1/8. Trauma-induced coagulopathy and treatment in kosovo.The 67th Combat Support Hospital at Camp Bondsteel, kosovo, treated victims of trauma on an almost daily basis at the beginning of U.S. peacekeeping efforts in the region. Military health care personnel must respond quickly and efficiently when confronted with patient wounds resulting in massive blood losses. The limited medical resources of a field hospital often complicate efforts to treat the most severe injuries. One such case involved a young farmer riddled with gunshot wounds. Early volume/blood resuscitation before, during, and after surgery led to a massive blood coagulopathy. This case study describes the actions the physicians and nurses initiated to save this victim of violence. The subsequent discussion delineates methods to reduce intraoperative blood losses, blood transfusion alternatives, and technological advances in trauma resuscitation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Successful reversal of deleterious coagulopathy by recombinant factor viia.Effective treatment of severe or uncontrolled bleeding is a challenge for physicians in the operating room and intensive care unit. However, even aggressive conventional therapy may ultimately fail in some patients. Administration of recombinant activated factor VII (rFVIIa) may be the only remaining therapeutic option to stop life-threatening coagulopathic bleeding. We here describe the clinical course of 5 patients exhibiting severe continuous bleeding that could not be stopped by surgical intervention and appropriate hemostatic management but resolved after a mean dose of 90 microg/kg of rFVIIa (range, 90-120 microg/kg). Four of the five patients recovered completely, and one patient died after developing sepsis in multiorgan failure. In all patients, bleeding from wound surfaces stopped within minutes of the administration of rFVIIa. Coagulation measurements improved, and transfusion requirements declined considerably. No adverse effects associated with rFVIIa were observed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Recurrent embolism in the course of marantic endocarditis.Marantic or nonbacterial thrombotic endocarditis (NBTE) associated with systemic embolism is usually a complication of advanced or terminal malignancies. We report on the case of a 46-year-old woman in whom nonbacterial thrombotic endocarditis (NBTE)-related cerebral embolism was the first clinical sign of ovarian neoplasm, which was diagnosed after cardiac surgery. Marantic endocarditis should alert the physician to make every effort to diagnose the possible background of this clinical phenomenon. Early identification of NBTE, treatment of the underlying disease, and the associated coagulopathy could possibly prevent cardiac surgery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. hematuria and clot retention after transvaginal oocyte aspiration: a case report.OBJECTIVE: To report a case of bladder injury with hematuria and urinary retention after transvaginal oocyte aspiration. DESIGN: Case report. SETTING: Emergency room in a university medical center. PATIENT(S): A 28-year-old woman presented with urinary retention and suprapubic pain 8 hours after oocyte aspiration. INTERVENTION(S): Foley catheter, intravenous fluid bolus, bladder irrigation, and computed tomography with postvoid films that showed a blood clot in the bladder. Patient was discharged home with antibiotics and catheter in place. MAIN OUTCOME MEASURE(S): Clinical follow-up. RESULT(S): Patient passed voiding trial 4 days later and was artificially inseminated. No further hematuria or voiding problems were reported, and she had a successful pregnancy. CONCLUSION(S): patients who elect to undergo oocyte aspiration should be warned about the possibility of bladder injury because of the close proximity of the ovaries to the bladder, and physicians should have an appropriate treatment plan.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Severe coagulopathy after a bite from a 'harmless' snake (Rhabdophis subminiatus).European physicians may occasionally be confronted with cases of snake venom poisoning. The increasing interest in snakes as pets has unfortunately resulted in the importation of a number of venomous snakes. We here report the third known case in the medical literature of a patient who was exposed to severe coagulopathy after being bitten by a 'harmless' ringsnake (Rhabdophis subminiatus). The prolonged bleeding diathesis and the complete depletion of fibrinogen observed in our patient are consistent with the presence of a factor x activator in the venom, as has been described in a murine model. In agreement with the two previous case reports, we found no evidence of severe organ damage, despite active intravascular coagulation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Prolonged activated partial thromboplastin time of unknown etiology: a prospective study of 100 consecutive cases referred for consultation.The activated partial thromboplastin time (aPTT) is frequently used to assess overall competency of the intrinsic pathway of coagulation. An abnormal value may be caused by any of several abnormalities along this pathway or by many other variables including the presence of inhibitors, poor collection of the sample, or variables in the laboratory. When the cause for the prolongation is unknown to the requesting physician, the hematologist may be consulted. In this prospective study, the cause and perceived hemostatic risk to 100 consecutive patients referred to use for consultation regarding a prolonged aPTT of previous unknown cause were evaluated. We found that these abnormal aPTTs may be either indicative of a hemostatic defect, in 50% of the cases, or of no particular risk, in 36% of the cases. In 14%, the aPTT was artifactually prolonged. Most (81%) patients with a prolonged aPTT due to a hemostatic defect had an abnormal hemostatic history but some (19%) did not. Even among true abnormal tests, the degree of abnormality indicated little or nothing about hemostatic competency. We conclude that the cause of an abnormal aPTT is more important than the result itself. These data may be of use to those who consult on such matters.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Fletcher factor deficiency, source of variations of the activated partial thromboplastin time test.The activated partial thromboplastin time test measures the integrity of the intrinsic clotting system. The sensitivity of this test to Fletcher factor deficiency is dependent upon the particular protocol and reagents utilized in the test system. The case report presented here demonstrates conflicting laboratory results obtained for a patient who had Fletcher factor deficiency, the results depending on the laboratory choice of test reagents. This serves to emphasize the importance of physician awareness of the procedures utilized in laboratory testing.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Unexplained menorrhagia and hematuria: a case report of Munchausen's syndrome by proxy.Unexplained menorrhagia and hematuria occurred in a 13-year-old female with a mild inherited platelet disorder who had never experienced prior bleeding as a result of this disorder. An intensive search revealed that this patient was receiving coumadin that was given by the mother. In addition, the mother drew large volumes of blood from the patient under the pretense of following a physician's orders. The mother also falsified the laboratory data to erase from her daughter's file a laboratory result documenting warfarin in the blood.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |