Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 27-year-old woman visited Kanto Teishin Hospital complaining of fever and petechiae in September, 1992. Her fetus had suddenly died in the uterus two weeks before (in the sixth month of pregnancy). Total white blood cell (WBC) count was 3.2 x 10(3)/microliters with 80% promyelocytes. Bone marrow was hypercellular with 90% promyelocytes. Disseminated intravascular coagulation (DIC) was recognized. She was diagnosed as having acute promyelocytic leukemia (APL), and treatment with daily oral administration of all-trans retinoic acid (ATRA) (70 mg/body/day) was begun. On day 4, hemiplegia and aphasia appeared. Broad cerebral infarction was suspected from computed tomography. On day 9, the WBC count increased rapidly, standard chemotherapy was added and she achieved complete remission. ATRA is known to have stimulatory effects on the differentiation of APL cells, but some reports have described thromboembolic events during the administration of ATRA. In this case, ATRA might have affected coagulability resulting in cerebral infarction.
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PMID:[Acute promyelocytic leukemia (APL) resulting in broad cerebral infarction during all-trans retinoic acid (ATRA) treatment]. 813 18

Intraamniotic instillation of urea is a common mode of legal second-trimester pregnancy termination. Associated mortality rarely occurs and is most commonly due to amniotic fluid embolism, pulmonary thromboembolism, infection, hemorrhage, and disseminated intravascular coagulation (DIC). We present the case of an 18-year-old gravida 2, para 1 white woman at 18 weeks' gestation who underwent intraamniotic instillation of hyperosmolar urea and intracervical insertion of laminaria tents; 19 h later, she became unresponsive, academic, and went into shock. Coagulation studies were diagnostic of DIC. Bacilli were seen on peripheral blood smear. Autopsy showed marked subcutaneous emphysema of the anterior abdominal wall, necrosis and emphysema of the uterus, diffuse pulmonary alveolar damage, and renal cortical necrosis. Antemortem blood cultures grew Clostridium perfringens and Escherichia coli. Postmortem culture of the uterus grew E. coli. The source of infection was most likely the introduction of vaginal organisms via laminaria insertion. This is apparently the first reported case of death caused by Clostridium perfringens and E. coli sepsis following urea instillation.
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PMID:Fatal Clostridium perfringens and Escherichia coli sepsis following urea-instillation abortion. 832 37

The aim of this paper is to determine the antecedent factors, clinical presentation, complications and management of uterine rupture in the context of modern obstetric practice in Singapore. We conducted a retrospective study of 26 proven cases of uterine rupture in Kandang Kerbau Hospital, Singapore between January 1983 to December 1992. These cases were analysed with regards to their past history, clinical presentation, complications, management and outcome. The incidence of uterine rupture was 1 in 6331 deliveries. The ratio of cases with scarred uteri against those with unscarred uteri was 3:1. The commonest antecedent factor was previous lower segment caesarean section for the scarred group and cephalo-pelvic disproportion in the unscarred group. Overall, 46.2% of the patients had augmentation with oxytocin. The major clinical presentations were abnormal cardiotocogram (25%) and blood-stained amniotic fluid (20%) in the scarred group, and postpartum haemorrhage (50%) and shock (33%) in the unscarred group. Repair of the uterus with or without tubal ligation was performed in 95% of the patients with scarred uteri, whereas 67% of the patients with unscarred uteri underwent total abdominal hysterectomy with or without salpingo-oophorectomy. There was 1 (3.8%) maternal death. Maternal morbidity included bladder injuries, broad ligament haematoma, disseminated intravascular coagulation and gastrointestinal bleeding. The overall incidence of fetal loss was 7.4%. When compared to a previous study on uterine rupture in the same hospital, there was an improvement in obstetric performance.
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PMID:A ten-year review of uterine rupture in modern obstetric practice. 883 90

From January 1990 to December 1994, 24 parturients were diagnosed as having HELLP syndrome alone or combined with preeclampsia/eclampsia among 8,224 patients who were delivered at our institution. They consisted of 14 primiparous and 10 multiparous patients. Mean maternal age was 28.9 +/- 3.3 and gestational age was 34.8 +/- 5.6 weeks. Of 24 parturients, 8 had vaginal delivery and the remaining 16 were delivered by caesarean section. Serious maternal morbidity included eclampsia (n = 3), preeclampsia (n = 18), renal failure (n = 5), hydrothorax (n = 4), and DIC (n = 1). There was no maternal death. There were 3 intrauterine fetal deaths and two neonatal deaths. Perinatal deaths were 2 (0.9%, 2/26). Three caesarean sections were performed under general anesthesia, and 13 under spinal anesthesia. In cases with apparent bleeding tendency, spinal and epidural anesthesia should be avoided. In providing general anesthesia, hypertension should be controlled, and the uterus is preferably dilated before the delivery and contracted there-after.
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PMID:[HELP syndrome and anesthetic management]. 884 89

Disseminated intravascular coagulation is the result of a severe underlying disorder that initiates massive activation of the coagulation system. It is always a symptom of the underlying disorder. These disorders may be as varied as meningococcemia and abdominal aortic aneurysm. Disseminated intravascular coagulation is a clinical diagnosis. Once the clinical impression has been considered, a small number of readily available tests will substantiate the diagnosis. Further testing is probably not necessary and certainly not cost-effective. Therapy for disseminated intravascular coagulation requires 1) the correction of the underlying problem, either by drainage of an abscess for sepsis, evacuation of the uterus in an obstetric catastrophe, or treatment of septicemia with antibiotics; and 2) the concomitant restoration of the circulatory system, perfusion, blood pressure, and electrolyte balance. Other forms of therapy are available but are quite secondary to these two. Success depends on the ability to recognize and correct the cause.
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PMID:Disseminated intravascular coagulation. 937 26

The syndrome of abruptio placentae was originally described in 1997. Total hysterectomy was advocated by Couvelaire in 1991. The placenta is fixed to the uterine wall by anchoring villi. When spiral arteries lack the physiologic trophoblast invasion, like in case of maternal hypertension placental infarcts/abruption might occur. Infusion of thromboplastic material induces disseminated intravascular coagulation. The uterus "en bois" representing hypertonicity and polysystolia probably safe-guard the entrance of further thromboplastic material into the maternal circulation. Prompt restoration of the intravascular volume with full blood avoids hysterectomy. Preventive measures are avoidance of the supine position, cocaine and smoking. Treatment of hyperhomocysteinemia probably can prevent vascular damage.
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PMID:Abruptio placentae. A "classic" dedicated to Elizabeth Ramsey. 944 49

Intra-uterine fetal death may seriously affect maternal health and implies considerable risk of maternal death, especially when clotting and septic disorders arise. Management od IUFD should include removal of the triggering mechanism for DIC, antiinfectious prophylaxis and consider prompt evacuation of uterus. Low-dose heparin therapy is safe and offers sufficient protection against coagulopathy associated with IUFD. Treatment with low-dose aspirin, steroids or substitutive ACTH therapy is useful for patients with a poor obstetrical outcome. Etiopathology of IUFD, complications, methods terminating of the pregnancies has also been presented.
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PMID:[Intra-uterine fetal death syndrome--not only a gynecologic problem]. 953 65

A 24-year-old, nulliparous woman in her 30th week of pregnancy was admitted due to threatened premature delivery. Ritodrin chloride relieved the premature contraction of the uterus but jaundice and drowsiness appeared 7 weeks later. Laboratory data revealed disseminated intravascular coagulation (DIC) with intrahepatic cholestasis, and ultrasound examination showed fatty liver. The patient was diagnosed with acute fatty liver of pregnancy (AFLP). Emergency delivery by Caesarean section was performed at 37 weeks of pregnancy and the liver function and DIC improved immediately. Liver biopsy 13 days after delivery showed nuclear swelling and cytoplasmic ballooning with mild fatty deposition. These findings were relatively compatible with acute AFLP. Higher magnification and electron microscopy revealed intracytoplasmic bacteria and fungus in the residual stage. The bacterial infection could be considered related to AFLP.
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PMID:Acute fatty liver of pregnancy showing microbial infection in the liver. 1119 91

A series of conformationally constrained cyclic analogues of the peptide hormone bradykinin (BK, Arg-Pro-Pro-Gly-Phe-Ser-Pro-Phe-Arg) was synthesized to check different turned structures proposed for the bioactive conformation of BK agonists and antagonists. Cycles differing in the size and direction of the lactam bridge were performed at the C- and N-terminal sequences of the molecule. Glutamic acid and lysine were introduced into the native BK sequence at different positions for cyclization through their side chains. Backbone cyclic analogues were synthesized by incorporation of N-carboxy alkylated and N-amino alkylated amino acids into the peptide chain. Although the coupling of Fmoc-glycine to the N-alkylated phenylalanine derivatives was effected with DIC/HOAt in SPPS, the dipeptide building units with more bulky amino acids were pre-built in solution. For backbone cyclization at the C-terminus an alternative building unit with an acylated reduced peptide bond was preformed in solution. Both types of building units were handled in the SPPS in the same manner as amino acids. The agonistic and antagonistic activities of the cyclic BK analogues were determined in rat uterus (RUT) and guinea-pig ileum (GPI) assays. Additionally, the potentiation of the BK-induced effects was examined. Among the series of cyclic BK agonists only compound 3 with backbone cyclization between positions 2 and 5 shows a significant agonistic activity on RUT. To study the influence of intramolecular ring closure we used an antagonistic analogue with weak activity, [D-Phe7]-BK. Side chain as well as backbone cyclization in the N-terminus of [D-Phe7]-BK resulted in analogues with moderate antagonistic activity on RUT. Also, compound 18 in which a lactam bridge between positions 6 and 9 was achieved via an acylated reduced peptide bond has moderate antagonistic activity on RUT. These results support the hypothesis of turn structures in both parts of the molecule as a requirement for BK antagonism. Certain active and inactive agonists and antagonists are able to potentiate the bradykinin-induced contraction of guinea-pig ileum.
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PMID:Synthesis and biological activities of new side chain and backbone cyclic bradykinin analogues. 1210 26

We report a case of severe Clostridium welchii infection following amniocentesis with septicaemia, haemolysis, DIC, pulmonary oedema and renal failure. Full recovery occurred following aggressive conservative management using antibiotics, endometrial curettage and intensive monitoring. The patient retained her uterus and had a successful pregnancy two years later although caesarean section for uterine rupture was required. Conservative management with conservation of the uterus and ovaries may be a safe and effective option in the management of severe Clostridium infections, using antibiotics, endometrial curettage and multidisciplinary team input.
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PMID:Clostridium welchii infection following amniocentesis: a case report and review of the literature. 1222 71


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