The Fundamental mechanisms of shock; proceedings of a symposium held in Oklahoma City, Oklahoma, October 1-2, 1971
A concerned group of approximately forty investigators from the United States and Canada met in Oklahoma City in 1964 to carry out experiments on animals in endotoxin shock. Nearly all of the proposed and then-current forms of therapy to prevent irreversible shock and death were attempted (J. Okla. State Med. Assoc. 59:407-484, 1966). Unfortunately, no clearly demonstrable therapeutic benefits accrued from this massive effort. However, this meeting was without historic precedence, marking the first time in which reportedly successful therapies had been attempted on a large scale. The results left most investigators puzzled and disappointed, and a pall descended over many laboratories of shock research. It seemed clear that we had failed to penetrate the hidden barriers to our understanding of the mechanisms of endotoxin shock. Even as this postmortem is laid bare eight years later, we still have no unequivocal proof of the precise chain of events leading to irreversible shock and death. Since the Shock Tour of 1964, the Oklahoma research group has regularly examined its position relative to an understanding of endotoxin shock. The critical need to clarify its mechanisms became apparent at that time, and we set to work conceiving experimental designs which might solve the problem. A great deal of research has been accomplished. Yet it appears that we are still skirting the core of the shock problem, endlessly wrestling with peripheral components, but never quite reaching the basic mechanisms. We have not advanced far enough in sequentially dissecting out those critical pathophysiological events early in shock which most assuredly lead to the irreversible state. The Oklahoma-based U.S. Navy Project THEMIS research group, activated in 1968 and composed of surgeons, internists, physiologists, pathologists, pharmacologists, and biochemists, represents the faculties and staff of the University of Oklahoma Medical School, the Veterans Administration Hospital, and the Oklahoma Medical Research Foundation. This group has attacked experimental septic shock with a wide spectrum of approaches, ranging from molecular to clinical studies. At times, we have become discouraged. The obstacles which block our understanding of the intimate mechanisms in shock have often seemed insurmountable. Nevertheless, these interdisciplinary efforts have stimulated an underlying conviction that the shock problem will be most effectively solved by vigorous team research. Well-trained, highly motivated investigators from the basic and clinical sciences must join together in a concerted effort to sort out and define the fundamental mechanisms in shock. The results of such studies are most likely to yield clinically applicable therapeutic procedures. In the spirit of this approach, we met with investigators from the United States, Canada, and Europe in Oklahoma City in October, 1971, to encourage an exchange of data and ideas, and hopefully to begin to unravel the fundamental mysteries of shock. These meetings were unique. A single, topically oriented conference provided a forum for an interdisciplinary group of research workers who might otherwise never have met in a single conference room for cross-pollination and challenge of one another's ideas. We hope that this symposium has proven its worth and that it establishes a pattern for future meetings
Congress
xx, 449 pages illustrations 26 cm.
9780306390234, 030639023X
549969
Introduction: An Overview of the Shock Problem.- Session I: Shock and the Cardiovascular System.- Introductory Remarks.- Proposed Reclassification of Shock States with Special Reference to Distributive Effects.- Discussion.- Participation of Endogenous Vasoactive Agents in the Pathogenesis of Endotoxin Shock.- Discussion.- Pulmonary Dysfunction in Shock.- Discussion.- The Lung Lesion in Shock.- Physiologic Mechanisms in Clinical Shock.- Role of Leukocytes in the Lung After Endotoxin Administration.- Fate of Endotoxin in the Circulation.- Discussion.- Splanchnic Blood Flow in Experimental Shock.- Discussion.- Are Adrenergic Overactivity and Splanchnic Vasoconstriction the Prime Pathophysiological Events in Shock?.- Effects of Endotoxin on the Vascular Architecture of Intestinal Mucosa.- Role of Vasopressin and Angiotensin in Response of Splanchnic Resistance Vessels to Hemorrhage.- Platelet, Hemodynamic, and Respiratory Changes in Shock, Sepsis, and Trauma.- Discussion.- Session II: Shock and Metabolism.- Introductory Remarks.- Immunochemical and Physiologic Insulin Lack During Lethal E. coli Septicemia in the Subhuman Primate.- What Mechanisms Influence Oxygen Transport and Oxygen Tissue Delivery in Endotoxic and Hemorrhagic Shock?.- Oxyhemoglobin Dissociation Curve in Hemorrhagic and Septic Shock.- Effects of Endotoxin and E. coli Shock on the Metabolism of Lipids and Carbohydrate.- The Mechanism of the "Lung Lesion" in Shock.- Irreversibility in the Post-Transfusion Phase of Hemorrhagic Shock.- Histamine Release in Endotoxin Shock: Effect of Dexamethasone Administration.- Dopamine in the Treatment of Shock.- Liver Metabolism and Energy Production in Staphylococcus aureus Septic Shock in Mice.- Myocardial Metabolism During Acute Hemorrhagic or Endotoxic Shock.- Metabolic Changes in Hemorrhagic Shock.- General Discussion.- Session III: Toxic Factors in Shock.- Introductory Remarks.- Release of Toxic Agents in Septic Shock.- The Relationship Between Oxygen Uptake and a Toxic Factor in Septic Shock.- Discussion.- Role of the Pancreas in the Pathogenesis of Circulatory Shock.- Vascular Lesions in Endotoxemia.- The Role of Targets and Mediators in Endotoxin Shock.- Discussion.- Liberation of Vasoactive Materials from Mast Cells in Anaphylactic Shock.- Proteases and Antiproteases in Experimental Low-Flow States.- Prolylcarboxypeptidase in Biological Fluids.- Discussion.- Does Endotoxin Have Direct or Indirect Effects on the Heart?.- Pulmonary Dysfunction After Shock and Trauma.- Discussion.- Biochemical-Biophysical Basis of Shock.- Afterword.- Participants and Special Guests.- General Subject Index.
Sponsored by United States Navy Project THEMIS and the University of Oklahoma Health Sciences Center