The Reticulo-Endothelial System (R.E.S.) in Traumatic Shock

  • Carlo Palmerio
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 9)


Early in shock the Sympathetic Nervous System is hyperactive in response to deficient perfusion of tissues. This response maintains capillary hydrostatic pressure essential for exchanges between tissues and blood1. Prolonged sympathetic overactivity further reduces tissue perfusion and causes functional damage of all organs particularly in the liver and spleen which are very sensitive to hypoxia. Since these organs contain the largest fraction of the defense against bacteria and bacterial endotoxin, it is in such circumstances that endotoxin of intestinal origin can reach the systemic circulation in its still toxic state2. The resulting endotoxemia increases the ischemia of the tissues for endotoxin and catecholamines act sinergistically to damage the peripheral circulation3. Further decline of the peripheral flow causes generalized disorganization at the cellular level. The vascular smooth muscle cells develop structural changes4 and consequently there is a loss of vascular tone and hyporeactivity of the vessels to catecholamines. A disproportionate amount of blood is retained in the peripheral bed so that progressive decline in venous return to the heart occurs. Cardiac output falls progressively. Death results when there is not enough blood to sustain the minimal requiriments of vital organs.


Vascular Tone Hemorrhagic Shock Bacterial Endotoxin Hemodynamic Deterioration Traumatic Shock 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1-.
    Palmerio, C. and Fine, J.-(1968)-La microcircolazione splancnica nello Shock Traumatico. Minerva Medica 59, 5323.PubMedGoogle Scholar
  2. 2-.
    Fine, J.-(1954)-The bacterial factor in traumatic Shock. C.C. Thomas and Company, Springfield, Illinois.Google Scholar
  3. 3-.
    Palmerio, C., Ming, S.C., Frank, E. and Fine, J.-(1962)-Cardiac tissue response to Endotoxin. Proceedings of the Society for Experimental Biology and Medicine. 109, 773.PubMedGoogle Scholar
  4. 4-.
    Ashford, T., Palmerio, C. and Fine, J.-(1966)-Structural Analogue in vascular muscle to the functional disorder in refractory traumatic Shock and reversal by corticosteroid: Electron Microscopic Evaluation. Annals of surgery. 4, 575.CrossRefGoogle Scholar
  5. 5-.
    Palmerio, C., Zettestrom, B., Shammash, J., Euchbaum, E., Frank, E. and Fine, J.-(1963)-Denervation of the Abdominal Viscera for the Treatment of traumatic Shock. New England Journal of Medicine. 269, 709.PubMedCrossRefGoogle Scholar
  6. 6-.
    Palmerio, C., Zettestrom, B., Tudor, J., Rutenburg, S. H. and Fine, J.-(1964)-Further studies on the Nature of the Circulating Toxin in Traumatic Shock. Journal of the Reticulo Endothelial Society. 1, 243.Google Scholar
  7. 7-.
    Rutenburg, S.H., Skarnes, R., Palmerio, C. and Fine, J.,-(1967)-Detoxification of Endotoxin by perfusion of Liver and Spleen. Proceedings of the Society for experimental Biology and Medicine. 125, 455.PubMedGoogle Scholar
  8. 8-.
    Zettestrom, B., Palmerio, C. and Fine, J.-(1964)-Protection of functional and vascular integrity of the Spleen in traumatic Shock by denervation. Proceedings of the Society for experimental Biology and Medicine. 117, 373.Google Scholar
  9. 9-.
    Glass, K., Palmerio, C. and Fine, J.-(1969)-Further Evidence of the role of the Reticulo-Endothelial System in the Maintenance of Vascular Integrity. Surgery. In Press.Google Scholar
  10. 10-.
    Fine, J., Palmerio, C. and Rutenburg, S.H.-(1968)-New Developments in Therapy of Refractory Traumatic Shock. Archives of Surgery. 96, 163.PubMedCrossRefGoogle Scholar
  11. 11-.
    Palmerio, C. and Fine, J.-(1969)-The Nature of Resistance to Shock. Archives of Surgery. 98, 679.PubMedCrossRefGoogle Scholar
  12. 12-.
    Springers, G.F., Wang, E.T., Nichols, J.H. and Smeat, J.M.-(1966)-Relation between Bacterial Lipopolysaccha-ride Structures and Those of Human cells. Annals of the New York Academy of Sciences. 113, 566.CrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1970

Authors and Affiliations

  • Carlo Palmerio
    • 1
  1. 1.Department of SurgeryHarvard Medical School and Beth Israel HospitalBostonUSA

Personalised recommendations