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M M DeCamp

Publications and source records attributed to M M DeCamp.

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Hepatic versus pulmonary uptake of particles injected into the portal circulation in sheep. Endotoxin escapes hepatic clearance causing pulmonary inflammation.

Removal of circulating particulates (bacteria, cell debris, endotoxin) is accomplished in most species by macrophages resident in the liver and spleen. We have shown that sheep and other species have phagocytic macrophages resident in their pulmonary capillaries. Moreover, these pulmonary intravascular macrophages accomplish the bulk of uptake of injected tracer particles, bacteria, or endotoxin (LPS). Because bacteria or LPS of intestinal origin enter the portal circulation, they would first encounter hepatic mononuclear phagocytes. We sought to determine the extent to which particulates injected into the portal circulation of sheep would be taken up by liver or by lung macrophages. Sheep (four per group) were injected via a mesenteric vein with radiolabeled gold colloid, magnetic iron oxide particles, live Pseudomonas aeruginosa, or 125I E. coli endotoxin. For each, the uptake pattern was determined 1 h after injection. Lung and liver were also fixed to determine the cells responsible for uptake and subsequent inflammatory changes. We found that for circulating gold colloid, iron oxide particles, or bacteria, hepatic uptake predominated, and Kupffer cells were responsible. After hepatic uptake of bacteria, inflammatory changes were confined to the liver. In contrast, nearly 50% of endotoxin escaped hepatic clearance and was subsequently removed by the lungs. We then saw inflammatory changes in both lungs and liver. Thus, hepatic macrophages are active in species with pulmonary intravascular macrophages, partially sparing the lungs from uptake and acute inflammation. Endotoxin, however, may elude hepatic uptake, be sequestered in the lungs, and initiate inflammation there.

Animals

Pulmonary removal of circulating endotoxin results in acute lung injury in sheep.

Endotoxemia has often been associated with the development of the adult respiratory distress syndrome. Our previous studies have shown that sheep, a popular animal model for adult respiratory distress syndrome, have abundant resident pulmonary intravascular macrophages that rapidly remove inorganic particles and live bacteria from the circulating blood. In this study, we examine the fate of circulating endotoxin in sheep and correlated the site of uptake with early morphologic evidence of tissue injury. Mature sheep and rats received intravenous 125I-labeled lipopolysaccharide (LPS). The dose was 0.8 microgram/kg in sheep and 17.0 micrograms/kg in rats. 125I-LPS clearance from the blood was assayed by gamma-counting of blood samples drawn over 1 hour and was correlated with circulating leukocyte numbers. The distribution of 125I-LPS was determined by gamma-counting of samples of major organs and tissues at time of necropsy. Lungs and liver were examined morphologically in both species. The half-life of circulating 125I-LPS was 2.38 minutes in sheep, and 12.39 minutes in rats. The endotoxin content of the lungs after injection was 77.58% of the total recovered dose in sheep, but only 2.02% in rats. Neutrophil margination occurred in the lungs of both species. In sheep, almost 25 minutes elapsed before peripheral neutrophil numbers decreased by 50%, much longer than the time required for LPS sequestration in the lungs. Rapid LPS uptake by the sheep lungs was associated with early (10-minute) ultrastructural changes including signs of pulmonary intravascular macrophage activation and microvascular congestion. By 60 minutes, many capillaries were occluded with neutrophils, platelets, and fibrin. There was interstitial edema, and endothelial cells showed evidence of severe injury. We conclude that in contrast to the rat, the sheep clears circulating endotoxin more rapidly and preferentially sequesters it in the lungs. Subsequent release of mediators by activated pulmonary intravascular macrophages may then lead to influx of other inflammatory cells and cascading injury.

Animals

Late development of intractable lymphocele after renal transplantation.

A case of lymphocele occurring 7 years after kidney transplantation and leading to intractable ascites and recurrent pleural effusion is presented. Ultrasound was used extensively for diagnosis, diagnostic sampling, and monitoring of resolution and recurrence. Invasive approaches to definitive therapy, including internal drainage and ligation of lower extremity lymphatics, alleviated the local problem of a lymphocele but led to recurrent ascites and symptomatic pleural effusions. A Denver shunt,reportedly helpful in cirrhotic and oncologic patients, was successfully employed to decompress the ascites and effusion of this patient. The pathophysiology and treatment of lymphoceles and the management of peritoneovenous shunts is discussed.

Adult