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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

About 15% of patients with cancer have cerebrovascular lesions, resulting from 4 kinds of disorders sometimes intermingled in advanced disseminated cancer: coagulation disorders, direct effects of the tumor, infections and therapeutic measures. Infarction, hardly less frequent than hemorrhage, mostly complicates lymphoma and carcinoma. Hypercoagulation states, such as chronic disseminated intravascular coagulation, nonbacterial thrombotic endocarditis, and nonmetastatic cerebral venous thrombosis account for about 50% of cases. Tumor emboli, as seen in intravascular malignant lymphomatosis, arteritis related to aspergillus, granulomatous angiitis with or without herpes zoster and radiation-induced atherosclerosis are rarer. Cerebral hemorrhages, excluding bleeding from the metastases of choriocarcinoma and melanoma are mainly associated with leukemia by acute disseminated intravascular coagulation as in promyelocytic leukemia, by leukostasis or by pancytopenia. Both infarction and hemorrhage rarely reveal the neoplasia. Lesions are often small and disseminated, and therefore produce a picture of diffuse acute or subacute encephalopathy rather than acute focal deficits. Finally, there may be no relationship between the cerebrovascular event and the neoplasia, and atherosclerosis or traumatic subdural hematoma may well be the causal factor.
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PMID:[Cerebrovascular complications of cancers]. 130 55

To evaluate a recently developed latex photometric immunoassay (LPIA) that which can measure 40 samples quantitatively within 30 minutes, we measured D-dimer levels in blood samples obtained from patients with disseminated intravascular coagulation (DIC). Linearity of D-dimer determination was shown over the range from 0.5 to 36 micrograms/ml, and recovery studies demonstrated 94 to 108% recovery. The intra-assay and inter-assay coefficients of variation ranged from 0.6 to 11.3% at plasma D-dimer levels of 0.54 to 30.1 micrograms/ml. No interference by lipids, bilirubin, haemoglobin, rheumatoid factor, or gamma-globulin was noted. The normal D-dimer range was less than 0.5 microgram/ml in healthy ambulatory subjects, while the level in elderly subjects with atherosclerosis (14%) or in immobilized subjects (38%) was well above this limit. There was a strong correlation between plasma and serum D-dimer levels (r = 0.993). D-dimer levels measured by this LPIA showed a good correlation with those determined using two kinds of ELISA. The LPIA D-dimer levels were elevated in some subjects with diseases predisposing to DIC, but remained below 10.0 micrograms/ml. On the other hand, the LPIA D-dimer levels in DIC subjects were almost always above 10.0 microgramS/ml. Our study showed that a hypercoagulable state should be suspected when the LPIA D-dimer level is greater than 0.5 microgram/ml and that DIC should be diagnosed when the level is greater than 10.0 micrograms/ml in the presence of an appropriate underlying disease. This LPIA system can rapidly evaluate the presence of a hypercoagulable state as accurately as any ELISA, and thus seems potentially valuable for both emergency and routine laboratory use.
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PMID:Rapid quantitative evaluation of plasma D-dimer levels in thrombotic states using an automated latex photometric immunoassay. 141 91

Fifty-seven patients who presented to the Royal Surrey County Hospital, Guildford, with critical upper limb ischaemia between 1980 and 1989 were studied. Only 13 patients had emboli, while 23 presented with arteritis, seven involving large vessels and 16 with small vessel disease. Other causes included nine patients with trauma, six with atherosclerosis (of whom five were women), and four with vascular complications of thoracic outlet obstruction. Single examples of ischaemia due to radiation fibrosis and disseminated intravascular coagulation were also seen. Critical ischaemia of the upper limb remains an uncommon yet challenging problem. The review demonstrates that total limb arteriography should be performed in all patients, except the minority who present with direct arterial trauma or classical emboli.
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PMID:Critical ischaemia of the upper limb. 143 88

We report a retrospective, clinicopathologic study of 139 patients who died during treatment of a severe burn. Fifty-three percent of the patients had central nervous system (CNS) complications-infections, cerebral infarcts and hemorrhages, metabolic encephalopathies, central pontine myelinolysis, and cerebral trauma. Children and adults were equally affected. Sixteen percent of the patients had a CNS infection. Candida species, Staphylococcus aureus and Pseudomonas aeruginosa caused almost 80% of them. S. aureus and candida caused cerebral microabscesses and septic infarcts. P. aeruginosa caused meningitis and infarcts due to meningitis. CNS infections arose as a result of spread from a systemic source. The major risk factors for CNS infection were an extensive burn, S. aureus endocarditis, and a burn wound infection due to candida or P. aeruginosa. Patients with burns of less than 30% of the surface area of their body, those without a systemic infection, and those in the first week after their burn were at low risk. Eighteen percent of the patients had cerebral infarcts. In almost half the patients, the infarcts were caused by septic arterial occlusions or other complications of the burn, viz, disseminated intravascular coagulation (DIC) and septic shock. In only one-third of the patients were infarcts due to atherosclerosis, atrial fibrillation, or other causes prevalent in the general population. Intracranial hemorrhages were only one-fifth as frequent as infarcts and were due to DIC and thrombocytopenia, caused by bacteremia. Diagnosis during life was difficult, because the neurologic picture of focal cerebral lesions and meningitis was indistinguishable from that of metabolic encephalopathies, and because many patients had more than 1 neurologic complication. However, our results suggest that a clinical approach that includes analysis of risk factors for CNS infection, cerebral imaging, examination of cerebrospinal fluid, and tests for DIC can lead to a neurologic and microbiologic diagnosis in most patients.
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PMID:Central nervous system complications of thermal burns. A postmortem study of 139 patients. 152 3

As the ages of patients undergoing cardiac operations have increased, noncardiac causes of death have increased. To identify these causes of death, we analyzed the autopsy findings in 221 patients undergoing myocardial revascularization or valve operations between 1982 and 1989. Mean age was 65.6 +/- 9.5 years and the range was from 32 to 94 years; 130 patients (58.8%) were male. Autopsies were complete in 129 patients (58.4%) and limited to the chest and abdomen in the remainder. Embolic disease was identified in 69 patients (31.2%). Atheroemboli or abnormalities consistent with atheroemboli were identified in 48 patients (21.7%). Fourteen patients had thromboembolism and 7 had disseminated intravascular coagulation. The prevalence of atheroembolic disease increased dramatically from 4.5% in 1982 to 48.3% in 1989 (p = 0.001). Atheroembolic disease was found in the brain in 16.3% of patients, spleen in 10.9%, kidney in 10.4%, and pancreas in 6.8%. Thirty (62.5%) of the 48 patients had multiple atheroembolic sites. Atheroemboli were more common in patients undergoing coronary artery procedures (43/165; 26.1%) than in those undergoing valve procedures (5/56; 8.9%) (p = 0.008). There was a high correlation of atheroemboli with severe atherosclerosis of the ascending aorta. Atheroembolic events occurred in 46 of 123 patients (37.4%) with severe disease of the ascending aorta but in only 2 of 98 patients (2%) without significant ascending aortic disease (p less than 0.0001). Forty-six of 48 patients (95.8%) who had evidence of atheroemboli had severe atherosclerosis of the ascending aorta. There was a direct correlation between age, severe atherosclerosis of the ascending aorta, and atheroemboli. Incremental risk factors for atheroembolic are peripheral vascular disease and severe atherosclerosis of the ascending aorta.
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PMID:Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery. 159 74

The study of immune and fibrinolytic systems in 216 atherosclerosis patients with associated chronic obstructions of the lungs revealed a discrete pattern of activity of plasminogen activator which is low in atherosclerosis in contrast to its elevation in combination of atherosclerosis with pulmonary obstructions. The latter cases manifest E-RFC relative number to be reduced in increased number of EAC-RFC. Growing amount of EA-RFM, elevated blood antithrombin III, activation of plasminogen activator in atherosclerosis coexistence with obstructive pulmonary lesions arrest the development of latent DIC syndrome and progression of atherosclerosis.
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PMID:[Changes in immune and fibrinolytic systems of patients with atherosclerosis and chronic nonspecific pulmonary diseases]. 178 74

Clostridial bacteremia is rare and has a variable presentation from asymptomatic to septic shock with disseminated intravascular coagulation (DIC), red cell hemolysis, and rapid death. In order to delineate the predisposing and prognostic factors in these patients, the authors reviewed 47 cases of clostridial bacteremia presenting over a seven year period at a major metropolitan teaching hospital. Predisposing factors included locally decreased oxidation reduction potential (Eh) in 43 per cent (including atherosclerosis, diabetes, and radiation therapy), systemic immunosuppression in 53 per cent (including alcohol abuse, chemotherapy, steroids, and malignancy), and a site of epithelial barrier disruption. The sites of clostridial invasion included: gastrointestinal tract (GI) (n = 22), pulmonary (n = 7), cutaneous (n = 7), undetermined (n = 7), and female genital tract (n = 4). Seven patients were found to have malignancy. Seventy-nine per cent of the blood culture isolates were histotoxic species (Clostridia perfringens and C. septicum). The overall mortality was 47 per cent. Significant differences between survivors and deaths included DIC, new onset renal failure, severe atherosclerotic disease, and age (P less than .05). The authors conclude that clostridial bacteremia is uncommon but highly lethal and may occur when decreased tissue Eh, systemic immunosuppression, and an epithelial barrier disruption are present. Poor outcome appears to be a reflection of advanced age, underlying illness, and presence of a histotoxic species.
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PMID:Clostridial bacteremia: implications for the surgeon. 204 53

We described here a seventy-one year-old male, who had repeated disseminated intravascular coagulation related to atherosclerosis and aneurysm of the aorta, and was successfully treated with self-subcutaneous injection of heparin sodium. He developed gingival bleeding and purpura in 1977. He was first treated with prednisolone (30 mg/day) and ACTH-Z under the diagnosis of idiopathic thrombocytopenic purpura associated with chronic thyroiditis, since platelet count (0.2 x 10(4)/microliters) was markedly decreased and megakaryocytes in the bone marrow were increased. By the treatment, platelet count recovered to 16.7 x 10(4)/microliters, while fibrin-degradation product levels were increased and hypofibrinogenemia developed, suggesting disseminated intravascular coagulopathy. Additional treatment with heparin was effective, and the coagulation studies became normal. In 1980, he again developed the episode with thrombocytopenia. At this time, prednisolone did not improve the episode, but heparin was effective. Since 1983, an enlargement of abdominal aorta had been recognized and gradually progressed. In 1983, he developed lumbago and abdominal pain, and received an emergency operation using artificial Y-graft vessel under the diagnosis of rupture of the aneurysm. There was no evidence of consumption coagulopathy at that time. He had been well until 1987, when he developed the third episode of thrombocytopenia with gingival bleeding. Thrombocytopenia was controlled with the treatment of heparin, but needed a continuous treatment with heparin. Thereafter, he has been well managed with self-injection of the anticoagulant, heparin sodium.
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PMID:[Disseminated intravascular coagulation related to atherosclerosis and aneurysm of aorta: successful management with subcutaneous self injection of heparin sodium]. 259 49

A method of apheresis of plasma euglobulin fraction, cryoglobulins and Willebrand factor was developed. In one session of plasmapheresis 1500-1700 ml of patient's plasma were removed, fractionated and returned. The method was used in 2 patients with immune complex vasculitides. In one of them the disease developed against a background of chronic active hepatitis, in the other patient it manifested itself in cryoglobulin- and cryofibrinogenemia. Clinical improvement was noted in both cases: the absence of myalgia, arthralgia, hemorrhagic eruption, and ulcerative-necrotic skin changes. The normalization of increased ristomycin-cofactor activity of Willebrand factor and CIC levels was noted in one case. A decrease in the content of plasma cryoglobulins, cryofibrinogen, and urine protein concentration (from 1.5 up to 0.03%) was noted in the other case. A possibility of the use of the method in other pathological conditions (DIC-syndrome, unstable angina, atherosclerotic angiopathy) accompanied by endothelial damage, was discussed. Willebrand factor multimers form complexes with low density lipoproteins therefore the removal of these complexes may be useful in the treatment of hypercholesteremia and atherosclerosis.
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PMID:[Apheresis of euglobulins, cryoglobulins and the von Willebrand factor in vasculitis]. 295 14

The importance of hemostasis investigations for present-day theoretical and clinical medicine is explained by the high incidence of thromboembolism which in recent years has noticeably increased in many countries of the world. Hemostasis is a physiological system that largely determines adaptability of man to the varying environment. The system may play a critical part in the sense that its disorders may cause severe complications. The mismatch of the system can be exemplified by the thrombohemorrhagic syndrome (THS) or disseminated intravascular coagulation of blood (DIC). Thrombogenesis or thromboembolism may strongly affect many physiological functions, particularly those of the cardiovascular and nervous systems. The process of thrombogenesis may also contribute significantly to atherosclerosis and should therefore be regarded as the leading factor in sudden and rapidly developing blood-vessel occlusion. Various aspects of blood coagulation are very important for the flying personnel exposed to many stress-effects in unusual and sometimes alien environments, e.g. hypoxia, acceleration, vibration, meteorological and climatic variations. In view of this, hemostasis maintenance as well as improved prophylaxis and treatment of thrombogenesis and atherosclerosis requires special attention.
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PMID:[Characteristics of the hemostasis system affected by factors of flight]. 341 14


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