Biomedical subjects
W Schumer
Publications and source records attributed to W Schumer.
Hypovolemic shock.
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Phenothiazine effect on gastrointestinal tract function.
Clinical evidence indicates that phenothiazines, specifically chlorpromazine (CPZ), used extensively in the treatment of patients with mental and/or neurologic disorders produce an ileus characterized by pseudoobstruction with an extended barium transit time of eight to ten days. Postoperatively, these patients have a protracted ileus, lasting from ten to fourteen days. In our present study we investigated the mechanism of action by which phenothiazines block gastrointestinal tract function as well as the possible reversal of this effect by pharmacologic agents. Guinea pigs were injected intraperitoneally with CPZ at a dose of 30 mg/kg/day for five to seventeen days. This caused deleterious effects in the gastrointestinal tract, such as cessation of peristalsis of small intestine and colon, and marked distension of the cecum. In vitro pharmacologic studies were performed on the electrically stimulated longitudinal muscle-myenteric plexus of the guinea pigs. We found that phenothiazines interfered with the neuromuscular mechanism of the intestine, as exemplified by a lack of response to electrical current stimulation. The effect was protracted, lasting at least 24 hours. These effects were reversed by the administration of the anticholinesterase, physostigmine (PGM), provided the block was less than 80 per cent. The paralytic ileus produced was similar to that found in man.
Supportive therapy in burn care. Consensus summary on metabolism.
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Endotoxin-challenged monkeys and rats.
Studies in our laboratory with both the monkey and the rat showed that, after three hours of endotoxemia, there was a significant decrease in the number of circulating platelets, total hemolytic complement (CH 50 units), and blood serotonin (5-HT) levels. Administration of dexamethasone sodium phosphate in the clinical dose range at the time of endotoxin challenge significantly attenuated the decrease in blood 5-HT levels when compared to the untreated groups in both the monkey and the rat experiments. In the monkey, CH 50 units remained at a higher level when dexamethasone was administered; however, the difference between the treated and untreated groups was not statistically significant. The number of circulating white blood cells and platelets did not appear to be significantly altered by corticosteroid treatment. It is suggested that glucocorticoids may interfere with lipopolysaccharide-induced alterations in complement components or factors regulating hemostasis that influence platelet 5-HT release.
Use of cefoxitin sodium in moderate to severe surgical infections.
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Glucocorticoid effect on hepatic carbohydrate metabolism in the endotoxin-shocked monkey.
This study investigated the effect of glucocorticoid treatment on survival, on hepatic carbohydrate metabolism, and on levels of hepatic adenine nucleotides in the endotoxin-shocked monkey. Dexamethasone sodium phosphate (DMP) administered either at the time of endotoxin challenge or up to 90 minutes afterward significantly increased the survival rates. Endotoxin administered alone caused profound hypoglycemia and lactic-acidemia, which were alleviated by the administration of DMP. Endotoxin administered alone significantly decreased the hepatic levels of glucose-6-phosphate, fructose-6-phosphate, phospho-enolpyruvate, adenosine triphosphate, adenosine diphosphate, and glycogen; and it significantly increased the hepatic levels of fructose-1,6-diphosphate, lactate, and adenosine mono-phosphate. The administration of DMP at the time of endotoxin challenge maintained the levels of all these metabolites at or near the control levels.
Steroids in the treatment of clinical septic shock.
A prospective (Part I) and a retrospective (Part II) study were used to determine the safety and efficacy of corticosteroids in the treatment of septic shock. In Part I, 172 consecutive patients in septic shock admitted over an 8-year period were treated with either steroid or saline: 43 received dexamethasone (DMP), 43 received methylprednisolone (MPS), and 86 received saline. The study was double-blind and randomized, and the three groups were compared for age, severity of shock, presence of underlying disease, and year of study. In the 86 saline-treated patients, the mortality rate was 38.4% (33/86); in the steroid-treated patients, it was 10.4% (9/86). With MPS the mortality rate was 11.6% (5/43), and with DMP it was 9.3% (4/43). Thus, overall mortality was significantly less in the steroid-treated group than in the control group. Further, there was no significant difference in mortality rate between the DMP- and the MPS-treated patients. In Part II, 328 patients were studied retrospectively. One-hundred sixty were treated without steroid, and 168 were treated with either DMP or MPS. Again, the two groups of patients were compared for severity of shock, underlying disease, age, and year of study. Mortality among patients treated without steroid was 42.5% (68/160) and among patients treated with steroid was 14% (24/168); there was no significant difference in mortality rate between DMP- and MPS-treated patients. In Parts I and II combined, complications occurred in 6% of steroid-treated patients with no significant difference between DMP- and MPS-treated groups.
Anaerobic Infections.
Oxygen-sensitive anaerobic bacteria comprise the largest group of organisms among the human endogenous microflora. The oral cavity, the vagina and the colon are areas where the obligate anaerobes are predominant and can be isolated in high numbers. Clinical clues that indicate anaerobic sepsis include a putrid odor of the exudate and evidence of abscess, necrosis or associated gas formation. A Gram stain is highly valuable in early identification. Surgical drainage and appropriate antibiotics are essential.
Influence of pharmacologic agents on tissue metabolism in circulatory shock.
Our research activities have been oriented to the effect of pharmacologic agents on tissue metabolism in the low flow state of circulatory shock. Specifically, we have been most interested in the effect of glucocorticoids on cellular metabolism because these agents exert a reproducible protective effect during septic and endotoxic shock in rats and monkeys. Further, we have studied the differences between untreated animals in shock and those treated with pharmacologic agents in an attempt to determine which cellular metabolic changes are critical to survival. This paper will present our studies as well as those of other laboratories, which have defined the effects on tissue metabolism of certain pharmacologic agents: those which stimulate cyclic adenosine monophosphate (AMP) (epinephrine, norepinephrine, glucagon, and prostaglandin) and those which do not (the glucocorticoids).
Septic shock: immunologic and metabolic pathology, diagnosis and treatment.
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