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Inhalation of Bacillus anthracis spores can cause a rapidly progressing fatal infection. B. anthracis secretes three protein toxins: lethal factor (LF), edema factor (EF), and protective antigen (PA). EF and LF may circulate as free or PA-bound forms. Both free EF (EF) and PA-bound-EF (ETx) have adenylyl cyclase activity converting ATP to cAMP. We developed an adenylyl cyclase activity-based method for detecting and quantifying total EF (EF+ETx) in plasma. The three-step method includes magnetic immunocapture with monoclonal antibodies, reaction with ATP generating cAMP, and quantification of cAMP by isotope-dilution HPLC-MS/MS. Total EF was quantified from 5PL regression of cAMP vs ETx concentration. The detection limit was 20 fg/mL (225 zeptomoles/mL for the 89 kDa protein). Relative standard deviations for controls with 0.3, 6.0, and 90 pg/mL were 11.7-16.6% with 91.2-99.5% accuracy. The method demonstrated 100% specificity in 238 human serum/plasma samples collected from unexposed healthy individuals, and 100% sensitivity in samples from 3 human and 5 rhesus macaques with inhalation anthrax. Analysis of EF in the rhesus macaques showed that it was detected earlier post-exposure than B. anthracis by culture and PCR. Similar to LF, the kinetics of EF over the course of infection were triphasic, with an initial rise (phase-1), decline (phase-2), and final rapid rise (phase-3). EF levels were ~ 2-4 orders of magnitude lower than LF during phase-1 and phase-2 and only ~ 6-fold lower at death/euthanasia. Analysis of EF improves early diagnosis and adds to our understanding of anthrax toxemia throughout infection. The LF/EF ratio may also indicate the stage of infection and need for advanced treatments.

In 76 injured persons with deep and superficial burns, having area from 3 to 65% of the total body surface and ageing 5-16 yrs old, there was investigated the impact of early surgical treatment on the metabolic intoxication severity in accordance to content of the oxidatively modified proteins carbonyl groups in the blood serum, and of a ceruloplasmin, what was considered as integral express-index of the organism antioxidant system state. Changes of these indices in ambustial disease of middle severity have witnessed a sufficiently compensated reaction of organism: of severe and extremely severe one--there were noted a deficiency of the organism antioxidant defense; and in stages of toxemia and septicotoxemia--attrition of the organism oxidant reserves and danger of the septic complications occurrence. Conduction of early surgical intervention have guaranteed maintenance of a ceruloplasmin content in stages of toxemia and septicotoxemia on the level of healthy persons, relief of the ambustial disease course, absence of critical metabolic intoxication and carbonyl stress, reduction of the septic complications rate in 1.5 times.

We describe a case of botulism infection in a patient who had undergone laparoscopic appendectomy, an occurrence not previously described in the literature. This case exemplifies the need for coordination between clinical and public health personnel to ensure the immediate recognition and treatment of suspected botulism cases.

Shiga toxin-producing Escherichia coli is a principal source of regional outbreaks of bloody diarrhea and hemolytic-uremic syndrome in the United States and worldwide. Primary bacterial virulence factors are Shiga toxin types 1 and 2 (Stx1 and Stx2), and we performed parallel analyses of the pathophysiologies elicited by the toxins in nonhuman primate models to identify shared and unique consequences of the toxemias. After a single intravenous challenge with purified Stx1 or Stx2, baboons (Papio) developed thrombocytopenia, anemia, and acute renal failure with loss of glomerular function, in a dose-dependent manner. Differences in the timing and magnitude of physiologic responses were observed between the toxins. The animals were more sensitive to Stx2, with mortality at lower doses, but Stx2-induced renal injury and mortality were delayed 2 to 3 days compared to those after Stx1 challenge. Multiplex analyses of plasma inflammatory cytokines revealed similarities (macrophage chemoattractant protein 1 [MCP-1] and tumor necrosis factor alpha [TNF-alpha]) and differences (interleukin-6 [IL-6] and granulocyte colony-stimulating factor [G-CSF]) elicited by the toxins with respect to the mediator induced and timing of the responses. Neither toxin induced detectable levels of plasma TNF-alpha. To our knowledge, this is the first time that the in vivo consequences of the toxins have been compared in a parallel and reproducible manner in nonhuman primates, and the data show similarities to patient observations. The availability of experimental nonhuman primate models for Stx toxemias provides a reproducible platform for testing antitoxin compounds and immunotherapeutics with outcome criteria that have clinical meaning.

Present investigations were carried out on 10 dead animals including eight in lambs, one in goat kid and one in calf during subtropical summer at a local farm. The weather was hot and humid with rain occurring during the period. The history suggests an association of weather and concentrate/lush green diet/fodder with occurrence of the disease. The most consistent clinical signs reported were no interest in feeding, herding in a corner with head down, diarrhea of low degree and temperature around 102 degrees F. At postmortem examination, the most consistent findings were swollen soft kidneys, hydropericardium, congested and edematous lungs, congested liver, myocardial hemorrhages and ballooning of intestines. The histopathological examination revealed the most striking changes in kidney of vacuolation in renal tubular epithelial cells and increased Bowman's space in the glomeruli. The histopathological examination of liver revealed congestion. Lungs revealed congestion and edema. The urine from urinary bladder collected showed high glucose. The deaths in these animals were probably due to enterotoxaemia type D.

The transcription factor NF-kappaB is an important regulator of homeostatic growth and inflammation. Although gene-targeting studies have revealed important roles for NF-kappaB, they have been complicated by component redundancy and lethal phenotypes. To examine the role of NF-kappaB in endothelial tissues, Tie2 promoter/enhancer-IkappaBalpha(S32A/S36A) transgenic mice were generated. These mice grew normally but exhibited enhanced sensitivity to LPS-induced toxemia, notable for an increase in vascular permeability and apoptosis. Moreover, B16-BL6 tumors grew significantly more aggressively in transgenic mice, underscoring a new role for NF-kappaB in the homeostatic response to cancer. Tumor vasculature in transgenic mice was extensive and disorganized. This correlated with a marked loss in tight junction formation and suggests that NF-kappaB plays an important role in the maintenance of vascular integrity and response to stress.

The quantitative changes in the vascular tree in placentas from pregnancies complicated by diabetes mellitus and preeclampsia (PE) are not well defined. The purpose of this study was to quantify placental villi cross-sectional area of capillaries assessed by a computerized morphometry system in pregnancies complicated by PE (n = 23), well-controlled pregestational diabetes mellitus (PGDM; n = 10), and healthy controls (n = 13). Our aims were to test whether villous capillarization volume was changed in PE without intrauterine growth restriction or PGDM compared with the control group and to study these effects in 3 different areas of the placenta. Examination of placentas in women with PGDM and PE revealed limited pathological changes on light microscopic examination. However, the morphometric analysis revealed a more than 5-fold decrease of villous vascular volume in PGDM compared with controls (P = .003) and a 1.6-fold decrease in the PE group that did not reach statistical significance. These findings show quantitative changes in the villous vascular tree in PGDM that are not detectable by conventional light microscopy and suggest that morphometric analysis of the capillary tree may have diagnostic importance in this entity. The findings differ significantly from those previously reported in pregestational diabetes and do not differ significantly from those reported in PE without intrauterine growth restriction.

Background: Simvastatin, a 3-hydroxy-methylglutaryl coenzyme A reductase inhibitor, has been shown to lower serum cholesterol levels in clinical use. Moreover, statins exert beneficial effects in vascular diseases by inhibition of leukocyte rolling, adherence, and transmigration. The aim of this study was to determine if pretreatment with simvastatin attenuates Staphylococcus aureus alpha-toxin-induced increase in leukocyte-endothelial interactions during exotoxemia., Methods and Results: The effects of simvastatin on leukocyte-endothelial cell interactions were observed by intravital microscopy in the rat mesenteric microcirculation. Simvastatin (50 or 100 microg/kg) was administered 18 hours before the study. Activation of microcirculation was induced by bolus administration of 40 microg/kg S aureus alpha-toxin. Exotoxemia resulted in a significant and time-dependent increase in leukocyte rolling, adherence, and transmigration of leukocytes as well as P-selectin expression on the intestinal vascular endothelium. Pretreatment with simvastatin significantly inhibited exotoxin-induced leukocyte rolling from 71+/-10 to 14+/-4.7 cells/min (P<0.01) and adherence from 14+/-3.5 to 0.4+/-0.2 cells (P<0.01). In addition, simvastatin pretreatment significantly inhibited transmigration of leukocytes from 10.5+/-1.2 to 4.2+/-0.9 (P<0.05) cells. Immunohistochemical detection of endothelial cell adhesion molecule P-selectin showed a 50% decrease in endothelial cell surface expression after simvastatin treatment. Furthermore, simvastatin treatment resulted in enhanced expression of endothelial cell NO synthase III in the intestinal microcirculation., Conclusions: These results demonstrate that simvastatin interferes with exotoxin-induced leukocyte-endothelial cell interactions, which may be relevant in various infectious diseases. Statin treatment may offer a new therapeutic strategy for these clinical conditions.

The clinical and microbial settings of staphylococcal and streptococcal toxemia in pediatric patients were investigated by the French National Reference Center for Staphylococcal Toxemia. From 1998 to 2000, the number of cases was low in regard to the usual putative incidence of these toxemia; this low incidence was probably linked to the passive collection of cases. The most significant finding was the evidence of skin infections as the source of the majorities of staphylococcal toxic shock syndrome and staphylococcal scarlet fever as described for streptococcal toxic shock syndrome or nosocomial suppurative infections. Moreover, most of scalded skin syndrome were from pediatric patients and were exceptional in adults. For other syndromes, no significant original findings were observed.

Pathogenic properties of thermostable toxin responsible for pathogenicity of Yersinia pseudotuberculosis were experimentally studied. The toxin exerted a pronounced polyorgan cytopathogenic effect with predominating degenerative destructive changes and membranolytic effect on cell ultrastructure of parenchymatous organs. The toxin is believed to be directly involved in the development of typical pathomorphological picture of pseudotuberculosis, which confirms its pathogenetic role.

Objective: To assess the effects of lidocaine on the hemodynamic and inflammatory responses to Escherichia coli endotoxemia in rabbits., Design: Prospective, randomized, controlled experimental study., Setting: University laboratory., Subjects: Twenty-seven female Japanese rabbits, anesthetized with urethane and ventilated mechanically., Interventions: Animals were randomly assigned to one of three groups: a) endotoxemic control group (n = 9), receiving intravenous Escherichia coli endotoxin (0.5 mg/kg bolus) via the mesenteric vein; b) laparotomy control group (n = 9), treated identically to the endotoxemic control group, except for substitution of 0.9% saline for endotoxin; and c) lidocaine-treated group (n = 9), treated identically to the endotoxemic controls and additionally, intravenous lidocaine (3 mg/kg bolus, followed by infusion at 2 mg/kg/hr) was administered immediately after endotoxin, Measurements and Main Results: We compared hemodynamics, blood gases, and microscopic findings of lung tissue obtained at necropsy in each group. Laparotomy alone had a minimal effect on the parameters and findings. Endotoxin injection decreased mean systolic arterial pressure from 135 +/- 6 (SD) to 95 +/- 25 mm Hg (p < .05) and increased the mean base deficit from -1.2 +/- 1.8 to -14.4 +/- 4.2 mmol/L (p < .05), and caused the infiltration of neutrophils into the lungs. Lidocaine administration abolished the hypotension and attenuated the increase the base deficit to -9.5 +/- 2.1 mmol/L (p < .05) and the cellular infiltration in comparison with endotoxemic controls., Conclusions: Lidocaine attenuated the hemodynamic and inflammatory responses to endotoxemia in rabbits. Findings suggest that lidocaine administration may prevent the development of hypotension and metabolic acidosis during endotoxemia.

Cytokine-induced neutrophil chemoattractant (CINC) is a member of the chemokine alpha sub-family. It is induced in rats by tumor necrosis factor-alpha (TNF-alpha), interleukin-1, and lipopolysaccharide and is implicated in neutrophil infiltration in response to inflammatory stimuli. We tested the hypothesis that pretreatment with anti-CINC antibody or by cobra venom factor attenuates hepatic neutrophil accumulation induced by a 90 min infusion of Escherichia coli endotoxin. Changes in the expression of CD11b/c and CD18 and in plasma TNF-alpha levels were also investigated. Cultured hepatocytes and Kupffer cells of endotoxic rats produced significantly more CINC than those of saline-infused controls. CINC generation by Kupffer cells was much lower than generation by hepatocytes. Pretreatment with anti-CINC antibody or cobra venom factor significantly reduced hepatic neutrophil sequestration, but did not affect the up-regulation of CD11b/c and CD18 expression on liver-sequestered neutrophils or plasma TNF-alpha levels. We conclude that CINC-mediated hepatic neutrophil accumulation may not be necessarily associated with up-regulation of neutrophil adhesion molecules or elevated circulating TNF-alpha levels. Attenuation of hepatic neutrophil sequestration by anti-CINC antibody is likely based on blocking of the chemotactic activity of CINC and thus diminishing the chemotactic gradient established in the liver.

Infestation of sheep by L. cuprina larvae produces extensive skin wounds, severe dermatitis, hyperammonaemia and stress with adrenal necrosis and haemmorhage. In infested sheep, intramuscular (im) injections of Dl-Alpha tocopherol induced wool shedding and Desferrioxamine im prevented declines in white blood cells (WBC). In further trials, daily im injections of sodium ascorbate with Dl-alpha tocopherol, desferrioxamine and oral butylated-hydroxyanisole prevented adrenal damage and induced adrenocortical hypertrophy of the zona fasciculata. The treatment boosted the levels of mature and juvenile neutrophils, and blood glucose. Increases in toxic ammonia levels were correlated with increased toxic and band neutrophils, and globulin levels in treated sheep and toxic neutrophils in non-treated sheep. Decreases in serum zinc were correlated with declining lymphocytes and globulin levels. The results suggested that antioxidants protect and enhance adrenal activation in hyperammonaemic toxaemia. The changes in WBC, globulins and glucose were consistent with protected adrenocortical activation.

Philadelphia (Ph)-positive leukemias invariably contain a chromosomal translocation fusing BCR to ABL. The BCR-ABL protein is responsible for leukemogenesis. Here we show that exposure of bcr-null mutant mice to gram-negative endotoxin led to severe septic shock and increased tissue injury by neutrophils. Neutrophils of bcr (-/-) mice showed a pronounced increase in reactive oxygen metabolite production upon activation and were more sensitive to priming stimuli. Activated (-/-) neutrophils displayed a 3-fold increased p21rac2 membrane translocation compared with (+/+) neutrophils. These results connect Bcr in vivo with the regulation of Rac-mediated superoxide production by the NADPH-oxidase system of leukocytes and suggest a link between Bcr function and the cell type affected in Ph-positive leukemia.

We examined the kinetics of tumor necrosis factor (TNF) production induced by Escherichia coli lipopolysaccharide (LPS) in relation to LPS tolerance and endotoxemic lesions of piglets. The plasma of piglets demonstrated cytotoxicity to TNF-sensitive L929 cells between 0.5 and 4 h after inoculation with 200 micrograms kg-1 of LPS. This cytotoxicity was neutralized by anti-bovine TNF serum. These piglets had disseminated intravascular coagulation (DIC) and meningoencephalitis. However, if piglets were first treated with three doses of 40 micrograms kg-1 of LPS, both TNF production and the occurrence of DIC were inhibited when 200 micrograms kg-1 of LPS was inoculated into these piglets. Repetitive inoculation with increasing doses of LPS induced fibrinoid vasculitis, meningoencephalitis and pneumonitis, while hemorrhage was minimal. A very low amount of TNF activity was detected from most of the samples of a piglet after repeated LPS inoculation. These results suggested that severity of the hemorrhagic and thrombotic lesions might relate to the amount of endogenous TNF activity, and that LPS tolerance might relate to inhibition of TNF production.

Eighty-six horses presented for examination at the Rural Veterinary Centre between January 1986 to December 1991 with acute diarrhoea. The average age of affected horses was 3.2 +/- 0.2 years (mean +/- SE), with 69% three years or younger. Sixty-one horses were male (36 stallions, 25 geldings) and 83 horses were Thoroughbreds (47) or Standardbreds (36). Sixty-six horses were undergoing routine training at the time of onset of diarrhoea. Eight horses were afflicted with a non-specific illness within one to five days before the onset of diarrhoea, whereas eight horses developed diarrhoea during or within 48 h of discontinuation of antimicrobial therapy. Three horses developed the diarrhoea within 24 h of road transportation. Clinically, the disorder was characterised by a fever, sudden onset of profuse diarrhoea, clinical evidence of dehydration (estimated to be 5 to 12% of body weight at the time of admission) and shock. Degenerative leucopaenia, hyponatraemia, hypochloraemia, hyperkalaemia, hyperglycaemia and azotaemia were characteristic laboratory findings. Laminitis was a sequel in about 30% of cases. The cause of diarrhoea remained undetermined in most cases. Salmonellas were isolated from faecal or tissue samples in only two cases. Similarly, there was no evidence of seroconversion to Erhlichia risticii in 17 cases. Sixty-two of the horses survived the acute phase of the disease in response to supportive care. In horses that did not survive, necropsies were performed and revealed sanguineous or turbid peritoneal fluid. The colonic and caecal walls were oedematous and thickened with serosal congestion and discolouration of these organs evident grossly.(ABSTRACT TRUNCATED AT 250 WORDS)

We studied the effects of external and internal biliary drainage on the development of endotoxemia in a rat model of obstructive jaundice. Male Donryu rats were allocated to four groups: sham operation, common hepatic bile duct ligation (BDL), internal or external biliary drainage after BDL, and biliary drainage after BDL with oral endotoxin administration. Portal and systemic blood endotoxin concentrations were measured and the histomorphology of the intestinal mucosa was examined. Portal endotoxemia was observed 7 days after BDL and both portal and systemic endotoxemia were observed after 14 days. Portal endotoxemia was reversed by both internal and external biliary drainage and systemic endotoxemia was prevented. The ratio of villous height to crypt depth in the mucosa of the terminal ileum was decreased in rats with external drainage. Oral administration of endotoxin induced marked disruption of the mucosal epithelium in rats with external biliary drainage, but not in rats with internal biliary drainage. Significant increases in portal and systemic blood endotoxin concentrations were observed only in the external drainage group after oral endotoxin administration. The relief of biliary obstruction effectively relieved portal endotoxemia. External biliary drainage, however, has the potentially deleterious effect of disrupting the intestinal mucosa, which may promote the development of endotoxemia. These findings have implications for the use of biliary drainage procedures to reduce postoperative complications in jaundiced patients.

To clarify whether neutrophils and platelets are implicated in the pathogenesis of focal hepatocellular necrosis in endotoxaemia, we examined the relationship between the changes in neutrophils and platelets in peripheral blood and the degree of focal hepatocellular necrosis and serum transaminase activity in rats after endotoxin injection. The number of neutrophils in the peripheral blood decreased rapidly during the first hour after endotoxin injection and then increased. This initial decrease might be caused by the adhesion of neutrophils to pulmonary capillary walls, and the subsequent increase might be caused by granulocyte colony-stimulating factor mediated by endotoxin. However, there was no relationship between the degree of focal hepatocellular necrosis and the number of neutrophils sticking to the walls of hepatic sinusoids or the changes in the neutrophil count in the peripheral blood. The number of platelets in the peripheral blood decreased rapidly after endotoxin injection. There was a statistically significant relationship between the number of platelets in the peripheral blood and the level of serum transaminase activity: the fewer the platelets, the more severe was focal hepatocellular necrosis. The present study suggests that rapid and extensive consumption of platelets, rather than neutrophils sticking to the sinusoidal walls, is involved in the pathogenesis of focal hepatocellular necrosis in endotoxaemia.

Hepatic macrophages and endothelial cells play an important role in the clearance of endotoxin from the portal circulation. These cells are activated by endotoxin to release reactive mediators including superoxide anion, hydrogen peroxide, and nitric oxide, which have been implicated in hepatic inflammation and tissue injury. In the present studies we analyzed mechanisms regulating the production of nitric oxide by hepatic macrophages and endothelial cells following in vivo exposure to endotoxin. Rats were injected intravenously with Escherichia coli lipopolysaccharide (LPS, 5 mg/kg). Cells were isolated from the animals 48 h later by in situ perfusion of the liver with collagenase and pronase followed by differential centrifugation and centrifugal elutriation. We found that macrophages and endothelial cells from both untreated and endotoxin-treated rats readily synthesized nitric oxide following in vitro stimulation with interferon-gamma (IFN-gamma) and LPS alone and in combination. This response was dependent on l-arginine and was blocked by two nitric oxide synthase inhibitors, NG-monomethyl-l-arginine and l-canavanine. Macrophages produced more nitric oxide in response to LPS or LPS plus IFN-gamma than endothelial cells. In addition, nitric oxide production by both cell types in response to LPS plus IFN-gamma was increased after treatment of rats with endotoxin. Macrophages appeared to be more sensitive than endothelial cells to the in vivo effects of this inflammatory stimulus. Northern and Western blot analysis demonstrated that nitric oxide production by macrophages and endothelial cells in response to LPS plus IFN-gamma was due to increased expression of an inducible form of nitric oxide synthase (iNOS) mRNA and protein. Using fluorescence image analysis, iNOS protein was found to be localized in the cytoplasm of the cells. Treatment of rats with endotoxin was associated with increased expression of iNOS protein in the macrophages. The phorbol ester 12-O-tetradecanoyl-phorbol-13-acetate (TPA) also stimulated nitric oxide production by macrophages and endothelial cells from endotoxin-treated rats, although not as effectively as LPS and IFN-gamma. Macrophages were more responsive than endothelial cells to TPA. Furthermore, depletion of the cells of glutathione using buthionine sulfoximine had no major effect on nitric oxide production by macrophages but resulted in small but significant inhibition in endothelial cells. This suggests that this sulfhydryl-containing tripeptide does not regulate intracellular levels of reactive nitrogen intermediates in activated macrophages.(ABSTRACT TRUNCATED AT 400 WORDS)

Some disease processes in which increased endotoxin and cytokine levels exist (e.g., sepsis and infantile diarrhea) are also associated with increased levels of blood nitrates, the stable end products of nitric oxide. Available evidence suggests that the effects of an endotoxic environment, with its attendant complex cytokine networks, on liver function are mediated in part by modulation of hepatic nitric oxide synthesis. This hypothesis was tested by means of studying nitric oxide formation and its regulation in liver parenchymal and nonparenchymal cells of rats that had been continuously infused with endotoxin for 30 hr. Hepatocytes of such rats responded to in vitro stimulation for 20 hr by single cytokines, tumor necrosis factor, interleukin-1 beta and interferon-gamma with enhanced nitric oxide formation. In combination, interferon-gamma and endotoxin had greater synergistic effect on hepatocytes than did tumor necrosis factor and endotoxin. Kupffer cells of these endotoxic rats responded to 20 hr of interferon-gamma stimulation with the same enhanced nitric oxide formation we documented previously for endotoxin. Potentiation of the effect, through combination of endotoxin and interferon-gamma, was not as marked as it was with hepatocytes. Challenge of Kupffer cells with tumor necrosis factor or interleukin-1 beta evoked no response. Hepatocytes and Kupffer cells of time-matched, saline solution-treated rats were unresponsive to endotoxin or cytokine stimulation. Small quantities of nitric oxide were produced by endothelial cells spontaneously; this production was somewhat enhanced in cells of the endotoxin-infused rats by a 20-hr in vitro endotoxin challenge. Studies with inhibitors suggest that enhanced nitric oxide formation by endotoxic hepatocytes and Kupffer cells in response to in vitro endotoxin stimulation is differentially regulated. Our findings indicate modulation of nitric oxide generation by cytokines in vitro in various liver cell types of endotoxic rats. A similar scenario may exist in vivo because of the prevailing inflammatory response to endotoxin administration.

The severity of burn toxemia mainly depends on the blood level of endotoxins, produced by bowel bacteria. The dynamics of endotoxemia have its supreme expression at the first day of burn injury. Enterosorption promotes significant decrease in blood concentrations of endotoxins and middle molecular mass peptides, depression of their cytological action, improvement of glycogen- and protidin-synthetizing hepatic function.

The exact pathogenesis of centrilobular necrosis following congestion of the liver is still unknown. We reviewed the clinical data related to systemic circulatory disturbance and histopathology of the liver and the gut in 320 autopsy subjects. Congestion of the liver alone was associated only with atrophy and loss of hepatocytes in centrilobular areas, but not with hepatocellular coagulative necrosis. In many patients with coagulative necrosis of centrilobular hepatocytes and congestion of the liver, fibrin thrombi and neutrophil infiltration in the sinusoids, which are the characteristic histopathological features of the liver in endotoxaemia, were found in and around the necrotic area. Congestion, erosion or haemorrhage of the intestinal mucosa, which may allow entrance of endotoxin into the liver through the portal vein, was seen in such patients. Prolonged hypotension or shock, which may lead to portal endotoxaemia, was present in half the patients with centrilobular necrosis and congestion of the liver. These results suggest that not only congestion of the liver but also portal endotoxaemia may be involved in the pathogenesis of centrilobular necrosis in patients with congestion of the liver.

Sorption capacity of erythrocytes (SCE) and erythrocyte membrane permeability (EMP) have been determined along with a number of other biochemical parameters to assess the degree of intoxication in 265 critically ill patients. EMP was determined by a modified technique of V. N. Kolmakov. A high correlation between EMP, SCE and the level of biologically active substances has been established. Therefore, EMP and SCE are regarded as basic criteria reflecting the severity of endogenous intoxication and changes in these values form the basis for intoxication classification.

Sarcoidosis is a systemic disease with frequent cutaneous manifestations. Among these exists a predominance of the so-called unspecific lesions because of their histopathological features. Within the specific lesions, that is those which showed non-caseous granulomas, subcutaneous nodules are underlined, which have been associated with chronic sarcoidosis with a frequency of 1.4%-6%. These lesions appear during the evolution of the disease but rarely constitute an initial manifestation of it. The patient whose case is discussed had a debut with toxic syndrome and subcutaneous nodules. Histopathological study of these nodules showed the existence of non caseous granulomas formed by histiocytes, epithelioid cells, Langhans and foreign body giant cells. Lobulet hepatic granulomas were showed together with mediastinal pulmonary captation of gallium. We conclude that sarcoidosis must be considered when performing the differential diagnosis of the disease which debut with subcutaneous nodules.

In the experiments carried out in rats, received endotoxin, the light and electronmicroscopic picture of dynamic changes of the alveolar macrophages and stellate reticuloendotheliocytes was given. It was shown that these organospecific macrophages phagocyte different material in depends on periods of the endotoxin shock.

The goal of this study was to determine whether tolerance would develop to endotoxin-induced mucosal injury, xanthine oxidase activation, and bacterial translocation. To accomplish this goal, four groups of mice were studied: 1) mice receiving ip injections of saline 96 and 24 hr prior to sacrifice, 2) mice receiving ip injections of saline 96 and endotoxin (0.1 mg) 24 hr prior to sacrifice, 3) mice receiving ip injections of endotoxin 96 and 24 hr prior to sacrifice, and 4) mice receiving ip injections of endotoxin 96 hr and saline 24 hr prior to sacrifice. In contrast to the saline control animals or mice sacrificed 96 hr after a single dose of endotoxin, mice sacrificed 24 hr after receiving a single dose of endotoxin had evidence of mucosal injury, elevated levels of ileal xanthine oxidase activity, and an 81% incidence of bacterial translocation. Mice sacrificed 24 hr after a second dose of endotoxin were largely protected against the toxic effects of endotoxin. Thus tolerance to endotoxin-induced bacterial translocation does develop and is associated with tolerance to endotoxin-induced ileal mucosal injury and xanthine oxidase activation.

The deformability (D) of erythrocytes and their ultrastructure in the microcirculatory channel of vital tissues of the organism were studied in experiments on rabbits in two types of extreme conditions: staphylococci toxicosis and the postischemic syndrome. Erythrocyte deformability in each of these extreme conditions occurred in the late phase of the process and was manifested by destruction of the ultrastructural organization of the membrane matrix and the cytoplasm of cells in the microvessels. Destruction of the erythrocyte membranes was linked with their disintegration into micro- and macro-fragments (in staphylococci toxicosis) and separation of membrane areas in the form of microvesicles (in the postischemic syndrome). Damage to the erythrocyte membrane and cytoplasm may be considered to be one of the typical manifestations of the organism's response to extreme effects accompanying the phenomena of disseminated intravascular clotting.

When O2 delivery (blood flow X arterial O2 content) is reduced, many tissues respond by increasing perfused capillary density. This facilitates the increase in O2 extraction required to maintain tissue O2 consumption in the face of limited O2 supply. In a previous study of isolated canine small intestine (J. Appl. Physiol. 64: 2410-2419, 1988), endotoxin administration was associated with an impaired ability to increase O2 extraction in response to progressive reductions in O2 delivery. The aim of the present study was to determine whether reductions in perfused capillary density occur after endotoxin administration. Fourteen male dogs were anesthetized with chloralose (150 mg/kg iv) and urethan (750 mg/kg iv), and a segment of small intestine was exteriorized through a midline laparotomy. The segment was isolated vascularly, autoperfused, and maintained at body temperature. Escherichia coli endotoxin (5 mg/kg) or sham challenge was administered, and the animals were allowed to stabilize. Blood flow and arterial and gut venous blood O2 contents were measured after 3 h. Perfused vessels were then labeled by injecting colloidal carbon (less than 0.8 microns) through the arterial cannula and clamping the artery and vein as the bolus passed through the tissue. In some of the experiments a second gut segment was successfully obtained within 1 h of the first, yielding a total of 14 gut segments in nine endotoxin animals and nine segments in five control animals. Morphological analysis of capillary surface density in mucosal villi and crypts showed a significantly higher perfused capillary density in control tissue blocks (77.8 +/- 9.2%) than in blocks from endotoxin-treated animals (68.8 +/- 8.0%, P less than 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Sublethal doses (1mg/kg) of endotoxin (ET) were intravenously administered on the first, third and fifth days after 34%, 70%, and 84% hepatectomies in rats. The same hepatectomy groups of rats without ET administration were made. Survival rates, distribution of Kupffer cells (Kc), regeneration rate of the liver weight, carbon clearance test (K value) and PTAH staining were compared between ET treated and untreated groups. Survival rates of 84% hepatectomy rats with ET injection on the 3rd postoperative day (POD) was significantly lower than those of 70% hepatectomy rats with ET on the 1st or 3rd POD. ET activated reticuloendothelial function of the non-hepatectomized and 34% hepatectomy rats, but reduced the number of the Kc in the central zone, especially in 84% hepatectomized rats. K values and the number of Kc in the central zone showed a good correlationship (r = 0.9) after 70% and 84% hepatectomies. Patchy hepatic necrosis and fibrin clots were observed histologically in the liver, kidney and spleen of rats died after ET administration. In conclusion, sublethal endotoxemia reduces the function and number of Kupffer cells in the regenerating liver and causes postoperative death in the rats with massive hepatectomy.

The lung and systemic response to Escherichia coli endotoxin either 2 or 5 micrograms/kg was measured in 16 sheep with chronic lung and soft tissue lymph fistulae. Oxidant-induced lung and liver lipid peroxidation was measured as tissue malondialdehyde (MDA). Conjugated dienes were also monitored. Both doses produced a comparable pulmonary hypertension and hypoxia as well as a comparable increase in protein-rich lymph flow, QL. However, lung MDA was significantly greater with the 5 micrograms/kg than with the 2 micrograms/kg dose, both being more than twofold greater than controls. The systemic physiologic responses between the two doses were quite different. The 5 microgram/kg dose resulted in a significant increase in oxygen delivery (DO2), oxygen consumption (VO2), and decrease in arterial O2 extraction in the 3-5 hr postendotoxin period compared with the 2 microgram/kg dose. A twofold increase in protein-rich soft tissue QL was also seen after the 5 micrograms/kg dose, whereas QL was not changed after 2 micrograms/kg. Liver MDA was only increased by 30% over controls with both doses. We conclude that the relationship between oxidant change and physiologic response varies considerably between lung and systemic tissues after endotoxemia with the degree of lung lipid peroxidation corresponding with the degree of impairment in systemic tissue O2 extraction and the onset of delivery-dependent O2 consumption.

Acute gastric mucosal lesion (AGML) was induced six hours after the administration of endotoxin. The decrease of gastric mucosal blood flow, used to be supposed as an important factor of the formation of AGML, was not found, but thiobarbituric acid (TBA) reactants in the gastric mucosa were increased three hours after endotoxin injection, 198 +/- 18.2 (vs control 130 +/- 18.2). The administration of platelet activating factor (PAF) inhibitor, CV3988, reduced the formation of AGML and increase of the TBA reactants. These results suggested that the chemical mediator like PAF and free radicals may play an important role in the pathogenesis of gastric mucosal injury induced by endotoxemia, without the decrease of mucosal blood flow.

A 31-year-old captive male African elephant (Loxodonta africana) of 5,000-kg body weight died suddenly in ventral recumbency. Lesions seen at necropsy were bilateral purulent pulpitis and periodontitis of both tusks, serous atrophy of coronary groove fat, Grammocephalus cholangitis, myocardial and skeletal lipofuscinosis, and scattered segmental necrosis in the pectoral muscles. Nonhemolytic streptococci, Corynebacterium sp, Peptostreptococcus anaerobius, Fusobacterium nucleatum, and Bacteroides sp, were recovered from the exudate around one or both tusks. We postulated that the elephant died of hypoxia from prolonged ventral recumbency because of weakness and inability to rise secondary to toxemia from bilateral pulpitis and periodontitis.

In conscious pigs the influence of intravenous infusion of live E. coli (7 x 10(8)/kg), of the equivalent amount of endotoxin (20 micrograms/kg) or of a high dose of endotoxin (2.5 mg/kg) on the hemodynamic, clinical and pathological parameters and on survival rate was studied. E. coli and endotoxin infusion resulted in pulmonary hypertension, systemic arterial hypotension, a decrease in cardiac output and an increase in heart rate. Clinical signs were characterized by respiratory and nervous disturbances, whereas necropsy revealed hemorrhages and edema in several organs. Although these findings were similar in the three groups, a marked difference in lethality was observed. Infusion of E. coli or of the high dose of endotoxin resulted in a significant mortality, whereas all pigs survived the infusion of the low dose of endotoxin. This suggests that the lethal pathophysiological mechanisms may only become activated when a sufficient amount of endotoxin is released into the circulation.

Vascular reaction of the liver has been studied in dogs, died and sacrificed during various periods of the burn disease; quantitative characteristics of vascular changes are presented. The data obtained demonstrate that during the whole course of the disease there is a sharp hepatic plethora and sinusoid dilatation demonstrated to a greater extent in the died than in the sacrificed animals. A prolonged capillary congestion (took place in the died animals) is accompanied by more pronounced tissue changes (in comparison with the sacrificed animals) in the form of large foci of albuminous dystrophy and necrotic processes. A suggestion is made that such morphological indices as sharp dilatation of the interlobular arteries and sinuses with pronounced phenomena of plethora, thrombosis of the portal vein branches, large focal hemorrhage could be considered as critical points in adaptation of the peripheral circulation.

A toxin isolated from Group B beta-hemolytic streptococci, Type III was infused into adult sheep and newborn lambs. A two-phased reaction was observed. There was an initial phase of pulmonary hypertension and high flow of protein-poor lymph. This was followed by a second phase when pressures returned to baseline but lymph flow remained twice the baseline values and protein concentration in lymph increased. During the second phase there was a significant increase in lymph protein clearance, suggestive of increased microvascular permeability to protein. The absolute granulocyte count decreased to 10% of baseline values by 60 min after the infusion, and was followed by a variable return to baseline. The sheep with the largest changes in protein clearance were those who had the slowest return to baseline values. Pathologic examination of lung tissue revealed there was capillary dilation, interstitial edema, and large numbers of granulocytes in the lungs. The basement membranes of both capillaries and arterioles showed disruption and widening, along with fragmentation of the internal elastic membrane. This study provides morphologic and physiologic evidence of increased pulmonary vascular permeability after injection of streptococcal toxin associated with granulocyte trapping in the lung. We postulate that granulocytes may be involved as mediators of the pulmonary vascular injury.

The intestine being a natural depot of the gram-negative bacteria, may be the source of the systemic endotoxinemia in various pathologic processes followed by the increase of bacteria death, mucous membrane damage, pancreas endocrine function deficiency, liver barrier function depression, decrease of the portal circulation speed or its shunting. At the same time, the systemic endotoxinemia in itself may be one of the most important etiological factors of the various digestive organs injury. The authors observations and the literature suggest an important role of the endotoxin-positive granulocytes in the pathogenesis of the haemorrhagic infarct of the intestine, mesenteric vein thrombosis, destructive appendicitis and cholecystitis.

A comparative study of changes in the pulmonary parenchyma of guinea pigs with toxemia caused by intraperitoneal injection of staphylococcal toxin or Pseudomonas aeruginosa endotoxin and in those with peritonitis induced by i. p. injection of a suspension of human or guinea-pig feces has shown the changes to be rather similar in these conditions. In particular, as soon as 10 min after the onset of disease, signs of damage were detected in lung cells and capillary endotheliocytes of the blood-air barrier; later on, microthrombi were detected in pulmonary capillaries. In guinea pigs with feces-induced peritonitis, microfoci of pneumonia were seen. Following the injection of human fecal suspension, early signs of the sludge syndrome were present. The observed changes resembled those described for the adult respiratory distress syndrome (shock lung).

Endotoxemia causes neutrophil sequestration in the pulmonary vascular bed. Such sequestration may be a critical initiating event in the generation of microvascular injury, although the mechanisms that lead to this localization are not understood. To investigate these phenomena, the following study employed intravenous pulses of 111Indium-tropolonate-labeled neutrophils (111In-neutrophils), which circulated in the rabbit with normal kinetics and responded in a manner indistinguishable from unlabeled, circulating neutrophils in response to an intravenous injection of purified endotoxic lipopolysaccharide (LPS) or epinephrine. Pulmonary sequestration of 111In-neutrophils was assessed by quantitative external gamma camera scintigraphy of a lung suprahilar region of interest. Noninvasive assessment of radioactivity by this method accurately reflected total lung radioactivity, which was shown by autoradiography to be confined to the injected 111In-neutrophils. Intravenously administered LPS caused a marked, dose-dependent sequestration of 111In-neutrophils in the pulmonary vasculature, and exhaustive ultrastructural autoradiography showed discretely radiolabeled neutrophils located within pulmonary capillaries. A distinct effect was seen with an intravenous injection of as little as 100 ng per rabbit (i.e., 500 pg/ml blood). A 5-min ex vivo pretreatment of 111In-neutrophils with 10 ng to 10 micrograms/ml LPS in heat-inactivated plasma (which resulted in retention of as little as 500 pg LPS per 10(7) neutrophils) also caused dose-dependent pulmonary sequestration of the pretreated 111In-neutrophils but did not cause generalized neutropenia in recipient rabbits. There was no evidence of complement activation on the surface of pretreated neutrophils.(ABSTRACT TRUNCATED AT 250 WORDS)

Rats were inoculated with viable Salmonella dublin organisms, or a crude S dublin endotoxin, at the fourteenth and nineteenth days of pregnancy. They were killed at intervals up to 96 hours after inoculation, and the pathogenesis of the lesions was compared. At each stage of pregnancy the initial lesions produced by live bacteria and crude endotoxin showed important similarities, confirming the significance of endotoxin in the pathogenesis of placental damage. There were differences in the later stages of the pathogenic process. Comparisons of the process of placental damage at the two stages of pregnancy have suggested that the same mechanism acts throughout the last third of pregnancy and that thrombosis and disseminated intravascular coagulation are not an important part of the mechanism of placental damage.