1/114. Trauma, sepsis, and disseminated intravascular coagulation.disseminated intravascular coagulation (DIC) was first observed clinically in a case of sepsis following severe trauma. It was postulated that the observed clotting defect and bleeding were due to the using up of clotting factors in an episode of intravascular clotting. It was also postulated that the multiple organ failure observed was due to obstruction of the microcirculation of the organs by microclots. Evidence for this process was worked out in many animal studies. It was then postulated that if these microclots could be lysed before organ necrosis was produced, organ failure could be prevented. This prevention was shown to be possible in animals. It was then tried in humans using plasminogen activators, and the approach was found to be effective. Using a low dose of plasminogen activator over a 24-hour period caused no changes in the coagulation profile or bleeding.- - - - - - - - - - ranking = 1keywords = coagulation (Clic here for more details about this article) |
2/114. vibrio cholerae O2 sepsis in a patient with AIDS.vibrio cholerae strains other than O1 and 0139 (non-O1 vibrio cholerae) are associated with sporadic diarrheal disorders and limited outbreaks of diarrhea and have often been reported in association with extraintestinal infections. The following is a presentation of a fatal case of non-O1 vibrio cholerae septicemia with disseminated intravascular coagulation and cutaneous bullous lesions that occurred in a patient infected with the acquired immunodeficiency syndrome. In order to prevent vibrio cholerae infection, patients with underlying diseases should be warned of the risk factors for acquiring such infection, including consumption of raw shellfish and exposure to sea and fresh water where shellfish are found.- - - - - - - - - - ranking = 0.16666666666667keywords = coagulation (Clic here for more details about this article) |
3/114. Fatal cerebroembolism from nonbacterial thrombotic endocarditis in a trauma patient: case report and review.Nonbacterial thrombotic endocarditis (NBTE) is a rare condition that may result in an unexpected and usually fatal cerebroembolism. It occurs in a variety of clinical situations, including malignancy, immune disorders, and sepsis, but it has rarely been reported after trauma. The formation of NBTE appears to require a hypercoagulable state and changes in valvular morphology, e.g., during a hyperdynamic state. patients with disseminated intravascular coagulation have a 21% incidence of NBTE. Although NBTE is usually found at autopsy, premorbid detection by echocardiography is currently possible and feasible. Untreated patients have a high incidence of embolic events, but anticoagulation with heparin may be life-saving. A lethal case of NBTE in a severely injured patient is reported here with the purpose of increasing awareness among medical personnel caring for trauma patients. Recommendations have been made for surveillance echocardiography in high-risk patients, e.g., critically ill patients with sepsis or disseminated intravascular coagulation.- - - - - - - - - - ranking = 0.5keywords = coagulation (Clic here for more details about this article) |
4/114. kasabach-merritt syndrome with terminal gram negative infection.A case of giant haemangioma with disseminated intravascular coagulation (Kasabach-Merritt) syndrome) is presented. death occurred despite therapy and postmortem evidence of clinically unrecognised gram negative bacteraemia was seen.- - - - - - - - - - ranking = 0.16666666666667keywords = coagulation (Clic here for more details about this article) |
5/114. fludrocortisone for the treatment of heparin-induced hyperkalemia.OBJECTIVE: To report the use of fludrocortisone for heparin-induced hyperkalemia and to briefly review the available literature relating to heparin-induced hyperkalemia. CASE SUMMARY: A 34-year-old African-American man was admitted to the hospital for pneumococcal pneumonia and sepsis. His hospital course was complicated by the development of acute respiratory distress syndrome, severe sepsis, acute renal failure, placement of a tracheostomy, and recurrent nasopharyngeal bleeding. The patient also developed a subclavian vein thrombosis with extension to the cephalic and basilic veins secondary to placement of a pulmonary artery catheter; anticoagulation with heparin was required. On day 9 of heparin therapy, the patient developed symptomatic hyperkalemia refractory to conventional therapies. Oral fludrocortisone 0.1 mg/d was initiated with resolution of the hyperkalemia within 24 hours despite the continued administration of heparin. DATA SOURCES: A medline (1966-October 1999) search was performed to identify case reports and clinical trials discussing heparin-induced hyperkalemia or the use of fludrocortisone for hyperkalemia. DISCUSSION: heparin has the potential to induce hyperkalemia by several mechanisms, including decreased aldosterone synthesis, reduction in number and affinity of aldosterone II receptors, and atrophy of the renal zona glomerulosa. fludrocortisone promotes potassium excretion by its direct actions on the renal distal tubules. In this patient, fludrocortisone resulted in a significant and rapid decrease in serum potassium even with continued heparin administration and acute renal failure. CONCLUSIONS: This case suggests that fludrocortisone is a reasonable alternative therapy for patients with hyperkalemia secondary to heparin therapy when the continued administration of heparin is necessary.- - - - - - - - - - ranking = 0.16666666666667keywords = coagulation (Clic here for more details about this article) |
6/114. Acute thrombocytopenic crisis following burns complicated by staphylococcal septicaemia.The pathophysiological changes in a burn patient can at times manifest as severe complications, the management of which can be extremely challenging to the burn surgeon. A case report of an adult male with burns (18% total body surface area) who developed an acute unexpected thrombocytopenia crisis (2x10(9) l(-1)) on day 3 followed by disseminated intravascular coagulation is presented. The various etiological factors and possible mechanisms leading to thrombocytopenia in burns are discussed. Minor burns may present acute major complications in the presence of other thrombocytopenic factors like trauma and sepsis and thrombocytopenia by it self can be a good indicator of sub-clinical infection.- - - - - - - - - - ranking = 0.16666666666667keywords = coagulation (Clic here for more details about this article) |
7/114. calciphylaxis associated with cholangiocarcinoma treated with low-molecular-weight heparin and vitamin K.calciphylaxis is a rare disorder of small-vessel calcification and cutaneous infarction associated with chronic renal failure. Rare cases of calciphylaxis not associated with chronic renal failure have been reported with breast cancer, hyperparathyroidism, and alcoholic cirrhosis. To our knowledge, we report the first case of calciphylaxis without chronic renal failure associated with cholangiocarcinoma and the first attempt to treat calciphylaxis with vitamin K. A 56-year-old woman presented with necrotic leg ulceration. She was treated initially with low-molecular-weight heparin, with no effect. A coagulation work-up showed vitamin k deficiency. During vitamin K therapy, the patient had fulminant progression of the calciphylaxis. She died, and an autopsy showed metastatic cholangiocarcinoma. thrombosis and protein c deficiency have been implicated in the pathophysiology of calciphylaxis. Functional protein c deficiency may be one of several factors contributing to the development of calciphylaxis. Vitamin K therapy was ineffective in our patient and may have been detrimental.- - - - - - - - - - ranking = 0.16666666666667keywords = coagulation (Clic here for more details about this article) |
8/114. Hyposplenic, coagulopathic, cryptogenetic pneumococcemia.An unusual case of sudden, fulminant pneumococcemia and disseminated intravascular coagulation occurred in a woman who had had incidental splenectomy 8 months previously, at the time of gastrectomy for duodenal ulcer. Similar cases in which there is constant relationship of splenectomy, pneumococcal sepsis, and waterhouse-friderichsen syndrome have been documented. Other similarities which are notable are a tendency for the disease to occur in women, lack of a nidus of infection, and proliferation of diplococci to numbers great enough to be seen easily on the peripheral blood smear.- - - - - - - - - - ranking = 0.16666666666667keywords = coagulation (Clic here for more details about this article) |
9/114. Successful thrombolytic therapy of pulmonary embolism associated with urosepsis in an infant.Childhood pulmonary embolism (PE) is a rare but serious condition marked by hypoxemia, shock, right-sided heart failure, and significant risk for fatality. Recommended treatment options include surgical embolectomy, anticoagulation, and thrombolysis. This report describes the successful use of recombinant tissue plasminogen activator to treat PE associated with urosepsis in a 34-day-old infant and reverse severe hemodynamic compromise. diagnosis of proximal PE and monitoring its treatment were successfully achieved by echocardiography.- - - - - - - - - - ranking = 0.16666666666667keywords = coagulation (Clic here for more details about this article) |
10/114. Acute promyelocytic leukemia in childhood. Report of a case with a review of the literature.A rare case of acute promyelcytic leukemia (APL) is reported in a 7-year-old boy. The patient displayed the typical features of APL including impaction of the marrow with promyelocytes, marked elevation of the serum vitamin B12 and transcobalamin I levels and a hemorrhagic diathesis. The bleeding diathesis in the case was due to thrombocytopenia, and there was no evidence for disseminated intravascular coagulation.- - - - - - - - - - ranking = 0.16666666666667keywords = coagulation (Clic here for more details about this article) |
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