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

In order to effectively treat shock the physician must understand the physiology of shock. Shock patients may have a low, normal, or high arterial blood pressure, and the blood volume may be below normal, normal, or above normal. Shock is not necessarily accompanied by low arterial pH or low peripheral resistance. Most cases of acute traumatic and hemorrhagic shock show a high arterial pH, partly due to the blowing off of CO2, despite an elevated blood lactic acid level. Most patients also show a very high resistance. A factor that all shock patients have in common is a deficient capillary perfusion, or an insufficient amount of blood flowing through the capillaries. The cornerstone of the treatment of hypovolemic shock is the administration of adequate amounts of the right kinds of intravenous fluids. Focus is on classification of shock (reversible shock, irreversible or fatal shock, hypovolemia), the heart in shock, respiration, drugs (steroids, vasoactive drugs), and disseminated intravascular coagulation. If edema is a problem, diuretics may be helpful. Antibiotics for infection are very important in sepsis and septic shock. Supportive drugs are also important. Steroids and vasoactive drugs have a secondary place in the treatment of shock, and they should be used when these treatments have failed to produce an adequate blood pressure and urinary output.
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PMID:Treatment of shock. 44 80

An attempt to early diagnose disseminated intravascular coagulation (DIC) in persons acutely intoxicated with exogenic compounds was undertaken. The investigation involved 56 persons, aged 12--72, in this -- 20 females. In 21 persons intoxicated with carbon monoxide, organic solvents, metallic compounds and Amanita phalloides DIC syndrome was was found, the diagnosis being established -- in 14 persons -- in the subclinic phase. The diagnosis of DIC syndrome was based on results of clinical examination and hemostasis system examinations, enabling to evaluate the effect of free thrombin upon fibrinogen, fibrin and thrombocytes. Clinical observations and results of laboratory test indicate that only early diagnosis of DIC syndrome and thereby an instant inculcation of heparin therapy allow to gain complete remission of hemostatic disturbances in acutely intoxicated persons.
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PMID:[Early diagnosis of disseminated intravascular coagulation in the clinic of acute intoxications]. 73 96

In adult normothermic cats cerebral blood flow was interrupted for 1 hour by clamping the innominate and subclavian arteries. Following ischemia the brains were recirculated with blood, and the coagulation system was investigated by measuring coagulation times and blood content of fibrinogen and platelets. Ischemia induced progressive consumption coagulopathy with an increase in coagulation times and a decrease of platelets and fibrinogen by more than 40%. Coagulopathy was accompanied by a respiratory distress syndrome with a significant increase in the alveolar-arterial carbon dioxide gradient from --3.3 to --13.5 mm Hg. A correlation was found between plasma fibrinogen concentration, cerebral blood flow and electrophysiological function, indicating that a relationship exists between the severity of postischemic coagulopathy and functional recovery following prolonged cerebral ischemia.
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PMID:Coagulopathy following experimental cerebral ischemia. 84 91

The effect on colloid osmotic pressure (COP) of heparinizing body fluids was estimated with a low compliant osmometer, using Diaflo PM-30 or PM-10 membranes (Amicon, Lexington, Mass., USA). It was found that collecting and storing samples in preheparinized glass capillaries may increase COP by up to 4.0 mmHg. Measurements on heparin and protein solutions, separately and mixed, show that these macromolecules have a mutually potentiating effect on COP, probably by excluding part of the water as distribution space for the other molecular species. While this 'heparin error' varies among various types and batches of capillaries (Vitrex, Modulohm I/S), the content of heparin in some batches appears to be two to three times greater than the declared minimum. Alternatively, the excess COP may result from addition of other water-soluble macromolecules in the heparinization process. Even if some batches do not give appreciable error, we recommend to avoid preheparinized capillaries for measurement of COP. Both defibrination, and the amount of heparin needed to anticoagulate macro blood samples, have insignificant effect on COP. Loss of CO2 by diffusion from separated plasma may increase pH towards 9.5. Concomitantly, COP increased by 2.1 mmHg per pH-unit. If plasma or serum samples are capped within some minutes after separation, they may be stored for weeks at 4 degrees C in polyethylene tubes without appreciable change of COP.
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PMID:Measurement of colloid osmotic pressure in body fluids: errors caused by preheparinized glass capillaries and by CO2 loss. 311 Sep 36

Treatment of severe acute respiratory failure with extracorporeal gas exchange necessitating near complete systemic anticoagulation requires a delicate balance to be maintained between disseminated intravascular coagulation and hemorrhagic complications. The present study describes our first experience using a heparin coated extracorporeal artificial lung and circuitry during clinical extracorporeal CO2 removal. In spite of a partial thromboplastin time and activated clotting time within or close to the normal range, neither laboratory evidence for disseminated intravascular coagulation induced by the extracorporeal circuit nor thrombi in the pulmonary vasculature were found. Scanning electron microscopy of the heparin coated hollow fiber gas exchanger demonstrated only minor deposits on the surface. Use of a heparin coated artificial lung may enhance the margin of safety of extracorporeal gas exchange and ultimately broaden its indications.
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PMID:Extracorporeal CO2-removal with a heparin coated artificial lung. 322 Oct 12

Burn injury causes dynamic alterations in the coagulation and fibrinolysis, and so-called DIC often occurs in burned patients. In this study the clinical significance of heparin therapy combined with antithrombin III concentrate in animal experiments and clinical experiences were discussed. The changes in blood coagulation, fibrinolysis and kidney function and the effect of anticoagulation therapy using heparin were investigated in rabbits with third degree burn covering 35% of the total body surface area. The animals were subjected to determinations for various kidney function tests, blood coagulation and fibrinolysis tests, blood viscosity and hematocrit value before induction of the burn and after 8 and 24 hours respectively. Thirty rabbits were divided into a non-therapy group, an intravenous infusion group, a heparin group, an antithrombin III group, and an antithrombin III plus heparin group and the results were compared among them. Oliguria and a disturbance of kidney function were noted even at hour 8 after burn in the non-therapy group. In the intravenous infusion group urine volume was maintained well although the early stage of non-oliguric renal insufficiency was noted. The changes noted in the intravenous infusion group were prevented almost completely in the heparin group at hour 8, but FENa and CH2O were elevated at hour 24 probably because antithrombin III activity was depressed markedly. In the antithrombin III group and the antithrombin III plus heparin group, however, creatinine clearance was moderately elevated while FENa and CH2O remained unchanged as compared with the values before the burn. The antithrombin III plus heparin group showed slightly better results than the antithrombin III group in Ucr/Pcr ratio, creatinine clearance and CH2O. The results of the present study indicate that it is extremely effective to initiate appropriate fluid infusion therapy immediately after a burn and administer antithrombin III concentrate in combination with or without heparin for the prevention of acute renal insufficiency in patient with a severe burn. The effects of antithrombin III concentrate when used clinically were also discussed.
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PMID:[Alteration in coagulation and fibrinolysis after burn injury and significance of anticoagulation therapy using heparin and antithrombin III concentrate]. 381 36

Capnocytophaga canimorsus, formerly designated Dysgonic fermenter 2 (DF-2) was first described in 1976; it is a commensal bacterium of dogs and cats saliva, which can be transmitted to man by bite (54% of cases), scratch (8.5%), or mere exposure to animals (27%). We present a review of the clinical and microbiological characteristics of the Capnocytophaga canimorsus infections and 12 cases of infection in France. Over 100 cases of human infections have been reported, mainly septicemia in patients with diminished defences, due to splenectomy (33%), alcohol abuse (24%), immunosuppression (5%). However 40% of septicemia occur in patients with no predisposing conditions. Other infections are less frequent: meningitis, endocarditis, arthritis, pleural and localized eye infections. These infections range from mild to fulminating disease, with shock, respiratory distress, disseminated intravascular coagulation. Dermatological lesions (macular or maculopapular rash, purpura) or gangrene are common. This fastidious Gram-negative bacterium grows slowly on chocolate agar or on heart infusion agar with 5% rabbit blood incubated in 5% CO2. In spite of a great susceptibility of bacteria to antibiotics, the mortality is of 30%. Because of the severity of these infections, taking into account this organism in the management of bites is necessary, especially in patients with predisposing factors.
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PMID:Capnocytophaga canimorsus infections in human: review of the literature and cases report. 890 16

Unicellular green algae and cyanobacteria have mechanism to actively concentrate dissolved inorganic carbon into the cells, only if they are grown with air levels of CO2. The carbon concentration mechanisms are commonly known as "CCM" or "DIC-pumps". The DIC-pumps are environmental adaptation that function to actively transport and accumulate inorganic carbon (HCO3- and CO2; Ci) within the cell and then uses this Ci pool to actively increase the concentration of CO2 at the site of ribulose bisphosphate carboxylase-oxygenase (Rubisco), the primary CO2-fixing enzyme. The current working model for dissolved inorganic carbon concentration mechanism in unicellular green algae includes several isoforms of carbonic anhydrase (CA), and ATPase driven active transporters at the plasmalemma and at the inner chloroplast envelopes. In the past fifteen years, significant progress has been made in isolating and characterizing the various isoforms of carbonic anhydrase at the biochemical and molecular level. However, we have an inadequate understanding of active transporters that are located on the plasmalemma and at the chloroplast envelopes. In this mini-review we focus on certain aspects of the induction, function and significance of the dissolved inorganic carbon concentration mechanisms in aquatic photosynthetic microorganisms.
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PMID:Carbon concentration mechanisms in photosynthetic microorganisms. 1135 25

In the cyanobacterium Synechococcus UTEX 625, the yield of chlorophyll a fluorescence decreased in response to the transport-mediated accumulation of intracellular inorganic carbon (CO2 + HCO3- + CO32- = dissolved inorganic carbon [DIC]) and subsequently increased to a near-maximum level following photosynthetic depletion of the DIC pool. When DIC accumulation was mediated by the active Na+-dependent HCO3- transport system, the initial rate of fluorescence quenching was found to be highly correlated with the initial rate of H14CO3- transport (r = 0.96), and the extent of fluorescence quenching was correlated with the size of the internal DIC pool (r = 0.99). Na+-dependent HCO3- transport-mediated accumulation of DIC caused fluorescence quenching in either the presence or absence of the CO2 fixation inhibitor glycolaldehyde, indicating that quenching was not due simply to NADP+ reduction. The concentration of Na+ required to attain one-half the maximum rate of H14CO3- transport, at 20 [mu]M external HCO3-, declined from 9 to 1 mM as the external pH increased from 8 to 9.6. A similar pH dependency was observed when fluorescence quenching was used to determine the kinetic constants for HCO3- transport. In cells capable of Na+-dependent HCO3- transport, both the initial rate and extent of fluorescence quenching increased with increasing external HCO3-, saturating at about 150 [mu]M. In contrast Na+-independent HCO3- transport-mediated fluorescence quenching saturated at an HCO3- concentration of about 10 [mu]M. It was concluded that measurement of chlorophyll a fluorescence emission provided a convenient, but indirect, means of following Na+-dependent HCO3- transport and accumulation in Synechococcus.
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PMID:Quenching of Chlorophyll a Fluorescence in Response to Na+-Dependent HCO3- Transport-Mediated Accumulation of Inorganic Carbon in the Cyanobacterium Synechococcus UTEX 625. 1223 26

The biogeochemical processes governing leachate attenuation inside a landfill leachate plume (Banisveld, the Netherlands) were revealed and quantified using the 1D reactive transport model PHREEQC-2. Biodegradation of dissolved organic carbon (DOC) was simulated assuming first-order oxidation of two DOC fractions with different reactivity, and was coupled to reductive dissolution of iron oxide. The following secondary geochemical processes were required in the model to match observations: kinetic precipitation of calcite and siderite, cation exchange, proton buffering and degassing. Rate constants for DOC oxidation and carbonate mineral precipitation were determined, and other model parameters were optimized using the nonlinear optimization program PEST by means of matching hydrochemical observations closely (pH, DIC, DOC, Na, K, Ca, Mg, NH4, Fe(II), SO4, Cl, CH4, saturation index of calcite and siderite). The modelling demonstrated the relevance and impact of various secondary geochemical processes on leachate plume evolution. Concomitant precipitation of siderite masked the act of iron reduction. Cation exchange resulted in release of Fe(II) from the pristine anaerobic aquifer to the leachate. Degassing, triggered by elevated CO2 pressures caused by carbonate precipitation and proton buffering at the front of the plume, explained the observed downstream decrease in methane concentration. Simulation of the carbon isotope geochemistry independently supported the proposed reaction network.
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PMID:Reactive transport modelling of biogeochemical processes and carbon isotope geochemistry inside a landfill leachate plume. 1513 77


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