DEVELOPMENT AND HEALING OF MASSIVE LIVER-NECROSES AFTER SINGLE ORTHOSTATIC SHOCK

Shock was produced in 42 rabbits by placing them in a vertical position. Four animals died spontaneously; the remaining 38 animals were killed 15 and 90 minutes, 3, 6, 12 and 24 hours, 2, 4, and 8 days later. Severe changes that developed in the parenchyma of the liver may be divided into three stages: 1. During the first stage, lasting to about 6 hours, non-characteristic changes were found: increased central sinusoids, fat-free vacuoles in the liver cells of the central and the intermediary region of the liver lobules, net-like necroses as well as disseminated focal liver cell necroses often surrounded by leucocytes. 2. In the second stage zonal liver necroses developed. About 6 to 8 hours after onset of shock liver cells stained abnormally. From these cells necroses formed after 24 hours; they were sharply circumscribed, often merging with one another and occupied the central and intermediary lobular zones. 3. The stage of reparation began first 48 hours after the shock. In a small zone at the periphery of the zonal necroses light-colored, regenerating cells appeared. These advanced, under simultaneous resorption of the necrotic tissue, to the central veins and slowly assumed the form of typical liver cells. Generally, this process led to a restitution ad integrum and ended after a few days. With the changes in the liver damage to the myocardium became evident light microscopically. The muscle fibers involved were primarily those of the inner half of the left ventricular wall near the endocardium. The changes were marked by interstitial edema, by intra-cellular vacuoles, by hyaline, intercalated disks, individual cell necroses and cell-group necroses. Within the necroses the local mesenchyma cells proliferated early. Paralleling the morphologic results, the serum levels of cell enzymes increased early, showing as a rule two peaks, and reached their higher peak 12 to 24 hours after the shock. © 1969 Springer-Verlag.