HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Related Article

Ann Thorac Surg 1995;60:376
© 1995 The Society of Thoracic Surgeons

---

Review of Recent Books

Reperfusion Injuries and Clinical Capillary Leak Syndrome

See also page 372.

This book is multiauthored, and its 21 chapters describe currently known aspects of shock, multiorgan failure, and reperfusion injury pathology and physiology. The authors of each chapter combine currently known research and clinical methodology. The chapters have 1,916 comprehensive references.

Part I has two chapters, which focus on the microscopic and ultrastructural changes in the capillary endothelial cell induced by shock, sepsis, and hypoxia.

Part II has three chapters devoted to explain the ``third space'' theory and the multiple biological-chemical products that result in the increase in microvascular permeability. The classic ``goldfish'' experiment illustrates the detrimental effect to tissue oxygenation by this increased fluid. One group of goldfish were placed in a cage near the top of a tank of water and the second group at the bottom. The water in the tank represented ``third space'' fluid, which prevented oxygen going to the cells. The fish at the bottom died whereas those near the surface survived.

Part III focuses on shock syndromes, ischemic muscle injury in extremity reperfusion, and myocardial muscle injury in reperfusion after myocardial infarctions. Cardiologists, peripheral vascular surgeons, and physicians dealing with shock would find these chapters very valuable.

Part IV has separate chapters on reperfusion injuries after transplantation of lung, kidney, liver, and pancreas. The multiple biochemical factors involved in damage to the transplanted organs from a research and clinical background are discussed. Effects of preservation fluids are presented and the reasons why the University of Wisconsin solution currently is the best.

Part V has three chapters on the mechanisms and clinical aspects of multiorgan failure, including the ``two-hit'' phenomenon, in which two separate and distinct insults to a patient are additive with much increased mortality. Invasive and physiologic monitoring parameters with aggressive fluid management currently is the treatment of choice.

Part VI is titled ``New Horizons in the Treatment of Shock and Reperfusion Injuries.'' Here the senior editors summarize the type of capillary injury discussed in all the previous chapters. They propose a new term, ``clinical capillary leak syndrome.'' Despite the many biochemical and humeral mediators responsible for metabolic changes in shock, sepsis, and organ reperfusion such as depletion of adenosine triphosphate, production of oxygen free radicals, complement activation, and all other factors, they conclude there is one single simple biophysical change.

This biophysical change is shrinking of the endothelial cell in the prevenous capillary. Contraction of the cell by all these biochemical products produces a hole through which fluid can escape into the third space. This then results in tissue edema and, by the goldfish experiment, in cell hypoxia and death of cells and organs.

It was not possible to view this clinically in organs or tissue. Therefore, their research required intravital microscopy of capillaries in the tails of salmon, trout, and goldfish fry. Then they used ultrafiltration of a hetastarch that has been used clinically as Hespan 6%. This pentastarch was ultrafiltered to produce a fluid with 60% larger molecules in the range of 300 kd to 1,000 kd. This filtrate with the larger molecules was used both experimentally and clinically to ``seal'' the spaces between the contracted endothelial cells. This prevented and often reversed the clinical capillary leak syndrome.

In summary, this book presents all current biological and pathologic aspects of the ``third space'' phenomenon and encourages the use of a new term, ``clinical capillary leak syndrome,'' for this process. Multiple chapters cover all aspects for the clinician and researcher and are referenced extensively. The editors present a biophysical approach to close the space between contracted endothelial cells with an ultrafiltrated pentastarch with large molecules to ``seal'' the endothelium and prevent the syndrome.

This is an especially valuable book for the researcher with its many references. It is also very helpful for the clinician involved in organ transplantation, treatment of shock and sepsis, peripheral vascular surgery, general surgery, cardiac surgery, and cardiology to increase their understanding of the complexities of multiorgan failure and new methods for prevention.

Footnotes

Edited by B. A. Zikria, MD; Co-edited by M. O. Oz, MD, and R. W. Carlson, MD, PhD New York, Futura, 1995 617 pp, illustrated, $85.00

Reviewed by George M. Kroncke, MD

Related Article

Antithymocyte Globulin and Methotrexate Therapy of Severe or Persistent Cardiac Allograft Rejection

Pasquale Ferraro, Michel Carrier, Michel White, Guy B. Pelletier, and L. Conrad Pelletier
Ann. Thorac. Surg. 1995 60: 372-376. [Abstract] [Full Text]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Related Article