1/167. 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 = intravascular coagulation, intravascular, coagulation (Clic here for more details about this article) |
2/167. 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 = 0.19702913505238keywords = intravascular coagulation, intravascular, coagulation, consumption (Clic here for more details about this article) |
3/167. Extensive late-onset primary subarachnoid hemorrhage in a preterm infant.Primary subarachnoid hemorrhage is a rare event in the preterm infant and is most often diagnosed at the postmortem examination. An extremely preterm infant who developed septicemia from staphylococcus aureus infection in the second postnatal week and presented with hypotension, metabolic acidosis, anemia, thrombocytopenia, and seizures is reported. Cranial ultrasound revealed a large extra-axial fluid collection involving the left parietal cortex that at postmortem examination was observed to be a large left-sided primary subarachnoid hemorrhage. The subarachnoid hemorrhage is most likely secondary to events associated with septic shock and probable disseminated vascular coagulopathy.- - - - - - - - - - ranking = 0.0034074484743406keywords = coagulopathy (Clic here for more details about this article) |
4/167. 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 = 0.39971442739111keywords = intravascular coagulation, intravascular, coagulation (Clic here for more details about this article) |
5/167. 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 = 0.19545025865072keywords = intravascular coagulation, intravascular, coagulation (Clic here for more details about this article) |
6/167. Sternal osteomyelitis and mediastinitis after open-heart operation: pathogenesis and prevention.Sternal osteomyelitis and mediastinitis caused by pseudomonas cepacia developed in a patient undergoing coronary artery bypass two weeks after the operation. P. cepacia bacteremia from a contaminated pressure transducer had preceded and probably caused the chest infection. While other authors have suggested that postoperative sternal osteomyelitis and mediastinitis result from local wound contamination, this case suggests the importance of bacteremia as a cause of such gram-negative infections. Since patients undergoing open-heart operation are exposed to many sources of bacteremia, prevention of severe postoperative chest infections may depend in large part on careful preoperative evaluation of each patienc antibiotic regimens, and, as shown in this patient, on very thorough periodic review of equipment sterilization and intravascular monitoring practices.- - - - - - - - - - ranking = 0.013934796656735keywords = intravascular (Clic here for more details about this article) |
7/167. Clostridial sepsis: is death avoidable?Massive intravascular hemolysis is a rare yet often fatal complication of clostridial sepsis. The only chance for survival is an early diagnosis and prompt initiation of treatment. We report a rapidly fatal case who developed electrocardiographic changes of acute myocardial injury. autopsy showed gas-filled bubbles and cysts in the myocardium partially filled with sporulating bacilli with the morphology of clostridia. Gas filled bubbles were also present in the lungs, liver, kidneys and spleen. The gastric mucosa showed hemorrhagic and necrotizing changes, the probable site of entry of the infection.- - - - - - - - - - ranking = 0.013934796656735keywords = intravascular (Clic here for more details about this article) |
8/167. 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 = 0.0088139100896698keywords = coagulation (Clic here for more details about this article) |
9/167. 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 = 0.19545025865072keywords = intravascular coagulation, intravascular, coagulation (Clic here for more details about this article) |
10/167. sepsis and multiple brain abscesses caused by salmonella paratyphi b in an infant: successful treatment with sulbactam-ampicillin and surgical drainage.abscess formation by Salmonella species is an uncommon but significant manifestation of salmonellosis, because this type of infection has high morbidity and mortality rates and is a potential nosocomial hazard. In infants, history of consumption of contaminated water should be especially quired. We report a case who had sepsis and multiple brain abscesses due to salmonella paratyphi b and who responded to sulbactam-ampicillin (SAM) therapy. sulbactam-ampicillin combination may be preferable due to its immunomodulator effect.- - - - - - - - - - ranking = 0.0015788764016614keywords = consumption (Clic here for more details about this article) |
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