Abstract
Intravenous bolus endotoxin elicits a marked but transient increase in plasma TxB2 and 6-keto-PGF1α in a large number of species. A smaller, delayed and more prolonged increase in TxB2 and 6-keto-PGF1α are reported in animals with septic shock, i.e., those with fecal peritonitis or cecal ligation. Thromboxane synthetase inhibitors or antagonists attenuate endotoxin-induced acute cardiopulmonary changes, the delayed increase in serum lysosomal enzymes, fibrin/fibrinogen degradation products and the thrombocytopenia in a number of species. While these drugs increase survival of rats or mice following endotoxin they do not alter survival of rats in septic shock. These results support the hypothesis that TxA2 exerts a pathophysiologic effect in shock following bolus endotoxin. In contrast, nonsteroidal antiinflammatory drugs (NSAID) and dietary essential fatty acid deficiency increase survival of rats subjected to endotoxin shock, and survival time in models of septic shock. These results also suggest that some other cyclooxygenase product(s) is involved in septic shock due to fecal peritonitis or cecal ligation. Preliminary experimental studies indicate salutary effects of leukotriene inhibitors and antagonists in endotoxin shock and in models of acute pulmonary injury. Clinical studies have demonstrated elevated plasma TxB2 and 6-keo-PGF1α concentrations in patients with septic shock, and elevated LTD4 in pulmonary edema fluid of patients with the adult respiratory distress syndrome. In view of these clinical and experimental results, clinical trials of NSAID and/or leukotriene inhibitors/antagonists should be considered.
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Anderegg K, Anzeveno P, Cook JA, Halushka PV, McCarthy J, Wagner E, Wise WC (1983) Effects of a pyridine derivative thromboxane synthetase inhibitor and its inactive isomer in endotoxic shock in the rat. Br J Pharmacol 78:725–732
Armstrong JM, Lattimer N, Moncada S, Vane JR (1978) Comparison of the vasodepressor effects of prostacyclin and 6-oxoprostaglandin F1α with those of prostaglandin E2 in rats and rabbits. Br J Pharmacol 62:125–130
Armstrong RA, Jones RL, Wilson NH (1985) Effect of the thromboxane receptor antagonist EP 092 on endotoxin shock in the sheep. Prostaglandins 29:703–713
Auclair M, Carli A, Lêchat P (1982) Diminution de l'hypertension induite par la phényléphrine chez la rat ayant reçu une dose sublétale d'endotoxine. Protection par l'indométacine. J Pharmacol (Paris) 13:341–351
Ball HA (1984) Ph. D. thesis Mechanism of the feline cardiopulmonary response to endotoxin. University of Strathclyde, Scotland, UK
Ball HA, Cook JA, Spicer KM, Halushka PV (1985) LY171883, a leukotriene D4/E4 antagonist attenuates leak in oleic acid induced pulmonary injury. Circulation 72 (114):106
Ball HA, Parratt JR (1983) Thromboxane and the pulmonary response to endotoxin in the cat. Circ Shock 10:263
Ball HA, Parratt JR (1984) Mechanisms of systemic hypotension following E. coli endotoxin in the cat. Presented at the European Shock Society Meeting, Manchester. September 1984
Ball HA, Parratt JR, Zeitlin IJ (1983) Effect of dazoxiben, a specific inhibitor of thromboxane synthetase, on acute pulmonary responses to E. coli endotoxin in anaesthetised cats. Br J Clin Pharmac 15:127S-131S
Begley CJ, Ogletree ML, Meyrick BO, Brigham KL (1984) Modification off pulmonary responses to endotoxemia in awake sheep by steroidal and nonsteroid anti-inflammatory agents. Am Rev Respir Dis 130:1140–1146
Bottoms GD, Templeton CB, Fessler JF, Johnson MA, Roesel OF, Ewert KM, Adams SB (1982) Thromboxane, prostaglandin I2 (epoprostenol), and the hemodynamic changes in equine endotoxin shock. Am J Vet Res 43:999–1002
Brater DC, Anderson S, Baird B, Campbell WB (1984) Sulindac does not spare the kidney. Clin Pharmacol Ther 35:229
Brigham KL, Ogletree ML (1981) Effects of prostaglandins and related compounds on lung vascular permeability. Bull Europ Physiopath Resp 17:703–722
Bult H, Beetens J, Herman AG (1980) Blood levels of 6-oxoprostaglandin F1α during endotoxin-induced hypotension in rabbits. Eur J Pharmacol 63:47–56
Bult H, Herman AG (1982) Prostaglandins and circulatory shock. In: Herman AG, Vanhoutte PM, Denolin H, Goossens A (eds) Cardiovascular pharmacology of prostaglandins. Raven Press, New York, p 327–345
Butler RR, Wise WC, Halushka PV, Cook JA (1982) Thromboxane and prostacyclin production during septic shock. Adv Shock Res 7:133–145
Butler RR, Wise WC, Halushka PV, Cook JA (1983) Gentamicin and indomethacin in the treatment of septic shock: Effects on prostacyclin and thromboxane A2 production. J Pharmacol Exp Therap 225:94–101
Casey LC, Flechter JR, Zmudka MI, Ramwell PW (1982) Prevention of endotoxin-induced pulmonary hypertension in primates by the use of a selective thromboxane synthetase inhibitor, OKY 1581. J Pharmacol Exp Therap 222:441–446
Cho MG, Allen MA (1978) Chemical stability of prostacyclin (PGI2) in aqueous solutions. Prostaglandins 15:943–954
Coker SJ, Hughes B, Parratt JR, Rodger IW, Zeitlin IJ (1983) The release of prostanoids during the acute pulmonary response to E. coli endotoxin in anaesthetized cats. Br J Pharmacol 78:561–570
Cook JA, Wise WC, Butler RR, Reines HD, Rambo W, Halushka PV (1984) The potential role of thromboxane and prostacyclin in endotoxin and septic shock. Am J Emerg Med 2:28–37
Cook JA, Wise WC, Halushka PV (1980) Elevated thromboxane levels in the rat during endotoxin shock: Protective effects of imidazole, 13-azaprostanoic acid, or essential fatty acid deficiency. J Clin Invest 65:227–230
Cook JA, Wise WC, Halushka PV (1985) Protective effect of a selective leukotriene antagonist in endotoxin shock in the rat. J Pharmacol Exp Therap 235:470
Cook JA, Wise WC, Knapp DR, Halushka PV (1981) Sensitization of essential fatty acid-deficient rats to endotoxin by arachidonate pretreatment role of thromboxane A2. Circ Shock 8:69–76
Cook JA, Wise WC, Knapp DR, Halushka PV (1981) Essential fatty acid deficient rats: A new model for evaluating arachidonate metabolism in shock. Adv Shock Res 6:93–105
Deby-Dupont G, Radoux L, Haas M, Larbuisson R, Noël FX, Lamy M (1982) Release of thromboxane B2 during adult respiratory distress syndrome and its inhibition by nonsteroidal anti-inflammatory substances in man. Arch Int Pharmacodyn 259:317–319
Demling RH, Smith M, Gunther R, Flynn JT, Gee MH (1981) Pulmonary injury and prostaglandin production during endotoxemia in conscious sheep. Am J Physiol 240:H348-H353
Dickey BF, Thrall RS, McCormick JR, Ward PA (1981) Oleic acid-induced lung injury in the rat. Failure of indomethacin treatment or complement depletion to ablate lung injury. Am J Pathol 103:376–383
Dunn MJ, Zambraski EJ (1980) Renal effects of drugs that inhibit prostaglandin synthesis. Kidney Int 18:609–622
Eiermann GF, Dickey BF, Thrall RS (1983) Polymorphonuclear leukocyte participation in acute oleic-acid-induced lung injury. Am Rev Respir Dis 128:845–850
Erdös EG, Hinshaw LB, Gill CC (1967) Effects of indomethacin in endotoxin shock in the dog. Proc Soc Exp Biol Med 125:916–919
Feuerstein G, Zukowska-Grojec Z, Kopin IJ (1981) Cardiovascular effects of leukotriene D4 in SHR and WKY rats. Eur J Pharmacol 76:107–110
Fink MP, Gardiner WM, Roethel R, Fletcher JR (1985) Plasma levels of 6-keto-PGF1α but not TxB2 increase in rats with peritonitis due to cecal ligation. Circ Shock 16:297–305
Fink MP, McVittie TJ, Casey LC (1983) Nonsteroidal antiinflammatory drugs (NSAID) decrease renal blood flow (RBF) in septic dogs. In: Abstracts, Association Academic Surgery p 87
Fink MP, MacVittie TJ, Casey LC (1984) Inhibition of prostaglandin synthesis restores normal hemodynamics in canine hyperdynamic sepsis. Am Surg 200:619–626
Fink MP, MacVittie TJ, Casey LC (1984) Effects of nonsteroidal anti-inflammatory drugs on renal function in septic dogs. J Surg Res 36:516–525
Fletcher JR (1982) The role of prostaglandins in sepsis. Scand J Infect Dis (Suppl) 31:55–60
Fletcher JR, Ramwell PW (1977) Modification, by aspirin and indomethacin, of the haemodynamic and prostaglandin releasing effects of E. coli endotoxin in the dog. Br J Pharmacol 61:175–181
Fletcher JR, Ramwell PW (1980) Prostaglandins in shock: To give or to block. Adv Shock Res 3:57–66
Fletcher JR, Ramwell PW (1980) Indomethacin improves survival after endotoxin in baboons. In: Samuelsson B, Ramwell PW, Paoletti R (eds) Adv Prostag Thromb Res. Raven Press, New York 7, p 821–828
Flechter JR, Short BL, Casey LC, Walker RI, Gardiner M, Ramwell PW (1983) Thromboxane inhibition in gram-negative sepsis fails to improve survival. In: Samuelsson B, Paoletti R, Ramwell P (eds) Adv Prostag Thromb Leuk Res, Raven Press, New York 12, p 117–120
Ford-Hutchinson AW, Bray MA, Doig MV, Shiply ME, Smith MJH (1980) Leukotriene B, a potent chemokinetic and aggregating substance released from polymorphonuclear leukocytes. Nature 286:264–265
Ford-Hutchinson AW, Rackman A (1983) Leukotrienes as mediators of skin inflammation. Br J Dermatol 109 [Suppl]:26–29
Fukumoto S, Tanaka K (1983) Protective effects of thromboxane A2-synthetase inhibitors on endotoxin shock. Prost Leuk Med 11:179–188
Furman BL, McKechnie K, Parratt JR (1984) Failure of drugs that selectively inhibit thromboxane synthesis to modify endotoxin shock in conscious rats. Br J Pharamacol 82:289–294
Greenway CV, Lautt WW, Stark RD (1969) Separation of acute and delayed hemodynamic responses to endotoxin in the cat. Am J Physiol 217:518–521
Griffin AJ, Goto M (1983) Indomethacin and dopamine in endotoxin shock: Improvement in hemodynamics and mortality. Circ Shock 16:71
Guenter CA, Fiorcica V, Hinshaw LB (1969) Cardiorespiratory and metabolic responses to live E. coli and endotoxin in the monkey. J Appl Physiol 26:780–786
Gunther RA, Smith GJ, Holcroft JW (1984) Pulmonary response to selective inhibition of thromboxane A2 synthesis during endotoxemia utilizing a unique inhibitor. Surgical Forum 35:42–44
Hagmann W, Denzlinger C, Keppler D (1984) Role of peptide leukotrienes and their hepatobiliary elimination in endotoxin action. Circ Shock 14:223–235
Hagmann W, Keppler D (1982) Leukotriene antagonists prevent endotoxin lethality. Naturwissenschaften 69:594–595
Hales CA, Sonne L, Peterson M, Kong D, Miller M, Watkins WD (1981) Role of thromboxane and prostacyclin in pulmonary vasomotor changes after endotoxin in dogs. J Clin Invest 68:497–505
Halushka PV, Cook JA, Wise WC (1983) Effects of UK 37248, a thromboxane synthetase inhibitor, in experimental endotoxic shock in the rat. Br J Clin Pharmacol 15:133S-139S
Halushka PV, Reines HD, Barrow SE, Blair IA, Dollery CT, Rambo W, Cook JA, Wise WC (1985) Elevated plasma 6-keto-prostaglandin F1α in patients in septic shock. Crit Care Med 13:451–453
Halushka PV, Wise WC, Cook JA (1981) Protective effects of aspirin in endotoxic shock. J Pharmacol Exp Therap 218:464–469
Halushka PV, Wise WC, Cook JA (1983) Studies on the beneficial effects of aspirin in endotoxin shock. Relationship to inhibition of arachindonic acid metabolism. Am J Med 14:91–96
Hamberg M, Svensson J, Samuelsson B (1975) Thromboxanes: A new group of biologically active compounds derived from prostaglandin endoperoxides. Proc Natl Acad Sci USA 72:2994–2998
Harlan J, Winn R, Hildebrandt J,Harker L (1983) Selective inhibition of thromboxane synthesis during experimental endotoxemia in the goat: effects on pulmonary haemodynamics and lung lymph flow. Br J Clin Pharmac 15:123S-126S
Harris RH, Zmudka M, Maddox Y, Ramwell PW, Fletcher JR (1980) Relationships of TxB2 and 6-keto-PGF1α to the hemodynamic changes during baboon endotoxic shock. In: Samuelsson B, Ramwell RW, Paoletti R (eds) Adv Prostag Thrombox Res, Raven Press, New York 7, p 843
Hassid A (1984) Stimulation of prostacyclin synthesis by thromboxane A2-like prostaglandin endoperoxide analogues in cultured vascular smooth muscle cells. Biochem Biophys Res Comm 123:21–26
Herndon DN, Abston S, Stein MD (1984) Increased thromboxane B2 levels in the plasma of burned and septic burned patients. Surg Gynec Obstet 159:210–213
Higgs G, Eakins K, Moncada S, Vane J (1980) The effects of non-steroidal anti-inflammatory drugs on leukocyte migration in carrageenin-induced inflammation. Eur J Pharmacol 68:81–86
Hinshaw LR, Solomon LA, Erdös EG, Reins DA, Gunter BJ (1967) Effects of acetylsalicylic acid on the canine response to endotoxin. J Pharmacol Exp Therap 157:665–671
Iacopino VJ, Fitzpatrick TM, Ramwell RW, Rose JC, Kot PA (1983) Cardiovascular responses to leukotriene C4 in the rat. J Pharmacol Exp Therap 227:224–247
Jacobs ER, Soulsby ME, Bone RC, Wilson FJ, Hiller FC (1982) Ibuprofen in canine endotoxin shock. J Clin Invest 70:536–541
Kaplan JE, Weinberg DA (1982) Depression of reticuloendothelial (RE) clearance by prostacyclin (PGI2). Fed Proc 41:559
Komoriya K, Ohmori H, Azuma A, Kurozumi S, Hashimoto Y, Nicolaou KC, Barnette WE, Magolda RL (1978) Prostaglandin I2 as a potentiator of acute inflammation in rats. Prostaglandins 15:557–564
Kreutner W, Siegal MI (1984) Biology of leukotrienes. Ann Rep Med Chem 19:241–251
Leeman M, Boeynaems J, Degaute J, Vincent J, Kahn RJ (1985) Administration of dazoxiben, a selective thromboxane synthetase inhibitor, in the adult respiratory distress syndrome. Chest 87:726–730
Lefer AM (1983) Role of prostaglandins and thromboxanes in shock states. In: Altura BM, Lefer AM, Schumer W (eds) Handbook of shock and trauma. Raven Press, New York, p 355–376
Levenson DJ, Simmons LE, Brenner BM (1982) Arachidonic acid metabolism, prostaglandins and the kidney. Am J Med 72:354–374
Lifshitz MD (1983) Renal effects of nonsteroidal anti-inflammatory agents. J Lab Clin Med 102:313–323
Matthay MA, Eschenbacher WL, Goetzl EJ (1984) Elevated concentrations of leukotriene D4 in pulmonary edema fluid of patients with the adult respiratory distress syndrome. J Clin Immunol 4:479–483
McCabe WR (1974) Gram-negative bacteremia. Adv Intern Med 19:135–158
McKechnie K, Furman BL, Parratt JR (1985) Metabolic and cardiovascular effects of endotoxin infusion in conscious unrestrained rats: Effects of methylprednisolone and BW755C. Circ Shock 15:205–215
Michelassi F, Landa L, Hill RD, Lowenstein E, Watkins WD, Petkau AJ, Zapol WM (1982) Leukotriene D4: A potent coronary artery vasoconstrictor associated with impaired ventricular contraction. Science 217:841–843
Moncada S, Vane JR (1979) Pharmacology and endogenous roles of prostaglandin, endoperoxides, thromboxane A2 and prostacyclin. Pharmacol Rev 30:293–331
Morgan DC, Wise WC, Halushka PV, Cook JA (1985) Effects of ticarcillin on plasma endotoxin and eicosanoid levels in septic shock in the rat. Submitted
Náray-Fejes-Tóth A, Fejes-Tóth E, Fischer C, Frölich JC (1984) Effect of dexamethasone on in vivo prostanoid production in the rabbit. J Clin Invest 74:120–123
Northover BJ, Subramanian G (1962) Analgesic-antipyretic drugs as antagonists of endotoxin shock in dogs. J Pathol Bacteriol 83:463–468
Oettinger WKE, Walker GO, Jensen UM, Beyer A, Peskar A (1983) Endogenous prostaglandin F2α in the hyperdynamic state of severe sepsis in man. Br J Surg 70:237–239
Ogletree ML, Brigham KL (1982) Effects of cyclooxygenase inhibitors on pulmonary vascular responses to endotoxin in unanesthetized sheep. Prost Leuk Med 8:489–502
Ogletree ML, Oates JA, Brigham KL, Hubbard WC (1982) Evidence for pulmonary release of 5-hydroxyeicosatetraenoic acid (5-HETE) during endotoxemia in unanesthetized sheep. Prostaglandin 23:459–468
Olanoff LS, Cook JA, Eller T, Knapp DR, Halushka PV (1985) Protective effects of trans-13-APT, a thromboxane receptor antagonist, in endotoxemia. J Cardiovasc Pharmacol 7:114–120
Parratt JR (1983) Neurohumoral agents and their, release in shock. In: Altura BM, Lefer AM, Schumer W (eds) Handbook of shock and trauma. Raven Press, New York, p 311–336
Parratt JR, Sturgess RM (1974) The effect of indomethacin on the cardiovascular and metabolic responses to E. coli endotoxin in the cat. Br J Pharmacol 50:177–183
Parratt JR, Sturgess RM (1975) E. coli endotoxin shock in the cat; treatment with indomethacin. Br J Pharmacol 53:485–488
Parratt JR, Sturgess RM (1975) The protective effect of sodium meclofenamate in experimental endotoxin shock. Br J Pharmacol 53:466P
Parratt JR, Sturgess RM (1976) The effect of a new anti-inflammatory drug, flubriprofen, on the respiratory, haemodynamic and metabolic responses to E. coli endotoxin shock in the cat. Br J Pharmacol 58:547–551
Rao PS, Cavanagh D, Gaston LW (1981) Endotoxic shock in the primate, effects of aspirin and dipyridamole administration. Am J Obstet Gynecol 140:914–922
Reines HD, Halushka PV, Cook JA, Loadholt CB (1985) Lack of effect of glucocorticoids upon plasma thromboxane in patients in a state of shock. Surg Gynec Obstet 160:320–322
Reines HD, Halushka PV, Cook JA, Wise WC, Rambo W (1982) Plasma thromboxane concentrations are raised in patients dying with septic shock. Lancet July 24:174–175
Reines HD, Halushka PV, Olanoff LS, Hunt PS (1985) Dazoxiben in human sepsis and adult respiratory distress syndrome. Clin Pharmacol Therap 37:391–395
Reitschel ET, Schade U, Luderitz D, Fischer H, Piskar BA (1980) Prostaglandins in endotoxicosis. In: Schlessinger D (ed) Microbiology-80. Am Soc Microbiol, Washington DC, p 66–83
Rie M, Peterson M, Kong D, Quinn D, Watkins D (1983) Plasma prostacyclin increases during acute human sepsis. Circ Shock 10:232
Roberts DG, Gerber JG, Nies AS (1984) Comparative effects of sulindac and indomethacin in humans. Clin Pharmacol Ther 35:269
Rogers F, Dunn R, Nolan P, Phunangsab A, Barrett J (1985) Diethylcarbamazine, a leukotriene inhibitor, improves survival of endotoxemia in the rat. Circ Shock 16:52
Roth DM, Lefer AM (1983) Mechanism of the constrictor action of leukotrienes in cat coronary arteries. The Pharmacologist 25:142
Schrauwen E, Vandeplassche G, Laekeman G, Houvenaghel A (1983) Endotoxin shock in the pig: Release of prostaglandins and beneficial effects of flurbiprofen. Arch Int Pharmacodyn 262:332–334
Short BL, Miller MK, Stround CY, Fletcher JR (1983) Comparison of thromboxane inhibitors to cyclooxygenase inhibitors on survival in a newborn rat model for group B streptococcal sepsis. In: Samuelsson B, Paoletti R, Ramwell P (eds) Adv Prostag Thrombox Leuk Res. Raven Press, New York 12, p 113–116
Steinberg SM, Dehring DJ, Reilley TR, Gower WL, Lowery BD, Cloutier CT (1983) Sulindac treatment of septic acute respiratory failure in a porcine model. Critical Care Med 11:251
Svartholm E, Ljungberg J, Bergqvist D, Haglund U (1985) The effect of a serotonin antagonist and a thromboxane synthetase inhibitor on the pulmonary vascular response to i.v. infusion of live E. coli. Circ Shock 16:89–90
Svensson J, Fredholm BB (1977) Vasoconstrictor effect of thromboxane A2. Acta Physiol Scand 101:366–368
Tempel GE, Cook JA, Wise WC, Halushka PV, Corral D (1985) Improvement in organ blood flow by inhibition of thromboxane synthetase during experimental endotoxic shock in the rat. J Cardiovasc Pharm (in press)
Toth PD, Hamburger SA, Hastings GH, Judy WV (1985) Benoxaprofen attenuation of lethal canine endotoxic shock. Circ Shock 15:89–103
Toth PD, Hamburger SA, Judy WV (1983) Reversal of lethal canine endotoxic shock. Circ Shock 10:233
Urbaschek R, Patscheke H, Stegmeier K, Urbaschek B (1985) The effect of a thromboxane receptor blocker in endotoxin shock. Circ Shock 16:71
Wardle N (1979) Bacteraemic and endotoxin shock. Br J Hosp Med 21:223–231
Watkins WD, Hüttemeier PC, Kong D, Peterson MB (1982) Thromboxane and pulmonary hypertension following E. coli endotoxin infusion in sheep: Effect of an imidazole derivative. Prostaglandins 23:273–285
Webb PJ, Westwick J, Scully MF, Zahavi J, Kakkar VV (1981) Do prostacyclin and thromboxane play a role in endotoxic shock? Br J Surg 68:720–724
Weis HJ, Turitto VT (1979) Prostacyclin (prostaglandin I2, PGI2) Inhibits platelet adhesion and thrombus formation on subendothelium. Blood 53:244–250
Westwick J, Fletcher MS, Kakkar VV (1983) Inhibition of thromboxane formation prevents endotoxin-induced renal fibrin deposition in jaundiced rats. In: Samuelsson B, Paoletti R, Ramwell P (eds). Adv Prost Thromb Leuk Res. Raven Press, New York 12, p 83–91
Wichterman KA, Baue AE, Chaudry IH (1980) Sepsis and septic shock — a review of laboratory models and a proposal. J Surg Res 29:189–201
Winn R, Harlan J, Nadir B, Harker L, Hildebrandt J (1983) Thromboxane A2 mediates lung vasoconstriction but not permeability after endotoxin. J Clin Invest 72:911–918
Wise WC, Cook JA, Eller T, Halushka PV (1980) Ibuprofen improves survival from endotoxic shock in the rat. J Pharmacol Exp Therap 215:160–164
Wise WC, Cook JA, Halushka PV, Knapp DR (1980) Protective effects of thromboxane synthetase inhibitors in rats in endotoxic shock. Circ Res 46:854–859
Wise WC, Halushka PV, Knapp RG, Cook JA (1985) Ibuprofen, methylprednisolone and gentamicin as conjoint therapy in septic shock. Circ Shock 17:59
Ziboh VA, Vanderhoek JY, Lands WEM (1974) Inhibition of sheep vesicular gland oxygenase by unsaturated fatty acids from skin of essential fatty acid deficient rats. Prostaglandins 5:233–240
Zipser RD, Hoefs JC, Speckart PF, Zia PK, Horton R (1979) Prostaglandins; modulators of renal function and pressor resistance in chronic liver disease. J Clin Endocrin Metab 48:895–900
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Ball, H.A., Cook, J.A., Wise, W.C. et al. Role of thromboxane, prostaglandins and leukotrienes in endotoxic and septic shock. Intensive Care Med 12, 116–126 (1986). https://doi.org/10.1007/BF00254925
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DOI: https://doi.org/10.1007/BF00254925