1/19. Pedal manifestations of disseminated intravascular coagulation.disseminated intravascular coagulation is a complex hemostatic imbalance associated with many disease states. The potentially lethal systemic consequences of this disease mandate that the podiatric physician obtain a complete detailed history in addition to proceeding with appropriate consultations from other specialties. If haste is utilized and surgical intervention is undertaken without careful consideration, a potentially fatal situation may ensue. A comprehensive case report highlighting the pedal presentation and complications, and an overview of this disease process are presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/19. Whole blood transfusion for exsanguinating coagulopathy in a US field surgical hospital in postwar kosovo.An urgent blood drive in which active duty military field surgical hospital personnel volunteered to donate whole blood was conducted, and administration of warm, whole blood prevented the exsanguination of a normothermic coagulopathic patient who had received a massive transfusion. In austere care settings in which full blood banking capability may not be available, physicians should consider that exsanguinating hemorrhage can potentially be controlled surgically, but nonsurgical bleeding requires specific replacement therapy, and whole blood may be the best selection for repleting deficiencies of components that are otherwise unavailable.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/19. thromboembolism associated with hiv infection: a case report and review of the literature.The array of the clinicopathologic spectrum related to hiv infection continues to increase and present new challenges to physicians caring for hiv-infected patients. Recent literature is encumbered with reports of various abnormalities consistent with a hypercoagulable state leading to thromboembolic complications. The coexistence of hiv/AIDS-related illnesses, such as malignancies, opportunistic infections, or autoimmune diseases, as well as drug therapy, may also predispose hiv-infected patients to thromboembolic disease. A case report of a 39-year-old man with Kaposi sarcoma who developed pulmonary embolism is presented, along with a review of the literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/19. Methylenedioxymethamphetamine (MDMA, "Ecstasy").Ecstasy (MDMA) is an amphetamine derivative of growing popularity. The drug produces a range of toxicities when taken either in standard doses or overdose. In overdose it has major toxicity, producing several different life-threatening manifestations. Hepatotoxicity and hyponatremia are common but poorly understood consequences of MDMA overdose. The drug can produce long-term, if not permanent, neurologic sequelae by destruction of serotonergic neurons. Chronic Ecstasy use can result in psychosis, depression, and suicidal ideation. In the ED setting, it is essential for physicians to recognize and treat appropriately those who present with intoxication from this drug.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/19. pulmonary embolism presenting as disseminated intravascular coagulation.We report an unusual case of disseminated intravascular coagulation. Occult pulmonary embolism is a recognised cause of disseminated intravascular coagulation. Unexplained shock should prompt the physician to search for a thrombotic cause such as pulmonary thromboembolism.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/19. hellp syndrome as a cause of unexpected rapid maternal death--a case report and review of the literature.Unexpected rapid death after delivery due to hellp syndrome (HS) may become the subject of a forensic expertise. Since this syndrome is rarely encountered in forensic pathology, our objective was to point to some specific findings which might present forensic aspects of HS. These include unexpectedness, suddenness and fulminant course of this syndrome, which may confuse physicians, and on the other hand these characteristics cast doubt on violent injury, diagnostic oversights or iatrogenic injuries. Absence of classical signs of preeclampsia and non-specific clinical symptoms cause considerable differential diagnostic problems leading to a diagnostic delay or initial wrong non-obstetric diagnosis. A definitive postmortem diagnosis of HS in questionable cases of maternal death and consecutive forensic expertise of suspected medical malpractice should be based on accepted laboratory criteria and characteristic histopathological alterations.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/19. Endogenous endophthalmitis and disseminated intravascular coagulation complicating a klebsiella pneumoniae perirenal abscess in a patient with type 2 diabetes.We describe a 56-year-old woman with type 2 diabetes complicated by a Klebsiella pneumoniae perirenal abscess. The patient further developed incipient diabetic ketoacidosis, disseminated intravascular coagulation, and endogenous endophthalmitis. Occurrence of the latter as a metastatic infection from perirenal abscess caused by this organism is very rare, and we know of no previously reported patient with the additional occurrence of disseminated intravascular coagulation. Since prompt intravitreal antibiotic administration is needed, physicians should be aware of these rare but severe complications of K pneumoniae infection, especially in patients with poorly controlled diabetes.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/19. disseminated intravascular coagulation associated with acute hemoglobinemia or hemoglobinuria following Rh(0)(D) immune globulin intravenous administration for immune thrombocytopenic purpura.The food and Drug Administration (FDA) licensed Rh(o)(D) immune globulin intravenous (anti-D IGIV) on March 24, 1995, for treatment of immune thrombocytopenic purpura (ITP). A previous review described data on 15 patients who experienced acute hemoglobinemia or hemoglobinuria following anti-D IGIV administration for ITP or secondary thrombocytopenia. Eleven of those patients also experienced clinically compromising anemia, transfusion with packed red blood cells, renal insufficiency, dialysis, or death. That review suggested that patients receiving anti-D IGIV be monitored for those and other potential complications of hemoglobinemia, particularly disseminated intravascular coagulation (DIC). Through November 30, 2004, the FDA received 6 reports of DIC associated with "acute hemolysis" (or similar terms), 5 of which involved fatalities. The attending or consulting physicians assessed that acute hemolysis or DIC caused or contributed to each death. This review presents the first case series of DIC associated with acute hemoglobinemia or hemoglobinuria following anti-D IGIV administration for ITP. The purpose of this review is to increase awareness among physicians and other health care professionals that DIC may be a rare but potentially severe complication of anti-D IGIV treatment. Increased awareness of DIC as a diagnostic possibility may enable prompt recognition and medical intervention in affected patients.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
9/19. Infantile fibrosarcoma of the hand associated with coagulopathy.BACKGROUND: Large congenital neoplasms of the extremities may be associated with coagulopathies and significant hemorrhage in the neonatal period. At times, the differences between coagulation derangements can be very subtle, leading to errors in diagnosis. Infants with vascular lesions and coagulopathies are often found to have the Kasabach-Merritt phenomenon, which is a platelet-trapping coagulopathy. However, other neoplasms or vascular malformations can be accompanied by disseminated intravascular coagulation. It is important to obtain accurate diagnoses of the neoplasm and the coagulopathy because the treatments of similar-appearing tumors and coagulopathies can be markedly different. methods: The authors report the case of a newborn with a congenital tumor of the left hand that was accompanied by a coagulopathy that caused significant bleeding. RESULTS: A presumption was made by the neonatal critical care physicians and hematologists that the infant had a kaposiform hemangioendothelioma along with the Kasabach-Merritt phenomenon. However, steroid treatment did not reduce the size of the mass or correct the coagulopathy. Only after obtaining consultation with a hand surgeon and a tissue diagnosis was it learned that the patient had an infantile fibrosarcoma that was accompanied by disseminated intravascular coagulation. Limb-sparing resection of the lesion along with chemotherapy markedly improved the patient's condition. CONCLUSIONS: Large congenital neoplasms presenting with attendant bleeding diatheses must be rapidly and accurately diagnosed with both a biopsy-proven tissue diagnosis and a hematologic characterization of the nature of the coagulopathy. The differential diagnosis of a vascular-appearing mass in the extremity can be subtle, and presumptive diagnosis, as occurred in this case, can lead to incorrect or delayed treatment. Specifically, kaposiform hemangioendothelioma must be differentiated from infantile fibrosarcoma. The principles of infantile fibrosarcoma treatment are limb-sparing resection and chemotherapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/19. Anticoagulant-induced pseudothrombocytopenia occurring after transcatheter arterial embolization for hepatocellular carcinoma.Pseudothrombocytopenia (PTCP) is the in vitro phenomenon of anticoagulant-activated platelet agglutination that results in spuriously low platelet counts. We report the case of a 65-year-old man with EDTA- and sodium citrate-dependent PTCP occurring after transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) due to hepatitis c cirrhosis. Invasion of the portal and hepatic veins by HCC formed severe trans-tumoral arterio-venous shunts that were effectively treated by TAE. Two days after the therapy, PTCP was seen on blood count and continued for 4 months. The patient received unnecessary treatment for disseminated intravascular coagulation (DIC) until the diagnosis of PTCP was established. PTCP is a rare complication but should be considered after TAE for HCC; lack of recognition may lead the physician to misdiagnosis and patient mismanagement.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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