cortical hormone is the maintenance of endothelial tonus.
Hence the use of cortical extract during the incipient stages of shock is logical.
Recent reports of its use in experimental and in clinical shock indicate beneficial
effects. The inhalation of oxygen may retard the progress of the circulatory deficiency,
since anoxia supplies the self-perpetuating quality in the mechanism of shock.
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References
- Anatomy and Physiology of the Capillaries.ed. 2. Yale University Press, New Haven1929
- Die lokale vasomotorische Reaktion der Haut und der inneren Organen.Arch. f. d. ges. Physiol. 1917; 169: 1
- Ueber Gewebsreizung und Gefässreaktion.Arch. f. d. ges. Physiol. 1923; 199: 197
- Capillärerweiterung, Urticaria und Schock.Klin. Wchnschr. 1923; 2: 1725
- A Chemotropic Substance Derived From Normal Tissues.Arch. Path. 1938; 25: 40
- Versuche und Fragen zur Lehre der Lymphbildung.Arch. f. d. ges. Physiol. 1891; 49: 209
- Lymphatics, Lymph and Tissue Fluid.Williams & Wilkins, Baltimore1933
- The Occurrence and Clinical Significance of Hemoconcentration.Ann. Int. Med. 1939; 13: 451
- Capillary Pressure and Capillary Permeability.Physiol. Rev. 1934; 14: 404
- Blood Concentration Changes in Extensive Superficial Burns and Their Significance for Systemic Treatment.Arch. Int. Med. 1923; 32: 31
- Experimental Pulmonary Edema.Arch. Path. 1936; 24: 642
- Blood Vessels of the Human Skin and Their Responses.Shaw & Sons, London1927
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© 1940 Published by Elsevier Inc.
