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March 30, 1963

Ischemic Necrosis of Multiple Organs in Prolonged Shock

Author Affiliations


From the departments of pathology and surgery, Chicago Wesley Memorial Hospital, and Northwestern University Medical School.; Dr. Haber and Dr. Schneider are Postdoctoral Fellows in Pathology. Dr. Brown is Chief Resident in Surgery, Chicago Wesley Memorial Hospital.

JAMA. 1963;183(13):1107-1109. doi:10.1001/jama.1963.63700130023017

CIRCULATORY FAILURE may be further aggravated by the use of vasopressor amines in the management of shock.1 Reversible shock may be converted to an irreversible state, and treatment directed at blood pressure elevation utilizing these agents may result in multiple foci of necrosis in visceral organs in the absence of demonstrable vascular occlusion.2,3 The histories presented are of two patients in whom, after prolonged shock, ischemic necrosis of the liver, intestines, and spleen was found at autopsy. A concept of the development of these lesions is presented.

Report of Cases 

Case 1.—  A 46-yr-old female with established rheumatic mitral valvular disease entered Chicago Wesley Memorial Hospital for a mitral valvuloplasty. Interpretation of a cardiac catheterization done 1 week prior to surgery indicated that she was suffering from severe mitral stenosis with mild insufficiency. Right-heart-catheterization data suggested tricuspid insufficiency and right-heart failure.A mitral commissurotomy was performed and

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