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Sample records for haemorrhagic septicaemia vhs

  1. Spatio-temporal risk factors for viral haemorrhagic septicaemia (VHS) in Danish aquaculture.

    PubMed

    Bang Jensen, Britt; Ersbøll, Annette Kjær; Korsholm, Henrik; Skall, Helle Frank; Olesen, Niels Jørgen

    2014-05-13

    Viral haemorrhagic septicaemia (VHS) is an economically very important fish disease in the northern hemisphere. When the VHS virus was first isolated in Denmark 50 yr ago, more than 80% of the 800 Danish fish farms were considered to be infected, but vigilant surveillance and eradication programmes led to a drastic reduction in prevalence, and finally, to complete eradication of VHS. Denmark thus obtained official status as an approved VHS-free member state within the European Union in November 2013. Data on outbreaks within the country have been collected since 1970, and here we combined these data with the geographical coordinates of fish farms to identify clusters of high disease prevalence and other risk factors. Our analyses revealed a statistically significant cluster in the southwestern part of the country, which persisted throughout the study period. Being situated within such a cluster was a significant risk factor for VHS. For freshwater rainbow trout farms situated inland, the number of upstream farms was a determining risk factor for VHS, as was distance to the nearest VHS-infected farm and year. Whether the farm used fresh or marine water in production did not have any influence on the risk of VHS, when accounting for whether the farm was situated inside a cluster of high risk. This information can be used when implementing risk-based surveillance programmes. PMID:24991736

  2. First isolation and genotyping of viruses from recent outbreaks of viral haemorrhagic septicaemia (VHS) in Slovenia.

    PubMed

    Toplak, Ivan; Hostnik, Peter; Rihtaric, Danijela; Olesen, Niels Jørgen; Skall, Helle Frank; Jencic, Vlasta

    2010-10-26

    In November and December 2007, the virus causing viral haemorrhagic septicaemia (VHS) was detected in rainbow trout Oncorhynchus mykiss from 2 fish farms in Slovenia. During 2008 and 2009 the infection spread only among rainbow trout farms and 4 new outbreaks were confirmed. High mortality and clinical signs of VHS were observed among the diseased fish. VHSV was confirmed by virus isolation, immunoperoxidase test, reverse transcriptase polymerase chain reaction (RT-PCR) and phylogenetic analysis. Based on 1 complete (1524 nucleotides [nt]) and 9 partial (600 nt) glycoprotein gene nucleotide sequences, 9 VHSV isolates from the 6 VHS outbreaks were genetically closely related (99 to 100% identity), and were classified into the Subgroup I-a of Genotype I, most closely related to the German isolates Dstg21-07, Dstg36-06, and Dstg54-1-07 (99 to 100% identity). Phylogenetic analysis and epidemiological investigations confirmed that the VHS virus had been (re)introduced with imported live fish, and that subsequent outbreaks were linked to the initial infection. Our study shows that direct nucleotide sequencing of RT-PCR products, amplified from the tissue of VHSV-infected fish, represents a reliable tool for fast routine genotyping in diagnostic laboratories. This is the first report of a natural epidemic associated with VHSV infection in Slovenia since the eradication of the disease in 1977. PMID:21166311

  3. Efficacy of a glycoprotein DNA vaccine against viral haemorrhagic septicaemia (VHS) in Pacific herring, Clupea pallasii Valenciennes

    USGS Publications Warehouse

    Hart, L.M.; Lorenzen, Niels; LaPatra, S.E.; Grady, C.A.; Roon, S.E.; O’Reilly, J.; Gregg, J.L.; Hershberger, P.K.

    2012-01-01

    Viral haemorrhagic septicaemia virus (VHSV) and its associated disease state, viral haemorrhagic septicaemia (VHS), is hypothesized to be a proximate factor accounting for the decline and failed recovery of Pacific herring populations in Prince William Sound, AK (Marty et al. 1998, 2003, 2010). Survivors of laboratory-induced VHSV epizootics develop resistance to subsequent viral exposure (Kocan et al. 2001; Hershberger et al. 2007, 2010), which is likely the result of immune system recognition of the viral glycoprotein (G) (Lecocq-Xhonneux et al. 1994), a surface antigen that contains neutralizing epitopes (Lorenzen, Olesen & Jorgensen 1990; Jørgensen et al. 1995) and cell attachment domains (Lecocq-Xhonneux et al. 1994; Estepa & Coll 1996). These properties have proven useful in the development of G-gene-based DNA vaccines for VHSV and a related rhabdovirus, infectious haematopoietic necrosis virus (IHNV) (Anderson et al. 1996; Heppell et al. 1998; Corbeil et al. 1999; Einer-Jensen et al. 2009). Rainbow trout fingerlings, Oncorhynchus mykiss (Walbaum), vaccinated with 1 µg of either the VHS or IHN vaccine are protected from VHS when exposed to virus as early as 4 days (44 degree days) post-vaccination (p.v.) (Lorenzen et al. 2002). At later time points (80 days p.v.; 880 degree days), the level of cross-protection against VHS by IHN vaccination is either completely lost (60 days p.v.; 660 degree days) (3 g rainbow trout; 1 µg vaccine dose) (Lorenzen et al. 2002) or present at intermediate levels (6.5 g rainbow trout; 1 µg vaccine dose) (Einer-Jensen et al. 2009). Comparatively, VHS vaccination remains effective as long as 9 months (2520 degree days) p.v. (100 g rainbow trout; 0.5 µg vaccine dose) (McLauchlan et al. 2003). These results suggest that IHN and VHS vaccination activate a rapid transitory innate immune response against VHSV that is followed by long-term adaptive immunity in VHS-vaccinated trout (Lorenzen et al. 2002).

  4. Identification of quantitative trait loci associated with resistance to viral haemorrhagic septicaemia (VHS) in turbot (Scophthalmus maximus ): a comparison between bacterium, parasite and virus diseases.

    PubMed

    Rodríguez-Ramilo, Silvia T; De La Herrán, Roberto; Ruiz-Rejón, Carmelo; Hermida, Miguel; Fernández, Carlos; Pereiro, Patricia; Figueras, Antonio; Bouza, Carmen; Toro, Miguel A; Martínez, Paulino; Fernández, Jesús

    2014-06-01

    One of the main objectives of genetic breeding programs in turbot industry is to reduce disease-related mortality. In the present study, a genome scan to detect quantitative trait loci (QTL) affecting resistance and survival to viral haemorrhagic septicaemia (VHS) was carried out. Three full-sib families with approximately 90 individuals each were genotyped and evaluated by linear regression and maximum likelihood approaches. In addition, a comparison between QTL detected for resistance and survival time to other important bacterial and parasite diseases affecting turbot (furunculosis and scuticociliatosis) was also carried out. Finally, the relationship between QTL affecting resistance/survival time to the virus and growth-related QTL was also evaluated. Several genomic regions controlling resistance and survival time to VHS were detected. Also significant associations between the evaluated traits and genotypes at particular markers were identified, explaining up to 14 % of the phenotypic variance. Several genomic regions controlling general and specific resistance to different diseases in turbot were detected. A preliminary gene mining approach identified candidate genes related to general or specific immunity. This information will be valuable to develop marker-assisted selection programs and to discover candidate genes related to disease resistance to improve turbot production. PMID:24078233

  5. Routine clinical inspections in Norwegian marine salmonid sites: A key role in surveillance for freedom from pathogenic viral haemorrhagic septicaemia (VHS).

    PubMed

    Lyngstad, Trude Marie; Hellberg, Hege; Viljugrein, Hildegunn; Bang Jensen, Britt; Brun, Edgar; Sergeant, Evan; Tavornpanich, Saraya

    2016-02-01

    Since the mid-1980s, clinical inspections of aquaculture sites carried out on a regular basis by authorized veterinarians and fish health biologists (known as fish health services: FHS) have been an essential part of aquatic animal health surveillance in Norway. The aims of the present study were (1) to evaluate the performance of FHS routine clinical inspections for the detection of VHS and (2) to explore the effectiveness of risk-based prioritisation of FHS inspections for demonstrating freedom from VHS in marine salmonid sites in Norway. A stochastic simulation model was developed to estimate site sensitivity (SeS), population sensitivity (SeP), and probability of freedom (PFree). The estimation of SeS takes into consideration the probability that FHS submit samples if a site is infected, the probability that a sample is tested if submitted, the effective probability of infection in fish with clinical signs, laboratory test sensitivity, and the number of tested samples. SeP and PFree were estimated on a monthly basis over a 12 month period for six alternative surveillance scenarios and included the risk factors: region, species, area production density, and biosecurity level. Model results indicate that the current surveillance system, based on routine inspections by the FHS has a high capability for detecting VHS and that there is a high probability of freedom from VHS in Norwegian marine farmed salmonids (PFree >95%). Sensitivity analysis identified the probabilities that samples are submitted and submitted samples are tested, as the most influential input variables. The model provides a supporting tool for evaluation of potential changes in the surveillance strategy, and can be viewed as a platform for similar exotic viral infectious diseases in marine salmonid farming in Norway, if they share similar risk factors. PMID:26754927

  6. Development of an oral vaccine for immunisation of rainbow trout (Oncorhynchus mykiss) against viral haemorrhagic septicaemia.

    PubMed

    Adelmann, Malte; Köllner, Bernd; Bergmann, Sven M; Fischer, Uwe; Lange, Bodo; Weitschies, Werner; Enzmann, Peter-Joachim; Fichtner, Dieter

    2008-02-01

    In the European Union Viral Haemorrhagic Septicaemia (VHS) eradication is still based on stamping out. Due to the lack of effective low cost vaccines immune prophylaxis is currently not used to combat VHS. This paper describes a new oral delivery method for immunisation of trout with attenuated virus. The vaccine consists of lyophilised virus surrounded by polyethylene glycol (PEG) and was extruded under low temperature. In the stomach of trout, the use of additional neutralising and adsorbing bases resulted in a neutral pH around the vaccine pellets, thus protecting the antigen against gastric acid. The in vivo efficacy of this delivery method was examined in three animal challenge experiments using an attenuated VHS virus (VHSV) strain as a vaccine. After vaccination, VHSV mRNA in gut, heart, kidney, spleen and blood was amplified by semi-nested PCR after RT-PCR. Indirect immune fluorescence test detected VHS vaccine virus in the gut. The expression of MHC class II, CD4 and CD8alpha mRNAs after oral vaccination was measured in gut using real-time RT-PCR. Antibody levels were measured by ELISA one week before vaccination and five weeks after vaccination. Animals were challenged six weeks after vaccination with highly virulent VHSV and mortality was recorded. The experiments showed that orally delivered vaccine virus was released from the vaccine preparation, penetrated the gut mucosa and led to higher expression levels of MHC class II and CD4 mRNAs when compared to control guts. VHSV antibodies were detected after oral vaccination. Immunisation with this new vaccine formulation was followed by a significant protection against VHSV. While the cumulative mortality in the non-vaccinated control group reached 70%, more than 75% of the orally vaccinated fish were protected upon challenge. PMID:18191880

  7. Comparative studies for serodiagnosis of haemorrhagic septicaemia in cattle sera

    PubMed Central

    El-Jakee, Jakeen K.; Ali, Samah Said; El-Shafii, Soumaya Ahmed; Hessain, Ashgan M.; Al-Arfaj, Abdullah A.; Mohamed, Moussa I.

    2015-01-01

    Haemorrhagic septicaemia caused by Pasteurella multocida is a major epizootic disease in cattle and buffaloes in developing countries with high morbidity and mortality rate. In the present study, a total of 88 P. multocida isolates were isolated from 256 nasopharyngeal swabs and lung tissues samples (34.4%) during the period from January, 2013 to March, 2014 from different governorates located in Egypt. Dead calves showed the highest percentage of P. multocida isolation followed by the emergency slaughtered calves, diseased calves then apparently healthy ones. These isolates were confirmed as P. multocida microscopically, biochemically by traditional tests and by API 20E commercial kit then by PCR. The percentages of positive serum samples using somatic antigen and micro-agglutination test at 1/1280 diluted serum were 10%, 54.49% and 0% in apparently healthy, diseased and emergency slaughtered samples, respectively whereas, the percentages using capsular antigen and indirect haemagglutination test were 40%, 60.89% and 60% in apparently healthy, diseased and emergency slaughtered samples, respectively. The ELISA showed the highest sensitivity for diagnosing P. multocida in apparently healthy, diseased and emergency slaughtered animals with percentages of 42%; 92.9% and 80%, respectively. The obtained results revealed that the ELISA using capsular antigen of P. multocida is a more sensitive and specific serological test for diagnosis of haemorrhagic septicaemia. PMID:26858538

  8. Comparative studies for serodiagnosis of haemorrhagic septicaemia in cattle sera.

    PubMed

    El-Jakee, Jakeen K; Ali, Samah Said; El-Shafii, Soumaya Ahmed; Hessain, Ashgan M; Al-Arfaj, Abdullah A; Mohamed, Moussa I

    2016-01-01

    Haemorrhagic septicaemia caused by Pasteurella multocida is a major epizootic disease in cattle and buffaloes in developing countries with high morbidity and mortality rate. In the present study, a total of 88 P. multocida isolates were isolated from 256 nasopharyngeal swabs and lung tissues samples (34.4%) during the period from January, 2013 to March, 2014 from different governorates located in Egypt. Dead calves showed the highest percentage of P. multocida isolation followed by the emergency slaughtered calves, diseased calves then apparently healthy ones. These isolates were confirmed as P. multocida microscopically, biochemically by traditional tests and by API 20E commercial kit then by PCR. The percentages of positive serum samples using somatic antigen and micro-agglutination test at 1/1280 diluted serum were 10%, 54.49% and 0% in apparently healthy, diseased and emergency slaughtered samples, respectively whereas, the percentages using capsular antigen and indirect haemagglutination test were 40%, 60.89% and 60% in apparently healthy, diseased and emergency slaughtered samples, respectively. The ELISA showed the highest sensitivity for diagnosing P. multocida in apparently healthy, diseased and emergency slaughtered animals with percentages of 42%; 92.9% and 80%, respectively. The obtained results revealed that the ELISA using capsular antigen of P. multocida is a more sensitive and specific serological test for diagnosis of haemorrhagic septicaemia. PMID:26858538

  9. A mortality event in wrasse species (Labridae) associated with the presence of viral haemorrhagic septicaemia virus.

    PubMed

    Munro, E S; McIntosh, R E; Weir, S J; Noguera, P A; Sandilands, J M; Matejusova, I; Mayes, A S; Smith, R

    2015-04-01

    Viral haemorrhagic septicaemia (VHS) is an infectious disease of farmed and wild fish and has an extensive host range in both freshwater and marine environments. In December 2012, a wrasse population consisting of ballan, Labrus bergylta (Ascanius), corkwing, Symphodus melops (L.), cuckoo, Labrus mixtus L., goldsinny, Ctenolabrus rupestris (L.), and rock cook, Centrolabrus exoletus (L.), held at a marine hatchery in the Shetland Isles, Scotland, experienced a mortality event. Approximately 10 000 wrasse were being held at the facility on behalf of an Atlantic salmon, Salmo salar L., aquaculture company prior to being deployed for the biological control of parasites on marine pen Atlantic salmon, aquaculture sites. Fish Health Inspectors from Marine Scotland Science initiated a diagnostic investigation, and subsequent diagnostic testing confirmed the site to be VHSV positive by qRT-PCR and virus isolation followed by ELISA. A VHSV genotype-specific qRT-PCR assay revealed that the isolates belonged to genotype III, the European marine strain of the virus. The virus genotype was further confirmed by nucleic acid sequencing of the partial nucleoprotein (N) and glycoprotein (G) genes followed by BLAST nucleotide searches. This study reports for the first time the detection of VHSV within multiple wrasse species and highlights the need for a comprehensive risk-based approach to the use of wrasse and other finfish species as biological controls within the aquaculture industry. PMID:24661037

  10. Susceptibility of goldsinny wrasse, Ctenolabrus rupestris L. (Labridae), to viral haemorrhagic septicaemia virus (VHSV) genotype III: Experimental challenge and pathology.

    PubMed

    Matejusova, I; Noguera, P A; Hall, M; McBeath, A J A; Urquhart, K; Simons, J; Fordyce, M J; Lester, K; Ho, Y-M; Murray, W; Bruno, D W

    2016-04-15

    Cleaner fish, such as wrasse, are being increasingly used to combat the sea lice infestation of Atlantic salmon (Salmo salar L.) in many European countries. To determine susceptibility of the goldsinny wrasse (Ctenolabrus rupestris L.) and pathogenesis of the viral haemorrhagic septicaemia virus (VHSV) genotype III isolate 12-654, previously associated with VHSV infection in the Shetland Islands in 2012, fish were experimentally challenged by intraperitoneal injection (IP), bath immersion and cohabitation routes. Cumulative proportion of moribund wrasse reached 17% following the virus immersion challenge while by the IP-route moribunds exceeded 50% within 14days post-challenge. Typical signs of VHS as reported in rainbow trout (Oncorhynchus mykiss), were not observed in moribund goldsinny wrasse. The most pronounced histopathological changes, consistent regardless of the route of infection, were observed within the heart and included atrium myofibril degeneration, focal infiltration and multifocal necrosis, with prominent swelling of the endocardium and occasional detachment. Pathological changes in the atrium were associated with presence of the viral antigen as confirmed by a positive immunohistochemical staining. Virus clearance and heart tissue recovery were noted although further experiments are required to confirm these observations. The results of a cohabitation experiment confirmed that goldsinny wrasse shed viable virus and therefore represent a risk of virus transmission to other VHSV susceptible species. Similarities between the pathology in goldsinny wrasse induced through the controlled experimental challenges and that of wrasse spp. from an infection occurrence in Shetland are discussed. PMID:27016771

  11. Comparative susceptibility among three stocks of yellow perch, Perca flavescens (Mitchill), to viral haemorrhagic septicaemia virus strain IVb from the Great Lakes

    USGS Publications Warehouse

    Olson, W.; Emmenegger, E.; Glenn, J.; Winton, J.; Goetz, F.

    2013-01-01

    The Great Lakes strain of viral haemorrhagic septicaemia virus IVb (VHSV-IVb) is capable of infecting a wide number of naive species and has been associated with large fish kills in the Midwestern United States since its discovery in 2005. The yellow perch, Perca flavescens (Mitchill), a freshwater species commonly found throughout inland waters of the United States and prized for its high value in sport and commercial fisheries, is a species documented in several fish kills affiliated with VHS. In the present study, differences in survival after infection with VHSV IVb were observed among juvenile fish from three yellow perch broodstocks that were originally derived from distinct wild populations, suggesting innate differences in susceptibility due to genetic variance. While all three stocks were susceptible upon waterborne exposure to VHS virus infection, fish derived from the Midwest (Lake Winnebago, WI) showed significantly lower cumulative % survival compared with two perch stocks derived from the East Coast (Perquimans River, NC and Choptank River, MD) of the United States. However, despite differences in apparent susceptibility, clinical signs did not vary between stocks and included moderate-to-severe haemorrhages at the pelvic and pectoral fin bases and exophthalmia. After the 28-day challenge was complete, VHS virus was analysed in subsets of whole fish that had either survived or succumbed to the infection using both plaque assay and quantitative PCR methodologies. A direct correlation was identified between the two methods, suggesting the potential for both methods to be used to detect virus in a research setting.

  12. Larval Pacific herring, Clupea pallasii (Valenciennes), are highly susceptible to viral haemorrhagic septicaemia and survivors are partially protected after their metamorphosis to juveniles

    USGS Publications Warehouse

    Hershberger, P.K.; Gregg, J.; Pacheco, C.; Winton, J.; Richard, J.; Traxler, G.

    2007-01-01

    Pacific herring were susceptible to waterborne challenge with viral haemorrhagic septicaemia virus (VHSV) throughout their early life history stages, with significantly greater cumulative mortalities occurring among VHSV-exposed groups of 9-, 44-, 54- and 76-day-old larvae than among respective control groups. Similarly, among 89-day-1-year-old and 1+year old post-metamorphosed juveniles, cumulative mortality was significantly greater in VHSV-challenged groups than in respective control groups. Larval exposure to VHSV conferred partial protection to the survivors after their metamorphosis to juveniles as shown by significantly less cumulative mortalities among juvenile groups that survived a VHS epidemic as larvae than among groups that were previously nai??ve to VHSV. Magnitude of the protection, measured as relative per cent survival, was a direct function of larval age at first exposure and was probably a reflection of gradual developmental onset of immunocompetence. These results indicate the potential for easily overlooked VHS epizootics among wild larvae in regions where the virus is endemic and emphasize the importance of early life history stages of marine fish in influencing the ecological disease processes. ?? 2007 The Authors.

  13. Comparative Genomic Analysis of Asian Haemorrhagic Septicaemia-Associated Strains of Pasteurella multocida Identifies More than 90 Haemorrhagic Septicaemia-Specific Genes

    PubMed Central

    Moustafa, Ahmed M.; Seemann, Torsten; Gladman, Simon; Adler, Ben; Harper, Marina; Boyce, John D.; Bennett, Mark D.

    2015-01-01

    Pasteurella multocida is the primary causative agent of a range of economically important diseases in animals, including haemorrhagic septicaemia (HS), a rapidly fatal disease of ungulates. There is limited information available on the diversity of P. multocida strains that cause HS. Therefore, we determined draft genome sequences of ten disease-causing isolates and two vaccine strains and compared these genomes using a range of bioinformatic analyses. The draft genomes of the 12 HS strains were between 2,298,035 and 2,410,300 bp in length. Comparison of these genomes with the North American HS strain, M1404, and other available P. multocida genomes (Pm70, 3480, 36950 and HN06) identified a core set of 1,824 genes. A set of 96 genes was present in all HS isolates and vaccine strains examined in this study, but absent from Pm70, 3480, 36950 and HN06. Moreover, 59 genes were shared only by the Asian B:2 strains. In two Pakistani isolates, genes with high similarity to genes in the integrative and conjugative element, ICEPmu1 from strain 36950 were identified along with a range of other antimicrobial resistance genes. Phylogenetic analysis indicated that the HS strains formed clades based on their country of isolation. Future analysis of the 96 genes unique to the HS isolates will aid the identification of HS-specific virulence attributes and facilitate the development of disease-specific diagnostic tests. PMID:26151935

  14. A novel multiplex RT-qPCR method based on dual-labelled probes suitable for typing all known genotypes of viral haemorrhagic septicaemia virus.

    PubMed

    Vázquez, D; López-Vázquez, C; Skall, H F; Mikkelsen, S S; Olesen, N J; Dopazo, C P

    2016-04-01

    Viral haemorrhagic septicaemia (VHS) is a notifiable fish disease, whose causative agent is a rhabdovirus isolated from a wide range of fish species, not only in fresh but also in marine and brackish waters. Phylogenetic studies have identified four major genotypes, with a strong geographical relationship. In this study, we have designed and validated a new procedure - named binary multiplex RT-qPCR (bmRT-qPCR) - for simultaneous detection and typing of all four genotypes of VHSV by real-time RT-PCR based on dual-labelled probes and composed by two multiplex systems designed for European and American/Asiatic isolates, respectively, using a combination of three different fluorophores. The specificity of the procedure was assessed by including a panel of 81 VHSV isolates covering all known genotypes and subtypes of the virus, and tissue material from experimentally infected rainbow trout, resulting in a correct detection and typing of all strains. The analytical sensitivity was evaluated in a comparative assay with titration in cell culture, observing that both methods provided similar limits of detection. The proposed method can be a powerful tool for epidemiological analysis of VHSV by genotyping unknown samples within a few hours. PMID:25952496

  15. REP-PCR analysis of Pasteurella multocida isolates that cause haemorrhagic septicaemia.

    PubMed

    Townsend, K M; Dawkins, H J; Papadimitriou, J M

    1997-01-01

    Amplification of multiple P multocida genomic DNA fragments by outwardly-directed primers based on the repetitive extragenic palindromic (REP) consensus sequence, generated complex profiles in a PCR-based fingerprinting method known as REP-PCR. Polymorphisms within REP-PCR profiles were used to characterise 38 isolates of P multocida. The high degree of homogeneity observed among haemorrhagic septicaemia (HS) strains of serotype B and E provided evidence of a disease-associated REP profile that may serve as a novel method for the identification of HS strains regardless of serotype. REP-PCR profiles of other P multocida serotypes were highly variable, illustrating the potential of this technique for the molecular fingerprinting of fowl cholera or atrophic rhinitis isolates. A specific amplified REP fragment was isolated and used to probe membrane-bound digested P multocida genomic DNA. Hybridisation patterns not only distinguished HS-causing isolates from non-HS P multocida, but also demonstrated a degree of relatedness between HS and HS-like strains. PMID:9429249

  16. Differentially expressed genes after viral haemorrhagic septicaemia virus infection in olive flounder (Paralichthys olivaceus).

    PubMed

    Hwang, Jee Youn; Kwon, Mun-Gyeong; Seo, Jung Soo; Do, Jung Wan; Park, Myoung-Ae; Jung, Sung-Hee; Ahn, Sang Jung

    2016-09-25

    A strain of viral haemorrhagic septicaemia virus (VHSV) was isolated from cultured olive flounder (Paralichthys olivaceus) during epizootics in South Korean. This strain showed high mortality to olive flounder in in vivo challenge experiment. The complete genomic RNA sequences were determined and phylogenetic analysis of the amino acid sequences of glycoprotein revealed that this isolate was grouped into genotype IVa of genus Novirhabdovirus. Expression profile of genes in olive flounder was analyzed at day 1 and day3 after infection with this VHSV isolate by using cDNA microarray containing olive flounder 13K cDNA clones. Microarray analysis revealed 785 up-regulated genes and 641 down-regulated genes by at least two-fold in virus-infected fish compared to healthy control groups. Among 785 up-regulated genes, we identified seven immune response-associated genes, including the interferon (IFN)-induced 56-kDa protein (IFI56), suppressor of cytokine signaling 1 (SOCS1), interleukin 8 (IL-8), cluster of differentiation 83 (CD83), α-globin (HBA), VHSV-induced protein-6 (VHSV6), and cluster of differentiation antigen 9 (CD9). Our results confirm previous reports that even virulent strain of VHSV induces expression of genes involved in protective immunity against VHSV. PMID:27599933

  17. New sites of localisation of Pasteurella multocida B:2 in buffalo surviving experimental haemorrhagic septicaemia

    PubMed Central

    2014-01-01

    Background Haemorrhagic septicaemia (HS) is an acute septicaemic disease of buffalo and cattle caused by Pasteurella multocida B:2 and E:2. Field outbreaks of HS are known to result in localisation of bacteria in the tonsils of surviving buffalo, confirming that animals can become carriers and the role of respiratory tract in the transmission of the disease. This report describes additional sites of localisation of P. multocida B:2 in surviving buffalo following experimental induction of HS. Results Following P. multocida B:2 infection, all calves in group 1 and one calf in group 2 that was allowed to commingle with infected calves from group 1 were euthanised within 48 h. Pasteurella multocida B:2 was detected from the nasal and rectal swab samples on days 5 and 6 from the remaining calves in group 2. The first injection of dexamethasone into the carrier animals resulted in reemergence in samples from the nose, rectum and vagina. However, subsequent dexamethasone injections failed to re-activate P. multocida B:2. When surviving carrier calves in group 2 were euthanised at the end of the experiment, P. multocida B:2 was detected in the lungs and various organs of the respiratory, gastrointestinal and urinary tracts. Conclusions Commingling naive buffalo calves with calves acutely infected with P. multocida B:2 resulted in carriers among surviving buffalo. Pasteurella was found in various organs of the respiratory, gastrointestinal and urinary tracts, suggesting their role in the pathogenesis of HS. PMID:24721163

  18. Sublethal concentrations of ichthyotoxic alga Prymnesium parvum affect rainbow trout susceptibility to viral haemorrhagic septicaemia virus.

    PubMed

    Andersen, Nikolaj Gedsted; Lorenzen, Ellen; Snogdal Boutrup, Torsten; Hansen, Per Juel; Lorenzen, Niels

    2016-01-13

    Ichthyotoxic algal blooms are normally considered a threat to maricultured fish only when blooms reach lethal cell concentrations. The degree to which sublethal algal concentrations challenge the health of the fish during blooms is practically unknown. In this study, we analysed whether sublethal concentrations of the ichthyotoxic alga Prymnesium parvum affect the susceptibility of rainbow trout Oncorhynchus mykiss to viral haemorrhagic septicaemia virus (VHSV). During exposure to sublethal algal concentrations, the fish increased production of mucus on their gills. When fish were exposed to the algae for 12 h prior to the addition of virus, a marginal decrease in the susceptibility to VHSV was observed compared to fish exposed to VHSV without algae. If virus and algae were added simultaneously, inclusion of the algae increased mortality by 50% compared to fish exposed to virus only, depending on the experimental setup. We concluded that depending on the local exposure conditions, sublethal concentrations of P. parvum could affect susceptibility of fish to infectious agents such as VHSV. PMID:26758652

  19. Genotyping of the fish rhabdovirus, viral haemorrhagic septicaemia virus, by restriction fragment length polymorphisms

    USGS Publications Warehouse

    Einer-Jensen, Katja; Winton, James R.; Lorenzen, Niels

    2005-01-01

    The aim of this study was to develop a standardized molecular assay that used limited resources and equipment for routine genotyping of isolates of the fish rhabdovirus, viral haemorrhagic septicaemia virus (VHSV). Computer generated restriction maps, based on 62 unique full-length (1524 nt) sequences of the VHSV glycoprotein (G) gene, were used to predict restriction fragment length polymorphism (RFLP) patterns that were subsequently grouped and compared with a phylogenetic analysis of the G-gene sequences of the same set of isolates. Digestion of PCR amplicons from the full-lengthG-gene by a set of three restriction enzymes was predicted to accurately enable the assignment of the VHSV isolates into the four major genotypes discovered to date. Further sub-typing of the isolates into the recently described sub-lineages of genotype I was possible by applying three additional enzymes. Experimental evaluation of the method consisted of three steps: (i) RT-PCR amplification of the G-gene of VHSV isolates using purified viral RNA as template, (ii) digestion of the PCR products with a panel of restriction endonucleases and (iii) interpretation of the resulting RFLP profiles. The RFLP analysis was shown to approximate the level of genetic discrimination obtained by other, more labour-intensive, molecular techniques such as the ribonuclease protection assay or sequence analysis. In addition, 37 previously uncharacterised isolates from diverse sources were assigned to specific genotypes. While the assay was able to distinguish between marine and continental isolates of VHSV, the differences did not correlate with the pathogenicity of the isolates.

  20. The Socioeconomic Impacts of Clinically Diagnosed Haemorrhagic Septicaemia on Smallholder Large Ruminant Farmers in Cambodia.

    PubMed

    Kawasaki, M; Young, J R; Suon, S; Bush, R D; Windsor, P A

    2015-10-01

    Haemorrhagic septicaemia (HS) is an acute fatal infectious disease of mainly cattle and buffalo and outbreaks occur commonly in Cambodia. Disease outbreak reports were examined to select five villages from three provinces for a retrospective investigation of HS epidemiology and socioeconomic impact on smallholders, with an aim of identifying potential benefits from improving disease prevention through biosecurity and vaccination. The Village Animal Health Worker (VAHW) or Chief in each village and 66 affected smallholders were surveyed. At the village level, 24% of all households were affected with an estimated mean village herd morbidity of 10.1% and mortality of 28.8%. Affected farmers reported HS disease morbidity and mortality at 42.7% and 63.6% respectively. Buffalo had a higher morbidity (OR = 2.3; P = 0.003) and mortality (OR = 6.9; P < 0.001) compared with cattle, and unvaccinated large ruminants a higher morbidity (OR = 2.9; P = 0.001). The financial impact varied depending on whether the animal survived, provision of treatment, draught replacement and lost secondary income. The mean cost per affected household was USD 952.50 based on ownership of five large ruminants. The impact per affected animal was USD 375.00, reducing the pre-disease value by 66.1%. A partial budget revealed an overwhelming incentive for farmers to practice biannual vaccination, with a net benefit of USD 951.58 per household based on an annual disease incidence rate of 1. Sensitivity analysis showed that a net benefit of USD 32.42 remained based on an outbreak every 20 years. This study indicates HS can cause a catastrophic financial shock to smallholders and remains a critical constraint to improving large ruminant productivity and profitability. Addressing HS disease control requires a focus on improving smallholder farmer knowledge of biosecurity and vaccination and should be priority to stakeholders interested in addressing regional food insecurity and poverty reduction. PMID

  1. Analysis of haemorrhagic septicaemia-causing isolates of Pasteurella multocida by ribotyping and field alternation gel electrophoresis (FAGE).

    PubMed

    Townsend, K M; Dawkins, H J; Papadimitriou, J M

    1997-10-16

    Ribotyping and field alternation gel electrophoresis (FAGE) were used to examine 19 Pasteurella multocida isolates, and to assess the ability of these techniques to differentiate P. multocida strains that cause haemorrhagic septicaemia (HS). Reproducible patterns were obtained from both methods, with FAGE demonstrating greater discriminatory power than ribotyping. FAGE analysis was particularly useful in distinguishing North American cultures originating from the 1922 Yellowstone National Park Buffalo 'B' strain, demonstrating the ability to detect genetic alterations induced by repeated subculture. A remarkable homogeneity was observed among Asian HS strains following ribotyping and FAGE analysis, with a clear distinction observed between virulent and avirulent HS isolates. This study has illustrated the value of genomic fingerprinting methods in distinguishing strains of similar serotype, and the capability of these methods to produce detailed characterisation of P. multocida isolates. PMID:9444075

  2. Interferon response following infection with genetically similar isolates of viral haemorrhagic septicaemia virus (VHSV) exhibiting contrasting virulence in rainbow trout.

    PubMed

    Campbell, S; McBeath, A; Secombes, C; Snow, M; Collet, B

    2011-01-01

    Isolates of viral haemorrhagic septicaemia virus (VHSV) were identified which are genetically similar yet, based on their isolation history were considered likely to differ in virulence in juvenile rainbow trout. An experimental infection study was performed in order to verify this hypothesis and provide an experimental infectivity model with which to investigate the basis for susceptibility of rainbow trout to this commercially important virus. Significant differences in mortality were obtained following both intraperitoneal (IP) injection and immersion challenges with an early marine (DK-M.Rhabdo) and early rainbow trout VHSV isolate (DK-F1) respectively. Expression of Type I IFN, Mx1 (an IFN-inducible protein), and viral genes (encoding nucleo-, phospho-, matrix, glyco- and non-viron proteins) was studied in sequential tissue samples using real-time quantitative PCR (QPCR). Resulting data revealed a significant increase in IFN and Mx1 expression detected in fish challenged by IP injection with both isolates. Expression levels of these genes were directly related to the degree of viral replication as measured by the expression of VHSV RNAs. In immersion-challenged fish a significant increase in Mx1 was observed only when using the virulent isolate DK-F1; however no elevated host response was detectable in fish challenged with the marine isolate DK-M.Rhabdo. Quintessentially the inability to detect any virus in trout challenged with the marine isolate via immersion suggests the virus was incapable of establishing infection. The mechanisms for this appear to be more related to initial cellular entry and replication rather than due to the overcoming of initial infection via an elevated host innate immune response. PMID:21056106

  3. Loop‑mediated Isothermal Amplification assay (LAMP) based detection of Pasteurella multocida in cases of haemorrhagic septicaemia and fowl cholera.

    PubMed

    Bhimani, Mayurkumar; Bhanderi, Bharat; Roy, Ashish

    2015-01-01

    Twenty two isolates of Pasteurella multocida were obtained from different tissues of dead birds and animals (cattle, buffalo, sheep, and goat) suspected of fowl cholera and haemorrhagic septicaemia. The isolates were confirmed as P. multocida by various biochemical tests and PM PCR. An attempt was made to standardize Loop mediated isothermal amplification (LAMP) using newly designed primer sequences of KMT1 gene. Loop mediated isothermal amplification was conducted using 6 sets of primers at 65°C for 30 minutes and the result was confirmed by visual observation using SYBR green fluorescence dye as marker of positive reaction under UV transilluminator. On electrophoretic analysis of the products on 2% agarose gel, a ladder like pattern was observed, which suggested a positive amplification, whereas no amplification was observed in negative controls. Additionally, product of positive reaction yielded a green fluorescence following addition of SYBR green under UV transilluminator. It was observed that LAMP is a more sensitive test than polymerase chain reaction (PCR), as the former could detect DNA to lower limit of 22.8 pg/µl, while the latter could detect DNA to lower limit of 2.28 ng/ µl, thus LAMP could detect 100 times lesser concentration of DNA in comparison to PCR. Loop mediated isothermal amplification is a rather newer molecular technique, which can be used for rapid detection of infectious agent at field level and which does not require sophisticated instrument, i.e. thermal cycler. Furthermore, unlike the conventional PCR technique, LAMP requires lesser time to perform and result can be read visually. PMID:26129662

  4. Serotyping of foot and mouth disease virus and Pasteurella multocida from Indian gaurs (Bos gaurus), concurrently infected with foot and mouth disease and haemorrhagic septicaemia.

    PubMed

    Chandranaik, Basavegowdanadoddi Marinaik; Hegde, Raveendra; Shivashankar, Beechagondahalli Papanna; Giridhar, Papanna; Muniyellappa, Handenahally Kaverappa; Kalge, Rajeshwar; Sumathi, Benamanahalli Raju; Nithinprabhu, Kumble; Chandrashekara, Narasimhaiah; Manjunatha, Venkataramanappa; Jaisingh, Nirupama; Mayanna, Asha; Chandrakala, Gowda Kallenahalli; Kanaka, Sermaraja; Venkatesha, Mudalagiri Dasappagupta

    2015-06-01

    We report the serotyping of foot-and-mouth disease virus (FMDV) and Pasteurella multocida from Indian gaurs which were concurrently infected with foot-and-mouth disease (FMD) and haemorrhagic septicaemia. Bannerghatta biological park (BBP), a national park located in the outskirts of Bengaluru city, Karnataka, India, is bordered by several villages. These villages witnessed massive outbreaks of FMD which spread rapidly to the herbivores at BBP. Post-mortem was conducted on carcasses of two Indian gaurs that died with symptoms of FMD. The salient gross findings included extensive vesicular lesions on the tongue, gums, cheeks, upper palate and hooves. Haemorrhagic tracheitis and ecchymotic haemorrhages on the heart were characteristic. The vesicular lesions of oral cavity were positive for 'O' type of FMD virus by sandwich enzyme-linked immuno sorbent assay (ELISA). The heart blood and spleen samples yielded growth of pure cultures of P. multocida. The isolates were typed as P. multocida type B using KTSP61 and KTT72 primers yielding specific amplicons of 620 bp. The phylogenetic analysis of the isolates was carried by sequencing of 1.4-Kbp nucleotides on the 16S ribosomal RNA (rRNA) gene of the isolates. PMID:25894817

  5. Isolation of viral haemorrhagic septicaemia virus from muskellunge, Esox masquinongy (Mitchill), in Lake St Clair, Michigan, USA reveals a new sublineage of the North American genotype

    USGS Publications Warehouse

    Elsayed, E.; Faisal, M.; Thomas, M.; Whelan, G.; Batts, W.; Winton, J.

    2006-01-01

    Viral haemorrhagic septicaemia virus (VHSV) was isolated from muskellunge, Esox masquinongy (Mitchill), caught from the NW portion of Lake St Clair, Michigan, USA in 2003. Affected fish exhibited congestion of internal organs; the inner wall of the swim bladder was thickened and contained numerous budding, fluid-filled vesicles. A virus was isolated using fish cell lines inoculated with a homogenate of kidney and spleen tissues from affected fish. Focal areas of cell rounding and granulation appeared as early as 24 h post-inoculation and expanded rapidly to destroy the entire cell sheet by 96 h. Electron microscopy revealed virions that were 170-180 nm in length by 60-70 nm in width having a bullet-shaped morphology typical of rhabdoviruses. The virus was confirmed as VHSV by reverse transcriptase-polymerase chain reaction. Sequence analysis of the entire nucleoprotein and glycoprotein genes revealed the virus was a member of the North American genotype of VHSV; however, the isolate was sufficiently distinct to be considered a separate sublineage, suggesting its origin may have been from marine species inhabiting the eastern coastal areas of the USA or Canada. ?? 2006 Blackwell Publishing Ltd.

  6. Factors controlling the early stages of viral haemorrhagic septicaemia epizootics: Low exposure levels, virus amplification and fish-to-fish transmission

    USGS Publications Warehouse

    Hershberger, P.K.; Gregg, J.L.; Grady, C.A.; Hart, L.M.; Roon, S.R.; Winton, J.R.

    2011-01-01

    Viral haemorrhagic septicaemia virus, Genogroup IVa (VHSV), was highly infectious to Pacific herring, Clupea pallasii (Valenciennes), even at exposure doses occurring below the threshold of sensitivity for a standard viral plaque assay; however, further progression of the disease to a population-level epizootic required viral amplification and effective fish-to-fish transmission. Among groups of herring injected with VHSV, the prevalence of infection was dose-dependent, ranging from 100%, 75% and 38% after exposure to 19, 0.7 and 0.07 plaque-forming units (PFU)/fish, respectively. Among Pacific herring exposed to waterborne VHSV (140PFUmL-1), the prevalence of infection, geometric mean viral tissue titre and cumulative mortality were greater among cohabitated herring than among cohorts that were held in individual aquaria, where fish-to-fish transmission was prevented. Fish-to-fish transmission among cohabitated herring probably occurred via exposure to shed virus which peaked at 680PFUmL-1; shed virus was not detected in the tank water from any isolated individuals. The results provide insights into mechanisms that initiate epizootic cascades in populations of wild herring and have implications for the design of VHSV surveys in wild fish populations. ?? Published 2011. This article is a US Government work and is in the public domain in the USA.

  7. Viral replication in excised fin tissues (VREFT) corresponds with prior exposure of Pacific herring, Clupea pallasii (Valenciennes), to viral haemorrhagic septicaemia virus (VHSV)

    USGS Publications Warehouse

    Grady, C.A.; Gregg, J.L.; Wade, R.M.; Winton, J.R.; Hershberger, P.K.

    2011-01-01

    Procedures for a viral replication in excised fin tissue (VREFT) assay were adapted to Pacific herring, Clupea pallasii, and optimized both to reduce processing time and to provide the greatest resolution between na??ve herring and those previously exposed to viral haemorrhagic septicaemia virus (VHSV), Genogroup IVa. The optimized procedures included removal of the left pectoral fin from a euthanized fish, inoculation of the fin with >105 plaque-forming units (PFU) mL-1 VHSV for 1 h, rinsing the fin in fresh medium six times to remove unadsorbed virions, incubation of the fin in fresh medium for 4 days and enumeration of the viral titre in a sample of the incubation medium by plaque assay. The optimized VREFT assay was effective at identifying the prior exposure history of laboratory-reared Pacific herring to VHSV. The geometric mean VREFT value was significantly greater (P < 0.01) among na??ve herring (1.2 ?? 103 PFU mL-1) than among groups that survived exposure to VHSV (1.0-2.9 ?? 102 PFU mL-1); additionally, the proportion of cultures with no detectable virus was significantly greater (P = 0.0002) among fish that survived exposure to VHSV (39-47%) than among na??ve fish (3.3%). The optimized VREFT assay demonstrates promise for identifying VHSV exposure history and forecasting disease potential in populations of wild Pacific herring. ?? 2010 Blackwell Publishing Ltd.

  8. Viral haemorrhagic septicaemia virus (VHSV) genotype II isolated from European river lamprey Lampetra fluviatilis in Finland during surveillance from 1999 to 2008.

    PubMed

    Gadd, Tuija; Jakava-Viljanen, Miia; Einer-Jensen, Katja; Ariel, Ellen; Koski, Perttu; Sihvonen, Liisa

    2010-02-17

    We examined the occurrence of viral haemorrhagic septicaemia virus (VHSV) in the main spawning stocks of wild European river lamprey Lampetra fluviatilis in the rivers of Finland from 1999 to 2008. Pooled samples of internal organs (kidney, liver and heart or brain) from 2621 lampreys were examined for the presence of VHSV by standard virological techniques. VHSV was isolated from 5 samples from the rivers Lestijoki and Kalajoki, which flow from Finland into the Bothnian Bay of the Baltic Sea. The presence of VHSV was confirmed by immunofluorescent antibody technique (IFAT), ELISA and RT-PCR. Phylogenetic analysis based on the full-length VHSV glycoprotein (G) gene sequence revealed that the isolates were most closely related to the VHSV strain isolated in 1996 from herring Clupea harengus and sprat Sprattus sprattus in the Eastern Gotland Basin of the Baltic Sea, and were therefore assigned to VHSV genotype II. The partial G gene sequences obtained (nt 1 to 672-1129) of all 5 lamprey VHSV isolates were identical, and so were the entire G genes (nt 1 to 1524) of 2 isolates sequenced. The virulence of one of the lamprey isolates was evaluated by an experimental infection trial in rainbow trout Oncorhynchus mykiss fry. No mortality was induced postinfection by waterborne and intraperitoneal challenge, respectively, while 2 genotype Id isolates originating from Finnish rainbow trout caused marked mortality under the same conditions. The infection in the European river lamprey is thought to be independent from the epidemic in farmed rainbow trout in Finnish brackish waters, because the isolates from rainbow trout were of a different genotype. This is the first report of VHSV found in the European river lamprey. The role of wild river lampreys in maintaining the infection in the marine environment remains unclear. PMID:20377008

  9. Real-time RT-PCR for detection, identification and absolute quantification of viral haemorrhagic septicaemia virus using different types of standards.

    PubMed

    Lopez-Vazquez, C; Bandín, I; Dopazo, C P

    2015-05-21

    In the present study, 2 systems of real-time RT-PCR-one based on SYBR Green and the other on TaqMan-were designed to detect strains from any genotype of viral haemorrhagic septicaemia virus (VHSV), with high sensitivity and repeatability/reproducibility. In addition, the method was optimized for quantitative purposes (qRT-PCR), and standard curves with different types of reference templates were constructed and compared. Specificity was tested against 26 isolates from 4 genotypes. The sensitivity of the procedures was first tested against cell culture isolation, obtaining a limit of detection (LD) of 100 TCID50 ml-1 (100-fold below the LD using cell culture), at a threshold cycle value (Ct) of 36. Sensitivity was also evaluated using RNA from crude (LD = 1 fg; 160 genome copies) and purified virus (100 ag; 16 copies), plasmid DNA (2 copies) and RNA transcript (15 copies). No differences between both chemistries were observed in sensitivity and dynamic range. To evaluate repeatability and reproducibility, all experiments were performed in triplicate and on 3 different days, by workers with different levels of experience, obtaining Ct values with coefficients of variation always <5. This fact, together with the high efficiency and R2 values of the standard curves, encouraged us to analyse the reliability of the method for viral quantification. The results not only demonstrated that the procedure can be used for detection, identification and quantification of this virus, but also demonstrated a clear correlation between the regression lines obtained with different standards, which will help scientists to compare sensitivity results between different studies. PMID:25993885

  10. In vivo virulence of viral haemorrhagic septicaemia virus (VHSV) in rainbow trout Oncorhynchus mykiss correlates inversely with in vitro Mx gene expression.

    PubMed

    Cano, Irene; Collet, Bertrand; Pereira, Clarissa; Paley, Richard; van Aerle, Ronny; Stone, David; Taylor, Nick G H

    2016-05-01

    The in vitro replication of viral haemorrhagic septicaemia virus (VHSV) isolates from each VHSV genotype and the associated cellular host Mx gene expression were analysed. All the isolates were able to infect RTG-2 cells and induce increased Mx gene expression (generic assay detecting isoforms 1 and 3 [Mx1/3]). A trout pathogenic, genotype Ia isolate (J167), showing high replication in RTG-2 cells (by infective titre and N gene expression) induced lower Mx1/3 gene expression than observed in VHSV isolates known to be non-pathogenic to rainbow trout: 96-43/8, 96-43/10 (Ib); 1p49, 1p53 (II); and MI03 (IVb). Paired co-inoculation assays were analysed using equal number of plaque forming units per ml (PFU) of J167 (Ia genotype) with other less pathogenic VHSV genotypes. In these co-inoculations, the Mx1/3 gene expression was significantly lower than for the non-pathogenic isolate alone. Of the three rainbow trout Mx isoforms, J167 did not induce Mx1 up-regulation in RTG-2 or RTgill-W1 cells. Co-inoculating isolates resulted in greater inhibition of Mx in both rainbow trout cell lines studied. Up-regulation of sea bream Mx in SAF-1 cells induced by 96-43/8 was also lower in co-inoculation assays with J167. The RTG-P1 cell line, expressing luciferase under the control of the interferon-induced Mx rainbow trout gene promoter, showed low luciferase activity when inoculated with pathogenic strains: J167, DK-5131 (Ic), NO-A-163/68 (Id), TR-206239-1, TR-22207111 (Ie), 99-292 (IVa), and CA-NB00-01 (IVc). Co-inoculation assays showed a J167-dose dependent inhibition of the luciferase activity. The data suggest that virulent VHSV isolates may interfere in the interferon pathways, potentially determining higher pathogenicity. PMID:27066706

  11. A retrospective study on the epidemiology of anthrax, foot and mouth disease, haemorrhagic septicaemia, peste des petits ruminants and rabies in Bangladesh, 2010-2012.

    PubMed

    Mondal, Shankar P; Yamage, Mat

    2014-01-01

    Anthrax, foot and mouth disease (FMD), haemorrhagic septicaemia (HS), peste des petits ruminants (PPR) and rabies are considered to be endemic in Bangladesh. This retrospective study was conducted to understand the geographic and seasonal distribution of these major infectious diseases in livestock based on data collected through passive surveillance from 1 January 2010 to 31 December 2012. Data analysis for this period revealed 5,937 cases of anthrax, 300,333 of FMD, 13,436 of HS, 247,783 of PPR and 14,085 cases of dog bite/rabies. While diseases were reported in almost every district of the country, the highest frequency of occurrence corresponded to the susceptible livestock population in the respective districts. There was no significant difference in the disease occurrences between districts bordering India/Myanmar and non-border districts (p>0.05). Significantly higher (p<0.01) numbers of anthrax (84.5%), FMD (88.3%), HS (84.9%) and dog bite/rabies (64.3%) cases were reported in cattle than any other species. PPR cases were reported mostly (94.8%) in goats with only isolated cases (5.2%) in sheep. The diseases occur throughout the year with peak numbers reported during June through September and lowest during December through April, with significant differences (p<0.01) between the months. The annual usages of vaccines for anthrax, FMD, HS and PPR were only 7.31%, 0.61%, 0.84% and 11.59% of the susceptible livestock population, respectively. Prophylactic vaccination against rabies was 21.16% of cases. There were significant differences (p<0.01) in the administration of anthrax, FMD and HS vaccines between border and non-border districts, but not PPR or rabies vaccines. We recommend that surveillance and reporting of these diseases need to be improved throughout the country. Furthermore, all suspected clinical cases should be confirmed by laboratory examination. The findings of this study can be used in the formulation of more effective disease management and

  12. A Retrospective Study on the Epidemiology of Anthrax, Foot and Mouth Disease, Haemorrhagic Septicaemia, Peste des Petits Ruminants and Rabies in Bangladesh, 2010-2012

    PubMed Central

    Mondal, Shankar P.; Yamage, Mat

    2014-01-01

    Anthrax, foot and mouth disease (FMD), haemorrhagic septicaemia (HS), peste des petits ruminants (PPR) and rabies are considered to be endemic in Bangladesh. This retrospective study was conducted to understand the geographic and seasonal distribution of these major infectious diseases in livestock based on data collected through passive surveillance from 1 January 2010 to 31 December 2012. Data analysis for this period revealed 5,937 cases of anthrax, 300,333 of FMD, 13,436 of HS, 247,783 of PPR and 14,085 cases of dog bite/rabies. While diseases were reported in almost every district of the country, the highest frequency of occurrence corresponded to the susceptible livestock population in the respective districts. There was no significant difference in the disease occurrences between districts bordering India/Myanmar and non-border districts (p>0.05). Significantly higher (p<0.01) numbers of anthrax (84.5%), FMD (88.3%), HS (84.9%) and dog bite/rabies (64.3%) cases were reported in cattle than any other species. PPR cases were reported mostly (94.8%) in goats with only isolated cases (5.2%) in sheep. The diseases occur throughout the year with peak numbers reported during June through September and lowest during December through April, with significant differences (p<0.01) between the months. The annual usages of vaccines for anthrax, FMD, HS and PPR were only 7.31%, 0.61%, 0.84% and 11.59% of the susceptible livestock population, respectively. Prophylactic vaccination against rabies was 21.16% of cases. There were significant differences (p<0.01) in the administration of anthrax, FMD and HS vaccines between border and non-border districts, but not PPR or rabies vaccines. We recommend that surveillance and reporting of these diseases need to be improved throughout the country. Furthermore, all suspected clinical cases should be confirmed by laboratory examination. The findings of this study can be used in the formulation of more effective disease management and

  13. Application of a sensitive, specific and controlled real-time PCR assay to surveillance indicates a low prevalence of viral haemorrhagic septicaemia virus (VHSV) in wild herring, Clupea harengus L., in Scottish waters.

    PubMed

    Matejusova, I; McKay, P; Bland, F; Snow, M

    2010-10-01

    Surveillance data on the distribution of viral haemorrhagic septicaemia virus (VHSV) in the North Sea (UK), targeting Atlantic herring in areas with previous virus detection, were obtained from research cruises conducted during 2005. The sensitive molecular approach of real-time RT-PCR (qRT-PCR) was applied alongside a newly developed endogenous positive control assay specific for herring (elongation factor 1α) to ensure integrity of template. Three hundred and five pools from 1937 individual herring were tested, and no evidence of VHSV in association with wild Atlantic herring was detected. Samples were obtained from Scottish waters where marine aquaculture is conducted. The results confirm that previous tissue culture studies have most likely not significantly underestimated the prevalence of carrier herring in this area. The significance of migratory species such as herring as a reservoir species for VHSV, with the potential to translocate virus genotypes between geographical areas, is discussed. PMID:20735797

  14. Can VHS Virus Bypass the Protective Immunity Induced by DNA Vaccination in Rainbow Trout?

    PubMed Central

    Sepúlveda, Dagoberto; Lorenzen, Niels

    2016-01-01

    DNA vaccines encoding viral glycoproteins have been very successful for induction of protective immunity against diseases caused by rhabdoviruses in cultured fish species. However, the vaccine concept is based on a single viral gene and since RNA viruses are known to possess high variability and adaptation capacity, this work aimed at evaluating whether viral haemorrhagic septicaemia virus (VHSV), an RNA virus and member of Rhabdoviridae family, was able to evade the protective immune response induced by the DNA vaccination of rainbow trout. The experiments comprised repeated passages of a highly pathogenic VHSV isolate in a fish cell line in the presence of neutralizing fish serum (in vitro approach), and in rainbow trout immunized with the VHS DNA vaccine (in vivo approach). For the in vitro approach, the virus collected from the last passage (passaged virus) was as sensitive as the parental virus to serum neutralization, suggesting that the passaging did not promote the selection of virus populations able to bypass the neutralization by serum antibodies. Also, in the in vivo approach, where virus was passaged several times in vaccinated fish, no increased virulence nor increased persistence in vaccinated fish was observed in comparison with the parental virus. However, some of the vaccinated fish did get infected and could transmit the infection to naïve cohabitant fish. The results demonstrated that the DNA vaccine induced a robust protection, but also that the immunity was non-sterile. It is consequently important not to consider vaccinated fish as virus free in veterinary terms. PMID:27054895

  15. 9 CFR 83.4 - VHS-regulated fish and VHS-regulated areas.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false VHS-regulated fish and VHS-regulated... HEMORRHAGIC SEPTICEMIA § 83.4 VHS-regulated fish and VHS-regulated areas. (a)(1) APHIS will list as a VHS-regulated fish any fish species found in freshwater to be susceptible to the North American (type IV)...

  16. 9 CFR 83.4 - VHS-regulated fish and VHS-regulated areas.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false VHS-regulated fish and VHS-regulated... HEMORRHAGIC SEPTICEMIA § 83.4 VHS-regulated fish and VHS-regulated areas. (a)(1) APHIS will list as a VHS-regulated fish any fish species found in freshwater to be susceptible to the North American (type IV)...

  17. VHS Movies: Perturbations for Morphogenesis.

    ERIC Educational Resources Information Center

    Holmes, Danny L.

    This paper discusses the concept of a family system in terms of an interactive system of interrelated, interdependent parts and suggests that VHS movies can act as perturbations, i.e., change promoting agents, for certain dysfunctional family systems. Several distinct characteristics of a family system are defined with particular emphasis on…

  18. Early and late neonatal septicaemia.

    PubMed Central

    Placzek, M M; Whitelaw, A

    1983-01-01

    Between 1979 and 1982 we reviewed 1000 consecutive admissions to the neonatal intensive care unit of this hospital. Sixty five infants had positive blood cultures. Mortality was 70% among 17 infants who had septicaemia in the first 48 hours of life and for whom appropriate treatment may have been too late because of difficulties of early diagnosis. In the remaining 48 infants mortality was 12%, septicaemia occurred later, and was associated with Staphylococcus epidermidis (56%) and with the presence of an intravascular catheter (50%). PMID:6625634

  19. Intracerebral haemorrhage

    PubMed Central

    Qureshi, Adnan I; Mendelow, A David; Hanley, Daniel F

    2011-01-01

    Intracerebral haemorrhage is an important public health problem leading to high rates of death and disability in adults. Although the number of hospital admissions for intracerebral haemorrhage has increased worldwide in the past 10 years, mortality has not fallen. Results of clinical trials and observational studies suggest that coordinated primary and specialty care is associated with lower mortality than is typical community practice. Development of treatment goals for critical care, and new sequences of care and specialty practice can improve outcome after intracerebral haemorrhage. Specific treatment approaches include early diagnosis and haemostasis, aggressive management of blood pressure, open surgical and minimally invasive surgical techniques to remove clot, techniques to remove intraventricular blood, and management of intracranial pressure. These approaches improve clinical management of patients with intracerebral haemorrhage and promise to reduce mortality and increase functional survival. PMID:19427958

  20. Intracerebral haemorrhage.

    PubMed

    Qureshi, Adnan I; Mendelow, A David; Hanley, Daniel F

    2009-05-01

    Intracerebral haemorrhage is an important public health problem leading to high rates of death and disability in adults. Although the number of hospital admissions for intracerebral haemorrhage has increased worldwide in the past 10 years, mortality has not fallen. Results of clinical trials and observational studies suggest that coordinated primary and specialty care is associated with lower mortality than is typical community practice. Development of treatment goals for critical care, and new sequences of care and specialty practice can improve outcome after intracerebral haemorrhage. Specific treatment approaches include early diagnosis and haemostasis, aggressive management of blood pressure, open surgical and minimally invasive surgical techniques to remove clot, techniques to remove intraventricular blood, and management of intracranial pressure. These approaches improve clinical management of patients with intracerebral haemorrhage and promise to reduce mortality and increase functional survival. PMID:19427958

  1. High throughput screening of scFv antibodies against viral hemorrhagic septicaemia virus by flow cytometry.

    PubMed

    Zhou, Yao; Xie, Zhi-Gang

    2015-07-01

    Viral hemorrhagic septicaemia (VHS) is an economically important disease that affects salmon and trout worldwide. In this study, a recombinant single chain variable fragment (scFv) antibody library derived from rainbow trout immunized with purified viral hemorrhagic septicaemia virus (VHSV) was constructed. The library was subjected to three rounds of screening by flow cytometry (FCM) against VHSV through a bacteria display technology, resulting in the enrichment of scFv. Four scFv clones with different fluorescence intensity were obtained by colony pick up at random following three rounds of screening. The isolated scFv antibodies were expressed and purified. Relative affinity assay showed the four clones had different sensitivity to VHSV, in accordance with FCM. The potential use of the selected VHSV-specific scFv antibodies was demonstrated by the successful application in Western blotting assay, ELISA and immunofluorescence antibody test (IFAT), and one of the isolated scFv molecular showed excellent in vitro and in vivo blocking activities against VHSV. scFv isolated in this study can be promising diagnostic and/or therapeutic reagents for VHS. This study provides powerful strategies for screening antibodies against new diseases. PMID:25813596

  2. Septicaemia in newborns and infants.

    PubMed

    Pettay, O

    1982-01-01

    In the lifespan of a human being the two extremes, the early childhood and old age are prone to septicaemia because of poorly functioning anti-infectious defensive mechanisms. In a newborn full term baby these mechanisms are all present but still unexperienced. The importance of both specific and nonspecific factors will be discussed. The etiologic agents, causing septicaemia in nurseries undergo continuous change. In Helsinki we have during the last 20 years experienced staphylococci to start with, changing then to Gram-negative rods, to streptococci group B and now we have increasing difficulties with hospital infections. In the treatment of these children antibiotics alone are not sufficient but repeated exchange transfusions and granulocyte transfusions are needed. In infants after the first month of life, septicaemias produce a clinical picture different from that in newborns but still different also from that in adults. Also in this age group a shift in etiology has been observed. Increasing resistance to antimicrobial agents in the bacteria encountered makes a reconsideration of therapeutic schemes necessary. PMID:7048513

  3. 9 CFR 83.4 - VHS-regulated fish and VHS-regulated areas.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...-regulated fish any fish species found in freshwater to be susceptible to the North American (type IV) strain... migrated into freshwater and from which VHS strain type IV(a) has been isolated will not be considered...

  4. 9 CFR 83.4 - VHS-regulated fish and VHS-regulated areas.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...-regulated fish any fish species found in freshwater to be susceptible to the North American (type IV) strain... migrated into freshwater and from which VHS strain type IV(a) has been isolated will not be considered...

  5. 9 CFR 83.4 - VHS-regulated fish and VHS-regulated areas.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...-regulated fish any fish species found in freshwater to be susceptible to the North American (type IV) strain... migrated into freshwater and from which VHS strain type IV(a) has been isolated will not be considered...

  6. 9 CFR 83.3 - Interstate movement of live VHS-regulated fish species from VHS-regulated areas.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...-regulated fish species from VHS-regulated areas. 83.3 Section 83.3 Animals and Animal Products ANIMAL AND...-regulated fish species from VHS-regulated areas. (a) Except as provided in paragraphs (b) through (e) of this section, live VHS-regulated fish, including fish moved to live fish markets, may only be...

  7. 9 CFR 83.3 - Interstate movement of live VHS-regulated fish species from VHS-regulated areas.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...-regulated fish species from VHS-regulated areas. 83.3 Section 83.3 Animals and Animal Products ANIMAL AND...-regulated fish species from VHS-regulated areas. (a) Except as provided in paragraphs (b) through (e) of this section, live VHS-regulated fish, including fish moved to live fish markets, may only be...

  8. 9 CFR 83.3 - Interstate movement of live VHS-regulated fish species from VHS-regulated areas.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...-regulated fish species from VHS-regulated areas. 83.3 Section 83.3 Animals and Animal Products ANIMAL AND...-regulated fish species from VHS-regulated areas. (a) Except as provided in paragraphs (b) through (e) of this section, live VHS-regulated fish, including fish moved to live fish markets, may only be...

  9. 9 CFR 83.3 - Interstate movement of live VHS-regulated fish species from VHS-regulated areas.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...-regulated fish species from VHS-regulated areas. 83.3 Section 83.3 Animals and Animal Products ANIMAL AND...-regulated fish species from VHS-regulated areas. (a) Except as provided in paragraphs (b) through (e) of this section, live VHS-regulated fish, including fish moved to live fish markets, may only be...

  10. 9 CFR 83.3 - Interstate movement of live VHS-regulated fish species from VHS-regulated areas.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...-regulated fish species from VHS-regulated areas. 83.3 Section 83.3 Animals and Animal Products ANIMAL AND...-regulated fish species from VHS-regulated areas. (a) Except as provided in paragraphs (b) through (e) of this section, live VHS-regulated fish, including fish moved to live fish markets, may only be...

  11. Pseudomonas septicaemia following tribal tatoo marks.

    PubMed

    Mathur, D R; Sahoo, A

    1984-09-01

    It is tradition in Northern Nigeria to make tribal tatoo marks on the face of a newborn, commonly on both sides of the angle of the mouth. A case of fatal septicaemia due to Pseudomonas aeruginosa following such tribal tatoo marks is reported. PMID:6506210

  12. Fatal outcome of Bacillus cereus septicaemia.

    PubMed

    Lede, I; Vlaar, A; Roosendaal, R; Geerlings, S; Spanjaard, L

    2011-01-01

    Bacillus cereus is a ubiquitous environmental micro-organism which is often a contaminant of clinical cultures. Infections due to B. cereus are described, but mostly in immunocompromised patients. We report a fatal outcome of B. cereus septicaemia in an immunocompetent patient with a mechanical mitral valve. PMID:22173364

  13. Epizootic Haemorrhagic Disease

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Epizootic haemorrhagic disease (EHD) is an infectious non contagious viral disease transmitted by insects of the genus Culicoides which affects wild and domestic ruminants. The causative agent, the epizootic haemorrhagic disease virus (EHDV), belongs to the family Reoviridae, genus Orbivirus and sha...

  14. First Scientific Results from the VISTA Hemisphere Survey (VHS)

    NASA Astrophysics Data System (ADS)

    McMahon, R. G.; Banerji, M.; Gonzalez, E.; Koposov, S. E.; Bejar, V. J.; Lodieu, N.; Rebolo, R.; VHS Collaboration

    2013-12-01

    The first Galactic and extragalactic results from the VISTA Hemisphere Survey (VHS) are presented. The aim of the VHS is to carry out a near-infrared survey which, when combined with other VISTA public surveys, will result in coverage of the whole southern celestial hemisphere (~20 000 square degrees) to a depth 30 times fainter than the Two Micron All Sky Survey in at least two wavebands (J and Ks). The VHS vision includes a deep optical survey over the same area and this is now being realised with the VST surveys and the Dark Energy Survey, which has recently started. A summary of the survey progress is presented, with some follow-up results on low-mass stars and high-redshift quasars.

  15. Prevention of intracerebral haemorrhage.

    PubMed

    Mitchell, Patrick; Mitra, Dipayan; Gregson, Barbara A; Mendelow, A David

    2007-07-01

    Nontraumatic intracerebral haemorrhages arise from a wide range of causes falling into two broad groups: discreet vascular "ictohaemorrhagic" lesions such as aneurysms, arteriovenous malformations, cavernomas, tumours, and dural fistulae; and more generalised amyloid or hypertension related conditions. It is now possible using family history, associated risk factors and gradient echo MRI to predict cases at high risk of hypertensive or amyloid related haemorrhage. There is considerable potential for prevention of hypertensive haemorrhages by treatment of high risk cases with antihypertensive medication. As yet no effective preventative treatment for amyloid angiopathy related ICH has emerged although a variety of drugs are under investigation. Prevention of haemorrhage from ictohaemorrhagic lesions revolves around removal or obliteration of the lesion. Although there is a wide range of such lesions available treatments come down to three modalities. These are surgical excision, stereotactic radiosurgery and endovascular embolisation. PMID:17630936

  16. Haemorrhagic Fevers, Viral

    MedlinePlus

    ... fever, dengue, Omsk haemorrhagic fever, Kyasanur forest disease). Ebola virus disease outbreak in West Africa in 2014-2015 All information on Ebola virus disease Ebola features map Dashboard - Progress update ...

  17. Recovery after subarachnoid haemorrhage.

    PubMed Central

    McKenna, P.; Willison, J. R.; Lowe, D.; Neil-Dwyer, G.

    1989-01-01

    OBJECTIVE--To determine the implications of subarachnoid haemorrhage for quality of life and aftercare. DESIGN--Prospective follow up study of patients surviving subarachnoid haemorrhage over one year (at discharge, three months, and one year) by examination of cognitive functions (a test battery) and changes in everyday life (semistructured interview). SETTING--Regional neurosurgical unit at a tertiary referral centre. PATIENTS--100 Patients with subarachnoid haemorrhage; 17 were lost during the study because of ineligibility (further surgery, previous head injury, relevant psychiatric history, and cultural differences), loss of contact, and non-compliance; a further 13 patients who developed a neurological deficit were considered separately. MAIN OUTCOME MEASURE--Performance on cognitive test battery and reported changes in quality of life. RESULTS--At discharge patients with and without neurological deficit scored below established norms with most tests, but by three months the difference had resolved in patients without deficit. Reduced quality of life attributable to subarachnoid haemorrhage at one year mainly included less energy (seven patients), adverse emotional changes (five), early retirement, affected social life, and domestic tension (three each). None reported reduced capacity for work. CONCLUSIONS--Patients surviving subarachnoid haemorrhage without neurological symptoms have a good prognosis and should be encouraged to return to a normal lifestyle within about three months. PMID:2507029

  18. The pseudorabies virus vhs protein cleaves RNA containing an IRES sequence.

    PubMed

    Liu, Ya-Fen; Tsai, Pei-Yun; Chulakasian, Songkhla; Lin, Fong-Yuan; Hsu, Wei-Li

    2016-03-01

    The virion host shutoff protein (vhs), encoded by the gene UL41, has RNase activity and is the key regulator of the early host shutoff response induced by type 1 herpes simplex virus. Despite low amino acid similarity, the vhs protein of the swine herpesvirus, pseudorabies virus (PrV), also exhibits RNase activity. However, the mechanism underlying the action of vhs remains undefined. Here, we report that the RNA degradation profile of PrV vhs is similar, but not identical, to that of type 1 herpes simplex virus vhs. Notably, the presence of a cap structure enhances both the degradation rate and the preferential targeting of the vhs protein towards the 3'-end of the encephalomyocarditis virus internal ribosome entry site (IRES). Furthermore, type 1 herpes simplex virus vhs produces a simple degradation pattern, but PrV vhs gives rise to multiple intermediates. The results of northern blotting using probes recognizing various regions of the RNA substrate found that PrV vhs also cleaves downstream of the IRES region and this vhs protein overall shows 5' to 3' RNase activity. Moreover, addition of the translation initiation factors eIF4H and eIF4B significantly increased the RNase activity of recombinant PrV vhs against capped RNA. Nonetheless, these proteins did not fully reconstitute the IRES-directed targeting pattern observed for vhs translated in a rabbit reticular lysate system. The interaction between PrV vhs and eIF4H/eIF4B implies that the translation initiation machinery within the cell is able to stimulate the nuclease activity of PrV vhs. However, this process remains inefficient in terms of the IRES-targeting pattern. PMID:26744129

  19. Intracranial haemorrhage in pregnancy

    PubMed Central

    Fairhall, Jacob M; Stoodley, Marcus A

    2009-01-01

    Intracranial haemorrhage (ICH) is a rare, yet potentially devastating event in pregnancy. There is a risk of maternal mortality or morbidity and a significant risk to the unborn child. The risk of haemorrhage increases during the third trimester and is greatest during parturition and the puerperium. ICH can be extradural, subdural, subarachnoid or intraparenchymal. Causes of bleeding include trauma, arteriovenous malformations, aneurysms, preeclampsia/eclampsia and venous thrombosis. Urgent neurosurgical conditions generally outweigh obstetric considerations in management decisions, although anaesthetic and surgical modifications can be made to minimize adverse effects to the fetus.

  20. Temporary protection of rainbow trout gill epithelial cells from infection with viral haemorrhagic septicaemia virus IVb.

    PubMed

    Al-Hussinee, L; Pham, P H; Russell, S; Tubbs, L; Tafalla, C; Bols, N C; Dixon, B; Lumsden, J S

    2016-09-01

    The branchial epithelium is not only a primary route of entry for viral pathogens, but is also a site of viral replication and subsequent shedding may also occur from the gill epithelium. This study investigated the potential of agents known to stimulate innate immunity to protect rainbow trout epithelial cells (RTgill-W1) from infection with VHSV IVb. RTgill-W1 cells were pretreated with poly I:C, FuGENE(®) HD + poly I:C, lipopolysaccharide (LPS), LPS + poly I:C or heat-killed VHSV IVb and then infected with VHSV IVb 4 days later. Cytopathic effect (CPE) was determined at 2, 3, 4, 7 and 11 days post-infection. Virus in cells and supernatant was detected using quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). All of the treatments delayed the onset of CPE (per cent of monolayer destruction), compared with untreated controls; however, killed VHSV or poly I:C combined with LPS was the most effective. Similarly, the detection of viral RNA in the supernatant was delayed, and the quantity was significantly (P < 0.05) reduced by all treatments with the exception of LPS alone (4 days). Unlike many of the other treatments, pretreatment of RTgill-W1 with heat-killed VHSV did not upregulate interferon 1, 2 or MX 1 gene expression. PMID:26850791

  1. Roles of nucleic acid substrates and cofactors in the vhs protein activity of pseudorabies virus.

    PubMed

    Liu, Ya-Fen; Tsai, Pei-Yun; Lin, Fong-Yuan; Lin, Kuan-Hsun; Chang, Tien-Jye; Lin, Hui-Wen; Chulakasian, Songkhla; Hsu, Wei-Li

    2015-01-01

    Pseudorabies virus (PrV) belongs to the α-herpesvirinae of which human simplex virus (HSV) is the prototype virus. One of the hallmarks of HSV infection is shutoff of protein synthesis that is mediated by various viral proteins including vhs (virion host shutoff), which is encoded by the UL41 gene. However, the function of PrV vhs is poorly understood. Due to the low sequence similarity (39.3%) between the HSV and PrV UL41 proteins, vhs might not share the same biochemistry characteristics. The purpose of this study was to characterize the nuclease activity of the PrV vhs protein with respect to substrate specificity, its requirements in terms of cofactors, and the protein regions, as well as key amino acids, which contribute to vhs activity. Our results indicated that, similar to HSV vhs, PrV vhs is able to degrade ssRNA and mRNA. However, PrV vhs also targeted rRNA for degradation, which is novel compared to the HSV-1 vhs. Activity assays indicated that Mg(2+) alone enhances RNA degradation mediated by PrV vhs, while K(+) and ATP are not sufficient to induce activity. Finally, we demonstrated that each of the four highly conserved functional boxes of PrV vhs contributes to RNA degradation and that, in particular, residues 152, 169, 171, 172, 173 343, 345, 352 and 356, which are conserved among α-herpesviruses, are key amino acids needed for PrV vhs ribonuclease activity. PMID:26704628

  2. Management of postpartum haemorrhage

    PubMed Central

    Bonnet, Marie Pierre; Benhamou, Dan

    2016-01-01

    Postpartum Haemorrhage (PPH) is a major cause of maternal morbidity and mortality. Treatment of acquired coagulopathy observed in severe PPH is an important part of PPH management, but is mainly based on literature in trauma patients, and data thus should be interpreted with caution. This review describes recent advances in transfusion strategy and in the use of tranexamic acid and fibrinogen concentrates in women with PPH. PMID:27408694

  3. Timing of intraventricular haemorrhage.

    PubMed Central

    Emerson, P; Fujimura, M; Howat, P; Howes, D; Keeling, J; Robinson, R O; Salisbury, D; Tizard, J P

    1977-01-01

    The detection of the onset of intraventricular haemorrhage (IVH) during life is a necessary preliminary to understanding the cause of this condition. In 10 infants of very low birthweight treated with serial transfusions of adult blood the proportions of transfused cells circulating after each transfusion were compared with the proportion of transfused cells found in the intraventricular clot at necropsy. This allowed the timing of IVH to be restricted retrospectively to the period between consecutive blood transfusions. In addition, the proportional changes of transfused cells produced by infusion of a known red cell mass allow changes in the babies' original red cell mass to be followed during life. A fall in this value occurred in 8 infants dying with IVH and was taken to indicate haemorrhage. Comparison of the two methods in 9 infants suggested that, while in some cases intraventricular bleeding occurs rapidly, in others it takes place over a period of time. The interval between birth and the onset of haemorrhage was directly proportional to the gestational age of the infant. PMID:848996

  4. Comparison of MPEG-1 digital videotape with digitized sVHS videotape for quantitative echocardiographic measurements

    NASA Technical Reports Server (NTRS)

    Garcia, M. J.; Thomas, J. D.; Greenberg, N.; Sandelski, J.; Herrera, C.; Mudd, C.; Wicks, J.; Spencer, K.; Neumann, A.; Sankpal, B.; Soble, J.

    2001-01-01

    Digital format is rapidly emerging as a preferred method for displaying and retrieving echocardiographic studies. The qualitative diagnostic accuracy of Moving Pictures Experts Group (MPEG-1) compressed digital echocardiographic studies has been previously reported. The goals of the present study were to compare quantitative measurements derived from MPEG-1 recordings with the super-VHS (sVHS) videotape clinical standard. Six reviewers performed blinded measurements from still-frame images selected from 20 echocardiographic studies that were simultaneously acquired in sVHS and MPEG-1 formats. Measurements were obtainable in 1401 (95%) of 1486 MPEG-1 variables compared with 1356 (91%) of 1486 sVHS variables (P <.001). Excellent agreement existed between MPEG-1 and sVHS 2-dimensional linear measurements (r = 0.97; MPEG-1 = 0.95[sVHS] + 1.1 mm; P <.001; Delta = 9% +/- 10%), 2-dimensional area measurements (r = 0.89), color jet areas (r = 0.87, p <.001), and Doppler velocities (r = 0.92, p <.001). Interobserver variability was similar for both sVHS and MPEG-1 readings. Our results indicate that quantitative off-line measurements from MPEG-1 digitized echocardiographic studies are feasible and comparable to those obtained from sVHS.

  5. [Management of post partum haemorrhage].

    PubMed

    Csorba, Roland

    2012-04-29

    Primary post partum haemorrhage is the most common form of major obstetric haemorrhage. The traditional definition of primary post partum haemorrhage is the loss of 500 ml or more of blood from the genital tract within 24 hours of the birth of a baby. Post partum haemorrhage can be minor (500-1000 ml) or major (more than 1000 ml). Major could be divided to moderate (1000-2000 ml) or severe (more than 2000 ml). The recommendations in this article apply to women experiencing primary post partum haemorrhage of 500 ml or more. Secondary post partum haemorrhage is defined as abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks postnatally. The main causes of the secondary form are: inflammations (endometritis), placental tissue retention, inadequate involution of the uterus and malignancy. Because of its importance as a leading cause of maternal morbidity and mortality, obstetric haemorrhage must be considered as a priority topic. According to the tragic and dramatic outcomes of this morbidity, and to the fact that most cases of post partum haemorrhage have no identifiable risk factors, the practical obstetricians should be aware of the accurate diagnosis and management of this illness. PMID:22543219

  6. Intraventricular haemorrhage and haemostasis defects.

    PubMed Central

    Beverley, D W; Chance, G W; Inwood, M J; Schaus, M; O'Keefe, B

    1984-01-01

    Twenty five of 106 preterm infants of 34 weeks' gestation or less developed intraventricular haemorrhage within the first 48 hours of life. A comparison of infants with and without intraventricular haemorrhage showed no significant differences in their haemostatic parameters at birth. At age 48 hours the group with intraventricular haemorrhage showed a prolonged activated partial thromboplastin time and reduced factor II, VII, and X activity. There was a significant correlation between the severity of intraventricular haemorrhage and the degree of haemostasis abnormality both in cord blood and in blood obtained at age 48 hours. Those infants sustaining grade IV intraventricular haemorrhage had a significantly prolonged activated partial thromboplastin time, reduced factor II, VII, and X activity; and a decreased fibrinogen concentration at birth. At age 48 hours these defects were accompanied by reduced platelet counts and an increased megathrombocyte index. Although intraventricular haemorrhage is multifactorial, we postulate that correction of haemostasis abnormalities at birth may prevent progression to more severe grades of haemorrhage. PMID:6732274

  7. Recrudescence and relapse of meningococcal meningitis and septicaemia.

    PubMed

    Nielsen, P E; Thelle, T; Tvede, M

    1995-03-01

    Three cases of recrudescence and relapse of Neisseria meningitidis group B meningitis and septicaemia are reported. The recrudescence and relapses could not be explained by infectious foci, increased bacterial penicillin resistance or immunological defects. As a supplement to antibiotic treatment, all three patients received corticosteroids for the initial 2 days of treatment, and this may have contributed to the unusual course of the disease in our patient. PMID:7780262

  8. Systemic lupus erythematosus presenting as pneumococcal septicaemia and septic arthritis.

    PubMed Central

    Webster, J; Williams, B D; Smith, A P; Hall, M; Jessop, J D

    1990-01-01

    A 50 year old woman presented with pneumococcal septicaemia, septic arthritis, and a lobar pneumonia and was subsequently diagnosed as having systemic lupus erythematosus. The blood film and splenic 99mTc sulphur colloid uptake were normal, although selective functional hyposplenism was shown by the impaired clearance of immunoglobulin coated erythrocytes. Systemic lupus erythematosus presenting with fulminating pneumococcal sepsis in the presence of selective defects in spleen function is previously unreported. PMID:2322028

  9. Intracranial haemorrhage and child abuse.

    PubMed

    Cheah, I G; Kasim, M S; Shafie, H M; Khoo, T H

    1994-01-01

    Intracranial haemorrhage is a major cause of severe morbidity and mortality in child abuse cases in developed countries. However, similar data are not available in most developing countries. This study therefore aimed to determine the incidence of intracranial haemorrhage amongst all cases of child physical abuse, the nature of the injuries incurred, and the morbidity and mortality resulting therefrom. Among 369 cases of physical abuse seen over a 4-year period, 41 (11.4%) had intracranial haemorrhage, of whom 37 (90%) were 2 years old or less. A history of trauma was present in only eight (20%), of which only two were compatible with the injuries incurred. Subdural haemorrhages accounted for 80% of the cases, with skull fractures present in only nine cases. Fifty-four per cent of the 37 children aged 2 years of age or less had no external signs of trauma, but 11 of them had retinal haemorrhages. This is in contrast to the children older than 2 years of age who all had external signs of trauma. The overall prognosis was dismal with an early mortality of almost 30% (13 cases) and at least seven cases with severe neurological sequelae. These findings are comparable with studies from developed countries which have established that non-accidental injury must be considered as a cause of intracranial haemorrhage in any young child, despite the absence of external signs of trauma. PMID:7880096

  10. Analysis of the nucleoprotein gene identifies three distinct lineages of viral haemorrhagic septicemia virus (VHSV) within the European marine environment

    USGS Publications Warehouse

    Snow, M.; Cunningham, C.O.; Melvin, W.T.; Kurath, G.

    1999-01-01

    A ribonuclease (RNase) protection assay (RPA) has been used to detect nucleotide sequence variation within the nucleoprotein gene of 39 viral haemorrhagic septicaemia virus (VHSV) isolates of European marine origin. The classification of VHSV isolates based on RPA cleavage patterns permitted the identification of ten distinct groups of viruses based on differences at the molecular level. The nucleotide sequence of representatives of each of these groupings was determined and subjected to phylogenetic analysis. This revealed grouping of the European marine isolates of VHSV into three genotypes circulating within distinct geographic areas. A fourth genotype was identified comprising isolates originating from North America. Phylogenetic analyses indicated that VHSV isolates recovered from wild caught fish around the British Isles were genetically related to isolates responsible for losses in farmed turbot. Furthermore, a relationship between naturally occurring marine isolates and VHSV isolates causing mortality among rainbow trout in continental Europe was demonstrated. Analysis of the nucleoprotein gene identifies distinct lineages of viral haemorrhagic septicaemia virus within the European marine environment. Virus Res. 63, 35-44. Available from: 

  11. VHS domains of ESCRT-0 cooperate in high-avidity binding to polyubiquitinated cargo

    SciTech Connect

    Ren, Xuefeng; Hurley, James H.

    2010-03-30

    VHS (Vps27, Hrs, and STAM) domains occur in ESCRT-0 subunits Hrs and STAM, GGA adapters, and other trafficking proteins. The structure of the STAM VHS domain-ubiquitin complex was solved at 2.6 {angstrom} resolution, revealing that determinants for ubiquitin recognition are conserved in nearly all VHS domains. VHS domains from all classes of VHS-domain containing proteins in yeast and humans, including both subunits of ESCRT-0, bound ubiquitin in vitro. ESCRTs have been implicated in the sorting of Lys63-linked polyubiquitinated cargo. Intact human ESCRT-0 binds Lys63-linked tetraubiquitin 50-fold more tightly than monoubiquitin, though only 2-fold more tightly than Lys48-linked tetraubiquitin. The gain in affinity is attributed to the cooperation of flexibly connected VHS and UIM motifs of ESCRT-0 in avid binding to the polyubiquitin chain. Mutational analysis of all the five ubiquitin-binding sites in yeast ESCRT-0 shows that cooperation between them is required for the sorting of the Lys63-linked polyubiquitinated cargo Cps1 to the vacuole.

  12. User's guide and documentation manual for BOAST-VHS for the PC''

    SciTech Connect

    Chang, Ming-Ming; Sarathi, P.; Heemstra, R.J.; Cheng, A.M.; Pautz, J.F.

    1992-01-01

    The recent advancement of computer technology makes reservoir simulations feasible in a personal computer (PC) environment. This manual provides a guide for running BOAST-VHS, a black oil reservoir simulator for vertical/horizontal/slant wells, using a PC. In addition to detailed explanations of input data file preparation for simulation runs, special features of BOAST-VHS are described and three sample problems are presented. BOAST-VHS is a cost-effective and easy-to-use reservoir simulation tool for the study of oil production from primary depletion and waterflooding in a black oil reservoir. The well model in BOAST-VHS permits specification of any combination of horizontal, slanted, and vertical wells in the reservoir. BOAST-VHS was designed for an IBM PC/AT, PS-2, or compatible computer with 640 K bytes of memory. BOAST-VHS can be used to model a three-dimensional reservoir of up to 810 grid blocks with any combination of rows, columns, and layers, depending on the input data supplied. This dynamic redimensioning feature facilitates simulation work by avoiding the need to recompiling the simulator for different reservoir models. Therefore the program is only supplied as executable code without any source code.

  13. User`s guide and documentation manual for ``BOAST-VHS for the PC``

    SciTech Connect

    Chang, Ming-Ming; Sarathi, P.; Heemstra, R.J.; Cheng, A.M.; Pautz, J.F.

    1992-01-01

    The recent advancement of computer technology makes reservoir simulations feasible in a personal computer (PC) environment. This manual provides a guide for running BOAST-VHS, a black oil reservoir simulator for vertical/horizontal/slant wells, using a PC. In addition to detailed explanations of input data file preparation for simulation runs, special features of BOAST-VHS are described and three sample problems are presented. BOAST-VHS is a cost-effective and easy-to-use reservoir simulation tool for the study of oil production from primary depletion and waterflooding in a black oil reservoir. The well model in BOAST-VHS permits specification of any combination of horizontal, slanted, and vertical wells in the reservoir. BOAST-VHS was designed for an IBM PC/AT, PS-2, or compatible computer with 640 K bytes of memory. BOAST-VHS can be used to model a three-dimensional reservoir of up to 810 grid blocks with any combination of rows, columns, and layers, depending on the input data supplied. This dynamic redimensioning feature facilitates simulation work by avoiding the need to recompiling the simulator for different reservoir models. Therefore the program is only supplied as executable code without any source code.

  14. The herpes simplex virus vhs protein induces endoribonucleolytic cleavage of target RNAs in cell extracts.

    PubMed

    Elgadi, M M; Hayes, C E; Smiley, J R

    1999-09-01

    The herpes simplex virus virion host shutoff (vhs) protein (UL41 gene product) is a component of the HSV virion tegument that triggers shutoff of host protein synthesis and accelerated mRNA degradation during the early stages of HSV infection. Previous studies have demonstrated that extracts from HSV-infected cells and partially purified HSV virions display vhs-dependent RNase activity and that vhs is sufficient to trigger accelerated RNA degradation when expressed as the only HSV protein in an in vitro translation system derived from rabbit reticulocytes. We have used the rabbit reticulocyte translation system to characterize the mode of vhs-induced RNA decay in more detail. We report here that vhs-dependent RNA decay proceeds through endoribonucleolytic cleavage, is not affected by the presence of a 5' cap or a 3' poly(A) tail in the RNA substrate, requires Mg(2+), and occurs in the absence of ribosomes. Intriguingly, sites of preferential initial cleavage were clustered over the 5' quadrant of one RNA substrate that was characterized in detail. The vhs homologue of pseudorabies virus also induced accelerated RNA decay in this in vitro system. PMID:10438802

  15. Subarachnoid Haemorrhage and Sports

    PubMed Central

    Sousa Nanji, Liliana; Melo, Teresa P.; Canhão, Patrícia; Fonseca, Ana Catarina; Ferro, José Manuel

    2015-01-01

    Background Some cases of subarachnoid haemorrhage (SAH) have been associated with vigorous physical activity, including sports. Our research aimed to describe the association between SAH and sports and to identify the types of sports that were more frequently found as precipitating factors in a tertiary single-centre SAH register. Methods We retrieved information from a prospectively collected SAH registry and reviewed discharge notes of acute SAH patients admitted to the Stroke Unit of Hospital de Santa Maria, Lisbon, between 1995 and 2014. Results Out of 738 patients included in the analysis, 424 (57.5%) cases of SAH were preceded by physical activity. Nine cases (1.2%) were associated with sports, namely running (2 cases), aerobics (2 cases), cycling, body balance, dance, surf and windsurf. Patients with SAH while practicing sports were younger than controls (average age 43.1 vs. 57.0 years; p = 0.007). In 1 patient, there was a report of trauma to the neck. Patients in the sports group only had Hunt and Hess scale grades 1 (11.1%) or 2 (88.9%) at admission, while patients in the control group had a wider distribution in severity. Conclusions Our findings indicate that SAH precipitated by sports is not very frequent and is uncommonly related to trauma. Patients who suffered SAH associated with sports were younger and apparently had a milder clinical presentation. PMID:26648972

  16. Ebolavirus and Haemorrhagic Syndrome

    PubMed Central

    Matua, Gerald A.; Van der Wal, Dirk M.; Locsin, Rozzano C.

    2015-01-01

    The Ebola virus is a highly virulent, single-stranded ribonucleic acid virus which affects both humans and apes and has fast become one of the world’s most feared pathogens. The virus induces acute fever and death, with haemorrhagic syndrome occurring in up to 90% of patients. The known species within the genus Ebolavirus are Bundibugyo, Sudan, Zaïre, Reston and Taï Forest. Although endemic in Africa, Ebola has caused worldwide anxiety due to media hype and concerns about its international spread, including through bioterrorism. The high fatality rate is attributed to unavailability of a standard treatment regimen or vaccine. The disease is frightening since it is characterised by rapid immune suppression and systemic inflammatory response, causing multi-organ and system failure, shock and often death. Currently, disease management is largely supportive, with containment efforts geared towards mitigating the spread of the virus. This review describes the classification, morphology, infective process, natural ecology, transmission, epidemic patterns, diagnosis, clinical features and immunology of Ebola, including management and epidemic containment strategies. PMID:26052448

  17. Epizootic haemorrhagic disease.

    PubMed

    Maclachlan, N J; Zientara, S; Savini, G; Daniels, P W

    2015-08-01

    Summary Epizootic haemorrhagic disease (EHD) is an arthropod-transmitted viral disease of certain wild ungulates, notably North American white-tailed deer and, more rarely, cattle. The disease in white-tailed deer results from vascular injury analogous to that caused by bluetongue virus (BTV), to which EHD virus (EHDV) is closely related. There are seven serotypes of EHDV recognised, and Ibaraki virus, which is the cause of sporadic disease outbreaks in cattle in Asia, is included in EHDV serotype 2. The global distribution and epidemiology of BTV and EHDV infections are also similar, as both viruses occur throughout temperate and tropical regions of the world where they are transmitted by biting Culicoides midges and infect a wide variety of domestic and wild ungulates. However, the global distribution and epidemiology of EHDV infection are less well characterised than they are for BTV. Whereas most natural and experimental EHDV infections (other than Ibaraki virus infection) of livestock are subclinical or asymptomatic, outbreaks of EHD have recently been reported among cattle in the Mediterranean Basin, Reunion Island, South Africa, and the United States. Accurate and convenient laboratory tests are increasingly available for the sensitive and specific serological and virological diagnosis of EHDV infection and confirmation of EHD in animals, but commercial vaccines are available only for prevention of Ibaraki disease and not for protection against other strains and serotypes of EHDV. PMID:26601439

  18. Complement depletion aggravates Staphylococcus aureus septicaemia and septic arthritis

    PubMed Central

    Sakiniene, E; Bremell, T; Tarkowski, A

    1999-01-01

    The aim of the study was to assess the role of the complement system in Staphylococcus aureus arthritis and septicaemia. The murine model of haematogenously acquired septic arthritis was used, injecting intravenously toxic shock syndrome toxin-1 (TSST-1), producing S. aureus LS-1. Complement was depleted using cobra venom factor (CVF). Evaluation of arthritis was performed clinically and histopathologically. In addition, the effect of complement depletion on the phagocytic activity of leucocytes was assessed in vivo and in vitro. Six days after inoculation of S. aureus the prevalence of arthritis in decomplemented mice was three-fold higher than that in controls (91% versus 25%). The clinical severity of arthritis at the end of the experiment, expressed as arthritic index, was 7.3 and 1.9, respectively. These findings were confirmed by histological index of synovitis as well as of cartilage and/or bone destruction being significantly higher in decomplemented mice than in controls (9.8 ± 1.7 versus 4.9 ± 1.2, P < 0.05; and 7.9 ± 1.7 versus 3.0 ± 0.9, P < 0.05, respectively). Also, the septicaemia-induced mortality was clearly higher in decomplemented mice compared with the controls. CVF treatment significantly reduced in vivo polymorphonuclear cell-dependent inflammation induced by subcutaneous injection of olive oil and mirroring the capacity of polymorphonuclear cells (PMNC) to migrate and/or extravasate. Besides, the decomplementation procedure significantly impaired phagocytic activity of peripheral blood leucocytes in vitro, since the number of phagocytes being able to ingest bacteria decreased by 50% when the cells were maintained in decomplemented serum compared with those in intact serum. The conclusion is that complement depletion aggravates the clinical course of S. aureus arthritis and septicaemia, possibly by a combination of decreased migration/extravasation of PMNC and an impairment of phagocytosis. PMID:9933426

  19. Early Onset Neonatal Septicaemia Caused by Pantoea agglomerans

    PubMed Central

    Sengupta, Mallika; Das, Niloy Kumar; Guchhait, Partha; Misra, Saheli

    2016-01-01

    Pantoea agglomerans is an opportunistic pathogen causing infection in the immunocompromised patients. It is a plant pathogen and a rare human pathogen causing neonatal sepsis, joint infection, urinary tract infection and bloodstream infections. Neonatal Gram negative septicaemia may have an unusual presentation of subtle generalised neonatal seizures without any other cardinal features of sepsis. An appropriate diagnosis is therefore the key to proper management. P. agglomerans being an unusual cause of neonatal sepsis should be diagnosed early with proper antibiogram for clinical cure. Here, we report a case of neonatal sepsis caused by P. agglomerans in a tertiary care hospital in Eastern India. PMID:27437219

  20. Comparison of MPEG digital video with super VHS tape for diagnostic echocardiographic readings

    NASA Technical Reports Server (NTRS)

    Soble, J. S.; Yurow, G.; Brar, R.; Stamos, T.; Neumann, A.; Garcia, M.; Stoddard, M. F.; Cherian, P. K.; Bhamb, B.; Thomas, J. D.

    1998-01-01

    BACKGROUND: Digital recording of echocardiographic studies is on the clinical horizon. However, full digital capture of complete echocardiographic studies in traditional video format is impractical, given current storage capacity and network bandwidth. To overcome these constraints, we evaluated the diagnostic image quality of digital video by using MPEG (Motion Picture Experts Group) compression. METHODS AND RESULTS: Fifty-eight complete, consecutive studies were recorded simultaneously with the use of MPEG-1 and sVHS videotape. Each matched MPEG and sVHS study pair was reviewed by two from a total of six readers, and findings were recorded with the use of a detailed, computerized reporting tool. Intrareader and interreader discrepancies were characterized as major or minor and analyzed in total and for specific subgroups of findings (left and right ventricular parameters, valvular insufficiency, and left ventricular regional wall motion). Intrareader discrepancies were reviewed by a consensus panel for agreement with either MPEG or sVHS findings. There was an exact concordance between MPEG and sVHS readings in 83% of findings. The majority of discrepancies were minor, with major discrepancies in only 2.7% of findings. There was no difference in the rate of consensus panel agreement with MPEG or sVHS for instances of intrareader discrepancy, either in total or for any subgroup of findings. Interreader discrepancy rates were nearly identical for both MPEG and sVHS. CONCLUSIONS: MPEG-1 digital video is equivalent to sVHS videotape for diagnostic echocardiography. MPEG increases the range of practical options for digital echocardiography and offers, for the first time, the advantages of digital recording in a familiar video format.

  1. The influence of septicaemia on spontaneous motility in preterm infants.

    PubMed

    Bos, A F; van Asperen, R M; de Leeuw, D M; Prechtl, H F

    1997-11-24

    The qualitative assessment of general movements (GMs) in preterm infants is a sensitive method to investigate the integrity of the central nervous system. The question arises whether systemic infections affect the quality of GMs in a similar fashion to brain lesions. We were able to provide an answer to this problem in six infants (gestational age 24.4-32.4 weeks, birth weight 600-1660 grams), who had initially normal GMs as analyzed from sequential video-recordings. All infants sustained a proven septicaemia (Candida albicans in two, Staphylococcus aureus in three, a coagulase-negative staphylococcus in one infant). Unintentionally, recordings were also made during the acute phase. The complexity and variability of the GMs remained largely intact in five of the six infants; only one infant had transiently abnormal GMs. Compared with 1 week before the acute phase, the speed and amplitude of the GMs were diminished, giving the GMs a sluggish appearance. One to two weeks after the acute phase of septicaemia, the quality of GMs, i.e. speed and amplitude, had normalized in all infants. This study demonstrates that it is possible to discriminate between abnormal GMs due to cerebral lesions and sluggish GMs due to severe systemic infections, when the complexity of the GMs is considered as the main characteristic for judgement of normality of GM-quality. PMID:9467694

  2. BOAST-VHS. 3D 3-Phase Black Oil Applied Simulator

    SciTech Connect

    Chang, M.; Sarathi, P.; Heemstra, R.J.; Cheng, A.M.; Pautz, J.F.

    1992-01-01

    BOAST-VHS is a three-dimensional, three-phase, finite-difference black oil simulator developed for use on a personal computer. It simulates isothermal, Darcy flow in three dimensions. The simulator assumes that the reservoir fluids can be described by three fluid phases (oil, gas, and water) of constant composition whose properties are functions of pressure only. BOAST-VHS can simulate oil and/or gas recovery by fluid expansion, displacement, gravity drainage, and imbibition mechanisms. BOAST-VHS is recommended as a cost-effective reservoir simulation tool for the study of such problems as primary depletion, pressure maintenance (by water and/or gas injection) and basic secondary recovery operations (such as waterflooding) in a black oil reservoir using slanted or horizontal wells, in addition to conventional vertical wells. The well model in BOAST-VHS permits specification of rate or pressure constraints on well performance. The model also allows the user to add or recomplete wells during the period represented by the simulation. BOAST-VHS has flexible initialization capabilities, a bubble point tracking scheme, an automatic time-step control method, a zero transmissibility option (inactive grid blocks), and a material balance check on solution stability.

  3. Amphetamine abuse and intracranial haemorrhage.

    PubMed Central

    Buxton, N; McConachie, N S

    2000-01-01

    Amphetamines taken by any route can cause cerebral vasculitis and intracranial haemorrhage. 8 cases were seen in a neurosurgical unit over 3.5 years. The published work indicates that those who experience these complications, mainly young adults, have poor outcomes. PMID:11089483

  4. 9 CFR 93.911 - Ports designated for the importation of live VHS-regulated fish species.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... of live VHS-regulated fish species. 93.911 Section 93.911 Animals and Animal Products ANIMAL AND... (INCLUDING POULTRY) AND ANIMAL PRODUCTS IMPORTATION OF CERTAIN ANIMALS, BIRDS, FISH, AND POULTRY, AND CERTAIN... Animal Species General Provisions for Vhs-Regulated Fish Species § 93.911 Ports designated for...

  5. 9 CFR 93.911 - Ports designated for the importation of live VHS-regulated fish species.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... of live VHS-regulated fish species. 93.911 Section 93.911 Animals and Animal Products ANIMAL AND... (INCLUDING POULTRY) AND ANIMAL PRODUCTS IMPORTATION OF CERTAIN ANIMALS, BIRDS, FISH, AND POULTRY, AND CERTAIN... Animal Species General Provisions for Vhs-Regulated Fish Species § 93.911 Ports designated for...

  6. 9 CFR 93.911 - Ports designated for the importation of live VHS-regulated fish species.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... of live VHS-regulated fish species. 93.911 Section 93.911 Animals and Animal Products ANIMAL AND... (INCLUDING POULTRY) AND ANIMAL PRODUCTS IMPORTATION OF CERTAIN ANIMALS, BIRDS, FISH, AND POULTRY, AND CERTAIN... Animal Species General Provisions for Vhs-Regulated Fish Species § 93.911 Ports designated for...

  7. 9 CFR 93.911 - Ports designated for the importation of live VHS-regulated fish species.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... of live VHS-regulated fish species. 93.911 Section 93.911 Animals and Animal Products ANIMAL AND... (INCLUDING POULTRY) AND ANIMAL PRODUCTS IMPORTATION OF CERTAIN ANIMALS, BIRDS, FISH, AND POULTRY, AND CERTAIN... Animal Species General Provisions for Vhs-Regulated Fish Species § 93.911 Ports designated for...

  8. 9 CFR 93.911 - Ports designated for the importation of live VHS-regulated fish species.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... of live VHS-regulated fish species. 93.911 Section 93.911 Animals and Animal Products ANIMAL AND... (INCLUDING POULTRY) AND ANIMAL PRODUCTS IMPORTATION OF CERTAIN ANIMALS, BIRDS, FISH, AND POULTRY, AND CERTAIN... Animal Species General Provisions for Vhs-Regulated Fish Species § 93.911 Ports designated for...

  9. Reduction in periventricular haemorrhage in preterm infants.

    PubMed Central

    Szymonowicz, W; Yu, V Y; Walker, A; Wilson, F

    1986-01-01

    Our previous cerebral ultrasound study of antecedents of periventricular haemorrhage in infants weighing 1250 g or less at birth suggested that neonatal events that caused increased or fluctuating cerebral blood flow lead to periventricular haemorrhage. As the risk period for this type of haemorrhage was the first four days of life strict guidelines were introduced to avoid the previously identified neonatal risk factors. No attempt was made to modify obstetric practice. Over the next two years, although the obstetric risk profile, the frequency and severity of hyaline membrane disease, and the gestation, birth weight, and sex distributions of a similar cohort of infants did not change, the incidence of periventricular haemorrhage decreased significantly from 60% to 36%. Significant antecedents of haemorrhage similar to those found in the previous study included severe bruising, low arterial:fractional inspiratory oxygen ratio and low packed cell volume on admission, hyaline membrane disease, hypercarbia, and hypoxaemia. Assisted ventilation, pneumothorax, treatment with tubocurarine, and hypotension were no longer significant risk factors for periventricular haemorrhage. A multivariate discriminant analysis correctly predicted haemorrhage in 86% of the study group when bruising, hypercarbia, hypoxaemia, hyaline membrane disease, and low gestation were considered. These results suggest that changes in neonatal practices can reduce the incidence of periventricular haemorrhage and that drug studies indicating similar reduction in haemorrhage need to be evaluated carefully to ensure that placebo and treated groups are in fact comparable. PMID:3740905

  10. Mouse model of intracerebellar haemorrhage.

    PubMed

    Tijjani Salihu, Abubakar; Muthuraju, Sangu; Aziz Mohamed Yusoff, Abdul; Ahmad, Farizan; Zulkifli Mustafa, Mohd; Jaafar, Hasnan; Idris, Zamzuri; Rahman Izaini Ghani, Abdul; Malin Abdullah, Jafri

    2016-10-01

    The present study aimed to investigate the behavior and neuronal morphological changes in the perihaemorrhagic tissue of the mouse intracerebellar haemorrhage experimental model. Adult male Swiss albino mice were stereotactically infused with collagenase type VII (0.4U/μl of saline) unilaterally in to the cerebellum, following anaesthesia. Motor deficits were assessed using open field and composite score for evaluating the mouse model of cerebellar ataxia at 1, 3, 7, 14 and 21 days after collagenase infusion. The animals were sacrificed at the same time interval for evaluation of perihaematomal neuronal degeneration using haematoxylin and eosin staining and Annexin V-FITC/Propidium iodide assay. At the end of the study, it was found that infusion of 0.4U collagenase produces significant locomotor and ataxic deficit in the mice especially within the first week post surgery, and that this gradually improved within three weeks. Neuronal degeneration evident by cytoplasmic shrinkage and nuclear pyknosis was observed at the perihaematomal area after one day; especially at 3 and 7 days post haemorrhage. By 21 days, both the haematoma and degenerating neurons in the perihaematomal area were phagocytosed and the remaining neuronal cells around the scar tissue appeared normal. Moreover, Annexin-V/propidium iodide-positive cells were observed at the perihaematomal area at 3 and 7 days implying that the neurons likely die via apoptosis. It was concluded that a population of potentially salvageable neurons exist in the perihaematomal area after cerebellar haemorrhage throughout a wide time window that could be amenable to treatment. PMID:27327104

  11. The Herpes Simplex Virus Type 1 vhs-UL41 Gene Secures Viral Replication by Temporarily Evading Apoptotic Cellular Response to Infection: Vhs-UL41 Activity Might Require Interactions with Elements of Cellular mRNA Degradation Machinery

    PubMed Central

    Barzilai, Ari; Zivony-Elbom, Ifaat; Sarid, Ronit; Noah, Eran; Frenkel, Niza

    2006-01-01

    We have previously shown that herpes simplex virus type 1 (HSV-1) infection is associated with early destabilization/degradation of infected cell mRNAs and consequent shutoff of host protein synthesis by the activity of the virion-associated host shutoff (vhs) UL41 protein. Wild-type (wt) virus destabilized/degraded the housekeeping β-actin and α-tubulin mRNAs as well host stress functions, like the heat shock 70 protein induced postinfection. vhs mutants did not degrade the mRNAs. Elaborate studies by others have been concerned with the mode of mRNA degradation and the mRNAs affected. We now describe vhs activity in primary cultures of mouse cerebellar granule neurons (CGNs). Specifically, (i) upon infection in the presence of actinomycin D to test activity of input viral particles, there was a generalized inhibition of protein synthesis, which depended on the input multiplicity of infection (MOI). (ii) Low-MOI infection with vhs-1 mutant virus was associated with increased synthesis of all apparent proteins. Higher MOIs caused some shutoff, albeit significantly lower than that of wt virus. This pattern could reflect an interaction(s) of vhs-1 protein with host machinery involved in cellular mRNA destabilization/degradation, sequestering this activity. (iii) wt virus infection was associated with cell survival, at least for a while, whereas mutant virus induced apoptotic cell death at earlier times. (iv) wt virus replicated well in the CGNs, whereas there was no apparent replication of the vhs-1 mutant virus. (v) The vhs-1 mutant could serve as helper virus for composite amplicon vectors carrying marker genes and the human p53 gene. Ongoing studies test the use of vhs-1-based composite oncolytic vectors towards cancer gene therapy. PMID:16352574

  12. Significance of placental pathology in transplacental haemorrhage

    PubMed Central

    Devi, Banti; Jennison, R. F.; Langley, F. A.

    1968-01-01

    Placentae were examined from 120 women whose pregnancy and delivery was normal, from 264 women whose pregnancy or delivery was complicated, and from 98 women who were Rh-negative without antibodies and 35 women Rh-negative with antibodies. The presence of Kline's haemorrhages, intervillous thrombi, infarcts, and retroplacental haemorrhages was positively correlated with the presence of foetal cells in the maternal circulation. When there were no maternal antibodies transplacental haemorrhages occurred occasionally in the absence of such placental lesions but more frequently when these lesions were present. Moreover, the greater the number of lesions in a placenta the greater the size of the transplacental haemorrhage. In Rh-negative women with antibodies the observed incidence of transplacental haemorrhage was significantly less despite an appreciable increase in placental lesions. Images PMID:4972435

  13. Desmopressin Acetate in Intracranial Haemorrhage

    PubMed Central

    Kapapa, Thomas; Röhrer, Stefan; Struve, Sabine; Petscher, Matthias; König, Ralph; Wirtz, Christian Rainer; Woischneck, Dieter

    2014-01-01

    Introduction. The secondary increase in the size of intracranial haematomas as a result of spontaneous haemorrhage or trauma is of particular relevance in the event of prior intake of platelet aggregation inhibitors. We describe the effect of desmopressin acetate as a means of temporarily stabilising the platelet function. Patients and Methods. The platelet function was analysed in 10 patients who had received single (N = 4) or multiple (N = 6) doses of acetylsalicylic acid and 3 patients (control group) who had not taken acetylsalicylic acid. All subjects had suffered intracranial haemorrhage. Analysis was performed before, half an hour and three hours after administration of desmopressin acetate. Statistical analysis was performed by applying a level of significance of P ≤ 0.05. Results. (1) Platelet function returned to normal 30 minutes after administration of desmopressin acetate. (2) The platelet function worsened again after three hours. (3) There were no complications related to electrolytes or fluid balance. Conclusion. Desmopressin acetate can stabilise the platelet function in neurosurgical patients who have received acetylsalicylic acid prior to surgery without causing transfusion-related side effects or a loss of time. The effect is, however, limited and influenced by the frequency of drug intake. Further controls are needed in neurosurgical patients. PMID:25610644

  14. Features of VHS Recorders of Particular Interest for School Use. ICEM Guidelines No. 7.

    ERIC Educational Resources Information Center

    Bauch, Werner

    This discussion of features of VHS video recorders of particular interest to educators uses the Telefunken A 990 N HiFi and C 960 HiFi models as examples. It is reported that both of these models have stereo HiFi sound. This sound has excellent quality which makes it conducive for the teaching of foreign languages. The models are equipped with an…

  15. Complete Genome Sequence of Virulence-Enhancing Siphophage VHS1 from Vibrio harveyi

    PubMed Central

    Khemayan, Krit; Prachumwat, Anuphap; Sonthayanon, Burachai; Intaraprasong, Aungkul; Sriurairatana, Siriporn

    2012-01-01

    Vibrio harveyi siphophage 1 (VHS1) is a tailed phage with an icosahedral head of approximately 66 nm in diameter and an unornamented, flexible tail of approximately 153 nm in length. When Vibrio harveyi 1114GL is lysogenized with VHS1, its virulence for the black tiger shrimp (Penaeus monodon) increases by more than 100 times, and this coincides with production of a toxin(s) associated with shrimp hemocyte agglutination. Curiously, the lysogen does not show increased virulence for the whiteleg shrimp (Penaeus [Litopenaeus] vannamei). Here we present and annotate the complete, circular genome of VHS1 (81,509 kbp; GenBank accession number JF713456). By software analysis, the genome contains 125 putative open reading frames (ORFs), all of which appear to be located on the same DNA strand, similar to the case for many other bacteriophages. Most of the putative ORFs show no significant homology to known sequences in GenBank. Notable exceptions are ORFs for a putative DNA polymerase and putative phage structural proteins, including a portal protein, a phage tail tape measure protein, and a phage head protein. The last protein was identified as a component of the species-specific toxin mixture described above as being associated with agglutination of hemocytes from P. monodon. PMID:22307287

  16. Complete genome sequence of virulence-enhancing Siphophage VHS1 from Vibrio harveyi.

    PubMed

    Khemayan, Krit; Prachumwat, Anuphap; Sonthayanon, Burachai; Intaraprasong, Aungkul; Sriurairatana, Siriporn; Flegel, Timothy W

    2012-04-01

    Vibrio harveyi siphophage 1 (VHS1) is a tailed phage with an icosahedral head of approximately 66 nm in diameter and an unornamented, flexible tail of approximately 153 nm in length. When Vibrio harveyi 1114GL is lysogenized with VHS1, its virulence for the black tiger shrimp (Penaeus monodon) increases by more than 100 times, and this coincides with production of a toxin(s) associated with shrimp hemocyte agglutination. Curiously, the lysogen does not show increased virulence for the whiteleg shrimp (Penaeus [Litopenaeus] vannamei). Here we present and annotate the complete, circular genome of VHS1 (81,509 kbp; GenBank accession number JF713456). By software analysis, the genome contains 125 putative open reading frames (ORFs), all of which appear to be located on the same DNA strand, similar to the case for many other bacteriophages. Most of the putative ORFs show no significant homology to known sequences in GenBank. Notable exceptions are ORFs for a putative DNA polymerase and putative phage structural proteins, including a portal protein, a phage tail tape measure protein, and a phage head protein. The last protein was identified as a component of the species-specific toxin mixture described above as being associated with agglutination of hemocytes from P. monodon. PMID:22307287

  17. A prospective study of septicaemia in colostrum-deprived foals.

    PubMed

    Robinson, J A; Allen, G K; Green, E M; Fales, W H; Loch, W E; Wilkerson, C G

    1993-05-01

    Fourteen mares and their foals were attended at parturition. After mare-foal bonding, 8 colostrum-deprived (CD) foals were removed from their dams, deprived of colostrum, and provided with an alternative milk source for the first 24 h of life. The mares were milked out every 2-4 h during this period to remove colostrum, after which the CD foals were returned to their mares and allowed to nurse. Six colostrum-fed (CF) foals were allowed to suck colostrum in the normal manner. Foal serum IgG concentration was determined by single radial immunodiffusion (means, CD = 0 mg/dl; CF = 1,508 mg/dl). Accepted methods were used to minimise infections in the neonatal foals. Of the 8 CD foals, 7 demonstrated clinical signs of sepsis. Septicaemia was confirmed in 5 of the 7 septicaemic CD foals by ante-mortem blood culture or by culture of tissue at necropsy. Organisms isolated included: Actinobacillus equuli, Escherichia coli, undifferentiated coliforms, Pseudomonas spp., and Actinomyces pyogenes. Clinically ill foals were treated with antimicrobial drugs, intravenous fluid therapy, flunixin meglumine, and anti-endotoxin hyperimmune serum. Three septicaemic CD foals survived. Four of 7 septicaemic CD foals died or were destroyed. Post-mortem lesions included bacterial embolic pneumonia, glomerulonephritis/nephritis, lymphoid depletion/atrophy, splenic and lymphoid necrosis, hepatitis, septic arthritis, and systemic bacterial embolism. None of the CF foals became septicaemic. One CF foal had foal heat diarrhoea and 1 CF foal had a serum IgG concentration of 160 mg/dl (i.e. failure of passive transfer), but both foals were otherwise normal.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8508750

  18. Viral haemorrhagic fever in children.

    PubMed

    MacDermott, Nathalie E; De, Surjo; Herberg, Jethro A

    2016-05-01

    Viral haemorrhagic fevers (VHFs) are currently at the forefront of the world's attention due to the recentZaire ebolavirusepidemic in West Africa. This epidemic has highlighted the frailty of the world's public health response mechanisms and demonstrated the potential risks to nations around the world of imported cases of epidemic diseases. While imported cases in children are less likely, the potential for such a scenario remains. It is therefore essential that paediatricians are aware of and prepared for potential imported cases of tropical diseases, VHFs being of particular importance due to their propensity to cause nosocomial spread. Examining the four families of viruses-Filoviridae,Arenaviridae,BunyaviridaeandFlaviviridae, we describe the different types of VHFs, with emphasis on differentiation from other diseases through detailed history-taking, their presentation and management from a paediatric perspective. PMID:26787609

  19. Bilateral adrenal haemorrhage leading to adrenal crisis

    PubMed Central

    McGowan-Smyth, Sam

    2014-01-01

    A 77-year-old man presented with an acute worsening of chronic back pain. CT showed dense bilateral adrenal glands suggestive of adrenal haemorrhage which was confirmed by MRI. Despite appropriate glucocorticoid replacement for adrenal insufficiency, 7 days after admission this patient suffered an adrenal crisis. Owing to the timely diagnosis, appropriate treatment was given and the patient survived. Large bilateral adrenal haemorrhage however, can lead to cardiovascular collapse and death if not appropriately diagnosed and managed promptly. Despite its rarity, bilateral adrenal haemorrhage should always be considered as a differential for back pain in the setting of an acute illness due to its potentially fatal consequences. PMID:24969071

  20. Surgical Craniotomy for Intracerebral Haemorrhage.

    PubMed

    Mendelow, A David

    2015-01-01

    Craniotomy is probably indicated for patients with superficial spontaneous lobar supratentorial intracerebral haemorrhage (ICH) when the level of consciousness drops below 13 within the first 8 h of the onset of the haemorrhage. Once the level drops below 9, it is probably too late to consider craniotomy for these patients, so clinical vigilance is paramount. While this statement is only backed up by evidence that is moderately strong, meta-analysis of available data suggests that it is true in the rather limited number of patients with ICH. Meta-analyses like this can often predict the results of future prospective randomised controlled trials a decade or more before the trials are completed and published. Countless such examples exist in the literature, as is the case for thrombolysis in patients with myocardial infarction in the last millennium: meta-analysis determined the efficacy more than a decade BEFORE the last trial (ISIS-2) confirmed the benefit of thrombolysis for myocardial infarction. Careful examination of the meta-analysis' Forest plots in this chapter will demonstrate why this statement is made at the outset. Other meta-analyses of surgery for ICH have also indicated that minimal interventional techniques using topical thrombolysis or endoscopy via burrholes or even twist drill aspiration may be particularly successful for the treatment of supratentorial ICH, especially when the clot is deep seated. Ongoing clinical trials (CLEAR III and MISTIE III) should confirm this in the fullness of time. There are 2 exceptions to these generalisations. First, based on trial evidence, aneurysmal ICH is best treated with surgery. Second, cerebellar ICH represents a special case because of the development of hydrocephalus, which may require expeditious drainage as the intracranial pressure rises. The cerebellar clot will then require evacuation, usually via posterior fossa craniectomy, rather than craniotomy. Technical advances suggest that image-guided surgery

  1. Acute Methanol Poisoning: Prevalence and Predisposing Factors of Haemorrhagic and Non-Haemorrhagic Brain Lesions.

    PubMed

    Zakharov, Sergey; Kotikova, Katerina; Vaneckova, Manuela; Seidl, Zdenek; Nurieva, Olga; Navratil, Tomas; Caganova, Blazena; Pelclova, Daniela

    2016-08-01

    The purpose was to study the prevalence and predisposing factors of brain lesions in survivors of acute methanol poisoning. Clinical data on 106 patients with methanol poisoning were collected during the Czech mass poisoning outbreak. Of 83 survivors, in 46 (55%) patients, follow-up examinations including magnetic resonance imaging of brain (MR) were performed 3-8 and 24-28 months after discharge from the hospital. Of 46 patients with a median age of 49 (interquartile range, 35-57) years, 24 (52%) patients had a total of 40 abnormal brain findings with haemorrhagic lesions detected in 15 (33%) and non-haemorrhagic lesions found in 9 (19%) patients. The patients with haemorrhagic brain lesions were more acidemic (lower arterial blood pH, higher base deficit) and had higher glycaemia and lactacidaemia on admission than those without haemorrhages (all p < 0.05). Thirteen of 32 (41%) of patients with systemic anticoagulation and 2 of 14 (14%) of patients without it had haemorrhagic lesions (p = 0.080). Bleeding complications during the treatment occurred in 4 of 15 (27%) patients, and 5 of 15 (33%) patients had conditions predisposing to haemorrhage in the group with haemorrhagic lesions. In three cases with a series of computer tomography (CT)/MR performed during hospitalization, the necrotic lesions in the brain remained non-haemorrhagic during hospitalization and haemorrhagic lesions were detected on the follow-up MR examinations only. No association between brain haemorrhages and systemic anticoagulation during dialysis was found: brain haemorrhages might occur in severely poisoned patients treated without systemic anticoagulation, whereas treatment with high doses of heparin might not lead to brain haemorrhages. PMID:26806851

  2. Amyloid angiopathy and lobar cerebral haemorrhage.

    PubMed Central

    Ishii, N; Nishihara, Y; Horie, A

    1984-01-01

    Seven cases of lobar cerebral haemorrhage due to amyloid angiopathy were found among 60 necropsy cases of intracerebral haemorrhage. Clinically five patients were demented and two had hypertension. Immediately after the onset of stroke there was a high incidence of headache and vomiting, followed by nuchal rigidity. Amyloid angiopathy was most prominent in the cerebral cortex and the leptomeninges. Senile plaques were noted in all cases. One should suspect that a haemorrhage may be due to amyloid angiopathy, when lobar cerebral haemorrhage occurs in an aged, normotensive patient with or without dementia. Surgical evacuation of the haematoma is inadvisable, because of the diffuse nature of amyloid angiopathy, high recurrence rate and less tendency to cause brain stem compression. Images PMID:6502178

  3. Chronic gastrointestinal haemorrhage controlled by antifibrinolytic agents.

    PubMed Central

    Willoughby, J. M.

    1989-01-01

    Antifibrinolytic agents are used chiefly for control of acute haemorrhage. Their applicability to chronic bleeding from inflammatory lesions of the gastrointestinal tract is illustrated by two case histories. PMID:2813242

  4. Neonatal Klebsiella Septicaemia in Ibadan: Implications for Neonatal Care in Developing Countries.

    ERIC Educational Resources Information Center

    Omokhodion, S. I.; And Others

    1993-01-01

    The antecedent events, clinical features, prevalence, and complications of neonatal Klebsiella septicaemia in 73 infants admitted to a special care baby unit in Nigeria are retrospectively reviewed and compared with those of 72 infants who had no risk factors for sepsis admitted to the same unit during the same period. A nosocomial acquisition of…

  5. VizieR Online Data Catalog: VISTA-VHS (MOVIS) minor planets NIR photometry (Popescu+, 2016)

    NASA Astrophysics Data System (ADS)

    Popescu, M.; Licandro, J.; Morate, D.; de, Leon J.; Nedelcu, D. A.; Rebolo, R.; McMahon, R. G.; Gonzalez-Solares, E.; Irwin, M.

    2016-05-01

    The retrieved photometric data is provided as a set of catalogs called MOVIS. These catalogs are obtained using a pipeline that finds the objects based on their ephemeris, retrieves the data by interfacing with VHS tables, removes the wrong associations, and do a post processing of the data (averaging, data combine, and colors computation). The correctness and reliability of the pipeline was assessed by analyzing the error distributions and by comparing the results with the 2MASS dataset. The results are reported in three catalogs: the detections catalog (MOVIS-D), the magnitudes catalog (MOVIS-M), and the colors catalog (MOVIS-C). (3 data files).

  6. 1/5 size vhs series blast and shock simulations. Technical paper

    SciTech Connect

    Noble, M.

    1983-06-29

    The simulation objective of the 1/5 Verifiable Horizontal Shelter (VHS( test series was to demonstrate the capability of a High Explosive Simulation Technique (HEST) simulator to adequately duplicate complex airblast waveform loadings. A principal feature of the HEST design was the requirement to produce double-peaked resultant overpressures. The modeling baseline was established by a test (D-1) producing dynamic flow. The HEST test (Sh-1) comparably matched the loading waveforms both in relative magnitude and phase chracteristics. The HEST simulator has proven its utility for both multiple shock effects and multi-pressure loadings on reflection and drag sensitive structures.

  7. Emergency Imaging of Intracerebral Haemorrhage.

    PubMed

    Alobeidi, Farah; Aviv, Richard I

    2015-01-01

    Spontaneous intracerebral haemorrhage (ICH) is a devastating condition with high mortality and morbidity despite advances in neurocritical care. Early deterioration is common in the first few hours after ICH onset, secondary to rapid haematoma expansion and growth. Rapid diagnosis and aggressive early management of these patients are therefore crucial. Imaging plays a key role in establishing the diagnosis and the underlying aetiology of ICH, identifying complications and predicting patients who are at high risk for haematoma expansion. In this chapter, we present an evidence-based imaging framework for the management of spontaneous ICH in the acute setting. Non-enhanced computed tomography is long established as the gold standard for ICH diagnosis but has limitations in demonstrating the underlying aetiology in cases of secondary ICH. There is now growing evidence for the ability of non-invasive angiography to establish the underlying aetiology and to predict further haematoma expansion. The presence of small enhancing foci within the haematoma on computed tomography angiography (CTA), the CTA Spot Sign, has been prospectively validated as a predictor of haematoma expansion. Early identification of patients at risk of haematoma expansion allows for the appropriate escalation of care to a neurosurgical team, admission to a neurocritical care unit, appropriate supportive therapy and targeted novel medical and surgical interventions. Catheter angiography, which remains the gold standard for identifying underlying secondary vascular lesions, should be used in selected cases. However, non-invasive vascular imaging should be considered as an important step in the diagnosis and early management of secondary ICH patients. Previous concerns related to the radiation dose, contrast-induced nephropathy and cost are addressed in this chapter. Recently, animal models have enabled the qualitative assessment of haematoma expansion, and our increased understanding of ICH may

  8. Haemorrhagic smolt syndrome (HSS) in Norway: pathology and associated virus-like particles.

    PubMed

    Nylund, A; Plarre, H; Hodneland, K; Devold, M; Aspehaug, V; Aarseth, M; Koren, C; Watanabe, K

    2003-03-17

    Atlantic salmon Salmo salar pre-smolt, smolt and post-smolt, with clinical signs of haemorrhagic smolt syndrome (HSS) have been found in several locations along the Norwegian coast (Rogaland to Troms). Affected fish had pale gills and bleeding at the fin bases, but seemed to be in good physical condition with no obvious weight loss. The internal organs and body cavity showed distinct bleedings. Petechiae were found on the gastrointestinal tract, swim bladder and peritoneum, visceral adipose tissue, heart and somatic musculature. The liver was bright yellow and sometimes mottled with petechiae and ecchymoses. Acitic fluid was found in the visceral cavity and fluid was also present in the pericardial cavity. Histological examination revealed haemorrhage in most organs. The glomeruli were degenerated and the renal tubules were filled with erythrocytes. The aims of this study were to describe the pathology and discover, if possible, the aetiology of the HSS. Tissues were collected for light and transmission electron microscopy (TEM), immunofluorescence (IFAT), reverse transcription (RT)-PCR diagnostics (screening for infectious salmon anaemia virus [ISAV], viral haemorrhagic septicaemia virus [VHSV], salmon pancreas disease virus [SPDV], sleeping disease virus [SDV] and infectious haematopoetic necrosis virus [IHNV]), and tissue homogenates (heart, liver, kidney and spleen) were sterile-filtered and inoculated into cell cultures. Homogenates made from several tissues were also injected intraperitoneally into salmon and rainbow trout Oncorhynchus mykiss. The diagnostic tests revealed no consistent findings of any pathogens, with the exception of TEM which showed 2 types of virus-like particles: Type I was 50 to 60 nm in diameter and Type II about 50 nm in diameter. These virus-like particles were found in salmon from all farms affected by HSS and screened by TEM. Several different cells, blood vessel endothelial cells, endocardial cells, heart myofibres, and leukocytes

  9. [Secondary right-sided diaphragmatic hernia following neonatal group B Streptococcal septicaemia in a preterm infant].

    PubMed

    Vedel-Werts, F; Desandes, R; Rouabah, M; Bach, P; de Miscault, G; Hascoët, J-M; Hamon, I

    2007-07-01

    We report on a case of a secondary right-sided diaphragmatic hernia following group B streptococcal (GBS) septicaemia in a very low birth weight infant born at 30 weeks. After initial improvement, the diagnosis of a secondary right-sided diaphragmatic hernia was suspected with the persistent radiological pulmonary right-sided image on the chest x-ray and the clinical degradation. The diagnosis was confirmed by ultrasonography on day 43. The postoperative course was simple. Persistent respiratory distress in a neonate, after a GBS septicaemia associated with a right pulmonary opacity on the chest x-ray, should prompt a careful evaluation. A secondary right-sided diaphragmatic hernia should be considered. Treatment is surgery, the prognosis is good in the absence of pulmonary hypoplasia. PMID:17451917

  10. Aeromonas hydrophila-associated skin lesions and septicaemia in a Nile crocodile (Crocodylus niloticus).

    PubMed

    Turutoglu, H; Ercelik, S; Corlu, M

    2005-03-01

    Aeromonas hydrophila is one of the most common bacteria associated with the aquatic environment. There are, however, limited data on A. hydrophila infection in crocodilians. The aim of this report is to describe a case of skin lesions and septicaemia associated with A. hydrophila in a Nile crocodile (Crocodylus niloticus). A captive male crocodile in the Zoological Park of Antalya (Turkey) was found dead without showing signs of any disease. Gross examination showed brown or red-spotted skin lesions of varying size. These lesions were mostly scattered over the abdomen and occasionally on the tail and feet. At necropsy, numerous white, multifocal and randomly distributed areas were seen on the liver. Gram-stained smears from skin and liver lesions showed Gram-negative bacilli arranged in clusters. Pure cultures of A. hydrophila were recovered from skin, internal organs and blood. Isolates were found to be susceptible to ceftiofur, amoxicillin + clavulanic acid, oxytetracycline, enrofloxacin, danofloxacin, neomycin, gentamicin, and lincomycin + neomycin. A pathogenicity test was performed using this isolate on 4 male 2-year-old New Zealand white rabbits. Local abscesses formed in 2 rabbits injected subcutaneously and the 2 that were injected intraperitoneally died as a result of septicaemia. In conclusion, this report has shown that A. hydrophila may cause skin lesions and even death due to septicaemia in crocodiles. PMID:15900900

  11. Nosocomial Staphylococcus epidermidis septicaemia among very low birth weight neonates in an intensive care unit.

    PubMed

    Carlos, C C; Ringertz, S; Rylander, M; Huovinen, P; Faxelius, G

    1991-11-01

    A cluster of cases of septicaemia caused by coagulase-negative staphylococci was observed among the infants at the Neonatal Intensive Care Unit (NICU) of the Karolinska Hospital in May 1987. The presence of a unique antibiogram among the blood culture isolates prompted an investigation to determine whether an epidemic strain existed or not, using antibiogram, biotyping and plasmid profiles as epidemiological markers. All 14 isolates with a unique antibiogram were investigated, and 22 isolates without the unique antibiogram served as controls. Of the 14 isolates, 11 were Staphylococcus epidermidis and had similar plasmid patterns. Of the 22 control isolates, 15 were S. epidermidis, and none had the special plasmid pattern nor any other recurring plasmid patterns. The use of plasmid profile analysis together with antibiograms thus identified a possible epidemic strain of S. epidermidis which may have been responsible for the upsurge of septicaemia cases at the NICU. The presence of an epidemic strain implies that hospital cross infection control could be important in preventing neonatal septicaemia caused by S. epidermidis. PMID:1685508

  12. Complex stability and dynamic subunit interchange modulates the disparate activities of the yeast moonlighting proteins Hal3 and Vhs3.

    PubMed

    Abrie, J Albert; Molero, Cristina; Ariño, Joaquín; Strauss, Erick

    2015-01-01

    Saccharomyces cerevisiae Hal3 and Vhs3 are moonlighting proteins, acting both as inhibitors of the serine/threonine protein phosphatase Ppz1 and as subunits (together with Cab3) of the unique heterotrimeric phosphopantothenoylcysteine decarboxylase (PPCDC) enzyme of Hemiascomycetous yeast. Both these roles are essential: PPCDC catalyses the third step of coenzyme A biosynthesis, while Ppz1 inhibition is required for regulation of monovalent cation homeostasis. However, the mechanisms by which these proteins' disparate activities are regulated are not well understood. The PPCDC domains (PDs) of Hal3, Vhs3 and Cab3 constitute the minimum requirement for these proteins to show both PPCDC activity and, in the case of Hal3 and Vhs3, to bind to Ppz1. Using these PD proteins as a model system to study the possibility of dynamic interchange between these roles, we provide evidence that Hal3 binds Ppz1 as a monomer (1:1 stoichiometry), requiring it to de-oligomerize from its usual homo- and heterotrimeric states (the latter having PPCDC activity). This de-oligomerization is made possible by structural features that set Hal3 apart from Vhs3, increasing its ability to undergo monomer exchange. These findings suggest that oligomer interchange may be a significant factor in the functional regulation of these proteins and their various unrelated (moonlighting) functions. PMID:26514574

  13. Near-infrared colors of minor planets recovered from VISTA-VHS survey (MOVIS)

    NASA Astrophysics Data System (ADS)

    Popescu, M.; Licandro, J.; Morate, D.; de León, J.; Nedelcu, D. A.; Rebolo, R.; McMahon, R. G.; Gonzalez-Solares, E.; Irwin, M.

    2016-06-01

    Context. The Sloan Digital Sky Survey (SDSS) and Wide-field Infrared Survey Explorer (WISE) provide information about the surface composition of about 100 000 minor planets. The resulting visible colors and albedos enabled us to group them in several major classes, which are a simplified view of the diversity shown by the few existing spectra. A large set of data in the 0.8-2.5 μm, where wide spectral features are expected, is required to refine and complement the global picture of these small bodies of the solar system. Aims: We aim to obtain the near-infrared colors for a large sample of solar system objects using the observations made during the VISTA-VHS survey. Methods: We performed a serendipitous search in VISTA-VHS observations using a pipeline developed to retrieve and process the data that corresponds to solar system objects (SSo). The resulting photometric data is analyzed using color-color plots and by comparison with the known spectral properties of asteroids. Results: The colors and the magnitudes of the minor planets observed by the VISTA survey are compiled into three catalogs that are available online: the detections catalog (MOVIS-D), the magnitudes catalog (MOVIS-M), and the colors catalog (MOVIS-C). They were built using the third data release of the survey (VISTA VHS-DR3). A total of 39 947 objects were detected, including 52 NEAs, 325 Mars Crossers, 515 Hungaria asteroids, 38 428 main-belt asteroids, 146 Cybele asteroids, 147 Hilda asteroids, 270 Trojans, 13 comets, 12 Kuiper Belt objects and Neptune with its four satellites. The colors found for asteroids with known spectral properties reveal well-defined patterns corresponding to different mineralogies. The distributions of MOVIS-C data in color-color plots shows clusters identified with different taxonomic types. All the diagrams that use (Y - J) color separate the spectral classes more effectively than the (J - H) and (H - Ks) plots used until now: even for large color errors (<0.1), the

  14. Spontaneous retroperitoneal haemorrhage in a young adult

    PubMed Central

    Baksi, Aditya; Gupta, Shahana; Ray, Udipta; Ghosh, Shibajyoti

    2014-01-01

    We report a rare case of a primary adrenal cortical malignancy presenting with spontaneous retroperitoneal haemorrhage in a young adult. To the best of our knowledge, this is the thirteenth such case to be reported in the English literature. PMID:24658522

  15. Transient global amnesia and left frontal haemorrhage.

    PubMed Central

    Jacome, D. E.; Yanez, G. F.

    1988-01-01

    A patient developed spontaneous, acute, dominant frontal lobe haemorrhage neighbouring on a zone of pre-existing post-traumatic encephalomalacia manifesting clinically as transient global amnesia. Amnesia can be secondary to disease of the frontal lobe, affecting pathways interconnecting the basal forebrain and hippocampus of the temporal lobe. Images Figure 1 PMID:3174526

  16. Hereditary haemorrhagic telangiectasia manifesting as subdural empyema.

    PubMed

    Solanki, Sandeep P; Taylor, Christopher; Robertson, Iain

    2016-06-01

    Hereditary haemorrhagic telangiectasia (HHT) also known as Osler-Weber-Rendu disease is a rare autosomal dominant condition causing vascular dysplasia. Cerebral abscess formation, secondary to paradoxical septic emboli via HHT-derived pulmonary arteriovenous malformations (pAVMs) in this context is well documented. Herein, we present the first case of subdural empyema with this aetiology. PMID:26982736

  17. Effect of neonatal periventricular haemorrhage on neurodevelopmental outcome.

    PubMed Central

    Catto-Smith, A G; Yu, V Y; Bajuk, B; Orgill, A A; Astbury, J

    1985-01-01

    All 56 infants born between 23 and 28 weeks' gestation admitted to this hospital in 1981 were examined for periventricular haemorrhage with cerebral ultrasonography. Haemorrhage was diagnosed in 34 (61%)-12 (22%) had germinal layer haemorrhage, 18 (32%) had intraventricular haemorrhage, and four (7%) had intracerebral haemorrhage. The two year outcome of survivors with and without periventricular haemorrhage was compared to determine the effect on neurodevelopment. Only three (16%) of 19 infants with normal scans or germinal layer haemorrhages had evidence of major disability but nine (75%) of 12 infants with intraventricular or intracerebral haemorrhage had major disability. The mental and psychomotor performance on the Bayley scales of infant development was also significantly worse in the latter group. All three survivors with intracerebral haemorrhage had major disability. The continuation of life support treatment for extremely preterm infants who are at very high risk of severe handicap is a matter of increasing concern in neonatal intensive care. Our results show that if extensive periventricular haemorrhage, in particular intracerebral haemorrhage, occurs in this gestational group, extreme pessimism is warranted. PMID:2578773

  18. A search for faint companions of the nearest stars with CanariCam and VHS .

    NASA Astrophysics Data System (ADS)

    Gauza, B.; Béjar, V. J. S.; Rebolo, R.; érez-Garrido, A. P.; Lodieu, N.; Álvarez, C.; UCD Group of the VHS; substellar Group of the CCST

    After two decades of discoveries, the census of substellar objects in the solar neighborhood remains incomplete. Current imaging surveys carried out in the near and mid-infrared are expected to unveil numerous ultracool dwarfs and expand the population to previously undetectable temperature ranges. Here we present a review of our searches for substellar companions around stars in the solar vicinity (d<10 pc). The searches are based on the southern near-infrared VISTA Hemisphere Survey (VHS) combined with WISE and 2MASS catalogues and on a deep mid-IR imaging program carried out with CanariCam at the 10.4m GTC, in the Northern sky. We achieve sensitivity and resolving power that enables us to detect early Y dwarfs (T_eff˜300-500 K) at separations larger than 10 AU.

  19. Effect of alum co-adjuvantation of oil adjuvant vaccine on emulsion stability and immune responses against haemorhagic septicaemia in mice

    PubMed Central

    Kumar, Sujeet; Chaturvedi, Vinod Kumar; Kumar, Bablu; Kumar, Pankaj; Somarajan, Sudha Rani; Mishra, Anil Kumar; Sharma, Bhaskar

    2015-01-01

    Background and Objectives: Haemorrhagic septicaemia (HS), caused by Pasteurella multocida, is the most important bacterial disease of cattle and buffaloes in India. Oil adjuvant vaccine (OAV) is the most potent vaccine available for the control of HS. The study aims to evaluate the effect of alum co-adjuvantation of OAV on emulsion stability and immune response. Materials and Methods: Two different oil adjuvant vaccines viz., standard oil adjuvant vaccine (OAV) and alum precipitated oil adjuvant vaccine (A–OAV) were prepared with Pasteurella multocida antigen. Emulsion stability was tested by centrifugation, storage at 37 °C for 3 months and microscopy. Immune responses were evaluated by ELISA antibody titer, CD4, CD8 T cell populations and survival post challenge by P. multocida in mice. Results: The separation of aqueous and oil phase of emulsion by centrifugation and storage test were 0 and 6.76% in A-OAV as compared to 11.00 and 26.39% in OAV, respectively. The mean droplet size was significantly smaller (p<0.01) in A–OAV as compared to OAV. The A–OAV recorded higher ELISA antibody titer (p<0.05) up to 21st days post vaccination, and higher CD4 (p>0.05) and CD8 T cell (p<0.05) populations compared to OAV. The A–OAV group conferred 100% protection after challenge with both 100 LD50 and 1000 LD50 as compared to 100 and 60% respective protection by OAV group. Conclusion: The results indicates that A–OAV had better emulsion stability, produces higher level of CD4, CD8 T cells and antibody titer with better protection compared to oil adjuvant vaccine. PMID:26622968

  20. Spontaneous cervical haemorrhage of a parathyroid adenoma

    PubMed Central

    Knee, Graham; Todd, Colin

    2015-01-01

    Summary Haemorrhage of a parathyroid adenoma is a rare clinical presentation. This report describes a previously fit and well 54-year-old woman who presented with acute neck swelling and pain with an overlying ecchymosis. Admission laboratory tests revealed a raised parathyroid hormone and hypercalcaemia. A computed tomography (CT) scan showed widespread anterior cervical haemorrhage and a lesion at the inferior pole of the left thyroid gland. A working diagnosis of spontaneous haemorrhage from a parathyroid adenoma was made. As she was haemodynamically stable, she was treated conservatively with a period of observation in hospital to monitor for signs of neck organ compression. Follow-up imaging with CT, ultrasound and sestamibi confirmed the likely source of haemorrhage as a parathyroid nodule with significant vascularity. The diagnosis was confirmed on histopathological analysis after elective surgical exploration of the neck 6 months after her presentation. This revealed a benign parathyroid adenoma with evidence of acute and chronic bleeding. The patient made a full recovery with immediate normalisation of her biochemistry post-operatively. Despite developing a hoarse voice in the immediate post-operative period, this resolved completely within 1 month. This case report provides further evidence to support a minimal delay for elective surgery after conservative management to reduce the risks associated with recurrent bleeding. Learning points Haemorrhage of a parathyroid adenoma should be a differential for all cases of acute cervical swelling or ecchymosis with no precipitating factor.The clerking should identify any risk factors for endocrine disease.Blood tests to screen for abnormal parathyroid biochemistry should be performed on admission.Detailed imaging of the neck is essential to identify the source of haemorrhage and risk of compression to vital neck organs.Conservative management is a suitable option for patients who remain haemodynamically stable

  1. European research priorities for intracerebral haemorrhage.

    PubMed

    Steiner, Thorsten; Petersson, Jesper; Al-Shahi Salman, Rustam; Christensen, Hanne; Cordonnier, Charlotte; Csiba, Laszlo; Harnof, Sagi; Krieger, Derk; Mendelow, David; Molina, Carlos; Montaner, Joan; Overgaard, Karsten; Roine, Risto O; Schmutzhard, Erich; Tatlisumak, Turgut; Toni, Danilo; Stapf, Christian

    2011-01-01

    Over 2 million people are affected by intracerebral haemorrhage (ICH) worldwide every year, one third of them dying within 1 month, and many survivors being left with permanent disability. Unlike most other stroke types, the incidence, morbidity and mortality of ICH have not declined over time. No standardised diagnostic workup for the detection of the various underlying causes of ICH currently exists, and the evidence for medical or surgical therapeutic interventions remains limited. A dedicated European research programme for ICH is needed to identify ways to reduce the burden of ICH-related death and disability. The European Research Network on Intracerebral Haemorrhage EURONICH is a multidisciplinary academic research collaboration that has been established to define current research priorities and to conduct large clinical studies on all aspects of ICH. PMID:21986448

  2. Dengue haemorrhagic fever with unusual prolonged thrombocytopaenia.

    PubMed

    Kamil, S M; Mohamad, N H; Narazah, M Y; Khan, F A

    2006-04-01

    We describe a case of dengue haemorrhagic fever with prolonged thrombocytopaenia. A 22-year-old Malay man with no prior illness presented with a history of fever and generalised macular rash of four days duration. Initial work-up suggested the diagnosis of dengue haemorrhagic fever based on thrombocytopaenia and positive dengue serology. Patient recovered from acute illness by day ten, and was discharged from the hospital with improving platelet count. He was then noted to have declining platelet count on follow-up and required another hospital admission on day 19 of his illness because of declining platelet count. The patient remained hospitalised till day 44 of his illness and managed with repeated platelet transfusion and supportive care till he recovered spontaneously. PMID:16572249

  3. European Research Priorities for Intracerebral Haemorrhage

    PubMed Central

    Steiner, Thorsten; Petersson, Jesper; Al-Shahi Salman, Rustam; Christensen, Hanne; Cordonnier, Charlotte; Csiba, Laszlo; Harnof, Sagi; Krieger, Derk; Mendelow, David; Molina, Carlos; Montaner, Joan; Overgaard, Karsten; Roine, Risto O.; Schmutzhard, Erich; Tatlisumak, Turgut; Toni, Danilo; Stapf, Christian

    2011-01-01

    Over 2 million people are affected by intracerebral haemorrhage (ICH) worldwide every year, one third of them dying within 1 month, and many survivors being left with permanent disability. Unlike most other stroke types, the incidence, morbidity and mortality of ICH have not declined over time. No standardised diagnostic workup for the detection of the various underlying causes of ICH currently exists, and the evidence for medical or surgical therapeutic interventions remains limited. A dedicated European research programme for ICH is needed to identify ways to reduce the burden of ICH-related death and disability. The European Research Network on Intracerebral Haemorrhage EURONICH is a multidisciplinary academic research collaboration that has been established to define current research priorities and to conduct large clinical studies on all aspects of ICH. PMID:21986448

  4. Lessons from nosocomial viral haemorrhagic fever outbreaks.

    PubMed

    Fisher-Hoch, Susan P

    2005-01-01

    The outbreak of Marburg haemorrhagic fever in Angola in 2004-2005 shows once again the devastating and rapid spread of viral haemorrhagic fevers in medical settings where hygiene practices are poorly applied or ignored. The legacy of years of war and poverty in Angola has resulted in very poor medical education and services. The initial high rate of infection among infants in Angola may have been related to poor hospital practices, possibly administration of vaccines. Though the outbreak in Angola was in a part of Africa not previously known to have filovirus infection, prior ecological modelling had predicted this location and many others. Prevention of future outbreaks will not be easy. The urgent need is dissemination of knowledge and the training, discipline and resources for good clinical practice. Educating the public to demand higher standards could be a powerful tool. Good practices are difficult to establish and maintain on the scale needed. PMID:16373655

  5. Bevacizumab in vitreous haemorrhage secondary to radiation retinopathy

    PubMed Central

    Montero, Javier Antonio; Yanez-Castro, Giovanni; Sanchis-Merino, Maria Eugenia; Ruiz-Moreno, Jose Maria

    2014-01-01

    Radiation retinopathy is a delayed-onset side effect of radiation exposure caused by retinal ischaemia that may induce proliferative retinopathy with neovascularisation, vitreous haemorrhage and macular oedema. An otherwise healthy, 51-year-old male patient who had been diagnosed with olfactory neuroblastoma and undergone complete surgical removal of the lesion followed by cranial irradiation developed bilateral cataracts and radiation retinopathy. The patient was treated by panretinal photocoagulation (PRP), followed by three-port pars-plana vitrectomy. Recurrent episodes of vitreous haemorrhages occurred following surgery and the patient was successfully treated by one intravitreal injection of bevacizumab with resolution of vitreous blood. Vitreous haemorrhage recurred 6 months later and a scheduled treatment with intravitreal bevacizumab every 4 months was established, preventing further haemorrhagic episodes. Six months after the last injection, a new episode of vitreous haemorrhage occurred. Scheduled intravitreal bevacizumab injections may help prevent recurrent vitreous haemorrhages in vitrectomised patients with radiation retinopathy. PMID:24510700

  6. Blood-culture-proven neonatal septicaemia: a review of 36 cases.

    PubMed

    Misallati, A; el-Bargathy, S; Shembesh, N

    2000-01-01

    The cases of 36 newborns seen in the neonatal unit of Al-Fatah Children's Hospital in Benghazi, Libyan Arab Jamahiriya, with blood-culture-proven septicaemia were reviewed to determine clinical profile and outcome. There were 22 males and 14 females. Of these, 12 infants were premature with a gestational age of < 37 weeks and 24 were full term (gestational age > 37 weeks). At diagnosis, 11 cases were under 4 days of age. The most common symptoms were lethargy and feeding intolerance. Klebsiella was the most common etiological microorganism. Bacterial isolates were resistant to ampicillin and gentamicin but sensitive to cefotaxime. Of the 36 infants, 12 died (fatality rate = 33%). PMID:11556040

  7. Successful vaginal delivery following spontaneous adrenal haemorrhage at term.

    PubMed

    Street, Sally; Dekker Nitert, Marloes; Callaway, Leonie K

    2016-01-01

    Spontaneous adrenal haemorrhage (SAH) is a rare event in the general population, estimated to be around 0.3-1.8%. The exact incidence in pregnancy is unknown but rare. Most cases of SAH at or near term have presented with massive haemorrhage and haemodynamic instability, requiring emergency caesarean delivery or intrauterine fetal death. This is the first reported case of a successful vaginal delivery after acute, spontaneous, left adrenal haemorrhage at term. PMID:27190116

  8. Factors associated with periventricular haemorrhage in very low birthweight infants.

    PubMed Central

    Cooke, R W

    1981-01-01

    Periventricular haemorrhage was diagnosed in vivo in 20 of 29 consecutively admitted infants of birthweight below 1500 g using an ultrasound scanner. Ten (51%) infants with haemorrhages survived. Mortality was related to the extent of the bleeding. Statistically significant associations with respiratory distress, ventilator therapy, metabolic acidosis, and hypercapnia were observed, lending support to their role in the pathogenesis of periventricular haemorrhage. Images Fig. 1 Fig. 2 Fig. 3a Fig. 4a Fig. 5a PMID:7259272

  9. Adaptive Optics imaging of VHS 1256-1257: A Low Mass Companion to a Brown Dwarf Binary System

    NASA Astrophysics Data System (ADS)

    Stone, Jordan M.; Skemer, Andrew J.; Kratter, Kaitlin M.; Dupuy, Trent J.; Close, Laird M.; Eisner, Josh A.; Fortney, Jonathan J.; Hinz, Philip M.; Males, Jared R.; Morley, Caroline V.; Morzinski, Katie M.; Ward-Duong, Kimberly

    2016-02-01

    Recently, Gauza et al. reported the discovery of a companion to the late M-dwarf, VHS J125601.92-125723.9 (VHS 1256-1257). The companion’s absolute photometry suggests its mass and atmosphere are similar to the HR 8799 planets. However, as a wide companion to a late-type star, it is more accessible to spectroscopic characterization. We discovered that the primary of this system is an equal-magnitude binary. For an age ˜300 Myr the A and B components each have a mass of {64.6}-2.0+0.8 {M}{Jup}, and the b component has a mass of {11.2}-1.8+9.7, making VHS 1256-1257 only the third brown dwarf triple system. There exists some tension between the spectrophotometric distance of 17.2 ± 2.6 pc and the parallax distance of 12.7 ± 1.0 pc. At 12.7 pc VHS 1256-1257 A and B would be the faintest known M7.5 objects, and are even faint outliers among M8 types. If the larger spectrophotmetric distance is more accurate than the parallax, then the mass of each component increases. In particular, the mass of the b component increases well above the deuterium burning limit to ˜ 35 {M}{Jup} and the mass of each binary component increases to {73}-17+20 {M}{Jup}. At 17.1 pc, the UVW kinematics of the system are consistent with membership in the AB Dor moving group. The architecture of the system resembles a hierarchical stellar multiple suggesting it formed via an extension of the star formation process to low masses. Continued astrometric monitoring will resolve this distance uncertainty and will provide dynamical masses for a new benchmark system.

  10. Bilateral eyelid ecchymosis and subconjunctival haemorrhage manifesting as presenting feature in a case of dengue haemorrhagic fever.

    PubMed

    Jain, Sparshi; Goswami, Anup; Singh, Nidhi; Kaur, Savleen

    2015-10-01

    We report a case of bilateral eyelid ecchymosis and subconjunctival haemorrhage, a rare presenting feature of dengue haemorrhagic fever. A 17-year-old boy presented to the emergency department with complaints of redness in both eyes and vomiting. He had bilateral eyelid ecchymosis with subconjunctival haemorrhage. Complete blood count revealed a significantly reduced platelet count of 11000/µL suggestive of dengue haemorrhagic fever (DHF). Ocular manifestations were followed by other systemic haemorrhagic manifestations of dengue later on which violates the usual sequence of events of dengue fever. Bilateral eyelid ecchymosis is a rare clinical manifestation and a rare presenting feature of dengue fever and one has to keep high index of suspicion for presence of dengue whenever a case of fever presents with lid ecchymosis/haemorrhage. PMID:25540163

  11. Acute myocardial infarction complicating subarachnoid haemorrhage

    PubMed Central

    van der Velden, L.B.J.; Otterspoor, L.C.; Schultze Kool, L.J.; Biessels, G.J.; Verheugt, F.W.A.

    2009-01-01

    An acute myocardial infarction is a rare complication of a subarachnoid haemorrhage. The combination of these two conditions imposes important treatment dilemmas. We describe two patients with this combination of life-threatening conditions. Patient 1 was treated with emergency percutaneous coronary intervention followed by clipping of the anterior communicating artery aneurysm. Six months after discharge the patient's memory and orientation had almost completely recovered. Patient 2 was treated with aspirin until coiling of the aneurysm could be performed. After successful coiling low-molecular-weight heparin was added. One week later the patient died due to a free wall rupture. (Neth Heart J 2009;17:284-7.19789696) PMID:19789696

  12. Neonatal cranial ultrasound screening for intraventricular haemorrhage.

    PubMed

    Tudehope, D I; Lamont, A C

    1998-04-01

    The cost effectiveness of performing routine neonatal cranial ultrasound scans to diagnose intraventricular haemorrhage (IVH) on cohorts of high risk infants is in question. In the early 1980s cranial ultrasound scans were performed on preterm infants to expand knowledge of the incidence, aetiology, pathogenesis and evolution of IVH. In many neonatal units high risk infants are scanned on days 5-7 and 10-14 and prior to discharge for extremely low birthweight (ELBW) infants. Cranial ultrasound scanning is often used as a surrogate for assessment of neurodevelopmental outcome with information from meta analyses used to counsel parents about the likelihood of subsequent neurosensory disability. PMID:9588629

  13. Subconjunctival haemorrhage from bronchoscopy: A case report

    PubMed Central

    Lim, Huey Ying; Puah, Ser Hon; Ang, Leslie Jonathan P.S.; Teo, En Qi; Lau, Sabrina Y.; Goh, Kee San; Lim, Albert Y.H.; Tai, Dessmon Y.H.; Abisheganaden, John; Verma, Akash

    2015-01-01

    Flexible bronchoscopy has been available for almost five decades. It has evolved as one of the most commonly used invasive diagnostic and therapeutic procedure in pulmonology, and its scope of applications is progressively expanding with the addition of new adjunct technologies such as endobronchial ultrasound, bronchial Thermoplasty, and navigational bronchoscopy. It is a safe procedure with complications ranging from fever, infiltrates, hypoxemia, bleeding, pneumothoraces and death, with most significant complications being bleeding and pneumothorax. We report a case of subconjuctival haemorrhage as an immediate complication of bronchoscopy. To our knowledge this is the first report documenting this rare complication. PMID:26744668

  14. Ultrasound and necropsy study of periventricular haemorrhage in preterm infants.

    PubMed Central

    Szymonowicz, W; Schafler, K; Cussen, L J; Yu, V Y

    1984-01-01

    The diagnostic accuracy of cerebral ultrasound for periventricular haemorrhage was determined by comparing this with necropsy findings in 30 preterm neonates of 30 weeks' gestation or less and birthweight under 1500 g. Ultrasound gave an accurate diagnosis of 85% in infants with germinal layer haemorrhage, 92% in intraventricular haemorrhage, and 97% in intracerebral haemorrhage. False positive errors were caused by vascular congestion; false negative errors occurred when the maximum dimension of haemorrhage was less than 3 mm. Cerebral ultrasound gave a diagnostic accuracy of 63% for periventricular leucomalacia. False negative errors occurred when periventricular leucomalacia was microscopic or when it was out of range of the scanner. The maximum width of the germinal layer was measured in 77 neonates of gestational age 23 to 36 weeks who died and had no periventricular haemorrhage at necropsy. The progressive involution of the germinal layer with increasing gestational age paralleled the steady decrease in incidence of periventricular haemorrhage diagnosed over the same gestational age range. Neonates of the youngest gestational age who had the most extensive germinal layers also had the highest risk for periventricular haemorrhage. Images Fig. 1 Fig. 2 Fig. 3 p640-b Fig. 4 PMID:6465933

  15. Ultrasound and necropsy study of periventricular haemorrhage in preterm infants.

    PubMed

    Szymonowicz, W; Schafler, K; Cussen, L J; Yu, V Y

    1984-07-01

    The diagnostic accuracy of cerebral ultrasound for periventricular haemorrhage was determined by comparing this with necropsy findings in 30 preterm neonates of 30 weeks' gestation or less and birthweight under 1500 g. Ultrasound gave an accurate diagnosis of 85% in infants with germinal layer haemorrhage, 92% in intraventricular haemorrhage, and 97% in intracerebral haemorrhage. False positive errors were caused by vascular congestion; false negative errors occurred when the maximum dimension of haemorrhage was less than 3 mm. Cerebral ultrasound gave a diagnostic accuracy of 63% for periventricular leucomalacia. False negative errors occurred when periventricular leucomalacia was microscopic or when it was out of range of the scanner. The maximum width of the germinal layer was measured in 77 neonates of gestational age 23 to 36 weeks who died and had no periventricular haemorrhage at necropsy. The progressive involution of the germinal layer with increasing gestational age paralleled the steady decrease in incidence of periventricular haemorrhage diagnosed over the same gestational age range. Neonates of the youngest gestational age who had the most extensive germinal layers also had the highest risk for periventricular haemorrhage. PMID:6465933

  16. Bichat guidelines for the clinical management of haemorrhagic fever viruses and bioterrorism-related haemorrhagic fever viruses.

    PubMed

    Bossi, Philippe; Tegnell, Anders; Baka, Agoritsa; Van Loock, Frank; Hendriks, Jan; Werner, Albrecht; Maidhof, Heinrich; Gouvras, Georgios

    2004-12-01

    Haemorrhagic fever viruses (HFVs) are a diverse group of viruses that cause a clinical disease associated with fever and bleeding disorder. HFVs that are associated with a potential biological threat are Ebola and Marburg viruses (Filoviridae), Lassa fever and New World arenaviruses (Machupo, Junin, Guanarito and Sabia viruses) (Arenaviridae), Rift Valley fever (Bunyaviridae) and yellow fever, Omsk haemorrhagic fever, and Kyanasur Forest disease (Flaviviridae). In terms of biological warfare concerning dengue, Crimean-Congo haemorrhagic fever and Hantaviruses, there is not sufficient knowledge to include them as a major biological threat. Dengue virus is the only one of these that cannot be transmitted via aerosol. Crimean-Congo haemorrhagic fever and the agents of haemorrhagic fever with renal syndrome appear difficult to weaponise. Ribavirin is recommended for the treatment and the prophylaxis of the arenaviruses and the bunyaviruses, but is not effective for the other families. All patients must be isolated and receive intensive supportive therapy. PMID:15677844

  17. Isolation of a herpes simplex virus type 1 mutant with a deletion in the virion host shutoff gene and identification of multiple forms of the vhs (UL41) polypeptide.

    PubMed Central

    Read, G S; Karr, B M; Knight, K

    1993-01-01

    The virion host shutoff (vhs) gene (UL41) of herpes simplex virus type 1 (HSV-1) encodes a virion component that induces degradation of host mRNAs and the shutoff of most host protein synthesis. Subsequently, the vhs protein accelerates the turnover of all kinetic classes of viral mRNA. To identify the vhs (UL41) polypeptide within infected cells and virions, antisera raised against a UL41-lacZ fusion protein were used to characterize the polypeptides encoded by wild-type HSV-1 and two mutants: vhs1, a previously characterized mutant that lacks detectable virion host shutoff activity, and vhs-delta Sma, a newly constructed mutant containing a deletion of 196 codons from UL41. Two forms of the vhs (UL41) polypeptide were identified in cells infected with the wild-type virus or vhs1. Wild-type HSV-1 produced a major 58-kDa polypeptide, as well as a less abundant 59.5-kDa form of the protein, while vhs1 produced 57- and 59-kDa polypeptides that were approximately equally abundant. Although for either virus, both forms of the protein were phosphorylated, they differed in the extent of phosphorylation. While both vhs polypeptides were found in infected cells, only the faster migrating, less phosphorylated form was incorporated into virions. vhs-delta Sma encoded a smaller, 31-kDa polypeptide which, although present in infected cells, was not incorporated into virions. The results identify multiple forms of the vhs (UL41) polypeptide and suggest that posttranslational processing affects its packaging into virions, as well as its ability to induce mRNA degradation. Images PMID:8230437

  18. Post transfusion septicaemia 1980-1989: importance of donor arm cleansing.

    PubMed Central

    Puckett, A.; Davison, G.; Entwistle, C. C.; Barbara, J. A.

    1992-01-01

    AIMS: To determine the prevalence of Pseudomonas fluorescens on the arms of blood donors, and to elucidate one possible cause for its predominance (60% of cases during 1980-89) in exogenous post transfusion septicaemia (PTS). METHODS: Skin swabs were taken from the arms of 782 blood donors and cultured on to heated blood agar. After incubation, Oxidase reagent and the Gram stain were used to select non-fermentative Gram negative rods, which were then subcultured and identified using the Analytical Profile System (API) 20 NE system. RESULTS: Non-fermentative Gram negative rods were found on the arms of 11.7% of donors, Pseudomonas spp on 1.0%, and Ps fluorescens on the arms of 0.3% of donors. CONCLUSIONS: This evidence emphasises the absolute requirement for efficient skin cleansing of blood donors' arms to minimise the risk of exogenous PTS. PMID:1541697

  19. Neonatal Septicaemia Caused by Vancomycin Resistant Enterococcus Faecium-A Case Report

    PubMed Central

    T, Nagarathnamma; DR, Pooja; TR, Harsha; R, Karthik

    2014-01-01

    Neonatal bacterial sepsis is one of the major causes of morbidity and mortality in neonates. 10% cases of neonatal bacteraemia and septicaemia are caused by Enterococci. The increasing incidence of Vancomycin resistant enterococci (VRE) is of particular concern because of limited treatment options and increased mortality. We report here a case of neonatal sepsis in a premature baby caused by vancomycin resistant Enterococcus faecium Van A phenotype from a tertiary care Hospital in South India. A preterm baby boy with low birth weight was admitted to the NICU with Respiratory distress and meconium aspiration. On 5th day the baby succumbed to death and a final diagnosis of respiratory distress and meconium aspiration with sepsis was made. Blood cultures sent yielded vancomycin resistant Enterococcus faecium (minimum inhibitory concentration ≥ 256 μg/ml). It was confirmed as Enterococcus feacium Van A phenotype by Automated Vitek system. PMID:25584223

  20. Spontaneously reported haemorrhagic adverse events associated with rivaroxaban and dabigatran in Australia

    PubMed Central

    Chen, Esa Y. H.; Diug, Basia; Bell, J. Simon; Mc Namara, Kevin P.; Dooley, Michael J.; Kirkpatrick, Carl M.; McNeil, John J.; Caughey, Gillian E.; Ilomäki, Jenni

    2016-01-01

    Objectives: The objective of our study was to describe spontaneously reported haemorrhagic adverse events associated with rivaroxaban and dabigatran in Australia. Methods: Data were sourced from the Australian Therapeutic Goods Administration (TGA) Database of Adverse Event Notifications between June 2009 and May 2014. Records of haemorrhagic adverse events in which rivaroxaban or dabigatran was considered as a potential cause were analysed. Results: There were 240 haemorrhagic adverse events associated with rivaroxaban and 504 associated with dabigatran. Age was specified for 164 (68%) haemorrhages associated with rivaroxaban, of which 101 occurred in people aged ⩾75 years. Age was specified for 437 (87%) haemorrhages associated with dabigatran, of which 300 occurred in people aged ⩾75 years. Time from treatment initiation to haemorrhage was specified for 122 (51%) haemorrhages associated with rivaroxaban, with 69 (57%) haemorrhages occurring within 30 days of rivaroxaban initiation. Time from treatment initiation to haemorrhage was specified for 253 (50%) haemorrhages associated with dabigatran, with 123 (49%) haemorrhages occurring within 30 days of dabigatran initiation. Gastrointestinal (GI) haemorrhages were the most frequent type of haemorrhages associated with both rivaroxaban (n = 105, 44%) and dabigatran (n = 302, 60%). Data were available on the severity of haemorrhage for 101 (42%) haemorrhages associated with rivaroxaban, with haemorrhage leading to death in 17 people. The severity of haemorrhage was specified for 384 (76%) haemorrhages associated with dabigatran, with haemorrhage leading to death in 61 people. Conclusions: Our study highlights the need for research on the haemorrhagic complications of anticoagulation in clinical care. A considerable proportion of reported haemorrhagic events occurred within 30 days of rivaroxaban and dabigatran initiation. This highlights the importance of considering bleeding risk at the time of treatment

  1. Edwardsiella Septicaemias

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The genus Edwardsiella includes two species of bacteria that cause major diseases in fish: Edwardsiella tarda (1965) infects fish and other animals and Edwardsiella ictaluri (Hawke 1979; Hawke et al. 1981) infects primarily fish. A third species, Edwardsiella hoshinae (Grimont et al. 1980), infects ...

  2. Spontaneous intracranial haemorrhage: computed tomographic patterns in Accra.

    PubMed

    Obajimi, M O; Nyame, P K; Jumah, K B; Wiredu, E K

    2002-01-01

    The diagnosis of stroke and the ability to distinguish the subtypes is central in the management of patients. This CT study has confirmed an increased prevalence of stroke (CVA) among Ghanaians. It has also reaffirmed a relatively higher incidence (52.9%) of spontaneous intracranial haemorrhage over cerebral infarcts among the 1,172 stroke patients studied. The study points to a male preponderance and a mean age of 55.7 years. Parenchymal haemorrhage was found to be the commonest variety of these haemorrhages. It occurred in 83.6% of cases while primary subarachnoid haemorrhage was reported in only 8.1% of cases. Ventricular extension of the parenchymal haemorrhage was reported in 22.7% of cases. The latter were mostly unilateral and on the left side especially in the parietal lobe (70.9%), subdural haemorrhage like the parenchymal variety was also reported to be more on the left, mainly unilateral and acute. Haemorrhages in the cerebellum and pons which are normally difficult to diagnose were also outlined with ease in the CT images. Other CT findings in these patients include parilesional oedema and mass effect found in 87.10% and 77.4% respectively. PMID:12081348

  3. Association of Streptococcus pluranimalium with valvular endocarditis and septicaemia in adult broiler parents.

    PubMed

    Hedegaard, L; Christensen, H; Chadfield, M S; Christensen, J P; Bisgaard, M

    2009-04-01

    The genus Streptococcus consists of more than 60 species, but only Streptococcus equi subspecies zooepidemicus, Streptococcus gallolyticus ssp. gallolyticus, Streptococcus gallinaceus, Streptococcus dysgalactiae, Streptococcus mutans and Streptococcus suis have been isolated from poultry. During investigations of the aetiology of increased mortality in broiler parent stock at the end of production, pure cultures of streptococcal-like organisms that could not be classified among these six species were obtained from 24 cases of septicaemia or valvular endocarditis and septicaemia. Phenotypic characterization using the API20 STREP kit identified the isolates as Aerococcus viridans (10), Aerococcus urinae (2), Leuconostoc species (4), Streptococcus salivarius (2), Streptococcus bovis II 3 (1), Enterococcus avium (3), Enterococcus faecium (1) or Gemella morbillorum (1). However, this identification was misleading as subsequent genetic investigations using pulse field gel electrophoresis and sequencing of 16S rRNA genes showed that 19 isolates were classified as Streptococcus pluranimalium, while the remaining isolates were E. avium (3), E. faecium (1) or Lactobacillus species (1). Misidentification by API20 STREP was related to the database provided by the manufacturer, as the phenotypic characteristics could identify these organisms as S. pluranimalium. The isolates of S. pluranimalium belonged to at least three different clones as determined by pulsed field gel electrophoresis of SmaI-digested genomic DNA. The capacity that these isolates had to colonize the valvular endothelium was suggested by the occurrence of valvular endocarditis in 12 of 19 cases. Demonstration of the same clone in all four houses on a farm suggested the pathogenic potential of this organism. PMID:19322715

  4. Experimental subarachnoid haemorrhage results in multifocal axonal injury.

    PubMed

    Kummer, Terrance T; Magnoni, Sandra; MacDonald, Christine L; Dikranian, Krikor; Milner, Eric; Sorrell, James; Conte, Valeria; Benetatos, Joey J; Zipfel, Gregory J; Brody, David L

    2015-09-01

    The great majority of acute brain injury results from trauma or from disorders of the cerebrovasculature, i.e. ischaemic stroke or haemorrhage. These injuries are characterized by an initial insult that triggers a cascade of injurious cellular processes. The nature of these processes in spontaneous intracranial haemorrhage is poorly understood. Subarachnoid haemorrhage, a particularly deadly form of intracranial haemorrhage, shares key pathophysiological features with traumatic brain injury including exposure to a sudden pressure pulse. Here we provide evidence that axonal injury, a signature characteristic of traumatic brain injury, is also a prominent feature of experimental subarachnoid haemorrhage. Using histological markers of membrane disruption and cytoskeletal injury validated in analyses of traumatic brain injury, we show that axonal injury also occurs following subarachnoid haemorrhage in an animal model. Consistent with the higher prevalence of global as opposed to focal deficits after subarachnoid haemorrhage and traumatic brain injury in humans, axonal injury in this model is observed in a multifocal pattern not limited to the immediate vicinity of the ruptured artery. Ultrastructural analysis further reveals characteristic axonal membrane and cytoskeletal changes similar to those associated with traumatic axonal injury. Diffusion tensor imaging, a translational imaging technique previously validated in traumatic axonal injury, from these same specimens demonstrates decrements in anisotropy that correlate with histological axonal injury and functional outcomes. These radiological indicators identify a fibre orientation-dependent gradient of axonal injury consistent with a barotraumatic mechanism. Although traumatic and haemorrhagic acute brain injury are generally considered separately, these data suggest that a signature pathology of traumatic brain injury-axonal injury-is also a functionally significant feature of subarachnoid haemorrhage, raising

  5. Experimental subarachnoid haemorrhage results in multifocal axonal injury

    PubMed Central

    Magnoni, Sandra; MacDonald, Christine L.; Dikranian, Krikor; Milner, Eric; Sorrell, James; Conte, Valeria; Benetatos, Joey J.; Zipfel, Gregory J.; Brody, David L.

    2015-01-01

    The great majority of acute brain injury results from trauma or from disorders of the cerebrovasculature, i.e. ischaemic stroke or haemorrhage. These injuries are characterized by an initial insult that triggers a cascade of injurious cellular processes. The nature of these processes in spontaneous intracranial haemorrhage is poorly understood. Subarachnoid haemorrhage, a particularly deadly form of intracranial haemorrhage, shares key pathophysiological features with traumatic brain injury including exposure to a sudden pressure pulse. Here we provide evidence that axonal injury, a signature characteristic of traumatic brain injury, is also a prominent feature of experimental subarachnoid haemorrhage. Using histological markers of membrane disruption and cytoskeletal injury validated in analyses of traumatic brain injury, we show that axonal injury also occurs following subarachnoid haemorrhage in an animal model. Consistent with the higher prevalence of global as opposed to focal deficits after subarachnoid haemorrhage and traumatic brain injury in humans, axonal injury in this model is observed in a multifocal pattern not limited to the immediate vicinity of the ruptured artery. Ultrastructural analysis further reveals characteristic axonal membrane and cytoskeletal changes similar to those associated with traumatic axonal injury. Diffusion tensor imaging, a translational imaging technique previously validated in traumatic axonal injury, from these same specimens demonstrates decrements in anisotropy that correlate with histological axonal injury and functional outcomes. These radiological indicators identify a fibre orientation-dependent gradient of axonal injury consistent with a barotraumatic mechanism. Although traumatic and haemorrhagic acute brain injury are generally considered separately, these data suggest that a signature pathology of traumatic brain injury—axonal injury—is also a functionally significant feature of subarachnoid haemorrhage

  6. [Anticoagulants after intracerebral haemorrhage in frail elderly].

    PubMed

    Olde Rikkert, Marcel; Claassen, Jurgen

    2015-01-01

    Restarting anticoagulants in frail older patients who have had an intracerebral haemorrhage as an adverse reaction to anticoagulant therapy is a major dilemma, and one which is not specifically addressed in the state-of-the-art paper on restarting anticoagulants elsewhere in this issue. Frail older persons have the highest risk of recurrent bleeding, but, in theory, also have the most benefit from anticoagulants due to the high absolute risk for ischemic events in atrial fibrillation, which is the major indication. However, frail older persons are largely excluded from trials with anticoagulants, which makes it impossible to solve this dilemma in an evidence-based way. Therefore, we argue that sound decision making cannot only be based on neurological or cardiological expertise, as proposed by others, but should include an overall comprehensive geriatric assessment, and, most importantly, patients and caregivers should be included in shared goal setting and shared decision making. PMID:25873225

  7. Pathogenesis of intraventricular haemorrhage in newborn infants

    PubMed Central

    Cole, Valerie A.; Durbin, G. M.; Olaffson, A.; Reynolds, E. O. R.; Rivers, R. P. A.; Smith, J. F.

    1974-01-01

    The ventricular CSF of a group of preterm infants dying in the newborn period contained a large excess of protein which appeared to be a plasma filtrate. This excess was found whether or not an intraventricular haemorrhage (IVH) was also present. After consideration of the clinical features of the infants, their coagulation status, and the findings at necropsy, we suggest that increased cerebral venous and capillary pressure, usually caused by heart failure resulting from hypoxia and acidosis, was responsible both for the IVH, by rupturing the terminal veins, and for promoting the filtration of plasma proteins into the CSF. Abnormalities of haemostasis, though very common, did not seem to provide an adequate explanation for the initiation of intraventricular bleeding, though they may have exacerbated it. PMID:4422777

  8. Viral haemorrhagic fevers in South Africa.

    PubMed

    Richards, Guy A; Weyer, Jacqueline; Blumberg, Lucille H

    2015-09-01

    Viral haemorrhagic fevers (VHFs) include a diverse array of diseases caused by a broad range of viruses transmitted from various animal hosts and originating from almost all the continents in the world. These are potentially fatal and highly transmissible diseases without specific treatments or prophylactic vaccines. As has been demonstrated during the Ebola virus disease outbreak in West Africa, the consequences of VHFs are not limited to specific countries - they may become epidemic, and may have considerable economic impact and disrupt local public health and social service structures. Intensive public health intervention is necessary to contain these diseases. Here we provide a concise overview of the VHFs that are of current public health importance to South Africa. PMID:26428973

  9. Doctors' Knowledge of Viral Haemorrhagic Fevers.

    PubMed

    Lisk, Clifford; Snell, Luke; Haji-Coll, Michael; Ellis, Jayne; Sufi, Saaidullah; Raj, Rohit; Sharma, A; Smith, C

    2015-01-01

    Viral Haemorrhagic Fevers (VHF) such as Ebola Virus Disease (EVD) are of increasing concern to clinicians and public heath bodies across Europe and America due to the on-going epidemic in West Africa. We conducted an online study to assess clinicians' knowledge of VHF across six hospital sites in London. This showed suboptimal knowledge of Public Health England guidance, EVD epidemiology and the risk factors for acquiring VHF. Knowledge about VHF was dependent on seniority of grade with the most junior grade of doctors performing worse in several areas of the survey. Poor knowledge raises concerns that those at risk of VHF will be inappropriately risk stratified and managed. Education of doctors and other healthcare professionals about VHF is necessary to address these knowledge gaps. PMID:26305080

  10. Bilateral adrenal gland haemorrhage: an unusual cause

    PubMed Central

    Shenoy, Vasant; Malabu, Usman; Cameron, Donald; Sangla, Kunwarjit

    2014-01-01

    Summary Our patient had drainage of a large amoebic liver abscess. This got complicated by a severe degree of hypotension, which required aggressive fluid resuscitation and hydrocortisone support. Computerised tomography (CT) of the abdomen revealed bilateral adrenal gland haemorrhage (BAH) resulting in primary adrenal gland failure, which was the cause for hypotension. Patient was on long-term warfarin for provoked deep vein thrombosis of lower limb, which was discontinued before the procedure. Thrombophilia profile indicated the presence of lupus anticoagulant factor with prolonged activated partial thromboplastin time (aPTT). Patient was discharged on lifelong warfarin. This case emphasises the need for strong clinical suspicion for diagnosing BAH, rare but life-threatening condition, and its association with amoebic liver abscess and anti-phospholipid antibody syndrome (APLS). Learning points Recognition of BAH as a rare complication of sepsis.APLS can rarely cause BAH. PMID:25276353

  11. Retinal haemorrhages associated with fatal paediatric infections.

    PubMed

    Salvatori, Marcus C; Lantz, Patrick E

    2015-04-01

    For many physicians, retinal haemorrhages (RHs) in infants and young children remain highly diagnostic of non-accidental (abusive) head trauma. Because clinicians have applied indirect ophthalmoscopy selectively to cases of suspected child abuse, the association between RH and other conditions such as infection, coagulopathy and accidental trauma has encountered habitual bias, creating the potential for iatrogenic misdiagnosis of child abuse. We present an autopsy case series of four children, aged three years old or younger, in whom RHs were detected by post-mortem monocular indirect ophthalmoscopy after the patients had died from infections. We discuss the laterality, number, type and location of RHs in these cases, and summarize proposed mechanisms of RH formation in fatalities from paediatric infection. We demonstrate that many of the ophthalmological findings that have been considered diagnostic of abusive head trauma can also occur in association with infective processes. PMID:24644226

  12. Helping Hands for Budding Prospects: ENTH/ANTH/VHS Accessory Proteins in Endocytosis, Vacuolar Transport, and Secretion[W

    PubMed Central

    Zouhar, Jan; Sauer, Michael

    2014-01-01

    Coated vesicles provide a major mechanism for the transport of proteins through the endomembrane system of plants. Transport between the endoplasmic reticulum and the Golgi involves vesicles with COPI and COPII coats, whereas clathrin is the predominant coat in endocytosis and post-Golgi trafficking. Sorting of cargo, coat assembly, budding, and fission are all complex and tightly regulated processes that involve many proteins. The mechanisms and responsible factors are largely conserved in eukaryotes, and increasing organismal complexity tends to be associated with a greater numbers of individual family members. Among the key factors is the class of ENTH/ANTH/VHS domain-containing proteins, which link membrane subdomains, clathrin, and other adapter proteins involved in early steps of clathrin coated vesicle formation. More than 30 Arabidopsis thaliana proteins contain this domain, but their generally low sequence conservation has made functional classification difficult. Reports from the last two years have greatly expanded our knowledge of these proteins and suggest that ENTH/ANTH/VHS domain proteins are involved in various instances of clathrin-related endomembrane trafficking in plants. This review aims to summarize these new findings and discuss the broader context of clathrin-dependent plant vesicular transport. PMID:25415979

  13. [Retinal haemorrhages in non-accidental head injury in childhood].

    PubMed

    Oberacher-Velten, I M; Helbig, H

    2014-09-01

    Retinal haemorrhages are one of the three cardinal manifestations of the "shaken baby syndrome" or "non-accidental head injury" in childhood. The role of an ophthalmologist in suspected non-accidental head injury has not only medical but also legal aspects and has been discussed controversially in the literature. The differential diagnosis and the specificity of retinal haemorrhages in childhood for an abusive head trauma will be pointed out in this paper. PMID:25181505

  14. Decreased plasma isoleucine concentrations after upper gastrointestinal haemorrhage in humans.

    PubMed Central

    Dejong, C H; Meijerink, W J; van Berlo, C L; Deutz, N E; Soeters, P B

    1996-01-01

    BACKGROUND: A decrease in arterial isoleucine values after intragastric blood administration in pigs has been observed. This contrasted with increased values of most other amino acids, ammonia, and urea. After an isonitrogenous control meal in these pigs all amino acids including isoleucine increased, and urea increased to a lesser extent, suggesting a relation between the arterial isoleucine decrease and uraemia after gastrointestinal haemorrhage. METHODS: To extend these findings to humans, plasma amino acids were determined after gastrointestinal haemorrhage in patients with peptic ulcers (n = 9) or oesophageal varices induced by liver cirrhosis (n = 4) and compared with preoperative patients (n = 106). RESULTS: After gastrointestinal haemorrhage, isoleucine decreased in all patients by more than 60% and normalised within 48 hours. Most other amino acids increased and also normalised within 48 hours. Uraemia occurred in both groups, hyperammonaemia was seen in patients with liver cirrhosis. CONCLUSIONS: These results confirm previous findings in animals and healthy volunteers that plasma isoleucine decreases after simulated upper gastrointestinal haemorrhage. This supports the hypothesis that the absence of isoleucine in blood protein causes decreased plasma isoleucine values after gastrointestinal haemorrhage, and may be a contributory factor to uraemia and hyperammonaemia in patients with normal and impaired liver function, respectively. Intravenous isoleucine administration after gastrointestinal haemorrhage could be beneficial and will be the subject of further research. PMID:8881800

  15. Aneurysmal subarachnoid haemorrhage: guidance in making the correct diagnosis

    PubMed Central

    Liebenberg, W; Worth, R; Firth, G; Olney, J; Norris, J

    2005-01-01

    Background: The natural history of untreated aneurysmal subarachnoid haemorrhage carries a dismal prognosis. Case fatalities range between 32% and 67%. Treatment with either surgical clipping or endovascular coiling is highly successful at preventing re-bleeding and yet the diagnosis is still missed. Methods: Based on the national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage and a review of other available literature this study has compiled guidance in making the diagnosis. Conclusion: In patients presenting with a suspected non-traumatic subarachnoid haemorrhage, computed tomography within 12 hours will reliably show 98% of subarachnoid haemorrhage. In patients who present after 12 hours with a negative computed tomogram, formal cerebrospinal fluid spectophotometry will detect subarachnoid haemorrhage for the next two weeks with a reliability of 96%. Between the early diagnosis with the aid of computed tomography and the later diagnosis with the added benefit of spectophotometry in the period where computed tomograms become less reliable, it should be possible to diagnose most cases of subarachnoid haemorrhage correctly. PMID:15998826

  16. Hyaline membrane disease, alkali, and intraventricular haemorrhage.

    PubMed Central

    Wigglesworth, J S; Keith, I H; Girling, D J; Slade, S A

    1976-01-01

    The relation between intraventricular haemorrhage (IVH) and hyaline membrane disease (HMD) was studied in singletons that came to necropsy at Hammersmith Hospital over the years 1966-73. The incidence of IVH in singleton live births was 3-22/1000 and of HMD 4-44/1000. Although the high figures were partily due to the large number of low birthweight infants born at this hospital, the incidence of IVH in babies weighing 1001-1500 g was three times as great as that reported in the 1658 British Perinatal Mortality Survey. Most IVH deaths were in babies with HMD, but the higher frequency of IVH was not associated with any prolongation of survival time of babies who died with HMD as compared with the 1958 survey. IVH was seen frequently at gestations of up to 36 weeks in babies with HMD but was rare above 30 weeks' gestation in babies without HMD. This indicated that factors associated with HMD must cause most cases of IVH seen at gestations above 30 weeks. Comparison of clinical details in infants with HMD who died with or without IVH (at gestations of 30-37 weeks) showed no significant differences between the groups other than a high incidence of fits and greater use of alkali therapy in the babies with IVH. During the 12 hours when most alkali therapy was given, babies dying with IVD received a mean total alkali dosage of 10-21 mmol/kg and those dying without IVH 6-34 mmol/kg (P less than 0-001).There was no difference in severity of hypoxia or of metabolic acidosis between the 2 groups. Babies who died with HMD and germinal layer haemorrhage (GLH) without IVH had received significantly more alkali than those who died with HMD alone, whereas survivors of severe respiratory distress syndrome had received lower alkali doses than other groups. It is suggested that the greatly increased death rate from IVH in babies with HMD indicates some alteration of management of HMD (since 1958) as a causative factor. Liberal use of hypertonic alkali solutions is the common factor

  17. Rabbit haemorrhagic disease (RHD) and rabbit haemorrhagic disease virus (RHDV): a review

    PubMed Central

    2012-01-01

    Rabbit haemorrhagic disease virus (RHDV) is a calicivirus of the genus Lagovirus that causes rabbit haemorrhagic disease (RHD) in adult European rabbits (Oryctolagus cuniculus). First described in China in 1984, the virus rapidly spread worldwide and is nowadays considered as endemic in several countries. In Australia and New Zealand where rabbits are pests, RHDV was purposely introduced for rabbit biocontrol. Factors that may have precipitated RHD emergence remain unclear, but non-pathogenic strains seem to pre-date the appearance of the pathogenic strains suggesting a key role for the comprehension of the virus origins. All pathogenic strains are classified within one single serotype, but two subtypes are recognised, RHDV and RHDVa. RHD causes high mortality in both domestic and wild adult animals, with individuals succumbing between 48-72 h post-infection. No other species has been reported to be fatally susceptible to RHD. The disease is characterised by acute necrotising hepatitis, but haemorrhages may also be found in other organs, in particular the lungs, heart, and kidneys due to disseminated intravascular coagulation. Resistance to the disease might be explained in part by genetically determined absence or weak expression of attachment factors, but humoral immunity is also important. Disease control in rabbitries relies mainly on vaccination and biosecurity measures. Such measures are difficult to be implemented in wild populations. More recent research has indicated that RHDV might be used as a molecular tool for therapeutic applications. Although the study of RHDV and RHD has been hampered by the lack of an appropriate cell culture system for the virus, several aspects of the replication, epizootology, epidemiology and evolution have been disclosed. This review provides a broad coverage and description of the current knowledge on the disease and the virus. PMID:22325049

  18. Discovery of a Young Planetary Mass Companion to the Nearby M Dwarf VHS J125601.92-125723.9

    NASA Astrophysics Data System (ADS)

    Gauza, Bartosz; Béjar, Victor J. S.; Pérez-Garrido, Antonio; Rosa Zapatero Osorio, Maria; Lodieu, Nicolas; Rebolo, Rafael; Pallé, Enric; Nowak, Grzegorz

    2015-05-01

    In a search for common proper motion companions using the VISTA Hemisphere Survey (VHS) and the 2MASS catalogs we have identified a very red (J-{{K}s}=2.47 mag) late-L dwarf companion of a previously unrecognized M dwarf VHS J125601.92-125723.9 (hereafter VHS 1256-1257), located at a projected angular separation of 8.″ 06 ± 0.″ 03. In this work we present a suite of astrometric, photometric, and spectroscopic observations of this new pair in an effort to confirm the companionship and characterize the components. From low-resolution (R ˜ 130-600) optical and near-infrared spectroscopy we classified the primary and the companion as M7.5 ± 0.5 and L7 ± 1.5, respectively. The primary shows slightly weaker alkali lines than field dwarfs of similar spectral type, but still consistent with either a high-gravity dwarf or a younger object of hundreds of millions of years. The secondary shows spectral features characteristic for low surface gravity objects at ages below several hundred million years, like the peaked triangular shape of the H-band continuum and alkali lines weaker than in field dwarfs of the same spectral type. The absence of lithium in the atmosphere of the primary and the likely kinematic membership to the Local Association allowed us to constrain the age of the system to the range of 150-300 Myr. We report a measurement of the trigonometric parallax π = 78.8 ± 6.4 mas, which translates into a distance of 12.7 ± 1.0 pc; the pair thus has a projected physical separation of 102 ± 9 AU. We derived the bolometric luminosities of the components and compared them with theoretical evolutionary models to estimate the masses and effective temperatures. For the primary, we determined a luminosity of log ({{L}bol}/{{L}⊙ })=-3.14 ± 0.10, and inferred a mass of 73-15+20 MJup at the boundary between stars and brown dwarfs and an effective temperature of 2620 ± 140 K. For the companion we obtained a luminosity of log ({{L}bol}/{{L}⊙ })=-5.05+/- 0.22 and

  19. Epidemiology of viral hemorrhagic septicemia (VHS) among juvenile Pacific herring and Pacific sandlances in Puget Sound, Washington

    USGS Publications Warehouse

    Kocan, R.M.; Hershberger, P.K.; Elder, N.E.; Winton, J.R.

    2001-01-01

    Viral hemorrhagic septicemia (VHS) and the associated virus (VHSV) were identified in newly metamorphosed Pacific herring Clupea pallasi and Pacific sand lances Ammodytes hexapterus captured from Puget Sound, Washington, between 1995 and 1998. During that 4-year period, virus was detected in less than 1% of free-ranging, age-0 Pacific herring; however, when groups of these fish were confined in the laboratory, they experienced severe mortality, occasionally exceeding 50%, with the prevalence of VHSV reaching 100% by 14 d postcapture. At 7–21 d postcapture, VHSV titers peaked in excess of 108 plaque-forming units/g of tissue; by 30 d postcapture, however, the virus could no longer be isolated. Fish surviving beyond 30 d eliminated the virus from their tissues, but some remained lethargic and continued to show signs of hemorrhage around the mouth, skin, and fins until about 6 weeks postcapture. No cutaneous ulcers were observed during either the acute or the recovery phases of infection. Eighteen-month-old Pacific herring captured from the same area were also negative for VHSV but developed active infections after confinement for 7 d. Unlike younger fish, only 8.4% of these older fish died of VHS, and 7.7% of survivors were positive for VHSV at 7–10 d postcapture, which suggests that a higher proportion of the older fish had developed resistance to VHSV from prior exposure to it. Three months after fatalities ceased in the laboratory-held fish, the surviving fish were challenged with 5 3 103 plaque-forming units/mL of VHSV for 1 h. No mortality was observed during the next 30 d, and virus was recoverable at very low titers in fewer than 5% of the challenged fish, indicating the development of an active immunity to VHSV. Laboratory cohabitation of infected wild Pacific herring with laboratory-reared, specific-pathogen-free Pacific herring resulted in transmission of VHSV to the nonimmune fish, with the resulting course of disease resembling that seen in wild

  20. The metabolic effects of moderately severe upper gastrointestinal haemorrhage in man.

    PubMed Central

    Foster, K. J.; Alberti, K. G.; Binder, C.; Holdstock, G.; Karran, S. J.; Smith, C. L.; Talbot, S.; Turnell, D. C.

    1982-01-01

    The metabolic effects of moderately severe gastrointestinal haemorrhage were investigated in man. Before resuscitation, patients had raised circulating concentrations of glucose, lactate, alanine, glycerol and cortisol. After urgent operation for haemorrhage, metabolite concentrations were similar to those of control patients having elective abdominal surgery, but insulin concentrations were higher and cortisol lower in haemorrhage patients. There were no significant differences in nitrogen excretion between haemorrhage patients and their controls, but urinary 3-methyl-histidine excretion by haemorrhage patients was lower indicating decreased muscle protein breakdown. Decreased amino acid release from muscle might account for previously reported imparied wound healing after haemorrhage. PMID:7045838

  1. Value of integron detection for predicting antibiotic resistance in patients with Gram-negative septicaemia.

    PubMed

    Barraud, Olivier; François, Bruno; Chainier, Delphine; Vignaud, Julie; Ploy, Marie-Cécile

    2014-10-01

    Multidrug-resistant Enterobacteriaceae are a major public health threat and complicate the choice of drugs for empirical antibiotic therapy, especially in sepsis patients who require rapid, appropriate treatment. The objective of this study was to examine the value of integrons as a global predictive marker of acquired antibiotic resistance in septicaemia-causing Enterobacteriaceae by direct detection in positive blood cultures. The integron genetic marker can be detected in a single test, whereas multiple PCRs are needed to detect the hundreds of known antibiotic resistance genes. A total of 166 positive blood cultures were included in the study, and integrons were detected with a quantitative PCR method both in positive blood cultures and isolated Enterobacteriaceae. The results of integron detection directly on positive blood cultures were consistent in 98.8% of cases with integron detection in isolated Enterobacteriaceae. Negative predictive values (NPVs) were >90% for resistance to third-generation cephalosporins, aminoglycosides, ciprofloxacin and trimethoprim/sulfamethoxazole. In the current context of antibiotic stewardship, these good NPVs indicate that this method might be useful for preserving broad-spectrum antibiotics. The results of this proof-of-concept study must be confirmed in order to demonstrate the clinical relevance of integron detection, not only in positive blood cultures but also, to gain time, in raw biological samples. PMID:25130099

  2. Septicaemia in emerald monitors (Varanus prasinus Schlegel 1839) caused by Streptococcus agalactiae acquired from mice.

    PubMed

    Hetzel, U; König, A; Yildirim, A O; Lämmler, Ch; Kipar, A

    2003-09-24

    The present study was performed to investigate both the identity and the source of the bacteria responsible for a fatal septicaemia observed in a group of three subadult emerald monitors (Varanus prasinus Schlegel 1839). The emerald monitors were necropsied and examined by light microscopy, including immunohistology, and by electron microscopy. Tissue samples were additionally submitted for bacteriological, virological and parasitological examinations. The virological and parasitological results were noncontributory, whereas the bacteriological investigation resulted in the isolation of gram-positive cocci which were characterized biochemically and serologically and by molecular analysis. The death of the emerald monitors was caused by a partially leukocyte-associated septicaemic infection with streptococci of serological group B of serotype V. Phenotypically and genotypically identical group B streptococci were isolated from the intestine of subadult mice, obtained from the feed used for the monitors. The genotypical characterization included an identical DNA fingerprint of strains of both origins, indicating the epidemiological relation between the feeding mice and the infections of the monitors. PMID:12935754

  3. Ebola haemorrhagic fever in Zaire, 1976

    PubMed Central

    1978-01-01

    Between 1 September and 24 October 1976, 318 cases of acute viral haemorrhagic fever occurred in northern Zaire. The outbreak was centred in the Bumba Zone of the Equateur Region and most of the cases were recorded within a radius of 70 km of Yambuku, although a few patients sought medical attention in Bumba, Abumombazi, and the capital city of Kinshasa, where individual secondary and tertiary cases occurred. There were 280 deaths, and only 38 serologically confirmed survivors. The index case in this outbreak had onset of symptoms on 1 September 1976, five days after receiving an injection of chloroquine for presumptive malaria at the outpatient clinic at Yambuku Mission Hospital (YMH). He had a clinical remission of his malaria symptoms. Within one week several other persons who had received injections at YMH also suffered from Ebola haemorrhagic fever, and almost all subsequent cases had either received injections at the hospital or had had close contact with another case. Most of these occurred during the first four weeks of the epidemic, after which time the hospital was closed, 11 of the 17 staff members having died of the disease. All ages and both sexes were affected, but women 15-29 years of age had the highest incidence of disease, a phenomenon strongly related to attendance at prenatal and outpatient clinics at the hospital where they received injections. The overall secondary attack rate was about 5%, although it ranged to 20% among close relatives such as spouses, parent or child, and brother or sister. Active surveillance disclosed that cases occurred in 55 of some 550 villages which were examined house-by-house. The disease was hitherto unknown to the people of the affected region. Intensive search for cases in the area of north-eastern Zaire between the Bumba Zone and the Sudan frontier near Nzara and Maridi failed to detect definite evidence of a link between an epidemic of the disease in that country and the outbreak near Bumba. Nevertheless it was

  4. Pathological mechanisms underlying aneurysmal subarachnoid haemorrhage and vasospasm.

    PubMed

    Penn, David L; Witte, Samantha R; Komotar, Ricardo J; Sander Connolly, E

    2015-01-01

    Aneurysmal subarachnoid haemorrhage is a cerebrovascular disease associated with an overall mortality as high as 50%. Delayed ischaemic neurologic deficits are a major contributor to this statistic, as well as the significant morbidity associated with the disease. Studies examining the pathophysiologic events causing these devastating changes in cerebral blood flow have identified several mechanisms which are thought to contribute to the development of delayed ischaemic neurological deficits, perhaps the most damaging of which are increased intracranial pressure and cerebral vasospasm. In addition, the presence of blood in the subarachnoid space can trigger a myriad of reactions resulting in increased capillary permeability, breakdown of the blood-brain barrier, and inflammation in surrounding neural tissue that adds to the devastating effects of haemorrhage. A detailed understanding of the post-haemorrhagic cellular and molecular changes that contribute to the development of cerebral ischaemia and vasospasm is imperative to the formulation of treatment and prevention options for subarachnoid haemorrhage patients. Despite a large body of research within this field, a complete understanding of rupture and vasospasm remains elusive. This study reviews the role of vasoactive substances, such as endothelin-1, as well as the histochemistry and molecular pathology of post-haemorrhage inflammation in the development of vasospasm and cerebral ischaemia. PMID:25113969

  5. Chronic haemorrhagic radiation proctitis: A review

    PubMed Central

    Nelamangala Ramakrishnaiah, Vishnu Prasad; Krishnamachari, Srinivasan

    2016-01-01

    Chronic haemorrhagic radiation proctitis (CHRP) is a difficult problem faced by the patients following radiation for pelvic malignancy. There is no standard treatment for this condition, but many methods of treatment are available. The aim of this study was to review the literature to see whether there is an improvement in the available evidence in comparison with previously published systematic reviews in treating patients with CHRP. The PubMed/Medline database and Google Scholar search was selectively searched. Studies, which treated patients with rectal bleeding due to chronic radiation proctitis or CHRP, were included. Seventy studies were finally selected out of which 14 were randomized controlled clinical trials. Though these studies could not be compared, it could be seen that there was an improvement in the methodology of the studies. There was an objective assessment of symptoms, signs and an objective assessment of outcomes. But, still, there were only a few studies that looked into the quality of life following treatment of CHRP. To increase recruitment to trials, a national registry of cases with established late radiation toxicity would facilitate the further improvement of such studies. Some of the conclusions that could be reached based on the available evidence are 4% formalin should be the first line treatment for patients with CHRP. Formalin and argon plasma coagulation (APC) are equally effective, but formalin is better for severe disease. Refractory patients, not responding to formalin or APC, need to be referred for hyperbaric oxygen therapy or surgery. Radio-frequency ablation is a promising modality that needs to be studied further in randomized trials. PMID:27462390

  6. Chronic haemorrhagic radiation proctitis: A review.

    PubMed

    Nelamangala Ramakrishnaiah, Vishnu Prasad; Krishnamachari, Srinivasan

    2016-07-27

    Chronic haemorrhagic radiation proctitis (CHRP) is a difficult problem faced by the patients following radiation for pelvic malignancy. There is no standard treatment for this condition, but many methods of treatment are available. The aim of this study was to review the literature to see whether there is an improvement in the available evidence in comparison with previously published systematic reviews in treating patients with CHRP. The PubMed/Medline database and Google Scholar search was selectively searched. Studies, which treated patients with rectal bleeding due to chronic radiation proctitis or CHRP, were included. Seventy studies were finally selected out of which 14 were randomized controlled clinical trials. Though these studies could not be compared, it could be seen that there was an improvement in the methodology of the studies. There was an objective assessment of symptoms, signs and an objective assessment of outcomes. But, still, there were only a few studies that looked into the quality of life following treatment of CHRP. To increase recruitment to trials, a national registry of cases with established late radiation toxicity would facilitate the further improvement of such studies. Some of the conclusions that could be reached based on the available evidence are 4% formalin should be the first line treatment for patients with CHRP. Formalin and argon plasma coagulation (APC) are equally effective, but formalin is better for severe disease. Refractory patients, not responding to formalin or APC, need to be referred for hyperbaric oxygen therapy or surgery. Radio-frequency ablation is a promising modality that needs to be studied further in randomized trials. PMID:27462390

  7. Induction of haemorrhagic anovulatory follicles in mares.

    PubMed

    Ginther, O J; Gastal, M O; Gastal, E L; Jacob, J C; Beg, M A

    2008-01-01

    A follicular wave and luteolysis were induced in mares by ablation of follicles > or =6 mm and treatment with prostaglandin F(2alpha) (PGF) on Day 10 (where ovulation = Day 0). The incidence of haemorrhagic anovulatory follicles (HAFs) in the induced waves (20%) was greater (P < 0.007) than in preceding spontaneous waves (2%). Hormone and follicle dynamics were compared between induced follicular waves that ended in ovulations (ovulating group; n = 36) v. HAFs (HAF group; n = 9). The day of the first ovulation or the beginning of HAF formation at the end of an induced wave was designated as post-treatment Day 0. The mean 13-day interval from Day 10 (PGF and ablation) to the post-treatment ovulation was normalised into Days 10 to 16, followed by Day -6 to Day 0 relative to the post-treatment ovulation. Concentrations of LH were greater (P < 0.05) in the HAF group than in the ovulating group on Days 10, 11, 12, 14, -3 and -2. The HAF group had greater (P < 0.003) LH concentrations on Day 10 of the preceding oestrous cycle with spontaneous ovulatory waves. The diameter of the largest follicle was less (P < 0.05) in the HAF group on most days between Day 13 and Day -1 and this was attributable to later (P < 0.002) emergence of the future largest follicle at 6 mm in the HAF group (Day 12.4 +/- 0.5) than in the ovulating group (Day 11.3 +/- 0.1). The results indicate that the high incidence of HAFs after PGF and ablation was associated with later follicle emergence and immediate and continuing greater LH concentration after PGF treatment, apparently augmented by an inherently high pretreatment LH concentration. PMID:19007559

  8. The collagen-binding protein of Streptococcus mutans is involved in haemorrhagic stroke

    PubMed Central

    Nakano, Kazuhiko; Hokamura, Kazuya; Taniguchi, Naho; Wada, Koichiro; Kudo, Chiho; Nomura, Ryota; Kojima, Ayuchi; Naka, Shuhei; Muranaka, Yoshinori; Thura, Min; Nakajima, Atsushi; Masuda, Katsuhiko; Nakagawa, Ichiro; Speziale, Pietro; Shimada, Nobumitsu; Amano, Atsuo; Kamisaki, Yoshinori; Tanaka, Tokutaro; Umemura, Kazuo; Ooshima, Takashi

    2011-01-01

    Although several risk factors for stroke have been identified, one-third remain unexplained. Here we show that infection with Streptococcus mutans expressing collagen-binding protein (CBP) is a potential risk factor for haemorrhagic stroke. Infection with serotype k S. mutans, but not a standard strain, aggravates cerebral haemorrhage in mice. Serotype k S. mutans accumulates in the damaged, but not the contralateral hemisphere, indicating an interaction of bacteria with injured blood vessels. The most important factor for high-virulence is expression of CBP, which is a common property of most serotype k strains. The detection frequency of CBP-expressing S. mutans in haemorrhagic stroke patients is significantly higher than in control subjects. Strains isolated from haemorrhagic stroke patients aggravate haemorrhage in a mouse model, indicating that they are haemorrhagic stroke-associated. Administration of recombinant CBP causes aggravation of haemorrhage. Our data suggest that CBP of S. mutans is directly involved in haemorrhagic stroke. PMID:21952219

  9. Vesical Artery Embolization in Haemorrhagic Cystitis in Children.

    PubMed

    García-Gámez, Andrés; Bermúdez Bencerrey, Patricia; Brio-Sanagustin, Sonia; Guerrero Vara, Rubén; Sisinni, Luisa; Stuart, Sam; Roebuck, Derek; Gómez Muñoz, Fernando

    2016-07-01

    Haemorrhagic cystitis is an uncommon and, in its severe form, potentially life-threatening complication of haematopoietic stem cell transplantation or cancer therapy in children. The severe form involves macroscopic haematuria with blood clots, urinary obstruction and/or renal impairment. There are many therapeutic options to treat acute haemorrhage, but only recombinant factor VII has a high level of clinical evidence in children. Supraselective vesical artery embolization (SVAE) is an increasingly used therapeutic procedure for controlling haemorrhage in adults, but is less commonly used in children. This might be due to several factors, such as the invasive nature of the procedure, lack of appropriate medical experience and possible long-term side effects. We present three cases of children successfully treated by means of effective SVAE. PMID:26850734

  10. Intraventricular haemorrhage and periventricular leucomalacia: ultrasound and autopsy correlation.

    PubMed Central

    Trounce, J Q; Fagan, D; Levene, M I

    1986-01-01

    The brains of 30 infants who died after at least one real time ultrasound scan were examined after fixation. The ultrasound diagnosis of either periventricular haemorrhage or periventricular leucomalacia was compared with the macroscopic and histological appearances. Each hemisphere was considered separately for both periventricular haemorrhage and periventricular leucomalacia. The accuracy of ultrasound diagnosis for periventricular haemorrhage was 88%, with sensitivity of 91% and specificity of 85%. The accuracy for periventricular leucomalacia was 90%, with sensitivity of 85% and specificity of 93%. Ultrasound was shown to diagnose the entire range of periventricular leucomalacia lesions. Three hemispheres showed the appearance of prolonged flare, and this correlated with extensive spongiosis and microcalcification of the periventricular white matter, although no macroscopic lesion was seen. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:3545096

  11. Haemorrhagic complications of pancreatitis: presentation, diagnosis and management.

    PubMed Central

    Ammori, B. J.; Madan, M.; Alexander, D. J.

    1998-01-01

    Massive haemorrhage is an uncommon complication in pancreatitis. Most affected patients suffer from chronic disease with associated pseudocyst. We present five patients (four male) with a mean age of 41 years (range 34-48 years). All patients had alcohol-induced pancreatitis complicated either by haematemesis (3), intraperitoneal haemorrhage (1) or both haematemesis and intraperitoneal haemorrhage (1). Source of bleeding was pseudocyst wall (2), splenic artery pseudoaneurysm (2) and splenic artery rupture (1). Distal pancreatectomy and splenectomy was performed in two patients, intracystic ligation and drainage in two, and packing with subsequent external drainage in one. Rebleeding occurred in two patients and required subsequent distal pancreatectomy and splenectomy in one; the other patient died of splenic rupture. No rebleeding and no mortality occurred after resection. Primary pancreatic resection is recommended whenever possible. Other management options include embolisation and ligation. Images Figure 1 PMID:9849330

  12. Nososcomial transmission of viral haemorrhagic fever in South Africa.

    PubMed

    Richards, Guy A

    2015-09-01

    Recent events in West Africa have highlighted the potential for the viral haemorrhagic fevers (VHFs) to cause considerable mortality and morbidity among heathcare workers. However, this is not a new threat as, although the risk is currently increased, it has always been present. In South Africa (SA) the only endemic haemorrhagic fever is Crimean-Congo haemorrhagic fever, transmitted by the Hyalomma tick, which is ubiquitous in cattle farming areas. Johannesburg, the commercial and transport hub of SA, is unusual in that all cases of VHF seen there are imported, either from rural areas in SA or from countries to the north. Johannesburg functions as the gateway to and from the rest of Africa, and as a destination for more affluent residents of neighbouring countries seeking medical attention. Numerous outbreaks of nosocomial infection have occurred in SA, and these are described in the form of brief case reports. PMID:26428962

  13. Blood transfusion and the anaesthetist: management of massive haemorrhage

    PubMed Central

    Thomas, D; Wee, M; Clyburn, P; Walker, I; Brohi, K; Collins, P; Doughty, H; Isaac, J; Mahoney, PF; Shewry, L

    2010-01-01

    Hospitals must have a major haemorrhage protocol in place and this should include clinical, laboratory and logistic responses. Immediate control of obvious bleeding is of paramount importance (pressure, tourniquet, haemostatic dressings). The major haemorrhage protocol must be mobilised immediately when a massive haemorrhage situation is declared. A fibrinogen < 1 g.l−1 or a prothrombin time (PT) and activated partial thromboplastin time (aPTT) of > 1.5 times normal represents established haemostatic failure and is predictive of microvascular bleeding. Early infusion of fresh frozen plasma (FFP; 15 ml.kg−1) should be used to prevent this occurring if a senior clinician anticipates a massive haemorrhage. Established coagulopathy will require more than 15 ml.kg−1 of FFP to correct. The most effective way to achieve fibrinogen replacement rapidly is by giving fibrinogen concentrate or cryoprecipitate if fibrinogen is unavailable. 1:1:1 red cell:FFP:platelet regimens, as used by the military, are reserved for the most severely traumatised patients. A minimum target platelet count of 75 × 109.l−1 is appropriate in this clinical situation. Group-specific blood can be issued without performing an antibody screen because patients will have minimal circulating antibodies. O negative blood should only be used if blood is needed immediately. In hospitals where the need to treat massive haemorrhage is frequent, the use of locally developed shock packs may be helpful. Standard venous thromboprophylaxis should be commenced as soon as possible after haemostasis has been secured as patients develop a prothrombotic state following massive haemorrhage. PMID:20963925

  14. Haemorrhagic complications of peripartum anticoagulation: A retrospective chart review

    PubMed Central

    Wang, Erica HZ; Marnoch, Catherine A; Khurana, Rshmi; Sia, Winnie

    2014-01-01

    Background Women with venous thromboembolism (VTE), thrombophilias or mechanical heart valves may require anticoagulation during pregnancy and postpartum. The incidence of postpartum hemorrhage (PPH) in the literature is 2.9–6%, but the rate while on anticoagulation is not well documented. Aims To determine the incidence of haemorrhagic complications associated with the use of peripartum anticoagulation, and the types and risk factors for haemorrhagic complications. Methods A retrospective chart review was conducted on women who delivered at an academic teaching hospital and received peripartum anticoagulation between January 2000 and August 2009. Women with known bleeding disorders were excluded. Results In total, 195 cases were identified with mean age 31.3 years and gestational age of 37.7 weeks. Of these, 49% had a history of VTE, 21% had active VTE in the index pregnancy, and 63% had vaginal delivery. Types of anticoagulation used antepartum were unfractionated heparin (UFH) (43%) and low molecular weight heparin (LMWH) (36%), with 26% receiving therapeutic doses. The rate of haemorrhagic complications was 12.8%, with majority being PPH (80%). Sixty percent of the PPH occurred before reintroduction of anticoagulation postpartum. Use of therapeutic UFH antepartum was associated with increased risk of haemorrhagic complications compared to LMWH (OR 3.08, 95% CI 0.663 – 15.03, p = 0.183). Conclusion The rate of haemorrhagic complications is higher in women on peripartum anticoagulation compared with published incidence in unselected obstetric populations; however, this rate is similar to our institution’s reported rates. Our findings inform clinicians about competing risks of thrombotic and haemorrhagic complications in this population.

  15. Treatment of septicaemia and severe bacterial infections in foals with a new cefquinome formulation: a field study.

    PubMed

    Rohdich, Nadja; Zschiesche, Eva; Heckeroth, Anja; Wilhelm, Cornelia; Leendertse, Ietje; Thomas, Emmanuel

    2009-09-01

    A multicentre field study was conducted in accordance with VICH Guideline on Good Clinical Practice (VICH 2000) to confirm the efficacy and safety of a new formulation of cefquinome for the treatment of naturally occurring severe bacterial infections and septicaemia in foals. Thirty-nine foals suffering from severe bacterial infections (such as pneumonia, gastro-enteritis, arthritis, omphalitis, or wound infections) or acute septicaemia were treated twice daily with the test product (1 mg cefquinome/kg body weight) intravenously for three days and then intramuscularly for three to 11 days. Investigators examined the foals daily and scored both systemic and local clinical signs to assess the response to treatment, treatment success and relapses. On the day of inclusion a blood sample was taken from each foal for IgG determination and blood culture. In case of abnormal clinical findings additional samples were taken for bacteriology. Treatment was successful in 87.2% of cases (34 of 39 foals) and no relapses were observed. The average duration of treatment was 7.5 days. At inclusion, bacterial culture was positive in 40.5% (15 out of 37) of the blood cultures. Escherichia coli, Clostridium perfringens and Staphylococcus spp. were the most common isolates and were all susceptible to cefquinome. E. coli predominated in swabs from umbilical and open wound infections, and in rectal swabs E. coli. There was no correlation between IgG at inclusion and study outcome or treatment duration. The test product was very well tolerated by all of the foals following intravenous and intramuscular injection. The cefquinome formulation tested was effective and safe in the treatment of severe bacterial infections and septicaemia in foals under field conditions. PMID:19813447

  16. A new NOTCH3 mutation presenting as primary intracerebral haemorrhage.

    PubMed

    Pradotto, Luca; Orsi, Laura; Daniele, Dino; Caroppo, Paola; Lauro, Danilo; Milesi, Alessandra; Sellitti, Luigi; Mauro, Alessandro

    2012-04-15

    Primary intracerebral haemorrhages (PICH) are defined as haemorrhages within the brain parenchyma in the absence of readily identifiable causes. CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is a hereditary vascular disease and its mainly clinical manifestations are early-onset infarcts. Spontaneous lobar haematomas are a rare occurrence. We report a very unusual presentation of CADASIL in a 65 year-old man carrying a new NOTCH3 mutation. The clinical onset of the disease was related to an intracerebral haematoma following colon surgery and causing a delirium. In brief, our report suggests that CADASIL must be considered in patient with PICH. PMID:22206696

  17. Management of post-haemorrhagic hydrocephalus in premature infants.

    PubMed

    Ellenbogen, Jonathan R; Waqar, Mueez; Pettorini, Benedetta

    2016-09-01

    Post-haemorrhagic hydrocephalus (PHH) is the most common neurological complication of preterm birth and can result in severe and life-long psychomotor and cognitive sequelae. Cerebrospinal fluid diversion is often required but the optimum time for intervention is unclear. Numerous neurosurgical procedures exist to temporise PHH but it is not clear which is the optimum method. Approximately 15% of preterm infants who suffer intraventricular haemorrhage (IVH) will require permanent cerebrospinal fluid diversion with a ventriculoperitoneal shunt. It is likely that earlier intervention may result in reduced neurological disability and ventriculoperitoneal shunt dependency. In this review we discuss the current methods of PHH management. PMID:27369088

  18. Haemorrhagic Lumbar Juxtafacet Cyst with Ligamentum Flavum Involvement

    PubMed Central

    Ghent, Finn; Davidson, Trent; Mobbs, Ralph Jasper

    2014-01-01

    Juxtafacet cysts are an uncommon cause of radiculopathy. They occur most frequently in the lumbar region, and their distribution across the spine correlates with mobility. Haemorrhagic complications are rare and may occur in the absence of any provocation, although there is some association with anticoagulation and trauma. We present a case of acute radiculopathy due to an L5/S1 juxtafacet cyst with unprovoked haemorrhage which was found to extend into ligamentum flavum. The patient underwent uncomplicated microscope assisted decompression with excellent results. The demographics, presentation, aetiology, and management of juxtafacet cysts are discussed. PMID:25580330

  19. Characterization of a VHS virus genotype III isolated from rainbow trout (Oncorhychus mykiss) at a marine site on the west coast of Norway

    PubMed Central

    2010-01-01

    Background Norwegian production of rainbow trout (Oncorhynchus mykiss) has been without any outbreaks of VHS for many years until the disease emerged in a farm in western Norway in November 2007. The fish were, in addition to VHS virus, positive for gill chlamydia-like bacteria, Flavobacterium psychrophilum, and a microsporidian. A new VHS virus genotype III was isolated from the fish in RTgill-W1 cells and the complete coding region (11,065 nucleotides) was sequenced. This virus was also used in a challenge experiment to see if it could cause any mortality in rainbow trout in sea water. Results This is the first time a nearly complete sequence of a genotype III virus isolate has been presented. The organization of the genes is the same as in the other VHS virus genotypes studied (GI and GIV). Between the ORFs are nontranslated regions that contain highly conserved sequences encompassing the polyadenylation signal for one gene, and the putative transcription initiation site of the next gene. The intergenic regions vary in length from 74 nt to 128 nt. The nucleotide sequence is more similar to genotype I isolates compared to isolates from genotype II and IV. Analyses of the sequences of the N and G protein genes show that this new isolate is distinct from other VHS virus isolates and groups closely together with isolates from genotype III. In a challenge experiment, using intraperitoneal (ip) injection of the isolate, co-habitation with infected fish, and bath challenge, mortalities slightly above 40% were obtained. There was no significant difference in mortality between the bath challenged group and the ip injected group, while the mortality in the co-habitation group was as low as 30%. Conclusions All VHS virus isolates in genotype III are from marine fish in the North East Atlantic. Unlike the other known genotype III isolates, which are of low virulence, this new isolate is moderately virulent. It was not possible to detect any changes in the virus genome that

  20. Expression of NLRC4 in children with septicaemia and mechanisms of NLRC4 in in vitro cytokine secretion.

    PubMed

    Zhu, Guoji; Chen, Jing; Tian, Jianmei; Ge, Lingqing; Xing, Aixia; Tang, Guangming

    2016-07-01

    Septicaemia, a systemic bacterial infection, frequently leads to morbidity and mortality in children. The NOD-like receptor (NLR) family, CARD domain containing 4 (NLRC4) is involved in the control of infections. The aim of the present study was to detect the expression of NLRC4 in the blood samples of children with septicaemia, in addition to investigating the importance of NLRC4 in cytokine production, and the signaling pathways that regulate NLRC4 expression in lipopolysaccharide (LPS)-stimulated macrophages. It was determined that when compared with the control, the mRNA and protein expression levels of NLRC4 were significantly increased in the blood samples of children with septicaemia, as demonstrated by the reverse transcription‑quantitative polymerase chain reaction and western blot analysis. The results from the western blotting indicated that treatment with LPS induced NLRC4 expression in a time‑ and dose‑dependent manner in RAW264.7 cells. A knockdown of NLRC4 by siRNA transfection enhanced the effect of LPS on interleukin (IL)‑1β and IL‑18 production, as determined by enzyme‑linked immunosorbent assay. Inhibitors of extracellular regulated protein kinases, c‑Jun N‑terminal kinases and p38 were used in the present study to block the mitogen‑activated protein kinase (MAPK) signaling pathway, and it was determined that LPS‑induced NLRC4 expression was reversed by the suppression of the MAPK signaling pathway. To the best of our knowledge, this is the first report regarding the expression of NLRC4 in children with septicaemia. Furthermore, a novel molecular mechanism for NLRC4 regulation in LPS‑induced RAW264.7 macrophage cells has been elucidated. The data in the present study supports the hypothesis that LPS activates the MAPK pathway in macrophages, thus resulting in the upregulation of NLRC4; however, NLRC4 inhibits IL‑1β and IL‑18 production, contributing to the anti-inflammatory response. PMID:27175981

  1. Flavimonas oryzihabitans septicaemia in a T-cell leukaemic child: a case report and review of the literature.

    PubMed

    Podbielski, A; Mertens, R; Ziebold, C; Kaufhold, A

    1990-03-01

    We describe the first case of septicaemia with Flavimonas oryzihabitans reported from Germany and possibly associated with colonisation of a venous port system. The patient, an 8-year-old T-cell leukaemic girl, was receiving a third course of chemotherapy before bone marrow transplantation. The cardinal symptom, fever, subsided when the venous port system for administration of drugs was no more used. The organism was tested extensively for characteristic biochemical features and antimicrobial susceptibility. We discuss the relevant literature and suggest the means of making a definitive microbiological diagnosis. PMID:2181025

  2. Neonatal mycotic internal iliac aneurysm due to methicillin-resistant Staphylococcus aureus (MRSA) septicaemia successfully treated by coil embolisation.

    PubMed

    Khandanpour, N; Chaudhuri, A; Roebuck, D J; Armon, M P

    2007-06-01

    A 12-day-old term male neonate presented with septic arthritis, multiple skin and intrabdominal abscesses and a mycotic aneurysm of the right internal iliac artery. He was diagnosed as having methicillin resistant staphylococcus aureus (MRSA) septicaemia and deemed unsuitable for surgical treatment of the aneurysm. Coil embolisation of the internal iliac artery was performed, followed by a successful recovery and with no evidence of residual or recurrent infection. The authors describe a method of treating internal iliac mycotic aneurysms in high-risk patients by endovascular means, which we believe has not been attempted in this precise scenario before. PMID:17276103

  3. Breathing-Impaired Speech after Brain Haemorrhage: A Case Study

    ERIC Educational Resources Information Center

    Heselwood, Barry

    2007-01-01

    Results are presented from an auditory and acoustic analysis of the speech of an adult male with impaired prosody and articulation due to brain haemorrhage. They show marked effects on phonation, speech rate and articulator velocity, and a speech rhythm disrupted by "intrusive" stresses. These effects are discussed in relation to the speaker's…

  4. Diffuse alveolar haemorrhage associated with aerosol propellant use

    PubMed Central

    Kelchen, Phillip; Jamous, Fady; Huntington, Mark K

    2013-01-01

    Diffuse alveolar haemorrhage (DAH) is a clinical syndrome resulting from injury to the alveolar microcirculation, most commonly associated with not only autoimmune disorders or connective tissue disease, but also a variety of infections, neoplasms and toxins. We report here a case of an otherwise healthy young man with DAH attributable to an inhalation injury resulting from use of aerosol spray paint. PMID:23955981

  5. Haemorrhage in seven cats with suspected anticoagulant rodenticide intoxication.

    PubMed

    Kohn, B; Weingart, C; Giger, U

    2003-10-01

    Clinical features were evaluated in seven adult cats (six males, one female) with haemorrhage and presumptive anticoagulant rodenticide intoxication. Haemorrhage appeared as thoracic haemorrhage, otic bleeding, haematoma, melena, haematochezia, and petechiation. The most common other presenting signs were lethargy, anorexia, and tachypnoea or dyspnoea. Six cats were anaemic, four cats were mildly thrombocytopenic (58000-161000/ microL), and three had slightly decreased plasma protein or albumin values. The prothrombin time (30.3->100 s, reference range: 16.5-27.5 s) and activated partial thromboplastin time values (32.6->100 s; reference range: 14-25 s) were markedly prolonged in all cats. All cats received vitamin K(1)subcutaneously or orally (3.7-5 mg/kg body weight initially) and depending on severity of signs five cats were transfused with fresh whole blood. Plasma coagulation times improved in all cats and returned to normal in 1-5 days. Rodenticide poisons represent an important but relatively rare cause of haemorrhage in cats and can be effectively treated. PMID:12948505

  6. The health, social and educational needs of children who have survived meningitis and septicaemia: the parents’ perspective

    PubMed Central

    2013-01-01

    Background Survivors of bacterial meningitis and septicaemia can experience a range of after-effects. There is little published research on the needs and provision of aftercare for children surviving bacterial meningitis and septicaemia. Methods Mixed methods study employing a survey and follow-up interviews with a sample of survey participants recruited from Meningitis Research Foundation’s member database and social media. Results Of 194 eligible survey respondents, 77% reported at least moderate short-term after-effects, and 57% a need for aftercare or support. Most parents reported that their child received a hearing test (98%) and follow-up appointment with a paediatrician (66%). Psychosocial after-effects were most common and the greatest need was for educational support. About half of participants felt their children’s needs for aftercare were met. We conducted interviews with 18 parents. Findings suggest access could be limited by: parents’ inability to navigate systems in place, child’s age, and delayed identification of sequelae. Parents felt a comprehensive explanation of possible after-effects on discharge from hospital was required, and found uncertain prognoses difficult. Good communication between professionals enabled a service tailored to the child’s needs. Conclusions Our study supports the NICE and SIGN guidelines and highlights areas for improvement in the aftercare of these children. PMID:24112360

  7. Endoscopic management of hypertensive intraventricular haemorrhage with obstructive hydrocephalus

    PubMed Central

    Yadav, Yad Ram; Mukerji, Gaurav; Shenoy, Ravikiran; Basoor, Abhijeet; Jain, Gaurav; Nelson, Adam

    2007-01-01

    Background Intracranial haemorrhage accounts for 30–60 % of all stroke admissions into a hospital, with hypertension being the main risk factor. Presence of intraventricular haematoma is considered a poor prognostic factor due to the resultant obstruction to CSF and the mass effect following the presence of blood resulting in raised intracranial pressure and hydrocephalus. We report the results following endoscopic decompression of obstructive hydrocephalus and evacuation of haematoma in patients with hypertensive intraventricular haemorrhage. Methods During a two year period, 25 patients diagnosed as having an intraventricular haemorrhage with obstructive hydrocephalus secondary to hypertension were included in this study. All patients underwent endoscopic evacuation of the haematoma under general anaesthesia. Post operative evaluation was done by CT scan and Glasgow outcome scale. Results Of the 25 patients, thalamic haemorrhage was observed in 12 (48%) patients, while, 11 (44%) had a putaminal haematoma. Nine (36%) patients had a GCS of 8 or less pre-operatively. Resolution of hydrocephalus following endoscopic evacuation was observed in 24 (96%) patients. No complications directly related to the surgical technique were encountered in our study. At six months follow-up, a mortality rate of 6.3% and 55.5% was observed in patients with a pre-operative GCS of ≥ 9 and ≤ 8 respectively. Thirteen of the 16 (81.3%) patients with a pre-operative GCS ≥ 9 had good recovery. Conclusion Endoscopic technique offers encouraging results in relieving hydrocephalus in hypertensive intraventricular haemorrhage. Final outcome is better in patient with a pre-operative GCS of >9. Future improvements in instrumentation and surgical techniques, with careful case selection may help improve outcome in these patients. PMID:17204141

  8. Resuscitation in massive obstetric haemorrhage using an intraosseous needle.

    PubMed

    Chatterjee, D J; Bukunola, B; Samuels, T L; Induruwage, L; Uncles, D R

    2011-04-01

    A 38-year-old woman experienced a massive postpartum haemorrhage 30 minutes after emergency caesarean delivery. The patient became severely haemodynamically compromised with an unrecordable blood pressure. Rapid fluid resuscitation was limited by the capacity of the intravenous cannula in place at the time and inability to establish additional vascular access using conventional routes in a timely manner. An intraosseous needle was inserted in the proximal humerus at the first attempt and administration of resuscitation fluid by this route subsequently enabled successful placement of further intravenous lines. Blood and blood products were deployed in conjunction with intra-operative cell salvage and transoesophageal Doppler cardiac output monitoring was used to assess adequacy of volume replacement. Haemorrhage control was finally achieved with the use of recombinant factor VIIa and hysterectomy. PMID:21401545

  9. Detection and localization of internal haemorrhaging using electrical bioimpedance

    NASA Astrophysics Data System (ADS)

    Morse, J.; Fenech, M.

    2013-04-01

    Electrical bioimpedance is an effective measuring tool to provide quick, non-invasive, real-time results which will be applied to the detection of internal haemorrhaging. Experiments were performed on female Fancy Rats weighing 333±44g, and 10mL of porcine blood was injected abdominally over 3 minutes. Data was collected using an 8×8 needle electrode array at 5 kHz, and 95 kHz and sent to the BioParHom Z-Flow. A strong correlation was found between the electrode paths crossing directly through the blood injection site, showing a decrease of about -0.17±0.1Ω/mL for the 5 kHz frequency. This correlation allows us to quickly detect internal haemorrhaging and also localize it with the current path set-up in the electrode array.

  10. Prevention of upper gastrointestinal haemorrhage: current controversies and clinical guidance

    PubMed Central

    Brooks, Johanne; Warburton, Richard

    2013-01-01

    Acute upper gastrointestinal (GI) bleeding is a common medical emergency and associated with significant morbidly and mortality. The risk of bleeding from peptic ulceration and oesophagogastric varices can be reduced by appropriate primary and secondary preventative strategies. Helicobacter pylori eradication and risk stratification with appropriate gastroprotection strategies when used with antiplatelet drugs and nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in preventing peptic ulcer bleeding, whilst endoscopic screening and either nonselective beta blockade or endoscopic variceal ligation are effective at reducing the risk of variceal haemorrhage. For secondary prevention of variceal haemorrhage, the combination of beta blockade and endoscopic variceal ligation is more effective. Recent data on the possible interactions of aspirin and NSAIDs, clopidogrel and proton pump inhibitors (PPIs), and the increased risk of cardiovascular adverse events associated with all nonaspirin cyclo-oxygenase (COX) inhibitors have increased the complexity of choices for preventing peptic ulcer bleeding. Such choices should consider both the GI and cardiovascular risk profiles. In patients with a moderately increased risk of GI bleeding, a NSAID plus a PPI or a COX-2 selective agent alone appear equivalent but for those at highest risk of bleeding (especially those with previous ulcer or haemorrhage) the COX-2 inhibitor plus PPI combination is superior. However naproxen seems the safest NSAID for those at increased cardiovascular risk. Clopidogrel is associated with a significant risk of GI haemorrhage and the most recent data concerning the potential clinical interaction of clopidogrel and PPIs are reassuring. In clopidogrel-treated patients at highest risk of GI bleeding, some form of GI prevention is indicated. PMID:23997925

  11. Spontaneous subdural haemorrhage in a patient with scleroderma renal crisis

    PubMed Central

    Bhangoo, Munveer Singh; Hein, Paul; Nicholson, Laura; Carter, Caitlin

    2014-01-01

    A 52-year-old woman with a history of systemic sclerosis presented with new onset seizures and renal failure. The patient's history, laboratory data and pathology supported the diagnosis of scleroderma renal crisis. The patient was also noted to have a subdural haemorrhage (SDH) in the absence of trauma. This is the first report of scleroderma renal crisis associated with a spontaneous SDH. PMID:25193814

  12. Early heparin therapy in patients with spontaneous intracerebral haemorrhage.

    PubMed Central

    Boeer, A; Voth, E; Henze, T; Prange, H W

    1991-01-01

    In 68 patients with spontaneous intracerebral haemorrhage the effect of heparin treatment beginning on the second, fourth or tenth day was investigated. Early (day 2) low-dose heparin medication significantly lowered the incidence of pulmonary embolism. An increase in the number of patients with rebleeding was not observed. The results indicate that the early use of heparin in these patients is safe and can be recommended for the prevention of thromboembolic complications. PMID:1865215

  13. Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II) Protocol

    PubMed Central

    2011-01-01

    Background Within the spectrum of spontaneous intracerebral haemorrhage there are some patients with large or space occupying haemorrhage who require surgery for neurological deterioration and others with small haematomas who should be managed conservatively. There is equipoise about the management of patients between these two extremes. In particular there is some evidence that patients with lobar haematomas and no intraventricular haemorrhage might benefit from haematoma evacuation. The STICH II study will establish whether a policy of earlier surgical evacuation of the haematoma in selected patients will improve outcome compared to a policy of initial conservative treatment. Methods/Design an international multicentre randomised parallel group trial. Only patients for whom the treating neurosurgeon is in equipoise about the benefits of early craniotomy compared to initial conservative treatment are eligible. All patients must have a CT scan confirming spontaneous lobar intracerebral haemorrhage (≤1 cm from the cortex surface of the brain and 10-100 ml in volume). Any clotting or coagulation problems must be corrected and randomisation must take place within 48 hours of ictus. With 600 patients, the study will be able to demonstrate a 12% benefit from surgery (2p < 0.05) with 80% power. Stratified randomisation is undertaken using a central 24 hour randomisation service accessed by telephone or web. Patients randomised to early surgery should have the operation within 12 hours. Information about the status (Glasgow Coma Score and focal signs) of all patients through the first five days of their trial progress is also collected in addition to another CT scan at about five days (+/- 2 days). Outcome is measured at six months via a postal questionnaire to the patient. Primary outcome is death or severe disability defined using a prognosis based 8 point Glasgow Outcome Scale. Secondary outcomes include: Mortality, Rankin, Barthel, EuroQol, and Survival. Trial

  14. Blood products and their use in traumatic major haemorrhage.

    PubMed

    Deveau, Simon Ross

    2016-02-01

    Blood loss due to trauma is a leading cause of death in young people and is the result of the 'lethal triad' of hypothermia, acidosis and coagulopathy, which collectively reduce haemostasis. Emergency department nurses can help to reverse the triad through the timely and efficient use of blood products and fluids. This article briefly examines different blood groups, describes the elements of the lethal triad, and discusses the blood products used to transfuse patients with major haemorrhage. PMID:26853674

  15. Nosocomial ventriculitis due to Roseomonas gilardii complicating subarachnoid haemorrhage.

    PubMed

    Nolan, Jason S; Waites, Ken B

    2005-04-01

    Roseomonas gilardii is a pink-pigmented, non-fermentative, Gram-negative coccobacillus that has been recognized as a rare cause of human infections. We report the first case of ventriculitis caused by R. gilardii in a 54-year-old man with a subarachnoid haemorrhage secondary to a vertebral artery aneurysm; discuss previous reports of this organism as a nosocomial and community-acquired pathogen, laboratory diagnosis, and patient management. PMID:15780421

  16. Intraventricular haemorrhage in the preterm infant without hyaline membrane disease.

    PubMed Central

    Wigglesworth, J S; Davies, P A; Keith, I H; Slade, S A

    1977-01-01

    The clinicopathological associations of 33 singleton infants who died with intraventricular haemorrhage (IVH) without hyaline membrane disease (HMD) ('IVH only') were compared with those of 39 infants who died with IVH+HMD over the same gestation range in order to determine what factors other than those related to HMD may contribute to the pathogenesis of IVH. The incidence of 'IVH only' was inversely related to gestational age in the Hammersmith birth population, whereas the incidence of IVH+HMD rose to a peak at 28-29 weeks' gestation. Infants with 'IVH only' lived longer on average than those with IVH+HMD despite a lower birthweight and shorter gestation. Infants who died in the first 12 hours from 'IVH only' had suffered severe birth asphyxia but in those who died later the main symptom was recurrent apnoea. Fewer infants with asphyxia but in those who died later the main symptom was.recurrent apnoea. Fewer infants with 'IVH only' were given alkali therapy or were connected to the ventilator as compared to those with IVH+HMD, but there were no differences in alkali therapy in those who lived for 12 hours or more. In the 'IVH only' group there was a high incidence of haemorrhage from other sites and of bacterial infections. It is suggested that, in the absence of HMD, extreme immaturity is the main factor determining the occurrence of IVH. Birth asphyxia, apnoeic attacks, haemorrhage, and infections may play subsidiary roles, possibly through development of metabolic acidosis. PMID:879829

  17. Managing Major Postpartum Haemorrhage following Acute Uterine Inversion with Rusch Balloon Catheter

    PubMed Central

    Keriakos, Remon; Chaudhuri, Smriti Ray

    2011-01-01

    Acute postpartum uterine inversion is a relatively rare complication. The uterus inverts and the uterine fundus prolapses to or through the dilated cervix. It is associated with major postpartum haemorrhage with or without shock. Shock is sometimes out of proportion to the haemorrhage. Minimal maternal morbidity and mortality can be achieved when uterine inversion is promptly and aggressively managed. We present this report of three cases of acute uterine inversion complicated with major postpartum haemorrhage and managed with Rusch balloon. The paper highlights the importance of early recognition and the safety of the use of intrauterine balloon to manage major postpartum haemorrhage in these cases. PMID:24826322

  18. Origin of intraventricular haemorrhage in the preterm infant.

    PubMed Central

    Hambleton, G; Wigglesworth, J S

    1976-01-01

    A technique has been developed for the injection and stereomicroscopic examination of blood vessels in the preterm newborn brain. Using this technique it can be seen that in the immature brain there is a rich capillary bed in the germinal layer region supplied mainly by Heubner's artery. Capillary channels drain directly into the terminal vein and its main branches. Study of 19 cases with spontaneous germinal layer haemorrhage (GLH) with or without intraventricular haemorrhage (IVH) failed to show rupture of the terminal vein or germinal layer infarction. In babies of up to 28 weeks' gestation GLH developed most frequently over the body of the caudate nucleus, whereas in babies of 29 weeks' gestation or more the haemorrhages were usually over the head of the caudate nucleus. Histological study of 10 cases of GLH failed to show rupture either of arteries or veins, though evidence of rupture at a capillary-vein junction was seen in one case and masses of fibrin adjacent to the vein wall in 2 others. Injection through the carotid artery caused prominent leaks of injection mass within the germinal layer capillary bed, often adjacent to the veins. Injection through the jugular veins in 2 cases failed to rupture the terminal vein but caused multiple vein ruptures at the junction of deep and cortical venous systems. Additional small ruptures in the germinal layer occurred in one of the cases only. It is suggested that the capillaries within the germinal layer may be ruptured by a rise in arterial pressure, particularly in conditions of hypercapnia and hypoxia. Images FIG. 3 FIG. 4 FIG. 5 FIG. 6 FIG. 7 FIG. 8 FIG. 9 FIG. 10 FIG. 11 FIG. 12 FIG. 13 PMID:999324

  19. Intracerebral haemorrhage in primary and metastatic brain tumours.

    PubMed

    Salmaggi, Andrea; Erbetta, Alessandra; Silvani, Antonio; Maderna, Emanuela; Pollo, Bianca

    2008-09-01

    Intracerebral haemorrhage may both be a presenting manifestation in unrecognised brain tumour or--more frequently--take place in the disease course of known/suspected brain tumour due to diagnostic/therapeutic procedures, including biopsy, locoregional treatments and anti-angiogenic therapies. Apart from the difficulties inherent to accurate neuroradiological diagnosis in selected cases with small tumour volume, the main clinical problem that neurologists face is represented by decision making in prophylaxis/treatment of venous thromboembolism in these patients. These points are briefly discussed and available evidence on the last point is commented on. PMID:18690513

  20. [Seizures caused by subarachnoid haemorrhage in a pregnant woman].

    PubMed

    Shim, Susy; Christiansen, Ulla Birgitte; Sørensen, Anne Nødgaard

    2016-07-25

    This case report describes a pregnant woman of gestational week 37 + 2 days who was admitted to the hospital with first-time seizures. The patient was stabilized, and an acute caesarian section was performed due to the possible aetiology of eclampsia and the advanced gestational age. Because of the atypical clinical history and normal maternal blood samples a computed tomography of the cerebrum was performed demonstrating a subarachnoid haemorrhage. A computed tomography-angiography revealed an aneurism at the anterior communicating artery. The aneurism was coiled the following day to reduce the risk of rebleeding. PMID:27460576

  1. Cerebral blood flow changes in acute experimental haemorrhagic vasospasm.

    PubMed

    Jakubowski, J; McCleery, W N; Todd, J H; Smart, R C

    1976-01-01

    Subarachnoid haemorrhage was produced in 26 dogs by injecting fresh homogenous blood into the cysterna chiasmatica. Two types of vasospasm were observed, firstly segmental arterial spasm closely related to the bleeding point and secondly generalized arterial vasospasm not directly related to the bleeding point and often occurring some way from the bleeding point. Reduction in CBF occurred in 61% of cases and was always accompanied by radiological vasospasm. However, in about one quarter of the cases with vasospasm there was no alteration in CBF. PMID:961484

  2. [Leptospirosis with necro-haemorrhagic cholecystitis in a Boxer puppy].

    PubMed

    Steil, D; Quandt, A; Mayer-Scholl, A; Sie, J M; Löhr, C V; Teifke, J P

    2014-01-01

    A Boxer puppy from the island of Rügen, which was properly vaccinated according to its age, was presented with acute gastrointestinal symptoms. The presumptive diagnosis of leptospirosis with acute renal failure, hepatic damage, and jaundice was confirmed by seroconversion (increased titre to 1 : 800 in a non-vaccine serogroup 4 weeks after disease onset). Cholecystitis was diagnosed based on clinical symptoms and sonographic results. After an initial improvement, the puppy's condition deteriorated and cholecystectomy was performed. Histopathological diagnosis indicated a haemorrhagic necrotizing cholecystitis. PMID:25423604

  3. B7 Costimulation Molecules Encoded by Replication-Defective, vhs-Deficient HSV-1 Improve Vaccine-Induced Protection against Corneal Disease

    PubMed Central

    Schrimpf, Jane E.; Tu, Eleain M.; Wang, Hong; Wong, Yee M.; Morrison, Lynda A.

    2011-01-01

    Herpes simplex virus 1 (HSV-1) causes herpes stromal keratitis (HSK), a sight-threatening disease of the cornea for which no vaccine exists. A replication-defective, HSV-1 prototype vaccine bearing deletions in the genes encoding ICP8 and the virion host shutoff (vhs) protein reduces HSV-1 replication and disease in a mouse model of HSK. Here we demonstrate that combining deletion of ICP8 and vhs with virus-based expression of B7 costimulation molecules created a vaccine strain that enhanced T cell responses to HSV-1 compared with the ICP8−vhs− parental strain, and reduced the incidence of keratitis and acute infection of the nervous system after corneal challenge. Post-challenge T cell infiltration of the trigeminal ganglia and antigen-specific recall responses in local lymph nodes correlated with protection. Thus, B7 costimulation molecules expressed from the genome of a replication-defective, ICP8−vhs− virus enhance vaccine efficacy by further reducing HSK. PMID:21826207

  4. The effect of acute haemorrhage in the dog and man on plasma-renin concentration

    PubMed Central

    Brown, J. J.; Davies, D. L.; Lever, A. F.; Robertson, J. I. S.; Verniory, A.

    1966-01-01

    1. The effect of acute haemorrhage on the plasma renin concentration was studied in the dog and man. 2. Plasma-renin concentration was regularly increased after the larger bleeds; after the smaller haemorrhages plasma-renin concentration remained unchanged. 3. The results are discussed in relation to current hypotheses concerning the control of renin and aldosterone secretion. PMID:4287431

  5. Purification and characterization of an organ specific haemorrhagic toxin from Vipera russelli russelli (Russell's viper) venom.

    PubMed

    Kole, L; Chakrabarty, D; Datta, K; Bhattacharyya, D

    2000-04-01

    A haemorrhagic toxin (VRR-12) from Vipera russelli russelli (Russell's viper) venom has been purified by ion-exchange chromatography on CM-Sephadex C-50 followed by size-exclusion HPLC to electrophoretically homogeneous state. It is a 12 kDa single polypeptide having 1 mole of Zn+2 ion. This toxin induces intense intestinal haemorrhage and to a lesser extent skeletal muscle haemorrhage in mice. It does not show detectable proteolytic and esterolytic activity with selected substrates under specified conditions, haemolytic and phospholipase activity. When VRR-12, preincubated with bivalent antiserum against Saw-scaled and Russell's viper venom or EDTA was injected, haemorrhagic activity was not reduced, on the other hand preincubation with phenylmethyl sulphonyl fluoride reduced the activity markedly. Biodistribution studies with 125I VRR-12 show that haemorrhagic manifestation by this toxin is not a direct function of the fraction of the totally administered toxin distributed to that tissue. PMID:10983422

  6. Recombinant activated factor VII in post partum haemorrhage

    PubMed Central

    Magon, Navneet; Babu, K. M.; Kapur, Krishan; Chopra, Sanjiv; Joneja, Gurdarshan Singh

    2013-01-01

    Post-partum haemorrhage (PPH) is a life-threatening obstetric complication and the leading cause of maternal death. Any bleeding that results in or could result in haemodynamic instability, if untreated, must be considered as PPH. There is no controversy about the need for prevention and treatment of PPH. The keystone of management of PPH entails first, non-invasive and nonsurgical methods and then invasive and surgical methods. However, mortality remains high. Therefore, new advancements in the treatment are most crucial. One such advancement has been the use of recombinant activated factor VII (rFVIIa) in PPH. First used 12 years back in PPH, this universal haemostatic agent has been effectively used in controlling PPH. The best available indicator of rFVIIa efficacy is the arrest of haemorrhage, which is judged by visual evidence and haemodynamic stabilization. It also reduces costs of therapy and the use of blood components in massive PPH. In cases of intractable PPH with no other obvious indications for hysterectomy, administration of rFVIIa should be considered before surgery. We share our experience in a series of cases of PPH, successfully managed using rFVIIa. PMID:24403703

  7. An outbreak of acute haemorrhagic conjunctivitis in Kaduna, Nigeria.

    PubMed Central

    Babalola, O E; Amoni, S S; Samaila, E; Thaker, U; Darougar, S

    1990-01-01

    Clinical studies were carried out on two groups of patients with acute haemorrhagic conjunctivitis (AHC) during an epidemic in 1985 in Northern Nigeria. Group 1 consisted of 99 students attending a girls' boarding school, group 2 of 200 patients selected randomly from 1000 examined at the local clinic. Moderate to severe hyperaemia and papillary responses were present in the palpebral conjunctiva of all patients, and 234 (66%) had subconjunctival haemorrhages. Transient superficial punctate keratitis was noted in over 60% of patients. A transient flare suggestive of a low grade iritis was seen in five patients. No neurological disorders were noted. Serological studies were carried out on patients from group 2. Fifteen paired and 20 single serum samples were titrated against adenovirus type 4 (Ad-4) and enterovirus type 70 (EV-70). Two pairs of sera showed a 4-fold rise in antibody levels to EV-70, whereas the antibody titres to EV-70 in the rest of the sera ranged from 1:20 (no antibody) to 1:160. None of the paired serum samples showed a 4-fold rise in antibody levels to adenovirus. The results of clinical studies and serological findings support EV-70 as a probable cause of AHC in Nigeria. PMID:2155654

  8. Intracerebral haemorrhage in Down syndrome: protected or predisposed?

    PubMed Central

    Buss, Lewis; Fisher, Elizabeth; Hardy, John; Nizetic, Dean; Groet, Jurgen; Pulford, Laura; Strydom, André

    2016-01-01

    Down syndrome (DS), which arises from trisomy of chromosome 21, is associated with deposition of large amounts of amyloid within the central nervous system. Amyloid accumulates in two compartments: as plaques within the brain parenchyma and in vessel walls of the cerebral microvasculature. The parenchymal plaque amyloid is thought to result in an early onset Alzheimer’s disease (AD) dementia, a phenomenon so common amongst people with DS that it could be considered a defining feature of the condition. The amyloid precursor protein ( APP) gene lies on chromosome 21 and its presence in three copies in DS is thought to largely drive the early onset AD. In contrast, intracerebral haemorrhage (ICH), the main clinical consequence of vascular amyloidosis, is a more poorly defined feature of DS. We review recent epidemiological data on stroke (including haemorrhagic stroke) in order to make comparisons with a rare form of familial AD due to duplication (i.e. having three copies) of the APP region on chromosome 21, here called ‘dup-APP’, which is associated with more frequent and severe ICH. We conclude that although people with DS are at increased risk of ICH, this is less common than in dup-APP, suggesting the presence of mechanisms that act protectively. We review these mechanisms and consider comparative research into DS and dup-APP that may yield further pathophysiological insight. PMID:27239286

  9. Platelet count and transfusion requirements during moderate or severe postpartum haemorrhage.

    PubMed

    Jones, R M; de Lloyd, L; Kealaher, E J; Lilley, G J; Precious, E; Burckett St Laurent, D; Hamlyn, V; Collis, R E; Collins, P W

    2016-06-01

    Limited data exist on platelet transfusion during postpartum haemorrhage. We retrospectively analysed a consecutive cohort from a single centre of 347 women with moderate or severe postpartum haemorrhage, transfused according to national guidelines. Twelve (3%) women required a platelet transfusion. There were no differences between women who did and did not receive platelets with respect to age, mode of initiation of labour or mode of delivery. Women receiving a platelet transfusion had a lower median (IQR [range]) platelet count at study entry than women who did not receive platelets before haemorrhage (135 (97-175 [26-259])×10(9) .l(-1) vs 224 (186-274 [91-1006])×10(9) .l(-1) ), respectively), and at diagnosis of postpartum haemorrhage (median 114 (78-153 [58-238])×10(9) .l(-1) vs 193 (155-243 [78-762])×10(9) .l(-1) respectively). Six women were thrombocytopenic pre-delivery. The cause of haemorrhage that was associated with the highest rate of platelet transfusion was placental abruption, with three of 14 women being transfused. If antenatal thrombocytopenia or consumptive coagulopathy were not present, platelets were only required for haemorrhage > 5000 ml. Early formulaic platelet transfusion would have resulted in many women receiving platelets unnecessarily. Using current guidelines, the need for platelet transfusion is uncommon without antenatal thrombocytopenia, consumptive coagulopathy or haemorrhage > 5000 ml. We found no evidence to support early fixed-ratio platelet transfusion. PMID:27062151

  10. Protective effect of vitamin E (DL-alpha-tocopherol) against intraventricular haemorrhage in premature babies.

    PubMed Central

    Chiswick, M L; Johnson, M; Woodhall, C; Gowland, M; Davies, J; Toner, N; Sims, D G

    1983-01-01

    Forty four babies, of less than 32 weeks' gestation, were either randomly given 25 mg/kg vitamin E (DL-alpha-tocopherol acetate) intramuscularly after birth (day 0) and on days 1, 2, and 3 or served as controls. Frequent real time ultrasound examinations of the brain were made in each baby during the first week and less frequently thereafter. In babies under 32 weeks' gestation the incidence of intraventricular haemorrhage was lower in supplemented babies (18.8%) compared with the controls (56.3%). On days 0, 1, 2, and 3 median plasma vitamin E concentrations in babies without haemorrhage and in those with subependymal haemorrhage only were similar. Babies with intraventricular haemorrhage had lower median concentrations on day 1 (p less than 0.002) and day 2 (p less than 0.05) compared with those with subependymal haemorrhage and lower concentrations on day 0 (p less than 0.02) and day 1 (p less than 0.05) compared with those without haemorrhage. These findings suggest that in premature babies vitamin E, an antioxidant, protects endothelial cell membranes from oxidative damage and disruption and limits the magnitude of haemorrhage and its spread from the subependyma into the ventricles. Images FIG 1 PMID:6407714

  11. Diagnostic laboratory for bleeding disorders ensures efficient management of haemorrhagic disorders.

    PubMed

    Riddell, A; Chuansumrit, A; El-Ekiaby, M; Nair, S C

    2016-07-01

    Haemorrhagic disorders like Postpartum haemorrhage and Dengue haemorrhagic fever are life threatening and requires an active and efficient transfusion service that could provide the most appropriate blood product which could be effective in managing them. This would essentially require prompt identification of the coagulopathy so that the best available product can be given to the bleeding patient to correct the identified haemostatic defect which will help control the bleeding. This would only be possible if the transfusion service has a laboratory to correctly detect the haemostatic defect and that too with an accuracy and precision which is ensured by a good laboratory quality assurance practices. These same processes are necessary for the transfusion services to ensure the quality of the blood products manufactured by them and that it contains adequate amounts of haemostasis factors which will be good to be effective in the management of haemorrhagic disorders. These issues are discussed in detail individually in the management of postpartum haemorrhage and Dengue haemorrhagic fever including when these can help in the use of rFVIIa in Dengue haemorrhagic fever. The requirements to ensure good-quality blood products are made available for the management of these disorders and the same have also been described. PMID:27405683

  12. Consent for Brain Tissue Donation after Intracerebral Haemorrhage: A Community-Based Study

    PubMed Central

    Samarasekera, Neshika; Lerpiniere, Christine; Farrall, Andrew J.; Wardlaw, Joanna M.; White, Philip M.; Torgersen, Antonia; Ironside, James W.; Smith, Colin; Al-Shahi Salman, Rustam

    2015-01-01

    Background Spontaneous intracerebral haemorrhage is a devastating form of stroke and its incidence increases with age. Obtaining brain tissue following intracerebral haemorrhage helps to understand its cause. Given declining autopsy rates worldwide, the feasibility of establishing an autopsy-based collection and its generalisability are uncertain. Methods We used multiple overlapping sources of case ascertainment to identify every adult diagnosed with intracerebral haemorrhage between 1st June 2010-31st May 2012, whilst resident in the Lothian region of Scotland. We sought consent from patients with intracerebral haemorrhage (or their nearest relative if the patient lacked mental capacity) to conduct a research autopsy. Results Of 295 adults with acute intracerebral haemorrhage, 110 (37%) could not be approached to consider donation. Of 185 adults/relatives approached, 91 (49%) consented to research autopsy. There were no differences in baseline demographic variables or markers of intracerebral haemorrhage severity between consenters and non-consenters. Adults who died and became donors (n = 46) differed from the rest of the cohort (n = 249) by being older (median age 80, IQR 76–86 vs. 75, IQR 65–83, p = 0.002) and having larger haemorrhages (median volume 23ml, IQR 13–50 vs. 13ml, IQR 4–40; p = 0.002). Conclusions Nearly half of those approached consent to brain tissue donation after acute intracerebral haemorrhage. The characteristics of adults who gave consent were comparable to those in an entire community, although those who donate early are older and have larger haemorrhage volumes. PMID:26302447

  13. Intravenous Immunoglobulin Responsive Persistent Thrombocytopenia after Dengue Haemorrhagic Fever

    PubMed Central

    Charaniya, Riyaz; Ghosh, Anindya; Sahoo, Ratnakar

    2016-01-01

    Dengue outbreak is common in Indian subcontinent and causes significant morbidity and mortality. Year 2015 has witnessed yet another Dengue epidemic in northern India and the number of cases this year is maximum in a decade. Dengue infection is a viral disease and there are 4 different serotypes DENV1, DENV2, DENV3 and DENV4. This year DENV2 and DENV4 have been isolated from most of the patients. Thrombocytopenia is hallmark of dengue infection and generally recovers within ten days of onset of symptoms. We report a case of dengue haemorrhagic fever in which thrombocytopenia persisted for almost a month and improved after Intravenous immunoglobulin (IVIG) administration. This is the first case where IVIG has been successfully used for treating persisting thrombocytopenia after dengue infection. PMID:27190868

  14. [“Sumo-compression” Stops Post PartumHaemorrhage].

    PubMed

    Spätling, L; Schneider, H

    2014-10-01

    Post partum haemorrhage (PPH) from uterine atony or extensive trauma of vaginal tissue is a major cause of maternal mortality. Compression of vaginal tissue and uterus by tightly packing the vagina with laparotomy pads is described as a novel approach for the management of PPH. A bandage is placed as a very tight belt above the uterus. Counterpressure is achieved by a second bandage, which runs from anterior to posterior and is tied to the belt pressing the pads inside the vagina firmly against the uterus. The term "Sumo-compression" was chosen to remind people of the pants of the Japanese wrestlers. Using this method 5 women were successfully treated between January 2010 and October 2012. PMID:25353217

  15. Progress towards the treatment of Ebola haemorrhagic fever.

    PubMed

    Ströher, Ute; Feldmann, Heinz

    2006-12-01

    Being highly pathogenic for human and nonhuman primates and the subject of former weapon programmes makes Ebola virus one of the most feared pathogens worldwide today. Due to a lack of licensed pre- and postexposure intervention, the current response depends on rapid diagnostics, proper isolation procedures and supportive care of case patients. Consequently, the development of more specific countermeasures is of high priority for the preparedness of many nations. Over the past years, enhanced research efforts directed to better understand virus replication and pathogenesis have identified potential new targets for intervention strategies. The authors discuss the most promising therapeutic approaches for Ebola haemorrhagic fever as judged by their efficacy in animal models. The current development in this field encourages discussions on how to move some of the experimental approaches towards clinical application. PMID:17107278

  16. Viewpoint: filovirus haemorrhagic fever outbreaks: much ado about nothing?

    PubMed

    Borchert, M; Boelaert, M; Sleurs, H; Muyembe-Tamfum, J J; Pirard, P; Colebunders, R; Van der Stuyft, P; van der Groen, G

    2000-05-01

    The recent outbreak of Marburg haemorrhagic fever in the Democratic Republic of Congo has put the filovirus threat back on the international health agenda. This paper gives an overview of Marburg and Ebola outbreaks so far observed and puts them in a public health perspective. Damage on the local level has been devastating at times, but was marginal on the international level despite the considerable media attention these outbreaks received. The potential hazard of outbreaks, however, after export of filovirus from its natural environment into metropolitan areas, is argued to be considerable. Some avenues for future research and intervention are explored. Beyond the obvious need to find the reservoir and study the natural history, public health strategies for a more timely and efficient response are urgently needed. PMID:10886793

  17. Intravenous Immunoglobulin Responsive Persistent Thrombocytopenia after Dengue Haemorrhagic Fever.

    PubMed

    Kumar, Prabhat; Charaniya, Riyaz; Ghosh, Anindya; Sahoo, Ratnakar

    2016-04-01

    Dengue outbreak is common in Indian subcontinent and causes significant morbidity and mortality. Year 2015 has witnessed yet another Dengue epidemic in northern India and the number of cases this year is maximum in a decade. Dengue infection is a viral disease and there are 4 different serotypes DENV1, DENV2, DENV3 and DENV4. This year DENV2 and DENV4 have been isolated from most of the patients. Thrombocytopenia is hallmark of dengue infection and generally recovers within ten days of onset of symptoms. We report a case of dengue haemorrhagic fever in which thrombocytopenia persisted for almost a month and improved after Intravenous immunoglobulin (IVIG) administration. This is the first case where IVIG has been successfully used for treating persisting thrombocytopenia after dengue infection. PMID:27190868

  18. Subarachnoid haemorrhage as the initial manifestation of cortical venous thrombosis

    PubMed Central

    Verma, Rajesh; Sahu, Ritesh; Lalla, Rakesh

    2012-01-01

    Aneurysmal rupture is the commonest cause of non-traumatic subarachnoid haemorrhage (SAH). SAH can rarely be the manifestation of cortical venous thrombosis (CVT). CVT is potentially lethal but treatable disorder with positive outcome if timely treatment is instituted. The site of bleeding is mainly on convexities and sulcus with sparing of basal cisterns in SAH related to CVT. Anticoagulation is the mainstay of treatment, in spite of SAH complicated by CVT. In this submission, the author highlighted a case of SAH presented as initial manifestation of CVT in an elderly woman. Early therapy with anticoagulation led to complete clinical and radiological recovery in a short duration of 2 weeks. Thus, diagnosis of CVT should be kept in mind in unusual presentation of SAH. PMID:22914236

  19. How to manage patients with hereditary haemorrhagic telangiectasia.

    PubMed

    Geisthoff, Urban W; Nguyen, Ha-Long; Röth, Alexander; Seyfert, Ulrich

    2015-11-01

    Hereditary haemorrhagic telangiectasia is a rare systemic autosomal dominantly inherited disorder of the fibrovascular tissue with a wide variety of clinical manifestations. Diagnosis is based on the clinical Curaçao criteria or molecular genetic testing. Dilated vessels can develop into telangiectases or larger vascular malformations in various organs, calling for an interdisciplinary approach. Epistaxis and gastrointestinal bleeding can result from these vascular defects. Various conservative and interventional treatments have been described for these conditions. However, no optimal therapy exists. Treatment can become especially difficult due to progressive anaemia or when anticoagulant or anti-thrombotic therapy becomes necessary. Screening for pulmonary arteriovenous malformations (PAVM) should be performed in all confirmed and suspected patients. Treatment by percutaneous transcatheter embolotherapy and antibiotic prophylaxis is normally effective for PAVM. Cerebral or hepatic vascular malformations and rare manifestations need to be evaluated on a case-by-case basis to determine the best course of action for treatment. PMID:26205234

  20. Haemorrhage after home birth: audit of decision making and referral.

    PubMed

    Smit, Marrit; Dijkman, Anneke; Rijnders, Marlies; Bustraan, Jacqueline; van Dillen, Jeroen; Middeldorp, Johanna; Havenith, Barbara; van Roosmalen, Jos

    2013-11-01

    In the Netherlands, 20 per cent of women give birth at home. In 0.7 per cent, referral to secondary care because of postpartum haemorrhage (PPH) is indicated. Midwives are regularly trained in managing obstetric emergencies. A postgraduate training programme developed for Dutch community-based midwives called 'CAVE' (pre-hospital obstetric emergency course) focuses on the identification and management of obstetric emergencies, including timely and adequate referral to hospital. This descriptive study aims to identify substandard care (SSC) in PPH after home birth in the Netherlands. Sixty seven cases of PPH reported by community-based midwives were collected. After applying selection criteria, seven cases were submitted to audit. The audit panel consisted of 12 midwives (of which seven contributed a case), 10 obstetricians, an educational expert and an ambulance paramedic. First, an individual assessment was performed by all members. Subsequently, at a plenary audit meeting, SSC factors were determined and assigned incidental, minor and major substandard care. PMID:24371910

  1. A rare case of Weil's disease with alveolar haemorrhage

    PubMed Central

    Chakrabarti, Abhiram; Nandy, Manab; Pal, Dipankar; Mallik, Sudesna

    2014-01-01

    Leptospirosis, a disease of protean manifestations occurs sporadically throughout the year with a peak seasonal incidence during the rainy season mimicking other febrile viral illness. In the rare case, the disease leads to renal and hepatic involvement with hemorrhage which may be associated with multisystem organ dysfunction in form of pulmonary, cardiac and central nervous system, when it is known as Weil's disease. Rarely haemorrhagic manifestations are assosciated. Early diagnosis is important as sometimes the disease may be life threatening. Proper antibiotics results in dramatic improvement. We hereby presented a case that had clinical features of Weil's disease with cough, dyspnoea and haemoptysis. Leptospirosis was detected on ELISA testing. Patient was cured rapidly with antibiotics. PMID:25183149

  2. Haemorrhage, hyponatraemia and more than just a hack

    PubMed Central

    Shah, Mitsu; Kandil, Hala

    2014-01-01

    A 43-year-old previously healthy solicitor presented with a 9-day history of cough productive of yellow sputum with a prodrome of sore throat and myalgia. The cough was paroxysmal in nature and severe enough to cause extensive bilateral subconjunctival haemorrhages and cough syncopes multiple times a day, with one bout of associated haematemesis on the day of admission. He was isolated, treated for a presumed atypical chest infection with tazocin and clarithromycin, and monitored carefully until the hyponatraemia on presentation was resolved. Atypical screen and blood cultures were sent off, though unexciting at first, eventually confirmed the unlikely; Bordetella pertussis, much to the surprise of many who had Legionella as the top differential. PMID:24943139

  3. Haemorrhage, hyponatraemia and more than just a hack.

    PubMed

    Shah, Mitsu; Kandil, Hala

    2014-01-01

    A 43-year-old previously healthy solicitor presented with a 9-day history of cough productive of yellow sputum with a prodrome of sore throat and myalgia. The cough was paroxysmal in nature and severe enough to cause extensive bilateral subconjunctival haemorrhages and cough syncopes multiple times a day, with one bout of associated haematemesis on the day of admission. He was isolated, treated for a presumed atypical chest infection with tazocin and clarithromycin, and monitored carefully until the hyponatraemia on presentation was resolved. Atypical screen and blood cultures were sent off, though unexciting at first, eventually confirmed the unlikely; Bordetella pertussis, much to the surprise of many who had Legionella as the top differential. PMID:24943139

  4. Remote Cerebellar Haemorrhage after Burr Hole Drainage of Chronic Subdural Haematoma: A Case Report

    PubMed Central

    Karaarslan, Numan; Gök, Sevki; Soyalp, Celaleddin

    2016-01-01

    Remote cerebellar haemorrhage (RCH) is an unusual complication of supratentorial neurosurgical procedures. Even the rarer is cerebellar haemorrhage occurring after supratentorial burr hole drainage of Chronic Subdural Haematoma (CSDH). The exact mechanism is still unclear despite some possible causative factors such as rapid evacuation of haematoma and overdrainage of CSF (Cerebrospinal Fluid). We report a 80-year-old male patient who developed cerebellar haemorrhage after burr hole drainage of left frontoparietal chronic subdural haematoma and discuss the possible aetiological mechanisms through the review of the current literature. PMID:27437296

  5. A risk scoring system for prediction of haemorrhagic stroke.

    PubMed

    Zodpey, S P; Tiwari, R R

    2005-01-01

    The present pair-matched case control study was carried out at Government Medical College Hospital, Nagpur, India, a tertiary care hospital with the objective to devise and validate a risk scoring system for prediction of hemorrhagic stroke. The study consisted of 166 hospitalized CT scan proved cases of hemorrhagic stroke (ICD 9, 431-432), and a age and sex matched control per case. The controls were selected from patients who attended the study hospital for conditions other than stroke. On conditional multiple logistic regression five risk factors- hypertension (OR = 1.9. 95% Cl = 1.5-2.5). raised scrum total cholesterol (OR = 2.3, 95% Cl = 1.1-4.9). use of anticoagulants and antiplatelet agents (OR = 3.4, 95% Cl =1.1-10.4). past history of transient ischaemic attack (OR = 8.4, 95% Cl = 2.1- 33.6) and alcohol intake (OR = 2.1, 95% Cl = 1.3-3.6) were significant. These factors were ascribed statistical weights (based on regression coefficients) of 6, 8, 12, 21 and 8 respectively. The nonsignificant factors (diabetes mellitus, physical inactivity, obesity, smoking, type A personality, history of claudication, family history of stroke, history of cardiac diseases and oral contraceptive use in females) were not included in the development of scoring system. ROC curve suggested a total score of 21 to be the best cut-off for predicting haemorrhag stroke. At this cut-off the sensitivity, specificity, positive predictivity and Cohen's kappa were 0.74, 0.74, 0.74 and 0.48 respectively. The overall predictive accuracy of this additive risk scoring system (area under ROC curve by Wilcoxon statistic) was 0.79 (95% Cl = 0.73-0.84). Thus to conclude, if substantiated by further validation, this scorincy system can be used to predict haemorrhagic stroke, thereby helping to devise effective risk factor intervention strategy. PMID:16479901

  6. Retroperitoneal Haematom due to Spontaneous Rupture and Haemorrhage of Adrenal Cyst Presenting with Grey Turner's Sign.

    PubMed

    Sonmez, Bedriye Muge; Yilmaz, Fevzi; Özkan, Fevzi Bircan; Ongar, Murat; Özturk, Derya; Cesur, Fatma

    2015-07-01

    Spontaneous retroperitoneal haemorrhage is a rare entity and a potentially life-threatening condition. A 41-year-old woman presented to our emergency department with left flank pain and dysuria. Her physical examination disclosed left abdominal and costovertebral angle tenderness, left flank ecchymosis (Grey Turner sign). Abdominal computerised tomography revealed spontaneous retroperitoneal haemorrhage. She was discharged after 10 days with recommendation of urology follow-up. PMID:26160093

  7. Foetal and neonatal intracranial haemorrhage in term newborn infants: Hacettepe University experience.

    PubMed

    Tavil, Betül; Korkmaz, Ayşe; Bayhan, Turan; Aytaç, Selin; Unal, Sule; Kuskonmaz, Baris; Yigit, Sule; Cetin, Mualla; Yurdakök, Murat; Gumruk, Fatma

    2016-03-01

    In this study, we aimed to evaluate the incidence, risk factors, causes and clinical management of intracranial haemorrhage (ICH) diagnosed during foetal life or in the first month of life in term neonates with a discussion of the role of haematological risk factors. This study included term neonates (gestational age 37-42 weeks) with ICH diagnosed, treated and followed up in the Neonatal Intensive Care Unit of Hacettepe University, Ankara, Turkey, between January 1994 and January 2014. Medical follow-up was obtained retrospectively from hospital files and prospectively from telephonic interviews and/or clinical visits. During the study period, 16 term neonates were identified as having ICH in our hospital. In six (37.5%) neonates, ICH was diagnosed during foetal life by obstetric ultrasonography, and in 10 (62.5%) neonates, it has been diagnosed after birth. Haemorrhage types included intraventricular haemorrhage (IVH) in eight (50.0%), intraparenchymal haemorrhage in six (37.5%), subarachnoid haemorrhage in one (6.2%) and subdural haemorrhage in one (6.2%) neonate. IVH was the most common (n = 5/6, 83.3%) haemorrhage type among neonates diagnosed during foetal life. Overall, haemorrhage severity was determined as mild in three (18.7%) neonates, moderate in three (18.75%) neonates and severe in 10 (62.5%) neonates. During follow-up, one infant was diagnosed as afibrinogenemia, one diagnosed as infantile spasm, one cystic fibrosis, one orofaciodigital syndrome and the other diagnosed as Friedrich ataxia. Detailed haematological investigation and search for other underlying diseases are very important to identify the reason of ICH in term neonates. Furthermore, early diagnosis, close monitoring and prompt surgical interventions are significant factors to reduce disabilities. PMID:26829281

  8. Historical overview and review of current day treatment in the management of acute variceal haemorrhage.

    PubMed

    Rajoriya, Neil; Tripathi, Dhiraj

    2014-06-01

    Variceal haemorrhage is one of the most devastating consequences of portal hypertension, with a 1-year mortality of 40%. With the passage of time, acute management strategies have developed with improved survival. The major historical treatment landmarks in the management of variceal haemorrhage can be divided into surgical, medical, endoscopic and radiological breakthroughs. We sought to provide a historical overview of the management of variceal haemorrhage and how treatment modalities over time have impacted on clinical outcomes. A PubMed search of the following terms: portal hypertension, variceal haemorrhage, gastric varices, oesophageal varices, transjugular intrahepatic portosystemic shunt was performed. To complement this, Google™ was searched with the aforementioned terms. Other relevant references were identified after review of the reference lists of articles. The review of therapeutic advances was conducted divided into pre-1970s, 1970/80s, 1990s, 2000-2010 and post-2010. Also, a summary and review on the pathophysiology of portal hypertension and clinical outcomes in variceal haemorrhage was performed. Aided by the development of endoscopic therapies, medication and improved radiological interventions; the management of variceal haemorrhage has changed over recent decades with improved survival from an often-terminating event in recent past. PMID:24914369

  9. UK guidelines on the management of variceal haemorrhage in cirrhotic patients

    PubMed Central

    Tripathi, Dhiraj; Stanley, Adrian J; Hayes, Peter C; Patch, David; Millson, Charles; Mehrzad, Homoyon; Austin, Andrew; Ferguson, James W; Olliff, Simon P; Hudson, Mark; Christie, John M

    2015-01-01

    These updated guidelines on the management of variceal haemorrhage have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines which this document supersedes were written in 2000 and have undergone extensive revision by 13 members of the Guidelines Development Group (GDG). The GDG comprises elected members of the BSG liver section, representation from British Association for the Study of the Liver (BASL) and Liver QuEST, a nursing representative and a patient representative. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. The nature of variceal haemorrhage in cirrhotic patients with its complex range of complications makes rigid guidelines inappropriate. These guidelines deal specifically with the management of varices in patients with cirrhosis under the following subheadings: (1) primary prophylaxis; (2) acute variceal haemorrhage; (3) secondary prophylaxis of variceal haemorrhage; and (4) gastric varices. They are not designed to deal with (1) the management of the underlying liver disease; (2) the management of variceal haemorrhage in children; or (3) variceal haemorrhage from other aetiological conditions. PMID:25887380

  10. Historical overview and review of current day treatment in the management of acute variceal haemorrhage

    PubMed Central

    Rajoriya, Neil; Tripathi, Dhiraj

    2014-01-01

    Variceal haemorrhage is one of the most devastating consequences of portal hypertension, with a 1-year mortality of 40%. With the passage of time, acute management strategies have developed with improved survival. The major historical treatment landmarks in the management of variceal haemorrhage can be divided into surgical, medical, endoscopic and radiological breakthroughs. We sought to provide a historical overview of the management of variceal haemorrhage and how treatment modalities over time have impacted on clinical outcomes. A PubMed search of the following terms: portal hypertension, variceal haemorrhage, gastric varices, oesophageal varices, transjugular intrahepatic portosystemic shunt was performed. To complement this, Google™ was searched with the aforementioned terms. Other relevant references were identified after review of the reference lists of articles. The review of therapeutic advances was conducted divided into pre-1970s, 1970/80s, 1990s, 2000-2010 and post-2010. Also, a summary and review on the pathophysiology of portal hypertension and clinical outcomes in variceal haemorrhage was performed. Aided by the development of endoscopic therapies, medication and improved radiological interventions; the management of variceal haemorrhage has changed over recent decades with improved survival from an often-terminating event in recent past. PMID:24914369

  11. A Combination Strategy of Ceftriaxone, Sulbactam and Disodium Edetate for the Treatment of Multi-Drug Resistant (MDR) Septicaemia: A Retrospective, Observational Study in Indian Tertiary Care Hospital

    PubMed Central

    Jambulingappa, Kiran Lakkol

    2015-01-01

    Introduction Previous studies have suggested the use of rational combination therapy for the treatment of multi-drug resistant (MDR) infections. An antibiotic adjuvant entity (AAE) of ceftriaxone, sulbactam and disodium edetate (Elores) was approved for multi-drug resistant infections in India. Aim This study was designed to investigate the efficacy and safety of this AAE in patients with sepsis due to extended spectrum beta lactamse (ESBL) and metallo-beta lactamase (MBL) producing pathogens. Materials and Methods A retrospective observational study was conducted in patients admitted in intensive care unit (ICU) at tertiary health care site in India, with enrollment from 24 March, 2012 to 7 Aug, 2012. Patients eligible for enrollment had clear infection of bacterial septicaemia, were aged 12-65 years, and were considered for treatment with Cephalosporins categories of antibiotics. Results Total 18 patients were included in the study and all assigned to combination of ceftriaxone, sulbactam and disodium edetate. Complete clinical cure in terms of relief and no-disease symptoms had observed in 15 (83.3%) subjects, however 3 (16.6%) showed treatment failure (TF). Similarly for bacteriological eradication response, 15 (83.3%) patients displayed complete bacteriological eradication response and 03 (16.6%) subjects showed TF. No serious side effect was observed during the study. Conclusion This study recommends the use of combination of ceftriaxone, sulbactam and disodium edetate (EDTA) for the treatment of MDR septicaemia associated with ESBL and MBL producing microbes. PMID:26673348

  12. Imaging cerebral haemorrhage with magnetic induction tomography: numerical modelling.

    PubMed

    Zolgharni, M; Ledger, P D; Armitage, D W; Holder, D S; Griffiths, H

    2009-06-01

    Magnetic induction tomography (MIT) is a new electromagnetic imaging modality which has the potential to image changes in the electrical conductivity of the brain due to different pathologies. In this study the feasibility of detecting haemorrhagic cerebral stroke with a 16-channel MIT system operating at 10 MHz was investigated. The finite-element method combined with a realistic, multi-layer, head model comprising 12 different tissues, was used for the simulations in the commercial FE package, Comsol Multiphysics. The eddy-current problem was solved and the MIT signals computed for strokes of different volumes occurring at different locations in the brain. The results revealed that a large, peripheral stroke (volume 49 cm(3)) produced phase changes that would be detectable with our currently achievable instrumentation phase noise level (17 m degrees ) in 70 (27%) of the 256 exciter/sensor channel combinations. However, reconstructed images showed that a lower noise level than this, of 1 m degrees , was necessary to obtain good visualization of the strokes. The simulated MIT measurements were compared with those from an independent transmission-line-matrix model in order to give confidence in the results. PMID:19491437

  13. Surgical management of postpartum haemorrhage: survey of French obstetricians

    PubMed Central

    Bouet, Pierre-Emmanuel; Brun, Stéphanie; Madar, Hugo; Schinkel, Elsa; Merlot, Benjamin; Sentilhes, Loïc

    2016-01-01

    The aim of our study was to assess the theoretical and practical knowledge of French obstetricians about the surgical management of postpartum haemorrhage (PPH). Our study is a national anonymous self-administered survey. A total of 363 obstetricians responded to this questionnaire between December 2013 and April 2014. Questionnaire sent through email to all French obstetricians who are members of either of two federations of hospital-based obstetricians. Answers were collected until the end of June 2014. The main outcome measure was obstetricians’ level of mastery of each surgical technique. The results were analysed descriptively (proportions). Only the 286 questionnaires fully completed were analysed; the complete response rate was 23% (286/1246). In all, 33% (95/286) of the responding obstetricians reported that they had not mastered sufficiently or even at all the technique for bilateral ligation of the uterine arteries, 37% (105/286) for uterine compression suture, 62% (178/286) for ligation of the internal iliac arteries, and 47% (134/286) for emergency peripartum hysterectomy. In all, 18% (52/286) of respondents stated that they had not mastered any of these techniques. Our study shows that a worrisome number of French obstetricians reported insufficient mastery of the surgical techniques for PPH management. PMID:27460158

  14. Three years prospective investigation of pituitary functions following subarachnoid haemorrhage.

    PubMed

    Karaca, Z; Tanriverdi, F; Dagli, A T; Selcuklu, A; Casanueva, F F; Unluhizarci, K; Kelestimur, F

    2013-03-01

    Subarachnoid haemorrhage (SAH) is known to be related to pituitary dysfuntion in retrospective and short-term prospective studies. We aimed to investigate pituitary functions in patients with SAH in longer follow-up periods to demonstrate if pituitary hormone deficiencies recover, persist or new hormone deficiencies occur. Twenty patients with SAH, who were followed up for 3 years, were included in the present study. Patients were evaluated with basal hormone levels and glucagon stimulation test (GST).Serum basal cortisol and adrenocorticotropic hormone (ACTH) levels were found to be significantly elevated at 3rd year of SAH compared to 1st year. Other basal hormone levels at 3rd year did not show a significant change from the levels found at 1st year. One of the patients had ACTH deficiency at 1st year of SAH and recovered at 3rd year. Growth hormone (GH) deficiency, according to GST,was diagnosed in 4 patients. One patient with GH deficiency at first year was still deficient, 3 of them recovered and 3 patients were found to have new-onset GH deficiency 3 years after SAH. SAH is associated with anterior pituitary dysfunction and GH is the most frequently found deficient hormone in the patients. Although one year after SAH seems to be an appropriate time for the evaluation of pituitary functions, further follow-up may be required at least in some cases due to recovered and new-onset hormone deficiencies at 3rd year of SAH. PMID:22315089

  15. Dengue fever and dengue haemorrhagic fever in adolescents and adults.

    PubMed

    Tantawichien, Terapong

    2012-05-01

    Dengue fever (DF) is endemic in tropical and subtropical zones and the prevalence is increasing across South-east Asia, Africa, the Western Pacific and the Americas. In recent years, the spread of unplanned urbanisation, with associated substandard housing, overcrowding and deterioration in water, sewage and waste management systems, has created ideal conditions for increased transmission of the dengue virus in tropical urban centres. While dengue infection has traditionally been considered a paediatric disease, the age distribution of dengue has been rising and more cases have been observed in adolescents and adults. Furthermore, the development of tourism in the tropics has led to an increase in the number of tourists who become infected, most of whom are adults. Symptoms and risk factors for dengue haemorrhagic fever (DHF) and severe dengue differ between children and adults, with co-morbidities and incidence in more elderly patients associated with greater risk of mortality. Treatment options for DF and DHF in adults, as for children, centre round fluid replacement (either orally or intravenously, depending on severity) and antipyretics. Further data are needed on the optimal treatment of adult patients. PMID:22668446

  16. Hereditary haemorrhagic telangiectasia in a black adult male: case report.

    PubMed

    Kitonyi, G W; Wambugu, P M; Oburra, H O; Ireri, J M

    2008-08-01

    Hereditary haemorrhagic telangiectasia, (HHT) or Rendu-Osler-Weber disease is a genetic autosomal dominant disorder that is characterised by telangiectasias, (small vascular malformations), in mucocutaneous tissues and arterial venous malformations, (AVMs), in various internal organs. Although HHT is relatively common in whites, the disorder has been reported to be rare in people of black African descent. Majority of HHT patients present with recurrent epistaxis, which in a significant proportion of patients is severe, warranting repeated blood transfusions and iron supplementation. Telangiectasias are most frequent on the tongue, hands, nose, lips and the gastrointestinal tract (GIT). AVMs occur in internal organs, particularly the lungs, brain, and the liver. Early and correct diagnosis of HHT is crucial as patients derive benefit from certain specific treatment modalities. Besides, AVMs which occur in various organs pose serious complications that may lead to death and therefore require early detection. We report a 55 year old black African male with HHT who presented with severe recurrent epistaxis and haematochezia leading to severe anaemia requiring repeated blood transfusions. His son, daughter and a maternal uncle experience milder recurrent epistaxis. The management of this patient and a brief review of the clinical features and management of HHT is presented. Our aim is to raise awareness of the occurrence of HHT in Kenya, in order to enhance early diagnosis and appropriate management. PMID:19115559

  17. Delineating the Association between Heavy Postpartum Haemorrhage and Postpartum Depression

    PubMed Central

    Eckerdal, Patricia; Kollia, Natasa; Löfblad, Johanna; Hellgren, Charlotte; Karlsson, Linnea; Högberg, Ulf; Wikström, Anna-Karin; Skalkidou, Alkistis

    2016-01-01

    Objectives To explore the association between postpartum haemorrhage (PPH) and postpartum depression (PPD), taking into account the role of postpartum anaemia, delivery experience and psychiatric history. Methods A nested cohort study (n = 446), based on two population-based cohorts in Uppsala, Sweden. Exposed individuals were defined as having a bleeding of ≥1000ml (n = 196) at delivery, and non-exposed individuals as having bleeding of <650ml (n = 250). Logistic regression models with PPD symptoms (Edinburgh Postnatal Depression scale (EPDS) score ≥ 12) as the outcome variable and PPH, anaemia, experience of delivery, mood during pregnancy and other confounders as exposure variables were undertaken. Path analysis using Structural Equation Modeling was also conducted. Results There was no association between PPH and PPD symptoms. A positive association was shown between anaemia at discharge from the maternity ward and the development of PPD symptoms, even after controlling for plausible confounders (OR = 2.29, 95%CI = 1.15–4.58). Path analysis revealed significant roles for anaemia at discharge, negative self-reported delivery experience, depressed mood during pregnancy and postpartum stressors in increasing the risk for PPD. Conclusion This study proposes important roles for postpartum anaemia, negative experience of delivery and mood during pregnancy in explaining the development of depressive symptoms after PPH. PMID:26807799

  18. Rabbit haemorrhagic disease: virus persistence and adaptation in Australia

    PubMed Central

    Schwensow, Nina I; Cooke, Brian; Kovaliski, John; Sinclair, Ron; Peacock, David; Fickel, Joerns; Sommer, Simone

    2014-01-01

    In Australia, the rabbit haemorrhagic disease virus (RHDV) has been used since 1996 to reduce numbers of introduced European rabbits (Oryctolagus cuniculus) which have a devastating impact on the native Australian environment. RHDV causes regular, short disease outbreaks, but little is known about how the virus persists and survives between epidemics. We examined the initial spread of RHDV to show that even upon its initial spread, the virus circulated continuously on a regional scale rather than persisting at a local population level and that Australian rabbit populations are highly interconnected by virus-carrying flying vectors. Sequencing data obtained from a single rabbit population showed that the viruses that caused an epidemic each year seldom bore close genetic resemblance to those present in previous years. Together, these data suggest that RHDV survives in the Australian environment through its ability to spread amongst rabbit subpopulations. This is consistent with modelling results that indicated that in a large interconnected rabbit meta-population, RHDV should maintain high virulence, cause short, strong disease outbreaks but show low persistence in any given subpopulation. This new epidemiological framework is important for understanding virus–host co-evolution and future disease management options of pest species to secure Australia's remaining natural biodiversity. PMID:25553067

  19. Viral haemorrhagic disease of rabbits and human health.

    PubMed Central

    Carman, J. A.; Garner, M. G.; Catton, M. G.; Thomas, S.; Westbury, H. A.; Cannon, R. M.; Collins, B. J.; Tribe, I. G.

    1998-01-01

    Viral haemorrhagic disease of rabbits (VHD), a potential biological control for wild rabbits in Australia and New Zealand, escaped from quarantined field trials on Wardang Island and spread to the mainland of Australia in October 1995. This study looked for any evidence of infection or illness in people occupationally exposed to the virus. Two hundred and sixty-nine people were interviewed and 259 blood samples were collected. Exposures to VHD-infected rabbits ranged from nil to very high. No VHD antibodies were detected in any of the 259 sera when tested by VHD competitive enzyme immunoassay, which had been validated with 1013 VHDV-specific antibody negative sera. A questionnaire designed to elicit symptoms of disease in a range of organ systems found no significant differences between illness in those exposed and those not exposed to VHD, nor could an association be found between exposure and subsequent episodes of illness. The findings are consistent with the view that exposure to VHD is not associated with infection or disease in humans. PMID:9825794

  20. The autophagy-lysosomal system in subarachnoid haemorrhage.

    PubMed

    Wu, Haijian; Niu, Huanjiang; Wu, Cheng; Li, Yong; Wang, Kun; Zhang, Jianmin; Wang, Yirong; Yang, Shuxu

    2016-09-01

    The autophagy-lysosomal pathway is a self-catabolic process by which dysfunctional or unnecessary intracellular components are degraded by lysosomal enzymes. Proper function of this pathway is critical for maintaining cell homeostasis and survival. Subarachnoid haemorrhage (SAH) is one of the most devastating forms of stroke. Multiple pathogenic mechanisms, such as inflammation, apoptosis, and oxidative stress, are all responsible for brain injury and poor outcome after SAH. Most recently, accumulating evidence has demonstrated that the autophagy-lysosomal pathway plays a crucial role in the pathophysiological process after SAH. Appropriate activity of autophagy-lysosomal pathway acts as a pro-survival mechanism in SAH, while excessive self-digestion results in cell death after SAH. Consequently, in this review article, we will give an overview of the pathophysiological roles of autophagy-lysosomal pathway in the pathogenesis of SAH. And approaching the molecular mechanisms underlying this pathway in SAH pathology is anticipated, which may ultimately allow development of effective therapeutic strategies for SAH patients through regulating the autophagy-lysosomal machinery. PMID:27027405

  1. Solute equilibrium over the extracellular fluid space in haemorrhagic hypotension: a study in a cannulated thoracic duct model.

    PubMed

    Ware, J; Norberg, K A; Nylander, G

    1983-01-01

    Haemorrhagic hypotension, 50 mm Hg, has been inflicted on non-starved rats. Osmolar and solute developments have been followed in lymph and arterial plasma to assess diffusion and equilibration characteristics of the initial stages of haemorrhage. Lymph flow changes have reflected an intracellular fluid mobilization to the interstitium, caused by an osmotic gradient due to the elevated levels of glucose. A fluid homeostatic effect of pseudodiabetes associated with stress and haemorrhage is postulated. PMID:6617708

  2. Transvaginal Oocyte Retrieval Complicated by Life-Threatening Obturator Artery Haemorrhage and Managed by a Vessel-Preserving Technique.

    PubMed Central

    Bolster, Ferdia; Mocanu, Edgar; Geoghegan, Tony; Lawler, Leo

    2014-01-01

    We report the case of a 36-year-old woman with secondary infertility who underwent routine transvaginal oocyte retrieval as part of IVF treatment. Four days following the procedure she presented with life threatening haemorrhagic shock. She underwent surgical laparotomy followed by CT and selective angiography, which demonstrated haemorrhage from a pseudoaneurysm of the obturator artery. The haemorrhage was successfully managed endovascularly with a vessel preserving covered stent. PMID:25484463

  3. Recommendations for the management of intracranial haemorrhage - part I: spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee.

    PubMed

    Steiner, Thorsten; Kaste, Markku; Katse, Markku; Forsting, Michael; Mendelow, David; Kwiecinski, Hubert; Szikora, Istvan; Juvela, Seppo; Marchel, Andrzej; Chapot, René; Cognard, Christophe; Unterberg, Andreas; Hacke, Werner

    2006-01-01

    This article represents the recommendations for the management of spontaneous intracerebral haemorrhage of the European Stroke Initiative (EUSI). These recommendations are endorsed by the 3 European societies which are represented in the EUSI: the European Stroke Council, the European Neurological Society and the European Federation of Neurological Societies. PMID:16926557

  4. A Five-Year Experience of Carbapenem Resistance in Enterobacteriaceae Causing Neonatal Septicaemia: Predominance of NDM-1

    PubMed Central

    Datta, Saswati; Roy, Subhasree; Chatterjee, Somdatta; Saha, Anindya; Sen, Barsha; Pal, Titir; Som, Tapas; Basu, Sulagna

    2014-01-01

    Treatment of neonatal sepsis has become a challenge with the emergence of carbapenemase-producing bacteria. This study documents the trend of carbapenem susceptibility in Enterobacteriaceae that caused septicaemia in neonates over a five year period (2007–2011) and the molecular characterisation of Enterobacteriaceae resistant to carbapenems and cephalosporins. Hundred and five Enterobacteriaceae including Escherichia coli (n = 27), Klebsiella pneumoniae (n = 68) and Enterobacter spp. (n = 10) were isolated from blood of septicaemic neonates followed by antibiotic susceptibility tests, determination of MIC values, phenotypic and genotypic detection of β-lactamases. Carbapenem was the most active antimicrobial tested after tigecycline. CTX-M type was the most prevalent ESBL throughout the period (82%). New Delhi Metallo-β-lactamase-1 (NDM-1), which is a recent addition to the carbapenemase list, was the only carbapenemase identified in our setting. Fourteen percent of the isolates possessed blaNDM-1. Carbapenem non-susceptibility was first observed in 2007 and it was due to loss of Omp F/Ompk36 in combination with the presence of ESBLs/AmpCs. NDM-1 first emerged in E. coli during 2008; later in 2010, the resistance was detected in K. pneumoniae and E. cloacae isolates. NDM-1-producing isolates were resistant to other broad-spectrum antibiotics and possessed ESBLs, AmpCs, 16S-rRNA methylases, AAC(6′)-Ib-cr, bleomycin resistant gene and class 1 integron. Pulsed field gel electrophoresis of the NDM-1-producing isolates indicated that the isolates were clonally diverse. The study also showed that there was a significantly higher incidence of sepsis caused by NDM-1-harbouring isolates in the male sex, in neonates with low birth weight and neonates born at an extramural centre. However, sepsis with NDM-1-harbouring isolates did not result in a higher mortality rate. The study is the first to review the carbapenem resistance patterns in neonatal sepsis

  5. Genetic contribution to postpartum haemorrhage in Swedish population: cohort study of 466 686 births

    PubMed Central

    Hernandéz-Diaź, Sonia; Frisell, Thomas; Greene, Michael F; Almqvist, Catarina; Bateman, Brian T

    2014-01-01

    Objective To investigate the familial clustering of postpartum haemorrhage in the Swedish population, and to quantify the relative contributions of genetic and environmental effects. Design Register based cohort study. Setting Swedish population (multi-generation and medical birth registers). Main outcome measure Postpartum haemorrhage, defined as >1000 mL estimated blood loss. Participants The first two live births to individuals in Sweden in 1997-2009 contributed to clusters representing intact couples (n=366 350 births), mothers with separate partners (n=53 292), fathers with separate partners (n=47 054), sister pairs (n=97 228), brother pairs (n=91 168), and mixed sibling pairs (n=177 944). Methods Familial clustering was quantified through cluster specific tetrachoric correlation coefficients, and the influence of potential sharing of known risk factors was evaluated with alternating logistic regression. Relative contributions of genetic and environmental effects to the variation in liability for postpartum haemorrhage were quantified with generalised linear mixed models. Results The overall prevalence of postpartum haemorrhage after vaginal deliveries in our sample was 4.6%. Among vaginal deliveries, 18% (95% confidence interval 9% to 26%) of the variation in postpartum haemorrhage liability was attributed to maternal genetic factors, 10% (1% to 19%) to unique maternal environment, and 11% (0% to 26%) to fetal genetic effects. Adjustment for known risk factors only partially explained estimates of familial clustering, suggesting that the observed shared genetic and environmental effects operate in part through pathways independent of known risk factors. There were similar patterns of familial clustering for both of the main subtypes examined (atony and retained placenta), though strongest for haemorrhage after retained placenta. Conclusions There is a maternal genetic predisposition to postpartum haemorrhage, but more than half of the total

  6. Intrauterine balloon tamponade as management of postpartum haemorrhage and prevention of haemorrhage related to low-lying placenta.

    PubMed

    Patacchiola, F; D'Alfonso, A; Di Fonso, A; Di Febbo, G; Kaliakoudas, D; Carta, G

    2012-01-01

    The aim of the present study was to evaluate the effectiveness of Bakri balloon in preventing and treating postpartum haemorrhage (PPH). Intrauterine Bakri balloon was used in a total of 16 patients with two different purposes: prophylactic placement of the balloon after cesarean section (CS) in six patients with low-lying placenta and therapeutic placement in ten patients with persistent bleeding from uterine atony, after spontaneous delivery, and administration of uterotonics. Intrauterine Bakri balloon was a successful approach in controlling and preventing PPH in all 16 patients. The median nadir hematocrit was 26.6% in six patients who underwent CS and 25.6% in ten patients with persistent bleeding after spontaneous delivery. The intrauterine balloon was in place for a duration of 24 hours. The median balloon infusion volume was 345 ml (range 250-455). No complications were reported. Bakri balloon tamponade was a useful measure in treating PPH unresponsive to pharmacological therapy in patients who delivered vaginally. Moreover, it was able to prevent persistent bleeding in patients who underwent CS for central placenta previa. PMID:23444752

  7. Gastro-intestinal haemorrhage risks of selective serotonin receptor antagonist therapy: a new look

    PubMed Central

    Opatrny, Lucie; Delaney, J A ‘Chris’; Suissa, Samy

    2008-01-01

    AIMS (i) To determine the effects of selective serotonin reuptake inhibitors (SSRI) and other classes of antidepressants on upper gastro-intestinal (GI) haemorrhage and (ii) to assess the drug–drug interaction effects of antidepressants and warfarin or clopidogrel on the risk of GI haemorrhage. METHODS This was a population-based case control study in the General Practice Research Database (GPRD). Cases with a first episode of upper GI haemorrhage between 2000 and 2005 were matched with up to 10 controls. Exposure to the study drugs was defined by a prescription issued in the 90 days before the index date. Rate ratios were estimated using conditional logistic regression. RESULTS Four thousand and twenty-eight cases of GI haemorrhage and 40 171 controls were identified. The excess risk of GI haemorrhage with SSRI use was small (Rate Ratio [RR]: 1.3; 95% confidence interval [CI]: 1.1, 1.6) and null with exposure to tricyclic antidepressants (TCAs) (RR 1.0; 95% CI: 0.8, 1.3). The risk of GI haemorrhage was highest with venlafaxine use (RR: 1.9; 95% CI: 1.3, 2.6). There was no drug–drug interaction between warfarin anticoagulation and antidepressant use. CONCLUSIONS This study supports a small increased risk of upper GI haemorrhage with the use of SSRI antidepressants compared with the older TCA drugs, but to a lesser extent than previously reported due to confounding by alcohol use. The small elevation in risk of GI haemorrhage with SSRI and venlafaxine should be weighed against the therapeutic benefit of their use. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT The known biological effects of selective serotonin reuptake inhibitors (SSRI) on platelets are consistent with an increased risk of gastrointestinal haemorrhage in patients on SSRI therapy.Previous research supports this increased risk among SSRI users with a large increase in bleeding risk observed. WHAT THIS STUDY ADDS This large study was able to compare the effects of different classes of antidepressant as

  8. Antecedents of periventricular haemorrhage in infants weighing 1250 g or less at birth.

    PubMed Central

    Szymonowicz, W; Yu, V Y; Wilson, F E

    1984-01-01

    Fifty infants who weighed 1250 g or less at birth were studied with serial real time cerebral ultrasound to evaluate the temporal relation of various perinatal factors to the onset and progression of periventricular haemorrhage (PVH). The significant antecedents of PVH were severe bruising at birth, low birthweight, short gestation, ratio of arterial oxygen pressure (PaO2) to fractional inspired oxygen (FiO2), and haematocrit on admission, hyaline membrane disease, assisted ventilation, pneumothorax, administration of tubocurarine, hypercapnia, hypoxaemia, and hypotension. Case control studies, in which infants with PVH at 26 weeks' and 28 weeks' gestation were compared with matched infants without PVH, confirmed that the antecedents identified were independent of gestational influences. A multivariate discriminant analysis for the antecedents of PVH showed that hyaline membrane disease, hypercapnia, and short gestation correctly classified presence or absence of PVH in 78% of the study group. A similar analysis comparing infants with germinal layer haemorrhage or intraventricular haemorrhage with those who developed intracerebral extension of haemorrhage showed that three factors found on admission (hypothermia, a low PaO2:FiO2 ratio, and severe bruising) combined to classify correctly 90% of the haemorrhages. Our data suggest that prevention of perinatal trauma and asphyxia as well as respiratory illness, especially hyaline membrane disease, and stabilisation of blood gas tensions, blood pressure, and haematocrit within the physiological range, are likely to be the most effective ways of preventing PVH in extremely preterm infants. PMID:6696488

  9. Central nervous system haemorrhage causing early death in acute promyelocytic leukaemia

    PubMed Central

    Borowska, Anna; Stelmaszczyk-Emmel, Anna

    2016-01-01

    Acute promyelocytic leukaemia (APL) is a rare type of paediatric leukaemia characterised by a specific genetic mutation and life-threatening coagulopathy. The discovery of all-trans retinoic acid (ATRA), which acts directly on promyelocytic locus-retinoic acid receptor α (PML-RARα) gene product, brought a revolution to the therapy of this disorder. Unfortunately, despite an improvement in the complete remission rate, the early death (ED) rate has not changed significantly, and the haemorrhages remain a major problem. The most common bleeding site, which accounts for about 65-80% of haemorrhages, is the central nervous system. Second in line are pulmonary haemorrhages (32%), while gastrointestinal bleedings are relatively rare. Haemorrhages result from thrombocytopaenia, disseminated intravascular coagulopathy (DIC), and systemic fibrinolysis. Herein we present a boy aged one year and nine months with APL. The patient was not eligible for ATRA administration due to poor clinical condition. He developed bleeding diathesis that presented as disseminated intravascular coagulation (DIC) and led to intracranial haemorrhage, which resulted in the patient's death. PMID:26862315

  10. Haemorrhagic disease of the newborn in the British Isles: two year prospective study.

    PubMed Central

    McNinch, A W; Tripp, J H

    1991-01-01

    OBJECTIVE--To determine the incidence of haemorrhagic disease of the newborn in the British Isles, study risk factors, and examine the effect of vitamin K prophylaxis. DESIGN--Prospective survey of all possible cases of haemorrhagic disease of the newborn as reported by consultant paediatricians using the monthly notification cards of the British Paediatric Surveillance Unit and a follow up questionnaire for each case to validate the diagnosis and accrue further data. SETTING--Britain (England, Scotland, and Wales) and Ireland (Northern Ireland and the Irish Republic) during December 1987 to March 1990. PATIENTS--27 infants classified as having confirmed (n = 25) or probable (n = 2) haemorrhagic disease of the newborn. RESULTS--24 of the 27 infants were solely breast fed. 10 suffered intracranial haemorrhage; two of these died and there was clinical concern about the remainder. 20 infants had received no vitamin K prophylaxis, and seven had received oral prophylaxis. Relative risk ratios for these groups compared with babies who had received intramuscular vitamin K were 81:1 and 13:1 respectively. Six infants had hepatitis (alpha 1 antitrypsin deficiency in four), unsuspected until presentation with haemorrhagic disease of the newborn, of whom four had received oral prophylaxis. One other baby had prolonged jaundice. One mother had taken phenytoin during pregnancy. CONCLUSIONS--All newborn infants should receive vitamin K prophylaxis. Intramuscular vitamin K is more effective than oral prophylactic regimens currently used in the British Isles. PMID:1747578

  11. Development and validation of the Essen Intracerebral Haemorrhage Score

    PubMed Central

    Weimar, C; Benemann, J; Diener, H‐C

    2006-01-01

    Background Spontaneous intracerebral haemorrhage (ICH) accounts for the highest in‐hospital mortality of all stroke types. Nevertheless, outcome is favourable in about 30% of patients. Only one model for the prediction of favourable outcome has been validated so far. Objective To describe the development and validation of the Essen ICH score. Methods Inception cohorts were assessed on the National Institutes of Health stroke scale (NIH‐SS) on admission and after follow up of 100 days. On the basis of previously validated clinical variables, a simple clinical score was developed to predict mortality and complete recovery (Barthel index after 100 days ⩾95) in 340 patients with acute ICH. Subscores for age (<60 = 0; 60–69 = 1; 70–79 = 2; ⩾80 = 3), NIH‐SS level of consciousness (alert = 0; drowsy = 1; stuporose = 2; comatose = 3), and NIH‐SS total score (0–5 = 0; 6–10 = 1; 11–15 = 2; 16–20 = 3; >20 or coma = 4) were combined into a prognostic scale with <3 predicting complete recovery and >7 predicting death. The score was subsequently validated in an external cohort of 371 patients. Results The Essen ICH score showed a high prognostic accuracy for complete recovery and death in both the development and validation cohort. For prediction of complete recovery on the Barthel index after 100 days, the Essen ICH score was superior to the physicians' prognosis and to two previous prognostic scores developed for a slightly modified outcome. Conclusions The Essen ICH score provides an easy to use scale for outcome prediction following ICH. Its high positive predictive values for adverse outcomes and easy applicability render it useful for individual prognostic indications or the design of clinical studies. In contrast, physicians tended to predict outcome too pessimistically. PMID:16354736

  12. Massive haemorrhage in liver transplantation: Consequences, prediction and management

    PubMed Central

    Cleland, Stuart; Corredor, Carlos; Ye, Jia Jia; Srinivas, Coimbatore; McCluskey, Stuart A

    2016-01-01

    From its inception the success of liver transplantation has been associated with massive blood loss. Massive transfusion is classically defined as > 10 units of red blood cells within 24 h, but describing transfusion rates over a shorter period of time may reduce the potential for survival bias. Both massive haemorrhage and transfusion are associated with increased risk of mortality and morbidity (need for dialysis/surgical site infection) following liver transplantation although causality is difficult to prove due to the observational design of most trials. The blood loss associated with liver transplantation is multifactorial. Portal hypertension secondary to cirrhosis results in extensive collateral circulation, which can bleed during hepatectomy particular if portal pressures are increased. Avoiding volume loading and maintenance of a low central venous pressure together with the use of vasopressors have been shown to reduce blood loss and transfusion during liver transplantation, but may increase the risk of renal impairment post-operatively. Coagulation defects may be present pre-transplant, but haemostasis is often re-balanced due to a deficit in both pro- and anti-coagulation factors. Further derangement of haemostasis may develop in the anhepatic and neohepatic phases due to absent hepatic metabolic function, hyperfibrinolysis and platelet sequestration in the donor liver. Point-of-care tests of coagulation such as the viscoelastic tests rotation thromboelastometry/thromboelastometry allow and more accurate and rapid assessment of these derangements in coagulation and guide the use of factor replacement and antifibrinolytics. Transfusion protocols guided by these tests have been shown to reduce transfusion rates compared with conventional coagulation tests, but have not shown improvements in mortality or morbidity. Pre-operative factors associated with massive transfusion include previous surgery, re-do transplantation, the aetiology and severity of liver

  13. Massive haemorrhage in liver transplantation: Consequences, prediction and management.

    PubMed

    Cleland, Stuart; Corredor, Carlos; Ye, Jia Jia; Srinivas, Coimbatore; McCluskey, Stuart A

    2016-06-24

    From its inception the success of liver transplantation has been associated with massive blood loss. Massive transfusion is classically defined as > 10 units of red blood cells within 24 h, but describing transfusion rates over a shorter period of time may reduce the potential for survival bias. Both massive haemorrhage and transfusion are associated with increased risk of mortality and morbidity (need for dialysis/surgical site infection) following liver transplantation although causality is difficult to prove due to the observational design of most trials. The blood loss associated with liver transplantation is multifactorial. Portal hypertension secondary to cirrhosis results in extensive collateral circulation, which can bleed during hepatectomy particular if portal pressures are increased. Avoiding volume loading and maintenance of a low central venous pressure together with the use of vasopressors have been shown to reduce blood loss and transfusion during liver transplantation, but may increase the risk of renal impairment post-operatively. Coagulation defects may be present pre-transplant, but haemostasis is often re-balanced due to a deficit in both pro- and anti-coagulation factors. Further derangement of haemostasis may develop in the anhepatic and neohepatic phases due to absent hepatic metabolic function, hyperfibrinolysis and platelet sequestration in the donor liver. Point-of-care tests of coagulation such as the viscoelastic tests rotation thromboelastometry/thromboelastometry allow and more accurate and rapid assessment of these derangements in coagulation and guide the use of factor replacement and antifibrinolytics. Transfusion protocols guided by these tests have been shown to reduce transfusion rates compared with conventional coagulation tests, but have not shown improvements in mortality or morbidity. Pre-operative factors associated with massive transfusion include previous surgery, re-do transplantation, the aetiology and severity of liver

  14. Acute intracerebral haemorrhage: grounds for optimism in management.

    PubMed

    Delcourt, Candice; Anderson, Craig

    2012-12-01

    Spontaneous intracerebral haemorrhage (ICH) is one of the most devastating types of stroke, which has considerable disease burden in "non-white" ethnic groups where the population-attributable risks of elevated blood pressure are very high. Since the treatment of ICH remains largely supportive and expectant, nihilism and the early withdrawal of active therapy influence management decisions in clinical practice. However, approaches to management are now better defined on the basis of evidence that both survival and speed (and degree) of recovery are critically dependent on the location, size, and degree of expansion and extension into the intraventricular system of the haematoma of the ICH. Although no medical treatment has been shown to improve outcome in ICH, several promising avenues have emerged that include haemostatic therapy and intensive control of elevated blood pressure. Conversely, there is continued controversy over the role of evacuation of the haematoma of ICH via open craniotomy. Despite being an established practice for several decades, and having undergone evaluation in multiple randomised trials, there is uncertainty over which patients have the most to gain from an intervention with clear procedural risk. Minimally invasive surgery via local anaesthetic applied drill-puncture of the cranium and infusion of a thrombolytic agent is an attractive option for patients requiring critical management of the haematoma, not just in low resource settings but arguably also in specialist centres of western countries. With several ongoing clinical trials nearing completion, these treatments could enter routine practice within the next few years, further justifying the urgency of "time is brain" and that active management within well-organized, comprehensive acute stroke care units includes patients with ICH. PMID:23088860

  15. ECMO Rescue Therapy in Diffuse Alveolar Haemorrhage: A Case Report with Review of Literature.

    PubMed

    Rawal, Gautam; Kumar, Raj; Yadav, Sankalp

    2016-06-01

    Extracorporeal Membrane Oxygenation (ECMO) has evolved as a treatment option for patients having potentially reversible severe respiratory failure who are deteriorating on conventional ventilation. During ECMO, systemic anticoagulation is needed to maintain patency of the circuit. Therefore, ongoing haemorrhage remains a relative contra-indication to ECMO as it can further increase the bleeding. There is only limited evidence available for the use of ECMO in patients with alveolar haemorrhage. Most of these patients did not receive any anticoagulation during ECMO. We describe our experience with a patient who received intravenous anticoagulation during ECMO for refractory hypoxemic respiratory failure due to Diffuse Alveolar Haemorrhage (DAH) associated with Granulomatosis polyangitis (Wegner's GPA). ECMO sustained life by maintaining gas exchange support and provided the time for the immunotherapy to be effective. We report the successful use of anticoagulation during ECMO in a patient with DAH. PMID:27504336

  16. Chronic Myeloid Leukaemia Presenting as Bilateral Retinal Haemorrhages with Multiple Retinal Infiltrates

    PubMed Central

    Barot, Rakesh K.; Gohel, Devadatta Jayantilal; Bhagat, Nupur

    2016-01-01

    Chronic Myeloid Leukaemia (CML) causes retinopathy manifesting as venous dilation and tortuosity, perivascular sheathing, retinal haemorrhages, microaneurysms, cotton-wool spots and optic nerve infiltration. Retina is the most commonly involved intraocular structure in CML. However, retinal involvement is a rare form of presentation of CML and few cases have been reported. We report a case of CML presenting as unilateral sudden visual loss. Fundus showed multiple white centered retinal haemorrhages in both eyes with unilateral macular oedema. Blood work-up showed raised WBC count, high platelet count and low Haemoglobin. Cytological analysis of bone marrow biopsy confirmed Philadelphia chromosome. After a course of Imatinib, visual acuity improved and haemorrhages resolved with normalization of macular thickness. In our case, patient presented early, leading to early detection producing better visual prognosis. This highlights the importance of detailed hematological work up in patients with retinal involvement to rule out leukaemic retinopathy.

  17. Mosquito-borne haemorrhagic fevers of South and South-East Asia.

    PubMed

    Halstead, S B

    1966-01-01

    During the past decade outbreaks of a severe haemorrhagic disease caused by dengue viruses of multiple types have been reported in the Philippines, Thailand, Malaysia, Viet-Nam and eastern India. In many of these outbreaks chikungunya virus, a group A arbovirus, was simultaneously the cause of similar but probably milder disease. Both these viruses appear to be able to be able to produce classical dengue fever in some individuals and disease with haemorrhagic manifestations in others. Because of the growing public health importance and the progressive spread of this disease a unified review of its clinical and epidemiological features has been needed. This paper presents the history and salient clinical features of mosquito-borne haemorrhagic fever and summarizes recent epidemiological studies and current diagnostic and control methods. PMID:5297536

  18. Acute Kidney Injury is More Common in Acute Haemorrhagic Stroke in Mymensingh Medical College Hospital.

    PubMed

    Ray, N C; Chowdhury, M A; Sarkar, S R

    2016-01-01

    Acute kidney injury (AKI) is a common complication after acute stroke and is an independent predictor of both early and long-term mortality after acute stroke. Acute kidney injury is associated with increased mortality in haemorrhagic stroke patients. This cross sectional observational study was conducted in Nephrology, Neuromedicine and Medicine department of Mymensingh Medical College & Hospital, Mymensingh from July 2012 to June 2014. A total of 240 patients with newly detected acute stroke confirmed by CT scan of brain were included in this study. According to this study, 15.42% of acute stroke patients developed AKI. Among the patients with haemorrhagic stroke 21.87% developed AKI while only 13.07% patients with ischaemic stroke developed AKI. So, early diagnosis and management of AKI in patients with acute stroke especially in haemorrhagic stroke is very important to reduce the morbidity and mortality of these patients. PMID:26931240

  19. Dating of Acute and Subacute Subdural Haemorrhage: A Histo-Pathological Study

    PubMed Central

    Rao, Murali G; Vashista, Rakesh Kumar; Sharma, Suresh Kumar

    2016-01-01

    Introduction Microscopic study of the organization of the Subdural Haemorrhage (SDH) verified against the time period can help us in the determination of its age which has serious medico-legal implications. Very few studies concerning the dating of SDH are present in the literature. Aim This study was conducted for dating the early subdural haemorrhage by routine histopathological stains. Materials and Methods A prospective analytical study was conducted during July 2009 to December 2010. A total of 100 cases (50 males and 50 females) fulfilling the inclusion and exclusion criteria were included in this study. Routine histopathological staining of the subdural haematoma was done. Results Correlation between the frequency of a given histomorphological phenomenon and the length of the Post-Traumatic Interval (PTI) was evidential. All the histomorphological features, when correlated with PTI groups, were found to be statistically significant, except for Polymorphonuclear Leukocytes (PMN). Conclusion We concluded that routine histopathology was reliable in the dating of early subdural haemorrhages.

  20. Mosquito-borne haemorrhagic fevers of South and South-East Asia*

    PubMed Central

    Halstead, Scott B.

    1966-01-01

    During the past decade outbreaks of a severe haemorrhagic disease caused by dengue viruses of multiple types have been reported in the Philippines, Thailand, Malaysia, Viet-Nam and eastern India. In many of these outbreaks chikungunya virus, a group A arbovirus, was simultaneously the cause of similar but probably milder disease. Both these viruses appear to be able to be able to produce classical dengue fever in some individuals and disease with haemorrhagic manifestations in others. Because of the growing public health importance and the progressive spread of this disease a unified review of its clinical and epidemiological features has been needed. This paper presents the history and salient clinical features of mosquito-borne haemorrhagic fever and summarizes recent epidemiological studies and current diagnostic and control methods. ImagesFIG. 4 PMID:5297536

  1. ECMO Rescue Therapy in Diffuse Alveolar Haemorrhage: A Case Report with Review of Literature

    PubMed Central

    Kumar, Raj; Yadav, Sankalp

    2016-01-01

    Extracorporeal Membrane Oxygenation (ECMO) has evolved as a treatment option for patients having potentially reversible severe respiratory failure who are deteriorating on conventional ventilation. During ECMO, systemic anticoagulation is needed to maintain patency of the circuit. Therefore, ongoing haemorrhage remains a relative contra-indication to ECMO as it can further increase the bleeding. There is only limited evidence available for the use of ECMO in patients with alveolar haemorrhage. Most of these patients did not receive any anticoagulation during ECMO. We describe our experience with a patient who received intravenous anticoagulation during ECMO for refractory hypoxemic respiratory failure due to Diffuse Alveolar Haemorrhage (DAH) associated with Granulomatosis polyangitis (Wegner’s GPA). ECMO sustained life by maintaining gas exchange support and provided the time for the immunotherapy to be effective. We report the successful use of anticoagulation during ECMO in a patient with DAH.

  2. Spontaneous idiopathic bilateral adrenal haemorrhage: a rare cause of abdominal pain.

    PubMed

    Nazir, Salik; Sivarajah, Surendra; Fiscus, Valena; York, Eugene

    2016-01-01

    We describe a case of a 62-year-old woman with a history of chronic obstructive pulmonary disease and gastro-oesophageal reflux disease who presented to the emergency department with left lower quadrant abdominal pain, flank pain with nausea and no history of preceding trauma. The patient had finished a course of azithromycin and oral methylprednisolone 1 day prior to presentation. Abdominal and pelvic CT scan identified changes suggestive of bilateral adrenal haemorrhage. The patient did not show signs of acute adrenal insufficiency but was started on steroid replacement therapy because of concerns about possible disease progression. All recognised causes of adrenal haemorrhage were excluded suggesting this was a case of spontaneous idiopathic bilateral adrenal haemorrhage, a rarely reported phenomenon in the literature. The patient was discharged after clinical improvement following 6 days in hospital, taking oral steroid replacement. PMID:27166002

  3. Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study.

    PubMed Central

    Blatchford, O.; Davidson, L. A.; Murray, W. R.; Blatchford, M.; Pell, J.

    1997-01-01

    OBJECTIVES: To determine the incidence and case fatality of acute upper gastrointestinal haemorrhage in the west of Scotland and to identify associated factors. DESIGN: Case ascertainment study. SETTING: All hospitals treating adults with acute upper gastrointestinal haemorrhage in the west of Scotland. SUBJECTS: 1882 patients aged 15 years and over treated in hospitals for acute upper gastrointestinal haemorrhage during a six month period. MAIN OUTCOME MEASURES: Incidence of acute upper gastrointestinal haemorrhage per 100,000 population per year, and case fatality. RESULTS: The annual incidence was 172 per 100,000 people aged 15 and over. The annual population mortality was 14.0 per 100,000. Both were higher among elderly people, men, and patients resident in areas of greater social deprivation. Overall case fatality was 8.2%. This was higher among those who bled as inpatients after admission for other reasons (42%) and those admitted as tertiary referrals (16%). Factors associated with increased case fatality were age, uraemia, pre-existing malignancy, hepatic failure, hypotension, cardiac failure, and frank haematemesis or a history of syncope at presentation. Social deprivation, sex, and anaemia were not associated with increased case fatality after adjustment for other factors. CONCLUSIONS: The incidence of acute upper gastrointestinal haemorrhage was 67% greater than the highest previously reported incidence in the United Kingdom, which may be partially attributable to the greater social deprivation in the west of Scotland and may be related to the increased prevalence of Helicobacter pylori. Fatality after acute upper gastrointestinal haemorrhage was associated with age, comorbidity, hypotension, and raised blood urea concentrations on admission. Although deprivation was associated with increased incidence, it was not related to the risk of fatality. PMID:9329304

  4. Novel bivalent vectored vaccine for control of myxomatosis and rabbit haemorrhagic disease.

    PubMed

    Spibey, N; McCabe, V J; Greenwood, N M; Jack, S C; Sutton, D; van der Waart, L

    2012-03-24

    A novel, recombinant myxoma virus-rabbit haemorrhagic disease virus (RHDV) vaccine has been developed for the prevention of myxomatosis and rabbit haemorrhagic disease (RHD). A number of laboratory studies are described illustrating the safety and efficacy of the vaccine following subcutaneous administration in laboratory rabbits from four weeks of age onwards. In these studies, both vaccinated and unvaccinated control rabbits were challenged using pathogenic strains of RHD and myxoma viruses, and 100 per cent of the vaccinated rabbits were protected against both myxomatosis and RHD. PMID:22266680

  5. Computational Intelligence Method for Early Diagnosis Dengue Haemorrhagic Fever Using Fuzzy on Mobile Device

    NASA Astrophysics Data System (ADS)

    Salman, Afan; Lina, Yen; Simon, Christian

    2014-03-01

    Mortality from Dengue Haemorrhagic Fever (DHF) is still increasing in Indonesia particularly in Jakarta. Diagnosis of the dengue shall be made as early as possible so that first aid can be given in expectation of decreasing death risk. The Study will be conducted by developing expert system based on Computational Intelligence Method. On the first year, study will use the Fuzzy Inference System (FIS) Method to diagnose Dengue Haemorrhagic Fever particularly in Mobile Device consist of smart phone. Expert system application which particularly using fuzzy system can be applied in mobile device and it is useful to make early diagnosis of Dengue Haemorrhagic Fever that produce outcome faster than laboratory test. The evaluation of this application is conducted by performing accuracy test before and after validation using data of patient who has the Dengue Haemorrhagic Fever. This expert system application is easy, convenient, and practical to use, also capable of making the early diagnosis of Dengue Haemorraghic to avoid mortality in the first stage.

  6. Acute haemorrhagic leucoencephalitis localised to the brainstem and cerebellum: a report of two cases

    PubMed Central

    Michaud, Jean; Helle, Todd L

    1982-01-01

    Two cases of acute haemorrhagic leucoencephalitis localised to the brainstem and cerebellum are reported. One followed the insertion of a ventriculoatrial shunt and the other an upper respiratory tract infection. The rare previously reported cases of this condition involving mainly the posterior fossa structures are reviewed. Images PMID:7069428

  7. Feasibility of electrical impedance tomography in haemorrhagic stroke treatment using adaptive mesh

    NASA Astrophysics Data System (ADS)

    Nasehi Tehrani, J.; Anderson, C.; Jin, C.; van Schaik, A.; Holder, D.; McEwan, A.

    2010-04-01

    EIT has been proposed for acute stroke differentiation, specifically to determine the type of stroke, either ischaemia (clot) or haemorrhage (bleed) to allow the rapid use of clot-busting drugs in the former (Romsauerova et al 2006) . This addresses an important medical need, although there is little treatment offered in the case of haemorrhage. Also the demands on EIT are high with usually no availability to take a 'before' measurement, ruling out time difference imaging. Recently a new treatment option for haemorrhage has been proposed and is being studied in international randomised controlled trial: the early reduction of elevated blood pressure to attenuate the haematoma. This has been shown via CT to reduce bleeds by up to 1mL by Anderson et al 2008. The use of EIT as a continuous measure is desirable here to monitor the effect of blood pressure reduction. A 1mL increase of haemorrhagic lesion located near scalp on the right side of head caused a boundary voltage change of less than 0.05% at 50 kHz. This could be visually observed in a time difference 3D reconstruction with no change in electrode positions, mesh, background conductivity or drift when baseline noise was less than 0.005% but not when noise was increased to 0.01%. This useful result informs us that the EIT system must have noise of less than 0.005% at 50 kHz including instrumentation, physiological and other biases.

  8. Large bilateral adrenal haemorrhages in a newborn with unrepaired cyanotic CHD.

    PubMed

    Morgan, Lerraughn M; Austin, Erle H; Holland, Brian J

    2016-06-01

    Management of newborns with cyanotic CHD and bilateral adrenal haemorrhages has not previously been described in the literature. These abnormalities present unique challenges due to the potential for haemodynamic instability, need for open heart surgery and associated systemic anticoagulation in the newborn period, and the risk of catastrophic bleeding. PMID:27056035

  9. Trends in maternal mortality due to haemorrhage: two decades of Indian rural observations.

    PubMed

    Chhabra, S; Sirohi, Ritu

    2004-01-01

    Obstetric haemorrhage continues to be a major cause of maternal mortality. Our analysis of records of over a period of 20 years from April 1982 to March 2002 reveals that it was a contributory cause of maternal mortality in 19.9% of cases. The majority of deaths, (65%) had occurred within 24 hours of admission and in 47.5% of cases there was severe anaemia on admission; 17.5% had died due to an atonic PPH, which was the largest category, followed by ruptured uterus (15%), abruptio placenta (15%) and retained placenta (12.5%). Deaths due to obstetric haemorrhage because of a ruptured uterus, retained placenta and abortion have decreased from 22.22% between 1982 and 1987 to zero in the last 5 years and an increase was seen in deaths due to haemorrhage because of gestational trophoblastic neoplasia and ectopic pregnancy, from 1.69% to 4.87%, unclassified haemorrhage 1.96% to 7.31% and placenta praevia from zero between 1982 and 1987 to 4.87% between 1997 and 2002. PMID:14675979

  10. Bilateral subhyaloid haemorrhage in a conscious patient: a new spectrum of ocular involvement by Plasmodium falciparum

    PubMed Central

    Abdali, Nasar; Malik, Azharuddin Mohammed; Shamim, Md Dilawez; Rizvi, Syed Wajahat Ali

    2014-01-01

    A 24-year-old woman presented with a history of high-grade fever with rigours since 3 days and bilateral sudden loss of vision since 6 h. She was conscious, oriented and her vitals were stable. She had a temperature of 101°F, anaemia, thrombocytopaenia, normal white cell count and moderate splenomegaly. On testing visual activity, she could only perceive hand movements although her pupils were bilaterally equal, and normal in size and reaction. On indirect ophthalmoscopy, optic discs were normal bilaterally; however, fovea of both eyes was masked by subhyaloid haemorrhage. Peripheral smear showed gametocytes of Plasmodium falciparum. The patient was started on arteminsinin-combined therapy and advised to be in propped-up position to help resolution of the haemorrhage. The patient was afebrile in 4 days and follow-up fundus examination showed gradual resolution of the haemorrhage. After two months, the patient regained normal visual acuity in both eyes; however, it took nearly 3 months for complete resolution of the haemorrhage. PMID:24862605

  11. Biochemical and functional characterization of Bothropoidin: the first haemorrhagic metalloproteinase from Bothrops pauloensis snake venom.

    PubMed

    Gomes, Mário Sérgio R; Naves de Souza, Dayane L; Guimarães, Denise O; Lopes, Daiana S; Mamede, Carla C N; Gimenes, Sarah Natalie C; Achê, David C; Rodrigues, Renata S; Yoneyama, Kelly A G; Borges, Márcia H; de Oliveira, Fábio; Rodrigues, Veridiana M

    2015-03-01

    We present the biochemical and functional characterization of Bothropoidin, the first haemorrhagic metalloproteinase isolated from Bothrops pauloensis snake venom. This protein was purified after three chromatographic steps on cation exchange CM-Sepharose fast flow, size-exclusion column Sephacryl S-300 and anion exchange Capto Q. Bothropoidin was homogeneous by SDS-PAGE under reducing and non-reducing conditions, and comprised a single chain of 49,558 Da according to MALDI TOF analysis. The protein presented an isoelectric point of 3.76, and the sequence of six fragments obtained by MS (MALDI TOF\\TOF) showed a significant score when compared with other PIII Snake venom metalloproteinases (SVMPs). Bothropoidin showed proteolytic activity on azocasein, Aα-chain of fibrinogen, fibrin, collagen and fibronectin. The enzyme was stable at pH 6-9 and at lower temperatures when assayed on azocasein. Moreover, its activity was inhibited by EDTA, 1.10-phenanthroline and β-mercaptoethanol. Bothropoidin induced haemorrhage [minimum haemorrhagic dose (MHD) = 0.75 µg], inhibited platelet aggregation induced by collagen and ADP, and interfered with viability and cell adhesion when incubated with endothelial cells in a dose and time-dependent manner. Our results showed that Bothropoidin is a haemorrhagic metalloproteinase that can play an important role in the toxicity of B. pauloensis envenomation and might be used as a tool for studying the effects of SVMPs on haemostatic disorders and tumour metastasis. PMID:25261583

  12. Experimental respiratory Marburg virus haemorrhagic fever infection in the common marmoset (Callithrix jacchus)

    PubMed Central

    Smither, Sophie J; Nelson, Michelle; Eastaugh, Lin; Laws, Thomas R; Taylor, Christopher; Smith, Simon A; Salguero, Francisco J; Lever, Mark S

    2013-01-01

    Marburg virus causes a highly infectious and lethal haemorrhagic fever in primates and may be exploited as a potential biothreat pathogen. To combat the infection and threat of Marburg haemorrhagic fever, there is a need to develop and license appropriate medical countermeasures. To determine whether the common marmoset (Callithrix jacchus) would be an appropriate model to assess therapies against Marburg haemorrhagic fever, initial susceptibility, lethality and pathogenesis studies were performed. Low doses of virus, between 4 and 28 TCID50, were sufficient to cause a lethal, reproducible infection. Animals became febrile between days 5 and 6, maintaining a high fever before succumbing to disease between 8 and 11 days postchallenge. Typical signs of Marburg virus infection were observed including haemorrhaging and a transient rash. In pathogenesis studies, virus was isolated from the animals’ lungs from day 3 postchallenge and from the liver, spleen and blood from day 5 postchallenge. Early signs of histopathology were apparent in the kidney and liver from day 3. The most striking features were observed in animals exhibiting severe clinical signs, which included high viral titres in all organs, with the highest levels in the blood, increased levels in liver function enzymes and blood clotting times, decreased levels in platelets, multifocal moderate-to-severe hepatitis and perivascular oedema. PMID:23441639

  13. Mitral endocarditis due to Rothia aeria with cerebral haemorrhage and femoral mycotic aneurysms, first French description.

    PubMed

    Collarino, R; Vergeylen, U; Emeraud, C; Latournèrie, G; Grall, N; Mammeri, H; Messika-Zeitoun, D; Vallois, D; Yazdanpanah, Y; Lescure, F-X; Bleibtreu, A

    2016-09-01

    Rothia aeria is a Rothia species from the Micrococcaceae family. We report here the first French R. aeria endocarditis complicated by brain haemorrhage and femoral mycotic aneurysms. Altogether, severity and antimicrobial susceptibility should make us consider the management of R. aeria endocarditis as Staphylococcus aureus methicillin-susceptible endocarditis. PMID:27408740

  14. Superselective embolization in an errosive haemorrhage of a carcinoma in the parotid gland.

    PubMed

    Feifel, H; Volle, E; Riediger, D; Gustorf-Aeckerle, R

    1991-12-01

    Haemorrhage due to errosion of blood vessels in tumors of the head and neck are a dramatic event. Superselective embolization plays an important role in the treatment of these entities. A therapeutic approach and method of embolization is described. PMID:1770245

  15. Visual outcome of 25-gauge microincision vitrectomy surgery in diabetic vitreous haemorrhage

    PubMed Central

    Khan, Burhan Abdul Majid; Rizvi, Syed Fawad; Mahmood, Syed Asaad; Mal, Washoo; Zafar, Shakir

    2015-01-01

    Objective: To assess the visual outcome and complications of 25-gauge micro incision vitrectomy surgery (MIVS) in diabetic vitreous haemorrhage. Methods: This Quasi Experimental study was conducted at LRBT, Tertiary eye care hospital Karachi, from February 2012 to January 2013. Sixty eyes of sixty patients with uncontrolled type II diabetes mellitus (DM) were included. There were 43 (71.7%) males and 17 (28.3%) females. Age range was 40 – 60 years. All randomly selected patients underwent 25-gauge sutureless micro incision vitrectomy surgery for diabetic vitreous haemorrhage. Main outcomes measured were best corrected visual acuity (BCVA) assessed with logMAR and post-operative complications. Follow ups were at one day, one week, one month, three months and six months post-operatively. Result: Best corrected visual acuity (BCVA) gradually improved in majority of subjects in each subsequent follow up visit. Preoperative visual acuity was 1.023 ±0.226 logMAR, which was improved after final follow up to 0.457±0.256 and P-value was < 0.001. Five patients developed recurrent vitreous haemorrhage during study period, one patient developed cataract (1.7%), one (1.7%) had ocular hypotony defined as intraocular pressure < 5 mmHg and one (1.7%) developed endophthalmitis. Conclusion: 25-gauge micro incision vitrectomy surgery (MIVS) is an effective sutureless parsplana vitrectomy surgery which has good visual outcome in diabetic vitreous haemorrhage with minimum manageable complications. PMID:26649013

  16. Evidence that venoconstriction reverses the phase II sympathoinhibitory and bradycardic response to haemorrhage.

    PubMed

    Potas, J R; Dampney, R A L

    2004-03-31

    Severe hypotensive haemorrhage results in a biphasic response, characterized by an initial increase in heart rate and sympathetic vasomotor activity (phase I) followed by a life-threatening hypotension, accompanied by profound sympathoinhibition and bradycardia (phase II). The phase II response is believed to be dependent on inputs from cardiopulmonary receptors, and may be triggered by the reduction in venous return and cardiac filling associated with severe haemorrhage. In this study, we tested the hypothesis that the phase II response could be reversed by venoconstriction, which is known to enhance venous return and cardiac filling, by comparing the effects of phenylephrine (which constricts veins as well as arterioles) with that of vasopressin (which constricts arterioles but not veins). In sodium pentobarbitone-anaesthetised rats, haemorrhage evoked an initial increase in heart rate (HR) and renal sympathetic activity (RSNA) followed by a large decrease in both variables to levels below the pre-haemorrhage baseline levels (phase II response). During the phase II response, an intravenous injection of phenylephrine, sufficient to restore mean arterial pressure to the pre-haemorrhage level, resulted in a gradually developing increase (over 3-4 min) in HR and RSNA back to the baseline levels. In contrast, intravenous injection of an equipressor dose of vasopressin did not result in any increase in RSNA and only a transient increase in HR. Injection of phenylephrine, but not vasopressin, also increased the pulsatile component of central venous pressure, indicative of reduced venous capacitance. The findings indicate that venoconstriction reverses the phase II sympathoinhibition and bradycardia. PMID:15109933

  17. Intracisternal naloxone and cardiac nerve blockade prevent vasodilatation during simulated haemorrhage in awake rabbits.

    PubMed Central

    Evans, R G; Ludbrook, J; Potocnik, S J

    1989-01-01

    1. Acute haemorrhage was simulated in five unanaesthetized rabbits, by inflating a cuff on the inferior vena cava so that cardiac output fell by 8.3% of its resting level per minute. Simulated haemorrhage was performed after sham treatment, after graded doses of intravenous and intracisternal naloxone, and after cardiac nerve blockade with intrapericardial procaine. 2. After sham treatment, the haemodynamic response to simulated haemorrhage was biphasic. During the first phase, systemic vascular conductance fell steadily, heart rate rose steadily, and arterial pressure fell only slightly. A second decompensatory phase began abruptly when cardiac output had fallen to approximately 55% of its resting level. Vascular conductance rose steeply, heart rate fell slowly, and arterial pressure fell precipitately. 3. Treatment with naloxone (intravenous, 0.04-0.4 mg kg-1; intracisternal, 0.2-2 micrograms kg-1) did not affect either phase of the haemodynamic response to simulated haemorrhage. 4. After treatment with larger doses of naloxone (intravenous, 4-8 mg kg-1; intracisternal, 4-69 micrograms kg-1), the first phase was unaffected, but the second phase no longer occurred. Throughout simulated haemorrhage, systemic vascular conductance fell steadily, heart rate rose, and arterial pressure was well maintained. The dose of intracisternal naloxone which prevented the second phase was 90-900 times less than the corresponding intravenous dose. The second phase was also prevented by cardiac nerve blockade. 5. We conclude that an endogenous opiate mechanism is responsible for the haemodynamic decompensation that occurs when cardiac output falls to a critical level. The mechanism is located within the central nervous system. It is triggered by a signal from the heart. PMID:2585286

  18. Prevalence and incidence of intracranial haemorrhage in a population of children with haemophilia. The Hemophilia Growth and Development Study.

    PubMed

    Nelson, M D; Maeder, M A; Usner, D; Mitchell, W G; Fenstermacher, M J; Wilson, D A; Gomperts, E D

    1999-09-01

    The prevalence of intracranial haemorrhage (ICH) in our population of haemophiliacs was 12%. The incidence of ICH was approximately 2% per year. At entry, 7% (21/309) had clinical histories of ICH without MRI evidence of old haemorrhage, indicating that either the haemorrhages had completely resolved, that routine MRI sequences are not particularly sensitive for the detection of old blood products, or a combination of both of these factors. One half (4/8) of the ICHs documented by entry MRI were clinically silent, and three of the 11 incident cases documented by MRI were clinically silent. HIV infection did not increase the risk of ICH. PMID:10583511

  19. Pituitary apoplexy can mimic acute meningoencephalitis or subarachnoid haemorrhage.

    PubMed

    Sadek, Ahmed-Ramadan; Gregory, Stephen; Jaiganesh, Thiagarajan

    2011-01-01

    symptoms and lack of prodrome, an urgent CT head scan was performed to rule out a cerebrovascular event. The scan demonstrated an enlarged pituitary gland (3 cm in diameter) with impingement of the optic chiasm. The centre of the enlarged pituitary gland was noted to be hypodense in comparison to its periphery, which was consistent with a diagnosis of pituitary apoplexy. A subsequent MRI confirmed the diagnosis (Figure 1) of an enlarged sella containing abnormal soft tissue with increased signal intensity suggestive of haemorrhage (Figure 1A).Post-MRI a lumbar puncture was performed revealing glucose 3.4 mmol/l, protein 1.0 g/l, red cells of 53/mm3 and white cells of 174/mm3 with predominant neutrophilia. No organisms were seen, and CSF cultures and HSV DNA tests were found to be negative. Endocrinological investigations demonstrated low concentrations of thyroid hormones [TSH: 0.14 mIu/l (0.35-5.5 mlU/l), FT3: 1.1 nmol/l (1.2-3.0 nmol/l), FT4: 9.6 pmol/l (8-22 pmol/l)], gonadal hormones (LH: < 1 u/l) and prolactin: 16 u/l (<450 u/l). Serum FSH was 2.9 u/l (0.8-11.5 u/L) and cortisol 575 nmol/l (450-700 nmol/l). The patient was treated for hypopituitarism based on clinical and radiological findings with intravenous fluids, hydrocortisone (100 mg) and thyroxine (50 μg) as loading doses in the ED.Within 24 h of commencement of therapy the patient's GCS rose to 15, and within 48 h there was marked improvement in the right sixth cranial nerve palsy. Formal visual field assessment demonstrated temporal visual field loss in the left eye. The patient was discharged to his usual residence a week later and follow-up was organised with both the endocrinologists and ophthalmologists. Follow-up MRI demonstrated that there was no significant change in either size or signal characteristics of the pituitary fossa mass (Figure 1B). PMID:21975129

  20. Epidemiology of Intracranial Haemorrhages Associated with Vitamin K Antagonist Oral Anticoagulants in Spain: TAC Registry

    PubMed Central

    Zapata-Wainberg, Gustavo; Ximénez-Carrillo Rico, Álvaro; Benavente Fernández, Lorena; Masjuan Vallejo, Jaime; Gállego Culleré, Jaime; Freijó Guerrero, María del Mar; Egido, José; Gómez Sánchez, José Carlos; Martínez Domeño, Alejandro; Purroy García, Francisco; Vives Pastor, Bárbara; Blanco González, Miguel; Vivancos, José

    2015-01-01

    Background Vitamin K antagonist oral anticoagulants (VKA-OACs) are effective for primary and secondary prevention of embolic events. The rate of haemorrhagic neurological complications in patients admitted to neurology departments in Spain is not yet known. Aims We aimed to determine the clinical and epidemiological characteristics of patients with intracranial haemorrhage secondary to VKA-OACs as well as the incidence of this severe complication. Methods We conducted a retrospective, descriptive, multi-centre study using information from the medical records of all patients admitted to neurology departments, diagnosed with spontaneous intracranial haemorrhage, and treated with VKA-OACs within a 1-year period. We collected demographic and care data from centres, patients' medical records [demographic data, medical history, haemorrhage origin, vascular risk factors, concomitant treatment, and National Institutes of Health Stroke Scale (NIHSS) scores], and patients' outcome at 3 months [independence (modified Rankin Scale score <3) and mortality rate]. Results Twenty-one hospitals serving a population of 8,155,628 inhabitants participated in the study. The total number of cases was 235, the mean age was 78.2 (SD 9.4) years, and the baseline NIHSS score was 11.6 (SD 9.5; median 9; interquartile range 14). The VKA-OACs used were acenocoumarol in 95.3% (224 patients) and warfarin in 4.7% (11 patients). The haemorrhage origin was deep in 29.8%, lobar in 25.5%, intraventricular in 11.5%, extensive in 17.4% (>100 ml), cerebellar in 12.3%, and in the brainstem in 3.4%. The international normalised ratio was within therapeutic ranges at admission (according to indication) in 29.4% (69 patients). The global incidence (cases per 100,000 inhabitants per year) is 2.88. The in-hospital mortality rate was 40%, and 24.3% of the patients were independent at 3 months, while the mortality at 3 months was 42.6%. Conclusion VKA-OAC treatment is associated with a large percentage of all

  1. Comparison of fibreoptic endoscopy in acute upper gastrointestinal haemorrhage in Africans and Europeans.

    PubMed

    Wicks, A C; Thomas, G E; Clain, D J

    1975-11-01

    The results of endoscopy in acute upper gastrointestinal haemorrhage were compared in a group of 138 Africans and one of 84 Europeans. Contrary to widely held clinical opinion, the incidence of gastric and duodenal ulceration was similar in the two races. Peptic ulcers were the main source of bleeding in both groups and were surprisingly more common than varices in the Africans. Bleeding from varices, however, was far more common in the Africans than in the Europeans. Stomal ulcers were confined to Europeans. Gastric erosions, often attributed to herbal medicines, were more common in the Africans but the difference was not significant. The study was not designed to determine reduced mortality since the introduction of endoscopy, but management, especially in the Africans, was aided by early recognition of haemorrhage from oesophageal varices and acute gastric erosions. PMID:1081417

  2. Alveolar haemorrhage in anti‐glomerular basement membrane disease without detectable antibodies by conventional assays

    PubMed Central

    Serisier, D J; Wong, R C W; Armstrong, J G

    2006-01-01

    Anti‐glomerular basement membrane (anti‐GBM) disease represents the spectrum of disease attributable to circulating anti‐GBM antibodies. While active anti‐GBM disease in the absence of circulating anti‐GBM antibodies has been described, it is considered rare with the use of current routinely available assays. We report four subjects with features consistent with active anti‐GBM antibody disease without detectable antibodies by routinely available enzyme linked immunosorbent assay (ELISA) and immunoblot techniques. All were smokers who presented with diffuse alveolar haemorrhage, minimal renal involvement, and undetectable anti‐GBM antibodies. Seronegative anti‐GBM disease with predominant pulmonary involvement may be more common than previously appreciated and should be part of the differential diagnosis for otherwise unexplained diffuse alveolar haemorrhage. Renal biopsy with immunofluorescent studies should be considered in the diagnostic evaluation of such subjects, including those with idiopathic pulmonary haemosiderosis. PMID:16807392

  3. Spinal Intradural Schwannoma with Acute Intratumoural Haemorrhage: Case Report and Review

    PubMed Central

    Kongwad, Lakshman I.; Valiathan, Manna G.

    2016-01-01

    Schwannomas account for around half of all intradural spinal tumours, with chronic progressive symptoms as the most common presenting features. Intratumoural haemorrhage as a presenting feature of spinal schwannoma is very rare and only 11 cases have been reported till date. Authors here report a previously asymptomatic 40-year-old male who presented with acute onset paraplegia 12 hours after a minor trauma. MR imaging revealed a C7-D3 intradural-extramedullary lesion with features of acute blood and showing no enhancement. Emergency laminectomy and complete removal of the mass was performed and histopathology revealed features of schwannoma with haemorrhage. Patient had modest improvement of his neurological deficits at a follow-up of 6 months. Pertinent literature is reviewed in brief. PMID:26894121

  4. Isolated impairment of posterior pituitary function secondary to severe postpartum haemorrhage due to uterine rupture.

    PubMed

    Adali, Ertan; Kucukaydin, Zehra; Adali, Fulya; Yildizhan, Recep

    2011-08-01

    Cranial diabetes insipidus (DI) due to postpartum haemorrhage is an extremely rare clinical event. We describe herein isolated posterior pituitary insufficiency in a 26-year-old woman who had undergone subtotal hysterectomy for severe postpartum haemorrhage because of uterine rupture. The patient experienced polyuria within 6 h postoperatively. DI was suggested by the elevated urine volumes and low urine specific gravity. The diagnosis of DI was confirmed by water deprivation test and vasopressin stimulation test. The anterior pituitary function was within normal limits. A high clinical suspicion is certainly required for the diagnosis of DI in the immediate postpartum period. To rapidly initiate appropriate therapy, the possibility of DI should always be kept in mind while evaluating patients who have polyuria and polydipsia after severe postpartum bleeding. Delay or failure to treat this condition might result in hypovolemic shock. PMID:20636230

  5. Successful treatment of active haemorrhage from a duodenal diverticulum using surgicel (absorbable haemostat): a case report.

    PubMed

    Muguti, Gi; Gandhi, H; Ridgeway, D

    2007-01-01

    Haemorrhage is one of the rare but serious complications of duodenal diverticula. Current methods of treatment include: endoscopy with injection therapy or hemoclip application and diverticulectomy. In this paper we present the case of a 61 year old man with life threatening haemorrhage who was managed successfully with gentle packing of a bleeding duodenal diverticulum using SURGICEL (Absorbable Haemostat). This appears to be a simple and effective way of dealing with the problem especially in situations where other methods are ineffective or inapplicable. Early surgical intervention before the development of any coagulopathy increases the chances of a successful outcome. It has not been possible to find a similar report from a thorough literature search. PMID:20353131

  6. Cervical tourniquet in case of uncontrollable haemorrhage during caesarean section owing to a placenta accreta

    PubMed Central

    Huijgen, Q C A; Gijsen, A F; Hink, E; Van Kesteren, P J M

    2013-01-01

    This case report describes a 38-year-old woman in whom a primary caesarean section for placenta previa was complicated by postpartum haemorrhage due to a placenta accreta. Despite tamponade with a Bakri balloon and placement of a B-Lynch suture, the amount of blood loss could not be effectively reduced. The blood loss was eventually minimised by the placement of a Penrose drain around the cervix as a cervical tourniquet. We think that a cervical tourniquet is an effective method of stopping haemorrhage during caesarean section, as shown in this case report, and we consider this technique to be a valuable addition to several existing methods through which fertility is preserved by preventing emergency hysterectomy. PMID:23608864

  7. Cervical tourniquet in case of uncontrollable haemorrhage during caesarean section owing to a placenta accreta.

    PubMed

    Huijgen, Q C A; Gijsen, A F; Hink, E; Van Kesteren, P J M

    2013-01-01

    This case report describes a 38-year-old woman in whom a primary caesarean section for placenta previa was complicated by postpartum haemorrhage due to a placenta accreta. Despite tamponade with a Bakri balloon and placement of a B-Lynch suture, the amount of blood loss could not be effectively reduced. The blood loss was eventually minimised by the placement of a Penrose drain around the cervix as a cervical tourniquet. We think that a cervical tourniquet is an effective method of stopping haemorrhage during caesarean section, as shown in this case report, and we consider this technique to be a valuable addition to several existing methods through which fertility is preserved by preventing emergency hysterectomy. PMID:23608864

  8. Pregnancy complicated by haemorrhagic ascites in a woman with newly diagnosed HIV.

    PubMed

    Morgan, Catrin; Nicholls, Kate; Gangat, Nusraat; Sansome, Stafford

    2016-01-01

    A young pregnant Zambian woman was referred from a district hospital in South Zambia to the university teaching hospital, Lusaka with severe anaemia and ascites. The ascites had developed over a month and the woman was currently 15 weeks pregnant. Further workup revealed that the patient was HIV-positive and the ascitic tap showed haemorrhagic fluid. After being reviewed by multiple doctors, the cause of the haemorrhagic ascites remained unclear; therefore, the decision was made to do a laparotomy. The laparotomy revealed haemoperitoneum and a large cyst attached to the liver containing 5 L of bloodstained fluid. The histopathology report revealed features consistent with a giant haemangioma. There were many barriers to accessing optimum healthcare in this case. These included limited access to blood, poor communication resulting in the patient being unaware of her HIV status and lack of patient education about HIV. PMID:27473033

  9. Subdural haemorrhage and severe coagulopathy resulting in transtentorial uncal herniation in a neonate undergoing therapeutic hypothermia

    PubMed Central

    Wang, Dianna; McMillan, Hugh; Bariciak, Erika

    2014-01-01

    Therapeutic hypothermia has been shown to be efficacious for improving long-term neurodevelopmental outcomes following perinatal asphyxia. Thus, cooling protocols have been adopted at most tertiary neonatal centres. We present a case of a term neonate who underwent therapeutic whole-body cooling for hypoxic ischaemic encephalopathy following a difficult forceps delivery. She abruptly deteriorated, exhibiting signs of transtentorial uncal herniation and severe disseminated intravascular coagulopathy. CT of the head confirmed a life-threatening subdural haematoma and a concealed skull fracture. Hypothermia has been shown to impair haemostasis in vivo and thus may potentially exacerbate occult haemorrhages in a clinical setting. Newborns that require instrument-assisted delivery are a particularly high-risk group for occult head injuries and should undergo careful clinical assessment for fractures and intracranial haemorrhage prior to initiation of therapeutic hypothermia. PMID:25100805

  10. [EHEC-associated colon stenosis after ulcerous-chronic haemorrhagic colitis and consecutive resulting ileus].

    PubMed

    Lipp, M J; Schirmer, J; Feyerabend, B; Stavrou, G A; Cordruwisch, W; Faiss, S; Oldhafer, K J

    2012-05-01

    We report on the case of a segmentally emphasised, ulcerous chronic haemorrhagic colitis with the development of granulation tissue und scarred fibrosis with consecutive resulting stenosis of the colon. A 49-year-old male patient was infected with enterohaemorrhagic Escherichia coli bacteria during the EHEC-epidemic in northern Germany in early summer 2011. In the course of the infection the patient suffered from haemolytic uraemic syndrome (HUS) with acute renal failure and neurological symptoms. Haemodialysis and plasmapheresis had become mandatory. A simultaneous ileus was estimated to be of paralytic origin. One month after treatment of the acute phase of the infection a CT scan of the abdomen was performed and discovered a symptomatic stenosis of the proximal colon transversum. This obstruction needed to be treated by performing a right hemicolectomy with an ileo-transverso anastomosis. After surgery the patient recovered continuously. The histopathological examination verified an ulcerous-chronic haemorrhagic colitis on the background of an EHEC infection. PMID:22581700

  11. Viral hemorrhagic septicaemia virus (VHSV) up-regulates the cytotoxic activity and the perforin/granzyme pathway in the rainbow trout RTS11 cell line.

    PubMed

    Ordás, M C; Cuesta, A; Mercado, L; Bols, N C; Tafalla, C

    2011-08-01

    A survey of immune-relevant genes that might be up-regulated in response to viral hemorrhagic septicaemia virus (VHSV) in the rainbow trout monocyte-macrophage cell line, RTS11, unexpectedly revealed an increased expression of perforin (PRF) and granzyme (GRZ) genes, which represent components of the major cytotoxic pathway. The natural killer-enhancing factor (NKEF), also known to modulate cytotoxic activity, was up-regulated at the gene but strikingly down-regulated at protein level. The expression of these genes was not affected in head kidney leukocytes (HKLs) infected with VHSV, leading us to evaluate the potential cytotoxic activity of RTS11 and HKLs. For the first time, the cytotoxic activity of RTS11 against xenogeneic targets has been demonstrated, although this was modest relative to HKLs. Yet the activity in RTS11 was significantly increased by VHSV, as in HKLs. This cytotoxic activity elicited by viral infection appeared to require viral gene expression because inactivated VHSV failed to increase RTS11 cytotoxic activity. As for other immune functions, RTS11 cells provide a model for further studying cytotoxic activities of fish monocyte-macrophages. PMID:21642001

  12. Elevated local skin temperature impairs cutaneous vasoconstrictor responses to a simulated haemorrhagic challenge while heat stressed

    PubMed Central

    Pearson, J.; Lucas, R. A. I.; Crandall, C. G.

    2016-01-01

    During a simulated haemorrhagic challenge, syncopal symptoms develop sooner when individuals are hyperthermic relative to normothermic. This is due, in part, to a large displacement of blood to the cutaneous circulation during hyperthermia, coupled with inadequate cutaneous vasoconstriction during the hypotensive challenge. The influence of local skin temperature on these cutaneous vasoconstrictor responses is unclear. This project tested the hypothesis that local skin temperature modulates cutaneous vasoconstriction during simulated haemorrhage in hyperthermic humans. Eight healthy participants (four men and four women; 32 ± 7 years old; 75.2 ± 10.8 kg) underwent lower-body negative pressure to presyncope while heat stressed via a water-perfused suit sufficiently to increase core temperature by 1.2 ± 0.2°C. At forearm skin sites distal to the water-perfused suit, local skin temperature was either 35.2 ± 0.6 (mild heating) or 38.2 ± 0.2°C (moderate heating) throughout heat stress and lower-body negative pressure, and remained at these temperatures until presyncope. The reduction in cutaneous vascular conductance during the final 90 s of lower-body negative pressure, relative to heat-stress baseline, was greatest at the mildly heated site (−10 ± 15% reduction) relative to the moderately heated site (−2 ± 12%; P = 0.05 for the magnitude of the reduction in cutaneous vascular conductance between sites), because vasoconstriction at the moderately heated site was either absent or negligible. In hyperthermic individuals, the extent of cutaneous vasoconstriction during a simulated haemorrhage can be modulated by local skin temperature. In situations where skin temperature is at least 38°C, as is the case in soldiers operating in warm climatic conditions, a haemorrhagic insult is unlikely to be accompanied by cutaneous vasoconstriction. PMID:22903981

  13. Visual outcomes of vitrectomy for polypoidal choroidal vasculopathy-related breakthrough vitreous haemorrhage

    PubMed Central

    Lin, H-C; Yang, C-H; Yang, C-M

    2014-01-01

    Purpose To evaluate the long-term visual outcomes of pars plana vitrectomy (PPV) for polypoidal choroidal vasculopathy (PCV)-associated vitreous haemorrhage (VH). Method We retrospectively reviewed the records of patients with PCV-related VH who underwent PPV. The main outcome measures were best-corrected visual acuity (BCVA) and fundus findings at 3 months postoperatively and final visit. Results Seventeen eyes of 17 patients with massive subretinal haemorrhage (16.7±7.1 disc size of mean subretinal haemorrhage area) were enrolled. The mean postoperative follow-up period was 25.2 months. Four eyes received intravitreal bevacizumab injections, and three eyes underwent photodynamic therapy before the onset of VH. The mean BCVA improved from logarithm of the minimum angle of resolution (LogMAR) of 2.63±0.57 preoperatively to 1.43±0.82 at final visit (P<0.001). Among the eyes with initial polyps at subfoveal or juxtafoveal area, 16.70% achieved final BCVA ≥20/400 (LogMAR 1.3), whereas 87.50% of eyes with initial polyps at extrafoveal area had final BCVA ≥20/400 (Fisher's exact test, P=0.026). Conclusions PCV with massive subretinal haemorrhage is at risk for breakthrough VH. The visual prognosis in eyes with PCV-related breakthrough VH is variable after vitrectomy. Initial polyps at the extrafoveal area led to better functional outcomes. Early vitrectomy may be beneficial for visual recovery after PCV-related VH. PMID:24924445

  14. Deaths associated with dengue haemorrhagic fever: the first in Australia in over a century.

    PubMed

    McBride, William J H

    2005-07-01

    A dengue fever epidemic was recognised in the Torres Strait Islands of Queensland in late 2003. Two fatal cases of dengue haemorrhagic fever occurred in early 2004. This severe manifestation is more common when a patient is infected a second time, with a different virus serotype to the first infection. These are the first fatalities related to dengue fever in Australia in over a century. PMID:15992338

  15. Transcatheter coil embolotherapy: a safe and effective option for major colonic haemorrhage

    PubMed Central

    Nicholson, A; Ettles, D; Hartley, J; Curzon, I; Lee, P; Duthie, G; Monson, J

    1998-01-01

    Background—The management of major colonic bleeding is problematic. A proportion of patients require emergency surgery which is associated with high morbidity and mortality. Percutaneous embolotherapy, previously considered a high risk procedure in the colon, may provide an alternative treatment in this group of patients. 
Aims—To assess the safety and efficacy of embolotherapy in the treatment of life threatening colonic haemorrhage. 
Patients and methods—Thirty eight patients with fresh haemorrhage per rectum were referred for surgery because of failed conservative treatment. All underwent angiography; in 14 a bleeding site or vascular abnormality was detected. A coaxial catheter was directed to the most distal bleeding artery and this was embolised with platinum coils. 
Results—Detection of a bleeding site correlated with haemodynamic stability at the time of angiography (r=1 for a systolic blood pressure less than 100 mm Hg). Bleeding sites or vascular abnormalities were detected and embolised in 14 patients (37%). In 12/14 there was immediate and sustained haemodynamic improvement; two continued to bleed and required emergency hemicolectomy (14%). Three developed ischaemic complications (21.4%); these were managed conservatively and required no intervention. The 30 day mortality was 7.1% in the embolotherapy group and 10.5% in the overall group of 38patients. 
Conclusion—Colonic embolotherapy for life threatening haemorrhage is an effective, relatively safe procedure with a low incidence of major complications. Its use depends on the identification of a focal bleeding point or vascular abnormality, which in turn depends on the haemodynamic stability of the patient at the time of angiography. 

 Keywords: colonic haemorrhage; embolisation; angiography; angiodysplasia; diverticular disease PMID:9771409

  16. Restoration of blood pressure by choline treatment in rats made hypotensive by haemorrhage.

    PubMed Central

    Ulus, I. H.; Arslan, B. Y.; Savci, V.; Kiran, B. K.

    1995-01-01

    1. Intracerebroventricular (i.c.v.) injection of choline (25-150 micrograms) increased blood pressure in rats made acutely hypotensive by haemorrhage. Intraperitoneal administration of choline (60 mg kg-1) also increased blood pressure, but to a lesser extent. Following i.c.v. injection of 25 micrograms or 50 micrograms of choline, heart rate did not change, while 100 micrograms or 150 micrograms i.c.v. choline produced a slight and short lasting bradycardia. Choline (150 micrograms) failed to alter the circulating residual volume of blood in haemorrhaged rats. 2. The pressor response to i.c.v. choline (50 micrograms) in haemorrhaged rats was abolished by pretreatment with mecamylamine (50 micrograms, i.c.v.) but not atropine (10 micrograms, i.c.v.). The pressor response to choline was blocked by pretreatment with hemicholinium-3 (20 micrograms, i.c.v.). 3. The pressor response to i.c.v. choline (150 micrograms) was associated with a several fold increase in plasma levels of vasopressin and adrenaline but not of noradrenaline and plasma renin. 4. The pressor response to i.c.v. choline (150 micrograms) was not altered by bilateral adrenalectomy, but was attenuated by systemic administration of either phentolamine (10 mg kg-1) or the vasopressin antagonist [beta-mercapto-beta,beta-cyclopenta-methylenepropionyl1, O-Me-Tyr2,Arg8]-vasopressin (10 micrograms kg-1). 5. It is concluded that the precursor of acetylcholine, choline, can increase and restore blood pressure in acutely haemorrhaged rats by increasing central cholinergic neurotransmission. Nicotinic receptor activation and an increase in plasma vasopressin and adrenaline level appear to be involved in this effect of choline. PMID:8528579

  17. Pulmonary haemorrhage due to an aortopulmonary collateral artery after arterial switch.

    PubMed

    Sugimoto, Ai; Ota, Noritaka; Sakamoto, Kisaburo

    2016-03-01

    A neonate with transposition of the great arteries and intact ventricular septum presented without pulmonary over-circulation, and subsequently developed pulmonary haemorrhage after corrective surgery. Postoperative CT revealed an aortopulmonary collateral artery arising from the descending aorta, and we performed successful embolisation on postoperative day 9. Aggressive imaging modalities such as angiography and/or CT imaging with contrast can detect unexpected extra-pulmonary blood supply and guide further management. PMID:26144860

  18. Optimization of oxygen delivery in a Jehovah's Witness with severe anaemia after postpartum haemorrhage

    PubMed Central

    Simmons, LaVone; Stephenson-Famy, Alyssa; Easterling, Thomas

    2011-01-01

    The delivery of a 25-year-old Jehovah's Witness was complicated by postpartum haemorrhage with a nadir haematocrit of 3%. To improve oxygen delivery without blood transfusion, FiO2 was increased to maximize dissolved oxygen delivery. Central venous oxygen saturation was used to assess tissue oxygenation. When blood products are refused, successful management of severe anaemia is possible with supportive medical care to achieve haemostasis, optimize oxygen delivery and promote haematopoiesis.

  19. Ergometrine given during caesarean section and incidence of delayed postpartum haemorrhage due to uterine atony.

    PubMed

    Lourens, R; Paterson-Brown, S

    2007-11-01

    Delayed postpartum haemorrhage due to uterine atony after caesarean section was occurring in women in our recovery area despite many of them already having an oxytocin infusion running to prevent such a problem. We therefore decided to compare the incidence of such problems for a 2-month period before and after altering our uterotonic policy: in addition to the routine bolus dose of 5 units of oxytocin after delivery of the baby, we added 500 microg of intramuscular ergometrine during abdominal closure. We noticed a reduced number of massive postpartum haemorrhages due to an atonic uterus in the recovery room but an increased incidence of nausea and vomiting. No prophylactic anti-emetic was given during this pilot study. This small study suggests that 50 women would need to be given ergometrine at caesarean section to prevent one delayed massive haemorrhage from uterine atony and four extra women would suffer with vomiting. We feel this is reasonable and now use a prophylactic anti-emetic as well as delaying the ergometrine until closure of the rectus sheath which reduces the incidence of nausea and vomiting. PMID:18097896

  20. Enlargement of the third ventricle and hyponatraemia in aneurysmal subarachnoid haemorrhage.

    PubMed Central

    Wijdicks, E F; Vandongen, K J; Vangijn, J; Hijdra, A; Vermeulen, M

    1988-01-01

    Hyponatraemia following aneurysmal subarachnoid haemorrhage is associated with an increased risk of cerebral infarction. Whether the development of hyponatraemia was related to enlargement of the third ventricle on the admission CT scan was investigated in a consecutive series of 133 patients who were seen within 72 hours of aneurysmal haemorrhage. Hyponatraemia occurred significantly more often in patients with enlargement of the third ventricle (with or without dilatation of the lateral ventricles) than in patients with a normal ventricular system (20/41 versus 24/92, p = 0.016). After ventricular drainage, the sodium levels returned to normal in two patients in whom the size of the third ventricle decreased and not in four patients with persistent enlargement of the third ventricle. The significant relationship between enlargement of the third ventricle and hyponatraemia remained after adjustment for the amount of cisternal blood, but not after adjustment for the amount of intraventricular blood. These results suggest that the size of the third ventricle is an important but not the only factor in the relationship between acute hydrocephalus and hyponatraemia in patients with aneurysmal subarachnoid haemorrhage. Images PMID:3379424

  1. Extensive haemorrhagic necrosis of liver is an unpredictable fatal complication in dengue infection: a postmortem study

    PubMed Central

    2014-01-01

    Background Dengue infection carries a potential risk of death despite stringent management of plasma leak and haemorrhage. It appears that the extent of liver dysfunction determines the outcome. Methods We present a postmortem study of five patients, died of dengue shock syndrome who had markedly elevated liver enzymes and irreparable circulatory failure. Results All were females with a median age of 46 years (range 20–50 years). All had positive NS1 and IgM. Clinically, one patient developed severe degree of hepatic encephalopathy whilst three patients developed uncontrollable bleeding manifestations. Dengue virus was detected in three liver specimens by reverse transcription PCR. Histology of the liver revealed massive necrosis with haemorrhages in these patients with evidence of micro and macrovesicular steatosis with significant periportal inflammatory infiltrate. No significant ischaemic changes or necrosis was observed in the other organs. Conclusions Severe haemorrhagic necrosis of the liver was the cause of death in these patients probably due to direct viral infection. Predilection for severe liver disease remains unknown. Therefore, it is prudent to think beyond plasma leak as the main pathology of dengue infection and attempts should be made to develop other treatment modalities to prevent and manage unforeseen fatal complications of dengue infection. PMID:24628767

  2. N-Butyl Cyanoacrylate Is Very Effective for Massive Haemorrhage during the Perinatal Period

    PubMed Central

    Igarashi, Suguru; Izuchi, Shinichirou; Ogawa, Yukihisa; Yoshimathu, Misako; Takizawa, Kenji; Nakajima, Yasuo; Tanaka, Mamoru; Ishizuka, Bunpei; Suzuki, Nao

    2013-01-01

    Objective The liquid embolic agent n-butyl cyanoacrylate (NBCA) is a tissue adhesive used as an immediate and permanent embolic agent when mixed with oil-based contrast medium. In this study, the preservation of fertility with TAE using NBCA for massive haemorrhage during pregnancy or the peripartum period and the utility of this therapy were investigated. Methods Cases from January 2005 to October 2010 in which TAE was performed for massive haemorrhage in pregnant women, particularly during the peripartum period, were investigated. Results TAE was performed in 27 pregnant women. The embolic agent used was GS only in five cases, NBCA only in 19 cases, and additional embolization with NBCA when the effect with GS was insufficient in three cases, one each of abruptio placentae, cervical pregnancy, and uterine atony.A comparison of mean blood loss when each embolic agent was used for haemostasis showed a significant difference between cases in which GS only was used and cases in which NBCA only was used. In a comparison of mean transfusion volume, a significant difference was seen between cases in which both GS and NBCA were used and cases in which NBCA only was used. In a postoperative follow-up survey, menses resumed in eight patients, including four patients who later became pregnant and three who delivered. Conclusions TAE with NBCA, which has an embolic effect unrelated to clotting dysfunction for massive haemorrhage during the peripartum period, is a minimally invasive and very effective treatment method for patients with severe DIC. PMID:24223099

  3. Update on the Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II): statistical analysis plan

    PubMed Central

    2012-01-01

    Background Previous studies had suggested that the outcome for patients with spontaneous lobar intracerebral haemorrhage (ICH) and no intraventricular haemorrhage (IVH) might be improved with early evacuation of the haematoma. The Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II) set out to establish whether a policy of earlier surgical evacuation of the haematoma in selected patients with spontaneous lobar ICH would improve outcome compared to a policy of initial conservative treatment. It is an international, multi-centre, prospective randomised parallel group trial of early surgery in patients with spontaneous lobar ICH. Outcome is measured at six months via a postal questionnaire. Results Recruitment to the study began on 27 November 2006 and closed on 15 August 2012 by which time 601 patients had been recruited. The protocol was published in Trials (http://www.trialsjournal.com/content/12/1/124/). This update presents the analysis plan for the study without reference to the unblinded data. The trial data will not be unblinded until after follow-up is completed in early 2013. The main trial results will be presented in spring 2013 with the aim to publish in a peer-reviewed journal at the same time. Conclusion The data from the trial will provide evidence on the benefits and risks of early surgery in patients with lobar ICH. Trial registration ISRCTN: ISRCTN22153967 PMID:23171588

  4. Chronic alveolar haemorrhage in a paediatric patient: a diagnostic and treatment challenge.

    PubMed

    Freitas, Ana; Senra, Virgílio; Marinho, António; Guedes, Margarida

    2015-01-01

    Pulmonary haemosiderosis is characterised by chronic alveolar haemorrhage, which can lead to serious cardiorespiratory complications. Although considered idiopathic in most patients, there are many possible aetiologies. We present a case of an 18-year-old woman with pulmonary haemosiderosis since 4 years of age, with an inconclusive initial study, who was treated with systemic corticosteroids and hydroxychloroquine until the age of 12 years, and azathioprine since then. Multiple exacerbations led to interstitial lung disease with restrictive functional pattern. Unilateral cochlear deafness was diagnosed at the age of 12 years and occasional polyarthralgias were recorded. When she was 16 years of age the study revealed an atypical myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) pattern. Cyclophosphamide and rituximab were administered with resolution of respiratory insufficiency and functional disability, without new episodes of alveolar haemorrhage. This case of chronic pulmonary haemorrhage was revealed to be an ANCA vasculitis, the diagnosis of which was possible only after 12 years of symptoms, with clinical and functional improvement with the association of cyclophosphamide and rituximab. PMID:25899510

  5. Late onset haemorrhagic disease in premature infants who received intravenous vitamin K1.

    PubMed

    Loughnan, P M; McDougall, P N; Balvin, H; Doyle, L W; Smith, A L

    1996-06-01

    The clinical details are reported of two premature infants who developed late onset haemorrhagic disease after receiving their initial doses of vitamin K1 prophylaxis intravenously. Both reported infants had received two doses of intravenous vitamin K1, 0.1 mg, in the 1st week of life, and a further oral dose, 1.0 mg, at 4 weeks. Bleeding due to vitamin K deficiency occurred on days 74 and 84, respectively. Vitamin K deficiency bleeding is rare in low birthweight infants, probably because it has been routine practice to give such infants intramuscular vitamin K1. One of the reported infants had cytomegalovirus hepatitis, the other did not have liver disease. These findings could be explained if intramuscular vitamin K1 were to have a longer duration of effect than intravenous vitamin K1. This may be because intramuscular vitamin K1 acts as a depot preparation. The findings suggest that intravenous vitamin K1 is less effective than intramuscular for long-term prophylaxis against late onset haemorrhagic disease. Intravenous vitamin K1 should not be used for long-term prophylaxis in the prevention of late onset haemorrhagic disease. PMID:8827551

  6. Introduction of an algorithm for ROTEM-guided fibrinogen concentrate administration in major obstetric haemorrhage.

    PubMed

    Mallaiah, S; Barclay, P; Harrod, I; Chevannes, C; Bhalla, A

    2015-02-01

    We compared blood component requirements during major obstetric haemorrhage, following the introduction of fibrinogen concentrate. A prospective study of transfusion requirements and patient outcomes was performed for 12 months to evaluate the major obstetric haemorrhage pathway using shock packs (Shock Pack phase). The study was repeated after the pathway was amended to include fibrinogen concentrate (Fibrinogen phase). The median (IQR [range]) number of blood components given was 8.0 (3.0-14.5 [0-32]) during the Shock Pack phase, and 3.0 (2.0-5.0 [0-26]) during the Fibrinogen phase (p = 0.0004). The median (IQR [range]) quantity of fibrinogen administered was significantly greater in the Shock Pack phase, 3.2 (0-7.1 [0-20.4]) g, than in the Fibrinogen phase, 0 (0-3.0 [0-12.4]) g, p = 0.0005. Four (9.5%) of 42 patients in the Shock Pack phase developed transfusion associated circulatory overload compared with none of 51 patients in the Fibrinogen phase (p = 0.038). Fibrinogen concentrate allows prompt correction of coagulation deficits associated with major obstetric haemorrhage, reducing the requirement for blood component therapy and the attendant risks of complications. PMID:25289791

  7. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study

    PubMed Central

    Stiell, Ian G; Sivilotti, Marco L A; Bullard, Michael J; Émond, Marcel; Symington, Cheryl; Sutherland, Jane; Worster, Andrew; Hohl, Corinne; Lee, Jacques S; Eisenhauer, Mary A; Mortensen, Melodie; Mackey, Duncan; Pauls, Merril; Lesiuk, Howard; Wells, George A

    2011-01-01

    Objective To measure the sensitivity of modern third generation computed tomography in emergency patients being evaluated for possible subarachnoid haemorrhage, especially when carried out within six hours of headache onset. Design Prospective cohort study. Setting 11 tertiary care emergency departments across Canada, 2000-9. Participants Neurologically intact adults with a new acute headache peaking in intensity within one hour of onset in whom a computed tomography was ordered by the treating physician to rule out subarachnoid haemorrhage. Main outcome measures Subarachnoid haemorrhage was defined by any of subarachnoid blood on computed tomography, xanthochromia in cerebrospinal fluid, or any red blood cells in final tube of cerebrospinal fluid collected with positive results on cerebral angiography. Results Of the 3132 patients enrolled (mean age 45.1, 2571 (82.1%) with worst headache ever), 240 had subarachnoid haemorrhage (7.7%). The sensitivity of computed tomography overall for subarachnoid haemorrhage was 92.9% (95% confidence interval 89.0% to 95.5%), the specificity was 100% (99.9% to 100%), the negative predictive value was 99.4% (99.1% to 99.6%), and the positive predictive value was 100% (98.3% to 100%). For the 953 patients scanned within six hours of headache onset, all 121 patients with subarachnoid haemorrhage were identified by computed tomography, yielding a sensitivity of 100% (97.0% to 100.0%), specificity of 100% (99.5% to 100%), negative predictive value of 100% (99.5% to 100%), and positive predictive value of 100% (96.9% to 100%). Conclusion Modern third generation computed tomography is extremely sensitive in identifying subarachnoid haemorrhage when it is carried out within six hours of headache onset and interpreted by a qualified radiologist. PMID:21768192

  8. Neutralization of the haemorrhagic activities of viperine snake venoms and venom metalloproteinases using synthetic peptide inhibitors and chelators.

    PubMed

    Howes, J-M; Theakston, R D G; Laing, G D

    2007-04-01

    Envenoming by the West African saw-scaled viper, Echis ocellatus resembles that of most vipers, in that it results in local blistering, necrosis and sometimes life-threatening systemic haemorrhage. While effective against systemic envenoming, current antivenoms have little or no effect against local tissue damage. The major mediators of local venom pathology are the zinc-dependant snake venom metalloproteinases (SVMPs). The high degree of structural and functional homology between SVMPs and their mammalian relatives the matrix metalloproteinases (MMPs) suggests that substrate/inhibitor interactions between these subfamilies are likely to be analogous. In this study, four recently developed MMP inhibitors (MMPIs) (Marimastat, AG-3340, CGS-270 23A and Bay-12 9566) are evaluated in addition to three metal ion chelators (EDTA, TPEN and BAPTA) for their ability to inhibit the haemorrhagic activities of the medically important E. ocellatus venom and one of its haemorrhagic SVMPs, EoVMP2. As expected, the metal ion chelators significantly inhibited the haemorrhagic activities of both whole E. ocellatus venom and EoVMP2, while the synthetic MMPIs show more variation in their efficacies. These variations suggest that individual MMPIs show specificity towards SVMPs and that their application to the neutralization of local haemorrhage may require a synthetic MMPI mixture, ensuring that a close structural component for each SVMP is represented. PMID:17196631

  9. Dietary supplement use and nosebleeds in hereditary haemorrhagic telangiectasia — an observational study

    PubMed Central

    Chamali, Basel; Finnamore, Helen; Manning, Richard; Laffan, Michael A; Hickson, Mary; Whelan, Kevin; Shovlin, Claire L

    2016-01-01

    Summary Understanding potential provocations of haemorrhage is important in a range of clinical settings, and particularly for people with abnormal vasculature. Patients with hereditary haemorrhagic telangiectasia (HHT) can report haemorrhage from nasal telangiectasia in real time, and suggested dietary factors may precipitate nosebleeds. To examine further, nosebleed severity, dietary supplement use, and blood indices were evaluated in an unselected group of 50 HHT patients recruited from a specialist UK service. Using the validated Epistaxis Severity Score, nosebleed severity ranged from 0 to 9.1 out of 10 (median 3.9). Using a Food Frequency Questionnaire, 24/50 (48%) participants reported use of dietary supplements in the previous year. A third (18/50; 36%) had used self prescribed, non-iron containing dietary supplements, ingesting between 1 and 3 different supplements each day. Eight (16%) used fish oils. Despite having more severe epistaxis (p = 0.012), the 12 iron supplement users had higher serum iron concentrations, and were able to maintain their red blood cell indices. In contrast, there was no evident benefit for the participants using non iron supplements. Furthermore, platelet counts and serum fibrinogen tended to be lower in fish oil/supplement users, and one fish oil user demonstrated reduced in vitro platelet aggregation. In conclusion, in this small study, a third of HHT patients used non-iron dietary supplements, and one in six ingested fish oils, unaware of their known anti-platelet activity. The scale of use, and potential of these “natural health supplements” to exacerbate nosebleeds has not been appreciated previously in HHT. PMID:27195194

  10. Visual detection of goose haemorrhagic polyomavirus in geese and ducks by loop-mediated isothermal amplification.

    PubMed

    Woźniakowski, Grzegorz; Tarasiuk, Karolina

    2015-01-01

    Goose haemorrhagic polyomavirus (GHPV) is an aetiological agent of haemorrhagic nephritis and enteritis of geese occurring in geese (Anser anser). GHPV may also infect Muscovy ducks (Carina mochata) and mule ducks. Early detection of GHPV is important to isolate the infected birds from the rest of the flock thus limiting infection transmission. The current diagnosis of haemorrhagic nephritis and enteritis of geese is based on virus isolation, histopathological examination, haemagglutination inhibition assay, ELISA and polymerase chain reaction (PCR). Recently, real-time PCR assay was developed which considerably improved detection of GHPV. In spite of many advantages, these methods are still time-consuming and inaccessible for laboratories with limited access to ELISA plate readers or PCR thermocyclers. The aim of our study was to develop loop-mediated isothermal amplification (LAMP) that may be conducted in a water bath. Two pairs of specific primers complementary to VP1 gene of GHPV were designed. The results of GHPV LAMP were recorded under ultraviolet light. Our study showed LAMP was able to specifically amplify VP1 fragment of a GHPV without cross-reactivity with other pathogens of geese and ducks. LAMP detected as little as 1.5 pg of DNA extracted from a GHPV standard strain (150 pg/µl). The optimized LAMP was used to examine 18 field specimens collected from dead and clinically diseased geese and ducks aged from 1 to 12 weeks. The positive signal for GHPV was detected in three out of 18 (16.6%) specimens. These results were reproducible and consistent with those of four real-time PCR. To the best of our knowledge this is the first report on LAMP application for the GHPV detection. PMID:25959267

  11. Late intracranial haemorrhage and subsequent carotid-cavernous sinus fistula after fracture of the facial bones.

    PubMed

    Chang, Chien-Ming; Cheng, Chi-Sheng

    2013-12-01

    Carotid-cavernous sinus fistula is an arteriovenous fistula between the internal carotid artery and the cavernous sinus, and is usually caused by a traumatic tear or a ruptured aneurysm of the cavernous segment of the internal carotid artery. We describe a rare case of delayed intracranial haemorrhage and carotid-cavernous sinus fistula that presented 3 weeks after fracture of the facial bones. The patient developed orbital apex syndrome including ptosis of upper eyelid, pulsatile exophthalmos, chemosis, loss of ocular motility, monocular blindness on the right, and numbness of the right infraorbital region. After transcatheter intra-arterial embolisation, the ptosis and chemosis improved. PMID:23958350

  12. Incidence of delayed cerebral ischaemia following subarachnoid haemorrhage of unknown cause.

    PubMed Central

    Barlow, P

    1985-01-01

    A retrospective study was made of 50 consecutive patients with spontaneous subarachnoid haemorrhage for which no cause was found, looking for evidence of delayed cerebral ischaemia particularly during the first 2 weeks after the bleed. Twenty-three patients had blood visible on the CT scan but only 4-6% developed delayed ischaemia, all of whom made a good recovery. The low incidence of this complication in this group of patients suggests that subarachnoid blood is not a sufficient cause for delayed ischaemia. PMID:3981169

  13. Haemorrhagic fever with renal syndrome: literature review and distribution analysis in China.

    PubMed

    Zou, Lu-Xi; Chen, Mao-Jie; Sun, Ling

    2016-02-01

    Hantaviruses infect their reservoir hosts and humans, but the infection only causes disease in humans. In Asia and Europe (the Old World), the hantaviruses usually cause haemorrhagic fever with renal syndrome (HFRS). This article summarizes the current understanding of hantavirus epidemiology, as well as the clinical manifestations, pathogenesis, renal pathology, diagnosis, treatment, and prevention of HFRS. Moreover, the spatiotemporal distribution of HFRS was analysed based on the latest data obtained from the Chinese Centre for Disease Control and Prevention, for the period January 2004 to April 2015, to provide valuable information for the practical application of more effective HFRS control and prevention strategies in China. PMID:26791541

  14. Overcoming entrenched disagreements: the case of misoprostol for post-partum haemorrhage.

    PubMed

    Ghinea, Narcyz; Lipworth, Wendy; Little, Miles; Kerridge, Ian; Day, Richard

    2015-04-01

    The debate about whether misoprostol should be distributed to low resource communities to prevent post-partum haemorrhage (PPH), recognized as a major cause of maternal mortality, is deeply polarised. This is in spite of stakeholders having access to the same evidence about the risks and benefits of misoprostol. To understand the disagreement, we conducted a qualitative analysis of the values underpinning debates surrounding community distribution of misoprostol. We found that different moral priorities, epistemic values, and attitudes towards uncertainty were the main factors sustaining the debate. With this understanding, we present a model for ethical discourse that might overcome the current impasse. PMID:25897445

  15. First detection of canine parvovirus type 2c in pups with haemorrhagic enteritis in Spain.

    PubMed

    Decaro, N; Martella, V; Desario, C; Bellacicco, A L; Camero, M; Manna, L; d'Aloja, D; Buonavoglia, C

    2006-12-01

    Canine parvovirus type 2 (CPV-2), the aetiological agent of haemorrhagic enteritis in dogs, includes three antigenic variants, types 2a, 2b and 2c. CPV-2c has been detected initially in Italy and subsequently in Vietnam. We report the first identification of this novel antigenic variant in Spain, where it caused an outbreak of fatal enteritis in basset hound pups in association with canine coronavirus type I and type II. We suggest that this new antigenic variant of CPV-2 could spread throughout Europe and that there is a subsequent need to update current CPV vaccines. PMID:17123424

  16. Partial Recovery of Audiological, Vestibular, and Radiological Findings following Spontaneous Intralabyrinthine Haemorrhage

    PubMed Central

    Pézier, Thomas; Hegemann, Stefan

    2013-01-01

    The diagnosis, work-up, and treatment of sudden sensorineural hearing loss and sudden vestibular loss vary widely between units. With the increasing access to both magnetic resonance imaging and objective vestibular testing, our understanding of the various aetiologies at hand is increasing. Despite this, the therapeutic options are limited and without a particularly strong evidence base. We present a rare, yet increasingly diagnosed, case of intralabyrinthine haemorrhage (ILH) together with radiological, audiological, and vestibular test results. Of note, this occurred spontaneously and has shown partial recovery in all the mentioned modalities. PMID:24455375

  17. Primary postpartum haemorrhage in an Australian tertiary hospital: a case-control study.

    PubMed

    Henry, Amanda; Birch, Mary-Rose; Sullivan, Elizabeth A; Katz, Sue; Wang, Yueping Alex

    2005-06-01

    The present study aimed to determine the incidence of primary postpartum haemorrhage (PPH) after vaginal birth at an Australian tertiary hospital, and to investigate risk factors for primary PPH at this hospital. A case-control study of women delivering vaginally at a tertiary hospital from February to June 2003 was performed. Demographic, antenatal, intrapartum, treatment and outcome data were abstracted from patient records. The study population comprised 125 cases and 125 controls, with a primary PPH rate of 12.1 per 100 vaginal births. Risk factors on multivariate analysis were past history of PPH, second stage labour > 60 min, forceps delivery, and incomplete placenta/ragged membranes. PMID:15904450

  18. A Rare Cause of Haemorrhage in the Upper Gastrointestinal System: Bochdalek Hernia

    PubMed Central

    Cevizci, MN; Erdemir, G; Cayir, A

    2015-01-01

    ABSTRACT Diaphragmatic hernia originates from insufficient closure of the pericardioperitoneal canals and pleuroperitoneal membranes. It is seen in one in every 4000 births. The general finding in the newborn period is respiratory difficulty. Mortality is 40–50%. There may be other accompanying organ anomalies. Congenital diaphragmatic hernias diagnosed after the newborn period are known as late-presenting congenital diaphragmatic hernias. This group is seen at a level of 5–20% and poses difficulty in diagnosis. This report describes a case under observation and receiving treatment for gastrointestinal haemorrhage, diagnosed as Bochdalek hernia. PMID:26360672

  19. Intracerebral haemorrhage and hemiplegia with heterotopic ossification of the affected hip.

    PubMed

    O'Brien, M M C; Murray, T; Keeling, F; Williams, D

    2015-01-01

    We present the case of a 72-year-old woman who developed right hemiparesis following a left frontal intraparenchymal haemorrhage. Three months following initial presentation, the patient noted poorly localised right lower quadrant pain. Following extensive investigations, a diagnosis of heterotopic ossification of the hip was made. We discuss the aetiology and pathogenesis of this uncommon entity, and discuss its relationship to ipsilateral neurological injury. The link with neurological injury can result in a delayed and atypical presentation. Early recognition and treatment are important for those caring for patients with acquired neurological deficits, and permit improved patient outcomes. PMID:26243751

  20. A global compendium of human Crimean-Congo haemorrhagic fever virus occurrence.

    PubMed

    Messina, Jane P; Pigott, David M; Duda, Kirsten A; Brownstein, John S; Myers, Monica F; George, Dylan B; Hay, Simon I

    2015-01-01

    In order to map global disease risk, a geographic database of human Crimean-Congo haemorrhagic fever virus (CCHFV) occurrence was produced by surveying peer-reviewed literature and case reports, as well as informal online sources. Here we present this database, comprising occurrence data linked to geographic point or polygon locations dating from 1953 to 2013. We fully describe all data collection, geo-positioning, database management and quality-control procedures. This is the most comprehensive database of confirmed CCHF occurrence in humans to-date, containing 1,721 geo-positioned occurrences in total. PMID:25977820

  1. Neurosurgical versus endovascular treatment of subarachnoid haemorrhage caused by ruptured cerebral aneurysm: comparison of patient outcomes.

    PubMed

    Kamensky, J

    2015-03-01

    The aim of this critical review is to determine whether endovascular treatment (EVT) of a subarachnoid haemorrhage (SAH) has better patient outcomes than neurosurgical treatment (NST). A review of six cohort studies (listed in Table 1) was carried out and the main findings were summarised in the conclusion. In addition the list of author's recommendations is included at the end of the paper. Theatre practitioners involved in neurosurgery might find this review useful in enhancing their understanding of how SAH is currently treated. It could also bring some insights about the reasons why a particular modality of the treatment was chosen for their patient. PMID:26016283

  2. Deep vein thrombosis induced by thalidomide to control epistaxis secondary to hereditary haemorrhagic telangiectasia.

    PubMed

    Penaloza, Andrea; Vekemans, Marie-Christiane; Lambert, Catherine; Hermans, Cedric

    2011-10-01

    Thalidomide was recently reported to reduce the severity and frequency of epistaxes in patients with hereditary haemorrhagic telangiectasia (HHT). We here describe the case of a patient with HHT and severe epistaxes refractory to medical and local surgical treatments who developed an extensive deep vein thrombosis shortly after initiation of treatment with thalidomide. This is the first report of venous thromboembolic complication induced by thalidomide prescribed in this setting. Although thalidomide was recently found to provide an alternative therapeutic strategy in patients with HHT and refractory epistaxes, this agent should be used with great caution in this indication, given its thrombogenicity and difficulties to manage systemic anticoagulation in patients with HHT. PMID:21885956

  3. Endoscopic resection of giant lipoma mimicking colonic neoplasm initially presenting with massive haemorrhage: a case report.

    PubMed

    Lazaraki, Georgia; Tragiannidis, Dimitrios; Xirou, Persefoni; Nakos, Andreas; Pilpilidis, Ioannis; Katsos, Ioannis

    2009-01-01

    Lipomas of the colon are benign tumors that rarely occur. Their size ranges from 2 mm to several cm. They are usually asymptomatic but occasionally they present with clinical manifestations depending on tumor size, localization and complications, which often lead to diagnostic difficulty. A 40-year-old man presented with massive rectal haemorrhage. During colonoscopy a giant polyp of over 50 mm in its bigger diameter, with a thick stalk of 2 cm, located in the transverse colon, was revealed. Endoscopic resection was performed with success. Histologic examination demonstrated a giant lipoma. In this report discussion over endoscopic resection of colonic lipomas mimicking neoplasms is also performed. PMID:20181161

  4. Endoscopic resection of giant lipoma mimicking colonic neoplasm initially presenting with massive haemorrhage: a case report

    PubMed Central

    2009-01-01

    Lipomas of the colon are benign tumors that rarely occur. Their size ranges from 2 mm to several cm. They are usually asymptomatic but occasionally they present with clinical manifestations depending on tumor size, localization and complications, which often lead to diagnostic difficulty. A 40-year-old man presented with massive rectal haemorrhage. During colonoscopy a giant polyp of over 50 mm in its bigger diameter, with a thick stalk of 2 cm, located in the transverse colon, was revealed. Endoscopic resection was performed with success. Histologic examination demonstrated a giant lipoma. In this report discussion over endoscopic resection of colonic lipomas mimicking neoplasms is also performed. PMID:20181161

  5. Simultaneous occurrence of internal capsule infarct and cerebellar haemorrhage in a patient with hemiplegia.

    PubMed

    Pande, Nikhil; Vivek, Ganapathiraman; Hande, Manjunath; Acharya, Vasudeva

    2014-01-01

    A 68-year-old woman with hypertension with no history of cerebrovascular events presented with a left-sided hemiplegia which had developed acutely 2 days ago. She was not on maintenance therapy with antiplatelets or anticoagulants. A CT scan showed acute ischaemic infarction of the right internal capsule and cerebellar haemorrhage. Cardiac evaluation was normal. Doppler ultrasonography of the extracranial carotid and vertebral arteries showed diffuse arteriosclerotic changes, but did not reveal any haemodynamic occlusion. The simultaneous development of dual strokes was considered to be an extension of the same arteriosclerotic process to the intracranial carotid and basilar arteries. PMID:24408941

  6. Bilateral macular haemorrhages secondary to hepatitis-associated aplastic anaemia, treated with Nd:YAG laser posterior hyaloidotomy.

    PubMed

    Ranganath, Akshatha; Mariatos, George; Thakur, Shakti

    2011-01-01

    Hepatitis-associated aplastic anaemia (HAAA) is an uncommon but distinct variant of aplastic anaemia in which pancytopenia and bone marrow failure appears 2-3 months after an acute attack of hepatitis. Although bilateral vision loss may rarely be the initial presentation of aplastic anaemia, no such report is known in HAAA. Here the authors report such a case presenting with large premacular subhyaloid haemorrhages secondary to severe anaemia and thrombocytopenia. Anaemic hypoxic damage to the vessel wall together with increased cardiac output and low platelet counts are interacting causal factors in the development of bleeding. Though these haemorrhages are benign and usually improve spontaneously, the presence of blood may cause permanent macular changes before it resolves. Posterior hyaloidotomy enabled rapid resolution of premacular subhyaloid haemorrhage thereby restoring vision and preventing need for vitreo-retinal surgery. These patients should be advised to refrain from valsalva manoeuvres, ocular rubbing and vigorous exercise to prevent ocular morbidity. PMID:22674943

  7. Successful aquatic animal disease emergency programmes.

    PubMed

    Håstein, T; Hill, B J; Winton, J R

    1999-04-01

    The authors provide examples of emergency programmes which have been successful in eradicating or controlling certain diseases of aquatic animals. The paper is divided into four parts. The first part describes the initial isolation of viral haemorrhagic septicaemia (VHS) virus in North America in the autumn of 1988 from feral adult chinook (Oncorhynchus tshawytscha) and coho salmon (O. kisutch) returning for spawning. The fish disease control policies at both State and Federal levels in the United States of America required quarantine and emergency eradication measures upon the finding of certain exotic fish pathogens, including VHS virus. The procedures for emergency plans, destruction of stocks and disinfection of facilities are described, as well as challenge experiments with the North American strains of VHS virus and the detection of the virus in marine fish species (cod [Gadus macrocephalus] and herring [Clupea harengus pallasi]) in the Pacific Ocean. The second part of the paper outlines the aquatic animal legislation in Great Britain and within the European Union, in regard to contingency plans, initial investigations, action on the suspicion of notifiable disease and action on confirmation of infection. The legal description is followed by an account of an outbreak of viral haemorrhagic septicaemia in turbot (Scophthalmus maximus) in Great Britain, including the stamping-out process at the affected farm and investigations conducted to screen other farms in the vicinity for possible infection. The third part provides a historical review of the build-up of infectious salmon anaemia (ISA) in Norway and the attempts to control the disease using legal measures in the absence of detailed knowledge of the aetiology, epizootiology, pathogenesis, etc. of the disease. The measures taken show that the spread of ISA can be controlled using restrictions on the movement of fish, disinfection procedures, etc. However, acceptance and understanding of the chosen strategy

  8. Successful aquatic animal disease emergency programmes

    USGS Publications Warehouse

    Hastein, T.; Hill, B.J.; Winton, J.R.

    1999-01-01

    The authors provide examples of emergency programmes which have been successful in eradicating or controlling certain diseases of aquatic animals. The paper is divided into four parts. The first part describes the initial isolation of viral haemorrhagic septicaemia (VHS) virus in North America in the autumn of 1988 from feral adult chinook (Oncorhynchus tshawytscha) and coho salmon (O.kisutch) returning for spawning. The fish disease control policies at both State and Federal levels in the United States of America required quarantine and emergency eradication measures upon the finding of certain exotic fish pathogens, including VHS virus. The procedures for emergency plans, destruction of stocks and disinfection of facilities are described, as well as challenge experiments with the North American strains of VHS virus and the detection of the virus in marine fish species (cod [Gadus macrocephalus] and herring [Clupea harengus pallasi]) in the Pacific Ocean. The second part of the paper outlines the aquatic animal legislation in Great Britain and within the European Union, in regard to contingency plans, initial investigations, action on the suspicion of notifiable disease and action on confirmation of infection. The legal description is followed by an account of an outbreak of viral haemorrhagic septicaemia in turbot (Scophthalmus maximus) in Great Britain, including the stamping-out process at the affected farm and investigations conducted to screen other farms in the vicinity for possible infection. The third part provides a historical review of the build-up of infectious salmon anaemia (ISA) in Norway and the attempts to control the disease using legal measures in the absence of detailed knowledge of the aetiology, epizootiology, pathogenesis, etc. of the disease. The measures taken show that the spread of ISA can be controlled using restrictions on the movement of fish, disinfection procedures, etc. However, acceptance and understanding of the chosen strategy by

  9. Immunohistochemical detection of IgM and IgG in lung tissue of dogs with leptospiral pulmonary haemorrhage syndrome (LPHS)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Leptospiral pulmonary haemorrhage syndrome (LPHS) is a severe form of leptospirosis. Pathogenic mechanisms are poorly understood. Lung tissues from 26 dogs with LPHS, 5 dogs with pulmonary haemorrhage due to other causes and 6 healthy lungs were labelled for IgG, IgM and leptospiral antigens. Three ...

  10. Design and Experimental Evaluation of a Non-Invasive Microwave Head Imaging System for Intracranial Haemorrhage Detection.

    PubMed

    Mobashsher, A T; Bialkowski, K S; Abbosh, A M; Crozier, S

    2016-01-01

    An intracranial haemorrhage is a life threatening medical emergency, yet only a fraction of the patients receive treatment in time, primarily due to the transport delay in accessing diagnostic equipment in hospitals such as Magnetic Resonance Imaging or Computed Tomography. A mono-static microwave head imaging system that can be carried in an ambulance for the detection and localization of intracranial haemorrhage is presented. The system employs a single ultra-wideband antenna as sensing element to transmit signals in low microwave frequencies towards the head and capture backscattered signals. The compact and low-profile antenna provides stable directional radiation patterns over the operating bandwidth in both near and far-fields. Numerical analysis of the head imaging system with a realistic head model in various situations is performed to realize the scattering mechanism of haemorrhage. A modified delay-and-summation back-projection algorithm, which includes effects of surface waves and a distance-dependent effective permittivity model, is proposed for signal and image post-processing. The efficacy of the automated head imaging system is evaluated using a 3D-printed human head phantom with frequency dispersive dielectric properties including emulated haemorrhages with different sizes located at different depths. Scattered signals are acquired with a compact transceiver in a mono-static circular scanning profile. The reconstructed images demonstrate that the system is capable of detecting haemorrhages as small as 1 cm3. While quantitative analyses reveal that the quality of images gradually degrades with the increase of the haemorrhage's depth due to the reduction of signal penetration inside the head; rigorous statistical analysis suggests that substantial improvement in image quality can be obtained by increasing the data samples collected around the head. The proposed head imaging prototype along with the processing algorithm demonstrates its feasibility for

  11. The release of transforming growth factor-beta following haemorrhage: its role as a mediator of host immunosuppression.

    PubMed Central

    Ayala, A; Meldrum, D R; Perrin, M M; Chaudry, I H

    1993-01-01

    Haemorrhage in the absence of trauma is reported to induce a profound depression in cell-mediated immunity. Recent studies have drawn attention to the cytokine transforming growth factor-beta (TGF-beta) that, while important in wound healing, also has marked immunosuppressive effects. The aim of this study was to determine whether: (1) haemorrhage induces an increase in circulating TGF-beta and if this is associated with the loss of host immunoresponsiveness; and (2) administration of monoclonal antibody (mAb) to TGF-beta following haemorrhage ablates these changes. To determine this, C3H/HeN mice were bled to and maintained at a mean arterial pressure of 35 mmHg for 1 hr. This required removing approximately 50% of the circulating blood volume. Following this period of hypotension, the mice were adequately resuscitated. Blood samples obtained at 24 and 72 hr, but not at 2 hr, following haemorrhage showed a significant elevation in plasma TGF-beta levels when compared to shams. At 24 hr, the increase of TGF-beta in the plasma was associated with decreases in both concanavalin A (Con A)-induced splenocyte proliferation and splenic macrophage antigen presentation. Treating animals with neutralizing antibody (animals received 200 micrograms mAb against bovine TGF-beta 1,2,3/mouse intraarterially) not only reduced the levels of TGF-beta in the blood at 24 hr, but also restored splenocyte functions, such as Con A-induced proliferation, interleukin-2 (IL-2) release, and the capacity of splenic macrophages to present antigen. However, elevated levels of prostaglandin E2 (PGE2) seen in plasma during haemorrhage were only partially depressed by the antibody treatment. These results indicate that the release of TGF-beta contributes to the protracted (> or = 24 hr) suppression of cell-mediated immunity following haemorrhage. PMID:8406575

  12. Lethal, oedema, haemorrhagic activity of spotted butterfish (Scatophagus argus, Linn) sting extract and its neutralization by antiserum and pharmacological antagonists.

    PubMed

    Muhuri, D; Dasgupta, S C; Gomes, A

    2005-06-01

    An attempt has been made in this communication to develop antiserum in rabbit against Scatophagus. argus sting extract. Antiserum did not neutralized the sting extract induced proinflammatory and haemorrhagic activity but successfully neutralized lethality upto 2LD50. Cyproheptadine, indomethacin and BW 755C pretreatment significantly reduced sting extract induced proinflammatory activity. The haemorrhagic activity of sting extract was significantly inhibited by temperature, UV-exposure, EDTA, cyproheptadine, indomethacin and BW 755C pretreatment. The results conclude that the local effects of S.argus venom is likely to be mediated through release of mediators and may be encountered by pharmacological antagonists better than the antiserum. PMID:15991572

  13. The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next?

    PubMed

    Weeks, A

    2015-01-01

    Postpartum haemorrhage (PPH) remains a major cause of maternal deaths worldwide, and is estimated to cause the death of a woman every 10 minutes. This review presents the latest clinical advice, including new evidence on controlled cord traction, misoprostol, and oxytocin. The controversy around the diagnosis of PPH, the limitations of universal prophylaxis, and novel ways to provide obstetric first aid are also presented. It ends with a call to develop high-quality front-line obstetric services that can deal rapidly with unexpected haemorrhages as well as minimising blood loss at critical times: major abruption, placenta praevia, and caesarean for prolonged labour. PMID:25289730

  14. Performance characteristics of methods for quantifying spontaneous intracerebral haemorrhage: data from the Efficacy of Nitric Oxide in Stroke (ENOS) trial

    PubMed Central

    Krishnan, Kailash; Mukhtar, Siti F; Lingard, James; Houlton, Aimee; Walker, Elizabeth; Jones, Tanya; Sprigg, Nikola; Cala, Lesley A; Becker, Jennifer L; Dineen, Robert A; Koumellis, Panos; Adami, Alessandro; Casado, Ana M; Bath, Philip M W; Wardlaw, Joanna M

    2015-01-01

    Background Poor prognosis after intracerebral haemorrhage (ICH) is related to haemorrhage characteristics. Along with developing therapeutic interventions, we sought to understand the performance of haemorrhage descriptors in large clinical trials. Methods Clinical and neuroimaging data were obtained for 548 participants with ICH from the Efficacy of Nitric Oxide in Stroke (ENOS) trial. Independent observers performed visual categorisation of the largest diameter, measured volume using ABC/2, modified ABC/2, semiautomated segmentation (SAS), fully automatic measurement methods; shape, density and intraventricular haemorrhage were also assessed. Intraobserver and interobserver reliability were determined for these measures. Results ICH volume was significantly different among standard ABC/2, modified ABC/2 and SAS: (mean) 12.8 (SD 16.3), 8.9 (9.2), 12.8 (13.1) cm3, respectively (p<0.0001). There was excellent agreement for haemorrhage volume (n=193): ABC/2 intraobserver intraclass correlation coefficient (ICC) 0.96–0.97, interobserver ICC 0.88; modified ABC/2 intraobserver ICC 0.95–0.97, interobserver ICC 0.91; SAS intraobserver ICC 0.95–0.99, interobserver ICC 0.93; largest diameter: (visual) interadjudicator ICC 0.82, (visual vs measured) adjudicator vs observer ICC 0.71; shape intraobserver ICC 0.88 interobserver ICC 0.75; density intraobserver ICC 0.86, interobserver ICC 0.73. Graeb score (mean 3.53) and modified Graeb (5.22) scores were highly correlated. Using modified ABC/2, ICH volume was underestimated in regular (by 2.2-2.5 cm3, p<0.0001) and irregular-shaped haemorrhages (by 4.8-4.9 cm3, p<0.0001). Fully automated measurement of haemorrhage volume was possible in only 5% of cases. Conclusions Formal measurement of haemorrhage characteristics and visual estimates are reproducible. The standard ABC/2 method is superior to the modified ABC/2 method for quantifying ICH volume. Clinical trial registration ISRCTN9941422. PMID:25575847

  15. Crimean-Congo haemorrhagic fever replication interplays with regulation mechanisms of apoptosis.

    PubMed

    Karlberg, Helen; Tan, Yee-Joo; Mirazimi, Ali

    2015-03-01

    Pathogenesis of viral haemorrhagic fevers is associated with alteration of vascular barrier function and haemorrhage. To date, the specific mechanism behind this is unknown. Programmed cell death and regulation of apoptosis in response to viral infection is an important factor for host or virus survival but this has not been well-studied in the case of Crimean-Congo hemorrhagic fever virus (CCHFV). In this study, we demonstrated that CCHFV infection suppresses cleavage of poly(ADP-ribose) polymerase (PARP), triggered by staurosporine early post-infection. We also demonstrated that CCHFV infection suppresses activation of caspase-3 and caspase-9. Most interestingly, we found that CCHFV N can suppress induction of apoptosis by Bax and inhibit the release of cytochrome c from the inner membrane of mitochondria to cytosol. However, CCHFV infection induces activation of Bid late post-infection, suggesting activation of extrinsic apoptotic signalling. Consistently, supernatant from cells stimulated late post-infection was found to induce PARP cleavage, most probably through the TNF-α death receptor pathway. In summary, we found that CCHFV has strategies to interplay with apoptosis pathways and thereby regulate caspase cascades. We suggest that CCHFV suppresses caspase activation at early stages of the CCHFV replication cycle, which perhaps benefits the establishment of infection. Furthermore, we suggest that the host cellular response at late stages post-infection induces host cellular pro-apoptotic molecules through the death receptor pathway. PMID:25481756

  16. Nitric oxide decreases intestinal haemorrhagic lesions in rat anaphylaxis independently of mast cell activation

    PubMed Central

    Tavares, J. Carvalho; Moreno, A.

    1997-01-01

    The purpose of this study is to assess the role of nitric oxide (NO) in the intestinal lesions of passive anaphylaxis, since this experimental model resembles necrotizing enterocolitis. Sprague-Dawley rats were sensitized with IgE anti-dinitrophenol monoclonal antibody. Extravasation of protein-rich plasma and haemorrhagia were measured in the small intestine. Plasma histamine was measured to assess mast cell activation. The effect of exogenous NO on the lesions was assessed by using two structurally unrelated NO-donors: sodium nitroprusside and S-nitroso-Nacetyl-penicillamine (SNAP). An increased basal production of NO was observed in cells taken after anaphylaxis, associated with a reduced response to platelet-activating factor, interleukin 1beta, and IgE/DNP-bovine serum albumin complexes. The response to bacterial lipopolysaccharide and dibutyryl cyclic adenosine monophosphate (AMP) was enhanced 24 h after challenge, but at earlier times was not significantly different from that observed in controls. Treatment with either sodium nitroprusside or SNAP produced a significant reduction of the haemorrhagic lesions, which are a hallmark of rat anaphylaxis. The extravasation of protein-rich plasma was not influenced by NO-donors. The increase of plasma histamine elicited by the anaphylactic challenge was not influenced by SNAP treatment. NO-donors protect intestinal haemorrhagic lesions of rat anaphylaxis by a mechanism apparently independent of mast cell histamine release. PMID:18472830

  17. Ischaemic and haemorrhagic brain lesions in newborns with seizures and normal Apgar scores.

    PubMed Central

    Mercuri, E.; Cowan, F.; Rutherford, M.; Acolet, D.; Pennock, J.; Dubowitz, L.

    1995-01-01

    Serial ultrasound scans and conventional and diffusion weighted magnetic resonance imaging (MRI) were performed on 16 neonates who presented with seizures. The Apgar scores were normal and subsequently no metabolic or infective cause could be found. The aim of the study was to evaluate the extent to which early sequential imaging can elucidate the cause of seizures in apparently neurologically normal infants. Fourteen of the infants had haemorrhagic or ischaemic lesions on MRI and these were detected by ultrasound scanning in 11. Early ultrasound scanning detected the haemorrhagic lesions but the ischaemic lesions were often not seen until the end of the first week of life. Early MRI, however, was able to detect all the ischaemic lesions. The evolution of the insult could be timed by using serial ultrasound scans and a combination of diffusion weighted and conventional MRI during the first week of life, confirming a perinatal insult even in the absence of fetal distress. Although the aetiology of these lesions remains obscure, serial ultrasound scans will detect the presence of cerebral lesions in neonates presenting with isolated seizures but additional MRI sequences will give better definition on type, site, and extent of the pathology. Images Figures 5 and 6 Figure 2 Figures 3 and 4 Figure 1 PMID:7583609

  18. A nairovirus isolated from African bats causes haemorrhagic gastroenteritis and severe hepatic disease in mice.

    PubMed

    Ishii, Akihiro; Ueno, Keisuke; Orba, Yasuko; Sasaki, Michihito; Moonga, Ladslav; Hang'ombe, Bernard M; Mweene, Aaron S; Umemura, Takashi; Ito, Kimihito; Hall, William W; Sawa, Hirofumi

    2014-01-01

    Bats can carry important zoonotic pathogens. Here we use a combination of next-generation sequencing and classical virus isolation methods to identify novel nairoviruses from bats captured from a cave in Zambia. This nairovirus infection is highly prevalent among giant leaf-nosed bats, Hipposideros gigas (detected in samples from 16 individuals out of 38). Whole-genome analysis of three viral isolates (11SB17, 11SB19 and 11SB23) reveals a typical bunyavirus tri-segmented genome. The strains form a single phylogenetic clade that is divergent from other known nairoviruses, and are hereafter designated as Leopards Hill virus (LPHV). When i.p. injected into mice, the 11SB17 strain causes only slight body weight loss, whereas 11SB23 produces acute and lethal disease closely resembling that observed with Crimean-Congo Haemorrhagic Fever virus in humans. We believe that our LPHV mouse model will be useful for research on the pathogenesis of nairoviral haemorrhagic disease. PMID:25451856

  19. A nairovirus isolated from African bats causes haemorrhagic gastroenteritis and severe hepatic disease in mice

    PubMed Central

    Ishii, Akihiro; Ueno, Keisuke; Orba, Yasuko; Sasaki, Michihito; Moonga, Ladslav; Hang’ombe, Bernard M.; Mweene, Aaron S.; Umemura, Takashi; Ito, Kimihito; Hall, William W.; Sawa, Hirofumi

    2014-01-01

    Bats can carry important zoonotic pathogens. Here we use a combination of next-generation sequencing and classical virus isolation methods to identify novel nairoviruses from bats captured from a cave in Zambia. This nairovirus infection is highly prevalent among giant leaf-nosed bats, Hipposideros gigas (detected in samples from 16 individuals out of 38). Whole-genome analysis of three viral isolates (11SB17, 11SB19 and 11SB23) reveals a typical bunyavirus tri-segmented genome. The strains form a single phylogenetic clade that is divergent from other known nairoviruses, and are hereafter designated as Leopards Hill virus (LPHV). When i.p. injected into mice, the 11SB17 strain causes only slight body weight loss, whereas 11SB23 produces acute and lethal disease closely resembling that observed with Crimean–Congo Haemorrhagic Fever virus in humans. We believe that our LPHV mouse model will be useful for research on the pathogenesis of nairoviral haemorrhagic disease. PMID:25451856

  20. Timing and evolution of periventricular haemorrhage in infants weighing 1250 g or less at birth.

    PubMed Central

    Szymonowicz, W; Yu, V Y

    1984-01-01

    The brains of 50 consecutively admitted infants who weighed 1250 g or less at birth were examined with real time ultrasound. Of 30 (60%) who had periventricular haemorrhage (PVH), 19 (63%) bled on the first day and 17 (57%) showed extension of the initial haemorrhage on serial scans. The median age was 16 hours when PVH was first detected and 48 hours when PVH reached its maximum extent. Ventricular size at birth correlated with gestation. Progressive ventricular growth was seen after birth in infants both with and without PVH. Charts of normal ranges of ventricular size and head circumference were drawn up from birth to 10 weeks of age. All infants with PVH showed a transient increase in ventricular size at 2 weeks of age but most returned to normal by 6 weeks of age. Ventricular dilatation after PVH that was greater than the 95th centile for this population developed in 5 (31%) of 16 survivors, four of whom subsequently developed hydrocephalus, although none required ventriculo peritoneal shunting. The optimal timing for diagnosis with ultrasound is at the end of the first week for PVH and the second to third week for ventricular dilatation. PMID:6696499

  1. Early and widespread injury of astrocytes in the absence of demyelination in acute haemorrhagic leukoencephalitis.

    PubMed

    Robinson, Christopher A; Adiele, Reginald C; Tham, Mylyne; Lucchinetti, Claudia F; Popescu, Bogdan F G H

    2014-01-01

    Acute hemorrhagic leukoencephalitis (AHL) is a fulminant demyelinating disease of unknown etiology. Most cases are fatal within one week from onset. AHL pathology varies with the acuteness of disease. Hemorrhages, vessel fibrinoid necrosis, perivascular fibrin exudation, edema and neutrophilic inflammation are early features, while perivascular demyelination, microglial foci and myelin-laden macrophages appear later. Reactive astrocytosis is not present in early hemorrhagic non-demyelinated lesions, but is seen in older lesions. This case report presents the pathology of an AHL case with fulminant course and fatal outcome within 48 hours from presentation. Severe hemorrhages, edema and neutrophilic inflammation in the absence of circumscribed perivascular demyelination affected the temporal neocortex and white matter, hippocampus, cerebellar cortex and white matter, optic chiasm, mammillary bodies, brainstem, cranial nerve roots and leptomeninges. Perivascular end-feet and parenchymal processes of astrocytes exhibited impressive swelling in haemorrhagic but non-demyelinated white matter regions. Astrocytes were dystrophic and displayed degenerating processes. Astrocytic swellings and remnants were immunoreactive for aquaporin-4, aquaporin-1 and glial fibrillary acidic protein. These morphological changes of astrocytes consistent with injury were also observed in haemorrhagic and normal appearing cortex. Our findings reinforce that perivascular demyelination is not present early in AHL. This is the first study that highlights the early and widespread astrocytic injury in the absence of demyelination in AHL, suggesting that, similarly to neuromyelitis optica and central pontine myelinolysis, demyelination in AHL is secondary to astrocyte injury. PMID:24887055

  2. Advances in the understanding of delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage

    PubMed Central

    Flynn, Liam; Andrews, Peter

    2015-01-01

    Delayed cerebral ischaemia has been described as the single most important cause of morbidity and mortality in patients who survive the initial aneurysmal subarachnoid haemorrhage. Our understanding of the pathophysiology of delayed cerebral ischaemia is meagre at best and the calcium channel blocker nimodipine remains the only intervention to consistently improve functional outcome after aneurysmal subarachnoid haemorrhage. There is substantial evidence to support cerebral vessel narrowing as a causative factor in delayed cerebral ischaemia, but contemporary research demonstrating improvements in vessel narrowing has failed to show improved functional outcomes. This has encouraged researchers to investigate other potential causes of delayed cerebral ischaemia, such as early brain injury, microthrombosis, and cortical spreading depolarisation. Adherence to a common definition of delayed cerebral ischaemia is needed in order to allow easier assessment of studies using multiple different terms. Furthermore, improved recognition of delayed cerebral ischaemia would not only allow for faster treatment but also better assessment of interventions. Finally, understanding nimodipine’s mechanism of action may allow us to develop similar agents with improved efficacy. PMID:26937276

  3. Diode laser treatment and clinical management of multiple oral lesions in patients with hereditary haemorrhagic telangiectasia.

    PubMed

    Favia, G; Tempesta, A; Limongelli, L; Suppressa, P; Sabbà, C; Maiorano, E

    2016-05-01

    Hereditary haemorrhagic telangiectasia (HHT) is rare, and characterised by vascular dysplasia that leads to various symptoms including visceral arteriovenous malformations and mucocutaneous telangiectatic lesions. Our aim was to describe the clinical features and options for the treatment of multiple oral lesions, and to illustrate the efficacy of the diode laser in the treatment of early (<2mm) and advanced lesions (2mm or more). We report 24 patients with 1200 oral telangiectatic lesions, which were often associated with regular bleeding (from monthly to daily), superinfection, pain, and swelling, and treated with multiple sessions of laser according to the number and size of the lesions. Early lesions were treated with a single laser impulse in ultrapulsed mode, and advanced lesions with repeated laser impulses in pulsed mode (t-on 200ms/t-off 500ms), at a power of 8W. Early lesions healed completely after laser photocoagulation with no operative or postoperative complications, while advanced lesions improved with a remarkable reduction in size but more discomfort. Protective occlusal plates were sometimes used to reduce the incidence of new lesions caused by dental trauma. The treatment of oral telangiectatic lesions is still being debated, and it is important to improve quality of life for patients. Diode laser surgery could be an effective treatment for oral lesions in those with hereditary haemorrhagic telangiectasia. PMID:26360009

  4. Resilience to orthostasis and haemorrhage: A pilot study of common genetic and conditioning mechanisms

    PubMed Central

    Davydov, Dmitry M.; Zhdanov, Renad I.; Dvoenosov, Vladimir G.; Kravtsova, Olga A.; Voronina, Elena N.; Filipenko, Maxim L.

    2015-01-01

    A major challenge presently is not only to identify the genetic polymorphisms increasing risk to diseases, but to also find out factors and mechanisms, which can counteract a risk genotype by developing a resilient phenotype. The objective of this study was to examine acquired and innate vagal mechanisms that protect against physical challenges and haemorrhages in 19 athletes and 61 non-athletes. These include examining change in heart rate variability (HF-HRV; an indicator of vagus activity) in response to orthostatic challenge, platelet count (PLT), mean platelet volume (MPV), and single-nucleotide polymorphisms in genes that encode several coagulation factors, PAI-1, and MTHFR. Individual differences in PLT and MPV were significant predictors, with opposite effects, of the profiles of the HF-HRV changes in response to orthostasis. Regular physical training of athletes indirectly (through MPV) modifies the genetic predisposing effects of some haemostatic factors (PAI-1 and MTHFR) on vagal tone and reactivity. Individual differences in vagal tone were also associated with relationships between Factor 12 C46T and Factor 11 C22771T genes polymorphisms. This study showed that genetic predispositions for coagulation are modifiable. Its potential significance is promoting advanced protection against haemorrhages in a variety of traumas and injuries, especially in individuals with coagulation deficits. PMID:26024428

  5. Resilience to orthostasis and haemorrhage: A pilot study of common genetic and conditioning mechanisms.

    PubMed

    Davydov, Dmitry M; Zhdanov, Renad I; Dvoenosov, Vladimir G; Kravtsova, Olga A; Voronina, Elena N; Filipenko, Maxim L

    2015-01-01

    A major challenge presently is not only to identify the genetic polymorphisms increasing risk to diseases, but to also find out factors and mechanisms, which can counteract a risk genotype by developing a resilient phenotype. The objective of this study was to examine acquired and innate vagal mechanisms that protect against physical challenges and haemorrhages in 19 athletes and 61 non-athletes. These include examining change in heart rate variability (HF-HRV; an indicator of vagus activity) in response to orthostatic challenge, platelet count (PLT), mean platelet volume (MPV), and single-nucleotide polymorphisms in genes that encode several coagulation factors, PAI-1, and MTHFR. Individual differences in PLT and MPV were significant predictors, with opposite effects, of the profiles of the HF-HRV changes in response to orthostasis. Regular physical training of athletes indirectly (through MPV) modifies the genetic predisposing effects of some haemostatic factors (PAI-1 and MTHFR) on vagal tone and reactivity. Individual differences in vagal tone were also associated with relationships between Factor 12 C46T and Factor 11 C22771T genes polymorphisms. This study showed that genetic predispositions for coagulation are modifiable. Its potential significance is promoting advanced protection against haemorrhages in a variety of traumas and injuries, especially in individuals with coagulation deficits. PMID:26024428

  6. Role of self-expanding metal stents in the management of variceal haemorrhage: Hype or hope?

    PubMed

    Hogan, Brian J; O'Beirne, James P

    2016-01-10

    Despite the advances of medical, endoscopic and radiological therapy over recent years the mortality rates of acute variceal haemorrhage are still 16%-20% and the medium term outcome has not improved in the last 25 years. Early transjugular intrahepatic portosystemic shunt has proved to be an effective therapy for selected groups of patients with a high risk of re-bleeding and moderate liver disease. However, there is an unmet need for a therapy that can be applied in patients with a high risk of re-bleeding and advanced liver disease either as definitive therapy or as a bridge to permanent therapy. Self-expanding metal stents can be placed without the need for endoscopic or fluoroscopic control and, once in place, will provide effective haemostasis and allow a route for oral fluids and nutrition. They can remain in place whilst liver function recovers and secondary prophylaxis is initiated. We review the results of 6 case series including a total of 83 patients and the first randomised controlled trial of self-expanding metal stents vs balloon tamponade (BT) in the management of refractory variceal haemorrhage. We report that self-expanding metal stents provide effective haemostasis and perform better than BT in refractory bleeding, where they are associated with fewer complications. Whilst the most effective place for self-expanding metal stents in the management algorithm needs to be determined by further randomised controlled trials, currently they provide an effective alternative to BT in selected patients. PMID:26788260

  7. A review on clinical management and pharmacological therapy on hereditary haemorrhagic telangiectasia (HHT).

    PubMed

    Zarrabeitia, Roberto; Albiñana, Virginia; Salcedo, Matilde; Señaris-Gonzalez, B; Fernandez-Forcelledo, Jose-Luis; Botella, Luisa-Maria

    2010-07-01

    Hereditary Haemorrhagic Telangiectasia (HHT) or Rendu-Osler-Weber syndrome, is an autosomal dominant rare disease characterized by localized angiodysplasia. This is manifested as epistaxis, mucocutaneous and gastrointestinal telangiectases, and arteriovenous malformations in the pulmonary, cerebral or hepatic circulation. The prevalence is between 1 in 5,000 to 8,000, although it is higher in some regions. The most frequent clinical manifestation of HHT is epistaxis, normally from light to moderate from the 4(th) decade of life. However, many patients show severe epistaxis which may interfere with their quality of life. The epistaxis is due to telangiectasia on the nasal mucosa. These are focally dilated postcapilar venules, which in advanced phases show many layers of smooth muscle cells without elastic fibers, and very frequently directly connect with dilated arterioles. As a consequence of these vascular alterations, telangiectases are very sensitive to slight trauma and even to the friction with the air when breathing, which gives rise to nose bleeds. Unfortunately, there is no optimal pharmacological treatment for the epistaxis in HHT. The use of antifibrinolytic agents for the treatment of HHT has been studied recently by our group as an effective relief for nasal and gastric haemorrhages. This work represents a systematic review and the beginning of a systematic laboratory work we are now conducting in our lab to screen for "orphan drugs" as therapeutic agents in HHT. In this context, the use of hormones, immunosuppresants and anti-angiogenic agents are under preclinical study in our laboratory. PMID:19485912

  8. Role of self-expanding metal stents in the management of variceal haemorrhage: Hype or hope?

    PubMed Central

    Hogan, Brian J; O’Beirne, James P

    2016-01-01

    Despite the advances of medical, endoscopic and radiological therapy over recent years the mortality rates of acute variceal haemorrhage are still 16%-20% and the medium term outcome has not improved in the last 25 years. Early transjugular intrahepatic portosystemic shunt has proved to be an effective therapy for selected groups of patients with a high risk of re-bleeding and moderate liver disease. However, there is an unmet need for a therapy that can be applied in patients with a high risk of re-bleeding and advanced liver disease either as definitive therapy or as a bridge to permanent therapy. Self-expanding metal stents can be placed without the need for endoscopic or fluoroscopic control and, once in place, will provide effective haemostasis and allow a route for oral fluids and nutrition. They can remain in place whilst liver function recovers and secondary prophylaxis is initiated. We review the results of 6 case series including a total of 83 patients and the first randomised controlled trial of self-expanding metal stents vs balloon tamponade (BT) in the management of refractory variceal haemorrhage. We report that self-expanding metal stents provide effective haemostasis and perform better than BT in refractory bleeding, where they are associated with fewer complications. Whilst the most effective place for self-expanding metal stents in the management algorithm needs to be determined by further randomised controlled trials, currently they provide an effective alternative to BT in selected patients. PMID:26788260

  9. Complications and pregnancy outcome following uterine compression suture for postpartum haemorrhage: a single centre experience.

    PubMed

    Liu, S; Mathur, M; Tagore, S

    2014-07-01

    In the treatment of postpartum haemorrhage from uterine atony, uterine compression sutures, such as the B-Lynch suture and its modifications have a role with the advantage of preservation of the uterus for fertility. There is however, a risk that apposition of the anterior and posterior walls of the uterus will impede drainage of lochia, resulting in undesirable complications. We undertook a five-year retrospective study of all women who underwent uterine compression sutures at the KK Women's and Children's Hospital, between 2008 and 2012. In total, 23 women had uterine compression sutures during the study period, of which, nineteen women managed to conserve their uterus. Our complication rate was 25%, which included persistent vaginal discharge, pyometra and endometritis. There were three conceptions, with two successful pregnancies. Our study shows uterine compression suture to be a safe and effective alternative to avoid hysterectomy with preservation of fertility at the time of major postpartum haemorrhage. The outcome of subsequent pregnancies is reassuring. PMID:24678816

  10. Viral haemorrhagic fevers in Europe--effective control requires a co-ordinated response.

    PubMed

    Crowcroft, N S; Morgan, D; Brown, D

    2002-03-01

    Viral haemorrhagic fevers (VHF) have attracted the attention of the medical world and general public for many reasons, some based in reality and more on misinformation. They are amongst the highest profile infections in the public mind, because they are thought to be highly infectious and to kill most of their victims in a dramatic way (1,2). To add to the intrigue, mysteries remain about the source of some of the viruses involved. They emerge and re-emerge in many countries, most recently Ebola in Uganda in 2000 (3) and Gabon in 2001/02 (4), and Congo Crimean Haemorrhagic Fever (CCHF) in Kosovo (5) and Pakistan in 2001 (6). Large outbreaks have affected populations in endemic areas, living mainly in inaccessible areas or refugee camps where living conditions are very difficult. Poorly resourced medical facilities have played a role in amplifying transmission and infection control measures have been difficult or virtually impossible to establish. These viruses are likely to remain a threat until the reservoir is identified and as long as endemic areas are afflicted with ecological change, poverty and social instability. Recent events since September 11 2001 remind us of their potential to be used as weapons, and that fear can present a risk to public health. PMID:12631941

  11. Complete tamponade system for management of severe postpartum vaginal haemorrhage due to uterine atony.

    PubMed

    Atilgan, Remzi; Ozkan, Zehra Sema; Orak, Ugur; Baspinar, Melike

    2014-01-01

    A 30-year-old, 39 weeks pregnant, multiparous woman with single fetus, attended our obstetric clinic with complete cervical dilation in intractable mentum anterior presentation. The fetus was delivered by caesarean section with vertical uterine incision under general anaesthesia and lithotomy position. After surgery, examination of the vagina revealed multiple, serious tears with severe haemorrhage. Vaginal bleeding could not be controlled by sutures and concurrently uterine atony developed, which could not be controlled with medical treatment. Owing to intractable bleeding from uterus and vagina, a complete tamponade system was used. After the instillation of the uterine balloon with 500 mL and vaginal balloon with 300 mL liquid, the bleeding was controlled. The estimated blood loss was 3200 mL. The vaginal wound healed well during the postoperative 2 weeks. A complete tamponade system may be an effective treatment method for treatment of postpartum haemorrhage owing to vaginal lacerations and uterine atony. PMID:25452297

  12. The use of an alum irrigation in the treatment of massive bladder haemorrhage.

    PubMed

    Schootstra, R; van Driel, M F; Hassankhan, R; van de Werff, R; Oremus, E T; Uges, D R; Mensink, H J

    1989-10-20

    Severe, massive bladder haemorrhage is a difficult and often frustrating clinical problem. The aetiologies are numerous and include irradiation, malignancy, severe infection and drug-induced changes. Among the numerous modalities of treatment that have been reported formalin, phenol and silver nitrate instillations have often been associated with significant side effects, morbidity and mortality and have had varying degrees of success. During the last two years we have used continuous closed irrigation of a sterile 0.5% alum solution in 16 patients. Alum is an astringent and acts by protein precipitation over the bleeding surface. Because of a low cell permeability its action is limited to the cell surface and interstitial spaces. The permeability of the cell membrane is reduced but remains viable. The preparation and the pharmaceutical aspects of the 0.5% alum irrigation will be discussed. The conclusion is that the technique of managing massive bladder haemorrhage is simple, efficient, nontoxic and less expensive than previously reported therapies. Therefore, irrigation with alum before instituting invasive means to control bleeding is recommended. PMID:2594469

  13. Leptospirosis pulmonary haemorrhage syndrome is associated with linear deposition of immunoglobulin and complement on the alveolar surface.

    PubMed

    Croda, J; Neto, A N D; Brasil, R A; Pagliari, C; Nicodemo, A C; Duarte, M I S

    2010-06-01

    Leptospirosis is a zoonotic infection associated with severe diseases such as leptospirosis pulmonary haemorrhage syndrome (LPHS). The cause of pulmonary haemorrhage is unclear. Understanding which mechanisms and processes are involved in LPHS will be important in treatment regimens under development for this life-threatening syndrome. In the present study, we evaluated 30 lung specimens from LPHS patients and seven controls using histology and immunohistochemistry (detection of IgM, IgG, IgA and C3) in order to describe the pathological features associated with this syndrome. Immunoglobulin deposits were detected on the alveolar surface in 18/30 LPHS patients. Three staining patterns were observed for the immunoglobulins and C3 in the lung tissues of LPHS patients: AS, delicate linear staining adjacent to the alveolar surface, which was indicative of a membrane covering the luminal surface of type I and II pneumocyte cells; S, heterogeneous staining which was sporadically distributed along the alveolar septum; and IA, weak, focal intra-alveolar granular staining. Human LPHS is associated with individual and unique histological patterns that differ from those of other causes of pulmonary haemorrhage. In the present study, it was found that the linear deposition of immunoglobulins (IgA, IgG and IgM) and complement on the alveolar surface may play a role in the pathogenesis of pulmonary haemorrhage in human leptospirosis. PMID:19778300

  14. Isolation of a haemorrhagic protein toxin (SA-HT) from the Indian venomous butterfish (Scatophagus argus, Linn) sting extract.

    PubMed

    Karmakar, S; Muhuri, D C; Dasgupta, S C; Nagchaudhuri, A K; Gomes, A

    2004-05-01

    A haemorrhagic protein toxin (SA-HT) was isolated and purified from the spine extract of the Indian venomous butterfish, S. argus Linn, by two step ion exchange chromatography. The toxin was homogeneous in native and SDS-PAGE gel. SDS-molecular weight of the toxin was found to be 18.1 +/- 0.09 kDa. SA-HT produced severe haemorrhage on stomach wall but devoid of cutaneous haemorrhage. UV, EDTA, trypsin, protease, cyproheptadine, indomethacin, acetylsalicylic acid and BW755C treatment significantly antagonized the haemorrhagic activity of SA-HT. The toxin produced dose and time dependent oedema on mice hind paw, which was significantly encountered by cyproheptadine, indomethacin and BW755C. SA-HT increased capillary permeability on guinea pig dorsal flank. On isolated guineapig ileum, rat fundus and uterus, SA-HT produced slow contraction which was completely antagonised by prostaglandin blocker SC19220. On isolated rat duodenum, SA-HT produced slow relaxation. SA-HT significantly increased plasma plasmin, serum MDA level and decreased serum SOD level indicating the possible involvement of cyclooxygenase and lipooxygenase pathway. PMID:15233468

  15. Involvement of the histaminergic system in the resuscitating effect of centrally acting leptin in haemorrhagic shock in rats.

    PubMed

    Jochem, J; Altinbas, B; Yalcin, M; Ottani, A; Giuliani, D; Savci, V; Kasperska-Zajac, A; Guarini, S

    2016-02-01

    Leptin, acting centrally as a neuromodulator, induces the activation of the sympathetic nervous system, which may lead to a pressor action in normotensive animals. In haemorrhagic shock, leptin administered intracerebroventricularly (icv.) evokes the resuscitating effect, with long-lasting rises in mean arterial pressure (MAP) and heart rate (HR), subsequent increase in peripheral blood flows, and a 100% survival at 2 h. Since leptin is able to activate histaminergic neurons, and centrally acting histamine also induces the resuscitating effect with the activation of the sympathetic nervous system, in the present study, we investigated an involvement of the histaminergic system in leptin-evoked cardiovascular effects in haemorrhagic shock. The model of irreversible haemorrhagic shock, with MAP decreased to and stabilised at 20 - 25 mmHg, has been used. Leptin (20 μg) given icv. at 5 min of critical hypotension evoked 181.5% increase in extracellular hypothalamic histamine concentration during the first 10 min after injection. Rises in MAP, HR and renal, mesenteric and hindquarters blood flows induced by leptin were inhibited by icv. pre-treatment with histamine H1 receptor antagonist chlorpheniramine (50 nmol). In contrast, there was no effect of H2, H3 and H4 receptor antagonists ranitidine (25 nmol), VUF 5681 (25 nmol) and JNJ 10191584 (25 nmol), respectively. In conclusion, the histaminergic system is involved in centrally-acting leptin-induced resuscitating effect in haemorrhagic shock in rats. PMID:27010896

  16. Design and Experimental Evaluation of a Non-Invasive Microwave Head Imaging System for Intracranial Haemorrhage Detection

    PubMed Central

    Mobashsher, A. T.; Bialkowski, K. S.; Abbosh, A. M.; Crozier, S.

    2016-01-01

    An intracranial haemorrhage is a life threatening medical emergency, yet only a fraction of the patients receive treatment in time, primarily due to the transport delay in accessing diagnostic equipment in hospitals such as Magnetic Resonance Imaging or Computed Tomography. A mono-static microwave head imaging system that can be carried in an ambulance for the detection and localization of intracranial haemorrhage is presented. The system employs a single ultra-wideband antenna as sensing element to transmit signals in low microwave frequencies towards the head and capture backscattered signals. The compact and low-profile antenna provides stable directional radiation patterns over the operating bandwidth in both near and far-fields. Numerical analysis of the head imaging system with a realistic head model in various situations is performed to realize the scattering mechanism of haemorrhage. A modified delay-and-summation back-projection algorithm, which includes effects of surface waves and a distance-dependent effective permittivity model, is proposed for signal and image post-processing. The efficacy of the automated head imaging system is evaluated using a 3D-printed human head phantom with frequency dispersive dielectric properties including emulated haemorrhages with different sizes located at different depths. Scattered signals are acquired with a compact transceiver in a mono-static circular scanning profile. The reconstructed images demonstrate that the system is capable of detecting haemorrhages as small as 1 cm3. While quantitative analyses reveal that the quality of images gradually degrades with the increase of the haemorrhage’s depth due to the reduction of signal penetration inside the head; rigorous statistical analysis suggests that substantial improvement in image quality can be obtained by increasing the data samples collected around the head. The proposed head imaging prototype along with the processing algorithm demonstrates its feasibility

  17. In vivo bioimpedance changes during haemorrhagic and ischaemic stroke in rats: towards 3D stroke imaging using electrical impedance tomography.

    PubMed

    Dowrick, T; Blochet, C; Holder, D

    2016-06-01

    Electrical impedance tomography (EIT) could be used as a portable non-invasive means to image the development of ischaemic stroke or haemorrhage. The purpose of this study was to examine if this was possible using time difference imaging, in the anesthetised rat using 40 spring-loaded scalp electrodes with applied constant currents of 50-150 μA at 2 kHz. Impedance changes in the largest 10% of electrode combinations were  -12.8%  ±  12.0% over the first 10 min for haemorrhage and  +46.1%  ±  37.2% over one hour for ischaemic stroke (mean  ±  SD, n  =  7 in each group). The volume of the pathologies, assessed by tissue section and histology post-mortem, was 12.6 μl  ±  17.6 μl and 12.6 μl  ±  17.6 μl for haemorrhage and ischaemia respectively. In time difference EIT images, there was a correspondence with the pathology in 3/7 cases of haemorrhage and none of the ischaemic strokes. Although the net impedance changes were physiologically reasonable and consistent with expectations from the literature, it was disappointing that it was not possible to obtain reliable EIT images. The reason for this are not clear, but probably include confounding effects of secondary ischaemia for haemorrhage and tissue and cerebrospinal fluid shifts for the stroke model. With this method, it does not appear that EIT with scalp electrodes is yet ready for clinical use. PMID:27200510

  18. Possible interaction between myxomatosis and calicivirosis related to rabbit haemorrhagic disease affecting the European rabbit.

    PubMed

    Marchandeau, S; Bertagnoli, S; Peralta, B; Boucraut-Baralon, C; Letty, J; Reitz, F

    2004-11-01

    Serological data on myxoma virus, rabbit haemorrhagic disease (RHD) virus and RHD-like viruses in juvenile rabbits (Oryctolagus cuniculus) trapped in 1995, 1996 and 1997 in two areas of France were analysed. For each disease, the effects of bodyweight, year, month and seropositivity for the other disease were modelled by using logistic regressions. In one area, a model including RHD seropositivity was selected to explain the myxoma virus seropositivity. Models including myxoma virus seropositivity were selected to explain the RHD seropositivity in both areas, and the odds of a rabbit being seropositive to both viruses were 5.1 and 8.4 times higher than the odds of a rabbit being seronegative to myxoma virus and seropositive to RHD. The year and bodyweight had significant effects for myxomatosis in one area and for RHD in both areas. PMID:15573951

  19. Improvised condom catheter with a draining channel for management of atonic post partum haemorrhage.

    PubMed

    Rishard, M R M; Galgomuwa, G V M P; Gunawardane, K

    2013-09-01

    Primary postpartum haemorrhage (PPH) is one of the five leading causes of maternal mortality in both developed and developing countries [1] . During the last two decades various uterine taponade devices have been used successfully in the management of PPH [2-5]. Success rates for the control of postpartum bleeding have ranged from 71% to 87% [6, 7]. So far, the Bakri balloon is the only balloon product that is specifically designed for 'the control of postpartum uterine bleeding' (Cook Medical; enclosed instruction leaflet J-SOS1106). It has a drainage lumen which allows real-time assessment of ongoing blood loss above the level of the bulb and may prevent delayed treatment. This advantage is not present in the condom catheter. We report an improvised version of the condom catheter with a draining channel which was successfully used to manage two cases of PPH with uterine atony. PMID:24081174

  20. Bluetongue virus and epizootic haemorrhagic disease of deer virus serotypes in northern Colombian cattle.

    PubMed Central

    Homan, E. J.; Taylor, W. P.; de Ruiz, H. L.; Yuill, T. M.

    1985-01-01

    There is recent evidence of bluetongue (BT) and epizootic haemorrhagic disease (EHD) virus infection of cattle in the American tropics, including BT group reactive antibody in Colombian cattle. These observations prompted a study to determine serologically the specific BT and EHD virus types present, and time of infection and to collect Culicoides spp. as potential vectors. A prospective study of BT and EHD virus infection was done on two farms in the Colombian department of Antioquia. Sequential sampling of young cattle indicated acquisition of neutralizing antibody to BT virus serotypes 12, 14 and 17, and EHD virus serotypes 1 and 2. Insect captures showed a high association of Culicoides insignis with infected cattle. PMID:2991365

  1. The link between intracranial haemorrhage and cardiogenic shock: a case of Takotsubo cardiomyopathy.

    PubMed

    Caretta, Giorgio; Vizzardi, Enrico; Rovetta, Riccardo; Evaristi, Laura; Quinzani, Filippo; Raddino, Riccardo; Dei Cas, Livio

    2012-06-01

    Myocardial dysfunction occurs frequently during subarachnoid haemorrhage (SAH) and it is often referred to as neurogenic stunned myocardium (NSM). Takotsubo cardiomyopathy (TTC), which can lead to life-threatening acute heart failure, has been considered a possible complication of SAH. Actually, NSM and TTC are believed to share the same pathophysiological mechanisms and are likely a manifestation of the same disease. We report a case of a 64-year-old woman with SAH and cardiogenic shock due to acute left ventricular dysfunction. Echocardiography and ventriculography showed the typical pattern of TTC. Angiography excluded coronary artery disease or coronary spasm. Short-term inotropic support was necessary. Rapid recovery of left ventricular function was observed after 8 days. Acute myocardial dysfunction due to TTC in the setting of SAH may lead to cardiogenic shock which is difficult to treat. Patients with SAH and haemodynamic instability warrant a careful assessment of ventricular function on admission to rule out TTC PMID:22870749

  2. Molecular characterisation of epizootic haemorrhagic disease virus associated with a Tunisian outbreak among cattle in 2006.

    PubMed

    Ben Dhaou, Sameh; Sailleau, Corinne; Babay, Besma; Viarouge, Cyril; Sghaier, Soufien; Zientara, Stephan; Hammami, Salah; Bréard, Emmanuel

    2016-06-01

    In 2006, epizootic haemorrhagic disease (EHD) outbreaks were recorded in the Maghreb (Tunisia, Morocco and Algeria) among cattle, resulting in severe repercussions on herds (oedema of the head, necrotic lesions of the oral mucosa, hyperthermia of the teats, accompanied by anorexia and respiratory distress) and economic losses. The present study gives new information on the molecular characterisation of the EHD virus (EHDV) that had circulated in Tunisia. Genome segments 2, 3, 6, 7 and 10 of EHDV, corresponding to the VP2, VP3, VP5, VP7 and NS3/NS3A proteins, respectively, were amplified from the blood of one animal by RT-PCR and sequenced. Nucleotide sequence comparisons of these five segments with sequences available in the GenBank demonstrated that an EHDV serotype 6 (EHDV-6) had been present in Tunisia in 2006. The possible origin of this strain is discussed. PMID:27342096

  3. Orofacial hereditary haemorrhagic telangiectasia: high power diode laser in early and advanced lesion treatment

    NASA Astrophysics Data System (ADS)

    Tempesta, Angela; Franco, Simonetta; Miccoli, Simona; Suppressa, Patrizia; De Falco, Vincenzo; Crincoli, Vito; Lacaita, Mariagrazia; Giuliani, Michele; Favia, Gianfranco

    2014-01-01

    Hereditary Haemorrhagic Telangiectasia (HHT) is a muco-cutaneous inherited disease. Symptoms are epistaxis, visceral arterio-venous malformations, multiple muco-cutaneous telangiectasia with the risk of number increasing enlargement, bleeding, and super-infection. The aim of this work is to show the dual Diode Laser efficacy in preventive treatment of Early Lesions (EL < 2mm) and therapeutic treatment of Advanced Lesions (AL < 2mm). 21 patients affected by HHT with 822 muco-cutaneous telangiectatic nodules have been treated in several sessions with local anaesthesia and cooling of treated sites. EL preventive treatment consists of single Laser impulse (fibre 320) in ultrapulsed mode (2 mm single point spot). AL therapeutic treatment consists of repeated Laser impulses in pulsed mode (on 200ms / off 400ms). According to the results, Diode Laser used in pulsed and ultra-pulsed mode is very effective as noninvasive treatment both in early and advanced oral and perioral telangiectasia.

  4. European survey on laboratory preparedness, response and diagnostic capacity for Crimean-Congo haemorrhagic fever, 2012.

    PubMed

    Fernandez-Garcia, M D; Negredo, A; Papa, A; Donoso-Mantke, O; Niedrig, M; Zeller, H; Tenorio, A; Franco, L

    2014-01-01

    Crimean-Congo haemorrhagic fever (CCHF) is an infectious viral disease that has (re-)emerged in the last decade in south-eastern Europe, and there is a risk for further geographical expansion to western Europe. Here we report the results of a survey covering 28 countries, conducted in 2012 among the member laboratories of the European Network for Diagnostics of 'Imported' Viral Diseases (ENIVD) to assess laboratory preparedness and response capacities for CCHF. The answers of 31 laboratories of the European region regarding CCHF case definition, training necessity, biosafety, quality assurance and diagnostic tests are presented. In addition, we identified the lack of a Regional Reference Expert Laboratory in or near endemic areas. Moreover, a comprehensive review of the biosafety level suitable to the reality of endemic areas is needed. These issues are challenges that should be addressed by European public health authorities. However, all respondent laboratories have suitable diagnostic capacities for the current situation. PMID:25011064

  5. Report of nine cases of Crimean-Congo haemorrhagic fever From Iran

    PubMed Central

    Ayatollahi, Jamshid; Shahcheraghi, Seyed Hossein; Mirjalili, Mahmood

    2015-01-01

    Crimean-Congo haemorrhagic fever (CCHF) is an often fatal viral infection described in about 30 countries around the world. It is transmitted to humans by the bite of an infected tick and by direct contact with blood or tissue from infected humans and livestock. In the following, we report nine cases of CCHF disease. This paper reported nine human CCHF cases, two in Tabas and Bandar Abbas and seven in Yazd. They were 21-, 33-, 28-, 29-, 61, 34, 35, 36 and 52 year-old men. The first, second and third patients were butchers and other patients were farmers. CCHF should be investigated in the patients with fever, bleeding and low platelet counts. PMID:25838635

  6. [Efficacy of plasma substitutes of different molecular weight in acute haemorrhagic shock in dogs (author's transl)].

    PubMed

    Klose, R; Hartung, H J; Ruffmann, R; Lutz, H

    1979-08-01

    Dogs were bled into haemorrhagic shock. They were then given isovolaemic infusions of dextran 60 and 40 and of hydroxyethyl starch with an average molecular weight of 200,000 and 40,000 respectively with a view of assessing the haemodynamic efficacy of these plasma substitutes. Solutions of high molecular weight hydroxyethyl starch (HES 400) were retained in the circulation for about the same length of time as was dextran 60. HES 40 (molecular weight 40,000) was retained for about 3-4 hours as measured by cardiac output. For normalizing a relative hypovolaemia, e.g. during anaesthesia or in some emergencies, colloidal plasma substitutes which will be retained for only a short time are entirely satisfactory. PMID:91161

  7. Postpartum haemorrhage in a woman with essential thrombocythemia carrying calreticulin mutation: a case report.

    PubMed

    Villani, Michela; Colaizzo, Donatella; Tiscia, Giovanni L; Chinni, Elena; Bodenizza, Carl'Antonio; Cascavilla, Nicola; Grandone, Elvira

    2016-09-01

    Coagulation disorder associated with essential thrombocythemia may exacerbate the prothrombotic state physiologically occurring during pregnancy. We report a case of a severe postpartum haemorrhage in a 35-year-old woman previously diagnosed with essential thrombocythemia and carrying the somatic calreticulin mutation. She was referred to our Thrombosis and Haemostasis Unit for pregnancy management. A treatment with low-dose aspirin was prescribed until the labour started, as the platelets count raised above 1000 × 10/l. At the time of bleeding, no residual placenta was detected at the revision of the uterine cavity.Although the postpartum is a high-risk period for thrombotic events, we have to carefully evaluate in women with essential thrombocythemia the likelihood of developing a hemorrhagic complication. PMID:26650457

  8. Diffuse pulmonary haemorrhage accompanied by haemothorax as a rare presentation of primary lung angiosarcoma

    PubMed Central

    Radzikowska, Elżbieta; Szołkowska, Małgorzata; Oniszh, Karina; Szczęsna, Magdalena; Roszkowski-Śliż, Kazimierz

    2015-01-01

    Primary pulmonary angiosarcoma is an extremely rare disease. Chest computed tomography demonstrates solitary or multifocal lesions, sometimes associated with ground-glass opacities or pleural effusion. Diagnosis is based on histological examination that reveals spindle-shaped epithelioid cells with positive staining for endothelial markers (factor VIII, CD 31, CD34, Fli-1, Ulex europaeus agglutinin 1, vimentin). The prognosis is poor and effective treatment is still being researched. This is a report of a 65-year-old patient with a four-month history of haemoptysis, cough, and dyspnoea. The primary radiological findings suggested interstitial lung disease. After one month the clinical presentation evolved into diffuse pulmonary haemorrhage with concomitant haemothorax. The diagnosis of primary lung angiosarcoma was based on histological and immunohistochemical examination of the lung and pleural biopsy obtained by videothoracoscopy. PMID:26855658

  9. Moyamoya Disease Associated with Recurrent Right Thalamic Haemorrhage and Hydrocephalus: A Case Report.

    PubMed

    Sinha, Rohan; Jain, Amit Kumar; Jagdhane, Nitin; Nandy, Parvati; Khanna, Satish Kumar

    2015-01-01

    Moyamoya disease, a rare chronic, progressive cerebrovascular disease leads to occlusion of intracranial internal carotid arteries and its proximal branches. We report a case of a 51-year-old female who presented with recurrent thalamic bleed and intraventricular haemorrhage nine years apart in the same territory. The first bleed was managed conservatively and second bleed led to development of hydrocephalus. The acute phase of the hydrocephalus was managed by external ventricular drainage and the final CSF diversion was managed by ventriculoperitoneal shunt. The definitive treatment could not be done to denial of consent from the patient. We present the case to highlight the role CSF diversion as a means of palliative treatment for the Moyamoya disease. PMID:26442554

  10. Immunosuppression abrogates resistance of young rabbits to Rabbit Haemorrhagic Disease (RHD)

    PubMed Central

    2014-01-01

    Rabbit Haemorrhagic Disease (RHD) is caused by a calicivirus (RHDV) that kills 90% of infected adult European rabbits within 3 days. Remarkably, young rabbits are resistant to RHD. We induced immunosuppression in young rabbits by treatment with methylprednisolone acetate (MPA) and challenged the animals with RHDV by intramuscular injection. All of these young rabbits died within 3 days of infection due to fulminant hepatitis, presenting a large number of RHDV-positive dead or apoptotic hepatocytes, and a significant seric increase in cytokines, features that are similar to those of naïve adult rabbits infected by RHDV. We conclude that MPA-induced immunosuppression abrogates the resistance of young rabbits to RHD, indicating that there are differences in the innate immune system between young and adult rabbits that contribute to their distinct resistance/susceptibility to RHDV infection. PMID:24490832

  11. Splenic rupture and intracranial haemorrhage in a haemophilic neonate: case report and literature review.

    PubMed

    Adamu, Ibrahim; Asarian, Armand; Xiao, Philip

    2012-01-01

    Splenic rupture and intracranial haemorrhage are life-threatening conditions infrequently encountered in neonates without history of birth trauma. External manifestations of birth trauma; namely, capput succadeneum and cephalhematoma, when present raise suspicions for more serious intracranial or visceral damage. Rupture of normal spleen without an obvious source of trauma in haemophilic neonate is a rare event. The concurrence of both conditions and the unusual presentation make this case a rare one that is seldom encountered in the literature. Additionally, when splenic rupture occurs, the consensus is to employ all non-operative techniques aimed at salvaging the spleen, thus avoiding the immune-compromised state associated with splenectomy. However, in this case, we present a 3-day-old male with family history of haemophilia A, who was diagnosed with splenic rupture and bilateral subdural haematomas and underwent splenectomy, albeit with post-operative complications, in light of haemodynamic instability and high ongoing transfusion requirements. PMID:22878771

  12. Meningeal haemorrhage secondary to cerebrospinal fluid drainage during thoracic endovascular aortic repair

    PubMed Central

    Mancio, Jennifer; Pires-Morais, Gustavo; Bettencourt, Nuno; Oliveira, Marco; Santos, Lino; Melica, Bruno; Rodrigues, Alberto; Braga, José Pedro; Ribeiro, Vasco Gama

    2014-01-01

    Thoracic endovascular aortic repair (TEVAR) has shown lower mortality compared with open surgical repair (OSR). However, the risk of spinal cord ischaemia (SCI) remains similar than OSR. As a prophylactic measure to reduce the risk of SCI, cerebrospinal fluid (CSF) drainage has been widely used in OSR. In TEVAR, the utility of this adjunct is still controversial. We report a case of a 56-year-old man referred for TEVAR for a descending thoracic aneurysm that previously underwent an abdominal aneurysmectomy with aortobifemoral bypass graft. On the day before, a lumbar cerebrospinal drain was placed prophylactically. Forty-eight hours after the procedure, meningeal symptoms without neurological deficits developed. Clinical investigation revealed meningeal haemorrhage. Therapy with nimodipine was initiated with symptomatic relief. Evidence from randomized controlled trials supporting the role of CSF drainage in TEVAR is still lacking. We discuss the current recommendations, potential benefits and risks and cautions associated with CSF drainage in TEVAR. PMID:25988028

  13. Functional Outcome at 6 Months in Surgical Treatment of Spontaneous Supratentorial Intracerebral Haemorrhage

    PubMed Central

    Ghani, Abdul Rahman Izaini; John, John Tharakan Kalappurakkal; Idris, Zamzuri; Ghazali, Mazira Mohamad; Murshid, Nur-Leem; Musa, Kamarul Imran

    2008-01-01

    A prospective cohort study was done to evaluate the role of surgery in patients with spontaneous supratentorial intracerebral haemorrhage (SICH) and to identify predictors of outcome including the use of invasive regional cortical cerebral blood flow (rCoBF) and microdialysis. Surgery consisted of craniotomy or decompressive craniectomy. The ventriculostomy for intracranial pressure (ICP) monitoring and drainage and regional cortical cerebral blood flow (rCoBF) and microdialysis were performed in all subjects. Pre and post operative information on subjects were collected. The study end points was functional outcome at 6 months based on a dichotomised Glasgow Outcome Scale (GOS).The selected clinical, radiological, biochemical and treatment factors that may influence the functional outcome were analysed for their significance. A total of 36 patients were recruited with 27(75%) patients had Glasgow Coma Score (GCS) between 5 to 8 on admission and 9(25%) were admitted with GCS of 9. At 6 months, 86 % had a poor or unfavourable outcome (GOS I–III) and 14% had good or favourable outcome (GOS IV–V). The mortality rate at 6 months was 55%. Univariate analysis for the functional outcome identified 2 significant variables, the midline shift (p=0.013) and mean lactate:pyruvate ratio (p=0.038). Multivariate analysis identified midline shift as the single significant independent predictor of functional outcome (p=0.013).Despite aggressive regional cortical cerebral blood flow (rCoBF) and microdialysis study for detection of early ischemia, surgical treatment for spontaneous intracerebral haemorrhage only benefited a small number of patients in terms of favourable outcome (14%) and in the majority of patients (86%), the outcome was unfavourable. Patients with midline shift > 5mm has almost 21 times higher chances (adj) OR 20.8 of being associated with poor outcome (GOS I–III). PMID:22589638

  14. Systemic lupus erythematosus complicated by diffuse alveolar haemorrhage: risk factors, therapy and survival

    PubMed Central

    Kazzaz, Nayef M; Coit, Patrick; Lewis, Emily E; McCune, W Joseph; Sawalha, Amr H; Knight, Jason S

    2015-01-01

    Objectives While diffuse alveolar haemorrhage (DAH) is recognised as a life-threatening complication of systemic lupus erythematosus (SLE), little is known about its risk factors and response to treatment. We describe 22 cases of DAH in a US lupus cohort of approximately 1000 patients, and compare them to 66 controls from the same outpatient cohort. Methods We captured variables pertaining to diagnoses of SLE and secondary antiphospholipid syndrome (APS), and analysed them by univariate testing. Those variables with p values <0.05 were then further considered in a multivariate model. Kaplan-Meier curves were constructed for each group, and survival was analysed by Log-rank test. Results Of the 22 patients with DAH, 59% were diagnosed with DAH within 5 years of lupus diagnosis. By univariate testing, several manifestations of SLE and APS were more common in patients with DAH, including history of thrombocytopenia, cardiac valve disease, low C3, leucopenia, neuropsychiatric features, haemolysis, arterial thrombosis, lupus anticoagulant, secondary APS and low C4. On multivariate analysis, history of thrombocytopenia and low C3 were maintained as independent risk factors. Importantly, only two patients had platelet counts <50 000/µL at the time of the DAH episode, arguing that DAH was not simply a haemorrhagic complication of thrombocytopenia. All patients were treated with increased immunosuppression, including various combinations of corticosteroids, plasmapheresis, cyclophosphamide, rituximab and mycophenolate mofetil. Notably, all patients in the cohort survived their initial episode of DAH. While the patients with DAH did well in the short-term, their long-term survival was significantly worse than controls. Several of the deaths were attributable to thrombotic complications after recovering from DAH. Conclusions To the best of our knowledge, this is the largest case–control study of lupus DAH to date. History of thrombocytopenia was strongly predictive of

  15. Comparative Evaluation of Crystalloid Resuscitation Rate in a Human Model of Compensated Haemorrhagic Shock

    PubMed Central

    Ho, Loretta; Lau, Lawrence; Churilov, Leonid; Riedel, Bernhard; McNicol, Larry; Hahn, Robert G.; Weinberg, Laurence

    2016-01-01

    ABSTRACT Introduction: The most effective rate of fluid resuscitation in haemorrhagic shock is unknown. Methods: We performed a randomized crossover pilot study in a healthy volunteer model of compensated haemorrhagic shock. Following venesection of 15 mL/kg of blood, participants were randomized to 20 mL/kg of crystalloid over 10 min (FAST treatment) or 30 min (SLOW treatment). The primary end point was oxygen delivery (DO2). Secondary end points included pressure and flow-based haemodynamic variables, blood volume expansion, and clinical biochemistry. Results: Nine normotensive healthy adult volunteers participated. No significant differences were observed in DO2 and biochemical variables between the SLOW and FAST groups. Blood volume was reduced by 16% following venesection, with a corresponding 5% reduction in cardiac index (CI) (P < 0.001). Immediately following resuscitation the increase in blood volume corresponded to 54% of the infused volume under FAST treatment and 69% of the infused volume under SLOW treatment (P = 0.03). This blood volume expansion attenuated with time to 24% and 25% of the infused volume 30 min postinfusion. During fluid resuscitation, blood pressure was higher under FAST treatment. However, CI paradoxically decreased in most participants during the resuscitation phase; a finding not observed under SLOW treatment. Conclusion: FAST or SLOW fluid resuscitation had no significant impact on DO2 between treatment groups. In both groups, changes in CI and blood pressure did not reflect the magnitude of intravascular blood volume deficit. Crystalloid resuscitation expanded intravascular blood volume by approximately 25%. PMID:26974423

  16. Lipopolysaccharide-induced lung injury in mice. I. Concomitant evaluation of inflammatory cells and haemorrhagic lung damage.

    PubMed

    Asti, C; Ruggieri, V; Porzio, S; Chiusaroli, R; Melillo, G; Caselli, G F

    2000-01-01

    Intratracheal instillation of lipopolysaccharide (LPS) induces an inflammatory response characterized by infiltration of polymorphonuclear neutrophils (PMNs) into the extracellular matrix and by the release of mediators that play a fundamental role in lung damage. In the present study, we developed a mouse model which allows correlation of the inflammatory response and haemorrhagic tissue injury in the same animal. In particular, the different steps of the inflammatory response and tissue damage were evaluated by the analysis of three parameters: myeloperoxidase (MPO) activity in the parenchyma, reflecting PMNs accumulation into the lung, inflammatory cells count in the bronchoalveolar lavage fluid (BALF), reflecting their extravasation, and total haemoglobin estimation in BALF, a marker of haemorrhagic tissue damage consequent to PMNs degranulation. In our experimental conditions, intra-tracheal administration of 10 microg/mouse of LPS evoked an increase of MPO activity in the lung at 4 h (131%) and 6 h (147%) from endotoxin challenge. A significant increase of PMNs in the BALF was noticed at these times with a plateau between the 12nd and 24th h. PMN accumulation produced a time-dependent haemorrhagic lung damage until 24 h after LPS injection (4 h: +38%; 6 h: +23%; 12 h: +44%; 24 h: +129% increase of haemoglobin concentration in the BALF vs. control). Lung injury was also assessed histopathologically. Twenty-four hours after the challenge, diffuse alveolar haemorrhage, as well as PMN recruitment in the interstitium and alveolus were observed in the LPS group. This model was pharmacologically characterized by pretreatment of LPS-treated mice with antiinflammatory drugs acting on different steps of the . We demonstrated that: a) betamethasone (1, 3, 10, 30 mg/kg p.o.) reduced in a dose-dependent manner the MPO activity, the number of inflammatory cells and, at the same time, lung injury; b) pentoxifylline, a TNFalpha production inhibitor (200

  17. Cerebral atrophy and subdural haemorrhage after cerebellar and cerebral infarcts in an 8-month-old child after having been stung by a scorpion

    PubMed Central

    Sığırcı, Ahmet; Öztürk, Mehmet; Yakıncı, Cengiz

    2014-01-01

    A scorpion sting causing cerebellar and cerebral infarctions with corpus callosum involvement and bilateral cerebral atrophy with subdural haemorrhage in an 8-month-old girl, has not been previously described to the best of our knowledge. PMID:24962491

  18. Subarachnoid haemorrhage from the rupture of two intracranial aneurysms in the same day: a rare occurrence, not a myth.

    PubMed

    Dubois, Jerome Laval Cyril; Major, Otto

    2016-01-01

    The incidence of intracranial aneurysms is approximately 6% throughout the world, although it can be more prevalent in some populations than others. Subarachnoid haemorrhage from a single aneurysm rupture can be devastating, with approximately 35% of patients not regaining consciousness after the initial bleed. In some cases, patients will have two or more aneurysms at presentation, and only one of them will have bled. Having two or more aneurysms that have bled within a few minutes or few hours of one another, is almost unheard of. Our case report is based on a patient who presented with subarachnoid haemorrhage from two ruptured aneurysms, confirmed intraoperatively and corroborated by the available, preoperative, standard head CT scan, which can be performed in any hospital with CT scanning facilities, and CT angiogram. PMID:26884073

  19. The use of Celox gauze as an adjunct to pelvic Packing in otherwise uncontrollable pelvic haemorrhage secondary to penetrating trauma.

    PubMed

    Arul, G S; Bowley, D M; DiRusso, S

    2012-12-01

    Haemorrhage from severe pelvic fractures can be associated with significant mortality. Modern civilian trauma centres may manage these injuries with a combination of external pelvic fixation, extra-peritoneal packing and/or selective angiography; however, military patterns of wounding are different and deployed medical facilities may be resource constrained. We report two successful instances of pelvic packing using chitosan impregnated gauze (Celox) when conventional surgical attempts at vascular control had failed. We conclude that pelvic packing should be considered early in patients with military pelvic trauma and major haemorrhage, as part of damage control surgery and that Celox gauze may be a useful adjunct. In our cases, the Celox gauze was easily removed after 24-48 hours without significant bowel adhesions and did not leave a residual phelgmon (of exudate or gel) that may predispose to infection. PMID:23402073

  20. Resuscitation with Na+/H+ exchanger inhibitor in traumatic haemorrhagic shock: cardiopulmonary performance, oxygen transport and tissue inflammation.

    PubMed

    Wu, Dongmei; Qi, Jiansong; Dai, Hui; Doods, Henri; Abraham, William M

    2010-03-01

    1. The aim of the present study was to examine the effects of inhibition of the Na(+)/H(+) exchanger (NHE-1) on cardiopulmonary performance, oxygen carrying capacity and tissue inflammation in a pig model of traumatic haemorrhage-resuscitation. 2. In 12 instrumented anaesthetized pigs, traumatic haemorrhage was modelled by producing tibia fractures, followed by haemorrhage of 25 mL/kg for 20 min, and then a 4 mm hepatic arterial tear with surgical repair after 20 min. Animals then underwent low-volume fluid resuscitation with either Hextend (vehicle; n = 6; Hospira, Lake Forest, IL, USA) or 3 mg/kg BIIB513 (an NHE-1 inhibitor) + Hextend (n = 6). The experiment was terminated 6 h after the beginning of resuscitation. 3. Compared with vehicle-treated controls, the addition of NHE-1 inhibition with BIIB513 significantly improved the left ventricle stroke work index and attenuated increases in pulmonary arterial pressure and pulmonary vascular resistance. Furthermore, BIIB513 treatment significantly increased the oxygenated haemoglobin ratio, blood oxygen content and mixed venous blood oxygen saturation and improved blood oxygen delivery. In addition, BIIB513 treatment reduced lung tissue levels of interleukin-6 by 80%, tumour necrosis factor-alpha by 37% and myeloperoxidase activity by 38%. Nuclear factor-kappaB DNA binding activity in the lung was also slightly and significantly attenuated following BIIB513 treatment. 4. In conclusion, the present study shows that NHE-1 inhibition facilitates the response to fluid resuscitation after traumatic haemorrhage by improving cardiac function, pulmonary vascular function and oxygen carrying capacity, which results in reduced tissue inflammatory injury. PMID:19769605

  1. Emergency reversal of anticoagulation with a three-factor prothrombin complex concentrate in patients with intracranial haemorrhage

    PubMed Central

    Imberti, Davide; Barillari, Giovanni; Biasioli, Chiara; Bianchi, Marina; Contino, Laura; Duce, Rita; D’Incà, Marco; Gnani, Maria Cristina; Mari, Elisa; Ageno, Walter

    2011-01-01

    Background Intracranial haemorrhage is a serious and potentially fatal complication of oral anticoagulant therapy. Prothrombin complex concentrates can substantially shorten the time needed to reverse the effects of oral anticoagulants. The aim of this study was to determine the efficacy and safety of a prothrombin complex concentrate for rapid reversal of oral anticoagulant therapy in patients with intracranial haemorrhage. Methods Patients receiving oral anticoagulant therapy and suffering from acute intracranial haemorrhage were eligible for this prospective cohort study if their International Normalised Ratio (INR) was higher than or equal to 2.0. The prothrombin complex concentrate was infused at doses of 35–50 IU/kg, stratified according to the initial INR. Results Forty-six patients (25 males; mean age: 75 years; range 38–92 years) were enrolled. The median INR at presentation was 3.5 (range, 2–9). At 30 minutes after administration of the prothrombin complex concentrate, the median INR was 1.3 (range, 0.9–3), and the INR then declined to less than or equal to 1.5 in 75% of patients. The benefit of the prothrombin complex concentrate was maintained for a long time, since the median INR remained lower than or equal to 1.5 (median, 1.16; range, 0.9–2.2) at 96% of all post-infusion time-points up to 96 hours. No thrombotic complications or significant adverse events were observed during hospitalisation; six patients (13%) died, but none of these deaths was judged to be related to administration of the prothrombin complex concentrate. Conclusions Prothrombin complex concentrates are an effective, rapid and safe treatment for the urgent reversal of oral anticoagulation in patients with intracranial haemorrhage. Broader use of prothrombin complex concentrates in this clinical setting appears to be appropriate. PMID:21251465

  2. Association between haemorrhages and treatment with selective and non-selective serotonergic antidepressants: Possible implications of quantitative signal detection.

    PubMed

    Gahr, Maximilian; Zeiss, René; Lang, Dirk; Connemann, Bernhard J; Hiemke, Christoph; Muche, Rainer; Freudenmann, Roland W; Schönfeldt-Lecuona, Carlos

    2015-09-30

    Inhibition of serotonin uptake in platelets seems to be the crucial mechanism underlying SSRI-associated haemorrhages. This effect is also present in antidepressants featuring non-selective serotonin reuptake inhibition (non-SSRI). Impact of selectivity of serotonin reuptake and/or affinity to the serotonin reuptake transporter on the bleeding risk have not yet been studied sufficiently. We retrieved country- and SSRI-/non-SSRI-specific data from the Uppsala Monitoring Centre and used a case/non-case approach to calculate substance-specific reporting odds ratios (ROR) to evaluate the statistical association of treatment with SSRI/non-SSRI and haemorrhages. Country-specific analysis revealed no clear trends towards an increased risk of bleeding related to particular agents of group SSRI/non-SSRI (sporadically ROR>1 for citalopram, duloxetine, escitalopram, fluvoxamine, paroxetine, sertraline, St. John's wort). There was a clear trend in the total dataset towards a "reduced protective effect" (suggested by ROR<1) on the development of haemorrhages with agents featuring comparatively high affinity to the 5-HTT and/or selective serotonin reuptake inhibition (as with escitalopram, citalopram, duloxetine or venlafaxine) in comparison to agents with lower affinity or non-selective serotonin reuptake inhibition (as with mirtazapine or doxepin). Comparison of group-specific aggregated data (SSRI vs. non-SSRI) revealed significant differences regarding the "protective effect" on the development of haemorrhages between groups SSRI vs. non-SSRI in favour of non-SSRI in nearly all countries as well as in the total dataset. Our findings provide preliminary evidence that agents with increased affinity to the 5-HTT and/or selective serotonin reuptake inhibition may be associated with an increased risk of bleeding. PMID:26208982

  3. Role of hydrogen sulphide in haemorrhagic shock in the rat: protective effect of inhibitors of hydrogen sulphide biosynthesis

    PubMed Central

    Mok, Ying-Yuan Pamela; Mohammed Atan, Mohammed Shirhan Bin; Ping, Cheong Yoke; Jing, Wang Zhong; Bhatia, Madhav; Moochhala, Shabbir; Moore, Philip K

    2004-01-01

    Haemorrhagic shock (60 min) in the anaesthetized rat resulted in a prolonged fall in the mean arterial blood pressure (MAP) and heart rate (HR). Pre-treatment (30 min before shock) or post-treatment (60 min after shock) with inhibitors of cystathionine γ lyase (CSE; converts cysteine into hydrogen sulphide (H2S)), dl-propargylglycine or β-cyanoalanine (50 mg kg−1, i.v.), or glibenclamide (40 mg kg−1, i.p.), produced a rapid, partial restoration in MAP and HR. Neither saline nor DMSO affected MAP or HR. Plasma H2S concentration was elevated 60 min after blood withdrawal (37.5±1.3 μm, n=18 c.f. 28.9±1.4 μm, n=15, P<0.05). The conversion of cysteine to H2S by liver (but not kidney) homogenates prepared from animals killed 60 min after withdrawal of blood was significantly increased (52.1±1.6 c.f. 39.8±4.1 nmol mg protein−1, n=8, P<0.05), as was liver CSE mRNA (2.7 ×). Both PAG (IC50, 55.0±3.2 μm) and BCA (IC50, 6.5±1.2 μm) inhibited liver H2S synthesizing activity in vitro. Pre-treatment of animals with PAG or BCA (50 mg kg−1, i.p.) but not glibenclamide (40 mg kg−1, i.p., KATP channel inhibitor) abolished the rise in plasma H2S in animals exposed to 60 min haemorrhagic shock and prevented the augmented biosynthesis of H2S from cysteine in liver. These results demonstrate that H2S plays a role in haemorrhagic shock in the rat. CSE inhibitors may provide a novel approach to the treatment of haemorrhagic shock. PMID:15504752

  4. The Correlation Between Age and Bleeding Volume in Haemorrhagic Stroke Using Multi Slice CT at District Hospitals in Jakarta.

    PubMed

    Saefudin, Tatan; Apriantoro, Nursama Heru; Hidayat, Ekaputra Syarif; Purnamawati, Schandra

    2016-04-01

    Haemorrhagic Stroke is a common disease in Indonesia. The best imaging modality for this disease is Multi Slice Computed Tomography Scanning (MSCT), as it may help strengthening the diagnosis as well as determining the brain bleeding volume. This study aimed to show correlation between bleeding volume of the brain and patient's age using cross-sectional approach. The 68 samples in this study were taken from secondary data from Head CT Scan of Haemorrhagic Stroke cases.  Brain bleeding volume is the dependent variable, obtained through slice thickness of 5 mm and ABC/2 method with software measurement in MSCT Scan device. The independent variable of this study is the patient's age. The result of the study was the average brain's bleeding volume of 21.76 ml ± 2.48 ml (range of 1.04 ml to 94.73 ml).The slice thickness using ABC/2 method, has a significant correlation with brain's bleeding volume in MSCT Scan examination, with correlation coefficient value r of 0.79. Brain bleeding volume in patients who have ages lower than 50 years and more or equal to 50 years were (18.93 ± 3.26) ml and (23.53 ± 3.47) ml respectively. There is no correlation between age and brain's bleeding volume in haemorrhagic stroke cases, with p value of 0.18, r = 0.19. PMID:26573030

  5. Angiogenesis in steno-occlusive vasculopathies as a common pathway for intracranial haemorrhage. A report of six cases.

    PubMed

    van den Berg, René; Rijssenbeek, Astrid L; Sprengers, Marieke E S; Bot, Joost C J; Majoie, Charles B L M; Roos, Yvo B W E M; Vandertop, William P

    2014-01-01

    Vasculopathies, including vasculitis of the central nervous system, can lead to stenosed, cicatrized vessels and the development of arterio-arteriolar collateral vessels. Bleeding due to these vascular changes, although rare, does occur. We describe six patients (all female, age range, 21-52 years; mean age, 42 years) with steno-occlusive lesions of intracranial vessels who presented with an acute intracranial haemorrhage. All had arterial steno-occlusive changes in conjunction with extensive leptomeningeal and arterio-arteriolar collaterals. Within the collaterals, focal dilatations could be identified, which were in close spatial relationship with the intracranial haemorrhage. Cause of bleeding was depicted on CT angiography in four out of six patients. One patient presented in childhood with acute stroke, one patient was diagnosed with Buerger's disease and one with sickle cell disease; the other three patients had no relevant history and the exact cause remained unclear. Outcome was favourable in all patients. Despite focal vascular weaknesses, no recurrent haemorrhage was seen during follow-up, supporting, at least in this small patient group, a conservative wait-and-see policy. PMID:24556309

  6. The Correlation Between Age and Bleeding Volume in Haemorrhagic Stroke Using Multi Slice CT at District Hospitals in Jakarta

    PubMed Central

    Saefudin, Tatan; Apriantoro, Nursama Heru; Hidayat, Ekaputra Syarif; Purnamawati, Schandra

    2016-01-01

    Haemorrhagic Stroke is a common disease in Indonesia. The best imaging modality for this disease is Multi Slice Computed Tomography Scanning (MSCT), as it may help strengthening the diagnosis as well as determining the brain bleeding volume. This study aimed to show correlation between bleeding volume of the brain and patient’s age using cross-sectional approach. The 68 samples in this study were taken from secondary data from Head CT Scan of Haemorrhagic Stroke cases. Brain bleeding volume is the dependent variable, obtained through slice thickness of 5 mm and ABC/2 method with software measurement in MSCT Scan device. The independent variable of this study is the patient’s age. The result of the study was the average brain’s bleeding volume of 21.76 ml ± 2.48 ml (range of 1.04 ml to 94.73 ml). The slice thickness using ABC/2 method, has a significant correlation with brain’s bleeding volume in MSCT Scan examination, with correlation coefficient value r of 0.79. Brain bleeding volume in patients who have ages lower than 50 years and more or equal to 50 years were (18.93 ± 3.26) ml and (23.53 ± 3.47) ml respectively. There is no correlation between age and brain’s bleeding volume in haemorrhagic stroke cases, with p value of 0.18, r = 0.19. PMID:26573030

  7. Dengue virus and antiplatelet autoantibodies synergistically induce haemorrhage through Nlrp3-inflammasome and FcγRIII.

    PubMed

    Lien, Te-Sheng; Sun, Der-Shan; Chang, Chia-Ming; Wu, Cheng-Yeu; Dai, Ming-Shen; Chan, Hao; Wu, Wen-Sheng; Su, Shu-Hui; Lin, You-Yen; Chang, Hsin-Hou

    2015-05-01

    Dengue haemorrhagic fever (DHF) typically occurs during secondary infections with dengue viruses (DENVs). Although it is generally accepted that antibody-dependent enhancement is the primary reason why patients with secondary infection are at an increased risk of developing DHF, a growing body of evidence shows that other mechanisms, such as the elicitation of antiplatelet autoantibodies by DENV nonstructural protein NS1, also play crucial roles in the pathogenesis of DHF. In this study, we developed a "two-hit" model of secondary DENV infection to examine the respective roles of DENV (first hit) and antiplatelet Igs (second hit) on the induction of haemorrhage. Mice were first exposed to DENV and then exposed to antiplatelet or anti-NS1 Igs 24 hours later. The two-hit treatment induced substantial haemorrhage, coagulopathy, and cytokine surge, and additional treatment with antagonists of TNF-α, IL-1, caspase-1, and FcγRIII ameliorated such effects. In addition, knockout mice lacking the Fcγ receptor III, Toll-like receptor 3, and inflammasome components Nlrp3 and caspase-1 exhibited considerably fewer pathological alterations than did wild type controls. These findings may provide new perspectives for developing feasible approaches to treat patients with DHF. PMID:25740324

  8. Bench-to-bedside review: Optimising emergency reversal of vitamin K antagonists in severe haemorrhage – from theory to practice

    PubMed Central

    Vigué, Bernard

    2009-01-01

    Critical care physicians are increasingly facing patients receiving oral anticoagulation for either cessation of major haemorrhage or to reverse the effects of vitamin K antagonists ahead of emergency surgery. Rapid reversal of anticoagulation is particularly essential in cases of life-threatening bleeding. In these situations, guidelines recommend the concomitant administration of prothrombin complex concentrates (PCCs) and oral or intravenous vitamin K for the fastest normalisation of the international normalised ratio (INR). Despite their universal recommendation, PCCs remain underused by many physicians who prefer to opt for fresh frozen plasma despite its limitations in anticoagulant reversal, including time to reverse INR and high risk of transfusion-related acute lung injury. In contrast, the lower volume required to normalise INR with PCCs and the room temperature storage facilitate faster preparation and administration time, thus increasing the speed at which haemorrhages can be treated. PCCs therefore allow faster, more reliable and complete reversal of vitamin K anticoagulation, especially when administered immediately following confirmation of haemorrhage. In the emergency setting, probabilistic dosing may be considered. PMID:19486503

  9. Individual patient data subgroup meta-analysis of surgery for Spontaneous Supratentorial Intracerebral Haemorrhage

    PubMed Central

    Gregson, Barbara A; Broderick, Joseph P; Auer, Ludwig M; Batjer, Hunt; Chen, Xian-Cheng; Juvela, Seppo; Morgenstern, Lewis B; Pantazis, George C; Teernstra, Onno PM; Wang, Wen-Zhi; Zuccarello, Mario; Mendelow, A David

    2012-01-01

    Background and purpose By 2010 there had been 14 published trials of surgery for intracerebral haemorrhage reported in systematic reviews or to the authors, but the role and timing of operative intervention remains controversial and the practice continues to be haphazard. This study attempted to obtain individual patient data from each of the 13 studies published since 1985 in order to better define groups of patients that might benefit from surgery. Methods Authors of identified published papers were approached by mail, email and at conferences and invited to take part in the study. Data were obtained from 8 studies (2186 cases). Individual patient data included patient's age, GCS at presentation, volume and site of haematoma, presence of IVH, method of evacuation, time to randomisation and outcome. Results Meta-analysis indicated that there was improved outcome with surgery if it was undertaken within 8 hours of ictus (p = 0.003), or the volume of the haematoma was 20-50ml. (p = 0.004), or the GCS was between 9 and 12 (p = 0.0009), or the patient was aged between 50 and 69 (p = 0.01). In addition there was some evidence that more superficial haematomas with no IVH might also benefit (p = 0.09). Conclusions There is evidence that surgery is of benefit if undertaken early before the patient deteriorates. This work identifies areas for further research. Ongoing studies in subgroups of patients, such as STICH II, will confirm whether these interpretations can be replicated. PMID:22511006

  10. Upper gastrointestinal haemorrhage in the acute cardiac care setting: antiplatelets and endoscopy.

    PubMed

    Musa, S A; Brecker, S J; Rahman, T M; Kang, J Y

    2012-05-01

    Upper gastrointestinal haemorrhage (UGIH) in cardiac patients receiving antiplatelets presents a difficult management problem. The aim of this study was to describe a series of cardiac inpatients receiving antiplatelets who underwent endoscopy for an acute UGIH. Cardiac inpatients receiving antiplatelets and requiring endoscopy for UGIH over an 18-month period were followed up. Forty-one patients were studied. Most patients (25 [61%]) presented with melaena. Antiplatelets were withheld in 34 (83%) patients; predominantly in those with higher pre-endoscopy Rockall scores (median, 4; interquartile range [IQR], 3-5 versus median, 3; IQR, 2-4; P < 0.05). Positive findings were identified at endoscopy in 80%. Duodenal ulcers were the most common lesion and adrenaline the most common method of haemostasis. Median time to first endoscopy was 0 (IQR, 0-1) days. Seven (17%) patients re-bled, median Rockall score was six (IQR, 4-8). Three (7%) patients experienced procedural complications, two patients became hypoxic and one patient died. Following endoscopy, antiplatelets were restarted after a median of three (IQR, 3-5) days. On discharge, 27/28 (96%) patients continued with antiplatelet and proton-pump inhibitor therapy. Thirty-day inpatient mortality was 7% (3 patients). One patient re-bled within six months of discharge. Endoscopy helped assess the risk of re-bleeding and timing of antiplatelet re-introduction in cardiac inpatients experiencing UGIH. PMID:22555229

  11. Slow improvement of clinically-diagnosed dengue haemorrhagic fever case fatality rates.

    PubMed

    Magpusao, Nelma S; Monteclar, Alan; Deen, Jacqueline L

    2003-07-01

    Dengue haemorrhagic fever (DHF) is recognized as a leading cause of hospitalization and death among children in many Southeast Asian countries. This study reviews the case fatality rates of DHF cases admitted to a referral hospital in Cebu (Philippines) over the past 5 years. Information on patients 14 years old or younger admitted from 1 January 1997 to 31 December 2001 with the final clinical diagnosis of DHF was collated and analysed. Case fatality rates were compared before and after a standardized management protocol was implemented by the healthcare staff and after introduction of revisions to that protocol. The case fatality rate during the 2-year periods prior and after introduction of the management protocol decreased significantly from 197/2644 (7.45%) to 39/1182 (3.30%) (P < 0.01). Following the introduction of revisions to the protocol, the case fatality was reduced even further to 52/1697 (3.06%) (P = 0.7). In this government hospital the introduction of a standardized management protocol for DHF was associated with a significant improvement in the case fatality rate of hospitalized children with clinically diagnosed DHF. However, compared with reports from hospitals in other dengue-endemic countries, the improvement has been slow. Possible ways to decrease fatality rates further have been identified. PMID:12870602

  12. Epidemiology of viral haemorrhagic disease and myxomatosis in a free-living population of wild rabbits.

    PubMed

    Calvete, C; Estrada, R; Villafuerte, R; Osácar, J J; Lucientes, J

    2002-06-22

    From January 1993 to June 1996, the epidemiology of myxomatosis and viral haemorrhagic disease (VHD) was studied in a free-living population of wild rabbits (Oryctolagus cuniculus) in Spain by means of serological surveys and radiotracking. Myxomatosis was endemic and associated with the breeding period. Its serological pattern was characterised by a 100 per cent prevalence of antibodies in adult rabbits and a rapid increase in antibodies in young rabbits in their first year. No mortality from myxomatosis was detected in adults, and mortality in young rabbits could not be estimated because of interference by predators and scavengers and the deaths of many radiotagged rabbits inside their burrows. VHD was also an endemic disease associated with the breeding period. Adults had a higher prevalence of antibodies against VHD than young rabbits, reaching values of 80 to 90 per cent. During the study, there was an increase in rabbit numbers as a result of a decrease in mortality from predation which was associated with an increase in mortality due to VHD and in the prevalence of antibodies to VHD. Mortality from VHD was lower in rabbits with VHD antibodies than in seronegative rabbits, but some mortality from the disease was also detected in seropositive rabbits. The annual mean mortality rate due to VHD in adult rabbits was estimated to be 21.8 per cent. PMID:12135072

  13. Coincidental cerebral venous thrombosis and subarachnoid haemorrhage related to ruptured anterior communicating artery aneurysm.

    PubMed

    Neubauer, Claudia; Baumgartner, Annette; Mader, Irina; Rijntjes, Michel; Meckel, Stephan

    2016-08-01

    Aneurysmal subarachnoid haemorrhage (SAH) and cerebral venous thrombosis (CVT) are rare cerebrovascular pathologies. Here, we report the extremely rare coincidental presentation of both entities and discuss the likely relationship in aetiology and their optimal management. A female patient presented with headache and progressive neurological deficits. Cranial computed tomography and contrast-enhanced magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) revealed dural venous sinus thrombosis, left-sided frontal and parietal infarcts, and left middle and anterior cerebral artery stenosis. In addition, left hemispheric subarachnoid haemosiderosis was seen on MRI. Following standard anticoagulation therapy for CVT, she represented with acute SAH. Digital subtraction angiography revealed a ruptured anterior communicating artery aneurysm and left middle cerebral artery/anterior cerebral artery vasospasms that were responsive to intra-arterial nimodipine. The latter were already present on the previous MRI, and had most likely prevented the detection of the aneurysm initially. The aneurysm was successfully coil embolised, and the patient improved clinically. Despite this case being an extremely rare coincidence, a ruptured aneurysm should be excluded in the presence of CVT and non-sulcal SAH. A careful consideration of treatment of both pathologies is required, since anticoagulation may have a potentially negative impact on aneurysmal bleeding. PMID:27188326

  14. Molecular epidemiology of Rabbit Haemorrhagic Disease Virus (RHDV) in Australia: when one became many

    PubMed Central

    Kovaliski, John; Sinclair, Ron; Mutze, Greg; Peacock, David; Strive, Tanja; Abrantes, Joana; Esteves, Pedro J.; Holmes, Edward C.

    2015-01-01

    Rabbit Haemorrhagic Disease Virus (RHDV) was introduced into Australia in 1995 as a biological control agent against the wild European rabbit (Oryctolagus cuniculus). We evaluated its evolution over a 16 year period (1995–2011) by examining 50 isolates collected throughout Australia, as well as the original inoculum strains. Phylogenetic analysis of capsid protein VP60 sequences of the Australian isolates, compared to those sampled globally, revealed that they form a monophyletic group with the inoculum strains (CAPM V-351 and RHDV351INOC). Strikingly, despite more than 3000 re-releases of RHDV351INOC since 1995, only a single viral lineage has sustained its transmission in the long-term, indicative of a major competitive advantage. In addition, we find evidence for widespread viral gene flow, in which multiple lineages entered individual geographic locations, resulting in a marked turnover of viral lineages with time, as well as a continual increase in viral genetic diversity. The rate of RHDV evolution recorded in Australia – 4.0 (3.3 – 4.7) × 10−3 nucleotide substitutions per site per year – was higher than previously observed in RHDV, and evidence for adaptive evolution was obtained at two VP60 residues. Finally, more intensive study of a single rabbit population (Turretfield) in South Australia provided no evidence for viral persistence between outbreaks, with genetic diversity instead generated by continual strain importation. PMID:24251353

  15. Pathology of human plaque vulnerability: mechanisms and consequences of intraplaque haemorrhages.

    PubMed

    Michel, Jean-Baptiste; Martin-Ventura, José Luis; Nicoletti, Antonino; Ho-Tin-Noé, Benoit

    2014-06-01

    Atherothrombotic diseases are still major causes of inability and mortality and fighting atherothrombosis remains a public health priority. The involvement of repeated intraplaque haemorrhages (IPH) in the evolution of atherothrombotic lesions towards complications was proposed as early as 1936. This important topic has been recently revisited and reviewed. Histological observations have been corroborated by magnetic resonance imaging (MRI) of human carotid atheroma, identifying IPH as the main determinant of plaque evolution towards rupture. Beside the intimal integration of asymptomatic luminal coagulum, inward sprouting of neovessels from the adventitia towards the plaque, is one source of IPH in human atheroma. We recently described that directed neo-angiogenesis from the adventitia towards the plaque, across the media, is initiated by lipid mediators generated by the plaque on the luminal side, outwardly convected to the medial VSMCs. Subsequent stimulation of VSMC PPAR-γ receptors induces VEGF expression which causes centripetal sprouting of adventitial vessels. However, this neovascularization is considered to be immature and highly susceptible to leakage. The main cellular components of IPH are Red Blood Cells (RBCs), which with their haemoglobin content and their cell membrane components, particularly enriched in unesterified cholesterol, participate in both the oxidative process and cholesterol accumulation. The presence of iron, glycophorin A and ceroids provides evidence of RBCs. IPH also convey blood leukocytes and platelets and are sites prone to weak pathogen contamination. Therefore prevention and treatment of the biological consequences of IPH pave the way to innovative preventive strategies and improved therapeutic options in human atherothrombotic diseases. PMID:24726899

  16. Recurrent non-aneurysmal subarachnoid haemorrhage in Takayasu arteritis: is the cause immunological or mechanical?

    PubMed Central

    Shuaib, Umar Ashfaq; Kate, Mahesh; Homik, Joanne; Jerrakathil, Thomas

    2013-01-01

    Aneurysmal subarachnoid haemorrhage (SAH) is rarely associated with Takayasu's arteritis (TA). The present report describes a 21-year-old woman with recurrent SAH and TA. In addition, she also had recurrent spells of postural weakness in the bilateral lower limb occurring at the same time. Sequential CT of the head and MRI showed bilateral cortical SAH. Vascular imaging with MR angiogram and CT angiogram showed bilateral subclavian arteries and left common carotid artery occlusion with multiple hypertrophied collaterals vessels in the neck. There was no evidence of aneurysms in the intracranial vasculature in the conventional angiogram. The CT angiogram of the aorta showed severe stenosis of the abdominal aorta above the renal arteries. The patient was treated with immunomodulatory therapy and had a favourable outcome without further recurrence at end of 1 year of follow-up. A review of the literature showed 21cases with aneurysmal SAH and three cases non-aneurysmal SAH in patients with TA have been reported. Various factors are responsible for the reorganisation of the intracranial of the arteries in patients with chronic vasculitis in the presence of extracranial stenosis and occlusion, which could possibly explain the SAH in absence of aneurysm in patients with TA. PMID:23771963

  17. Risk factors in the development of intraventricular haemorrhage in the preterm neonate.

    PubMed Central

    Levene, M I; Fawer, C L; Lamont, R F

    1982-01-01

    One hundred and forty-six infants of 34 weeks' gestation or less were repeatedly scanned by means of real-time ultrasound to diagnose the presence of intraventricular haemorrhage (IVH), its severity, and the timing of onset of the condition. We describe a new method for grading the extent of the IVH which does not depend on ventricular size. IVH was clearly present in 52 (36%) of the 146 infants and in 32 (50%) of the 64 infants of 30 weeks' gestation or less. Repeated scans accurately timed the onset of IVH in 41 infants, and 32 (78%) had the first sign of IVH before 72 hours of age. Thirty-two clinical factors were analysed for possible correlation with the development of IVH: outborn compared with inborn, administration of sodium bicarbonate, hypothermia, intermittent positive pressure ventilation, continuous positive airways pressure, hypercapnia, severe acidosis, and respiratory distress syndrome all reached statistical significance. Analysis of variance showed that respiratory distress syndrome was the most important factor, but severe acidosis had some independent action on the development of IVH. Seventeen (81%) of 21 infants with hypercapnia (PCO2 greater than 6 kPa) together with severe acidosis (pH less than 7.1) developed IVH, of which more than half was moderate or severe in degree. Images Fig. 1 PMID:7092304

  18. Risk factors associated with an outbreak of dengue fever/dengue haemorrhagic fever in Hanoi, Vietnam.

    PubMed

    Toan, D T T; Hoat, L N; Hu, W; Wright, P; Martens, P

    2015-06-01

    Dengue fever/dengue haemorrhagic fever (DF/DHF) appears to be emerging in Hanoi in recent years. A case-control study was performed to investigate risk factors for the development of DF/DHF in Hanoi. A total of 73 patients with DF/DHF and 73 control patients were included in the study. The risk factor analysis indicated that living in rented housing, living near uncovered sewers, and living in a house discharging sewage directly into to ponds were all significantly associated with DF/DHF. People living in rented houses were 2·2 times more at risk of DF/DHF than those living in their own homes [adjusted odds ratio (aOR) 2·2, 95% confidence interval (CI) 1·1-4·6]. People living in an unhygienic house, or in a house discharging sewage directly to the ponds were 3·4 times and 4·3 times, respectively, more likely to be associated with DF/DHF (aOR 3·4, 95% CI 1-11·7; aOR 4·3, 95% CI 1·1-16·9). These results contribute to the understanding of the dynamics of dengue transmission in Hanoi, which is needed to implement dengue prevention and control programmes effectively and efficiently. PMID:25308711

  19. Molecular epidemiology of Rabbit Haemorrhagic Disease Virus in Australia: when one became many.

    PubMed

    Kovaliski, John; Sinclair, Ron; Mutze, Greg; Peacock, David; Strive, Tanja; Abrantes, Joana; Esteves, Pedro J; Holmes, Edward C

    2014-02-01

    Rabbit Haemorrhagic Disease Virus (RHDV) was introduced into Australia in 1995 as a biological control agent against the wild European rabbit (Oryctolagus cuniculus). We evaluated its evolution over a 16-year period (1995-2011) by examining 50 isolates collected throughout Australia, as well as the original inoculum strains. Phylogenetic analysis of capsid protein VP60 sequences of the Australian isolates, compared with those sampled globally, revealed that they form a monophyletic group with the inoculum strains (CAPM V-351 and RHDV351INOC). Strikingly, despite more than 3000 rereleases of RHDV351INOC since 1995, only a single viral lineage has sustained its transmission in the long-term, indicative of a major competitive advantage. In addition, we find evidence for widespread viral gene flow, in which multiple lineages entered individual geographic locations, resulting in a marked turnover of viral lineages with time, as well as a continual increase in viral genetic diversity. The rate of RHDV evolution recorded in Australia -4.0 (3.3-4.7) × 10(-3) nucleotide substitutions per site per year - was higher than previously observed in RHDV, and evidence for adaptive evolution was obtained at two VP60 residues. Finally, more intensive study of a single rabbit population (Turretfield) in South Australia provided no evidence for viral persistence between outbreaks, with genetic diversity instead generated by continual strain importation. PMID:24251353

  20. Travelling waves in the occurrence of dengue haemorrhagic fever in Thailand

    NASA Astrophysics Data System (ADS)

    Cummings, Derek A. T.; Irizarry, Rafael A.; Huang, Norden E.; Endy, Timothy P.; Nisalak, Ananda; Ungchusak, Kumnuan; Burke, Donald S.

    2004-01-01

    Dengue fever is a mosquito-borne virus that infects 50-100 million people each year. Of these infections, 200,000-500,000 occur as the severe, life-threatening form of the disease, dengue haemorrhagic fever (DHF). Large, unanticipated epidemics of DHF often overwhelm health systems. An understanding of the spatial-temporal pattern of DHF incidence would aid the allocation of resources to combat these epidemics. Here we examine the spatial-temporal dynamics of DHF incidence in a data set describing 850,000 infections occurring in 72 provinces of Thailand during the period 1983 to 1997. We use the method of empirical mode decomposition to show the existence of a spatial-temporal travelling wave in the incidence of DHF. We observe this wave in a three-year periodic component of variance, which is thought to reflect host-pathogen population dynamics. The wave emanates from Bangkok, the largest city in Thailand, moving radially at a speed of 148km per month. This finding provides an important starting point for detecting and characterizing the key processes that contribute to the spatial-temporal dynamics of DHF in Thailand.

  1. Environmental correlates of crimean-congo haemorrhagic fever incidence in Bulgaria

    PubMed Central

    2012-01-01

    Background Crimean-Congo Haemorrhagic Fever (CCHF) is a zoonotic viral disease transmitted by ixodid tick bites, mainly of Hyalomma spp., or through contact with blood/tissues from infected people or animals. CCHF is endemic in the Balkan area, including Bulgaria, where it causes both sporadic cases and community outbreaks. Methods We described trends of CCHF in Bulgaria between 1997 and 2009 and investigated the associations between CCHF incidence and a selection of environmental factors using a zero-inflated modelling approach. Results A total of 159 CCHF cases (38 women and 121 men) were identified between 1997 and 2009. The incidence was 0.13 cases per 100,000 population/year with a fatality rate of 26%. An epidemic peak was detected close to the Turkish border in the summer of 2002. Most cases were reported between April and September. Increasing mean temperature, Normalized Difference Vegetation Index (NDVI), savannah-type land coverage or habitat fragmentation increased significantly the incidence of CCHF in the CCHF-affected areas. Similar to that observed in Turkey, we found that areas with warmer temperatures in the autumn prior to the case-reporting year had an increased probability of reporting zero CCHF cases. Conclusions We identified environmental correlates of CCHF incidence in Bulgaria that may support the prospective implementation of public health interventions. PMID:23270399

  2. Mid-facial deformity secondary to a traumatic haemorrhage in a maxillary cyst

    PubMed Central

    Adachi, Masatoshi; Miyata, Yusuke; Ito, Yuki

    2016-01-01

    Serious symptoms caused by intra-cystic bleeding are very rare. We describe a case of a maxillary cyst presenting with mid-facial deformity in a Japanese woman. She underwent bilateral Caldwell–Luc procedure 21 years earlier and suffered left cheek trauma 4 years earlier. She presented soon after the trauma complaining of left mid-facial deformity, and computed tomography showed a trilocular cystic lesion in the left maxilla. We performed facial osteotomy concurrent with cyst enucleation with lateral rhinotomy. Serosanguineous fluid filled the cyst cavity just below the face; however, additional cyst cavities contained straw-coloured fluid. She showed no signs of recurrence at the end of a 20-month follow-up, and her postoperative appearance was excellent. Histopathological examination showed that all cyst walls were lined by ciliated columnar epithelium, which was consistent with surgical ciliated cyst. We consider that the increased intra-cystic pressure caused by traumatic haemorrhage induced expansion of the pre-existing surgical ciliated cyst. PMID:26865702

  3. Plant-produced Crimean-Congo haemorrhagic fever virus nucleoprotein for use in indirect ELISA.

    PubMed

    Atkinson, Richard; Burt, Felicity; Rybicki, Edward P; Meyers, Ann E

    2016-10-01

    Crimean-Congo haemorrhagic fever (CCHF) is a disease of serious public concern caused by the CCHF virus (CCHFV). Anti-CCHFV IgG in humans can be detected using ELISA with native antigen prepared from cell cultures which have been infected with virus or from brain tissue of suckling mice which have been inoculated with virus. However, the preparation of these reagents requires high biosafety levels and is expensive. A safer, more cost-effective recombinantly-produced NP reagent is desirable. Recently, plants have been shown to be a cost-effective and safe system for expression of recombinant proteins. This work describes cloning of the CCHFV NP gene into three different plant expression systems and comparison of expression in Nicotiana benthamiana. The highest expressing construct was selected. Expressed NP was purified by ammonium sulphate fractionation prior to histidine affinity chromatography. Purified NP was tested in an indirect ELISA to determine if the recombinant antigen was able to detect anti-CCHFV IgG in sera from convalescent patients. Plant-produced NP detected IgG antibodies against CCHFV in 13/13 serum samples from convalescent patients and 0/13 samples collected from volunteers with no history of CCHFV infection. Results were compared with commercially available immunofluorescent assays and 100% concordance was obtained between the two assays. This suggests that a full evaluation of the plant produced NP for application as a safe recombinant is warranted. PMID:27474493

  4. Polymorphisms of apolipoprotein E and aneurysmal subarachnoid haemorrhage: A meta-analysis.

    PubMed

    Arati, S; Sibin, M K; Bhat, Dhananjaya I; Narasingarao, K V L; Chetan, G K

    2016-09-01

    Subarachnoid haemorrhage (SAH) is characterised by bleeding in the subarachnoid space in the brain. There are various polymorphisms in genes which are associated with this disease. We performed a systematic meta- analysis to investigate the relationship of APOE polymorphism on aSAH. A comprehensive literature search was done in the Pubmed database, Science Direct, Cochrane library and Google Scholar. The OR and 95% CI were evaluated for the gene and aSAH association using fixed and random effect models. Publication bias was assessed using Begg's funnel plot and Egger's regression test. All statistical evaluations were done using the software Review Manager 5.0 and Comprehensive Meta Analysis v2.2.023. A total of 9 studies were assessed on APOE polymorphism (1100 Cases, 2732 Control). Meta analysis results showed significant association in ε2/ ε2 versus ε3/ε3, ε2 versus ε3 genetic models and ε2 allele frequency. In subgroup analysis statistically significant association was observed in Asians in the genetic models ε2/ ε2 versus ε3/ε3, ε2/ε3 versus ε3/ε3, ε2 versus ε3 and also in ε2 allele frequency. However, in Caucasian population only ε2/ε2 versus ε3/ε3 genetic model showed significant association between APOE and risk of aSAH. In this meta-analysis study, the ε2/ε2 genotype is associated with increased risk of aSAH. PMID:27408823

  5. Intra-operative correction of acidosis, coagulopathy and hypothermia in combat casualties with severe haemorrhagic shock.

    PubMed

    Morrison, J J; Ross, J D; Poon, H; Midwinter, M J; Jansen, J O

    2013-08-01

    We assessed acidosis, coagulopathy and hypothermia, before and after surgery in 51 combat troops operated on for severe blast injury. Patients were transfused a median (IQR [range]) of 27 (17-38 [5-84]) units of red cell concentrate, 27 (16-38 [4-83]) units of plasma, 2.0 (0.5-3.5 [0-13.0]) units of cryoprecipitate and 4 (2-6 [0-17]) pools of platelets. The pH, base excess, prothrombin time and temperature increased: from 7.19 (7.10-7.29 [6.50-7.49]) to 7.45 (7.40-7.51 [7.15-7.62]); from -9.0 (-13.5 to -4.5 [-28 to -2]) mmol.l⁻¹ to 4.5 (1.0-8.0 [-7 to +11]) mmol.l⁻¹; from 18 (15-21 [9-24]) s to 14 (11-18 [9-21]) s; and from 36.1 (35.1-37.1 [33.0-38.1]) °C to 37.4 (37.0-37.9 [36.0-38.0]) °C, respectively. Contemporary intra-operative resuscitation strategies can normalise the physiological derangements caused by haemorrhagic shock. PMID:23724784

  6. Molecular evolution of American field strains of bluetongue and epizootic haemorrhagic disease viruses.

    PubMed

    Wilson, William C; Gaudreault, Natasha N; Jasperson, Dane C; Johnson, Donna J; Ostlund, Eileen N; Chase, Christopher L; Ruder, Mark G; Stallknecht, David E

    2015-01-01

    Recent Orbivirus occurrences in the Americas have been investigated using whole genome amplification and sequencing followed by phylogenetic analysis. The bluetongue virus (BTV) and epizootic haemorrhagic disease virus (EHDV) whole genomes were amplified without prior sequence knowledge and deep sequenced. This technology was applied to evaluate BTV‑3 isolates spanning 4 decades from Florida, Arkansas, Mississippi, South Dakota, Central America, and the Caribbean basin. The results of the dataset analysis are consistent with the hypothesis that these viruses were introduced into the United States from Central America and the Caribbean basin. A similar analysis has been performed on a recent BTV‑2 isolate from California. It indicates that the BTV‑2 strain was likely introduced into Florida and then moved South to the Caribbean and West to California. A historical (1955‑2012) molecular characterisation of EHDV strains was also completed, and subsequently used as reference sequence for comparison of genomes from recent 2012 cattle isolates associated with clinical disease. Finally, this analysis was performed on BTV‑11 isolated from 2 canine cases and demonstrated that the genome sequences of the virus isolates from these cases were almost identical. These studies indicate the value of this technology in understanding virus epidemiology and ecology. PMID:26741243

  7. Follow-up of pulmonary right-to-left shunt in hereditary haemorrhagic telangiectasia.

    PubMed

    Vorselaars, Veronique M M; Velthuis, Sebastiaan; Snijder, Repke J; Westermann, Cornelis J J; Vos, Jan A; Mager, Johannes J; Post, Martijn C

    2016-06-01

    Pulmonary arteriovenous malformations (PAVMs) are associated with severe neurological complications in hereditary haemorrhagic telangiectasia (HHT). Transthoracic contrast echocardiography (TTCE) is recommended for screening of pulmonary right-to-left shunts (RLS). Although growth of PAVMs is shown in two small studies, no studies on follow-up with TTCE exist.All HHT patients underwent a second TTCE 5 years after initial screening. Patients with a history of PAVM embolisation were excluded. Pulmonary RLS grade on TTCE after 5 years was compared to the grade at screening.200 patients (53.5% female, mean±sd age at screening 44.7±14.1 years) were included. Increase in RLS grade occurred in 36 (18%) patients, of whom six (17%) underwent embolisation. The change in grade between screening and follow-up was not more than one grade. Of patients with nontreatable pulmonary RLS at screening (n=113), 14 (12.4%) underwent embolisation. In patients without pulmonary RLS at initial screening (n=87), no treatable PAVMs developed during follow-up.Within 5 years, no treatable PAVMs developed in HHT patients without pulmonary RLS at initial screening. Increase in pulmonary RLS grade occurred in 18% of patients, and never increased by more than one grade. Of patients with nontreatable pulmonary RLS at initial screening, 12% underwent embolisation. PMID:26965291

  8. A single subcutaneous bolus of erythropoietin normalizes cerebral blood flow autoregulation after subarachnoid haemorrhage in rats

    PubMed Central

    Springborg, Jacob Bertram; Ma, XiaoDong; Rochat, Per; Knudsen, Gitte Moos; Amtorp, Ole; Paulson, Olaf B; Juhler, Marianne; Olsen, Niels Vidiendal

    2002-01-01

    Systemic administration of recombinant erythropoietin (EPO) has been demonstrated to mediate neuroprotection. This effect of EPO may in part rely on a beneficial effect on cerebrovascular dysfunction leading to ischaemic neuronal damage. We investigated the in vivo effects of subcutaneously administered recombinant EPO on impaired cerebral blood flow (CBF) autoregulation after experimental subarachnoid haemorrhage (SAH).Four groups of male Sprague-Dawley rats were studied: group A, sham operation plus vehicle; group B, sham operation plus EPO; group C, SAH plus vehicle; group D, SAH plus EPO. SAH was induced by injection of 0.07 ml of autologous blood into the cisterna magna. EPO (400 iu kg−1 s.c.) or vehicle was given immediately after the subarachnoid injection of blood or saline. Forty-eight hours after the induction of SAH, CBF autoregulatory function was evaluated using the intracarotid 133Xe method.CBF autoregulation was preserved in both sham-operated groups (lower limits of mean arterial blood pressure: 91±3 and 98±3 mmHg in groups A and B, respectively). In the vehicle treated SAH-group, autoregulation was abolished and the relationship between CBF and blood pressure was best described by a single linear regression line. A subcutaneous injection of EPO given immediately after the induction of SAH normalized autoregulation of CBF (lower limit in group D: 93±4 mmHg, NS compared with groups A and B).Early activation of endothelial EPO receptors may represent a potential therapeutic strategy in the treatment of cerebrovascular perturbations after SAH. PMID:11834631

  9. [Multiple Ebola virus haemorrhagic fever outbreaks in Gabon, from October 2001 to April 2002].

    PubMed

    Nkoghe, D; Formenty, P; Leroy, E M; Nnegue, S; Edou, S Y Obame; Ba, J Iba; Allarangar, Y; Cabore, J; Bachy, C; Andraghetti, R; de Benoist, A C; Galanis, E; Rose, A; Bausch, D; Reynolds, M; Rollin, P; Choueibou, C; Shongo, R; Gergonne, B; Koné, L M; Yada, A; Roth, C; Mve, M Toung

    2005-09-01

    Outbreaks of Ebola virus haemorrhagic fever have been reported from 1994 to 1996 in the province of Ogooué Ivindo, a forest zone situated in the Northeast of Gabon. Each time, the great primates had been identified as the initial source of human infection. End of November 2001 a new alert came from this province, rapidly confirmed as a EVHV outbreak. The response was given by the Ministry of Health with the help of an international team under the aegis of WHO. An active monitoring system was implemented in the three districts hit by the epidemic (Zadié, Ivindo and Mpassa) to organize the detection of cases and their follow-up. A case definition has been set up, the suspected cases were isolated at hospital, at home or in lazarets and serological tests were performed. These tests consisted of the detection of antigen or specific IgG and the RT-PCR. A classification of cases was made according to the results of biological tests, clinical and epidemiological data. The contact subjects were kept watch over for 21 days. 65 cases were recorded among which 53 deaths. The first human case, a hunter died on the 28th of October 2001. The epidemic spreads over through family transmission and nosocomial contamination. Four distinct primary foci have been identified together with an isolated case situated in the South East of Gabon, 580 km away from the epicenter. Deaths happened within a delay of 6 days. The last death has been recorded on the 22nd of March 2002 and the end of the outbreak was declared on the 6th of May 2002. The epidemic spreads over the Gabon just next. Unexplained deaths of animals had been mentionned in the nearby forests as soon as August 2001: great primates and cephalophus. Samples taken from their carcasses confirmed a concomitant animal epidemic. PMID:16267965

  10. Dengue haemorrhagic fever — a public health problem and a field for research*

    PubMed Central

    Halstead, S. B.

    1980-01-01

    Dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS) is an enigmatic and growing public health problem which is confined at present to countries of South-East Asia. Since 1956, over 350 000 patients have been hospitalized and nearly 12 000 deaths have been reported. Dengue viruses, a group of four flaviviruses, are transmitted to man by Aedes aegypti. Currently, dengue viruses are actively transmitted in 61 countries which circle the globe in the tropical zone and have a combined population of 1500 million. Because the precise antecedents to DHF/DSS are unknown, the public health hazard posed by this syndrome is potentially worldwide. Epidemiological studies in South-East Asia clearly link DHF/DSS to individuals who have had a previous dengue infection or who have acquired maternal dengue antibody. Such antibody may serve as an opsonin, enhancing dengue virus infection of mononuclear phagocytes—the type of cell in man to which dengue infection may be confined. Antibody-mediated infection of these cells is the central concept in the hypothesis of immune infection enhancement. This hypothesis provides a conceptual framework for design of future research. There is an urgent need for a comprehensive identification of ”risk factors” in DHF/DSS. This research could be approached by undertaking comparative prospective epidemiological studies in dengue-endemic areas with and without DHF/DSS. Although important progress is being made in the development of attenuated dengue vaccines for each dengue type, a clearer understanding of the pathogenesis of DHF/DSS may be required to provide guidelines for safe and lasting immunoprophylaxis in man. PMID:6966540

  11. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends

    PubMed Central

    de Rooij, N K; Linn, F H H; van der Plas, J A; Algra, A; Rinkel, G J E

    2007-01-01

    Background and aim To update our 1996 review on the incidence of subarachnoid haemorrhage (SAH) and assess the relation of incidence with region, age, gender and time period. Methods We searched for studies on the incidence of SAH published until October 2005. The overall incidences with corresponding 95% confidence intervals were calculated. We determined the relationship between the incidence of SAH and determinants by means of univariate Poisson regression. Results We included 51 studies (33 new), describing 58 study populations in 21 countries, observing 45 821 896 person‐years. Incidences per 100 000 person‐years were 22.7 (95% CI 21.9 to 23.5) in Japan, 19.7 (18.1 to 21.3) in Finland, 4.2 (3.1 to 5.7) in South and Central America, and 9.1 (8.8 to 9.5) in the other regions. With age category 45–55 years as the reference, incidence ratios increased from 0.10 (0.08 to 0.14) for age groups younger than 25 years to 1.61 (1.24 to 2.07) for age groups older than 85 years. The incidence in women was 1.24 (1.09 to 1.42) times higher than in men; this gender difference started at age 55 years and increased thereafter. Between 1950 and 2005, the incidence decreased by 0.6% (1.3% decrease to 0.1% increase) per year. Conclusions The overall incidence of SAH is approximately 9 per 100 000 person‐years. Rates are higher in Japan and Finland and increase with age. The preponderance of women starts only in the sixth decade. The decline in incidence of SAH over the past 45 years is relatively moderate compared with that for stroke in general. PMID:17470467

  12. Bazedoxifene, a new orphan drug for the treatment of bleeding in hereditary haemorrhagic telangiectasia.

    PubMed

    Zarrabeitia, Roberto; Ojeda-Fernandez, Luisa; Recio, Lucia; Bernabéu, Carmelo; Parra, Jose A; Albiñana, Virginia; Botella, Luisa M

    2016-06-01

    Hereditary haemorrhagic telangiectasia (HHT), or Rendu-Osler-Weber syndrome, is a dominant genetic vascular disorder. In HHT, blood vessels are weak and prone to bleeding, leading to epistaxis and anaemia, severely affecting patients' quality of life. Development of vascular malformations in HHT patients is originated mainly by mutations in ACVRL1/ALK1 (activin receptor-like kinase type I) or Endoglin (ENG) genes. These genes encode proteins of the TGF-β signalling pathway in endothelial cells, controlling angiogenesis. Haploinsufficiency of these proteins is the basis of HHT pathogenicity. It was our objective to study the efficiency of Bazedoxifene, a selective estrogen receptor modulator (SERM) in HHT, looking for a decrease in epistaxis, and understanding the underlying molecular mechanism. Plasma samples of five HHT patients were collected before, and after 1 and 3 months of Bazedoxifene treatment. ENG and ALK1 expression in activated mononuclear cells derived from blood, as well as VEGF plasma levels, were measured. Quantification of Endoglin and ALK1 mRNA was done in endothelial cells derived from HHT and healthy donors, after in vitro treatment with Bazedoxifene. Angiogenesis was also measured by tubulogenesis and wound healing assays. Upon Bazedoxifene treatment, haemoglobin levels of HHT patients increased and the quantity and frequency of epistaxis decreased. Bazedoxifene increased Endoglin and ALK1 mRNA levels, in cells derived from blood samples and in cultured endothelial cells, promoting tube formation. In conclusion, Bazedoxifene seems to decrease bleeding in HHT by partial compensation of haploinsufficiency. The results shown here are the basis of a new orphan drug designation for HHT by the European Medicine Agency (EMA). PMID:26818701

  13. Does Preendoscopy Rockall Score Safely Identify Low Risk Patients following Upper Gastrointestinal Haemorrhage?

    PubMed Central

    Johnston, Matthew R.; Murray, Iain A.; Schultz, Michael; McLeod, Peter; O'Donnell, Nathan; Norton, Heather; Baines, Chelsea; Fawcett, Emily; Fesaitu, Terry; Leung, Hin; Park, Jeong-Yoon; Salleh, Adibah; Zhang, Wei; García, José A.

    2015-01-01

    Objective. To determine if preendoscopy Rockall score (PERS) enables safe outpatient management of New Zealanders with upper gastrointestinal haemorrhage (UGIH). Methods. Retrospective analysis of adults with UGIH over 59 consecutive months. PERS, diagnosis, demographics, need for endoscopic therapy, transfusion or surgery and 30-day mortality and 14-day rebleeding rate, and sensitivity and specificity of PERS for enabling safe discharge preendoscopy were calculated. Results. 424 admissions with UGIH. Median age was 74.3 years (range 19–93 years), with 55.1% being males. 30-day mortality was 4.6% and 14-day rebleeding rate was 6.0%. Intervention was required in 181 (46.6%): blood transfusion (147 : 37.9%), endoscopic intervention (75 : 19.3%), and surgery (8 : 2.1%). 42 (10.8%) had PERS = 0 with intervention required in 15 (35.7%). Females more frequently required intervention, OR 1.73 (CI: 1.12–2.69). PERS did not predict intervention but did predict 30-day mortality: each point increase equated to an increase in mortality of OR 1.46 (CI: 1.11–1.92). Taking NSAIDs/aspirin reduced 30-day mortality, OR 0.22 (CI: 0.08–0.60). Conclusion. PERS identifies 10.8% of those with UGIH as low risk but 35.7% required intervention or died. It has a limited role in assessing these patients and should not be used to identify those suitable for outpatient endoscopy. PMID:26089867

  14. Chemical- and radiation-induced haemorrhagic cystitis: current treatments and challenges.

    PubMed

    Payne, Heather; Adamson, Andrew; Bahl, Amit; Borwell, Jonathan; Dodds, David; Heath, Catherine; Huddart, Robert; McMenemin, Rhona; Patel, Prashant; Peters, John L; Thompson, Andrew

    2013-11-01

    • To review the published data on predisposing risk factors for cancer treatment-induced haemorrhagic cystitis (HC) and the evidence for the different preventive and therapeutic measures that have been used in order to help clinicians optimally define and manage this potentially serious condition. • Despite recognition that HC can be a significant complication of cancer treatment, there is currently a lack of UK-led guidelines available on how it should optimally be defined and managed. • A systematic literature review was undertaken to evaluate the evidence for preventative measures and treatment options in the management of cancer treatment-induced HC. • There is a wide range of reported incidence due to several factors including variability in study design and quality, the type of causal agent, the grading of bleeding, and discrepancies in definition criteria. • The most frequently reported causal factors are radiotherapy to the pelvic area, where HC has been reported in up to 20% of patients, and treatment with cyclophosphamide and bacillus Calmette-Guérin, where the incidence has been reported as up to 30%. • Mesna (2-mercaptoethane sodium sulphonate), hyperhydration and bladder irrigation have been the most frequently used prophylactic measures to prevent treatment-related cystitis, but are not always effective. • Cranberry juice is widely cited as a preventative measure and sodium pentosanpolysulphate as a treatment, although the evidence for both is very limited. • The best evidence exists for intravesical hyaluronic acid as an effective preventative and active treatment, and for hyperbaric oxygen as an equally effective treatment option. • The lack of robust data and variability in treatment strategies used highlights the need for further research, as well as best practice guidance and consensus on the management of HC. PMID:24000900

  15. Current management of intracerebral haemorrhage in China: a national, multi-centre, hospital register study

    PubMed Central

    2011-01-01

    Background We aimed to examine current practice of the management and secondary prevention of intracerebral haemorrhage (ICH) in China where the disease is more common than in Western populations. Methods Data on baseline characteristics, management in-hospital and post-stroke, and outcome of ICH patients are from the ChinaQUEST (QUality Evaluation of Stroke Care and Treatment) study, a multi-centre, prospective, 62 hospital registry in China during 2006-07. Results Nearly all ICH patients (n = 1572) received an intravenous haemodiluting agent such as mannitol (96%) or a neuroprotectant (72%), and there was high use of intravenous traditional Chinese medicine (TCM) (42%). Neurosurgery was undertaken in 137 (9%) patients; being overweight, having a low Glasgow Coma Scale (GCS) score on admission, and Total Anterior Circulation Syndrome (TACS) clinical pattern on admission, were the only baseline factors associated with this intervention in multivariate analyses. Neurosurgery was associated with nearly three times higher risk of death/disability at 3 months post-stroke (odd ratio [OR] 2.60, p < 0.001). Continuation of antihypertensives in-hospital and at 3 and 12 months post-stroke was reported in 732/935 (78%), 775/935 (83%), and 752/935 (80%) living patients with hypertension, respectively. Conclusions The management of ICH in China is characterised by high rates of use of intravenous haemodiluting agents, neuroprotectants, and TCM, and of antihypertensives for secondary prevention. The controversial efficacy of these therapies, coupled with the current lack of treatments of proven benefit, is a call for action for more outcomes based research in ICH. PMID:21276264

  16. Intraventricular haemorrhage and the renin-angiotensin-aldosterone system in very low birthweight infants.

    PubMed

    Leslie, G I; Philips, J B; Cassady, G

    1989-11-01

    Blood volume, plasma renin activity (PRA) and urine aldosterone excretion (UAE) were measured in ten very low birthweight infants who had a Grade 3 or 4 intraventricular haemorrhage (IVH) during the first 2 days after birth. Mean (range) birthweight was 950 (630-1500) g and gestational age was 27 (23-31) weeks. Nine infants were receiving assisted ventilation and one was breathing spontaneously. Eight IVH occurred on the first postnatal day and two on the second; seven were symptomatic and three asymptomatic. PRA was significantly higher than control values on Day 1 only; median 244 (range 91-654) ng/ml per h vs. 64 (4-259) ng/ml per h (P less than 0.01). Infants with symptomatic IVH in the preceding 8 h (n = 6) all had PRA greater than 300 ng/ml per h; none of these infants had received transfusions or volume expansion between IVH and PRA measurement. PRA was less than 100 ng/ml per h in the three infants with asymptomatic IVH and one infant with greater than 24 h interval between IVH and PRA measurement; three of these four had received transfusions prior to PRA measurement. UAE was not significantly different from control values on either Day 1 or Day 2. Blood volume at 22 +/- 3 h postnatal age ranged from 75 to 107 ml/kg. There was an inverse logarithmic correlation between PRA and blood volume (r = 0.883; P less than 0.005), with PRA values exceeding 300 ng/ml per h when blood volume was less than 90 ml/kg. UAE did not correlate with either PRA or blood volume.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2591335

  17. [Acute therapeutic measures for limb salvage Part 1 : Haemorrhage control, emergency revascularization, compartment syndrome].

    PubMed

    Willy, C; Stichling, M; Engelhardt, M; Vogt, D; Back, D A

    2016-05-01

    The primary care of Gustilo-Anderson type IIIC extremity injuries with relevant vessel lacerations is decisive for the success of a limb salvage procedure. This article shall present substantial emergency procedures for the salvage of the nutritive perfusion of a mangled extremity, based on the current literature. After provisory control of a peripheral haemorrhage (e. g. by manual pressure or tourniquet), an immediate decision must be made about the kind of emergency revascularization to be implemented as the limb salvage procedure. Here, the temporary intravascular shunt will be the fastest technique that can ensure a sufficient tissue perfusion in the case of vessel lacerations. Regarding the treatment of a fracture versus perfusion recovery, a shortening of ischemia time should have priority over fracture stabilization.If an acute compartment syndrome is suspected, a documented monitoring has to be performed in the limb salvage situation for 24 hours with clinical controls every 4 hours. Disproportional pain that does not respond to analgesics, and passive muscle stretching pain can be seen as cardinal symptoms. The positive predictive value of clinical findings is <15 %. During the observation period with an impending but not manifest compartment syndrome, an elevation of the extremity above heart level or its cooling are contraindicated. An intracompartmental pressure measurement is the most important instrument-based supplemental diagnostic method. The open fasciotomy of the affected compartments is the only causal therapy and should be performed as fast as possible. A decision against fasciotomy in cases of non-explicit clinical signs should not be made without a documented intracompartmental pressure measurement. PMID:27160729

  18. The effect of the results of the STICH trial on the management of spontaneous supratentorial intracerebral haemorrhage in Newcastle.

    PubMed

    Kirkman, M A; Mahattanakul, W; Gregson, B A; Mendelow, A D

    2008-12-01

    Recently, the Surgical Trial in IntraCerebral Haemorrhage (STICH) was unable to show an overall benefit from 'early surgery' compared with a policy of 'initial conservative treatment'. Here, we evaluated the impact of the STICH results on the management of spontaneous supratentorial intracerebral haemorrhage (ICH) in the Newcastle upon Tyne Hospitals. The STICH results were released to the Neurosurgery Department at Newcastle General Hospital in November 2003; using ICD-10 data, we analysed ICH admissions before (2002) and after (2004, 2006, 2007) this. We assessed numbers of Neurosurgery and Stroke Unit admissions, numbers of clot evacuation procedures, and 30-day mortality rate (Neurosurgery vs. Stroke Unit admissions). Subarachnoid haemorrhage (SAH) admissions data were also collected to corroborate our findings. There were 478 spontaneous supratentorial ICH admissions in total; 156 in 2002, 120 in 2004, 106 in 2006 and 96 in 2007. SAH admissions remained remarkably constant over this period. Neurosurgery admissions decreased significantly across the four time periods, from 71% of total ICH admissions (n = 156) in 2002 to 55% (n = 96) in 2007, and Stroke Unit admissions increased significantly from 8% (n = 156) in 2002 to 30% (n = 96) in 2007 (chi(2) = 20.968, p < 0.001, df = 3). Clot evacuation procedures also decreased significantly from 32% (n = 111) of Neurosurgery admissions in 2002 to 17% (n = 53) in 2007 (chi(2) = 11.919, p = 0.008, df = 3). 30-day mortality increased in Neurosurgery from 14% of Neurosurgery admissions (n = 111) in 2002 to 26% (n = 53) in 2007, and decreased in the Stroke Unit, from 42% of Stroke Unit admissions (n = 12) in 2002 to 17% (n = 29) in 2007. The STICH results have significantly impacted ICH management in Newcastle, with a trend towards fewer Neurosurgery admissions and clot evacuations, and increased Stroke Unit admissions. The role of surgery for ICH remains controversial, and randomization continues in STICH II for patients

  19. Bone marrow depletion with haemorrhagic diathesis in calves in Germany: characterization of the disease and preliminary investigations on its aetiology.

    PubMed

    Kappe, Eva C; Halami, Mohammad Yahya; Schade, Benjamin; Alex, Michaela; Hoffmann, Doris; Gangl, Armin; Meyer, Karsten; Dekant, Wolfgang; Schwarz, Bernd-Andreas; Johne, Reimar; Buitkamp, Johannes; Böttcher, Jens; Müller, Hermann

    2010-01-01

    Since 2007 a new fatal haemorrhagic diathesis in calves has been observed in all areas of Germany. Analysis of 56 cases submitted for necropsy allowed its characterization. Calves fell ill within the first month of life independent of breed and sex. Only single or a few animals per herd were affected. Petechial and ecchymotic haemorrhages in many organs and tissues, particularly in skin, subcutis and gastrointestinal tract, were major findings in all animals. Microscopically a severe depletion of bone marrow cells was always observed. Lymphocytic depletion (43%) and inflammatory lesions (46%) were less frequently observed. Blood analysis of five animals indicated an aplastic pancytopenia. The resulting thrombocytopenia is regarded as major pathomechanism of this Haemorrhagic Disease Syndrome (HDS). Pedigree analysis gave no indication of hereditary disease. Tests for specific toxins such as S-(1,2-Dichlorovinyl)-L-cysteine (DCVC), furazolidone, or mycotoxins resulting in bone marrow depletion were negative. Bacterial infections, Bovine Viral Diarrhoea Virus, and Bluetongue Virus were ruled out as cause of the disease. HDS shares similarities with a circoviral infection in chickens (chicken infectious anaemia). A broad-spectrum PCR allowed detection of circoviral DNA in 5 of 25 HDS cases and in 1 of 8 non-HDS cases submitted for necropsy. Sequencing of the whole viral genome revealed a high similarity (up to 99%) with Porcine Circovirus type 2b. Single bone marrow cells stained weakly positive for PCV2 antigen by immunohistochemistry in 1 of 8 tested HDS animals. This is the first report of circovirus detection in cattle in Germany. The exact cause of HDS still remains unknown. A multifactorial aetiology involving infection, poisoning, immunopathy, or a genetic predisposition is conceivable. Additional research is necessary to clarify the pathogenesis and the potential role of PCV2 in HDS. PMID:20135908

  20. Snakebites and ethnobotany in the northwest region of Colombia. Part III: neutralization of the haemorrhagic effect of Bothrops atrox venom.

    PubMed

    Otero, R; Núñez, V; Barona, J; Fonnegra, R; Jiménez, S L; Osorio, R G; Saldarriaga, M; Díaz, A

    2000-11-01

    Thirty-one of 75 extracts of plants used by traditional healers for snakebites, had moderate or high neutralizing ability against the haemorrhagic effect of Bothrops atrox venom from Antioquia and Chocó, north-western Colombia. After preincubation of several doses of every extract (7.8-4000 microg/mouse) with six minimum haemorrhagic doses (10 microg) of venom, 12 of them demonstrated 100% neutralizing capacity when the mixture was i.d. injected into mice (18-20 g). These were the stem barks of Brownea rosademonte (Caesalpiniaceae) and Tabebuia rosea (Bignoniaceae); the whole plants of Pleopeltis percussa (Polypodiaceae), Trichomanes elegans (Hymenophyllaceae) and Senna dariensis (Caesalpiniaceae); rhizomes of Heliconia curtispatha (Heliconiaceae); leaves and branches of Bixa orellana (Bixaceae), Philodendron tripartitum (Araceae), Struthanthus orbicularis (Loranthaceae) and Gonzalagunia panamensis (Rubiaceae); the ripe fruits of Citrus limon (Rutaceae); leaves, branches and stem of Ficus nymphaeifolia (Moraceae). Extracts of another 19 species showed moderate neutralization (21-72%) at doses up to 4 mg/mouse, e.g. the whole plants of Aristolochia grandiflora (Aristolochiaceae), Columnea kalbreyeriana (Gesneriaceae), Sida acuta (Malvaceae), Selaginella articulata (Selaginellaceae) and Pseudoelephantopus spicatus (Asteraceae); rhizomes of Renealmia alpinia (Zingiberaceae); the stem of Strychnos xinguensis (Loganiaceae); leaves, branches and stems of Hyptis capitata (Lamiaceae), Ipomoea cairica (Convolvulaceae), Neurolaena lobata (Asteraceae), Ocimum micranthum (Lamiaceae), Piper pulchrum (Piperaceae), Siparuna thecaphora (Monimiaceae), Castilla elastica (Moraceae) and Allamanda cathartica (Apocynaceae); the macerated ripe fruits of Capsicum frutescens (Solanaceae); the unripe fruits of Crescentia cujete (Bignoniaceae); leaves and branches of Piper arboreum (Piperaceae) and Passiflora quadrangularis (Passifloraceae). When the extracts were independently administered

  1. Metachronous Multiplicity of Spinal Cord Arteriovenous Fistula and Spinal Dural AVF in a Patient with Hereditary Haemorrhagic Telangiectasia

    PubMed Central

    Ling, J.C.M.; Agid, R.; Nakano, S.; Souza, M.P.S.; Reintamm, G.; TerBrugge, K.G.

    2005-01-01

    Summary HHT (Hereditary Haemorrhagic Telangiectasia or Rendu Osler Weber disease) is a known autosomal dominant dysplasia. The first clinical presentation of HHT in a child may be a cerebral or spinal AVM. We present the case of a young boy with HHT who had a previous spinal cord AVF treated by surgical obliteration and then presented with a spinal dural AVF nine months later. This patient had surgical obliteration of a spinal cord perimedullary AVF and subsequently developed a new spinal dural AVF at a different level. The diagnosis was made by spinal MR imaging and spinal angiography PMID:20584440

  2. Neutralisation of Local Haemorrhage Induced by the Saw-Scaled Viper Echis carinatus sochureki Venom Using Ethanolic Extract of Hibiscus aethiopicus L.

    PubMed

    Hasson, S S; Al-Balushi, M S; Said, E A; Habbal, O; Idris, M A; Mothana, R A A; Sallam, T A; Al-Jabri, A A

    2012-01-01

    The objective of the study is to investigate the anti-snake venom activities of a local plant, Hibiscus aethiopicus L. The H. aethiopicus was dried and extracted with ethanol. Different assays were performed according to standard techniques, to evaluate the plant's acute toxicity and its antivenom activities. The results of evaluating the systemic acute toxicity of the H. aethiopicus extract using "oral and intra-peritoneal" route were normal even at the highest dose (24 g/kg) tested. All guinea pigs (n = 3) when treated with venoms E. c. sochureki (75 μg) alone induced acute skin haemorrhage. In contrast, all guinea pigs (n = 18) treated with both venom and the plant extract at a concentration between 500 and 1000 mg/kg showed no signs of haemorrhage. Moreover, all guinea pigs (n = 18) treated with venom and the plant extract below 400 mg/kg showed acute skin haemorrhage. All guinea pigs treated with venom E. c. sochureki (75 μg) alone induced acute skin haemorrhage after both 24 and 32 hours. In contrast, all guinea pigs treated with both venom and the plant extract (administered independently) at concentrations between 500 and 1000 mg/kg showed no signs of haemorrhage after 32 hours. However, after 24 hours all tested guinea pigs showed less inhibition (<60%) compared to that obtained after 32 hours. The outcome of this study reflects that the extract of H. aethiopicus plant may contain an endogenous inhibitor of venom induced local haemorrhage. PMID:22666294

  3. The effect of immunosuppression on the development of cerebral oedema in an experimental model of intracerebral haemorrhage: whole body and regional irradiation.

    PubMed Central

    Kane, P J; Modha, P; Strachan, R D; Cook, S; Chambers, I R; Clayton, C B; Mendelow, A D

    1992-01-01

    The oedema which forms around an intracerebral haemorrhage has a complex aetiology. The immune response may have a role in its formation. There is clinical and experimental evidence that circulating leucocytes and platelets may mediate oedema formation. Global depletion of circulating leucocytes and platelets by whole body irradiation in a rodent model of intracerebral haemorrhage was found to confer protection against both ischaemia and oedema formation. This was not a direct effect of irradiation of the brain. The possible mechanisms for this protection are discussed. PMID:1402968

  4. Anaesthesia in a patient with subarachanoidal haemorrhage and high oxygen affinity haemoglobinopathy (HB york): case report

    PubMed Central

    2012-01-01

    Background Approximately 90 haemoglobinopathies have been identified that result in abnormally high oxygen affinity. One of these is haemoglobinopathy York (HbY), first described in 1976. HbY causes an extreme leftward shift of the oxygen dissociation curve with the P50 value changing to 12.5 - 15.5 mmHg (normal value 26.7 mmHg), indicating that approximately half of the haemoglobin is not available as oxygen carrier. Patients with haemoglobinopathies with increased oxygen affinity could suffer from the risk developing ischaemic complications due to a lack of functional oxygen carriers. This is, to best of our knowledge, the first case report on a patient with HbY published in connection with anesthesia. Case Presentation A 42-year-old female with a severe headache and Glasgow coma scale (GCS) of 15 was admitted to the neurosurgical intensive care unit with a ruptured, right sided ICA aneurysm with consecutive subarachnoid haemorrhage [Fisher III, World Federation of Neurosurgical Societies (WFNS) I)]. The medical history of the patient included an erythrocytosis (Hb 17.5 g/dl) on the base of a high-oxygen-affinity haemoglobinopathy, called Hb York (HbY). With no time available to take special preoperative precautions, rapid blood loss occurred during the first attempt to clip the aneurysm. General transfusion procedures, according to the guidelines based on haemoglobin and haematocrit values, could not be applied due to the uncertainty in the oxygen carrier reduction. To maintain tissue oxygen supply, clinical indicators of ischaemia were instead utilized to gauge the appropriate required blood products, crystalloids and colloids replacements. Despite this, the patient survived the neurosurgical intervention without any neurological deficit. Conclusions Family members of patients with HbY (and other haemoglobinopathies with increased oxygen affinity) should undergo clinical assessment, particularly if they are polycythaemic. If the diagnosis of HbY is confirmed

  5. Comparative quantitative monitoring of rabbit haemorrhagic disease viruses in rabbit kittens

    PubMed Central

    2014-01-01

    Background Only one strain (the Czech CAPM-v351) of rabbit haemorrhagic disease virus (RHDV) has been released in Australia and New Zealand to control pest populations of the European rabbit O. cuniculus. Antigenic variants of RHDV known as RHDVa strains are reportedly replacing RHDV strains in other parts of the world, and Australia is currently investigating the usefulness of RHDVa to complement rabbit biocontrol efforts in Australia and New Zealand. RHDV efficiently kills adult rabbits but not rabbit kittens, which are more resistant to RHD the younger they are and which may carry the virus without signs of disease for prolonged periods. These different infection patterns in young rabbits may significantly influence RHDV epidemiology in the field and hence attempts to control rabbit numbers. Methods We quantified RHDV replication and shedding in 4–5 week old rabbits using quantitative real time PCR to assess their potential to shape RHDV epidemiology by shedding and transmitting virus. We further compared RHDV-v351 with an antigenic variant strain of RHDVa in kittens that is currently being considered as a potential RHDV strain for future release to improve rabbit biocontrol in Australia. Results Kittens were susceptible to infection with virus doses as low as 10 ID50. Virus growth, shedding and transmission after RHDVa infection was found to be comparable or non-significantly lower compared to RHDV. Virus replication and shedding was observed in all kittens infected, but was low in comparison to adult rabbits. Both viruses were shed and transmitted to bystander rabbits. While blood titres indicated that 4–5 week old kittens mostly clear the infection even in the absence of maternal antibodies, virus titres in liver, spleen and mesenteric lymph node were still high on day 5 post infection. Conclusions Rabbit kittens are susceptible to infection with very low doses of RHDV, and can transmit virus before they seroconvert. They may therefore play an important

  6. Ventricular longitudinal function is associated with microvascular obstruction and intramyocardial haemorrhage

    PubMed Central

    Foley, James R J; Musa, Tarique Al; Ripley, David P; Swoboda, Peter P; Erhayiem, Bara; Dobson, Laura E; McDiarmid, Adam K; Greenwood, John P; Plein, Sven

    2016-01-01

    Background Microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) are associated with adverse prognosis, independently of infarct size after reperfused ST-elevation myocardial infarction (STEMI). Mitral annular plane systolic excursion (MAPSE) is a well-established parameter of longitudinal function on echocardiography. Objective We aimed to investigate how acute MAPSE, assessed by a four-chamber cine-cardiovascular MR (CMR), is associated with MVO, IMH and convalescent left ventricular (LV) remodelling. Methods 54 consecutive patients underwent CMR at 3T (Intera CV, Philips Healthcare, Best, The Netherlands) within 3 days of reperfused STEMI. Cine, T2-weighted, T2* and late gadolinium enhancement (LGE) imaging were performed. Infarct and MVO extent were measured from LGE images. The presence of IMH was investigated by combined analysis of T2w and T2* images. Averaged-MAPSE (medial-MAPSE+lateral-MAPSE/2) was calculated from 4-chamber cine imaging. Results 44 patients completed the baseline scan and 38 patients completed 3-month scans. 26 (59%) patients had MVO and 25 (57%) patients had IMH. Presence of MVO and IMH were associated with lower averaged-MAPSE (11.7±0.4 mm vs 9.3±0.3 mm; p<0.001 and 11.8±0.4 mm vs 9.2±0.3 mm; p<0.001, respectively). IMH (β=−0.655, p<0.001) and MVO (β=−0.567, p<0.001) demonstrated a stronger correlation to MAPSE than other demographic and infarct characteristics. MAPSE ≤10.6 mm demonstrated 89% sensitivity and 72% specificity for the detection of MVO and 92% sensitivity and 74% specificity for IMH. LV remodelling in convalescence was not associated with MAPSE (AUC 0.62, 95% CI 0.44 to 0.77, p=0.22). Conclusions Postreperfused STEMI, LV longitudinal function assessed by MAPSE can independently predict the presence of MVO and IMH. PMID:27175286

  7. Postpolypectomy haemorrhage following removal of large polyps using mechanical haemostasis or epinephrine: a meta-analysis

    PubMed Central

    Burger, Daniel C; Horgan, Gareth; Bailey, Adam A; East, James E

    2014-01-01

    Background and aim Postpolypectomy haemorrhage (PPH) is a known adverse event that can occur following polypectomy, occurring in 0.3–6.1% of cases. Previous meta-analysis has included small polyps, which are less likely to bleed, and less amenable to some methods of mechanical haemostasis. No comprehensive cost–benefit analysis of this topic is available. The aim of this study was to perform a meta-analysis of randomized trials and a cost–benefit analysis of prophylactic haemostasis in PPH. Methods A total of 3092 abstracts from prospective trials conducted in human colonoscopic polypectomy were screened. Outpatients undergoing polypectomy in seven suitable studies (1426 episodes), without polyposis syndromes or bleeding diathesis, were identified. The interventions of prophylactic haemostatic measures (clips, loops, and/or adrenaline injection) to prevent PPH were assessed. The main outcome measurements were PPH measured by haematochezia or drop in haematocrit >10% or haemoglobin >1 g/dl. Risk ratio and number needed to treat (NNT) were generated using meta-analysis. Results Comparing any prophylactic haemostasis to none, the pooled risk ratio for PPH was 0.35 (0.21–0.57; p < 0.0001), NNT was 13.6, and cost to prevent one PPH was USD652. Using adrenaline alone vs. no prophylactic haemostasis revealed a pooled risk ratio of 0.37 (0.20–0.66; p = 0.001), NNT 14.0, cost to prevent one PPH USD382. Any prophylactic mechanical haemostasis compared to adrenaline produced a RR for PPH of 0.28 (0.14–0.57; p < 0.0001), NNT 12.3, and cost to prevent one PPH USD1368. Conclusions Adrenaline injection or mechanical haemostasis reduces the risk of PPH. Routine prophylactic measures to reduce PPH for polyps larger than 10 mm are potentially cost effective, although more thorough cost–benefit modelling is required. PMID:24918017

  8. Not All Acute Abdomen Cases in Early Pregnancy Are Ectopic; Expect the Unexpected: Renal Angiomyolipoma Causing Massive Retroperitoneal Haemorrhage.

    PubMed

    Rana, Muhammad Asim; Mady, Ahmed F; Jakaraddi, Nagesh; Mumtaz, Shahzad A; Ahmad, Habib; Naser, Kamal

    2016-01-01

    Retroperitoneal haemorrhage (or retroperitoneal haematoma) refers to an accumulation of blood found in the retroperitoneal space. It is a rare clinical entity with variable aetiology including anticoagulation, ruptured aortic aneurysm, acute pancreatitis, malignancy, and bleeding from renal aneurysm. Diagnosis of retroperitoneal bleed is sometimes missed or delayed as presentation is often nonspecific. Multislice CT and arteriography are important for diagnosis. There is no consensus about the best management plan for patients with retroperitoneal haematoma. Stable patients can be managed with fluid resuscitation, correction of coagulopathy if any, and blood transfusion. Endovascular options involving selective intra-arterial embolisation or stent-grafts are clearly getting more and more popularity. Open repair is usually reserved for cases when there is failure of conservative or endovascular measures to control the bleeding or expertise is unavailable and in cases where the patient is unstable. Mortality of patients with retroperitoneal haematoma remains high if appropriate and timely measures are not taken. Haemorrhage from a benign renal tumour is a rarer entity which is described in this case report which emphasizes that physicians should have a wide index of suspicion when dealing with patients presenting with significant groin, flank, abdominal, or back pain, or haemodynamic instability of unclear cause. Our patient presented with features of acute abdomen and, being pregnant, was thought of having a ruptured ectopic pregnancy. PMID:27429809

  9. Sole haemorrhages in tied primiparous cows as an indicator of periparturient laminitis: effects of diet, flooring and season.

    PubMed

    Bergsten, C; Frank, B

    1996-01-01

    Fifty-six tied heifers calving in autumn (trial I) and 21 tied heifers calving in late spring (trial II) were fed either a high or a low concentrate diet from 3 weeks before expected calving until 13 weeks after calving. Half the heifers in trial I were kept on concrete floors and the others were kept on rubber mats; all the heifers in trial II were on concrete floors. The hooves were trimmed and the soles were photographed 3 weeks before expected calving and again 13 weeks after calving. The photographs were evaluated, each claw was scored for sole haemorrhages, and the total score for all 8 claws was calculated. Before calving there were no differences between the groups of heifers within trial I or trial II, but the heifers in trial II had higher scores than those in trial I. Thirteen weeks after calving the scores had increased in both trials. In trials I the animals fed the high concentrate diet and kept on concrete floors had the highest score, and the type of floor had a greater influence than the level of concentrates fed. The heifers calving in the autumn had higher scores than those calving in the spring. The sudden change from being at pasture to being housed, and the events related to the periparturient period were the most significant factors for the development of sole haemorrhages. PMID:9050271

  10. Not All Acute Abdomen Cases in Early Pregnancy Are Ectopic; Expect the Unexpected: Renal Angiomyolipoma Causing Massive Retroperitoneal Haemorrhage

    PubMed Central

    Mady, Ahmed F.; Jakaraddi, Nagesh; Naser, Kamal

    2016-01-01

    Retroperitoneal haemorrhage (or retroperitoneal haematoma) refers to an accumulation of blood found in the retroperitoneal space. It is a rare clinical entity with variable aetiology including anticoagulation, ruptured aortic aneurysm, acute pancreatitis, malignancy, and bleeding from renal aneurysm. Diagnosis of retroperitoneal bleed is sometimes missed or delayed as presentation is often nonspecific. Multislice CT and arteriography are important for diagnosis. There is no consensus about the best management plan for patients with retroperitoneal haematoma. Stable patients can be managed with fluid resuscitation, correction of coagulopathy if any, and blood transfusion. Endovascular options involving selective intra-arterial embolisation or stent-grafts are clearly getting more and more popularity. Open repair is usually reserved for cases when there is failure of conservative or endovascular measures to control the bleeding or expertise is unavailable and in cases where the patient is unstable. Mortality of patients with retroperitoneal haematoma remains high if appropriate and timely measures are not taken. Haemorrhage from a benign renal tumour is a rarer entity which is described in this case report which emphasizes that physicians should have a wide index of suspicion when dealing with patients presenting with significant groin, flank, abdominal, or back pain, or haemodynamic instability of unclear cause. Our patient presented with features of acute abdomen and, being pregnant, was thought of having a ruptured ectopic pregnancy. PMID:27429809

  11. Replicate surveys of larval habitats of Aedes aegypti in relation to dengue haemorrhagic fever in Bangkok, Thailand*

    PubMed Central

    Tonn, R. J.; Sheppard, P. M.; MacDonald, W. W.; Bang, Y. H.

    1969-01-01

    Dengue haemorrhagic fever in Bangkok and Thonburi occurs principally during the wet season. The mosquito vector is Aedes aegypti. A study was made of the larval habitats of A. aegypti in 14 localities, at three different times of the year, to determine whether there were fluctuations in the A. aegypti population, as measured by the number of occupied habitats, which could be correlated with the incidence of the infection. The habitats were classified into 6 categories and a single larva was collected for identification from each one that was occupied. The number and percentage of occupied habitats of each category per 100 houses were analysed to determine whether there were differences between localities and between times of the year. Almost all the comparisons between localities were highly significant. There was evidence of slight changes in the number of occupied habitats from time to time, the chief increase being between the cool and the warm seasons and the chief decrease from the wet to the cool season, but it seems unlikely that outbreaks of dengue haemorrhagic fever can be explained by increases in A. aegypti densities during the wet season. PMID:5307596

  12. The development of quality indicators for the prevention and management of postpartum haemorrhage in primary midwifery care in the Netherlands

    PubMed Central

    2013-01-01

    Background At present, there are no guidelines on prevention and management of postpartum haemorrhage in primary midwifery care in the Netherlands. The first step towards implementing guidelines is the development of a set of quality indicators for prevention and management of postpartum haemorrhage for primary midwifery supervised (home) birth in the Netherlands. Methods A RAND modified Delphi procedure was applied. This method consists of five steps: (1) composing an expert panel (2) literature research and collection of possible quality indicators, (3) digital questionnaire, (4) consensus meeting and (5) critical evaluation. A multidisciplinary expert panel consisting of five midwives, seven obstetricians and an ambulance paramedic was assembled after applying pre-specified criteria concerning expertise in various domains relating to primary midwifery care, secondary obstetric care, emergency transportation, maternal morbidity or mortality audit, quality indicator development or clinical guidelines development and representatives of professional organisations. Results After literature review, 79 recommendations were selected for assessment by the expert panel. After a digital questionnaire to the expert panel seven indicators were added, resulting in 86 possible indicators. After excluding 41 indicators that panel members unanimously found invalid, 45 possible indicators were assessed at the consensus meeting. During critical evaluation 18 potential indicators were found to be overlapping and two were discarded due to lack of measurability. Conclusions A set of 25 quality indicators was considered valid for testing in practice. PMID:24139411

  13. Flavorase, a novel non-haemorrhagic metalloproteinase in Protobothrops flavoviridis venom, is a target molecule of small serum protein-3.

    PubMed

    Shioi, Narumi; Nishijima, Ayumi; Terada, Shigeyuki

    2015-07-01

    Some venomous snakes possess anti-toxic proteins in their sera that may play a role in neutralizing the haemorrhagic factors or toxins in their own venom. Five small serum proteins (SSP-1-SSP-5) were isolated from the serum of Japanese viper (Protobothrops flavoviridis), and were found to act as self-defence proteins against the viper's own toxic components. However, the physiological function of SSP-3 has not been completely elucidated. Affinity chromatography of the venom on an SSP-3-immobilized column identified a novel 55-kDa protein as the target molecule of SSP-3. Sequences of internal fragments of this SSP-3-binding protein showed high homology to those of metalloproteinases from the P. flavoviridis venom. The cDNA sequence revealed that this protein, termed flavorase, is a P-III class metalloproteinase consisting of 423 amino acid residues. The purified protein did not show haemorrhagic and cytotoxic activity. Biacore measurements revealed that SSP-3 was bound to flavorase with a dissociation constant of 6.4 × 10(-9) M. SSP-3 non-competitively inhibited the peptidase activity of flavorase with an inhibition constant of 6.6 × 10(-9) M. PMID:25681613

  14. Intracranial haemorrhages in French haemophilia patients (1991-2001): clinical presentation, management and prognosis factors for death.

    PubMed

    Stieltjes, N; Calvez, T; Demiguel, V; Torchet, M F; Briquel, M E; Fressinaud, E; Claeyssens, S; Coatmelec, B; Chambost, H

    2005-09-01

    Intracranial haemorrhage (ICH) is known to be a severe although uncommon complication of haemophilia. A national survey has been conducted in France in order to collect information about ICHs which occurred in haemophiliacs between 1991 and 2001 and to propose recommendations for the diagnostic and treatment of ICH. Within this period, 123 episodes of ICH were recorded from 106 patients. Two-thirds of ICH concerned patients with severe haemophilia. Half of the cases occurred in patients under 15 years of age, 67.2% of which were post-traumatic. Ten cases occurred in neonates with three fatal outcomes. Overall mortality was high (21.9%) suggesting that availability of clotting factor concentrates has not improved the prognosis of this event. Morbidity was also high with 60% of long-term sequelae. The following parameters have been identified as prognostic factors for death: thrombocytopenia, HCV infection, intraventricular or intraparenchymatous haemorrhage. A delay in diagnosis was mentioned in 43.3% of cases, often related to the lack of recognition of the initial symptoms, which may be very common (apathy, tearfulness in young children and headache in elder patients). Delayed replacement therapy was recorded in 37.2% of cases. Emergency units initially dealt with half of these patients. Information concerning recognition and management of these episodes, not only in severe haemophilia, but also in moderate and mild forms, should be regularly supplied to paediatricians in maternity and physicians from emergency units, as well as to patients and their relatives. PMID:16128887

  15. The Massive Bleeding after the Operation of Hip Joint Surgery with the Acquired Haemorrhagic Coagulation Factor XIII(13) Deficiency: Two Case Reports.

    PubMed

    Kanda, Akio; Kaneko, Kazuo; Obayashi, Osamu; Mogami, Atsuhiko

    2013-01-01

    Two women, aged 81 and 61, became haemorrhagic after surgery. Their previous surgeries were uneventful with no unexpected bleeding observed. Blood tests prior to the current surgeries indicated normal values including those related to coagulation. There were no problems with the current surgeries prior to leaving the operating room. At 3 hours after the surgery, the 81-year-old patient had an outflow of the drain at 1290 grams and her blood pressure decreased. She had disseminated intravascular coagulation (DIC). The 61-year-old woman had repeated haemorrhages after her current surgery for a long time. Their abnormal haemorrhages were caused by a deficiency of coagulation factor XIII(13). The mechanism of haemorrhagic coagulation factor XIII(13) deficiency is not understood, and it is a rare disorder. The only diagnostic method to detect this disorder is to measure factor XIII(13) activity in the blood. In this paper, we used Arabic and Roman numerals at the same time to avoid confusion of coagulation factor XIII(13) with coagulation factor VIII(8) that causes hemophilia A. PMID:23533879

  16. The immediate lifesaving management of maxillofacial, life-threatening haemorrhages due to IED and/or shrapnel injuries: "when hazard is in hesitation, not in the action".

    PubMed

    Shuker, Sabri T

    2012-09-01

    Maxillofacial/neck vascular injuries caused by improvised explosive devices IEDs or ballistics injuries are life threatening when they cause severe haemorrhage resulting in airway compromise. One should always keep in mind that the best technique used is that which saves the patient's life and not the most expensive and/or technologically advanced. Medical professionals on the scene should have the necessary experience to handle the emergency situations of airway compromise and haemorrhage control. In this instance there is only, "one to a few minutes" to clear airway obstruction and arrest haemorrhage to prevent death. The patients in this study had life-threatening shrapnel injuries of the carotid and/or jugular vessels, and facial primary blast affect implosion of facial middle third air-containing cavities injuries. In a massive casualties arenas, where time=lifesaving, we should need to replace "non-battlefield" civilian techniques with "time driven", combat management for IEDs injuries. In these cases, the immediate and effective compression tamponade using digital, Foley catheter tamponade, packs and/or vessels ligation for severe facial/neck haemorrhage were used successfully. PMID:22070881

  17. Autoradiographic determination of regional cerebral blood flow and metabolism in conscious rats after fluid resuscitation from haemorrhage with a haemoglobin-based oxygen carrier.

    PubMed

    Waschke, K F; Albrecht, D M; van Ackern, K; Kuschinsky, W

    1994-10-01

    The effects of resuscitation fluids on the brain have been investigated in previous studies by global measurements of cerebral blood flow and metabolism. In this study we have examined the effects of a novel haemoglobin-based oxygen carrier on local cerebral blood flow (LCBF) and local cerebral glucose utilization (LCGU) after resuscitation from a volume-controlled haemorrhage of 30 min (3.0 ml/100 g body weight) with ultrapurified, polymerized, bovine haemoglobin (UPBHB). LCBF and LCGU were measured in 34 brain structures of conscious rats 2 h after resuscitation using quantitative iodo(14C)antipyrine and 2-(14C)-deoxy-D-glucose methods. The data were compared with a control group without haemorrhage and fluid resuscitation. In the haemorrhage group, LCBF increased after resuscitation by 12-56% in the different brain structures (mean 36%). LCGU changed less (0 to +18%, mean +9%). In the control group there was a close relationship between LCGU and LCBF (r = 0.95). After fluid resuscitation the relationship was preserved (r = 0.95), although it was reset at a higher ratio of LCBF to LCGU (P < 0.05). We conclude that fluid resuscitation of a 30 min volume-controlled haemorrhage using the haemoglobin-based oxygen carrier, UPBHB, induced a moderate degree of heterogeneity in the resulting changes of LCGU and LCBF. Local disturbances of cerebral blood flow or metabolism were not observed. PMID:7999496

  18. Prehospital antiplatelet use and functional status on admission of patients with non-haemorrhagic moyamoya disease: a nationwide retrospective cohort study (J-ASPECT study)

    PubMed Central

    Onozuka, Daisuke; Hagihara, Akihito; Nishimura, Kunihiro; Kada, Akiko; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Suzuki, Akifumi; Kataoka, Hiroharu; Nakamura, Fumiaki; Kamitani, Satoru; Nishimura, Ataru; Kurogi, Ryota; Sayama, Tetsuro; Iihara, Koji

    2016-01-01

    Objectives To elucidate the association between antiplatelet use in patients with non-haemorrhagic moyamoya disease before hospital admission and good functional status on admission in Japan. Design Retrospective, multicentre, non-randomised, observational study. Setting Nationwide registry data in Japan. Participants A total of 1925 patients with non-haemorrhagic moyamoya disease admitted between 1 April 2012 and 31 March 2014 in Japan. Main outcome measure We performed propensity score-matched analysis to examine the association between prehospital antiplatelet use and no significant disability on hospital admission, as defined by a modified Rankin Scale score of 0 or 1. Results Propensity-matched patients who received prehospital antiplatelet drugs were associated with a good outcome on hospital admission (OR adjusted for all covariates, 3.82; 95% CI 1.22 to 11.99) compared with those who did not receive antiplatelet drugs prior to hospital admission. Conclusions Prehospital antiplatelet use was significantly associated with good functional status on hospital admission among patients with non-haemorrhagic moyamoya disease in Japan. Our results suggest that prehospital antiplatelet use should be considered when evaluating outcomes of patients with non-haemorrhagic moyamoya disease. PMID:27008684

  19. Global situation of dengue and dengue haemorrhagic fever, and its emergence in the Americas.

    PubMed

    Pinheiro, F P; Corber, S J

    1997-01-01

    About two-thirds of the world's population live in areas infested with dengue vectors, mainly Aedes aegypti. All four dengue viruses are circulating, sometimes simultaneously, in most of these areas. It is estimated that up to 80 million persons become infected annually although marked underreporting results in the notification of much smaller figures. Currently dengue is endemic in all continents except Europe and epidemic dengue haemorrhagic fever (DHF) occurs in Asia, the Americas and some Pacific islands. The incidence of DHF is much greater in the Asian countries than in other regions. In Asian countries the disease continues to affect children predominantly although a marked increase in the number of DHF cases in people over 15 years old has been observed in the Philippines and Malaysia during recent years. In the 1990's DHF has continued to show a higher incidence in South-East Asia, particularly in Viet Nam and Thailand which together account for more than two-thirds of the DHF cases reported in Asia. However, an increase in the number of reported cases has been noted in the Philippines, Lao People's Democratic Republic, Cambodia, Myanmar, Malaysia, India, Singapore and Sri Lanka during the period 1991-1995 as compared to the preceding 5-year period. In the Americas, the emergence of epidemic DHF occurred in 1981 almost 30 years after its appearance in Asia, and its incidence is showing a marked upward trend. In 1981 Cuba reported the first major outbreak of DHF in the Americas, during which a total of 344,203 cases of dengue were notified, including 10,312 severe cases and 158 deaths. The DHF Cuban epidemic was associated with a strain of dengue-2 virus and it occurred four years after dengue-1 had been introduced in the island causing epidemics of dengue fever. Prior to this event suspected cases of DHF or fatal dengue cases had been reported by five countries but only a few of them fulfilled the WHO criteria for diagnosis of DHF. The outbreak in Cuba is

  20. The FIB-PPH trial: fibrinogen concentrate as initial treatment for postpartum haemorrhage: study protocol for a randomised controlled trial

    PubMed Central

    2012-01-01

    Background Postpartum haemorrhage (PPH) remains a leading cause of maternal mortality worldwide. In Denmark 2% of parturients receive blood transfusion. During the course of bleeding fibrinogen (coagulation factor I) may be depleted and fall to critically low levels, impairing haemostasis and thus worsening the ongoing bleeding. A plasma level of fibrinogen below 2 g/L in the early phase of postpartum haemorrhage is associated with subsequent development of severe haemorrhage. Use of fibrinogen concentrate allows high-dose substitution without the need for blood type crossmatch. So far no publications of randomised controlled trials involving acutely bleeding patients in the obstetrical setting have been published. This trial aims to investigate if early treatment with fibrinogen concentrate reduces the need for blood transfusion in women suffering severe PPH. Methods/Design In this randomised placebo-controlled double-blind multicentre trial, parturients with primary PPH are eligible following vaginal delivery in case of: manual removal of placenta (blood loss ≥ 500 ml) or manual exploration of the uterus after the birth of placenta (blood loss ≥ 1000 ml). Caesarean sections are also eligible in case of perioperative blood loss ≥ 1000 ml. The exclusion criteria are known inherited haemostatic deficiencies, prepartum treatment with antithrombotics, pre-pregnancy weight <45 kg or refusal to receive blood transfusion. Following informed consent, patients are randomly allocated to either early treatment with 2 g fibrinogen concentrate or 100 ml isotonic saline (placebo). Haemostatic monitoring with standard laboratory coagulation tests and thromboelastography (TEG, functional fibrinogen and Rapid TEG) is performed during the initial 24 hours. Primary outcome is the need for blood transfusion. To investigate a 33% reduction in the need for blood transfusion, a total of 245 patients will be included. Four university-affiliated public

  1. Comparative study of CXC chemokines modulation in brown trout (Salmo trutta) following infection with a bacterial or viral pathogen.

    PubMed

    Gorgoglione, Bartolomeo; Zahran, Eman; Taylor, Nick G H; Feist, Stephen W; Zou, Jun; Secombes, Christopher J

    2016-03-01

    Chemokine modulation in response to pathogens still needs to be fully characterised in fish, in view of the recently described novel chemokines present. This paper reports the first comparative study of CXC chemokine genes transcription in salmonids (brown trout), with a particular focus on the fish specific CXC chemokines (CXCL_F). Adopting new primer sets, optimised to specifically target mRNA, a RT-qPCR gene screening was carried out. Constitutive gene expression was assessed first in six tissues from SPF brown trout. Transcription modulation was next investigated in kidney and spleen during septicaemic infection induced by a RNA virus (Viral Haemorrhagic Septicaemia virus, genotype Ia) or by a Gram negative bacterium (Yersinia ruckeri, ser. O1/biot. 2). From each target organ specific pathogen burden, measured detecting VHSV-glycoprotein or Y. ruckeri 16S rRNA, and IFN-γ gene expression were analysed for their correlation to chemokine transcription. Both pathogens modulated CXC chemokine gene transcript levels, with marked up-regulation seen in some cases, and with both temporal and tissue specific effects apparent. For example, Y. ruckeri strongly induced chemokine transcription in spleen within 24h, whilst VHS generally induced the largest increases at 3d.p.i. in both tissues. This study gives clues to the role of the novel CXC chemokines, in comparison to the other known CXC chemokines in salmonids. PMID:26866873

  2. Effects of vaccination against viral haemorrhagic disease and myxomatosis on long-term mortality rates of European wild rabbits.

    PubMed

    Calvete, C; Estrada, R; Lucientes, J; Osacar, J J; Villafuerte, R

    2004-09-25

    The effects of vaccination against myxomatosis and viral haemorrhagic disease (VHD) on long-term mortality rates in European rabbits (Oryctolagus cuniculus) were studied from 1993 to 1996 by radiotracking a free-living population of wild rabbits. During the three months after immunisation, unvaccinated young rabbits weighing between 180 and 600 g were 13.6 times more likely to die than vaccinated young rabbits. In adult rabbits, vaccination did not significantly decrease mortality, mainly owing to the high proportion of rabbits which had previously been exposed to the antigens of both diseases. Compared with adult rabbits with natural antibodies to VHD, rabbits without these antibodies were 5.2 times more likely to die of VHD during annual outbreaks. PMID:15499810

  3. [Epidemics of Ebola haemorrhagic fever in Gabon (1994-2002). Epidemiologic aspects and considerations on control measures].

    PubMed

    Milleliri, J M; Tévi-Benissan, C; Baize, S; Leroy, E; Georges-Courbot, M C

    2004-08-01

    Based on the description of the four Ebola haemorrhagic fever epidemics (EHF) occurred in Gabon between 1994 and 2002, the authors are considering the cultural and psycho-sociological aspects accounting for the difficulty to implement control measures. On the whole, the result of these raging epidemics came up to 207 cases and 150 dead (lethality: 72%). Analysing precisely the aspects of the third epidemic and pointing up the possible factors explaining its spreading far beyond its epicentre, the authors bring about the limits of measures not always understood by local populations. The discussion will deal with the possibilities of a better surveillance, a quick management of intervention means including a regional permanent pre-alert and taking into account the issue raised by the possible Ebola virus endemic. PMID:15462203

  4. Restoration of pretrabeculectomy visual acuity and a functioning filtering bleb in an eye with delayed suprachoroidal haemorrhage following trabeculectomy.

    PubMed

    Senthil, Sirisha; Gupta, Supriya; Balijepalli, Pasyanthi

    2015-01-01

    A 35-year-old myopic man with juvenile open angle glaucoma was referred to us with fluctuating intraocular pressure (IOP) and progression in his only seeing left eye. He had systemic features suggestive of Marfan's syndrome. He underwent trabeculectomy with low dose mitomycin-C with operative precautions to prevent postoperative hypotony in view of high myopia and scleral thinning. On the second postoperative day, he had severe pain in his left eye, with vomiting, and presented with decreased vision, high IOP and a flat anterior chamber. Ultrasound B scan revealed 360° haemorrhagic choroidal detachment. He was conservatively managed and monitored over the next 1 month with appropriate medical treatment. He not only recovered his pretrabeculectomy visual acuity but also had a well functioning bleb at the end of 2 months. PMID:26661281

  5. Healthcare-associated Crimean-Congo haemorrhagic fever in Turkey, 2002-2014: a multicentre retrospective cross-sectional study.

    PubMed

    Leblebicioglu, H; Sunbul, M; Guner, R; Bodur, H; Bulut, C; Duygu, F; Elaldi, N; Cicek Senturk, G; Ozkurt, Z; Yilmaz, G; Fletcher, T E; Beeching, N J

    2016-04-01

    Healthcare-related transmission of Crimean-Congo haemorrhagic fever (CCHF) is a well-recognized hazard. We report a multicentre retrospective cross-sectional study undertaken in Turkey in 2014 in nine hospitals, regional reference centres for CCHF, covering the years 2002 to 2014 inclusive. Data were systematically extracted from charts of all personnel with a reported health care injury/accident related to CCHF. Blood samples were tested for CCHF IgM/IgG by enzyme-linked immunosorbent assay and/or viral nucleic acid detection by PCR after the injury. Fifty-one healthcare-related exposures were identified. Twenty-five (49%) of 51 resulted in laboratory-confirmed infection, with a 16% (4/25) overall mortality. The main route of exposure was needlestick injury in 32/51 (62.7%). A potential benefit of post-exposure prophylaxis with ribavirin was identified. PMID:26806137

  6. Testing the accuracy ratio of the Spatio-Temporal Epidemiological Modeler (STEM) through Ebola haemorrhagic fever outbreaks.

    PubMed

    Baldassi, F; D'Amico, F; Carestia, M; Cenciarelli, O; Mancinelli, S; Gilardi, F; Malizia, A; DI Giovanni, D; Soave, P M; Bellecci, C; Gaudio, P; Palombi, L

    2016-05-01

    Mathematical modelling is an important tool for understanding the dynamics of the spread of infectious diseases, which could be the result of a natural outbreak or of the intentional release of pathogenic biological agents. Decision makers and policymakers responsible for strategies to contain disease, prevent epidemics and fight possible bioterrorism attacks, need accurate computational tools, based on mathematical modelling, for preventing or even managing these complex situations. In this article, we tested the validity, and demonstrate the reliability, of an open-source software, the Spatio-Temporal Epidemiological Modeler (STEM), designed to help scientists and public health officials to evaluate and create models of emerging infectious diseases, analysing three real cases of Ebola haemorrhagic fever (EHF) outbreaks: Uganda (2000), Gabon (2001) and Guinea (2014). We discuss the cases analysed through the simulation results obtained with STEM in order to demonstrate the capability of this software in helping decision makers plan interventions in case of biological emergencies. PMID:27029910

  7. A Novel Vaccine against Crimean-Congo Haemorrhagic Fever Protects 100% of Animals against Lethal Challenge in a Mouse Model

    PubMed Central

    Buttigieg, Karen R.; Dowall, Stuart D.; Findlay-Wilson, Stephen; Miloszewska, Aleksandra; Rayner, Emma; Hewson, Roger; Carroll, Miles W.

    2014-01-01

    Crimean-Congo Haemorrhagic Fever (CCHF) is a severe tick-borne disease, endemic in many countries in Africa, the Middle East, Eastern Europe and Asia. Between 15–70% of reported cases are fatal. There is no approved vaccine available, and preclinical protection in vivo by an experimental vaccine has not been demonstrated previously. In the present study, the attenuated poxvirus vector, Modified Vaccinia virus Ankara, was used to develop a recombinant candidate vaccine expressing the CCHF virus glycoproteins. Cellular and humoral immunogenicity was confirmed in two mouse strains, including type I interferon receptor knockout mice, which are susceptible to CCHF disease. This vaccine protected all recipient animals from lethal disease in a challenge model adapted to represent infection via a tick bite. Histopathology and viral load analysis of protected animals confirmed that they had been exposed to challenge virus, even though they did not exhibit clinical signs. This is the first demonstration of efficacy of a CCHF vaccine. PMID:24621656

  8. Increased virulence of Rabbit Haemorrhagic Disease Virus associated with genetic resistance in wild Australian rabbits (Oryctolagus cuniculus)

    PubMed Central

    Elsworth, Peter; Cooke, Brian D.; Kovaliski, John; Sinclair, Ronald; Holmes, Edward C.; Strive, Tanja

    2015-01-01

    The release of myxoma virus (MYXV) and Rabbit Haemorrhagic Disease Virus (RHDV) in Australia with the aim of controlling overabundant rabbits has provided a unique opportunity to study the initial spread and establishment of emerging pathogens, as well as their co-evolution with their mammalian hosts. In contrast to MYXV, which attenuated shortly after its introduction, rapid attenuation of RHDV has not been observed. By studying the change in virulence of recent field isolates at a single field site we show, for the first time, that RHDV virulence has increased through time, likely because of selection to overcome developing genetic resistance in Australian wild rabbits. High virulence also appears to be favoured as rabbit carcasses, rather than diseased animals, are the likely source of mechanical insect transmission. These findings not only help elucidate the co-evolutionary interaction between rabbits and RHDV, but reveal some of the key factors shaping virulence evolution. PMID:25146599

  9. Duplex Real-Time RT-PCR Assays for the Detection and Typing of Epizootic Haemorrhagic Disease Virus

    PubMed Central

    Viarouge, Cyril; Breard, Emmanuel; Zientara, Stephan; Vitour, Damien; Sailleau, Corinne

    2015-01-01

    Epizootic haemorrhagic disease virus (EHDV) may cause severe clinical episodes in some species of deer and sometimes in cattle. Laboratory diagnosis provides a basis for the design and timely implementation of disease control measures. There are seven distinct EHDV serotypes, VP2 coding segment 2 being the target for serotype specificity. This paper reports the development and validation of eight duplex real-time RT-PCR assays to simultaneously amplify the EHDV target (S9 for the pan-EHDV real-time RT-PCR assay and S2 for the serotyping assays) and endogenous control gene Beta-actin. Analytical and diagnostic sensitivity and specificity, inter- and intra-assay variation and efficiency were evaluated for each assay. All were shown to be highly specific and sensitive. PMID:26161784

  10. Pulmonary Delivery of an Ultra-Fine Oxytocin Dry Powder Formulation: Potential for Treatment of Postpartum Haemorrhage in Developing Countries

    PubMed Central

    Ibrahim, Jibriil P.; Bischof, Robert J.; Nassta, Gemma C.; Olerile, Livesey D.; Russell, Adrian S.; Meiser, Felix; Parkington, Helena C.; Coleman, Harold A.; Morton, David A. V.; McIntosh, Michelle P.

    2013-01-01

    Oxytocin is recommended by the World Health Organisation as the most effective uterotonic for the prevention and treatment of postpartum haemorrhage. The requirement for parenteral administration by trained healthcare providers and the need for the drug solution to be maintained under cold-chain storage limit the use of oxytocin in the developing world. In this study, a spray-dried ultrafine formulation of oxytocin was developed with an optimal particle size diameter (1-5 µm) to facilitate aerosolised delivery via the lungs. A powder formulation of oxytocin, using mannitol, glycine and leucine as carriers, was prepared with a volume-based median particle diameter of 1.9 µm. Oxytocin content in the formulation was assayed using high-performance liquid chromatography-mass spectroscopy and was found to be unchanged after spray-drying. Ex vivo contractility studies utilising human and ovine uterine tissue indicated no difference in the bioactivity of oxytocin before and after spray-drying. Uterine electromyographic (EMG) activity in postpartum ewes following pulmonary (in vivo) administration of oxytocin closely mimicked that observed immediately postpartum (0-12 h following normal vaginal delivery of the lamb). In comparison to the intramuscular injection, pulmonary administration of an oxytocin dry powder formulation to postpartum ewes resulted in generally similar EMG responses, however a more rapid onset of uterine EMG activity was observed following pulmonary administration (129 ± 18 s) than intramuscular injection (275 ± 22 s). This is the first study to demonstrate the potential for oxytocin to elicit uterine activity after systemic absorption as an aerosolised powder from the lungs. Aerosolised oxytocin has the potential to provide a stable and easy to administer delivery system for effective prevention and treatment of postpartum haemorrhage in resource-poor settings in the developing world. PMID:24376618

  11. Pulmonary delivery of an ultra-fine oxytocin dry powder formulation: potential for treatment of postpartum haemorrhage in developing countries.

    PubMed

    Prankerd, Richard J; Nguyen, Tri-Hung; Ibrahim, Jibriil P; Bischof, Robert J; Nassta, Gemma C; Olerile, Livesey D; Russell, Adrian S; Meiser, Felix; Parkington, Helena C; Coleman, Harold A; Morton, David A V; McIntosh, Michelle P

    2013-01-01

    Oxytocin is recommended by the World Health Organisation as the most effective uterotonic for the prevention and treatment of postpartum haemorrhage. The requirement for parenteral administration by trained healthcare providers and the need for the drug solution to be maintained under cold-chain storage limit the use of oxytocin in the developing world. In this study, a spray-dried ultrafine formulation of oxytocin was developed with an optimal particle size diameter (1-5 µm) to facilitate aerosolised delivery via the lungs. A powder formulation of oxytocin, using mannitol, glycine and leucine as carriers, was prepared with a volume-based median particle diameter of 1.9 µm. Oxytocin content in the formulation was assayed using high-performance liquid chromatography-mass spectroscopy and was found to be unchanged after spray-drying. Ex vivo contractility studies utilising human and ovine uterine tissue indicated no difference in the bioactivity of oxytocin before and after spray-drying. Uterine electromyographic (EMG) activity in postpartum ewes following pulmonary (in vivo) administration of oxytocin closely mimicked that observed immediately postpartum (0-12 h following normal vaginal delivery of the lamb). In comparison to the intramuscular injection, pulmonary administration of an oxytocin dry powder formulation to postpartum ewes resulted in generally similar EMG responses, however a more rapid onset of uterine EMG activity was observed following pulmonary administration (129 ± 18 s) than intramuscular injection (275 ± 22 s). This is the first study to demonstrate the potential for oxytocin to elicit uterine activity after systemic absorption as an aerosolised powder from the lungs. Aerosolised oxytocin has the potential to provide a stable and easy to administer delivery system for effective prevention and treatment of postpartum haemorrhage in resource-poor settings in the developing world. PMID:24376618

  12. Evaluation of circulating haematopoietic progenitor cells in patients with Trauma Haemorrhagic shock and its correlation with outcomes

    PubMed Central

    Kumar, Manoj; Bhoi, Sanjeev; Subramanian, Arulselvi; Kamal, Vineet Kumar; Mohanty, Sujata; Rao, DN; Galwankar, Sagar

    2016-01-01

    Background: Haemorrhagic shock accounts up to 50% of early trauma deaths. Hematopoietic failure has been observed in experimental animals and human following shock and injury. One of the facets of bone marrow failure is multiple organ dysfunction syndrome and is commonly seen in patients recovering from severe trauma and hemorrhagic shock. Bone Marrow (BM) dysfunction is associated with mobilization of hematopoietic progenitor cells (HPCs) into peripheral blood. Present study explored the association of peripheral blood hematopoietic progenitor cells (HPCs) with mortality in trauma haemorrhagic shock patients (T/HS). Materials and Methods: Prospective cohort studies of patients presenting within 8 hrs of injury with T/HS to the Department of Emergency Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences were recruited. Peripheral blood samples were collected in each patient for measurement of peripheral blood HPCs. Peripheral blood progenitor cell (PBPC) quantification was performed by measuring HPCs counts using the haematology analyzer (Sysmex XE-2100). Clinical and laboratory data were prospectively collected after consent. Ethical approval was taken and data was analysed by Stata 11.2. Results: 39 patients with trauma hemorrhagic shock and 30 normal healthy controls were recruited. HPCs were significantly higher (P < 0.001) in the T/HS as compared to control. Among study group, 14 patients died within 24 h. at the hospital admission, and found HPCs concentrations were highly significant (<0.001) in non-survivors (n = 14) when compared with survivors (n = 25) among T/HS patients. Conclusions: Our studies suggest the peripheral blood HPCs may be early prognostic marker for mortality among patients who presented with trauma hemorrhagic shock on admission. But the exact molecular mechanism and signalling pathway involved in the change of the behaviour of bone marrow microenvironment is still unclear. PMID:27308251

  13. Is sclerosant injection mandatory after an epinephrine injection for arrest of peptic ulcer haemorrhage? A prospective, randomised, comparative study.

    PubMed Central

    Lin, H J; Perng, C L; Lee, S D

    1993-01-01

    A prospective, randomised, comparative study was performed to assess the need for a pure alcohol injection after an epinephrine injection in the arrest of active peptic ulcer bleeding. Sixty four patients with active ulcer bleeding were enrolled in the study. The two groups (epinephrine and epinephrine plus pure alcohol) were matched for sex, age, site of bleed, endoscopic findings, shock, haemoglobin, and concomitant illness at randomisation. The volume of injected epinephrine in the epinephrine and the epinephrine plus pure alcohol groups mean (SD) was 6.0 (3.0) ml and 5.5 (3.0) ml respectively (p > 0.05). The volume of injected pure alcohol in the epinephrine plus pure alcohol group was 1.9 (1.1) ml. Bleeding was initially controlled in 31 (97%) of the epinephrine group and all of the epinephrine plus pure alcohol group. Rebleeding occurred in 11 (36%) of the epinephrine group and in five (16%) of the epinephrine plus pure alcohol group (p > 0.05). Rebleeding was successfully controlled in some patients with treatment by a second injection. Other patients had heat probe thermocoagulation or surgery. Ultimate haemostatic rates were 69% (22/32) and 88% (28/32) for the epinephrine and the epinephrine plus pure alcohol groups respectively (p > 0.05). The epinephrine plus pure alcohol group achieved a better haemostatic effect for spurting haemorrhage (9/10 v 5/11, p < 0.05). The need for emergency operations and blood transfusions were comparable in both groups. The stay in hospital were less in the epinephrine plus pure alcohol group (mean 4.3 v 7.1, p < 0.05). It is concluded that pure alcohol injection after an epinephrine injection can improve the haemostatic rate in patients with spurting haemorrhage and shorten the hospital stay for patients with active bleeding. PMID:8406150

  14. Simple and validated UHPLC-MS/MS analysis of nimodipine in plasma and cerebrospinal fluid of patients with subarachnoid haemorrhage.

    PubMed

    Mohamed, Susan; Riva, Roberto; Contin, Manuela

    2016-08-15

    We present a simple, fast and validated method for the determination of nimodipine in plasma and cerebrospinal fluid (CSF) of patients with subarachnoid haemorrhage using ultra high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). Plasma or CSF 250μL aliquots were pretreated with acetonitrile spiked with lacosamide as internal standard. The chromatographic separation was performed on a Fusion (3μm) 50×2.0mm I.D. column with gradient elution of 0.1% (v/v) formic acid in water and 0.1% (v/v) formic acid in acetonitrile at a flow rate of 0.35mL/min. The MS/MS ion transitions were 419.1→343 for nimodipine and 251.1→91 for the internal standard. The linearity was determined from 2.0 to 40.0ng/mL in plasma and 40.0-800.0pg/mL in CSF. The lower limit of quantitation (LLOQ) of nimodipine was 0.4ng/mL in plasma and 40pg/mL in CSF. The mean recovery for nimodipine was ≥75% in plasma and ≥90% in CSF at all three considered concentrations. Intra- and interassay precision and accuracy were ≤15% at all quality control concentrations in plasma and CSF. The method was applied to measure plasma and CSF concentrations of nimodipine in a series of patients with subarachnoid haemorrhage treated with intravenous nimodipine. The present procedure, omitting time-consuming liquid-liquid extraction and drying steps, is faster, simpler and cheaper than published LC-MS/MS analytical methods for nimodipine in plasma and the first validated one for nimodipine in CSF. PMID:27327399

  15. The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial

    PubMed Central

    2010-01-01

    Background Each year, worldwide about 530,000 women die from causes related to pregnancy and childbirth. Of the deaths 99% are in low and middle income countries. Obstetric haemorrhage is the leading cause of maternal mortality, most occurring in the postpartum period. Systemic antifibrinolytic agents are widely used in surgery to prevent clot breakdown (fibrinolysis) in order to reduce surgical blood loss. At present there is little reliable evidence from randomised trials on the effectiveness of tranexamic acid in the treatment of postpartum haemorrhage. Methods The Trial aims to determine the effect of early administration of tranexamic acid on mortality, hysterectomy and other morbidities (surgical interventions, blood transfusion, risk of non-fatal vascular events) in women with clinically diagnosed postpartum haemorrhage. The use of health services and safety, especially thromboembolic effect, on breastfed babies will also be assessed. The trial will be a large, pragmatic, randomised, double blind, placebo controlled trial among 15,000 women with a clinical diagnosis of postpartum haemorrhage. All legally adult women with clinically diagnosed postpartum haemorrhage following vaginal delivery of a baby or caesarean section will potentially be eligible. The fundamental eligibility criterion is the responsible clinician's 'uncertainty' as to whether or not to use an antifibrinolytic agent in a particular woman with postpartum haemorrhage. Treatment will entail a dose of tranexamic acid (1 gram by intravenous injection) or placebo (sodium chloride 0.9%) will be given as soon as possible after randomisation. A second dose may be given if after 30 minutes bleeding continues, or if it stops and restarts within 24 hours after the first dose. The main analyses will be on an 'intention to treat' basis, irrespective of whether the allocated treatment was received or not. Subgroup analyses for the primary outcome will be based on type of delivery; administration or not

  16. Reversible Akinetic Mutism after Aneurysmal Subarachnoid Haemorrhage in the Territory of the Anterior Cerebral Artery without Permanent Ischaemic Damage to Anterior Cingulate Gyri

    PubMed Central

    Sibille, François-Xavier; Duprez, Thierry; van Pesch, Vincent; Giglioli, Simone

    2016-01-01

    We report on two cases of transient akinetic mutism after massive subarachnoid haemorrhage due to the rupture of an intracranial aneurysm of the anterior cerebral artery (ACA). In the two cases, vasospasm could not be demonstrated by imaging studies throughout the clinical course. Both patients shared common radiological features: a hydrocephalus due to haemorrhagic contamination of the ventricular system and a mass effect of a subpial hematoma on the borders of the corpus callosum. Patients were also investigated using auditory event-related evoked potentials at acute stage. In contrast to previous observations of akinetic mutism, P300 wave could not be recorded. Both patients had good recovery and we hypothesized that this unexpectedly favourable outcome was due to the absence of permanent structural damage to the ACA territory, with only transient dysfunction due to a reversible mass effect on cingulate gyri. PMID:27418987

  17. Treatment of Resıstant Cyclophosphamide Induced Haemorrhagic Cystıtıs: Revıew of Literature and Three Case Reports.

    PubMed

    Ebiloglu, Turgay; Kaya, Engin; Yilmaz, Sercan; Özgür, Gökhan; Kibar, Yusuf

    2016-04-01

    Haemorrhagic Cystitis (HC) is defined as diffuse inflammatory bladder bleeding due to many aetiologies. Massive HC often arises from anticancer chemotherapy or radiotherapy for the treatment of pelvic malignancies. Phosphamides are the anti-cancer drugs used for treating breast cancer, B-cell lymphoma, leukemia, rheumatoid arthritis and systemic lupus erythaematosis by cross-linking strands of DNA and preventing the cell division. They are also used in bone marrow transplantation for prevention of Graft Versus Host Disease (GVHD). Hepatic metabolism of phosphamide forms acrolein, and acrolein makes ulceration, haemorrhage, edema and necrosis of the urothelium during its excretion by the urine. Infectious causes of HC in immunocomprimesed patients are adenovirus, BK polyoma-virus (BK), JC virus, and Cytomegalovirus (CMV). The present article attempts to make a review of literature for the treatment of intractable HC and report three cases with HC. PMID:27190887

  18. Treatment of Resıstant Cyclophosphamide Induced Haemorrhagic Cystıtıs: Revıew of Literature and Three Case Reports

    PubMed Central

    Kaya, Engin; Yilmaz, Sercan; Özgür, Gökhan; Kibar, Yusuf

    2016-01-01

    Haemorrhagic Cystitis (HC) is defined as diffuse inflammatory bladder bleeding due to many aetiologies. Massive HC often arises from anticancer chemotherapy or radiotherapy for the treatment of pelvic malignancies. Phosphamides are the anti-cancer drugs used for treating breast cancer, B-cell lymphoma, leukemia, rheumatoid arthritis and systemic lupus erythaematosis by cross-linking strands of DNA and preventing the cell division. They are also used in bone marrow transplantation for prevention of Graft Versus Host Disease (GVHD). Hepatic metabolism of phosphamide forms acrolein, and acrolein makes ulceration, haemorrhage, edema and necrosis of the urothelium during its excretion by the urine. Infectious causes of HC in immunocomprimesed patients are adenovirus, BK polyoma-virus (BK), JC virus, and Cytomegalovirus (CMV). The present article attempts to make a review of literature for the treatment of intractable HC and report three cases with HC. PMID:27190887

  19. Detection of the new emerging rabbit haemorrhagic disease type 2 virus (RHDV2) in Sicily from rabbit (Oryctolagus cuniculus) and Italian hare (Lepus corsicanus).

    PubMed

    Camarda, A; Pugliese, N; Cavadini, P; Circella, E; Capucci, L; Caroli, A; Legretto, M; Mallia, E; Lavazza, A

    2014-12-01

    Rabbit haemorrhagic disease virus (RHDV), a member of the genus Lagovirus, causes rabbit haemorrhagic disease (RHD), a fatal hepatitis of rabbits, not previously reported in hares. Recently, a new RHDV-related virus emerged, called RHDV2. This lagovirus can cause RHD in rabbits and disease and mortality in Lepus capensis (Cape hare). Here we describe a case of RHDV2 infection in another hare species, Lepus corsicanus, during a concurrent RHD outbreak in a group of wild rabbits. The same RHDV2 strain infected rabbits and a hare, also causing a RHD-like syndrome in the latter. Our findings confirmed the capability of RHDV2 to infect hosts other than rabbits and improve the knowledge about the epidemiology and the host range of this new lagovirus. PMID:25458493

  20. Intracerebral haemorrhage in a population-based stroke registry (LuSSt): incidence, aetiology, functional outcome and mortality.

    PubMed

    Palm, F; Henschke, N; Wolf, J; Zimmer, K; Safer, A; Schröder, R J; Inselmann, G; Brenke, C; Becher, H; Grau, A J

    2013-10-01

    Data on incidence of intracerebral haemorrhage (ICH) vary widely. Population-based data on predictors of ICH survival and functional outcome are rare. The Ludwigshafen Stroke Study is a prospective, population-based stroke registry which started in January 2006. All residents of the city of Ludwigshafen, Germany, who suffer from acute stroke or transient ischaemic attack are registered. Patients with first-ever primary intracerebral haemorrhage (FE-pICH) between 2006 and 2010 were included in the present analysis. Between January 1st, 2006 and December 31st, 2010, 152 patients suffered a FE-pICH. Crude and age-adjusted incidence rates per 100,000 for FE-pICH were 18.7 (95 % CI 15.9-21.9) and 11.9 (95 % CI 10.2-14.0), respectively, and remained stable over time. Case-fatality rates for FE-pICH were 27.0, 34.9 and 44.1 % at days 28, 90 and 365, respectively. In 21 patients, an (21.3 %) early do-not resuscitate-order was documented. Excluding these patients from multivariate analyses, National Institute of Health Stroke Scale (NIHSS) (OR 1.22, 95 % CI 1.08-1.36), hypercholesterolemia (OR 0.16, 95 % CI 0.05-0.55) and modified Rankin Scale (mRS) prior to stroke (OR 1.56, 95 % CI 1.06-2.3) were independently associated with risk of 1-year mortality, whereas NIHSS (OR 1.41, 95 % CI 1.20-1.66) and leukocyte count on admission (OR 1.48, 95 % CI 1.16-1.89) were independently associated with good or moderate functional outcome (mRS ≤ 3) after 1 year. Incidence of FE-ICH is in the lower range of those reported from other registries and remained stable over the observation period. Higher treatment rates for hypertension might partly account for this. Stroke severity as indicated by NIHSS was independently associated with mortality and functional outcome after 1 year. We found no association between aetiology and outcome in ICH patients. PMID:23812642

  1. Effects of green tea catechins on the pro-inflammatory response after haemorrhage/resuscitation in rats.

    PubMed

    Relja, Borna; Töttel, Eva; Breig, Lara; Henrich, Dirk; Schneider, Heinz; Marzi, Ingo; Lehnert, Mark

    2011-06-28

    Plant polyphenols, i.e. green tea extract (GTE), possess high antioxidative and anti-inflammatory capacity, thus being protective in various models of acute inflammation. However, their anti-inflammatory effect and a feasible mechanism in haemorrhage/resuscitation (H/R)-induced liver injury remain unknown. We investigated the effects of GTE and the role of NF-κB in the pathogenesis of liver injury induced by H/R, and their effects on intercellular adhesion molecule-1 (ICAM-1) expression and neutrophil infiltration. Female Lewis rats were fed a standard chow diet (control, ctrl) or a diet containing 0·1 % polyphenolic GTE for five consecutive days before H/R. Rats were haemorrhaged to a mean arterial pressure of 30 (sem 2) mmHg for 60 min and resuscitated. Control groups (sham_ctrl and sham_GTE) underwent surgical procedures without H/R. At 2 h after resuscitation, tissues were harvested. Serum alanine aminotransferase (ALT) and IL-6 were measured. Hepatic necrosis, ICAM-1 expression and polymorphonuclear leucocyte (PMNL) infiltration were assessed. Hepatic expression of IκBα (phospho) was measured. H/R induced strong liver damage with increased necrosis and serum ALT levels. Compared with both sham groups, inflammatory markers (serum IL-6 and hepatic PMNL infiltration) were elevated after H/R (P < 0·05). Also, H/R increased IκBα phosphorylation. GTE administration markedly (P < 0·05) decreased serum ALT and IL-6 levels, hepatic necrosis as well as PMNL infiltration and the expression of ICAM-1 and phosphorylated IκBα compared with H/R. In conclusion, we observed that NF-κB activation plays an important role in the pathogenesis of liver injury after H/R through the up-regulation of hepatic ICAM-1 expression and subsequent PMNL infiltration. GTE pre-treatment prevents liver damage in this model of acute inflammation through a NF-κB-dependent mechanism. PMID:21294935

  2. Clinical decision-making: midwifery students' recognition of, and response to, post partum haemorrhage in the simulation environment

    PubMed Central

    2012-01-01

    Background This paper reports the findings of a study of how midwifery students responded to a simulated post partum haemorrhage (PPH). Internationally, 25% of maternal deaths are attributed to severe haemorrhage. Although this figure is far higher in developing countries, the risk to maternal wellbeing and child health problem means that all midwives need to remain vigilant and respond appropriately to early signs of maternal deterioration. Methods Simulation using a patient actress enabled the research team to investigate the way in which 35 midwifery students made decisions in a dynamic high fidelity PPH scenario. The actress wore a birthing suit that simulated blood loss and a flaccid uterus on palpation. The scenario provided low levels of uncertainty and high levels of relevant information. The student's response to the scenario was videoed. Immediately after, they were invited to review the video, reflect on their performance and give a commentary as to what affected their decisions. The data were analysed using Dimensional Analysis. Results The students' clinical management of the situation varied considerably. Students struggled to prioritise their actions where more than one response was required to a clinical cue and did not necessarily use mnemonics as heuristic devices to guide their actions. Driven by a response to single cues they also showed a reluctance to formulate a diagnosis based on inductive and deductive reasoning cycles. This meant they did not necessarily introduce new hypothetical ideas against which they might refute or confirm a diagnosis and thereby eliminate fixation error. Conclusions The students response demonstrated that a number of clinical skills require updating on a regular basis including: fundal massage technique, the use of emergency standing order drugs, communication and delegation of tasks to others in an emergency and working independently until help arrives. Heuristic devices helped the students to evaluate their

  3. Immunohistochemical detection of IgM and IgG in lung tissue of dogs with leptospiral pulmonary haemorrhage syndrome (LPHS).

    PubMed

    Schuller, Simone; Callanan, John J; Worrall, Sheila; Francey, Thierry; Schweighauser, Ariane; Kohn, Barbara; Klopfleisch, Robert; Posthaus, Horst; Nally, Jarlath E

    2015-06-01

    Leptospiral pulmonary haemorrhage syndrome (LPHS) is a severe form of leptospirosis. Pathogenic mechanisms are poorly understood. Lung tissues from 26 dogs with LPHS, 5 dogs with pulmonary haemorrhage due to other causes and 6 healthy lungs were labelled for IgG (n=26), IgM (n=25) and leptospiral antigens (n=26). Three general staining patterns for IgG/IgM were observed in lungs of dogs with LPHS with most tissues showing more than one staining pattern: (1) alveolar septal wall staining, (2) staining favouring alveolar surfaces and (3) staining of intra-alveolar fluid. Healthy control lung showed no staining, whereas haemorrhagic lung from dogs not infected with Leptospira showed staining of intra-alveolar fluid and occasionally alveolar septa. Leptospiral antigens were not detected. We conclude that deposition of IgG/IgM is demonstrable in the majority of canine lungs with naturally occurring LPHS, similar to what has been described in other species. Our findings suggest involvement of the host humoral immunity in the pathogenesis of LPHS and provide further evidence to support the dog as a natural disease model for human LPHS. PMID:25963899

  4. A systematic review of the effects and mechanisms of preoperative 5α-reductase inhibitors on intraoperative haemorrhage during surgery for benign prostatic hyperplasia.

    PubMed

    Zong, Huan-Tao; Peng, Xiao-Xia; Yang, Chen-Chen; Zhang, Yong

    2011-11-01

    5α-reductase inhibitors (5α-RIs), including finasteride and dutasteride, are commonly used medical therapies for benign prostatic hyperplasia (BPH). Many studies reported that preoperative 5α-RI had impact on intraoperative haemorrhage during surgery for BPH, but it was still in controversial. So, we conducted a systematic review of the effects and mechanisms of 5α-RIs on intraoperative bleeding for BPH. MEDLINE, EMBASE, the Cochrane Controlled Trail Register of Controlled Trials and the reference lists of retrieved studies were searched in the analysis. Sixteen publications involving 15 different randomized controlled trials (RCTs) and a total of 1156 patients were used in the analysis, including 10 RCTs for finasteride and five RCTs for dutasteride. We found that preoperative finasteride treatment decreases microvessel density (MVD) in resected prostate specimens. Total blood loss, blood loss per gram of resected prostate tissue and decreases in haemoglobin were all greatly reduced in the finasteride group as compared to controls. Dutasteride appeared to have no effect on bleeding. This meta-analysis shows that preoperative finasteride treatment could decrease intraoperative haemorrhage during surgery for BPH. Preoperative dutasteride had no effect on intraoperative haemorrhage, but further high-quality prospective studies are still needed to confirm this observation. PMID:21892196

  5. Haemorrhagic pneumonia in sled dogs caused by Streptococcus equi subsp. zooepidemicus - one fatality and two full recoveries: a case report

    PubMed Central

    2013-01-01

    In spite of yearly vaccination, outbreaks of canine infectious respiratory disease are periodically seen amongst domestic dogs. These infections compromise host defense mechanisms, and, when combined with other stressful events, allow opportunistic pathogens like Streptococcus equi subsp. zooepidemicus to create serious disease. Early recognition and treatment are tremendously important for a successful outcome in these cases. A polyvalent vaccine was given to 22 racing dogs three days after a competition, followed by two days of rest, and then the dogs were returned to regular training. Coughing was noticed among the dogs four days after immunisation. Three days after this outbreak one of the dogs was unusually silent and was found dead the next morning. Simultaneously two other dogs developed haemorrhagic expectorate, depression and dyspnea and were brought in to the veterinary hospital. Streptococcus equi subsp. zooepidemicus was isolated in pure culture from all three cases. They were treated and rehabilitated successfully, and won a sledge race three months later. This paper discusses the necropsy results, treatment regime, rehabilitation and the chronology of vaccination, stressful events and disease. PMID:24020788

  6. Programmes for advance distribution of misoprostol to prevent post-partum haemorrhage: a rapid literature review of factors affecting implementation.

    PubMed

    Smith, Helen J; Colvin, Christopher J; Richards, Esther; Roberson, Jeffrey; Sharma, Geeta; Thapa, Kusum; Gülmezoglu, A Metin

    2016-02-01

    Recent efforts to prevent post-partum haemorrhage (PPH) in low-income countries have focused on providing women with access to oral misoprostol during home birth. The WHO recommends using lay health workers (LHWs) to administer misoprostol in settings where skilled birth attendants are not available. This review synthesizes current knowledge about the barriers and facilitators affecting implementation of advance community distribution of misoprostol to prevent PPH, where misoprostol may be self-administered or administered by an LHW.We searched for and summarized available empirical evidence, and collected primary data from programme stakeholders about their experiences of programme implementation.We present key outcomes and features of advanced distribution programmes that are in operation or have been piloted globally. We categorized factors influencing implementation into those that operate at the health system level, factors related to the community and policy context and those factors more closely connected to the end user.Debates around advance distribution have centred on the potential risks and benefits of making misoprostol available to pregnant women and community members during pregnancy for administration in the home. However, the risks of advance distribution appear manageable and the benefits of self-administration, especially for women who have little chance of expert care for PPH, are considerable. PMID:25797470

  7. The effect of anaesthesia on the haemodynamic and sympathoadrenal responses of the dog in experimental haemorrhagic shock.

    PubMed

    Adamicza, A; Tárnoky, K; Nagy, A; Nagy, S

    1985-01-01

    Studies were carried out to demonstrate the effect of sodium pentobarbital and morphine-pentobarbital anaesthesia on the haemodynamic and sympathoadrenal responses of dogs in haemorrhagic shock. The results were compared to those of conscious dogs and of dogs receiving only morphine. The reactivity of the cardiovascular system to exogenous adrenaline was also studied in every group. Pentobarbital did not change the resting plasma level of catecholamines but reduced the increase of plasma catecholamines in shock. In the pentobarbital-anaesthetized dogs in which shock was less severe, the reactivity of blood vessels to adrenaline was higher than in conscious dogs. In the haemodynamic response to shock the increase of heart rate predominated in the conscious dogs while the rise of blood pressure was more pronounced in the pentobarbital-anaesthetized animals. Subcutaneously injected morphine decreased the heart rate and increased the plasma catecholamine and histamine levels. Morphine-pentobarbital anaesthesia decreased the resting arterial pressure and increased the plasma histamine level while the plasma catecholamines were near their initial levels. Morphine alone increased the plasma catecholamines, and the subsequent shock could not induce as high a sympathoadrenal response as in the conscious dogs. Pentobarbital administered following morphine decreased the plasma level of catecholamines nearly to the conscious level but could not inhibit the sympathoadrenal activation induced by shock. Anaesthesia is a significant additional factor in the evaluation of shock experiments carried out on anaesthetized animals. PMID:4013763

  8. Transmission of haemorrhagic fever with renal syndrome in china and the role of climate factors: a review.

    PubMed

    Hansen, Alana; Cameron, Scott; Liu, Qiyong; Sun, Yehuan; Weinstein, Philip; Williams, Craig; Han, Gil-Soo; Bi, Peng

    2015-04-01

    Haemorrhagic fever with renal syndrome (HFRS) is a rodent-borne disease that poses a serious public health threat in China. HFRS is caused by hantaviruses, mainly Seoul virus in urban areas and Hantaan virus in agricultural areas. Although preventive measures including vaccination programs and rodent control measures have resulted in a decline in cases in recent years, there has been an increase in incidence in some areas and new endemic areas have emerged. This review summarises the recent literature relating to the effects of climatic factors on the incidence of HFRS in China and discusses future research directions. Temperature, precipitation and humidity affect crop yields, rodent breeding patterns and disease transmission, and these can be influenced by a changing climate. Detailed surveillance of infections caused by Hantaan and Seoul viruses and further research on the viral agents will aid in interpretation of spatiotemporal patterns and a better understanding of the environmental and ecological drivers of HFRS amid China's rapidly urbanising landscape and changing climate. PMID:25704595

  9. A Novel SMAD4 Mutation Causing Severe Juvenile Polyposis Syndrome with Protein Losing Enteropathy, Immunodeficiency, and Hereditary Haemorrhagic Telangiectasia

    PubMed Central

    Johansson, Joel; Sahin, Christofer; Pestoff, Rebecka; Ignatova, Simone; Forsberg, Pia; Edsjö, Anders; Ekstedt, Mattias; Stenmark Askmalm, Marie

    2015-01-01

    Juvenile polyposis syndrome (JPS) is a rare genetic disorder characterized by juvenile polyps of the gastrointestinal tract. We present a new pathogenic mutation of the SMAD4 gene and illustrate the need for a multidisciplinary health care approach to facilitate the correct diagnosis. The patient, a 47-year-old Caucasian woman, was diagnosed with anaemia at the age of 12. During the following 30 years, she developed numerous gastrointestinal polyps. The patient underwent several operations, and suffered chronic abdominal pain, malnutrition, and multiple infections. Screening of the SMAD4 gene revealed a novel, disease-causing mutation. In 2012, the patient suffered hypoalbuminemia and a large polyp in the small bowel was found. Gamma globulin was given but the patient responded with fever and influenza-like symptoms and refused more treatment. The patient underwent surgery in 2014 and made an uneventful recovery. At follow-up two months later albumin was 38 g/L and IgG was 6.9 g/L. Accurate diagnosis is essential for medical care. For patients with complex symptomatology, often with rare diseases, this is best provided by multidisciplinary teams including representatives from clinical genetics. Patients with a SMAD4 mutation should be followed up both for JPS and haemorrhagic hereditary telangiectasia and may develop protein loosing enteropathy and immunodeficiency. PMID:25705527

  10. Importation of Hyalomma marginatum, vector of Crimean-Congo haemorrhagic fever virus, into the United Kingdom by migratory birds.

    PubMed

    Jameson, Lisa J; Morgan, Peter J; Medlock, Jolyon M; Watola, George; Vaux, Alexander G C

    2012-04-01

    Hyalomma marginatum ticks are an important vector of Crimean-Congo haemorrhagic fever virus which can result in a severe and potentially fatal disease in humans. Given the continued emergence of clinical cases in Eurasia and focalised upsurges of H. marginatum populations in Europe, it seemed prudent to assess the potential of this vector species to be introduced into the United Kingdom. Immature forms of H. marginatum are frequent ectoparasites of passerine birds many of which migrate from Africa to the UK each spring. Incoming birds were inspected for ticks during the spring migration in 2010 and 2011. A total of 68 ticks was collected from 971 birds (29 bird species), 21% (14) of the ticks were identified as H. marginatum. Oenanthe oenanthe (Northern wheatear) and Sylvia communis (Whitethroat) were found to be infested by this tick in both years and with multiple ticks. Single specimens were also removed from Acrocephalus schoenobaenus (Sedge warbler) and Phoenicurus phoenicurus (Common redstart) in 2010. This study provides the first contemporary evidence for substantial importation of this tick species into the UK. PMID:22300969

  11. Postpartum Pyomyoma, a Rare Complication of Sepsis Associated with Chorioamnionitis and Massive Postpartum Haemorrhage Treated with an Intrauterine Balloon

    PubMed Central

    Kaler, Mandeep; Gailer, Ruth; Iskaros, Joseph; David, Anna L.

    2015-01-01

    We report the successful treatment of a postpartum pyomyoma, a rare but serious complication of uterine leiomyomata in a 28-year-old primigravida. The patient was treated for an Escherichia Coli (E. Coli) urinary tract infection (UTI) at 16 weeks of gestation. She had asymptomatic short cervical length on ultrasound scan at 20 weeks that was managed conservatively due to the presence of further UTI and received antibiotics. She was known to have a left sided intramural leiomyoma. She presented with abdominal pain and vaginal bleeding at 23+1 weeks of gestation and the next day she had spontaneous vaginal delivery and collapsed with E. Coli septic shock, massive postpartum haemorrhage, and disseminated intravascular coagulation and was successfully treated with oxytocic drugs, a Rusch intrauterine balloon, and intravenous antibiotics. Eleven days postnatally she re-presented with systemic sepsis and was treated for retained products of conception. Sepsis persisted and investigations showed a postpartum pyomyoma that was initially managed with intravenous antibiotics to avoid surgery. Ultimately she required laparotomy, drainage of pyomyoma, and myomectomy. Postoperative recovery was good and the patient had a successful pregnancy two years later. PMID:26199774

  12. Haemorrhagic cystitis due to BK virus in a child with ALL on standard chemotherapy without stem cell transplant

    PubMed Central

    Alavi, Samin; Yazdi, Mohammad Kaji; Parvin, Mahmoud; Zohrehbandian, Farahnaz; Azma, Roxana

    2013-01-01

    The BK virus (BKV) is a nonenveloped double-stranded DNA virus of the polyomavirus family that primarily affects immunocompromised people. BKV infects humans at an early age. Initial infections with BKV are mainly asymptomatic and usually remain latent in the brain, peripheral blood, kidneys, and urothelium. Following the primary infection, viruses persist indefinitely as ‘latent’ infections of the kidney and urinary system because the virus is urotheliotropic. Reactivation of the virus infections occurs in individuals with severe immunosuppression states such as kidney and stem cell transplantation and rarely in pregnancy. In this line, BKV has been implicated as a common cause of late-onset haemorrhagic cystitis (HC) in patients who have undergone stem cell transplantation. In contrast, reports of BKV-associated diseases in nontransplant paediatric patients are almost exclusively in patients with human immunodeficiency virus infection. Herein, we report the first case of a child with acute lymphoblastic leukaemia who developed BKV-associated HC without receiving stem cell transplantation while on standard maintenance chemotherapy. PMID:24062808

  13. Expectant and medical management of placenta increta in a primiparous woman presenting with postpartum haemorrhage: The role of Imaging

    PubMed Central

    Dasari, Papa; Venkatesan, Bhuvaneswari; Thyagarajan, Chitra; Balan, Sathyalakshmy

    2010-01-01

    We report a case of postpartum hemorrhage due to adherent placenta. A 28 year old primiparous woman who underwent manual removal of placenta for primary postpartum haemorrhage soon after delivery was referred to our Institute on her third postnatal day because of persistent tachycardia and low grade fever. Placenta accreta was suspected on initial ultrasonographic examination. MRI examination confirmed the diagnosis of placenta accreta in few areas and revealed increta in other areas. On expectant management she developed genital tract sepsis and hence she was treated with intravenous Methotrexate after controlling infection with appropriate antibiotics. Doppler Imaging showed decreased blood flow to the placental mass and increased echogenecity on gray scale USG after Methotrexate administration. She expelled the whole placental mass on 35th postnatal day and MRI performed the next day showed empty uterine cavity. Morbid adhesion of placenta should be suspected even in primiparous women without any risk factors when there is history of post-partum hemorrhage. MRI is the best modality for evaluation of adherent placenta. PMID:22470732

  14. Generation of virus-like particles for emerging epizootic haemorrhagic disease virus: Towards the development of safe vaccine candidates.

    PubMed

    Alshaikhahmed, Kinda; Roy, Polly

    2016-02-17

    Epizootic haemorrhagic disease virus (EHDV) is an insect-transmitted pathogen which causes high mortality in deer populations and may also cause high morbidity in cattle. EHDV belongs to the Orbivirus genus and is closely related to the prototype Bluetongue virus (BTV). To date seven distinct serotypes have been recognized. However, a live-attenuated vaccine is commercially available against only one serotype namely EHDV-2, which has been responsible for multiple outbreaks in North America, Canada, Asia and Australia. Here we expressed four major capsid proteins (VP2, VP3, VP5 and VP7) of EHDV-1 using baculovirus multiple gene expression systems and demonstrated that three-layered VLPs were assembled mimicking the authentic EHDV particles but lacking the viral genomic RNA segments and the transcriptase complex (TC). Antibodies generated with VLPs not only neutralized EHDV-1 infection in cell culture but also showed cross neutralizing reactivity against two other serotypes, EHDV-2 and EHDV-6. For proof of concept, we demonstrated that EHDV-2 VLPs could be generated rapidly by expressing the EHDV-2 variable outer capsid proteins (VP2, VP5) together with EHDV-1 VP3 and VP7, the two inner capsid proteins, which are highly conserved among the 7 serotypes. Data presented in this study validate the VLPs as a potential vaccine and demonstrate that a vaccine could be developed rapidly in the event of an outbreak of a new serotype. PMID:26805595

  15. Efficacy of Selective Arterial Embolisation for the Treatment of Life-Threatening Post-Partum Haemorrhage in a Large Population

    PubMed Central

    Saada, Julien; Pelage, Jean-Pierre; Payen, Didier; Vicaut, Eric; Jacob, Denis; Rafii, Arash

    2008-01-01

    Background The objective of this study was to assess efficacy and determine the optimal indication of selective arterial embolisation (SAE) in patients with life-threatening post-partum haemorrhage (PPH). Methodology/Principal Findings One hundred and two patients with PPH underwent SAE and were included from January 1998 to January 2002 in our university care center. Embolisation was considered effective when no other surgical procedure was required. Univariate and multivariate statistical analysis were performed. SAE was effective for 73 patients (71.5%), while 29 required surgical procedures. SAE was effective in 88.6% of women with uterine atony that was associated with positive outcome (OR 4.13, 1.35–12.60), whereas caesarean deliveries (OR 0.16, 0.04–0.5) and haemodynamic shock (OR 0.21, 0.07–0.60) were associated with high failure rates, 47.6% and 39.1%, respectively. Conclusions/Significance Success rate for SAE observed in a large population is lower than previously reported. It is most likely to succeed for uterine atony but not recommended in case of haemodynamic shock or after caesarean section. PMID:19043573

  16. Delayed postpartum haemorrhage secondary to a ruptured uterine artery pseudo-aneurysm, successfully treated by transarterial embolisation

    PubMed Central

    Moatti, Zoe; Nisner, Tamar; Saini, Ashish; Karoshi, Mahantesh

    2011-01-01

    A 29-year-old woman (gravida 1, para 1) had an uneventful first pregnancy and a delivery by emergency caesarean section at term. The caesarean section was complicated by a massive obstetric haemorrhage of 5000 ml. After closure, an immediate re-laparotomy was indicated due to heavy vaginal bleeding. The site of bleeding was identified as an extension of the uterine incision, and was sutured. She was stabilised by transfusion of blood and blood products in the intensive therapy unit, and discharged 5 days later. The patient was re-admitted 6 weeks later with brisk, painless vaginal bleeding, passing large clots from a well-contracted uterus. Her haemoglobin decreased from 11.8 to 7.8 g/dl overnight. In view of her history, an urgent CT angiogram was performed, which revealed the presence of a pseudo-aneurysm arising from the left uterine artery. This was successfully occluded by transarterial embolisation, obviating the need for further surgical exploration. PMID:22674937

  17. Delayed postpartum haemorrhage secondary to a ruptured uterine artery pseudo-aneurysm, successfully treated by transarterial embolisation.

    PubMed

    Moatti, Zoe; Nisner, Tamar; Saini, Ashish; Karoshi, Mahantesh

    2011-01-01

    A 29-year-old woman (gravida 1, para 1) had an uneventful first pregnancy and a delivery by emergency caesarean section at term. The caesarean section was complicated by a massive obstetric haemorrhage of 5000 ml. After closure, an immediate re-laparotomy was indicated due to heavy vaginal bleeding. The site of bleeding was identified as an extension of the uterine incision, and was sutured. She was stabilised by transfusion of blood and blood products in the intensive therapy unit, and discharged 5 days later. The patient was re-admitted 6 weeks later with brisk, painless vaginal bleeding, passing large clots from a well-contracted uterus. Her haemoglobin decreased from 11.8 to 7.8 g/dl overnight. In view of her history, an urgent CT angiogram was performed, which revealed the presence of a pseudo-aneurysm arising from the left uterine artery. This was successfully occluded by transarterial embolisation, obviating the need for further surgical exploration. PMID:22674937

  18. Serum concentration of adhesion molecules in patients with delayed ischaemic neurological deficit after aneurysmal subarachnoid haemorrhage: the immunoglobulin and selectin superfamilies

    PubMed Central

    Nissen, J; Mantle, D; Gregson, B; Mendelow, A

    2001-01-01

    OBJECTIVES—Adhesion molecules are involved in the pathogenesis of cerebral ischaemia and may play a part in the pathophysiology of delayed ischaemic neurological deficit (DIND) after aneurysmal subarachnoid haemorrhage. It was hypothesised that after aneurysmal subarachnoid haemorrhage, adhesion molecules may play a part in the pathophysiology of DIND as reflected by significantly altered serum concentrations in patients with and without DIND.
METHODS—In a prospective study, mean serum concentrations of ICAM-1, VCAM-1, PECAM, and E, P, and L-selectin were compared between patients without (n=23) and with (n=13) DIND in patients with World Federation of Neurological Surgeons (WFNS) grades 1 or 2subarachnoid haemorrhage. Serum was sampled from patients within 2 days of haemorrhage and on alternate days until discharge. Concentrations of adhesion molecules were measured by standard procedures using commercially available enzyme linked immunoabsorbent assays.
RESULTS—There were non-significant differences in serum concentrations of ICAM-1 (290.8 ng/ml v 238.4 ng/ml, p=0.0525), VCAM-1 (553.2ng/ml v 425.8 ng/ml, p=0.053), and PECAM (22.0 ng/ml v 21.0 ng/ml, p=0.56) between patients without and with DIND respectively. The E-selectin concentration between the two patient groups (44.0ng/ml v 37.4 ng/ml, p=0.33) was similar. The P-selectin concentration, however, was significantly higher in patients with DIND compared with those patients without DIND (149.5 ng/ml v 112.9 ng/ml, p=0.039). By contrast, serum L-selectin concentrations were significantly lower in patients with DIND (633.8 ng/ml v 897.9 ng/ml, p=0.013).
CONCLUSIONS—Of all the adhesion molecules examined in this study, P and L-selectin are involved in the pathophysiology of DIND after aneurysmal subarachnoid haemorrhage.

 PMID:11511705

  19. Actinobacillus suis septicaemia in two foals.

    PubMed

    Nelson, K M; Darien, B J; Konkle, D M; Hartmann, F A

    1996-01-13

    A 24-hour-old Hackney ony filly developed signs of weakness, depression and a poor suck reflex, with harsh lung sounds over both fields, and a 48-hour-old Arabian colt from a normal birth which had sucked vigorously developed loose stools and became depressed, weak and anorectic. Both foals had serum IgG concentrations greater than 800 mg/dl, but each had a severe neutropenia with a left shift, and blood cultures from both of them yielded Actinobacillus suis. The A suis isolates had different antimicrobial susceptibility patterns and, in the case of the Arabian, the isolate was resistant to commonly used broad spectrum antimicrobial agents. PMID:8629322

  20. Vaccination against enteric septicaemia of catfish

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Edwardsiella ictaluri, the causative agent of enteric septicemia (ESC) of catfish, is one of the most economically important diseases of cultured channel catfish. In 2002, Wagner and coworkers reported that enteric septicemia of catfish (ESC) and columnaris (Flavobacterium columnaris) were the two m...

  1. Factors influencing occurrence of postpartum haemorrhage in pregnant women with hepatitis E infection and deranged coagulation profile

    PubMed Central

    Puri, Manju; Patra, Sharda; Singh, Preeti; Malhotra, Nidhi; Trivedi, Shubha Sagar; Sharma, Sunita; Kumar, Ashish; Sarin, Shiv Kumar

    2011-01-01

    Coagulopathy is an important complication associated with hepatitis E virus (HEV) infection in pregnant women. Postpartum haemorrhage (PPH) remains a serious risk while managing the labour of these women. The aim of this paper is to study the factors influencing the occurrence of PPH in pregnant women with hepatitis E infection with coagulopathy. The labours of 38 pregnant women with hepatitis E and deranged coagulation profile were followed. Factors that may predict postpartum bleeding complications in women with HEV infection and deranged coagulation profile were statistically analysed. Of 38 pregnant women with acute viral hepatitis due to HEV, 13 (34%) suffered a PPH while 25 (66%) did not. On univariate analysis low alanine aminotransferase (P = 0.016), high international normalized ratio (P = 0.003), high levels of d-dimer (P = 0.008), presence of hepatic encephalopathy (P = 0.028), intrauterine fetal death (P = 0.001) and gastrointestinal bleeding (P = 0.004) were found to predict PPH. However, on multivariate analysis the only independent variable that predicted PPH was the presence gastrointestinal (GI) bleeding (odds ratio [OR] 11.363; 95% CI: 1.003, 125; P = 0.050). Women with GI bleeding have 11 times higher risk of PPH than those without a GI bleed; however, the confidence interval is very wide. Administration of fresh frozen plasma in the peripartum period reduces the risk of PPH. In conclusion, early recognition of factors which predict the risk of PPH and timely intervention with judicious use of blood and blood components in the peripartum period can improve the outcome of pregnant women with HEV infection with deranged coagulation.

  2. Primary postpartum haemorrhage in women with von Willebrand disease or carriership of haemophilia despite specialised care: a retrospective survey.

    PubMed

    Stoof, S C M; van Steenbergen, H W; Zwagemaker, A; Sanders, Y V; Cannegieter, S C; Duvekot, J J; Leebeek, F W G; Peters, M; Kruip, M J H A; Eikenboom, J

    2015-07-01

    Pregnant women with bleeding disorders require specialised peripartum care to prevent postpartum haemorrhage (PPH). If third trimester coagulation factor levels are <0.50 IU mL(-1) , prophylactic treatment is indicated and administered according to international guidelines. However, optimal dose and duration are unknown and bleeding may still occur. The aim of this study was to investigate the outcome in women with von Willebrand disease (VWD) or haemophilia carriership treated according to current practice guidelines. From the period 2002-2011, 185 deliveries in 154 VWD women or haemophilia carriers were retrospectively included. Data on blood loss, bleeding disorder characteristics and obstetric risk factors were obtained. The outcome was primary PPH, defined as blood loss ≥500 mL within 24 h postpartum and severe PPH as blood loss ≥1000 mL. Primary PPH was observed in 62 deliveries (34%), 14 (8%) of which resulted in severe PPH. In 26 deliveries prophylactic treatment was administered due to factor levels below the 0.50 IU mL(-1) cut-off in the third trimester, 14 of which (54%) were complicated by PPH. We found an increased PPH risk in deliveries given prophylactic treatment compared with deliveries without (OR 2.7, 95% CI 1.2-6.3). In conclusion, PPH incidence was highest in deliveries with the lowest factor levels in the third trimester. Currently, delivery outcome in women with bleeding disorders is unsatisfactory, given the high PPH incidence despite specialised care. Future studies are required to optimise management of deliveries in this patient population. PMID:25688733

  3. Protective role of free and quercetin-loaded nanoemulsion against damage induced by intracerebral haemorrhage in rats

    NASA Astrophysics Data System (ADS)

    Galho, A. R.; Cordeiro, M. F.; Ribeiro, S. A.; Marques, M. S.; Antunes, M. F. D.; Luz, D. C.; Hädrich, G.; Muccillo-Baisch, A. L.; Barros, D. M.; Lima, J. V.; Dora, C. L.; Horn, A. P.

    2016-04-01

    Intracerebral haemorrhage (ICH) is a worldwide public health problem. Experimental studies have shown that oxidative stress plays an important role in the pathogenesis of ICH and could represent a target for its treatment. However, the blood-brain barrier is an obstacle to be overcome, as it hampers the administration of compounds to the central nervous system. In this study, we compared the effects of a quercetin-loaded nanoemulsion (QU-N) with the free form of the drug (QU-SP) in a collagenase-induced ICH rat model. Quercetin (QU) is a polyphenol that has an antioxidant effect in vitro, but due to its high lipophilicity, it has low bioavailability in vivo. In this study, animals submitted or not to ICH were treated with a single intraperitoneal QU dose (free or nanoemulsion) of 30 mg kg-1. Motor assessment was evaluated by the open field, foot fault and beam walking behavioural tests. 72 h after surgery the haematoma size was evaluated and biochemical measurements were performed. Animals treated with QU-N had a significant improvement in the beam walking and open field tests. Also, QU-N was able to reduce the size of the haematoma, preserving the activity of glutathione S-transferase (GST), increasing GSH content, and the total antioxidant capacity. QU-SP recovered locomotor activity and increased the GSH content and the total antioxidant capacity. Thus, it can be observed that QU presented antioxidant activity in both formulations, but the incorporation into nanoemulsions increased its antioxidant effect, which was reflected in the improvement of the motor skills and in the haematoma size decrement. These results suggest that the nanoemulsion containing QU developed in this study could be promising for future studies on treatments for ICH.

  4. Preparing for presymptomatic DNA testing for early onset Alzheimer's disease/cerebral haemorrhage and hereditary Pick disease.

    PubMed Central

    Tibben, A; Stevens, M; de Wert, G M; Niermeijer, M F; van Duijn, C M; van Swieten, J C

    1997-01-01

    The acceptability of presymptomatic testing in 21 people at 50% risk for the APP-692 mutation causing presenile Alzheimer's disease or cerebral haemorrhage resulting from cerebral amyloid angiopathy (FAD-CH), and in 43 people at 50% risk for hereditary Pick disease (HPD) was assessed. Neither group differed in demographic variables. Thirty-nine people (64%) in the whole group would request presymptomatic testing if it were clinically available, although two-thirds did not yet feel ready to take it. The most important reasons in the HPD and FAD-CH group for taking the test were: to further basic research (42% and 47%, respectively), informing children (47% and 50%, respectively), future planning (29% and 47%, respectively), and relieving uncertainty (46% and 27%, respectively). The most commonly cited effect of an unfavourable test result concerned increasing problems for spouses (75% and 76%, respectively) and children (61% and 57%, respectively). Most respondents denied that an unfavourable result would have adverse effects on personal mood or relationship. One-third of all respondents favoured prenatal testing where one of the parents had an increased risk for HPD or FAD-CH. Participants would encourage their offspring to have the test before starting a relationship (35%) and before family planning (44%). Thirty-seven percent of the respondents would encourage their children to opt for prenatal diagnosis. People at risk for HPD were significantly more preoccupied with the occurrence of potential symptoms in themselves, compared with those at risk for FAD-CH, reflecting the devastating impact that disinhibition in the affected patient has on the family. Our findings underline the need for adequate counselling and the availability of professional and community resources to deal with the impact of test results in subjects and their relatives. PMID:9032652

  5. Protective role of free and quercetin-loaded nanoemulsion against damage induced by intracerebral haemorrhage in rats.

    PubMed

    Galho, A R; Cordeiro, M F; Ribeiro, S A; Marques, M S; Antunes, M F D; Luz, D C; Hädrich, G; Muccillo-Baisch, A L; Barros, D M; Lima, J V; Dora, C L; Horn, A P

    2016-04-29

    Intracerebral haemorrhage (ICH) is a worldwide public health problem. Experimental studies have shown that oxidative stress plays an important role in the pathogenesis of ICH and could represent a target for its treatment. However, the blood-brain barrier is an obstacle to be overcome, as it hampers the administration of compounds to the central nervous system. In this study, we compared the effects of a quercetin-loaded nanoemulsion (QU-N) with the free form of the drug (QU-SP) in a collagenase-induced ICH rat model. Quercetin (QU) is a polyphenol that has an antioxidant effect in vitro, but due to its high lipophilicity, it has low bioavailability in vivo. In this study, animals submitted or not to ICH were treated with a single intraperitoneal QU dose (free or nanoemulsion) of 30 mg kg(-1). Motor assessment was evaluated by the open field, foot fault and beam walking behavioural tests. 72 h after surgery the haematoma size was evaluated and biochemical measurements were performed. Animals treated with QU-N had a significant improvement in the beam walking and open field tests. Also, QU-N was able to reduce the size of the haematoma, preserving the activity of glutathione S-transferase (GST), increasing GSH content, and the total antioxidant capacity. QU-SP recovered locomotor activity and increased the GSH content and the total antioxidant capacity. Thus, it can be observed that QU presented antioxidant activity in both formulations, but the incorporation into nanoemulsions increased its antioxidant effect, which was reflected in the improvement of the motor skills and in the haematoma size decrement. These results suggest that the nanoemulsion containing QU developed in this study could be promising for future studies on treatments for ICH. PMID:26965041

  6. Topiramate attenuates early brain injury following subarachnoid haemorrhage in rats via duplex protection against inflammation and neuronal cell death.

    PubMed

    Tian, Yong; Guo, Song-Xue; Li, Jian-Ru; Du, Hang-Gen; Wang, Chao-Hui; Zhang, Jian-Min; Wu, Qun

    2015-10-01

    Early brain injury (EBI) following aneurysmal subarachnoid haemorrhage (SAH) insults contributes to the poor prognosis and high mortality observed in SAH patients. Topiramate (TPM) is a novel, broad-spectrum, antiepileptic drug with a reported protective effect against several brain injuries. The current study aimed to investigate the potential of TPM for neuroprotection against EBI after SAH and the possible dose-dependency of this effect. An endovascular perforation SAH model was established in rats, and TPM was administered by intraperitoneal injection after surgery at three different doses (20mg/kg, 40mg/kg, and 80mg/kg). The animals' neurological scores and brain water content were evaluated, and ELISA, Western blotting and immunostaining assays were conducted to assess the effect of TPM. The results revealed that TPM lowers the elevated levels of myeloperoxidase and proinflammatory mediators observed after SAH in a dose-related fashion, and the nuclear factor-kappa B (NF-κB) signalling pathway is the target of neuroinflammation regulation. In addition, TPM ameliorated SAH-induced cortical neuronal apoptosis by influencing Bax, Bcl-2 and cleaved caspase-3 protein expression, and the effect of TPM was enhanced in a dose-dependent manner. Various dosages of TPM also upregulated the protein expression of the γ-aminobutyric acid (GABA)-ergic signalling molecules, GABAA receptor (GABAAR) α1, GABAAR γ2, and K(+)-Cl(-) co-transporter 2 (KCC2) together and downregulated Na(+)-K(+)-Cl(-) co-transporter 1 (NKCC1) expression. Thus, TPM may be an effective neuroprotectant in EBI after SAH by regulating neuroinflammation and neuronal cell death. PMID:26086367

  7. Improvement in patient outcomes following endovascular treatment of WFNS grade V subarachnoid haemorrhage from 2000 to 2014.

    PubMed

    Inamasu, Joji; Sadato, Akiyo; Oheda, Motoki; Hayakawa, Motoharu; Nakae, Shunsuke; Ohmi, Tatsuo; Adachi, Kazuhide; Nakahara, Ichiro; Hirose, Yuichi

    2016-05-01

    Patient outcomes following grade V subarachnoid haemorrhage (SAH) have been dismal, although they may have improved following recent technological advances in endovascular treatment (EVT). A single-centre, retrospective study was conducted to evaluate whether outcomes have improved from 2000 to 2014 for patients with World Federation of Neurosurgical Societies (WFNS) grade V SAH. Coiling has been the preferred first-line treatment for grade V SAH patients in our institution since 2000. Patients who underwent EVT (n=115) were grouped on the basis of their hospital admission year: 2000-2004 (n=44), 2005-2009 (n=37) and 2010-2014 (n=34). Patient demographics, outcomes and in-hospital mortality rates were compared between the groups. Patient outcomes at discharge were evaluated using the Glasgow Outcome Scale (GOS), with GOS scores of 4-5 defined as favourable outcomes. There were no significant intergroup differences in patient demographics. In addition, there were no significant differences in the frequencies of favourable outcomes (14% in 2000-2004, 16% in 2005-2009 and 26% in 2010-2014). Mortality rates were 52% in 2000-2004, 43% in 2005-2009 and 24% in 2010-2014, with a significantly lower mortality rate in 2010-2014 than in 2000-2004 (p=0.01). Both perioperative rebleeding and delayed cerebral ischaemia decreased over time; however, multivariate regression analysis showed that the former contributed more to the decrease in mortality. Age was the only variable associated with favourable outcomes. The results of this study indicate that EVT is an appropriate therapeutic option for grade V SAH patients. However, multi-centre, prospective trials are required to provide evidence-based verification of the efficacy of EVT. PMID:26778358

  8. Prediction of two month modified Rankin Scale with an ordinal prediction model in patients with aneurysmal subarachnoid haemorrhage

    PubMed Central

    2010-01-01

    Background Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating event with a frequently disabling outcome. Our aim was to develop a prognostic model to predict an ordinal clinical outcome at two months in patients with aSAH. Methods We studied patients enrolled in the International Subarachnoid Aneurysm Trial (ISAT), a randomized multicentre trial to compare coiling and clipping in aSAH patients. Several models were explored to estimate a patient's outcome according to the modified Rankin Scale (mRS) at two months after aSAH. Our final model was validated internally with bootstrapping techniques. Results The study population comprised of 2,128 patients of whom 159 patients died within 2 months (8%). Multivariable proportional odds analysis identified World Federation of Neurosurgical Societies (WFNS) grade as the most important predictor, followed by age, sex, lumen size of the aneurysm, Fisher grade, vasospasm on angiography, and treatment modality. The model discriminated moderately between those with poor and good mRS scores (c statistic = 0.65), with minor optimism according to bootstrap re-sampling (optimism corrected c statistic = 0.64). Conclusion We presented a calibrated and internally validated ordinal prognostic model to predict two month mRS in aSAH patients who survived the early stage up till a treatment decision. Although generalizability of the model is limited due to the selected population in which it was developed, this model could eventually be used to support clinical decision making after external validation. Trial Registration International Standard Randomised Controlled Trial, Number ISRCTN49866681 PMID:20920243

  9. Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial

    PubMed Central

    Deneux-Tharaux, Catherine; Dupont, Corinne; Colin, C.; Rabilloud, Muriel; Touzet, S.; Lansac, Jacques; Harvey, Thierry; Tessier, Véronique; Chauleur, C.; Pennehouat, G.; Morin, X.; Bouvier-Colle, Marie-Hélène; Rudigoz, René

    2010-01-01

    Objective Decreasing the prevalence of severe postpartum haemorrhages (PPH) is a major obstetrical challenge. These are often considered to be associated with substandard initial care. Strategies to increase the appropriateness of early management of PPH must be assessed. We tested the hypothesis that a multifaceted intervention aimed at increasing the translation into practice of a protocol for early management of PPH, would reduce the incidence of severe PPH. Design Cluster-randomised trial Population 106 maternity units in 6 French regions Methods Maternity units were randomly assigned to receive the intervention, or to have the protocol passively disseminated. The intervention combined outreach visits to discuss the protocol in each local context, reminders, and peer reviews of severe cases, and was implemented in each maternity hospital by a team pairing an obstetrician and a midwife. Main outcome measures The primary outcome was the incidence of severe PPH, defined as a composite of one or more of: transfusion, embolisation, surgical procedure, transfer to intensive care, peripartum haemoglobin delta of 4 g/dl or more, death. The main secondary outcomes were PPH management practices. Results The mean rate of severe PPH was 1.64% (SD0.80) in the intervention units and 1.65% (SD0.96) in control units; difference not significant. Some elements of PPH management were applied more frequently in intervention units –help from senior staff (p=0.005)-, or tended to – second line pharmacological treatment (p=0.06), timely blood test (p=0.09). Conclusion This educational intervention did not affect the rate of severe PPH as compared to control units, although it improved some practices. Trial registration: ClinicalTrials.gov NCT 00344929 PMID:20573150

  10. Soluble Toll-Like Receptors 2 and 4 in Cerebrospinal Fluid of Patients with Acute Hydrocephalus following Aneurysmal Subarachnoid Haemorrhage

    PubMed Central

    Sokół, Bartosz; Jankowski, Roman; Hołysz, Marcin; Więckowska, Barbara; Jagodziński, Paweł

    2016-01-01

    Background Toll-like receptor (TLR) signalling begins early in subarachnoid haemorrhage (SAH), and plays a key role in inflammation following cerebral aneurysm rupture. Available studies suggest significance of endogenous first-line blockers of a TLR pathway—soluble TLR2 and 4. Methods Eighteen patients with SAH and acute hydrocephalus underwent endovascular coiling and ventriculostomy; sTLR2 and 4 levels were assayed in cerebrospinal fluid (CSF) collected on post-SAH days 0–3, 5, and 10–12. Release kinetics were defined. CSF levels of sTLR2 and 4 were compared with a control group and correlated with the clinical status on admission, the findings on imaging, the degree of systemic inflammation and the outcome following treatment. Results None of study group showed detectable levels of sTLR2 and 4 on post-SAH day 0–3. 13 patients showed increased levels in subsequent samples. In five SAH patients sTLR2 and 4 levels remained undetectable; no distinctive features of this group were found. On post-SAH day 5 the strongest correlation was found between sTLR2 level and haemoglobin level on admission (cc = -0.498, P = 0.037). On post-SAH day 10–12 the strongest correlation was revealed between sTLR2 and treatment outcome (cc = -0.501, P = 0.076). Remaining correlations with treatment outcome, status at admission, imaging findings and inflammatory markers on post-SAH day 5 and 10–12 were negligible or low (-0.5 ≤ cc ≤ 0.5). Conclusions In the majority of cases, rupture of a cerebral aneurysm leads to delayed release of soluble TLR forms into CSF. sTLR2 and 4 seem to have minor role in human post-SAH inflammation due to delayed release kinetics and low levels of these protein. PMID:27223696

  11. Protocol for a systematic review of the clinical effectiveness of pre-hospital blood components compared to other resuscitative fluids in patients with major traumatic haemorrhage

    PubMed Central

    2014-01-01

    Background There is growing interest in the use of blood components for pre-hospital resuscitation of patients with major traumatic haemorrhage. It has been speculated that early resuscitation with blood components may have benefits in terms of treating trauma-induced coagulopathy, which in turn may influence survival. The proposed systematic review will evaluate the evidence on the clinical effectiveness of pre-hospital blood components (red blood cells and/or plasma or whole blood), in both civilian and military settings, compared with other resuscitation strategies in patients with major traumatic haemorrhage. Methods/design Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. General medical and specialist databases will be searched; the search strategy will combine terms for the population, intervention and setting. Studies will be selected for review if the population includes adult patients with major traumatic haemorrhage who receive blood components in a pre-hospital setting (civilian or military). Systematic reviews, randomised and non-randomised controlled trials and controlled observational studies will be included. Uncontrolled studies will be considered depending on the volume of controlled evidence. Quality assessment will be tailored to different study designs. Both patient related and surrogate outcomes will be considered. Synthesis is likely to be primarily narrative, but meta-analyses and subgroup analyses will be undertaken where clinical and methodological homogeneity exists. Discussion Given the increasing use by emergency services of blood components for pre-hospital resuscitation, this is a timely systematic review, which will attempt to clarify the evidence base for this practice. As far as the authors are aware, the proposed systematic review will be the first to address this topic. Systematic review registration PROSPERO CRD42014013794 PMID:25344301

  12. The Effect of the Combined Use of Methylergonovine and Oxytocin during Caesarean Section in the Prevention of Post-partum Haemorrhage.

    PubMed

    Şentürk, Şenol; Kağıtçı, Mehmet; Balık, Gülşah; Arslan, Halit; Kır Şahin, Figen

    2016-05-01

    We aimed to show to patients the benefit of post-partum haemorrhage prophylaxis treatment and the effectiveness as a uterotonic agent of the combined use of methylergonovine and oxytocin infusion in the prevention of haemorrhage during and after Caesarean section, by comparison with a control group which received oxytocin infusion only. Two groups of patients undergoing Caesarean section at the same clinic were included in the study. A combination of methylergonovine and oxytocin was administered to the first group during the intra-operative and post-operative periods. The second group did not receive methylergonovine and was administered only with oxytocin infusion in the intra-operative and post-operative periods. Pre-operative and post-operative haemogram readings were taken for all patients in each of the groups for comparison. No difference was found between the two groups with regard to mean ages and pre-operative haemogram values. The decrease in post-operative haemoglobin values for the group administered with methylergonovine maleate and oxytocin was found to be significantly greater than for the group administered with oxytocin only. Results indicated that prophylactic methylergonovine treatment was clearly successful for the patients and no adverse side effects were found. The routine use of methylergonovine and oxytocin infusion in combination during the intra-operative period of Caesarean section reduced the level of post-partum haemorrhage considerably. We believe that this procedure will also reduce the risk of uterine atony, but clearly, prospective studies will be necessary in future to confirm this assumption. PMID:26449959

  13. Diagnostic yield and accuracy of CT angiography, MR angiography, and digital subtraction angiography for detection of macrovascular causes of intracerebral haemorrhage: prospective, multicentre cohort study

    PubMed Central

    Velthuis, Birgitta K; Rinkel, Gabriël J E; Algra, Ale; de Kort, Gérard A P; Witkamp, Theo D; de Ridder, Johanna C M; van Nieuwenhuizen, Koen M; de Leeuw, Frank-Erik; Schonewille, Wouter J; de Kort, Paul L M; Dippel, Diederik W; Raaymakers, Theodora W M; Hofmeijer, Jeannette; Wermer, Marieke J H; Kerkhoff, Henk; Jellema, Korné; Bronner, Irene M; Remmers, Michel J M; Bienfait, Henri Paul; Witjes, Ron J G M; Greving, Jacoba P; Klijn, Catharina J M

    2015-01-01

    Study question What are the diagnostic yield and accuracy of early computed tomography (CT) angiography followed by magnetic resonance imaging/angiography (MRI/MRA) and digital subtraction angiography (DSA) in patients with non-traumatic intracerebral haemorrhage? Methods This prospective diagnostic study enrolled 298 adults (18-70 years) treated in 22 hospitals in the Netherlands over six years. CT angiography was performed within seven days of haemorrhage. If the result was negative, MRI/MRA was performed four to eight weeks later. DSA was performed when the CT angiography or MRI/MRA results were inconclusive or negative. The main outcome was a macrovascular cause, including arteriovenous malformation, aneurysm, dural arteriovenous fistula, and cavernoma. Three blinded neuroradiologists independently evaluated the images for macrovascular causes of haemorrhage. The reference standard was the best available evidence from all findings during one year’s follow-up. Study answer and limitations A macrovascular cause was identified in 69 patients (23%). 291 patients (98%) underwent CT angiography; 214 with a negative result underwent additional MRI/MRA and 97 with a negative result for both CT angiography and MRI/MRA underwent DSA. Early CT angiography detected 51 macrovascular causes (yield 17%, 95% confidence interval 13% to 22%). CT angiography with MRI/MRA identified two additional macrovascular causes (18%, 14% to 23%) and these modalities combined with DSA another 15 (23%, 18% to 28%). This last extensive strategy failed to detect a cavernoma, which was identified on MRI during follow-up (reference strategy). The positive predictive value of CT angiography was 72% (60% to 82%), of additional MRI/MRA was 35% (14% to 62%), and of additional DSA was 100% (75% to 100%). None of the patients experienced complications with CT angiography or MRI/MRA; 0.6% of patients who underwent DSA experienced permanent sequelae. Not all patients with negative CT angiography and

  14. Leptospirosis among the self-supporting convicts of Andaman Island during the 1920s - the first report on pulmonary haemorrhage in leptospirosis?

    PubMed Central

    Vijayachari, P.; Sugunan, A.P.; Singh, S.S.; Mathur, P.P.

    2015-01-01

    Several researchers had carried out investigations on the possibility of existence of Weil's disease in Andaman Islands during early 20th century. The first report of a series of confirmed cases of leptospirosis that occurred during1929 was published in 1931. There were several reports during 1995 to 2009 that described detailed account of leptospirosis including various clinical syndromes. The possibility of pulmonary involvement in leptospirosis being a manifestation historically overlooked rather than newly emerged during the past two decades is examined in this review in the context of Andaman Islands. Two case series of leptospirosis, one occurred in 1929 and the other in 1996-1997 were reviewed with special emphasis on pulmonary involvement and haemorrhagic manifestations. The similarities and differences in the clinical profile of patients of the two case series were analysed. The review shows that respiratory system involvement and pulmonary haemorrhage as evidenced by presence of haemoptysis as a complication of leptospirosis was occurring during 1920s in Andaman Islands. The incidence of pulmonary involvement, however, rose from 9.4 per cent during 1929 to 52 per cent in 1996-1997. The case fatality ratio in patients with pulmonary involvement, which was 50 per cent during 1929 and 42.9 per cent during 1996-1997, was higher than that in cases without pulmonary involvement. Fever, conjunctival congestion, jaundice, vomiting, diarrhoea, hepatomagaly, haemoptysis, haematemesis and subconjunctival haemorrhage were common in both series. The case series in Andaman Islands in 1929 was probably the first report of pulmonary haemorrhage as a manifestation of leptospirosis. The increase in the incidence of pulmonary involvement in leptospirosis in the recent past is probably due to the increase in the density and diversityof its animal vectors, the broadening of the range of circulating serovars and the interactions between the vector and the agent. An increased

  15. Hidden threat of tortoise ticks: high prevalence of Crimean-Congo haemorrhagic fever virus in ticks Hyalomma aegyptium in the Middle East

    PubMed Central

    2014-01-01

    It is the first time that Crimean-Congo haemorrhagic fever virus (CCHFV), causing potentially lethal disease of humans, has been reported from the Middle East region and from the tortoise tick Hyalomma aegyptium from a tortoise host, whose epidemiological significance may have remained almost completely overlooked so far. We used RT-PCR to screen for 245 ticks collected from 38 Testudo graeca tortoise individuals. Results of our genetic screening provide unambiguous evidence of occurrence of CCHFV in this region and host, suggesting a potentially important role of H. aegyptium in CCHF epidemiology. PMID:24618184

  16. Early treatment of acute submacular haemorrhage secondary to wet AMD using intravitreal tissue plasminogen activator, C3F8, and an anti-VEGF agent.

    PubMed

    de Silva, S R; Bindra, M S

    2016-07-01

    PurposeAcute submacular haemorrhage secondary to wet age-related macular degeneration (AMD) has a poor prognosis for which there is currently no 'gold standard' treatment. We evaluated the efficacy of early treatment using intravitreal triple therapy of tissue plasminogen activator (tPA), expansile gas, and an anti-VEGF agent.MethodsThis retrospective case series included eight patients presenting with acute submacular haemorrhage involving the fovea. All patients received treatment with 50 μg (0.05 ml) tPA, 0.3 ml 100% perfluoropropane (C3F8), and an anti-VEGF agent (0.05 mg Ranibizumab or 1.25 mg Bevacizumab in 0.05 ml) administered via intravitreal injection. An anterior chamber paracentesis post injection or vitreous tap was performed before injection to prevent retinal vascular occlusion secondary to raised intra-ocular pressure. Outcomes assessed were visual acuity, change in macular morphology, and complications.ResultsPatients presented promptly with delay between symptom onset and clinic review being 1.9±0.6 days (mean±SD). Treatment was delivered quickly with interval from presentation to treatment being 1.1±1.2 days. Symptom onset to treatment was 3.0±1.0 days. Subfoveal haemorrhage was effectively displaced in all patients. LogMAR visual acuity improved from 1.67±0.47 at presentation to 0.63±0.33 at final follow-up (P<0.0001), a mean of 7.9±4.8 months after treatment. Central retinal thickness improved from 658.1±174.2 μm at presentation to 316.6±142.4 μm at final follow-up (P=0.0028).ConclusionsEarly treatment of submacular haemorrhage using intravitreal tPA, C3F8, and anti-VEGF was effective in significantly improving visual acuity in this series of patients who presented soon after symptom onset. Treatment was well tolerated in this group of elderly and potentially frail patients. PMID:27080482

  17. Marburg Haemorrhagic Fever

    MedlinePlus

    ... control measures and reinforcement of standard precautions, particularly hand hygiene, use of personal protective equipment (PPE), safe injection ... the basic level of infection control and include hand hygiene, use of personal protective equipment to avoid direct ...

  18. Management of gastrointestinal haemorrhage

    PubMed Central

    Ghosh, S; Watts, D; Kinnear, M

    2002-01-01

    A variety of endoscopic haemostatic techniques have enabled major advances in the management of not only bleeding peptic ulcers and bleeding varices, but also in a variety of bleeding lesions in the small intestine and in the colon. Indeed, the development and widespread implementation of endoscopic haemostasis has been one of the most important developments in clinical gastroenterology in the past two decades. An increasingly ageing cohort of patients with multiple co-morbidity are being treated and therefore improving the outcome of gastrointestinal bleeding continues to pose major challenges. PMID:11796865

  19. Surgical Trial In Traumatic intraCerebral Haemorrhage (STITCH): a randomised controlled trial of Early Surgery compared with Initial Conservative Treatment.

    PubMed Central

    Gregson, Barbara A; Rowan, Elise N; Francis, Richard; McNamee, Paul; Boyers, Dwayne; Mitchell, Patrick; McColl, Elaine; Chambers, Iain R; Unterberg, Andreas; Mendelow, A David

    2015-01-01

    BACKGROUND While it is accepted practice to remove extradural (EDH) and subdural haematomas (SDH) following traumatic brain injury, the role of surgery in parenchymal traumatic intracerebral haemorrhage (TICH) is controversial. There is no evidence to support Early Surgery in this condition. OBJECTIVES There have been a number of trials investigating surgery for spontaneous intracerebral haemorrhage but none for TICH. This study aimed to establish whether or not a policy of Early Surgery for TICH improves outcome compared with a policy of Initial Conservative Treatment. DESIGN This was an international multicentre pragmatic parallel group trial. Patients were randomised via an independent telephone/web-based randomisation service. SETTING Neurosurgical units in 59 hospitals in 20 countries registered to take part in the study. PARTICIPANTS The study planned to recruit 840 adult patients. Patients had to be within 48 hours of head injury with no more than two intracerebral haematomas greater than 10 ml. They did not have a SDH or EDH that required evacuation or any severe comorbidity that would mean they could not achieve a favourable outcome if they made a complete recovery from their head injury. INTERVENTIONS Patients were randomised to Early Surgery within 12 hours or to Initial Conservative Treatment with delayed evacuation if it became clinically appropriate. MAIN OUTCOME MEASURES The Extended Glasgow Outcome Scale (GOSE) was measured at 6 months via a postal questionnaire. The primary outcome was the traditional dichotomised split into favourable outcome (good recovery or moderate disability) and unfavourable outcome (severe disability, vegetative, dead). Secondary outcomes included mortality and an ordinal assessment of Glasgow Outcome Scale and Rankin Scale. RESULTS Patient recruitment began in December 2009 but was halted by the funding body because of low UK recruitment in September 2012. In total, 170 patients were randomised from 31 centres in 13

  20. Pox-like lesions and haemorrhagic fever in two concurrent cases in the Central African Republic: case investigation and management in difficult circumstances

    PubMed Central

    Froeschl, Guenter; Kayembe, Pitchou Kasongo

    2015-01-01

    Cases of monkeypox in humans are frequently reported from the Democratic Republic of Congo. The few reports from the Central African Republic have been limited to cases in the far South closely bordering the Congos. Team members of an international medical organisation have suspected clinically two human cases of MPX, associated with clinical signs of coagulopathy and haemorrhage in the North of the country. Key findings were history of a squirrel, fever and vesicular dermal eruptions. Subsequently patients developed profuse epistaxis and hematemesis, associated with clinical signs of shock. Both patients were isolated and treated symptomatically. Samples were sent to a regional reference laboratory, who initially issued a confirmation of the suspected diagnosis of MPX in both cases. The result was later revised, and additional analyses of samples could not confirm the diagnosis. PMID:26664524