Hepatic plasma and blood flows were determined in dogs with modified portacaval transposition. Mean hepatic blood flow was 43 ml. per kilogram per minute, approximately that expected in a normal dog. Similarly, the rate of Bromsulphalein clearance was in the range expected for normal dogs. © 1962

Scanlon, WA

Schlachter, L

Shoemaker, WC

Starzl, TE

Thornton, FH

Wendel, RM

English

PubMed

Scanlan, WA

Name not available

Studies on hepatic blood flow and the rate of bromsulphalein clearance in dogs with portacaval transposition

D-Scholarship@Pitt

Studies o n  hepatic blood Row and the rate of Bro~nsulphalein THOSlAS E. ST-iRZL. 11.D." clearance in dogs with \\'ILLI.\SI A. SC.ASLON. SI.D. \VILLI;\lI C. SHOESl.\KER. 1I.D. FRED H. T H O R S T O S .  B..\ portacut-a1 transposition ,, ,,,, LXIVRESCE SCHL.iCHTER. 1I.D. CHIC.I(;O. ILL. DESVER.  COLO. From the  Depar tmen t s  of Surger l  and Rad io lop ; .  Sorthrcestern C n i ~ e r s i t ?  .\fedical School ,  the Department  of Surgical Research of the Michael Reese Hospital a n d  .\fedical Cen te r ,  and the Departmentr  o f  Surgery ,  L'niccrsity of Colorado and the  Denz,er Ve t e rans  Adminis trat ion Hosp~tc . '  Child and his group,3 has been widely used \x ia t ions  resulting from the development oi in recent )-ears for the study of hepatic and venous collaterals. .411 ileocaval t r i b u t a r i ~  gastrointestinal physioloq. Except for a from the inguinal liyament to the diaphragr. slo~ved rate of ammonia detoxification in the \\.ere ligated in conjunction with trani- preparation. li\.er function is thought to be position. and only the renal veins' I t e r r  normal.l. 6. 9. 14 spared. Inasmuch as portacaval transposition in- volves a radical change in the 1.ascular .METHODS supply to the liver. knowledge of hepatic Fifteen adult mongrel doys ~ceighiny from blood flow after operation \could appear to 12 to 20 kilograms were used. Transposition I,e important. In the present study, hepatic was performed under hypothermialj. '' 1 11lood flo\\-s were studied I\-ith the Brom- months or more before testing. All tributati sulphalein BSP) method in a group of dogs \.essels to the iliac \.eins and inferior vena \vith portacaval transposition. under resting cava were ligated except the renal \.eins." ltnanesthetized conditions and under certain Postoperatively, the animals were taught io conditions of stress. Quantitative corollary lie quietly on a n  animal table. data were obtained on the capacity for BSP O n  the day of testing, catheters were in- clearance. serted into the left main hepatic vein and .4 modification of Child's transposition was inferior vena cava16 under local anesthesia. The dogs were given a priming dose of 3 :O 6 my. BSP and then BSP was constanti)- ~ h i i  work supported bv G l a n s  A-31i6. A-3115, and infused at  the rate of .05 my. per kilo- A-5489 from the United States Public Health Service, gram per minute into a. foreley vein. Pre- Yational Inrtinrtes of Health, Btthesda, .\Id. lilninary analyses were made of the BSP Received for publication Feb. 15, 1962. level in the vena cava. When the p l a s m  'Sbrkle Scholar. Present address: Univenity of Colorado hfedical k h o l ,  Denver 20, Colo. level rose or  fell appreciably, the BSP con- 660 . . . . . - - . - ,.. P,.~t:c,;: .:.' : ! r : , f , p o , i ~ i o ~ ~  /o r  I ~ ~ , / ) a t i c  plas?na anti  blc~o<i / l o x  ,iudic.s 661 , ,,r~rrntion in the iniusion \\.as ~ L > I . I . C C ~ C ~  bv OJ , ~ I ~ ~ I I I ;  level \\ere rnathcAaticz.:~. c o ~  rected. $: d o /  I- . I - - - -  : llepaiic -. t i n  ,tnd \ ena I \\.as repeated 4 months later and Jvas iound RESULTS to be unchanyed from the initial cletermi- Rare of BSP removed. The ::lean rate of nation. ESP removed in 14 do" \\.as . $ 4 9  z .001 For colnparison, RSP ~.erno\.al \\-as 3. E. In:. per kilogram per c:inure. Esccpt 111easured in 3 dogs with Eck fistulas -7 to 4 ior one animal. the spread in \-alues \\.as tveeks after operation. l l ean  rare o i  removal tueen transposition and Eck fistula \ \ere due to chance is less than 1 per cent. A series of 13 unanesthetized normal doas : xc r uhich had hepatlc lessels that had been - - - -  I previouslv cathetenzed lemoled BSP zit the - ..v rate of 036 = 001 S. E m c  per Li lor~am 0 3 per minute Fic 1 . I 3 f 3 C  D 2- . - 0 Hepatic blood flow with transposition. Fourteen restin: doys \\ere studled. .Ail ap- peared to be healthv. The hematocrit level \ \as abo\e 30 per cent in 13 animaij and above 35 per cent in 10 .At least 3 f lo~ \ s  at  13 minute intenals \\ere obtained In  some cases. flo\\s \\ere obtained and le- peated 8 hours later. Little ~ a r ~ a t l o n  \ \as  - - - ,  -c- p o l ~ s e ~ \ e d  \tithin this time limit 1 Fic. 2 ' .  The mean hepatic blood f l o ~  mas 43 z 4 .,. - 1  - - r  1 S. E. 1111. per hilogram per minute. 11-e did not obsene the \ariations in hepatlc blood flo\\r to be related to differences in hema- S ~ r t o ~ o r o ~  _ ,+Ula b r m o  h q s  Norrnol Dogs. =:- tocrit or other ob\ious factors. Tranlpo . 3- Sc .-ill awoke Effect of stress on hepatic blood flow. Fig. 1. BSP eutractlon in does with portacaval \ fusci~lar acti\ itv or excitement caused larne transposition comuared to that of normal animals and erratic rises in hepatic flow, \ \ hen  a ~ l l d  those w ~ t h  Eck fistulas. F i c r e s  o n  normal sorlrce of irritation \\as protracted. lises in finesthetized docs calculated from Selkurt's data.'? animals am induded for flow uere  sustained for Ion.; periods i Fir. 3 . l ) . ~ r ~ s ~ n  The  chronic placement of the catheters S u r e e r v  O c t o b e r  196.2 ' J O O ,  \\.as responsible for rises in flow. In T dogs, the catheters \<ere left in place !or 3 to t days. Duriny this period. the does developed fe\.er. and. in some cases. ceased eating. Hepatic blood flow rose in 6 of the 7 animals DISCCSSION Quantitation of hepatic blood How after portacaval transposition has received little attention. Heer, Sylvius, and Harper.%sine the colloidal ?old technique. reported a mean hepatic blood flow of 43.6 C.C. per kilogram per minute in 6 dogs with transposition under unstated conditions. Mean flow in the present study, using a different method, lb 20 33 do 50 60 7b 80 j o  100 I;O was 43 ml. per kiloeram per minute in the Tirna in m~nutas resting unanesthetized state. Fig. 3. Influence oi painfully distended bladder Portacaval transposition has been used in on hepatic plasma How. two general types of investigation: xvhere it is desirable to avoid a direct hepatic in- fluence on splanchnic hemodynamics or chemical constituents. and where it is desir- able to divert splanchnic substances which could affect the function of the liver. The advantage of the preparation has been as- sumed to be that hepatic function and vas- cularity are normal. although vascularization is '.' Data in the present study support this con- cept. The mean hepatic blood flow of 43 ml. per kilogram per minute is essentially the same or slightly hieher than the flows in normal dogs which have been obtained by numerous investieators with various tech- niques.'. 5, 7, 10-13. 1: Evaluation of BSP extraction also pro- vides a highly quantitative minute to minute evaluation of one facet of liver function. The dye clearance of .048 \mg. per kilogram per minute is almost the same as that described for normal anesthetized dogs by Selkurtl' of .O52 mg. per kilogram per minute (Fig. 1 )  and is identical if a single anomalously low value is excluded from computation of present statistics. The BSP extraction rate of the transposed group was also similar to the rate of BSP extraction of the unanesthetized Fig. 4. Influence of indwelling catheters on hepatic flow. developed fever with prolonged intact does which \\.ere studied in our own catheterization. laboratories. Potintci;~al i r a ~ i s ~ o . ~ i r i o r ~  for I~c./la:ii. / ) / ~ ~ m a  auli bluoci / l o x  studics 6-3 Hepatic plasma and blood flo\vs were determined in dozs ~ i t h  modified portaca\.nl transposition. Mean hepatic blood flow \\.as 43 ml. per kilogram per minute. approsi- matell; that espected in n normal doe. Si~nilarly. the rate of Bron~sulphalein clcar- ance \\.as in tlie I.an:e erpccred for normal do:s. REFERESCES 1. Blalock. .+.. and Sfason, Xi .  F.: Obsemations on the blood flow and gaseous metabolism of the liver of unanesthetized does, :lm. J. Physiol. 117: 328. 1936. 2. Bradley. S. E.. Ineelfinqer. F. J., Bradie\., G. P.. and Curry. J. J.: The estimation of hepatic blood flow in man. J. Clin. Invest. 24: 890. 1945. 3. Child. C. G.. Barr. D.. Hols~vade. G. R.. and Harrison. C .  S.: Liver reeeneration following ponacaval transposition in does. .Ann. Sure. 138: 600. 1953. +. De Riemer, R.  H., Hine. D. E.. and Harper. H. -4.: An evaluation of ammonia intoxica- tion in normal dogs and in dogs having a portacaval anastomosis. S. Forum 5: 205. 1954. 5. Drapanas. T.. Kluee. D. S . ,  and Schenk. I\'. G.: Sleasurement of hepatic blood flow bv Bromsulphalein and by the electromagnetic flowmeter. SCRGERY 48: 1017. 1950. 6. Heer. F. IV. .  Silvius. D. E., and Harper. H. A,: The  reiation between hepatic blood flow and function in normal does and does with cirrhosis after portacaval shunt or transposition. S. Forum 9: 182. 1960. i. Lipscomb. .\.. and Crandall. L. .4., Jr.: Hepatic blood flow and ?lucose output in normal unanesthetized does. .in. J.  Phys:ol. 118: 302, 1947. LIevrr. \\'. 11.. J r .  .lnd Starzl. T. E.: T!.: reverse port:~i;lval shunt. SVRGERY 49: 3:: .  1959. Owslev. J .  (2.. Goin. J.  Sf.. C l ~ r k e ,  J. C .  Ifarper. II. .\.. and SlcCorkle. H. J.: .\ corr- parison of ealactose clearance by the liver ic:- lowine portacaval transposition or Eck f i s t u l ~  S. F o n ~ m  9: 515, 3 958. Pratt. E. B.. Benedict. F. D.. 2nd Holmer. J .  I-I.: lieasurement oi  liver blood flow I:. unanesthetized doe usinq the Brornsulphale::. dve method. .\m. J. Physiol. 171: 4 i l .  1951. Restrepo, J .  E.. \Varren. I V .  D.. Xolan. S. P.. and >fuller. \t'. H.: Radioactive eold teck- niaue for the estimation of liver blood flow: Sormal values and technical cons id era ti or^ SCRCERY 48: 748. 1960. Selkurt. E. E.: Comparison of the Broz- sulphalein method with simultaneous direc: hepatic blood flow. Circulation Res. 2: 155. 1954. Shoemaker. \V. C.: Sfeasurement of hepat.c blood flow in the unanesthetized doe by i modified Bromsulphalein method, J. .lpp:. Phvsiol. 15: +i3 ,  1960. Silen. LV.. Sfawdsley. D. L.. \Veirich. W. L.. and Harper. H. .\.: Studies of hepatic func- tion in does with Eck fistula or portaca\al transposition. .A. M. .\. Arch. Surg. 74: 964, 1957. Stanl.  T. E.. Butz. G. \V.. Jr.. and Sfuneer. D. H.: Technique for portacaval transposi- tion (addendum),  J. S. Res. 1: 218, 1961. Stanl,  T. E.. Lazarus. R. E.. Schlachter. L.. Thornton. F. H.. \Vendel, R.  Sf.. Steam, B.. and Scanlon. IV. .\.: .\ multiple catheter technique for studies of hepatic metabolisr. and blood flow in does with portacaval traps- position. SURGERY 52: 654. 1962. IVeiner, .A. Y.. and Honvath. S. V.: ?rfeasurt- ment of hepatic blood flow in the doe by the Bromsulphalein method. J. Clin. Invest. 31: +33.  1952. 

Studies on hepatic blood flow and the rate of Bromsulphalein clearance in dogs with portacaval transposition

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Studies on hepatic blood flow and the rate of Bromsulphalein clearance in dogs with portacaval transposition

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