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

Histopathological study on 723 brains from routine necropsies was performed. Ten brains (1.38 percent) were found to have histological lesions of disseminated intravascular coagulation (DIC) with multiple fresh fibrin and/or platelet thrombi in the cerebral microcirculation. Among them, premortem diagnosis was made in only one case, and only two cases also showed evidence of visceral involvement. Microthrombi were found most frequently in the cerebral cortex and hypothalamic region and in the cerebral white matter, brain stem, and cerebellum, in descending order. Neurological symptoms and signs, including lethargy, coma and seizure, were detected in all cases. The abnormal body temperature and/or urinary output observed in most patients appeared to be related to the frequent hypothalamic involvement by DIC. The exclusive or predominant involvement of the brain by multiple microthrombi may be considered as a localized form of DIC. It is probably related to cerebral ischemia since severe acute neuronal ischemic changes also were noted in most brains.
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PMID:Disseminated intravascular coagulation involving the brain: a topographical study. 712 Apr 79

Cases of three infants and 3 children with clinically manifest generalized bleeding due to a consumption coagulopathy disorder (CC) after severe head injury are described. Despite invasive neurointensive care for normalization of intracranial pressure and coagulation factor replacement therapy, all patients died due to severe brain swelling with uncal and brainstem herniation. Abnormal bleeding in a comatose, head-injured patient with laboratory finding compatible with CC appears to be an expression of a very severe injury with poor prognosis.
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PMID:Consumption coagulopathy after severe head injury in children. 715 75

Sixty-five patients with a bleeding disorder and coexistent neurologic abnormalities were examined over a 4-year period to determine: (1) the CNS pathology due to disseminated intravascular coagulation (DIC); (2) the clinical setting in which CNS dysfunction due to DIC occurs; and (3) the neurologic complications of DIC as opposed to those patients dying with concurrent DIC. Criteria for inclusion in the study were the combination of: (1) a neurologic disorder in a patient with clinical evidence of a bleeding disorder; and (2) evidence of DIC by laboratory criteria or the detection of fibrin thrombi in multiple organs at postmortem. Twenty-four of 65 patients met these diagnostic criteria, including 14 men and 10 women, aged 24 to 84 years. Autopsies were obtained in 17 patients. These patients were divided into two groups Group I consisted of 10 patients with evidence of cerebral bleeding or infarction at the onset of DIC. Group II consisted of 14 patients who met the diagnostic criteria for DIC but did not demonstrate postmortem evidence of hemorrhage or infarction in the brain. Patients with malignancy who present with findings suggestive of a large-vessel stroke are likely to have DIC and nonbacterial thrombotic endocarditis. The most common neurologic complications of DIC are large vessel occlusion, obtundation and coma, subarachnoid hemorrhage, and multiple cortical and brainstem hemorrhages and infarction.
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PMID:Neurologic complications of disseminated intravascular coagulation. 720 75

22 patients with severe preeclampsia-eclampsia were treated in our Intensive Care Unit from 1972 to 1978. Control of convulsions was achieved by diazepam, diphenylhydantoin and phenobarbital. In 11 comatose patients brain monitoring was carried out by frequent neurological examination and use of computerized x-ray tomography; aspiration of gastric contents was prevented by nasotracheal intubation. Brain oedema therapy included controlled hyperventilation, steroids and mannitol (7 patients). 10 patients with respiratory failure (due to pulmonary oedema, "shock lung" or aspiration pneumonitis) were treated by mechanical ventilation. Diastolic blood pressure above 100 mm Hg was reduced by hydralazine. Diuresis was induced by normalization of hypovolaemia with albumin and plasma expanders. Six patients died (27%); main causes of death included intracerebral haemorrhage, brain oedema, heart failure, acute pulmonary thromboembolism and bleeding from DIC.
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PMID:[Intensive care of severe preeclampsia-eclampsia. A report on 22 cases (author's transl)]. 742 60

This report outlines our experience with streptococcal toxic shock syndrome (STSS) at the Veterans General Hospital-Kaohsiung during the period October 1990 to November 1993. Group A streptococci were isolated from blood or normally sterile tissue in association with hypotension and multi-organ failure in the eight cases studied. A primary focus of infection was identified in seven cases, including pneumonia (1), septic arthritis (1) and soft-tissue infections (5). The remaining patient suffered from hyperglycemic hyperosmolar non-ketotic coma and Group A streptococcal bacteremia, without an obvious focus of infection. There were four cases of bacteremia. Clinical complications included acute renal failure in all eight cases, disseminated intravascular coagulation in five cases, liver involvement in two cases, adult respiratory distress syndrome in one case and soft-tissue necrosis in five cases. All isolates were sensitive to penicillin, and most patients were treated with intravenous penicillin G, with or without other antibiotics (gentamicin or clindamycin). Of the six patients with soft-tissue infection, two underwent amputation of the infected limb, and one patient underwent sono-guided pigtail drainage of psoas muscle abscess. Three of the patients died. STSS may be uncommon in Taiwan, but it is not rare. Early recognition of STSS (facilitated by Gram stain and culture), prompt debridement and drainage, and adequate antibiotic treatment with penicillin or clindamycin, or both, are necessary for control of such lethal infections.
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PMID:Streptococcal toxic shock syndrome in southern Taiwan. 760 78

Two men aged 33 and 31 years suffered a fatal heat stroke on a warm summer day. One of them used pimozide and clomipramine, the other zuclopenthixol, dexetimide, droperidol, promethazine and propranolol as psychiatric medication. Both of them had a body temperature > 42.3 degrees C, without perspiring. At first only a comatose situation with practically normal laboratory values existed; this was rapidly followed by massive liver damage, disseminated intravascular coagulation, anaemia, thrombopenia and acute renal failure. In spite of adequate and rapid treatment these complications were fatal. Both patients used medication with an antidopaminergic and anticholinergic (side) effect. The set point of the temperature regulation centre can be elevated by the antidopaminergic activity of antipsychotics. Use of anticholinergic medication can disturb the thermoregulation via inhibition of the parasympathicomimetically mediated sweat secretion. It is recommended to point out the danger of unusually high outdoor temperatures to patients using this medication.
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PMID:[Psychiatric drugs as risk factor in fatal heat stroke]. 862 30

The clinical, laboratory, radiological and operative recordings of a patient with disseminated intravascular coagulation (DIC) related to therapeutic abortion is reported. During a comatose state following respiratory arrest, anisocoria with right dilated unreactive pupil and decerebration signs appeared. A brain CT scan showed a right frontotemporal hemorrhage. On surgical intervention a subdural hematoma was found and removed. The patient remained in a persistent vegetative state. The rarity of subdural hematoma complicating DIC is presented and the causes of intracranial bleeding in obstetrics are reviewed.
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PMID:Acute subdural hematoma following disseminated intravascular coagulation associated with an obstetric catastrophe. 763 98

We report a fatal case of heatstroke in an obese boy who developed multi-organ failure. Six other cases of exertional heatstroke admitted to our hospital over the last 5 years were also reviewed. All of them showed some degree of renal impairment. The causes of renal failure are multifactorial, with rhabdomyolysis being the major mechanism. All cases except one responded to alkaline diuresis without the need for dialysis. Continuous venovenous hemofiltration appeared to be a good alternative in hemodynamically unstable patients. Renal function recovered completely after varying intervals in all surviving cases. Interestingly, rhabdomyolysis in our heatstroke patients was usually associated with hypokalemia or normokalemia instead of hyperkalemia. Mortality in our series was largely related to the long duration of hyperthermia and coma, the severity of disseminated intravascular coagulation, and the presence of cardiogenic shock and severe acidosis.
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PMID:Renal failure and heatstroke. 764 68

In a retrospective study we analyzed the clinical and blood chemical data of 12 patients with severe tropical malaria in the intensive care units of the University Hospital Zurich and the Stadtspital Triemli, Zurich, between 1991 and 1994. None of the 12 patients had been exposed to malaria before or had taken drugs for chemoprophylaxis. 7 patients survived, 5 died from complications of malaria. According to the criteria of severe tropical malaria defined by the WHO, the following pathological clinical and blood chemical parameters were noted on admission: cerebral coma (2/12); blood hemoglobin < 5 g/dl (0/12), < 8 g/dl (2/12); serum creatinine > 265 mumol/l (3/12); blood glucose < 2.2 mmol/l (0.12); circulatory collapse/shock (0/12); bleeding/signs of disseminated intravascular coagulation in laboratory tests (4/12); acidosis with pH < 7.25 (1/12). Further signs of severe tropical malaria were: hyperparasitemia > 5% (9/12); qualitative and quantitative disturbances of consciousness (6/12); thrombocytopenia < 30 x 10(9)/l (9/12); hyponatremia 125-135 mmol/l (9/12), < 125 mmol/l (2/12); rhabdomyolysis with creatine kinase > 1000 U/l (4/12). The basic treatment consisted of parenteral quinine hydrochloride in all patients; doxycycline was added in 8 cases, clindamycin in 3. Adjuvant therapy with desferrioxamin was given in 3 cases. 6 patients had exchange transfusions. Parasitemia cleared in all patients within 5 to 6 days. Later in the course, 5 patients developed acute respiratory distress syndrome, 6 required hemofiltration due to oliguria, and one became comatose.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Intensive care aspects in severe tropical malaria: clinical aspects, therapy and prognostic factors]. 777 Jul 59

Hemolytic uremic syndrome (HUS) is defined as microangiopathic hemolytic anemia, thrombocytopenia and uremia. It is an important cause of acute renal failure (ARF) in children all over the world. The present study was carried out to assess the incidence, clinical presentation, hematological and biochemical profile of children presenting with HUS from 1987 to 1990. Out of the 100 cases who presented with ARF 22 had HUS. A majority of these children were males below 1 year of age, and had a prodromal phase of mainly gastrointestinal manifestations lasting for about a week. Anemia was a constant feature followed by bleeding diathesis, mainly melena and purpura. Neurological manifestations included altered sensorium, irritability, coma, hypertensive encephalopathy and convulsions. Renal problems mainly included oliguria, hypertension, hematuria and edema. Investigations revealed thrombocytopenia and microangiopathic hemolytic anemia in all cases. Evidence of disseminated intravascular coagulation (DIC) was observed in 3 cases as decreased fibrinogen levels, increased fibrinogen degradation products and deranged clotting studies. Blood biochemistry revealed azotemia in all cases, hyponatremia in 5 cases, hypernatremia in 3 cases and hyperkalemia in 12 cases. Stool culture showed the presence of Shigella in 8, E. coli in 6 and Klebsiella in 4 cases. Out of 22 cases of HUS, 15 were treated conservatively; of these 2 died. Both of these deaths were due to DIC 7 children were put on peritoneal dialysis; only 1 child died in this group. Factors affecting the outcome were duration of oliguria, levels of blood urea and presence of encephalopathy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A clinico-hematological profile of hemolytic-uremic syndrome. 788 99


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