Adult mongrel dogs were given a lethal dose of E. Coli endotoxin by rapid intravenous injection. Total serotonin levels in the serum fell rapidly, with the concentration in the portal vein and pulmonary artery significantly exceeding that in the femoral artery within the first minute after injection. Small rises in plasma serotonin were found in some of the animals. These changes were coincident with a sharp fall in the number of circulating platelets, with striking changes in platelet morphology, and with the initial fall in blood pressure.T HE in vivo administration'of gram negative bacterial endotoxins is associated with certain characteristic manifestations. These include leukopenia, thrombocytopenia, and profound vasomotor disturbances, terminating in shock. 1 In the dog spasm of the small hepatic veins occurs, followed promptly by a rise in the portal venous pressure, with pooling of blood in the liver and intestine, and a subsequent reduction in cardiac output. 2 Changes similar to those produced by endotoxin are also seen after injection of over 70 substances, including glycogen, 3 and bear a remarkable resemblance to the phenomena seen in anaphylaxis.Recent work has shown that serotonin and histamine are released from platelets by antigen antibody reactions, 4 as well as by glycogen, 5 in the rabbit. A histamine like substance also has been identified in dog plasma after endotoxin. 3 Observations by Gordon and Lipton, 6 and by Gilbert 7 have suggested indirectly that serotonin might play a role in endotoxin shock. Because of these findings this work was undertaken to assess the direct effects of intravenously injected endotoxin on serotonin concentrations and on platelets. MethodsMongrel dogs, weighing between 18 and 30 Kg., were lightly anesthetized with thiopental sodium. In 9 dogs the chest was entered through the bed of the left fourth rib. A Starling pump was used to give positive pressure respiration. The lung was retracted and the pericardium opened over the pulmonary artery and outflow tract. The pulmonary artery was secured by means of a 3-0 purse string suture. The arterial wall was incised 1 to 2 cm. above the pulmonary valve, and a salino filled no. 280 polyethylene eannula was inserted into the pulmonai-y artery to record pressure changes. By means of a concentrically fitting cuff the catheter was firmly secured in the desired position. In a similar fashion another catheter, for sampling, was placed in the pulmonary outflowtract, extending through the valves.A chest tube was placed in position to catch dependent drainage, the catheters were brought out between the interlobar fissure to separate stab wounds, and the chest closed. In a second group of 9 dogs the pancreatieoduodenal vein was cannulated, and the catheter was extended into the portal vein. In all dogs bilateral femoral artery cannulation was done, and an additional eannula was placed in the inferior vena cava, via the common femoral vein.Purified E.

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This study reports the clinical presentation and hospital course of 21 patients with cholangitis and malignant diseases, obstructing the biliary tree. Eleven of 21 patients had cholangitis as the initial presentation of biliary disease, and the diagnosis of carcinoma was made at operation or autopsy examination. A total of 14 patients with cholangitis had no prior biliary surgery. Patients who underwent operations to relieve biliary obstructions during episodes of cholangitis had greater incidences of resolution of cholangitis (eight of 14 patients) than those patients treated non-operatively (none of eight patients). Only five patients survived long enough to leave the hospital, but each of these patients were palliated by some sort of drainage procedure. These data suggest that a small portion of this high risk group of patients may benefit significantly from early operative therapy of their cholangitis.

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