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1

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

USGS Publications Warehouse

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).

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

2

Eighteen years of vaccination against viral haemorrhagic septicaemia in France  

E-print Network

Eighteen years of vaccination against viral haemorrhagic septicaemia in France P de Kinkelin M. This provided the impetus for immuno- prophylaxis development that resulted in 3 successive types of vaccines: inactivated, live attenuated and recombinant vaccines. When delivered by intraperitoneal injection, the 2

Paris-Sud XI, Université de

3

Selection of rainbow trout resistant to viral haemorrhagic septicaemia virus and transmission  

E-print Network

Selection of rainbow trout resistant to viral haemorrhagic septicaemia virus and transmission a programme of selection for resistance to viral haemorrhagic septicaemia virus (VHSV) in rainbow trout poorly as compared with the fins of susceptible fish. rainbow trout / selection / viral haemorrhagic

Paris-Sud XI, Université de

4

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

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.

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

2013-01-01

5

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

PubMed

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. PMID:23305522

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

2013-08-01

6

The olive leaf extract exhibits antiviral activity against viral haemorrhagic septicaemia rhabdovirus (VHSV)  

Microsoft Academic Search

A commercial plant extract derived from olive tree leaf (Olea europaea) (LExt) and its major compound, oleuropein (Ole), inhibited the in vitro infectivity of the viral haemorrhagic septicaemia virus (VHSV), a salmonid rhabdovirus. Incubation of virus with LExt or Ole before infection reduced the viral infectivity to 10 and 30%, respectively. Furthermore, LExt drastically decreased VHSV titers and viral protein

Vicente Micol; Nuria Caturla; Laura Pérez-Fons; Vicente Más; Luis Pérez; Amparo Estepa

2005-01-01

7

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

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.

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

2007-01-01

8

Protective immunity to VHS in rainbow trout ( Oncorhynchus mykiss , Walbaum) following DNA vaccination  

Microsoft Academic Search

Rainbow trout fingerlings were immunized by intramuscular injection of a plasmid DNA vector encoding the viral haemorrhagic septicaemia virus (VHSV) glycoprotein (G) or nucleocapsid protein (N) genes under the control of a cytomegalovirus promoter. Challenge with VHSV 52 days later demonstrated that both viral genes, and the G gene in particular, were able to induce protective immunity against VHS. In

N. LORENZEN; E. LORENZEN; K. EINER-JENSEN; J. HEPPELL; T. WU; H. DAVIS

1998-01-01

9

MLST typing of Pasteurella multocida associated with haemorrhagic septicaemia and development of a real-time PCR specific for haemorrhagic septicaemia associated isolates.  

PubMed

Two serovars of Pasteurella multocida, B:2 and E:2, have been reportedly associated with haemorrhagic septicaemia (HS), a peracute and devastating disease mainly affecting cattle and water buffaloes. We multilocus sequence typed (MLST) 64 isolates of P. multocida including 55 associated with HS and found that they mainly included sequence type (ST) 122 (n=50) and rarely ST63 (n=1), ST147 (n=2) and ST162 (n=2) compared to other members of the species isolated from other lesion types and hosts. Single-nucleotide polymorphisms suitable for specific detection of STs associated with HS were detected in the est gene. A new HS-est-RT-PCR (est indicating the target gene) specifically detected ST122, ST63, ST147 and ST162 associated with HS. The new HS-est-RT-PCR did not detect strains of ST151 with capsular type D isolated from pigs that were found positive with a previously published HS PCR detection method. The new HS-est-RT-PCR represents a fast and specific detection of the specific types of P. multocida involved in HS. The HS-est-RT-PCR developed in the current study seems to more accurately identify isolates of P. multocida associated with HS compared to PCR detection methods previously published. PMID:24636905

Petersen, Andreas; Bisgaard, Magne; Townsend, Kirsty; Christensen, Henrik

2014-06-01

10

The olive leaf extract exhibits antiviral activity against viral haemorrhagic septicaemia rhabdovirus (VHSV).  

PubMed

A commercial plant extract derived from olive tree leaf (Olea europaea) (LExt) and its major compound, oleuropein (Ole), inhibited the in vitro infectivity of the viral haemorrhagic septicaemia virus (VHSV), a salmonid rhabdovirus. Incubation of virus with LExt or Ole before infection reduced the viral infectivity to 10 and 30%, respectively. Furthermore, LExt drastically decreased VHSV titers and viral protein accumulation (virucidal effect) in a dose dependent manner when added to cell monolayers 36 h post-infection. On the other hand, both the LExt and Ole were able to inhibit cell-to-cell membrane fusion induced by VHSV in uninfected cells, suggesting interactions with viral envelope. Therefore, we propose that O. europaea could be used as a potential source of promising natural antivirals, which have demonstrated to lack impact on health and environment. In addition, Ole could be used to design other related antiviral agents. PMID:15869811

Micol, Vicente; Caturla, Nuria; Pérez-Fons, Laura; Más, Vicente; Pérez, Luis; Estepa, Amparo

2005-06-01

11

Development of a rapid, sensitive and non-lethal diagnostic assay for the detection of viral haemorrhagic septicaemia virus  

Microsoft Academic Search

A non-lethal diagnostic procedure based on polymerase chain reaction (PCR) technology was developed to detect viral haemorrhagic septicaemia virus (VHSV). Sensitivity of the assay was tested using purified viral RNA and seeded tissues. Detection limits of the reverse transcriptase-polymerase chain reaction (RT-PCR) assay were estimated to be 10fg of purified RNA and 0.97×103 or 100TCID50\\/g of seeded tissue, depending on

C. López-Vázquez; C. P. Dopazo; J. G. Olveira; J. L. Barja; I. Bandín

2006-01-01

12

An RNA-binding domain in the viral haemorrhagic septicaemia virus nucleoprotein.  

PubMed

The gene encoding the nucleoprotein (N) and PCR-derived subfragments from viral haemorrhagic septicaemia virus (VHSV), a salmonid rhabdovirus, were overexpressed in Escherichia coli BL21(DE3) transformed by recombinant expression vector pET-14b containing N and PCR-generated sub-fragment cDNAs under the control of the T7 RNA polymerase promoter. Following induction with IPTG, recombinant His-tagged proteins were expressed, purified by affinity metal chelation chromatography under denaturing conditions and renatured. Protein blots were hybridized with various radiolabelled nucleic acid probes. Results obtained using genomic or messenger virus RNA as a probe indicated that the middle part of N was possibly an RNA-binding domain. To confirm this observation, two more accurate approaches were undertaken: (i) a gel retardation assay of RNA and purified protein complexes was done; and (ii) RNA-protein complexes were cross-linked by UV light and analysed on a denaturing polyacrylamide gel. All these experiments led us to conclude that the middle part of N is the domain which interacts with RNA, despite the absence of homology with known consensus amino acid sequences of other RNA-binding proteins. PMID:9460921

Said, T; Bruley, H; Lamoureux, A; Brémont, M

1998-01-01

13

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

PubMed

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:24750574

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

2013-10-01

14

Do imports of rainbow trout carcasses risk introducing viral haemorrhagic septicaemia virus into England and Wales?  

PubMed

A qualitative import risk assessment was undertaken to assess the likelihood of introduction and establishment of viral haemorrhagic septicaemia virus (VHSV) genotype 1a in England and Wales (E&W), via the processing of imported rainbow trout (Oncorhynchus mykiss) carcasses from continental Europe. The likelihood was estimated for one import from an infected farm. Four main routes by which susceptible populations could be exposed to VHSV via processing waste were considered: (i) run-off from solid waste to watercourses, (ii) contamination of birds or rodents with VHSV by scavenging solid waste, (iii) discharge of liquid waste to mains drainage, and (iv) discharge of liquid waste directly to watercourses. Data on the biophysical characteristics of VHSV, its epidemiology, fish processing practices and waste management were collected. Likelihoods for each step of the four pathways were estimated. Pathway 4 (discharge of liquid waste to a watercourse) was judged as the most likely to result in infection of susceptible individuals. Levels of virus entering the aquatic environment via pathways 1-3 were judged to be many times lower than pathway 4 due mainly to the treatment of solid waste (pathways 1 and 2) and high levels of dilution (pathways 1, 2 and 3). Thirty-four trout farms process fish, of which seven have imported carcasses for processing. Compared with other processing facilities, on-farm processing results in a higher likelihood of VHSV exposure and establishment via all four pathways. Data availability was an issue; the analysis was particularly constrained by a lack of data on the prevalence of VHSV in Europe, volume of trade of carcasses into the UK and processing practices in E&W. It was concluded that the threat of VHSV introduction into E&W could be reduced by treatment of liquid effluent from processing plants and by sourcing carcasses for on-farm processing only from approved VHSV free areas. PMID:23095349

Pearce, F M; Oidtmann, B C; Thrush, M A; Dixon, P F; Peeler, E J

2014-06-01

15

Validation of real time RT-PCR applied to cell culture for diagnosis of any known genotype of viral haemorrhagic septicaemia virus  

Microsoft Academic Search

Viral haemorrhagic septicaemia virus (VHSV), a member of the Rhabdoviridae family, is a major viral pathogen of cultured salmonid fish, and also infects a wide range of marine fish species. In the present study, two real time PCR protocols (based on SYBR Green and TaqMan®) were developed for the detection of strains belonging to all known genotypes of VHSV. Validation

J. M. Cutrín; J. G. Olveira; I. Bandín; C. P. Dopazo

2009-01-01

16

Transcriptome analysis of rainbow trout in response to non-virion (NV) protein of viral haemorrhagic septicaemia virus (VHSV).  

PubMed

The non-virion (NV) protein of viral haemorrhagic septicaemia virus (VHSV), an economically important fish novirhabdovirus, has been implicated in the interference of some host innate mechanisms (i.e. apoptosis) in vitro. This work aimed to characterise the immune-related transcriptome changes in rainbow trout induced by NV protein that have not yet been established in vivo. For that purpose, immune-targeted microarrays were used to analyse the transcriptomes from head kidney and spleen of rainbow trout (Oncorhynchus mykiss) after injection of recombinant NV (rNV). Results showed the extensive downregulation (and in some cases upregulation) of many innate and adaptive immune response genes not related previously to VHSV infection. The newly identified genes belonged to VHSV-induced genes (vigs), tumour necrosis factors, Toll-like receptors, antigen processing and presentation, immune co-stimulatory molecules, interleukins, macrophage chemotaxis, transcription factors, etc. Classification of differentially downregulated genes into rainbow trout immune pathways identified stat1 and jun/atf1 transcription factor genes as the most representative of the multipath gene targets of rNV. Altogether, these results contribute to define the role and effects of NV in trout by orchestrating an immunosuppression of the innate immune responses for favouring viral replication upon VHSV infection. Finally, these transcriptome results open up the possibility to find out new strategies against VHSV and better understand the interrelationships between some immune pathways in trout. PMID:25592735

Chinchilla, Blanca; Encinas, Paloma; Estepa, Amparo; Coll, Julio M; Gomez-Casado, Eduardo

2015-02-01

17

Development of a rapid, sensitive and non-lethal diagnostic assay for the detection of viral haemorrhagic septicaemia virus.  

PubMed

A non-lethal diagnostic procedure based on polymerase chain reaction (PCR) technology was developed to detect viral haemorrhagic septicaemia virus (VHSV). Sensitivity of the assay was tested using purified viral RNA and seeded tissues. Detection limits of the reverse transcriptase-polymerase chain reaction (RT-PCR) assay were estimated to be 10 fg of purified RNA and 0.97 x 10(3) or 10(0) TCID(50)/g of seeded tissue, depending on the experimental approach employed (viral adsorption allowed for 1 or 24h). Addition of nested PCR increased sensitivity up to 100-fold when cDNA excised from the agarose gel was used as template. Both, RT-PCR and nested RT-PCR, as well as Southern blot were applied to RNA extracted from blood of experimentally infected brown trout and the results were compared with those obtained by applying the same techniques to tissues and also with those of conventional viral isolation in cell culture. The superiority of the nested RT-PCR applied to blood samples has been clearly demonstrated in terms of sensitivity, obtaining positive results in 85% of fish tested, as against 40% obtained by RT-PCR and Southern blot, and only 5% viral isolations in cell culture. This procedure could turn into an important tool for screening of wild stocks as well as valuable individuals in commercial fish farms, since it makes to kill the fish unnecessary. PMID:16332395

López-Vázquez, C; Dopazo, C P; Olveira, J G; Barja, J L; Bandín, I

2006-05-01

18

Susceptibility of various Japanese freshwater fish species to an isolate of viral haemorrhagic septicaemia virus (VHSV) genotype IVb.  

PubMed

Genotype IVb of viral haemorrhagic septicaemia virus (VHSV) was isolated for the first time in the Great Lakes basin in 2003, where it spread and caused mass mortalities in several wild fish species throughout the basin. In order to prevent further spreading of the disease and to assess risks of new genotypes invading new watersheds, basic microbiological information such as pathogenicity studies are essential. In this study, experimental infections were conducted on 7 indigenous freshwater fish species from Japan by immersion with a VHSV genotype IVb isolate. In Expt 1, cumulative mortalities in bluegill Lepomis macrochirus used as positive controls, Japanese fluvial sculpin Cottus pollux, and iwana Salvelinus leucomaenis pluvius were 50, 80 and 0%, respectively. In Expt 2, cumulative mortalities of 100, 100 and 10% were observed in Japanese fluvial sculpin C. pollux, Japanese rice fish Oryzias latipes and yoshinobori Rhinogobius sp., respectively. No mortality was observed in honmoroko Gnathopogon caerulescens, akaza Liobagrus reini or Japanese striped loach Cobitis biwae. VHSV was detected by RT-PCR from samples of kidney, spleen, and brain from all dead fish, and virus re-isolation by cell culture was successful from all dead fish. We detected the virus in the brain from a few surviving bluegill 50 d post exposure by both cell culture and RT-PCR. These results revealed that VHSV IVb could become a serious threat to wild freshwater fish species in Japan, and that some surviving fish might become healthy carriers of the virus. PMID:24270018

Ito, Takafumi; Olesen, Niels Jørgen

2013-11-25

19

Epidemiological aspects of viral haemorrhagic septicaemia virus genotype II isolated from Baltic herring, Clupea harengus membras L.  

PubMed

This study was carried out to clarify the role of wild fish, especially Baltic herring, Clupea harengus membras L., in the epidemiology of viral haemorrhagic septicaemia virus (VHSV) in brackish water in Finland. Baltic herring with no visible signs of disease were collected from the Archipelago Sea, the Gulf of Bothnia and the eastern Gulf of Finland. In total, 7580 herring were examined by virus isolation as 758 pooled samples and 3029 wild salmonid broodfish as pooled samples during 2004-2006. VHSV was isolated from 51 pooled herring samples in bluegill fibroblast-2 cells, but not in epithelioma papulosum cyprini cells. The majority of isolations were from the coastal archipelago and from fish caught during the spawning season. Based on glycoprotein (G) gene sequences, the virus was classified as a member of genotype II of VHSV. Pairwise comparisons of the G gene regions of herring isolates revealed that all the isolates were closely related, with 98.8-100% nucleotide homology. Phylogenetic analyses revealed that they were closely related to the strains isolated previously from herring and sprat, Sprattus sprattus (L.), in Gotland and to the VHSV isolates from European river lamprey, Lampetra fluviatilis (L.), in the rivers that flow into the Bothnian Bay. The infection in Baltic herring is likely to be independent of the VHSV Id epidemic in farmed rainbow trout, Oncorhynchus mykiss (Walbaum). PMID:21623835

Gadd, T; Jakava-Viljanen, M; Tapiovaara, H; Koski, P; Sihvonen, L

2011-07-01

20

Model for ranking freshwater fish farms according to their risk of infection and illustration for viral haemorrhagic septicaemia.  

PubMed

We developed a model to calculate a quantitative risk score for individual aquaculture sites. The score indicates the risk of the site being infected with a specific fish pathogen (viral haemorrhagic septicaemia virus (VHSV); infectious haematopoietic necrosis virus, Koi herpes virus), and is intended to be used for risk ranking sites to support surveillance for demonstration of zone or member state freedom from these pathogens. The inputs to the model include a range of quantitative and qualitative estimates of risk factors organised into five risk themes (1) Live fish and egg movements; (2) Exposure via water; (3) On-site processing; (4) Short-distance mechanical transmission; (5) Distance-independent mechanical transmission. The calculated risk score for an individual aquaculture site is a value between zero and one and is intended to indicate the risk of a site relative to the risk of other sites (thereby allowing ranking). The model was applied to evaluate 76 rainbow trout farms in 3 countries (42 from England, 32 from Italy and 2 from Switzerland) with the aim to establish their risk of being infected with VHSV. Risk scores for farms in England and Italy showed great variation, clearly enabling ranking. Scores ranged from 0.002 to 0.254 (mean score 0.080) in England and 0.011 to 0.778 (mean of 0.130) for Italy, reflecting the diversity of infection status of farms in these countries. Requirements for broader application of the model are discussed. Cost efficient farm data collection is important to realise the benefits from a risk-based approach. PMID:24815039

Oidtmann, Birgit C; Pearce, Fiona M; Thrush, Mark A; Peeler, Edmund J; Ceolin, Chiara; Stärk, Katharina D C; Dalla Pozza, Manuela; Afonso, Ana; Diserens, Nicolas; Reese, R Allan; Cameron, Angus

2014-08-01

21

Development of a walleye cell line and use to study the effects of temperature on infection by viral haemorrhagic septicaemia virus group IVb.  

PubMed

A cell line, WE-cfin11f, with a fibroblast-like morphology was developed from a walleye caudal fin and used to study the intersection of thermobiology of walleye, Sander vitreus (Mitchill), with the thermal requirements for replication of viral haemorrhagic septicaemia virus (VHSV) IVb. WE-cfin11f proliferated from 10 to 32 °C and endured as a monolayer for at least a week at 1-34 °C. WE-cfin11f adopted an epithelial shape and did not proliferate at 4 °C. Adding VHSV IVb to cultures at 4 and 14 °C but not 26 °C led to cytopathic effects (CPE) and virus production. At 4 °C, virus production developed more slowly, but Western blotting showed more N protein accumulation. Infecting monolayer cultures at 4 °C for 7 days and then shifting them to 26 °C resulted in the monolayers being broken in small areas by CPE, but with time at 26 °C, the monolayers were restored. These results suggest that at 26 °C, the VHSV IVb life cycle stages responsible for CPE can be completed, but the production of virus and the initiation of infections cannot be accomplished. PMID:25589167

Vo, N T K; Bender, A W; Lee, L E J; Lumsden, J S; Lorenzen, N; Dixon, B; Bols, N C

2015-02-01

22

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

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 control strategies, including appropriate vaccination policies in Bangladesh. PMID:25101836

Mondal, Shankar P.; Yamage, Mat

2014-01-01

23

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

Code of Federal Regulations, 2011 CFR

...2011-01-01 false VHS-regulated fish and VHS-regulated areas. 83.4 ...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...

2011-01-01

24

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

Code of Federal Regulations, 2010 CFR

...2010-01-01 false VHS-regulated fish and VHS-regulated areas. 83.4 ...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...

2010-01-01

25

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

Code of Federal Regulations, 2013 CFR

...2013-01-01 false VHS-regulated fish and VHS-regulated areas. 83.4 ...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...

2013-01-01

26

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

Code of Federal Regulations, 2012 CFR

...2012-01-01 false VHS-regulated fish and VHS-regulated areas. 83.4 ...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...

2012-01-01

27

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

Code of Federal Regulations, 2014 CFR

...2014-01-01 false VHS-regulated fish and VHS-regulated areas. 83.4 ...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...

2014-01-01

28

Hypoglycaemia and septicaemia.  

PubMed Central

A patient with severe hypoglycaemia complicating staphylococcal septicaemia is reported. No recognized cause of hypoglycaemia was detected during life or at autopsy. This case adds to the existing evidence that through several possible mechanisms septicaemia can give life-threatening hypoglycaemia. PMID:6462987

Walsh, T. D.

1984-01-01

29

VHS Movies: Perturbations for Morphogenesis.  

ERIC Educational Resources Information Center

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…

Holmes, Danny L.

30

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

Code of Federal Regulations, 2011 CFR

...Interstate movement of live VHS-regulated fish species from VHS-regulated areas. ...Interstate movement of live VHS-regulated fish species from VHS-regulated areas. ...of this section, live VHS-regulated fish, including fish moved to live fish...

2011-01-01

31

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

Code of Federal Regulations, 2012 CFR

...Interstate movement of live VHS-regulated fish species from VHS-regulated areas. ...Interstate movement of live VHS-regulated fish species from VHS-regulated areas. ...of this section, live VHS-regulated fish, including fish moved to live fish...

2012-01-01

32

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

Code of Federal Regulations, 2013 CFR

...Interstate movement of live VHS-regulated fish species from VHS-regulated areas. ...Interstate movement of live VHS-regulated fish species from VHS-regulated areas. ...of this section, live VHS-regulated fish, including fish moved to live fish...

2013-01-01

33

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

Code of Federal Regulations, 2014 CFR

...Interstate movement of live VHS-regulated fish species from VHS-regulated areas. ...Interstate movement of live VHS-regulated fish species from VHS-regulated areas. ...of this section, live VHS-regulated fish, including fish moved to live fish...

2014-01-01

34

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

Code of Federal Regulations, 2010 CFR

...Interstate movement of live VHS-regulated fish species from VHS-regulated areas. ...Interstate movement of live VHS-regulated fish species from VHS-regulated areas. ...of this section, live VHS-regulated fish, including fish moved to live fish...

2010-01-01

35

Common signs & symptoms of meningitis & septicaemia  

E-print Network

Common signs & symptoms of meningitis & septicaemia © Meningitis Trust July 2011 · Next review July at all. Early symptoms can include fever, headache, vomiting, muscle pain and fever with cold hands, cold hands & feet Unusual cry, moaning Tense, bulging fontanelle Neck stiffness, dislike bright lights

36

Brain damage complicating septic shock: acute haemorrhagic leucoencephalitis as a complication of the generalised Shwartzman reaction.  

PubMed Central

The neuropathological findings in six patients who developed neurological signs after the onset of "septic shock" caused by Gram-negative septicaemia are described. The changes in the brains were characteristic of acute haemorrhagic leucoencephalitis, and there was evidence, particularly in the kidneys, of disseminated intravascular coagulation with tubular necrosis and, in some, appearances indistinguishable from membrano-proliferative glomerulonephritis. It is agreed that acute haemorrhagic leucoencephalitis is another manifestation of a generalised Shwartzman reaction, and it is suggested that activation of complement is the final common pathway that produces tissue damage in the brain and kidney. Images PMID:762582

Graham, D I; Behan, P O; More, I A

1979-01-01

37

Haemorrhagic Fevers, Viral  

MedlinePLUS

... fever, dengue, Omsk haemorrhagic fever, Kyasanur forest disease). Ebola virus diseases All information on Ebola virus disease Technical information, publications, situation assessments, feature ...

38

Natural history of adrenal haemorrhage in the newborn  

PubMed Central

5 cases of unilateral and 3 cases of bilateral haemorrhage are described. Only 1 infant died, from venous thromboses elsewhere. Apart from this case, all had an above average birthweight. Probable predisposing causes apart from large size were fetal hypoxia, septicaemia, thrombocytopenia, coagulation defect, and disseminated thromboembolic disease. The condition must be distinguished from renal vein thrombosis. In the acute stage pyelography shows depression of the kidney on the affected side, with flattening of the upper calyces. Calcification develops rapidly round the periphery of the mass, then slowly contracts into an area of the size and shape of the original gland. Treatment is with antibiotics and blood transfusion, with intravenous corticosteroids in severely shocked or bilateral cases. Adrenal insufficiency is rarely found on follow-up even in bilateral cases, but renal hypertension should be looked for. No single cause for the haemorrhage could be discovered, but the preponderance of haemorrhage into the right adrenal gland is probably due to anatomical differences between the venous drainage of the two sides. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5 PMID:4735041

Black, John; Williams, David Innes

1973-01-01

39

Viral haemorrhagic fever.  

PubMed

Viral haemorrhagic fevers (VHF) are a range of viral infections with potential to cause life-threatening illness in humans. Apart from Crimean-Congo haemorrhagic fever (CCHF), they are largely confined to Africa, distribution being dependent on the ecology of reservoir hosts. At present, the largest ever epidemic of Ebola virus disease (EVD or Ebola) is occurring in West Africa, raising the possibility that cases could be imported into non-endemic countries. Diagnosis and management is challenging due to the non-specificity of early symptoms, limited laboratory facilities in endemic areas, severity of disease, lack of effective therapy, strict infection control requirements and propensity to cause epidemics with secondary cases in healthcare workers. PMID:25650201

Fhogartaigh, Caoimhe Nic; Aarons, Emma

2015-02-01

40

Delayed traumatic intracerebral haemorrhage  

PubMed Central

Twenty-one out of 7,866 head injuries were complicated by the development of delayed intracerebral haematomata. The age distribution of patients with this condition closely resembled that of patients with subdural haematomata and differed sharply from patients with extradural haemorrhage. This finding, combined with the fact that the two conditions often coexisted, suggests the possibility of similar aetiological factors operating in their production. The injury producing the lesion was often minor and the larger haematomata appeared to be associated with longer `asymptomatic' intervals. The neurological deterioration was in most instances clearly the result of an increase in intracranial pressure. When possible, angiography followed by definitive craniotomy was the most satisfactory method of management and multiple burr holes even when combined with needling of the hemisphere yielded unsatisfactory results. The distribution of lesions tended to confirm their traumatic origin. On no occasion was there a vascular abnormality to account for the haemorrhage and, despite the fact that the ages of most patients were in the seventh and eighth decades, the incidence of degenerative vascular disease was small. Contusional injury causes a local failure of the mechanisms that regulate cerebral blood flow. Hypoxia, hypercapnia, and venous congestion produce cerebral hyperaemia which encourages gradual haematoma formation particularly at the sites of injury. This explains not only the situation of the lesions but also the latency between the trauma and their development. PMID:5084138

Baratham, Gopal; Dennyson, William G.

1972-01-01

41

Haemorrhagic Enteropathies in Red Deer (Cervus Elaphus)  

Microsoft Academic Search

Sir, — I would like to draw your readers’ attention to the occurrence of post-stress haemorrhagic enteropathies in red deer (Cervus elaphus). Haemorrhagic enteropathy has been observed in approximately 75 percent of red deer necropsied at the Invermay Animal Health Laboratory and has also been seen in wapiti (Cervus canadensis). Deer dying with post-stress haemorrhagic enteropathy commonly have splash haemorrhages

H. J. F. McAllum

1982-01-01

42

Pathophysiology of haemorrhagic shock.  

PubMed

The immediate effect of sudden blood loss is the activation of a variety of homeostatic responses. These include increased sympathetic activity and increased release or production of renin, angiotensin, anti-diuretic hormone, aldosterone, adrenocorticotrophic hormone, beta-endorphins, glucocorticoids, glucagon, erythropoeitin, 2-3 diphosphoglycerate, prostaglandins and complement. This may be followed by the release of many substances, some initially appropriate locally, and some the products of damaged cells, which may go on to cause both local and systemic damage. These include lysosomal enzymes, kinins, histamines, serotonin, lactic acid, free oxygen radicals, neutrophil proteases, fibrinogen degradation products, endotoxins, myocardial depressant polypeptides, and passive transferable lethal factor. The early and late effects on the cardiovascular and respiratory systems, and on the blood, brain, kidneys, gut, liver, pancreas, and on overall metabolism and cellular function, are considered in turn. Although an enormous research effort has increased our understanding of the pathophysiology of haemorrhagic shock, no special measures have yet been shown to influence morbidity or mortality in man. Management still hinges on the early recognition and treatment of bleeding, on general supportive measures, and on safeguarding each link in the oxygen delivery chain. PMID:6517266

Runciman, W B; Skowronski, G A

1984-08-01

43

Spontaneous adrenal haemorrhage in pregnancy  

PubMed Central

The authors present a case of spontaneous adrenal haemorrhage, in a 28-year-old woman at 36 weeks of a twin pregnancy. Initial symptom was sudden onset chest pain which soon migrated to abdomen, accompanied by hypovolaemic shock and fetal bradycardia. Subsequent caesarean section for suspected placental abruption and resuscitation with nine units of blood, 10 of cryoprecipitate, four of fresh frozen plasma and two of platelets, in order to treat anaemia of Hgb of 3.6 g/dl and disseminated intravascular coagulation, failed to stabilise the woman. A CT scan of abdomen and pelvis then revealed a 15×17×17 cm retroperitoneal haematoma, secondary to right adrenal haemorrhage. Management was with laparotomy drainage and packing of the retroperitoneal haematoma along with the use of activated factor VII. Adrenal haemorrhage in pregnancy is an extremely rare, acute, life-threatening condition, presenting with non-specific symptoms. PMID:22679231

A, Anagnostopoulos; S, Sharma

2011-01-01

44

The emergency control of traumatic maxillofacial haemorrhage.  

PubMed

Maxillofacial trauma is common and may lead to haemorrhage that is associated with actual or impending airway compromise. This study briefly discusses the aetiology of midfacial haemorrhage and describes a simple effective technique of midface splintage for haemorrhage control, which may be applied in the prehospital and emergency environments. This technique has been used successfully by the London Helicopter Emergency Medical Service. PMID:20603900

Harris, Tim; Rice, Scott; Watts, Beverley; Davies, Gareth

2010-08-01

45

MANAGEMENT OF POSTPARTUM HAEMORRHAGE AIM  

E-print Network

The consideration of early interventional radiology in the management of postpartum haemorrhage. BACKGROUND 1 Postpartum haemorrhage remains a significant cause of maternal morbidity and mortality. Confidential enquiries and near miss reports indicate that large numbers of women suffer severe morbidity requiring blood transfusions, hysterectomy and intensive care facilities because of excessive blood loss. This may be predictable where there is known placenta accreta or placenta praevia. However, the majority of postpartum haemorrhage is unpredictable. TECHNIQUE The procedure is performed by an interventional radiologist in an angiography suite. The common femoral artery is punctured and a guide wire is advanced, followed by a catheter into the distal aorta. Pelvic angiograms and selective bilateral internal iliac angiograms identify the internal iliac of interest. Catheterisation of the internal iliac with digital “road mapping ” to subselect the bleeding vessel is performed and this vessel is then occluded by gelfoam pledgets, coils or rings. The contralateral internal iliac is then catheterised. Vascular occlusion is confirmed by repeat angiography. Initial catheterisation of the anterior branch of the internal iliacs can be done with occluding balloon catheters prior to planned surgery and eventual embolotherapy in order to reduce blood loss and control postpartum haemorrhage.

Postpartum Haemorrhage; King Edward; Memorial Hospital

2006-01-01

46

Dengue/dengue haemorrhagic fever  

NSDL National Science Digital Library

A World Health Organization page devoted to the control of dengue. Many excellent informative PDF files are available from this page dealing with vector control, as well as recognition of symptoms, and treatment of dengue haemorrhagic fever. Estimated numbers of at risk people are staggering. A powerful resource for teaching the importance of vector borne diseases.

0000-00-00

47

[Acute haemorrhagic oedema of infancy.  

PubMed

This is a case report of acute haemorrhagic oedema of infancy. An 11-month-old boy with a prolonged relapsing course within three weeks with fever and an increase in CRP necessitating antibiotic treatment. This disease is a leukocytoclastic vasculitis sharing features with Schönlein-Henoch purpura, but with a more benign self-limiting course with minimal risk of organ involvement. The characteristic distribution and appearance of the cutaneous symptoms often allows a clinical diagnosis of the condition. PMID:25294333

Knakkergaard, Anna; Thelle, Thomas

2014-09-22

48

Generation of adenoviruses encoding the herpes simplex virus vhs gene: A novel strategy to generate adenoviruses expressing genes toxic to producer cells  

Microsoft Academic Search

Adenovirus vectors expressing suicide genes represent a promising approach for cancer gene therapy. We wanted to determine whether the virion host shutoff ( vhs ) gene of herpes simplex virus could be used as a suicide gene for gene therapy of glioblastomas. The vhs gene was cloned downstream of the glial fibrillary acidic protein promoter to direct tissue-specific expression, and

Gary M Glenn; Subhendra Chatterjee

2001-01-01

49

'Pseudocirrhosis' in hereditary haemorrhagic telangiectasia.  

PubMed Central

Telangiectasia-associated hepatic fibrosis (TAHF) in a 68-year-old woman with hereditary haemorrhagic telangiectasia (HHT) is described. The patient died of oat-cell carcinoma of the lung. In addition to the structural alterations which have been described previously in HHT, the liver exhibited focal midlobular hepatocytic necrosis and tumour metastases. The possibility that treatment of HHT was causally related to some of the hepatic abnormalities found in our patient and the differentiation of TAHF from true cirrhosis are discussed. Images PMID:203609

Cooney, T; Sweeney, E C; Coll, R; Greally, M

1977-01-01

50

Haemorrhage associated with silastic dural substitute.  

PubMed Central

Three cases of haemorrhage after the use of a silastic dural substitute are presented. In all cases the implant was removed and further haemorrhage has not occurred. Published work is reviewed and the implications for the continued use of silastic are discussed. Images PMID:8201348

Thompson, D; Taylor, W; Hayward, R

1994-01-01

51

Desmopressin Acetate in Intracranial Haemorrhage  

PubMed Central

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

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

2014-01-01

52

[Yersinia enterocolitica septicaemia associated with Yersinia intestinal lesions detected by colonoscopy (author's transl)].  

PubMed

A 78-year-old patient previously operated upon for rectal carcinoma and who had no sign of immune system deficiency developed septicaemia. Blood cultures were positive for Yersinia enterocolitica (chemotype 4, serotype 0 : 3, lysotype VIII) and the histocompatibility antigen HLA B 27 was present. The disease responded to gentamicin and doxycycline. Colonoscopy was performed on the 8th day through the permanent colostomy opening and showed lesions of the ascending colon typical of Yersinia enterocolitis : whitish, oval ulcerations on an erythematous background. This appears to be the first published case of Yersinia septicaemia where lesions of intestinal Yersinia infection were found on colonoscopy. PMID:7322896

Vitaux, J; Delaville, M R; Gavillon, C; Trousset, M; Théodore, C; Guiyoule, A; Goullet, P; Paolaggi, J A

1981-12-01

53

Supratentorial Intraparenchymal Haemorrhages during Spine Surgery  

PubMed Central

Intracranial haemorrhages are rare but potentially life-threatening complications of spine surgery. Most reported cases involved subdural or cerebellar haemorrhages; supratentorial parenchymal bleeding is very uncommon. We report a 28-year-old woman who underwent resection of a thoracic Ewing's sarcoma, and developed fatal haemorrhages around her cerebral metastases during surgery. The clinical presentations, possible pathogenesis and potential preventive measures are discussed. Patients with disseminated metastases within the neural axis are at risks of intracranial complications during spine surgery. The presence of intracranial mass lesions should be considered as a relative contraindication to intradural spine surgery. PMID:24653806

Chan, Johnny Ping Hon

2014-01-01

54

Haemostatic management of obstetric haemorrhage.  

PubMed

The haemostatic management of major obstetric haemorrhage remains challenging, and current published guidance relies heavily on experience from the non-pregnant population and expert opinion. In recent years, an interest in the implications of relative hypofibrinogenaemia, point-of-care monitoring of coagulation abnormalities, and the potential to give goal-directed therapy to correct coagulopathies, have created the possibility of significantly challenging and changing guidance. There is evidence that the haemostatic impairment in the pregnant population is different from trauma-induced bleeding, and the type and rate of onset of coagulopathies differ depending on the underlying cause. This review examines areas such as possible intervention points, describes evidence for over-transfusion of fresh frozen plasma in some situations and challenges conventional thinking on formulaic management. It also examines the rationale for other therapeutic options, including fibrinogen concentrate and tranexamic acid. PMID:25440400

Collis, R E; Collins, P W

2015-01-01

55

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

Microsoft Academic Search

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

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

1992-01-01

56

Bacterial isolates from blood cultures of children with suspected septicaemia in Calabar, Nigeria  

Microsoft Academic Search

BACKGROUND: Septicaemia is a common cause of morbidity and mortality among children in the developing world. This pattern has changed little in the past decade. Physical signs and symptoms, though useful in identifying possible cases have limited specificity. Definitive diagnosis is by bacteriologic culture of blood samples to identify organisms and establish antibiotic susceptibility. These results are usually not available

Martin M Meremikwu; Chukwuemeka E Nwachukwu; Anne E Asuquo; Joseph U Okebe; Simon J Utsalo

2005-01-01

57

The source of haemorrhage in traumatic basal subarachnoid haemorrhage.  

PubMed

Traumatic basal subarachnoid haemorrhage (TBSH) following trauma to the head, face or neck is well-established as a cause of death; however it remains a heavily disputed topic as the site of vascular injury is difficult to identify. Whilst many regions within the vasculature of the head and neck have been proposed as more susceptible to rupture, the vertebral artery remains the focal point of many investigations. We present a retrospective case review of TBSH in our forensic centre at Forensic and Scientific Services in Brisbane, Australia, from 2003 to 2011. Thirteen cases of TBSH were found, one case excluded due to vasculopathy. All decedents were male, the majority of which were involved in an altercation receiving blows to the head, face, or neck and were unconscious at the scene. All victims were under the influence of alcohol, drugs, or a combination thereof. External examination revealed injuries to the head, face, and neck in all cases. Various combinations of further examination techniques were used during the post-mortem examination including brain and/or cervical spine retention, CT imaging, and angiography. Vascular injury was identified in eight of the twelve cases, all of which occurred intracranially, with seven involving the vertebral artery. Histology was most reliable in identifying the rupture site and angiography failed to reveal a rupture site. The added benefits of histology over angiography are the ability to identify the microscopic architecture of the tear and to diagnose vasculopathy that may have rendered the individual more susceptible to TBSH. PMID:25572079

Wong, Brittany; Ong, Beng Beng; Milne, Nathan

2015-01-01

58

Nasal and intrapulmonary haemorrhage in sudden infant death syndrome  

PubMed Central

BACKGROUND—Fresh intrapulmonary and oronasal haemorrhages in cases of sudden infant death syndrome (SIDS) might be markers for accidental or intentional smothering inappropriately diagnosed as SIDS.?AIM—To compare the incidence, epidemiological association, and inter-relation of nasal haemorrhage, intrapulmonary haemorrhage, and intrathoracic petechiae in infant deaths certified as SIDS.?METHODS—In SIDS cases from a large nationwide case-control study, a wide range of variables were compared in cases with and without reported nasal haemorrhage and, in a subgroup of cases, in those with and without pathologically significant intrapulmonary haemorrhage.?RESULTS—Nasal haemorrhage was reported in 60 of 385 cases (15%) whose parents were interviewed. Pathologically significant intra-alveolar pulmonary haemorrhage was found in 47% of 115 cases studied, but was severe in only 7%. Infants with nasal haemorrhage had more haemorrhage into alveoli and air passages than age matched cases without nasal haemorrhage. In multivariate analysis, nasal haemorrhage was associated with younger infant age, bed sharing, and the infant being placed non-prone to sleep. Intrapulmonary haemorrhage was associated with the same three factors in univariate analysis, but in multivariate analysis only younger infant age remained statistically significant. There was no significant association between nasal or intra-alveolar haemorrhages and intrathoracic petechiae.?CONCLUSIONS—Nasal and intrapulmonary haemorrhages have common associations not shared with intrathoracic petechiae. Smothering is a possible common factor, although is unlikely to be the cause in most cases presenting as SIDS.?? PMID:11466185

Becroft, D; Thompson, J; Mitchell, E

2001-01-01

59

Haemangioma calcificans presenting as intracranial haemorrhages during pregnancy  

Microsoft Academic Search

A 33-year-old female with intracerebral haemorrhage during pregnancy, associated with subarachnoid and intraventricular haemorrhages, is presented.Intracranial haemorrhages during pregnancy are known to frequently result from cerebral aneurysms or arteriovenous malformations. We believe that this is caused by haemangioma calcificans and is noteworthy in considering the indications for surgical treatment for intracranial calcified lesions suggestive of cavernous haemangioma.

Masayuki Fujioka; Kazuo Okuchi; Toshisuke Sakaki; Shigeru Tsunoda; Akio Masuda

1997-01-01

60

Bacterial isolates from blood cultures of children with suspected septicaemia in Calabar, Nigeria  

PubMed Central

Background Septicaemia is a common cause of morbidity and mortality among children in the developing world. This pattern has changed little in the past decade. Physical signs and symptoms, though useful in identifying possible cases have limited specificity. Definitive diagnosis is by bacteriologic culture of blood samples to identify organisms and establish antibiotic susceptibility. These results are usually not available promptly. Therefore a knowledge of epidemiologic and antimicribial susceptibility pattern of common pathogens is useful for prompt treatment of patients. This report highlights the pattern of bacterial isolates in our environment from a retrospective study of our patients' records. Methods One thousand, two hundred and one blood samples were analysed from children aged 0–15 years, admitted into the children's wards of the University of Calabar Teaching Hospital, Calabar, Nigeria with features suggesting septicaemia. Samples were collected under aseptic conditions and cultured for aerobic and anaerobic organisms. Isolates were identified using bacteriologic and biochemical methods and antibiotic sensitivity determined by agar diffusion method using standard antibiotic discs. Results Bacteria was isolated in 552 (48.9%) of samples with highest rates among newborns (271 : 50.8). The most frequent isolates were Staphylococcal aureus (48.7%) and Coliforms (23.4%). Results showed high susceptibilities to the Cephalosporins (Ceftriazone- 100%:83.2%, Cefuroxime-100%:76.5%) and Macrolides (Azithromycin-100%:92.9%) for S. aureus and coliforms respectively. This study underscores the importance of septicaemia as a common cause of febrile illness in children and provides information on common prevalent aetiologic agents and drug susceptibilities of the commonest pathogens. Conclusion Staphylococcus aureus and coliforms were the leading causes of septicaemia in children in this locality, and the third generation cephalosporins and azithromycin were shown to be effective against these pathogens. PMID:16336657

Meremikwu, Martin M; Nwachukwu, Chukwuemeka E; Asuquo, Anne E; Okebe, Joseph U; Utsalo, Simon J

2005-01-01

61

Fatal Clostridium sordellii ischio-rectal abscess with septicaemia complicating ultrasound-guided transrectal prostate biopsy  

Microsoft Academic Search

Clostridium sordellii is a Gram-positive spore-forming anaerobic bacillus rarely encountered in human infection. A case of C. sordellii ischio-rectal abscess with rapidly fatal septicaemia is described which complicated ultrasound-guided transrectal biopsy of the prostate, despite ciprofloxacin prophylaxis. Neither C. sordellii ischio-rectal abscess nor ischio-rectal abscess complicating transrectal biopsy have been reported previously. Judging from our experience and the reviewed literature,

A. Borer; J. Gilad; E. Sikuler; K. Riesenberg; F. Schlaeffer; D. Buskila

1999-01-01

62

Airway emergency from spontaneous haemorrhagic thyroid cancer.  

PubMed

Spontaneous thyroid haemorrhages are rare. There are reported cases occurring in thyroid nodules and cysts but none in thyroid malignancies. We describe a 48 year old who presented to the on-call ENT team with a rapidly progressing neck swelling that was interfering with his airway. After resuscitation, the patient underwent a right lobectomy to stop the bleeding. Histology showed a thyroid follicular carcinoma. As per the regional multidisciplinary team discussion, he underwent a completion thyroidectomy followed by radioactive iodine treatment. We conclude that spontaneous haemorrhages of the thyroid gland can occur in malignancies and stress the importance of early histological diagnosis. PMID:25500848

Vijendren, A; Ladha, N; Hilger, A W

2014-08-01

63

Effect of neonatal periventricular haemorrhage on neurodevelopmental outcome.  

PubMed Central

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

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

1985-01-01

64

Evolutionary analysis of the ENTH/ANTH/VHS protein superfamily reveals a coevolution between membrane trafficking and metabolism  

PubMed Central

Background Membrane trafficking involves the complex regulation of proteins and lipids intracellular localization and is required for metabolic uptake, cell growth and development. Different trafficking pathways passing through the endosomes are coordinated by the ENTH/ANTH/VHS adaptor protein superfamily. The endosomes are crucial for eukaryotes since the acquisition of the endomembrane system was a central process in eukaryogenesis. Results Our in silico analysis of this ENTH/ANTH/VHS superfamily, consisting of proteins gathered from 84 complete genomes representative of the different eukaryotic taxa, revealed that genomic distribution of this superfamily allows to discriminate Fungi and Metazoa from Plantae and Protists. Next, in a four way genome wide comparison, we showed that this discriminative feature is observed not only for other membrane trafficking effectors, but also for proteins involved in metabolism and in cytokinesis, suggesting that metabolism, cytokinesis and intracellular trafficking pathways co-evolved. Moreover, some of the proteins identified were implicated in multiple functions, in either trafficking and metabolism or trafficking and cytokinesis, suggesting that membrane trafficking is central to this co-evolution process. Conclusions Our study suggests that membrane trafficking and compartmentalization were not only key features for the emergence of eukaryotic cells but also drove the separation of the eukaryotes in the different taxa. PMID:22748146

2012-01-01

65

From germinal matrix to cerebellar haemorrhage.  

PubMed

Abstract For many years cerebellar development after preterm birth has been poorly investigated and has been studied without taking germinal matrix-intraventricular haemorrhage into account. Advanced neuroimaging techniques like magnetic resonance imaging, as well as the use of various acoustic windows (mastoid fontanelle, occipital foramen) have allowed for in vivo diagnosis of acquired focal haemorrhagic lesions in the cerebellum of very preterm babies. The vulnerability of the cerebellum also seems to be related to specific gestational ages, i.e., between 23 and 27 weeks, when rapid growth in cerebellar volume occurs and at a much faster rate than mean brain volume increase. In this paper, the contribution of the cerebellum in long-term motor cognitive, learning and behavioural functions, including psychiatric ones, is discussed. PMID:23968333

Fumagalli, Monica; Bassi, Laura; Sirgiovanni, Ida; Mosca, Fabio; Sannia, Andrea; Ramenghi, Luca A

2013-08-23

66

Timing of neonatal cerebroventricular haemorrhage with ultrasound.  

PubMed Central

Sequential real-time ultrasound examinations were performed in 174 neonates to determine the time of occurrence of cerebroventricular haemorrhage (CVH). Of the 47 infants in whom CVH was detected, in 36 (77%) CVH was present at the first examination. Of the 34 infants with CVH who were examined first within 6 hours of birth, 24 (71%) already had haemorrhage demonstrable at the initial scan. Extension of a CVH after its initial detection occurred in only 3 infants. Of 124 consecutive infants of birthweights less than 1500 g, 38 (31%) developed CVH, 56% of the outborn and 27% of the inborn babies. Our results indicate that most infants who develop CVH have done so within 6 hours of birth. PMID:7073304

de Crespigny, L C; Mackay, R; Murton, L J; Roy, R N; Robinson, P H

1982-01-01

67

Lessons from nosocomial viral haemorrhagic fever outbreaks.  

PubMed

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

Fisher-Hoch, Susan P

2005-01-01

68

Haemorrhagic pulmonary oedema: post-pulmonary embolectomy.  

PubMed Central

A case of haemorrhagic pulmonary oedema after successful pulmonary embolectomy is presented. The relevant literature is reviewed. Thirteen cases are analysed as well as the four survivors. The aetiology appears to be ischaemic damage of the capillary bed. This had previously been called incomplete infarction by Castleman. The incidence is low after acute pulmonary embolectomies but appears to be much higher after chronic endarterectomies, especially with severe pulmonary hypertension. Therapy is outlined. Images PMID:996824

Garvey, J W; Wisoff, G; Voletti, C; Hartstein, M

1976-01-01

69

Simultaneous hypertensive intracerebral haemorrhages: what are the odds?  

PubMed Central

The simultaneous development of two (or more) spontaneous, hypertensive, non-traumatic intraparenchymal cerebral haemorrhages is rare and constitutes less than 5.6% of all hypertensive cerebral haemorrhages. In addition to having a high early mortality, these haemorrhages carry a considerable morbidity figure in patients who survive the event. We report a 68-year-old hypertensive and diabetic woman who presented with a sudden onset of headache, vomiting, and dense right-sided weakness. In less than an hour, she became obtunded. An urgent non-contrast CT brain scan revealed two left-sided supratentorial hemispheric haemorrhages; putamenal and thalamic. PMID:23345495

Amin, Osama S M

2013-01-01

70

Cerebellar haemorrhage after evacuation of an acute supratentorial subdural haematoma.  

PubMed

Recent reports have highlighted the unusual complication of distant cerebellar haemorrhage after supratentorial craniotomy, with only 25 previous cases reported in the literature. Nearly all reported cases occurred after craniotomy for temporal lobectomy or for deep seated intracerebral pathology requiring brain retraction and removal of CSF at surgery. Only one previous case of a cerebellar haemorrhage after evacuation of an extracerebral fluid collection has been reported. We describe the case of a cerebellar haemorrhage complicating the evacuation of an acute/subacute supratentorial subdural haematoma in a 83-year-old woman. The literature is reviewed and possible mechanisms of haemorrhage discussed. PMID:10562849

Kaplan, S S; Lauryssen, C

1999-06-01

71

Development of DNA vaccines for fish: vector design, intramuscular injection and antigen expression using viral haemorrhagic septicaemia virus genes as model  

Microsoft Academic Search

Disease control is one of the major concerns in the aquaculture industry. However, there are no vaccines available for the prevention of many piscine infectious diseases, especially those of viral and parasitic origin. DNA-based vaccination could circumvent several problems associated with traditional methods of immunization, but little is known on its efficacy in fish. The luciferase and lacZ reporter genes

JOËL HEPPELL; NIELS LORENZEN; NEIL K. ARMSTRONG; TONG WU; ELLEN LORENZEN; KATJA EINER-JENSEN; JOACHIM SCHORR; HEATHER L. DAVIS

1998-01-01

72

In vitro inhibition of the replication of haemorrhagic septicaemia virus (VHSV) and African swine fever virus (ASFV) by extracts from marine microalgae.  

PubMed

We have screened for in vitro inhibition of viral replication with extracts from the following marine microalgae: Porphyridium cruentum, Phaeodactylum tricornutum, Tetraselmis suecica, Chlorella autotrophica, Dunaliella tertiolecta, Dunaliella bardawil, Isochrysis galbana, Isochrysis galbana var Tiso, Ellipsoidon sp. and Tetraselmis tetrathele. We have used as viral models two enveloped viruses of significant economic importance, the viral hemorrhagic septicemia virus (VHSV) of salmonid fish and the African swine fever virus (ASFV). The aqueous extracts from P. cruentum, C. autotrophica and Ellipsoidon sp., produced a significant inhibition of the in vitro replication of both viruses in a dose-dependent manner. That this inhibition could be due to sulfated polysaccharides was suggested because the same pattern of viral inhibition was obtained by using exocellular extracts from microalgae enriched in these compounds and/or dextran sulfate of high molecular weight. However, the inhibition of viral replication did not correlate with the percentage of sulfatation of the exocellular polysaccharides. Extracts from marine microalgae may have prophylactic utility against fish and mammalian viral diseases. PMID:10588334

Fabregas, J; García, D; Fernandez-Alonso, M; Rocha, A I; Gómez-Puertas, P; Escribano, J M; Otero, A; Coll, J M

1999-11-01

73

Ebola haemorrhagic fever in Sudan, 1976  

PubMed Central

A large outbreak of haemorrhagic fever (subsequently named Ebola haemorrhagic fever) occurred in southern Sudan between June and November 1976. There was a total of 284 cases; 67 in the source town of Nzara, 213 in Maridi, 3 in Tembura, and 1 in Juba. The outbreak in Nzara appears to have originated in the workers of a cotton factory. The disease in Maridi was amplified by transmission in a large, active hospital. Transmission of the disease required close contact with an acute case and was usually associated with the act of nursing a patient. The incubation period was between 7 and 14 days. Although the link was not well established, it appears that Nzara could have been the source of infection for a similar outbreak in the Bumba Zone of Zaire. In this outbreak Ebola haemorrhagic fever was a unique clinical disease with a high mortality rate (53% overall) and a prolonged recovery period in those who survived. Beginning with an influenza-like syndrome, including fever, headache, and joint and muscle pains, the disease soon caused diarrhoea (81%), vomiting (59%), chest pain (83%), pain and dryness of the throat (63%), and rash (52%). Haemorrhagic manifestations were common (71%), being present in half of the recovered cases and in almost all the fatal cases. Two post mortems were carried out on patients in November 1976. The histopathological findings resembled those of an acute viral infection and although the features were characteristic they were not exclusively diagnostic. They closely resembled the features described in Marburg virus infection, with focal eosinophilic necrosis in the liver and destruction of lymphocytes and their replacement by plasma cells. One case had evidence of renal tubular necrosis. Two strains of Ebola virus were isolated from acute phase sera collected from acutely ill patients in Maridi hospital during the investigation in November 1976. Antibodies to Ebola virus were detected by immunofluorescence in 42 of 48 patients in Maridi who had been diagnosed clinically, but in only 6 of 31 patients in Nzara. The possibility of the indirect immunofluorescent test not being sufficiently sensitive is discussed. Of Maridi case contacts, in hospital and in the local community, 19% had antibodies. Very few of them gave any history of illness, indicating that Ebola virus can cause mild or even subclinical infections. Of the cloth room workers in the Nzara cotton factory, 37% appeared to have been infected, suggesting that the factory may have been the prime source of infection. ImagesFig. 4Fig. 5Fig. 3Fig. 6Fig. 7 PMID:307455

1978-01-01

74

The rabbit blood shunt subarachnoid haemorrhage model.  

PubMed

The recently introduced rabbit blood shunt subarachnoid haemorrhage model is based on the two standard procedures of subclavian artery cannulation and transcutaneous cisterna magna puncture. An extracorporeal shunt placed in between the arterial system and the subarachnoid space allows examiner-independent SAH in a closed cranium. Despite its straightforwardness, it is worth examining some specific features and characteristics of the model. We outline technical considerations to successfully perform the model with minimal mortality and morbidity. In addition, we discuss outcome measures, advantages and limitations, and the applicability of the model for the study of early brain injury and delayed cerebral vasospasm after SAH. PMID:25366648

Marbacher, Serge; Fathi, Ali Reza; Muroi, Carl; Coluccia, Daniel; Andereggen, Lukas; Neuschmelting, Volker; Widmer, Hans Rudolf; Jakob, Stephan M; Fandino, Javier

2015-01-01

75

Of cascades and perfect storms: the immunopathogenesis of dengue haemorrhagic  

E-print Network

REVIEW Of cascades and perfect storms: the immunopathogenesis of dengue haemorrhagic fever-dengue witnessed a consolidation of the original observations made in the 1970s that dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) have an immunological basis. Following reinfection with a dengue virus

Cai, Long

76

Intracranial tumoural haemorrhage – a report of 58 cases  

Microsoft Academic Search

In order to study the computerized tomographic (CT) appearances and clinical characteristics of intracranial tumoural haemorrhage (ITH), we analyzed retrospectively fifty-eight patients with ITH and reviewed the literature. As a result, 91% patients had acute or subacute onset and 26% manifested haemorrhage as their first symptoms. CT scanning indicated that intratumoural bleeding occurred in 23 cases, bleeding into parenchyma 18

Liu Yuguang; Liu Meng; Zhu Shugan; Jiang Yuquan; Li Gang; Li Xingang

2002-01-01

77

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

PubMed

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

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

2004-12-01

78

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

PubMed Central

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 ?g/ml). It was confirmed as Enterococcus feacium Van A phenotype by Automated Vitek system.

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

2014-01-01

79

Antithrombotic medicines following intracerebral haemorrhage: where's the evidence?  

PubMed Central

The use of antithrombotic medicines in patients who have a history of intracerebral haemorrhage is widely perceived as being contraindicated. However, many patients with intracerebral haemorrhage may suffer from conditions for which antithrombotic medicines are indicated. Such scenarios represent a therapeutic dilemma whereby treating infers an increased risk of recurrent intracerebral haemorrhage, but not treating infers an increase of thrombotic complications. Despite the importance of this dilemma, there is very little guidance for prescribers. This perspective review considered previous systematic reviews that addressed this issue, together with recently published research findings from the Tayside Stroke Cohort. Systematic reviews of experimental and observational studies have concluded that there is a marked lack of data on which to judge the safety of oral anticoagulant agents following intracerebral haemorrhage. In addition, the limited data available regarding the use of antiplatelet medicines following intracerebral haemorrhage provide no evidence that they are harmful, and again further data are required. In the absence of such data, a decision analysis approach has been proposed. This considers the findings of other studies to infer the likely impact of using antithrombotic agents in patients with intracerebral haemorrhage. The success of this approach is contingent on the availability of reliable data that describe the rate of recurrent intracerebral haemorrhage; however, published data on this varies widely. There are a number of factors that conspire against researchers addressing this issue. The current paucity of evidence to guide prescribers faced with this therapeutic dilemma seems likely to remain for some time. PMID:25083213

Doney, Alexander

2011-01-01

80

Antithrombotic medicines following intracerebral haemorrhage: where's the evidence?  

PubMed

The use of antithrombotic medicines in patients who have a history of intracerebral haemorrhage is widely perceived as being contraindicated. However, many patients with intracerebral haemorrhage may suffer from conditions for which antithrombotic medicines are indicated. Such scenarios represent a therapeutic dilemma whereby treating infers an increased risk of recurrent intracerebral haemorrhage, but not treating infers an increase of thrombotic complications. Despite the importance of this dilemma, there is very little guidance for prescribers. This perspective review considered previous systematic reviews that addressed this issue, together with recently published research findings from the Tayside Stroke Cohort. Systematic reviews of experimental and observational studies have concluded that there is a marked lack of data on which to judge the safety of oral anticoagulant agents following intracerebral haemorrhage. In addition, the limited data available regarding the use of antiplatelet medicines following intracerebral haemorrhage provide no evidence that they are harmful, and again further data are required. In the absence of such data, a decision analysis approach has been proposed. This considers the findings of other studies to infer the likely impact of using antithrombotic agents in patients with intracerebral haemorrhage. The success of this approach is contingent on the availability of reliable data that describe the rate of recurrent intracerebral haemorrhage; however, published data on this varies widely. There are a number of factors that conspire against researchers addressing this issue. The current paucity of evidence to guide prescribers faced with this therapeutic dilemma seems likely to remain for some time. PMID:25083213

Flynn, Robert; Doney, Alexander

2011-10-01

81

Detection of subarachnoid haemorrhage with magnetic resonance imaging  

Microsoft Academic Search

OBJECTIVESTo measure the sensitivity and specificity of five MRI sequences to subarachnoid haemorrhage.METHODSForty one patients presenting with histories suspicious of subarachnoid haemorrhage (SAH) were investigated with MRI using T1 weighted, T2 weighted, single shot fast spin echo (express), fluid attenuation inversion recovery (FLAIR), and gradient echo T2* sequences, and also by CT. Lumbar puncture was performed in cases where CT

P Mitchell; I D Wilkinson; N Hoggard; M N J Paley; D A Jellinek; T Powell; C Romanowski; T Hodgson; P D Griffiths

2001-01-01

82

Enhanced gastric mucosal haemostasis after upper gastrointestinal haemorrhage.  

PubMed Central

An endoscopic technique for the measurement of gastric mucosal bleeding time has been developed to study gastric haemostasis in patients with acute upper gastrointestinal haemorrhage. The relation of gastric mucosal bleeding time to skin bleeding time and nonsterodial anti-inflammatory drug usage was examined in 61 control patients and in 47 patients presenting with bleeding peptic ulcers or erosions. Gastric mucosal bleeding time was shorter in patients with haemorrhage (median 2 minutes, range 0-5 minutes) than in the control group (median 4 minutes, range 2-8 minutes) (p less than 0.001). Skin bleeding times were similar in the two groups (medians 4 minutes in patients with haemorrhage and 4.5 minutes in controls). In 21 patients with haemorrhage who were taking non-steroidal anti-inflammatory drugs, the median gastric mucosal bleeding time (2.5 minutes, range 1.0-5.0 minutes) was similar to that in 26 patients with haemorrhage not associated with these drugs (2.0 minutes, range 0.0-5.0 minutes). These results show that gastric mucosal haemostasis is accelerated in response to haemorrhage in the upper gastrointestinal tract, even in patients taking nonsteroidal anti-inflammatory drugs. This enhanced gastric haemostasis probably reflects a local protective response to minimise blood loss from the bleeding lesion. PMID:1855678

Allison, M C; Fullarton, G M; Brown, I L; Crean, G P; McColl, K E

1991-01-01

83

Epizootic occurrence of haemorrhagic nephritis enteritis virus infection of geese.  

PubMed

Recent outbreaks of haemorrhagic nephritis enteritis in geese flocks of 3 to 10 weeks in age in Hungary were investigated. Mortality varied between 4% and 67%. Affected birds generally died suddenly. Occasional clinical signs included tremors of the head and neck, subcutaneous haemorrhages and excretion of faeces containing partly digested blood. At necropsy the most frequent findings were a turgid wall and reddish mucosa of the intestines and reddish discolouration of the swollen kidneys, but oedema and haemorrhages of the subcutaneous connective tissue, hydropericardium and ascites were also seen. In subacute cases, visceral gout was frequently observed. Histological examination revealed zonal necrosis of the tubular epithelial cells with haemorrhages in the kidney. Other histological findings were serous hepatitis with fatty infiltration, necrotizing haemorrhagic enteritis and haemorrhages in the different organs including the brain. Experimental geese infected parenterally with crude liver and spleen homogenates prepared from diseased birds died after 8 to 20 days without premonitory signs, and had typical gross and histological lesions. Attempts to isolate cytopathic virus on different tissue cultures failed. The presence of polyomavirus was proven by polymerase chain reaction. Five isolates were further investigated by analysing their complete VP1 gene sequence. All tested strains were very closely related to each other on the basis of the nucleotide sequence, and they were identical at the deduced amino acid level. PMID:15276995

Palya, Vilmos; Ivanics, Eva; Glávits, Róbert; Dán, Adám; Mató, Tamás; Zarka, Péter

2004-04-01

84

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

PubMed Central

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

2012-01-01

85

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

PubMed

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

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

2014-10-01

86

Factors influencing haemorrhagic transformation in ischaemic stroke.  

PubMed

Haemorrhagic transformation (HT) of ischaemic infarction occurs when an area of brain infarction is stained with blood products, mainly red blood cells. An abnormally permeable blood-brain barrier resulting from ischaemia of the capillary endothelium allows this extravasation of blood products. HT is part of the natural history of some forms of ischaemic infarction, especially cerebral embolism, but it can be precipitated or enhanced by therapeutic interventions used in the acute phase of ischaemic stroke. The old view of HT after cerebral embolism as a generally asymptomatic change in a tissue that is already necrotic has been challenged by observations from therapeutic thrombolysis that suggest that HT can have a negative effect on patients' outcomes. Understanding of the risk factors for and the underlying mechanisms and clinical variability of HT in the context of acute therapeutic interventions in ischaemic stroke could help in the early detection of this complication, in determining the safety of recanalisation approaches, and in setting the stage for future research into the prevention or treatment of HT in patients with acute ischaemic stroke. PMID:23726850

Álvarez-Sabín, José; Maisterra, Olga; Santamarina, Estevo; Kase, Carlos S

2013-07-01

87

Correlation between electrophoretic types B1 and B2 of carboxylesterase B and host-dependent factors in Escherichia coli septicaemia.  

PubMed

Electrophoretic types B1 and B2 of carboxylesterase B produced by strains of Escherichia coli isolated from 100 septicaemia cases were correlated with alpha-haemolysin and mannose resistant haemagglutinin (MRHA) production and with clinical data including eventual underlying diseases, origin of septicaemia and evolution. Electrophoretic type B2 was phenotypically linked with alpha-haemolysin and MRHA production. The proportion of type B2 isolates varied significantly with occurrence of an underlying illness (45% for patients without an underlying disease and 22% for compromised patients) and with the site of origin of the septicaemia (40% for those of urinary origin and 18% for infection of digestive origin). In the former infections, type B2 isolates were obtained in the majority from male patients while type B1 isolates predominated in women. The septicaemias associated with type B1 were characterized by a lower proportion of isolates producing alpha-haemolysin and MRHA and by a greater frequency of septic shock and death than those associated with type B2. These facts emphasize the importance of host-dependent factors in E. coli septicaemia. PMID:3276540

Picard, B; Goullet, P

1988-02-01

88

Periventricular haemorrhage and leukomalacia in extremely low birthweight infants.  

PubMed

Forty (49%) of 82 extremely low birthweight (ELBW, less than 1000 g) infants had periventricular haemorrhage (PVH). Ten (12%) had germinal layer haemorrhage (GLH) alone, 16 (20%) had intraventricular haemorrhage (IVH) and 14 (17%) had intracerebral haemorrhage (ICH). Almost all the cases of PVH had developed by 4 days of age. Small-for-gestational age infants (12% of study population) had a significantly lower incidence and severity of PVH than appropriate-for-gestational age infants. Of 94 infants born between 23 and 28 weeks gestation, 45 (48%) had PVH. The PVH incidence was 60% in those of 23-26 weeks and 38% in those of 27-28 weeks. The hospital survival rate of ELBW infants was 69% in those without PVH and 43% in those with PVH; 70% in GLH alone; 50% in IVH and 14% in ICH. Three survivors developed post-haemorrhage hydrocephalus of whom two required ventriculoperitoneal shunting. Five survivors developed periventricular leukomalacia (PVL) evidenced by cysts identified between 3 and 7 weeks of age. A significant decrease in the incidence of PVH occurred over the study period (67% in 1982, 38% in 1983 and 33% in 1984). This decrease was seen for all grades of PVH. The reasons for this decreased incidence are still to be ascertained but this trend suggests that improvements in neonatal intensive care have the potential to improve the neurological outcome of more recent ELBW survivors. PMID:3533024

Szymonowicz, W; Yu, V Y

1986-08-01

89

Massive retroperitoneal haemorrhage after extracorporeal shock wave lithotripsy (ESWL).  

PubMed

A 76-year-old male suffering from nephrolithiasis developed a shock syndrome 5 days after extracorporal shock wave lithotripsy (ESWL). CT scan of the abdomen showed massive haemorrhage around the right kidney. Although nephrectomy was performed immediately, the haemorrhage could not be controlled. Numerous units of erythrocytes were transfused, but the patient died. The autopsy revealed massive retroperitoneal haemorrhage around the right kidney. The kidney showed a subcapsular haematoma and a rupture of the capsule. The right renal artery was dissected. The inferior vena cava was lacerated. Accordingly, a hemorrhagic shock as the cause of death was determined, which might mainly have resulted from the laceration of the inferior vena cava due to ESWL. ESWL seems to be a relatively non-invasive modality, but one of its severe complications is perirenal hematoma. The injuries of the blood vessels might have been caused by excessive shock waves. Subsequently, anticoagulation therapy had been resumed 3 days after EWSL, which might have triggered the haemorrhage. Physicians should note that a haemorrhage after an ESWL can occur and they should pay attention to the postoperative management in aged individuals especially when they are under anticoagulation therapy. PMID:20623295

Inoue, Hiromasa; Kamphausen, Thomas; Bajanowski, Thomas; Trübner, Kurt

2011-01-01

90

Ebola haemorrhagic fever in Zaire, 1976  

PubMed Central

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 established that people can and do make the trip between Nzara and Bumba in not more than four days: thus it was regarded as quite possible that an infected person had travelled from Sudan to Yambuku and transferred the virus to a needle of the hospital while receiving an injection at the outpatient clinic. Both the incubation period, and the duration of the clinical disease averaged about one week. After 3-4 days of non-specific symptoms and signs, patients typically experienced progressively severe sore throat, developed a maculopapular rash, had intractable abdominal pain, and began to bleed from multiple sites, principally the gastrointestinal tract. Although laboratory determinations were limited and not conclusive, it was concluded that pathogenesis of the disease included non-icteric hepatitis and possibly acute pancreatitis as well as disseminated intravascular coagulation. This syndrome was caused by a virus morphologically similar to Marburg virus, but immunologically distinct. It was named Ebola virus. The agent was isolated from the blood of 8 of 10 suspected cases using Vero cell cultures. Titrations of serial specimens obtained from one patient disclosed persistent viraemia of 106.5-104.5 infectious units from the third day of illness until death on the eighth day. Ebola virus particles were found in formalin- PMID:307456

1978-01-01

91

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

PubMed

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

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

2009-09-01

92

Haemorrhagic complications of pancreatitis: presentation, diagnosis and management.  

PubMed Central

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

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

1998-01-01

93

[Upper gastrointestinal haemorrhage after venous bypass in cirrhotics (author's transl)].  

PubMed

In a series of 76 patients who had undergone venous bypass for upper gastrointestinal haemorrhage, the authors noted 13 recurrences of bleeding, six resulting in death directly or secondary to hepatic failure. Repeated rupture of esophageal varices after thrombosis of an anastomosis is well known but in one out of two cases a second bypass involving another part of the portal territory resulted in cure. The important problem remains that of the precise aetiological diagnosis of the haemorrhage, there often being a doubt between esophageal varices and haemorrhagic gastritis. In certain cases there is no good indication for a bypass, as indicated by the absence of further bleeding after certain anastomotic thromboses. Ulcers due to venous bypass are rare. Secondary medical or surgical treatment in patients with a patent anastomosis should be undertaken with caution, in particular in the case of splenectomy for residual hypersplenism. PMID:303354

Lataste, J; Carlier, M

1977-10-01

94

Acute scrotal swelling: a sign of neonatal adrenal haemorrhage.  

PubMed

Two neonates presented with acute scrotal swelling suggestive of testicular torsion. Surgical exploration in one patient revealed an infected haematoma. Subsequent investigations including ultrasonography and urinary catecholamine determination disclosed adrenal haemorrhage as the cause of the scrotal haematoma. A second patient in whom a purplish discolouration of the right hemiscrotum was noted was also investigated with ultrasonography, which revealed a normal right testis and a right adrenal haematoma. Both cases of adrenal haemorrhage resolved spontaneously on conservative treatment. Adrenal haemorrhage should be considered as a possible cause of acute scrotal swelling in neonates. Ultrasonography assessment should be performed in such cases to examine the intra-abdominal organs especially the adrenal glands. PMID:7946555

Liu, K W; Ku, K W; Cheung, K L; Chan, Y L

1994-08-01

95

Neonatal intracranial haemorrhage: the cause of the ultrasound appearances.  

PubMed

We report experimental studies showing the relationship of the reflectivity of blood clot to both the red cell mass and the fibrin mesh. The highest amplitude echoes are returned by the fibrin mesh. These studies are compared with clinical examples of the different types of neonatal intracranial haemorrhage, as demonstrated by ultrasound. We conclude that the typical high-amplitude echoes characteristic of intracerebral haemorrhage are primarily due to the amount of fibrin mesh present, and not to the intact red cell mass, as has been previously suggested. PMID:6626868

Dewbury, K C; Bates, R I

1983-11-01

96

Haemorrhagic Lumbar Juxtafacet Cyst with Ligamentum Flavum Involvement  

PubMed Central

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.

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

2014-01-01

97

Diffuse alveolar haemorrhage secondary to propylthiouracil-induced vasculitis.  

PubMed

Propylthiouracil is a drug used to treat hyperthyroidism. It can cause several side effects including pulmonary disorders that, although rare, can be severe. The authors describe the case of a woman treated with propylthiouracil who developed diffuse alveolar haemorrhage with severe respiratory failure and anaemia, which improved with discontinuation of the antithyroid drug and on starting systemic corticosteroid therapy. PMID:25661751

Ferreira, Catarina; Costa, Teresa; Marques, Ana Vieira

2015-01-01

98

Diffuse alveolar haemorrhage associated with aerosol propellant use.  

PubMed

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

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

2013-01-01

99

REVIEW Open Access Rabbit haemorrhagic disease (RHD) and rabbit  

E-print Network

5. Virus life cycle 6. Mechanisms of resistance to RHD 7. Genetic diversity/RHDV evolution 7 haemorrhagic disease (RHD) in adult European rabbits (Oryctolagus cuniculus). First described in China in 1984. Resistance to the disease might be explained in part by genetically determined absence or weak expression

Paris-Sud XI, Université de

100

Bilateral basal ganglion haemorrhage in diabetic ketoacidotic coma: case report  

Microsoft Academic Search

We report bilateral oedema and haemorrhagic transformation in the basal ganglia of a 59-year old woman with severe diabetic\\u000a ketoacidosis. Lack of cerebral vascular autoregulation, followed by blood-brain barrier disruption due to the so-called breakthrough\\u000a mechanism is presumed to be the cause.

B. Ertl-Wagner; O. Jansen; S. Schwab; K. Sartor

1999-01-01

101

Breathing-Impaired Speech after Brain Haemorrhage: A Case Study  

ERIC Educational Resources Information Center

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…

Heselwood, Barry

2007-01-01

102

Detection and localization of internal haemorrhaging using electrical bioimpedance  

NASA Astrophysics Data System (ADS)

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±0.1?/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.

Morse, J.; Fenech, M.

2013-04-01

103

Rehabilitation following intracerebral haemorrhage secondary to extracorporeal membrane oxygenation (ECMO).  

PubMed

Extracorporeal membrane oxygenation (ECMO) was first used in adults with severe respiratory failure in the 1970s. Its use has been steadily increasing since the 1990s after a trial demonstrated improved survival. There are currently seven centres in the UK offering ECMO to adults. Neurological complications are often picked up within the first few days of initiating ECMO. Intracerebral haemorrhage is a well recognised complication and it is the leading cause of death in infants on ECMO and rates of 9-18.9% in adults have been reported. We report a 52-year-old woman admitted in severe type 1 respiratory failure in January 2012. She was transferred to a tertiary centre and suffered bitemporal and right parietal haemorrhages on ECMO in late February. She was repatriated to our unit for rehabilitation in April 2012. Her rehabilitation needs represent the complexity of this patient group with multiple medical, behavioural and physical challenges. PMID:23709548

Kilsby, Amanda; Buddha, Sandeep

2013-01-01

104

Bilateral adrenal haemorrhagic infarction in a patient with antiphospholipid syndrome.  

PubMed

A 68-year-old woman with antiphospholipid syndrome presented with a 3-day history of bilateral loin pain, vomiting, fever and confusion. On examination she was febrile, hypotensive and tachycardic. Investigations revealed raised inflammatory markers, renal impairment and hyponatraemia. Abdominal ultrasound revealed two well-defined heterogeneous areas bilaterally in the region of the adrenal glands. This prompted serum cortisol measurement and a CT of the abdomen. Cortisol was low in the context of sepsis at 48?nmol/L, and CT confirmed bilateral heterogeneous adrenal pathology. The patient was managed for septic shock and adrenal insufficiency. She was recognised to have several risk factors for haemorrhagic infarction of the adrenals: antiphospholipid syndrome, sepsis, postoperative state and anticoagulant therapy. She was discharged well on glucocorticoid and mineralocorticoid therapy and a repeat CT at 4?weeks confirmed the diagnosis of bilateral adrenal infarct and haemorrhage. PMID:25410037

Godfrey, Rebecca Louise; Clark, James; Field, Benjamin

2014-01-01

105

Resuscitation in massive obstetric haemorrhage using an intraosseous needle.  

PubMed

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

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

2011-04-01

106

Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II) Protocol  

PubMed Central

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 Registration ISRCTN: ISRCTN22153967 PMID:21586127

2011-01-01

107

Moyamoya disease with repeated intracranial haemorrhage in two consecutive pregnancies  

Microsoft Academic Search

A 26-year-old woman presented with an intraventricular haemorrhage during the 27th week of gestation in July 1996, and recovered without general or neurological complications after external ventricular drainage. The fetus was delivered spontaneously through the vagina at the 30th week of gestation, but eventually died. Cerebral angiography demonstrated typical appearances of moyamoya disease with occlusion of the supraclinoid portion of

Tae-Sun Kim; Je-Hyuk Lee; In-Young Kim; Jung-Kil Lee; Shin Jung; Jae-Hyoo Kim; Soo-Han Kim; Sam-Suk Kang

2004-01-01

108

Basilar Dolichoectasia with Clot Formation and Subarachnoid Haemorrhage  

Microsoft Academic Search

PATIENT 1See Fig. 1. A 71-year-old hypertensive man on clopidogrel for a previous heart attack experienced a mild brainstem ischaemic stroke, followed by progressive hearing loss. 17 months later, acute anarthria, deafness, multiple cranial nerve deficits, and bilateral corticospinal signs developed. 24 h after admission, he died suddenly from an acute subarachnoid haemorrhage.PATIENT 2See Fig. 2. An 82-year-old hypertensive lady,

P. Michel; A. Lobrinus; M. Wintermark; J. Bogousslavsky

2005-01-01

109

Insights into the mechanism of haemorrhage caused by snake venom metalloproteinases  

Microsoft Academic Search

Local and systemic haemorrhage are common consequences of crotaline and viperine envenoming. Several studies carried out using purified toxins have indicated that local haemorrhage can be attributed to a distinct class of venom metalloproteinases. Analyses of their cDNAs predict multi-domain enzymes, with an N-terminal metalloproteinase domain, a disintegrin-like domain and a Cys-rich C-terminus. Haemorrhagic metalloproteinases are responsible for degrading proteins

Aura S. Kamiguti; Charles R. M. Hay; R. David G. Theakston; Mirko Zuzel

1996-01-01

110

Pre-Eclampsia Increases the Risk of Postpartum Haemorrhage: A Nationwide Cohort Study in The Netherlands  

PubMed Central

Background Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide. Identifying risk indicators for postpartum haemorrhage is crucial to predict this life threatening condition. Another major contributor to maternal morbidity and mortality is pre-eclampsia. Previous studies show conflicting results in the association between pre-eclampsia and postpartum haemorrhage. The primary objective of this study was to investigate the association between pre-eclampsia and postpartum haemorrhage. Our secondary objective was to identify other risk indicators for postpartum haemorrhage in the Netherlands. Methods A nationwide cohort was used, containing prospectively collected data of women giving birth after 19 completed weeks of gestation from January 2000 until January 2008 (n?=? 1 457 576). Data were extracted from the Netherlands Perinatal Registry, covering 96% of all deliveries in the Netherlands. The main outcome measure, postpartum haemorrhage, was defined as blood loss of ?1000 ml in the 24 hours following delivery. The association between pre-eclampsia and postpartum haemorrhage was investigated with uni- and multivariable logistic regression analyses. Results Overall prevalence of postpartum haemorrhage was 4.3% and of pre-eclampsia 2.2%. From the 31 560 women with pre-eclampsia 2 347 (7.4%) developed postpartum haemorrhage, compared to 60 517 (4.2%) from the 1 426 016 women without pre-eclampsia (odds ratio 1.81; 95% CI 1.74 to 1.89). Risk of postpartum haemorrhage in women with pre-eclampsia remained increased after adjusting for confounders (adjusted odds ratio 1.53; 95% CI 1.46 to 1.60). Conclusion Women with pre-eclampsia have a 1.53 fold increased risk for postpartum haemorrhage. Clinicians should be aware of this and use this knowledge in the management of pre-eclampsia and the third stage of labour in order to reach the fifth Millenium Developmental Goal of reducing maternal mortality ratios with 75% by 2015. PMID:24367496

von Schmidt auf Altenstadt, Joost F.; Hukkelhoven, Chantal W. P. M.; van Roosmalen, Jos; Bloemenkamp, Kitty W. M.

2013-01-01

111

Post-operative bilateral adrenal haemorrhage: A case report  

PubMed Central

INTRODUCTION Bilateral adrenal haemorrhage is a rare, but serious, illness carrying an estimated 15% mortality.1,2 The majority of cases occur in patients with acute, stressful illness, however the exact mechanism underlying adrenal haemorrhage remains unclear. This medical emergency carries significant diagnostic difficulty4 with non-specific clinical symptoms and variations in electrolyte abnormalities. Timely treatment is important as it prevents both the acute and long-term sequelae of adrenal failure. PRESENTATION OF CASE This report describes a medical emergency in a surgical patient following emergency surgery for intra-abdominal sepsis. The patient reported non-specific symptoms of confusion, mild pyrexia and vague abdominal pain during the post-operative phase, with subtle electrolyte abnormalities and a low serum cortisol suggestive of adrenal crisis. Timely medical treatment, with intravenous hydrocortisone and intensive monitoring, and appropriate medical follow-up with addition of long-term fludrocortisone resulted in a satisfactory outcome. DISCUSSION This report describes a potentially life-threatening complication of intra-abdominal sepsis with adrenal crisis secondary to bilateral adrenal haemorrhage. In particular, this case highlights the diagnostic difficulty in such surgical patients due to vague symptoms and, in this case, the presence of a presentation variant with acute hyponatraemia and normal potassium. CONCLUSION This case highlights the importance of awareness of both the symptoms and signs and variation in electrolyte profile when assessing surgical patients post-operatively. In addition, this case highlights the benefit of early recognition and initiation of treatment and the importance of follow-up as long-term medical management is often required to prevent further relapse. PMID:25437659

McNicol, R.E.; Bradley, A.; Griffin, J.; Duncan, G.; Eriksen, C.A.; Guthrie, G.J.K.

2014-01-01

112

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

PubMed

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

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

2014-12-10

113

Neurodevelopmental outcome of periventricular haemorrhage and leukomalacia in infants 1250 g or less at birth.  

PubMed

The brains of 50 consecutively admitted infants weighing 1250 g or less at birth were serially examined beyond the neonatal period for periventricular haemorrhage and for periventricular leukomalacia with real-time ultrasound. There was significant correlation between the presence or absence and the severity of haemorrhage with survival. A prospective neurodevelopmental assessment was completed at 2 years of age, corrected for prematurity, on all survivors. None of the 20 survivors with normal scans or germinal layer haemorrhages had evidence of major disability and all four survivors with intracerebral haemorrhage or periventricular leukomalacia had major disability. The mental performance on the Bayley scales of infant development was also significantly worse in the latter group. Six of the eight survivors with intraventricular haemorrhage had no major disability, including three who had post-haemorrhagic hydrocephalus. Our results showed that cerebral ultrasound detection of brain pathology is a good predictor of neurodevelopmental outcome in such extremely low birthweight infants. However, as the maximum extent of periventricular haemorrhage may develop beyond one week of age and cystic periventricular leukomalacia commonly develops after the neonatal period, serial scanning is mandatory to ensure diagnostic accuracy for both periventricular haemorrhage and leukomalacia. PMID:3525094

Szymonowicz, W; Yu, V Y; Bajuk, B; Astbury, J

1986-07-01

114

Intraventricular recombinant tissue plasminogen activator for treatment of spontaneous intraventricular haemorrhage in pregnancy  

Microsoft Academic Search

Spontaneous intracranial haemorrhage during pregnancy, which is usually subarachnoid or intraparenchymal in nature, causes significant maternal and foetal morbidity and mortality. Solitary intraventricular haemorrhage (IVH) in pregnancy has never been previously reported nor has the use of intraventricular fibrinolysis in this situation. A 28-year-old woman presented at 20 weeks' gestation with status epilepticus from spontaneous severe IVH. Angiography and magnetic

K. Y. C Goh; J. N. K Hsiang; X. L Zhu; W. S Poon

1999-01-01

115

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

Microsoft Academic Search

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

A W McNinch; J H Tripp

1991-01-01

116

Clinical features of the haemorrhage type moyamoya disease based on 31 cases  

Microsoft Academic Search

Summary We evaluated and analysed our own 31 cases of the haemorrhagic type of moyamoya disease to clarify the clinical features of this disease. The cases were divided into three groups. Group A consisted of 12 cases with aneurysms. Aneurysms on the circle of Willis were treated as ordinary saccular aneurysms. Group B consisted of 14 cases with intracerebral haemorrhage

S. Kawaguchi; T. Sakaki; T. Kakizaki; K. Kamada; T. Shimomura; H. Iwanaga

1996-01-01

117

Classification of Non-Aneurysmal Subarachnoid Haemorrhage: CT Correlation to the Clinical Outcome.  

PubMed

To propose a new computed tomography (CT)-based classification system for nonaneurysmal subarachnoid haemorrhage (SAH), which predicts patients' discharge clinical outcome and helps to prioritize appropriate patient management. A 5-year, retrospective, two-centre study was carried out involving 1486 patients presenting with SAH. One hundred and ninety patients with nonaneurysmal SAH were included in the study. Initial cranial CT findings at admission were correlated with the patients' discharge outcomes measured using the Modified Rankin Scale (MRS). A CT-based classification system (type 1 e 4) was devised based on the topography of the initial haemorrhage pattern. Seventy-five percent of the patients had type 1 haemorrhage and all these patients had a good clinical outcome with a discharge MRS of 1. Eight percent of the patients presented with type 2 haemorrhage, 62% of which were discharged with MRS of 1 and 12% of patients had MRS 3 or 4. Type 3 haemorrhage was found in 10%, of which 16% had good clinical outcome, but 53% had moderate to severe disability (MRS 3 and 4) and 5% were discharged with severe disability (MRS 5). Six percent of patients presented with type 4 haemorrhage of which 42% of the patients had moderate to severe disability (MRS 3 and 4), 42% had severe disability and one-sixth of the patients died. Highly significant differences were found between type 1 (1a and 1b) and type 2 (p¼ 0.003); type 2 and type 3 (p ¼ 0.002); type 3 and type 4 (p ¼ 0.001). Haemorrhages of the type 1 category are usually benign and do not warrant an extensive battery of clinical and radiological investigations. Type 2 haemorrhages have a varying prognosis and need to be investigated and managed along similar lines as that of an aneurysmal haemorrhage with emphasis towards radiological investigation. Type 3 and type 4 haemorrhages need to be extensively investigated to find an underlying cause. PMID:24059766

Nayak, S; Kunz, A B; Kieslinger, K; Ladurner, G; Killer, M

2011-10-31

118

w RAPID RISK ASSESSMENT Outbreak of Ebola haemorrhagic  

E-print Network

Main conclusions and recommendations An outbreak of Ebola haemorrhagic fever is currently ongoing in Uganda with 38 cases reported, including 16 deaths. Two similar outbreaks have been seen in the past in Uganda. Through these, Uganda has developed a solid experience in dealing with such outbreaks, with the support currently of the World Health Organization, the US Centers for Disease Control and Prevention, and specialised non-governmental organisations. As the incubation period can be up to three weeks, it is likely that additional cases will be identified in the coming weeks. However, control measures currently implemented in Uganda with the support of international partners, such as isolation of cases and active monitoring of contacts, should prevent further spread of the disease. It is unlikely, but not impossible, that travellers infected in Uganda could arrive in the EU while incubating the disease and develop symptoms while in the EU. However, such cases should seek medical attention and be isolated, therefore preventing further transmission. EU citizens in Uganda are not at risk of becoming infected unless they are in direct contact with bodily fluids of dead or living infected persons or animals. Avoiding such contact would effectively mitigate this risk. Public health issue To assess the risk at EU level associated with the current Ebola haemorrhagic fever outbreak in Uganda. Source and date of request ECDC internal decision on 1 August 2012. Consulted experts ECDC experts.

unknown authors

2012-01-01

119

Ocular significance of intraventricular haemorrhage in premature infants  

PubMed Central

AIM—To document ocular outcome in premature infants with intraventricular haemorrhages (IVH).?METHODS—68 preterm infants with IVH were examined.?RESULTS—Mean gestational age was 28.1 weeks (range 24-35). Mean birth weight was 1045.9 g (630-2240). Mean follow up was 54.6 months (6-150). IVH is graded from 1 to 4 based on the severity of haemorrhages. The incidence of ocular abnormalities was compared between low grade IVH (grade 1 and 2) and high grade IVH (grade 3 and 4). Of the 68 infants with IVH, ROP occurred in 33 infants (48.5%); 13 (43.3%) had low grade IVH; 20 (52.6%) had high grade IVH. Strabismus developed in 30 infants (44.1%); 14 (46.6%) had low grade IVH; 16 (42.1%) had high grade IVH. Infants with high grade IVH were at significant greater risk than infants with low grade IVH for the development of optic atrophy (31.5% v 16.6%), hydrocephalus (57.8% v 10%).?CONCLUSION—This study highlights the serious significance of all grades of IVH with the higher incidence of optic atrophy and hydrocephalus with high grade IVH.?? PMID:11222347

O'Keefe, M.; Kafil-Hussain, N.; Flitcroft, I.; Lanigan, B.

2001-01-01

120

Recombinant activated factor VII in post partum haemorrhage.  

PubMed

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

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

2013-09-01

121

Submacular haemorrhages associated with neovascular age-related macular degeneration.  

PubMed

The exact incidence of submacular haemorrhage (SMH) in patients with neovascular age-related macular degeneration (nAMD) is unknown, and risk factors for its occurrence ill defined. It is known, however, to be a relatively common problem and important because the visual prognosis of these patients is poor. Unfortunately, patients with significant SMH were excluded from all the recent major randomised control trials for nAMD with antivascular endothelial growth factor (VEGF) agents and photodynamic therapy, and as such, the optimum management of patients is uncertain. SMH can present initially or during treatment of nAMD. The location, size, thickness and duration of SMH have an important bearing on treatment and outcomes. Thin or extrafoveal SMH are probably best treated with anti-VEGF agents alone. It has been proposed that patients with moderate-sized SMH, particularly thick haemorrhages, have an improved prognosis with surgical SMH displacement combined with treatment of CNVM if present. SMH drainage, macular translocation and RPE patch grafting are reserved for more severe extensive cases of SMH. Using these techniques, outcomes better than the natural history have been achieved. This review aims to summarise what is known about SMH in nAMD and will discuss a variety of therapeutic interventions. PMID:20813746

Steel, David Henry William; Sandhu, Sukhpal Singh

2011-08-01

122

[Topical Application of Tranexamic Acid to Prevent Post-tonsillectomy Haemorrhage.  

PubMed

Topical Application of Tranexamic Acid to Prevent Post-tonsillectomy Haemorrhage Background: Haemorrhage after tonsillectomy (TE) is a frequent and possibly major complication. The aim of the present study was to examine, if the rate of haemorrhage after tonsillectomy could be reduced by the topical application of Tranexamic acid (TXA) postoperatively. Material and Methods: Between November 2011 and April 2013, all patients (n=246) received TXA postoperatively to prevent haemorrhage after TE. The patients were instructed to dilute 1 ampulla of TXA in 300?ml of tap water (concentration 0.2%) from postoperative day 5-10 and to gargle or spray the tonsillar fossae 5-6 times daily. The study group was compared retrospectively with a control group of patients undergoing TE with-out postoperative application of TXA from December 2010 to November 2011 (n=248). Results: The overall rate of postoperative haemorrhage was 19% and 22% in the study and control group, respectively. The rate of postoperative bleeding that needed surgical intervention was at 8.9% and 11.3% in the study and control group, respectively. Topical application of TXA did not significantly reduce the rate of postoperative haemorrhage after TE. Conclusion: Topically applied TXA did not reduce postoperative haemorrhage after TE. However, a slight tendency to less bleeding which needed surgical intervention was found in pa-tients older than ??12 years. PMID:24967824

Hinder, D; Tschopp, K

2014-06-26

123

Rodent control programmes in areas affected by Bolivian haemorrhagic fever  

PubMed Central

Bolivian haemorrhagic fever (BHF) caused by Machupo virus is acquired by contact with the excretions and secretions of Calomys callosus, an indigenous cricetine rodent which is preadapted to peridomestic habitats. It competes successfully with Mus musculus, but not with Rattus rattus. A successful disease control programme has functioned in Beni Department since 1964. It is based on trapping surveys and the detection of splenomegaly in Calomys rodents as an index of chronic virus infection. Mass trapping and poisoning are used initially, and regular trapping is employed to control Calomys populations in towns where disease has occurred. More than 1000 cases of BHF were recorded from 1960-1964, but less than 200 in the past 10 years. The cost of this programme is approximately $30 000 annually. PMID:182405

Mercado R., Rodolfo

1975-01-01

124

The Bulgarian vaccine Crimean-Congo haemorrhagic fever virus strain.  

PubMed

The Crimean-Congo haemorrhagic fever virus (CCHFV) is a 3-segmented RNA virus, which causes disease with a high fatality rate in humans. An inactivated suckling mouse brain-derived vaccine is used in Bulgaria for protection against CCHF. Strain V42/81 is currently used for the vaccine preparation. As the M-RNA segment plays a major role in the immune response, the full-length M segment sequence of the V42/81 strain was characterized. A great genetic diversity was observed among CCHFV strains. In order to gain an insight into the topology of the strain in the CCHFV phylogenetic trees, the full-length S and partial L segments were additionally sequenced and analyzed. PMID:21142621

Papa, Anna; Papadimitriou, Evangelia; Christova, Iva

2011-03-01

125

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

PubMed

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

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

2013-11-01

126

Pulmonary hypertension in a patient with hereditary haemorrhagic telangiectasia  

PubMed Central

A young male patient reported for evaluation of progressive easy fatigability, accompanied by a recent history of recurrent haemoptysis. His clinical examination was unremarkable except for evidence of pulmonary arterial hypertension (PAH). Routine investigations (haemogram, coagulogram, serological tests for connective tissue disorders and a sputum Ziehl Neelsen stain for acid-fast bacilli) were normal. Two-dimensional echocardiography suggested PAH (pulmonary artery systolic pressure—67?mm?Hg), whereas the 64-slice spiral CT pulmonary angiogram showed a dilated main pulmonary artery along with bilateral arteriovenous malformations. Cardiac catheterisation performed subsequently confirmed the presence of PAH. On the basis of the above findings, a diagnosis of hereditary haemorrhagic telangiectasia (HHT) complicated with PAH was made, and the patient was started on oral sildenafil therapy to which he responded well. This rare complication of HHT, which requires a high degree of suspicion for diagnosis, is discussed. PMID:23378554

Chadha, Davinder; Handa, Ajay; Kumar, Abhishek

2013-01-01

127

Haemorrhage, hyponatraemia and more than just a hack.  

PubMed

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

Shah, Mitsu; Kandil, Hala

2014-01-01

128

Direct binding of the Kex2p cytosolic tail to the VHS domain of yeast Gga2p facilitates TGN to prevacuolar compartment transport and is regulated by phosphorylation.  

PubMed

Human Golgi-localized, ?-ear-containing, ADP-ribosylation factor-binding proteins (Ggas) bind directly to acidic dileucine sorting motifs in the cytosolic tails (C-tails) of intracellular receptors. Despite evidence for a role in recruiting ubiquitinated cargo, it remains unclear whether yeast Ggas also function by binding peptide-sorting signals directly. Two-hybrid analysis shows that the Gga1p and Gga2p Vps27, Hrs, Stam (VHS) domains both bind a site in the Kex2p C-tail and that the Gga2p VHS domain binds a site in the Vps10p C-tail. Binding requires deletion of an apparently autoinhibitory sequence in the Gga2p hinge. Ser(780) in the Kex2p C-tail is crucial for binding: an Ala substitution blocks but an Asp substitution permits binding. Biochemical assays using purified Gga2p VHS-GGA and TOM1 (GAT) and glutathione S-transferase-Kex2p C-tail fusions show that Gga2p binds directly to the Kex2p C-tail, with relative affinities Asp(780) > Ser(780) > Ala(780). Affinity-purified antibody against a peptide containing phospho-Ser-(780) recognizes wild-type Kex2p but not S(780)A Kex2p, showing that Ser(780) is phosphorylated in vivo; phosphorylation of Ser(780) is up-regulated by cell wall-damaging drugs. Finally, mutation of Ser(780) alters trafficking of Kex2p both in vivo and in cell-free trans-Golgi network (TGN)-prevacuolar compartment (PVC) transport. Thus yeast Gga adaptors facilitate TGN-PVC transport by direct binding of noncanonical phosphoregulated Gga-binding sites in cargo molecules. PMID:23408788

De, Mithu; Abazeed, Mohamed E; Fuller, Robert S

2013-02-01

129

Recurrent hypertensive intracerebral haemorrhages: what should we do when a new hemispheric ischaemic event strikes?  

PubMed Central

Hypertensive intracerebral haemorrhage is usually a once in a lifetime event and recurrences are rare. Most recurrences usually develop within 2?years of the first event and the majority usually target the basal ganglia and thalami. Failure of blood pressure control is the most important, potentially preventable, culprit behind the development of primary intracerebral haemorrhages. However, the occurrence of a recurrent bleed in patients with optimally controlled hypertension should always prompt the physician to think of a new co-operating factor. We report on a 60-year-old hypertensive woman who developed right-sided thalamic haemorrhage 5?days after sustaining a lacunar infarct of the left thalamus for which she had been prescribed a dual antiplatelet therapy: aspirin and clopidrogrel. She had a history of two bilateral sequential hypertensive deep cerebellar haemorrhages which were developed 2?years ago. PMID:23264163

Amin, Osama S M

2012-01-01

130

Low cerebral blood flow is a risk factor for severe intraventricular haemorrhage  

Microsoft Academic Search

AIMSTo investigate the relation between cerebral blood flow on the first day of postnatal life and the severity of any subsequent germinal matrix haemorrhage–intraventricular haemorrhage (GMH–IVH).METHODSCerebral blood flow was measured in 24 babies during the first 24 hours of life using near infrared spectroscopy. Repeated cerebral ultrasound examination was performed to define the maximum extent of GMH–IVH. Infants were classified

Judith H Meek; Lidia Tyszczuk; Clare E Elwell; J S Wyatt

1999-01-01

131

Cerebellar haemorrhage as a cause of neurogenic pulmonary edema-case report  

Microsoft Academic Search

The neurogenic pulmonary edema is a rare clinical situation caused by an imbalance characterized by an excessive sympathetic\\u000a outflow. It is observed mostly in young patients, is associated with brain or spinal cord haemorrhage, trauma, tumours or\\u000a infections and is usually fatal. A case of neurogenic pulmonary edema in a 27-year-old woman is presented, caused by a cerebellar\\u000a haemorrhage due

Victor Gonçalves; Lu’is Silva-Carvalho; Isabel Rocha

2005-01-01

132

Major Haemorrhage during Vitamin K Antagonist Treatment: The Influence of Thyroid Hormone Levels  

PubMed Central

Background Annually, approximately 1-3% of patients treated with vitamin K antagonists (VKA) suffer from major haemorrhage. Since high levels of free thyroxine (fT4) are associated with increased thrombosis risk, the aim was to assess whether low levels of fT4 contribute to major haemorrhage in patients under VKA treatment. Methods The FACTORS (Factors in Oral Anticoagulant Safety) study is a case-control study on patients receiving VKA treatment, including 110 cases with major haemorrhage. Controls were 220 matched participants treated with VKA without major haemorrhage. Odds ratios (OR) and 95% confidence intervals (95% CI) for the association of fT4 levels with major haemorrhage were calculated for different fT4 cutoffs by conditional logistic regression. Results In patients with an fT4 level below 13 pmol/l, the risk of major haemorrhage was 5-fold increased (OR = 5.1; 95% CI: 0.9-28.6) compared with patients with an fT4 level above 13 pmol/l. At a cutoff of 14 pmol/l, the risk was 3-fold increased (OR = 2.9; 95% CI: 1.0-8.5). High levels of fT4 did not affect bleeding risk. No clear effect of thyroid-stimulating hormone and thyroid peroxidase antibodies was seen on the risk of major haemorrhage. Conclusions These results indicate that fT4 levels below 14 pmol/l play a role in the aetiology of major haemorrhage in VKA users. PMID:24847463

Debeij, Jan; Cannegieter, Suzanne C.; van Zaane, Bregje; van Zanten, Anton P.; Rosendaal, Frits R.; Gerdes, Victor E.A.; Reitsma, Pieter H.; Dekkers, Olaf M.

2014-01-01

133

[Oedema and haemorrhagic diathesis in a 50-year-old woman with thyrotoxicosis].  

PubMed

We describe the case of a 50-year-old woman who presented with tachyarrhythmia, mild fever, peripheral oedema, ascites, epistaxis and gastrointestinal haemorrhage. Blood analysis revealed hyperthyroxinaemia. Analysis of thyroid-stimulating antibodies highlighted Graves' disease being the cause of the prevailing thyrotoxic crisis. Remarkable in this case of thyrotoxicosis is a liver affection without elevated transaminases but disturbed serum protein synthesis leading to hypalbuminaemic oedema and haemorrhagic complications. Thyrostatic treatment led to clinical response. PMID:25056734

Kozlov, A; Joeres, R; Braun, U

2014-11-01

134

Factor VIII R:Ag as a prognostic parameter in intracranial haemorrhage.  

PubMed Central

Factor VIII R:Ag was measured serially in 42 patients who had intracranial haemorrhage. It was found that the factor decreased or remained static in the 24 patients who improved (p less than 0.025), while it increased in the 18 who died (p less than 0.0005). It is suggested that this factor can be used as a prognostic parameter to predict the outcome after intracranial haemorrhage. PMID:3106577

Almaani, W S; Awidi, A S; Karmi, M Z

1987-01-01

135

Clinical features of crimean-congo haemorrhagic fever in the united arab emirates  

Microsoft Academic Search

Summary Crimean-Congo haemorrhagic fever (C-CHF) re-emerged recently in the United Arab Emirates. The clinical outcome of 11 cases of viral haemorrhagic fever patients admitted to hospital between June 1994 and January 1995 is described. Four cases were laboratory confirmed retrospectively as C-CHF, the other patients were diagnosed likely to have the same disease on epidemiological and clinical grounds. In 72.7%

T. F. Schwarz; H. Nsanze; A. M. Ameen

1997-01-01

136

Good functional recovery following intervention for delayed suprachoroidal haemorrhage post bleb needling: a case report  

PubMed Central

Introduction Bleb needling is a recognised procedure in the management of patients with failing trabeculectomies. Suprachoroidal haemorrhage can occur as an unusual complication. We report a pseudophakic man who had early surgical intervention for this complication. This intervention may have contributed to the good recovery of his visual acuity and the minimum changes to his visual fields. Case presentation A 79-year-old pseudophakic man with chronic open angle glaucoma presented with further deterioration of his right visual field despite maximum medical therapy and a previous trabeculectomy. The right visual acuity was 6/9 with an intraocular pressure (IOP) of 16 mmHg. Bleb needling with 5-fluouracil was performed in a standard manner. His postoperative IOP was 6 mmHg. Thirty-six hours later the visual acuity was reduced to hand movements and two large choroidal detachments where observed clinically, which progressed to suprachoroidal haemorrhages. Five days after the initial needling, the patient had complex surgery involving anterior chamber reformation, a bleb compression suture and drainage of the haemorrhagic suprachoroidal detachments. Subsequently, the patient had a right vitrectomy with endolaser following a vitreous haemorrhage. The final visual acuity was 6/9 with an intraocular pressure of 8 mmHg on travoprost and brinzolamide. The final visual field showed little change when compared with the pre-suprachoroidal haemorrhage visual field. Conclusion It is important to consider the possibility of delayed suprachoroidal haemorrhage as a complication in bleb needling, and early surgical intervention may be beneficial. PMID:18339199

Cannon, Paul S; Spencer, A Fiona; Lavin, Michael

2008-01-01

137

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

PubMed Central

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

Rajoriya, Neil; Tripathi, Dhiraj

2014-01-01

138

Clinical features of the haemorrhage type moyamoya disease based on 31 cases.  

PubMed

We evaluated and analysed our own 31 cases of the haemorrhagic type of moyamoya disease to clarify the clinical features of this disease. The cases were divided into three groups. Group A consisted of 12 cases with aneurysms. Aneurysms on the circle of Willis were treated as ordinary saccular aneurysms. Group B consisted of 14 cases with intracerebral haemorrhage (ICH) without aneurysms. These were managed almost as spontaneous ICH. Group C consisted of 5 cases with intraventricular haemorrhage (IVH) without aneurysms or ICH. Twenty-two surgical procedures for aneurysms, ICH and IVH were done in 19 cases (62%). Nineteen procedures for preventing future strokes were undertaken in 11 cases (35%). The overall initial outcome was excellent in 12 cases (39%), good in 7 cases (23%), poor in 7 cases (23%), and death in 5 cases (15%). During the follow-up period (mean: 6.5 years), rebleeding occurred in two cases (8%), and ischaemic attacks in two cases (8%). The rate of rebleeding or ischaemic attacks was 1.19% per patient-year during the follow-up period. There was no ischaemic or rebleeding episode in cases treated by STA-MCA bypass with encephalomyosynagiosis (EMS) during the follow-up period. Management of the primary haemorrhage should be according to the clinical condition, type of haemorrhage, and source of haemorrhage. When the patient needs to undergo revascularization surgery to prevent future strokes, we recommend STA-MCA bypass with EMS instead of encephaloduro-arteriosynangiosis (EDAS). PMID:8955440

Kawaguchi, S; Sakaki, T; Kakizaki, T; Kamada, K; Shimomura, T; Iwanaga, H

1996-01-01

139

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

PubMed Central

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

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

2014-01-01

140

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

PubMed Central

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 ?-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-?-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 over an extended period of time. The study highlights the persistence of ESBLs (CTX-Ms) and the emergence of NDM-1 in Enterobacteriaceae in the unit. PMID:25406074

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

2014-01-01

141

Rabbit haemorrhagic disease: virus persistence and adaptation in Australia  

PubMed Central

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

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

2014-01-01

142

Dengue fever and dengue haemorrhagic fever in adolescents and adults  

PubMed Central

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

Tantawichien, Terapong

2012-01-01

143

A modified Kleihauer technique for the quantification of foetomaternal haemorrhage.  

PubMed

The Kleihauer technique, based on acid elution of maternal red cells, is the mostly widely used technique in the UK to screen for, and estimate the volume of, foetomaternal haemorrhage (FMH) and for determining the need for additional doses of anti-D immunoglobulin to prevent maternal alloimmunization. However, technicians often report difficulties in identifying and accurately counting maternal red cells in the blood film, leading to imprecision in the calculated FMH. In this report, we describe a simple modification of the standard Kleihauer technique, based on performing acid elution of only half of the film. Compared to the standard method, the modified technique showed improved accuracy and reduced interobserver variability across a range of simulated FMH volumes. There was a high degree of correlation between the new technique and FMH estimated by flow cytometry (r2 = 0.916, P < 0.001). Technicians found the new technique easy to incorporate into routine practice in a busy teaching hospital laboratory and were impressed by the relative ease of counting maternal ghost cells. The modified technique has been used routinely in our laboratory for 3 years, during which time our performance in the UK National External Quality Assurance Scheme for FMH has been uniformly satisfactory. PMID:12473154

Howarth, D J; Robinson, F M; Williams, M; Norfolk, D R

2002-12-01

144

National mutation study among Danish patients with hereditary haemorrhagic telangiectasia.  

PubMed

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominantly inherited vascular disease characterized by the presence of mucocutaneous telangiectasia and visceral arteriovenous malformations (AVM). The clinical diagnosis of HHT is based on the Curaçao criteria. About 85% of HHT patients carry mutations in the ENG, ACVRL1 or SMAD4 genes. Here, we report on the genetic heterogeneity in the Danish national HHT population and address the prevalence of pulmonary arteriovenous malformations (PAVM). Probands of 107 apparently unrelated families received genetic testing, including sequencing and multiplex ligation-dependent probe amplification (MLPA) analyses of ENG, ACVRL1 and SMAD4. These 107 families included 320 patients confirmed to have HHT either clinically or genetically. In 89% of the probands (n=95), a mutation was identified. We detected 64 unique mutations of which 27 (41%) were novel. Large deletions were identified in ENG and ACVRL1. The prevalence of PAVM was 52.3% in patients with an ENG mutation and 12.9% in the ACVRL1 mutation carriers. We diagnosed 80% of the patients clinically, fulfilling the Curaçao criteria, and those remaining were diagnosed by genetic testing. It is discussed when to assign pathogenicity to missense and splice site mutations. The adding of an extra criterion to the Curaçao criteria is suggested. PMID:24001356

Tørring, P M; Brusgaard, K; Ousager, L B; Andersen, P E; Kjeldsen, A D

2014-08-01

145

Haemostatic monitoring during postpartum haemorrhage and implications for management  

PubMed Central

Summary Postpartum haemorrhage (PPH) is a major risk factor for maternal morbidity and mortality. PPH has numerous causative factors, which makes its occurrence and severity difficult to predict. Underlying haemostatic imbalances such as consumptive and dilutional coagulopathies may develop during PPH, and can exacerbate bleeding and lead to progression to severe PPH. Monitoring coagulation status in patients with PPH may be crucial for effective haemostatic management, goal-directed therapy, and improved outcomes. However, current PPH management guidelines do not account for the altered baseline coagulation status observed in pregnant patients, and the appropriate transfusion triggers to use in PPH are unknown, due to a lack of high-quality studies specific to this area. In this review, we consider the evidence for the use of standard laboratory-based coagulation tests and point-of-care viscoelastic coagulation monitoring in PPH. Many laboratory-based tests are unsuitable for emergency use due to their long turnaround times, so have limited value for the management of PPH. Emerging evidence suggests that viscoelastic monitoring, using thrombelastography- or thromboelastometry-based tests, may be useful for rapid assessment and for guiding haemostatic therapy during PPH. However, further studies are needed to define the ranges of reference values that should be considered ‘normal’ in this setting. Improving awareness of the correct application and interpretation of viscoelastic coagulation monitoring techniques may be critical in realizing their emergency diagnostic potential. PMID:23075633

Solomon, C.; Collis, R. E.; Collins, P. W.

2012-01-01

146

Intra-alveolar haemorrhage in sudden infant death syndrome: a cause for concern?  

PubMed Central

BACKGROUND: The "Back to Sleep" campaign in 1991 resulted in a dramatic decrease in the incidence of sudden infant death syndrome (SIDS). The proportion of presumed SIDS deaths being actually suspicious deaths from airway obstruction is likely to have become relatively greater. There is usually little pathological evidence to suggest smothering, but intra-alveolar haemorrhage appears to be more prominent in cases where interference with the airway is suspected. AIM: To attempt to quantify intra-alveolar haemorrhage to see whether it could be used as a marker to distinguish between smothering/overlaying and SIDS. METHODS: Intra-alveolar haemorrhage was quantified using digital image analysis on haematoxylin/eosin stained sections taken from the lungs of 62 consecutive infants who had died suddenly and unexpectedly. Cases were initially classified according to the original cause of death. After quantitation, the case histories were critically reviewed. Three pathologists independently made microscopic assessments of the degree of intra-alveolar haemorrhage in the first 24 cases to see whether these accurately reflected the quantitative results. RESULTS: 73% of those infants with a history suggesting possible involuntary overlaying and 45% of those with a history suspicious of smothering had significant intra-alveolar haemorrhage (> 5% of total lung surface area assessed). From the history, the cause of death in 11 cases initially classified as SIDS would better have been given as "Unascertained." Simple microscopic assessments underestimated the true extent of the haemorrhage in 33% (8/24). CONCLUSIONS: If a moderate degree (at least 5%) of pulmonary parenchymal haemorrhage is observed, this may be an indicator of airway obstruction for a significant period, either from overlaying or possibly smothering. The diagnosis of SIDS may be being used inappropriately in such cases. Images PMID:10645227

Yukawa, N; Carter, N; Rutty, G; Green, M A

1999-01-01

147

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

PubMed Central

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 variation in liability is attributable to factors that are not shared in families. PMID:25121825

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

2014-01-01

148

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

PubMed

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

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

2012-01-01

149

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

PubMed Central

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 well as to test for drug–drug interactions with warfarin.The discovery of alcohol abuse as a strong confounder may partially explain the very high risks of bleed seen in previous studies that did not adjust for this confounder. PMID:18460039

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

2008-01-01

150

Haemorrhagic disease in newborn and older infants: a study in hospitalized children in Kelantan, Malaysia.  

PubMed

This is a retrospective study of the epidemiology, clinical features, laboratory findings, treatment and outcome of haemorrhagic disease in 42 Kelantanese infants who were admitted to Hospital Universiti Sains Malaysia during a 2-year period (1987-1988). Classical haemorrhagic disease of the newborn was the commonest presentation (48%), followed by early onset (29%) and late onset (24%) disease. Home deliveries accounted for 81% of the affected infants. Most of these babies were not given vitamin K at birth in contrast to those delivered in hospitals. All except one infant were breastfed. The six commonest presenting clinical features were pallor, jaundice, umbilical cord bleeding, tense fontanelle, convulsions and hepatomegaly. All the infants had prolonged prothrombin and partial thromboplastin times which were corrected by administration of vitamin K. Subdural haemorrhage was the commonest form of intracranial haemorrhage, followed by subarachnoid haemorrhage. The overall case fatality rate was 14%. The results of this study once again emphasize the value of vitamin K prophylaxis in the newborn. PMID:7825997

Choo, K E; Tan, K K; Chuah, S P; Ariffin, W A; Gururaj, A

1994-01-01

151

Dengue/dengue haemorrhagic fever: history and current status.  

PubMed

Dengue fever (DF) is an old disease; the first record of a clinically compatible disease being recorded in a Chinese medical encyclopaedia in 992. As the global shipping industry expanded in the 18th and 19th centuries, port cities grew and became more urbanized, creating ideal conditions for the principal mosquito vector, Aedes aegypti. Both the mosquitoes and the viruses were thus spread to new geographic areas causing major epidemics. Because dispersal was by sailing ship, however, there were long intervals (10-40 years) between epidemics. In the aftermath of World War II, rapid urbanization in Southeast Asia led to increased transmission and hyperendemicity. The first major epidemics of the severe and fatal form of disease, dengue haemorrhagic fever (DHF), occurred in Southeast Asia as a direct result of this changing ecology. In the last 25 years of the 20th century, a dramatic global geographic expansion of epidemic DF/DHF occurred, facilitated by unplanned urbanization in tropical developing countries, modern transportation, lack of effective mosquito control and globalization. As we go into the 21st century, epidemic DF/DHF is one of the most important infectious diseases affecting tropical urban areas. Each year there are an estimated 50-100 million dengue infections, 500000 cases of DHF that must be hospitalized and 20000-25 000 deaths, mainly in children. Epidemic DF/DHF has an economic impact on the community of the same order of magnitude as malaria and other important infectious diseases. There are currently no vaccines nor antiviral drugs available for dengue viruses; the only effective way to prevent epidemic DF/DHF is to control the mosquito vector, Aedes aegypti. PMID:17319151

Gubler, Duane J

2006-01-01

152

Sudden headache, third nerve palsy and visual deficit: thinking outside the subarachnoid haemorrhage box.  

PubMed

A 75-year-old lady presented with sudden severe headache and vomiting. Examination was normal, and CT and lumbar puncture not convincing for subarachnoid haemorrhage. Shortly thereafter, she developed painless diplopia. Examination confirmed right third cranial nerve palsy plus homonymous left inferior quadrantanopia. Urgent cerebral MRI with angiography was requested to assess for a possible posterior communicating artery aneurysm, but revealed an unsuspected pituitary mass. Pituitary adenoma with pituitary apoplexy was diagnosed. Pituitary apopolexy is a syndrome comprising sudden headache, meningism, visual and/or oculomotor deficits, with an intrasellar mass. It is commonly due to haemorrhage or infarction within a pituitary adenoma. Treatment includes prompt steroid administration, and potentially surgical decompression. While subarachnoid haemorrhage is an important, well-recognised cause of sudden severe headache, other aetiologies, including pituitary apoplexy, should be considered and sought. PMID:23913476

Ní Chróinín, Danielle; Lambert, John

2013-11-01

153

The protective action of allopurinol in an experimental model of haemorrhagic shock and reperfusion.  

PubMed Central

Haemorrhagic shock was induced in anaesthetized, open-chest dogs by controlled arterial bleeding, sufficient to reduce and maintain mean arterial blood pressure at 40 mmHg for 30 min. The blood volume was then restored to the pre-shock level by rapid, intravenous reinfusion of the blood shed during the shock period. Haemorrhagic shock produced significant haemodynamic changes, characterized by a marked depression of myocardial function. Cardiac output (1226 +/- 57 ml min-1), peak aortic blood flow (6030 +/- 383 ml min-1) and maximum rate of rise of left ventricular pressure (2708 +/- 264 mmHg s-1) were all reduced by more than 50%. The haemodynamic profile was markedly improved by reinfusion of shed blood but this improvement was not sustained. There was a gradual decline such that 50% of the untreated animals suffered complete circulatory collapse and death between 60 and 120 min following reinfusion. Neither haemorrhagic shock, nor reinfusion of shed blood produced any consistent or significant changes in the myocardial adenine nucleotide pool. The ATP, ADP and AMP levels were, respectively, 25.9 +/- 4.2; 15.6 +/- 1.0; 4.3 +/- 1.9 nmol g-1 protein, before haemorrhagic shock; 21.6 +/- 3.4; 21.5 +/- 2.5; 10.2 +/- 2.7 nmol g-1 protein, after 30 min haemorrhagic shock; and 29.9 +/- 3.9; 16.5 +/- 1.2; 4.2 +/- 1.1 nmol g-1 protein, 60 min following reinfusion of shed blood. Pretreatment with allopurinol (50.0 mg kg-1 i.v.), 60 min before inducing haemorrhagic shock, had no significant effect upon the haemodynamic response to shock, but did prevent the gradual decline seen following reinfusion in the untreated animals.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3801769

Allan, G.; Cambridge, D.; Lee-Tsang-Tan, L.; Van Way, C. W.; Whiting, M. V.

1986-01-01

154

Low superior vena cava flow and intraventricular haemorrhage in preterm infants  

Microsoft Academic Search

OBJECTIVESTo document the incidence, timing, degree, and associations of systemic hypoperfusion in the preterm infant and to explore the temporal relation between low systemic blood flow and the development of intraventricular haemorrhage (IVH).STUDY DESIGN126 babies born before 30 weeks' gestation (mean 27 weeks, mean body weight 991 g) were studied with Doppler echocardiography and cerebral ultrasound at 5, 12, 24,

Martin Kluckow; Nick Evans

2000-01-01

155

Nosocomial infection of Crimean-Congo haemorrhagic fever in eastern Iran: case report.  

PubMed

An outbreak of Crimean-Congo haemorrhagic fever occurred in the county of Birjand in eastern Iran in November 2011. Four cases were involved in this outbreak. Two patients died after admission to hospital, one of whom was a nurse who acquired the infection nosocomially, and the others were treated successfully. PMID:23266037

Chinikar, Sadegh; Shayesteh, Majid; Khakifirouz, Sahar; Jalali, Tahmineh; Rasi Varaie, Fereshteh Sadat; Rafigh, Mahboubeh; Mostafavi, Ehsan; Shah-Hosseini, Nariman

2013-01-01

156

The response of the Eagle Owl ( Bubo bubo ) to an outbreak of the rabbit haemorrhagic disease  

Microsoft Academic Search

Summary The Eagle Owl (Bubo bubo) is a generalist predator that in Mediterranean areas feeds mainly on Rabbits (Oryctolagus cuniculus) At the end of 1997, a local outbreak of the rabbit haemorrhagic disease (RHD) decimated Rabbit populations in the area of Alicante (eastern Spain) so that Rabbit numbers in 1998 crashed to almost nil. Prior to the outbreak we had

Jose Antonio Martínez; Ifiigo Zuberogoitia

2001-01-01

157

Hyaline membrane disease and intraventricular haemorrhage in small for gestational age infants  

Microsoft Academic Search

19 small for gestational age (SGA) infants with gestational ages less than or equal to 32 weeks were matched with 19 appropriate for gestational age (AGA) preterm neonates with similar risk factors for intraventricular haemorrhage and hyaline membrane disease. Gestational age, 1- and 5-minute Apgar scores, type of delivery, survival rate, use of corticosteroids before delivery, sex, twinning, presence of

R S Procianoy; J A Garcia-Prats; J M Adams; A Silvers; A J Rudolph

1980-01-01

158

[Specific epidemiologic features of Crimean haemorrhagic fever in Stavropol' region in 1999-2000].  

PubMed

The results of the epidemiological analysis of morbidity in Crimean haemorrhagic fever in the Stavropol Territory in 1999-2000 are presented. The epidemiological features, specifically characteristic of the manifestations of this infection in the territory, have been determined. PMID:12718188

Onishchenko, G G; Efremenko, V I; Kovalev, N G; Shibkov, N A; Fedorov, Iu M; Zhilina, N Ia; Fedosova, G N; Sysoliatina, G V; Evchenko, Iu M; Be?er, A P; Popov, V A; Shenetts, K V; Marchukova, L N; Afanas'ev, E N; Vasilenko, N V

2001-01-01

159

Use of thermography to monitor sole haemorrhages and temperature distribution over the claws of dairy cattle.  

PubMed

Subclinical laminitis, an early pathological event in the development of many claw diseases, is an important factor in the welfare and economics of high-producing dairy cows. However, the aetiology and pathogenesis of this complex claw disease are not well understood. The present study investigated to what extent thermographic examination of claws is able to give information about corium inflammation, and whether the technique may be used as a diagnostic tool for early detection of subclinical laminitis. Moreover, the temperature distribution over the individual main claws was investigated to obtain further knowledge about pressure distribution on the claws. For this purpose the claws of 123 cows were evaluated in the first week after calving as well as after the second month of lactation for presence of sole haemorrhages (a sign of subclinical laminitis). Furthermore, the ground contact area was analysed by thermography. Sole haemorrhages were significantly increased by the second month of lactation. Thermography showed clear differences between the claws of the front limbs and hindlimbs, as well as between lateral and medial claws. Although the distribution of sole haemorrhages was consistent with the pattern of the temperature distribution over the main claws, no clear correlation was found between the claw temperature after calving and the visible laminitis-like changes (sole haemorrhages) eight weeks later. PMID:25380792

Wilhelm, K; Wilhelm, J; Fürll, M

2015-02-01

160

Name: dhr. prof. dr. G.J.E. Rinkel Neurology, in particular haemorrhagic stroke  

E-print Network

-mail address g.j.e.rinkel@umcutrecht.nl Research Intracranial aneurysms and subarachnoid haemorrhage and cardiologists. Another line within the research is genetics of intracranial aneurysms. Most of the research has and benefits of screening for intracranial aneurysms in first-degree relatives of patients with sporadic

Utrecht, Universiteit

161

Risk of gastrointestinal haemorrhage with calcium antagonists in hypertensive persons over 67 years old  

Microsoft Academic Search

SummaryBackground Calcium antagonists are used frequently in management of hypertension. In addition to their cardiovascular effects, these drugs inhibit platelet aggregation. Therefore we examined whether the use of calcium antagonists was associated with an increased risk of gastrointestinal haemorrhage (GIH).Methods A prospective cohort study was conducted from 1985 through 1992 on 1636 hypertensive persons aged ?68 years living in three

M Pahor; P Carbonin; J. M Guralnik; R. J Havlik; C. D Furberg

1996-01-01

162

Application of transcranial Doppler sonography in surgical aspects of hypertensive putaminal haemorrhage  

Microsoft Academic Search

Summary From May 1992 to February 1993, 22 cases of hypertensive putaminal haemorrhage (HPH) treated at our hospital were serially measured with transcranial Doppler (TCD) sonography. Among them, 13 patients underwent surgical intervention (3 stereotaxic surgery and 10 craniotomies), and 9 were conservatively treated. Most of the patients of the two operative groups had larger haematomas and developed clinical and\\/or

E.-J. Lee; Ch.-Ch. Chio; H.-J. Lin; L.-H. Yang; H.-H. Chen

1996-01-01

163

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

PubMed Central

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

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

2013-01-01

164

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

PubMed

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

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

2014-01-01

165

Arrest of Liver Haemorrhage Secondary to Percutaneous Liver Biopsy of a Haemangioma with Fibrin Glue  

PubMed Central

Background Haemorrhage resulting from blunt and penetrating injury to the liver remains a difficult therapeutic problem, often resulting in massive intraperitoneal blood loss. Perihepatic liver packing and inflow occlusive techniques in combination with finger fracture exploration of injuries to allow vessel ligation are the mainstays if treatment with normal liver parenchyma. More recently fibrin glue haemostatic agents have been used to arrest traumatic haemorrhage from the liver. We report a case of the use of fibrin glue to arrest the bleeding caused by the percutaneous biopsy of a liver haemangioma. Case Outline A 42 year-old woman underwent percutaneous diagnostic biopsy of a liver lesion and subsequently experienced shock secondary to massive bleeding from the biopsy site. At laparotomy there was massive bleeding from the puncture site of the liver lesion. Control of haemorrhage was obtained by injecting fibrin glue down the biopsy site tract. This manoeuvre resulted in complete arrest of haemorrhage with no adverse effect. Discussion The use of fibrin glue as a haemostatic agent in trauma is an important adjunct to perihepatic liver packing and finger fracture exploration of injuries. It may have exceptional utility in patients with penetrating trauma to the liver by direct intraparenchymal injection. This case illustrates that fibrin glue can be used to arrest bleeding from vascular tumours such as haemangiomas. It may help to minimise bleeding for all percutaneous liver biopsies. PMID:18332950

Dixon, Elijah

2002-01-01

166

Observations on the impacts of rabbit haemorrhagic disease on agricultural production values in Australia  

Microsoft Academic Search

Rabbit haemorrhagic disease (RHD) may be the most important rabbit control agent to be made available to graziers in Australia since the advent of myxomatosis. Documenting the benefits of RHD to agricultural production values is an important process in determining best-practice strategies for the use of the disease in controlling rabbit populations. In this paper we review previous studies on

Glen SaundersA; David ChoquenotA

167

Observations on the impacts of rabbit haemorrhagic disease on agricultural production values in Australia  

Microsoft Academic Search

Abstract. Rabbit haemorrhagic ,disease (RHD) may ,be the ,most important rabbit control agent to be ,made available to graziers in Australia since the advent of myxomatosis. Documenting the benefits of RHD to agricultural production values is an important process in determining best-practice strategies for the use of the ,disease in controlling rabbit populations. In this paper we review previous studies

Glen Saunders; Barry Kay; Greg Mutze; David Choquenot

2002-01-01

168

Intestinal protein loss in patients with haemorrhagic fever with renal syndrome  

Microsoft Academic Search

and characterized by vascular dysfunction (5-8). Clinically, retroperitoneal oedema and free fluid accu- Background. In haemorrhagic fever with renal syn- drome (HFRS ) vascular dysfunction has been mulations in the body cavities with haemoconcentra- tion reflect the vascular leak present in HFRS. observed in various organs, but the involvement of the intestine has not yet been reported. This study was

Young Ok Kim; Chul Woo Yang; Sun Ae Yoon; Ho Cheol Song; Yong Soo Kim; Suk Young Kim

169

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

NASA Astrophysics Data System (ADS)

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.

Salman, Afan; Lina, Yen; Simon, Christian

2014-03-01

170

Cell proliferation in human ganglionic eminence and suppression after prematurity-associated haemorrhage.  

PubMed

In premature infants, germinal matrix haemorrhage in the brain is a common occurrence. However, cell proliferation and fate determination in the normal human germinal matrix is poorly understood. Human ganglionic eminence samples were collected prospectively from autopsies of premature and term infants with no evidence of pathological process (n=78; dying at post-menstrual age 14-88 weeks). The ganglionic eminence was thickest at 20-26 weeks and involuted by 34-36 weeks. Proliferating cells, detected by Ki67 immunoreactivity, were abundant throughout the ganglionic eminence prior to 18 weeks, after which a sharp boundary between the dorsal and ventral ganglionic eminence appeared with reduced cell proliferation in the dorsal region. Ki67 immunoreactivity persisted in the majority of ventral cells until ?28 weeks, after which time the proportion of proliferating cells dropped quickly. The expression of cell lineage markers (such as Olig2, SOX2, platelet-derived growth factor receptor alpha) showed partitioning at the microscopic level. The hypothesis that germinal matrix haemorrhage suppresses cell proliferation was then addressed. In comparison to controls, germinal matrix haemorrhage (n=47; born at post-menstrual age 18-34 weeks followed by survival of 0?h to 98 days) was associated with significantly decreased cell proliferation if survival was >12?h. The cell cycle arrest transcription factor p53 was transiently increased and the oligodendroglial lineage markers Olig2 and platelet-derived growth factor receptor alpha were decreased. Cell death was negligible. A low level of microglial activation was detected. Haemorrhage-associated suppression of cell proliferation in premature human infants could partially explain the reduced brain size and clinical effects in children who suffer germinal matrix haemorrhage after premature birth. PMID:21478186

Del Bigio, Marc R

2011-05-01

171

Pituitary apoplexy can mimic acute meningoencephalitis or subarachnoid haemorrhage.  

PubMed

Pituitary apoplexy is an uncommon but life-threatening condition that is often overlooked and underdiagnosed. We report a 45-year-old man who presented to our emergency department with a sudden onset headache, acute confusion, signs of meningeal irritation and ophthalmoplegia. An initial diagnosis of acute meningoencephalitis was made, which was amended to pituitary apoplexy following thorough investigation within the emergency department.A 45-year-old man was brought to our emergency department by ambulance with a history of sudden onset of frontal headache and acute confusion. His wife provided the history. There was no significant past medical history of diabetes, hypertension, recent travel abroad, exposure to sick contacts, involvement in outdoor pursuits such as hiking/cave diving, or trauma. He worked in a bank and had been well until 24 h prior to the onset of sudden headache, which was gradually worsening in nature and associated with increasing confusion. The patient's wife reported that he had neither experienced any fevers, night sweats, or coryzal symptoms nor received any recent vaccinations. He was not on any regular medications. He was a non-smoker and occasionally consumed alcohol. There was no significant family history. On examination in the ED, his temperature was 37.6°C, his pulse was 110/min, and he was normotensive and normoglycaemic. A macular blanching rash was noted over the patient's trunk. The patient was disoriented to time and place. Neurological examination revealed reduced GCS (11/15-E3, M6, V2), marked neck stiffness, a positive Kernig's sign and a right sixth nerve palsy.A provisional diagnosis of acute meningoencephalitis was made and the patient was started on a course of intravenous antibiotics with benzyl penicillin 1.2 g, cefotaxime 2 g and acyclovir 750 mg. Baseline blood investigations revealed hyponatraemia (122 mmol/l), a white-cell count of 11 × 109/l and a C-reactive protein > 250. Due to the sudden onset of the 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 ?g) 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

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

2011-01-01

172

Diffuse alveolar haemorrhage may be associated with intravitreal injection of bevacizumab in a patient with systemic risk factors  

PubMed Central

The authors present a rare case where acute respiratory failure occurred after the intravitreal bevacizumab injection for a branch retinal vein occlusion. Chest CT scan showed ground-glass opacity in the bilateral lung fields. The finding of bronchoalveolar lavage fluid revealed alveolar haemorrhage. Corticosteroid therapy resulted in a rapid improvement of respiratory failure. This report suggests that intravitreal injection of bevacizumab may be associated with diffuse alveolar haemorrhage and acute lung injury. PMID:22714606

Seto, Ruriko; Yamada, Hideto; Wada, Hiroshi; Osawa, Makoto; Nagao, Taishi; Nakano, Yasutaka

2011-01-01

173

Belgrade and Hantaan hantaviruses — the causative agents of severe haemorrhagic fever with renal syndrome in children in Serbia  

Microsoft Academic Search

During an outbreak of haemorrhagic fever with renal syndrome (HFRS) in 1989, five children (3 girls, 2 boys, aged 6.8–16 years) with a severe form of the disease were treated; four of these were followed for 22–28 months. The main clinical features in all five patients were: fever, headache, myalgia, abdominal and back pain and vomiting; haemorrhagic syndrome was present

Radovan Bogdanovic; Ana Gligic; Vesna Nikolic; Miloš Ognjanovi?; Milanka Markovi?; Ljudmila Sarjanovi?

1994-01-01

174

Haemorrhage after home birth: audit of decision making and referral. Part 2: Results and discussion.  

PubMed

This descriptive study aims to identify substandard care (SSC) in PPH after home birth in the Netherlands. Sixty seven cases of postpartum haemorrhage (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 whom 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 or major status. Major SSC was identified in two out of seven cases. We conclude that communication between different healthcare providers should be optimised and a proactive attitude taken to select women who plan to give birth at home, taking into account the possibility of timely referral in case of PPH or retained placenta. National multidisciplinary guidelines on managing obstetric haemorrhage in home birth are urgently needed. PMID:24386705

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

2013-12-01

175

Complete tamponade system for management of severe postpartum vaginal haemorrhage due to uterine atony.  

PubMed

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

Atilgan, Remzi; Ozkan, Zehra Sema; Orak, Ugur; Baspinar, Melike

2014-01-01

176

Bilateral adrenal haemorrhage associated with heparin-induced thrombocytopaenia during treatment of Fournier gangrene.  

PubMed

We present a case of bilateral adrenal haemorrhage (BAH) associated with heparin-induced thrombocytopaenia (HIT) in a 61-year-old man admitted to hospital for the treatment of Fournier's gangrene. He presented to hospital with scrotal swelling and fever, and developed spreading erythaema and a gangrenous scrotum. His scrotum was surgically debrided and intravenous broad-spectrum antibiotics were administered. Unfractionated heparin was given postoperatively for venous thromboembolism prophylaxis. The patient deteriorated clinically 8-11?days postoperatively with delirium, chest pain and severe hypertension followed by hypotension and thrombocytopaenia. Abdominal CT scan revealed bilateral adrenal haemorrhage. Antibodies to the heparin-platelet factor 4 complex were present. HIT-associated BAH was diagnosed and heparin was discontinued. Intravenous bivalirudin and hydrocortisone were started, with rapid improvement in clinical status. BAH is a rare complication of HIT and should be considered in the postoperative patient with unexplained clinical deterioration. PMID:25315802

Tattersall, Timothy Lee; Thangasamy, Isaac A; Reynolds, Jamie

2014-01-01

177

Christmas disease: diagnosis and management of a haemorrhagic diathesis following dentofacial trauma.  

PubMed

Haemorrhagic diathesis has been of much concern to health professionals including dentists. It is not infrequent that a dentist becomes the first person to diagnose a bleeding disorder while performing dental treatment. Haemophilia is an X linked disorder with a frequency of about 1:10?000 births. Haemophilia B is much less common than haemophilia A, and affects only 1:300?000 males born alive. The clinical features of haemophilia B are very similar to those of haemophilia A with a prolongation of activated partial thromboplastin time. This case report describes the dental management of a patient with an uncommon haematological disorder, namely, factor IX deficiency, which remained undiagnosed until the patient had to undergo dentofacial trauma with unexpected severe haemorrhage. Preventive dentistry remains vital to young haemophiliacs. Surgical dental procedures may be performed for haemophiliacs but they must be judiciously coordinated by dental and medical health professionals. PMID:25568261

Tamagond, Sridevi B; Hugar, Santosh I; Patil, Anil; Huddar, SandhyaRani

2015-01-01

178

Protein S Deficiency and an Adult Case with Moyamoya Syndrome that Presented with Primary Intraventricular Haemorrhage  

PubMed Central

Background: Moyamoya syndrome associated with protein S deficiency is rarely encountered and is usually reported in paediatric cases with cerebral ischaemia. Case Report: A 32-year-old woman had symptoms of sudden-onset severe headache, projectile vomiting, impaired consciousness, and slight neck stiffness. The computed tomography scan of her brain showed primary intraventricular haemorrhage, and the subsequent four vessel cerebral angiographies revealed stage 3 to 4 Moyamoya disease according to Suzuki and Takaku’s angiographic classification. The coagulation profile showed the presence of protein S deficiency. The patient was treated with external ventricular drainage and conservative management until blood clot resolution. The patient was discharged with normal neurological examination findings after her initial impaired consciousness and orientation defect gradually recovered. Conclusion: This case report would alert physicians to the possible coexistence of Moyamoya syndrome and protein S deficiency, even in adult cases presenting with primary intraventricular haemorrhage. PMID:25207193

Çevik, Betül; Acu, Berat; Aksoy, Dürdane; Kurt, Semiha

2014-01-01

179

Histological verification of microaneurysms as a cause of cerebral haemorrhage in surgical specimens.  

PubMed Central

Surgical specimens taken from 14 patients with lobar intracerebral haemorrhage or cerebellar haemorrhage without vascular abnormalities on angiograms were examined histologically. In seven of the 14 patients, arteriovenous malformation or amyloid angiopathy were found by ordinary pathological examinations. Among the remaining seven patients, definite microaneurysms were verified in five and possible ones in two patients by using the technique of serial sectioning of the solid nodular tissues removed from the presumed bleeding site, where an arterial connection between the tissues and the surrounding brain was noted. Four of these seven patients had no history of hypertension and showed normal blood pressure before and after surgery. To verify microaneurysms in surgical specimens, it seems important to search the presumed bleeding site properly by a meticulous microsurgical technique and to section the tissues serially for the histological examination. Images PMID:2732728

Wakai, S; Nagai, M

1989-01-01

180

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

PubMed

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

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

2012-05-01

181

Dietary fibre intake and risk of ischaemic and haemorrhagic stroke in the UK Women's Cohort Study.  

PubMed

Background:Stroke risk is modifiable through many risk factors, one being healthy dietary habits. Fibre intake was associated with a reduced stroke risk in recent meta-analyses; however, data were contributed by relatively few studies, and few examined different stroke types.Methods:A total of 27?373 disease-free women were followed up for 14.4 years. Diet was assessed with a 217-item food frequency questionnaire and stroke cases were identified using English Hospital Episode Statistics and mortality records. Survival analysis was applied to assess the risk of total, ischaemic or haemorrhagic stroke in relation to fibre intake.Results:A total of 135 haemorrhagic and 184 ischaemic stroke cases were identified in addition to 138 cases where the stroke type was unknown or not recorded. Greater intake of total fibre, higher fibre density and greater soluble fibre, insoluble fibre and fibre from cereals were associated with a significantly lower risk for total stroke. For total stroke, the hazard ratio per 6?g/day total fibre intake was 0.89 (95% confidence intervals: 0.81-0.99). Different findings were observed for haemorrhagic and ischaemic stroke in healthy-weight or overweight women. Total fibre, insoluble fibre and cereal fibre were inversely associated with haemorrhagic stroke risk in overweight/obese participants, and in healthy-weight women greater cereal fibre was associated with a lower ischaemic stroke risk. In non-hypertensive women, higher fibre density was associated with lower ischaemic stroke risk.Conclusions:Greater total fibre and fibre from cereals are associated with a lower stroke risk, and associations were more consistent with ischaemic stroke. The different observations by stroke type, body mass index group or hypertensive status indicates potentially different mechanisms.European Journal of Clinical Nutrition advance online publication, 3 December 2014; doi:10.1038/ejcn.2014.260. PMID:25469464

Threapleton, D E; Burley, V J; Greenwood, D C; Cade, J E

2014-12-01

182

Cimetidine prevents suppression of delayed hypersensitivity in an animal model of haemorrhagic shock  

Microsoft Academic Search

Background: Cimetidine reverses immunosuppression following trauma, however, its effect on pure haemorrhagic shock is unknown. Methods: Mice sensitized by injection of sheep red blood cells (SRBCs), were subjected to cardiac puncture and randomized to a control group-A (n=11) and three shock groups (35% of blood volume extracted): group-S had no treatment (n=16), group-CP received cimetidine 50mg\\/kg intraperitoneally (n=16), group-CW received

Peter MacD Hewitt; Neil Armstrong; Patricia Bowrey; Maya Cherian; David Lawson Morris

2002-01-01

183

Spontaneous mediastinal haemorrhage linked with thymic carcinoma and myelodysplasia: a case report  

PubMed Central

We report an unusual sequence of clinico-pathological manifestations of myelodysplastic syndrome and thymic squamous cell carcinoma. A 77-year-old man with a two-month history of myelodysplastic syndrome was admitted with acute chest pain and shortness of breath. Radiological investigations revealed an anterior mediastinal mass, associated with mediastinal haemorrhage. The mass was excised via a standard median sternotomy and was found to be an infiltrating squamous cell carcinoma, which arose from a multilocular thymic cyst. PMID:19830017

Van Tornout, Filip; Ball, Richard Y; Wimperis, Jennie Z

2009-01-01

184

Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial  

Microsoft Academic Search

OBJECTIVE--To determine the efficacy of oral nimodipine in reducing cerebral infarction and poor outcomes (death and severe disability) after subarachnoid haemorrhage. DESIGN--Double blind, placebo controlled, randomised trial with three months of follow up and intention to treat analysis. To have an 80% chance with a significance level of 0.05 of detecting a 50% reduction in an incidence of cerebral infarction

J. D. Pickard; G. D. Murray; R. Illingworth; M. D. Shaw; G. M. Teasdale; P. M. Foy; P. R. Humphrey; D. A. Lang; R. Nelson; P. Richards

1989-01-01

185

[Digestive haemorrhage in a patient with oropharyngeal cancer. A case study].  

PubMed

Gastric metastases from solid tumours are very infrequent and in most cases appear simultaneously with other metastases. The most frequent primary tumors are lung and breast. Clinical data and symptoms are non-specific, and can range from abdominal discomfort to massive gastrointestinal bleeding. The diagnoses must be established by gastroscopy and biopsy. We present an unusual case of digestive haemorrhage secondary to gastric metastases from oropharyngeal carcinoma. PMID:20094105

Rico, M; Arias de la Vega, F; Vila, M T; Chicata, V; Asín, G; Gómez Dorronsoro, M I

2009-01-01

186

Primary Supratentorial Haemorrhage – Surgery or no Surgery in an Indian Setup  

PubMed Central

Introduction: Rise of hypertension among younger age group has increased the prevalence of intracranial haemorrhage. Conflicting reviews regarding the mode of treatment has been a concern to the treating physicians especially in a developing country like India. This study was undertaken to underline the importance of management and propose a local protocol for primary supra-tentorial haemorrhage. Materials and Methods: Patients presenting with primary supratentorial (ST) haemorrhage fulfilling inclusion criteria are included in the study. Decompression craniotomy done in all the patients and the patient particulars noted. The primary outcome of death is correlated with various particulars and statistical analysis done with SPSS version 16. Results: Mean age of presentation was 54.2 years, ranging from 38-71years. Male comprised 82.1% (23 patients). Seven out of eight patients with Glasgow coma scale (GCS) ?7 (87.5%) expired whereas only 3 out of 20 (15%) patients with GCS >7 expired. 50% of the patients with intracranial haemorrhage (ICH) in temporo-pari et al., (2/4) or in basal ganglia with cortical extension (5/10) expired whereas the mortality in cases of ICH in parietal lobe and frontal lobes were 25% (1/4) and 20% (2/10) respectively. Clot volume ?100ml had a mortality of 19% (4/21) whereas the mortality was as high as 85.7% (6/7) with clot volume >100ml. Conclusion: Emergency Craniotomy and Evacuation of the Hematoma could be a feasible option in between 40 ml to 100ml of Primary ST ICH without intra-ventricular extension. In cases of intra-ventricular extension of haematoma surgery is less helpful. Midline shift of 5 mm or more might be a poor prognostic factor. PMID:25386479

Singh, Th Gojendra; Ghalige, Hemanth S; S, Abhilash; Singh, Motilal; Berma, Subrata Kishore Deb; N, Prasanna Kumar

2014-01-01

187

Disposition and pharmacodynamics of propofol during isovolaemic haemorrhage followed by crystalloid resuscitation in humans  

PubMed Central

Aims The purpose of this study was to estimate the changes in unbound propofol concentration and pharmacodynamics of propofol during isovolaemic haemorrhage followed by crystalloid resuscitation. Methods Ten patients undergoing measure elective surgery were enrolled in this study. Anaesthesia was maintained by 60% nitrous oxide in oxygen, fentanyl 10–20 µg kg?1 and an infusion of propofol at 8 mg kg?1 h?1 until the end of the operation. Radial arterial samples were collected for measurement of propofol concentration just before the start of the operation, and at the point when blood loss was > 10 ml kg?1, 20 ml kg?1 and 30 ml kg?1. Cardiac output (CO), haemoglobin values and plasma concentrations of albumin were also determined. Patients were resuscitated with lactated Ringer's solution to maintain a mean arterial blood pressure (± 20% of prehaemorrhage). Bispectral index (BIS) was measured continuously. Results Mean blood pressure, heart rate and CO were well maintained during the operation in all patients. Haemoglobin values and plasma albumin concentrations decreased significantly during surgery. There were no significant differences in total propofol concentrations across the time points. The unbound propofol concentration was increased from 0.10 ± 0.040 µg ml?1 to 0.17 ± 0.041 µg ml?1 after the haemorrhage of 30 ml kg?1 (P < 0.05). BIS was significantly decreased from 47 ± 5.9 to 39 ± 3.7 (P < 0.05) after the haemorrhage of 30 ml kg?1. Conclusions The hypnotic potency of propofol is increased during isovolaemic haemorrhage in crystalloid resuscitated patients even if CO is maintained. PMID:16487218

Takizawa, Eri; Takizawa, Daisuke; Hiraoka, Haruhiko; Saito, Shigeru; Goto, Fumio

2006-01-01

188

Intraventricular haemorrhage in preterm infants - Can we improve outcome by addressing coagulation?  

PubMed

Abstract During the last few decades, the survival of preterm infants has increased dramatically. Nevertheless, with the increasing number of very young and extremely low birth weight infants, morbidity is still a major problem. Intraventricular Haemorrhage (IVH) is a major complication of preterm birth, and large haemorrhages or haemorrhages associated with parenchymal brain lesions may yield a high rate of future disability. IVH is a complex, multi-factorial disorder. Prematurity and low birth weight remain as its most important risk factors, affecting vulnerability of the germinal matrix as well as the coagulation system. Approximately 80% of IVHs occur by 72?h after birth, but a considerable proportion of IVH is already visible on the first cranial ultrasound scan within a few hours of birth. The hypothesis that a severe coagulation deficiency in the premature newborn could be a major contributing factor to IVH has been suggested, and small open label interventional studies targeting the premature coagulation system have been conducted with ethamsylate, vitamin K, fresh frozen plasma, recombinant activated factor VII and prothrombin complex concentrate. The outcome of these studies will be reviewed. PMID:23968273

Kuperman, Amir A; Brenner, Benjamin; Kenet, Gili

2013-08-23

189

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

PubMed Central

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

2012-01-01

190

New Prognostic Score for the Prediction of 30-Day Outcome in Spontaneous Supratentorial Cerebral Haemorrhage  

PubMed Central

Aims. The purpose of the present study was to evaluate predictors of outcome in primary supratentorial cerebral haemorrhage. Furthermore, we aimed to develop a prognostic model to predict 30-day fatality. Methods. We retrospectively analyzed a database of 156 patients with spontaneous supratentorial haemorrhage to explore the relationship between clinical and CT characteristics and fatal outcome within 30 days using multiple logistic regression analysis. The analyzed factors included volumetric data assessed by neuropathological and CT volumetry. A second CT scan in survivors or neuropathological ABC/2 volumetry in nonsurvivors was used along with the baseline CT to assess the growth index of haematoma. Results. Systolic blood pressure, serum potassium and glucose levels, platelet count, absolute and relative haematoma volumes, and presence and size of intraventricular haemorrhage statistically significantly predicted the fatal outcome within 30 days. Based on our results we formulated a six-factor scoring algorithm named SUSPEKT to predict outcome. Conclusions. After validation the SUSPEKT score may be applicable in general clinical practice for early patient selection to optimize individual management or for assessment of eligibility for treatment trials. PMID:25648158

Szepesi, Rita; Széll, Ibolya Katalin; Hortobágyi, Tibor; Kardos, László; Nagy, Katalin; Lánczi, Levente István; Berényi, Ervin; Bereczki, Dániel; Csiba, László

2015-01-01

191

[Massive intrahepatic haemorrhage responsible for an inferior vena cava syndrome: an exceptional complication of hepatocellular carcinoma].  

PubMed

Intralesional massive haemorrhage responsible for inferior vena cava syndrome is a very rare complication of hepatocellular carcinoma. A 36-year-old man with no past medical history was referred to hospital for abdominal pain with clinical and biological signs of internal bleeding. An abdominal CT scan showed a huge right liver mass, with regular margins and a fluid content, indicating a large intratumoral haemorrhage complicating hepatocellular carcinoma. Due to haemodynamic stability and the signs of inferior vena cava compression conservative management was chosen prior to surgical treatment of the tumour. Three months later, the huge liver mass remained unchanged but the inferior vena cava syndrome had decreased and the patient's condition improved. After evaluation of liver function and the extent of the tumour, a surgical procedure was performed via a subcostal incision with midline extension and sternotomy to control the intrapericardial inferior vena cava and perform a veno-venous bypass with the technique used for orthotopic liver transplantation. Then, right hepatectomy (segments V to VIII) was performed with an anterior approach. The postoperative course was uneventful. This two-step strategy allowed successful surgery for this rare complication of a hepatocellular carcinoma on a normal liver and could be recommended for the management of any unruptured intratumoral haemorrhages. PMID:16633318

Ettorre, Giuseppe Maria; Douard, Richard; Santoro, Roberto; Vidiri, Antonello; Vennarecci, Giovanni; Carboni, Fabio; Boschetto, Arianna; Corazza, Valerio; Maritti, Michela; Antonini, Mario; Santoro, Eugenio

2006-03-01

192

Relationship of tumour necrosis factor and endotoxin to macrophage cytotoxicity, haemorrhagic necrosis and lethal shock.  

PubMed

In this communication we discuss preliminary evidence suggesting a very strong synergism between tumour necrosis factor (TNF) and lipopolysaccharide (LPS) or between TNF and other bacteria in causing haemorrhagic necrosis and lethal shock. We found that TNF by itself does not cause haemorrhagic necrosis when injected into normal skin. TNF also had a rather low systemic toxicity when injected into disease-free, germfree-derived, defined-flora animals. On the other hand the addition of small amounts of LPS markedly raised the lethality of intravenous TNF treatments, and LPS injected into normal skin 'prepared' the site of injection for subsequent induction of haemorrhagic necrosis by locally injected TNF. Similar synergism was observed between TNF and mycoplasma. We suggest that the synergism between TNF and bacterial endotoxin (or other bacteria or bacterial products) may be part of an important defence mechanism against infections which is independent of specific immunity mediated by B and T cells. This synergism may be useful in increasing the therapeutic effects of TNF on tumours if the development of systemic toxicity in this treatment can be prevented. PMID:3330008

Rothstein, J L; Schreiber, H

1987-01-01

193

Contribution of neovascularization and intraplaque haemorrhage to atherosclerotic plaque progression and instability.  

PubMed

Atherosclerosis is a continuous pathological process that starts early in life and progresses frequently to unstable plaques. Plaque rupture leads to deleterious consequences such as acute coronary syndrome, stroke and atherothrombosis. The vulnerable lesion has several structural and functional hallmarks that distinguish it from the stable plaque. The unstable plaque has large necrotic core (over 40% plaque volume) composed of cholesterol crystals, cholesterol esters, oxidized lipids, fibrin, erythrocytes and their remnants (haeme, iron, haemoglobin), and dying macrophages. The fibrous cap is thin, depleted of smooth muscle cells and collagen, and is infiltrated with proinflammatory cells. In unstable lesion, formation of neomicrovessels is increased. These neovessels have weak integrity and leak thereby leading to recurrent haemorrhages. Haemorrhages deliver erythrocytes to the necrotic core where they degrade promoting inflammation and oxidative stress. Inflammatory cells mostly presented by monocytes/macrophages, neutrophils and mast cells extravagate from bleeding neovessels and infiltrate adventitia where they support chronic inflammation. Plaque destabilization is an evolutionary process that could start at early atherosclerotic stages and whose progression is influenced by many factors including neovascularization, intraplaque haemorrhages, formation of cholesterol crystals, inflammation, oxidative stress and intraplaque protease activity. PMID:25515699

Chistiakov, D A; Orekhov, A N; Bobryshev, Y V

2015-03-01

194

Haemorrhagic effect of enoxaparin, a low molecular weight heparin. Comparison with unfractionated heparin in humans.  

PubMed

The haemorrhagic effects of unfractionated heparin (UFH) and the low molecular weight heparin (LMWH) enoxaparin were investigated and compared in the gastric mucosa (haemorrhage induced by biopsy) and skin (haemorrhage induced by Simplate) of 12 healthy volunteers. Administration of UFH and LMWH (given in a dose of 75 anti-Xa U/kg intravenously) increased median gastric bleeding time (3.5 min) and geometric mean blood loss (11.5 microliters) to 19 min (p = 0.00003) and 54.1 microliters (p = 0.0021) after UFH and to 13 min (p = 0.008) and 29.0 microliters (p = 0.275) after LMWH. Median skin bleeding time (4.25 min) increased to 6.0 min after UFH (p = 0.003) and to 6.75 min after LMWH (p = 0.0008). Mean heparin activity in plasma was 20% higher after LMWH than after UFH. The calculated gastric bleeding time to heparin activity ratio was significantly lower for LMWH than for UFH (p < 0.05). PMID:1333639

Bang, C J; Riedel, B; Talstad, I; Berstad, A

1992-11-01

195

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

PubMed Central

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

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

2013-01-01

196

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

PubMed

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

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

2015-02-01

197

sensibilit la SHV/sensibilit la NPI pourra alors tre tudie plus prcisment sur des re-  

E-print Network

and rainbow trout x brook trout) to infectious pancreatic necrosis and viral haemorrhagic septicaemia viruses) Resistance of triploid rainbow trout x book trout hybrids to viral haemorrhagic septicaemia. Abstract M, Chevassus B (1986) Susceptibility of two salmonid triploid hybrids (rainbow trout x coho salmon

Paris-Sud XI, Université de

198

Post partum haemorrhage secondary to uterine atony, complicated by platelet storage pool disease and partial placenta diffusa: a case report  

PubMed Central

Introduction Uterine atony is the most common cause of primary post partum haemorrhage. We report a case where this was complicated by two rare conditions, platelet storage pool disease and placenta diffusa. Platelet storage pool disease is a platelet aggregation disorder associated with mild to moderate bleeding diathesis. There are limited cases reported in pregnancy. Placenta diffusa is a rare anomaly where all or part of the fetal membranes remain covered by chorionic villi, and is associated with post partum haemorrhage. Case presentation A 37-year-old woman was referred to the obstetric haematology clinic for prenatal counselling with a history of three severe post partum haemorrhages, two of which were complicated by placental retention. Platelet aggregation studies confirmed a diagnosis of platelet storage pool disease. She was counselled regarding her risk of a recurrent haemorrhage and a planned delivery was discussed. She subsequently presented at 15 weeks' gestation. Following an uneventful pregnancy, she was covered with prophylactic desmopressin and tranexamic acid before a planned induction of labour. She had a normal delivery but placenta was retained. In theatre, an uncomplicated manual removal was followed by massive haemorrhage secondary to uterine atony. Aggressive medical management and B lynch sutures at laparotomy failed to contract the uterus. Hysterectomy was therefore performed. Placental histology later showed evidence of partial placenta diffusa. Conclusion Post partum haemorrhage continues to be a leading cause of maternal morbidity and mortality. In this patient, despite identification and attempts at correction of an identified clotting disorder, major obstetric haemorrhage was not avoided. An additional rare placental abnormality was later found. This case highlights the need for medical staff to be aware and alert to unusual risk factors. However, these factors may be unavoidable and early surgical intervention as per local protocol is recommended to minimise maternal morbidity. PMID:19077291

Rahman, Shimma S; Myers, Jenny E; Gillham, Joanna C; Fitzmaurice, Richard; Johnston, Tracey A

2008-01-01

199

Activation of NF-?B after chronic ethanol intake and haemorrhagic shock/resuscitation in mice  

PubMed Central

BACKGROUND AND PURPOSE Chronic ethanol abuse and haemorrhagic shock are major causes of global mortality and, separately, induce profound hepato- and immune-toxic effects via activation of NF-?B. Here, we assessed the effects of chronic ethanol intake upon the pathophysiological derangements after haemorrhagic shock with subsequent resuscitation (H/R), with particular attention to the contribution of NF-?B. EXPERIMENTAL APPROACH Transgenic NF-?BEGFP mice, expressing the enhanced green fluorescent protein (EGFP) under the transcriptional control of NF-?B cis-elements were fed a Lieber-DeCarli diet containing ethanol (EtOH-diet) or an isocaloric control diet for 4 weeks and were then pairwise subjected to H/R. Liver tissues and peripheral blood were sampled at 2 or 24 h after H/R. Cytokines in blood and tissue and leukocyte activation (as CD11b expression) were measured, along with EGFP as a marker of NF-?B activation. KEY RESULTS The EtOH-diet increased mortality at 24 h after H/R and elevated liver injury, associated with an up-regulation of NF-?B-dependent genes and IL-6 release; it also increased production of NF-?B-driven intercellular adhesion molecule 1 (ICAM-1) and EGFP in liver tissue. At 2h after the H/R procedure in ethanol-fed mice we observed the highest proportion of NF-?B activated non-parenchymal cells and an NF-?B-dependent increase in polymorphonuclear leukocyte CD11b expression. CONCLUSIONS AND IMPLICATIONS The EtOH-diet exacerbated liver injury after H/R, accompanying an overwhelming hepatic and systemic immune response. Our findings contribute to evidence implicating NF-?B as a key player in the orchestration of the immune response in haemorrhagic shock patients with a history of chronic ethanol abuse. PMID:23646923

Maraslioglu, M; Weber, R; Korff, S; Blattner, C; Nauck, C; Henrich, D; Jobin, C; Marzi, I; Lehnert, M

2013-01-01

200

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

PubMed Central

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

Ranganath, Akshatha; Mariatos, George; Thakur, Shakti

2011-01-01

201

Acute Aneurismal Bilateral Subdural Haematoma without Subarachnoid Haemorrhage: A Case Report and Review of the Literature.  

PubMed

Spontaneous pure acute bilateral subdural haematoma (ASDH) without intraparenchymal or subarachnoid haemorrhage caused by a ruptured cerebral aneurysm is extremely rare. It can follow rupture of different aneurysms specially located in anterior incisural space; the most frequently encountered location is the PcoA aneurysms as demonstrated in the present case. We present a case report of a PcoA aneurysm presenting as pure bilateral ASDH. A high level of suspicion for bleeding of arterial origin should be maintained in all cases of acute subdural haematoma without history of trauma. The neurological status on admission dictates the appropriate timing and methodology of the neuroradiological investigations. PMID:25045554

Mansour, Ossama; Hassen, Tamer; Fathy, Sameh

2014-01-01

202

Acute Aneurismal Bilateral Subdural Haematoma without Subarachnoid Haemorrhage: A Case Report and Review of the Literature  

PubMed Central

Spontaneous pure acute bilateral subdural haematoma (ASDH) without intraparenchymal or subarachnoid haemorrhage caused by a ruptured cerebral aneurysm is extremely rare. It can follow rupture of different aneurysms specially located in anterior incisural space; the most frequently encountered location is the PcoA aneurysms as demonstrated in the present case. We present a case report of a PcoA aneurysm presenting as pure bilateral ASDH. A high level of suspicion for bleeding of arterial origin should be maintained in all cases of acute subdural haematoma without history of trauma. The neurological status on admission dictates the appropriate timing and methodology of the neuroradiological investigations. PMID:25045554

Mansour, Ossama; Hassen, Tamer; Fathy, Sameh

2014-01-01

203

Circulating immune complexes in serum from patients with dengue haemorrhagic fever.  

PubMed Central

Circulating immune complexes were detectable in 80% of serum from patients with dengue haemorrhagic fever. The immune complexes were detected for the first time on day two after the onset of the fever. The amount of complexes reached the maximum value on day 4 or 5 after onset, or when the patients developed shock or subsidence of fever, after which the complexes decreased in number. The number of complexes also correlated well with the clinical grading (severity) of the disease, i.e. the maximum amount was shown in grade III. These complexes may play a part in the pathogenesis of this disease. PMID:380857

Ruangjirachuporn, W; Boonpucknavig, S; Nimmanitya, S

1979-01-01

204

Subarachnoid haemorrhage above the age of 59: are intracranial investigations justified?  

PubMed Central

Out of 186 patients aged over 59 referred to a neurosurgical department after spontaneous subarachnoid haemorrhage, 143 underwent cerebral angiography; only 28 (15%) of the patients had surgery, of whom 16 were independent one year later. The doubtful benefit of surgery and the small proportion of patients who underwent surgery have economic and ethical implications; in particular, neurosurgical beds and neuroradiological facilities should not be occupied by such patients if this delays the admission of younger patients and those requiring investigation of intracranial space-occupying and spinal lesions. PMID:414813

Martindale, B V; Garfield, J

1978-01-01

205

Early and late complications of germinal matrix-intraventricular haemorrhage in the preterm infant: what is new?  

PubMed

Germinal matrix-intraventricular haemorrhage (GMH-IVH) remains a serious problem in the very and extremely preterm infant. This article reviews current methods of diagnosis, treatment and neurodevelopmental outcome in preterm infants with low-grade and severe GMH-IVH. We conclude that there is still no consensus on timing of intervention and treatment of infants with GMH-IVH, whether or not complicated by post-haemorrhagic ventricular dilatation. The discrepancies between the studies underline the need for international collaboration to define the optimal strategy for these infants. PMID:25171657

Brouwer, Annemieke J; Groenendaal, Floris; Benders, Manon J N L; de Vries, Linda S

2014-01-01

206

The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next?  

PubMed

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

Weeks, A

2015-01-01

207

Lethal, oedema, haemorrhagic activity of spotted butterfish (Scatophagus argus, Linn) sting extract and its neutralization by antiserum and pharmacological antagonists.  

PubMed

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

Muhuri, D; Dasgupta, S C; Gomes, A

2005-06-01

208

Effects of current and waveform on the incidence of breast meat haemorrhages in electrically stunned broiler chicken carcases.  

PubMed

The effects of the current and its waveform on the prevalence of broken bones and breast meat haemorrhages in electrically stunned broiler chickens were examined at two poultry processing plants. Increasing the current over the range from 68 to 115 mA per bird had very little effect on the carcase quality, but increased the incidence of broken furculum and coracoid bones in birds stunned with a sinusoidal alternating current (AC). Clipping a sinusoidal AC with a thyristor had a pronounced effect on the carcase quality, and resulted in more broken bones and breast meat haemorrhages. PMID:7502464

Gregory, N G; Wilkins, L J; Wotton, S B; Middleton, A L

1995-09-01

209

RAPID RISK ASSESSMENT Outbreak of Ebola haemorrhagic fever in the Democratic Republic of Congo  

E-print Network

An outbreak of Ebola haemorrhagic fever is ongoing in the Democratic Republic of Congo (DRC) with 15 cases reported, including nine deaths in Orientale province. It is the first time that the Ebola species Bundibugyo has been laboratory confirmed as the cause of an Ebola outbreak in DRC. This finding indicates that the current outbreak in DRC is not related to the recently ended outbreak in Uganda, which was caused by the Ebola species Sudan. The epidemiological features of this outbreak are consistent with previous outbreaks of Ebola haemorrhagic fever, although the currently observed case fatality rate is significantly higher than the one observed in the first outbreak of Bundingbuyo virus in 2007 in Uganda. However, it is premature to draw final conclusions about the pathogenicity of this Bundingbuyo viral strain. As the incubation period can last up to three weeks, it is likely that additional cases will be identified in the coming weeks. However, control measures currently implemented in DRC with the support of international partners, e.g. isolation of cases and active monitoring of contacts, should prevent further spread of the disease. It is unlikely, but not impossible, that travellers infected in DRC could arrive in the EU while incubating the disease and develop symptoms while in the EU. These cases would seek medical attention and be isolated, preventing further transmission.

Main Conclusions

2012-01-01

210

A nairovirus isolated from African bats causes haemorrhagic gastroenteritis and severe hepatic disease in mice  

PubMed Central

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

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

211

Acute primary haemorrhagic omental torsion mimicking perforated appendicitis: an unorthodox surgical paradox.  

PubMed

Acute primary haemorrhagic omental torsion is an atypical and deceptive cause of acute abdomen that could closely mimic a myriad of intra-abdominal catastrophes, especially perforated appendicitis. The author reports a 30 years man who had presented with gradually worsening right-sided abdominal pain of 2 days duration. Laboratory work-up and abdominal radiographs were inconclusive. Abdominal sonography detected presence of free fluid in the pelvic cul-de-sac. Based on clinical and sonographic findings, presumptive diagnosis of perforated appendicitis was made and the patient was explored through extended Rockey-Davis incision. About 500 - 700 ml of dark-coloured blood (haemoperitoneum) was present in the peritoneal cavity and the pelvis secondary to acute haemorrhagic omental torsion. The appendix was grossly normal. Omentectomy and prophylactic appendicectomy resulted in uneventful recovery of the patient. Acute primary omental torsion is an uncommon pathology that must be kept in mind during differential diagnosis of acute abdomen, especially acute or perforated appendicitis. PMID:25149843

Rehman, Abdul

2014-08-01

212

Blood, sweat and tears: androgenic-anabolic steroid misuse and recurrent primary post-tonsillectomy haemorrhage.  

PubMed

A 30-year-old male body builder and androgenic-anabolic steroid and insulin abuser was admitted for day case elective tonsillectomy (bipolar). He returned with primary post-tonsillectomy haemorrhage 18 h after the operation and required bipolar cautery to the multiple small bleeding points in the right and left tonsillar fossa. Thorough coagulation screen was normal. Recurrent primary haemorrhage occurred 3 h post-operatively requiring immediate surgical intervention, removal of the inferior poles, precautionary throat packs, intubation and observation on the intensive treatment unit (ITU). Re-examination in theatre revealed a bleeding left superior pole that was under-run to achieve haemostasis and the patient returned to ITU. Hypertensive episodes were noted in the emergency department and intraoperatively including one recording >200 mm Hg. Haemostasis was eventually achieved once the blood pressure was adequately controlled. A slow wean of steroids was also instigated and the patient was managed on a surgical ward for 2 weeks post-tonsillectomy. PMID:25398921

Fox, Richard; Varadharajan, Kiran; Patel, Bhavesh; Beegun, Issa

2014-01-01

213

First dengue haemorrhagic fever epidemic in the Americas, 1981: insights into the causative agent.  

PubMed

Historical records describe a disease in North America that clinically resembled dengue haemorrhagic fever during the latter part of the slave-trading period. However, the dengue epidemic that occurred in Cuba in 1981 was the first laboratory-confirmed and clinically diagnosed outbreak of dengue haemorrhagic fever in the Americas. At that time, the presumed source of the dengue type 2 strain isolated during this epidemic was considered controversial, partly because of the limited sequence data and partly because the origin of the virus appeared to be southern Asia. Here, we present a molecular characterisation at the whole-genome level of the original strains isolated at different time points during the epidemic. Phylogenetic trees constructed using Bayesian methods indicated that 1981 Cuban strains group within the Asian 2 genotype. In addition, the study revealed that viral evolution occurred during the epidemic - a fact that could be related to the increasing severity from month to month. Moreover, the Cuban strains exhibited particular amino acid substitutions that differentiate them from the New Guinea C prototype strain as well as from dengue type 2 strains isolated globally. PMID:25091743

Rodriguez-Roche, Rosmari; Hinojosa, Yoandri; Guzman, Maria G

2014-12-01

214

Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis  

Microsoft Academic Search

SummaryIn patients with variceal bleeding as a complication of hepatic cirrhosis, propranolol therapy reduces the risk of recurrent variceal haemorrhage. However, the relation between portal pressure response to pharmacological treatment and clinical events has not been well defined. This relation was prospectively investigated in 69 cirrhotic patients receiving continued propranolol therapy after an episode of variceal bleeding. Hepatic venous pressure

F Feu; J. C García-Pagán; J Bosch; A Luca; A Escorsell; J Rodés; J Terés

1995-01-01

215

Policymakers’ views on dengue fever\\/dengue haemorrhagic fever and the need for dengue vaccines in four southeast Asian countries  

Microsoft Academic Search

A survey of policymakers and other influential professionals in four southeast Asian countries (Cambodia, Indonesia, Philippines and Vietnam) was conducted to determine policymakers’ views on the public health importance of dengue fever and dengue haemorrhagic fever (DHF), the need for a vaccine and the determinants influencing its potential introduction. The survey, which involved face-to-face interviews with policymakers, health programme managers,

Denise DeRoeck; Jacqueline Deen; John D. Clemens

2003-01-01

216

Isolation of a haemorrhagic protein toxin (SA-HT) from the Indian venomous butterfish (Scatophagus argus, Linn) sting extract.  

PubMed

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

Karmakar, S; Muhuri, D C; Dasgupta, S C; Nagchaudhuri, A K; Gomes, A

2004-05-01

217

Point-of-care testing of coagulation and fibrinolytic status during postpartum haemorrhage: developing a thrombelastography®-guided transfusion algorithm.  

PubMed

Thrombelastography® is a monitor of coagulation and fibrinolytic status, with point-of-care applications in managing haemorrhaging patients. Advocates have suggested a possible role in managing obstetric haemorrhage. This study aims to develop a pregnancy-specific thrombelastography-guided transfusion algorithm, which could be integrated into the management of postpartum haemorrhage. In this prospective observational study, 57 healthy, term-parturients provided pre-caesarean whole blood specimens for thrombelastography analyses. Specimens were processed according to a standardised protocol involving simultaneous analyses using three assays: native (non-activated); kaolin-activated; and kaolin and tissue factor-activated (RapidTEG®). For each assay, the following thrombelastography parameters were measured: reaction time (minutes); clot formation kinetics time (minutes); maximum amplitude (mm); and a angle (degree). Subsequent reference values were used to establish assay-specific reference intervals. For all thrombelastography parameters studied, reference values obtained using a non-activated assay differed from the corresponding values obtained using activated assays, and also demonstrated greater inter-sample variability. From the assay-specific reference intervals obtained, it was possible to establish a pregnancy-specific thrombelastography-guided transfusion algorithm. Specific features of this transfusion algorithm included the preferential use of activated assays, the need for duplicates and a recommendation that an initial baseline thrombelastography measurement is established for subsequent serial comparisons. This transfusion algorithm has been developed to assist with assessment of coagulation and fibrinolytic status during postpartum haemorrhage. PMID:23194210

Hill, J S; Devenie, G; Powell, M

2012-11-01

218

An information value based analysis of physical and climatic factors affecting dengue fever and dengue haemorrhagic fever incidence  

Microsoft Academic Search

BACKGROUND: Vector-borne diseases are the most dreaded worldwide health problems. Although many campaigns against it have been conducted, Dengue Fever (DF) and Dengue Haemorrhagic Fever (DHF) are still the major health problems of Thailand. The reported number of dengue incidences in 1998 for the Thailand was 129,954, of which Sukhothai province alone reported alarming number of 682. It was the

Kanchana Nakhapakorn; Nitin Kumar Tripathi

2005-01-01

219

Of cascades and perfect storms: the immunopathogenesis of dengue haemorrhagic fever-dengue shock syndrome (DHF\\/DSS)  

Microsoft Academic Search

The past four decades has witnessed a consolidation of the original observations made in the 1970s that dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) have an immunological basis. Following reinfection with a dengue virus of different serotype, severe disease is linked to high levels of antibody-enhanced viral replication early in illness which is followed by a cascade of

Tikki Pang; Mary Jane Cardosa; Maria G Guzman

2007-01-01

220

Effects of current and waveform on the incidence of breast meat haemorrhages in electrically stunned broiler chicken carcases  

Microsoft Academic Search

The effects of the current and its waveform on the prevalence of broken bones and breast meat haemorrhages in electrically stunned broiler chickens were examined at two poultry processing plants. Increasing the current over the range from 68 to 115 mA per bird had very little effect on the carcase quality, but increased the incidence of broken furculum and coracoid

NG Gregory; LJ Wilkins; SB Wotton; AL Middleton

1995-01-01

221

A prospective study of BK-virus-associated haemorrhagic cystitis in paediatric patients undergoing allogeneic haematopoietic stem cell transplantation  

Microsoft Academic Search

We investigated the incidence, risk factors and outcome of haemorrhagic cystitis (HC) in paediatric patients undergoing HSCT and the predictive value of BK viruria and viraemia for developing HC. Over a period of 54 months, 74 patients were recruited. The cumulative incidence of HC was 22%. Among 15 patients prospectively monitored for BK viruria and viraemia, four patients developed HC

S Cesaro; C Facchin; G Tridello; C Messina; E Calore; M A Biasolo; M Pillon; S Varotto; A Brugiolo; C Mengoli; G Palù

2008-01-01

222

Innate immune responses of salmonid fish to viral infections.  

PubMed

Viruses are the most serious pathogenic threat to the production of the main aquacultured salmonid species the rainbow trout Oncorhynchus mykiss and the Atlantic salmon Salmo salar. The viral diseases Infectious Pancreatic Necrosis (IPN), Pancreatic Disease (PD), Infectious Haemorrhagic Necrosis (IHN), Viral Haemorrhagic Septicaemia (VHS), and Infectious Salmon Anaemia (ISA) cause massive economic losses to the global salmonid aquaculture industry every year. To date, no solution exists to treat livestock affected by a viral disease and only a small number of efficient vaccines are available to prevent infection. As a consequence, understanding the host immune response against viruses in these fish species is critical to develop prophylactic and preventive control measures. The innate immune response represents an important part of the host defence mechanism preventing viral replication after infection. It is a fast acting response designed to inhibit virus propagation immediately within the host, allowing for the adaptive specific immunity to develop. It has cellular and humoral components which act in synergy. This review will cover inflammation responses, the cell types involved, apoptosis, antimicrobial peptides. Particular attention will be given to the type I interferon system as the major player in the innate antiviral defence mechanism of salmonids. Viral evasion strategies will also be discussed. PMID:23981327

Collet, Bertrand

2014-04-01

223

Extensive pulmonary embolism after severe postpartum haemorrhage: management with an inferior vena cava filter.  

PubMed

We report the case of a 36-year-old woman with an inferior vena cava thrombosis and extensive pulmonary embolism six days after a severe postpartum haemorrhage. She had undergone caesarean section with bleeding managed by massive transfusion, hysterectomy, and two attempts at uterine artery embolization. Systemic thrombolysis and catheter-directed thrombolysis in intensive care were abandoned due to recent and incomplete uterine artery embolization. A temporary inferior vena cava filter was chosen because of significant risk of massive pulmonary embolism. This was a controversial decision because guidelines from different professional groups offer conflicting recommendations. The therapeutic options for the management of massive postpartum pulmonary embolism when thrombolysis is contraindicated are discussed. PMID:25223642

Bilger, A; Pottecher, J; Greget, M; Boudier, E; Diemunsch, P

2014-11-01

224

European survey on laboratory preparedness, response and diagnostic capacity for Crimean-Congo haemorrhagic fever, 2012.  

PubMed

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

Fernandez-Garcia, M D; Negredo, A; Papa, A; Donoso-Mantke, O; Niedrig, M; Zeller, H; Tenorio, A; Franco, L

2014-01-01

225

Risk factors and surgical interventions associated with primary postpartum haemorrhage unresponsive to first-line therapies.  

PubMed

The aim of this study was to investigate risk factors and surgical interventions associated with primary postpartum haemorrhage (PPH) unresponsive to first-line therapies. A retrospective analysis was performed of 212 women who experienced primary PPH (blood loss ? 500 ml). Logistic regression analysis identified that caesarean section (odds ratio [OR] 2.745; 95% confidence interval [CI], 1.063-7.085; p = 0.037) and abnormal placental adhesion (OR 3.823; 95% CI, 1.333-10.963; p = 0.013) were risk factors for PPH unresponsive to first-line therapies. There was no significant difference in blood loss, blood transfusion and success rate among intrauterine tamponade, B-Lynch suture and uterine artery ligation. Intrauterine tamponade is the least invasive and most rapid approach, so it should be taken as the first choice for surgical management after unresponsiveness to first-line therapies. PMID:24911676

Yan, J-Y; Zhou, Z-M; Xu, X; Huang, X-Y; Xu, R-L; Lin, S-H

2014-10-01

226

Long-time octreotide in an adolescent with severe haemorrhagic gastrointestinal vascular malformation  

PubMed Central

Gastrointestinal vascular malformations are a rare cause of acute or chronic blood loss. Usually they are treated by endoscopic obliteration or surgical resection. When such a therapy is inapplicable, pharmacotherapy may be required. At the age of 15 years, our female patient suffered from transfusion dependent recurrent gastrointestinal haemorrhage due to multiple gastrointestinal vascular malformations. Gastroscopy, coloscopy and capsule endoscopy revealed numerous foci making both endoscopic obliteration and complete surgical resection impossible. Neither regular transfusions nor substitution with coagulation factors were helpful. However, subcutaneous octreotide resulted in immediate stop of bleeding. Initial treatment by daily subcutaneous injections was followed by monthly depot application. Over 3 years only 2 transfusions had to be given. The patient required thyroxin substitution, otherwise, no side effects occurred and the girl had a good quality of life. The authors conclude that octreotide is safe and effective in gastrointestinal angiodysplasias inaccessible to endoscopy or surgery. PMID:22688939

Classen, Carl Friedrich; Haffner, Dieter; Hauenstein, Christina; Wolf, Ricarda; Kyank, Ulrike

2011-01-01

227

Dot enzyme immunoassay: an alternative diagnostic aid for dengue fever and dengue haemorrhagic fever.  

PubMed Central

A dot enzyme immunoassay (DEIA) for the detection of antibodies to dengue virus was tested for use as a tool in the presumptive diagnosis of dengue fever and dengue haemorrhagic fever. Paired sera from the following groups of patients were tested using the DEIA and the haemagglutination inhibition (HI) test: those with primary dengue fever; those experiencing a second dengue infection; and febrile patients who did not have dengue. The data obtained show that the DEIA can be effectively used at a serum dilution of 1:1000 to confirm presumptive recent dengue in patients with a second dengue infection. However, demonstration of seroconversion proved necessary for patients with primary dengue. At a serum dilution of 1:1000 the DEIA has a specificity of 97.3%. The role of this simple and rapid test in improving the effectivity of programmes for the control of dengue virus infection is discussed. PMID:1786623

Cardosa, M. J.; Tio, P. H.

1991-01-01

228

Isolated hypoplastic circumflex coronary artery: a rare cause of haemorrhagic myocardial infarction in a young athlete  

PubMed Central

Hypoplastic coronary artery disease is a rare condition that may lead to myocardial infarction and sudden death. Here we describe for the first time an isolated hypoplasia of the left circumflex artery (LCX). An otherwise healthy and athletically active 16-year-old boy was admitted to the intensive care unit (ICU) after out-of-hospital cardiac arrest. He died 12 hours after the initial event. Autopsy revealed an isolated hypoplastic LCX and acute haemorrhagic infarction in the posterolateral myocardium. The existence of isolated hypoplasia of the LCX challenges our understanding of coronary artery development. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1558483061962648 PMID:23742172

2013-01-01

229

Orofacial hereditary haemorrhagic telangiectasia: high power diode laser in early and advanced lesion treatment  

NASA Astrophysics Data System (ADS)

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.

Tempesta, Angela; Franco, Simonetta; Miccoli, Simona; Suppressa, Patrizia; De Falco, Vincenzo; Crincoli, Vito; Lacaita, Mariagrazia; Giuliani, Michele; Favia, Gianfranco

2014-01-01

230

Endovascular Management of Complete Vertebral Artery Dissection Presenting with Subarachnoid Haemorrhage  

PubMed Central

Summary Spontaneous vertebral artery (VA) dissection may involve the intradural segment of the VA and result in subarachnoid haemorrhage (SAH). These lesions are frequently associated with recurrent SAH, and have a high mortality. Prior to the development of endovascular techniques the majority of these lesions were treated surgically. In cases where the dissection involved the posterior inferior cerebellar artery (PICA) origin surgery was associated with significant complications including recurrent SAH from retrograde VA flow into the dissected segment above the surgical clip. We describe two cases of complete VA dissection in which the entire intradural VA was sacrificed to prevent recurrent SAH. The first case tolerated planned left PICA occlusion without developing a significant neurological deficit. The second case had infarcted the right PICA territory at presentation. PMID:20670506

Lenthall, R.K.; White, B.D.; Mcconachie, N.S.

1999-01-01

231

Immunosuppression abrogates resistance of young rabbits to Rabbit Haemorrhagic Disease (RHD)  

PubMed Central

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

2014-01-01

232

Pulmonary embolism with haemorrhagic pericardial effusion and tamponade: a clinical dilemma.  

PubMed

The synchronous presentation of a patient with pulmonary embolism (PE) and haemorrhagic cardiac tamponade is uncommon and presents a therapeutic dilemma. Both conditions can be life-threatening and require opposing management strategies. The authors report a 50-year-old woman who presented with abdominal symptoms and subsequent rapid development of dyspnoea and cardiogenic shock. Investigations demonstrated bilateral segmental PEs and a large pericardial effusion causing cardiac tamponade. This large blood-stained effusion was drained urgently. She developed acute kidney injury and acute hepatic injury with synthetic failure. She was initially deemed unsuitable for anticoagulation so an inferior vena cava filter was placed to minimise risk of further PE. When no early re-accumulation of pericardial fluid occurred, a heparin infusion was started to treat the PEs. Pericardial fluid cytology was suggestive of metastatic carcinoma, with the immunophenotype most consistent with metastatic non-small cell lung cancer. She was subsequently treated with the tyrosine kinase inhibitor, erlotinib. PMID:25213782

Thomas, Charlotte; Lane, Katie; Cecconi, Maurizio

2014-01-01

233

Coincidence of Glanzmann's thrombasthenia with hereditary haemorrhagic telengiectasia in a man with gastrointestinal bleeding.  

PubMed

Here we report a case of a 57-year-old man referred to our hospital with weakness, lethargy, melena, and rectorrhalgia. His physical examination and past medical history showed gingival bleeding, several episodes of epistaxis and post-surgery bleeding. Primary laboratory evaluation revealed only anaemia. Gastrointestinal findings including upper endoscopy and colonoscopy documented normal status, but balloon endoscopy illustrated telengiectasia-like lesions in the mid-jejunum. The case was suspected to be haemophilia due to the past medical history, although complete haemostatic evaluation demonstrated Glanzmann's thrombasthenia. The diagnosis of co-occurrence of hereditary haemorrhagic telengiectasia and Glanzmann's thrombasthenia was confirmed. This case revealed the coincidence of two bleeding tendencies, which, although rare, is a possible phenomenon. We recommend carrying out both primary and secondary haemostatic profiles for every patient with bleeding diathesis. PMID:25083772

Khosravi, Ahmad; Rahimi, Hossein; Mansouritorghabeh, Hassan

2015-01-01

234

Reorganization of visual fields after periventricular haemorrhagic infarction: potentials and limitations.  

PubMed

Visual functions are often impaired in preterm infants with periventricular haemorrhagic infarction, because of the involvement of the region where the optic radiations are located. In some cases an unexpected sparing of the visual fields has been described, and related to the plasticity of thalamo-cortical afferents that are supposedly able to bypass the lesion when it occurs in the early third trimester of gestation. We systematically reviewed the literature in the field to determine the limits and potentials of this type of reorganization. We found four studies meeting our criteria, from which we extracted case reports on 19 individuals with intraventricular haemorrhagic infarction. Eleven of the 19 did not have visual field defects, five had a bilateral visual field defect, and the remaining three had a unilateral visual field defect. The involvement of the optic radiations was often associated with normal visual fields as only one of the four individuals with damaged optic radiations showed visual field defects. Conversely, the presence of basal ganglia/thalamus involvement apparently prevented such reorganization, as the only two individuals with unilateral field restriction and available magnetic resonance imaging data both showed abnormalities in those structures. Consistent with this, we report on a further individual in which visual field restriction was associated with abnormal tractography on brain magnetic resonance imaging. Overall, this review supports the existence of effective mechanisms of plastic reorganization that allow a rewiring of geniculo-calcarine connections with restoration of full field vision but which are hindered by the involvement of the basal ganglia and thalamus. PMID:24237275

Guzzetta, Andrea; Fiori, Simona; Scelfo, Danilo; Conti, Eugenia; Bancale, Ada

2013-11-01

235

Endoplasmic Reticulum Quality Control Is Involved in the Mechanism of Endoglin-Mediated Hereditary Haemorrhagic Telangiectasia  

PubMed Central

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant genetic condition affecting the vascular system and is characterised by epistaxis, arteriovenous malformations and mucocutaneous and gastrointestinal telangiectases. This disorder affects approximately 1 in 8,000 people worldwide. Significant morbidity is associated with this condition in affected individuals, and anaemia can be a consequence of repeated haemorrhages from telangiectasia in the gut and nose. In the majority of the cases reported, the condition is caused by mutations in either ACVRL1 or endoglin genes, which encode components of the TGF-beta signalling pathway. Numerous missense mutations in endoglin have been reported as causative defects for HHT but the exact underlying cellular mechanisms caused by these mutations have not been fully established despite data supporting a role for the endoplasmic reticulum (ER) quality control machinery. For this reason, we examined the subcellular trafficking of twenty-five endoglin disease-causing missense mutations. The mutant proteins were expressed in HeLa and HEK293 cell lines, and their subcellular localizations were established by confocal fluorescence microscopy alongside the analysis of their N-glycosylation profiles. ER quality control was found to be responsible in eight (L32R, V49F, C53R, V125D, A160D, P165L, I271N and A308D) out of eleven mutants located on the orphan extracellular domain in addition to two (C363Y and C382W) out of thirteen mutants in the Zona Pellucida (ZP) domain. In addition, a single intracellular domain missense mutant was examined and found to traffic predominantly to the plasma membrane. These findings support the notion of the involvement of the ER's quality control in the mechanism of a significant number, but not all, missense endoglin mutants found in HHT type 1 patients. Other mechanisms including loss of interactions with signalling partners as well as adverse effects on functional residues are likely to be the cause of the mutant proteins' loss of function. PMID:22022569

Ali, Bassam R.; Ben-Rebeh, Imen; John, Anne; Akawi, Nadia A.; Milhem, Reham M.; Al-Shehhi, Nouf A.; Al-Ameri, Mouza M.; Al-Shamisi, Shamma A.; Al-Gazali, Lihadh

2011-01-01

236

Neuroprotective effects of argatroban and C5a receptor antagonist (PMX53) following intracerebral haemorrhage.  

PubMed

Intracerebral haemorrhage (ICH) is a subtype of stroke that associated with neurological dysfunction and inflammation, which may be ameliorated by a neuroprotective strategy targeting the complement cascade. The protective effect of C5a-receptor antagonist (PMX53) solely and in combination with thrombin antagonist (argatroban) was investigated in the ICH mouse model, respectively. Adult male C57BL/6J wild-type (WT) mice and C3(-/-) mice were randomized to receive PMX53/argatroban 1, 3 and 5 days after ICH. A double injection technique was used to infuse 25??l of autologous whole blood into the right striatum. Mice in the sham group received only needle insertion. Brain water content and mRNA of inflammatory factors were measured on the first, third and fifth days after ICH, respectively. Neurological dysfunction was assessed using a 28-point neurological scoring system in the three cohorts, namely, on days 1, 3 and 5 following ICH. Animals treated with PMX53/argatroban demonstrated significant improvements in neurological function and fewer neurological apoptosis detected by TUNEL [terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end-labelling] and ?III-tubulin dual-staining compared with vehicle-treated animals. Compared with sham-treated mice, the brain water content in argatroban/PMX53-treated mice was decreased significantly in both the ipsilateral cortex and ipsilateral striatum. Administration of PMX53/argatroban provided a synergistic neuroprotective effect via reducing inflammatory factors and brain oedema, leading to improvements in neurofunctional outcome. The results of this study indicated that simultaneous blockade of the thrombin and C5a receptors represent a promising neuroprotective strategy in haemorrhagic stroke. PMID:24117111

Li, G; Fan, R-M; Chen, J-L; Wang, C-M; Zeng, Y-C; Han, C; Jiao, S; Xia, X-P; Chen, W; Yao, S-T

2014-02-01

237

Effects of ubiquinol with fluid resuscitation following haemorrhagic shock on rat lungs, diaphragm, heart and kidneys.  

PubMed

Haemorrhagic shock (HS) and fluid resuscitation can lead to increased reactive oxygen species (ROS), contributing to ischaemia-reperfusion injury and organ damage. Ubiquinol is a potent antioxidant that decreases ROS. This study examined the effects of ubiquinol administered with fluid resuscitation following controlled HS. Adult male Sprague-Dawley rats were randomly assigned to treatment [ubiquinol, 1 mg (100 g body weight)(-1)] or control groups. Rats were subjected to 60 min of HS by removing 40% of the total blood volume to a mean arterial pressure ?45-55 mmHg. The animals were resuscitated with blood and lactated Ringer solution, with or without ubiquinol, and monitored for 120 min. At the end of the experiments, the rats were killed and the lungs, diaphragm, heart and kidneys harvested. Leucocytes were analysed for mitochondrial superoxide at baseline, end of shock and 120 min following fluid resuscitation using MitoSOX Red. Diaphragms were examined for hydrogen peroxide using dihydrofluorescein diacetate and confocal microscopy. The apoptosis in lungs, diaphragm, heart and kidneys was measured using fluorescence microscopy with acridine orange and ethidium bromide. Leucocyte mitochondrial superoxide levels were significantly lower in rats that received ubiquinol than in the control animals. Production of hydrogen peroxide and apoptosis were significantly reduced in the organs of rats treated with ubiquinol. These findings suggest that ubiquinol, administered with fluid resuscitation after HS, attenuates ROS production and apoptosis. Thus, ubiquinol is a potent antioxidant that may be used as a potential treatment to reduce organ injury following haemorrhagic events. PMID:24860150

Bennetts, Paul; Shen, Qiuhua; Thimmesch, Amanda R; Diaz, Francisco J; Clancy, Richard L; Pierce, Janet D

2014-07-01

238

Neutralisation of Local Haemorrhage Induced by the Saw-Scaled Viper Echis carinatus sochureki Venom Using Ethanolic Extract of Hibiscus aethiopicus L.  

PubMed Central

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??g) 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??g) 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

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

239

Presenile dementia and cerebral haemorrhage linked to a mutation at codon 692 of the ?-amyloid precursor protein gene  

Microsoft Academic Search

Several families with an early-onset form of familial Alzheimer's disease have been found to harbour mutations at a specific codon (717) of the gene for the beta-amyloid precursor protein (APP) on chromosome 21. We now report, a novel base mutation in the same exon of the APP gene which co-segregates in one family with presenile dementia and cerebral haemorrhage due

Lydia Hendriks; Duijn van C. M; Patrick Cras; Marc Cruts; Wim Van Hul; Frans van Harskamp; Andrew Warren; Melvin G. McInnis; Stylianos E. Antonarakis; Jean-Jacques Martin; Broeckhoven van C; A. Hofman

1992-01-01

240

Complications and outcome in patients with aneurysmal subarachnoid haemorrhage: a prospective hospital based cohort study in The Netherlands  

PubMed Central

OBJECTIVE—The aim of this study was to investigate prospectively in an unselected series of patients with an aneurysmal subarachnoid haemorrhage what at present the complications are, what the outcome is, how many of these patients have "modern treatment"—that is, early obliteration of the aneurysm and treatment with calcium antagonists—what factors cause a delay in surgical or endovascular treatment, and what the estimated effect on outcome will be of improved treatment.?METHODS—A prospective, observational cohort study of all patients with aneurysmal subarachnoid haemorrhage in the hospitals of a specified region in The Netherlands. The condition on admission, diagnostic procedures, and treatments were recorded. If a patient had a clinical deterioration, the change in Glasgow coma score (GCS), the presence of focal neurological signs, the results of additional investigations, and the final diagnosed cause of the deterioration were recorded.? Clinical outcome was assessed with the Glasgow outcome scale (GOS) at 3 month follow up. In patients with poor outcome at follow up, the cause was diagnosed.?RESULTS—Of the 110 patients, 47 (43%) had a poor outcome. Cerebral ischaemia, 31 patients (28%), was the most often occurring complication. Major causes of poor outcome were the effects of the initial haemorrhage and rebleeding in 34% and 30% of the patients with poor outcome respectively. Of all patients 102 (93%) were treated with calcium antagonists and 45 (41%) patients had early treatment to obliterate the aneurysm. The major causes of delay of treatment were a poor condition on admission or deterioration shortly after admission, in 31% and 23% respectively.?CONCLUSIONS—In two thirds of the patients with poor outcome the causes of poor outcome are the effects of the initial bleeding and rebleeding. Improved treatment of delayed or postoperative ischaemia will have only minor effects on the outcome of patients with subarachnoid haemorrhage.?? PMID:10675216

Roos, Y; de Haan, R J; Beenen, L; Groen, R; Albrecht, K; Vermeulen, M

2000-01-01

241

Emergency reversal of anticoagulation with a three-factor prothrombin complex concentrate in patients with intracranial haemorrhage  

PubMed Central

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

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

242

Roles of histamine receptors and oxyradicals in aggravation of acid-induced gastric haemorrhagic ulcers in endotoxaemic rats  

Microsoft Academic Search

We clarified the roles of histamine H1-, H2-, H3-receptors and oxyradicals in the exacerbation of acid-induced gastric haemorrhage and stomach ulcer in endotoxaemic rats\\u000a by measuring changes in gastric mucosal glutathione concentrations, lipid peroxide generation and histamine levels as well\\u000a as in luminal electrolytes and haemoglobin contents. Stomach ulcers were evaluated by morphological and histological examination.\\u000a Rats were deprived of

C. R. Hung; D.-Z. HSU

1998-01-01

243

Transjugular intrahepatic portasystemic stent shunting for control of acute and recurrent upper gastrointestinal haemorrhage related to portal hypertension.  

PubMed Central

The insertion of a transjugular intrahepatic portasystemic stent shunt (TIPSS) was evaluated in 22 patients with recurrent upper gastrointestinal haemorrhage related to portal hypertension (bleeding from oesophageal varices 10, gastric varices six, portal hypertensive gastropathy six). TIPSS was successfully performed electively in 15 patients and as an emergency in three patients. Twelve patients have had no further admissions with bleeding after TIPSS. Single episodes of bleeding were noted in six patients after TIPSS associated with shunt thrombosis (two), intimal hyperplasia within the shunt (two), and shunt migration (one). Another patient presented with reaccumulated ascites suggesting poor shunt function but died from massive variceal haemorrhage before further assessment could be performed. There was one death related to the procedure. Two patients developed encephalopathy after TIPSS, in one patient this was controlled by the insertion of a smaller diameter stent within the existing TIPSS. Several complications arose in earlier patients that have not recurred after modification of the initial technique. TIPSS can be life saving and is effective in controlling variceal haemorrhage and rebleeding from oesophageal or gastric varices and portal hypertensive gastropathy. Larger and longer term studies are required, however, to define the role of TIPSS in the overall management of such patients. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 PMID:8344585

Simpson, K J; Chalmers, N; Redhead, D N; Finlayson, N D; Bouchier, I A; Hayes, P C

1993-01-01

244

Rosette-forming glioneuronal tumour of the fourth ventricle with previous intratumoural haemorrhage: case report and review of the literature.  

PubMed

The case is reported of a rosette-forming glioneuronal tumour of the fourth ventricle (RGTFV) in a 27-year-old male. Symptoms included headache, severe vomiting and clumsy walking that had progressively worsened over 14 days. Computed tomography and magnetic resonance imaging indicated a 3.0 x 2.5 x 2.0 cm solid-cystic mass in the fourth ventricle and obstructive hydrocephalus. The tumour showed evidence of previous intra-tumour haemorrhage, with heterogeneous enhancement after contrast administration. Complete excision of the lesion was performed. Signs of previous intra-tumoural haemorrhage were seen intra-operatively. The detailed clinical, radiological and pathological features in this patient are described and compared with existing literature on this type of tumour. Despite benign histological features and a reported favourable post-operative course, there is still limited clinical experience with this type of tumour, however intratumoural haemorrhage may result in morbidity and mortality. This report will help provide better characterization of this entity, improving the diagnosis and potentially reducing mortality in RGTFV. PMID:19589282

Li, Y M; Li, W Q; Pan, Y; Lu, Y C; Long, N Y; Tao, X F; Yu, H Y

2009-01-01

245

Bench-to-bedside review: Optimising emergency reversal of vitamin K antagonists in severe haemorrhage – from theory to practice  

PubMed Central

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

Vigué, Bernard

2009-01-01

246

Spinal arachnoid cyst associated with arachnoiditis following subarachnoid haemorrhage in adult patients: A case report and literature review.  

PubMed

Objective. Arachnoiditis is an inflammatory process resulting with the fibrosis of arachnoid mater. It can vary in severity from mild thickenings to catastrophic adhesions that ruins subarachnoid space. As a result, arachnoid cysts can be formed. Arachnoid cyst induced by symptomatic spinal arachnoiditis is a rare complication of subarachnoid haemorrhages. In this article, we aimed to present a case of spinal arachnoid cyst formation following subarachnoid haemorrhage and examine similar cases in the literature. Case Report. Forty-six years old, previously healthy female patient has been treated medically for headaches due to perimesencephalic subarachnoid bleeding. Approximately two and a half months later, she started to have severe headaches and diplopia. We detected hydrocephalus and performed ventriculoperitoneal shunt surgery. Two months later, she started to have complaints of weakness in her lower extremities. On neurological examination, she had paraparesis and on spinal magnetic resonance imaging she had an arachnoid cyst lengthening from C7 to T2 and compressing the spinal cord posteriorly. We performed partial laminectomy, drainage of arachnoid cyst and replacement of cystopleural T tube shunt. On follow-up, her lower extremity strength has ameliorated. She was taken into a physical therapy and rehabilitation programme. Three months later she was able to walk with a crutch. Conclusion. Subarachnoiditis and associated arachnoid cyst can cause severe morbidity. This rare situation (which especially occurs following subarachnoid haemorrhage of posterior fossa) should be known and physicians should keep in mind that it requires urgent surgical procedure. PMID:25365662

Basaran, Recep; Kaksi, Mustafa; Efendioglu, Mustafa; Onoz, Mustafa; Balkuv, Ece; Kaner, Tuncay

2014-11-01

247

Nonatonic Obstetric Haemorrhage: Effectiveness of the Nonpneumatic Antishock Garment in Egypt  

PubMed Central

The study aims to determine if the nonpneumatic antishock garment (NASG), a first aid compression device, decreases severe adverse outcomes from nonatonic obstetric haemorrhage. Women with nonatonic aetiologies (434), blood loss > 1000?mL, and signs of shock were eligible. Women received standard care during the preintervention phase (226) and standard care plus application of the garment in the NASG phase (208). Blood loss and extreme adverse outcomes (EAO-mortality and severe morbidity) were measured. Women who used the NASG had more estimated blood loss on admission. Mean measured blood loss was 370?mL in the preintervention phase and 258?mL in the NASG phase (P < 0.0001). EAO decreased with use of the garment (2.9% versus 4.4%, (OR 0.65, 95% CI 0.24–1.76)). In conclusion, using the NASG improved maternal outcomes despite the worse condition on study entry. These findings should be tested in larger studies. PMID:21845226

Fathalla, Mohamed M. F.; Youssif, Mohammed Mourad; Meyer, Carinne; Camlin, Carol; Turan, Janet; Morris, Jessica; Butrick, Elizabeth; Miller, Suellen

2011-01-01

248

Procoagulant phospholipids and tissue factor activity in cerebrospinal fluid from patients with intracerebral haemorrhage.  

PubMed

Brain contains large amounts of tissue factor, the major initiator of the coagulation cascade. Neuronal apoptosis after intracerebral haemorrhage (ICH) leads to the shedding of procoagulant phospholipids (PPLs). The aim of this study was to investigate the generation of PPL, tissue factor activity (TFa), and D-Dimer (D-Di) in the cerebrospinal fluid (CSF) at the acute phase of ICH in comparison with other brain diseases and to examine the relationship between these factors and the outcome of ICH. CSF was collected from 112 patients within 48 hours of hospital admission. Thirty-one patients with no neurological or biochemical abnormalities were used to establish reference range in the CSF ("controls"). Thirty had suffered an ICH, and 51 other neurological diagnoses [12: ventricular drainage following brain surgery, 13: viral meningitis, 15: bacterial meningitis, and 11 a neurodegenerative disease (NDD)]. PPL was measured using a factor Xa-based coagulation assay and TFa by one home test. PPL, D-Di, and TFa were significantly higher (P < 0.001) in the CSF of patients with ICH than in controls. TFa levels were significantly (P < 0.05) higher in ICH than in patients with meningitides or NDD. Higher levels (P < 0.05) of TFa were observed in patients with ICH who died than in survivors. TFa measurement in the CSF of patients with ICH could constitute a new prognostic marker. PMID:24696689

Van Dreden, Patrick; Hue, Guy; Dreyfus, Jean-François; Woodhams, Barry; Vasse, Marc

2014-01-01

249

Environmental correlates of crimean-congo haemorrhagic fever incidence in Bulgaria  

PubMed Central

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

2012-01-01

250

A recent epidemic of Coxsackie virus type A24 acute haemorrhagic conjunctivitis in Singapore.  

PubMed Central

A recent epidemic of acute conjunctivitis in Singapore showed again the importance of Coxsackie virus type A24 variant as a causative agent of acute haemorrhagic conjunctivitis (AHC). Although the ocular manifestations appeared similar to those described for the 1970 and 1975 outbreaks, a markedly higher rate of respiratory involvements was noted. Not observed in previous epidemics were herpes-like vesicles in the conjunctiva and eyelids of one patient and vesicles in the buccal mucosa and lips of another from whom Coxsackie virus A24 was isolated. The most interesting finding in this study was the isolation of five wild (non-Sabin) poliovirus type 1 strains. Three strains were obtained from conjunctival and two from throat swabs of patients with mild to severe conjunctivitis. It is conceivable that the rare reports of polio-like paralysis or radiculomyelitis accompanying or following AHC in a few Asian countries could be attributed to concurrent infections with a poliovirus and either enterovirus type 70 or Coxsackie virus type A24. Images PMID:3024697

Yin-Murphy, M; Baharuddin-Ishak; Phoon, M C; Chow, V T

1986-01-01

251

Relationship between Watershed Infarcts and Recent Intra Plaque Haemorrhage in Carotid Atherosclerotic Plaque  

PubMed Central

Objective Watershed infarcts (WSI) are thought to result from hemodynamic mechanism, but studies have suggested that microemboli from unstable carotid plaques may distribute preferentially in watershed areas, i.e., between two cerebral arterial territories. Intraplaque haemorrhage (IPH) is an emerging marker of plaque instability and microembolic activity. We assessed the association between WSI and IPH in patients with recently symptomatic moderate carotid stenosis. Methods and Results We selected 65 patients with symptomatic moderate (median NASCET degree of stenosis?=?31%) carotid stenosis and brain infarct on Diffusion-Weighted Imaging (DWI) on Magnetic Resonance Imaging (MRI) from a multicentre prospective study. Fourteen (22%) had WSI (cortical, n?=?8; internal, n?=?4; cortical and internal, n?=?2). Patients with WSI were more likely to have IPH than those without WSI although the difference was not significant (50% vs. 31%, OR?=?2.19; 95% CI, 0.66–7.29; P?=?0.20). After adjustment for degree of stenosis, age and gender, the results remained unchanged. Conclusion About one in fifth of brain infarcts occurring in patients with moderate carotid stenosis were distributed in watershed areas. Albeit not significant, an association between IPH - more generally plaque component - and WSI, still remains possible. PMID:25272160

Isabel, Clothilde; Lecler, Augustin; Turc, Guillaume; Naggara, Olivier; Schmitt, Emmanuelle; Belkacem, Samia; Oppenheim, Catherine; Touzé, Emmanuel

2014-01-01

252

Risk factors associated with an outbreak of dengue fever/dengue haemorrhagic fever in Hanoi, Vietnam.  

PubMed

SUMMARY 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

Toan, D T T; Hoat, L N; Hu, W; Wright, P; Martens, P

2014-10-13

253

The role of erythropoietin in aneurysmal subarachnoid haemorrhage: from bench to bedside.  

PubMed

Subarachnoid haemorrhage (SAH) caused by a ruptured aneurysm accounts for only 5 % of strokes, but occurs at a fairly young age and carries a poor prognosis. Delayed cerebral ischaemia (DCI) is an important cause of death and dependence after aneurysmal SAH. The current mainstay of preventing DCI is nimodipine and maintenance of normovolemia, but even with this strategy DCI occurs in a considerable proportion of patients.Several drugs have been developed that have the potential to limit cerebral vasospasm and delayed ischaemic neurologic deficit, thus improving outcome for patients. However, although numerous agents can prevent arterial narrowing and/or block the excitatory cascade of events leading to ischaemic neuronal death in experimental conditions, there is still no pharmacologic agent that has been shown conclusively to improve the outcome in clinical practice.Erythropoietin (EPO) is a well-known erythropoietic hormone recently found to exert neuroprotective properties and has been shown to reduce cerebral vasospasm and infarct volume after experimental SAH. In humans, although EPO treatment did not impact the overall incidence of vasospasm, it significantly reduced the incidence of severe vasospasm, the incidence of delayed ischaemic deficits with new cerebral infarcts, and the duration of impaired autoregulation. The current study provides new evidence for the potential benefit and relative safety of EPO for the treatment of SAH in humans. Future clinical trials will hopefully provide definite evidence whether EPO treatment is beneficial in SAH patients. PMID:25366603

Grasso, Giovanni; Buemi, Michele; Giambartino, Filippo

2015-01-01

254

A case of Crimean-Congo haemorrhagic fever with normal laboratory findings.  

PubMed

Crimean-Congo haemorrhagic fever (CCHF) is a tick-borne disease caused by Nairovirus, of the family Bunyaviridae. This is the first case report of a confirmed CCHF case without laboratory abnormality. A 36-year-old woman was admitted to our clinic with the complaints of fever, chills, myalgia and vomiting. She was living in a CCHF-endemic region and had received a tick bite ten days previously. Her complaints had started five days after the tick bite, and bleeding of the nose and vagen followed. Under laboratory analysis, serum white blood cell (WBC) was 7300/mm3, haemoglobin (Hb)11.9 gr/dL, platelet (Plt) count 293000/mm3, aspartate transaminase (AST) was 23 U/L, alanine transaminase (ALT) 14 U/L, lactate dehydrogenase (LDH) 139 U/L, creatinine phosphokinase (CPK) 39 U/L, INR 0.8 and APTT 26.2 seconds. Based on these clinical and epidemiological findings, a diagnosis of CCHF infection was suspected, and the diagnosis of CCHF was confirmed with a blood sample tested by TaqMan-based one-step RT-PCR positivity and IgM antibody positivity. We suggest that patients from an endemic region who have typical epidemiological and clinical findings should be evaluated as a possible case for CCHF even if the laboratory findings are not compatible. PMID:25269965

Sari, Tugba; Hatipoglu, Cigdem Ataman

2014-09-01

255

Carbetocin versus oxytocin in caesarean section with high risk of post-partum haemorrhage  

PubMed Central

Summary Objectives the aims of the present study were to compare the haemodynamic effects of oxytocin and carbetocin and to assess the efficacy of these two drugs in terms of blood loss and the additional uterotonic needed in caesarean section at high risk of primary post-partum haemorrhage. Methods women in the carbetocin group (group A) received a bolus of 100 ?g IV; women in the control group (group B) received 20 IU of oxytocin in 1000 ml of 0,9% Na-Cl solution IV (150 mL/hour). The main parameter evaluated was the haemodynamic effects of drugs and the need for additional uterotonic agents. In addition we compared the drop in haemoglobin level, the uterine tone, the uterine fundal state and the diuresis. Results regarding the haemodynamic effects, both drugs have a hypotensive effect, but we found a greater reduction in blood pressure within the oxytocin group. Significantly more women needed additional uterotonic agents in the oxytocin group (23,5% vs 0%, p<0.01), though there was no significant difference in estimated blood loss and in the drop haemoglobin level (p>0.05). There was a significant difference in the diuresis, higher in carbetocin group (1300 ml ± 450 ml vs 1100 ml ± 250 ml, p=0.01). Conclusions a single injection of carbetocin appears to be more effective than a continuous infusion of oxytocin to prevent the PPH, with a similar haemodynamic profile and minor antidiuretic effect. PMID:23741542

Larciprete, Giovanni; Montagnoli, Carlotta; Frigo, Mariagrazia; Panetta, Valentina; Todde, Cristina; Zuppani, Benedetta; Centonze, Chiara; Bompiani, Alessandro; Malandrenis, Ioannis; Cirese, Alio; Valensise, Herbert

2013-01-01

256

Experimental infection of ostriches with Crimean-Congo haemorrhagic fever virus.  

PubMed Central

Following the occurrence of an outbreak of Crimean-Congo haemorrhagic fever (CCHF) among workers at an ostrich abattoir in South Africa in 1996, 9 susceptible young ostriches were infected subcutaneously with the virus in order to study the nature of the infection which they undergo. The ostriches developed viraemia which was demonstrable on days 1-4 following infection, with a maximum intensity of 4.0 log10 mouse intracerebral LD50/ml being recorded on day 2 in 1 of the birds. Virus was detectable in visceral organs such as spleen, liver and kidney up to day 5 post-inoculation, 1 day after it could no longer be found in blood. No infective virus was detected in samples of muscle, but viral nucleic acid was detected by reverse transcription-polymerase chain reaction in muscle from a bird sacrificed on day 3 following infection. It was concluded that the occurrence of infection in ostriches at abattoirs could be prevented by keeping the birds free of ticks for 14 days before slaughter. PMID:9825796

Swanepoel, R.; Leman, P. A.; Burt, F. J.; Jardine, J.; Verwoerd, D. J.; Capua, I.; Brückner, G. K.; Burger, W. P.

1998-01-01

257

Changes in plasma levels of vasopressin and renin in response to haemorrhage in dogs  

PubMed Central

1. The rabbit rectum superfused with blood or Krebs solution was used to assay vasopressin in circulating blood and in plasma extracts respectively. 2. Vasopressin was released by a rapid fall in diastolic pressure of as little as 5 mmHg, and the amount of vasopressin released was proportional to the magnitude of the fall in diastolic pressure in the range studied. These results would indicate that vasopressin release follows the magnitude of the fall in diastolic pressure more closely than the actual decrease in blood volume in haemorrhagic hypotension. 3. It was shown that the time required to induce an increase in circulating vasopressin is inversely proportional to the severity of the fall in diastolic pressure; this suggested that the stimulation of neurosecretory reflex arc varies with the intensity of the stimulus. 4. The slight changes in plasma renin activity as well as the pattern of renin release suggested the unlikeliness of the influence of renin upon vasopressin secretion under these circumstances. On the contrary, the results suggested that the secretion of large amounts of vasopressin tended to inhibit renin release. PMID:4722045

Cousineau, D.; Gagnon, D. J.; Sirois, P.

1973-01-01

258

Hospital based clinical surveillance for dengue haemorrhagic fever in Bandung, Indonesia 1994-1995.  

PubMed

In Indonesia, by law dengue haemorrhagic fever (DHF) cases must be reported within 24 h to the district health authority. The objective of this study was to evaluate the adequacy, accuracy and reporting delay of this reporting system. In four major hospitals of the city of Bandung, medical records of hospitalised DHF cases admitted between April 1994 and March 1995 were reviewed. This list of DHF cases was compared with the list of reported cases to the Bandung Municipality Health Office. During the study period, 569 DHF cases and 81 dengue shock syndrome (DSS) cases were diagnosed. Only 199 (31%) of the 650 hospitalised cases with suspected DHF/DSS were reported to the Bandung Municipality Health Office. The percentage of fatal cases was significantly lower among all hospitalised cases 11/650 (1.7%) than among reported cases 5/199 (2.5%). In only 443 of the 583 hospitalised cases (76%) in which a dengue serological test was performed, was this test positive. Of the 199 reported DHF/DSS cases 151 (76%) had a positive haemagglutination inhibition test. This study shows that the surveillance system for DHF/DSS in Bandung should be strengthened. DHF/DSS cases should be reported on the basis of a diagnosis made during hospitalisation preferably after a serological confirmation is obtained. PMID:11600087

Chairulfatah, A; Setiabudi, D; Agoes, R; van Sprundel, M; Colebunders, R

2001-10-22

259

Travelling waves in the occurrence of dengue haemorrhagic fever in Thailand  

NASA Astrophysics Data System (ADS)

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.

Cummings, Derek A. T.; Irizarry, Rafael A.; Huang, Norden E.; Endy, Timothy P.; Nisalak, Ananda; Ungchusak, Kumnuan; Burke, Donald S.

2004-01-01

260

The James Blundell Award Lecture 2006: transfusion and the treatment of haemorrhage: past, present and future.  

PubMed

In the early years of the 19th century, James Blundell reported in the Lancet the first clinical application of blood transfusion for the treatment of haemorrhage. Although these initial experiments may appear to us to have burst upon the medical world, Blundell had in fact done a decade of pre clinical research using animal models to establish principles to be brought to the clinic. His pivotal pre clinical experiments and the insights he gained are described in detail. Today, blood transfusion remains the cornerstone of treatment for serious bleeding - not only to restore oxygen carrying capacity but also to improve haemostasis, arrest and prevent bleeding. However, the indications for the use of blood components to treat bleeding remain ill-defined. In particular, despite the enormous volumes of fresh frozen plasma (FFP) transfused worldwide, the evidence that commonly used coagulation tests are reliable guides to transfusion with FFP is scant. Recent laboratory and clinical studies provide insight into the weaknesses of current coagulation tests as a guide to blood management. In the future, the application of genomics to haemostasis will uncover genetic polymorphisms leading to improved diagnostics and more tailored medical therapeutics. Examples of the emerging use of clinical genomics are presented. Ultimately, the application of widescale genomics testing will refresh our understanding of human physiology and will reassert the importance of the individual in patient care. PMID:17903138

Dzik, W H

2007-10-01

261

A case of airway obstruction secondary to acute haemorrhage into a benign thyroid cyst.  

PubMed

A 70-year-old female, with a history of progressive dyspnoea, was admitted to the critical care unit after successful resuscitation following a witnessed, out of hospital cardiorespiratory arrest. A presumptive diagnosis of cardiorespiratory arrest secondary to an exacerbation of chronic obstructive pulmonary disease was made. However, on more detailed examination a large anterior, midline neck mass was noted. Following tracheal intubation, a computerised tomography scan of the patient's neck and thorax revealed a seven-centimetre, well-defined, nonenhancing, rounded homogeneous opacity at the thoracic inlet, consistent with a large midline thyroid cyst. Needle aspiration of the cyst was performed and yielded approximately 50?mL of frank blood. After an uncomplicated tracheal extubation and recovery, an elective subtotal thyroidectomy was performed prior to hospital discharge. Histology of the specimen revealed a benign thyroid cyst within a multinodular goitre. Euthyroid multinodular goitres are more likely to be managed conservatively due to an asymptomatic clinical course in most patients. However, the risk of respiratory distress and acute airway obstruction from tracheal compression or acute haemorrhage should be kept in mind. Patients at risk of this life threatening complication should be managed with elective thyroidectomy to reduce morbidity and mortality. PMID:25215246

Vijapurapu, Ravi; Kaur, Kamal; Crooks, Neil H

2014-01-01

262

Use of ELISAs in field studies of rabbit haemorrhagic disease (RHD) in Australia.  

PubMed Central

ELISA techniques developed for the veterinary diagnosis of Rabbit Haemorrhagic Disease (RHD) in domestic rabbits were used for studying the epidemiology of RHD in Australian wild rabbits. The combination of ELISA techniques that distinguished IgA, IgG and IgM antibody responses and a longitudinal data set, mainly based on capture-mark-recapture of rabbits, provided a reliable basis for interpreting serology and set the criteria used to classify rabbits' immunological status. Importantly, young with maternal antibodies, immune rabbits and rabbits apparently re-exposed to RHD were readily separated. Three outbreaks of RHD occurred in 1996-7. The timing of RHD outbreaks was mainly driven by recruitment of young rabbits that generally contracted RHD after they lost their maternally derived immunity. Young that lost maternal antibodies in summer were not immediately infected, apparently because transmission of RHDV slows at that time, but contracted RHD in the autumn when conditions were again suitable for disease spread. PMID:10982081

Cooke, B. D.; Robinson, A. J.; Merchant, J. C.; Nardin, A.; Capucci, L.

2000-01-01

263

A model for the investigation of factors influencing haemorrhagic necrosis mediated by tumour necrosis factor in tissue sites primed with mycobacterial antigen preparations.  

PubMed Central

Mycobacterial lesions and skin sites challenged with soluble mycobacterial antigen are very sensitive to the necrotizing effect of tumour necrosis factor (TNF). We have used a model that permits separate quantitative assessment of swelling and haemorrhage to show that when these reactions are elicited in mice that have not been deliberately immunized, pretreatment of the mice with lipopolysaccharide (LPS), or with a MoAb to CR3 which blocks emigration of myeloid cells into the tissues, will block both the swelling and the haemorrhage. On the other hand, treatment with an inhibitor of platelet-activating factor (PAF), or with misoprostol (a synthetic prostaglandin E1 analogue), or with cobra venom factor (CVF) which depletes complement, preferentially blocks the haemorrhagic component, while leaving the swelling relatively unaltered. As swelling occurs before the haemorrhage is seen, it is possible that these factors act at a late stage in the cascade of events leading to the tissue damage. However, LPS and CVF were able to inhibit swelling and haemorrhage in the massive reactions elicited in pre-immunized animals, whereas the PAF inhibitor had no detectable effect. PMID:1606738

al Attiyah, R; Rosen, H; Rook, G A

1992-01-01

264

Chemical- and radiation-induced haemorrhagic cystitis: current treatments and challenges  

PubMed Central

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

Payne, Heather; Adamson, Andrew; Bahl, Amit; Borwell, Jonathan; Dodds, David; Heath, Catherine; Huddart, Robert; McMenemin, Rhona; Patel, Prashant; Peters, John L; Thompson, Andrew

2013-01-01

265

Endothelin and aneurysmal subarachnoid haemorrhage: a study of subarachnoid cisternal cerebrospinal fluid.  

PubMed Central

Endothelin (ET) is considered one of the most potent vasoconstrictor polypeptides; several experimental studies have suggested its possible role in the pathogenesis of arterial vasospasm after subarachnoid haemorrhage (SAH). Previously reported data on plasma and CSF levels of endothelin in patients with a diagnosis of SAH have been controversial. Cisternal endothelin CSF levels and the possibility that they could be related to vasospasm and other clinical patterns of SAH were investigated. CSF samples were obtained from 55 patients admitted after angiographic diagnosis of intracranial aneurysm. Levels of ET-1 and ET-3 were measured through radio-immunoassay technique. Twelve patients who had operations for unruptured aneurysms were considered control cases; 43 patients with SAH were classified according to: Hunt and Hess grading at admission, vasospasm grading, CT classification and timing of surgery. In all 55 patients ET-1 was measured, while positive levels of ET-3 were found only in 17 cases of 48. No linear correlation was found between cisternal CSF ET-1 levels when considering time of surgery, CT classification, Hunt and Hess grading at admission, and vasospasm grading. The results of ET-3 assay should be considered with great caution because of the low percentage of positive cases. Cisternal CSF levels of ET-1 and ET-3 are not directly related to the occurrence of arterial vasospasm after the aneurysm rupture, or to other major clinical patterns of SAH; however, ET-1 expression occurs either in paraphysiological (unruptured aneurysm) or in pathological conditions (SAH). It is suggested that ET may potentiate, or may be potentiated by, other factors playing a consistent pathophysiological role in the development of vasospasm. PMID:8301307

Gaetani, P; Rodriguez y Baena, R; Grignani, G; Spanu, G; Pacchiarini, L; Paoletti, P

1994-01-01

266

Burden of disease and costs of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom  

PubMed Central

Background To estimate life years and quality-adjusted life years (QALYs) lost and the economic burden of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom including healthcare and non-healthcare costs from a societal perspective. Methods All UK residents in 2005 with aSAH (International Classification of Diseases 10th revision (ICD-10) code I60). Sex and age-specific abridged life tables were generated for a general population and aSAH cohorts. QALYs in each cohort were calculated adjusting the life tables with health-related quality of life (HRQL) data. Healthcare costs included hospital expenditure, cerebrovascular rehabilitation, primary care and community health and social services. Non-healthcare costs included informal care and productivity losses arising from morbidity and premature death. Results A total of 80,356 life years and 74,807 quality-adjusted life years were estimated to be lost due to aSAH in the UK in 2005. aSAH costs the National Health Service (NHS) £168.2 million annually with hospital inpatient admissions accounting for 59%, community health and social services for 18%, aSAH-related operations for 15% and cerebrovascular rehabilitation for 6% of the total NHS estimated costs. The average per patient cost for the NHS was estimated to be £23,294. The total economic burden (including informal care and using the human capital method to estimate production losses) of a SAH in the United Kingdom was estimated to be £510 million annually. Conclusion The economic and disease burden of aSAH in the United Kingdom is reported in this study. Decision-makers can use these results to complement other information when informing prevention policies in this field and to relate health care expenditures to disease categories. PMID:20423472

2010-01-01

267

Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review  

PubMed Central

Aim To report the retinal signs that distinguish abusive head trauma (AHT) from non-abusive head trauma (nAHT). Methods A systematic review of literature, 1950–2009, was conducted with standardised critical appraisal. Inclusion criteria were a strict confirmation of the aetiology, children aged <11 years and details of an examination conducted by an ophthalmologist. Post mortem data, organic disease of eye, and inadequate examinations were excluded. A multivariate logistic regression analysis was conducted to determine odds ratios (OR) and probabilities for AHT. Results Of the 62 included studies, 13 provided prevalence data (998 children, 504 AHT). Overall, retinal haemorrhages (RH) were found in 78% of AHT vs 5% of nAHT. In a child with head trauma and RH, the OR that this is AHT is 14.7 (95% confidence intervals 6.39, 33.62) and the probability of abuse is 91%. Where recorded, RH were bilateral in 83% of AHT compared with 8.3% in nAHT. RH were numerous in AHT, and few in nAHT located in the posterior pole, with only 10% extending to periphery. True prevalence of additional features, for example, retinal folds, could not be determined. Conclusions Our systematic review confirms that although certain patterns of RH were far commoner in AHT, namely large numbers of RH in both the eyes, present in all layers of the retina, and extension into the periphery, there was no retinal sign that was unique to abusive injury. RH are rare in accidental trauma and, when present, are predominantly unilateral, few in number and in the posterior pole. PMID:23079748

Maguire, S A; Watts, P O; Shaw, A D; Holden, S; Taylor, R H; Watkins, W J; Mann, M K; Tempest, V; Kemp, A M

2013-01-01

268

Self-perceived health status following aneurysmal subarachnoid haemorrhage: a cohort study  

PubMed Central

Objective The objective of the study was to assess the long-term self-reported health status and quality of life (QoL) of patients following an aneurysmal subarachnoid haemorrhage (ASAH) using a self-completed questionnaire booklet. Design A two-cohort study. Setting A regional tertiary neurosurgical centre. Participants 2 cohorts of patients with ASAH treated between 1998 and 2008 and followed up at approximately 1?year. Interventions Routine care. Primary and secondary outcomes A range of standardised scales included: AKC Short Sentences Test, the Barthel Index, the Self-Report Dysexecutive Questionnaire, the Everyday Memory Questionnaire, Stroke Symptom Checklist, Wimbledon Self-Report Scale, Modified Rankin Score (MRS) and a new Stroke-QoL. The data from summated scales were fit to the Rasch measurement model to validate the summed score. Results 214 patients (48%) returned the questionnaires; the majority (76%) had a World Federation of Neurosurgeons grade of 1 or 2. The most frequent aneurysm type was that of the anterior communicating artery (28%) with approximately 90% of aneurysms of the anterior circulation. Of those previously in full or part-time employment, 48.9% were unemployed at follow-up. All summated scales satisfied the Rasch measurement model requirements, such that their summed scores were a sufficient statistic. Given this, one-third of patients were noted to have a significant mood disorder and 25% had significant dysexecutive function. Patients with an MRS of 3, 4 or 5 had significantly worse scores on most outcome measures, but a significant minority of those with a score of zero had failed to return to work and displayed significant mood disorder. Conclusions A range of self-reported cognitive and physical deficits have been highlighted in a cohort of patients with ASAH. While the MRS has been shown to provide a reasonable indication of outcome, in routine clinical follow-up it requires supplementation by instruments assessing dysexecutive function, memory and mood. PMID:24699459

Quinn, Audrey C; Bhargava, Deepti; Al-Tamimi, Yahia Z; Clark, Matthew J; Ross, Stuart A; Tennant, Alan

2014-01-01

269

Dengue haemorrhagic fever — a public health problem and a field for research*  

PubMed Central

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

Halstead, S. B.

1980-01-01

270

Postpartum haemorrhage in midwifery care in the Netherlands: validation of quality indicators for midwifery guidelines.  

PubMed

BackgroundPostpartum haemorrhage (PPH) is still one of the major causes of severe maternal morbidity and mortality worldwide. Currently, no guideline for PPH occurring in primary midwifery care in the Netherlands is available. A set of 25 quality indicators for prevention and management of PPH in primary care has been developed by an expert panel consisting of midwives, obstetricians, ambulance personal and representatives of the Royal Dutch College of Midwives (KNOV) and the Dutch Society of Obstetrics and Gynecology (NVOG). This study aims to assess the performance of these quality indicators as an assessment tool for midwifery care and suitability for incorporation in a professional midwifery guideline.MethodsFrom April 2008 to April 2010, midwives reported cases of PPH. Cases were assessed using the 25 earlier developed quality indicators. Quality criteria on applicability, feasibility, adherence to the indicator, and the indicator¿s potential to monitor improvement were assessed.Results98 cases of PPH were reported during the study period, of which 94 were analysed. Eleven indicators were found to be applicable and feasible. Five of these indicators showed improvement potential: routine administration of uterotonics, quantifying blood loss by weighing, timely referral to secondary care in homebirth and treatment of PPH using catherisation, uterine massage and oxytocin and the use of oxygen.ConclusionsEleven out of 25 indicators were found to be suitable as an assessment tool for midwifery care of PPH and are therefore suitable for incorporation in a professional midwifery guideline. Larger studies are necessary to confirm these results. PMID:25481692

Smit, Marrit; Chan, Kar-Li L; Middeldorp, Johanna M; van Roosmalen, Jos

2014-12-01

271

Fibrin glue in initial treatment of epistaxis in hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease).  

PubMed

The purpose of the present study was to evaluate the haemostatic efficacy of fibrin sealant in patients with hereditary haemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease suffering epistaxis. A retrospective observational study of patients with HHT who were admitted to an emergency room for anterior or posterior epistaxis during May 2000-March 2003. A total of 24 patients were evaluated, of whom 15 were managed with foam nasal packing during May 2000-March 2002 and another nine were treated during March 2002-March 2003 with 0.3 ml fibrin sealant spray (Quixil; Omrix, Belgium). The immediate and the distant results were compared. Immediate haemostasis was achieved in all seven patients treated with fibrin glue, with good healing of bleeding sites, no secondary bleeding, no inflammation, and no plaque or crists. Twelve months of follow-up monitoring (until October 2003) of atrophic changes of nasal mucosa, bleeding frequency and intensity proved absence of atrophy of nasal mucosa and decreased bleeding frequency. In this group, the bleeding episode duration averaged 2 min 35 s since the moment of admittance. In the nasal packing group, we found local swelling, pain, and slow healing of the bleeding site with accidental atrophy of nasal mucosa and no effect on further bleeding frequency and intensity. Removal of nasal packing frequently initiates secondary bleeding. The rates of these side effects were higher in comparison with the fibrin glue group. The bleeding episode duration was also longer. In patients with HHT suffering profuse epistaxis, fibrin glue is more effective and convenient for the patients as compared with foam nasal packing. It is also safer, since it lacks the complications that usually accompany packing as swelling, atrophy of the nasal mucosa, and secondary bleeding provoked by the removal of the pack. PMID:15166924

Vaiman, Michael; Martinovich, Uri; Eviatar, Efraim; Kessler, Alex; Segal, Samuel

2004-06-01

272

Diagnosis of Ebola haemorrhagic fever by RT-PCR in an epidemic setting.  

PubMed

This study reports the first field evaluation of a new diagnostic technique for Ebola virus disease with sensitivity and specificity. Ebola virus causes rare but fulminating outbreaks in Equatorial Africa. Rapid differentiation from other infections is critical for timely implementation of public health measures. Patients usually die before developing antibodies, necessitating rapid virus detection. A reverse transcriptase-polymerase chain reaction (RT-PCR) assay was developed, implemented and evaluated at Centre International de Recherches Médicales de Franceville (CIRMF) in Gabon, to detect Ebola viral RNA in peripheral blood mononuclear cells (PBMC). Twenty-six laboratory-confirmed patients during and 5 after the acute phase of Ebola haemorrhagic fever, 15 healthy controls and 20 febrile patients not infected with Ebola virus were studied. RT-PCR results were compared with ELISA antigen capture, and Ebola specific IgM and IgG antibody detection. Ebola virus RNA was amplified from 26/26 specimens from the acute phase, 3/5 during recovery, 0/20 febrile patients and 1/15 negative controls. Sensitivity of RT-PCR in identifying acute infection and early convalescence compared with antigen or IgM detection was 100% and 91% respectively, and specificity compared with antigen detection and IgM assay combined was 97%. Antigen capture detected only 83% of those identified by PCR, and IgM only 67%. Ebola virus RNA was detected in all 13 fatalities, only 5 of whom had IgM and none IgG. RT-PCR detected Ebola RNA in PBMC one to three weeks after disappearance of symptoms when antigen was undetectable. RT-PCR was the most sensitive method and able to detect virus from early acute disease throughout early recovery. PMID:10686031

Leroy, E M; Baize, S; Lu, C Y; McCormick, J B; Georges, A J; Georges-Courbot, M C; Lansoud-Soukate, J; Fisher-Hoch, S P

2000-04-01

273

Idiopathic pulmonary calcification and ossification in an elderly woman with a missed diagnosis of subarachnoid haemorrhage.  

PubMed

This is a case of idiopathic pulmonary calcification and ossification in a 70 year old with long-standing diabetes and hypertension. Thirteen years prior to her demise, she was first noticed to have multiple calcific deposits in her lungs on a chest X-ray film. She had no risk factors for soft tissue calcification and ossification. Histology of tissue from autopsy showed intraparenchymal pulmonary calcification and ossification with marrow elements. Idiopathic pulmonary calcification and ossification is rare. At autopsy, she was also found to have had bilateral subarachnoid haemorrhage (SAH), a diagnosis missed during clinical evaluation. We highlight the pertinent details in our patient's management that could have helped to prevent a missed diagnosis of SAH. Even though SAH occurs most commonly following head trauma, the more familiar medical use of SAH is for non-traumatic SAH occurring following a ruptured cerebral aneurysm. This patient had notable risk factors for cerebral aneurysm formation but an aneurysm was not identified at autopsy. The location of the blood high on the cerebral convexities further suggests a traumatic origin rather than a ruptured aneurysm. Heterotopic calcification and ossification (HO) is known to occur in the setting of severe neurologic disorders such as traumatic brain injury but the fact that the lung calcification in our patient predated the brain injury by over 10 years makes it unlikely for the HO to have been due to the brain trauma. Other organ pathologies found at autopsy include chromophobe renal cell carcinoma, renal papillary necrosis, lymphocytic thyroiditis, and seborrheic keratosis. PMID:24391231

Odubanjo, M O; Abdulkareem, F B; Banjo, A; Ekwere, T E; Awelimobor, D I

2013-09-01

274

Current management of intracerebral haemorrhage in China: a national, multi-centre, hospital register study  

PubMed Central

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

2011-01-01

275

Predictors of good outcome in medium to large spontaneous supratentorial intracerebral haemorrhages  

PubMed Central

Objective: To determine potential predictors of good outcome in primary medium to large intracerebral haemorrhages (ICH) which could be useful for selecting patients for surgical procedures. Methods: Subjects were 138 patients with spontaneous hemispheric ICH >20 ml. They were non-surgically treated and were admitted consecutively to 15 hospitals within the first 12 hours of symptom onset (mean (SD), 5.8 (3.1) hours). Haematoma volume was measured on computed tomography (CT) at admission. Stroke severity was assessed by the Canadian stroke scale (CSS). Good outcome was defined as modified Rankin score ?2 at three months. Results: At the end of the follow up period, 45 patients (32.6%) had good outcome. Baseline stroke severity, systolic and diastolic blood pressure, body temperature, and acute phase reaction biochemical markers (ESR, C-reactive protein, fibrinogen, neutrophil count) were significantly associated with good outcome in bivariate analyses. Of the initial CT scan variables, intraventricular contamination, deep location, mass effect, and greater ICH volume were related to poor outcome. On multiple logistic regression analysis, cortical location of bleeding (odds ratio 3.79 (95% confidence interval 1.2 to 12.01); p = 0.023), high CSS score (OR 2.3 (1.6 to 3.1); p<0.0001), and low fibrinogen concentrations (OR 0.92 (0.87 to 0.97); p = 0.001) were independent predictors of good outcome. These three factors correctly classified 85% of patients. Conclusions: Good outcome in medium to large ICH can be predicted on admission by three readily assessable factors (CSS score, ICH location, and fibrinogen levels). These predictors may be helpful in selecting patients for surgical treatment. PMID:15834028

Castellanos, M; Leira, R; Tejada, J; Gil-Peralta, A; Davalos, A; Castillo, J; t for

2005-01-01

276

Postpartum Haemorrhage in Canada and France: A Population-Based Comparison  

PubMed Central

Objective Maternal mortality ratio due to postpartum haemorrhage (PPH) is higher in France than in Canada. We explored this difference by comparing PPH features between these two countries. Methods Using data between 2004 and 2006, we compared the incidence, risk factors, causes and use of second-line treatments, of PPH between France (N?=?6,660 PPH) and Canada (N?=?9,838 PPH). We assessed factors associated with PPH through multivariate logistic models. Results PPH incidence, overall (4.8% (95% CI 4.7–4.9) in Canada and 4.5% (95% CI 4.4–4.7) in France), and after vaginal delivery (5.3% (95%CI 5.2–5.4) in Canada and 4.8 (95%CI 4.7–4.9) in France), were significantly higher in Canada than in France, but not after caesarean delivery. Women delivering without PPH were similar between the two populations, except for macrosomia (11% in Canada, 7% in France, p<0.001), caesarean delivery (27% in Canada, 18% in France, p<0.001), and episiotomy (17% in Canada, 34% in France, p<0.001). After vaginal delivery, factors strongly associated with PPH were multiple pregnancy, operative delivery and macrosomia in both populations, and episiotomy only in France (Odds Ratio 1.39 (95% CI 1.23–1.57)). The use of second-line treatments for PPH management was significantly more frequent in France than in Canada after both vaginal and caesarean delivery. Conclusion PPH incidence was not higher in France than in Canada and there was no substantial difference in PPH risk factors between the 2 countries. Greater use of second-line treatments in PPH management in France suggests a more frequent failure of first-line treatments and a higher rate of severe PPH, which may be involved in the higher maternal mortality ratio due to PPH. PMID:23826165

Bonnet, Marie-Pierre; Basso, Olga; Bouvier-Colle, Marie-Hélène; Dupont, Corinne; Rudigoz, René-Charles; Fuhrer, Rebecca; Deneux-Tharaux, Catherine

2013-01-01

277

Long Non-Coding RNA Expression Profiles in Hereditary Haemorrhagic Telangiectasia  

PubMed Central

Hereditary Haemorrhagic Telangiectasia (HHT) is an autosomal dominantly inherited vascular disease characterized by the presence of mucocutaneous telangiectasia and arteriovenous malformations in visceral organs. HHT is predominantly caused by mutations in ENG and ACVRL1, which both belong to the TGF-? signalling pathway. The exact mechanism of how haploinsufficiency of ENG and ACVRL1 leads to HHT manifestations remains to be identified. As long non-coding RNAs (lncRNAs) are increasingly recognized as key regulators of gene expression and constitute a sizable fraction of the human transcriptome, we wanted to assess whether lncRNAs play a role in the molecular pathogenesis of HHT manifestations. By microarray technology, we profiled lncRNA transcripts from HHT nasal telangiectasial and non-telangiectasial tissue using a paired design. The microarray probes were annotated using the GENCODE v.16 dataset, identifying 4,810 probes mapping to 2,811 lncRNAs. Comparing HHT telangiectasial tissue with HHT non-telangiectasial tissue, we identified 42 lncRNAs that are differentially expressed (q<0.001). Using GREAT, a tool that assumes cis-regulation, we showed that differently expressed lncRNAs are enriched for genomic loci involved in key pathways concerning HHT. Our study identified lncRNAs that are aberrantly expressed in HHT telangiectasia and indicates that lncRNAs may contribute to regulate protein-coding loci in HHT. These results suggest that the lncRNA component of the transcriptome deserves more attention in HHT. A deeper understanding of lncRNAs and their role in telangiectasia formation possesses potential for discovering therapeutic targets in HHT. PMID:24603890

Tørring, Pernille M.; Larsen, Martin Jakob; Kjeldsen, Anette D.; Ousager, Lilian Bomme; Tan, Qihua; Brusgaard, Klaus

2014-01-01

278

Snakebites and ethnobotany in the northwest region of Colombia. Part III: neutralization of the haemorrhagic effect of Bothrops atrox venom.  

PubMed

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 by oral, i.p. or i.v. route either before or after an i.d. venom injection (10 microg), neutralization of haemorrhage dropped below 25% for all the extracts. Additionally, B. rosademonte and P. percussa extracts were able to inhibit the proteolytic activity of B. atrox venom on casein. PMID:11025161

Otero, R; Núñez, V; Barona, J; Fonnegra, R; Jiménez, S L; Osorio, R G; Saldarriaga, M; Díaz, A

2000-11-01

279

Effect of dietary omega-3 and omega-6 fatty acids on clotting activities of Factor V, VII and X in fatty liver haemorrhagic syndrome-susceptible laying hens.  

PubMed

1. The relationship between concentrations of omega-3 and omega-6 fatty acids in plasma and Factor V, VII and X clotting activities was determined using a crossover feeding trial with diets supplemented with either soy oil or flax oil. 2. Laying hens on the soy diet, which is high in omega-6 fatty acids, had substantially higher clotting activity for all three factors compared to laying hens on the flax diet that was high in omega-3 fatty acids. 3. Positive associations were seen between liver haemorrhage score and the percentage of liver weight and between the percentage of liver weight and the severity of haemorrhagic and fatty changes seen on histology. 4. These results support the hypothesis that concentrations of omega-6 and omega-3 fatty acids in plasma affect clotting activity; however, there was no relationship between the extent of liver haemorrhages and the composition of plasma fatty acids. PMID:19637039

Yeh, E; Wood, R D; Leeson, S; Squires, E J

2009-05-01

280

Metachronous Multiplicity of Spinal Cord Arteriovenous Fistula and Spinal Dural AVF in a Patient with Hereditary Haemorrhagic Telangiectasia  

PubMed Central

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

Ling, J.C.M.; Agid, R.; Nakano, S.; Souza, M.P.S.; Reintamm, G.; TerBrugge, K.G.

2005-01-01

281

Ischaemic stroke after acute intracranial haemorrhage in patients with moyamoya disease: six new cases and a short literature review  

Microsoft Academic Search

Background  We report six new cases of ischaemic stroke after cerebral haemorrhage in patients with moyamoya disease (MMD) and analyse\\u000a their clinical and radiological characteristics, together with cases reported in the literature, to deduce the mechanism of\\u000a cerebral infarct.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Six (2%) of 246 patients with MMD who were admitted to our hospitals between 1993 and 2009 suffered cerebral infarct after\\u000a intracranial

Dal-Soo Kim; Dong-Kyu Jang; Pil-Woo Huh; Do-Sung Yoo; Young-Min Han; Choon-Woong Huh

2011-01-01

282

Use of portal pressure studies in the management of variceal haemorrhage  

PubMed Central

Portal hypertension occurs as a complication of liver cirrhosis and complications such as variceal bleeding lead to significant demands on resources. Endoscopy is the gold standard method for screening cirrhotic patients however universal endoscopic screening may mean a lot of unnecessary procedures as the presence of oesophageal varices is variable hence a large time and cost burden on endoscopy units to carry out both screening and subsequent follow up of variceal bleeds. A less invasive method to identify those at high risk of bleeding would allow earlier prophylactic measures to be applied. Hepatic venous pressure gradient (HVPG) is an acceptable indirect measurement of portal hypertension and predictor of the complications of portal hypertension in adult cirrhotics. Varices develop at a HVPG of 10-12 mmHg with the appearance of other complications with HPVG > 12 mmHg. Variceal bleeding does not occur in pressures under 12 mmHg. HPVG > 20 mmHg measured early after admission is a significant prognostic indicator of failure to control bleeding varices, indeed early transjugular intrahepatic portosystemic shunt (TIPS) in such circumstances reduces mortality significantly. HVPG can be used to identify responders to medical therapy. Patients who do not achieve the suggested reduction targets in HVPG have a high risk of rebleeding despite endoscopic ligation and may not derive significant overall mortality benefit from endoscopic intervention alone, ultimately requiring TIPS or liver transplantation. Early HVPG measurements following a variceal bleed can help to identify those at risk of treatment failure who may benefit from early intervention with TIPS. Therefore, we suggest using HVPG measurement as the investigation of choice in those with confirmed cirrhosis in place of endoscopy for intitial variceal screening and, where indicated, a trial of B-blockade, either intravenously during the initial pressure study with assessment of response or oral therapy with repeat HVPG six weeks later. In those with elevated pressures, primary medical prophylaxis could be commenced with subsequent close monitoring of HVPG thus negating the need for endoscopy at this point. All patients presenting with variceal haemorrhage should undergo HVPG measurement and those with a gradient greater than 20 mmHg should be considered for early TIPS. By introducing portal pressure studies into a management algorithm for variceal bleeding, the number of endoscopies required for further intervention and follow up can be reduced leading to significant savings in terms of cost and demand on resources. PMID:22816007

Addley, Jennifer; Tham, Tony CK; Cash, William Jonathan

2012-01-01

283

Low superior vena cava flow and intraventricular haemorrhage in preterm infants  

PubMed Central

OBJECTIVES—To document the incidence, timing, degree, and associations of systemic hypoperfusion in the preterm infant and to explore the temporal relation between low systemic blood flow and the development of intraventricular haemorrhage (IVH).?STUDY DESIGN—126 babies born before 30 weeks' gestation (mean 27 weeks, mean body weight 991 g) were studied with Doppler echocardiography and cerebral ultrasound at 5, 12, 24, and 48 hours of age. Superior vena cava (SVC) flow was assessed by Doppler echocardiography as the primary measure of systemic blood flow returning from the upper body and brain. Other measures included colour Doppler diameters of ductal and atrial shunts, as well as Doppler assessment of shunt direction and velocity, and right and left ventricular outputs. Upper body vascular resistance was calculated from mean blood pressure and SVC flow.?RESULTS—SVC flow below the range recorded in well preterm babies was common in the first 24 hours (48 (38%) babies), becoming significantly less common by 48 hours (6 (5%) babies). These low flows were significantly associated with lower gestation, higher upper body vascular resistance, larger diameter ductal shunts, and higher mean airway pressure. Babies whose mothers had received antihypertensives had significantly higher SVC flow during the first 24 hours. Early IVH was already present in 9 babies at 5 hours of age. Normal SVC flows were seen in these babies except in 3 with IVH, which later extended, who all had SVC flow below the normal range at 5 and/or 12 hours. Eight of these 9 babies were delivered vaginally. Late IVH developed in 18 babies. 13 of 14 babies with grade 2to 4 IVH had SVC flow below the normal range before development of an IVH. Two of 4 babies with grade 1 IVH also had SVC flow below the normal range before developing IVH, and the other 2had SVC flow in the low normal range. In all, IVH was first seen after the SVC flow had improved, and the grade of IVH related significantly to the severity and duration of low SVC flow. The 9 babies who had SVC flow below the normal range and did not develop IVH or periventricular leucomalacia were considerably more mature (median gestation 28 v 25weeks).?CONCLUSIONS—Low SVC flow may result from an immature myocardium struggling to adapt to increased extrauterine vascular resistances. Critically low flow occurs when this is compounded by high mean airway pressure and large ductal shunts out of the systemic circulation. Late IVH is strongly associated with these low flow states and occurs as perfusion improves.? PMID:10794784

Kluckow, M.; Evans, N.

2000-01-01

284

Anaesthesia in a patient with subarachanoidal haemorrhage and high oxygen affinity haemoglobinopathy (HB york): case report  

PubMed Central

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, they should carry an "emergency anaesthesiology card" in order to avert perioperative risks arising from their "hidden" anemia. PMID:22870883

2012-01-01

285

First experiences with an individual nasal olive in patients with hereditary haemorrhagic telangiectasia (HHT).  

PubMed

Hereditary haemorrhagic teleangiectasia (HHT) is most notably characterized by vulnerable vascular formations of the nasal superficial mucosa. Epistaxis is one of the most common symptoms of the afflicted patients, with an incidence of more than 90 %. A variable series of treatments have been described, ranging from nasal ointments to the complete surgical occlusion of the nose. The objective of this pilot study is the presentation of first experiences in treating patients suffering from HHT and chronically recurrent epistaxis with an individual nasal olive made from silicone. Eleven patients (six men, five women) aging from 44 to 80 years with known HHT were treated at the ENT department of Homburg/Saar between October 2008 and July 2012 because of nasal bleeding by Nd:YAG laser or argon plasma coagulation. After the surgical treatment, an imprint of the nasal aditus was taken to manufacture an individual custom-made silicone nasal olive. Patients were wearing the nasal olive for 3-8 h a day. Check-ups were made every 6 months. Epistaxis severity score (ESS) was used pre- and post-nasal olive application. The observation period was 12-48 months. The utilization of the silicone nasal olive led to a distinct reduction of epistaxis events. Apart from the nasal olive, our patients needed no further treatment of the nose during the observation period except for a nasal ointment. Insertion and removal of the nasal olive were handled by the patients themselves. The local manipulation in handling the nasal olive caused no epistaxis itself. A significant improvement of the ESS and satisfaction was reported in all patients. Use of an individually manufactured silicone nasal olive is a promising extension to the established treatments of epistaxis in HHT patients. Tolerance towards this treatment by the patients was high due to the low personal burden and encumbrance. The extended use of the presented method in HHT patients may be beneficial. However, a more prolonged observation period is necessary in the future to judge the long-term efficiency of individual nasal olives. PMID:24854232

Al Kadah, Basel; Papaspyrou, George; Schneider, Mathias; Schick, Bernhard

2015-01-01

286

Pituitary-adrenal function in patients with acute subarachnoid haemorrhage: a prospective cohort study  

PubMed Central

Introduction Subarachnoid haemorrhage (SAH) may damage the hypothalamo-pituitary-adrenal gland (HPA) axis and disturb cortisol metabolism. There are no available data that relates to the response of the HPA axis in the acute phase of SAH. We aimed to characterise the behavior of serum adrenocorticotropic hormone (ACTH), total cortisol, stimulated total cortisol and free cortisol concentrations in acute aneurysmal SAH. Methods A prospective cohort study was conducted of patients with acute aneurysmal SAH (n = 30) admitted to a tertiary university hospital. Patients admitted for elective aneurysmal surgery (n = 16) served as the control group. An ACTH stimulation test was performed twice during the first week and at three months. The main outcome measure was description of the ACTH-cortisol response by calculating serum free cortisol and measuring total cortisol and ACTH concentrations. A mixed models method was used for testing between the groups, allowing heterogeneity between the groups. Results Patients with SAH had higher initial serum total cortisol (mean +/- SD; 793 +/- 312 nmol/L) and free cortisol concentrations (83 +/- 55 nmol/L) than control patients (535 +/- 193 nmol/L, p = 0.001 and 33 +/- 18 nmol/L, p < 0.001, respectively). Thereafter, there were no differences in this respect. Serum free and total cortisol concentrations correlated but were unaffected by the severity of SAH. ACTH concentrations were comparable between SAH and control groups. Patients with Hunt-Hess grades IV to V had higher ACTH concentrations at day one (10.7 +/- 7.1 pmol/l/L) and day five (8.2 +/- 7.7 pmol/L) than patients with grade I-III (day one: 3.8 +/- 2.0 pmol/L, p = 0.002; day five: 4.7 +/- 1.8 pmol/L, p = 0.04). Conclusions Calculation of serum free cortisol concentration was not helpful in identifying patients with potential hypocortisolism. SAH severity did not affect cortisol concentrations, possibly indicating relative pituitary-adrenal insufficiency in patients with more severe bleeding. Trial registration ClinicalTrials.gov Identifier NCT00614887. PMID:18851750

Bendel, Stepani; Koivisto, Timo; Ruokonen, Esko; Rinne, Jaakko; Romppanen, Jarkko; Vauhkonen, Ilkka; Kiviniemi, Vesa; Uusaro, Ari

2008-01-01

287

Specific cancer rates may differ in patients with hereditary haemorrhagic telangiectasia compared to controls  

PubMed Central

Background Hereditary haemorrhagic telangiectasia (HHT) is inherited as an autosomal dominant trait, affects ~1 in 5,000, and causes multi-systemic vascular lesions and life-limiting complications. Life expectancy is surprisingly good, particularly for patients over 60ys. We hypothesised that individuals with HHT may be protected against life-limiting cancers. Methods To compare specific cancer rates in HHT patients and controls, we developed a questionnaire capturing data on multiple relatives per respondent, powered to detect differences in the four most common solid non skin cancers (breast, colorectal, lung and prostate), each associated with significant mortality. Blinded to cancer responses, reports of HHT-specific features allowed assignment of participants and relatives as HHT-subjects, unknowns, or controls. Logistic and quadratic regressions were used to compare rates of specific cancer types between HHT subjects and controls. Results 1,307 participants completed the questionnaire including 1,007 HHT-subjects and 142 controls. The rigorous HHT diagnostic algorithm meant that 158 (12%) completed datasets were not assignable either to HHT or control status. For cancers predominantly recognised as primary cancers, the rates in the controls generally matched age-standardised rates for the general population. HHT subjects recruited through the survey had similar demographics to controls, although the HHT group reported a significantly greater smoking habit. Combining data of participants and uniquely-reported relatives resulted in an HHT-arm of 2,161 (58% female), and control-arm of 2,817 (52% female), with median ages of 66ys [IQR 53–77] and 77ys [IQR 65–82] respectively. In both crude and age-adjusted regression, lung cancers were significantly less frequent in the HHT arm than controls (age-adjusted odds ratio 0.48 [0.30, 0.70], p?=?0.0012). Breast cancer prevalence was higher in HHT than controls (age-adjusted OR 1.52 [1.07, 2.14], p?=?0.018). Overall, prostate and colorectal cancer rates were equivalent, but the pattern of colorectal cancer was modified, with a higher prevalence in younger HHT patients than controls. Conclusions These preliminary survey data suggest clinically significant differences in the rates of lung, breast and colorectal cancer in HHT patients compared to controls. For rare diseases in which longitudinal studies take decades to recruit equivalent datasets, this type of methodology provides a good first-step method for data collection. PMID:24354965

2013-01-01

288

A long diagnostic delay in patients with Hereditary Haemorrhagic Telangiectasia: a questionnaire-based retrospective study  

PubMed Central

Background The difficulty in establishing a timely correct diagnosis is a relevant matter of concern for several rare diseases. Many rare-disease-affected patients suffer from considerable diagnostic delay, mainly due to their poor knowledge among healthcare professionals, insufficient disease awareness among patients’ families, and lack of promptly available diagnostic tools. Hereditary Haemorrhagic Telangiectasia (HHT) is an autosomal-dominantly inherited vascular dysplasia, affecting 1:5,000-10,000 patients. HHT is characterized by high variability of clinical manifestations, which show remarkable overlapping with several common diseases. Aim To perform a detailed analysis concerning the diagnostic time lag occurring in patients with HHT, defined as the time period spanning from the first clinical manifestation to the attainment of a definite, correct diagnosis. Methods A questionnaire was administered to the HHT patients previously recruited from 2000 and 2009. Clinical onset, first referral to a physician for disease manifestations, and first correct diagnosis of definite HHT were collected. Eventual misdiagnosis at first referral and serious complications occurring throughout the time elapsing between disease onset and definite diagnosis were also addressed. Results In the 233 respondents, the clinical onset of disease occurred at an age of 14.1 yrs, while the age of first referral and the age of first definite diagnosis of HHT were 29.2 yrs and 40.1 yrs, respectively. Only 88/233 patients received a correct diagnosis at first counseling. Thus, the diagnostic time lag, represented by the time elapsing from disease onset and first definite diagnosis of HHT, proved to be 25.7 yrs. Twenty-two patients suffered from severe complications during this time interval. The diagnostic delay was significantly longer (p?

2012-01-01

289

Replicate surveys of larval habitats of Aedes aegypti in relation to dengue haemorrhagic fever in Bangkok, Thailand*  

PubMed Central

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

Tonn, R. J.; Sheppard, P. M.; MacDonald, W. W.; Bang, Y. H.

1969-01-01

290

Impact of pulmonary arteriovenous malformations on respiratory-related quality of life in patients with hereditary haemorrhagic telangiectasia.  

PubMed

Fifteen to fifty percent of patients with hereditary haemorrhagic telangiectasia have pulmonary arteriovenous malformations. The objective of this study was to measure the effect of the presence of pulmonary arteriovenous malformations and of their embolisation on respiratory-related quality of life (QoL). We prospectively recruited patients with a diagnosis of hereditary haemorrhagic telangiectasia based on the Curaçao criteria and/or the identification of a pathogenic mutation. Respiratory-related quality of life was measured using the Saint George's Respiratory Questionnaire (SGRQ). Patients who underwent embolisation of pulmonary arteriovenous malformations completed the questionnaire before and 6-12 mo after the procedure. The 56 participants were divided into three groups: no pulmonary arteriovenous malformation (group A, n?=?10), small pulmonary arteriovenous malformations not accessible to embolotherapy (group B, n?=?19), and large pulmonary arteriovenous malformations accessible to embolotherapy (group C, n?=?27). The SGRQ score was significantly higher in group C compared to the other groups, indicating a worse respiratory-specific QoL. There was no significant difference between groups A and B. Among the 17 patients who underwent an embolisation, the SGRQ score decreased significantly after the procedure, to a value similar to that in patients without pulmonary arteriovenous malformation. Our results indicate that the presence of large but not small pulmonary arteriovenous malformations negatively affects the respiratory-related quality of life and that embolisation of pulmonary arteriovenous malformations normalizes the respiratory-related quality of life. PMID:24603803

Blivet, Sandra; Cobarzan, Daniel; Beauchet, Alain; El Hajjam, Mostafa; Lacombe, Pascal; Chinet, Thierry

2014-01-01

291

Combination treatment with an erythropoiesis-stimulating agent and intravenous iron alleviates anaemia in patients with hereditary haemorrhagic telangiectasia  

PubMed Central

Background Patients with hereditary haemorrhagic telangiectasia (HHT) suffer from recurrent epistaxis and bleeding from gastrointestinal telangiectasias that occur despite otherwise normal haemostasis and result in iron deficiency anaemia with increasing severity. In advanced disease, anaemia may be severe, be irresponsive to iron supplementation, and may lead to red blood cell transfusion dependency. Methods We conducted a retrospective study at our Centre for Osler’s Disease to evaluate the effectiveness of adding an erythropoiesis-stimulating agent (ESA) to intravenous iron supplementation in the management of anaemic HHT patients. Blood values and treatment parameters were collected for nine months before combination therapy (iron supplementation only) and 12 months during combination therapy (iron supplementation plus ESA). Results Four patients received intravenous iron and an ESA with mean weekly doses of 126 mg and 17,300 units (U), respectively. Mean haemoglobin improved significantly during combination therapy, from 106 g/L to 119 g/L (p < 0.001). Conclusion Conclusion. Anaemia can be alleviated in patients with HHT who are irresponsive to intravenous iron supplementation, by addition of an ESA. The proposed mechanism behind the iron irresponsiveness is that the anaemia is caused by a combination of recurrent haemorrhage and anaemia of chronic disease. PMID:25188751

Cherif, Honar

2014-01-01

292

Clinical implications of microvascular obstruction and intramyocardial haemorrhage in acute myocardial infarction using cardiovascular magnetic resonance imaging  

PubMed Central

Objectives To investigate the clinical implications of microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) in acute myocardial infarction (AMI). Methods Ninety patients with a first AMI undergoing primary percutaneous coronary intervention (PCI) were studied. T2-weighted, cine and late gadolinium-enhanced cardiovascular magnetic resonance imaging was performed at 5?±?2 and 103?±?11 days. Patients were categorised into three groups based on the presence or absence of MVO and IMH. Results MVO was observed in 54% and IMH in 43% of patients, and correlated significantly (r?=?0.8, p?haemorrhage and microvascular obstruction are strongly related. Pre-PCI TIMI 3 flow is less frequently observed in patients with MVO and IMH. Only infarct size was an independent predictor of LV remodelling. PMID:20577881

Smulders, Martijn W.; Passos, Valéria Lima; Leiner, Tim; Waltenberger, Johannes; Gorgels, Anton P. M.; Schalla, Simon

2010-01-01

293

Role of neuronal and vascular Ca(2+)-channels in the ACTH-induced reversal of haemorrhagic shock.  

PubMed Central

1. In a rat model of volume-controlled haemorrhagic shock causing the death of all control (saline-treated) animals within 30 min, the intravenous (i.v.) bolus injection of ACTH-(1-24) at a dose of 160 micrograms kg-1 produced an impressive and sustained restoration of arterial pressure, pulse pressure and respiratory function, with 100% survival at the end of the observation period (2 h). 2. Both intracerebroventricular (i.c.v., 0.015-0.06 microgram kg-1) and i.v. (5 micrograms kg-1) pretreatment with the N-calcium channel blocker, omega-conotoxin GVIA, and i.v. (but not i.c.v.) pretreatment with the L-calcium channel blocker, nicardipine (125-500 micrograms kg-1) dose-dependently prevented the ACTH-induced shock reversal. 3. These results further indicate that the effect of ACTH in haemorrhagic shock may involve a neuronal link and the eventual restoration of vascular tone mediated by N- and L-type calcium channels, respectively. PMID:8395293

Guarini, S.; Bazzani, C.; Bertolini, A.

1993-01-01

294

Impact of Pulmonary Arteriovenous Malformations on Respiratory–Related Quality of Life in Patients with Hereditary Haemorrhagic Telangiectasia  

PubMed Central

Fifteen to fifty percent of patients with hereditary haemorrhagic telangiectasia have pulmonary arteriovenous malformations. The objective of this study was to measure the effect of the presence of pulmonary arteriovenous malformations and of their embolisation on respiratory-related quality of life (QoL). We prospectively recruited patients with a diagnosis of hereditary haemorrhagic telangiectasia based on the Curaçao criteria and/or the identification of a pathogenic mutation. Respiratory-related quality of life was measured using the Saint George’s Respiratory Questionnaire (SGRQ). Patients who underwent embolisation of pulmonary arteriovenous malformations completed the questionnaire before and 6–12 mo after the procedure. The 56 participants were divided into three groups: no pulmonary arteriovenous malformation (group A, n?=?10), small pulmonary arteriovenous malformations not accessible to embolotherapy (group B, n?=?19), and large pulmonary arteriovenous malformations accessible to embolotherapy (group C, n?=?27). The SGRQ score was significantly higher in group C compared to the other groups, indicating a worse respiratory-specific QoL. There was no significant difference between groups A and B. Among the 17 patients who underwent an embolisation, the SGRQ score decreased significantly after the procedure, to a value similar to that in patients without pulmonary arteriovenous malformation. Our results indicate that the presence of large but not small pulmonary arteriovenous malformations negatively affects the respiratory-related quality of life and that embolisation of pulmonary arteriovenous malformations normalizes the respiratory-related quality of life. PMID:24603803

Blivet, Sandra; Cobarzan, Daniel; Beauchet, Alain; El Hajjam, Mostafa; Lacombe, Pascal; Chinet, Thierry

2014-01-01

295

Expert consultation on risk factors for introduction of infectious pathogens into fish farms.  

PubMed

An expert consultation was conducted to provide quantitative parameters required to inform risk-based surveillance of aquaculture holdings for selected infectious hazards. The hazards were four fish diseases endemic in some or several European countries: infectious salmon anaemia (ISA), viral haemorrhagic septicaemia (VHS), infectious haematopoietic necrosis (IHN), and koi herpes virus disease (KHD). Experts were asked to provide estimates for the relative importance of 5 risk themes for the hazard to be introduced into and infect susceptible fish at the destination. The 5 risk themes were: (1) live fish and egg movements; (2) exposure via water; (3) on-site processing; (4) short distance mechanical transmission and (5) distance independent mechanical transmission. The experts also provided parameter estimates for hazard transmission pathways within the themes. The expert consultation was undertaken in a 2 step approach: an online survey followed by an expert consultation meeting. The expert opinion indicated that live fish movements and exposure via water were the major relevant risk themes. Experts were recruited from several European countries and thus covered a range of farming systems. Therefore, the outputs from the expert consultation have relevance for the European context. PMID:24780587

Oidtmann, Birgit C; Peeler, Edmund J; Thrush, Mark A; Cameron, Angus R; Reese, R Allan; Pearce, Fiona M; Dunn, Peter; Lyngstad, Trude M; Tavornpanich, Saraya; Brun, Edgar; Stärk, Katharina D C

2014-08-01

296

The Massive Bleeding after the Operation of Hip Joint Surgery with the Acquired Haemorrhagic Coagulation Factor XIII(13) Deficiency: Two Case Reports.  

PubMed

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

Kanda, Akio; Kaneko, Kazuo; Obayashi, Osamu; Mogami, Atsuhiko

2013-01-01

297

Delayed extradural haemorrhage: a case for intracranial pressure monitoring in sedated children with traumatic brain injury within tertiary centres  

PubMed Central

A 15-year-old girl sustained a mild isolated traumatic brain injury  following a pedestrian road traffic accident. She was ventilated for head computed tomography (CT) scan which revealed no intracranial abnormalities. Ventilation was not withdrawn until 15?h later when poor neurological recovery prompted urgent repeat CT, which demonstrated a delayed extradural haemorrhage (EDH). She underwent surgical evacuation, and intracranial pressure (ICP) monitoring was initiated postoperatively. She developed persistently raised ICP resistant to medical therapy, prompting further CT. This showed a recurrence of the delayed EDH requiring further surgical drainage. She made a good neurological recovery. There should be a low threshold for repeat CT to exclude delayed EDH when neurological status is poor despite normal CT soon after initial primary injury. ICP monitoring should be undertaken in children and adolescents who have normal initial CT, but in whom serial neurological assessment is not possible owing to sedation. PMID:23420720

Hughes, Anna; Lee, Conrad; Kirkham, Fenella; Durnford, Andrew J

2013-01-01

298

Internal haemorrhagic pachymeningiosis: specific disease or complication of chronic subdural hematoma? Report of five cases surgically treated and literature review  

PubMed Central

Background Internal haemorrhagic pachymeningiosis (IHP) is a rare disease characterized by a fibrous thickening and inflammatory infiltration in dural space mimicking chronic subdural hematoma. The pathogenesis of IHP is not entirely clear yet and treatment is still controversial. Objective We want to emphasize the importance of differentiating pachymeningiosis from chronic subdural hematoma as distinct pathological entities. Patients and methods The records of five selected cases of IHP histologically confirmed were reviewed, focusing onset, neuroimaging, surgery and outcomes. Conclusions IHP is most likely underestimated. Only through multidisciplinary approach it is possible to plane the proper therapeutic strategy. The diagnosis of IHP is confirmed by definitive histology but in some cases is possible with intraoperative frozen section. PMID:25174295

CARANGELO, B.; LAVALLE, L.; MUSCAS, G.; PERI, G.; TIEZZI, G.; BRANCO, D.; TACCHINI, D.; COSTANTINO, G.; MARIOTTINI, A.; MATURO, A.

2014-01-01

299

Situation of hantavirus infections and haemorrhagic fever with renal syndrome in European countries as of December 2006.  

PubMed

Hantavirus infections are widely distributed in Europe with the exception of the far north and the Mediterranean regions. The underlying causes of varying epidemiological patterns differ among regions: in western and central Europe epidemics of haemorrhagic fever with renal syndrome (HFRS) caused by hantavirus infections follow mast years with increased seed production by oak and beech trees followed by increased rodent reproduction. In the northern regions, hantavirus infections and HFRS epidemics occur in three to four year cycles and are thought to be driven by prey - predator interactions. Hantavirus infections and HFRS seem to be on the increase in Europe, partly because of better diagnostics, partly perhaps due to environmental changes. Unfortunately, hantavirus infections are still heavily under-diagnosed in many European countries. Here we report the results of a survey conducted in 2007 amongst the member laboratories of the European Network for diagnostics of Imported Viral Diseases (ENIVD). PMID:18761927

Heyman, P; Vaheri, A

2008-07-10

300

A Novel Vaccine against Crimean-Congo Haemorrhagic Fever Protects 100% of Animals against Lethal Challenge in a Mouse Model  

PubMed Central

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

Buttigieg, Karen R.; Dowall, Stuart D.; Findlay-Wilson, Stephen; Miloszewska, Aleksandra; Rayner, Emma; Hewson, Roger; Carroll, Miles W.

2014-01-01

301

Brain abscess as an initial presentation in a patient of hereditary haemorrhagic telangiectasia caused by a novel ENG mutation.  

PubMed

Hereditary haemorrhagic telangiectasia (HHT) is a rare inherited autosomal-dominant vascular dysplasia involving multiple organs. Brain abscess is an uncommon and potential fatal complication. We report a case of HHT caused by a novel ENG mutation who initially presented as brain abscess. The patient, with a family history of epistaxis, presented with fever, headache and right-sided haemiparesis. Upon examination, brain MRI showed a contrast-enhanced abscess on the left fronto-parietal region. Open brain drainage was performed and pus culture yielded Actinomyces meyeri. The chest image revealed multiple pulmonary arterio-venous fistulas. HHT was diagnosed according to Curacao criteria. Genetic analysis revealed a novel duplication on exon 6 of ENG gene, which segregates with symptomatic subjects in her family. Clinicians should be cautiously aware of HHT as a differential diagnosis if patients presented with an unknown entry source of intracerebral infections. PMID:23440993

Chen, Kai-Hsiang; Lin, Chin-Hsien

2013-01-01

302

Hantavirus infection in rodents and haemorrhagic fever with renal syndrome in Shaanxi province, China, 1984-2012.  

PubMed

SUMMARY The transmission of haemorrhagic fever with renal syndrome (HFRS) is deeply influenced by the reservoir and hantavirus prevalence rate. In this study, a surveillance on human HFRS cases, relative rodent abundance, and hantavirus infection prevalence was conducted in Shaanxi province, China, during 1984-2012. A generalized linear model with Poisson-distributed residuals and a log link was used to quantify the relationship between reservoir, virus and HFRS cases. The result indicated that there was a significant association of HFRS incidence with relative rodent density and the prevalence rate. This research provides evidence that the changes of infection prevalence in the reservoir could lead directly to the emergence of a new epidemic. It was concluded that the measurement of a number of these variables could be used in disease surveillance to give useful advance warning of potential disease epidemics. PMID:24787374

Yu, P B; Tian, H Y; Ma, C F; Ma, C A; Wei, J; Lu, X L; Wang, Z; Zhou, S; Li, S; Dong, J H; Xu, J R; Xu, B; Wang, J J

2015-01-01

303

Risk factors for development of sterile haemorrhagic cystitis in canine lymphoma patients receiving oral cyclophosphamide: a case-control study.  

PubMed

Sterile haemorrhagic cystitis (SHC) is a known risk of cyclophosphamide treatment; however, most canine reports are case series. This case-control study examined risk factors for SHC in dogs with lymphoma receiving oral cyclophosphamide. Twenty-two dogs with SHC and 66 control dogs were identified. On univariate analysis, SHC risk factors included age (P?=?0.041), induction protocol (P?=?0.021) and cumulative cyclophosphamide dose (P?=?0.002). On multivariate analysis, increasing cumulative cyclophosphamide dose was associated with increased risk of SHC and the 'short' induction protocol (protocol 1) was associated with decreased risk. Controlling for age and induction protocol, odds of SHC increased by 2.21 per 750?mg?m(-2) increase in cyclophosphamide dose (P?=?0.001). SHC from oral cyclophosphamide is a predominately delayed toxicity resulting from high cumulative doses. PMID:23078083

Gaeta, R; Brown, D; Cohen, R; Sorenmo, K

2014-12-01

304

Pulmonary Delivery of an Ultra-Fine Oxytocin Dry Powder Formulation: Potential for Treatment of Postpartum Haemorrhage in Developing Countries  

PubMed Central

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

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

305

Oxytocin during labour and risk of severe postpartum haemorrhage: a population-based, cohort-nested case–control study  

PubMed Central

Objectives Postpartum haemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Experimental studies support the hypothesis that oxytocin administration during labour, a common although not evidence-based practice, may increase the risk of atonic PPH. The clinical studies, however, are inconclusive. The objectives of this study was to investigate the association between the level of oxytocin exposure during labour and the risk of severe PPH and to explore whether the prophylactic use of oxytocin after birth modifies this association. Design Population-based, cohort-nested case–control study. Setting 106 French hospitals from December 2004 through November 2006. Participants Women with term singleton vaginal deliveries, after an uncomplicated pregnancy. Cases were 1483 women with severe PPH, defined by peripartum change in haemoglobin of ?4?g/dl or need for blood transfusion. Controls were 1758 women from a random sample of parturients without PPH. Main outcome measures The independent association between the level of oxytocin during labour and the risk of severe PPH was tested and quantified with ORs through two-level multivariable logistic regression modelling. Results Oxytocin was administered during labour to 73% of cases and 61% of controls (crude OR: 1.7, 95% CI 1.5 to 2.0). After adjustment for all potential confounders, oxytocin during labour was associated with a significantly higher risk of severe PPH (adjusted OR: 1.8, 95% CI 1.3 to 2.6) in women who did not receive prophylactic oxytocin after delivery; the OR for haemorrhage increased from 1 to 5 according to the level of oxytocin exposure. In women who had prophylactic oxytocin after delivery, this association was significant only for the highest exposure categories. Conclusions Oxytocin during labour appears to be an independent risk factor for severe PPH. The results emphasise the need for guidelines clarifying the evidence-based indications for this procedure and the minimal useful regimens. PMID:22189353

Belghiti, Jérémie; Kayem, Gilles; Dupont, Corinne; Rudigoz, René-Charles; Bouvier-Colle, Marie-Hélène

2011-01-01

306

Detection of the new emerging rabbit haemorrhagic disease type 2 virus (RHDV2) in Sicily from rabbit (Oryctolagus cuniculus) and Italian hare (Lepus corsicanus).  

PubMed

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

Camarda, A; Pugliese, N; Cavadini, P; Circella, E; Capucci, L; Caroli, A; Legretto, M; Mallia, E; Lavazza, A

2014-10-16

307

Experimental haemorrhage and blood component transfusion in humans: no change in plasma concentration of thrombin-antithrombin complex and plasmin-antiplasmin complex.  

PubMed

The influence of haemorrhage and blood transfusion on primary haemostasis, coagulation and fibrinolysis was investigated in ten healthy male volunteers. Acute loss of 10% of the blood volume did not give any significant alteration in thrombin- antithrombin III (TAT) complex and plasmin-alpha 2-antiplasmin (PAP) complex levels compared with a control series. The skin bleeding time with the Simplate II device was not altered after the 10% blood loss. Acute loss of 10% of blood volume followed by transfusion of packed red cells or stored plasma did not resulted in any significant change in bleeding time, TAT and PAP complex levels. It could be concluded that a controlled haemorrhage does not give any detectable changes of the platelet dependent primary haemostasis, blood coagulation and fibrinolysis. Transfusion of one unit of packed red cells or stored plasma does not seem to adversely affect the haemostasis. PMID:8771701

Henriksson, A E; Nilsson, T K; Jansson, U; Bergqvist, D

1996-06-01

308

Acute post-stroke blood pressure relative to premorbid levels in intracerebral haemorrhage versus major ischaemic stroke: a population-based study  

PubMed Central

Summary Background It is often assumed that blood pressure increases acutely after major stroke, resulting in so-called post-stroke hypertension. In view of evidence that the risks and benefits of blood pressure-lowering treatment in acute stroke might differ between patients with major ischaemic stroke and those with primary intracerebral haemorrhage, we compared acute-phase and premorbid blood pressure levels in these two disorders. Methods In a population-based study in Oxfordshire, UK, we recruited all patients presenting with stroke between April 1, 2002, and March 31, 2012. We compared all acute-phase post-event blood pressure readings with premorbid readings from 10-year primary care records in all patients with acute major ischaemic stroke (National Institutes of Health Stroke Scale >3) versus those with acute intracerebral haemorrhage. Findings Of 653 consecutive eligible patients, premorbid and acute-phase blood pressure readings were available for 636 (97%) individuals. Premorbid blood pressure (total readings 13?244) had been measured on a median of 17 separate occasions per patient (IQR 8–31). In patients with ischaemic stroke, the first acute-phase systolic blood pressure was much lower than after intracerebral haemorrhage (158·5 mm Hg [SD 30·1] vs 189·8 mm Hg [38·5], p<0·0001; for patients not on antihypertensive treatment 159·2 mm Hg [27·8] vs 193·4 mm Hg [37·4], p<0·0001), was little higher than premorbid levels (increase of 10·6 mm Hg vs 10-year mean premorbid level), and decreased only slightly during the first 24 h (mean decrease from <90 min to 24 h 13·6 mm Hg). By contrast with findings in ischaemic stroke, the mean first systolic blood pressure after intracerebral haemorrhage was substantially higher than premorbid levels (mean increase of 40·7 mm Hg, p<0·0001) and fell substantially in the first 24 h (mean decrease of 41·1 mm Hg; p=0·0007 for difference from decrease in ischaemic stroke). Mean systolic blood pressure also increased steeply in the days and weeks before intracerebral haemorrhage (regression p<0·0001) but not before ischaemic stroke. Consequently, the first acute-phase blood pressure reading after primary intracerebral haemorrhage was more likely than after ischaemic stroke to be the highest ever recorded (OR 3·4, 95% CI 2·3–5·2, p<0·0001). In patients with intracerebral haemorrhage seen within 90 min, the highest systolic blood pressure within 3 h of onset was 50 mm Hg higher, on average, than the maximum premorbid level whereas that after ischaemic stroke was 5·2 mm Hg lower (p<0·0001). Interpretation Our findings suggest that systolic blood pressure is substantially raised compared with usual premorbid levels after intracerebral haemorrhage, whereas acute-phase systolic blood pressure after major ischaemic stroke is much closer to the accustomed long-term premorbid level, providing a potential explanation for why the risks and benefits of lowering blood pressure acutely after stroke might be expected to differ. Funding Wellcome Trust, Wolfson Foundation, UK Medical Research Council, Stroke Association, British Heart Foundation, National Institute for Health Research. PMID:24582530

Fischer, Urs; Cooney, Marie Therese; Bull, Linda M; Silver, Louise E; Chalmers, John; Anderson, Craig S; Mehta, Ziyah; Rothwell, Peter M

2014-01-01

309

Clinical decision-making: midwifery students' recognition of, and response to, post partum haemorrhage in the simulation environment  

PubMed Central

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 interventions to illuminate what else could be done whilst they awaited the emergency team. They did not necessarily serve to prompt the students' or help them plan care prospectively. The limitations of the study are critically explored along with the pedagogic implications for initial training and continuing professional development. PMID:22443712

2012-01-01

310

Incidence, predisposing factors, management and survival following cardiac arrest due to subarachnoid haemorrhage: a review of the literature  

PubMed Central

Introduction The prevalence of cardiac arrest among patients with subarachnoid haemorrhage [SAH], and the prevalence of SAH as the cause following out-of-hospital cardiac arrest [OHCA] or in-hospital cardiac arrest [IHCA] is unknown. In addition it is unclear whether cardiopulmonary resuscitation [CPR] and post-resuscitation care management differs, and to what extent this will lead to meaningful survival following cardiac arrest [CA] due to SAH. Aim We reviewed the literature in order to describe; 1.The prevalence and predisposing factors of CA among patients with SAH 2.The prevalence of SAH as the cause of OHCA or IHCA and factors characterising CPR 3.The survival and management of SAH patients with CA. Material and methods The following sources, PubMed, CinAHL and The Cochrane DataBase were searched using the following Medical Subheadings [MeSH]; 1. OHCA, IHCA, heart arrest and 2. subarachnoid haemorrhage. Articles containing relevant data based on the abstract were reviewed in order to find results relevant to the proposed research questions. Manuscripts in other languages than English, animal studies, reviews and case reports were excluded. Results A total of 119 publications were screened for relevance and 13 papers were included. The prevalence of cardiac or respiratory arrest among all patients with SAH is between 3-11%, these patients commonly have a severe SAH with coma, large bleeds and evidence of raised intracerebral pressure on computed tomography scans compared to those who did not experience a CA. The prevalence of patients with SAH as the cause of the arrest among OHCA cases vary between 4 to 8% among those who die before hospital admission, and between 4 to 18% among those who are admitted. The prevalence of SAH as the cause following IHCA is low, around 0.5% according to one recent study. In patients with OHCA survival to hospital discharge is poor with 0 to 2% surviving. The initial rhythm is commonly asystole or pulseless electrical tachycardia. In IHCA the survival rate is variable with 0-27% surviving. All survivors experience brief cardiac arrests with short latencies to ROSC. Conclusion Cardiac arrest is a fairly common complication following severe SAH and these patients are encountered both in the pre-hospital and in-hospital setting. Survival is possible if the arrest occurs in the hospital and the latency to ROSC is short. In OHCA the outcome seems to be uniformly poor despite initially successful resuscitation. PMID:23151345

2012-01-01

311

Zebrafish fin immune responses during high mortality infections with viral haemorrhagic septicemia rhabdovirus. A proteomic and transcriptomic approach  

PubMed Central

Background Despite rhabdoviral infections being one of the best known fish diseases, the gene expression changes induced at the surface tissues after the natural route of infection (infection-by-immersion) have not been described yet. This work describes the differential infected versus non-infected expression of proteins and immune-related transcripts in fins and organs of zebrafish Danio rerio shortly after infection-by-immersion with viral haemorrhagic septicemia virus (VHSV). Results Two-dimensional differential gel electrophoresis detected variations on the protein levels of the enzymes of the glycolytic pathway and cytoskeleton components but it detected very few immune-related proteins. Differential expression of immune-related gene transcripts estimated by quantitative polymerase chain reaction arrays and hybridization to oligo microarrays showed that while more transcripts increased in fins than in organs (spleen, head kidney and liver), more transcripts decreased in organs than in fins. Increased differential transcript levels in fins detected by both arrays corresponded to previously described infection-related genes such as complement components (c3b, c8 and c9) or class I histocompatibility antigens (mhc1) and to newly described genes such as secreted immunoglobulin domain (sid4), macrophage stimulating factor (mst1) and a cluster differentiation antigen (cd36). Conclusions The genes described would contribute to the knowledge of the earliest molecular events occurring in the fish surfaces at the beginning of natural rhabdoviral infections and/or might be new candidates to be tested as adjuvants for fish vaccines. PMID:20875106

2010-01-01

312

Policymakers' views on dengue fever/dengue haemorrhagic fever and the need for dengue vaccines in four southeast Asian countries.  

PubMed

A survey of policymakers and other influential professionals in four southeast Asian countries (Cambodia, Indonesia, Philippines and Vietnam) was conducted to determine policymakers' views on the public health importance of dengue fever and dengue haemorrhagic fever (DHF), the need for a vaccine and the determinants influencing its potential introduction. The survey, which involved face-to-face interviews with policymakers, health programme managers, researchers, opinion leaders and other key informants, revealed an almost uniformly high level of concern about dengue fever/DHF and a high perceived need for a dengue vaccine. Several characteristics of the disease contribute to this high sense of priority, including its geographic spread, occurrence in outbreaks, the recurrent risk of infection each dengue season, its severity and the difficulty in diagnosis and management, its urban predominance, its burden on hospitals, and its economic toll on governments and families. Research felt to be key to future decision-making regarding dengue vaccine introduction include: disease surveillance studies, in-country vaccine trials or pilot projects, and studies on the economic burden of dengue and the cost-effectiveness of dengue vaccines. The results suggest favourable conditions for public and private sector markets for dengue vaccines and the need for creative financing strategies to ensure their accessibility to poor children in dengue-endemic countries. PMID:14604579

DeRoeck, Denise; Deen, Jacqueline; Clemens, John D

2003-12-01

313

The effect of formal training on the clinical utility of transcranial Doppler ultrasound monitoring in patients with aneurysmal subarachnoid haemorrhage.  

PubMed

We have previously shown that the clinical utility of transcranial Doppler (TCD) ultrasound monitoring for vasospasm in patients with aneurysmal subarachnoid haemorrhage, as performed by untrained operators in a busy neurosurgical unit, is questionable, despite the recommendations for its use in the literature. We determined if formal training improved the utility of TCD. Twelve untrained operators and one trained operator performed a total of 206 TCD examinations. There was poor agreement of results between trained and untrained operators. For the left middle cerebral artery (MCA), right MCA, left anterior cerebral artery (ACA) and right ACA, the blood flow velocities (BFV) recorded by the trained operator were greater than those recorded by the untrained operators by a mean (95% confidence interval) of 27.7 (25.0-30.4), 24.3 (21.4-27.1), 28.2 (25.6-30.9) and 28.1 (24.9-31.1) cm/s, respectively (p<0.001 for all vessels). Greater sensitivity was observed in TCD measurements from the trained operator (100%) compared to untrained operators (40%). To improve the utility of TCD, operators should be provided with training or a professional sonographer employed. PMID:22727749

Bhuiyan, M Rasin; Deb, Smita; Mitchell, Ruth A; Teddy, Peter J; Drummond, Katharine J

2012-09-01

314

Prognostic value of the amount of post-traumatic subarachnoid haemorrhage in a six month follow up period.  

PubMed Central

Clinical and radiological patterns from 148 patients with post-traumatic subarachnoid haemorrhage (TSAH) were analysed with specific regard for the amount and distribution of blood in subarachnoid spaces to verify if these variables have any influence on overall outcome. The degree and extent of TSAH were classified according to Fisher's criteria: in 93 patients it was grade 1, in 36 grade 2, in 13 grade 3, and in six grade 4. There was a significant correlation between increasing clinical severity at admission and the amount of subarachnoid bleeding and a direct relation between a favourable outcome and a low Fisher grade. The distribution of subarachnoid blood was not significantly related to clinical condition at admission, whereas the pattern had a significant impact on the outcome. The results of the present study confirm that TSAH is a negative prognostic factor. Whereas the degree of TSAH is mainly related to clinical conditions at admission, the presence of subarachnoid blood clots both in basal cisterns and over the cerebral convexity indicates a poor outcome. PMID:7500106

Gaetani, P; Tancioni, F; Tartara, F; Carnevale, L; Brambilla, G; Mille, T; Rodriguez y Baena, R

1995-01-01

315

VHS Surveillance in Dr. Greg Whitledge, Dr. Jesse Trushenski,  

E-print Network

) ­ April ­ First collection outside of Great Lakes watershed · Milwaukee ­ June ­ Round goby and yellow perch · Lake Huron ­ June ­ Sea Lamprey (new species) · Winthrop Harbor ­ June ­ first collection status of IL waters other than Lake Michigan?? #12;IL Aquaculture Facilities Distribution Hybrid Striped

316

Reporting errors, incidence and risk factors for postpartum haemorrhage and progression to severe PPH: a prospective observational study  

PubMed Central

Objective To quantify reporting errors, measure incidence of postpartum haemorrhage (PPH) and define risk factors for PPH (?500 ml) and progression to severe PPH (?1500 ml). Design Prospective observational study. Setting Two UK maternity services. Population Women giving birth between 1 August 2008 and 31 July 2009 (n = 10 213). Methods Weighted sampling with sequential adjustment by multivariate analysis. Main outcome measures Incidence and risk factors for PPH and progression to severe PPH. Results Errors in transcribing blood volume were frequent (14%) with evidence of threshold preference and avoidance. The incidences of PPH ?500, ?1500 and ?2500 ml were 33.7% (95% CI 31.2–36.2), 3.9% (95% CI 3.3–4.6) and 0.8% (95% CI 0.6–1.0). New independent risk factors predicting PPH ? 500 ml included Black African ethnicity (adjusted odds ratio [aOR] 1.77, 95% CI 1.31–2.39) and assisted conception (aOR 2.93, 95% CI 1.30–6.59). Modelling demonstrated how prepregnancy- and pregnancy-acquired factors may be mediated through intrapartum events, including caesarean section, elective (aOR 24.4, 95% CI 5.53–108.00) or emergency (aOR 40.5, 95% CI 16.30–101.00), and retained placenta (aOR 21.3, 95% CI 8.31–54.7). New risk factors were identified for progression to severe PPH, including index of multiple deprivation (education, skills and training) (aOR 1.75, 95% CI 1.11–2.74), multiparity without caesarean section (aOR 1.65, 95% CI 1.20–2.28) and administration of steroids for fetal reasons (aOR 2.00, 95% CI 1.24–3.22). Conclusions Sequential, interacting, traditional and new risk factors explain the highest rates of PPH and severe PPH reported to date. PMID:24517180

Briley, A; Seed, PT; Tydeman, G; Ballard, H; Waterstone, M; Sandall, J; Poston, L; Tribe, RM; Bewley, S

2014-01-01

317

Evolutionary history and molecular epidemiology of rabbit haemorrhagic disease virus in the Iberian Peninsula and Western Europe  

PubMed Central

Background Rabbit haemorrhagic disease virus (RHDV) is a highly virulent calicivirus, first described in domestic rabbits in China in 1984. RHDV appears to be a mutant form of a benign virus that existed in Europe long before the first outbreak. In the Iberian Peninsula, the first epidemic in 1988 severely reduced the populations of autochthonous European wild rabbit. To examine the evolutionary history of RHDV in the Iberian Peninsula, we collected virus samples from wild rabbits and sequenced a fragment of the capsid protein gene VP60. These data together with available sequences from other Western European countries, were analyzed following Bayesian Markov chain Monte Carlo methods to infer their phylogenetic relationships, evolutionary rates and demographic history. Results Evolutionary relationships of RHDV revealed three main lineages with significant phylogeographic structure. All lineages seem to have emerged at a common period of time, between ~1875 and ~1976. The Iberian Peninsula showed evidences of genetic isolation, probably due to geographic barriers to gene flow, and was also the region with the youngest MRCA. Overall, demographic analyses showed an initial increase and stabilization of the relative genetic diversity of RHDV, and a subsequent reduction in genetic diversity after the first epidemic breakout in 1984, which is compatible with a decline in effective population size. Conclusions Results were consistent with the hypothesis that the current Iberian RHDV arose from a single infection between 1869 and 1955 (95% HPD), and rendered a temporal pattern of appearance and extinction of lineages. We propose that the rising positive selection pressure observed throughout the history of RHDV is likely mediated by the host immune system as a consequence of the genetic changes that rendered the virus virulent. Consequently, this relationship is suggested to condition RHDV demographic history. PMID:21067589

2010-01-01

318

Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial  

PubMed Central

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

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

319

Intracranial haemorrhage in thrombocytopenic haematology patients—a nested case–control study: the InCiTe study protocol  

PubMed Central

Introduction Intracranial haemorrhage (ICH) is one of the most serious side-effects of severe thrombocytopenia in haematology patients. ICH is rare, but can have devastating consequences (death or major morbidity). It is unknown why some patients with severe thrombocytopenia bleed and others do not. Study aims Primary aim was to identify risk factors for ICH in patients with haematological malignancies. Secondary aims were to identify short-term outcomes for these patients at 30?days (major morbidity and mortality) and produce a more accurate estimate of ICH incidence in this population. This information is key to identifying means to improve treatment and quality of care. Methods/analysis This is a UK-wide case–control study of ICH nested within a 4-year prospective surveillance study set up specifically for the case–control study. Each case will be matched to one control. Cases will be adult haematology patients (?16?years) who have had any type or severity of ICH who are receiving, about to receive or have just received myeloablative chemotherapy (defined as chemotherapy expected to cause a significant thrombocytopenia <50×109/L for >5?days) or a haemopoietic stem cell transplant. Only patients being treated with curative intent will be included. Controls will be patients who fulfil the same inclusion criteria as cases (apart from ICH) and were treated at the same hospital immediately before the index case. Cases and controls will be matched to type of treatment (myeloablative chemotherapy or haemopoietic stem cell transplant). Hospitals across the UK will participate in a monthly email reporting strategy (started June 2011), as to whether a case of ICH occurred during the preceding calendar month. Case and control forms will be sent to any hospital reporting an eligible case. Conditional logistic regression will be used to calculate ORs. Denominator data for incidence estimates will use national registry data. Study Registration ISRCTN05026912 (prospective registration). NIHR Portfolio (UKCRN ID 10712). PMID:24508852

Estcourt, Lise J; Stanworth, Simon J; Collett, Dave; Murphy, Mike F

2014-01-01

320

Benefit of cerebrospinal fluid spectrophotometry in the assessment of CT scan negative suspected subarachnoid haemorrhage: A diagnostic accuracy study.  

PubMed

This study aimed to determine if performing cerebrospinal fluid spectrophotometry in addition to visual inspection detects more ruptured cerebral aneurysms than performing cerebrospinal fluid visual inspection alone in patients with a normal head CT scan but suspected of suffering an aneurysmal subarachnoid haemorrhage (SAH). We performed a single-centre retrospective study of patients presenting to the emergency department of a tertiary hospital who underwent both head CT scan and lumbar puncture to exclude SAH. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of an approach utilising both spectrophotometry and visual inspection (combined approach) was compared to visual inspection alone. A total of 409 patients (mean age 37.8years, 56.2% female) were recruited and six (1.5%) had a cerebral aneurysm on angiography. The sensitivity of visual inspection was 50% (95% confidence interval [CI]: 12.4-82.6%), specificity was 99% (95% CI: 97.5-99.7%), PPV was 42.9% (95% CI: 10.4-81.3%) and NPV was 99.2% (95% CI: 97.8-99.8%). The combined approach had a sensitivity of 100% (95% CI: 54.1-100%), specificity of 79.7% (95% CI: 75.4-83.5%), PPV of 6.8% (95% CI: 2.6-14.3%) and a NPV of 100% (95% CI: 98.8-100%). The sensitivity of the combined approach was not significantly different to that of visual inspection alone (p=0.25). Visual inspection had a significantly higher specificity than the combined approach (p<0.01). The combined approach detected more cases of aneurysmal SAH than visual inspection alone, however the difference in sensitivity was not statistically significant. Visual xanthochromia should prompt angiography because of a superior specificity and PPV. Due to its reduced sensitivity, caution should be applied when using only visual inspection of the supernatant. PMID:25439758

Hann, Angus; Chu, Kevin; Greenslade, Jaimi; Williams, Julian; Brown, Anthony

2015-01-01

321

Trends in incidence and in short term survival following a subarachnoid haemorrhage in Scotland, 1986 - 2005: a retrospective cohort study  

PubMed Central

Background To examine age and sex specific incidence and 30 day case fatality for subarachnoid haemorrhage (SAH) in Scotland over a 20 year period. Methods A retrospective cohort study using routine hospital discharge data linked to death records. Results Between 1986 and 2005, 12,056 individuals experienced an incident SAH. Of these 10,113 (84%) survived to reach hospital. Overall age-standardised incidence rates were greater in women than men and remained relatively stable over the study period. In 2005, incidence in women was 12.8 (95% CI 11.5 to 14.2) and in men 7.9 (95% CI 6.9 to 9.1). 30 day case fatality in individuals hospitalised with SAH declined substantially, falling from 30.0% in men and 33.9% in women in 1986-1990 to 24.5% in men and 29.1% in women in 2001-2005. For both men and women, the largest reductions were observed in those aged between 40 to 59 years. After adjustment for age, socio-economic status and co-morbidity, the odds of death at 30 days in 2005 compared to odds of death in 1986 was 0.64 (0.54 to 0.76), p < 0.001 for those below 70 years, and 1.14 (0.83 to 1.56), p = 0.4 in those 70 years and above. Conclusions Incidence rates for SAH remained stable between 1986 and 2005 suggesting that a better understanding of SAH risk factors and their reduction is needed. 30 day case fatality rates have declined substantially, particularly in middle-age. However, they remain high and it is important to ensure that this is not due to under-diagnosis or under-treatment. PMID:21447158

2011-01-01

322

Achieved serum magnesium concentrations and occurrence of delayed cerebral ischaemia and poor outcome in aneurysmal subarachnoid haemorrhage  

PubMed Central

Background Magnesium therapy probably reduces the frequency of delayed cerebral ischaemia (DCI) in subarachnoid haemorrhage (SAH) but uncertainty remains about the optimal serum magnesium concentration. We assessed the relationship between serum magnesium concentrations achieved with magnesium sulphate therapy 64?mmol/day and the occurrence of DCI and poor outcome in patients with SAH. Methods Differences in magnesium concentrations between patients with and without DCI and with and without poor outcome were calculated. Quartiles of last serum magnesium concentrations before the onset of DCI, or before the median day of DCI in patients without DCI, were related to the occurrence of DCI and poor outcome at 3?months using logistic regression. Results Compared with the lowest quartile of serum magnesium concentration (1.10–1.28?mmol/l), the risk of DCI was decreased in each of the higher three quartiles (adjusted odds ratio (OR) in each quartile 0.2; lower 95% CI 0.0 to 0.1; upper limit 0.8 to 0.9). The OR for poor outcome was 1.8 (95% CI 0.5 to 6.9) in the second quartile, 1.0 (95% CI 0.2 to 4.5) in the third quartile and 4.9 (95% CI 1.2 to 19.7) in the highest quartile. Discussion Magnesium sulphate 64?mmol/day results in a stable risk reduction of DCI over a broad range of achieved serum magnesium concentrations, and strict titration of the dosage therefore does not seem necessary. However, concentrations ?1.28?mmol/l could decrease the effect on DCI while concentrations ?1.62 might have a negative effect on clinical outcome. PMID:17135457

Mees, Sanne M Dorhout; van den Bergh, Walter M; Algra, Ale; Rinkel, Gabriel J E

2007-01-01

323

Epidemiological investigation of a temporal increase in atonic postpartum haemorrhage: a population-based retrospective cohort study  

PubMed Central

Objective Increases in atonic postpartum haemorrhage (PPH) have been reported from several countries in recent years. We attempted to determine the potential cause of the increase in atonic and severe atonic PPH. Design Population-based retrospective cohort study. Setting British Columbia, Canada, 2001–2009. Population All women with live births or stillbirths. Methods Detailed clinical information was obtained for 371 193 women from the British Columbia Perinatal Data Registry. Outcomes of interest were atonic PPH and severe atonic PPH (atonic PPH with blood transfusion ?1 unit; atonic PPH with blood transfusion ?3 units or procedures to control bleeding), whereas determinants studied included maternal characteristics (e.g. age, parity, and body mass index) and obstetrics practice factors (e.g. labour induction, augmentation, and caesarean delivery). Year-specific unadjusted and adjusted odds ratios for the outcomes were compared using logistic regression. Main outcome measures Atonic PPH and severe atonic PPH. Results Atonic PPH increased from 4.8% in 2001 to 6.3% in 2009, atonic PPH with blood transfusion ?1 unit increased from 16.6 in 2001 to 25.5 per 10 000 deliveries in 2009, and atonic PPH with blood transfusion ?3 units or procedures to control bleeding increased from 11.9 to 17.6 per 10 000 deliveries. The crude 34% (95% CI 26–42%) increase in atonic PPH between 2001 and 2009 remained unchanged (42% increase, 95% CI 34–51%) after adjustment for determinants of PPH. Similarly, adjustment did not explain the increase in severe atonic PPH. Conclusions Changes in maternal characteristics and obstetric practice do not explain the recent increase in atonic and severe atonic PPH. PMID:23464351

Mehrabadi, A; Hutcheon, JA; Lee, L; Kramer, MS; Liston, RM; Joseph, KS

2013-01-01

324

Effect of maternal tocolysis on the incidence of severe periventricular/intraventricular haemorrhage in very low birthweight infants  

PubMed Central

AIM—To examine the relation between grade III-IV periventricular/intraventricular haemorrhage (PVH/IVH) and antenatal exposure to tocolytic treatment in very low birthweight (VLBW) premature infants.?STUDY DESIGN—The study population consisted of 2794 infants from the Israel National VLBW Infant Database, of gestational age 24-32 weeks, who had a cranial ultrasound examination during the first 28 days of life. Infants of mothers with pregnancy induced hypertension or those exposed to more than one tocolytic drug were excluded. Of the 2794 infants, 2013 (72%) had not been exposed to tocolysis and 781 (28%) had been exposed to a single tocolytic agent. To evaluate the effect of tocolysis and confounding variables on grade III-IV PVH/IVH, the ?2 test, univariate analysis, and a logistic regression model were used.?RESULTS—Of the 781 infants (28%) exposed to tocolysis, 341 (12.2%) were exposed to magnesium sulphate, 263 (9.4%) to ritodrine, and 177 (6.3%) to indomethacin. The overall incidence of grade III-IV PVH/IVH was 13.4%. In the multivariate logistic regression analysis, the following factors were related significantly and independently to grade III-IV PVH/IVH: no prenatal steroid treatment, low gestational age, one minute Apgar score 0-3, respiratory distress syndrome, patent ductus arteriosus, mechanical ventilation, and pneumothorax. Infants exposed to ritodrine tocolysis (but not to the other tocolytic drugs) were at significantly lower risk of grade III-IV PVH/IVH after adjustment for other variables (odds ratio = 0.3; 95% confidence interval 0.2 to 0.6).?CONCLUSION—This study suggests that antenatal exposure of VLBW infants to ritodrine tocolysis, in contrast with tocolysis induced by magnesium sulphate or indomethacin, was associated with a lower incidence of grade III-IV PVH/IVH.?? PMID:11420315

Weintraub, Z; Solovechick, M; Reichman, B; Rotschild, A; Waisman, D; Davkin, O; Lusky, A; Bental, Y

2001-01-01

325

Acute subdural haemorrhage in the postpartum period as a rare manifestation of possible HELLP (haemolysis, elevated liver enzymes, and low-platelet count) syndrome: a case report  

PubMed Central

Background The HELLP syndrome (haemolysis, elevated liver enzymes, and low-platelet count) occurs in about 0.5 to 0.9% of all pregnancies. With occurrence of thrombocytopaenia, it signals for several potentially lethal conditions such as complete or partial HELLP syndrome, thrombotic thrombocytopaenic purpura and acute fatty liver of pregnancy. Case presentation A previously healthy 27-year-old, Sinhala ethnic primigravida with pregnancy-induced hypertension was admitted at 38 weeks of gestation with lower abdominal pain and a blood pressure of 140/90 mmHg. She underwent emergency Caesarian section due to faetal distress giving birth to a healthy baby girl. Since postpartum day one, she was having intermittent fever spikes. All the routine investigations were normal in the first three weeks. Platelet count started dropping from post-partum day-20 onwards. On day-23, she had developed a seizure and computed tomography scan brain showed a subdural haemorrhage. She had a platelet count of 22,000?×?109/liter and was managed conservatively. She also had elevated liver enzymes, lactate dehydrogenase and bilirubin levels. Blood picture on day-24 showed haemolytic anemia. On day- 36, patient again developed seizures and she was having intermittent fever with generalized headache and signs of meningism. Computed tomography scan revealed an acute on chronic subdural haemorrhage. Conclusions Hypertensive disorders in pregnancy should be managed as high-risk throughout the postpartum period. Development of thrombocytopaenia can be considered as an early warning sign for HELLP, thrombotic thrombocytopaenic purpura or acute fatty liver of pregnancy which are lethal conditions. Prompt recognition of intracranial haemorrhages and early neurosurgical intervention is lifesaving. PMID:24972626

2014-01-01

326

Hidden threat of tortoise ticks: high prevalence of Crimean-Congo haemorrhagic fever virus in ticks Hyalomma aegyptium in the Middle East.  

PubMed

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

Široký, Pavel; B?lohlávek, Tomáš; Papoušek, Ivo; Jandzik, David; Mikulí?ek, Peter; Kubelová, Michaela; Zdražilová-Dubská, Lenka

2014-01-01

327

Hidden threat of tortoise ticks: high prevalence of Crimean-Congo haemorrhagic fever virus in ticks Hyalomma aegyptium in the Middle East  

PubMed Central

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

2014-01-01

328

Predicting long-term outcome in poor grade aneurysmal subarachnoid haemorrhage patients utilising the Glasgow Coma Scale.  

PubMed

The Glasgow Coma Scale (GCS) is the most universally accepted system for grading level of consciousness. Predicting outcome is particularly difficult in poor grade aneurysmal subarachnoid haemorrhage (aSAH) patients. We hypothesised that the GCS and individual examination components would correlate with long-term outcome and have varying prognostic value depending on assessment time points. GCS scores of 160 aSAH patients presenting in stupor or coma were prospectively recorded on admission and each subsequent day until hospital day 14. Early treatment was planned for each patient unless the patient's family refused aggressive intervention or the patient died before surgery. Outcomes were assessed by the modified Rankin scale (mRS) at 14 days, 3 months, and one year. All patients who did not receive surgical treatment died within one year. Of the 104 patients who received surgical treatment, 13.5% of them had a favourable outcome at 14 days, 38.5% at 3 months, and 51% at one year (p<0.0001). Admission GCS scores significantly correlated with outcome (Spearman rank test, rs=0.472, p<0.0001). On admission, motor examination correlated best with one-year outcome (rs=0.533, p<0.0001). Each point increase in motor examination predicted a 1.8-fold increased odds of favourable long-term outcome (95% confidence interval [CI], 1.4-2.3). At discharge, eye examination (rs=0.760, p<0.0001) correlated best with one-year outcome, and a one point increase in eye examination predicted a 3.1-fold increased odds of favourable outcome (95% CI, 1.8-5.4). During hospitalisation, the best eye exam (rs=0.738, p<0.0001) and worst motor exam (rs=0.612, p<0.0001) were the most highly correlated with the one-year outcome. Long-term follow-up is necessary when evaluating recovery after aSAH, as outcomes improve significantly during the first year. The GCS and its individual components correlate well with long-term outcome. Admission motor examination and spontaneous eye opening during hospitalisation are most predictive of favourable recovery. PMID:19008104

Starke, Robert M; Komotar, Ricardo J; Otten, Marc L; Schmidt, J Michael; Fernandez, Luis D; Rincon, Fred; Gordon, Errol; Badjatia, Neeraj; Mayer, Stephan A; Connolly, E Sander

2009-01-01

329

Left atrial appendage occlusion with the Watchman device in a patient with paroxysmal atrial fibrillation and intolerance of all forms of anticoagulation due to hereditary haemorrhagic telangiectasia.  

PubMed

An elderly woman presented to our attention because of paroxysmal atrial fibrillation and cerebrovascular events requiring systemic anticoagulation and a concomitant, serious bleeding diathesis (the Osler-Weber-Rendu syndrome, or hereditary haemorrhagic telangiectasia). Her risk of suffering a major stroke was significant given a CHA(2)DS(2)VASc score of 6. However, she was unable to tolerate any form of anticoagulation because of torrential epistaxis and previous gastrointestinal haemorrhage on antiplatelet therapy. We proceeded with percutaneous occlusion of the left atrial appendage with a Watchman device. Ten months post-procedure she is well, without recurrence of neurological symptoms, and off all forms of anticoagulation. The current internationally accepted practice post-deployment of the Watchman device mandates warfarin transition for 6 months to allow for endothelialisation of the device. However, there is no evidence in the literature to support left atrial appendage occlusion without any peri-procedural antiplatelet and anticoagulation therapy and therefore our case represents novel and important anecdotal evidence that secondary stroke prevention with left atrial appendage occlusion may be effective and safe even in patients who cannot tolerate any form of anticoagulation at all. PMID:24621286

Spina, R; Gunalingam, B

2014-03-01

330

RT-PCR Assays for Seven Serotypes of Epizootic Haemorrhagic Disease Virus & Their Use to Type Strains from the Mediterranean Region and North America  

PubMed Central

Epizootic haemorrhagic disease virus (EHDV) infects wild ruminants, causing a frequently fatal haemorrhagic disease. However, it can also cause bluetongue-like disease in cattle, involving significant levels of morbidity and mortality, highlighting a need for more rapid and reliable diagnostic assays. EHDV outer-capsid protein VP2 (encoded by genome-segment 2 [Seg-2]) is highly variable and represents the primary target for neutralising antibodies generated by the mammalian host. Consequently VP2 is also the primary determinant of virus “serotype”, as identified in virus neutralisation tests (VNT). Although previous reports have indicated eight to ten EHDV serotypes, recent serological comparisons and molecular analyses of Seg-2 indicate only seven EHDV “types”. Oligonucleotide primers were developed targeting Seg-2, for use in conventional RT-PCR assays to detect and identify these seven types. These assays, which are more rapid and sensitive, still show complete agreement with VNT and were used to identify recent EHDV isolates from the Mediterranean region and North America. PMID:20862243

Maan, Narender S.; Maan, Sushila; Nomikou, Kyriaki; Johnson, Donna J.; El Harrak, Mehdi; Madani, Hafsa; Yadin, Hagai; Incoglu, Serife; Yesilbag, Kadir; Allison, Andrew B.; Stallknecht, David E.; Batten, Carrie; Anthony, Simon J.; Mertens, Peter P. C.

2010-01-01

331

Marburg Haemorrhagic Fever  

MedlinePLUS

... Angola, Democratic Republic of the Congo, Kenya, South Africa (in a person with recent travel history to ... being evaluated. Natural hosts of Marburg virus In Africa, the Old World fruit bats of the family ...

332

pH-Dependent Solution Structure and Activity of a Reduced Form of the Host-Defense Peptide Myticin C (Myt C) from the Mussel Mytilus galloprovincialis  

PubMed Central

Myticin C (Myt C) is a highly variable host-defense peptide (HDP) associated to the immune response in the mediterranean mussel (Mytilus galloprovincialis), which has shown to be active across species due to its strong antiviral activity against a fish rhabdovirus found in fish cells overexpressing this HDP. However, the potential antimicrobial properties of any synthetic analogue of Myt C has not yet been analysed. Thus, in this work we have synthesised the sequence of the mature peptide of Myt C variant c and analysed the structure activity relationships of its reduced (non-oxidized) form (red-MytCc). In contrast to results previously reported for oxidized isoforms of mussel myticins, red-MytCc was not active against bacteria at physiological pH and showed a moderate antiviral activity against the viral haemorrhagic septicaemia (VHS) rhabdovirus. However, its chemotactic properties remained active. Structure/function studies in neutral and acid environments by means of infrared spectroscopy indicated that the structure of red-MytCc is pH dependent, with acid media increasing its alpha-helical content. Furthermore, red-MytCc was able to efficiently aggregate artificial phospholipid membranes at low pH, as well as to inhibit the Escherichia coli growth, suggesting that this activity is attributable to its more structured form in an acidic environment. All together, these results highlight the dynamic and environmentally sensitive behavior of red-Myt C in solution, and provide important insights into Myt C structure/activity relationships and the requirements to exert its antimicrobial/immunomodulatory activities. On the other hand, the pH-dependent direct antimicrobial activity of Myt C suggests that this HDP may be a suitable template for the development of antimicrobial agents that would function selectively in specific pH environments, which are sorely needed in this “antibiotic-resistance era”. PMID:23880927

Martinez-Lopez, Alicia; Encinar, Jose Antonio; Medina-Gali, Regla Maria; Balseiro, Pablo; Garcia-Valtanen, Pablo; Figueras, Antonio; Novoa, Beatriz; Estepa, Amparo

2013-01-01

333

pH-dependent solution structure and activity of a reduced form of the host-defense peptide myticin C (Myt C) from the mussel Mytilus galloprovincialis.  

PubMed

Myticin C (Myt C) is a highly variable host-defense peptide (HDP) associated to the immune response in the mediterranean mussel (Mytilus galloprovincialis), which has shown to be active across species due to its strong antiviral activity against a fish rhabdovirus found in fish cells overexpressing this HDP. However, the potential antimicrobial properties of any synthetic analogue of Myt C has not yet been analysed. Thus, in this work we have synthesised the sequence of the mature peptide of Myt C variant c and analysed the structure activity relationships of its reduced (non-oxidized) form (red-MytCc). In contrast to results previously reported for oxidized isoforms of mussel myticins, red-MytCc was not active against bacteria at physiological pH and showed a moderate antiviral activity against the viral haemorrhagic septicaemia (VHS) rhabdovirus. However, its chemotactic properties remained active. Structure/function studies in neutral and acid environments by means of infrared spectroscopy indicated that the structure of red-MytCc is pH dependent, with acid media increasing its alpha-helical content. Furthermore, red-MytCc was able to efficiently aggregate artificial phospholipid membranes at low pH, as well as to inhibit the Escherichia coli growth, suggesting that this activity is attributable to its more structured form in an acidic environment. All together, these results highlight the dynamic and environmentally sensitive behavior of red-Myt C in solution, and provide important insights into Myt C structure/activity relationships and the requirements to exert its antimicrobial/immunomodulatory activities. On the other hand, the pH-dependent direct antimicrobial activity of Myt C suggests that this HDP may be a suitable template for the development of antimicrobial agents that would function selectively in specific pH environments, which are sorely needed in this "antibiotic-resistance era". PMID:23880927

Martinez-Lopez, Alicia; Encinar, Jose Antonio; Medina-Gali, Regla Maria; Balseiro, Pablo; Garcia-Valtanen, Pablo; Figueras, Antonio; Novoa, Beatriz; Estepa, Amparo

2013-07-01

334

A five-year perspective on the situation of haemorrhagic fever with renal syndrome and status of the hantavirus reservoirs in Europe, 2005-2010.  

PubMed

Hantavirus infections are reported from many countries in Europe and with highly variable annual case numbers. In 2010, more than 2,000 human cases were reported in Germany, and numbers above the baseline have also been registered in other European countries. Depending on the virus type human infections are characterised by mild to severe forms of haemorrhagic fever with renal syndrome. The member laboratories of the European Network for diagnostics of Imported Viral Diseases present here an overview of the progression of human cases in the period from 2005 to 2010. Further we provide an update on the available diagnostic methods and endemic regions in their countries, with an emphasis on occurring virus types and reservoirs. PMID:21924118

Heyman, P; Ceianu, C S; Christova, I; Tordo, N; Beersma, M; João Alves, M; Lundkvist, A; Hukic, M; Papa, A; Tenorio, A; Zelená, H; Essbauer, S; Visontai, I; Golovljova, I; Connell, J; Nicoletti, L; Van Esbroeck, M; Gjeruldsen Dudman, S; Aberle, S W; Avši?-Županc, T; Korukluoglu, G; Nowakowska, A; Klempa, B; Ulrich, R G; Bino, S; Engler, O; Opp, M; Vaheri, A

2011-01-01

335

High infection rate of bank voles (Myodes glareolus) with Puumala virus is associated with a winter outbreak of haemorrhagic fever with renal syndrome in Croatia.  

PubMed

An outbreak of haemorrhagic fever with renal syndrome (HFRS) started on Medvednica mountain near Zagreb in January 2012. In order to detect the aetiological agent of the disease in small rodents and to make the link with the human outbreak, rodents were trapped at four different altitudes. Using nested RT-PCR, Puumala virus (PUUV) RNA was detected in 41/53 (77·4%) bank voles (Myodes glareolus) and Dobrava virus (DOBV) RNA was found in 6/61 (9·8%) yellow-necked mice (Apodemus flavicollis). Sequence analysis of a 341-nucleotide region of the PUUV S segment, obtained from all infected bank voles and five HFRS patients, showed 98·8-100% sequence similarity, indicating that the patients were probably exposed to PUUV on Medvednica mountain. A very large bank-vole population combined with an extremely high infection rate of PUUV was responsible for this unusual winter outbreak of HFRS in Croatia. PMID:24800636

Tadin, A; Bjedov, L; Margaletic, J; Zibrat, B; Krajinovic, L Cvetko; Svoboda, P; Kurolt, I C; Majetic, Z Stritof; Turk, N; Rode, O Dakovic; Civljak, R; Kuzman, I; Markotic, A

2014-09-01

336

Scientific foundation and possible implications for practice of the Minimizing Adverse Haemorrhagic Events by Transradial Access Site andSystemic Implementation of AngioX (MATRIX) trial.  

PubMed

Early invasive management and the use of combined antithrombotic therapies have decreased the risk of recurrent ischaemia in patients with acute coronary syndrome (ACS) but have also increased the bleeding risk. Transradial intervention (TRI) and bivalirudin infusion compared to transfemoral intervention (TFI) or unfractionated heparin (UFH) plus glycoprotein IIb/IIIa inhibitors (GPI) decrease bleeding complications in patients with ACS. To what extent, a bleeding preventive strategy incorporating at least one of these two treatment options translates into improved outcomes is a matter of debate. The Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX study is a large-scale, multicenter, prospective, open-label trial, conducted at approximately 100 sites in Europe aiming to primarily assess whether TRI and bivalirudin infusion, as compared to TFI and UFH plus provisional GPI, decrease the 30-day incidence of death, myocardial infarction or stroke across the whole spectrum of ACS patients. PMID:24395497

Valgimigli, Marco; Calabrò, Paolo; Cortese, Bernardo; Frigoli, Enrico; Garducci, Stefano; Rubartelli, Paolo; Andò, Giuseppe; Santarelli, Andrea; Galli, Mario; Garbo, Roberto; Repetto, Alessandra; Ierna, Salvatore; Briguori, Carlo; Limbruno, Ugo; Violini, Roberto; Gagnor, Andrea

2014-02-01

337

Topical timolol for treatment of epistaxis in hereditary haemorrhagic telangiectasia associated with bradycardia: a look at CYP2D6 metabolising variants.  

PubMed

A 59-year-old man presented to the emergency department with lightheadedness. He had started intranasal administration of ophthalmic timolol for the prevention of epistaxis associated with hereditary haemorrhagic telangiectasia approximately 3 weeks earlier with excellent response. His heart rate was about half its normal rate, an ECG revealed sinus bradycardia, and it was determined he had significant cardiac issues in his family history. Essentially all other tests were normal. The discontinuation of the intranasal use of timolol resolved any further episodes of lightheadedness and bradycardia. It was determined through genetic testing that he is an intermediate metaboliser of CYP2D6, the main enzyme contributing to the metabolism of timolol. This explains the development of the bradycardia after intranasal timolol use. The metabolising variants of CYP2D6 need to be considered when prescribing medications metabolised by this enzyme, so possible adverse effects can be avoided. PMID:24518395

Epperla, Narendranath; Brilliant, Murray H; Vidaillet, Humberto

2014-01-01

338

Emergency cholecystectomy and hepatic arterial repair in a patient presenting with haemobilia and massive gastrointestinal haemorrhage due to a spontaneous cystic artery gallbladder fistula masquerading as a pseudoaneurysm  

PubMed Central

Background Haemobilia usually occurs secondary to accidental or iatrogenic hepatobiliary trauma. It can occasionally present with cataclysmal upper gastrointestinal haemorrhage posing as a life threatening emergency. Haemobilia can very rarely be a complication of acute cholecystitis. Here we report a case of haemobilia manifesting as massive gastrointestinal haemorrhage in a patient without any prior history of biliary surgery or intervention and present a brief review of literature. Case presentation A 22 year old male admitted with history suggestive of acute cholecystitis subsequently developed waxing waning jaundice and recurrent episodes of upper gastrointestinal bleed. Endoscopy showed an ulcer in the first part of duodenum with a clot, no active bleed was visible. Angiography was suggestive of a ruptured pseudoaneurysm in the vicinity of the right hepatic artery probably originating from the cystic artery. Coil embolization was tried but the coil dislodged into the right branch of hepatic artery distal to the site of pseudoaneurysm. Review of angiographic video in light of operative findings demonstrated a fistulous communication between cystic artery and gallbladder as the cause, a simultaneous cholecystoduodenal fistula was also noted. Retrograde cholecystectomy, closure of cholecystoduodenal fistula and right hepatic arteriotomy with retrieval of the endo-coil and hepatic arterial repair was performed. Conclusion Fistula between the cystic artery and gallbladder has been commonly reported to occur after laparoscopic cholecystectomy. Spontaneous fistulous communication, i.e. in the absence of any prior trauma or intervention, between cystic artery and gallbladder is rare with very few reports in literature. Aetiopathogenesis of the disease, in the context of current literature is reviewed. The diagnostic dilemma posed by the confounding finding of an ulcer in the duodenum, the iconic video angiographic depiction as also the therapeutic challenge of a failed embolization with consequent microcoil migration and primary hepatic arterial repair in the emergency situation is discussed. PMID:23452779

2013-01-01

339

Fetal intracranial haemorrhages caused by fetal and neonatal alloimmune thrombocytopenia: an observational cohort study of 43 cases from an international multicentre registry  

PubMed Central

Objective To characterise pregnancies where the fetus or neonate was diagnosed with fetal and neonatal alloimmune thrombocytopenia (FNAIT) and suffered from intracranial haemorrhage (ICH), with special focus on time of bleeding onset. Design Observational cohort study of all recorded cases of ICH caused by FNAIT from the international No IntraCranial Haemorrhage (NOICH) registry during the period 2001–2010. Setting 13 tertiary referral centres from nine countries across the world. Participants 37 mothers and 43 children of FNAIT pregnancies complicated by fetal or neonatal ICH identified from the NOICH registry was included if FNAIT diagnosis and ICH was confirmed. Primary and secondary outcome measures Gestational age at onset of ICH, type of ICH and clinical outcome of ICH were the primary outcome measures. General maternal and neonatal characteristics of pregnancies complicated by fetal/neonatal ICH were secondary outcome measures. Results From a total of 592 FNAIT cases in the registry, 43 confirmed cases of ICH due to FNAIT were included in the study. The majority of bleedings (23/43, 54%) occurred before 28 gestational weeks and often affected the first born child (27/43, 63%). One-third (35%) of the children died within 4?days after delivery. 23 (53%) children survived with severe neurological disabilities and only 5 (12%) were alive and well at time of discharge. Antenatal treatment was not given in most (91%) cases of fetal/neonatal ICH. Conclusions ICH caused by FNAIT often occurs during second trimester and the clinical outcome is poor. In order to prevent ICH caused by FNAIT, at-risk pregnancies must be identified and prevention and/or interventions should start early in the second trimester. PMID:23524102

Tiller, Heidi; Kamphuis, Marije M; Flodmark, Olof; Papadogiannakis, Nikos; David, Anna L; Sainio, Susanna; Koskinen, Sinikka; Javela, Kaija; Wikman, Agneta Taune; Kekomaki, Riitta; Kanhai, Humphrey H H; Oepkes, Dick; Husebekk, Anne; Westgren, Magnus

2013-01-01

340

Exercise-induced pulmonary haemorrhage in the horse: results of a detailed clinical, post mortem and imaging study. IV. Changes in the bronchial circulation demonstrated by C.T. scanning and microradiography.  

PubMed

The purpose of this study was to use radiographic contrast techniques and special imaging methods to identify and high-light bronchial arterial involvement in lung lesions associated with exercise-induced pulmonary haemorrhage (EIPH) in horses. The lungs from four horses with histories of EIPH were prepared for computerised tomographic scanning and microradiography by perfusing the broncho-oesophageal artery with a mixture of red latex and either barium or iodine contrast materials while the pulmonary supply received only blue latex. Computerised tomographic scan slices of the prepared inflated lungs were obtained from the caudal tip of the lung to the hilus. Microradiography of selected lung slices was also performed on a Faxitron. Diffuse areas of increased density, with preferential bronchial arterial supply noted on the computerised tomographic scans were confirmed by microradiography. Dense focal and diffuse plexuses of markedly hypertrophied and highly branched bronchial arterial networks were identified, centred around certain small airways. The vascular supply to these plexuses was recruited predominantly from neighbouring bronchial vessels, and in some cases, from the enlarged vasa vasorum of pulmonary arteries sending anastomoses to the affected areas. The authors conclude that bronchial vascular lesions in EIPH cases are the likely origin of haemorrhage; that small airway disease is the probable initiating stimulus for bronchial vascular proliferation in these lesions; and that the morphology and nature of the neovascular tissue in these lesions provides the conditions leading to haemorrhage in the lungs of horses with EIPH. PMID:3678182

O'Callaghan, M W; Pascoe, J R; Tyler, W S; Mason, D K

1987-09-01

341

A critical review of anaesthetised animal models and alternatives for military research, testing and training, with a focus on blast damage, haemorrhage and resuscitation.  

PubMed

Military research, testing, and surgical and resuscitation training, are aimed at mitigating the consequences of warfare and terrorism to armed forces and civilians. Traumatisation and tissue damage due to explosions, and acute loss of blood due to haemorrhage, remain crucial, potentially preventable, causes of battlefield casualties and mortalities. There is also the additional threat from inhalation of chemical and aerosolised biological weapons. The use of anaesthetised animal models, and their respective replacement alternatives, for military purposes -- particularly for blast injury, haemorrhaging and resuscitation training -- is critically reviewed. Scientific problems with the animal models include the use of crude, uncontrolled and non-standardised methods for traumatisation, an inability to model all key trauma mechanisms, and complex modulating effects of general anaesthesia on target organ physiology. Such effects depend on the anaesthetic and influence the cardiovascular system, respiration, breathing, cerebral haemodynamics, neuroprotection, and the integrity of the blood-brain barrier. Some anaesthetics also bind to the NMDA brain receptor with possible differential consequences in control and anaesthetised animals. There is also some evidence for gender-specific effects. Despite the fact that these issues are widely known, there is little published information on their potential, at best, to complicate data interpretation and, at worst, to invalidate animal models. There is also a paucity of detail on the anaesthesiology used in studies, and this can hinder correct data evaluation. Welfare issues relate mainly to the possibility of acute pain as a side-effect of traumatisation in recovered animals. Moreover, there is the increased potential for animals to suffer when anaesthesia is temporary, and the procedures invasive. These dilemmas can be addressed, however, as a diverse range of replacement approaches exist, including computer and mathematical dynamic modelling of the human body, cadavers, interactive human patient simulators for training, in vitro techniques involving organotypic cultures of target organs, and epidemiological and clinical studies. While the first four of these have long proven useful for developing protective measures and predicting the consequences of trauma, and although many phenomena and their sequelae arising from different forms of trauma in vivo can be induced and reproduced in vitro, non-animal approaches require further development, and their validation and use need to be coordinated and harmonised. Recommendations to these ends are proposed, and the scientific and welfare problems associated with animal models are addressed, with the future focus being on the use of batteries of complementary replacement methods deployed in integrated strategies, and on greater transparency and scientific cooperation. PMID:24329746

Combes, Robert D

2013-11-01

342

[Upper gastrointestinal bleeding and haemorrhagic shock at the end of the holidays: pre-hospital and in-hospital management of a gastrointestinal emergency].  

PubMed

Upon returning from holidays, a 55-year-old patient presenting with melena and haemorrhagic shock was admitted to a University hospital after receiving first emergency medical care in a German InterCity train. In an interdisciplinary effort, haemodynamics were stabilised and the airway and respiratory function were secured. Under emergency care conditions the patient then underwent an emergency upper GI endoscopy where a spurting arterial upper gastrointestinal bleeding (Forrest 1a) was found. While the bleeding could not be controlled with endoscopic techniques, definitive haemostasis was achieved with a surgical laparotomy. While not commonly established for patients with severe GI bleeding, by spontaneous implementation of an interdisciplinary trauma room approach following established trauma algorithms the team was able to achieve stabilisation of vital functions and final control of bleeding in this highly unstable patient. Although the majority of upper gastrointestinal bleedings spontaneously cease, emergency care algorithms should be developed and implemented for patients with severe gastrointestinal bleedings in shock. Following the case vignette, we discuss a potential approach and develop an exemplary protocol for shock room management in this patient subgroup. PMID:24824909

Nguyen-Tat, M; Hoffman, A; Marquardt, J U; Buggenhagen, H; Münzel, T; Kneist, W; Galle, P R; Kiesslich, R; Rey, J W

2014-05-01

343

Extra-cerebral severe infections associated with haemorrhagic hereditary telangiectasia (Rendu-Osler-Weber Disease): five cases and a review of the literature.  

PubMed

Hereditary haemorrhagic telangiectasia (HHT) is one of the most common autosomal dominant disorders and is characterized by genetically determined abnormalities of vascular structure. People affected by HHT are predisposed to severe infections such as cerebral abscesses, typical of patients with pulmonary arteriovenous malformations, and extra-cerebral infections such as bacteraemia, septic arthritis, osteomyelitis, hepatic abscesses, skin infections and infective endocarditis. We present a retrospective series of severe bacterial extra-cerebral infections in five patients affected by HHT, admitted to our Institute from January 2007 to June 2013. We also reviewed the literature of the last five years concerning infectious complications in people affected by HHT. Our study shows that HHT patients with infectious complications exclusively localized in extra-cerebral sites are usually fragile, old and affected by comorbidities. Moreover, we recognized a trend of Staphylococcus aureus (SA) severe infection recurrence in such patients, both in our series and in the literature. In our opinion these results suggest the need to evaluate the possible benefits of SA nasal colonization screening and decolonization in such patients. PMID:24651092

Musso, Maria; Capone, Alessandro; Chinello, Pierangelo; Di Bella, Stefano; Galati, Vincenzo; Noto, Pasquale; Taglietti, Fabrizio; Topino, Simone; Petrosillo, Nicola

2014-03-01

344

Carica papaya Leaves Juice Significantly Accelerates the Rate of Increase in Platelet Count among Patients with Dengue Fever and Dengue Haemorrhagic Fever  

PubMed Central

The study was conducted to investigate the platelet increasing property of Carica papaya leaves juice (CPLJ) in patients with dengue fever (DF). An open labeled randomized controlled trial was carried out on 228 patients with DF and dengue haemorrhagic fever (DHF). Approximately half the patients received the juice, for 3 consecutive days while the others remained as controls and received the standard management. Their full blood count was monitored 8 hours for 48 hours. Gene expression studies were conducted on the ALOX 12 and PTAFR genes. The mean increase in platelet counts were compared in both groups using repeated measure ANCOVA. There was a significant increase in mean platelet count observed in the intervention group (P < 0.001) but not in the control group 40 hours since the first dose of CPLJ. Comparison of mean platelet count between intervention and control group showed that mean platelet count in intervention group was significantly higher than control group after 40 and 48 hours of admission (P < 0.01). The ALOX 12 (FC??=??15.00) and PTAFR (FC??=??13.42) genes were highly expressed among those on the juice. It was concluded that CPLJ does significantly increase the platelet count in patients with DF and DHF. PMID:23662145

Subenthiran, Soobitha; Choon, Tan Chwee; Cheong, Kee Chee; Thayan, Ravindran; Teck, Mok Boon; Muniandy, Prem Kumar; Afzan, Adlin; Abdullah, Noor Rain; Ismail, Zakiah

2013-01-01

345

Bilateral anterior cerebral artery aneurysm due to mucormycosis  

Microsoft Academic Search

True mycotic aneurysms are extremely rare cerebrovascular lesions with a dismal prognosis. They mostly follow fungal meningitis or septicaemia and herald their presence with the development of subarachnoid haemorrhage. The authors report an extremely rare occurrence of bilateral anterior cerebral artery aneurysms caused by mucormycosis. The infection was diagnosed after investigation of prolonged fever following transsphenoidal surgery. The aneurysm was

Manish K. Kasliwal; Vemuru Sunil K. Reddy; Sumit Sinha; Bhawani S. Sharma; Prasenjit Das; Vaishali Suri

2009-01-01

346

Antagonism of the transient receptor potential ankyrin 1 (TRPA1) attenuates hyperalgesia and urinary bladder overactivity in cyclophosphamide-induced haemorrhagic cystitis.  

PubMed

The aim of this study was to investigate the involvement of the transient receptor potential ankyrin 1 (TRPA1) in haemorrhagic cystitis, the main side effect of cyclophosphamide-based chemotherapy. Hannover female rats received intraperitoneal (i.p.) injection of cyclophosphamide (three doses of 100 mg/kg, every other day, in a total of five days). This treatment was followed by the treatment with TRPA1 antagonist HC 030031 (50 mg/kg, p.o.). The threshold for hindpaw withdrawal or abdominal retraction to von Frey Hair and the locomotor activity were measured. The treatment with the TRPA1 antagonist HC 030031 significantly decreased mechanical hyperalgesia induced by cyclophosphamide without interfere with locomotor activity. Urodynamic parameters were performed by cystometry 24 h after a single treatment with cyclophosphamide (200 mg/kg, i.p.) in control and HC 030031 treated rats. Analyses of the urodynamic parameters showed that a single dose of cyclophosphamide was enough to significantly increase the number and amplitude of non-voiding contractions and to decrease the voided volume and voiding efficiency, without significantly altering basal, threshold or maximum pressure. The treatment with HC 030031 either before (100 mg/kg, p.o.) or after (30 mg/kg, i.v.) cyclophosphamide inhibited the non-voiding contractions but failed to counteract the loss in voiding efficiency. Our data demonstrates that nociceptive symptoms and urinary bladder overactivity caused by cyclophosphamide, in part, are dependent upon the activation of TRPA1. In this context, the antagonism of the receptor may be an alternative to minimise the urotoxic symptoms caused by this chemotherapeutic agent. PMID:23523557

Meotti, Flavia C; Forner, Stefânia; Lima-Garcia, Juliana F; Viana, Alice F; Calixto, João B

2013-04-25

347

A Phase 1 clinical trial of Hantaan virus and Puumala virus M-segment DNA vaccines for haemorrhagic fever with renal syndrome delivered by intramuscular electroporation.  

PubMed

Haemorrhagic fever with renal syndrome (HFRS) is endemic in Asia, Europe and Scandinavia, and is caused by infection with the hantaviruses Hantaan (HTNV), Seoul (SEOV), Puumala (PUUV), or Dobrava (DOBV) viruses. We developed candidate DNA vaccines for HFRS expressing the Gn and Gc genes of HTNV or PUUV and evaluated them in an open-label, single-centre Phase 1 study. Three groups of nine participants each were vaccinated on days 0, 28 and 56 with the DNA vaccines for HTNV, PUUV, or a mixture of both vaccines using the Ichor Medical Systems TriGrid Intramuscular Delivery System. All vaccinations consisted of a total dose of 2.0 mg DNA in an injected volume of 1 mL saline. For the combined vaccine, the mixture contained equal amounts (1.0 mg) of each DNA vaccine. There were no study-related serious adverse events. Neutralizing antibody responses were measured by a plaque reduction neutralization test. Neutralizing antibody responses were detected in five of nine and seven of nine individuals who completed all three vaccinations with the HTNV or PUUV DNA vaccines, respectively. In the combined vaccine group, seven of the nine volunteers receiving all three vaccinations developed neutralizing antibodies to PUUV. The three strongest responders to the PUUV vaccine also had strong neutralizing antibody responses to HTNV. These results demonstrate that the HTNV and PUUV DNA vaccines delivered by electroporation separately or as a mixture are safe. In addition, both vaccines were immunogenic, although when mixed together, more participants responded to the PUUV than to the HTNV DNA vaccine. PMID:24447183

Hooper, J W; Moon, J E; Paolino, K M; Newcomer, R; McLain, D E; Josleyn, M; Hannaman, D; Schmaljohn, C

2014-05-01

348

Evaluation of Trends of Inpatient Hospitalisation for Significant Haemorrhage in Patients Anticoagulated for Atrial Fibrillation before and after the Release of Novel Anticoagulants.  

PubMed

Compared to Vitamin K antagonists (VKA), novel oral anticoagulants (NOACs) appear to be safer in terms of major bleeding risks with added advantage of having fixed dosing schedules when used in patients with non-valvular atrial fibrillation (AF). We sought to study the differences as sources and severity of anticoagulant-associated haemorrhage in patients with AF in the year preceding introduction of NOACs (first cohort) as compared to post approval of the NOACs (second cohort) by retrospectively reviewing the hospital admissions, as well as the pharmacodynamic and pharmacokinetic interactions between time periods. There were 359 patients for the first cohort and 405 patients for the second cohort, including 57 patients prescribed NOACs. There was no significant difference in age, deaths, source of bleeding, or rate of pharmacokinetic or pharmacodynamic interaction between the two time periods. Comparing all VKA patients to patients prescribed NOAC's, there were non-significant but higher rates of intracerebral bleed, significantly higher rates of pharmacokinetic (194 (25.4%) versus 0 (0%), p<.001) and similar rates of pharmacodynamic interactions (505 (66.1%) versus 39 (68.4%), p=.70). Drug-renal interactions were seen in 7 of the 57 (12.3%) NOAC-treated patients, in which all seven had acute renal failure that may have prolonged the effects of the anticoagulants. NOACs hold promise in that drug interactions are far less common than those seen in VKAs, and intracerebral bleeds appear to be less common in randomised trials as well as our review. For patients on dabigatran or rivaroxaban, consideration should be given to serial monitoring of renal function. PMID:25108758

Badal, Madan; Aryal, Madan Raj; Mege, Joan; Chaudhary, Ashok; Donato, Anthony A

2015-01-01

349

Training traditional birth attendants on the use of misoprostol and a blood measurement tool to prevent postpartum haemorrhage: lessons learnt from Bangladesh.  

PubMed

A consensus emerged in the late 1990s among leaders in global maternal health that traditional birth attendants (TBAs) should no longer be trained in delivery skills and should instead be trained as promoters of facility-based care. Many TBAs continue to be trained in places where home deliveries are the norm and the potential impacts of this training are important to understand. The primary objective of this study was to gain a more nuanced understanding of the full impact of training TBAs to use misoprostol and a blood measurement tool (mat) for the prevention of postpartum haemorrhage (PPH) at home deliveries through the perspective of those involved in the project. This qualitative study, conducted between July 2009 and July 2010 in Bangladesh, was nested within larger operations research, testing the feasibility and acceptability of scaling up community-based provision of misoprostol and a blood measurement tool for prevention of PPH. A total of 87 in-depth interviews (IDIs) were conducted with TBAs, community health workers (CHWs), managers, and government-employed family welfare visitors (FWVs) at three time points during the study. Computer-assisted thematic data analysis was conducted using ATLAS.ti (version 5.2). Four primary themes emerged during the data analysis, which all highlight changes that occurred following the training. The first theme describes the perceived direct changes linked to the two new interventions. The following three themes describe the indirect changes that interviewees perceived: strengthened linkages between TBAs and the formal healthcare system; strengthened linkages between TBAs and the communities they serve; and improved quality of services/service utilization. The data indicate that training TBAs and CHW supervisors resulted in perceived broader and more nuanced changes than simply improvements in TBAs' knowledge, attitudes, and practices. Acknowledgeing TBAs' important role in the community and in home deliveries and integrating them into the formal healthcare system has the potential to result in changes similar to those seen in this study. PMID:24847601

Bell, Suzanne; Passano, Paige; Bohl, Daniel D; Islam, Arshadul; Prata, Ndola

2014-03-01

350

IL-33/ST2 Correlates with Severity of Haemorrhagic Fever with Renal Syndrome and Regulates the Inflammatory Response in Hantaan Virus-Infected Endothelial Cells  

PubMed Central

Background Hantaan virus (HTNV) causes a severe lethal haemorrhagic fever with renal syndrome (HFRS) in humans. Despite a limited understanding of the pathogenesis of HFRS, the importance of the abundant production of pro-inflammatory cytokines has been widely recognized. Interleukin 33 (IL-33) has been demonstrated to play an important role in physiological and pathological immune responses. After binding to its receptor ST2L, IL-33 stimulates the Th2-type immune response and promotes cytokine production. Depending on the disease model, IL-33 either protects against infection or exacerbates inflammatory disease, but it is unknown how the IL-33/ST2 axis regulates the immune response during HTNV infection. Methodology/Principal Findings Blood samples were collected from 23 hospitalized patients and 28 healthy controls. The levels of IL-33 and soluble ST2 (sST2) in plasma were quantified by ELISA, and the relationship between IL-33, sST2 and the disease severity was analyzed. The role of IL-33/sST2 axis in the production of pro-inflammatory cytokines was studied on HTNV-infected endothelial cells. The results showed that the plasma IL-33 and sST2 were significantly higher in patients than in healthy controls. Spearman analysis showed that elevated IL-33 and sST2 levels were positively correlated with white blood cell count and viral load, while negatively correlated with platelet count. Furthermore, we found that IL-33 enhanced the production of pro-inflammatory cytokines in HTNV-infected endothelial cells through NF-?B pathway and that this process was inhibited by the recombinant sST2. Conclusion/Significance Our results indicate that the IL-33 acts as an initiator of the “cytokine storm” during HTNV infection, while sST2 can inhibit this process. Our findings could provide a promising immunotherapeutic target for the disease control. PMID:25658420

Zhang, Yusi; Zhang, Chunmei; Zhuang, Ran; Ma, Ying; Zhang, Yun; Yi, Jing; Yang, Angang; Jin, Boquan

2015-01-01

351

The effect of intravenous interleukin-1 receptor antagonist on inflammatory mediators in cerebrospinal fluid after subarachnoid haemorrhage: a phase II randomised controlled trial  

PubMed Central

Background Interleukin-1 (IL-1) is a key mediator of ischaemic brain injury induced by stroke and subarachnoid haemorrhage (SAH). IL-1 receptor antagonist (IL-1Ra) limits brain injury in experimental stroke and reduces plasma inflammatory mediators associated with poor outcome in ischaemic stroke patients. Intravenous (IV) IL-1Ra crosses the blood–brain barrier (BBB) in patients with SAH, to achieve cerebrospinal fluid (CSF) concentrations that are neuroprotective in rats. Methods A small phase II, double-blind, randomised controlled study was carried out across two UK neurosurgical centres with the aim of recruiting 32 patients. Adult patients with aneurysmal SAH, requiring external ventricular drainage (EVD) within 72 hours of ictus, were eligible. Patients were randomised to receive IL-1Ra (500 mg bolus, then a 10 mg/kg/hr infusion for 24 hours) or placebo. Serial samples of CSF and plasma were taken and analysed for inflammatory mediators, with change in CSF IL-6 between 6 and 24 hours as the primary outcome measure. Results Six patients received IL-1Ra and seven received placebo. Concentrations of IL-6 in CSF and plasma were reduced by one standard deviation in the IL-1Ra group compared to the placebo group, between 6 and 24 hours, as predicted by the power calculation. This did not reach statistical significance (P?=?0.08 and P?=?0.06, respectively), since recruitment did not reach the target figure of 32. No adverse or serious adverse events reported were attributable to IL-1Ra. Conclusions IL-1Ra appears safe in SAH patients. The concentration of IL-6 was lowered to the degree expected, in both CSF and plasma for patients treated with IL-1Ra. PMID:24383930

2014-01-01

352

A prospective randomised trial to compare the efficacy and safety of hemabate and syntometrine for the prevention of primary postpartum haemorrhage.  

PubMed

In a prospective, open-label, assessor-blind, randomised parallel group study the efficacy and safety of Hemabate (Pharmacia-Upjohn Pharmaceuticals, Milton Keynes, Buckinghamshire) an analogue of 15-methyl-prostaglandin (PGF2alpha) analogue was compared with Syntometrine (Alliance Pharmaceuticals, Chippenham, Wilts) the standard combination of ergometrine and syntocinon used for the active management of the third stage of labour and the prevention of primary postpartum haemorrhage (PPH). The study was set in a district general hospital with approximately 4,000 deliveries annually. The study was discontinued at the time of the interim analysis because of unacceptable gastrointestinal side effects. At the time of the interim analysis, a total of 529 women had completed the study with 263 randomised to receive PGF2alpha and 266 to receive ergometrine and syntocinon. In a pre-specified subgroup analysis, women delivered vaginally were further subdivided into those considered to be at high or low risk of primary PPH. The measured blood loss and incidence of PPH was similar in both treatment groups whether delivered by caesarean section or vaginally independent of whether women were considered to be at high or low risk. Adverse gastrointestinal events were recorded more often in the Hemabate group. The most common symptom was diarrhoea which occurred in 21% of women who received Hemabate compared to only 0.8% of Syntometrine users. PGF2alpha is as effective as Syntometrine in the prophylaxis of primary PPH in all groups studied but there was a statistically significantly increased risk of diarrhoea among users of PGF2alpha. PMID:11577783

Lamont, R F; Morgan, D J; Logue, M; Gordon, H

2001-10-01

353

Clinical and laboratory findings in patients with oliguric and non-oliguric hantavirus haemorrhagic fever with renal syndrome: an analysis of 128 patients.  

PubMed

Patients with haemorrhagic fever with renal syndrome (HFRS) may present without significant oliguria. We compared different initial clinical symptoms and laboratory findings in patients who developed oliguric acute renal failure (ARF) with those in patients who did not develop oliguric ARF. Overall, 128 patients with serologically confirmed HFRS were hospitalized at the University Hospital for Infectious Disease, Zagreb, Croatia between January 1999 and December 2010. Clinical signs and laboratory findings were extracted from medical charts, and were assessed for their relationship to the development of oliguric ARF. Puumala virus infection was diagnosed in 101 (79%) patients, and Dobrava-Belgrade virus infection in 27 (21%). Oliguria or anuria developed in 30% of patients. We identified the following risk factors for the development of oliguria and anuria on multivariable analysis: conjunctival hyperaemia or bleeding (relative risk (RR) 1.84, 95% CI 1.09-3.10; p?0.023), diarrhoea (RR 1.45, 95% CI 1.07-1.97; p?0.017), serum sodium of ?133?mM (RR 2.21, 95% CI 1.34-3.64; p?0.002), and dipstick protein value of >1.5?g/L (RR 1.59, 95% CI 1.09-2.33; p?0.016), as well as hiking in the forest (RR 1.92, 95% CI 1.13-3.26; p?0.016). Our findings may help physicians in the earlier identification of patients with a more severe form of HFRS caused by Puumala and Dobrava-Belgrade viruses. Particular attention should be given to findings such as conjunctival hyperaemia or bleeding, diarrhoea, a low serum sodium level, and proteinuria. PMID:22963396

Tur?inov, D; Puljiz, I; Markoti?, A; Kuzman, I; Begovac, J

2013-07-01

354

Role of CXCR2 and TRPV1 in functional, inflammatory and behavioural changes in the rat model of cyclophosphamide-induced haemorrhagic cystitis  

PubMed Central

Background and Purpose:?Cyclophosphamide induces urotoxicity characterized by the development of cystitis, which involves bladder overactivity and inflammation. Here, we investigated the roles of chemokine receptor 2 (CXCR2) and transient receptor potential vanilloid 1 (TRPV1) channels in a rat model of cyclophosphamide-induced cystitis. Experimental Approach:?Cystitis induced by cyclophosphamide in rats was assessed by gross morphology, histology and immunohistochemistry of bladder tissue. mRNA for CXCR2 and TRPV1 channels were measured by RT-PCR. Nociceptive responses in paw and abdomen, along with cystometric measures were recorded. Key Results:?Cyclophosphamide, i.p., induced pain behaviour, bladder inflammation and voiding dysfunction. The CXCR2 antagonist, SB225002, the TRPV1 channel antagonist, SB366791 or their combination reduced the mechanical hypersensitivity of paw and abdominal area and nociceptive behaviour after cyclophosphamide. Cyclophosphamide-induced cystitis was characterized by haemorrhage, oedema, neutrophil infiltration and other inflammatory changes, which were markedly decreased by the antagonists. Up-regulation of CXCR2 and TRPV1 mRNA in the bladder after cyclophosphamide was inhibited by SB225002, SB366791 or their combination. Expression of CXCR2 and TRPV1 channels was increased in the urothelium after cyclophosphamide. Bladder dysfunction was shown by increased number of non-voiding contractions (NVCs) and bladder pressures and a reduction in bladder capacity (BC), voided volume (VV) and voiding efficiency (VE). SB225002 or its combination with SB366791 reduced bladder pressures, whereas SB225002, SB366791 or their combination increased BC, VV and VE, and also reduced the number of NVCs. Conclusions and Implications:?CXCR2 and TRPV1 channels play important roles in cyclophosphamide-induced cystitis in rats and could provide potential therapeutic targets for cystitis. PMID:24117268

Dornelles, Fabiana N; Andrade, Edinéia L; Campos, Maria M; Calixto, João B

2014-01-01

355

Variceal pressure is a strong predictor of variceal haemorrhage in patients with cirrhosis as well as in patients with non-cirrhotic portal hypertension  

PubMed Central

BACKGROUND—Variceal pressure is a strong predictor for a first variceal bleed in patients with cirrhosis.?AIMS—To evaluate whether variceal pressure is also a determinant of the risk of a first variceal bleed in patients with non-cirrhotic portal hypertension.?METHODS—Variceal pressure was measured non-invasively in 25 patients with non-cirrhotic portal hypertension and large varices while receiving a stable therapeutic regimen. Factors predictive of bleeding were compared with those observed in 87 cirrhotics.?RESULTS—The one year incidence of variceal bleeding was 32% (n=28) for the cirrhotic and 20% (n=5) for the non-cirrhotic patients. There was no difference in factors predicting the risk of bleeding between the groups, except for variceal pressure. For the same level of variceal pressure, the risk of variceal bleeding was lower in patients with non-cirrhotic portal hypertension. Multiple logistic regression analysis revealed the following variables as having a significant predictive power: variceal pressure (p=0.0001), red spots (p=0.004), and the time interval between the first observation of the varices and the moment of variceal pressure measurement (p=0.0046). For the non-cirrhotics the risk of bleeding increased with higher Child-Pugh score (p=0.0024); this was not the case for the cirrhotic patients (p=0.9521).?CONCLUSION—Variceal pressure is a major predictor of variceal bleeding in patients with cirrhosis as well as in patients with non-cirrhotic portal hypertension. The risk of bleeding in non-cirrhotics is less than in cirrhotics for the same level of variceal pressure. In patients with non-cirrhotic portal hypertension the risk of variceal bleeding increases more with advancing disease.???Keywords: variceal haemorrhage; variceal pressure; non-cirrhotic portal hypertension PMID:10486375

El Atti, E A; Nevens, F; Bogaerts, K; Verbeke, G; Fevery, J

1999-01-01

356

Influence of HLA-DRB alleles on haemorrhagic fever with renal syndrome in a Chinese Han population in Hubei Province, China.  

PubMed

Specific human leucocyte antigen (HLA) alleles are considered a genetic risk factor for the progression of haemorrhagic fever with renal syndrome (HFRS) caused by hantaviruses. The aim of this study was to establish whether HLA-DRB alleles are associated with the severity of HFRS caused by different types of hantaviruses in a Chinese Han population from Hubei Province of central China. Twenty-two specific HLA-DRB alleles were analysed by sequence-specific primer-polymerase chain reaction (SSP-PCR) in 100 HFRS patients and 213 healthy volunteers. Associations of HLA-DRB alleles with the severity and clinical parameters of HFRS caused by Hantaan virus (HTNV) or Seoul virus (SEOV) infection were evaluated. Six alleles (HLA-DRB1*0401-0411, HLA-DRB1*1001, HLA-DRB1*1101-1105, HLA-DRB1*1201-1202, HLA-DRB1*1305 and DRB5*0101-0201) demonstrated strong associations with HFRS caused by HTNV and SEOV infections. Further comparison of these HLA-DRB1 allele frequencies between HFRS patients with differing severities and healthy controls demonstrated that the HLA-DRB1*0401-0411, HLA-DRB1*1001 and DRB1*1305 alleles were more frequent in the moderate course of HTNV-infected HFRS. Meanwhile, the DRB1*1101-1105 allele was more frequently observed in the severe course of HTNV-infected HFRS. We also found that the HLA-DRB1*1201-1202 allele frequency was higher in the moderate course of SEOV-infected HFRS, whereas the DRB5*0101-0201 allele may play a protective role in moderate HFRS caused by both HTNV and SEOV infections. These results provide evidence of the influence of HLA-DRB on the severity of HFRS and confirm the effect of HLA-DRB on HFRS during different types of hantavirus infection in a Chinese Han population in Hubei Province, China. PMID:25169964

Zhu, N; Luo, F; Chen, Q; Li, N; Xiong, H; Feng, Y; Yang, Z; Hou, W

2015-01-01

357

Septicaemia in a granulocytopenic patient caused by Corynebacterium striatum.  

PubMed Central

A 64 year old woman with metastatic endometrial carcinoma was admitted to the hospital after three grand mal seizures. Blood cultures yielded Corynebacterium striatum. The patient responded to parenteral ampicillin therapy. This is believed to be the first case of sepsis caused by this organism. PMID:2594603

Dall, L.; Barnes, W. G.; Hurford, D.

1989-01-01

358

Staphylococcal septicaemia after insertion of an intrauterine contraceptive device.  

PubMed

Your recent lead article on toxic shock and tampons (November 1, p. 1161) prompts me to report a case of pelvic infection and staphylococcal septicemia 8 days after the insertion of a Lippes loop. Pelvic infection is a recognized complication of IUDs; although there have been 2 reports of endocarditis occurring in susceptible patients following the insertion of an IUD, septicemia is rare. A previously healthy 31-year old married woman had a loop inserted at a family planning clinic. 3 days later she developed sweating, vomiting, confusion, and cough and during the following 48 hours became disoriented with hallucinations. She was referred to the hospital with suspected encephalitis and on admission was febrile (38.8 degrees Celsius) and stuporose but responded to simple commands. Blood pressure was 95/60 mmHg but there were no other abnormal signs. Hemoglobin was 12.2 g/dl, white blood count 4.0x109/1 (80% neutrophils), erythrocyte sedimentation rate 70mm in the 1st hour; cerebrospinal fluid normal. Chest x-ray examination revealed patchy consolidation in the upper lobes of both lungs and an electroencephalogram showed bilateral nonspecific abnormality. 3 blood cultures taken on admission yielded penicillin-resistant Staphylococcus aureus. She was treated with high-dose intravenous cloxacillin and 24 hours after starting the antibiotic had improved markedly and the IUD was removed. Culture from the coil and also from a high vaginal swab yielded Staph aureus with a similar antibiogram to that of the organism cultured from the blood. Subsequent recovery was uneventful, although repeat chest x-ray examination showed small abscess cavities in the upper lobes of both lungs. The patient was discharged 4 weeks after admission and serial chest radiographs have confirmed complete resolution of the pneumonia and abscesses. There is little doubt that this patients' septicemia with lung abscess formation and encephalopathy originated in the genital tract. The patient was both toxic and shocked but was different from patients with the recently described toxic shock syndrome in that her blood culture was positive for Staph aureus. The case provides another example of the importance of this organism as a cause of infection associated with the insertion of foreign bodies into or through the vagina. PMID:7448549

Geddes, A M

1980-12-13

359

Features of Postmenopausal Uterine Haemorrhage  

PubMed Central

ABSTRACT Introduction: Postmenopausal uterine bleeding is a „cancer until proven otherwise”. Endometrial cancer is a typical disease among postmenopause woman, because every bleeding in this age etiology associated with endometrial cancer (10-30%). The lifespan of women today has been extended and post menopause today last one third of a woman’s life. Early diagnosis of endometrial cancer has a very high cure rate. Screening for this cancer has limits in practice and is necessary given the definition of high-risk groups would be subject to primary and secondary prevention. Goal: Primary to evaluate the leading causes of postmenopausal uterine bleeding among patients at risk for endometrial cancer (diabetes, obesity, nulliparity, late menopause (after 55 years) and compared them with the causes of postmenopausal uterine bleeding patients without this risk. Material and methods: A retrospective, descriptive study with a targeted sample of 50 consecutive patients who had registered postmenopausal uterine bleeding in high-risk groups (cohorts) and the same number of patients with postmenopausal uterine bleeding that does not belong to the risk group (control group). Each patient underwent clinical examination, then fractionated curettements and its histopathological verification and assessment of treated clinical stage of disease with PH analysis of the resected specimens. Results: The patients of the studied risk group were significantly affected by endometrial cancer compared with the control group (RR=2.45, 95% CI 1.2 4.6, p=0.005). Endocervical pathology did not differ between groups. Clinical forms of bleeding: for those that are profuse bleeding cancer was present in 54.6% of cases. With intermittent bleeding cancer is verified in the 33.3% of patients. Risk patient groups with cancer frequently suffer from clinically more advanced stages of histologically aggressive endometrial cancer (serous adenocarcinoma–type II, low differentiated cancer).

Izetbegovic, Sebija; Stojkanovic, Goran; Ribic, Nihad; Mehmedbasic, Eldar

2013-01-01

360

Crimean-Congo Haemorrhagic Fever  

MedlinePLUS

... fluids of infected persons. CCHF is endemic in Africa, the Balkans, the Middle East and Asia, in ... rate of 10–40%. CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries ...

361

The non-pathogenic Australian rabbit calicivirus RCV-A1 provides temporal and partial cross protection to lethal Rabbit Haemorrhagic Disease Virus infection which is not dependent on antibody titres  

PubMed Central

The endemic non-pathogenic Australian rabbit calicivirus RCV-A1 is known to provide some cross protection to lethal infection with the closely related Rabbit Haemorrhagic Disease Virus (RHDV). Despite its obvious negative impacts on viral biocontrol of introduced European rabbits in Australia, little is known about the extent and mechanisms of this cross protection. In this study 46 rabbits from a colony naturally infected with RCV-A1 were exposed to RHDV. Survival rates and survival times did not correlate with titres of serum antibodies specific to RCV-A1 or cross reacting to RHDV, but were instead influenced by the time between infection with the two viruses, demonstrating for the first time that the cross protection to lethal RHDV infection is transient. These findings are an important step towards a better understanding of the complex interactions of co-occurring pathogenic and non-pathogenic lagoviruses. PMID:23834204

2013-01-01

362

Ethno – veterinary Plants of Nadurbar district of Maharashtra, India  

PubMed Central

A survey of medicinal plants of Nandurbar district of Maharashtra, India in regard to their veterinary uses, has been done. While collecting the data, special emphasis is given to the foot and Mouth disease, Haemorrhagic Septicaemia, Maggotted Wounds, Retention of Placcenta, Timpany and Worms, which are the most common animal ailment in the district. After short listing, about 29 plant species are found to be in regular use by various tribal veterinary doctors in the district. PMID:22557165

Ramalah, P.V.; Patil, M B

2005-01-01

363

Management of traumatic haemorrhage - the European perspective.  

PubMed

Trauma-induced coagulopathy represents a life-threatening complication in severely injured patients. To avoid exsanguination, rapid surgical bleeding control coupled with immediate and aggressive haemostatic treatment is mandatory. In most trauma centres, coagulation therapy is established with transfusion of high volumes of fresh frozen plasma. Due to logistic issues, only busy trauma facilities store pre-thawed plasma ready for immediate transfusion. Thus, substantial time delays have been reported between the first unit of red blood cells transfused and the administration of fresh frozen plasma. An alternative for rapid improvement of haemostatic capacity is purified coagulation factor concentrates. They contain a well-defined concentration of coagulation proteins, carry a low risk for transfusion-related lung injury and virus transmission, and are available for immediate use without the need for blood group matching. In some European trauma centres, treatment algorithms have been developed for the administration of coagulation factor concentrates based on visco-elastic test results. PMID:25440403

Schöchl, H; Voelckel, W; Schlimp, C J

2015-01-01

364

[Venous angioma with associated cerebellar haemorrhage].  

PubMed

Venous angiomas are a developmental anomaly in which embryonic venous drainage is still present into adulthood. They are usually asymptomatic and benign course but they can cause seizures and less commonly bleeding, usually associated to cavernous malformation. Normally, treatment is not necessary although bleeding, severe clinical and lesions in which it is possible a favourable approach, we can consider treatment. We show a case of a 11 years old boy with acute decrease level of consciousness. We observed hematoma in the right cerebellar hemisphere with radial tubular structures consistent with developmental venous anomaly. The hematoma was evacuated without a demonstrable other reason justifying the bleeding. PMID:23218501

Sánchez Medina, Yanire; Pérez del Rosario, Pedro Antonio; Domínguez, Jaime; Millán, Ana

2013-01-01

365

[Septicaemia of chironomid larvae (Diptera: Chironomidae) promoted by Bacillus cereus and B. thuringiensis].  

PubMed

Natural factors regulating the population of chironomids were studied. The bacteria Bacillus cereus were isolated from chironomids sampled from Kuyalnitskii Firth after epizooty of Chironomus sp., and bacteria Bacillus thuringiensis spp. israelensis (Bti) were isolated from dead larva of Chironomus plumosus sampled in the Sea of Azov (3-m depth). Bti were characterized by high insecticide activity on midges Anopheles messeae Fall., Aedes cireneus Mg., and Culex pipiens pipiens f. pipiens L. PMID:22988756

Khodyrev, V P

2012-01-01

366

AGE-modified albumin containing infusion solutions boosts septicaemia and inflammation in experimental peritonitis  

PubMed Central

HSA preparations for i.v. use are administered in critically ill patients. Although increasing intravascular osmotic pressure seems to be a pathophysiologically orientated treatment, clinical trials do not indicate a benefit for mortality in HSA-treated patients. Instead, there is evidence for inflammatory reactions upon infusion of different HSA batches. A neglected issue concerning the safety and quality of these therapeutics is processing-related post-transcriptional protein modifications, such as AGEs. We therefore tested the hypothesis that commercially available infusion solutions contain AGEs and studied whether these protein modifications influence outcome and inflammation in a murine model of sepsis induced by CLP. Screening of different HSA and Ig preparations in this study revealed an up to approximate tenfold difference in the amount of AGE modifications. Application of clinically relevant concentrations of CML-modified HSA in CLP led to increased inflammation and enhanced mortality in wild-type mice but not in mice lacking the RAGE. Lethality was paralleled by increased activation of the proinflammatory transcription factor NF-?B, NF-?B-dependent gene expression, and infiltration of inflammatory cells in the peritoneal cavity. This study implies that infusion solutions containing a high load of the AGE-modified protein have the potential to activate RAGE/NF-?B-mediated inflammatory reactions, causing increased mortality in experimental peritonitis. PMID:19401390

Humpert, Per M.; Lukic, Ivan K.; Thorpe, Suzanne R.; Hofer, Stefan; Awad, Ezzat M.; Andrassy, Martin; Deemer, Elizabeth K.; Kasper, Michael; Schleicher, Erwin; Schwaninger, Markus; Weigand, Markus A.; Nawroth, Peter P.; Bierhaus, Angelika

2009-01-01

367

The Media and Reserve Library, located on the lower level west wing, has over 13,000 videotapes, DVDs and audiobooks covering a multitude of subjects. Below is a listing of titles currently available on the topic of Music. For more information on these ti  

E-print Network

VHS-1350 Aerosmith: Big Ones You Can Look At VHS-5910 Africa: Egypt/Uganda/Senegal VHS-5275 Africa: Kenya/Malawi/Botswana/South Africa VHS-5277 Africa: The Gambia/Liberia/Ghana/Nigeria VHS-5276 African' Jack DVD-4401 6/17/2014 #12;Bamboo and Bronze in Southeast Asian Music VHS-5893 Bardic Divas: Women

Saldin, Dilano

368

Structural analysis and cross-protective efficacy of recombinant 87 kDa outer membrane protein (Omp87) of Pasteurella multocida serogroup B:2.  

PubMed

Pasteurella multocida serogroup B:2, a causative agent of haemorrhagic septicaemia (HS) in cattle and buffalo especially in tropical regions of Asian and African countries, is known to possess several outer membrane proteins (OMPs) as immunogenic antigens. In the present study, omp87 gene encoding for 87 kDa OMP (Omp87) protein of P. multocida serogroup B:2 strain P52, has been amplified (?2304 bp), cloned in to pET32a vector and over-expressed in recombinant Escherichia coli as fusion protein. The recombinant Omp87 protein (?102 kDa) including N-terminus hexa-histidine tag was purified under denaturing condition. Immunization of mice with rOmp87 resulted in increased antigen specific IgG titres in serum and provided protection of 66.6 and 83.3% following homologous (B:2) and heterologous (A:1) challenge, respectively. A homology model of Omp87 revealed the presence of two distinct domains; N-terminal domain with four POTRA repeats in the periplasmic space and a pore forming C-terminal ?-barrel domain (?1- ?16) in the outer membrane of P. multocida, which belong to Omp85-TpsB transporter superfamily of OMPs. The study indicated the potential possibilities to use rOmp87 protein along with suitable adjuvant in developing subunit vaccine for haemorrhagic septicaemia and pasteurellosis in livestock. PMID:24120691

Kumar, Abhinendra; Yogisharadhya, Revanaiah; Ramakrishnan, Muthannan A; Viswas, K N; Shivachandra, Sathish B

2013-12-01

369

Paracetamol: a haemorrhagic risk factor in patients on warfarin  

PubMed Central

Aim To quantify the effect of paracetamol on the anticoagulant effect of warfarin under normal clinical conditions. Patients and methods In a prospective double-blind, cross-over, placebo-controlled study, 11 patients on stable warfarin therapy received in random order two 14-day regimens of paracetamol 4 g day?1 or placebo, with a 14-day or more wash-out period in between, time necessary to fulfil the inclusion criteria. Results In patients on paracetamol, the mean maximum increase in the International Normalized Ratio (INR) observed was 1.04 ± 0.55 vs. 0.20 ± 0.32 in those on placebo (P = 0.003). The mean maximum INR observed was significantly higher with paracetamol than with placebo (3.47 vs. 2.61, P = 0.01). In patients receiving paracetamol, the mean observed INR was significantly increased after 4 days (+ 0.6 ± 0.6, P < 0.001). Conclusion Paracetamol at 4 g day?1 induces a significant increase in INR in patients receiving a stable regimen of warfarin, increasing the risk of bleeding associated with warfarin. PMID:15752384

Mahé, I; Bertrand, N; Drouet, L; Simoneau, G; Mazoyer, E; Bal dit Sollier, C; Caulin, C; Bergmann, J F

2005-01-01

370

Survey of management in acute upper gastrointestinal haemorrhage1  

PubMed Central

The answers to a questionnaire concerning attitudes of members of the British Society of Gastroenterology to the management of acute upper gastrointestinal bleeding are analysed. In the majority of cases patients were admitted to general wards under the care of physicians. Use of intensive therapy units and venous pressure monitoring varied widely. Emergency endoscopy appeared readily available and was usually the first diagnostic procedure. Double contrast radiology and emergency angiography were available in relatively few centres. Specific nonoperative treatments (angiographic and endoscopic) were scarcely employed. Most respondents agreed that elderly patients fared badly, but there was little agreement concerning other factors which influence re-bleeding or outcome. There was a wide divergence of opinion concerning the need for surgical intervention in certain hypothetical clinical situations. Despite the difficulties involved, we believe that controlled trials are necessary to improve the management of bleeding patients. PMID:6971943

Thomas, G E; Cotton, P B; Clark, C G; Boulos, P B

1980-01-01

371

To Look Beyond Vasospasm in Aneurysmal Subarachnoid Haemorrhage  

PubMed Central

Delayed cerebral vasospasm has classically been considered the most important and treatable cause of mortality and morbidity in patients with aneurysmal subarachnoid hemorrhage (aSAH). Secondary ischemia (or delayed ischemic neurological deficit, DIND) has been shown to be the leading determinant of poor clinical outcome in patients with aSAH surviving the early phase and cerebral vasospasm has been attributed to being primarily responsible. Recently, various clinical trials aimed at treating vasospasm have produced disappointing results. DIND seems to have a multifactorial etiology and vasospasm may simply represent one contributing factor and not the major determinant. Increasing evidence shows that a series of early secondary cerebral insults may occur following aneurysm rupture (the so-called early brain injury). This further aggravates the initial insult and actually determines the functional outcome. A better understanding of these mechanisms and their prevention in the very early phase is needed to improve the prognosis. The aim of this review is to summarize the existing literature on this topic and so to illustrate how the presence of cerebral vasospasm may not necessarily be a prerequisite for DIND development. The various factors determining DIND that worsen functional outcome and prognosis are then discussed. PMID:24967389

Messerer, Mahmoud; Oddo, Mauro; Daniel, Roy Thomas

2014-01-01

372

["Acute scrotum" in the neonate. Adrenal haemorrhage as cause].  

PubMed

The most common causes of an 'acute scrotum' in childhood are testicular torsion, torsion of an appendix testis, epididyoorchitis, idiopathic edema, and hematoma. In rare cases a scrotal hematoma can originate from an extra- or intraperitoneal adrenal bleeding. 12 such cases have been described in the literature, yet. We report on 3 further cases, that occurred in our institution between 1992 and 1997. In the first case we performed a scrotal exploration due to a suspected testicular torsion, but only a normal testicle and liquid hematoma were seen. Postoperatively we discovered an ipsilateral adrenal hemorrhage by sonography. In the latter two cases the adrenal bleeding was recognized primarily as causal for the scrotal mass and operation remained undone. In newborns adrenal hemorrhage is mostly due to birth-trauma, large birth-weight, hypoxia, and asphyxia. This was present as well with our 3 children. If the clinical situation of the child is stable, complete restitution under conservative therapy can be expected. PMID:10663196

Anding, R; Fastnacht-Urban, E; Walz, P H

2000-01-01

373

Formalin dab for treatment of haemorrhagic radiation proctitis  

Microsoft Academic Search

The authors present a case of a 75-year-old man who underwent 2 months of radiotherapy for prostate cancer. He developed rectal bleeding 6 months later. A colonoscopy showed radiation proctitis with no other abnormalities up to the caecum. He was treated with a variety of medical therapies and argon beam laser with minimal effect. He was treated with epinephrine injection

Azzam Al-Amin; Richard Cowley; Nigel Scott

2011-01-01

374

Subcortical lobar intracerebral haemorrhage: clinical-computed tomographic correlations.  

PubMed Central

Fifty patients with spontaneous lobar haematomas were reviewed. Thirty-two were normotensive and eighteen were hypertensive. Vomiting, seizures, and altered consciousness were more common in hypertensive than in normotensive patients. Haematoma size (greater than 4.0 cm) and intraventricular extension occurred most commonly in hypertensive and rarely in normotensive patients. Twenty-eight per cent of hypertensive patients died, whereas none of the normotensive patients died. Images PMID:4078572

Weisberg, L A

1985-01-01

375

Haemorrhagic presentation of a craniopharyngioma in a pregnant woman.  

PubMed

Objective. Craniopharyngioma is a rare tumour, and, consequently, acute clinical presentation and diagnosis, during pregnancy, of this pathology are quite difficult to find. Only few cases are reported in the literature, and no one describes these two conditions in association. Methods. We report a particular case of craniopharyngioma presenting both of the above conditions. Results. The patient was successfully operated with endoscopic technique. Conclusions. Rare and difficult cases, created by the superposition of different clinical conditions, need multidisciplinary management, with collaboration, integration, and cooperation between different medical specialists. PMID:25161785

Zoia, Cesare; Cattalani, Andrea; Turpini, Elena; Custodi, Viola Marta; Benazzo, Marco; Pagella, Fabio; Carena, Paolo; Lovati, Elisabetta; Lucotti, Pietro; Gaetani, Paolo

2014-01-01

376

Haemorrhagic Presentation of a Craniopharyngioma in a Pregnant Woman  

PubMed Central

Objective. Craniopharyngioma is a rare tumour, and, consequently, acute clinical presentation and diagnosis, during pregnancy, of this pathology are quite difficult to find. Only few cases are reported in the literature, and no one describes these two conditions in association. Methods. We report a particular case of craniopharyngioma presenting both of the above conditions. Results. The patient was successfully operated with endoscopic technique. Conclusions. Rare and difficult cases, created by the superposition of different clinical conditions, need multidisciplinary management, with collaboration, integration, and cooperation between different medical specialists. PMID:25161785

Cattalani, Andrea; Turpini, Elena; Custodi, Viola Marta; Pagella, Fabio; Carena, Paolo; Lovati, Elisabetta; Lucotti, Pietro; Gaetani, Paolo

2014-01-01

377

Subdural haemorrhage following endoscopic third ventriculostomy. A rare complication  

Microsoft Academic Search

Summary  Subdural collections or hematomas are frequently observed after shunt placement [7–9, 13], but rarely after ETV [6]. A review\\u000a of literature revealed 7 cases [1, 5, 6, 10, 12], of which only 1 was symptomatic [5]. We will discuss the causes, management,\\u000a and methods of prevention of this complication and we will present a case of symptomatic subdural haematoma, following

M. H. Kamel; M. Murphy; K. Aquilina; C. Marks

2006-01-01

378

Transfusion Practices in Postpartum Haemorrhage: a Population-Based Study1 Running headline: Transfusion in Postpartum Haemorrhage3  

E-print Network

-00809169,version1-8Apr2013 #12;4 Abstract1 2 Objective: To describe transfusion practices and blood loss the rate of red blood cell (RBC)8 transfusion in PPH overall and according to transfusion guidelines. Transfusion practices and9 blood loss severity were described by mode of delivery and cause of PPH in women

Paris-Sud XI, Université de

379

9 CFR 93.912 - Import permits.  

Code of Federal Regulations, 2014 CFR

...IMPORTATION OF CERTAIN ANIMALS, BIRDS, FISH, AND POULTRY, AND CERTAIN ANIMAL...General Provisions for Vhs-Regulated Fish Species § 93.912 Import permits. (a) Live VHS-regulated fish imported from VHS-regulated...

2014-01-01

380

9 CFR 93.913 - Health certificate.  

Code of Federal Regulations, 2011 CFR

... (2) Tests must include virus isolation or other assays authorized by the competent authority, using appropriate cell lines to detect VHS virus, if present. All suspect VHS cytopathic effects must be positively identified as VHS through...

2011-01-01

381

9 CFR 83.6 - Testing requirements.  

Code of Federal Regulations, 2013 CFR

...higher health status. (2) Include virus isolation or other assays authorized by the Administrator, using appropriate cell lines to detect VHS virus, if present. All suspect VHS cytopathic effects must be positively identified as VHS through...

2013-01-01

382

9 CFR 83.6 - Testing requirements.  

Code of Federal Regulations, 2012 CFR

...higher health status. (2) Include virus isolation or other assays authorized by the Administrator, using appropriate cell lines to detect VHS virus, if present. All suspect VHS cytopathic effects must be positively identified as VHS through...

2012-01-01

383

9 CFR 93.913 - Health certificate.  

Code of Federal Regulations, 2013 CFR

... (2) Tests must include virus isolation or other assays authorized by the competent authority, using appropriate cell lines to detect VHS virus, if present. All suspect VHS cytopathic effects must be positively identified as VHS through...

2013-01-01

384

9 CFR 83.6 - Testing requirements.  

Code of Federal Regulations, 2011 CFR

...higher health status. (2) Include virus isolation or other assays authorized by the Administrator, using appropriate cell lines to detect VHS virus, if present. All suspect VHS cytopathic effects must be positively identified as VHS through...

2011-01-01

385

9 CFR 83.6 - Testing requirements.  

Code of Federal Regulations, 2014 CFR

...higher health status. (2) Include virus isolation or other assays authorized by the Administrator, using appropriate cell lines to detect VHS virus, if present. All suspect VHS cytopathic effects must be positively identified as VHS through...

2014-01-01

386

9 CFR 93.913 - Health certificate.  

Code of Federal Regulations, 2012 CFR

... (2) Tests must include virus isolation or other assays authorized by the competent authority, using appropriate cell lines to detect VHS virus, if present. All suspect VHS cytopathic effects must be positively identified as VHS through...

2012-01-01

387

Overview of recent DNA vaccine development for fish  

USGS Publications Warehouse

Since the first description of DNA vaccines for fish in 1996, numerous studies of genetic immunisation against the rhabdovirus pathogens infectious haematopoietic necrosis virus (IHNV) and viral haemorrhagic septicaemia virus (VHSV) have established their potential as both highly efficacious biologicals and useful basic research tools. Single small doses of rhabdovirus DNA constructs provide extremely strong protection against severe viral challenge under a variety of conditions. DNA vaccines for several other important fish viruses, bacteria, and parasites are under investigation, but they have not yet shown high efficacy. Therefore, current research is focussed on mechanistic studies to understand the basis of protection, and on improvement of the nucleic acid vaccine applications against a wider range of fish pathogens.

Kurath, G.

2005-01-01

388

Mucosal immunization provides better protection than subcutaneous immunization against Pasteurella multocida (B:2) in mice preimmunized with the outer membrane proteins.  

PubMed

To investigate the effect of boosting immunity via mucosal route vis-a-vis parenteral route in the mouse model of haemorrhagic septicaemia, mice preimmunized with OMP of Pasteurella multocida (B:2) were immunized with 10(2) cfu of P. multocida via intranasal and subcutaneous routes. Mice were challenged through intranasal route (natural route of infection) with 10(8) cfu 14 days after immunization. Group of mice which were immunized intranasally showed significant protection (P?

Kharb, Subhash; Charan, Shiv

2011-10-01

389

9 CFR 93.910 - General restrictions; exceptions.  

Code of Federal Regulations, 2011 CFR

...IMPORTATION OF CERTAIN ANIMALS, BIRDS, FISH, AND POULTRY, AND CERTAIN ANIMAL... General Provisions for Vhs-Regulated Fish Species § 93.910 General restrictions...a) No live VHS-regulated species of fish may be imported into the United...

2011-01-01

390

9 CFR 93.910 - General restrictions; exceptions.  

Code of Federal Regulations, 2012 CFR

...IMPORTATION OF CERTAIN ANIMALS, BIRDS, FISH, AND POULTRY, AND CERTAIN ANIMAL... General Provisions for Vhs-Regulated Fish Species § 93.910 General restrictions...a) No live VHS-regulated species of fish may be imported into the United...

2012-01-01

391

9 CFR 93.910 - General restrictions; exceptions.  

Code of Federal Regulations, 2010 CFR

...IMPORTATION OF CERTAIN ANIMALS, BIRDS, FISH, AND POULTRY, AND CERTAIN ANIMAL... General Provisions for Vhs-Regulated Fish Species § 93.910 General restrictions...a) No live VHS-regulated species of fish may be imported into the United...

2010-01-01

392

9 CFR 93.910 - General restrictions; exceptions.  

Code of Federal Regulations, 2014 CFR

...IMPORTATION OF CERTAIN ANIMALS, BIRDS, FISH, AND POULTRY, AND CERTAIN ANIMAL... General Provisions for Vhs-Regulated Fish Species § 93.910 General restrictions...a) No live VHS-regulated species of fish may be imported into the United...

2014-01-01

393

9 CFR 93.914 - Declaration and other documents.  

Code of Federal Regulations, 2014 CFR

...IMPORTATION OF CERTAIN ANIMALS, BIRDS, FISH, AND POULTRY, AND CERTAIN ANIMAL... General Provisions for Vhs-Regulated Fish Species § 93.914 Declaration and...documents. (a) For live VHS-regulated fish offered for importation under this...

2014-01-01

394

Antithrombotic drug use, cerebral microbleeds and intracerebral haemorrhage: a systematic review of published and unpublished studies   

E-print Network

.7) in antiplatelet users and 8.0 (range, 3.5–17.8) in warfarin users (P difference=0.01). There was also an excess of MB in warfarin users vs nonusers with ICH (OR, 2.7; 95% CI, 1.6–4.4; P<0.001) but none in warfarin users with IS/TIA (OR, 1.3; 95% CI, 0.9–1.7; P=0...

Lovelock, CE; Cordonnier, C; Naka, H; Al-Shahi Salman, R; Sudlow, Cathie; Sorimachi, T; Werring, DJ; Gregoire, SM; Imaizumi, T; Lee, SH; Briley, D; Jackson, Caroline Anne; Dennis, M; Wardlaw, Joanna M; Potter, Gillian Margaret; Rothwell, PM

395

International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia  

Microsoft Academic Search

BackgroundHHT is an autosomal dominant disease with an estimated prevalence of at least 1\\/5000 which can frequently be complicated by the presence of clinically significant arteriovenous malformations in the brain, lung, gastrointestinal tract and liver. HHT is under-diagnosed and families may be unaware of the available screening and treatment, leading to unnecessary stroke and life-threatening hemorrhage in children and adults.ObjectiveThe

M E Faughnan; V A Palda; G Garcia-Tsao; U W Geisthoff; J McDonald; D D Proctor; J Spears; D H Brown; E Buscarini; M S Chesnutt; V Cottin; A Ganguly; J R Gossage; A E Guttmacher; R H Hyland; S J Kennedy; J Korzenik; J J Mager; A P Ozanne; J F Piccirillo; D Picus; H Plauchu; M E M Porteous; R E Pyeritz; D A Ross; C Sabba; K Swanson; P Terry; M C Wallace; C J J Westermann; R I White; L H Young; R Zarrabeitia

2009-01-01

396

Effect of Cerebral Ischaemia on the Cerebrovascular and Cardiovascular Response to Haemorrhage  

Microsoft Academic Search

Summary  ?Reports studying the combination of low blood pressure and cerebral ischaemia are few, and it remains to be determined how\\u000a cerebral circulatory insufficiency modifies the cerebral perfusion and the central haemodynamic response to blood loss. We\\u000a hypothesised that occlusion of arteries to the brain modifies the cerebrovascular and cardiovascular responses to blood loss.\\u000a Continuous measurements of the cerebral microcirculation with

I. R. Rise; O. J. Kirkeby

1998-01-01

397

Comparison of the clinical and serologic diagnosis of haemorrhagic fever with renal syndrome (HFRS) and leptospirosis  

Microsoft Academic Search

fluorescence assay (IFA), in 1:16 dilution, for IgG and IgM antibodies to Hantaan 76-118, Seoul, Porogia and Puumala viruses. Positive sera were further tested in two-fold dilutions against the corresponding virus and the serologic diagnosis of HFRS was confirmed by the presence of increasing antibody titers (IgM- and IgG-specific) to the corresponding Hantavirus. For the serodiagnosis of Leptospirosis, all sera

A. Antoniadis; S. Alexiou-Daniel; L. Fidani; E. F. K. Bautz

1995-01-01

398

Severe Intraperitoneal Haemorrhage following Suprapubic Catheter Insertion in a Patient Treated with Iloprost  

PubMed Central

Suprapubic catheter (SPC) insertion is a common urological procedure, performed both in the elective and emergency settings. The authors present an unusual case of severe intraperitoneal bleeding following the insertion of an SPC under direct vision, where the use of prostacyclin analogue may have been a contributing factor. PMID:24058740

Spence, R. A. J.; Thwaini, A.; O'Brien, Aidan

2013-01-01

399

Severe Intraperitoneal Haemorrhage following Suprapubic Catheter Insertion in a Patient Treated with Iloprost.  

PubMed

Suprapubic catheter (SPC) insertion is a common urological procedure, performed both in the elective and emergency settings. The authors present an unusual case of severe intraperitoneal bleeding following the insertion of an SPC under direct vision, where the use of prostacyclin analogue may have been a contributing factor. PMID:24058740

Spence, R A J; Thwaini, A; O'Brien, Aidan

2013-01-01

400

Cerebrospinal Fluid from Patients with Subarachnoid Haemorrhage and Vasospasm Enhances Endothelin Contraction in Rat Cerebral Arteries  

PubMed Central

Introduction Previous studies have suggested that cerebrospinal fluid from patients with subarachnoid hemorrhage (SAH) leads to pronounced vasoconstriction in isolated arteries. We hypothesized that only cerebrospinal fluid from SAH patients with vasospasm would produce an enhanced contractile response to endothelin-1 in rat cerebral arteries, involving both endothelin ETA and ETB receptors. Methods Intact rat basilar arteries were incubated for 24 hours with cerebrospinal fluid from 1) SAH patients with vasospasm, 2) SAH patients without vasospasm, and 3) control patients. Arterial segments with and without endothelium were mounted in myographs and concentration-response curves for endothelin-1 were constructed in the absence and presence of selective and combined ETA and ETB receptor antagonists. Endothelin concentrations in culture medium and receptor expression were measured. Results Compared to the other groups, the following was observed in arteries exposed to cerebrospinal fluid from patients with vasospasm: 1) larger contractions at lower endothelin concentrations (p<0.05); 2) the increased endothelin contraction was absent in arteries without endothelium; 3) higher levels of endothelin secretion in the culture medium (p<0.05); 4) there was expression of ETA receptors and new expression of ETB receptors was apparent; 5) reduction in the enhanced response to endothelin after ETB blockade in the low range and after ETA blockade in the high range of endothelin concentrations; 6) after combined ETA and ETB blockade a complete inhibition of endothelin contraction was observed. Conclusions Our experimental findings showed that in intact rat basilar arteries exposed to cerebrospinal fluid from patients with vasospasm endothelin contraction was enhanced in an endothelium-dependent manner and was blocked by combined ETA and ETB receptor antagonism. Therefore we suggest that combined blockade of both receptors may play a role in counteracting vasospasm in patients with SAH. PMID:25629621

Assenzio, Barbara; Martin, Erica L.; Stankevicius, Edgaras; Civiletti, Federica; Fontanella, Marco; Boccaletti, Riccardo; Berardino, Maurizio; Mazzeo, AnnaTeresa; Ducati, Alessandro; Simonsen, Ulf; Mascia, Luciana

2015-01-01

401

Functional renal failure and haemorrhagic gastritis associated with endotoxaemia in cirrhosis  

Microsoft Academic Search

Forty-three patients with cirrhosis and ascites, 21 with normal renal function, 10 with a progressive functional renal failure (FRF), and 12 with a steady FRF, were investigated for the presence of endotoxaemia by the Limulus lysate test. Endotoxaemia was found in nine patients with FRF and in none of the 21 with normal renal function (P less than 0-01). A

C Clemente; J Bosch; J Rodés; V Arroyo; A Mas; S Maragall

1977-01-01

402

Necrotic, haemorrhagic, hepatomegalic hepatitis associated with vasculitis and amyloidosis in commercial laying hens.  

PubMed

A 60,000 layer flock in a multi-age commercial operation experienced high weekly mortality ranging from 0.17% to 0.36% starting at 40 weeks of age. The most prominent post-mortem findings were enlargement of the liver and spleen (up to 3 times normal) and liquid blood in the abdominal cavity. Microscopic examination of the liver revealed large or small areas of coagulative necrosis and occasional granulomas. Small pools of amorphous eosinophilic material were found around some areas of necrosis and cords of hepatocytes were separated by pink-staining material. There was generalized lymphoid depletion and multifocal areas of interwoven, light pink-staining material in the spleen. The pink material was shown to contain amyloid by Congo red staining. A vasculitis, characterized by the proliferation of inflammatory cells within and around the portal veins, was also observed. These findings tend to strengthen a theory that 'hepatitis-liver hemorrhage syndrome' could be precipitated by a continuous immune response to an infectious agent such as would occur by vaccination with a live vaccine that continues to replicate in the body or with an inactivated vaccine containing a slow-release adjuvant. PMID:18671138

Tablante, N L; Vaillancourt, J P; Julian, R J

1994-12-01

403

Threat of dengue fever and dengue haemorrhagic fever to Egypt from travelers.  

PubMed

Dengue (DF) and dengue hemorrhagic fevers (DHF) are present in urban and suburban areas in the Americas, South-East Asia, the Eastern Mediterranean and the Western Pacific, but dengue fever is present mainly in the rural areas of Africa. Several factors have combined to produce epidemiological conditions in developing countries in the tropics and subtropics that favour viral transmission by the main mosquito vector, Aedes aegypti as the rapid population growth, rural-urban migration, inadequate basic urban infrastructure (eg. the unreliable water supply leading householders to store water in containers close to homes) and the increase in volume of solid waste, such as discarded plastic containers and other abandoned items which provide larval habitats in urban areas. Geographical expansion of the mosquito has been aided by the international commercial trade particularly in used car-tyres which easily accumulate rainwater. Increased air travel and the breakdown of vector control measures have also contributed greatly to the global burden of dengue and DH fevers. The presence of Ae. aegypti and endemicity of DF and DHF in the neighbor- ing regional countries must be in mind of the Public Health Authorities. PMID:21980768

El-Bahnasawy, Mamdouh M; Khalil, Hazem H M; Morsy, Ayman T A; Morsy, Tosson A

2011-08-01

404

Spatial and Temporal Dynamics of Dengue Haemorrhagic Fever Epidemics, Nakhon Pathom Province, Thailand, 1997-2001  

Microsoft Academic Search

Several environmental factors modulate the distribution of dengue fever (DF), such as climate, density of vector and human populations in urban areas and distribution of herd immunity. In order to identify geographical variables involved in the spread of a DHF process, a Geographic Information System (GIS) has been built to create links between geo-referenced data including medical records and socioeconomic

Wutjanun Muttitanon; Pongpan Kongthong; Chusak Kongkanon; Sutee Yoksan; Narong Nitatpattana; Jean Paul Gonzalez; Philippe Barbazan

2004-01-01

405

Using GIS technology to identify risk area of Dengue Fever (DF) and Dengue Haemorrhagic Fever (DHF)  

Microsoft Academic Search

Vector-borne diseases have been the most important worldwide health problem for many years and still represent a constant and serious risk to a large part of the world's population. DHF is now a significant public health problem in most of the countries in the tropical areas of the South- East Asia and Western Pacific Regions. The disease is among the

Kanchana NAKHAPAKORN

406

Accelerated vaccination for Ebola virus haemorrhagic fever in non-human primates  

Microsoft Academic Search

Containment of highly lethal Ebola virus outbreaks poses a serious public health challenge. Although an experimental vaccine has successfully protected non-human primates against disease, more than six months was required to complete the immunizations, making it impractical to limit an acute epidemic. Here, we report the development of accelerated vaccination against Ebola virus in non-human primates. The antibody response to

Nancy J. Sullivan; Thomas W. Geisbert; Joan B. Geisbert; Ling Xu; Zhi-yong Yang; Mario Roederer; Richard A. Koup; Peter B. Jahrling; Gary J. Nabel

2003-01-01

407

Accelerated vaccination for Ebola virus haemorrhagic fever in non-human primates.  

PubMed

Containment of highly lethal Ebola virus outbreaks poses a serious public health challenge. Although an experimental vaccine has successfully protected non-human primates against disease, more than six months was required to complete the immunizations, making it impractical to limit an acute epidemic. Here, we report the development of accelerated vaccination against Ebola virus in non-human primates. The antibody response to immunization with an adenoviral (ADV) vector encoding the Ebola glycoprotein (GP) was induced more rapidly than with DNA priming and ADV boosting, but it was of lower magnitude. To determine whether this earlier immune response could nonetheless protect against disease, cynomolgus macaques were challenged with Ebola virus after vaccination with ADV-GP and nucleoprotein (NP) vectors. Protection was highly effective and correlated with the generation of Ebola-specific CD8(+) T-cell and antibody responses. Even when animals were immunized once with ADV-GP/NP and challenged 28 days later, they remained resistant to challenge with either low or high doses of virus. This accelerated vaccine provides an intervention that may help to limit the epidemic spread of Ebola, and is applicable to other viruses. PMID:12904795

Sullivan, Nancy J; Geisbert, Thomas W; Geisbert, Joan B; Xu, Ling; Yang, Zhi-Yong; Roederer, Mario; Koup, Richard A; Jahrling, Peter B; Nabel, Gary J

2003-08-01

408

Segmental haemorrhagic infarction of the testis in a paediatric patient: a rare aftermath of epididymitis  

PubMed Central

Testicular infarction is an uncommon finding in paediatric age and is usually due to testicular torsion or trauma causing venous rupture with thrombosis and/or arteriolar obstruction. Other causes of segmental infarction of the testes are represented by polyarteritis nodosa, thromboangioiitis obliterans and hypersensitivity angiitis. A few cases of testicular infarction due to epididymitis have been described in the literature related mainly to adult patients. Epididymitis is usually treated in the outpatient setting with close follow-up, but according to our present experience, and reviewing the literature, there may be some cases in which, surgical exploration is mandatory in order to avoid testicular damage. PMID:23299693

Adorisio, Ottavio; Ceriati, Emanuela; Camassei, Francesca Diomedi; De Peppo, Francesco

2013-01-01

409

Ventriculocisternal drainage via endoscopic third ventriculostomy after endovascular embolization for aneurysmal subarachnoid haemorrhage  

Microsoft Academic Search

Coil embolization is a favoured method of treating acutely ruptured aneurysms. However, subarachnoid clots cannot be removed with endovascular treatment, which is disadvantageous from the view point of preventing vasospasm. The authors report intrathecal fibrinolytic therapy via a ventricular drainage tube instituted after endoscopic third ventriculostomy for effective prevention of vasospasm after coil embolization. Two cases of poor grade aneurysmal

Hisashi Nagashima; Hiroshi Okudera; Shigeaki Kobayashi; Yoshiki Ichinose

1999-01-01

410

Diffuse alveolar haemorrhage: a fatal complication after alemtuzumab induction therapy in renal transplantation.  

PubMed

We report a fatal case of alemtuzumab-induced diffuse alveolar hemorrhage in an 18-year-old male with Alport syndrome. The patient developed acute onset shortness of breath, hemoptysis and fever after renal transplantation. Computed tomography findings were consistent with adult respiratory distress syndrome. Bronchoscopy and broncho-alveolar lavage was performed that showed no evidence of pathogenic bacteria or opportunistic infection. The patient was intubated and ventilated because of worsening respiratory function. The patient received plasma electrophoresis and was maintained on tacrolimus and steroids; however, unfortunately the patient died 31 days post-transplantation due to worsening respiratory function and declining graft function. Although the prevalence and the exact mechanism of this fatal complication remain unknown, an awareness of this complication is important to all clinicians using alemtuzumab. This is a second report of diffuse alveolar hemorrhage secondary to alemtuzumab induction in patients with Alport syndrome. PMID:25645795

Tahir, W; Hakeem, A; Baker, R; Ahmad, N

2015-01-01

411

Emergency Liver Resection with Staplers for Spontaneous Liver Haemorrhage in a Patient Receiving Anticoagulant Therapy  

PubMed Central

Introduction. Emergency liver resection during active bleeding in a patient who takes anticoagulant therapy is a complicated and high-risk surgery. Aim. We described a technique that is combination of staplers, total hepatic vascular occlusion, and hemostatic agent (TachoSil) application for safe and quick hepatectomy. Patient and Method. A 72-year-old woman who uses warfarin regularly due to valvuloplasty admitted emergency unit with abdominal pain and shock. At admission, her hemoglobin, hematocrit, and INR values were 5.2?g/dL, 14.9%, and 6.7, respectively. Radiologic evaluation revealed abdominal free fluid and a liver lesion on segments V, VI, and VII. Emergency laparotomy was required. There was an active bleeding from a liver hematoma that could not be controlled by packing, and an urgent hepatic resection was required. Under total hepatic vascular occlusion, segments V, VI, and VII were resected with endoscopic nonvascular staplers. Cut surface of the liver was coagulated with bipolar cautery and covered with a hemostatic material. Results. Hepatectomy took six minutes, and the duration of surgery was 80 minutes. There was no complication and no transfusion required after surgery, and the patient was discharged on 8th day, uneventfully. Conclusion. Emergency hepatectomy with staplers, under vascular control with hemostatic agents, provided a rapid and safe surgery. PMID:23935634

Kutlutürk, Koray; Soyer, Vural; Dirican, Abuzer; Unal, Bulent; Aydin, Cemalettin; Kayaalp, Cuneyt; Yilmaz, Sezai

2013-01-01

412

The Utility of a Board Game for Dengue Haemorrhagic Fever Health Education  

ERIC Educational Resources Information Center

Purpose: The purpose of this study is to test the effectiveness of an educational board game for increasing knowledge, positive attitudes-beliefs, and self-efficacy for dengue prevention in a sample of Philippine school children and adolescents. Effective board games are more advantageous than lectures because they are adaptable, inexpensive and…

Lennon, Jeffrey L.; Coombs, David W.

2007-01-01

413

Outer Membrane Proteome Analysis of Indian Strain of Pasteurella multocida Serotype B:2 by MALDI-TOF/MS Analysis  

PubMed Central

Identification of outer membrane proteins (OMPs) is important to understand the bacteria structure and function, host-pathogen interaction, development of novel vaccine candidates, and diagnostic antigens. But till now the key antigens of P. multocida B:2 isolate causing haemorrhagic septicaemia (HS) in animals are not clearly defined. In this study, P52 strain of P. multocida serotype B:2 was grown in vitro under iron-rich and iron-limited condition. The OMPs were extracted by sarkosyl method followed by SDS-PAGE and the proteins were identified by MALDI-TOF/MS analysis. In total, 22 proteins were identified, of which 7 were observed exclusively under iron-limited condition. Most of the high molecular weight proteins (TbpA, HgbA, HgbB, HasR, IroA, and HemR) identified in this study were involved in iron acquisition. Some hypothetical proteins (HP-KCU-10206, HP and AAUPMB 08244, HP AAUPMB 21592, HP AAUPMB 19766, AAUPMB 11295) were observed for the first time in this study which could be unique to serotype B:2. Further functional in vivo study of the proteins identified are required to explore the utility of these proteins in developing diagnostics and vaccine against HS. PMID:25587569

Prasannavadhana, A.; Kumar, Santosh; Thomas, Prasad; Sarangi, Laxmi Narayan; Gupta, Santosh Kumar; Priyadarshini, Adyasha; Nagaleekar, Viswas Konasagara; Singh, Vijendra Pal

2014-01-01

414

A ray of hope for a woman with Sheehan's syndrome  

PubMed Central

A 25-year-old woman presented with a history of secondary amenorrhoea for the last 3?years, coinciding with her delivery. She delivered at home and had massive postpartum haemorrhage. She was brought in a state of circulatory collapse to the nearest teaching hospital, where she was resuscitated. She developed anaemia, septicaemia and extradural empyema. The complications were managed and the woman improved. Presently, she approached us for infertility. She was investigated and diagnosed with postpartum hypopituitarism, that is, Sheehan's syndrome. Her gonadotrophin levels, luteinising hormone/follicle-stimulating hormone, were normal, serum oestradiol was low and serum prolactin was also on the lower side. She had started with genital atrophy and was given three cycles of cyclic oestrogen +progesterone combination. Ovulation was induced. She conceived and her antenatal period was uneventful. She delivered a full-term baby vaginally. However, she had inadequate lactation after delivery and lost the baby at one-and-a-half months’ age due to gastroenteritis. PMID:23386498

Jain, Deepti

2013-01-01

415

Complete Genome Sequence and Comparative Analysis of the Fish Pathogen Lactococcus garvieae  

PubMed Central

Lactococcus garvieae causes fatal haemorrhagic septicaemia in fish such as yellowtail. The comparative analysis of genomes of a virulent strain Lg2 and a non-virulent strain ATCC 49156 of L. garvieae revealed that the two strains shared a high degree of sequence identity, but Lg2 had a 16.5-kb capsule gene cluster that is absent in ATCC 49156. The capsule gene cluster was composed of 15 genes, of which eight genes are highly conserved with those in exopolysaccharide biosynthesis gene cluster often found in Lactococcus lactis strains. Sequence analysis of the capsule gene cluster in the less virulent strain L. garvieae Lg2-S, Lg2-derived strain, showed that two conserved genes were disrupted by a single base pair deletion, respectively. These results strongly suggest that the capsule is crucial for virulence of Lg2. The capsule gene cluster of Lg2 may be a genomic island from several features such as the presence of insertion sequences flanked on both ends, different GC content from the chromosomal average, integration into the locus syntenic to other lactococcal genome sequences, and distribution in human gut microbiomes. The analysis also predicted other potential virulence factors such as haemolysin. The present study provides new insights into understanding of the virulence mechanisms of L. garvieae in fish. PMID:21829716

Oshima, Kenshiro; Yoshizaki, Mariko; Kawanishi, Michiko; Nakaya, Kohei; Suzuki, Takehito; Miyauchi, Eiji; Ishii, Yasuo; Tanabe, Soichi; Murakami, Masaru; Hattori, Masahira

2011-01-01

416

Life-threatening complications following multidose methotrexate for medical management of ectopic pregnancy.  

PubMed

A 25-year-old primigravida was diagnosed to be suffering from unruptured ectopic pregnancy. The serum ?-human chorionic gonadotropin levels were 2851 mIU/l and the ectopic gestational sac was 2.7×2.7 cm without any fetal pole. It was decided to manage her by expectant therapy. But she received medical therapy with multidose methotrexate because of misinterpretation of expectant therapy as medical therapy. She suffered from methotrexate toxicity, which manifested as high-grade fever, vomiting, melena, oral ulcerations, pneumonitis, subconjunctival haemorrhages and skin pigmentation. She developed severe third space fluid collection and shock, which was mistaken for rupture ectopic gestation. Her haematological picture showed severe neutropaenia and thrombocytopaenia which confirmed the clinical picture to be due to methotrexate toxicity. She also developed septicaemia and candidal infection secondary to immunosuppression. She was managed in intensive care unit with ventilatory support, high-dose leucovorin and injection filgastrim. She responded well to the therapy with dramatic recovery in 4 days. PMID:22922914

Dasari, Papa; Sagili, Haritha

2012-01-01

417

Development of an aquatic pathogen database (AquaPathogen X) and its utilization in tracking emerging fish virus pathogens in North America  

USGS Publications Warehouse

The AquaPathogen X database is a template for recording information on individual isolates of aquatic pathogens and is freely available for download (http://wfrc.usgs.gov). This database can accommodate the nucleotide sequence data generated in molecular epidemiological studies along with the myriad of abiotic and biotic traits associated with isolates of various pathogens (e.g. viruses, parasites and bacteria) from multiple aquatic animal host species (e.g. fish, shellfish and shrimp). The cataloguing of isolates from different aquatic pathogens simultaneously is a unique feature to the AquaPathogen X database, which can be used in surveillance of emerging aquatic animal diseases and elucidation of key risk factors associated with pathogen incursions into new water systems. An application of the template database that stores the epidemiological profiles of fish virus isolates, called Fish ViroTrak, was also developed. Exported records for two aquatic rhabdovirus species emerging in North America were used in the implementation of two separate web-accessible databases: the Molecular Epidemiology of Aquatic Pathogens infectious haematopoietic necrosis virus (MEAP-IHNV) database (http://gis.nacse.org/ihnv/) released in 2006 and the MEAP- viral haemorrhagic septicaemia virus (http://gis.nacse.org/vhsv/) database released in 2010.

Emmenegger, E.J.; Kentop, E.; Thompson, T.M.; Pittam, S.; Ryan, A.; Keon, D.; Carlino, J.A.; Ranson, J.; Life, R.B.; Troyer, R.M.; Garver, K.A.; Kurath, G.

2011-01-01

418

Motor skills in extremely low birthweight children at the age of 6 years.  

PubMed

Fifty three children aged 6 years old who had weighed less than 1251 g at birth without cerebral palsy and receiving mainstream education, were entered into a controlled study of motor skills. The index and control children were matched by age, sex, and school. The index group were considered by their teachers to have similar academic performances to their index group were considered by their teachers to have similar academic performances to their controls, although two index cases were receiving remedial teaching. On the test of motor impairment extremely low birthweight children had significantly more motor difficulties than controls. In addition, the index group had more minor neurological signs, lower intelligence quotients, and more adverse behavioural traits. The higher motor impairment scores among index children were independent of differences in intelligence quotient between the two groups. There was no association between impairment score and the presence or degree of periventricular haemorrhage or periventricular leucomalacia on neonatal cerebral ultrasound. Children with Apgar scores at five minutes of less than 7 had significantly higher impairment scores compared with those whose scores were 7 or more. Three perinatal factors (Apgar score at five minutes, neonatal septicaemia, and abnormal movements) explained 32% of the variance in impairment score at the age of 6 years. In children who do not have cerebral palsy perinatal factors may still be important in the development of motor skills. The presence of subtle neuromotor impairments at 6 years of age has implications for schooling that need further evaluation. PMID:2476079

Marlow, N; Roberts, B L; Cooke, R W

1989-06-01

419

Vibrio anguillarum colonization of rainbow trout integument requires a DNA locus involved in exopolysaccharide transport and biosynthesis.  

PubMed

Vibrio anguillarum, part of the normal flora of the aquatic milieu, causes a fatal haemorrhagic septicaemia in marine fish. In this study, a rainbow trout model was used to characterize the colonization of fish skin by V. anguillarum. Within 5 h after infection, the bacterium penetrated the skin mucosal layer, attached to the scales within 12 h, and formed a biofilm by 24-48 h. Two divergently transcribed putative operons, orf1-wbfD-wbfC-wbfB and wza-wzb-wzc, were shown to play a role in skin colonization and virulence. The first operon encodes proteins of unknown function. The wza-wzb-wzc genes encode a secretin, tyrosine kinase and tyrosine phosphatase, respectively, which are similar to proteins in polysaccharide transport complexes. Compared with the wild type, polar mutations in wza, orf1 and wbfD caused a decrease in exopolysaccharide biosynthesis but not lipopolysaccharide biosynthesis. The wza and orf1 mutants did not attach to fish scales; whereas, the wbfD mutant had a wild-type phenotype. Moreover, the wza and orf1 mutants had decreased exoprotease activity, in particular the extracellular metalloprotease EmpA, as well as mucinase activity suggesting that these mutations also affect exoenzyme secretion. Thus, the exopolysaccharide transport system in V. anguillarum is required for attachment to fish skin, possibly preventing mechanical removal of bacteria via natural sloughing of mucus. PMID:17222135

Croxatto, Antony; Lauritz, Johan; Chen, Chang; Milton, Debra L

2007-02-01

420

Persistence of viral RNA in fish infected with VHSV-IVb at 15°C and then moved to warmer temperatures after the onset of disease.  

PubMed

Smallmouth bass, Micropterus dolomieu Lacepède, bluegill, Lepomis macrochirus Rafinesque (coppernose strain), koi carp, Cyprinus carpio L., and channel catfish Ictalurus punctatus (Rafinesque), were infected by intraperitoneal injection with viral haemorrhagic septicaemia virus genotype IVb (VHSV-IVb) at 15?°C. When clinical signs of disease developed, one-third of the fish was moved to 20°C and one-third to 25°C. Mortality in challenged fish at all three temperatures ranged from 25 to 45% in smallmouth bass and from 70 to 90% in bluegill. No koi carp or channel catfish died during the study. Viral copy numbers detected by quantitative real-time reverse transcriptase PCR (qrt-RTPCR) in fish dying at 20 and 25°C decreased over time. In survivors of the challenge, viral copy numbers were higher in the more susceptible species (smallmouth bass and bluegill) than in the more VHSV-IVb disease-resistant species (koi carp and channel catfish). In fish surviving 28days post-infection, prevalence of infection was 66-100% depending on species and temperature, and VHSV-IVb was detected at 10(3) -10(5) copies ?g(-1) host RNA. Our results show that qrt-RTPCR is a useful tool to investigate fish kills even 28days after temperatures are elevated above those known to be permissive for VHSV replication. PMID:22582793

Goodwin, A E; Merry, G E; Noyes, A D

2012-07-01