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

Sixteen cases of neonatal cold injury, five of them fatal, were seen in the winter of 1974-75. The affected infants, who weighed from 2.5 to 3 kg. had developed symptoms when the ambient termperature was below 10 C. Few of them were referred as cases of hypothermia. Refusal to eat was the most common complaint and less often edema and/or apathy. No correlation was found between death and ethnic origin, sex, duration of illness or minimum temperature. Admission weight, however, tended to be lower in the infants who died. The consistent finding of thrombocytopenia and the suspected bleeding phenomena suggested that disseminated intravascular coagulation may have been a factor in the unfavorable outcome of some of the cases. Evidence supporting such a hypothesis and proposals for the prevention. Diagnosis and treatment of neonatal cold injury are presented.
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PMID:Cold injury in early infancy. 32 24

An investigation of 78 cases of adrenal haemorrhage and necrosis disclosed that 32 were examples of adrenal venous infarction. In all these cases there was thrombosis of the main adrenal vein and in most there was also thrombosis of the capsular veins, a finding which has not been well established. In a number of cases with venous infarction there was clinical and pathological evidence that disseminated intravascular coagulation (DIC) had occurred, but it appears that it was not the direct cause of venous thrombosis. The majority of cases of venous infarction occur in patients with severe infection, frequently of the respiratory tract. Venous infarction was found in five cases with hypothermia an association which had rarely been described, and in three of these there was evidence of DIC. This is apparently the first occasion on which DIC has been demonstrated in cases of hypothermia in man. The cause of venous thrombosis in the adrenal glands is obscure in most cases of venous infarction, although in three it was due to involvement by metastatic carcinoma. It is suggested that the factors responsible for the initiation of thrombosis in the adrenal veins are catecholamines, thrombin, fibrin and endotoxin. Localisation of the thrombi to the adrenal vein is due to the unique anatomical structure of the vein which, under certain circumstances, results in the local stasis of blood.
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PMID:Venous infarction of the adrenal glands. 93 79

Problems encountered regarding the examination in forensic pathology are variable, even if the field of interest in limited to trauma alone. The most important problem appears to be the establishment of a causal relationship between the trauma and the death of the victim. From the materials I have contributed concerning examinations in forensic medicine, the problems inherent in the examination of the victim of traumatic shock may be introduced. The results from animal studies, which have been attempted to provide an experimental background to support the observations, are also discussed. My personal opinions on several trial cases in which there was a disagreement of opinion regarding the examination results will also be expressed. 1. Distinguishing death due to traumatic shock from death due to disease In the "Yacht school" incident, children with emotional disturbances and youths with a history of misconduct were treated with training which included physical punishment. Autopsy findings were compared between a 13-year old boy who was concluded to have died of traumatic shock from numerous beatings and a 21-year old youth who died of hemorrhagic pneumonia. In my opinion, a causative role of injury in the death was found in both cases. 2. Shock due to tourniquet This autopsy case concerns a 23-year-old male who entered a yoga training center, was tightly bound with a rope and died on the 8th day. Histological examination revealed thrombus formation in the small blood vessels and leukocyte agglutination within the blood vessels of the alveolar wall, suggesting DIC. While these findings were thought to be almost indistinguishable from those found in traumatic shock, the background conditions, including hunger, dehydration and hypothermia cannot be neglected in the evaluation. 3. Child abuse In one incident, a mother and her lover beat a 25-month old girl every day until her death. The original examination concluded that the cause of death was traumatic shock due to multiple trauma over the entire body caused by both adults. A second examination concluded that the cause of death was delayed suffocation due to binding of the chest and compression against a mattress. Based on an overall evaluation of the circumstances at the time of detection (including photographic evidence) as well as the contents of the statement made by the lover, I inferred that the head-down hanging of the child in the bathtub by the lover was directly related to the cause of death. In my opinion, the liability of the two adults in the crime was not the same.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Problems regarding the examination in forensic medicine]. 262 31

In healthy subjects, when oxygen transport is gradually decreased, oxygen consumption is maintained as tissue oxygen extraction is increased. When delivery is decreased further, there is a critical level below which tissue extraction cannot increase in proportion to the reduced delivery, and oxygen consumption falls. Blood lactate levels then rise, a sign of tissue hypoxia, despite further increases in oxygen extraction as delivery drops below this critical level. There are two major mechanisms which tend to prevent tissue hypoxia in case of reduced oxygen delivery: regional redistribution of blood flow and an increase in the number of perfused capillaries. This possibility of regulating blood flow distribution may be lost during disseminated intravascular coagulation, alpha-adrenergic receptor blockade, hypothermia, arteriovenous shunting. All these alterations have been reported as occurring in sepsis. An abnormal dependency on oxygen supply is observed during bacteriaemia or endotoxinaemia. This is secondary to a reduced ability, at the whole body level, to extract oxygen from a limited supply. The inability to increase oxygen extraction is related to a maldistribution of the cardiac output, with "stealing" of blood, i.e. overperfusion of some organs (skeletal muscle) rather than those where perfusion is rapidly compromised (small intestine). Endotoxin also reduces the efficacy of oxygen extraction within the isolated intestinal segment, whereas that within other organs is preserved. These observations are similar to findings in patients with sepsis who seem to have both an increased demand in oxygen, and a reduced ability to extract it at the tissue level.
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PMID:[Relation of oxygen transport and consumption. Role of impaired tissue uptake]. 263 67

The terms "consumption coagulopathy" and "disseminated intravascular coagulation" are used synonymously, though the former expression refers to the process of consuming the haemostatic potential, whereas the latter is based upon the generalized formation of microthrombi. Both terms apply to an acquired disturbance of blood clotting leading to an increased turnover of coagulation factors and platelets by which the production sites are being exhausted. Such a process is triggered off by generalized activation of the haemostatic system: after a period of hypercoagulability, haemostasis changes into hypocoagulability with subsequent haemorrhagic diathesis. Additionally, the generalized activation of the haemostatic system leads to a formation of microthrombi in the microcirculation. Since consumption coagulopathies are bound to be secondary disorders, any underlying disease prone to lead to disseminated intravascular coagulation, should be treated as early and as intensively as possible. Solely by this and by restoring circulatory functions impaired by the underlying disease, it is possible in the majority of cases to stop the consumptive coagulopathy and to repair its sequelae. The shock frequently going along with a consumption coagulopathy requires immediate therapy: correction of hypothermia, treatment of acid-base and electrolyte disorders as well as fighting against hypovalaemia, anuria, and uraemia. Dextran does not serve only as plasma expander, but also corrects hypercoagulability and improves the rheological qualities of circulating blood. If these measures fail to stop the consumptive reaction of blood coagulation and/or fail to restore microcirculation in vital organs, indication for the use of anticoagulants or fibrinolytic drugs is given.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Therapy of consumption coagulopathies]. 307 Mar 63

Injuries missed at initial operation have the potential to cause the most disastrous complications in trauma patients. Over the past 5 years, 12 patients have required re-operation for 14 injuries missed at initial laparotomy and/or thoracotomy. Six missed injuries were vascular, two each in the thorax, pelvis, and retroperitoneum. The other eight were visceral: three small bowel (one patient), two pancreatic, and one each of the heart, ureter, and diaphragm. Five patients (42%) died, three with missed vascular and two with missed visceral injuries. Three died due to complications directly related to their missed injuries, while the unrecognized injury did not play a significant role in the other two. Indications for re-operation in patients with vascular injuries were hypotension in two patients, persistent output from drains in three, and refractory acidosis in one. Re-exploration in visceral injuries was for clinical sepsis in three patients, DIC in one, cardiac tamponade in one, and persistent chest tube drainage in one. Eleven of the 12 patients presented to the E.D. in shock. All patients had multiple injuries with a mean of 3.25 organ systems injured. Hypotension, coagulopathy, and/or hypothermia (T less than 92 degrees) were felt to have contributed to missing the injury in five of the patients with vascular, and three of the patients with visceral injuries. In the four other patients, injuries were missed due to inadequate exploration or a low index of suspicion in the presence of multiple injuries.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Injuries missed at operation: nemesis of the trauma surgeon. 339 94

Clinical features and specific aspects of treatment were evaluated in 612 patients with gram-negative bacteremia observed over a 10 year period. Coagulation abnormalities or thrombocytopenia were observed in 64 per cent of the patients. Evidence of disseminated intravascular coagulation (DIC) was found in approximately 10 per cent of them but was of sufficient severity to be associated with subcutaneous or visceral bleeding in 3 per cent of them. The frequency of coagulation abnormalities, other than DIC, was greater in patients with more severe underlying disease but DIC occurred with similar frequency irrespective of the severity of underyling host disease. Coagulation abnormalities of all types were associated with increased fatality rates. Hypothermia was noted in 13 per cent of the patients at the onset of bacteremia but was transient and was not associated with increased fatality. Failure to mount a febrile response greater than 99.6 degrees F within the first 24 hours of bacteremia was associated with a significant increase in fatality rates. Prior corticosteroid therapy diminished the febrile response to bacteremia. Age, underlying host disease, granulocytopenia, congestive heart failure, diabetes mellitus, renal insufficiency, nosocomial infections, and antecedent treatment with antibiotics, corticosteroids, and antimetabolites significantly increased fatality rates. Appropriate antibiotic treatment reduced the fatality rate of those with bacteremia by approximately one-half among patients in each category of severity of underlying host disease. In addition, it was shown that early appropriate antibiotic therapy also reduced the frequency with which shock developed by one half. Even after development of shock, appropriate antibiotic therapy significantly reduced fatality rates. The use of combinations of antibiotics could not be demonstrated to significantly improve survival rates. Minimal differences in therapeutic efficacy could be demonstrated between individual antibiotics and various combinations of antimicrobials. Shock occurred in approximately 40 per cent of the patients and its frequency was not influenced by the species of etiologic agent. Contrary to previous reports, corticosteroid therapy in patients with shock did not enhance survival and treatment with an average of 4.0 g/day of hydrocortisone or its equivalents was associated with a significant increase in fatality rates.
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PMID:Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. 698 71

A patient with severe hypothermia (core temperature of 22.2 C) and ventricular fibrillation had manual cardiopulmonary resuscitation for 3 1/2 hours while various rewarming technics raised her temperature to a level permitting successful electrical cardioversion. Laboratory testing revealed disseminated intravascular coagulation and several endocrinologic abnormalities. The need for prolonged, aggressive resuscitative measures and the possible role of corticosteroids in the management of profound hypothermia are discussed.
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PMID:Profound hypothermia: value of prolonged cardiopulmonary resuscitation. 722 65

Two cases of severe accidental hypothermia (core temperature below 25 degrees C) are reported. Both occurred in an urban area during the same winter period. Both patients had the same age and similar clinical symptoms. In the first patient, the EEG, the echocardiography and the blood gases were in favour of a good tolerance of hypothermia, which led to choice a non aggressive rewarming method. The latter included the rewarming of inhaled gas mixture as well as i.v. fluids and gastro-intestinal lavage fluid. The outcome was uneventful. In the second patient, the visceral and biological consequences were more important (pH: 6.80, blood glucose concentration: 1.48 mmol.L-1, major coagulation disorders). Therefore a rapid rewarming via a cardiopulmonary bypass was preferred. The patient died from a prolonged shock with disseminated intravascular coagulation. The use of cardiopulmonary bypass which is essential in case of cardiac arrest rhythm, is controversial in case of severe hypothermia with a still beating heart.
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PMID:[Severe accidental hypothermia]. 748 9

Recent studies have suggested that postoperative bleeding is decreased in pediatric heart operations if fresh whole blood instead of blood component therapy is used for postoperative transfusions. Because this is in contrast to our practice to use whole blood for only the priming of the cardiopulmonary bypass circuit and then to use blood components for additional transfusion requirements, it was our interest to analyze the bleeding complications and the use of blood products after heart operations in infants. The patient records of the 73 infants operated on in 1992 were reviewed. The chest tube drainage varied from 3 to 51 ml/kg per 6 hours (mean 10 ml/kg) and it did not correlate with any of the tested clinical or laboratory parameters. One infant underwent reoperation because of surgical bleeding. Disseminated intravascular coagulation developed in another patient. Sixty-eight patients (93%) needed red blood cell supplementation. Sixty-eight percent of patients between 1 month and 1 year old could be treated without any other postoperative transfusion except for red blood cell supplementation. In contrast, in the neonates, platelet concentrates or fresh frozen plasma, or both, were used in 61% of the patients. In addition to the known immaturity of the hemostatic system, the increased need for platelet concentrates in the neonates was attributed to longer cardiopulmonary bypass time, deeper hypothermia in association with circulatory arrest, larger dosages of heparin, and more extensive plasma dilution during cardiopulmonary bypass. In conclusion, a low rate of bleeding complications and acceptably low general blood loss can be achieved postoperatively with blood component therapy.
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PMID:Bleeding and use of blood products after heart operations in infants. 787 14


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