140 The Chemistry of the Injured Cell 



peripheral vessels to the actions of endotoxin. It seems quite likely, 

 therefore, that the role of these phagocytic cells is to remove endo- 

 toxin from the circulation. It is possible, too, that the RES is neces- 

 sary for the inactivation of other endogenous shock-producing sub- 

 stances. Thus there is evidence that inactivation of VDM depends 

 upon the workings of the RES. The liver may be implicated here 

 since in shocked animals, uptake of carbon particles by the Kupffer 

 cells of the RES is confined to the periportal areas instead of being 

 uniform throughout the lobule as in normal animals (Zweifach 

 and Benacerraf, 1958) . The formation of toxic compounds may be 

 also checked by the RES, since blockade of this system is said to in- 

 crease proteolytic activity in blood. 



SUMMARY 



Figure 1 1 depicts the possible inter-relationship of some of the 

 changes described in the preceding sections that may lead to de- 

 compensation of parts of the peripheral circulation during shock. 

 It is not intended to imply, however, that all the phenomena and 

 profound metabolic disturbances of irreversible shock are due to 

 vascular decompensation alone. 



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