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

The statement that amniotic fluid embolism is the most dangerous and untreatable condition in obstetrics appears to be true. It must be suspected in any patient who collapses or bleeds excessively during labour or the immediate post-partum period. Attempts should be made to secure a definitive diagnosis in life by examination of blood obtained from the right side of the heart and the sputum for elements of amniotic fluid. Lung scanning is a useful aid to diagnosis. The principal factors that have been implicated in the clinical syndrome of amniotic fluid embolism are anaphylaxis, vascular obstruction by particulate matter, vascular spasm due to prostaglandins and possibly some other vasoactive substances, and the possibility that all the changes could be explained by disseminated intravascular coagulation as a primary event. Further work is required to elucidate the relative contributions of these various factors. Due to the suddeness of the catastrophe and the very high mortality, haemodynamic data in humans is virtually non-existent. With improved methods of resuscitation it is to be hoped that the mortality rate will be reduced and that such data will become available. In this way it might become possible to apply the results of animal research and indicate the most effective method of treatment.
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PMID:Amniotic fluid embolism. 37 60

In short, bacterial sepsis is associated with a number of peripheral manifestations involving the skin and soft tissues. The pathogenesis of the lesions observed is not fully understood and is almost certainly multifactorial. In ecthyma gangrenosum, the presence of large numbers of gram-negative bacilli in the walls of small blood vessels without a substantial inflammatory response suggests that either the bacteria themselves or bacterial products are responsible for tissue damage. Endotoxin probably plays a prominent role in producing these lesions. That Pseudomonas and Aeromonas species seem to cause ecthyma out of proportion to their prevalence as a cause of bacteremia might suggest that the endotoxin of these organisms has a special predilection for skin and subcutaneous structures. More likely, it indicates that other bacterial substances, such as exotoxins or proteases, are involved. The absence of PMN leukocytes is thought to play a permissive role, allowing unopposed bacterial proliferation. Lesions of symmetric peripheral gangrene characteristically do not have bacteria present. The presence of intravascular fibrin accumulation probably resembles the generalized Shwartzman phenomenon. However, the gangrenous lesions themselves more likely result from systemic hypotension and the resulting hypoperfusion of the tissues than from vessel obstruction. In lesions associated with vigorous inflammatory response, bacterial products may damage tissue either directly or by attracting leukocytes that, in turn, release substances that cause further tissue damage. An etiologic role for endotoxin or the gram-positive bacterial cell wall is likely, since endotoxin is known to produce similar lesions in the localized Shwartzman reaction. Favoring a role for other bacterial substances is the predisposition of V. vulnificus to cause cellulitis or of C. fetus to cause inflammation of the major vessels during sepsis; the mechanisms for these reactions are entirely unknown. It is interesting that in most instances in which peripheral lesions are caused by sepsis, either a large number of bacteria or an intense inflammatory response by PMNs is present, but not both. In both kinds of lesion, the tendency to involve blood vessels by different pathogenetic mechanisms contributes to the evolution of the disease process. In intensely inflamed lesions, veins and arteries can be shown histologically to be occluded. In the absence of inflammation, bacterial invasion of vessel walls or simply the presence of bacterial products adjacent to the vessel may produce spasm. As noted, the pathogenetic significance of thrombosis observed in the lesions of DIC remains unclear.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cutaneous manifestations of bacterial sepsis. 252 95

Pathomorphology of eclampsia is reviewed on the basis of literature data and it is noted that the problem has been studied insufficiently. Morphological features of eclampsia are subdivided into two groups; changes in the microcirculatory bed, that are generalized and undergo the following stages: spasm----wall swelling or necrosis----microthrombosis; and postischemic organ changes, such as dystrophy, necroses and hemorrhages. The role of disseminated intravascular coagulation syndrome is discussed in the development of some clinico-morphological features of eclampsia.
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PMID:[Pathomorphology of eclampsia]. 353 71

The model of chest trauma accompanied by acute respiratory failure was studied on 78 guinea-pigs. Histological and electron microscopic methods have revealed a typical pattern of shock lung: combination of diffuse bilateral microfocal distelectases and microcirculation disturbances, i.e. pulmonary venular spasm accompanied by sludge, disseminated intravascular coagulation, focal hemorrhages and interstitial edema. In 5 out of 13 cases 72 hours later hyaline membranes were observed as conglomerations of eosinophilic masses of plate form, distinct from intraalveolar edema. At the ultrastructural level hyaline membranes could be identified as stripes of granular or fibrillar accumulations containing cellular organella debris, ajacent to alveolar walls.
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PMID:[Mechanism and time periods of the development of hyaline membranes in acute respiratory failure of traumatic origin]. 385 83

This article gives an overview of amniotic fluid embolism, which still carries a fatality rate of approximately 86% and which accounts for 9% of all maternal deaths. A case report is presented which ended with a fatal outcome. Photomicrographs show fetal squames and lanugo hairs in the pulmonary capillaries as well as ones aspirated from the right atrium. The treatment is discussed in terms of acute primary and acute secondary care. Acute primary care centers around the prompt recognition and treatment of pulmonary edema. This is apparently due to the mechanical blockade of the pulmonary vasculature and particulate matter from the amniotic fluid and also to an anaphylactoid reaction adding to the pulmonary arteriolar spasm. The acute secondary treatment deals with combating the almost inevitable disseminated intravascular coagulation and uterine atony. Being always alert to the possible occurrence of this condition and being able to institute appropriate therapy rapidly are necessary for a successful outcome.
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PMID:Amniotic fluid embolism: an overview and case report. 401 35

A 72-year-old man was admitted to the emergency ward in our hospital on July 20, 2001, because of consciousness disturbance, fever, generalized skin eruption, and severe general weakness beginning 7 days previously. Physical examination on admission revealed marked systemic cyanosis, erythema, and purpura. Laboratory findings indicated disseminated intravascular coagulation (DIC) and multiorgan failure (platelet count, 0.9 x 10(4)/micro l; fibrin degradation product, 110 micro g/ml; C-reactive protein, 22.6 mg/dl). Soluble interleukin 2-receptor (sIL-2R) was markedly increased to 14 710 U/ml. Blood gas analysis demonstrated severe metabolic acidosis. He was diagnosed with multiorgan failure due to DIC. Administration of heparin and sodium bicarbonate was started immediately, but respiratory failure was exacerbated and systemic spasm caused by encephalitis was noted. Although he was supported by an artificial ventilator, deterioration of metabolic acidosis occurred, and the blood pressure decreased to less than 60 mm Hg. He died 5.5 h after admission. The serological test showed no positive antibody titers against Orientia tsutsugamushi, Rickettsia japonica, or Rickettsia typhi. However, a specific DNA band derived from R. japonica was detected by the polymerase chain reaction (PCR) method using a primer from a blood clot. Therefore, he was definitively diagnosed as having Japanese spotted fever. The PCR method may be markedly useful for establishing a definitive diagnosis of Japanese spotted fever during the critical stage.
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PMID:Fulminant Japanese spotted fever definitively diagnosed by the polymerase chain reaction method. 1237 93

We report the case of a 40 year old woman admitted for dilatation and curettage at 12 weeks of amenorrhoea with post-abortion partial placental retention. Clinically she had developed disseminated intravascular coagulation (DIC) complicated by an acute coronary syndrome with persistent ST elevation in the inferior leads. Management of her myocardial ischaemia was symptomatic, due to the underlying complex coagulation disorder making coronary reperfusion techniques impossible. After treatment for the cause of DIC, coronary angiography revealed no detectable angiographic lesion or spasm. In this context, the most likely aetiological hypothesis is a thrombus related to the DIC in an otherwise healthy heart, which was spontaneously lysed.
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PMID:[Myocardial infarction during post-abortion DIC]. 1655 3