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)

The purpose of this study was to analyse the clinical course of 410 patients of severe surgical infections (primary 251, postoperative 159) during recent 5 years and to evaluate the important background factors which make these patients serious. As a result, the following patients such as, (1) who have refractory primary infections, for example malignant lymphoma, severe pancreatitis etc. (2) whose infectious foci were uncontrolled. (3) who had finally complicated a septic MOF or DIC, seemed to be especially critical even though recent advanced surgical therapy. To improve these severe conditions, we believe to need a renewed approach like so called "multi-disciplinary therapy", additionally with both conventional antibiotics administration and drainage for infectious foci. Several methods such as, (1) rational nutrition management using indirect calorimetry. (2) plasma exchange for removing toxic substances such as bacterial toxins, chemical mediators etc, from circulating blood. (3) pharmacological block of these toxic substances, were shown. In terms of the harmful chemical mediators, we supposed that both PAF (platelet activating factor) and oxygen free radical were extremely important in septic conditions from previous clinico-experimental studies. Therefore the effects of those pharmacological blockers such as PAF antagonists, SOD, protease inhibitor in experimental endotoxin shock were discussed in detail.
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PMID:[Clinico-experimental analysis of backgrounds of the severe surgical infections]. 194 10

The blood level of endotoxin after operations in patients with digestive diseases, mainly liver cirrhosis and obstructive jaundice, and the complications most likely related to the presence of endotoxemia were investigated. Twenty-seven patients without either liver cirrhosis or obstructive jaundice showed a minimal elevation of the endotoxin level in blood, as shown by 6.1 +/- 3.9 pg/ml at the first postoperative day and there was only one anastomotic leakage. On the other hand, 18 patients with liver cirrhosis showed a notable and persistent endotoxemia after surgery. The cirrhotic patients who especially underwent splenectomy and hepatectomy showed marked elevations of endotoxin level at the first postoperative day, with values of 151.0 +/- 46.1 pg/ml and 101.3 +/- 36.2 pg/ml, respectively, and one of these patients died of hepatic failure. Thirteen patients with obstructive jaundice developed endotoxemia evidenced by the value of 21.6 +/- 4.8 pg/ml at the first day after surgery. Among these patients, two had gastrointestinal bleeding and one developed DIC. The markedly high and persistent levels of endotoxin in patients with liver cirrhosis or obstructive jaundice may be possibly related with the development of MOF.
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PMID:[Endotoxemia after surgery in digestive diseases]. 362 92

Severe surgical infection is one of the most obvious clinical settings of DIC. Although many initiating triggers have been discussed, the most potent might be a bacterial endotoxin which activates Hageman factor or some components of serum complement. We examined a disorder of blood coagulation system in severe surgical infection in terms of the results of limulus test for detection of circulating endotoxin. In 59 of such patients, 10 cases (32.3%) of DIC diagnosed by MINNA 's criteria were recognized in 31 limulus positive cases, whereas only 4 cases (14.3%) in 28 limulus negative groups. Each clinical course, prognosis, or the relationship with MOF were also discussed in detail. It was emphasized that the first requirement for diagnosis of DIC should be awareness of its possibility and careful observation of platelet counts. The immediate needs for treatment of DIC are (1) a cure of underlying infection by surgical drainage and chemotherapy, and (2) inhibition of intravascular coagulation by use of heparin and/or FOY etc. Our experiments performed by a continuous drop infusion of both 0.2 mg/kg 055; B5 E. Coli endotoxin and several doses of FOY for 4 hours into rabbits showed that the most potent inhibitory effect of FOY on platelet and WBC was observed in 0.1 mg/kg/min.
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PMID:[Severe surgical infection and DIC]. 642 96

The authors describe a malignant malaria clinic case complicated by shock, disseminated intravascular coagulation (DIC) and multiple organ failure (renal, heart, lung failure): MOF. Early diagnosis and suitable therapy, with multiple organ failure intensive care allowed a good patient outcome.
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PMID:[Multiple organ failure (MOF) in tertian malaria. Report of a clinical case]. 780 Jan 89

The clinical relevance of determination of plasma antithrombin III(ATIII) and alpha 2-plasmin inhibitor (alpha 2 PI) activities in patients with disseminated intravascular coagulation (DIC) was analyzed. Although the plasma ATIII activity was decreased in patients with DIC, no significant correlation was observed between plasma level of ATIII and that of thrombin-antithrombin III complex or prothrombin fragment 1+2. The extent of the decrease of ATIII in DIC was the most marked in cases associated with septicemia. The plasma level of ATIII in septicemia without DIC was significantly lower than that in DIC cases without septicemia, suggesting that the decrease of ATIII level could not be related to the pathophysiology of DIC, but to that of septicemia. The plasma half-life of ATIII in septicemia without DIC was significantly shortened in the absence of the increase of TAT level, suggesting that the extravasation of ATIII might be induced probably due to the endothelial damage in septicemia. The alpha 2-Plasmin inhibitor level was decreased in DIC patients. The decrease was the most marked (lower than 60% of normal) in patients with excessive fibrinolysis in which fibrinogen degradation was induced. The plasma level of alpha 2PI was significantly higher in the DIC cases with septicemia than in those without septicemia. The ATIII/alpha 2PI ratio was significantly lower in DIC cases with septicemia than in those with solid tumor or acute leukemia. Moreover, the ATIII/alpha 2PI ratio was significantly lower in MOF cases than in non-MOF cases in septicemia. The mortality of the MOF cases did not correlate with the ATIII/alpha 2PI ratio, but with the plasma level of PAI-1, suggesting that the decrease of ATIII/alpha 2PI ratio might not reflect the irreversible endothelial cell damage. Based on these observations, the calculation of ATIII/alpha 2PI in DIC patients would provide the following information; (1) a low ATIII/alpha 2PI ratio (less than 0.6) was frequently observed in septicemia, which could be related to the occurrence of organ dysfunction; (2) a high ATIII/alpha 2PI ratio (higher than 1.0) with the marked decrease of alpha 2PI level (lower than 60% of normal) suggests the occurrence of excessive fibrinolysis in which anti-fibrinolytic therapy should be considered when clinical bleeding was present; (3) The ATIII/alpha 2PI ratio near 1.0 was observed in DIC associated with the pathological conditions other than described above, such as solid tumors, in which the coagulation and fibrinolysis was almost equally activated.
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PMID:[Clinical relevance of determination of plasma ATIII and alpha 2 PI activities in patients with DIC--application of the molecular markers for the analysis of pathophysiology of DIC]. 810 83

Pathophysiologic concept of SIRS has been proposed for the better management of postoperative severe infection and septic MOF, and the concept has been found to be very useful. It is very important to identify the high risk SIRS patients of the development of septic MOF and to treat those patients aggressively to prevent the development of septic MOF. In the prevention and treatment of septic MOF, the blood purification has been found to be very effective. Among the blood purifications, continuous blood purification, such as continuous hemodiafiltration (CHDF) should be chosen for this purpose. CHDF has been claimed to be very effective to removal of causative humoral mediators from the blood stream. The concept of DIC has been changed recently and the concept of DII (disseminated intravascular inflammation) should be applied instead of DIC, since the main feature of this pathologic condition is the damage of endothelial cells due to extensive systemic inflammation.
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PMID:[Prevention and treatment of postoperative septic MOF and DIC and efficacy of blood purification]. 903 85

We experienced the perioperative management of a hemorrhagic shock associated with postpartum uterine rupture. After the emergency abdominal total hysterectomy, massive blood transfusion was required to maintain the hemodynamics and the laparotomy for hemostasis was performed on the 1st, 2nd and 7th ICU day. Total amount of transfused blood products was 37,000 ml during one week. The patient immediately developed DIC and acute renal failure. Laboratory data showed increased leukocyte count (the peak value was 56,100 microliters-1 on the 12th ICU day), and neutrophilic fraction was more than 90% of leucocyte. After the decrease in CRP, the decrease in total bilirubin concentration was delayed. There were no other signs of infection and no remarkable change in MOF score. There was a discrepancy between this leukocytosis and the severity of organ dysfunction, and the cause of the leukocytosis was unknown.
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PMID:[A case of leukocytosis after massive blood transfusion for postpartum hemorrhagic shock]. 909 12

From the middle of 1990's, there repeated in winter season an outbreak of encephalopathy in Japan that appeared to be associated with influenza. A national survey was conducted, and a total of 507 patients was diagnosed as having influenza-associated encephalopathy during 1998-2002 on the basis of virologic analysis. Type A influenza was more pathogenic than type B, and A: H3 type was more invasive than A: H1 type. Encephalitis developed mainly in children below 5 years of age, either on the day that influenza signs appeared or on the next day. We hypothesized that the replicated viruses at nasopharyngeal epithelium disrupt the olfactory mucosa. Via olfactory nerve system, the stimuli may be transmitted to the brain eventually to activate glial cells, and to induce the production of pro-inflammatory cytokines. The cytokine storm results in neural cell damage as well as apoptosis of glial cells due to TNF-induced mitochondrial respiratory failure. The disruption of blood-brain barrier progresses to the systemic cytokine storm, resulting in DIC and MOF.
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PMID:[Influenza-associated encephalopathy--pathophysiology and disease mechanisms]. 1461 37

Patients with a new type of influenza-associated encephalopathy with high mortality are increasing in Japan and the United States. We present three patients treated with methyprednisolone pulse treatment and plasma exchange to remove cytokines, and all three patients recovered without severe sequela. IL-6 decreased dramatically after the start of the plasma exchange and methyprednisolone. Therefore when influenza-associated encephalopathy is actually diagnosed, steroid pulse therapy should be started at an early stage, and when signs of DIC and/or MOF appear, plasma exchange is recommended to remove the cytokines and NOx.
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PMID:Efficacy of plasma exchange and methylprednisolone pulse therapy on influenza-associated encephalopathy. 1603 52

The systemic inflammatory response syndrome (SIRS) is a clinicopathological manifestation of overexuberant acute-phase inflammation caused by infectious or noninfectious etiologies. The systemic release of pro-inflammatory cytokines, chemokines, and lipid and vasoactive mediators induces endothelial damage and microvascular thrombosis, potentially culminating in disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and multiple organ dysfunction (MOD) or failure (MOF). We present five cases in the pig-tailed macaque and olive baboon where SIRS resulted in MOF, ARDS, DIC, and the Waterhouse-Friderichsen syndrome; each with gross and histological elements manifested as edema, deposition of fibrin, hemorrhage, and thrombosis. In the described cases, SIRS was the end-common pathway for multiple risk factors that parallel those documented in humans: major surgery, obstetric complications, and infection. The diagnosis of SIRS should be considered when evaluating nonhuman primate (NHP) cases of MOF manifesting with histological evidence of vascular leakage. Experimental manipulation of NHP models may be complicated by SIRS and accompanying rapid clinical decompensation. Such adverse events may compromise toxicological studies and should be avoided when possible.
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PMID:Systemic inflammatory response syndrome in nonhuman primates culminating in multiple organ failure, acute lung injury, and disseminated intravascular coagulation. 1977 93


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