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

Current management of hemorrhage in cirrhotic patients is disappointing, probably because it deals only with the portal hypertension, while the coagulation disorders are neglected. Some new suggestions can be made : 1) Hemorrhage originates in coagulation disorders. The mechanical lesion of the mucosa is only the opportunity for these disorders to become apparent. The lesion may be : infrequently, a ruptured esophageal varix or a gastroduodenal peptic ulcer ; a lesion of the cardia (hiatal hernia, reflux, esophagitis, minimal traumatic tears) ; a gastric anomaly (hemorrhagic gastritis, superficial ulcerations, petechiae) ; in some cases no mucosal lesion is apparent. 2) Any widespread liver disease results in lasting hypercoagulability which is responsible for : permanent lysis, consumption, DIC. The spleen is responsible for the functional alteration of the platelets. Splenectomy is followed by permanent recovery. 3) Changes involving the platelets are responsible for most hemorrhages. Thrombopenia and severe anomalies of platelet aggregation are common findings in liver cirrhosis. Further deterioration can be induced by acetylsalicylic acid, especially if it is absorbed after an immoderate ingestion of alcohol. Emergency treatment consists in platelet transfusions. 4) Stasis in the portal system may, however, result in permanent activation of coagulation. 5) Cirrhosis results in chronic hypercoagulability and severe platelet deterioration. Any stress involving coagulation mechanisms may therefore induce hemorrhage : infection, acetyl salicylic acid, respiratory distress, estrogens, massive transfusion. It is always dangerous to "feed" consumption or to restrain lysis. 6) Coagulation tests should be performed rapidly, in order to evaluate hypercoagulability, consumption, lysis, and evidence of DIC ; FDP can probably be responsible for inflammatory changes in the liver and spleen. 8) Coagulation disorders are permanent since the hepatic alterations are irreversible.
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PMID:[Hemorrhage in liver cirrhosis : new suggestions (author's transl)]. 627 81

Acute leptospirosis in Europe (Weil's disease) is a rare and in more than 90% of the cases undiagnosed febrile, self-limited disease. We report the case of a 39-year-old sewerage worker, who was admitted to our hospital with fever, jaundice, pain in his calves and acute renal failure. Serology revealed elevated antibody titers against Leptospira canicola, L. icterhaemorrhagica and L. sejroe. The patient developed disseminated intravascular coagulation (DIC) with diffuse gastrointestinal bleeding due to thrombocytopenia. The ECG showed atrial fibrillation with irregularly irregular rhythm. Cardiac arrest developed, most likely due to hypoxia, with a drop in the blood pressure. Despite immediate resuscitation efforts the patient developed severe hypoxic brain damage and died a few days later. Autopsy disclosed histologic signs of a generalized leptospiral infection, signs of shock and within the lungs a necrotizing herpes simplex virus pneumonia causing the death of the patient. The virus pneumonia most probably was caused by retrograde canalicular dissemination of oral secretions since herpetic tracheitis and esophagitis were found and herpetic lesions were readily identified on the lips and tongue. A medical opinion asked for by the professional association having liability for occupational safety and insurance was given, the disease being recognized as an occupational disease.
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PMID:[Weil's disease and necrotizing herpes pneumonia as the cause of death of a 39-year-old sewage drain worker]. 908 72

Fungal infection is a major opportunistic infection in AIDS. Histoplasmosis is often seen in American AIDS, but only one case has been reported in Japan. We report a AIDS case of with histoplasmosis in Japan. The patient was a forty year old male living in the U.S from 1987 to 1990. He was diagnosed as candidial esophagitis in July, 1994, and human immunodeficiency virus type 1 (HIV) antibody positive led to a diagnosis of AIDS. He was admitted to our hospital with fever and lymphadenopathy (neck, abdomen) in August. The therapy for candidial esophagitis was successful and he was recovering, but he was newly diagnosed as atypical mycobacteriosis and Kaposi's sarcoma. Though the fever was slight, it persisted. He was discharged from our hospital in October. He was readmitted for a high fever and dehydration in December, but died after a week from disseminated intravascular coagulation (DIC). Histoplasma capsulatum was found by blood and ascites cultures on second admission. Many yeast like histoplasma cells in granuloma of the liver were found at autopsy. For moderate or severe histoplasmosis, amphotericin B is generally used as the first induction therapy. Fluconazole (FLCZ) is used as a maintenance therapy. We did not use amphotericin B, but used FLCZ because we did not diagnose histoplasmosis before death, and his general condition became worse. The effect of FLCZ therapy was unclear in our case because he had other infections. We expect that AIDS with histoplasimosis will increase in Japan through HIV infected patients infected in the U.S.A.
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PMID:[A case of acquired immunodeficiency syndrome (AIDS) with histoplasmosis]. 1065 85

Infectious complications are a major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL) due to impaired immunity secondary to the disease itself and to the immunosuppressive therapies administered to these patients. We report a 78-year-old woman with CLL who was treated with steroids for autoimmune hemolytic anemia (AIHA). A few weeks later, she was admitted for severe acute hepatitis with disseminated intravascular coagulation (DIC). Despite the symptomatic treatment of DIC, standard reanimation and probabilistic antibiotics, the patient died within 24h with severe hepatic failure. Autopsy was in favor of a disseminated viral infection with esophageal, hepatic and pulmonary cytopathologic lesions with acidophilic intranuclear inclusions suggestive of herpes virus, even though HSV 1 and 2, CMV and HHV6 PCRs were negative. This case of severe viral hepatitis with esophagitis occurring three weeks after the introduction of high-dose steroid treatment for AIHA in a CLL patient calls for anti-herpetic prophylaxis in such patients, immunodepressed by their diseases and the treatment they receive.
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PMID:Severe viral hepatitis in a patient with chronic lymphocytic leukemia (CLL) complicated with autoimmune hemolytic anemia (AIHA), treated with steroids. 2554 74