ISSN:0077-8923    

DOI:10.1111/j.1749-6632.1968.tb14700.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

摘要:

SummaryLocal microvascular disturbances in the injured tissue, as well as systemic circulatory changes, are described on the basis of studies in animals and in man, using vital microscopy, electron microscopy and microangiography. The structural and functional analysis covers intravascular shape and behaviour of blood cells, plasma rheology, endothelia1 and periendothelial ceilular changes immediately after trauma, as well as the later phase of repair and regeneration.The use of infrared thermography is described for diagnostic evaluation of the extent and degree of severe burns, even in large numbers of patients, and for follow‐up of the effect of local therapeutic measure

ISSN:0077-8923    

DOI:10.1111/j.1749-6632.1968.tb14701.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

ISSN:0077-8923    

DOI:10.1111/j.1749-6632.1968.tb14702.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

ISSN:0077-8923    

DOI:10.1111/j.1749-6632.1968.tb14703.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

摘要:

SummaryMicrocirculatory flow following a severe burn is hindered by the formation of aggregates of erythrocytes which frequently completely fill the lumena of small arteries, arterioles, and venules. On the arterial side, clusters of cells are often too large to enter branching vessels; large aggregates grow from smaller clusters, and vessels fill with packed, adherent erythrocytes for some distance proximal to divarications. However, if erythrocytes enter capillaries, they move independently of other erythrocytes and are transformed into hollow paraboloids as they are in the absence of trauma to tissue or in the absence of infused thromboplastin.The hypothesis that aggregation of erythrocytes is caused either directly or indirectly by release of thromboplastins from damaged tissue is based upon the following evidence:1) Following a severe burn the observed phenomena in cinephotographic film recorded at conventional film speeds and up to 3200 frames per sec, are similar to those observed following the infusion of thromboplastin.2) Changes in clotting and fibrinolytic components following a severe burn can be duplicated by the infusion of canine thromboplastin. The most pronounced alteration is the shortening of the Stypvin time which is highly dependent upon the concentration of phospholipids.3) Complete fibrinogenolysis results in improvement in microcirculatory flow following a severe burn and following the infusion of thromboplastin, indicating that an altered fibrinogen, or possibly fibrin, is involved in the adherence between erythrocytes in both experimental conditions.

ISSN:0077-8923    

DOI:10.1111/j.1749-6632.1968.tb14704.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

摘要:

SummaryThree recent discoveries in the field of interstitial fluid dynamics make it pos‐ sible to construct a relatively complete analysis of the regulation of interstitial fluid volume and interstitial pressure. These three discoveries are the following: First, the normal interstitial fluid pressure is about ‐7 mm Hg in contrast to the previously believed values of + 1 to +8 mm Hg. Second, the volume‐pressure curve of the interstitial spaces is very nonlinear: a very slight increase in interstitial fluid volume above normal will increase the interstitial fluid pressure from ‐7 mm Hg up to equal atmospheric pressure (0 mm Hg), but, once the interstitial fluid pressure has risen above this level, the tissue spaces balloon outward rapidly, in such a way that tremendous volumes of fluid can then be accommodated in the tissue spaces with almost no further rise in interstitial fluid pressure. Indeed, at positive pressures of +2 to +5 mm Hg, 4+ edema occurs in the S.C. tissues of the body. Third, the fluids normally present in the interstitial spaces appear not to be motile but instead bound and held firmly in place. This fluid can diffuse back and forth between the circulation and interstitial spaces because of the tremendous pressures (up to one million mm Hg) that exist for causing the process of diffusion to occur. On the other hand, this fluid cannot be removed from the tissue spaces by the usual, comparatively weak hydrostatic forces that develop in the lymphatic system or that develop as a result of osmosis at the capillary membrane. When edema occurs, essentially all the extra fluid that appears in the tissues is in the motile state and can be moved easily from one part of the tissue to another with only 0 to 5 mm Hg pressure gradient. Under normal conditions, two different factors, (a) lymphatic flow caused by arterial pulsation and other types of motion in the tissues, and (b) osmosis of fluid from the tissue spaces through the capillary membrane, keep the tissues “dry” of motile fluid and thereby maintain a negative interstitial fluid pressure of about ‐7 mm Hg. Therefore, the normal interstitial fluid volume is regulated to essentially zeromotilefluid in the interstitid spaces, and the fluid that is present in the interstitial spaces appears to be only that amount entrapped by the gel in the ground substance of the tissue spaces or held by capillarity in very minute

ISSN:0077-8923    

DOI:10.1111/j.1749-6632.1968.tb14705.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

摘要:

Summary1. Two hundred and eighty‐eight radiant energy burns were produced on anesthetized pigs and were studied at biopsy at 4, 24 and 48 hr. There is progressive destruction of epithelial cells in hair follicles and “sweat” glands during this interval.2. In radiant energy burns of the ears of anesthetized rabbits, peripheral nerve fibers are progressively destroyed for two days after injury.3. To compare the effects of superimposing two burns, 588 single or double exposures to radiant energy were made on anesthetized pigs. Intervals between double exposure were one min, one hr, five hr or six hr. The results show that some tissue, which will remain viable if left alone, will be destroyed by a second exposure, which would not, by itself, have caused detectable injury to that tissue.4. Many varieties of systemic fluid therapy can insure the early survival of severely burned patients. It is proposed that we would have good reason to prefer one over the others, if it could be shown to halt or decrease progressive tissue destruction during the early hours or days following a

ISSN:0077-8923    

DOI:10.1111/j.1749-6632.1968.tb14706.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

ISSN:0077-8923    

DOI:10.1111/j.1749-6632.1968.tb14707.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

ISSN:0077-8923    

DOI:10.1111/j.1749-6632.1968.tb14708.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

ISSN:0077-8923    

DOI:10.1111/j.1749-6632.1968.tb14709.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY