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

We report the cases of three patients with anorexia nervosa (AN) who each recovered rapidly after experiencing a life-threatening episode with severe thrombocytopenia. All three cases were the typical restricting-type of AN, occurring in adolescence. They refused to be admitted to a hospital until their general condition had been severely deteriorated. Their lowest platelet counts were 2.9, 4.6, and 2.3 x 10(4)/mm3, respectively. Apparent hemorrhagic tendencies, such as purpura, gingival and nasal bleeding, and gastrointestinal bleeding were observed. The bone marrow examination showed apparent hypoplasia in two patients. No evidence of disseminated intravascular coagulation or autoantibody to platelets was detected. The platelet counts recovered rapidly by water and nutritional supplementation. The recovery from the AN itself was excellent in all three patients without specific psychotherapy.
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PMID:Rapid recovery from anorexia nervosa after a life-threatening episode with severe thrombocytopenia: report of three cases. 992 61

Vibrio cholerae strains other than O1 and 0139 (non-O1 Vibrio cholerae) are associated with sporadic diarrheal disorders and limited outbreaks of diarrhea and have often been reported in association with extraintestinal infections. The following is a presentation of a fatal case of non-O1 Vibrio cholerae septicemia with disseminated intravascular coagulation and cutaneous bullous lesions that occurred in a patient infected with the acquired immunodeficiency syndrome. In order to prevent Vibrio cholerae infection, patients with underlying diseases should be warned of the risk factors for acquiring such infection, including consumption of raw shellfish and exposure to sea and fresh water where shellfish are found.
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PMID:Vibrio cholerae O2 sepsis in a patient with AIDS. 1035 55

Disseminated intravascular coagulation (DIC) is a frequent complication of meningococcal sepsis in children. Despite the availability of potent antibiotics, mortality in meningococcal disease remains high (about 10%), rising to 40% in patients presenting in severe shock and consecutive DIC. As the clinical course and the severity of manifestations of systemic meningococcal infections varies there is a need for early diagnosis of the infection and of the stage of coagulopathy in order to reduce the high mortality rate. Few and rapidly available parameters are needed to classify the wide spectrum of clinical and laboratory findings in patients with DIC. The parameters include partial thromboplastin time, prothrombin time, plasma levels of fibrinogen, antithrombin III (AT III), fibrin monomers and D-dimer concentration, fibrin degradation products and the thrombocyte count. Monitoring the course of hemostasis findings in 28 pediatric patients (age between 3 months and 8 years, mean 3.1 years) with systemic meningococcal infections we observed a change of coagulation parameters already in the first stages of the infection: A prolongation of partial thromboplastin time mean 69.1 sec (range 22-150 sec, normal 30-45 sec), a decrease of prothrombin time to 45.7% (range 13-71%, normal 70-100%) and of AT III to an average level of 70% (normal 85-125%) was found 1 to 4 (-6) hours after admission. The following deterioration of prothrombin time and partial thromboplastin time turned out to be statistically significant (p < 0.05, signed rank test). The monitoring of hemostasis parameters mentioned above made it to possible define the stage of coagulopathy and thus to start a stage related therapy. Treatment consisted of shock control by liquid substitution, compensation of metabolic acidosis, correction of clotting disorders (AT III and heparin in case of pre-DIC; AT III and fresh frozen plasma in case of advanced DIC), antibiotic treatment (beta-lactam antibiotics e.g. cefotaxime or ceftriaxone), and--when necessary--catecholamine infusions. An early assessment of the coagulation disorders in meningococcal disease can be based on few coagulation parameters. Thus an appropriate treatment can be arranged in order to prevent a fatal outcome of meningococcal sepsis and to protect against the development of a Water-house-Friderichsen-syndrome.
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PMID:Diagnosis and stage-related treatment of disseminated intravascular coagulation in meningococcal infections. 1040 13

Sixty cases of P. falciparum and 165 cases of P. vivax were studied clinically along with species identification of parasite after examination of the blood slide by experts at Calcutta. It was observed that malaria had been changing its clinical profile. The classic paroxysm is evident only in 40% cases of P. falciparum and 47.27% of P. vivax malaria, but the difference between the two groups is not statistically significant. On the other hand continuous or remittent type of fever has been observed in 40% and 27.27% cases of P. falciparum and P. vivax respectively, while absence of classic paroxysms of fever, in association with splenomegaly when present, poses a diagnostic difficulty with enteric fever. Association of jaundice in 40% and 9.09% cases with P. falciparum and P. vivax respectively along with hepatomegaly in 80% and 63.63% in them in conjunction with nausea and/or vomiting leads to clinical mimicry with infective hepatitis. Splenomegaly which has been described as cardinal feature of malaria was observed in 40% cases with P. falciparum and only in 18.18% cases of P. vivax malaria and this is a clear deviation from earlier description and this difference between the two groups is highly significant at 99% level of confidence. Co-existent enteric fever was observed in 3.33% of falciparum and 2.6% of vivax malaria, though this difference is not statistically significant. Acute respiratory distress was observed in 6.6% of P. falciparum malaria only. Oliguria with impaired renal function was noted in 5% cases of P. falciparum malaria. The present study has also noted convulsion or coma in 8.33%, purpura with disseminated intravascular coagulation in 3.33% and black water fever in 3.33% cases in falciparum malaria which were not observed in cases with vivax malaria and these differences are statistically significant. However, stupor with bilateral extensor planter response was observed in two cases (1.3%) of vivax malaria.
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PMID:Changing scenario of malaria: a study at Calcutta. 1044 29

Leptospirosis, a zoonosis with worldwide distribution, may have a broad spectrum of clinical manifestations that can delay the diagnosis, especially in wet climates where other conditions may dissimulate the main aspects. The authors describe 42 cases of patients with leptospirosis admitted to the Infectious Diseases Unit of a general hospital since 1990. The goal was to analyse epidemiological features, clinical manifestations, laboratory findings, treatment and evolution. There were 23 males (54.7%) and 19 females (45.2%), with ages ranging from 17 to 82 years. Most cases occurred in occupational settings, especially in those in contact with animals or stagnant water. All the cases had serological confirmation (by MAT or ELISA methods). Anicteric forms represented 42.9% of the total, which implies that in many cases a diagnosis is not immediately evident. The main symptoms, other than fever (97.6%) and jaundice (57.1%), were myalgia (71.4%), headache (42.8%) and nausea (33.3%). Renal involvement was common (52%), but the most severe forms occurred in 3 patients who required hemodialysis; followed by D.I.C. in 9.5%; meningitis in 4.7% and pulmonary involvement in 2.3% of the cases. The serovars most commonly identified were L. icterohaemorraghiae (28.5%), L. australis (14.3%), L. grippothyphosa (11.9%) and L. canicola (9.5%). The patients were treated with penicillin G (83.3%) or doxycyclin (9.5%). Two of them deceased (4.7%) and the remainder had a good evolution. The diagnosis of leptospirosis may be delayed if physicians fail to include this infection in the initial differential diagnosis. In view of this, the authors emphasize that when nonspecific clinical manifestations occur, a good epidemiological history is useful in proposing this diagnosis.
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PMID:[Human leptospirosis. A short review concerning a caseload]. 1089 35

The body's ability to regulate core temperature depends on both host (internal) and environmental (external) factors. Although athletes are commonly thought to be most at risk for heat illnesses, children and the elderly are particularly vulnerable. Heat cramps, which are caused by fluid and electrolyte imbalances, are treated with massage, and fluid and electrolyte replacement. Heat exhaustion occurs both as water- and sodium-depleted types, with associated symptoms such as malaise, vomiting, and confusion. Treatment involves taking the affected person to a cool environment and replacing fluids and electrolytes if needed. In more serious cases, intravenous hydration may be necessary, although monitoring of serum sodium levels is important to prevent cerebral edema. If not treated promptly, heat exhaustion may evolve into heatstroke, a deadly form of heat illness. Heatstroke occurs in classic and exertional forms and is present when the core body temperature exceeds 40 degrees C (104 degrees F). The patient may experience cardiac arrhythmias, rhabdomyolysis, serum chemistry abnormalities, disseminated intravascular coagulation, and death. Heatstroke is a medical emergency that should be treated immediately with temperature-lowering techniques such as immersion in an ice bath or evaporative cooling. Fluid resuscitation is important but should be closely monitored, and renal function may need to be protected with mannitol and diuretics. It is important to be vigilant for heat illnesses because they occur insidiously but progress rapidly.
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PMID:Evaluation and treatment of heat-related illnesses. 1272 45

3,4-Methylenedioxymethamphetamine (MDMA, or "ecstasy") has gained an undeserved reputation as a "safe" drug among its users. However, hyperthermia, rhabdomyolysis, hepatotoxicity, disseminated intravascular coagulation, long-term serotonergic neurotoxicity, and death are all associated with MDMA use. Hyponatremia is also reported, and its manifestations are frequently delayed several hours after the drug is ingested. The etiology of this hyponatremia is unclear; both the syndrome of inappropriate antidiuretic hormone release (SIADH) and free-water intoxication are advanced as explanations. We describe a 19-year-old female who presented to the emergency department with altered mental status 1 day after using MDMA. Her initial serum sodium was 121 mmol/L, and computerized tomography (CT) of her head demonstrated cerebral edema. She was treated with hypertonic saline and fluid restriction, and her serum sodium increased to 132 mmol/L over the next 24 hours. She regained consciousness completely within 48 hours of presentation and recovered uneventfully. MDMA toxicity, particularly the pathophysiology and treatment of MDMA-induced hyponatremia, are discussed.
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PMID:The "ecstasy" hangover: hyponatremia due to 3,4-methylenedioxymethamphetamine. 1246 74

It has been possible to duplicate in the hemophilic dog four of the major experiments which have suggested in humans an "anticephalin" hypothesis for the pathogenesis of hemophilia. The experiments in the dog have been considerably extended, as compared with the human experiments, by a variety of techniques. I. Asbestos was placed in contact with hemophilic dog plasma, and the clotting time became shorter. When transfused, this plasma had no effect on the defective prothrombin utilization of hemophilic dogs, in contrast to untreated normal plasma. II. The ionic strength of native dog plasma and dog plasma citrated (38 per cent sodium citrate) then recalcified (0.2 M CaCl(2)) were calculated. The ionic strength of the native plasma was approximately 0.15 while that of the citrated plasma was approximately 0.21. Conductivity and freezing point determinations on the plasmas described above were consistent with the idea that the ionic strength of the citrated plasma was significantly higher. The biphasic dilution curve, to which much significance has been attached in arriving at the "anticephalin" hypothesis, can be produced readily in the dog. Diluting dog plasma with "iso-ionic" or "hyper-ionic" NaCl solution abolished the biphasic phenomenon. Dilution with distilled water exaggerated the biphasic curve. These experiments suggest that the biphasic curve is an artifact of uncontrolled ionic strength. III. The prothrombin utilization rates of undiluted whole hemophilic dog blood and hemophilic dog blood diluted 1:2 with 0.85 per cent NaCl were found to be the same. IV. Ether extraction of both normal and hemophilic dog plasma removed fibrinogen and reduced somewhat the concentration of prothrombin. In treated normal plasma AHF was reduced to the level of untreated hemophilic plasma, thus producing a quasi-hemophilic plasma. Defibrination and ether extraction of both normal and hemophilic dog plasma "generated" clotting activity which shortened the clotting time of hemophilic plasma and was active in the thromboplastin generation test. The activity "generated" by defibrination and ether extraction of dog plasma was adsorbed by a BaSO(4) suspension and shown, therefore, not to be the anti-hemophilic factor (AHF). Transfusion of ether-extracted normal or hemophilic dog plasma into hemophilic dogs had no effect on the prothrombin utilization rate, unlike untreated normal plasma which had a marked effect. Thus, four of the main lines of evidence supporting the "anticephalin" hypothesis were duplicated in the dog. However, by extending the experiments it was found that all were explainable on bases other than the presence of "anticephalin." Such an hypothesis is not necessary, therefore, to explain the pathogenesis of canine hemophilia. The apparent identity of hemophilia in the two species suggests that the hypothesis is also not applicable to humans.
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PMID:The pathogenesis of hemophilia; an experimental analysis of the anticephalin hypothesis in hemophilic dogs. 1344 37

Vibrio vulnificus is a Gram-negative, motile, curved bacillus of the family Vibrionaceae that is a rare cause of gastroenteritis, septicemia, and wound infections in humans. V. vulnificus is halophilic, flourishes in warm temperatures, and is part of the bacterial flora of the marine environment. The location of our health care setting, on the Gulf of Mexico, has given us the opportunity to observe a wide variety of clinical presentations of infections caused by this organism. In the first case, a 27-year-old man struck by lightning while windsurfing was found pulseless in the water and was resuscitated. The patient subsequently developed cardiac arrhythmias, respiratory failure, and necrotizing fasciitis, blood cultures yielded V. vulnificus. After antibiotic therapy and several fasciotomies, the patient recovered. The second case was that of a 43-year-old Asian man employed as an oyster shucker who presented with complaints of redness, tearing, and photophobia of the right eye. The diagnosis of corneal ulcer secondary to V. vulnificus was made after culture of the right eye revealed the organism. The third case involved a 46-year-old man who presented with complaints of abdominal pain, nausea, chills, and bullous lesions on the lower extremities. He developed disseminated intravascular coagulation, and cultures of the lesions on his lower extremities showed V. vulnificus. Initially, the patient denied any exposure to raw seafood or seawater, but he eventually remembered eating raw oysters 3 days before his illness. The fourth case is that of a 32-year-old, human immunodeficiency virus-positive, hepatitis C-positive woman with cirrhosis who presented with productive cough, chills, fever, and red spots on her extremities and buttocks. Blood cultures revealed V. vulnificus and the patient was treated with antibiotics and improved clinically. These four cases illustrate the wide range of clinical presentations associated with this organism.
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PMID:Varied clinical presentations of Vibrio vulnificus infections: a report of four unusual cases and review of the literature. 1498 56

A comprehensive understanding of the transport and geochemical processes controlling solutes in clay-rich aquitard confining units is needed to accurately predict the long-term migration of contaminants into the subsurface. To this end, the geochemical and stable isotopic composition of porewaters in the upper 22 m of a thick, unoxidized and nonfractured clay-rich, till aquitard (Sutherland Group) was examined in detail. The aquitard is overlain by about 8 m of oxidized and fractured till (Floral Fm). Concentrations of TDS, SO4(2-), HCO3-, Cl-, Na+, Mg2+, Ca2+ and porewater deuterium were greater in the Floral Fm and decreased with depth through the aquitard. The elevated and seasonably variable solute concentrations in the oxidized Floral Fm were attributed to geochemical weathering and dynamic water movement through fractures. Good fits between measured delta2H, TDS, SO4(2-), Cl- and HCO3- profiles through the aquitard and simulated solute transport profiles were obtained by diffusion (without advection) with transport times of 4-6 ka. The deficiency of geochemical reactions affecting HCO3- and SO4(2-) in the aquitard was supported by delta13C(DIC) and delta34S(SO4) analyses. Geochemical and isotope mass balance modelling (NETPATH) indicated that diffusive mixing with minor calcite dissolution and ion exchange could account for the distribution of Na+, Ca2+ and Mg2+ in the aquitard. Results of this study further suggested that microbiological activity in the aquitard was limited. With minor exceptions, the solute and isotopic profiles, their transport and the controlling geochemical reactions in the Sutherland are similar to those determined at another clay-rich till aquitard, 160 km south of this site, suggesting that geochemical and biological processes in some clay-rich aquitards may have a minimal effect on the migration of dissolved constituents.
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PMID:Transport and geochemical controls on the distribution of solutes and stable isotopes in a thick clay-rich till aquitard, Canada. 1508 80


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