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 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An analysis of seven sporadic cases of Legionnaires' disease confirmed clinical features recorded during epidemics and identified aspects of the illness either unreported or not emphasized. Four patients had central nervous system abnormalities. Mental status changes included somnolence, obtundation, delirium, disorientation, and confusion. Three patients experienced visual hallucinations, and one patient without pneumonia had a grand mal seizure with residual memory deficit. Two patients had disseminated intravascular coagulation with thrombocytopenia, elevated split fibrin products, and prolonged partial thromboplastin and prothrombin times. Four patients had severe hypoxia; one patient had an exudative pleuritis. One patient whose treatment included erythromycin had radiologic improvement of his pneumonia despite deteriorating ventilatory function that led to death. The concept of Legionnaires' disease as a severe, diagnostically perplexing pneumonic illness is valid but too narrow. The emerging spectrum is that of a multisystem disease that, besides the lungs, often involves the central nervous system and can be accompanied by disseminated intravascular coagulation.
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PMID:Sporadic cases of Legionnaires' disease: the expanding clinical spectrum. 43 28

Two patients exposed during surgery to bovine thrombin developed antibodies reacting with both bovine and human thrombin and Factor V. Their thrombin times were markedly prolonged with bovine thrombin and modestly prolonged with human thrombin. High titer anti-bovine Factor V created diagnostic confusion in one patient by neutralizing bovine Factor V in a prothrombin assay substrate. Although weaker, antibody activity against human Factor V led to postoperative factor V deficiency in both patients. Such cross-reacting antibodies, recognizable by their higher titer against bovine than human Factor V, should be suspected when a patient surgically exposed to bovine thrombin develops a Factor V anticoagulant after operation. Crossed immunoelectrophoresis of adsorbed bovine plasma with each patient's plasma as antibody revealed many precipitin arcs indicative of immunization of the patients to additional proteins in a commercial thrombin preparation.
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PMID:Clinical significance of antibodies to bovine and human thrombin and factor V after surgical use of bovine thrombin. 172 69

Forty-two patients with proven intra-abdominal sepsis were studied in a prospective clinical trial. The following parameters were evaluated: (1) Nine parameters on admission: age, sex, obesity, malnutrition, history of cardiac, respiratory or renal disease, diabetes mellitus and malignant neoplasia. Four of these parameters had a prognostic value (p less than 0.05): age 65 years, diabetes mellitus and cardiac disease. (2) Thirty parameters representing the functional status of six organic systems during sepsis: respiratory, cardiovascular, nervous, kidneys, blood coagulation, liver. Six of these parameters had a prognostic values: PEEP 0-10 cm H2O to keep PaO2 greater than 60 mmHg (p less than 0.001), serum creatinine greater than 3.6 mg/dl (p less than 0.01), prothrombin time greater than 15'' or platelet count less than 100,000/mm3 (p less than 0.001), need of vasoconstrictive drug to keep arterial pressure greater than 100 mmHg (p less than 0.001), bilirubin greater than 3 mg/dl (p less than 0.01) and mental confusion. The combination of these ten statistically significant prognostic criteria for each patient showed that the mortality was 0 with 0-2 criteria, 36% with 3-5 criteria, 94% with 6-8 criteria and 100% with 8-10 criteria. Patients with more than five of these criteria had a significant higher mortality risk (p less than 0.001).
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PMID:Prognostic criteria in intra-abdominal sepsis. 367 39

The clinical syndrome of "shock liver," also known as ischemic hepatitis, is characterized by sudden elevation (to more than 20 times the upper limit of normal) of SGOT and SGPT in response to cellular anoxia, followed by resolution to near normal levels within seven to ten days. In our experience with ten cases, systemic hypotension was documented in only four, but processes characterized by decreased cellular perfusion were identified in all and included cardiac failure or arrhythmia, sepsis, cerebrovascular accidents, renal failure, and chronic obstructive pulmonary disease. We were also able to document the transient rise in serum bilirubin and alkaline phosphatase levels and prolonged prothrombin time that followed the transaminase elevations by 24 to 48 hours in most cases, followed by rapid resolution. In neither of the two cases in which tissue was available by biopsy after resolution of the biochemical abnormalities did we find the classic histologic picture of necrosis in zone 3 ("centrilobular necrosis"). The clinical picture of shock liver is so characteristic and resolves so rapidly that there should be no confusion with other causes of marked elevations of transaminase levels.
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PMID:Shock liver. 407 Nov 67

Two sets of prognostic indicators were recently proposed for selection of patients with acute liver failure for emergency liver transplantation. According to the London criteria, patients with non-paracetamol-induced acute liver failure should be referred for liver transplantation when the prothrombin time is > 100 s or when any three of the following prognostic indicators are present: age < 10 or > 40 yr; non-A, non-B hepatitis, halothane hepatitis or idiosyncratic drug reaction; duration of jaundice before onset of encephalopathy > 7 days; prothrombin time > 50 s; serum bilirubin > 300 mumol/l. According to the Clichy criteria, in acute viral hepatitis, liver transplantation should be decided in patients with coma or confusion, and Factor V < 20% (age < 30 yr) or < 30% (age > 30 yr). To assess the accuracy of these criteria, 81 non-transplanted patients with non-paracetamol-induced acute liver failure were retrospectively studied. The mortality rate was 0.81. The predictive accuracies, respectively on admission and 48 h before death, were 0.80 and 0.79 for the London criteria, and 0.60 and 0.73 for the Clichy criteria. The positive and negative predictive values, 48 h before death, were 0.89 and 0.47 for the London criteria, and 0.89 and 0.36 for the Clichy criteria, respectively. In the 49 patients with acute viral liver failure, the results of the Clichy criteria were similar. In a subgroup of 24 patients who had not received either fresh frozen plasma or sedative-hypnotic drug, the positive predictive values were equal to 1 for the two sets of prognostic indicators, but the predictive accuracies only slightly increased.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Emergency liver transplantation for acute liver failure. Evaluation of London and Clichy criteria. 844 7

Five newly developed instruments for five routine blood coagulation tests including prothrombin time, APTT, thrombotest, normotest and fibrinogen assay and the other specialized tests were introduced by each manufacturer. In four instruments, the principal of clot detection is based on the change of optical density due to fibrin thread. One instrument detects viscosity change. All instruments were easy to use due to full-automation, and the precision and accuracy in one laboratory use were high in quality. There were difficult problems when a user switches from the reagent recommended by the manufacturer to another commercially available one. The user needs to re-evaluate the standard curve using international reference plasma. In Japan, international normalized ratio (INR) presentation of prothrombin time is not common even in a large scale laboratory. When a patient with warfarin moves to another hospital, the presentation of prothrombin time from the former laboratory can not be used because of the difference in reagent and equipment. Much confusion concerning prothrombin time occurred due to differences in reagent and equipment after the Hanshin-Awaji earthquake. Many patients taking warfarin had to evacuate under severe stress condition, and had prothrombin time out of the optimal therapeutic range not knowing whether it was due to quake-stress or intra-laboratory difference. Selection of automated coagulation instrument which can easily print out the INR in prothrombin time is recommended.
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PMID:[Some aspects of newly developed instruments for blood coagulation tests]. 856 30

A retrospective case note review was undertaken to assess the clinical significance of hepatic dysfunction with jaundice in typhoid fever. Of the 57 patients, 21 (36.8%) had jaundice, while 36 (63.2%) did not have jaundice. Significantly higher proportions of jaundiced patients were females (P = 0.04). Confusion (P = 0.01), upper abdominal pain (P = 0.02), right upper quadrant tenderness (P = 0.0001), and low prothrombin index (P = 0.04) were statistically significant occurrences in jaundiced patients on admission. Admission mean values of serum bilirubin (P = 0.0001), gamma-glutamyltranspeptidase (GGT; P = 0.009), and alanine aminotransferase (ALT; P = 0.0005) were significantly higher in icteric patients while mean values of total serum protein (P = 0.0009) and albumin (P = 0.0001) were significantly higher in anicteric patients. There were no deaths. Glomerulonephritis occurred significantly (P = 0.001) more frequently in icteric patients. It is concluded that hepatic dysfunction with jaundice in typhoid fever indicates more severe hepatic injury, which may precipitate the development of clinically detectable glomerulonephritis.
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PMID:Clinical significance of hepatic dysfunction with jaundice in typhoid fever. 1008 Jan 55

Acute hepatic failure is a rare and serious complication of severe falciparum malaria. The management of uncomplicated falciparum malaria comprises of specific antimalarial drugs and supportive therapy. In a few patients who are critically ill because of severe falciparum malaria and heavy parasitaemia, exchange transfusion has been used. We describe a young male Saudi patient who presented with a 2-day history of fever, jaundice, and confusion. On examination he was deeply jaundiced, confused, and irritable. There were no signs of chronic liver disease. His laboratory workup revealed a markedly raised direct hyperbilirubinaemia and transaminases with prolonged prothrombin time. His serology was negative for HbsAg, HBc IgM, anti-HCV, HAV IgM, HEV IgM, and IgG. He was initially treated with parenteral quinine and other supportive treatment, without any improvement of his clinical and laboratory parameters. At this stage he was treated with whole blood exchange transfusion. He slowly improved, with complete normalization of his liver function tests and prothrombin time.
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PMID:Usefulness of exchange transfusion in acute liver failure due to severe falciparum malaria. 1071 80

Included among the more than 300 species of elapid snakes worldwide is the Australian genus Demansia, or whip snakes. Despite evidence to suggest adverse clinical outcomes from envenomation by these snakes, together with confusion on their true phylogenetic relationship to other Australian elapids, not a single toxin sequence has previously been reported from the venom of a Demansia species. We describe here a combined proteomic and transcriptomic approach characterizing the venom from the black whip snake, Demansia vestigiata. A total of 13 distinct toxin families were identified, including homologues of all of the major toxic components previously reported from the venom of other Australian elapids, such as factor X-like prothrombin activators, neurotoxins, phospholipases, cysteine rich secretory proteins, textilinin-like molecules, nerve growth factors, l-amino acid oxidases, vespryns, 5' nucleotidases, metalloproteinases, and C-type lectins as well as a novel dipeptidyl peptidase family. Phylogenetic analysis of these sequences revealed an early evolutionary split of the black whip snake from all other characterized Australian snakes, with a low degree of sequence identity between D. vestigiata and the other snakes, across all toxin families. The results of this study have important implications not only for the further characterization of venom from whip snakes, but also for our understanding of the evolutionary relationship of Australian snake species.
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PMID:Diversity of toxic components from the venom of the evolutionarily distinct black whip snake, Demansia vestigiata. 1760 13

A 76 year old white-female initially presented with signs and symptoms of acute hepatitis. While liver function tests were elevated, viral hepatitis and autoimmune hepatitis panels were negative. The patient was subsequently discharged on the 4th day of hospitalization when her condition appeared to stabilize. Four weeks later she was readmitted to the hospital, this time with signs and symptoms of acute liver failure with ascites, confusion, and jaundice. A liver biopsy was performed with pathology suggestive of an autoimmune etiology despite the negative autoimmune antibody panel. She was diagnosed with cryptogenic autoimmune hepatitis. The patient was placed on intravenous steroids and later oral prednisone that resulted in the resolution of the liver failure and disappearance of the encephalopathy along with a downward trend of the liver enzymes, bilirubin and the prothrombin time. One year later, the liver enzymes had normalized and the autoimmune disease remained in remission with maintenance medications consisting of low dose prednisone and azathioprine.
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PMID:Cryptogenic hepatitis: a case study in autoantibody negative autoimmune hepatitis. 2228 15


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