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In order to determine if pharmacological intervention would modify the morphological alterations that we previously observed in the human liver in a rat hypovolemic shock model, male Sprague-Dawley rats were bled to a mean arterial pressure of 40 torr for 30 minutes. Following the shock period, animals were injected with either dopamine-HCl (30 micrograms/kg/min), glucagon (50 micrograms/kg/min) or methylprednisolone sodium succinate (30 mg/kg/min) over a 30-minute period. Following treatment, the shed blood was returned. Animals were killed at either 1 or 48 hours, a wedge biopsy of the liver was taken for morphological study, and a blood sample was taken for the determination of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT). Alterations in the untreated shock controls were consistent with those seen in the human liver by ultrastructural study in cases of mild to moderate shock. The most prominent alteration in the rat liver was the formation of autophagic vacuoles at 1 hour, while at 48 hours there was an increase in residual bodies with a decrease in autophagic vacuoles in both glucagon treated and in untreated controls. While dopamine and methylprednisolone significantly reduced the number of autophagic vacuoles and residual bodies in the animals studied, SGOT levels were increased in the glucagon and methylprednisolone treated animals at 48 hours and SGPT levels were increased only in the glucagon-treated animals at the same time period. Results suggest that methylprednisolone or dopamine prevent sublethal alterations in the rat liver in moderate hypovolemic shock.

A patient with chronic myelogenous leukemia was treated with cimetidine and antibiotics after pneumonectomy. The prolonged suppression of the WBC that followed may be related to cimetidine administration in a stressed patient. Such patients should have periodic white blood cell counts because substituting the cyanoguanidine group for the thiourea group may not eliminate the hematologic effects of the H2 receptor antagonists.

Sexual function and internal iliac artery (IIA) patency were determined in 24 patients who had received at least two renal transplants, one in each iliac fossa, at the University of Maryland and Johns Hopkins Hospitals from 1975 to 1979. The pelvic hemodynamics of each patient were assessed with a penile/brachial blood pressure index (PBI). The rate of sexual dysfunction, as determined by questionnaires and personal interviews, was 46% (11 of 24 patients) compared with only 21% (five of 24 patients) after a single transplant. Nine of the 11 patients who were impotent had bilateral IIA occlusion and four of these nine had a PBI less than 0.70. One of the four patients regained full sexual function after a revascularization procedure, which confirmed that this impotence had a vascular etiology. Results of this study show that vascular insufficiency, but not necessarily vasculogenic impotence, was present in at least four of the 11 patients who were impotent (36%) and may have been avoidable by sparing at least one IIA during renal transplant procedures.

A review of patients with acute diverticulitis admitted to the University of Maryland Hospital over the past ten years revealed a high frequency of surgical intervention. In addition to the usual indications for surgery (obstruction, perforation, and fistula), we found persistent mass combined with other clinical indices, such as fever, leukocytosis, tachycardia, or recurrence required surgical intervention. Medical therapy (i.e., intravenous hydration, antibiotics, diet, nasogastric suction, etc.) varied with the clinical presentation. Only 43 per cent of the medically treated patients received antibiotics. If the bowel can be adequately prepared, a one-stage operation may be possible. Otherwise more stages may be necessary. A prognostic index has been devised for acute diverticulitis for the evaluation of medical vs. surgical therapy. The higher the index, the more extensive the procedure that will be used. Our study supports the general usefulness of a Hartman (two-stage) procedure for those patients requiring surgery.