1/37. disseminated intravascular coagulation in a patient treated with strontium-89 for metastatic carcinoma of the prostate.strontium-89 is effective in the palliation of bone pain caused by skeletal metastases. Its primary side effect is mild thrombocytopenia that typically recovers in 3 or 4 months. Subclinical disseminated intravascular coagulation is reported to be present in approximately 10% to 20% of patients with advanced prostate cancer. These patients may be at increased risk for severe marrow depression after radionuclide therapy for bone pain palliation. This report describes a patient with painful bony metastases resulting from prostate carcinoma. He had a normal platelet count and no clinical evidence of a coagulation disorder at the time of strontium-89 therapy, and a severe disseminated intravascular coagulation developed and lead to death after treatment. A normal platelet count before strontium-89 therapy does not preclude subsequent disseminated intravascular coagulation, and we support the Society of nuclear medicine's bone pain treatment procedure guideline that patients referred for bone palliation should be screened for disseminated intravascular coagulation before therapy.- - - - - - - - - - ranking = 1keywords = intravascular coagulation, intravascular, coagulation (Clic here for more details about this article) |
2/37. Acquired factor viii inhibitor associated with prostatic cancer: successful treatment with steroid and immunosuppressive therapy.factor viii inhibitors are antibodies of the IgG class that block functional epitopes or antigenic sites of factor viii. They occur in about 5-20% of hemophilia a patients after infusions of factor viii concentrate. antibodies to factor viii can also arise spontaneously in association with various autoimmune and chronic inflammatory diseases, hematologic malignancies, solid tumors, certain drugs, dermatologic conditions, and in puerperium. In the majority of cases, the clinical course is characterized by severe hemorrhages. Strategies to treat such inhibitors are controversial. We present the case of a patient with prostatic cancer who developed acquired factor viii inhibitor. His severe bleeding complications were treated successfully with cyclophosphamide in combination with methylprednisolone. Within a few months, moreover, the immunosuppressive therapy brought about complete disappearance of the inhibitor and normalization of coagulation parameters. Our case illustrates that, although the clinical course in patients with acquired factor viii inhibitor is not predictable, and the inhibitor may disappear spontaneously, combined therapy with cyclophosphamide and methylprednisolone should be considered for patients with severe hemorrhages.- - - - - - - - - - ranking = 0.0066936768723259keywords = coagulation (Clic here for more details about this article) |
3/37. Increased warfarin sensitivity as an early manifestation of occult prostate cancer with chronic disseminated intravascular coagulation.Increased sensitivity to warfarin anticoagulation is usually attributed to liver disease, vitamin k deficiency, or drug interactions. We describe a patient with unexplained sensitivity to warfarin and mildly elevated prostate-specific antigen levels in whom subsequent developments indicated that warfarin sensitivity was the first manifestation of occult prostatic cancer. A review of all published cases of coagulopathy associated with cancer of the prostate shows that, unlike other solid tumors with secondary disseminated intravascular coagulation (DIC), in prostate cancer increased bleeding is more common than thrombotic phenomena. Chronic DIC due to occult prostate cancer should be included in the differential diagnosis of excessive prothrombin time prolongation in patients receiving anticoagulants.- - - - - - - - - - ranking = 0.63060910394477keywords = intravascular coagulation, intravascular, coagulation, coagulopathy (Clic here for more details about this article) |
4/37. disseminated intravascular coagulation and PC-SPES: a case report and literature review.BACKGROUND: PC-SPES is a herbal remedy gaining acceptance amongst prostate cancer patients and health care providers due to credible laboratory and clinical studies. However, PC-SPES has not been assessed in the standard rigorous approval process mandated for conventional agents. OBJECTIVES: To present a case of a patient with prostate cancer who, while using PC-SPES, developed disseminated intravascular coagulation (DIC). A review of the literature was conducted to determine if there is a relationship between PC-SPES and hemorrhagic disorders. methods: Searches were conducted in medline (1966-December 2000) and the Cochrane Collaboration's database. RESULTS: There are 116 clinical and laboratory based studies of PC-SPES published to date. There are no randomized controlled trials. Clinical studies have demonstrated a significant reduction in prostate specific antigen (PSA) levels within 6 weeks. Improved quality-of-life, reduction in the volume of tumor deposits and reduction in analgesic use has been demonstrated in hormone refractory patients. Laboratory studies suggest that the beneficial effects of PC-SPES are unrelated to physiologic estrogens. However, PC-SPES has a side-effect profile similar to diethylstilbestrol. There is data demonstrating a <5% risk of thromboembolic events, but this is the first report of DIC. CONCLUSION: The study of PC-SPES is in its infancy. This case may serve as a cautionary note to health care providers and patients regarding herbal remedies. Those using PC-SPES should have an increased level of surveillance for bleeding disorders.- - - - - - - - - - ranking = 0.6208164519548keywords = intravascular coagulation, intravascular, coagulation (Clic here for more details about this article) |
5/37. ketoconazole and flutamide in the treatment of disseminated intravascular clotting from prostate cancer: a case report and review.Disseminated intravascular clotting (DIC) is a well-recognized complication of malignancy. Prostatic cancer can produce chronic DIC as well as acute severe DIC. Treatment of DIC are general supportive measures including heparin, transfusion of blood, platelets and clotting factors, but the most important aspect is correction of underlying malignant diseases i.e. cancer of the prostate gland. For metastatic prostatic cancer presenting with an emergency oncologic condition, the treatment of choice is surgical orchiectomy, but surgery may not be possible in the presence of severe DIC. ketoconazole and flutamide are drugs with different mechanisms for hormonal manipulation of this cancer. Due to severe DIC, we combined both drugs trying to put maximum therapeutic effect on this life threatening profound DIC patient.- - - - - - - - - - ranking = 0.040224868207855keywords = intravascular (Clic here for more details about this article) |
6/37. Microscopic pulmonary tumor embolism secondary to adenocarcinoma of the prostate.We report a case of pulmonary tumor embolism involving multiple emboli from an unusual site, an adenocarcinoma of the prostate. A 78-year-old Japanese man was diagnosed with stage IV (1997 version of the TNM classification) moderately differentiated adenocarcinoma of the prostate in December 1997. He underwent bilateral orchiectomy and hormonal therapy with flutamide was started. The patient suffered from relapse in April 1998, and estramustine phosphate was administered as treatment for hormone-refractory prostate cancer. He noticed a dry cough in May 1998, and on June 13, he developed acute progressive dyspnea and was admitted to our hospital. Radiological findings, blood gas analysis, and clinical symptoms suggested pulmonary thrombosis. Despite anticoagulation and oxygen therapy, he remained severely dyspnoeic. He died of respiratory failure 4 days after admission. autopsy confirmed dissemination of poorly differentiated adenocarcinoma of the prostate to the majority of the pulmonary muscular arteries.- - - - - - - - - - ranking = 0.0066936768723259keywords = coagulation (Clic here for more details about this article) |
7/37. Periprostatic subendothelial intravascular granulomatosis: a mimic of high-grade intravascular prostatic adenocarcinoma.A rare case of intravascular granulomatous inflammation mimicking intravascular prostatic adenocarcinoma is reported. To the author's knowledge, there have been no previous reports of prostatic or periprostatic intravascular granulomatous inflammation. A 67-year-old man presented with elevated serum prostate specific antigen (PSA) and was found to have a high-grade adenocarcinoma of the prostate. A radical prostatectomy revealed intravascular subendothelial granulomatous inflammation mimicking vascular invasion of a high-grade adenocarcinoma found elsewhere in the prostate. Immunoperoxidase stains confirmed that the subendothelial infiltrate was composed of histiocytes and not tumor cells. Periprostatic subendothelial intravascular granulomatosis is a rare event, which may mimic vascular involvement of high-grade prostatic adenocarcinoma and may result from a previous needle biopsy of the prostate. Possible mechanisms for this finding are discussed. It is important to distinguish this process from high-grade prostatic adenocarcinoma involving blood vessels for obvious clinical reasons.- - - - - - - - - - ranking = 0.10458465734042keywords = intravascular (Clic here for more details about this article) |
8/37. Coagulopathy in prostate cancer.patients with metastatic hormone-refractory prostate carcinoma may have dramatic and life-threatening coagulation complications from their disease. We report here the case of a man with relapsing disseminated intravascular coagulation, and review the different coagulation disorders that may occur during prostatic carcinoma evolution. We focus mainly on disseminated intravascular coagulation (DIC), the most frequent coagulation complication. Other coagulopathies associated with prostate cancer are thrombocytopenic thrombotic purpura, thrombosis, Trousseau's syndrome and acquired factor viii inhibitor development.- - - - - - - - - - ranking = 0.2684076113989keywords = intravascular coagulation, intravascular, coagulation (Clic here for more details about this article) |
9/37. Direct evidence for systemic fibrinogenolysis in a patient with metastatic prostatic cancer.Although the possible occurrence of systemic fibrinogenolysis has been suggested in patients with metastasising prostatic cancer (MPC), direct evidence is lacking. We report on a patient with MPC whose laboratory data were consistent with hyperfibrinolysis: marked decrease of alpha 2-antiplasmin (AP) level (less than 50% of normal), increase of plasmin-alpha 2-antiplasmin complex, D-fragment of fibrin and fibrinogen degradation products [FDP(D)] and cross-linked fibrin degradation products (XDP). The patient neither showed laboratory nor clinical evidence for consumption coagulopathy except for a slight increase in thrombin-antithrombin iii complex level. immunoblotting of the patient's serum using an anti-fibrinogen antibody revealed the presence of a 250 kDa protein in addition to DD fragments. Following reduction of this protein by 2-mercaptoethanol after extraction from SDS-PAGE gel, gamma-chain of fibrinogen (47 kDa) was found by immunoblotting using a monoclonal antibody recognising a 86-302 residue of the gamma-remnant of fibrinogen. Moreover, the 250 kDa protein did not bind to sepharose 4B to which a monoclonal antibody recognising the N-terminus of fragment D was conjugated. These findings indicated that this protein was not fragment DY, but rather fibrinogen fragment X. With the retraction of the prostatic tumour by an effective therapy, the patient's AP level increased gradually. When the plasma AP level rose to 60% of normal, the fragment X was no longer detectable. These findings suggested that systemic fibrinogenolysis occurred in the patient with MPC only when AP levels were markedly decreased.- - - - - - - - - - ranking = 0.0030989751176483keywords = coagulopathy (Clic here for more details about this article) |
10/37. Orbital haemorrhage with loss of vision in a patient with disseminated intravascular coagulation and prostatic carcinoma.A 65-year-old man with sudden profound loss of vision in his right eye due to sub-periosteal orbital haemorrhage was found to have disseminated intravascular coagulation (DIC) secondary to metastatic prostatic carcinoma. CT-scan did not reveal any orbital metastases. A lateral canthotomy did not help to restore the vision. Orbital haemorrhage is known to occur with DIC due to different causes. To the best of our knowledge this is the first report of orbital haemorrhage with DIC related to prostatic carcinoma. This case emphasises the importance of considering systemic factors in cases of non-traumatic haemorrhage, along with imaging studies to rule out any co-existing vascular anomaly.- - - - - - - - - - ranking = 0.6208164519548keywords = intravascular coagulation, intravascular, coagulation (Clic here for more details about this article) |
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