70 



HANDBOOK OF PHYSIOLOGY 



CIRCULATION I 



subjects. Fifty others received gelatin for shock. No 

 reactions were seen and there was no sensitivity when 

 injections were repeated. Artz and associates (6) 

 gave combat casualties 200 units of modified fluid 

 gelatin; the injection units were 500 ml each. The 

 average molecular weight of the gelatin was 34,000. 

 As much as 3000 ml was given to some subjects. The 

 circulation was supported for the period of evacuation 

 — 3.5 hours. There was no toxicity. These injections 

 were made in human combat casualties. Maurer & 

 Lebovitz (72) studied the antigenicity of modified 

 fluid gelatin. This was used in human volunteers in 

 four groups of five each. Each group recei\ed fi\e 

 daily injections of 2, 5, 15, or 30 mg of modified fluid 

 gelatin per ml at each injection. Three weeks after 

 the last injection, 50 ml of blood was taken and intra- 

 cutaneous tests were performed. No skin reactions 

 or precipitating antibodies were produced. Modified 

 fluid gelatin was antigenic in rabbits only when in- 

 jected in water-in-oil emulsion, but not in saline or as 

 an alum precipitate. 



Polyvinylpyrrolidone 



Arden and associates (5) gave 3.8% PVP to 37 

 patients. Blood pressure effects were favorable and 

 there were no untoward reactions. Maurer (70) 

 studied PVP K 30, average molecular weight 40,000, 

 which when used as a plasma volume expander 

 showed no evidence of antigenicity in man or rabbit. 

 Rabbit sera showed no antigenicity to this P\'P 

 preparation. PVP K 87, average molecular weight 

 1,000,000, showed evidence of antigenicity in man via 

 antibody production in the serum. Also two subjects 

 developed itching, and one a rash after PVP K 87. 

 This fraction, however, is not used as a clinical plasma 

 volume expander. 



Ohlke & Scales (82) used dextran in 56 surgical 

 cases, none of whom had a reaction. Wilkinson & 

 Storey (114) gave 5 normal subjects 6% dextran in 

 0.9% saline. They were given 500 ml or 1000 ml in 

 47 to 1 1 o minutes. These subjects developed vasomo- 

 tor instability which lasted up to i week. The dextran 

 which was used had a molecular weight of 1 30,000 to 

 250,000 in 65% of the fraction. The name of the 

 manufacturer was not given. In contrast only 2 of 40 

 infusions made in patients in shock were associated 

 with mild and transient reactions. Allen & Kabat (2) 

 showed that levan was capable of producing skin 

 sensitivity and precipitins in man. Kabat & Berg (65) 

 showed production of cutaneous sensitivity and pre- 

 cipitins in man after two subcutaneous dextran injec- 



tions of 0.5 ml each. The tests were made 21 days 

 after the second injection. The materials were native 

 dextran or Swedish clinical dextran of high molecular 

 weight. The authors thought there was insufficient 

 nitrogen impurity in dextran to account for the reac- 

 tion. Bryan & Scudder (18) showed a cross activity 

 between tissue antibodies to native dextran and 

 pneumococcus polysaccharides, Types II, XII, and 

 XX. Bowman (17) in over 500 infusions of 6 % dextran 

 in isotonic saline observed only two reactions, which 

 took the form of itching, urticaria, chills, and a rise 

 in body temperature to as much as 103° F. The 

 material used was Plavolex. Jaenike & Waterhouse 

 (6 1 ) gave daily infusions of 6 % dextran in physiologi- 

 cal saline to five patients, in amounts of 1000 to 2000 

 ml per day for 2 to 10 days, and 1 2 % dextran in 0.5 % 

 sodium chloride to two patients, 1000 ml daily for 6 

 days. There were no vasomotor or pyrogenic reac- 

 tions. One 58-year-old patient with hypertension de- 

 veloped pulmonary congestion after 2 days and the 

 study was discontinued. One patient with neuro- 

 dermatitis developed an exudative hemorrhagic 

 quality to the skin lesions on the third day. Stucki & 

 Thompson (100) showed that intraperitoneal dextran 

 produced edema of the paws, snout, ears, and external 

 genitalia of the rat. Anesthetic doses of phenobarbital, 

 chlorpromazine, antihistaminics, or epinephrine were 

 effective in inhibiting this edema. The amount of 

 dextran used was 300 mg or 600 mg of 6 % dextran in 

 saline. Bennett (10) studied the production of fever 

 and the Schwartzman phenomenon by native dextran. 

 In rabbits, the skin was prepared with a poly- 

 saccharide from Serralia marcescens. Twenty-four hours 

 later 50 mg of native dextran given intravenously 

 produced local hemorrhage in 50 %. Two hundred 

 milligrams of dextran caused hemorrhage in 95 %. 

 Native dextran w^ith a molecular weight of several 

 million produced fever and leukopenia. It is important 

 to know that this dextran is not used clinically. Clini- 

 cal dextran did not produce fever, leukopenia, or the 

 Schwartzman reaction. Maurer (71) showed that the 

 intracutaneous injection of dextran was followed in 3 

 weeks by dextran precipitins and cutaneous sensitivity 

 in the form of wheal and erythema production. Both 

 native and clinical dextrans were used. Antibodies to 

 dextran were shown to persist in human sera for over 

 I year. Tarrow & Pulaski (loi) infused 109 volunteers 

 with Macrodex (Swedish dextran) and 97 with Com- 

 mercial Solvents Corporation United States dextran. 

 The amounts infused were from 500 to 1000 ml in 10 

 to 65 minutes. These authors observed headache, 

 chills, flushing, urticaria, angioneurotic edema, 



