An Appraisal of Fulminant Meningococcemia with Reference to the Shwartzman Phenomenon

PEDIATRICS ◽  
1959 ◽  
Vol 23 (2) ◽  
pp. 341-341
Keyword(s):  
Steroid Therapy ◽  
Special Interest ◽  
Primary Lesion ◽  
Adrenal Steroids ◽  
Cortical Necrosis ◽  
Vascular Thrombosis ◽  
Adrenal Steroid ◽  
Shwartzman Reaction ◽  
Time Of Admission ◽  
Shwartzman Phenomenon

The object of this study was to evaluate the evidence for and against operation of the Shwartzman phenomenon (local or generalized) in meningococcemia. It is based on 52 cases of meningococcus infection seen at the Cincinnati Children's Hospital in a 20 year period. The fatal cases were compared with 152 patients who survived meningococcus infection. Vascular thrombosis appears to be the primary lesion involved in the production of the hemorrhagic lesions of the skin and adrenals in acute meningococcemia. It is suggested that these lesions may be produced by a local Shwartzman phenomenon. Of special interest is the occurrence of three instances of renal cortical necrosis, such as is seen characteristically in the generalized Shwartzman reaction. Because of the similarity of the lesions found in the fatal cases of meningococcus infection with the Shwartzman phenomenon, and the fact that cortisone is one of the most efficient methods of potentiating the Shwartzman phenomenon, led the authors to question the wisdom of the use of adrenal steroid therapy in fulminating meningococcus septicemia. It was also found that of 156 patients with meningococcus infection, not in shock at the time of admission, there was a mortality of 21% for the patients who received adrenal steroid therapy compared with a 7% mortality in those who did not receive adrenal steroids.

THE METABOLISM OF MUCOPOLYSACCHARIDES: I. ADRENAL STEROIDS AND THE SYNTHESIS OF GLUCOSAMINE-6-PHOSPHATE

1963 ◽  
Vol 41 (10) ◽  
pp. 2141-2146 ◽  
Author(s):  
T. S. Foster
Keyword(s):  
Enzyme Activity ◽  
Connective Tissue ◽  
Steroid Therapy ◽  
Adrenal Steroids ◽  
Adrenal Steroid ◽  
Level Of Activity ◽  
Significant Change

The transamidase which synthesizes glucosamine-6-phosphate was studied in liver and connective tissue of rats. Adrenalectomy was found to result in a significant reduction in enzyme activity in liver. Adrenal steroid therapy with individual corticoids did not restore the level of activity, and cortisone caused a further significant decrease.Neither adrenalectomy nor therapy with the adrenal steroids corticosterone or cortisone effected any significant change in the level of activity in connective tissue. However, in the case of three other steroids, deoxycorticosterone, hydrocortisone, or progesterone, which were tested individually, the level was significantly decreased. Treatment with Reichstein's substance S resulted in a significantly increased enzyme activity.

THE METABOLISM OF MUCOPOLYSACCHARIDES: I. ADRENAL STEROIDS AND THE SYNTHESIS OF GLUCOSAMINE-6-PHOSPHATE

1963 ◽  
Vol 41 (1) ◽  
pp. 2141-2146 ◽  
Author(s):  
T. S. Foster
Keyword(s):  
Enzyme Activity ◽  
Connective Tissue ◽  
Steroid Therapy ◽  
Adrenal Steroids ◽  
Adrenal Steroid ◽  
Level Of Activity ◽  
Significant Change

The transamidase which synthesizes glucosamine-6-phosphate was studied in liver and connective tissue of rats. Adrenalectomy was found to result in a significant reduction in enzyme activity in liver. Adrenal steroid therapy with individual corticoids did not restore the level of activity, and cortisone caused a further significant decrease.Neither adrenalectomy nor therapy with the adrenal steroids corticosterone or cortisone effected any significant change in the level of activity in connective tissue. However, in the case of three other steroids, deoxycorticosterone, hydrocortisone, or progesterone, which were tested individually, the level was significantly decreased. Treatment with Reichstein's substance S resulted in a significantly increased enzyme activity.

Studies on the Pathogenesis of the Generalized Shwartzman Reaction

1964 ◽  
Vol 12 (02) ◽  
pp. 462-470 ◽  
Author(s):  
F Rodríguez-Erdmann
Keyword(s):  
Fibrinolytic System ◽  
Factor V ◽  
Morphological Pattern ◽  
Cortical Necrosis ◽  
G Factor ◽  
Conventional Form ◽  
Renal Cortical Necrosis ◽  
Shwartzman Reaction

SummaryAnimals treated in the conventional form to elicit the generalized Shwartzman reaction (gSr) by means of properly spaced injections of endotoxin develop an abrupt consumption of the plasmatic factors of the clotting mechanism, as demonstrated by the reduction of the activity of prothrombin and Ac-G (factor V). These animals show ultimatly characteristic morphological pattern: bilateral cortical necrosis of the kidney. Rabbits treated four hours after the second (‘‘provocative”) endotoxin injection with streptokinase (Varidase/Lederle) in order to activate the fibrinolytic system failed to develop the renal cortical necrosis, but their prothrombin and Ac-G (factor V) level decreased abruptly.Through indirect deduction the intravascular presence of thrombin-like activity is accepted four hours after the “provocative” endotoxin injection.

SEASONAL ADJUSTMENTS IN CAPTURED WILD NORWAY RATS: III. PRODUCTION OF ADRENAL STEROIDS IN VITRO

1963 ◽  
Vol 41 (1) ◽  
pp. 1147-1153
Author(s):  
J. S. Willmer ◽  
O. Héroux
Keyword(s):  
Environmental Conditions ◽  
Rattus Norvegicus ◽  
Seasonal Effect ◽  
Seasonal Adjustment ◽  
Adrenal Steroids ◽  
Steroid Secretion ◽  
Adrenal Steroid ◽  
White Rats ◽  
Norway Rats

The in vitro adrenal steroid secretion of wild Norway rats (Rattus norvegicus) captured during the winter differed in quantity, but not in quality, from that of similar rats captured during the summer. Whereas there was no evident seasonal effect on adrenal weight either in males or in females, adrenals of both sexes secreted at a faster rate during the winter than during the summer, this increase involving the four groups of steroids characterized chromatographically during both seasons and in both sexes; the predominant steroid secreted was corticosterone. This seasonal adjustment in adrenal activity is similar to that observed in white rats kept in group cages exposed outdoors to the natural summer and winter environmental conditions, but it differs from that found in white rats cold-acclimated in the laboratory, in which adrenal activity is lower than normal after cold acclimation.

scholarly journals The Generalized Shwartzman Reaction and Haemophilus Infections in Pigs

1967 ◽  
Vol 4 (3) ◽  
pp. 245-253 ◽  
Author(s):  
K. Nordstoga ◽  
M. Fj⊘lstad
Keyword(s):  
Bacterial Endotoxin ◽  
Vascular Lesions ◽  
Cortical Necrosis ◽  
Renal Cortical Necrosis ◽  
Haemophilus Parainfluenzae ◽  
Shwartzman Reaction ◽  
Fibrinoid Degeneration

Four pigs were injected intravenously twice at a 24-hour interval with disintegrated cells of Haemophilus parainfluenzae and killed 24 h later. Two of the pigs developed bilateral renal cortical necrosis (BCN) and renal and extrarenal vascular lesions characterized by fibrinous thrombosis and fibrinoid degeneration. The BCN is interpreted as being the result of a generalized Shwartzman reaction to bacterial endotoxin. The experiment supports the view that the vascular lesions accompanying outbreaks of Haemophilus infections in swine are due to a generalized Shwartzman reaction.

STUDIES ON HUMAN ADRENAL STEROIDS: 1. THE EFFECT OF CORTICOTROPIN ON COMPONENTS OF THE FREE AND CONJUGATED PLASMA C2l ADRENAL STEROID FRACTIONS

1956 ◽  
Vol 34 (2) ◽  
pp. 146-157 ◽  
Author(s):  
C. M. Southcott ◽  
S. K. Gandossi ◽  
A. D. Barker ◽  
H. E. Bandy ◽  
Hamish McIntosh ◽  
...  
Keyword(s):  
Individual Variation ◽  
Preliminary Data ◽  
Plasma Levels ◽  
Adrenal Steroids ◽  
Adrenal Steroid ◽  
Peripheral Plasma ◽  
Before And After ◽  
Normal Human ◽  
Considerable Individual Variation

The free and conjugated adrenal steroid fractions of peripheral plasma from12 normal human males were studied. Specimens were withdrawn before and after the administration of corticotropin. Hydrocortisone was identified chemically and some evidence was obtained for the presence of corticosterone. Hydrocortisone levels showed a marked but variable increase after corticotropin treatment. In some cases the administration of corticotropin resulted in the appearance of an unconjugated compound which may have been a tetrahydro derivative of cortisone or hydrocortisone. A method for studying the conjugated fraction was developed and preliminary data indicated that four components were present in some specimens after hydrolysis with β-glucuronidase. The level of these conjugates appeared to increase after treatment with corticotropin. In general, the response to a given dose of corticotropin showed considerable individual variation in the plasma levels of the components of both the free and conjugated corticosteroid fractions.

Prevention Of Shwartzman’S Phenomenon In Factor XIII Deficiency

1981 ◽  
Author(s):  
Soo Young Lee ◽  
Sung Keun Chang ◽  
Soo II Chung
Keyword(s):  
Factor Xiii ◽  
Rabbit Platelet ◽  
Factor Xiii Deficiency ◽  
Platelet Factor ◽  
Cortical Necrosis ◽  
Rate Of Increase ◽  
Shwartzman Reaction

Cross-linked clots formed in vitro are reported to be more resistant to fibrinolysis but the relevance of these observations to the situation in vivo is uncertain. The possible role of Factor XIII in the formation of diffuse intravascular fibrin deposition was examined in experimentally induced Factor XIII deficient rabbits. Factor XIII deficiency was induced by intravenous infusion of IgG isolated from goat anti-rabbit platelet Factor XIII. Control received normal goat IgG. The Shwartzman reaction was produced by two injections of bacterial endotoxin given 24 hours apart.The most striking histological differences were observed after 48 hours. A large number of glomerular loops were enlarged and engorged with red blood cells and platelet- fibrin thrombi; extensive bilateral cortical necrosis was observed in 8 out of 10 endotoxin injected control rabbits but none in the Factor XIII deficient group.Fibrinogen levels in control rabbits were increased 3-4 fold (1.1g/100 ml), at 24 hours and slightly decreased at 48 hours after endotoxin injection, whereas in Factor XIII deficient animals, the rate of increase was slower but reached similar levels at 48 hours. Fibrinolytic activity in vivo, studied by the degradation of infused 125I-fibrinogen, was significantly increased in both endotoxin injected groups, irrespective of Factor XIII levels.These results strongly suggest that cross-linked thrombi are more resistant to fibrinolysis in vivo as well as in vitro.

scholarly journals PLATELETS AND THE SHWARTZMAN PHENOMENON

1965 ◽  
Vol 121 (2) ◽  
pp. 235-246 ◽  
Author(s):  
Jack Levin ◽  
Leighton E. Cluff
Keyword(s):  
Intravenous Injection ◽  
Renal Lesions ◽  
Shwartzman Reaction ◽  
Hemorrhagic Lesion ◽  
Shwartzman Phenomenon

Studies are reported on the effect of immunologically induced thrombocytopenia upon the local and generalized Shwartzman phenomena. Intravenous injection of antiplatelet serum to rabbits produced profound but transient thrombocytopenia unaccompanied by significant changes in circulating leucocytes. Platelet antiserum alone given to rabbits prepared with thorotrast produced renal lesions characteristic of the Shwartzman reaction. Thrombocytopenia induced by platelet antiserum did not inhibit the cutaneous hemorrhagic lesion of the local Shwartzman phenomenon produced by sequential injections of endotoxin intracutaneously and intravenously. The implications of these observations in the pathogenesis of the local cutaneous and generalized Shwartzman reaction are discussed.

scholarly journals A HYPERCALCEMIC CRISIS FOLLOWING ABRUPT DISCONTINUATION OF LONG TERM ADRENAL STEROID THERAPY

1968 ◽  
Vol 57 (1) ◽  
pp. 105-112
Author(s):  
Yotaro HURUKAWA ◽  
Chikashi SASAKI ◽  
Toshio OTOMO ◽  
Tsutomu TAKAWA ◽  
Isao Miwa ◽  
...  
Keyword(s):  
Steroid Therapy ◽  
Adrenal Steroid ◽  
Hypercalcemic Crisis ◽  
Abrupt Discontinuation
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