Since the dietary management of patients with cirrhosis is of great importance it was felt that assessment of the vascular and metabolic responses of the splanchnic area to protein and glucose feeding would shed some light on reactions of the splanchnic vasculature and of the liver parenchyma which might be therapeutically desirable, or the reverse. METHODSThe subjects for this investigation were patients from the Medical Wards of the University Service, Kings County Hospital. A total of 40 patients were studied. Fourteen patients who had recovered from recent acute infections or other minor illnesses and were considered to have normal liver function by the usual clinical and laboratory criteria, served as a control group. There were 26 subjects in the cirrhotic group. Twenty-one of these cirrhotic patients had a history of prolonged excessive alcoholic intake and poor nutrition; 5 had a history of acute hepatitis years previous to the onset of their present illness. The diagnosis of cirrhosis was supported by laboratory studies in all cases, and in 15 subjects by liver biopsy. Ten of the cirrhotic patients had ascites and paracenteses were performed 24 hours before study so that they were as "dry" as possible during the study.The estimated splanchnic blood flow (ESBF) and splanchnic oxygen consumption (SOC) were determined in all subjects in the morning after a fast of at least 12 hours, and for variable periods up to 90 minutes following the ingestion of either protein or glucose. The splanchnic blood flow was determined by the bromsulfalein (BSP) method (3). An infusion of BSP (in 0.85 per cent saline) was administered intravenously at a constant rate maintained in a few instances by a tunnel clamp and in the remaining cases by a calibrated Bowman pump. The rate of infusion was adjusted so 'This work was supported by a grant from Abbott Laboratories, North Chicago, Illinois. that the peripheral BSP concentration was maintained at a constant level throughout each study below 2.0 mgm. per cent following a priming dose of 150 mgm. A specially designed double lumen venous catheter in which the lumina are 3 inches apart was introduced into the right hepatic vein under fluoroscopic control, advanced as far as possible, and was kept in that position throughout each study. All blood sampling was done from the proximal opening, which was positioned in a branch of the hepatic vein. Samples of blood for arterial oxygen content and BSP concentration were obtained through an indwelling arterial needle in either the femoral or brachial artery. Thirty to 60 minutes after the establishment of proper BSP levels 3 or 4 simultaneous samples of arterial and hepatic venous blood were obtained at 5 to 10-minute intervals for colorimetric determination of plasma bromsulfalein concentration. Samples of arterial and hepatic venous blood were also obtained without exposure to air for the determination of oxygen differences. Care was taken to assure a free flow of blood from the catheter so as to prevent inadvertent dilution and thus i...

The augmenting effect of pyrogens on urine flow in the dog has been demonstrated and shown to be associated with increased solute excretion (1) and unresponsiveness of the renal tubule to antidiuretic doses of Pitressin@ (2). The possible experimental and clinical usefulness of a group of substances which are able to increase solute excretion and interfere with antidiuretic activity is obvious.The present report records our observations of the renal effects of pyrogen on mongrel dogs and an analysis of the mechanism of a pyrogen diuresis. MATERIAL AND METHODSA total of 21 female mongrel dogs were used in these experiments. All animals were studied in the postabsorptive state under light anesthesia. Initial anesthesia was produced by the intravenous injection of 25 mgm. Pentobarbital per kilogram of body weight approximately 45 minutes before the start of any experiment. Light anesthesia was maintained throughout the remainder of the experiment by the administration of 25-mgm. doses of Pentobarbital at approximately hourly intervals.The constant infusion technique was used for the measurement of renal dynamics. Clearances of creatinine (Cc,) and para-aminohippurate (CPAH{) were used as measures of glomerular filtration rate and renal plasma flow, respectively. Timed urine collections were made through an indwelling bladder catheter. Mid-period blood sampling was done through a polyethylene catheter from either the femoral or iliac vein. Plasma and urine osmolarity and urine flow were measured, and from these total solute excretion, free water clearance, and osmolar clearance were calculated. Timed urine collections were 1 This work was supported by a grant from the Orange County Heart Association and the American Heart Association.

No abstract

No abstract