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Sample records for acute disseminated intravascular

  1. Acute Disseminated Intravascular Coagulation in Neuroendocrine Carcinoma

    PubMed Central

    Teh, Ru-Wen; Tsoi, Daphne T.

    2012-01-01

    Malignancy is a common cause of disseminated intravascular coagulation and usually presents as a chronic disorder in solid organ tumours. We present a rare case of recurrent acute disseminated intravascular coagulation in neuroendocrine carcinoma after manipulation, firstly, by core biopsy and, later, by cytotoxic therapy causing a release of procoagulants and cytokines from lysed tumour cells. This is reminiscent of tumour lysis syndrome where massive quantities of intracellular electrolytes and nucleic acid are released, causing acute metabolic imbalance and renal failure. This case highlights the potential complication of acute disseminated intravascular coagulation after trauma to malignant cells. PMID:23139666

  2. Disseminated intravascular coagulation and acute myocardial necrosis caused by lightning.

    PubMed

    Ekoé, J M; Cunningham, M; Jaques, O; Balague, F; Baumann, R P; Humair, L; de Torrenté, A

    1985-01-01

    A 24-year-old woman was struck by lightning and suffered 20% second degree burns. She was admitted after cardiac and respiratory arrest. Despite intensive supportive care she died 24 h later of cardiogenic shock complicated by disseminated intravascular coagulation. At autopsy there was myocardial necrosis. Disseminated intravascular coagulation and myocardial necrosis are only rarely described as complications of lightning.

  3. Acute kidney injury and disseminated intravascular coagulation due to mercuric chloride poisoning

    PubMed Central

    Dhanapriya, J.; Gopalakrishnan, N.; Arun, V.; Dineshkumar, T.; Sakthirajan, R.; Balasubramaniyan, T.; Haris, M.

    2016-01-01

    Mercury is a toxic heavy metal and occurs in organic and inorganic forms. Inorganic mercury includes elemental mercury and mercury salts. Mercury salts are usually white powder or crystals, and widely used in indigenous medicines and folk remedies in Asia. Inorganic mercury poisoning causes acute kidney injury (AKI) and gastrointestinal manifestations and can be life-threatening. We describe a case with unknown substance poisoning who developed AKI and disseminated intravascular coagulation (DIC). Renal biopsy showed acute tubular necrosis. Later, the consumed substance was proven to be mercuric chloride. His renal failure improved over time, and his creatinine normalized after 2 months. PMID:27194836

  4. [Disseminated intravascular coagulation and acute kidney injury requiring renal replacement therapy after diagnostic amniocentesis].

    PubMed

    Ratković, Marina; Bašić-Jukić, Nikolina; Gledović, Branka; Radunović, Danilo

    2014-04-01

    Disseminated intravascular coagulation (DIC) is a very rare complication of amniocentesis. We present a case of a 33-year-old patient who developed DIC with acute respiratory distress syndrome and acute kidney injury after diagnostic amniocentesis. The patient required replacement of renal function for 59 days with continuous venovenous hemodiafiltration and later with hemodialysis. She was treated with heparin, fresh frozen plasma, platelets and cryoprecipitate. Her condition was further complicated with the development of intracranial hematoma. After 67 days of hospitalization, she was discharged from the hospital with serum creatinine 337 μmol/L. Three years later, her serum creatinine was 102 μmol/L, and she is currently in the 7th month of pregnancy.

  5. Thromboemboli, acute right heart failure and disseminated intravascular coagulation after intraoperative application of a topical hemostatic matrix.

    PubMed

    Ferschl, Marla B; Rollins, Mark D

    2009-02-01

    Topical hemostatic agents are frequently used in spine surgeries to control or reduce bleeding. Although there are a number of commercially available products, at our institution, an absorbable gelatin powder (Surgifoam) is mixed with bovine thrombin and used for this purpose. We report the case of a patient undergoing a posterior spinal fusion for scoliosis who developed acute right heart failure, cardiac arrest, and disseminated intravascular coagulation after probable intravascular hemostatic agent-induced emboli. Clinicians need to be aware of this potentially deadly complication associated with topical hemostatic agents.

  6. [Role of genetic polymorphisms of the hemostatic system in the development of multiple organ dysfunctions in acute disseminated intravascular coagulation].

    PubMed

    Vorob'eva, N A; Kapustin, S I

    2007-01-01

    The paper deals with the hereditary predisposition of the hemostatic system to the severe course of acute disseminated intravascular coagulation (DIC). The results of evaluation of some types of genetic polymorphisms of the factors of coagulation and of the fibrinolytic system are recent and important for clinical application. Analysis of mortality in the fulminant course of acute DIC showed significant differences in the detection rates of the variants of genetic polymorphism in the type I plasminogen activator inhibitor gene, which is indicative of the possible genetic determination of acute DIC.

  7. Shock, acute disseminated intravascular coagulation, and microvascular thrombosis: is 'shock liver' the unrecognized provocateur of ischemic limb necrosis?

    PubMed

    Warkentin, T E; Pai, M

    2016-02-01

    For unknown reasons, a small minority of critically ill patients with septic or cardiogenic shock, multiorgan failure, and disseminated intravascular coagulation develop symmetrical acral (distal extremity) limb loss due to microvascular thrombosis ('limb gangrene with pulses'). Case reports have described preceding 'shock liver' in some critically ill patients who developed such a picture of ischemic limb necrosis. This suggests that profoundly disturbed procoagulant-anticoagulant balance featuring uncontrolled generation of thrombin-resulting from failure of the protein C and antithrombin natural anticoagulant systems due to insufficient hepatic synthesis of these crucial proteins-could explain the microvascular thrombosis and associated limb loss. We hypothesize that shock liver is the key predisposing risk factor underlying ischemic limb necrosis in the majority of patients who develop this complication in the setting of acute disseminated intravascular coagulation complicating septic or cardiogenic shock. As shock liver precedes onset of limb ischemia by several days, therapeutic intervention may be possible.

  8. [A case of cat-scratch-induced Pasteurella multocida infection presenting with disseminated intravascular coagulation and acute renal failure].

    PubMed

    Fukuchi, Takahiko; Morisawa, Yuji

    2009-09-01

    Domestic animals are the main reservoirs of Pasteurella species for human zoonosis due to bites and scratches. Pasterurella multocida may cause serious soft-tissue infection and, less commonly, sepsis or septic shock, particularly in insufficient initial therapy and an immunocompromised host. We report a case of cat-scratch-induced P. multocida infection, presenting with disseminated intravascular coagulation and acute renal failure. A febrile 83-year-old woman with consciousness disturbance and a subcutaneous left-foot abscess due to a scratch from a pet cat. She was successfully treated with antibiotic piperacillin and clindamycin therapy and aggressive wound drainage.

  9. Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? An observational study

    PubMed Central

    2011-01-01

    Introduction It is debated whether early trauma-induced coagulopathy (TIC) in severely injured patients reflects disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype, acute coagulopathy of trauma shock (ACoTS) or yet other entities. This study investigated the prevalence of overt DIC and ACoTS in trauma patients and characterized these conditions based on their biomarker profiles. Methods An observational study was carried out at a single Level I Trauma Center. Eighty adult trauma patients (≥18 years) who met criteria for full trauma team activation and had an arterial cannula inserted were included. Blood was sampled a median of 68 minutes (IQR 48 to 88) post-injury. Data on demography, biochemistry, injury severity score (ISS) and mortality were recorded. Plasma/serum was analyzed for biomarkers reflecting tissue/endothelial cell/glycocalyx damage (histone-complexed DNA fragments, Annexin V, thrombomodulin, syndecan-1), coagulation activation/inhibition (prothrombinfragment 1+2, thrombin/antithrombin-complexes, antithrombin, protein C, activated protein C, endothelial protein C receptor, protein S, tissue factor pathway inhibitor, vWF), factor consumption (fibrinogen, FXIII), fibrinolysis (D-dimer, tissue-type plasminogen activator, plasminogen activator inhibitor-1) and inflammation (interleukin (IL)-6, terminal complement complex (sC5b-9)). Comparison of patients stratified according to the presence or absence of overt DIC (International Society of Thrombosis and Hemostasis (ISTH) criteria) or ACoTS (activated partial thromboplastin time (APTT) and/or international normalized ratio (INR) above normal reference). Results No patients had overt DIC whereas 15% had ACoTS. ACoTS patients had higher ISS, transfusion requirements and mortality (all P < 0.01) and a biomarker profile suggestive of enhanced tissue, endothelial cell and glycocalyx damage and consumption coagulopathy with low protein C, antithrombin, fibrinogen and FXIII levels

  10. Sepsis and disseminated intravascular coagulation in an eastern spiny softshell turtle (Apalone spinifera spinifera) with acute mycobacteriosis.

    PubMed

    Murray, Maureen; Waliszewski, Nicole T; Garner, Michael M; Tseng, Florina S

    2009-09-01

    An adult, captive eastern spiny softshell turtle (Apalone spinifera spinifera) was examined for a 4-day history of lethargy and plastron discoloration. The turtle was obtunded and had pale mucous membranes, hemorrhagic nasal discharge, and petechiae on all limbs. The turtle was euthanized due to its grave condition. Necropsy revealed hemorrhagic coelomic effusion, petechiae on the serosal surfaces of the intestinal tract, and bilaterally hemorrhagic lungs. Histologic examination revealed numerous emboli of bacteria associated with fibrinocellular thrombi throughout the blood vessels of multiple tissues. The bacteria in the thrombi were slender bacilli that stained intensely acid fast. Culture of the coelomic fluid yielded Mycobacterium chelonae. Although mycobacteriosis in reptiles is typically a chronic, granulomatous disease, this case demonstrates that mycobacteriosis should be considered in reptiles presenting with acute, nongranulomatous disease. This case also describes clinically apparent hemorrhage due to disseminated intravascular coagulation, which is rarely described in chelonians.

  11. Acute kidney injury due to menstruation-related disseminated intravascular coagulation in an adenomyosis patient: a case report.

    PubMed

    Son, Jungmin; Lee, Dong Won; Seong, Eun Young; Song, Sang Heon; Lee, Soo Bong; Kang, Jin; Yang, Byeong Yun; Lee, Su Jin; Choi, Jong-Ryeol; Lee, Kyu-Sup; Kwak, Ihm Soo

    2010-09-01

    The authors report a case of acute kidney injury (AKI) resulting from menstruation-related disseminated intravascular coagulation (DIC) in an adenomyosis patient. A 40-yr-old woman who had received gonadotropin for ovulation induction therapy presented with anuria and an elevated serum creatinine level. Her medical history showed primary infertility with diffuse adenomyosis. On admission, her pregnancy test was negative and her menstrual cycle had started 1 day previously. Laboratory data were consistent with DIC, and it was believed to be related to myometrial injury resulting from heavy intramyometrial menstrual flow. Gonadotropin is considered to play an important role in the development of fulminant DIC. This rare case suggests that physicians should be aware that gonadotropin may provoke fulminant DIC in women with adenomyosis.

  12. Early thrombomodulin-α administration outcome for acute disseminated intravascular coagulopathy in gastrointestinal surgery

    PubMed Central

    Konishi, Hirotaka; Okamoto, Kazuma; Shoda, Katsutoshi; Arita, Tomohiro; Kosuga, Toshiyuki; Morimura, Ryo; Komatsu, Shuhei; Murayama, Yasutoshi; Shiozaki, Atsushi; Kuriu, Yoshiaki; Ikoma, Hisashi; Nakanishi, Masayoshi; Ichikawa, Daisuke; Fujiwara, Hitoshi; Otsuji, Eigo

    2017-01-01

    AIM To investigate the efficacy of thrombomodulin (TM)-α for treatment of disseminated intravascular coagulopathy (DIC) in the field of gastrointestinal surgery. METHODS Thirty-six peri-operative DIC patients in the field of gastrointestinal surgery who were treated with TM-α were retrospectively investigated. The relationships between patient demographics and the efficacy of TM-α were examined. Analysis of survival at 28 d was also performed on some parameters by means of the Kaplan-Meier method. Relationships between the initiation of TM-α and patient demographics were also evaluated. RESULTS Abscess formation or bacteremia was the most frequent cause of DIC (33%), followed by digestive tract perforation (31%). Twenty-six patients developed DIC after surgery, frequently within 1 wk (81%). TM-α was most often administered within 1 d of the DIC diagnosis (72%) and was continued for more than 3 d (64%). Although bleeding tendency was observed in 7 patients (19%), a hemostatic procedure was not needed. DIC scores, systemic inflammatory response syndrome (SIRS) scores, quick-sequential organ failure assessment (qSOFA) scores, platelet counts, and prothrombin time ratios significantly improved after 1 wk (P < 0.05, for all). The overall survival rate at 28 d was 71%. The duration of TM-α administration (≥ 4 , ≤ 6) and improvements in DIC-associated scores (DIC, SIRS and qSOFA) at 1 wk were significantly better prognostic factors for 28-d survival (P < 0.05, for all). TM-α was administered significantly earlier to patients with severe clinical symptoms, such as high qSOFA scores, sepsis, shock or high lactate values (P < 0.05, for all). CONCLUSION Early administration of TM-α and improvements in each parameter were essential for treatment of DIC. The diagnosis of patients with mild symptoms requires further study. PMID:28223734

  13. Evaluation of the safety and efficacy of recombinant soluble thrombomodulin for patients with disseminated intravascular coagulation associated with acute leukemia: multicenter prospective study by the Tohoku Hematology Forum.

    PubMed

    Yokoyama, Hisayuki; Takahashi, Naoto; Katsuoka, Yuna; Inomata, Mitsue; Ito, Toshihiro; Meguro, Kuniaki; Kameoka, Yoshihiro; Tsumanuma, Riko; Murai, Kazunori; Noji, Hideyoshi; Ishizawa, Kenichi; Ito, Shigeki; Onishi, Yasushi; Harigae, Hideo

    2017-02-07

    It has been suggested that use of recombinant soluble thrombomodulin (rTM) is superior to conventional drugs in treatment of disseminated intravascular coagulation (DIC) complicating acute leukemia. However, its safety and efficacy have not been fully examined in prospective studies. Here, we performed a multicenter prospective study to examine outcomes of rTM treatment for DIC in patients with acute leukemia. Of 33 patients registered in this study, 13 had acute myeloid leukemia (AML), three had acute lymphoblastic leukemia (ALL), and 17 had acute promyelocytic leukemia (APL). The cumulative rates of DIC resolution at day 7 and day 35 were 56 and 81% in AML/ALL and 53 and 77% in APL, respectively. The median time from the initiation of rTM to DIC resolution was 4 days in AML/ALL and 6 days in APL patients. Adverse events related to hemorrhage occurred in two AML/ALL patients (13%) and three APL patients (18%). Of these, one AML/ALL patient died with intracranial hemorrhage, and two APL patients died with intracranial hemorrhage and pulmonary hemorrhage. These results suggest that rTM may improve the survival of acute leukemia patients with DIC by inhibiting early death related to hemorrhagic events, as reported previously.

  14. Hypothesis: Disseminated Intravascular Inflammation as the Inflammatory Counterpart to Disseminated Intravascular Coagulation

    NASA Astrophysics Data System (ADS)

    Bull, Brian S.; Bull, Maureen H.

    1994-08-01

    We have identified a leukocyte activation syndrome that is occasionally associated with the transfusion of intraoperatively recovered erythrocytes. This syndrome appears to result from intravascular damage caused by leukocytes activated during the erythrocyte salvage process. We hypothesize that this syndrome is part of a larger disease grouping: disseminated intravascular inflammation (DII). DII is the analog of the coagulation disorder disseminated intravascular coagulation. In disseminated intravascular coagulation, the organ damage results from uncontrolled activation of the clotting pathway; in DII the damage is caused by leukocytes that have become activated by direct contact with bacteria or in rare instances-such as erythrocyte salvage-in the absence of bacteria and bacterial products. Recent studies of the hazards associated with intraoperative blood salvage indicate that activation of leukocytes can be achieved by exposure to activated platelets alone. If such activated leukocytes are reinfused along with the washed erythrocytes, widespread organ damage may result. The lung is the organ most severely affected by activated leukocytes. Adult respiratory distress syndrome is one outcome. It is likely that DII is a presently unrecognized pathophysiological process that complicates a variety of primary disease states and increases their lethality.

  15. Quinine-Induced Disseminated Intravascular Coagulation

    PubMed Central

    2016-01-01

    Every drug comes with some side effect. It is the benefit/risk ratio that determines the medical use of the drug. Quinine, a known antimalarial drug, has been used for nocturnal leg cramps since the 1930s; it is associated with severe life-threatening hematological and cardiovascular side effects. Disseminated intravascular coagulation (DIC), albeit rare, is a known coagulopathy associated with Quinine. It is imperative to inquire about the Quinine intake in medication history in patients with coagulopathy, as most patients still consider it a harmless home remedy for nocturnal leg cramps. In this report, we present a case of coagulopathy in a middle-aged woman, who gave a history of taking Quinine for nocturnal leg cramps, as her home remedy. Early identification of the offending agent led to the diagnosis, prompt discontinuation of the medication, and complete recovery and prevented the future possibility of recurrence. PMID:27293443

  16. Prostate cancer: beware of disseminated intravascular coagulation

    PubMed Central

    Desai, Mihir; John, Babbin; Evans, Gillian; Eddy, Ben

    2015-01-01

    Disseminated intravascular coagulation (DIC) is a pathological systemic condition resulting from aberrant activation of the coagulation system. It is characterised by the release and activation of procoagulants into the blood, with an associated consumption coagulopathy. Its association with solid and haematological malignancies is well described in literature. This case describes an elderly man, known to have prostate cancer, who following transurethral resection of the prostate developed DIC with haematuria, spontaneous ecchymoses and mucosal bleeding. Subsequent investigations revealed a prostate-specific antigen (PSA) >1000 µg/L, and staging CT showed multiple sclerotic metastatic lesions affecting the thoracic and lumbar vertebra, as well as infiltration into his left femur. Coagulation normalised with blood products and vitamin K within 1 week, and the patient responded to antiandrogen therapy with a reduction in pain and PSA on discharge. PMID:25819815

  17. The thromboelastometric discrepancy between septic and trauma induced disseminated intravascular coagulation diagnosed by the scoring system from the Japanese association for acute medicine

    PubMed Central

    Koami, Hiroyuki; Sakamoto, Yuichiro; Sakurai, Ryota; Ohta, Miho; Imahase, Hisashi; Yahata, Mayuko; Umeka, Mitsuru; Miike, Toru; Nagashima, Futoshi; Iwamura, Takashi; Yamada, Kosuke Chris; Inoue, Satoshi

    2016-01-01

    Abstract The aim of this study is to evaluate the hematological differences between septic and traumatic disseminated intravascular coagulation (DIC) using the rotational thromboelastometry (ROTEM). This retrospective study includes all sepsis or severe trauma patients transported to our emergency department who underwent ROTEM from 2013 to 2014. All patients were divided into 2 groups based on the presence of DIC diagnosed by the Japanese Association for Acute Medicine (JAAM) DIC score. We statistically analyzed the demographics, clinical characteristics, laboratory data, ROTEM findings (EXTEM and FIBTEM), and outcome. Fifty-seven patients (30 sepsis and 27 severe trauma) were included in primary analysis. Sepsis cases were significantly older and had higher systemic inflammatory response syndrome (SIRS) scores, whereas there were no significant differences in other parameters including Acute Physiology and Chronic Health Evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score. Twenty-six patients (14 sepsis and 12 severe trauma) were diagnosed with DIC. The Septic DIC (S-DIC) group was significantly older and had higher DIC scores than the traumatic DIC (T-DIC) group. Hematologic examination revealed significantly higher CRP, fibrinogen, lower FDP, DD, and higher FDP/DD ratio were found in the S-DIC group in comparison with the T-DIC group. ROTEM findings showed that the A10, A20, and MCF in the FIBTEM test were significantly higher in the S-DIC group. However, no statistical differences were confirmed in the LI30, LI45, and ML in EXTEM test. The plasma fibrinogen level and fibrinogen based clot firmness in whole-blood test revealed statistical significance between septic and traumatic DIC patients. PMID:27495106

  18. [Intravascular lymphoma causing acute abdomen].

    PubMed

    Kröber, S M

    2007-02-01

    A 65-year old man presented with acute abdominal pain and fever. The initial diagnosis was small bowel gangrene. Pathology revealed small to large abdominal vessels obliterated by cells of intravascular B-cell-lymphoma (IVL). Visceral IVL involvement is common at autopsy but rarely reported in patients with acute abdomen. The subtype of diffuse large B-cell lymphoma is a rare and aggressive malignancy, which in typical cases is characterized by cephalic or cutaneous manifestation. Few cases showed involvement of large vessels which in combination to fibrin thrombi may lead to infarction of the organ involved. Thus IVL should be considered in cases of ischemic diseases with fever of unknown origin.

  19. [Kidney donor with severe disseminated intravascular coagulation: transplantation however successful].

    PubMed

    Keeris, Lodewijk M; Bergmans, Dennis C J J; van der Sande, Frank M; Wind, Tineke J; van Suylen, Robert Jan; van Mook, Walther N K A

    2009-01-01

    A 41-year-old male, with no previous medical history, was admitted to our intensive care unit with severe isolated neurotrauma and a Glasgow Coma Scale of E1-M1-V1, mid-dilated unreactive pupils and severe abnormalities on the brain CT-scan. A severe syndrome of disseminated intravascular coagulation (DIC) and non-oliguric renal insufficiency developed. Following clinical and neurophysiological examination the patient was declared brain-dead, and the family gave permission for organ donation. The left kidney was transplanted and functioned well immediately. However, in view of the DIC and renal function disorders the right kidney was not considered usable for transplantation elsewhere. Pathological examination revealed many fibrin thrombi in the glomerular capillaries and acute tubular necrosis. This case supports the view that thrombotic microangiopathy in kidneys of patients with DIS, even with renal function impairment, is not an a priori reason for excluding donation.

  20. Extremely refractory Kawasaki disease with disseminated intravascular coagulation.

    PubMed

    Koh, Young Kwon; Lee, Jae Hee; Park, Yeong Bong

    2017-03-07

    Disseminated intravascular coagulation is a rare complication of Kawasaki disease and appears in <0.1% of Kawasaki disease patients. We report a case of refractory Kawasaki disease complicated with disseminated intravascular coagulation and giant coronary aneurysm. A 5-month-old boy presented with Kawasaki disease with coagulopathy. Although the coagulopathy improved after fresh-frozen plasma and antithrombin-III administration, the fever persisted despite two rounds of intravenous immunoglobulin, along with intravenous methylprednisolone pulse therapy and infliximab administration. Despite all efforts to treatment, the patient had giant coronary aneurysms and died suddenly.

  1. Acute Disseminated Encephalomyelitis.

    PubMed

    Gray, Matthew Philip; Gorelick, Marc H

    2016-06-01

    Acute disseminated encephalomyelitis is a primarily pediatric, immune-mediated disease characterized by demyelination and polyfocal neurologic symptoms that typically occur after a preceding viral infection or recent immunization. This article presents the pathophysiology, diagnostic criteria, and magnetic resonance imaging characteristics of acute disseminated encephalomyelitis. We also present evaluation and management strategies.

  2. Acute disseminated encephalomyelitis.

    PubMed

    Alper, Gulay

    2012-11-01

    Acute disseminated encephalomyelitis is an immune-mediated inflammatory and demyelinating disorder of the central nervous system, commonly preceded by an infection. It principally involves the white matter tracts of the cerebral hemispheres, brainstem, optic nerves, and spinal cord. Acute disseminated encephalomyelitis mainly affects children. Clinically, patients present with multifocal neurologic abnormalities reflecting the widespread involvement in central nervous system. Cerebrospinal fluid may be normal or may show a mild pleocytosis with or without elevated protein levels. Magnetic resonance image (MRI) shows multiple demyelinating lesions. The diagnosis of acute disseminated encephalomyelitis requires both multifocal involvement and encephalopathy by consensus criteria. Acute disseminated encephalomyelitis typically has a monophasic course with a favorable prognosis. Multiphasic forms have been reported, resulting in diagnostic difficulties in distinguishing these cases from multiple sclerosis. In addition, many inflammatory disorders may have a similar presentation with frequent occurrence of encephalopathy and should be considered in the differential diagnosis of acute disseminated encephalomyelitis.

  3. Choline or CDP-choline attenuates coagulation abnormalities and prevents the development of acute disseminated intravascular coagulation in dogs during endotoxemia.

    PubMed

    Yilmaz, Zeki; Ozarda, Yesim; Cansev, Mehmet; Eralp, Oya; Kocaturk, Meric; Ulus, Ismail H

    2010-06-01

    Sepsis/endotoxemia causes platelet dysfunctions, abnormalities in coagulation and hemostatic mechanisms leading to organ dysfunctions and mortality. Choline prevents organ injury and improves survival during endotoxemia. The main objective of the present study was to determine the effects of choline or cytidine-5'-diphosphocholine (CDP-choline) on endotoxin-induced activation of coagulation and development of disseminated intravascular coagulation (DIC). Dogs were treated intravenously (i.v.) with saline, choline (20 mg/kg), or CDP-choline (70 mg/kg) three times with 4-h intervals starting 5 min before i.v. injection of endotoxin (1 mg/kg). Platelet counts and functions, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, coagulation factors, D-dimer and antithrombin (AT) were measured before and at 0.5-96 h after endotoxin. Circulating platelet, fibrinogen, coagulation factors and AT were decreased, whereas PT and aPTT were prolonged and serum D-dimer levels were elevated after endotoxin. Endotoxin-induced reductions in platelet counts and functions, fibrinogen, coagulation factors and AT were attenuated or blocked by choline or CDP-choline. Choline or CDP-choline blocked endotoxin-induced prolongation in PT and aPTT and enhancement in D-dimer. Elevated DIC scores were attenuated by choline and blocked by CDP-choline. Choline administration increased serum choline concentrations and caused bradycardia. Choline also increased choline and acetylcholine contents of circulating mononuclear cells and inhibited radioligand binding to their cholinergic receptors. These data show that choline administration, as choline chloride or CDP-choline, restores the abnormalities in the primary, secondary, and tertiary hemostasis and prevents the development of DIC during experimental endotoxemia in dogs probably by increasing both neuronal and non-neuronal cholinergic activity.

  4. Disseminated Intravascular Coagulation after Surgery for Facial Injury

    PubMed Central

    Tachibana, Hirohiko; Ishikawa, Shigeo; Yusa, Kazuyuki; Kitabatake, Kenichirou; Iino, Mitsuyoshi

    2016-01-01

    A case of disseminated intravascular coagulation (DIC) presenting after surgery for facial trauma associated with multiple facial bone fractures is described. With regard to the oral and maxillofacial region, DIC has been described in the literature following head trauma, infection, and metastatic disease. Until now, only 5 reports have described DIC after surgery for facial injury. DIC secondary to facial injury is thus rare. The patient in this case was young and had no medical history. Preoperative hemorrhage or postoperative septicemia may thus induce DIC. PMID:27313913

  5. Eptifibatide-induced thrombocytopenia: with thrombosis and disseminated intravascular coagulation immediately after left main coronary artery percutaneous coronary angioplasty.

    PubMed

    Tempelhof, Michael W; Benzuly, Keith H; Fintel, Dan; Krichavsky, Marc Z

    2012-01-01

    Early clinical trials of eptifibatide did not show a significant association between eptifibatide and the development of thrombocytopenia, thrombosis, or disseminated intravascular coagulation. However, more recent literature has suggested a significant association between eptifibatide and the development of thrombocytopenia and thrombosis. Although the true incidence and the pathophysiology of these associations are unknown, the development of these events can be life-threatening. Herein, we describe the case of a patient who experienced acute onset of profound thrombocytopenia, developing thrombosis, pulmonary emboli, and disseminated intravascular coagulation. This paper adds to the few previous reports of cases that suggested an association between thrombocytopenia, thrombosis, and the administration of eptifibatide. To the best of our knowledge, this is the first case report in the medical literature that associates the new onset of thrombocytopenia, thrombosis, and disseminated intravascular coagulation with the administration of eptifibatide. We also provide a subject review.

  6. The syndrome of pneumococcemia, disseminated intravascular coagulation and asplenia.

    PubMed Central

    Kingston, M E; MacKenzie, C R

    1979-01-01

    A 58-year-old man who survived an episode of fulminant pneumococcal septicemia with disseminated intravascular coagulation had undergone splenectomy 23 years previously. In the literature there are 25 reported cases of fulminant septicemia and disseminated intravascular coagulation associated with asplenia in adults (excluding cases in which corticosteroid or immunosuppressive therapy was given). The pneumococcus was responsible for all of these cases as well. The mortality in this series was more than 90%, and death occurred within 24 hours of presentation at hospital in almost 70% of the fatal cases and was associated with high-density bacteremia and adrenal hemorrhage. Gram-staining of the buffy coat of the peripheral blood or the exudate from purpuric skin lesions was carried out in only 6 of the 26 cases but yielded positive results in all but 1. It is concluded that a diagnosis of septicemia in asplenic adults can be established within a short time of presentation on the basis of statistical probability and the results of Gram-staining of the peripheral blood and exudate from the skin lesions. Prevention appears to be the cornerstone of management because of the variable interval from splenectomy to the onset of the syndrome and the high mortality. Images FIG. 1 PMID:38002

  7. A short contemporary history of disseminated intravascular coagulation.

    PubMed

    Levi, Marcel; van der Poll, Tom

    2014-11-01

    Disseminated intravascular coagulation (DIC) is a syndrome characterized by systemic intravascular activation of coagulation, leading to a widespread deposition of fibrin in the circulation. There is ample experimental and pathological evidence that the fibrin deposition contributes to multiple organ failure. The massive and ongoing activation of coagulation may result in depletion of platelets and coagulation factors, which may cause bleeding (consumption coagulopathy). The syndrome of DIC is well known in the medical literature for centuries, although a more precise description of the underlying mechanisms had to await the 20th century. Initial ideas on a role of the contact activation system as the primary trigger for the systemic activation of coagulation as well as a presumed hyperfibrinolytic response in DIC have been found to be misconceptions. Experimental and clinical evidence now indicate that the initiation of coagulation in DIC is caused by tissue factor expression, which in combination with downregulated physiological anticoagulant pathways and impaired fibrinolysis leads to widespread fibrin deposition. In addition, an extensive bidirectional interaction between coagulation and inflammation may further contribute to the pathogenesis of DIC.

  8. Advanced Congestive Heart Failure Associated With Disseminated Intravascular Coagulopathy.

    PubMed

    Sarcon, Annahita; Liu, Xiaoli; Ton, David; Haywood, James; Hitchcock, Todd

    2015-01-01

    Background. Disseminated intravascular coagulopathy (DIC) is a complication of an underlying disease and not a primary illness. It is most commonly associated with sepsis, trauma, obstetrical complications, and malignancies. There are very few cases in the literature illustrating the association between DIC and congestive heart failure. Findings. In this report, we present a case of severe congestive heart failure, leading to biventricular thrombi and subsequently DIC. Conclusion. We suggest that the association between congestive heart failure and DIC is an underrecognized one. Congestive heart failure continues to remain a major cause of morbidity and mortality despite advances in medical therapies. Thus far, the precise role of coagulation factors in congestive heart failure is unknown. Further investigations are needed to elucidate the pathophysiology of congestive heart failure and coagulation factors.

  9. Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management.

    PubMed

    Erez, Offer; Mastrolia, Salvatore Andrea; Thachil, Jecko

    2015-10-01

    Disseminated intravascular coagulation (DIC) is a life-threatening situation that can arise from a variety of obstetrical and nonobstetrical causes. Obstetrical DIC has been associated with a series of pregnancy complications including the following: (1) acute peripartum hemorrhage (uterine atony, cervical and vaginal lacerations, and uterine rupture); (2) placental abruption; (3) preeclampsia/eclampsia/hemolysis, elevated liver enzymes, and low platelet count syndrome; (4) retained stillbirth; (5) septic abortion and intrauterine infection; (6) amniotic fluid embolism; and (7) acute fatty liver of pregnancy. Prompt diagnosis and understanding of the underlying mechanisms of disease leading to this complication in essential for a favorable outcome. In recent years, novel diagnostic scores and treatment modalities along with bedside point-of-care tests were developed and may assist the clinician in the diagnosis and management of DIC. Team work and prompt treatment are essential for the successful management of patients with DIC.

  10. Trombocytopenia: one of the markers of disseminated intravascular coagulation.

    PubMed

    Ten Cate, Hugo

    Disseminated intravascular coagulation (DIC) is a complication of a variety of severe underlying diseases and a contributing factor in multi-organ failure and death. DIC is diagnosed on the basis of clinical findings (organ failure, bleeding) and laboratory abnormalities. The laboratory data include (repeated) measurements of platelet count and global clotting tests, to which more specific and sensitive tests for activated coagulation are added. The focus of this paper is on thrombocytopenia (platelet count < 100 x 103/microl) as a marker in DIC. First, in patients with suspected DIC it is imperative to consider alternative causes of thrombocytopenia,such as related to heparin use (heparin induced thrombocytopenia II) or thrombocytopenic purpura. Second, the observation of thrombocytopenia in relation to DIC should be interpreted as a marker of advanced or overt DIC and not as an early indicator. According to recommended guidelines measurements of platelet counts should always be coupled to a panel of coagulation markers and not be used as single marker of DIC (or other syndromes). In general, thrombocytopenia should not trigger platelet transfusions except in patients with severe bleeding complications.

  11. Rifampicin-induced disseminated intravascular coagulation in pulmonary tuberculosis treatment

    PubMed Central

    Chen, Guo; He, Jian-Qing

    2017-01-01

    Abstract Rationale: Disseminated intravascular coagulation (DIC) induced by daily rifampicin therapy is rare, especially the patient is absent of malignancy, severe infection, and prior exposure to rifampicin. Patient concerns: We report a case of DIC induced by daily rifampicin treatment for pulmonary tuberculosis. A 22-year-old, previously healthy man received an anti-tuberculosis therapy consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide on the daily dose recommended by the World Health Organization tuberculosis guidelines after a diagnosis of pulmonary tuberculosis. Two weeks later, he was transferred to the West China Hospital with nasal hemorrhage for 1 week, hematochezia, hematuria, and petechiae for 5 days. Diagnoses: Laboratory data and symptoms on admission indicated DIC. Interventions: The anti-tuberculosis drugs were discontinued after admission and he was initiated with targeted treatment for DIC, omeprazole and polyene hosphatidylcholine infusion, as well as nutrition supportive treatment. Five days after admission, ethambutol, moxifloxacin, and amikacin were added to the patient without further active hemorrhage. Eight days after admission, the platelet count had risen gradually. Isoniazid was administered on 24 days after admission, while his liver function tests and platelet counts returned to normal. No recurrence of DIC occurred. The diagnosis of rifampicin-induced DIC was confirmed. Outcomes: The patient recovered and left hospital with isoniazid, ethambutol, levofloxacin, and streptomycin after 4 weeks of hospitalization. There was no recurrence of DIC or hemorrhage during the 8 months of follow-up. The literature review revealed that there were 10 other cases of rifampicin-induced DIC. Only 4 cases received rifampicin on a daily basis for pulmonary tuberculosis treatment and the others were on intermittent dosing schedule for pulmonary tuberculosis or leprosy treatment. Lessons: As a rare adverse effect, DIC induced by

  12. Disseminated intravascular coagulation due to IgM-mediated autoimmune hemolytic anemia.

    PubMed

    Bleakly, N Teresa; Fontaine, Magali J; Pate, Lisa L; Sutherland, Scott M; Jeng, Michael

    2011-08-01

    Disseminated intravascular coagulation (DIC) due to red cell hemolysis has been previously attributed to transfusion-related hemolytic reactions, but not to autoimmune hemolytic anemia. We report a case of DIC in a child with complement-fixing IgM-mediated cold-agglutinin autoimmune hemolysis, which resulted in arterial thrombosis and gangrene of the upper and lower extremities.

  13. [Disseminated intravascular coagulation. Case series and literature review].

    PubMed

    Del Carpio-Orantes, Luis; García-Ortiz, Jorge José

    2014-01-01

    INTRODUCCIÓN: la coagulación intravascular diseminada es una entidad caracteriza por activación de la cascada de la coagulación y fibrinólisis endógena, que puede provocar la muerte. Nuestros objetivos fueron identificar la incidencia de coagulación intravascular diseminada, sus agentes etiológicos y la correlación entre la puntuación de la escala Apache II y la propuesta por la Sociedad Internacional de Trombosis y Hemostasia para el diagnóstico de esta entidad. MÉTODOS: estudio retrospectivo, observacional y descriptivo de pacientes atendidos en una unidad de cuidados intensivos en un periodo de 17 meses. Se analizó etiología, edad, sexo, conteo de plaquetas, coagulograma, niveles de fibrinógeno sérico y cuantificación del dímero D. Se calculó la puntuación de la escala propuesta por la Sociedad Internacional de Trombosis y Hemostasia y de la escala APACHE II.

  14. Current Pathological and Laboratory Considerations in the Diagnosis of Disseminated Intravascular Coagulation

    PubMed Central

    Alhamdi, Yasir; Abrams, Simon T.

    2016-01-01

    Systemically sustained thrombin generation in vivo is the hallmark of disseminated intravascular coagulation (DIC). Typically, this is in response to a progressing disease state that is associated with significant cellular injury. The etiology could be infectious or noninfectious, with the main pathophysiological mechanisms involving cross-activation among coagulation, innate immunity, and inflammatory responses. This leads to consumption of both pro- and anticoagulant factors as well as endothelial dysfunction and disrupted homeostasis at the blood vessel wall interface. In addition to the release of tissue plasminogen activator (tPA) and soluble thrombomodulin (sTM) following cellular activation and damage, respectively, there is the release of damage-associated molecular patterns (DAMPs) such as extracellular histones and cell-free DNA. Extracellular histones are increasingly recognized as significantly pathogenic in critical illnesses through direct cell toxicity, the promotion of thrombin generation, and the induction of neutrophil extracellular trap (NET) formation. Clinically, high circulating levels of histones and histone–DNA complexes are associated with multiorgan failure, DIC, and adverse patient outcomes. Their measurements as well as that of other DAMPs and molecular markers of thrombin generation are not yet applicable in the routine diagnostic laboratory. To provide a practical diagnostic tool for acute DIC, a composite scoring system using rapidly available coagulation tests is recommended by the International Society on Thrombosis and Haemostasis. Its usefulness and limitations are discussed alongside the advances and unanswered questions in DIC pathogenesis. PMID:27578502

  15. Distal polyneuropathy after canine heartworm disease therapy complicated by disseminated intravascular coagulation.

    PubMed

    Dillon, A R; Braund, K G

    1982-08-01

    A 3-year-old male Setter-type dog had a progressive distal sensorimotor polyneuropathy characterized by weakness, bilateral atrophy of distal appendicular musculature, and reduced response to tactile stimuli. The diagnosis of a distal axonopathy was supported by electromyographic findings of fibrillation potentials, positive sharp waves in distal limb muscles, and absence of evoked action potentials, myopathic changes of atrophic angular fibers, and myelinated nerve fiber depletion in distal parts of peripheral nerves. The neuropathy appeared 5 weeks after 38 days of heparin therapy for disseminated intravascular coagulation. The disseminated intravascular coagulation, a complication of thiacetarsamide therapy for heartworm disease, had resolved 40 days after the end of heparin therapy. The cause of the neuropathy was not determined.

  16. Thromboelastographic profile for a dog with hypocoagulable and hyperfibrinolytic phase of disseminated intravascular coagulopathy.

    PubMed

    Vilar-Saavedra, P; Hosoya, K

    2011-12-01

    The objective of this study is to report the use of thromboelastography as a diagnostic tool for the hyperfibrinolytic phase of disseminated intravascular coagulopathy in a dog with metastatic haemangiosarcoma. We established a cytological (i.e. fine needle aspirate) and histopathological (i.e. excisional surgical biopsy) diagnosis of haemangiosarcoma in a 10-year-old male castrated Bichon Frise with multiple dark purple dermoepidermal nodules on the ventral abdomen and medial stifle areas, multiple small pulmonary nodules and a solitary liver mass. The dog was treated with chemotherapy (AC protocol). Forty-nine days after completion of four treatment cycles, the dog was presented for recheck. Complete blood count revealed anaemia and mild thrombocytopenia. Chemistry profile showed no significant abnormalities. Analysis of haemostasis consisted of prolonged clotting times (prothrombin time, activated partial thromboplastin time), mild hypofibrinogenaemia and increased D-dimers. A presumptive diagnosis of disseminated intravascular coagulopathy was made. A re-calcified thromboelastography was simultaneously done to confirm the coagulopathy. Thromboelastographic tracings correlated with the plasma-based test results showing hypocoagulability (prolonged clotting times and prolonged thromboelastography clot kinetics; weaker clot with decreased fibrinogen levels, platelet count and lower thromboelastography tracing amplitude) and hyperfibrinolysis (increased D-dimers and increased D-dimers and increased thromboelastography lysis parameters). Based on these results, the dog was considered to be in the hyperfibrinolytic phase of disseminated intravascular coagulopathy. Results of the conventional haemostasis tests supported those obtained on thromboelastography. Humane euthanasia was performed because of poor prognosis and progressive disease, making further follow-up unavailable. As demonstrated in this case report, thromboelastography was found to be a helpful

  17. Comparison of Two Diagnostic Scores of Disseminated Intravascular Coagulation in Pregnant Women Admitted to the ICU

    PubMed Central

    Ducloy-Bouthors, Anne Sophie

    2016-01-01

    Objective To compare the validity of two previously published diagnostic scores of disseminated intravascular coagulation (DIC) in pregnant women admitted to ICU for an acute thrombotic or hemorrhagic complication of delivery and postpartum. Methods This was a population based retrospective study of 154 patients admitted to ICU for severe delivery and postpartum complications in a University Hospital. A recently published score (adapted to physiological changes of pregnancy and based on three components: platelet count, prothrombin time difference and fibrinogen) was compared to the International Society for Thrombosis and Hemostasis (ISTH) score (based on four components: platelet count, fibrinogen, prothrombin time, and fibrin related marker). Both scores were calculated at delivery, ICU admission (day 0), day 1 and day 2 during the postpartum ICU stay. The validity of both scores was assessed by comparison with the consensual and blinded analysis of two experts. The sensitivity, specificity, and area under the curve (AUC) of each score were calculated at each time and overall by generalized linear mixed model. The agreement between the two scores was evaluated by the Kappa coefficient. Results The new score had a sensitivity of 0.78, a specificity of 0.97 (p <0.01) and a global AUC of 96% while the ISTH score had a sensitivity of 0.31, a specificity of 0.99 and an AUC of 94% (p <0.01). The Kappa coefficient of correlation between both scores was 0.35. The lower sensitivity of the ISTH score was mainly explained by the lack of fibrinogen and fibrin-related peptides thresholds adapted to the physiological changes of coagulation induced by pregnancy. Conclusion The new DIC score seem highly discriminant in the subset of patients admitted to the ICU after delivery for an acute specific complication. The ISTH score is not recommended in pregnant women because of its poor sensitivity. PMID:27861597

  18. Risk of disseminated intravascular coagulation in patients with type 2 diabetes mellitus: retrospective cohort study

    PubMed Central

    Nogami, Kenichiro; Muraki, Isao; Imano, Hironori; Iso, Hiroyasu

    2017-01-01

    Objectives To determine quantitatively the association between type 2 diabetes mellitus (T2DM) and disseminated intravascular coagulation (DIC). Design Retrospective cohort study using a claims database. Setting Medical care institutions representing 9% of all secondary hospitals (acute care hospitals) in Japan. Participants In total, 797 324 admissions, comprising 435 354 patients aged 18–79 years at the time of admission, were enrolled between January 2010 and September 2014. All patients were diagnosed with diabetes or admitted to hospitals that provided laboratory data. Main outcome measures Incidence of DIC reported by physicians in claims data. Results Logistic regression analysis found that the risk of DIC was significantly higher in T2DM patients than in non-DM patients (fully adjusted OR: 1.39 (95% CI 1.32 to 1.45)), independent of age, sex, admission year and potential underlying diseases. The higher risk of DIC in T2DM patients was apparent in those who were treated with insulin within the 30-day period prior to admission (1.53 (1.37 to 1.72)). When stratified by the potential underlying diseases, the risk of DIC was higher in T2DM patients with non-septic severe infection (1.67 (1.41 to 1.97)) and with solid tumour (1.59 (1.47 to 1.72)) than in non-DM patients with those underlying diseases. The risk was similar between T2DM and non-DM patients with sepsis (0.98 (0.90 to 1.08)) and lower in T2DM patients with acute leukaemia (0.70 (0.59 to 0.84)). Conclusions T2DM was associated with a higher risk of DIC, particularly when recently treated with insulin, as well as among admissions with solid tumour or non-septic severe infection. PMID:28122835

  19. Massive Bleeding as the First Clinical Manifestation of Metastatic Prostate Cancer due to Disseminated Intravascular Coagulation with Enhanced Fibrinolysis

    PubMed Central

    Lopes, João Madeira; Victorino, Rui M. M.; Meneses Santos, João

    2016-01-01

    Disseminated intravascular coagulation (DIC) is the most frequent coagulation disorder associated with metastatic prostate adenocarcinoma. However, DIC with enhanced fibrinolysis as an initial presentation of prostate cancer is extremely rare. The appropriate treatment to control bleeding in these situations is challenging, controversial, and based on isolated case reports in the literature. A 66-year-old male presented at the emergency department with acute severe spontaneous ecchymoses localized to the limbs, laterocervical hematoma, and hemothorax. Prostate specific antigen level was 385 μg/L, bone scintigraphy revealed multiple bone metastases, and prostate biopsy confirmed adenocarcinoma (Gleason 9; 4 + 5). Laboratory investigation showed a pattern of enhanced fibrinolysis rather than the more common intravascular coagulation mechanism. Epsilon aminocaproic acid in monotherapy was initiated with a clear and rapid control of bleeding manifestations. This rare case of massive bleeding due to DIC with enhanced fibrinolysis as the first manifestation of prostate cancer suggests that in selected cases where the acute bleeding dyscrasia is clearly associated with a dominant fibrinolysis mechanism it is possible to use an approach of monotherapy with antifibrinolytics. PMID:27803823

  20. Helicobacter pylori Eradication Therapy for Thrombocytopenia after Surgery for Abdominal Aortic Aneurysm with Disseminated Intravascular Coagulation

    PubMed Central

    Akiyama, Daichi; Okada, Hiroshi; Date, Kazuma; Furukawa, Hiroshi; Takeda, Makoto

    2016-01-01

    Abdominal aortic aneurysm (AAA) is known to be rarely accompanied by disseminated intravascular coagulation (DIC). We report a case of AAA with DIC. An 81-year-old man with abdominal pain referred to our hospital. Computed tomography demonstrated an AAA (maximum diameter: 90 mm). The patient underwent a laparotomy, and an abdominal aorta replacement was performed. At the 3-month follow-up, the patient underwent Helicobacter pylori eradication treatment for 1 week. After treatment, the platelet count dramatically increased. The mechanism by which H. pylori eradication therapy improves hematological parameters has not been elucidated; however, this noninvasive treatment effectively resolved DIC associated with AAA. PMID:28018509

  1. Inflammatory abdominal aortic aneurysm followed by disseminated intravascular coagulation and immune thrombocytopenia.

    PubMed

    Machida, Hisanori; Kobayashi, Makoto; Taguchi, Hirokuni

    2002-11-01

    A 71-year-old man was diagnosed as having an abdominal aortic aneurysm when he was treated for idiopathic interstitial pneumonia (IIP). Three years later, he developed severe thrombocytopenia and had disseminated intravascular coagulation (DIC) that was associated with the inflammatory abdominal aortic aneurysm (IAAA). The coagulation abnormalities were corrected by low-molecular weight heparin, however the platelet count remained low. Bone marrow showed normocellularity with an increase of immature and mature forms of megakaryocytes. Platelet-associated IgG level was high. These findings suggested that the patient had severe thrombocytopenia caused by unusual complications of immune thrombocytopenic purpura and IAAA-associated DIC.

  2. Disseminated Intravascular Coagulation and Excessive Fibrinolysis (DIC XFL) Syndrome in Prostate Cancer: A Rare Complicated Disorder

    PubMed Central

    Hamzah, Azhar Bin Amir; Choo, Yew Maw; Saleem, Fahad; Verma, Ashutosh Kumar

    2017-01-01

    Disseminated Intravascular Coagulation (DIC) develops in patient with prostate cancer, which is manifested by systemic, intracranial, intracavitary or intracutaneous bleeding indicating uncompensated or excessive fibrinolysis (XFL). This case report is a description of a 61-year-old male with metastatic prostate cancer that progressed to manifest DIC. The condition is rare in clinical practice, and even rarer when is coupled with XFL. Treatment was mainly replenishing coagulation factors, platelets and controlling the disease progression with aggressive hormonal therapy. The patient progressed to coagulopathy further with fibrinolysis, hence leading to mortality. This case study discusses the pathophysiology of this complication and various methods to monitor the disease progression are discussed. PMID:28274032

  3. A Case of Hypereosinophilic Syndrome Presenting With Multiorgan Infarctions Associated With Disseminated Intravascular Coagulation

    PubMed Central

    Park, Sun-Mi; Park, Ji-Won; Kim, Sung-Min; Koo, Eun-Hee; Lee, Jin-Young; Lee, Chul-Su; Choi, Dong-Chull

    2012-01-01

    Thromboembolism is one of the most critical complications of hypereosinophilic syndrome (HES). We report here a case of multi-organ infarctions related to HES. A 23-year-old woman was referred to our hospital with hemoptysis. Not only pulmonary, but also renal and splenic infarctions were detected on computed tomography images. Blood tests showed profound peripheral eosinophilia. She was diagnosed with HES with disseminated intravascular coagulation (DIC). We initiated infusion of corticosteroids, which effectively suppressed peripheral eosinophilia. However, consumptive coagulopathy did not improve and intracerebral hemorrhage related to thrombosis then developed. Addition of interferon-alpha resulted in the correction of the DIC associated with HES. PMID:22548210

  4. Rash, disseminated intravascular coagulation and legionella: Episode 10 and a rewind into the past

    PubMed Central

    Thalanayar, Prashanth M.; Holguin, Fernando

    2015-01-01

    Legionella pneumophila is the most common cause of legionellosis and is one of the organisms causing atypical pneumonia. We report the presentation of disseminated intravascular coagulation (DIC) and skin rash in a single case of severe Legionella pneumonia. The unique clinical presentation of a diffuse rash diagnosed as purpura fulminans and the unpredictable variations encountered during the diagnostic work-up of the case make this write-up crucial. This article synthesizes all reported cases of L. pneumonia associated with cutaneous manifestations as well as cases presenting with DIC. Furthermore, this manuscript illustrates the correlation between cutaneous and coagulopathic manifestations, and morbidity and mortality from L. pneumonia. PMID:26236615

  5. Disseminated intravascular coagulation in a patient with metastatic prostate cancer: Fatal outcome following strontium-89 therapy

    SciTech Connect

    Leong, C.; McKenzie, R.; Coupland, D.B.

    1994-10-01

    A patient with metastatic prostate cancer was found to have low-grade disseminated intravascular coagulation (DIC). He had significant bone pain despite external-beam radiotherapy and was given {sup 89}Sr with subsequent thrombocytopenia and epistaxis. The patient died from generalized hemorrhage 36 days postinjection. Although it is not possible to establish a causal relationship between {sup 89}Sr and DIC, practitioners should be alert to complications associated with the primary disorder which might occur at a time to raise concern about the intervention. 8 refs., 1 tab.

  6. Nephrotic syndrome resulting in thromboembolic disease and disseminated intravascular coagulation in a dog.

    PubMed

    Ritt, M G; Rogers, K S; Thomas, J S

    1997-01-01

    Thromboembolic disease and progression to disseminated intravascular coagulation (DIC) are potential life-threatening complications for dogs with nephrotic syndrome. Platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), plasma concentration of fibrinogen degradation products (FDPs), antithrombin III (ATIII), protein C, and plasminogen were used to identify hemostatic abnormalities in a dog with nephrotic syndrome. Pulmonary thromboembolic disease was diagnosed by thoracic radiography, arterial blood gas analysis, and pulmonary scintigraphy. Prompt recognition and treatment of hemostatic complications is necessary in dogs with nephrotic syndrome.

  7. Primary antiphospholipid syndrome and chronic disseminated intravascular coagulation: the differences and the similarities.

    PubMed

    Lee, H C; Groothuis, J S; Schlueter, W J; Laya, M B

    1992-01-01

    A middle aged woman with a medical history of recurrent spontaneous abortions and chronic leg ulcers presented with a pulmonary embolism and inferior vena caval thrombosis. Primary antiphospholipid syndrome (PAPS) was diagnosed by evidence of extremely high titers of anticardiolipin IgG and IgM, typical clinical features and the absence of other autoimmune diseases. Multiple coagulation parameters suggested chronic disseminated intravascular coagulation (DIC). It is important to distinguish PAPS from true chronic DIC as the underlying causes, treatment and prognosis differ greatly. In describing this case of PAPS presenting hematologically as a chronic DIC, we offer a discussion of the means to distinguish between these two coagulopathies and briefly discuss their treatments.

  8. Massive haematuria successfully managed by intravesical Ankaferd in a haemodialysis patient complicated with disseminated intravascular coagulation.

    PubMed

    Solak, Yalcin; Gaipov, Abduzhappar; Ozbek, Orhan; Hassan, Mustafa Aziz; Yeksan, Mehdi

    2012-12-23

    Massive haematuria is a life-threatening condition, demanding immediate management of bleeding. The mortality is very high in the case of delayed management of bleeding, especially in elderly patients with concomitant comorbidity. The treatment options of haematuria are wide, and depend on underlying conditions. However, therapeutic choices are limited in the presence of massive and intractable haematuria caused by disseminated intravascular coagulation (DIC). Ankaferd blood stopper (ABS) is a novel, commercially available, haemostatic agent, which has been approved by the Ministry of Health for local use in Turkey. Here, for the first time in the literature, we report a case of diffuse intravesical bleeding stopped by intravesical use of ABS in a 72-year-old man, haemodialysis patient complicated with sepsis and DIC.

  9. A Rare Sequela of Acute Disseminated Encephalomyelitis

    PubMed Central

    Kodadhala, Vijay; Kurukumbi, Mohankumar; Jayam-Trouth, Annapurni

    2014-01-01

    Acute disseminated encephalomyelitis is a demyelinating disease, typically occurring in children following a febrile infection or a vaccination. Primary and secondary immune responses contribute to inflammation and subsequent demyelination, but the exact pathogenesis is still unknown. Diagnosis of acute disseminated encephalomyelitis is strongly suggested by temporal relationship between an infection or an immunization and the onset of neurological symptoms. Biopsy is definitive. In general, the disease is self-limiting and the prognostic outcome is favorable with anti-inflammatory and immunosuppressive agents. Locked-in syndrome describes patients who are awake and conscious but have no means of producing limb, speech, or facial movements. Locked-in syndrome is a rare complication of acute disseminated encephalomyelitis. We present a case of incomplete locked-in syndrome occurring in a 34-year-old male secondary to acute disseminated encephalomyelitis. Our case is unique, as acute disseminated encephalomyelitis occurred in a 34-year-old which was poorly responsive to immunosuppression resulting in severe disability. PMID:24977089

  10. Serotonin syndrome, disseminated intravascular coagulation, and hepatitis after a single ingestion of MDMA in an Asian woman.

    PubMed

    Nadkarni, Girish N; Hoskote, Sumedh S; Piotrkowski, Jared; Annapureddy, Narender

    2014-01-01

    N-Methyl-3,4-methylenedioxyamphetamine (MDMA), also called "Ecstasy," is a commonly abused psychoactive drug among the American youth. We present the case of a 23-year-old Korean-American woman who presented with seizure, delirium, and rigidity after MDMA ingestion. She was febrile (38.7°C), tachycardic (188 beats/min), tachypneic (26 breaths/min) with a borderline blood pressure (95/43 mm Hg). Examination revealed generalized muscle rigidity, tremors, hyperreflexia, and ocular clonus, leading to the diagnosis of serotonin syndrome. Urine toxicology screen was only positive for amphetamines, consistent with the history of MDMA ingestion. Initial laboratory testing showed thrombocytopenia, further testing showed deranged prothrombin time, partial thromboplastin time, decreased fibrinogen, and elevated D-dimer, suggesting disseminated intravascular coagulation. Hepatic transaminases trended up dramatically reflecting acute hepatitis. The patient received supportive care and improved by hospital day 3. MDMA toxicity manifested as serotonin syndrome, hepatitis, and coagulopathy is exceedingly rare. MDMA is metabolized by the hepatic CYP2D6 enzyme. Certain populations, such as Koreans, Chinese, and Japanese have a high prevalence of a polymorphism that confers reduced enzyme activity. We discuss this hypothesis as a possible cause for this severe presentation in our patient after a single ingestion.

  11. Acute disseminated encephalomyelitis associated with acute Toxoplasma gondii Infection.

    PubMed

    Aksoy, Ayse; Tanir, Gonul; Ozkan, Mehpare; Oguz, Melek; Yıldız, Yasemin Tasci

    2013-03-01

    Acute disseminated encephalomyelitis is an acute demyelinating disorder of the central nervous system, which principally affects the brain and spinal cord. It usually follows a benign infection or vaccination in children. Although a number of infectious agents have been implicated in acute disseminated encephalomyelitis, Toxoplasma gondii infection has not been described previously in children. Acquired T. gondii infection presents with lymphadenopathy and fever and usually spontaneously resolves in immunocompetent patients. We describe a previously healthy 10-year-old boy with acute disseminated encephalomyelitis associated with acute acquired Toxoplasma gondii infection, the symptoms of which initially began with nuchal stiffness, difficulty in walking, and urinary and stool incontinence; he later had development of motor and sensory impairment in both lower extremities and classical magnetic resonance imaging lesions suggestive of the disease. The patient recovered completely after the specific therapy for acquired T. gondii infection and pulse prednisolone. Although acute acquired Toxoplasma gondii infection has not been reported previously in association with acute disseminated encephalomyelitis, clinicians should keep in mind this uncommon cause of a common disease when evaluating a patient with acute disseminated encephalomyelitis.

  12. Acute disseminated encephalomyelitis presenting with hypertensive emergency.

    PubMed

    Ganguly, Samrat; Das, Mousumi; Bagchi, Nilay Ranjan

    2014-04-01

    We report a 12-year-old girl presenting with acute disseminated encephalomyelitis (ADEM) along with hypertensive emergency. Hypertension persisted for few weeks following recovery and subsided with oral clonidine. Although autonomic instability in ADEM has been reported before, hypertensive emergency was not previously documented as presenting feature of ADEM.

  13. Defining encephalopathy in acute disseminated encephalomyelitis.

    PubMed

    Fridinger, S E; Alper, Gulay

    2014-06-01

    The International Pediatric Multiple Sclerosis Study Group requires the presence of encephalopathy to diagnose acute disseminated encephalomyelitis. Clinical characteristics of encephalopathy are inadequately delineated in the pediatric demyelinating literature. The authors' purpose was to better define encephalopathy in pediatric acute disseminated encephalomyelitis by describing the details of the mental status change. A retrospective chart review was conducted for 25 children diagnosed with acute disseminated encephalomyelitis according to the International Pediatric Multiple Sclerosis Study Group guidelines. Frequency of encephalopathy-defining features was determined. Clinical characteristics, cerebrospinal fluid findings, and electroencephalography (EEG) findings were compared between patients with different stages of encephalopathy. The authors found irritability (36%), sleepiness (52%), confusion (8%), obtundation (20%), and coma (16%) as encephalopathy-defining features in acute disseminated encephalomyelitis. Twenty-eight percent had seizures, and 65% demonstrated generalized slowing on EEG. Approximately half of the patients in this study were diagnosed with encephalopathy based on the presence of irritability and/or sleepiness only. Such features in young children are often subtle and transient and thus difficult to objectively determine.

  14. Flow cytometric evaluation of disseminated intravascular coagulation in a canine endotoxemia model.

    PubMed

    Yu, Dohyeon; Noh, Dongho; Park, Jinho

    2015-01-01

    Sepsis is associated with substantial morbidity and mortality in dogs. Alterations in hemostasis by systemic inflammation play an important role in the pathophysiology of sepsis. To evaluate the functional hemostatic changes in sepsis, we evaluated coagulation profiles and flow cytometric measurement of P-selectin (CD62P) expression on platelets, as well as platelet-leukocyte aggregation from a lipopolysaccharide (LPS)-induced endotoxemia model in dogs (n = 7). A sublethal dose of LPS [1 mg/kg body weight (BW)] induced thrombocytopenia and increased activated partial thromboplastin time (aPTT), prothrombin time (PT), and D-dimer concentrations. Flow cytometry analysis showed a significant increase in P-selectin expression on platelets between 1 and 24 h of a total 48 h of the experiment. In addition, platelet-leukocyte aggregation was significantly increased in the early stage of endotoxemia (at 1 and < 6 h for platelet-monocyte aggregation and at 3 h for platelet-neutrophil aggregation). Our results suggest that CD62P expression on platelets and platelet-leukocyte aggregation, as measured by flow cytometry, can be useful biomarkers of disseminated intravascular coagulation (DIC) in canine sepsis. These functional changes contribute to our understanding of the pathophysiology of hemostasis in endotoxemia.

  15. Targeted mutagenesis of zebrafish antithrombin III triggers disseminated intravascular coagulation and thrombosis, revealing insight into function

    PubMed Central

    Liu, Yang; Kretz, Colin A.; Maeder, Morgan L.; Richter, Catherine E.; Tsao, Philip; Vo, Andy H.; Huarng, Michael C.; Rode, Thomas; Hu, Zhilian; Mehra, Rohit; Olson, Steven T.; Joung, J. Keith

    2014-01-01

    Pathologic blood clotting is a leading cause of morbidity and mortality in the developed world, underlying deep vein thrombosis, myocardial infarction, and stroke. Genetic predisposition to thrombosis is still poorly understood, and we hypothesize that there are many additional risk alleles and modifying factors remaining to be discovered. Mammalian models have contributed to our understanding of thrombosis, but are low throughput and costly. We have turned to the zebrafish, a tool for high-throughput genetic analysis. Using zinc finger nucleases, we show that disruption of the zebrafish antithrombin III (at3) locus results in spontaneous venous thrombosis in larvae. Although homozygous mutants survive into early adulthood, they eventually succumb to massive intracardiac thrombosis. Characterization of null fish revealed disseminated intravascular coagulation in larvae secondary to unopposed thrombin activity and fibrinogen consumption, which could be rescued by both human and zebrafish at3 complementary DNAs. Mutation of the human AT3-reactive center loop abolished the ability to rescue, but the heparin-binding site was dispensable. These results demonstrate overall conservation of AT3 function in zebrafish, but reveal developmental variances in the ability to tolerate excessive clot formation. The accessibility of early zebrafish development will provide unique methods for dissection of the underlying mechanisms of thrombosis. PMID:24782510

  16. Emergent Uterine Arterial Embolization Using N-Butyl Cyanoacrylate in Postpartum Hemorrhage with Disseminated Intravascular Coagulation

    PubMed Central

    Kasai, Michi; Kasai, Junko; Seki, Kazuo; Sekikawa, Zenjiro; Torimoto, Izumi; Takebayashi, Shigeo; Hirahara, Fumiki

    2017-01-01

    Although it is widely accepted that uterine artery embolization (UAE) is an effective therapeutic strategy for postpartum hemorrhage (PPH), no consensus has been reached regarding the efficacy of UAE in patients with PPH with disseminated intravascular coagulation (DIC). This single-center retrospective cohort study included patients treated with UAE using NBCA for PPH between 2010 and 2015. The patients were divided into DIC and non-DIC groups, according to the obstetrical DIC score and the overt DIC diagnostic criteria issued by the International Society of Thrombosis and Haemostasis (ISTH), and their clinical outcomes were compared. There were 28 patients treated with UAE using NBCA. Complete hemostasis was achieved by UAE in 19 of 28 patients. In eight of nine patients with unsuccessful hemostasis, surgical hemostatic interventions were performed after UAE, and hemostasis was achieved in seven patients. UAE using NBCA showed no significant intergroup differences in complete hemostasis according to the presence or absence of DIC based on obstetrical DIC score (70% versus 62.5%, P = 1.000) or ISTH DIC score (54.5% versus 76.5%, P = 0.409). UAE using NBCA may be a useful first-choice treatment for PPH with DIC. PMID:28251148

  17. [Acute arterial occlusion associated disseminated hydatidosis].

    PubMed

    Somocurcio, Jose; Alvarez, Gamero; Lara Campos, Gloria; Cahuana Aparco, Judith; Calongos Porras, Estefanny; Bermejo Cataño, Pedro; Tejada Llacsa, Paul

    2014-04-01

    Hydatidosis or echinococcosis are terms used to denote the zoonotic infestation caused by adult and larval stages (metacestode) of the cestode from the genus Echinococcus (family tenidae). The term hydatidosis should be applied to the infestation caused by the metacestode while echinococcosis for the larval and adult stages. In Peru there is a high prevalence of this infection, liver and lung being the most affected organs. There are factors from the host and from the infectious agent that contribute to this infection, with the immune component of the host as an important infection and dissemination point. A case of acute arterial occlusion associated with disseminated hydatidosis in a 54 years old patient, born and from Huancavelica, with sudden onset of an acute arterial obstruction is reported. The patient did not improve after surgery and died within 48 hours of presentation.

  18. Intravascular clearance of disseminating Cryptococcus neoformans in the brain can be improved by enhancing neutrophil recruitment in mice.

    PubMed

    Sun, Donglei; Zhang, Mingshun; Liu, Gongguan; Wu, Hui; Li, Chang; Zhou, Hong; Zhang, Xiquan; Shi, Meiqing

    2016-07-01

    Extrapulmonary dissemination of Cryptococcus neoformans (C. neoformans) is one of the most critical steps in the development of meningoencephalitis. Here, we report that clearance of the disseminating C. neoformans occurs within the brain microvasculature. Interestingly, the efficiency of the intravascular clearance in the brain is reduced compared to that in the lung. Intravascular clearance is mainly mediated by neutrophils, and complement C5a receptor signaling is crucial for mediating neutrophil recruitment in the vasculature. C. neoformans stimulated actin polymerization of neutrophils is critically involved in their recruitment to the lung, which is associated with the unique vascular structure detected in the lung. The relatively lower efficiency of fungal clearance in the brain vasculature correlates with less efficient recruitment of neutrophils. Accordingly, intravascular clearance of C. neoformans in the brain could be remarkably improved by increasing the recruitment of neutrophils. We conclude that neutrophils have the ability to eliminate C. neoformans arrested in the vasculature. However, insufficient recruitment of neutrophils limited the optimal clearance of this microorganism in the brain. These results imply that a therapeutic strategy aimed at enhancing the accumulation of neutrophils could help prevent cryptococcal meningoencephalitis.

  19. Evidence of disseminated intravascular coagulation in a porcine model following radiation exposure

    NASA Astrophysics Data System (ADS)

    Krigsfeld, G. S.; Shah, J. B.; Sanzari, J. K.; Lin, L.; Kennedy, A. R.

    2014-10-01

    Recent evidence has suggested that disseminated intravascular coagulation (DIC) plays an integral role in death at the LD50 dose of either gamma or solar particle event (SPE)-like proton radiation in ferrets. In these studies, Yucatan minipigs were evaluated to determine whether they were susceptible to the development of radiation induced DIC. Yucatan minipigs were exposed to a dose of 2.5 Gray (Gy) with X-rays and monitored over the course of 30 days. Evidence of DIC was evaluated by way of thromboelastometry parameters, platelet counts, fibrinogen concentration, and the d-dimer assay. Pigs exposed to X-rays developed signs of DIC within 2 days' post-irradiation. The development of DIC was exacerbated over the course of the studies, and one of the pigs died at day 14 and another had to be euthanized on day 16 post-irradiation. For both of these pigs, DIC was evident at the time of death. The following observations were indicated or were suggestive of DIC: whole blood clotting was impaired (as evidenced by thromboelastometry alterations), there were decreased platelet counts, elevated d-dimer concentrations in the blood, and/or hemorrhaging and the presence of fibrin in tissues observed during post-mortem examination. The extrapolation of data from these studies, in combination with other published data, have led to the hypothesis that there could be a correlation between the propensity to develop DIC, as indicated by hemorrhaging at death at relatively low doses of radiation, and the LD50 for a particular species. Our data suggest that the development of DIC may contribute to death at the LD50 dose in large mammals.

  20. Evidence of Disseminated Intravascular Coagulation in a Porcine Model Following Radiation Exposure

    PubMed Central

    Krigsfeld, G.S.; Shah, J.B.; Sanzari, J.K.; Lin, L.; Kennedy, A.R.

    2014-01-01

    Recent evidence has suggested that disseminated intravascular coagulation (DIC) plays an integral role in death at the LD50 dose of either gamma or solar particle event (SPE)-like proton radiation in ferrets. In these studies, Yucatan minipigs were evaluated to determine whether they were susceptible to the development of radiation induced DIC. Yucatan minipigs were exposed to a dose of 2.5 Gray (Gy) with x-rays and monitored over the course of 30 days. Evidence of DIC was evaluated by way of thromboelastometry parameters, platelet counts, fibrinogen concentration, and the d-dimer assay. Pigs exposed to x-rays developed signs of DIC within 2 days post-irradiation. The development of DIC was exacerbated over the course of the studies, and one of the pigs died at day 14 and another had to be euthanized on day 16 post-irradiation. For both of these pigs, DIC was evident at the time of death. The following observations were indicated or were suggestive of DIC: whole blood clotting was impaired (as evidenced by thromboelastometry alterations), there were decreased platelet counts, elevated d-dimer concentrations in the blood, and/or hemorrhaging and the presence of fibrin in tissues observed during post-mortem examination. The extrapolation of data from these studies, in combination with other published data, have led to the hypothesis that there could be a correlation between the propensity to develop DIC, as indicated by hemorrhaging at death at relatively low doses of radiation, and the LD50 for a particular species. Our data suggest that the development of DIC may contribute to death at the LD50 dose in large mammals. PMID:25197627

  1. [Effect of xuebijing oral effervescent tablet on endotoxin induced fever and disseminated intravascular coagulation rabbit model].

    PubMed

    Guo, Shan-Shan; Gao, Ying-Jie; Tian, Xue-Chuan; Jin, Ya-Hong; Liu, Fang-Zhou; Cui, Xiao-Lan

    2013-08-01

    In order to discover the mechanism of Xuebijing oral effervescent tablet (XBJOET) to treat infectious diseases, the effect of XBJOET on endotoxin induced rabbit fever and disseminated intravascular coagulation (DIC) was investigated. Auricle microcirculation in rabbit was detected by laser speckle blood perfusion imager system; coagulation function was measured by coagulation analyzer, fibrinolytic system was quantified by Elisa assay and micro thrombosis in tissues was observed with HE staining under light microscope. The results demonstrated that the body temperature of rabbit decreased significantly at 1-3 h after administration with 4.8, 2.4 and 1.2 g x kg(-1) XBJOET to endotoxin induced DIC rabbit model, the auricle microcirculation blood flow in model group (54.45 +/- 14.53) PU was lower than that in control group (77.18 +/- 12.32) PU. The auricle microcirculation blood flow increased markedly and there was significant difference between model group and 1.2 g x kg(-1) XBJOET group. There was significant difference between model group and control group in the content of PAI1 and FIB. The PAI1 levels in model and control groups were (30.48 +/- 2.46) ng x mL(-1) and (20.93 +/- 3.25) ng x mL(-1), respectively. The FIB levels in model and control group were (3.34 +/- 1.09) g x L(-1) and (4.84 +/- 1.10) g x L(-1), respectively. The content of PAI1 in rabbit plasma decreased notably, there were significant differences between model group and 4.8, 2.4 g x kg(-1) XBJOET groups. On the contrary the content of FIB increased. XBJOET possessed pharmacological activities of curing infectious fever and DIC, the mechanism of which is related to amelioration of microcirculation disturbance, inhibition of fibrinolytic system activation and coagulation and micro thrombosis elimination.

  2. Aortic aneurysm and chronic disseminated intravascular coagulation: a retrospective study of 235 patients.

    PubMed

    Zhang, Yun; Li, Chen; Shen, Min; Liu, Bao; Zeng, Xuejun; Shen, Ti

    2017-03-01

    Chronic disseminated intravascular coagulation (DIC) is a rare but devastating complication of aortic aneurysm (AA). This study investigated the clinical manifestations, laboratory findings, and treatment of patients with AA-associated chronic DIC (AA-DIC) and explored the mechanisms, duration, and therapeutic response of AA-DIC. We retrospectively reviewed the medical records of 235 AA patients admitted at the Peking Union Medical College Hospital between September 2009 and January 2015. The patients were classified as those with DIC (AA-DIC) and those without DIC (non-DIC). The AA-DIC group showed a significantly higher proportion of female patients and a significantly longer AA disease course than the non-DIC group did. The AA-DIC patients presented mural thrombi, dissecting aneurysms, a family history of AA, and diabetes significantly more frequently than the non-DIC patients did. Furthermore, multiple regression analyses revealed that sex, mural thrombus, aneurysm type, diabetes, and stent surgery are possible independent risk factors for AA-DIC patients. Fifty-two (22.1%) patients presented AA-DIC. Among these patients, 43 had non-typical DIC and 9 had typical DIC; the mortality rate of the latter was 22.2%. The mean age of the patients with typical DIC was significantly higher than of that of patients with non-typical DIC. The non-typical DIC patients also presented abnormal coagulation disorders of varying degrees. Furthermore, heparin or low-molecular-weight heparin improved the clinical symptoms and laboratory parameters in patients with AA and typical DIC. Thus, chronic DIC should be considered in patients with AA.

  3. Acute disseminated encephalomyelitis (ADEM) after pertussis infection.

    PubMed

    Budan, B; Ekici, B; Tatli, B; Somer, A

    2011-01-01

    Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating disorder of the central nervous system which is usually precipitated by a viral infection or vaccination. A 3-month-old boy is reported who developed ADEM a week after full recovery from pertussis. MRI detected a high-intensity lesion extending from the pons to the mesencephalon, compatible with ADEM. Following the administration of intravenous immunoglobulins, the patient's clinical symptoms improved. This case report demonstrates that pertussis is capable of inducing an immune-mediated demyelinating disorder of the central nervous system.

  4. [Acute disseminated encephalomyelitis: a pediatric case report].

    PubMed

    Charpentier, P; Demonceau, N; Mulder, A; Lebrun, F; Demaret, P

    2015-02-01

    Acute disseminated encephalomyelitis (ADEM) is a disease of the central nervous system (CNS) mainly affecting children. It usually occurs within 2 days to 4 weeks following a triggering factor such a viral infection or an immunization. Clinical presentation is characterized by an acute encephalopathy and by multifocal neurologic abnormalities. In the absence of specific biologic marker, the diagnosis of ADEM is based on clinical, biological and radiological data including cerebrospinal fluid (CSF) analysis and magnetic resonance imaging (MRI). Brain MRI typically shows multifocal lesions predominantly involving the white matter. Treatment is based on high doses of steroids. Intravenous immunoglobulins or plasmapheresis are sometimes required. The prognosis is usually favorable but neurological sequellae can occur.

  5. Differing Tales of Two Patients after Receiving a Kidney Transplant from a Donor with Disseminated Intravascular Coagulation

    PubMed Central

    Kadambi, Pradeep V.; Gamilla-Crudo, Ann K.; Almiani, Mohammad; Josephson, Michelle A.

    2014-01-01

    In order to decrease the time on the deceased donor kidney wait list and to have more organs available, criteria for acceptable organs for transplant could be made less stringent. There are reports of successful recipient outcomes using kidney donors presenting with disseminated intravascular coagulation (DIC). We report a unique circumstance where two patients received kidneys from the same deceased donor who had DIC; one patient developed thrombotic microangiopathy (TMA) while the other did not. This difference in outcome may indicate that both donor and recipient factors contribute to the development of posttransplant TMA. PMID:25061532

  6. Successful treatment of hemophagocytic lymphohistiocytosis and disseminated intravascular coagulation secondary to histoplasmosis in a patient with HIV/AIDS.

    PubMed

    Nieto, John Fredy; Gómez, Sandra Milena; Moncada, Diana Carolina; Serna, Lina María; Hidrón, Alicia Inés

    2016-04-01

    Haemophagocytic lymphohistiocytosis is an uncommon syndrome that results from an uncontrolled activation of macrophages and lymphocytes resulting in the compromise of multiple organs that is potentially fatal without timely treatment. It can be hereditary or a secondary result of infectious processes, neoplasms or autoimmune conditions. We present the case of a patient with HIV/AIDS who developed hemophagocytic lymphohistiocytosis as well as disseminated intravascular coagulation associated with histoplasmosis and who was successfully treated with amphotericin B, steroids and transitory dialytic support.

  7. Increasing concentrations of prothrombin complex concentrate induce disseminated intravascular coagulation in a pig model of coagulopathy with blunt liver injury.

    PubMed

    Grottke, Oliver; Braunschweig, Till; Spronk, Henri M H; Esch, Stephanie; Rieg, Annette D; van Oerle, Rene; ten Cate, Hugo; Fitzner, Christina; Tolba, Rene; Rossaint, Rolf

    2011-08-18

    Despite increasing use of prothrombin complex concentrate (PCC) to treat hemorrhage-associated coagulopathy, few studies have investigated PCC in trauma, and there is a particular lack of safety data. This study was performed to evaluate PCC therapy in a porcine model of coagulopathy with blunt liver injury. Coagulopathy was induced in 27 anesthetized pigs by replacing approximately 70% blood volume with hydroxyethyl starch 130/0.4 and Ringer's lactate solution; erythrocytes were collected and retransfused. Ten minutes after trauma, animals randomly received PCC (35 or 50 IU/kg) or saline. Coagulation parameters including thromboelastometry, thrombin generation, and blood loss were monitored for 2 hours. Internal organs were examined macroscopically and histologically to determine the presence of emboli and assess liver injury. Total blood loss was significantly lower and survival was higher in both PCC groups versus the control group (P < .05). These outcomes appeared to be dose-independent. Thromboembolism was found in all animals treated with 50 IU/kg PCC; 44% also showed signs of disseminated intravascular coagulation. Liver injury was similar in all animals. In conclusion, 35 IU/kg PCC safely improved coagulation and attenuated blood loss. However, the higher dose of PCC (50 IU/kg) appeared to increase the risk of thromboembolism and disseminated intravascular coagulation.

  8. Disseminated fusariosis and endogenous fungal endophthalmitis in acute lymphoblastic leukemia following platelet transfusion possibly due to transfusion-related immunomodulation

    PubMed Central

    2011-01-01

    Background To report a case of disseminated fusariosis with endogenous endophthalmitis in a patient with acute lymphoblastic leukemia. Transfusion-associated immune modulation secondary to platelet transfusion could play an important role in the pathophysiology of this case. Case Presentation A 9 year-old male with acute lymphoblastic leukemia complicated by pancytopenia and disseminated Intravascular coagulation was given platelet transfusion. He developed disseminated fusariosis and was referred to the ophthalmology team for right endogenous endophthalmitis. The infection was controlled with aggressive systemic and intravitreal antifungals. Conclusion Patients with acute lymphoblastic leukemia are predisposed to endogenous fungal endophthalmitis. Transfusion-associated immune modulation may further increase host susceptibility to such opportunistic infections. PMID:22044440

  9. Effective control of relapsing disseminated intravascular coagulation in a patient with decompensated liver cirrhosis by recombinant soluble thrombomodulin.

    PubMed

    Hasebe, Takumu; Sawada, Koji; Nakajima, Shunsuke; Maeda, Shigeaki; Abe, Masami; Suzuki, Yasuaki; Ohtake, Takaaki; Hasebe, Chitomi; Fujiya, Mikihiro; Kohgo, Yutaka

    2014-01-01

    A 70-year-old Japanese man was hospitalized for expanding purpura and chronic disseminated intravascular coagulation (DIC) caused by decompensated liver cirrhosis. As there are no effective treatments for chronic DIC caused by liver cirrhosis, we decided to administer recombinant human soluble thrombomodulin (rhsTM) after he provided informed consent. The DIC was rapidly improved; however, the purpura and coagulopathy recurred after two months, and repeated rhsTM treatments were required. The rhsTM treatment sufficiently controlled the coagulopathy for two years, without any complications, including bleeding. This is the first report demonstrating that rhsTM can be administered safely and repeatedly to a patient with decompensated liver cirrhosis, and that it appears to be associated with a favorable outcome.

  10. Acute disseminated toxoplasmosis in a juvenile cheetah (Acinonyx jubatus).

    PubMed

    Lloyd, Christopher; Stidworthy, Mark F

    2007-09-01

    A juvenile cheetah (Acinonyx jubatus) died with rapidly progressive pyrexia, tachypnea, abdominal effusion, and hepatomegaly. Postmortem examination revealed lesions consistent with acute disseminated infection with Toxoplasma gondii. The presence of this organism was confirmed in multiple organs by immunohistochemistry and polymerase chain reaction. To the best of our knowledge, we propose this to be the first reported case of primary acute disseminated toxoplasmosis in a cheetah.

  11. Chronic disseminated intravascular coagulation induced by left atrial thrombus in a patient with giant “normal” heart

    PubMed Central

    Shao, Qianqian; Tian, Ran; Zhang, Xu; Gao, Xin; Lai, Jinzhi; Tian, Zhuang; Yan, Xiaowei; Zhang, Shuyang

    2016-01-01

    Abstract Introduction: We herein describe a patient with chronic disseminated intravascular coagulation (DIC) induced by a giant thrombus in the left atrium. A 63-year-old woman was admitted to our hospital for evaluation of extensive mucocutaneous hemorrhage, especially at the sites of venipuncture, on May 21, 2015. Considering her long history of rheumatic heart disease and atrial fibrillation and her mitral valve replacement performed several years previously, we strongly suspected that the bleeding was closely related to postoperative over-anticoagulation of warfarin. After careful investigation, we found that her coagulopathy was induced by the chronic DIC, which was in turn secondary to a left atrial giant thrombus. This is a rarely reported cause of chronic DIC. Cardiac computed tomography and echocardiography showed apparent biatrial enlargement; the morphology and function of the ventricles were unaffected. After anticoagulant therapy, the bleeding tendency and coagulation index were significantly improved. Conclusion: A left atrial thrombus should be considered as a differential diagnosis of chronic DIC, especially in patients with predisposing heart conditions. Because treatment of the underlying cause is paramount in the management of chronic DIC, this case is of great clinical value. PMID:28002328

  12. Cardiac metastasis of squamous cell carcinoma of the thyroid gland with severe disseminated intravascular coagulation: A case report.

    PubMed

    Yoshihiro, Tomoyasu; Tsuchihashi, Kenji; Kusaba, Hitoshi; Nakashima, Torahiko; Obara, Teppei; Nio, Kenta; Takayoshi, Kotoe; Kodama, Hiroyuki; Tsuruta, Nobuhiro; Kiyohara, Hideyuki; Asai, Kaori; Harada, Eiji; Kamezaki, Kenjiro; Arita, Takeshi; Sato, Masanobu; Yamamoto, Hidetaka; Arita, Shuji; Ariyama, Hiroshi; Odashiro, Keita; Oda, Yoshinao; Akashi, Koichi; Baba, Eishi

    2017-01-01

    Distant metastasis of primary squamous cell carcinoma (SCC) of the thyroid gland is rare and, to the best of our knowledge, cardiac metastasis has not been reported to date. A 57-year-old man underwent surgery and adjuvant chemoradiotherapy for stage IVA SCC of the thyroid gland. After 3 months, the patient was admitted to the Kyushu University Hospital (Fukuoka, Japan) with subcutaneous hematomas of the left thigh and lower leg, and he was diagnosed with cardiac and mediastinal lymph node metastases of SCC of the thyroid gland with severe disseminated intravascular coagulation (DIC). Echocardiography revealed a mass, 52 mm in greatest diameter, protruding from the interventricular septum towards the right ventricle. Weekly administration of paclitaxel and concurrent irradiation of the cardiac and lymph node metastases were performed. Eighteen days after the initiation of chemoradiotherapy, the DIC and hematomas had significantly improved, and the cardiac metastasis was stable. However, 2 months after admission, the patient developed dyspnea and multiple nodular shadows appeared to be spreading in the subpleura of the lungs bilaterally, which were initially suspected to be pulmonary tumor embolisms. Prednisolone and subsequent administration of lenvatinib were not effective and the patient succumbed to respiratory failure. Severe DIC caused by extremely rare cardiac metastasis of SCC of the thyroid gland was effectively controlled by chemoradiotherapy. However, intensive local control appears to be required for this condition.

  13. Cardiac metastasis of squamous cell carcinoma of the thyroid gland with severe disseminated intravascular coagulation: A case report

    PubMed Central

    Yoshihiro, Tomoyasu; Tsuchihashi, Kenji; Kusaba, Hitoshi; Nakashima, Torahiko; Obara, Teppei; Nio, Kenta; Takayoshi, Kotoe; Kodama, Hiroyuki; Tsuruta, Nobuhiro; Kiyohara, Hideyuki; Asai, Kaori; Harada, Eiji; Kamezaki, Kenjiro; Arita, Takeshi; Sato, Masanobu; Yamamoto, Hidetaka; Arita, Shuji; Ariyama, Hiroshi; Odashiro, Keita; Oda, Yoshinao; Akashi, Koichi; Baba, Eishi

    2017-01-01

    Distant metastasis of primary squamous cell carcinoma (SCC) of the thyroid gland is rare and, to the best of our knowledge, cardiac metastasis has not been reported to date. A 57-year-old man underwent surgery and adjuvant chemoradiotherapy for stage IVA SCC of the thyroid gland. After 3 months, the patient was admitted to the Kyushu University Hospital (Fukuoka, Japan) with subcutaneous hematomas of the left thigh and lower leg, and he was diagnosed with cardiac and mediastinal lymph node metastases of SCC of the thyroid gland with severe disseminated intravascular coagulation (DIC). Echocardiography revealed a mass, 52 mm in greatest diameter, protruding from the interventricular septum towards the right ventricle. Weekly administration of paclitaxel and concurrent irradiation of the cardiac and lymph node metastases were performed. Eighteen days after the initiation of chemoradiotherapy, the DIC and hematomas had significantly improved, and the cardiac metastasis was stable. However, 2 months after admission, the patient developed dyspnea and multiple nodular shadows appeared to be spreading in the subpleura of the lungs bilaterally, which were initially suspected to be pulmonary tumor embolisms. Prednisolone and subsequent administration of lenvatinib were not effective and the patient succumbed to respiratory failure. Severe DIC caused by extremely rare cardiac metastasis of SCC of the thyroid gland was effectively controlled by chemoradiotherapy. However, intensive local control appears to be required for this condition. PMID:28123737

  14. [Acute disseminated encephalomyelitis (ADEM): its diagnostic criteria and therapy].

    PubMed

    Hara, Toshiro

    2013-05-01

    Acute disseminated encephalomyelitis (ADEM) is an immune-mediated central nervous system disorder in an individual with genetic susceptibility. It is characterized by acute or subacute onset of multifocal neurologic deficits with encephalopathy, often following a viral illness or vaccination. Since ADEM is diverse in its clinical features, the diagnostic criteria of ADEM require the exclusion of other etiologies. In this review, I will explain the diagnostic algorism and criteria, and therapy of ADEM.

  15. Complement-mediated thrombotic microangiopathy secondary to sepsis-induced disseminated intravascular coagulation successfully treated with eculizumab

    PubMed Central

    Abe, Tomohiro; Sasaki, Akira; Ueda, Taichiro; Miyakawa, Yoshitaka; Ochiai, Hidenobu

    2017-01-01

    Abstract Secondary thrombotic microangiopathies (TMAs) are induced by several underlying conditions; most are resolved by treating background disease. Eculizumab is a human monoclonal antibody that blocks the final stage of the complement system and effectively treats atypical hemolytic uremic syndrome (aHUS). In this report, we present a patient with TMA secondary to sepsis- induced coagulopathy, who was successfully treated with eculizumab. A 44-year-old woman, who had no special medical history or familial history of TMAs, was admitted on suspicion of septic shock. Physical examination revealed gangrene on her soles. Blood tests revealed a decreased platelet count, disseminated intravascular coagulation (DIC), renal dysfunction, hemolysis, and infection. Although the coagulation disorder improved with intensive care, the low platelet count, elevated lactate dehydrogenase levels, and renal dysfunction persisted. Our investigations subsequently excluded thrombotic thrombocytopenic purpura and Shiga toxin-producing Escherichia coli-induced HUS. Plasma exchange only improved lactate dehydrogenase levels. We clinically diagnosed this case as atypical HUS and started eculizumab treatment. The patient's platelet count increased, her renal dysfunction improved, and the gangrene on her feet was ameliorated. The patient was discharged without maintenance dialysis therapy after approximately 3 months. Subsequent tests revealed elevated serum levels of soluble C5b-9, and genetic testing revealed compound heterozygous c.184G > A (Val62Ile) and c.1204T > C (Tyr402His) single-nucleotide polymorphisms in complement factor H. We encountered a case of complement-mediated TMA accompanied by DIC, which was successfully treated with eculizumab. Further studies are necessary to support the optimal use of eculizumab for TMA with background diseases. PMID:28178155

  16. Evidence for Radiation-Induced Disseminated Intravascular Coagulation as a Major Cause of Radiation-Induced Death in Ferrets

    PubMed Central

    Krigsfeld, Gabriel S.; Savage, Alexandria R.; Billings, Paul C.; Lin, Liyong; Kennedy, Ann R.

    2014-01-01

    Purpose/Objectives(s) The studies reported here were performed as part of a program in space radiation biology in which proton radiation like that present in solar particle events (SPEs), as well as conventional gamma radiation, were being evaluated in terms of the ability to affect hemostasis. Methods and Materials Ferrets were exposed to 0 – 2 Gray (Gy) of whole body proton or gamma radiation and monitored for 30 days. Blood was analyzed for blood cell counts, platelet clumping, thromboelastometry, and fibrin clot formation. Results The lethal dose of radiation to 50% of the population, known as the LD50, of ferrets was established at ~ 1.5 Gy, with 100% mortality at 2 Gy. Hypocoagulability was present as early as day 7 post-irradiation, with animals unable to generate a stable clot and exhibiting signs of platelet aggregation, thrombocytopenia, and fibrin clots in blood vessels of organs. Platelet counts were at normal levels during the early times post-irradiation when coagulopathies were present and progressively becoming more severe; platelet counts were greatly reduced at the time of the white blood cell nadir of 13 days. Conclusions The data presented here provide evidence that death at the LD50 in ferrets is most likely due to disseminated intravascular coagulation (DIC). These data question the current hypothesis that death at relatively low doses of radiation is solely due to the cell killing effects of hematopoietic cells. The recognition that radiation-induced DIC is the most likely mechanism of death in ferrets raises the question of whether DIC is a contributing mechanism to radiation induced death at relatively low doses in large mammals. PMID:24495588

  17. Evidence for Radiation-Induced Disseminated Intravascular Coagulation as a Major Cause of Radiation-Induced Death in Ferrets

    SciTech Connect

    Krigsfeld, Gabriel S.; Savage, Alexandria R.; Billings, Paul C.; Lin, Liyong; Kennedy, Ann R.

    2014-03-15

    Purpose: The studies reported here were performed as part of a program in space radiation biology in which proton radiation like that present in solar particle events, as well as conventional gamma radiation, were being evaluated in terms of the ability to affect hemostasis. Methods and Materials: Ferrets were exposed to 0 to 2 Gy of whole-body proton or gamma radiation and monitored for 30 days. Blood was analyzed for blood cell counts, platelet clumping, thromboelastometry, and fibrin clot formation. Results: The lethal dose of radiation to 50% of the population (LD{sub 50}) of the ferrets was established at ∼1.5 Gy, with 100% mortality at 2 Gy. Hypocoagulability was present as early as day 7 postirradiation, with animals unable to generate a stable clot and exhibiting signs of platelet aggregation, thrombocytopenia, and fibrin clots in blood vessels of organs. Platelet counts were at normal levels during the early time points postirradiation when coagulopathies were present and becoming progressively more severe; platelet counts were greatly reduced at the time of the white blood cell nadir of 13 days. Conclusions: Data presented here provide evidence that death at the LD{sub 50} in ferrets is most likely due to disseminated intravascular coagulation (DIC). These data question the current hypothesis that death at relatively low doses of radiation is due solely to the cell-killing effects of hematopoietic cells. The recognition that radiation-induced DIC is the most likely mechanism of death in ferrets raises the question of whether DIC is a contributing mechanism to radiation-induced death at relatively low doses in large mammals.

  18. Abnormal factor VIII coagulant antigen in patients with renal dysfunction and in those with disseminated intravascular coagulation.

    PubMed Central

    Weinstein, M J; Chute, L E; Schmitt, G W; Hamburger, R H; Bauer, K A; Troll, J H; Janson, P; Deykin, D

    1985-01-01

    Factor VIII antigen (VIII:CAg) exhibits molecular weight heterogeneity in normal plasma. We have compared the relative quantities of VIII:CAg forms present in normal individuals (n = 22) with VIII:CAg forms in renal dysfunction patients (n = 19) and in patients with disseminated intravascular coagulation (DIC; n = 7). In normal plasma, the predominant VIII: CAg form, detectable by sodium dodecyl sulfate polyacrylamide gel electrophoresis, was of molecular weight 2.4 X 10(5), with minor forms ranging from 8 X 10(4) to 2.6 X 10(5) D. A high proportion of VIII:CAg in renal dysfunction patients, in contrast, was of 1 X 10(5) mol wt. The patients' high 1 X 10(5) mol wt VIII: CAg level correlated with increased concentrations of serum creatinine, F1+2 (a polypeptide released upon prothrombin activation), and with von Willebrand factor. Despite the high proportion of the 1 X 10(5) mol wt VIII:CAg form, which suggests VIII:CAg proteolysis, the ratio of Factor VIII coagulant activity to total VIII:CAg concentration was normal in renal dysfunction patients. These results could be simulated in vitro by thrombin treatment of normal plasma, which yielded similar VIII:CAg gel patterns and Factor VIII coagulant activity to antigen ratios. DIC patients with high F1+2 levels but no evidence of renal dysfunction had an VIII:CAg gel pattern distinct from renal dysfunction patients. DIC patients had elevated concentrations of both the 1 X 10(5) and 8 X 10(4) mol wt VIII:CAg forms. We conclude that an increase in a particular VIII:CAg form correlates with the severity of renal dysfunction. The antigen abnormality may be the result of VIII:CAg proteolysis by a thrombinlike enzyme and/or prolonged retention of proteolyzed VIII:CAg fragments. Images PMID:3932466

  19. Complement-mediated thrombotic microangiopathy secondary to sepsis-induced disseminated intravascular coagulation successfully treated with eculizumab: A case report.

    PubMed

    Abe, Tomohiro; Sasaki, Akira; Ueda, Taichiro; Miyakawa, Yoshitaka; Ochiai, Hidenobu

    2017-02-01

    Secondary thrombotic microangiopathies (TMAs) are induced by several underlying conditions; most are resolved by treating background disease. Eculizumab is a human monoclonal antibody that blocks the final stage of the complement system and effectively treats atypical hemolytic uremic syndrome (aHUS). In this report, we present a patient with TMA secondary to sepsis- induced coagulopathy, who was successfully treated with eculizumab.A 44-year-old woman, who had no special medical history or familial history of TMAs, was admitted on suspicion of septic shock. Physical examination revealed gangrene on her soles. Blood tests revealed a decreased platelet count, disseminated intravascular coagulation (DIC), renal dysfunction, hemolysis, and infection. Although the coagulation disorder improved with intensive care, the low platelet count, elevated lactate dehydrogenase levels, and renal dysfunction persisted. Our investigations subsequently excluded thrombotic thrombocytopenic purpura and Shiga toxin-producing Escherichia coli-induced HUS. Plasma exchange only improved lactate dehydrogenase levels. We clinically diagnosed this case as atypical HUS and started eculizumab treatment. The patient's platelet count increased, her renal dysfunction improved, and the gangrene on her feet was ameliorated. The patient was discharged without maintenance dialysis therapy after approximately 3 months. Subsequent tests revealed elevated serum levels of soluble C5b-9, and genetic testing revealed compound heterozygous c.184G > A (Val62Ile) and c.1204T > C (Tyr402His) single-nucleotide polymorphisms in complement factor H.We encountered a case of complement-mediated TMA accompanied by DIC, which was successfully treated with eculizumab. Further studies are necessary to support the optimal use of eculizumab for TMA with background diseases.

  20. The role of medical management for acute intravascular hemolysis in patients supported on axial flow LVAD.

    PubMed

    Hasin, Tal; Deo, Salil; Maleszewski, Joseph J; Topilsky, Yan; Edwards, Brooks S; Pereira, Naveen L; Stulak, John M; Joyce, Lyle; Daly, Richard; Kushwaha, Sudhir S; Park, Soon J

    2014-01-01

    Continuous flow left ventricular assist devices (LVADs) are used with good outcome. However, acute intravascular hemolysis due to thrombus in the pump remains a clinical challenge. We screened for LVAD-related intravascular hemolysis among 115 consecutive patients surviving HeartMateII implantation and investigated the role of medical therapy in resolving the hemolysis. Hemolytic events were identified in 7% of patients, 2-26 months after implant, manifested by peak lactate dehydrogenase (LDH) levels >6 times normal. With the institution of heparin and enhanced antiplatelet therapy, LDH levels receded rapidly reaching a stable trough level near baseline within 2 weeks with the resolution of clinical symptoms except in one patient who required additional therapy with tissue plasminogen activator (tPA). Complications included transient renal failure, one splenic infarct, and a cerebrovascular attack after tPA. The acute event of hemolysis resolved with medical therapy, and all were successfully discharged. However, recurrent hemolysis was common (6/8 patients over the next 1-7 months). At the end of follow-up, three patients were transplanted, one patient died refusing LVAD exchange for recurrent hemolysis, and 4 remained alive on LVAD support. Medical treatment with intensification of anticoagulation can be effective in resolving the acute hemolytic event. However, a definitive long-term strategy should be planned because the recurrence rate is high.

  1. Early rehabilitative treatment for pediatric acute disseminated encephalomyelitis: case report.

    PubMed

    Carlisi, E; Pavese, C; Mandrini, S; Carenzio, G; Dalla Toffola, E

    2015-06-01

    Although the diagnosis of and therapy for acute disseminated encephalomyelitis (ADEM) have been extensively investigated, the role of rehabilitation in modifying its functional outcome has received little attention in the literature so far. We report a case of pediatric ADEM who showed complete functional recovery following early rehabilitative treatment, started in the Intensive Care Unit.

  2. Refractory Fulminant Acute Disseminated Encephalomyelitis (ADEM) in an Adult.

    PubMed

    Rodríguez-Porcel, Federico; Hornik, Alejandro; Rosenblum, Jordan; Borys, Ewa; Biller, José

    2014-01-01

    Acute disseminated encephalomyelitis (ADEM) is characterized by its rapid progression with variable symptoms and severity in adults and children. Multiple therapeutic options have been proposed, but solid evidence is yet to be gathered. We describe an adult man with a fulminant form of ADEM unresponsive to numerous treatment modalities.

  3. Retrospective Evaluation of New Chinese Diagnostic Scoring System for Disseminated Intravascular Coagulation

    PubMed Central

    Deng, Jun; Wang, Huafang; Guo, Tao; Mei, Heng; Hu, Yu

    2015-01-01

    Objectives To retrospectively validate the new Chinese DIC scoring system (CDSS). Methods This study retrospectively collected the information of 619 patients (371 cases with non-hematologic malignancies, 248 cases with hematologic malignancies) who suspected of DIC in Wuhan Union Hospital during 2013-4 to 2014-6. We validated CDSS by comparing it with three leading scoring systems, from International Society on Thrombosis and Haemostasis (ISTH), Japanese Association for Acute Medicine (JAAM) and Japanese Ministry of Health and Welfare (JMHW), and evaluated its prognostic value by 28 days mortality, APACHE II and SOFA score. Results In non-hematologic malignancies, CDSS was more specific than JAAM (72.55% vs. 50.49%, p<0.05) and more sensitive than ISTH (77.07% vs. 62.03%, p<0.05). In hematologic malignancies, the area under the ROC curve of CDSS was larger than ISTH and JMHW (0.933 vs. 0.889, p<0.01 with ISTH, 0.944 vs. 0.845, p<0.01 with JMHW). In addition, the 28-day mortality rate, SOFA scores, APACHE II scores of DIC patients diagnosed by CDSS were significantly greater than non-DIC (P <0.05). Conclusions We are the first group to propose CDSS. It emphasized the values of the clinical manifestations, the rapidly declining platelet count, APTT in the diagnosis of DIC and used D-dimer as the fibrin-related maker. DIC with hematological malignancies was treated as a special part. In this study we can see that CDSS displayed an acceptable property for the diagnosis of DIC with appropriate sensitivity and specificity, and also had a good prognostic value for DIC patients. PMID:26076032

  4. Multiphasic acute disseminated encephalomyelitis associated with atypical rubella virus infection.

    PubMed

    Shinoda, Koji; Asahara, Hideaki; Uehara, Taira; Miyoshi, Katsue; Suzuki, Satoshi O; Iwaki, Toru; Kira, Jun-ichi

    2015-02-01

    We report the first case of an occurrence of multiphasic acute disseminated encephalomyelitis (ADEM) associated with atypical rubella virus infection with no rash and long-term increased titers of serum anti-rubella IgM in a 17-year-old male who had no history of rubella vaccination. He suffered from at least six clinical exacerbations with disseminated hyperintense lesions on FLAIR MR images during the course of 18 months. Repeated methylprednisolone pulse therapy and intravenous immunoglobulin therapy resolved the exacerbations. In patients with multiphasic ADEM of unknown etiology, clinicians should also consider the possibility of preceding infection with rubella virus.

  5. Severe starvation hypoglycemia and congestive heart failure induced by thyroid crisis, with accidentally induced severe liver dysfunction and disseminated intravascular coagulation.

    PubMed

    Kobayashi, Chiaki; Sasaki, Hideo; Kosuge, Keiichiro; Miyakita, Yasushi; Hayakawa, Masahumi; Suzuki, Akiko; Abe, Eri; Suzuki, Katsunori; Aizawa, Yoshifusa

    2005-03-01

    A 69-year-old woman caught a cold resulting in nausea, vomiting, diarrhea and severe anorexia. Then she suffered progressively from dyspnea and leg edema, and finally became delirious. On admission severe hypoglycemia, hypothermia, marked tachycardia, generalized edema, mild jaundice and cachexy were noted. EKG showed atrial fibrillation. A chest X-ray, chest CT and echocardiography showed congestive heart failure. Therapeutic use of diuretics induced shock leading to serious liver dysfunction and disseminated intravascular coagulation. However, combined therapy by intravenous glucose, digitalis, diuretics, anti-fibrinolytic drug and hydrocortisone were effective. Addition of antithyroid therapy brought a further favorable outcome.

  6. Disseminated intravascular coagulation (DIC)

    MedlinePlus

    ... serious disorder in which the proteins that control blood clotting become overactive. Causes When you are injured, proteins ... Supportive treatments may include: Plasma transfusions to replace blood clotting factors if a large amount of bleeding is ...

  7. Acute disseminated encephalomyelitis: current knowledge and open questions.

    PubMed

    Steiner, Israel; Kennedy, Peter G E

    2015-10-01

    Acute disseminated encephalomyelitis (ADEM) is usually an acute, multi-focal, and monophasic immune-mediated disease of the central nervous system. The disorder is mainly a condition of the pediatric age group, but neurologists are also involved in the management of adult patients. The lack of defined diagnostic criteria for ADEM underlies the limited understanding of its epidemiology, etiology, pathogenesis, course, prognosis, therapy, as well as the association with, and distinction from, multiple sclerosis. The present review summarizes current knowledge and outlines unanswered questions the answers to which should be eventually provided through a synergistic combination of clinical and basic research.

  8. Acute disseminated encephalomyelitis and other inflammatory demyelinating variants.

    PubMed

    Scolding, Neil

    2014-01-01

    Acute disseminated encephalomyelitis (ADEM) is an immune-mediated inflammatory central nervous system disorder characterized by acute or subacute onset of multifocal neurologic deficits with headache and impaired conscious level. Acute haemorrhagic leuoko-encephalitis (AHEM) is a more sever, often fatal variant. These disorders often follows a viral illness or vaccination, and are usually monophasic, though (probably more commonly in childhood) a multiphasic variant of ADEM is recognized. Because of the relative non-specificity of the clinical presentation (a sub-acute encephalopathy with focal signs), the differential diagnosis is wide; and distinction from the first episode of relapsing-remitting multiple sclerosis can occasionally be difficult. Here the clinical and investigational features of these disorders and their treatment are discussed.

  9. Can recombinant human thrombomodulin increase survival among patients with severe septic-induced disseminated intravascular coagulation: a single-centre, open-label, randomised controlled trial

    PubMed Central

    Hagiwara, Akiyoshi; Tanaka, Noriko; Uemura, Tatsuki; Matsuda, Wataru; Kimura, Akio

    2016-01-01

    Objective To determine whether treatment with recombinant human thrombomodulin (rhTM) increases survival among patients with severe septic-induced disseminated intravascular coagulation (DIC). Design Single-centre, open-label, randomised controlled trial. Setting Single tertiary hospital. Participant 92 patients with severe septic-induced DIC. Interventions Patients with DIC scores ≥4, as defined by the Japanese Association of Acute Medicine, were diagnosed with DIC. The envelope method was used for randomisation. The treatment group (rhTM group, n=47) was intravenously treated with rhTM within 24 hours of admission (day 0), and the control group (n=45) did not receive any anticoagulants, except in cases of deep venous thrombosis and pulmonary embolism. Primary and secondary measurements Data were collected on days 0 (admission), 1, 2, 3, 5, 7 and 10. The primary outcome was survival at 28 and 90 days. The secondary end points comprised changes in DIC scores, platelet counts, d-dimer, antithrombin III and C reactive protein levels, and Sequential Organ Failure Assessment (SOFA) scores. All analyses were conducted on an intent-to-treat basis. Main results The 28-day survival rates were 84% and 83% in the control and rhTM groups, respectively (p=0.745, log-rank test). The 90-day survival rates were 73% and 72% in the control and rhTM groups, respectively (p=0.94, log-rank test). Meanwhile, the rates of recovery from DIC (<4) were significantly higher in the rhTM group than in the control group (p=0.001, log-rank test). Relative change from baseline of d-dimer levels was significantly lower in the rhTM group than in the control group, on days 3 and 5. Conclusions rhTM treatment decreased d-dimer levels and facilitated DIC recovery in patients with severe septic-induced DIC. However, the treatment did not improve survival in this cohort. Trial registration number UMIN000008339. PMID:28039291

  10. A Case of De Novo CD5+ Disseminated Intravascular Large B-Cell Lymphoma Presenting as Multiorgan Failure

    PubMed Central

    Kapuria, Devika; Nanua, Suparna; Gaur, Rakesh

    2016-01-01

    Intravascular large B-cell lymphoma is an extremely rare extranodal lymphoma that proliferates in the lumen of the blood vessels while sparing the organ parenchyma. It usually presents with CNS and skin involvement. A 65-year-old Caucasian female presented with fevers and chills of 3-4 months' duration. Bone marrow biopsy done 3 months prior showed no significant myelodysplasia or lymphoid aggregates. The patient later died due to multiorgan failure. A bone marrow biopsy showed 20–30% CD5+ B cells consistent with infiltrative large B-cell lymphoma. An autopsy performed revealed diffuse intravascular invasion by lymphoma cells. Multiorgan involvement by intravascular B-cell lymphoma is very rare. Based on our literature review and to the best of our knowledge, there are only 5 case reports describing the presentation of this lymphoma with multiorgan failure. The immunophenotypic studies performed revealed that our patient had de novo CD5+ intravascular large B-cell lymphoma which is known to be aggressive with very poor prognosis. Although it is an extremely rare lymphoma, it should be considered as a potential cause of multiorgan failure when no other cause has been identified. A prompt tissue diagnosis and high-dose chemotherapy followed by ASCT can sometimes achieve remission. PMID:27777803

  11. Acute Disseminated Encephalomyelitis in a Child Following Plasmodium vivax Malaria.

    PubMed

    Purkait, Radheshyam; Mukherji, Aritra; Sinhamahapatra, Tapankumar; Bhadra, Ramchandra

    2015-07-01

    Acute Disseminated Encephalomyelitis (ADEM) is a multifocal, monophasic, acute demyelinating disease of the brain and spinal cord, which is commonly preceded by viral infections and occasionally bacterial infections or immunizations. Its occurrence following malarial infection, especially Plasmodium vivax Malaria is very uncommon. We report an 11-year girl who presented with clinical features of encephalopathy and generalized convulsions, 10 days following complete recovery from the Plasmodium vivax Malaria. Diagnosis of ADEM as a complication of Plasmodium vivax Malaria was made based on acute onset of neurological events, characteristic findings on Magnetic Resonance Imaging (MRI) of brain and prompt response to corticosteroid therapy. Follow-up MRI, 6 months after discharge, showed complete resolution of change found on the initial MRI. To the best of our knowledge, only two such cases have been reported in the English literature till date.

  12. Medical and surgical management of acute disseminated encephalomyelitis.

    PubMed

    Ellis, B D; Kosmorsky, G S; Cohen, B H

    1994-12-01

    Two children with a recent history of viral illness developed visual loss secondary to optic neuritis. Clinical findings and neuroimaging were consistent with acute disseminated encephalomyelitis (ADEM). Markedly elevated opening pressures were noted on lumbar puncture. The patients demonstrated an initial favorable response to high-dose corticosteroid administration. Both had recurrence of symptoms after being tapered off oral corticosteroids. High-dose corticosteroids were reinstituted and a bilateral optic nerve sheath decompression was performed on one patient who developed profound visual loss. A second patient underwent a lumboperitoneal shunt. Both children had resolution of their symptoms and had a recovery of normal visual acuity.

  13. Multimodality Intravascular Imaging Assessment of Plaque Erosion versus Plaque Rupture in Patients with Acute Coronary Syndrome

    PubMed Central

    Kwon, Jee Eun; Mintz, Gary S.; Hong, Young Joon; Lee, Sung Yun; Kim, Ki Seok; Hahn, Joo-Yong; Kumar, Kaup Sharath; Won, Hoyoun; Hyeon, Seong Hyeop; Shin, Seung Yong; Lee, Kwang Je; Kim, Tae Ho; Kim, Chee Jeong; Kim, Sang Wook

    2016-01-01

    Background and Objectives We assessed plaque erosion of culprit lesions in patients with acute coronary syndrome in real world practice. Subjects and Methods Culprit lesion plaque rupture or plaque erosion was diagnosed with optical coherence tomography (OCT). Intravascular ultrasound (IVUS) was used to determine arterial remodeling. Positive remodeling was defined as a remodeling index (lesion/reference EEM [external elastic membrane area) >1.05. Results A total of 90 patients who had plaque rupture showing fibrous-cap discontinuity and ruptured cavity were enrolled. 36 patients showed definite OCT-plaque erosion, while 7 patients had probable OCT-plaque erosion. Overall, 26% (11/43) of definite/probable plaque erosion had non-ST elevation myocardial infarction (NSTEMI) while 35% (15/43) had ST elevation myocardial infarction (STEMI). Conversely, 14.5% (13/90) of plaque rupture had NSTEMI while 71% (64/90) had STEMI (p<0.0001). Among plaque erosion, white thrombus was seen in 55.8% (24/43) of patients and red thrombus in 27.9% (12/43) of patients. Compared to plaque erosion, plaque rupture more often showed positive remodeling (p=0.003) with a larger necrotic core area examined by virtual histology (VH)-IVUS, while negative remodeling was prominent in plaque erosion. Overall, 65% 28/43 of plaque erosions were located in the proximal 30 mm of a culprit vessel-similar to plaque ruptures (72%, 65/90, p=0.29). Conclusion Although most of plaque erosions show nearly normal coronary angiogram, modest plaque burden with negative remodeling and an uncommon fibroatheroma might be the nature of plaque erosion. Multimodality intravascular imaging with OCT and VH-IVUS showed fundamentally different pathoanatomic substrates underlying plaque rupture and erosion. PMID:27482258

  14. Acute disseminated encephalomyelitis: Updates on an inflammatory CNS syndrome.

    PubMed

    Pohl, Daniela; Alper, Gulay; Van Haren, Keith; Kornberg, Andrew J; Lucchinetti, Claudia F; Tenembaum, Silvia; Belman, Anita L

    2016-08-30

    Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating CNS disorder with predilection to early childhood. ADEM is generally considered a monophasic disease. However, recurrent ADEM has been described and defined as multiphasic disseminated encephalomyelitis. ADEM often occurs postinfectiously, although a causal relationship has never been established. ADEM and multiple sclerosis are currently viewed as distinct entities, generally distinguishable even at disease onset. However, pathologic studies have demonstrated transitional cases of yet unclear significance. ADEM is clinically defined by acute polyfocal neurologic deficits including encephalopathy. MRI typically demonstrates reversible, ill-defined white matter lesions of the brain and often also the spinal cord, along with frequent involvement of thalami and basal ganglia. CSF analysis may reveal a mild pleocytosis and elevated protein, but is generally negative for intrathecal oligoclonal immunoglobulin G synthesis. In the absence of a specific diagnostic test, ADEM is considered a diagnosis of exclusion, and ADEM mimics, especially those requiring a different treatment approach, have to be carefully ruled out. The role of biomarkers, including autoantibodies like anti-myelin oligodendrocyte glycoprotein, in the pathogenesis and diagnosis of ADEM is currently under debate. Based on the presumed autoimmune etiology of ADEM, the current treatment approach consists of early immunotherapy. Outcome of ADEM in pediatric patients is generally favorable, but cognitive deficits have been reported even in the absence of other neurologic sequelae. This review summarizes the current knowledge on epidemiology, pathology, clinical presentation, neuroimaging features, CSF findings, differential diagnosis, therapy, and outcome, with a focus on recent advances and controversies.

  15. [Successful treatment for disseminated intra-vascular coagulation due to sepsis and brain abscess with low molecular weight heparin in a patient with antiphospholipid syndrome].

    PubMed

    Hiroishi, K; Shigenobu, Y; Asai, M; Tsuzuki, Y; Hayashi, N; Tominaga, K; Matsui, K; Hada, T; Higashino, K

    1999-02-01

    The management of disseminated intravascular coagulation (DIC) in a 22-year-old female patient with antiphospholipid syndrome is reported. Gabexate mesilate was given by continuous drip infusion at 1.5 g/day. No effect was seen, therefore Dalteparin sodium (DS) was administered by continuous drip infusion at 70 U/kg/day. The DIC score improved gradually during the first 4 days to normalization by 10 days. However, convulsive seizure was developed. Computed tomographic scan of brain demonstrated brain abscess at lt-basal ganglia. Continuous drainage was performed while administered continuous drip infusion of DS. Follow-up CT after operation showed reduction of low density area which means brain abscess. Finding in this case suggest that DS may play a role in the management of DIC accompanying intracranial infection.

  16. Acute disseminated encephalomyelitis mimicking late CNS relapse of acute lymphoblastic leukaemia: case report

    PubMed Central

    Kumar, Ram; Nijalingappa, Shobha; Grainger, John; Ismayl, Omar

    2007-01-01

    Background Acute encephalomyelopathy occurring after an allogeneic bone marrow transplant for leukaemia is a diagnostic emergency. The diagnosis can be challenging since there is a wide set of alternative diagnoses, including opportunistic infections and relapse of the leukaemia. Case presentation A 13-year old girl presented with a severe acute myelopathy and encephalopathy. She was in prolonged remission from a central nervous system and bone marrow relapse of an acute lymphoblastic leukaemia, treated with allogeneic bone marrow transplantation. Neuroimaging showed multifocal grey and white matter lesions of demyelinating appearance in the brain and entire spine. Immunophenotyping and cytogenetic investigations of the girl's cerebrospinal fluid lymphocytosis excluded a late central nervous system relapse of her leukaemia. The diagnosis was acute disseminated encephalomyelitis. With standard immunosuppressive therapy, the girl had early cerebral recovery but a prolonged period of recovery from her myelopathy. Conclusion Acute disseminated encephalomyelitis should be considered in the differential diagnosis of acute encephalomyelopathy after bone marrow transplantation for leukaemia. Demyelinating syndromes such as acute disseminated encephalomyelitis may be late sequelae of bone marrow transplantation. PMID:17411447

  17. Acute Disseminated Talaromyces marneffei in An Immunocompetent Patient.

    PubMed

    Wang, Pingli; Chen, Youfei; Xu, Hao; Ding, Liren; Wu, Zuqun; Xu, Zhijiang; Wang, Kai

    2017-03-27

    Talaromyces marneffei (also called Penicilliosis Marneffei or T. marneffei) is a rare fungal disease that is prevalent mainly in Southeast Asia and commonly seen in immunocompromised hosts. It was rarely observed in immunocompetent hosts. We report a case of acute disseminated T. marneffei in an immunocompetent patient in the non-prevalent region. This patient had never visited the endemic area. The patient experienced a persistent fever. Brain CT and magnetic resonance imaging (MRI) showed a mass in the right frontal with osteolytic damage. Excessive white blood cell (WBC) count and C-reactive protein content were observed. Antibiotics including meropenem and linezolid could not play an effect, and another two hard masses appeared in his right neck and front chest wall. The aspirates from the right frontal mass and bone marrow were cultured. The final diagnose of this infection was disseminated T. marneffei. After voriconazole treatment, all symptoms improved gradually. We present this case and aim to promote more clinicians and microbiologists in the non-endemic region to recognize this rare disease.

  18. Acute disseminated encephalomyelitis associated with meningitis due to Mycobacterium intracellulare.

    PubMed

    Okada, Hiroshi; Yoshioka, Keiji

    2010-01-01

    A 73-year-old woman was admitted to our hospital because of persistent fever, headache and fatigue for several weeks. On admission, she was diagnosed as having meningitis due to Mycobacterium intracellulare (M. intracellulare) detected in her cerebrospinal fluid (CSF) by polymerase chain reaction. Even though anti-tuberculous therapy improved her CSF findings, her condition was not restored. Brain MRI showed multifocal and asymmetrical increases in T2 signals involving white matter and cortical gray-white junction of cerebral hemispheres, cerebellum and brainstem. Based on the progression of clinical symptoms and radiological features, we diagnosed her illness as acute disseminated encephalomyelitis (ADEM) associated with meningitis due to M. intracellulare. Steroid therapy dramatically improved her condition. This is the first report of ADEM following meningitis due to M. intracellulare in a non-immunocompromized host.

  19. Acute disseminated encephalomyelitis: current controversies in diagnosis and outcome.

    PubMed

    Koelman, Diederik L H; Mateen, Farrah J

    2015-09-01

    Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory, demyelinating disorder of the CNS. Only in the past 15 years have larger groups of patients from several geographical areas been reported for comparisons across studies. In spite of the increased recognition of ADEM, the diagnosis of ADEM remains clinical, aided by neuroimaging confirmation, because of the lack of a biological marker. The diagnosis may be difficult, given that several diseases may present similar to ADEM. The controversial existence of multiphasic forms necessitates a continuous evaluation of the diagnosis by tracking subsequent events. Despite proposed consensus criteria, the diagnostic criteria employed to characterize ADEM range widely among the largest reported cohorts to date. This review comprehensively evaluates the current knowledge and controversies that surround ADEM, with special consideration of the distinction between ADEM and other demyelinating diseases such as multiple sclerosis. In addition, we present implications of the current knowledge of ADEM for both research and clinical practice.

  20. Atypical presentations of acute disseminated encephalomyelitis (ADEM) in HIV infection.

    PubMed

    Naidoo, Ansuya; Paruk, Hoosain; Bhagwan, Bhupendra; Moodley, Anand

    2017-02-01

    Acute disseminated encephalomyelitis is a monophasic demyelinating disorder of the central nervous system associated with various viral infections including HIV infection. We present the findings of seven HIV-infected patients with mild to moderate immunosuppression presenting with atypical features. Four patients had a multiphasic course; three patients had tumefactive lesions, and two patients had corpus callosum lesions. Two patients with the multiphasic course also had tumefactive lesions. Their clinical and radiological findings are presented. Despite the few cases, we propose that the dysimmune process lying between marked immunosuppression (CD4 < 200 cells/μL) and normal CD4 counts (CD4 > 500 cells/μL) might be responsible for these atypical presentations.

  1. Rapid improvement of disseminated intravascular coagulation by donor leukocyte infusions in a patient with promyelocytic crisis of chronic myelogenous leukemia after reduced-intensity stem cell transplantation from an HLA 2-antigen-mismatched mother.

    PubMed

    Matsue, Kosei; Yamada, Konagi; Takeuchi, Masami; Tabayashi, Takayuki

    2003-05-01

    Donor leukocyte infusion (DLI) is recognized as effective therapy for relapse after stem cell transplantation in patients with chronic myelogenous leukemia (CML). However, the clinical efficacy of DLI in the advanced phase of CML or other types of leukemia has not been clearly defined because of its varying degree of success. We describe a 22-year-old male patient with promyelocytic crisis of CML who had a relapse after peripheral blood stem cell transplantation, under reduced-intensity conditioning, from his HLA 2-antigen-mismatched mother. Complete hematologic remission was obtained after transplantation. However, a relapse that occurred on day 66 posttransplantion was characterized by an increase in number of leukemic promyelocytes with simultaneous exacerbation of disseminated intravascular coagulation (DIC). The patient received DLI containing 1 x 10(7)/kg CD3+ cells on day 73. Because rapid improvement of DIC paralleled the decrease in leukemic cells and because it was observed soon after DLI and before the development of acute graft-versus-host disease (GVHD), we hypothesized that leukemia-specific cells other than natural killer cells or cytotoxic T-cells unrelated to GVHD played a role in the graft-versus-leukemia effect observed in our patient. In addition, this may be the first report of effective correction of DIC by DLI after stem cell transplantation.

  2. Changes in Plasma Levels of Natural Anticoagulants in Disseminated Intravascular Coagulation: High Prognostic Value of Antithrombin and Protein C in Patients with Underlying Sepsis or Severe Infection

    PubMed Central

    Choi, Qute; Hong, Ki Ho; Kim, Ji-Eun

    2014-01-01

    Background Dysfunctional natural anticoagulant systems enhance intravascular fibrin for mation in disseminated intravascular coagulation (DIC), and plasma levels of natural anti coagulants can be used in the diagnosis and prognosis of DIC. Herein, the diagnostic value of 4 natural anticoagulants was assessed, and the prognostic value of antithrombin and protein C were validated in a large population. Methods Part 1 study included 126 patients with clinically suspected DIC and estimated plasma levels of 4 candidate anticoagulant proteins: antithrombin, protein C, protein S, and protein Z. Part 2 comprised 1,846 patients, in whom plasma antithrombin and protein C levels were compared with other well-known DIC markers according to the underlying dis eases. The 28-day mortality rate was used to assess prognostic outcome. Results Antithrombin and protein C showed higher areas under the ROC curve than pro tein S and protein Z. In part 2 of the study, antithrombin and protein C levels significantly correlated with DIC score, suggesting that these factors are good indicators of DIC severity. Antithrombin and protein C showed significant prognostic power in Kaplan-Meier analyses. In patients with sepsis/severe infection, antithrombin and protein C showed higher hazard ratios than D-dimer. Platelet count showed the highest hazard ratio in patients with hemato logic malignancy. In patients with liver disease, the hazard ratio for antithrombin levels was significantly high. Conclusions Decreased plasma anticoagulant levels reflect florid consumption of the phys iologic defense system against DIC-induced hypercoagulation. Plasma antithrombin and protein C levels are powerful prognostic markers of DIC, especially in patients with sepsis/severe infection. PMID:24624342

  3. Acute disseminated encephalomyelitis presenting as a brainstem encephalitis.

    PubMed

    Atherton, Daniel S; Perez, Sarah R; Gundacker, Nathan D; Franco, Ricardo; Han, Xiaosi

    2016-04-01

    Acute disseminated encephalomyelitis (ADEM) is a disease characterized by inflammation and destruction of myelin. Acute hemorrhagic leukoencephalitis (AHLE) is a severe form of ADEM known for its particularly poor outcome. We present a case of a young Caucasian female who presented with drowsiness and slurred speech followed by rapid brainstem involvement resembling rhomboencephalitis. Despite multiple diagnostic tests and empiric therapy with immunosuppressants, immunoglobulins, and antimicrobials, she lost most brainstem reflexes within a few weeks and ultimately passed away. Magnetic resonance imaging (MRI) showed progression of lesions from the brainstem to eventually involve bilateral cerebral hemispheres. Autopsy and microscopic examination of the brain revealed several hemorrhagic lesions throughout the brain and rendered a diagnosis of AHLE. AHLE was initially described in 1941 and is thought to be autoimmune related, possibly related to cross reactivity between the immune system and CNS tissues like myelin. While a definitive inciting pathogen was not discovered, this case emphasizes the importance of considering AHLE in the differential diagnosis of patients with rapid loss of neurologic function and highlights an atypical presentation of ADEM/AHLE.

  4. Acute viral hepatitis, intravascular haemolysis, severe hyperbilirubinaemia and renal failure in glucose-6-phosphate dehydrogenase deficient patients.

    PubMed Central

    Agarwal, R. K.; Moudgil, A.; Kishore, K.; Srivastava, R. N.; Tandon, R. K.

    1985-01-01

    Five patients with acute viral hepatitis developed severe intrasvascular haemolysis and unusually high levels of serum bilirubin (427 to 1368 mumol/l). All 5 had high fever, marked anaemia, reticulocytosis and neutrophilic leucocytosis. Three of them developed acute renal failure, which was of non-oliguric type in 2. The clinical course was protracted, but complete recovery occurred in 4 patients between 4 to 10 weeks. One patient with hepatic coma and oliguric renal failure died. Deficiency of the enzyme G-6-PD was confirmed in 4 cases. Massive haemolysis in the patients was probably induced by the administration of chloroquine and other drugs. Intravascular haemolysis should be suspected in patients with acute viral hepatitis, if they show unexplained anaemia and very high serum bilirubin levels, and measures to prevent renal failure should be instituted in such cases. PMID:4070114

  5. UNUSUAL CLINICAL CASES THAT MIMIC ACUTE DISSEMINATED ENCEPHALOMYELITIS.

    PubMed

    Duman, Özgür; Yürekli, Vedat Ali; Gencpinar, Pinar; Karaali, Kamil; Gümüş, Hakan; Okuyaz, Çetin; Hazar, Volkan; Haspolat, Şenay

    2015-09-01

    Acute disseminated encephalomyelitis (ADEM) is an immune-mediated monophasic inflammatory demyelinating disorder of the central nervous system which poses a diagnostic challenge. We report on six cases of different etiologies that mimicked the clinical and radiologic findings of ADEM. The cases were collected from four different reference hospitals in Turkey. The same radiologist from the Akdeniz University Faculty of Medicine examined the magnetic resonance images of all patients. Three (50%) patients had antecedent infections. Initial symptoms of the patients were as follows: fever in 50%, altered consciousness in 33.3% and convulsions in 16.7% of patients. Neurologic examination showed long tract signs in 83.3%, ataxia in 50% and altered consciousness in 50% of patients. Cerebrospinal fluid examination revealed lymphocytic pleocytosis only in case 6. Four patients received steroid pulse therapy and one of these initially underwent intravenous immunoglobulin therapy. The patients' definitive diagnoses were as follows: paraspinal neuroblastoma-associated paraneoplastic syndrome; histiocytic sarcoma; mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes; and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy in one patient each, while two patients had hemophagocytic syndrome. The present case series demonstrated difficulties in diagnosing ADEM while revealing extremely rare disorders that mimic ADEM radiologically and clinically.

  6. Cardiogenic shock from atypical Takotsubo cardiomyopathy attributed to acute disseminated encephalomyelitis lesion involving the medulla.

    PubMed

    Venkatraman, A; Bajaj, N S; Khawaja, A; Meador, W

    2016-04-01

    We present here a case of atypical Takotsubo cardiomyopathy arising as a result of a lesion in the medulla oblongata. The patient was diagnosed with acute disseminated encephalomyelitis, and had improvement with intravenous steroids.

  7. Therapeutic plasma exchange in acute disseminated encephalomyelitis in children.

    PubMed

    Borras-Novell, Cristina; García Rey, Enric; Perez Baena, Luis Francisco; Jordan Garcia, Iolanda; Catella Cahiz, Dolors; Cambra, Francisco

    2015-12-01

    Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that is probably due to an autoimmune mechanism with an acute presentation and a monophasic course. The management of patients with ADEM is based on supportive therapy, corticosteroids, and intravenous immunoglobulin, and in selected cases, with therapeutic plasma exchange (TPE). The aim of our study is to evaluate the efficacy of TPE, as adjuvant therapy in pediatric patients with ADEM. We retrospectively reviewed the medical records of children with the diagnosis of ADEM between 2009 and 2011 to which TPE was indicated and were admitted in the ICU of Hospital Sant Joan de Deu (Spain). The diagnosis of ADEM was made by clinical and laboratory criteria and by the presence of compatible lesions on cranio-spinal Magnetic Resonance Imaging (MRI). For signaling TPE, we followed the guidelines established by the American Association of Apheresis (ASFA) in 2010. Five cases were identified. The predominant neurological symptoms in our patients were: altered level of consciousness, seizures, motor deficits, cranial nerve disorders, and aphasia. Most important demyelinating lesions were located in cortical and subcortical white matter of the brain and highlighted brainstream. Patients performed between 4 and 5 sessions, with no reported side effects. Progressive clinical improvement was evident in all patients, with good neurosensory response to stimulation, cessation of seizures, and recovery of limb mobility. Nowadays, one patient's right paresis persists and another suffers epileptic seizures. None of the cases in our series presented new episodes of demyelination. Due to the suggested immune-mediated pathogenesis of ADEM, treatment is based on immunomodulatory agents, being glucocorticoids the most important ones. The treatment can be complemented with intravenous immunoglobulin and plasmapheresis. Available data suggests that plasma exchange is beneficial

  8. Benign-onset acute disseminated encephalomyelitis: a report on two cases.

    PubMed

    Degirmenci, Eylem; Erdogan, Cagdas; Oguzhanoglu, Attila; Bir, Levent Sinan

    2013-05-30

    The signs and symptoms of acute disseminated encephalomyelitis are heterogeneous and dependent on the location and severity of the inflammatory process. The meningoencephalitic presentation may include meningism, impaired consciousness (occasionally leading to coma), seizures and confusion, or behavioral disturbances. Multifocal neurological features include a combination of optic neuritis, visual field defects, cranial neuropathy, sensorimotor impairment, ataxia, aphasia, and involuntary movements. One definition of acute disseminated encephalomyelitis is "an initial clinical event with a presumed inflammatory and demyelinating cause, with acute or sub-acute onset affecting multifocal areas of the central nervous system". Patients with acute disseminated encephalomyelitis frequently suffer from seizures, disturbances of consciousness, fever, and headaches, and occasionally there are focal signs and symptoms. Here, we report on two cases who presented with different symptoms, but the clinical findings that the patients showed were benign.

  9. Intravascular Ultrasound Observation of the Mechanism of No-Reflow Phenomenon in Acute Myocardial Infarction

    PubMed Central

    Li, Junxia; Wu, Longmei; Tian, Xinli; Zhang, Jian; Shi, Yujie

    2015-01-01

    Objective To study the mechanism of the no-reflow phenomenon using coronary angiography (CAG) and intravascular ultrasound (IVUS). Methods A total of 120 patients with acute myocardial infarction (AMI) who successfully underwent indwelling intracoronary stent placement by percutaneous coronary intervention (PCI). All patients underwent pre- and post-PCI CAG and pre-IVUS. No-reflow was defined as post-PCI thrombolysis in myocardial infarction (TIMI) grade 0, 1, or 2 flow in the absence of mechanical obstruction. Normal reflow was defined as TIMI grade 3 flow. The pre-operation reference vascular area, minimal luminal cross-sectional area, plaque cross-sectional area, lesion length, plaque volume and plaque traits were measured by IVUS. Results The no-reflow group was observed in 14 cases (11.6%) and normal blood-flow group in 106 cases (89.4%) based on CAG results. There was no statistically significant difference in the patients’ medical history, reference vascular area (no-flow vs. normal-flow; 15.5 ± 3.2 vs. 16.2 ± 3.3, p> 0.05) and lesion length (21.9 ± 5.1 vs. 19.5 ± 4.8, p> 0.05) between the two groups. No-reflow patients had a longer symptom onset to reperfusion time compared to normal blood-flow group [(6.6 ± 3.1) h vs (4.3 ± 2.7) h; p< 0.05] and higher incidence of TIMI flow grade< 3 (71.4% vs 49.0%, p< 0.05). By IVUS examination, the no-reflow group had a significantly increased coronary plaque area and plaque volume compared to normal blood-flow group [(13.7 ± 3.0) mm2 vs (10.2 ± 2.9) mm2; (285.4 ± 99.8) mm3 vs (189.7 ± 86.4) mm3; p< 0.01]. The presence of IVUS-detected soft plaque (57.1% vs. 24.0%, p< 0.01), eccentric plaque (64.2% vs. 33.7%, p< 0.05), plaque rupture (50.0% vs. 21.2%, p< 0.01), and thrombosis (42.8% vs. 15.3%) were significantly more common in no-reflow group. Conclusion There was no obvious relationship between the coronary risk factors and no-reflow phenomenon. The symptom onset to reperfusion time, TIMI flow grade before

  10. A Case of Acute Myocardial Infarction due to Left Main Trunk Occlusion Complicated With Aortic Dissection as Diagnosed by Intravascular Ultrasound

    PubMed Central

    Okamoto, Masashi; Amano, Tomonori; Matsuoka, Shunzo; Hirai, Hideki; Masuda, Kazunori; Nakajima, Kanta; Sueyoshi, Atsushi

    2012-01-01

    A 52-year-old man was transferred to our hospital with a sudden onset of severe chest pains. His electrocardiogram revealed ST-segment elevation suggestive of acute myocardial infarction. Emergency coronary angiography showed subtotal occlusion of left main trunk (LMT) with delayed coronary flow. Because intravascular ultrasound revealed a large intimal flap, we diagnosed aortic dissection involving the LMT. After stenting of the LMT, the patient underwent surgical repair of the aortic dissection. Although it is difficult to obtain a correct diagnosis of aortic dissection complicated with myocardial ischemia, we succeeded in diagnosing this rare condition by use of a intravascular ultrasound.

  11. What Is Disseminated Intravascular Coagulation?

    MedlinePlus

    ... bleeding. Clotting factors are proteins needed for normal blood clotting. With fewer platelets and clotting factors in the ... DIC, it helps to understand the body's normal blood clotting process. Your body has a system to control ...

  12. Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis.

    PubMed

    Brenton, J Nicholas; Banwell, Brenda L

    2016-01-01

    Acquired pediatric demyelinating diseases manifest acutely with optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, or with various other acute deficits in focal or polyfocal areas of the central nervous system. Patients may experience a monophasic illness (as in the case of acute disseminated encephalomyelitis) or one that may manifest as a chronic, relapsing disease [e.g., multiple sclerosis (MS)]. The diagnosis of pediatric MS and other demyelinating disorders of childhood has been facilitated by consensus statements regarding diagnostic definitions. Treatment of pediatric MS has been modeled after data obtained from clinical trials in adult-onset MS. There are now an increasing number of new therapeutic agents for MS, and many will be formally studied for use in pediatric patients. There are important efficacy and safety concerns regarding the use of these therapies in children and young adults. This review will discuss acute management as well as chronic immunotherapies in acquired pediatric demyelination.

  13. Acute Increase in Hepatic Arterial Flow During TIPS Identified by Intravascular Flow Measurements

    SciTech Connect

    Radeleff, Boris Sommer, Christof-Matthias; Heye, Tobias; Lopez-Benitez, Ruben; Sauer, Peter; Schmidt, Jan; Kauczor, Haus-Ulrich; Richter, Goetz Martin

    2009-01-15

    The purpose of this study was to investigate alterations of hepatic arterial flow during transjugular intrahepatic portosystemic stent shunt (TIPS) applying intravascular Doppler sonography. This prospective monocenter study included 25 patients with liver cirrhosis (alcohol induced [n = 19], chronic hepatitis associated [n = 3], primary biliary cirrhosis associated [n = 1], and cryptogenic [n = 2]) successfully treated with TIPS. All patients underwent intravascular hepatic arterial flow measurements during TIPS using an endoluminal flow sensor. The average arterial peak velocity (APV) and the maximum arterial peak velocity (MPV) were registered. Twenty-two patients (88%) showed increased APV, one patient (4%) showed unaffected APV, and two patients (8%) showed decreased APV after TIPS. The average portosystemic pressure gradient decreased significantly, from 22.0 {+-} 5.1 mmHg before TIPS to 11.0 {+-} 4.1 mmHg after TIPS (-50.0%; p < 0.0001). The average APV increased significantly, from 41.9 {+-} 17.8 cm/s before TIPS to 60.7 {+-} 19.0 cm/s after TIPS (+44.9%; p < 0.0001). The average MPV increased significantly, from 90.8 {+-} 31.7 cm/s before TIPS to 112.6 {+-} 34.9 cm/s after TIPS (+24.0%; p = 0.0002). These changes in perfusion set in within seconds after TIPS tract formation in all the patients with increased APV. We conclude that TIPS-induced portosystemic decompression leads to a significant increase in hepatic arterial flow. The changes occurred within seconds, suggesting a reflex-like mechanism.

  14. Successful treatment of disseminated mucormycosis in a neutropenic patient with T-cell acute lymphoblastic leukaemia

    PubMed Central

    Guymer, Chelsea; Khurana, Sanjeev; Suppiah, Ram; Hennessey, Iain; Cooper, Celia

    2013-01-01

    Mucormycosis is a rare angioinvasive fungal infection, more commonly seen in immunosuppressed patients, with reported mortality rates of 95% in disseminated disease. We present a case report of a patient with T-cell acute lymphoblastic leukaemia who developed disseminated infection with mucormycosis (involving the pancreas, left occipital lobe, right lower lobe of lung, appendix and right kidney) after having completed induction and consolidation chemotherapy. Growth of Lichtheimia corymbifera was initially isolated following a right pleural tap with fungal elements identified repeatedly on subsequent pathology specimens. Following radical surgical debridement and concurrent treatment with combination antifungal therapy, the patient survived. This case demonstrates that aggressive multisite surgical de-bulking of disseminated fungal foci, in conjunction with combination antifungal therapy and reversal of immunosuppression, can result in survival despite the grave prognosis associated with disseminated mucormycosis. PMID:23904418

  15. Disseminated Infection Caused by Scedosporium prolificans in a Patient with Acute Multilineal Leukemia

    PubMed Central

    de Batlle, J.; Motjé, M.; Balanzà, R.; Guardia, R.; Ortiz, R.

    2000-01-01

    In this report, we describe a case of disseminated infection caused by Scedosporium prolificans (S. inflatum) in a patient affected by chemotherapy-induced acute multilineal leukemia and neutropenia. For the fungus isolated in four blood cultures, high MICs of currently available antifungal agents were found. Postmortem examination revealed multiorgan involvement. PMID:10747173

  16. Therapeutic hypothermia with the use of intracranial pressure monitoring for acute disseminated encephalomyelitis with brainstem lesion: a case report.

    PubMed

    Miyamoto, Kenji; Kozu, Seiki; Arakawa, Akiko; Tsuboi, Tatsuo; Hirao, Jun-Ichi; Ono, Kazuyuki; Arisaka, Osamu

    2014-09-01

    Acute disseminated encephalomyelitis confined to the brainstem is associated with poor prognosis. We describe a case of a 10-year-old boy with acute disseminated encephalomyelitis in the brainstem that developed after influenza A infection. A 10-year-old boy presented with fever and prolonged disturbance of consciousness and was admitted to our hospital. Magnetic resonance imaging (MRI) of the midbrain, with T2-weighted and fluid-attenuated inversion recovery images, suggested acute disseminated encephalomyelitis accompanied by a brainstem lesion. Lumbar puncture showed pleocytosis and increased protein content, including myelin basic protein, interleukin-6, and immunoglobulin G, all suggestive of acute disseminated encephalomyelitis. Treatments such as methylprednisolone pulse therapy, intravenous immunoglobulin, and therapeutic hypothermia were performed. Although the patient presented with anisocoria with increased intracranial pressure monitoring during hypothermia, prompt therapy with d-mannitol and dopamine was effective. Our case results suggest that hypothermia could be included in the choice of therapy for acute disseminated encephalomyelitis with brainstem lesions.

  17. Intravascular OCT

    NASA Astrophysics Data System (ADS)

    Schmitt, Joseph M.; Adler, Desmond; Xu, Chenyang

    Since the first coronary angioplasty was performed in the late 1970s, imaging has played a central role in percutaneous coronary intervention (PCI). Today more than three million PCI procedures are performed worldwide to expand narrowed arteries and to clear blood clots that can cause debilitating symptoms of myocardial ischemia or fatal heart attacks. Although X-ray angiography is still the workhorse imaging modality in the field of interventional cardiology, intravascular imaging has become an indispensable tool for guiding complex PCI procedures. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the two most commonly used catheter-based imaging technologies in coronary procedures. Since the first commercial intravascular OCT systems were introduced in Japan and the European Union in 2004 and in the United States in 2009, the application of intravascular OCT has grown rapidly [3, 15, 16].

  18. Patrolling monocytes promote intravascular neutrophil activation and glomerular injury in the acutely inflamed glomerulus

    PubMed Central

    Finsterbusch, Michaela; Hall, Pam; Li, Anqi; Devi, Sapna; Westhorpe, Clare L. V.; Kitching, A. Richard

    2016-01-01

    Nonclassical monocytes undergo intravascular patrolling in blood vessels, positioning them ideally to coordinate responses to inflammatory stimuli. Under some circumstances, the actions of monocytes have been shown to involve promotion of neutrophil recruitment. However, the mechanisms whereby patrolling monocytes control the actions of neutrophils in the circulation are unclear. Here, we examined the contributions of monocytes to antibody- and neutrophil-dependent inflammation in a model of in situ immune complex-mediated glomerulonephritis. Multiphoton and spinning disk confocal intravital microscopy revealed that monocytes patrol both uninflamed and inflamed glomeruli using β2 and α4 integrins and CX3CR1. Monocyte depletion reduced glomerular injury, demonstrating that these cells promote inappropriate inflammation in this setting. Monocyte depletion also resulted in reductions in neutrophil recruitment and dwell time in glomerular capillaries and in reactive oxygen species (ROS) generation by neutrophils, suggesting a role for cross-talk between monocytes and neutrophils in induction of glomerulonephritis. Consistent with this hypothesis, patrolling monocytes and neutrophils underwent prolonged interactions in glomerular capillaries, with the duration of these interactions increasing during inflammation. Moreover, neutrophils that interacted with monocytes showed increased retention and a greater propensity for ROS generation in the glomerulus. Also, renal patrolling monocytes, but not neutrophils, produced TNF during inflammation, and TNF inhibition reduced neutrophil dwell time and ROS production, as well as renal injury. These findings show that monocytes and neutrophils undergo interactions within the glomerular microvasculature. Moreover, evidence indicates that, in response to an inflammatory stimulus, these interactions allow monocytes to promote neutrophil recruitment and activation within the glomerular microvasculature, leading to neutrophil

  19. Acute disseminated encephalomyelitis: the time until diagnosis and its subsequent course in children.

    PubMed

    Omata, Taku; Fujii, Katsunori; Tanabe, Yuzo; Arai, Hidee; Motojima, Toshino

    2014-01-01

    Acute disseminated encephalomyelitis has an acute onset followed by improvement over several weeks. However, some cases require more time for a definitive diagnosis after protracted psychiatric or nonspecific symptoms. The authors investigated the time from onset to definitive diagnosis, subsequent course of treatment, and outcomes in 7 children with acute disseminated encephalomyelitis treated at the authors' hospital. The mean duration of illness before definitive diagnosis was 20.7 days (range: 2-50 days). Steroid pulse therapy was performed in all cases, and rapid improvements were observed; the mean duration from treatment initiation to hospital discharge was 8.6 days (range: 4-14 days). None of the cases showed neurological sequelae. Although this study investigated a small number of patients, its results suggest that time to diagnosis is often longer in children than in adults, and even in cases of delayed treatment, response to steroid pulse therapy is good and outcomes may not necessarily be affected.

  20. An atypical case of acute disseminated encephalomyelitis associated with cytomegalovirus infection.

    PubMed

    De Fino, Chiara; Nociti, Viviana; Modoni, Anna; Bizzarro, Alessandra; Mirabella, Massimiliano

    2016-01-01

    We present the case of a young man admitted to our hospital for persistent headache associated with fever, retrorbitary pain and vomiting, who rapidly developed encephalopathy with drowsiness, paraplegia, hypoesthesia with a D6 sensory level and urinary retention. Brain and spinal cord MRI revealed findings compatible with acute disseminated encephalomyelitis (ADEM) and microbiological tests documented a cytomegalovirus (CMV) infection. CMV infection is extraordinarily associated with ADEM, but must be included in microbiological tests, because early diagnosis and treatment ameliorate the neurological outcome.

  1. Acute Disseminated Encephalomyelitis in an Adult: An Uncommon Case of Paroxysmal Sympathetic Hyperactivity.

    PubMed

    Holder, Eric K; McCall, Joseph C; Feeko, Kristofer J

    2015-07-01

    Acute disseminated encephalomyelitis (ADEM) is an uncommon acute, rapidly progressive autoimmune demyelinating disease of the central nervous system that is most often due to infection or immunization. Generally, it is monophasic, but there is potential for recurrence and risk for development of multiple sclerosis. Although there has been literature documenting autonomic dysreflexia and hypertensive emergency in 2 pediatric cases of ADEM, to our knowledge there has not been a case detailing paroxysmal sympathetic hyperactivity in an adult patient with ADEM. This case report describes a fulminant case of ADEM and serves to expand the list of diagnoses associated with paroxysmal sympathetic hyperactivity.

  2. A case of acute disseminated encephalomyelitis associated with hepatitis C virus infection.

    PubMed

    Sim, Jae Eun; Lee, Jun-Bum; Cho, Yu Na; Suh, Sang Hyun; Kim, Ja Kyung; Lee, Kyung-Yul

    2012-07-01

    Acute disseminated encephalomyelitis (ADEM) is a monophasic autoimmune demyelinating disease of the central nervous system, which typically follows acute viral or bacterial infection or vaccination. We report a case of ADEM associated with hepatitis C virus (HCV) infection with positive serum and cerebrospinal fluid (CSF) anti-HCV antibody. After steroid treatment, neurologic symptoms were improved. Virus triggers autoimmunity or direct viral invasion plays a part in the genesis of ADEM. This is the first reported case of ADEM with anti-HCV antibody in the CSF.

  3. Possible induction of acute disseminated encephalomyelitis (ADEM)-like demyelinating illness by intrathecal mesenchymal stem cell injection.

    PubMed

    Kishk, Nirmeen A; Abokrysha, Noha T; Gabr, Hala

    2013-02-01

    We report a 27-year-old woman with an episode of encephalitis and optic neuritis, followed by autologous bone marrow mesenchymal stem cell transplants and possible induction of acute disseminated encephalomyelitis-like demyelinating illness.

  4. Intravascular ultrasound-guided percutaneous coronary intervention in a human immunodeficiency virus-positive patient with cocaine-associated acute myocardial infarction: case report and review.

    PubMed

    Sonne, Carolin; Stempfle, Hans-Ulrich; Klauss, Volker; Schiele, Thomas M

    2005-09-01

    Cocaine use is a major problem worldwide and there are numerous reports about cocaine-associated myocardial infarction. Nevertheless minimal data are available from randomised clinical trials to suggest evidence-based approaches to the management of cocaine-associated myocardial ischemia. Moreover, most reports have been limited to conservative management of cocaine-associated myocardial infarction. We report a case of a young male cocaine user with acute myocardial infarction, undergoing diagnostic coronary angiography and intravascular ultrasound revealing severe atherosclerosis, followed by successful stent implantation.

  5. Progressive disseminated histoplasmosis in systemic lupus erythematosus-an unusual presentation of acute tenosynovitis and a literature review.

    PubMed

    Lim, Sian Yik; Kijsirichareanchai, Kunut; Winn, Richard

    2013-01-01

    Progressive disseminated histoplasmosis is a disease where Histoplasma capsulatum affects multiple organs due to the inability of host cellular immunity to control the infection. Progressive disseminated histoplasmosis mainly involves the bone marrow, liver, and lungs. We report an unusual initial presentation of progressive disseminated histoplasmosis presenting as acute tenosynovitis in a systemic lupus erythematosus (SLE) patient. This report highlights the point that H. capsulatum may present as focal lesions and a high level of suspicion is needed to make the diagnosis, especially in SLE patients. We specifically reviewed reported cases of progressive disseminated histoplasmosis in SLE patients, and a review of the literature is presented.

  6. [Acute disseminated encephalomyelitis in children as the result of aseptic meningitis - a report of two cases].

    PubMed

    Gołąbek, Violetta; Woźniakowska-Gęsicka, Teresa; Sokołowska, Dorota

    2011-01-01

    Acute disseminated encephalomyelitis (ADEM) is an inflammation of the spinal cord and brain. Diagnosis of ADEM, due to its rare occurrence and lack of definite laboratory indices, is difficult and is never totally certain. The clinical criterion required for the diagnosis is presence of acute symptoms from the brain and/or spine with fever, occurring after viral or bacterial infection, vaccination or serum administration. Differentiation between ADEM and acute multiple sclerosis in children is difficult, and diagnosis of ADEM may only be confirmed after years of observation, especially as multiple sclerosis is more common than ADEM. The most useful tool in differentiation between the two diseases is MRI. The aim of the study was to present two cases of ADEM with unknown aetiology after aseptic meningitis in children.

  7. Acute disseminated encephalomyelitis associated with hepatitis B virus reinfection--consequence or coincidence?

    PubMed

    Lazibat, Ines; Brinar, Vesna

    2013-12-01

    Acute disseminated encephalomyelitis (ADEM) is an idiopathic inflammatory demyelinating disease of the CNS that is particularly difficult to differentiate from the first episode of multiple sclerosis. ADEM typically occurs as a post-infectious phenomenon, and usually presents a monophasic episode, but also includes recurrent and multiphasic forms. We report a case of ADEM associated with hepatitis B virus (HBV) reinfection. After steroid and IV immunoglobulin treatment, neurologic symptoms were improved. We suppose that the HBV reinfection was the cause of ADEM, but possible pathogenetic mechanism is still obscure.

  8. Cognitive and behavioral outcomes in individuals with a history of acute disseminated encephalomyelitis (ADEM).

    PubMed

    Kuni, Bravina J; Banwell, Brenda L; Till, Christine

    2012-01-01

    We describe cognitive and behavioral outcomes in 12 males and 7 females diagnosed with acute disseminated encephalomyelitis (ADEM) in childhood. Age at assessment ranged from 6 to 23 years and all participants were at least 2 years post-ADEM presentation (mean 5.4 years). Performance was compared with 18 control subjects. Three of 19 ADEM patients met criteria for cognitive impairment, defined as performance falling ≤1.5 SD on at least three tests. Age at ADEM-onset was not associated with outcome. Despite the transient nature of the illness and absence of persistent physical disability, cognitive sequelae occur in some individuals following childhood ADEM.

  9. Two Cases of Acute Disseminated Encephalomyelitis Following Vaccination Against Human Papilloma Virus.

    PubMed

    Sekiguchi, Kenji; Yasui, Naoko; Kowa, Hisatomo; Kanda, Fumio; Toda, Tatsushi

    We herein present two cases of acute disseminated encephalomyelitis (ADEM) following vaccination against human papilloma virus (HPV). Case 1 experienced diplopia and developed an unstable gait 14 days after a second vaccination of Cervarix. Brain magnetic resonance imaging (MRI) showed an isolated small, demyelinating lesion in the pontine tegmentum. Case 2 experienced a fever and limb dysesthesia 16 days after a second vaccination of Gardasil. Brain MRI revealed hyperintense lesion in the pons with slight edema on a T2-weighted image. Both cases resolved completely. It is important to accumulate further data on confirmed cases of ADEM temporally associated with HPV vaccination.

  10. Partial Klüver-Bucy syndrome in a patient with acute disseminated encephalomyelitis.

    PubMed

    Jha, Sanjeev; Ansari, M K

    2010-11-01

    The symptoms of Klüver-Bucy syndrome (KBS) include hyperorality, hypersexuality, visual agnosia, hypermetamorphosis and decreased motor or vocal reaction to fear- or anger-provoking stimuli. This syndrome has been associated with a wide variety of neurodegenerative disorders, as well as traumatic, non-traumatic and infectious brain injuries. We report an 11-year-old boy who developed a fairly classical presentation of KBS, presumably in the setting of post-infectious acute disseminated encephalomyelitis (ADEM). This patient's presentation is a reminder of this rare syndrome and extends the clinical manifestations of ADEM, which is a relatively more common condition.

  11. Fulminant form of acute disseminated encephalomyelitis in a child treated with mild hypothermia.

    PubMed

    Ichikawa, Kazushi; Motoi, Hirotaka; Oyama, Yoshitaka; Watanabe, Yoshihiro; Takeshita, Saoko

    2013-12-01

    We describe the case of a 3-year-old boy diagnosed with the fulminant form of acute disseminated encephalomyelitis (ADEM). He developed general fatigue, fever, drowsiness and difficulty in walking. He had extensive multiple high-intensity lesions in the white matter of the cerebrum and cerebellum, which are typical findings of ADEM. He became comatose and developed decerebrate rigidity with severe brain edema despite high-dose methylprednisolone therapy, and then was subjected to mild hypothermia therapy, and given i.v. immunoglobulin. The patient recovered remarkably with the sequela of only mild action tremor. The patient was considered to have acute hemorrhagic leukoencephalitis (AHLE), an extremely severe form of ADEM, in terms of the rapidly deteriorating clinical course and neuroimaging features. It was speculated that AHLE and ADEM might be a continuous disease spectrum. It is considered that the severe brain edema associated with ADEM or AHLE is a suitable indication for mild hypothermia therapy.

  12. Acute disseminated encephalomyelitis following Campylobacter jejuni gastroenteritis: Case report and review of the literature.

    PubMed

    Marziali, Simone; Picchi, Eliseo; Di Giuliano, Francesca; Altobelli, Simone; Mataluni, Giorgia; Marfia, Girolama; Garaci, Francesco; Floris, Roberto

    2017-02-01

    We describe a case of a 25-year-old male with a diagnosis of acute disseminated encephalomyelitis (ADEM) following infection with Campylobacter jejuni, which is implicated in various human pathologies regarding the central nervous system (CNS) with acute course like Guillain-Barré syndrome (GBS), Miller-Fisher syndrome (MFS), Bickerstaff's brainstem encephalitis (BEE), acute transverse myelitis (ATM) as well as ADEM. These conditions are caused by cross-reactivity between Campylobacter's epitopes and cells of the CNS that causes an immunomediated inflammatory demyelination of the CNS. In the acute phase, magnetic resonance (MR) can detect pathologic signal intensity at the CNS with areas of pathologic contrast enhancement at cortical and spinal white matter that normalize over time or can be stable. These findings can be associated with edema in parts of the CNS. The lesions typically appear at different times during the disease course and also can have a different evolution. Our purpose therefore was to describe the clinical course and MR findings of this case and perform a critical review of the literature.

  13. Acute ischemia of bilateral lower extremities as a presenting feature of disseminated mucormycosis endocarditis: A case report

    PubMed Central

    Tachamo, Niranjan; Rajagopalan, Priya; Nazir, Salik; Lohani, Saroj; Le, Brian; Patel, Nitin

    2016-01-01

    Disseminated mucormycosis endocarditis is extremely rare, and only a few cases have actually been reported in the literature. It is almost universally fatal despite aggressive surgical and medical management. In this article, we present the case of a 48-year-old immunocompromised male with mucormycosis endocarditis, who presented with acute bilateral lower extremity ischemia and passed away due to subsequent multi-organ failure. To our knowledge, this is the first case report of disseminated mucormycosis native valve endocarditis presenting as acute bilateral lower extremity ischemia. PMID:27987284

  14. Disseminated tuberculosis

    MedlinePlus

    ... Complications Complications of disseminated TB can include: Adult respiratory distress syndrome ( ARDS ) Liver inflammation Lung failure Return of the ... Elsevier Saunders; 2015:chap 251. Read More Acute respiratory distress syndrome Granulomatosis with polyangiitis HIV/AIDS Lymph system Meningitis ...

  15. Acute disseminated encephalomyelitis and thrombocytopenia following Epstein-Barr virus infection.

    PubMed

    Saeed, Muhammad; Dabbagh, Omar; Al-Muhaizae, Muhammad; Dhalaan, Hesham; Chedrawi, Aziza

    2014-11-01

    Epstein-Barr Virus (EBV) causes a broad spectrum of disease in humans with several clinical syndromes and is ubiquitous, infecting more than 95% of the world's population. Central Nervous System (CNS) disease alone associated with Epstein-Barr virus rarely occurs in previously healthy individuals. Systemic viral illness in children and complications are rare, but may occur. In few cases, it is associated with a variety of CNS and hematological complications like acute disseminated encephalomyelitis, transverse myelitis, neuropsychiatric syndrome, GBS, autoimmune thrombocytopenia and hemolytic anemia and they usually respond to immunotherapy. We report previously healthy boy, who presented with left sided weakness, headache and thrombocytopenia following EBV infection. The thrombocytopenia was resistant to intravenous immunoglobulin and methylprednisolone but responded well to Rituximab.

  16. [A case of acute disseminated encephalomyelitis (ADEM) with an anti-galactocerebroside antibody].

    PubMed

    Kuzume, Daisuke; Sajima, Kazuaki; Kon-no, Yuko; Kaneko, Keiko; Yamasaki, Masahiro

    2015-01-01

    Acute disseminated encephalomyelitis (ADEM) with an anti-galactocerebroside antibody is very rare. We report a case of 82-year-old man with ADEM associated with anti-galactocerebroside antibody in serum. He was admitted to our hospital after developing disturbed consciousness and respiratory failure. A cerebrospinal fluid examination disclosed an albuminocytologic dissociation and elevation of myelin basic protein. Magnetic resonance images revealed lesions in the medulla oblongata, pons, midbrain, bilateral cerebellar hemisphere and thalami. Initially, he was treated with methylprednisolone (1 g/day) for three days. His clinical symptoms improved. We found on 15(th) hospital day that an anti-galactocerebroside antibody was positive in serum without serological evidence of Mycoplasma pneumoniae infection. This case can be diagnosed as ADEM associated with an anti-galactocerebroside antibody.

  17. Outcome of children with acute disseminated encephalomyelitis in a tertiary care center in India.

    PubMed

    Dhooria, Gurdeep S; Bains, Harmesh S; Bhat, Deepak; Wats, Shalini

    2014-01-01

    Acute disseminated encephalomyelitis (ADEM) is an immune-mediated disease of the brain that follows viral infection or vaccination, or even appears spontaneously. The objective of the study was to evaluate the clinical, neuroimaging and laboratory profiles of children with ADEM. Seventeen children admitted to the Pediatric Department of Dayanand Medical College and Hospital, Ludhiana, whose cases were consistent with the diagnosis of ADEM, were included. Their clinical and neuroimaging profiles and outcomes were studied. The most common presenting features were fever (71%), altered sensorium (59%) and headache and convulsions (41%). Brain MRI identified lesions in subcortical white matter (75%) and periventricular white matter (38%). Most patients were treated with corticosteroids. A favorable outcome was seen in 88% of patients. Although 59% of patients had neurologic sequelae at discharge, only one patient had a major neurological deficit at follow-up. Prognosis for survival and outcome was good in the majority of patients. Neurological sequelae at discharge do not predict poor outcome.

  18. Acute disseminated encephalomyelitis (ADEM)--a rare complication of falciparum malaria.

    PubMed

    Rachita, Sarangi; Satyasundar, Mahapatra; Mrutunjaya, Dash; Birakishore, Rath

    2013-06-01

    A 4-y-old girl was admitted with fever and altered sensorium. Peripheral blood smear and quantified buffy coat test showed Plasmodium falciparum infection. She received antimalarial therapy and got discharged on seventh day without any neurological deficit. Seven days later she was readmitted with fever and disorientation. Neurological examination revealed coma and decerebration. The deep tendon reflexes were exaggerated and babiniski response was positive in the right lower limb. MRI of brain revealed multifocal asymmetrical T2W/FLAIR hyperintensities in cerebral hemispheres, sub cortical white matter and midbrain. There was minimal patchy enhancement on contrast study. Any feature of grey matter involvement was not observed. The child improved remarkably after the treatment with methyl prednisolone. A follow up MRI after one year showed a complete resolution of demyelinating lesions. Diagnosis of acute disseminated encephalomyelitis (ADEM) as a complication of falciparum malaria was made based on sudden onset of neurological events, MRI findings and prompt response to corticosteroid therapy.

  19. Acute disseminated encephalomyelitis in a case of autoimmune haemolytic anaemia: a rare association.

    PubMed

    Hajra, Adrija; Bandyopadhyay, Dhrubajyoti

    2016-06-07

    Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease that may occur in a postvaccination condition or as a parainfectious encephalomyelitis. It is almost always monophasic. The underlying pathogenesis of ADEM may include perivascular inflammation, oedema and demyelination in the central nervous system. We present a case of a 15-year-old girl who was diagnosed as having ADEM, as well as detected to be a follow-up case of autoimmune haemolytic anaemia on steroid treatment. She presented with progressive weakness of the right lower limb for the past 4 days. MRI showed multiple subcortical lesions of varying size showing hyperintensities in T2 fluid-attenuated inversion recovery (FLAIR). The patient responded well to steroid therapy. No residual lesion was found on follow-up. Very few cases have been found with this rare association in the literature.

  20. Acute disseminated encephalomyelitis associated with dengue infection: a case report with literature review.

    PubMed

    Gupta, Meena; Nayak, Rajeev; Khwaja, Geeta A; Chowdhury, Debashish

    2013-12-15

    Dengue is the commonest arboviral illness caused by four antigenically distinct dengue virus serotypes (DEN-1 through DEN-4). The clinical spectrum of the disease ranges from asymptomatic or mild infection to catastrophic dengue shock syndrome (DSS). In last few years, neurological manifestations of dengue infection have been increasingly observed and reported mainly with serotypes DEN-2 and DEN-3. The pathogenesis of neurological manifestations includes: neurotrophic effect of the dengue virus, related to the systemic effects of dengue infection, and immune mediated. Encephalopathy and encephalitis are the most frequently reported neurological manifestations followed by meningitis, myositis, hypokalemic periodic paralysis, stroke, Guillain-Barré syndrome and transverse myelitis. Acute disseminated encephalomyelitis (ADEM) associated with dengue infection is rarely reported. We herein report a case of ADEM associated with classic dengue fever. Favourable clinical outcome occurred after a five-day course of intravenous methylprednisolone therapy.

  1. Acute disseminated encephalomyelitis progressing to multiple sclerosis: are infectious triggers involved?

    PubMed

    Smyk, Daniel S; Alexander, Anaïs K; Walker, Mary; Walker, Martin

    2014-10-01

    Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are demyelinating disorders affecting the central nervous system. An autoimmune aetiology has been proposed for both. ADEM principally affects adolescents following acute infection by a variety of pathogens and has also been reported to occur following vaccination. ADEM typically resolves following medical treatment, whereas MS follows a more relapsing and remitting course. The pathogenesis of MS remains unclear, but it is thought that a combination of infectious and non-infectious environmental factors and host genetics act synergistically to cause disease. A variety of viruses, including Epstein Barr virus, cytomegalovirus, herpes simplex virus and varicella zoster virus, have been implicated as possible infectious triggers. The similar clinical and pathological presentation of ADEM and MS presents a diagnostic challenge for distinguishing ADEM from a first episode of MS. Some cases of ADEM progress to MS for reasons that are not currently clear. This review examines the evidence for infectious agents as triggers for ADEM progressing to MS and suggests potential methods that may facilitate identification of infectious agents that may be responsible for the pathogenesis of ADEM to MS.

  2. Clinical study of childhood acute disseminated encephalomyelitis, multiple sclerosis, and acute transverse myelitis in Fukuoka Prefecture, Japan.

    PubMed

    Torisu, Hiroyuki; Kira, Ryutaro; Ishizaki, Yoshito; Sanefuji, Masafumi; Yamaguchi, Yui; Yasumoto, Sawa; Murakami, Yoshihiko; Shimono, Masayuki; Nagamitsu, Shinichiro; Masuzaki, Mayumi; Amamoto, Masano; Kondo, Rikako; Uozumi, Tomohiko; Aibe, Miyuki; Gondo, Kenjiro; Hanai, Toshio; Hirose, Sinichi; Matsuishi, Toyojiro; Shirahata, Akira; Mitsudome, Akihisa; Hara, Toshiro

    2010-06-01

    Acute disseminated encephalomyelitis (ADEM) has recently been studied in several countries owing to the development and wide spread use of imaging technology, but few epidemiological studies of childhood ADEM have been undertaken in Asian countries. To perform a comprehensive survey of ADEM and related diseases in Japanese children, we conducted a multicenter, population-based study on childhood ADEM, multiple sclerosis, and acute isolated transverse myelitis in Fukuoka Prefecture, Japan. We identified 26 children with ADEM, 8 with multiple sclerosis, and 4 with acute transverse myelitis during 5 years between September 1998 and August 2003. The incidence of childhood ADEM under the age of 15 years was 0.64 per 100,000 person-years, mean age at onset was 5.7 years, and male-female ratio was 2.3:1. The prevalence of childhood multiple sclerosis was 1.3 per 100,000 persons. The mean age at onset of multiple sclerosis, 9.3 years, was significantly higher than that of ADEM. Nineteen (73%) and four (15%) patients with ADEM experienced antecedent infectious illnesses and vaccinations, respectively, within 1 month before the onset. Clinical and radiological findings of ADEM revealed that the frequency of seizures, mean white blood cell counts in cerebrospinal fluid, and the frequency of subcortical lesions in Fukuoka study, seemed to be higher than those in previous non-Asian studies. These findings suggest that there are ethnic or geographical differences in the incidence and clinical features of ADEM, and that there might be potent genetic or environmental risk factors for ADEM distinct from those for multiple sclerosis.

  3. Rehabilitation outcomes after combined acute disseminated encephalomyelitis and Guillain-Barré syndrome in a child: a case report.

    PubMed

    Korupolu, Radha; Ngo, Thien; Hack, Nawaz; Escott, Edward; Salles, Sara

    2014-01-01

    A 5-year old female presented with acute tetraparesis and areflexia. Initial imaging and cerebrospinal fluid analysis were suggestive of acute disseminated encephalomyelitis (ADEM). Minimal clinical response with intravenous steroids prompted further work up. Limited nerve conduction studies suggested possible acute motor-sensory axonal neuropathy, a rare variant of Guillain-Barré syndrome (GBS). Repeat imaging was compatible with polyradiculopathy indicating concomitance of ADEM and GBS. The patient suffered severe motor deficits and neuropathic pain. Slow but significant functional recovery was noted after intensive inpatient rehabilitation followed by continued rehabilitation via home health services.

  4. Acute Disseminated Encephalomyelitis after Oral Therapy with Herbal Extracts: A Case Report

    PubMed Central

    Kaymakamzade, Bahar; Karabudak, Rana; Kurne, Aslı Tuncer; Nurlu, Gülay

    2016-01-01

    Background: Acute disseminated encephalomyelitis (ADEM) is a rare demyelinating disease of the central nervous system, commonly attributed to infections or vaccinations. Toxic or allergenic compounds can also trigger a response in the immune system and may cause demyelination. We present a case with ADEM after using oral herbal medications. Case Report: A 25 year-old male developed bilateral central facial palsy and severe quadriparesis after taking herbal drugs (containing echinacea and many other herbal ingredients) for two weeks. He had used the extract to increase his potency and reproductivity. He had no past history of recent immunization or viral infection. The clinical findings, cerebrospinal fluid (CSF) analysis and brain magnetic resonance imaging (MRI) were compatible with ADEM. The neurological findings were improved after seven doses of pulse methylprednisolone treatment. To our knowledge, this is the third report in the literature that links herbal therapy and demyelinating disease. Conclusion: Most of the ADEM cases related to herbal therapy in the literature similarly used echinacea. It is our opinion that other ingredients of the herbal extract used by our case, besides echinacea, could have the potential to cause a trigger in the immune system. Further studies are needed to clarify the immunological effects of different kinds of herbal compounds, as well as the effects of different parts of the plants and the results of various dosages. Moreover, ingredients should also be tested for toxicity, adverse effects and drug interactions. PMID:27308086

  5. Acute disseminated encephalomyelitis complicating dengue infection with neuroimaging mimicking multiple sclerosis: A report of two cases.

    PubMed

    Viswanathan, S; Botross, N; Rusli, B N; Riad, A

    2016-11-01

    Acute disseminated encephalomyelitis (ADEM) complicating dengue infection is still exceedingly rare even in endemic countries such as Malaysia. Here we report two such cases, the first in an elderly female patient and the second in a young man. Both presented with encephalopathy, brainstem involvement and worsening upper and lower limb weakness. Initial magnetic resonance imaging (MRI) of the brain was normal in the first case. Serum for dengue Ig M and NS-1 was positive in both cases. Cerebrospinal fluid (CSF) showed pleocytosis in both with Dengue IgM and NS-1 positive in the second case but not done in the first. MRI brain showed changes of perpendicular subcortical palisading white matter, callosal and brainstem disease mimicking multiple sclerosis (MS) in both patients though in the former case there was a lag between the onset of clinical symptoms and MRI changes which was only clarified on reimaging. The temporal evolution and duration of the clinical symptoms, CSF changes and neuroimaging were more suggestive of Dengue ADEM rather than an encephalitis though initially the first case began as dengue encephalitis. Furthermore in dengue encephalitis neuroimaging is usually normal or rarely edema, haemorrhage, brainstem, thalamic or focal lesions are seen. Therefore, early recognition of ADEM as a sequelae of dengue infection with neuroimaging mimicking MS and repeat imaging helped in identifying these two cases. Treatment with intravenous steroids followed by maintenance oral steroids produced good outcome in both patients.

  6. Meningeal inflammation and demyelination in a patient clinically diagnosed with acute disseminated encephalomyelitis.

    PubMed

    Koshihara, Hiroshi; Oguchi, Kenya; Takei, Yo-ichi; Kitazawa, Kazuo; Higuchi, Kayoko; Ohara, Shinji

    2014-11-15

    Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are both CNS inflammatory demyelinating diseases with overlapping clinical features. A case is reported of a 51-year-old female who presented with headache, progressive aphasia and hemiparesis without preceding infection or vaccination. Brain MRI revealed multiple, often confluent, subcortical white matter lesions without enhancement, affecting predominantly the left cerebral hemisphere. CSF examination failed to reveal oligoclonal bands. Brain biopsy revealed both pathological features of ADEM and findings are consistent with the early stage of MS, including meningeal B and T lymphocytic infiltration, perivenular demyelination, subpial demyelination and discrete confluent plaque-like foci of demyelination. Steroid treatment resulted in remarkable clinical and radiological improvement and there has been no recurrence in six years of follow-up. This case highlights the difficulties in differentiating between ADEM and the first attack of MS and further suggests that ADEM and the early stage of MS, and its tumefactive variant, may have a common underlying pathologic mechanism, which may have a therapeutic implication in treating these diseases.

  7. Vasculitis and rheumatologic diseases may play role in the pathogenesis of acute disseminated encephalomyelitis (ADEM).

    PubMed

    Sabayan, B; Zolghadrasli, Abdolali

    2007-01-01

    Acute disseminated encephalomyelitis (ADEM) is defined as a multifocal, monophasic, demyelinating, and inflammatory disease involving the central nervous system. It typically begins within 6 weeks of an antigenic challenge such as infection or immunization. Perivenous inflammation, edema and demyelination are the pathological hallmarks of ADEM. Reactivity of T-cells against myelin components such as myelin basic protein has been found in children with ADEM. The triggers for immune responses in ADEM are not known, but the two most widely accepted hypotheses are molecular mimicry and self-sensitization secondary to CNS infection. Inflammatory cytokines including tumor necrosis factor alpha (TNFalpha), interleukin 2 (IL2) and interferon gamma (INFgamma) are thought to be important in lesion formation in ADEM. Due to the active role of inflammatory cytokines in the pathogenesis of ADEM, any disease contributing to systemic formation of inflammatory cytokines can potentially be an etiologic factor for the initiation of ADEM. In vasculitis and rheumatologic diseases the number of T-cells, T helper type 1 cytokines and other inflammatory cytokines such as TNFalpha increase substantially. We present this hypothesis that in such setting of inflammation, adhesion molecules are up-regulated on the brain capillary endothelium by cytokines and other inflammatory mediators, altering the permeability of the brain blood barrier and so allowing for inflammatory cell migration. The migratory cells attack the basic myelin protein and the final result is the demyelination seen in ADEM. So we propose that vasculitis and rheumatologic diseases may play role in the pathogenesis of ADEM.

  8. Isolated and persistent cognitive dysfunction in a patient with acute disseminated encephalomyelitis.

    PubMed

    Adamec, Ivan; Klepac, Nataša; Kolenc, Danijela; Ozretić, David; Habek, Mario

    2013-03-01

    We report a case of pathology-proven acute disseminated encephalomyelitis (ADEM) in which the patient's symptoms were solely cognitive. Although cognitive dysfunction is a well-recognized symptom in adults with multiple sclerosis, cognitive assessment of adults with ADEM has rarely been reported. A 35-year-old woman was referred to our center for evaluation of cognitive disturbance and demyelinating lesions seen on brain magnetic resonance imaging (MRI). We performed a neurologic examination, full neuropsychological assessment, brain MRI, blood and cerebrospinal fluid analyses, visual evoked potentials, and brain biopsy. The patient's Mini-Mental State Examination score was 26/30. Cognitive assessment revealed multiple severe dysfunctions, mainly in executive and attention tasks. She scored below the normal range on the Digit Span Forward and Backward Test and the Trail Making Test Part B. The Frontal Assessment Battery showed deficits in mental flexibility, motor programming, and inhibitory control. She also scored in the impaired range on tests of verbal fluency and memory. The brain MRI and biopsy confirmed a diagnosis of ADEM. This case report points to the limitations of relying on clinical presentation, neuroimaging, and current controversial diagnostic criteria in diagnosing ADEM in adults, and highlights the essential role of pathologic evaluation.

  9. Madariaga virus infection associated with a case of acute disseminated encephalomyelitis.

    PubMed

    Luciani, Kathia; Abadía, Iván; Martínez-Torres, Alex O; Cisneros, Julio; Guerra, Ilka; García, Mariana; Estripeaut, Dora; Carrera, Jean-Paul

    2015-06-01

    We present the first report of a pediatric case of acute disseminated encephalomyelitis (ADEM) associated with Madariaga virus infection (MADV, Alphavirus, Togaviridae; formerly known as South American variants of eastern equine encephalitis virus [EEEV]) in a patient of the 2010 alphaviral epidemic reported in Panama. The patient was admitted to the Hospital del Niño in Panama City with suspected meningitis, exhibited with decreased alertness and disorientation in space and time, hemiparesis, and left Babinski sign. The patient was transferred to the intensive care unit and treated with aciclovir and methylprednisolone. The magnetic resonance imaging (MRI) of the brain revealed multiple hyperintense lesions at T2-weighted images (T2) and fluid-attenuated inversion recovery (FLAIR) on the cortical-subcortical level. Sera samples obtained on days 6 and 12 were immunoglobulin M (IgM) positive for MADV. The findings on the clinical and cerebrospinal analyses, rapid symptom progression as well as neuroimaging, and serologic studies support our diagnosis. Our results suggest that MADV should be included in the etiologic differential diagnosis of ADEM in endemic countries.

  10. Acute disseminated encephalomyelitis with severe neurological outcomes following virosomal seasonal influenza vaccine.

    PubMed

    Alicino, Cristiano; Infante, Maria Teresa; Gandoglia, Ilaria; Miolo, Nadia; Mancardi, Gian Luigi; Zappettini, Simona; Capello, Elisabetta; Orsi, Andrea; Tamburini, Tiziano; Grandis, Marina

    2014-01-01

    Acute disseminated encephalomyelitis (ADEM) is an inflammatory, usually monophasic, immune mediate, demyelinating disease of the central nervous system which involves the white matter. ADEM is more frequent in children and usually occurs after viral infections, but may follow vaccinations, bacterial infections, or may occur without previous events. Only 5% of cases of ADEM are preceded by vaccination within one month prior to symptoms onset. The diagnosis of ADEM requires both multifocal involvement and encephalopathy and specific demyelinating lesions of white matter. Overall prognosis of ADEM patients is often favorable, with full recovery reported in 23% to 100% of patients from pediatric cohorts, and more severe outcome in adult patients. We describe the first case of ADEM occurred few days after administration of virosomal seasonal influenza vaccine. The patient, a 59-year-old caucasic man with unremarkable past medical history presented at admission decreased alertness, 10 days after flu vaccination. During the 2 days following hospitalization, his clinical conditions deteriorated with drowsiness and fever until coma. The magnetic resonance imaging of the brain showed multiple and symmetrical white matter lesions in both cerebellar and cerebral hemispheres, suggesting demyelinating disease with inflammatory activity, compatible with ADEM. The patient was treated with high dose of steroids and intravenous immunoglobulin with relevant sequelae and severe neurological outcomes.

  11. A spectrum of inflammation and demyelination in acute disseminated encephalomyelitis (ADEM) of children.

    PubMed

    Esposito, Susanna; Di Pietro, Giada Maria; Madini, Barbara; Mastrolia, Maria Vincenza; Rigante, Donato

    2015-10-01

    Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that involves multifocal areas of the white matter, rarely the gray matter and spinal cord, mainly affecting children and mostly occurring 1-2weeks after infections or more rarely after vaccinations. Though a specific etiologic agent is not constantly identified, to evaluate carefully patient's clinical history and obtain adequate samples for the search of a potential ADEM causal agent is crucial. In the case of a prompt diagnosis and adequate treatment, most children with ADEM have a favorable outcome with full recovery, but in the case of diagnostic delays or inappropriate treatment some patients might display neurological sequelae and persistent deficits or even show an evolution to multiple sclerosis. The suspicion of ADEM rises on a clinical basis and derives from systemic and neurologic signs combined with magnetic resonance imaging of the central nervous system. Other advanced imaging techniques may help an appropriate differential diagnosis and definition of exact disease extension. Although there is no standardized protocol or management for ADEM, corticosteroids, intravenous immunoglobulin, and plasmapheresis have been successfully used. There is no marker that permits to identify the subset of children with worse prognosis and future studies should try to detect any biological clue for prevision of neurologic damage as well as should optimize treatment strategies using an approach based on the effective risk of negative evolution.

  12. Haematological abnormalities in acute pancreatitis. A prospective study.

    PubMed Central

    Murphy, D.; Imrie, C. W.; Davidson, J. F.

    1977-01-01

    Twenty-five patients with acute pancreatitis were studied prospectively in the first week of their admission using haematological and coagulation tests. Platelet counts initially fell and later returned to admission levels. Rising levels of plasma fibrinogen were recorded. The kaolin cephalin clotting time was shorter than its control in twenty-one patients. Eighteen patients had elevated fibrinogen degradation products and fourteen had a positive ethanol gelation test. It is suggested that by taking into account the results in series of individual patients a degree of intravascular coagulation may be a common feature of acute pancreatitis. In one patient (presented in detail) strong evidence for disseminated intravascular coagulation was found PMID:887529

  13. Acute In Vivo Performance Evaluation of the Fluorescence Affinity Sensor in the Intravascular and Interstitial Space in Swine

    PubMed Central

    Dutt-Ballerstadt, Ralph; Evans, Colton; Pillai, Arun P.; Gowda, Ashok; McNichols, Roger; Rios, Jesse; Cohn, William

    2013-01-01

    Objective We assessed and compared the performance levels of a fiber-coupled fluorescence affinity sensor (FAS) for glucose detection in the intradermal tissue and intravascular bed during glucose clamping and insulin administration in a large animal model. Research Design and Methods The FAS (BioTex Inc., Houston, TX) was implanted in interstitial tissue and in the intravenous space in nondiabetic, anesthetized pigs over 6–7 h. For intradermal assessment, a needle-type FAS was implanted in the upper back using a hypodermic needle. For intravenous assessment, the FAS was inserted through a catheter into the femoral artery and vein. Blood glucose changes were induced by infusion of dextrose and insulin through a catheterized ear or jugular vein. Results Based on retrospective analysis, the mean absolute relative error (MARE) of the sensor in blood and interstitial tissue was 11.9% [standard deviation (SD) = ±9.6%] and 23.8% (SD = ±19.4%), respectively. When excluding data sets from sensors that were affected by exogenous insulin, the MARE for those sensors tested in interstitial tissue was reduced to 16.3% (SD = ±12.5%). Conclusions The study demonstrated that the performance level of the FAS device implanted in interstitial tissue and blood can be very high. However, under certain circumstances, exogenous insulin caused the glucose concentration in interstitial tissue to be lower than in blood, which resulted in an overall lower level of accuracy of the FAS device. How significant this physiological effect is in insulin-treated persons with diabetes remains to be seen. In contrast, the level of accuracy of the FAS device in blood was very high because of high mass transfer conditions in blood. While the use of the FAS in both body sites will need further validation, its application in critically ill patients looks particularly promising. PMID:23439158

  14. How Is Disseminated Intravascular Coagulation Treated?

    MedlinePlus

    ... Treatments Living With Clinical Trials Links Related Topics Blood Transfusion Deep Vein Thrombosis Heart Attack Stroke Send a ... emergency treatment in a hospital. Treatment may include blood transfusions , medicines, and oxygen therapy . (Oxygen is given through ...

  15. How Is Disseminated Intravascular Coagulation Diagnosed?

    MedlinePlus

    ... Platelets are blood cell fragments that help with blood clotting. Abnormal platelet numbers may be a sign of ... following tests examine the proteins active in the blood clotting process and how long it takes them to ...

  16. Commentary on "Possible induction of acute disseminated encephalomyelitis (ADEM)-like demyelinating illness by intrathecal mesenchymal stem cell injection".

    PubMed

    Butzkueven, Helmut

    2013-02-01

    The case report that is the subject of this Commentary describes a 27-year-old woman, who, 3 months after a devastating low cervical myelitis, underwent intrathecal mesenchymal stem cell (MSC) infusions. Six hours after the third infusion, she became unconscious, febrile and cerebral MRI showed acute bitemporal and left cerebellar lesions, consistent with an acute disseminated encephalomyelitis. It is likely that this is the first reported patient with neuroinflammatory exacerbation after MSC therapy. This case suggests that, in addition to their malignant potential, autologous MSC expanded in vitro can exhibit immune-activating properties leading to autoimmune exacerbation.

  17. The efficiency analysis of thrombolytic rt-PA combined with intravascular interventional therapy in patients with acute basilar artery occlusion

    PubMed Central

    Xianxian, Zhao; Chengsong, Yue; Qiang, Mei; Fei, Wei; Lin, Shen; Huiyan, Ding; Zili, Gong

    2017-01-01

    In order to further optimize the treatment strategy for the patients with acute basilar artery occlusion, we were dedicated to study the therapeutic effects and influential factors in the process of treated basilar artery occlusion with thrombolytic combined vascular interventional therapy. 75 patients with acute basilar artery occlusion treated with arterial thrombolytic therapy were analyzed retrospectively. In accordance with the discharge records of patients, their short-term curative effect with 24-hour treatment and 14-days treatment were evaluated. Our data showed that the survival condition of the patients with acute acute basilar artery occlusion were visibly improved by combination thrombolytic and interventional therapy. Moreover, their BI scores were remarkably improved, while NIHSS and mRS scores were evidently reduced. These data proved that our treatment strategy was able to improve the survival condition of patients with acute basilar artery occlusion. Furthermore, our data showed that coagulation related factors remarkably improved in the patients, when they treated by combination thrombolytic therapy with interventional therapy. In addition, our results suggested that the patients' bilateral Babinski(+), revascularization and coma symptom were closely related to their prognosis after treated the patients with combination thrombolytic and vascular interventional therapy, and the difference was statistically significant (p<0.05, p<0.05, p<0.05). Besides, our data also displayed that the with stent assisted angioplasty was significantly superior to the patients with balloon angioplasty, and the difference was statistically significant (p<0.05). Anyhow, combination thrombolytic with interventional therapy can effectively promote the prognosis of the patients with acute basilar artery occlusion. The coma symptom, bilateral Babinski(+), and revascularization in the patients with acute basilar artery occlusion have an appreciable impact on the patients

  18. Long-Term Neuropsychological Outcomes of Childhood Onset Acute Disseminated Encephalomyelitis (ADEM): a Meta-Analysis.

    PubMed

    Burton, Karen L O; Williams, Tracey A; Catchpoole, Sarah E; Brunsdon, Ruth K

    2017-03-31

    The long-term neurocognitive prognosis of childhood onset acute disseminated encephalomyelitis (ADEM) is unclear. This review and quantitative synthesis of the available literature examined whether there are long-term impacts of childhood ADEM on neurocognitive functioning. A search of online databases (MEDLINE, EMBASE, EBSCO CINAHL, PsycINFO and the Cochrane Database of Systematic Reviews) from their inception to October 2015 and reference lists identified 13 papers eligible for inclusion in the systematic review; seven of these were eligible for inclusion in meta-analyses. The systematic review indicated that, at a group level there is a positive long-term neuropsychological outcome from childhood onset ADEM. However, despite the apparent absence of long-term negative impacts of ADEM at a group level, at an individual level impairments in the areas of IQ, attention, executive functioning, processing speed, learning and memory, visuospatial skills and internalising symptoms were found in up to 43% of patients when aggregated across the studies. No significant negative effect of ADEM for any of the neuropsychological domains examined was found in meta-analyses. However, the effects for Processing Speed (r mean = -0.296 (CI 95% = -0.605-0.013)) and Internalising symptoms (r mean = 0.242 (CI 95% = -0.014-0.564)) approached significance (p = 0.06), suggesting a trend towards ADEM leading to long-term reduced processing speed and elevated internalising symptoms. Together, our findings suggest that despite a generally positive neurocognitive outcome post childhood ADEM there are a subset of individuals who can suffer from ongoing specific cognitive impairments. Clinical implications and research priorities are discussed.

  19. Serum autoantibodies to myelin peptides distinguish acute disseminated encephalomyelitis from relapsing-remitting multiple sclerosis

    PubMed Central

    Van Haren, Keith; Tomooka, Beren H; Kidd, Brian A; Banwell, Brenda; Bar-Or, Amit; Chitnis, Tanuja; Tenembaum, Silvia N; Pohl, Daniela; Rostasy, Kevin; Dale, Russell C; O’Connor, Kevin C; Hafler, David A; Steinman, Lawrence; Robinson, William H

    2015-01-01

    Background and objective Acute disseminated encephalomyelitis (ADEM) and relapsing remitting multiple sclerosis share overlapping clinical, radiologic, and laboratory features at onset. Because autoantibodies may contribute to the pathogenesis of both diseases, we sought to identify autoantibody biomarkers capable of distinguishing them. Methods We used custom antigen arrays to profile anti-myelin-peptide autoantibodies in sera derived from individuals with pediatric ADEM (n = 15), pediatric multiple sclerosis (n = 11), and adult multiple sclerosis (n = 15). Using isotype-specific secondary antibodies,we profiled both IgG and IgM reactivities. We used Statistical Analysis of Microarrays to confirm differences in autoantibody reactivity profiles between ADEM and multiple sclerosis samples. We used Prediction Analysis of Microarrays to generate and validate prediction algorithms based on the autoantibody reactivity profiles. Results ADEM was characterized by IgG autoantibodies targeting epitopes derived from myelin basic protein, proteolipid protein, myelin-associated oligodendrocyte basic glycoprotein, and alpha-B-crystallin. In contrast, multiple sclerosis was characterized by IgM autoantibodies targeting myelin basic protein, proteolipid protein, myelin-associated oligodendrocyte basic glycoprotein, and oligodendrocyte specific protein. We generated and validated prediction algorithms that distinguish ADEM serum (sensitivity 62–86%; specificity 56–79%) from multiple sclerosis serum (sensitivity 40–87%; specificity 62–86%) on the basis of combined IgG and IgM anti-myelin autoantibody reactivity to a small number of myelin peptides. Conclusions Combined profiles of serum IgG and IgM autoantibodies identify myelin antigens that may be useful for distinguishing multiple sclerosis from ADEM. Further studies are required to establish clinical utility. Further biological assays are required to delineate the pathogenic potential of these antibodies. PMID:23612879

  20. Clinical Profiles and Short-Term Outcomes of Acute Disseminated Encephalomyelitis in Adult Chinese Patients

    PubMed Central

    Yang, Hong-Qi; Zhao, Wen-Cong; Yang, Wei-Min; Li, Yong-Li; Sun, Zhi-Kun; Chen, Shuai

    2016-01-01

    Background and Purpose Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder that predominantly affects children. Previous studies have mostly involved children in Western developed countries. Methods This study retrospectively reviewed the clinical profiles of ADEM in adult Chinese patients. Results ADEM occurred during summer and autumn in about two-thirds of the 42 included patients. Prior infection was found in five patients and no preimmunization was recorded. The most frequent clinical presentations were alterations in consciousness (79%) and behavior changes (69%), followed by motor deficits (64%) and fever (50%). About one-quarter (26%) of the patients showed positive results for oligoclonal bands, and about half of them exhibited increases in the IgG index and 24-hour IgG synthesis rate. Magnetic resonance imaging showed white- and gray-matter lesions in 83% and 23% of the patients, respectively. Steroids were the main treatment, and full recovery occurred in 62% of the patients, with residual focal neurological deficits recorded in a few patients. After a mean follow-up period of 3.4 years, two patients exhibited recurrence and one patient exhibited a multiphasic course. One patient was diagnosed with multiple sclerosis (MS). Conclusions With the exception of the seasonal distribution pattern and prior vaccine rate, the clinical profiles of ADEM in adult Chinese patients are similar to those in pediatric populations. No specific markers are available for distinguishing ADEM from MS at the initial presentation. Careful clinical evaluations, cerebrospinal fluid measurements, and neuroradiological examinations with long-term follow-up will aid the correct diagnosis of ADEM. PMID:27449911

  1. Breakthrough disseminated zygomycosis induced massive gastrointestinal bleeding in a patient with acute myeloid leukemia receiving micafungin.

    PubMed

    Suzuki, Kei; Sugawara, Yumiko; Sekine, Takao; Nakase, Kazunori; Katayama, Naoyuki

    2014-11-01

    A 69-year-old man, who had been receiving prednisolone for 11 months for treatment of interstitial pneumonia, was diagnosed with acute myeloid leukemia. During induction therapy, he developed severe pneumonia. Although meropenem and micafungin were started, he died of circulatory failure owing to massive gastrointestinal bleeding. Autopsy specimens obtained from the stomach revealed fungal hyphae, which had invaded diffusely into submucosal vessels and caused the massive gastric bleeding. The same hyphae were also observed in both lungs. A diagnosis of disseminated zygomycosis was confirmed by its characteristic histopathological findings. Because zygomycetes are spontaneously resistant to the newer antifungal agents, such as voriconazole or micafungin, it seems likely that the prevalence of zygomycosis as a breakthrough infection may increase in the future. Zygomycosis is a rare, but life-threatening, deep fungal infection that appears in immunologically or metabolically compromised hosts. Its manifestations are clinically similar to those of invasive aspergillosis. In addition to the well-established epidemiology of zygomycosis, this case suggests the following new characteristics. (1) Although the gastrointestinal manifestation of zygomycosis is relatively rare, it is observed more frequently than invasive aspergillosis. (2) Gastrointestinal zygomycosis occasionally leads to the development of necrotic ulcers and may induce hemorrhagic shock.(3) We should be cautious of an occurrence of breakthrough zygomycosis when we use echinocandins for patients with known risk factors, especially steroid use and neutropenia. (4) For patients who are receiving broad-spectrum antibiotics and echinocandins, who are negative for culture studies and aspergillus antigen, and who present with unresolved fever, it is important to make a prompt clinical diagnosis of zygomycosis.

  2. Acute disseminated encephalomyelitis: a 10-year cohort study in Thai children.

    PubMed

    Visudtibhan, Anannit; Tuntiyathorn, Lochana; Vaewpanich, Jarin; Sukjit, Prapasri; Khongkatithum, Chaiyos; Thampratankul, Lunliya; Chiemchanya, Surang; Visudhiphan, Pongsakdi

    2010-11-01

    Childhood acute disseminated encephalomyelitis (ADEM) is a demyelinating disease with variable clinical courses and outcomes. Its evolution to multiple sclerosis in Asian children is yet to be determined. Medical records, investigation results and magnetic resonance imaging of brain of Thai children aged less than 15 years with initial diagnosis of ADEM at a referral university hospital in Thailand from January 1997 to December 2006 were reviewed. Clinical course and the outcome were finalized by telephone interview, self-report questionnaire, and/or neurological examination by December 2008. Modified Rankin Score was applied for determination of disability. MRI findings were categorized along with the locations and number of areas of abnormalities shown by T2-weight and FLAIR. 16 patients consisting of 5 boys and 11 girls (age-range 1-14 years, mean 6.9 ± 3.6 years, median 6 years) were identified. Nine patients had cranial nerve dysfunctions including one child with optic neuropathy. One patient died with confirmed pathological diagnosis of ADEM. Among the remaining 15, who were followed from 2 to 10 years (mean 5.8 years), 13 and 3 patients were classified into monophasic ADEM and multiple sclerosis, respectively. Ten of 13 with final diagnosis of ADEM had complete recovery. There was no association between number of lesions or location in the initial MRI and the outcome and final diagnosis. ADEM in Thai children had similar clinical presentation and outcome to previous studies in Western countries. ADEM can occasionally evolve to multiple sclerosis in Thai children as being shown in previous reports from other Asian countries.

  3. Pathological laughter associated with paroxysmal kinesigenic dyskinesia: A rare presentation of acute disseminated encephalomyelitis.

    PubMed

    Chaudhry, Neera; Puri, Vinod; Patidar, Yogesh; Khwaja, Geeta A

    2013-01-01

    A 13-year-old boy presented with recurrent episodes of sudden brief posturing of the right upper and lower limbs accompanied by transient inability to speak and a tendency to smile which would sometimes break into laughter. Awareness was retained during the attack, and there was no associated emotional abnormality. The events were precipitated by walking and occurred several times in a day. The laughter was pathological in nature, and the abnormal posturing was akin to 'paroxysmal kinesigenic dyskinesia' (PKD). 'Pathological laughter or crying' is defined as an involuntary, inappropriate, unmotivated laughter, crying or both, without any associated mood change. It can occur as a result of cerebral lesions like tumors, trauma, vascular insults, multiple sclerosis and/or degenerative disorders. It can also be a component of gelastic epilepsy which is characterized by stereotyped recurrences, presence of interictal and ictal epileptiform discharges and absence of external precipitants. In our patient, however, there was no ictal or interictal EEG correlate. Paroxysmal kinesigenic dyskinesia is characterized by intermittent, involuntary movements triggered by kinesigenic stimuli and is usually familial but can also be secondary to metabolic and structural brain disorders. Magnetic Resonance Imaging (MRI), in our case, revealed multiple T2 and FLAIR hyperintense, non-enhancing lesions in the periaqueductal gray matter, pontine and midbrain tegmentum, bilateral thalami and left lentiform nucleus suggesting a diagnosis of 'acute disseminated encephalomyelitis', in which this unique combination of pathological laughter and PKD has not been described so far. Magnetic Resonance Spectroscopy (MRS) confirmed a demyelinating pathology, and the patient responded well to steroids.

  4. Acute alterations in the regulation of lipid metabolism after intravascular reexposure to a single bolus of homologous virus during influenza B infection in ferrets: possible model of epiphenomena associated with influenza.

    PubMed Central

    Kang, E. S.; Galloway, M. S.; Bean, W.; Cook, G. A.; Olson, G.

    1991-01-01

    Metabolic responses occurring 24 h following the secondary haematogenous dissemination of influenza B virus during convalescence from infection were examined in the ferret as a possible model for epiphenomena which can occur following infection with influenza. Among the major changes found were a further rise in the mean fasting serum free fatty acid (FFA) level to three times the control mean value and a 50% drop in the mean serum triglyceride (TG) concentration after the intravascular administration of a single bolus of virus compared to levels found in uninfected or convalescent animals. In adipose tissue, hormone-sensitive and lipoprotein lipase activities were increased six and three-fold, respectively, over mean control values, probably accounting for the changes that were observed in serum lipid concentrations. In the liver, total carnitine palmitoyltransferase (CPT) activity was affected only slightly and the total lipid content of the liver remained unchanged. These findings indicate that 24 h after the intravascular dissemination of homologous virus in a single bolus during convalescence from influenza B infection, major distortions in the regulation of lipid metabolism occur in the ferret. Loss of the synchronous regulation of the two adipose tissue lipases is a significant consequence leading to the mobilization of a large amount of FFA during fasting from both adipose tissue and the circulating plasma TG stores. PMID:1843259

  5. Real-Time Assessment of Cardiac Perfusion, Coronary Angiography, and Acute Intravascular Thrombi Using Dual-Channel Near-Infrared Fluorescence Imaging

    PubMed Central

    Tanaka, Eiichi; Chen, Frederick Y.; Flaumenhaft, Robert; Graham, Gwenda J.; Laurence, Rita G.; Frangioni, John V.

    2009-01-01

    Objectives We have developed an image-guided surgery system based on invisible near-infrared (NIR) fluorescent light. Presently, the only clinically-available NIR fluorophore is indocyanine green (ICG), which fluoresces at ≈ 800 nm and is used for coronary angiography. Our objective was to determine if methylene blue (MB), already FDA-approved for other indications, has useful NIR fluorescence properties for image-guided cardiac surgery. Methods The optical properties of MB were measured after dissolution in 100% serum. Biodistribution and clearance were quantified in organs and tissues after intravenous bolus injection of 2 mg/kg MB in N = 3 rats. Coronary arteriography and cardiac perfusion were imaged in real-time after intravenous bolus injection of 1 mg/kg MB in N = 5 pigs with coronary obstructions. Coronary angiography and acute thrombi were assessed using 800 nm fluorophores, ICG and IR-786-labeled platelets, respectively. Results The peak absorbance and emission of MB as a NIR fluorophore occur at 667 nm and 686 nm, respectively. After intravenous injection, MB provides highly sensitive coronary angiography. A lipophilic cation, MB is extracted rapidly into tissue, with myocardium displaying unusually high uptake. MB permits real-time visualization and quantitative assessment of myocardial perfusion. Because of absent spectral overlap, use of two independent fluorophores on our imaging system permits simultaneous quantification of perfusion, venous drainage and/or intravascular thrombi. Conclusions MB is an effective NIR fluorophore that provides direct visualization of coronary arteriography and cardiac perfusion. In conjunction with ≈ 800 nm NIR fluorophores, important functional assessments during cardiac surgery are also possible. PMID:19577070

  6. The magnetic resonance imaging appearance of monophasic acute disseminated encephalomyelitis: an update post application of the 2007 consensus criteria.

    PubMed

    Marin, Samantha E; Callen, David J A

    2013-05-01

    Acute disseminated encephalomyelitis (ADEM) is an immunologically mediated inflammatory disease of the central nervous system that typically occurs after a viral infection or recent vaccination, and is most commonly seen in the pediatric population. In 2007 the International Pediatric Multiple Sclerosis Study Group proposed a consensus definition for ADEM for application in research and clinical settings. This article gives an overview of ADEM in children, focusing on differences that have emerged since the consensus definition was established. Although the focus is on neuroimaging in these patients, a synopsis of the clinical features, immunopathogenesis, treatment, and prognosis of ADEM is provided.

  7. Acute disseminated encephalomyelitis in two renal transplant patients: is there a role for Epstein-Barr virus reactivation?

    PubMed

    Caucheteux, N; Maarouf, A; Daelman, L; Toupance, O; Lavaud, S; Tourbah, A

    2013-08-01

    Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory demyelinating disease of the central nervous system, usually occurring after a vaccination or infectious disease. It has been exceptionally described in transplanted patients. The pathophysiology remains incompletely understood. We report the clinical, biological and magnetic resonance imaging (MRI) presentation and evolution of two kidney-transplanted patients with ADEM associated with local Epstein-Barr virus (EBV) reactivation. ADEM may occur in transplanted patients with favorable evolution. Its pathophysiology is uncertain, and the implication of EBV is discussed.

  8. Post-infective transverse myelitis following Streptococcus pneumoniae meningitis with radiological features of acute disseminated encephalomyelitis: a case report

    PubMed Central

    2012-01-01

    Introduction Post-infectious autoimmune demyelination of the central nervous system is a rare neurological disorder typically associated with exanthematous viral infections. We report an unusual presentation of the condition and a previously undocumented association with Streptococcus pneumonia meningitis. Case presentation A 50-year-old Caucasian woman presented to our facility with an acute myelopathy three days after discharge following acute Streptococcus pneumoniae meningitis. Imaging studies of the spine ruled out an infective focus and no other lesions were seen within the cord. Diffuse, bilateral white matter lesions were seen within the cerebral hemispheres, and our patient was diagnosed as having a post-infective demyelination syndrome that met the diagnostic criteria for an acute transverse myelitis. Our patient clinically and radiologically improved following treatment with steroids. Conclusions The novel association of a Streptococcus pneumoniae infection with post-infectious autoimmune central nervous system demyelination should alert the reader to the potentially causative role of this common organism, and gives insights into the pathogenesis. The unusual dissociation between the clinical presentation and the location of the radiological lesions should also highlight the potential for the condition to mimic the presentation of others, and stimulates debate on the definitions of acute transverse myelitis and acute disseminated encephalomyelitis, and their potential overlap. PMID:22992300

  9. [Acute kidney failure due to kidney cortex necrosis. 2 clinical cases of surviving patients].

    PubMed

    Fuenzalida, E

    1991-07-01

    A 22 year old female developed preeclampsia with fetal death in utero. After cesarean section she developed uterine inertia and acute hemorrhagic anemia complicated by sepsis, disseminated intravascular coagulation and total anuria for 4 weeks. She was treated with hemodialysis. The second patient, a 49 year old man developed sepsis and intravascular coagulation after a dog bite. Acute renal failure with a 3 week total anuria followed. He was initially treated with peritoneo dialysis. Renal biopsy showed evidence of renal cortical necrosis in both patients.

  10. Iatrogenic subtle acute aortic dissection during coronary angioplasty for in-stent restenosis. Value of intravascular ultrasound for diagnosis and management.

    PubMed

    Alfonso, Fernando; Alvarez, Lucia; Almeria, Carlos

    2004-09-01

    A patient with a subtle, iatrogenic, type A aortic dissection following a coronary angioplasty is described. Intravascular ultrasound was useful to confirm the diagnosis of the confined aortic dissection and also to guide adequate stent coverage of its coronary entry door. Both transesophageal echocardiography and magnetic resonance imaging failed to detect any significant aortic wall abnormality.

  11. Observations on glial inclusion bodies in a case of acute disseminated sclerosis

    PubMed Central

    Field, E. J.; Miller, Henry; Russell, Dorothy S.

    1962-01-01

    An unusual rod-like structure enclosed within a vacuole is described as occurring in enlarged glial cells associated with the lesions encountered in an uncommonly acute case of multiple sclerosis apparently heralded by an attack of `viral encephalitis'. Similar bodies were not found in a variety of other enlarged glial cells. An encapsulated `grape-fruit' like structure was also seen. Images PMID:13892761

  12. Intravascular ultrasound imaging

    SciTech Connect

    Cavaye, D.M.; White, R.A. )

    1992-01-01

    This book will give vascular surgeons, cardiologists, radiologists, and technologists a complete working knowledge of intravascular ultrasound imaging and the crucial role of this new technology in endovascular diagnosis and therapy. The book reviews the essential principles of vascular pathology and ultrasound imaging and then provides state-of-the-art information on intraluminal ultrasound imaging devices and techniques, including practical guidelines for using catheters, optimizing image quality, and avoiding artifacts. Image interpretation and computerized image reconstruction are also discussed in detail. The first section explains the diagnostic, therapeutic, and experimental applications of intravascular ultrasound, particularly as a adjunct to angioplasty and other current interventional procedures.

  13. Disseminated exfoliative dermatitis associated with all-transretinoic Acid in the treatment of acute promyelocytic leukemia.

    PubMed

    Ipek, Yonal; Hulya, Dogru; Melih, Aktan

    2012-01-01

    Acute promyelocytic leukemia (APL) is a biologically and clinically separate type of acute myeloid leukemia characterized by a translocation involving the retinoic acid receptor-alpha (RARa) locus on chromosome 17, the great majority of which is t(15; 17)(q24.1; q21.1) (Collins (1998), Melnick and Licht (1999), and Grimwade (1999)). Retinoic acid is a critical ligand in the differentiation pathway of multiple tissues, mediated through binding to an RAR. All-trans retinoic acid (ATRA) is a subgroup of the retinoid family, which induces complete remission (CR) in APL by causing differentiation and apoptosis in immature malignant promyelocytes rather than inducing cell death by cytotoxicity (Warrell et al. (1993), Liu et al. (2000), and Cassinat et al. (2001)). ATRA-associated toxicity consisting of headache, fever, weakness, fatigue, dry skin, dermatitis, gastrointestinal disorders, and hypertriglyceridemia has been shown to be mild (Kurzrock et al. (1993)). Herein, we describe a patient with APL that developed an erythematous reaction of the whole body followed by desquamation and exfoliation during ATRA therapy.

  14. Pattern and Outcome of Acute Disseminated Encephalomyelitis (ADEM) in Children: Experience in a Tertiary Center, Upper Egypt

    PubMed Central

    Sadek, Abdelrahim Abdrabou; Mohamed, Mostafa Ashry; Abou-Taleb, Ashraf; Mohammed, Marwa Ibrahim

    2016-01-01

    Introduction Acute disseminated encephalomyelitis (ADEM) is an immune mediated disease of the brain. Although it occurs in all ages, most reported cases are in children and adolescents. The aims of this study were to study the clinical pattern and outcome of ADEM in children in a tertiary center in Upper Egypt and to determine the effect of combined use of steroids and IVIg on outcome. Methods This observational study was carried out from January 2014 through December 2014 in the Pediatric Department of Sohag University Hospital (Egypt). All children diagnosed as ADEM during a one year period were included in this study. The treatments used were IV methylprednisolone followed by oral prednisone taper and intravenous immunoglobulin for severe cases. All studied cases were followed up and reevaluated at three months and six months. We used SPSS version 10 and Chi Square, Spearman’s test and t-test for data analysis. Results Eighteen children were included in this study (10 males and 8 females), the average age was 5.5 ± 0.9 years. Prodroma was found in 72.22% of the cases while the main complaint was encephalopathy (83.33%) followed by seizures (11.11%). The neurological findings were convulsions in 83.33%, quadriparesis (33.33%), hemiparesis (33.33), bladder involvement (both retention and incontinence) in 61.11%, and cranial nerve affection (11.11%). Demyelination patches were multifocal in 50%, mainly subcortical in 27.78%. Intelligence quotient (IQ) assessment after 6 months follow up showed that 50% were below average, 25% had mild MR while neurological evaluation showed that 75% of our patients were completely cured. The predictors of better outcome were; children related to the age group (1–4 years) (p = 0.01), children with higher GCS (6–14) (p = 0.01), and children who received steroids on the first day of symptoms and intravenous immunoglobulin in the first week (p = 0.03). Conclusion The clinical pattern of acute disseminated encephalomyelitis is

  15. Methodological Challenges in Protein Microarray and Immunohistochemistry for the Discovery of Novel Autoantibodies in Paediatric Acute Disseminated Encephalomyelitis.

    PubMed

    Peschl, Patrick; Ramberger, Melanie; Höftberger, Romana; Jöhrer, Karin; Baumann, Matthias; Rostásy, Kevin; Reindl, Markus

    2017-03-22

    Acute disseminated encephalomyelitis (ADEM) is a rare autoimmune-mediated demyelinating disease affecting mainly children and young adults. Differentiation to multiple sclerosis is not always possible, due to overlapping clinical symptoms and recurrent and multiphasic forms. Until now, immunoglobulins reactive to myelin oligodendrocyte glycoprotein (MOG antibodies) have been found in a subset of patients with ADEM. However, there are still patients lacking autoantibodies, necessitating the identification of new autoantibodies as biomarkers in those patients. Therefore, we aimed to identify novel autoantibody targets in ADEM patients. Sixteen ADEM patients (11 seronegative, 5 seropositive for MOG antibodies) were analysed for potential new biomarkers, using a protein microarray and immunohistochemistry on rat brain tissue to identify antibodies against intracellular and surface neuronal and glial antigens. Nine candidate antigens were identified in the protein microarray analysis in at least two patients per group. Immunohistochemistry on rat brain tissue did not reveal new target antigens. Although no new autoantibody targets could be found here, future studies should aim to identify new biomarkers for therapeutic and prognostic purposes. The microarray analysis and immunohistochemistry methods used here have several limitations, which should be considered in future searches for biomarkers.

  16. Methodological Challenges in Protein Microarray and Immunohistochemistry for the Discovery of Novel Autoantibodies in Paediatric Acute Disseminated Encephalomyelitis

    PubMed Central

    Peschl, Patrick; Ramberger, Melanie; Höftberger, Romana; Jöhrer, Karin; Baumann, Matthias; Rostásy, Kevin; Reindl, Markus

    2017-01-01

    Acute disseminated encephalomyelitis (ADEM) is a rare autoimmune-mediated demyelinating disease affecting mainly children and young adults. Differentiation to multiple sclerosis is not always possible, due to overlapping clinical symptoms and recurrent and multiphasic forms. Until now, immunoglobulins reactive to myelin oligodendrocyte glycoprotein (MOG antibodies) have been found in a subset of patients with ADEM. However, there are still patients lacking autoantibodies, necessitating the identification of new autoantibodies as biomarkers in those patients. Therefore, we aimed to identify novel autoantibody targets in ADEM patients. Sixteen ADEM patients (11 seronegative, 5 seropositive for MOG antibodies) were analysed for potential new biomarkers, using a protein microarray and immunohistochemistry on rat brain tissue to identify antibodies against intracellular and surface neuronal and glial antigens. Nine candidate antigens were identified in the protein microarray analysis in at least two patients per group. Immunohistochemistry on rat brain tissue did not reveal new target antigens. Although no new autoantibody targets could be found here, future studies should aim to identify new biomarkers for therapeutic and prognostic purposes. The microarray analysis and immunohistochemistry methods used here have several limitations, which should be considered in future searches for biomarkers. PMID:28327523

  17. Relief of vasospasm by intravascular ultraviolet irradiation

    NASA Astrophysics Data System (ADS)

    Nakai, Kanji; Morimoto, Yuji; Ito, Hirotaka; Kominami, Kimito; Matsuo, Hirotaka; Arai, Tsunenori; Kikuchi, Makoto

    1998-05-01

    We investigated the photovasorelaxation with intravascular transluminal irradiation using in vivo model. A 2.5 Fr. catheter was inserted in the femoral artery of a rabbit under anesthesia. A 400 micrometers diameter quartz fiber was inserted through the catheter. The catheter was withdrawn from the distal end to the proximal end of the exposed femoral artery without laser irradiation in order to observe the mechanical dilation by the procedure. The femoral artery lumen was irradiated by a Helium-Cadmium(He-Cd) laser (wavelength; 325 nm) with 8 mW through the fiber during 30 s. We carried out that the laser irradiation produced vasorelaxation (185% on the average) compared with mechanical vasodilation (150% on the average) with angiography. The results suggest that intravascular transluminal irradiation with low-power UV laser might be applicable to the relief of acute arterial vasospasm.

  18. Acute myocardial infarction as a finding of acute promyelocytic leukemia-related coagulation disorder.

    PubMed

    Özkurt, Zübeyde N; Aypar, Eda; Sarifakiogullari, Serpil; Taçoy, Gülten; Özdag, Murat; Kahraman, Seda; Çengel, Atiye

    2015-12-01

    Acute promyelocytic leukemia (APL) has one of the most favorable prognoses among other leukemia subtypes. However, the major cause of mortality in APL is disseminated intravascular coagulation at the presentation. We present a case of acute myocardial infarction (MI) at the time of APL diagnosis before treatment. The patient suffered from chest pain, sweating and giddiness. He was hypoxic, hypotensive and bradycardic. ECG showed inferior MI. Unfractioned heparin infusion (850 U/h) was started and 5 min after the previous ECG showed total ST resolution. We suggest that in this case, MI was not related to atherosclerotic plaque rupture but related to DIC manifestation.

  19. A disseminated infection with the antifungal-multiresistant teleomorphic fungus Neocosmospora vasinfecta in a patient with acute B-lymphoblastic leukemia

    PubMed Central

    Gabriel, Frédéric; D’Almeida, Mahussi; Albert, Olivier; Fitton-Ouhabi, Valérie; Noël, Thierry; Accoceberry, Isabelle

    2013-01-01

    We report on a fatal invasive infection due to the ascomycetous fungus Neocosmospora vasinfecta, in a 20-year-old European patient suffering from an acute lymphoblastic leukemia. The infection could not be controlled by a bitherapy combining liposomal amphotericin B and voriconazole. This is the second case of disseminated infection reported with this unusual fungus, which develops under its teleomorphic state, is fully resistant to all systemic antifungals, and which is known to live in tropical countries. PMID:24432214

  20. Intravascular ultrasound elastography.

    PubMed

    van der Steen, A F; de Korte, C L; Céspedes, E I

    1998-10-01

    Intravascular Ultrasound Blastography. The response of a tissue to mechanical excitation is a function of its mechanical properties. Excitation can be dynamic or quasistatic in nature. The response (e.g. displacement, velocity, compression) can be measured via ultrasound. This is the main principle underlying ultrasound elasticity imaging, sonoelasticity imaging, or ultrasound elastography. It is of great interest to know the local hardness of vessel wall and plaques. Intravascular elastography yields information unavailable or inconclusive if obtained from IVUS alone and thus contributes to more correct diagnosis. Potentially it can be used for therapy guidance. During the last decade several working groups used elastography in intravascular applications with varying success. In this paper we discuss the various approaches by different working groups. Focus will be on the approach of the Rotterdam group. Using a 30 MHz IVUS catheter, RF data are acquired from vessels in vitro at different intraluminal pressures. Local tissue displacement estimation by cross-correlation is followed by computation of the local strain. The resulting image supplies local information on the elastic properties of the vessel and plaque with high spatial resolution. Feasibility and usefulness are shown by means of phantom measurements. Furthermore, initial in vitro results of femoral arteries and correlation with histology are discussed. Phantom data show that the elastograms reveal information not presented by the echogram. In vitro artery data prove that in principle elastography is capable of identifying plaque composition where echography fails.

  1. [Freshly frozen preserved plasma for the treatment of intravascular coagulation in polytraumatized patients].

    PubMed

    Hehne, H J; Nyman, D; Burri, H; Wolff, G

    1976-05-15

    Coagulation disorders in hemorrhagic shock need not represent an isolated intravascular coagulation. They may also occur as a complex of local disseminated intravascular consumption, extravascular consumption, dilution, and reduced synthesis of coagulation factors. In the severely bleeding patient with hemorrhagic diathesis heparin is contraindicated because it does not normalize coagulability. Therefore, it fails to stop hemorrhage and shock remains untreatable. Fresh frozen plasma, however, has proved to be suitable as simultaneous substitution therapy of coagulopathy and of hypovolemic shock. 11 patients suffering from traumatic-hemorrhagic shock associated with intravascular coagulation and hemorrhagic diathesis were successfully treated with fresh frozen plasma, after conventional shock therapy had failed over a period of hours.

  2. Acute Disseminated Encephalomyelitis

    MedlinePlus

    ... Strategy Current Research Research Funded by NINDS Basic Neuroscience Clinical Research Translational Research Research at NINDS Focus ... Information Current Research Research Funded by NINDS Basic Neuroscience Clinical Research Translational Research Research at NINDS Focus ...

  3. Acute disseminated encephalomyelitis (ADEM).

    PubMed

    Wender, Mieczysław

    2011-02-01

    ADEM is a disease that is characterized by an inflammatory reaction and demyelination in the central nervous system, with a distinct tendency to a peripheral localization of pathological changes. ADEM happens to occur with a temporal, and probably also with a causative relationship to viral, exanthematous diseases, as well as to preventive vaccinations. However, there are still many unresolved problems with respect to the relationship of ADEM to multiple sclerosis (MS), especially in instances with a multiphasic course of the disease. Many question marks can also be raised in cases, in which the examinations were unable to determine the exact preceding or causative factor. A lot of studies on cytokines and chemokines in blood plasma and CSR from patients with ADEM have enabled investigators to get a better insight into some stages of immunopathological processes, leading to an evolvement of the disease, without a more important impact on the clinical diagnosis.

  4. An intravascular protein osmometer.

    PubMed

    Henson, J W; Brace, R A

    1983-05-01

    Our purpose was to develop an intravascular osmometer for measuring the colloid (i.e., protein) osmotic pressure (COP) of circulating blood. A semipermeable hollow fiber from a Cordis Dow artificial kidney (C-DAK 4000) was attached to polyethylene tubing on one end, filled with saline, and sealed at the other end. This was small enough to be inserted into the vasculature of research animals. Protein osmotic pressure plus hydrostatic pressure was measured by a Statham pressure transducer attached to the hollow fiber. Simultaneously, a second catheter and transducer was used to measure hydrostatic pressure, which was subtracted from the pressure measured from the fiber with an on-line computer. The system was documented by a variety of tests. The colloid osmotic pressure vs. albumin concentration curve determined with the fiber is identical to the curve determined by standard membrane osmometry. The time constant for 2- and 8-cm fibers was 2.6 +/- 0.6 and 1.5 +/- 0.5 (+/- SD) min, respectively. The reflection coefficient (+/- SD) of the fiber for NaCl is 0.042 +/- 0.019 (n = 38); COP measured at varying temperatures (absolute scale) changed linearly as expected from COP = nCRT (i.e., van't Hoff's law). Finally, hollow-fiber osmometers were inserted into femoral veins of dogs and sheep, and blood COP was continuously recorded during osmotic manipulations. In conclusion, we attempted to develop and document a simple method for continuous measurement of intravascular colloid osmotic pressure.

  5. Bath Salts: A Newly Recognized Cause of Acute Kidney Injury

    PubMed Central

    McNeely, Jonathan; Parikh, Samir; Valentine, Christopher; Haddad, Nabil; Shidham, Ganesh; Rovin, Brad; Hebert, Lee; Agarwal, Anil

    2012-01-01

    Bath salts are substance of abuse that are becoming more common and are difficult to recognize due to negative toxicology screening. Acute kidney injury due to bath salt use has not previously been described. We present the case of a previously healthy male who developed acute kidney injury and dialysis dependence after bath salt ingestion and insufflation. This was self-reported with negative toxicology screening. Clinical course was marked by severe hyperthermia, hyperkalemia, rhabdomyolysis, disseminated intravascular coagulation, oliguria, and sepsis. We discuss signs and symptoms, differential diagnoses, potential mechanisms of injury, management, and review of the literature related to bath salt toxicity. PMID:24555135

  6. Simultaneous presentation of acute disseminated encephalomyelitis (ADEM) and systemic lupus erythematosus (SLE) after enteroviral infection: can ADEM present as the first manifestation of SLE?

    PubMed

    Kim, J-M; Son, C-N; Chang, H W; Kim, S-H

    2015-05-01

    Central Nervous System (CNS) involvement of Systemic Lupus Erythematosus (SLE) includes a broad range of neuropsychiatric syndromes. Acute Disseminated Encephalomyelitis (ADEM) is a demyelinating CNS disorder characterized by encephalopathy and multifocal lesions predominantly involving the white matter on brain magnetic resonance imaging. ADEM associated with SLE has been only rarely reported. We report an unusual case of a 17-year-old girl who developed ADEM after enteroviral infection as the first manifestation of SLE. The authors emphasize that the patient's illness was preceded by enteroviral infection and that ADEM occurred before any other symptoms of SLE, which makes this case unique.

  7. An Adult Case of Anti-Myelin Oligodendrocyte Glycoprotein (MOG) Antibody-associated Multiphasic Acute Disseminated Encephalomyelitis at 33-year Intervals.

    PubMed

    Numa, Soichiro; Kasai, Takashi; Kondo, Takayuki; Kushimura, Yukie; Kimura, Ayaka; Takahashi, Hisashi; Morita, Kanako; Tanaka, Akihiro; Noto, Yu-Ichi; Ohara, Tomoyuki; Nakagawa, Masanori; Mizuno, Toshiki

    2016-01-01

    Acute disseminated encephalomyelitis (ADEM) followed by optic neuritis (ON) has been reported as a distinct phenotype associated with anti-myelin oligodendrocyte protein (MOG) antibody. We herein report the case of a 37-year-old woman who was diagnosed with ADEM at 4 years old of age and who subsequently developed ON followed by recurrent ADEM 33 years after the initial onset. A serum analysis showed anti-MOG antibody positivity. This phenotype has only previously been reported in pediatric cases. Neurologists thus need to be aware that the phenotype may occur in adult patients, in whom it may be assumed to be atypical multiple sclerosis.

  8. Positron autoradiography for intravascular imaging: feasibility evaluation.

    PubMed

    Shikhaliev, Polad M; Xu, Tong; Ducote, Justin L; Easwaramoorthy, Balasubramaniam; Mukherjee, Jogeshwar; Molloi, Sabee

    2006-02-21

    Approximately 70% of acute coronary artery disease is caused by unstable (vulnerable) plaques with an inflammation of the overlying cap and high lipid content. A rupturing of the inflamed cap of the plaque results in propagation of the thrombus into the lumen, blockage of the artery and acute ischaemic syndrome or sudden death. Morphological imaging such as angiography or intravascular ultrasound cannot determine inflammation status of the plaque. A radiotracer such as 18F-FDG is accumulated in vulnerable plaques due to higher metabolic activity of the inflamed cap and could be used to detect a vulnerable plaque. However, positron emission tomography (PET) cannot detect the FDG-labelled plaques because of respiratory and heart motions, small size and low activity of the plaques. Plaques can be detected using a miniature particle (positron) detector inserted into the artery. In this work, a new detector concept is investigated for intravascular imaging of the plaques. The detector consists of a storage phosphor tip bound to the end of an intravascular catheter. It can be inserted into an artery, absorb the 18F-FDG positrons from the plaques, withdrawn from the artery and read out. Length and diameter of the storage phosphor tip can be matched to the length and the diameter of the artery. Monte Carlo simulations and experimental evaluations of coronary plaque imaging with the proposed detector were performed. It was shown that the sensitivity of the storage phosphor detector to the positrons of 18F-FDG is sufficient to detect coronary plaques with 1 mm and 2 mm sizes and 590 Bq and 1180 Bq activities in the arteries with 2 mm and 3 mm diameters, respectively. An experimental study was performed using plastic tubes with 2 mm diameter filled with an FDG solution, which simulates blood. FDG spots simulating plaques were placed over the surface of the tube. A phosphor tip was inserted into the tube and imaged the plaques. Exposure time was 1 min in all simulations and

  9. Positron autoradiography for intravascular imaging: feasibility evaluation

    NASA Astrophysics Data System (ADS)

    Shikhaliev, Polad M.; Xu, Tong; Ducote, Justin L.; Easwaramoorthy, Balasubramaniam; Mukherjee, Jogeshwar; Molloi, Sabee

    2006-02-01

    Approximately 70% of acute coronary artery disease is caused by unstable (vulnerable) plaques with an inflammation of the overlying cap and high lipid content. A rupturing of the inflamed cap of the plaque results in propagation of the thrombus into the lumen, blockage of the artery and acute ischaemic syndrome or sudden death. Morphological imaging such as angiography or intravascular ultrasound cannot determine inflammation status of the plaque. A radiotracer such as 18F-FDG is accumulated in vulnerable plaques due to higher metabolic activity of the inflamed cap and could be used to detect a vulnerable plaque. However, positron emission tomography (PET) cannot detect the FDG-labelled plaques because of respiratory and heart motions, small size and low activity of the plaques. Plaques can be detected using a miniature particle (positron) detector inserted into the artery. In this work, a new detector concept is investigated for intravascular imaging of the plaques. The detector consists of a storage phosphor tip bound to the end of an intravascular catheter. It can be inserted into an artery, absorb the 18F-FDG positrons from the plaques, withdrawn from the artery and read out. Length and diameter of the storage phosphor tip can be matched to the length and the diameter of the artery. Monte Carlo simulations and experimental evaluations of coronary plaque imaging with the proposed detector were performed. It was shown that the sensitivity of the storage phosphor detector to the positrons of 18F-FDG is sufficient to detect coronary plaques with 1 mm and 2 mm sizes and 590 Bq and 1180 Bq activities in the arteries with 2 mm and 3 mm diameters, respectively. An experimental study was performed using plastic tubes with 2 mm diameter filled with an FDG solution, which simulates blood. FDG spots simulating plaques were placed over the surface of the tube. A phosphor tip was inserted into the tube and imaged the plaques. Exposure time was 1 min in all simulations and

  10. Multi-Frequency Intravascular Ultrasound (IVUS) Imaging

    PubMed Central

    Ma, Teng; Yu, Mingyue; Chen, Zeyu; Fei, Chunlong; Shung, K. Kirk; Zhou, Qifa

    2015-01-01

    Acute coronary syndrome (ACS) is frequently associated with the sudden rupture of a vulnerable atherosclerotic plaque within the coronary artery. Several unique physiological features, including a thin fibrous cap accompanied by a necrotic lipid core, are the targeted indicators for identifying the vulnerable plaques. Intravascular ultrasound (IVUS), a catheter-based imaging technology, has been routinely performed in clinics for more than 20 years to describe the morphology of the coronary artery and guide percutaneous coronary interventions. However, conventional IVUS cannot facilitate the risk assessment of ACS because of its intrinsic limitations, such as insufficient resolution. Renovation of the IVUS technology is essentially needed to overcome the limitations and enhance the coronary artery characterization. In this paper, a multi-frequency intravascular ultrasound (IVUS) imaging system was developed by incorporating a higher frequency IVUS transducer (80 to 150 MHz) with the conventional IVUS (30–50 MHz) system. The newly developed system maintains the advantage of deeply penetrating imaging with the conventional IVUS, while offering an improved higher resolution image with IVUS at a higher frequency. The prototyped multi-frequency catheter has a clinically compatible size of 0.95 mm and a favorable capability of automated image co-registration. In vitro human coronary artery imaging has demonstrated the feasibility and superiority of the multi-frequency IVUS imaging system to deliver a more comprehensive visualization of the coronary artery. This ultrasonic-only intravascular imaging technique, based on a moderate refinement of the conventional IVUS system, is not only cost-effective from the perspective of manufacturing and clinical practice, but also holds the promise of future translation into clinical benefits. PMID:25585394

  11. Spatiotemporal Interplay of Severe Acute Respiratory Syndrome Coronavirus and Respiratory Mucosal Cells Drives Viral Dissemination in Rhesus Macaques

    PubMed Central

    Liu, Li; Wei, Qiang; Nishiura, Kenji; Peng, Jie; Wang, Haibo; Midkiff, Cecily; Alvarez, Xavier; Qin, Chuan; Lackner, Andrew; Chen, Zhiwei

    2015-01-01

    Innate immune responses play a critical role in the control of early virus replication and dissemination. It remains unknown, however, how SARS-CoV evades respiratory innate immunity to establish a systemic infection. Here, we show in Chinese macaques that SARS-CoV traversed the mucosa through the respiratory tract within 2 days, resulting in extensive mucosal infiltration by T cells, MAC387+ and CD163+ monocytes/macrophages followed by limited viral replication in the lung but persistent viral shedding into the upper airway. Mucosal monocytes/macrophages sequestered virions in intracellular vesicles together with infected Langerhans cells (LCs) and migrated into the tonsils and/or draining lymph nodes (LNs) within 2 days. In lymphoid tissues, viral RNA and proteins were detected in infected monocytes upon differentiation into dendritic cells (DCs) within 3 days. Systemic viral dissemination was observed within 7 days. This study provides a comprehensive overview of the spatiotemporal interactions of SARS-CoV, monocytes/macrophages and the dendritic cell network in mucosal tissues and highlights the fact that while these innate cells contribute to viral clearance, they probably also serve as shelters and vehicles to provide a mechanism for the virus to escape host mucosal innate immunity and disseminate systemically. PMID:26647718

  12. Disseminated sporotrichosis

    PubMed Central

    Romero-Cabello, Raúl; Bonifaz, Alexandro; Romero-Feregrino, Raúl; Sánchez, Carlos Javier; Linares, Yancy; Zavala, Jorge Tay; Romero, Leticia Calderón; Romero-Feregrino, Rodrigo; Vega, José T Sánchez

    2011-01-01

    Sporotrichosis is a subacute or chronic infection caused by Sporothrix schenckii. It is a primary cutaneous infection and it has different clinical forms: disseminated by lymphatic vessels (75%), localised cutaneous form (20%), disseminated cutaneous and extracuteus rarely. The systemic disseminated sporotrichosis is considered a severe opportunistic infection. The best diagnostic test is the culture. The authors report a case of a 36-year-old man, originally from Puebla, Mexico, with a diagnosis of disseminated sporotrichosis. Differential diagnosis with other pathologies includes leishmaniasis, chromoblastomycosis, tuberculosis verrucose and lymphangitis. The development of unusual presentations in immunocompromised patients has been reported. PMID:22700076

  13. Disseminated sporotrichosis.

    PubMed

    Romero-Cabello, Raúl; Bonifaz, Alexandro; Romero-Feregrino, Raúl; Sánchez, Carlos Javier; Linares, Yancy; Zavala, Jorge Tay; Romero, Leticia Calderón; Romero-Feregrino, Rodrigo; Vega, José T Sánchez

    2011-03-25

    Sporotrichosis is a subacute or chronic infection caused by Sporothrix schenckii. It is a primary cutaneous infection and it has different clinical forms: disseminated by lymphatic vessels (75%), localised cutaneous form (20%), disseminated cutaneous and extracuteus rarely. The systemic disseminated sporotrichosis is considered a severe opportunistic infection. The best diagnostic test is the culture. The authors report a case of a 36-year-old man, originally from Puebla, Mexico, with a diagnosis of disseminated sporotrichosis. Differential diagnosis with other pathologies includes leishmaniasis, chromoblastomycosis, tuberculosis verrucose and lymphangitis. The development of unusual presentations in immunocompromised patients has been reported.

  14. What Are the Signs and Symptoms of Disseminated Intravascular Coagulation?

    MedlinePlus

    ... signs or symptoms. Signs and Symptoms of Excessive Blood Clotting In DIC, blood clots form throughout the body's small blood vessels. ... increased clotting activity uses up the platelets and clotting factors in the blood. As a result, serious bleeding can occur. DIC ...

  15. [Disseminated intravascular coagulopathy in a dog with Angiostrongylus vasorum infection].

    PubMed

    Kruse, B D; Hartmann, K; Groth, A; Schulz, B; Wehner, A

    2013-01-01

    A 2-year-old female spayed Epagneul-Breton dog was presented with ecchymoses, but an undisturbed general condition. Clinical examination additionally revealed petechia and a haematoma. Travel history included Italy and Denmark. Laboratory abnormalities were moderate thrombocytopenia, prolonged PT, aPTT and TT, and elevated d-dimers. Initial therapy consisted of plasma transfusions, fluids, doxycycline and famotidine administration. Babesiosis, ehrlichiosis, leishmaniosis, dirofilariosis or anaplasmosis could not be confirmed. Abdominal ultrasound was unremarkable, while thoracic radiographs showed a bronchointerstitial pattern. Faecal samples collected over 3 days were positive for Angiostrongylus vasorum after examination using the Baermann lungworm test. The A. vasorum infection was successfully treated with fenbendazole, whereupon thrombocytopenia and prolonged coagulation times were resolved. In regions of low prevalence, an infection with A. vasorum should also be considered as a differential diagnosis in dogs with coagulation abnormalities. Respiratory signs can be absent with this disease. The patient may have acquired the infection abroad or in Germany.

  16. Fast integrated intravascular photoacoustic/ultrasound catheter

    NASA Astrophysics Data System (ADS)

    Choi, Changhoon; Cho, Seunghee; Kim, Taehoon; Park, Sungjo; Park, Hyoeun; Kim, Jinmoo; Lee, Seunghoon; Kang, Yeonsu; Jang, Kiyuk; Kim, Chulhong

    2016-03-01

    In cardiology, a vulnerable plaque is considered to be a key subject because it is strongly related to atherosclerosis and acute myocardial infarction. Because conventional intravascular imaging devices exhibit several limitations with regard to vulnerable plaque detection, the need for an effective lipid imaging modality has been continuously suggested. Photoacoustic (PA) imaging is a medical imaging technique with a high level of ultrasound (US) resolution and strong optical contrast. In this study, we successfully developed an integrated intravascular photoacoustic/ultrasound (IV-PAUS) imaging system with a catheter diameter of 1.2 mm for lipid-rich atherosclerosis imaging. An Nd:YAG pulsed laser with an excitation wavelength of 1064 nm was utilized. IV-PAUS offers 5-mm depth penetration and axial and lateral PA imaging resolutions of 94 μm and 203 μm, respectively, as determined by imaging a 6-μm carbon fiber. We initially obtained 3-dimensional (3D) co-registered PA/US images of metal stents. Subsequently, we successfully obtained 3D coregistered PA/US ex vivo images using an iliac artery from a rabbit atherosclerosis model. Accordingly, lipid-rich plaques were sufficiently differentiated from normal tissue in the ex vivo experiment. We validated these findings histologically to confirm the lipid content.

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

    PubMed Central

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

    1979-01-01

    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

  18. Splenic hematoma in acute pancreatitis. Role of coagulation disorders.

    PubMed

    Clavé, P; Guillaumes, S; Blanco, I; Martínez de Hurtado, J; Esquius, J; Marruecos, L; Fontcuberta, J; Pérez, C; Farré, A; Lluís, F

    1992-08-01

    Splenic hematomas are infrequent complications of acute pancreatitis. In some cases, local factors that may play a role in the pathogenesis of the hematoma (thrombosis of the splenic artery or veins, intrasplenic pseudocysts, perisplenic adhesions, enzymatic digestion) are found. In the absence of local factors, the etiology of splenic hemorrhage remains unknown. We report two cases of splenic hematoma occurring during an acute necro-hemorrhagic pancreatitis associated with renal failure that required renal replacement therapy (hemodialysis and continuous arteriovenous hemodialysis). In both cases, more than half of splenic parenchyma was affected by multiple infarctions. No local factors responsible for the splenic abnormalities were detected in either case. Thrombosis of the splenic arterial microcirculation and a coagulation disorder consistent with disseminated intravascular coagulation was detected in one patient. In the second patient, coagulation disorders secondary to either liver disease, pancreatitis and its septic complications, or extracorporeal circuit heparinization for renal replacement therapy were present. Coagulation disorders should be considered whenever a splenic hematoma is found in a patient with acute pancreatitis. Disseminated intravascular coagulation may be the etiology of a splenic hematoma in acute pancreatitis.

  19. Effect of Corticosteroids on RVNA production of a patient with acute disseminated encephalomyelitis following rabies vaccination as well as administration of HRIG

    PubMed Central

    Peng, Jun; Chen, Li; Zhu, Zheng-Gang; Zhu, Ze-Rong; Hu, Quan; Fang, Yuan

    2015-01-01

    It has not been reported that administration of combining rabies vaccines and immunoglobulin resulted in acute disseminated encephalomyelitis (ADEM) yet. This report described that an old man acquired ADEM after being administrated with purified Vero cell rabies vaccine (PVRV) and Human Rabies Immunoglobulin (HRIG). Then he was given intravenous and oral glucocorticoids. Simultaneously, rabies vaccination was continued with purified Chick embryo cell vaccines (PCECV) instead of PVRV. Furthermore, we analyzed the rabies virus neutralizing antibodies (RVNA) levels in the patient's blood at different time points after rabies vaccination. Collectively, we observed that PCECV vaccination did not affect the prognosis of ADEM, and glucocorticoid was crucial and effective, which had no significant influence on efficacy of PCECV. PMID:25668669

  20. A Case of Disseminated Infection with Skin Manifestation Due to Non-neoformans and Non-gattii Cryptococcus in a Patient with Refractory Acute Myeloid Leukemia.

    PubMed

    Park, Sun Seob; Lee, Hyewon; Park, Weon Seo; Hwang, Sang Hyun; Choi, Sang Il; Choi, Mi Hong; Lee, Si Won; Ko, Eun Jung; Choi, Young Ju; Eom, Hyeon Seok

    2017-01-16

    Cryptococcus spp. other than Cryptococcus neoformans or Cryptococcus gattii were previously considered saprophytes and thought to be non-pathogenic to humans. However, opportunistic infections associated with non-neoformans and non-gattii species, such as Cryptococcus laurentii and Cryptococcus albidus, have increased over the past four decades. We experienced a case of cryptococcosis caused by non-neoformans and non-gattii spp. in a 47-year-old female with refractory acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation. The patient underwent salvage chemotherapy with fluconazole prophylaxis and subsequently developed neutropenic fever with multiple erythematous umbilicated papules. A skin biopsy revealed fungal hyphae and repetitive blood cultures showed yeast microorganisms that were identified later as C. laurentii by Vitek-II®. Skin lesions and fever began to improve with conventional amphotericin B therapy. The treatment regimen was continued for 21 days until the disseminated cryptococcosis was completely controlled.

  1. Post vaccine acute disseminated encephalomyelitis as the first manifestation of chromosome 22q11.2 deletion syndrome in a 15-month old baby: a case report.

    PubMed

    Valenzise, Mariella; Cascio, Antonio; Wasniewska, Malgorzata; Zirilli, Giuseppina; Catena, Maria Ausilia; Arasi, Stefania

    2014-09-29

    We describe a case of a 15-month-old female child admitted to our hospital because of fever, rash, neurological signs (oscillation between states of irritability and drowsiness), palpebral edema and drooping eyelid, appeared 10 days after the vaccination for measles, mumps and rubella. Brain MRI images showed multiple bilateral hyperintense lesions in the white matter typical of acute disseminated encephalomyelitis (ADEM), an autoimmune demyelinating disorder with inflammatory lesions of the central nervous system, due to viral antigens or vaccines. In the mean time, because of patient's vague phenotypic manifestations, suggestive of a genetic defect, array comparative genomic hybridization was carried out which showed the presence of a microdeletion 22q11.21, linked to the DiGeorge syndrome. Our case suggests that pediatric cases of post-vaccination ADEM, in which neurological signs persist, should be investigated for genetic phenotypical features, in order to exclude the presence of a genetic syndrome or disease.

  2. Acute disseminated encephalomyelitis (ADEM) following a H3N3 parainfluenza virus infection in a pregnant asthmatic woman with respiratory failure.

    PubMed

    Zeb, Qaiser; Alegria, Ana

    2014-10-03

    This case report relates to a 31-year-old pregnant woman, asthmatic, admitted to the intensive care unit with respiratory failure, secondary to a viral community-acquired pneumonia. A type 3 (H3N3) parainfluenza virus RNA was isolated in her throat swab. The patient developed neurological symptoms (behavioural changes, irritability, agitation and impaired consciousness) while being weaned off sedation and ventilatory support. Cerebrospinal fluid was clear with an opening pressure of 26 cm H2O. Brain MRI showed features compatible with acute disseminated encephalomyelitis. Immune screen and EEG were normal. She was treated with intravenous methylprednisolone followed by oral prednisolone. The patient made an almost full neurological recovery within 4 weeks after starting on steroids. The patient delivered a healthy baby at 38 weeks gestation. This case highlights the importance to keep in mind rare conditions that need early recognition and prompt treatment. Brain MRI is the key to early diagnosis and treatment.

  3. Effect of Corticosteroids on RVNA production of a patient with acute disseminated encephalomyelitis following rabies vaccination as well as administration of HRIG.

    PubMed

    Peng, Jun; Chen, Li; Zhu, Zheng-Gang; Zhu, Ze-Rong; Hu, Quan; Fang, Yuan

    2014-01-01

    It has not been reported that administration of combining rabies vaccines and immunoglobulin resulted in acute disseminated encephalomyelitis (ADEM) yet. This report described that an old man acquired ADEM after being administrated with purified Vero cell rabies vaccine (PVRV) and Human Rabies Immunoglobulin (HRIG). Then he was given intravenous and oral glucocorticoids. Simultaneously, rabies vaccination was continued with purified Chick embryo cell vaccines (PCECV) instead of PVRV. Furthermore, we analyzed the rabies virus neutralizing antibodies (RVNA) levels in the patient's blood at different time points after rabies vaccination. Collectively, we observed that PCECV vaccination did not affect the prognosis of ADEM, and glucocorticoid was crucial and effective, which had no significant influence on efficacy of PCECV.

  4. Persistent presence of the anti-myelin oligodendrocyte glycoprotein autoantibody in a pediatric case of acute disseminated encephalomyelitis followed by optic neuritis.

    PubMed

    Miyauchi, Akihiko; Monden, Yukifumi; Watanabe, Meri; Sugie, Hideo; Morita, Mitsuya; Kezuka, Takeshi; Momoi, Mariko; Yamagata, Takanori

    2014-06-01

    We report the case of a 5-year-old Japanese girl who initially had acute disseminated encephalomyelitis (ADEM) and was positive for the myelin oligodendrocyte glycoprotein (MOG) antibodies and developed unilateral optic neuritis (ON) 71 days after ADEM onset. The patient's serum was positive for the anti-MOG antibodies from the onset of ADEM to the development of ON. This phenotype has been reported in only two previous articles, and the specific mechanism of action of the anti-MOG antibodies is not yet understood. Our case suggests that the anti-MOG antibody can be associated with the pathogenesis of ADEM followed by ON. Thus, patients with ADEM who test positive for the anti-MOG antibody may be at risk of developing subsequent ON.

  5. Toxoplasma gondii infection in llama (Llama glama): acute visceral disseminated lesions, diagnosis, and development of tissue cysts

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Clinical toxoplasmosis has been reported in many species of warm-blooded animals, but is rare in camelids. Here we report acute fatal systemic toxoplasmosis involving heart, thyroid gland, stomach, intestine, diaphragm, adrenal glands, and liver of a 13-mo-old llama (Llama glama). Many Toxoplasma go...

  6. New clinical and histological patterns of acute disseminated histoplasmosis in human immunodeficiency virus-positive patients with acquired immunodeficiency syndrome.

    PubMed

    Ollague Sierra, Jose E; Ollague Torres, Jose M

    2013-04-01

    Histoplasmosis has attained increasing relevance in the past 3 decades because of the appearance of the human immunodeficiency virus (HIV). In most immunocompetent persons, the infection is asymptomatic or can produce a respiratory condition with symptoms and radiological images similar to those observed in pulmonary tuberculosis; in non-HIV+ immunocompromised patients, it can cause respiratory symptoms or evolve into a disseminated infection. The same can occur in acquired immunodeficiency syndrome (AIDS) patients. We have observed a series of HIV+ patients with AIDS who presented with cutaneous histoplasmosis and in whom the clinical and histopathological features were highly unusual, including variable mucocutaneous lesions that were difficult to diagnose clinically. These patients displayed unusual, previously undescribed, histological patterns, including lichenoid pattern, nodular pseudomyxoid pattern, pyogenic granuloma-like pattern, perifollicular pattern, and superficial (S), mid (M), and deep perivascular dermatitis; and more commonly encountered patterns, such as histiocytic lobular panniculitis and focal nodular dermatitis. The novel histopathological patterns of cutaneous involvement by histoplasmosis seen in these patients resembled other common inflammatory and infectious conditions and required a high level of suspicion and the application of special stains for organisms for confirmation. These new, clinical, and histological findings do not seem to be commonly encountered in HIV- patients infected with the fungus but seem to be displayed most prominently in HIV+ patients with AIDS.

  7. Intravascular photoacoustic tomography for characterization of atherosclerotic lipid and inflammation

    NASA Astrophysics Data System (ADS)

    Zhang, Jian; Qin, Huan; Shi, Yujiao; Yang, Sihua; Xing, Da

    2014-09-01

    Photoacoustic imaging is a fast growing imaging technology depending on its high optical resolution of optics while taking the advantage of the high penetration depth of ultrasound. In this paper, we demonstrate the new progress in the photoacoustic imaging. Atherosclerosis is characterized by a progressive build-up of lipid in the arterial wall, which is known as plaque. Histological studies demonstrate that the primary cause of acute cardiovascular events is the rupture of atherosclerotic plaques. Lipid and inflammation within the plaque are related to influence the propensity of plaques to disrupt. Photoacoustic intravascular tomography (IVPAT) holds a great advantage in providing comprehensive morphological and functional information of plaques. Lipid relative concentration maps of atherosclerotic aorta were obtained and compared with histology. Furthermore, by selectively targeting the intravascular inflammatory cytokines, IVPAT is also capable of mapping the inflamed area and determining the degree of inflammation.

  8. Image Processing in Intravascular OCT

    NASA Astrophysics Data System (ADS)

    Wang, Zhao; Wilson, David L.; Bezerra, Hiram G.; Rollins, Andrew M.

    Coronary artery disease is the leading cause of death in the world. Intravascular optical coherence tomography (IVOCT) is rapidly becoming a promising imaging modality for characterization of atherosclerotic plaques and evaluation of coronary stenting. OCT has several unique advantages over alternative technologies, such as intravascular ultrasound (IVUS), due to its better resolution and contrast. For example, OCT is currently the only imaging modality that can measure the thickness of the fibrous cap of an atherosclerotic plaque in vivo. OCT also has the ability to accurately assess the coverage of individual stent struts by neointimal tissue over time. However, it is extremely time-consuming to analyze IVOCT images manually to derive quantitative diagnostic metrics. In this chapter, we introduce some computer-aided methods to automate the common IVOCT image analysis tasks.

  9. Carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae across a hospital system: impact of post-acute care facilities on dissemination

    PubMed Central

    Perez, Federico; Endimiani, Andrea; Ray, Amy J.; Decker, Brooke K.; Wallace, Christopher J.; Hujer, Kristine M.; Ecker, David J.; Adams, Mark D.; Toltzis, Philip; Dul, Michael J.; Windau, Anne; Bajaksouzian, Saralee; Jacobs, Michael R.; Salata, Robert A.; Bonomo, Robert A.

    2010-01-01

    Background Resistance to carbapenems among Acinetobacter baumannii and Klebsiella pneumoniae presents a serious therapeutic and infection control challenge. We describe the epidemiology and genetic basis of carbapenem resistance in A. baumannii and K. pneumoniae in a six-hospital healthcare system in Northeast Ohio. Methods Clinical isolates of A. baumannii and K. pneumoniae distributed across the healthcare system were collected from April 2007 to April 2008. Antimicrobial susceptibility testing was performed followed by molecular analysis of carbapenemase genes. Genetic relatedness of isolates was established with repetitive sequence-based PCR (rep-PCR), multilocus PCR followed by electrospray ionization mass spectrometry (PCR/ESI-MS) and PFGE. Clinical characteristics and outcomes of patients were reviewed. Results Among 39 isolates of A. baumannii, two predominant genotypes related to European clone II were found. Eighteen isolates contained blaOXA-23, and four isolates possessed blaOXA-24/40. Among 29 K. pneumoniae isolates with decreased susceptibility to carbapenems, two distinct genotypes containing blaKPC-2 or blaKPC-3 were found. Patients with carbapenem-resistant A. baumannii and K. pneumoniae were elderly, possessed multiple co-morbidities, were frequently admitted from and discharged to post-acute care facilities, and experienced prolonged hospital stays (up to 25 days) with a high mortality rate (up to 35%). Conclusion In this outbreak of carbapenem-resistant A. baumannii and K. pneumoniae across a healthcare system, we illustrate the important role post-acute care facilities play in the dissemination of multidrug-resistant phenotypes. PMID:20513702

  10. Toxoplasma gondii infection in llama (Llama glama): acute visceral disseminated lesions, diagnosis, and development of tissue cysts.

    PubMed

    Dubey, J P; Newell, T K; Verma, S K; Calero-Bernal, R; Stevens, E L

    2014-06-01

    Clinical toxoplasmosis has been reported in many species of warm-blooded animals but is rare in camelids. Here we report acute fatal systemic toxoplasmosis involving heart, thyroid gland, stomach, intestine, diaphragm, kidneys, adrenal glands, and liver of a 13-mo-old llama (Llama glama). Many Toxoplasma gondii tachyzoites were associated with tissue necrosis in multiple organs. Death was attributed to severe myocarditis. Ulcers associated with numerous tachyzoites were present in the C3 compartment of the stomach. Tissue cyst development was followed using bradyzoite-specific T. gondii antibodies. Individual intracellular, and groups of 2 or more, bradyzoites were identified in hepatocytes, biliary epithelium, myocardiocytes, lung, diaphragm, thyroid gland, spleen, and stomach. Lesions in the brain were a few microglial nodules and very early tissue cysts containing 1-3 bradyzoites. These observations suggest that the animal had acquired toxoplasmosis recently. Diagnosis was confirmed immunohistochemically by reaction with T. gondii -specific polyclonal rabbit serum but not with antibodies to the related protozoan Neospora caninum . Genetic typing using the DNA extracted from paraffin-embedded myocardium of llama and 10 PCR-restriction fragment length polymorphism (RFLP) markers revealed a type II allele at the SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, PK1 L358, and Apico loci; therefore, this isolate belongs to the ToxoDB PCR-RFLP genotype #1, which is most common in North America and Europe.

  11. Acute disseminated encephalomyelitis without optic neuritis followed by optic neuritis in a child due to the sudden cessation of steroid therapy.

    PubMed

    Ryu, Won Yeol; Sohn, Eun Jung; Kwon, Yoon Hyung; Jeung, Woo Jin; Ahn, Hee Bae; Park, Woo Chan; Rho, Sae Heun

    2014-01-01

    Acute disseminated encephalitis (ADEM) is an autoimmune demyelinating disorder of the central nervous system that usually occurs in children after viral infection or vaccination. It is not uncommon for ADEM to be accompanied by optic neuritis. However, ADEM followed by optic neuritis is a rare. We report the case of a 6-year-old girl who initially presented with ADEM (without optic neuritis) due to a live measles, mumps, and rubella vaccine and was treated with intravenous high-dose corticosteroids. After steroid therapy, she recovered neurologically and was not prescribed any medication, including an oral steroid taper, for use after discharge. Three weeks later, she developed unilateral optic neuritis and was again treated with steroid therapy. This is a rare case of ADEM without optic neuritis in a child, followed by optic neuritis due to the sudden cessation of steroid therapy. Further studies and follow-ups are needed to determine whether ADEM followed by optic neuritis can be considered a specific clinical form of this disorder.

  12. An intravascular immune response to Borrelia burgdorferi involves Kupffer cells and iNKT cells

    PubMed Central

    Lee, Woo-Yong; Moriarty, Tara J; Wong, Connie H Y; Zhou, Hong; Strieter, Robert M; van Rooijen, Nico; Chaconas, George; Kubes, Paul

    2016-01-01

    Here we investigate the dynamics of the hepatic intravascular immune response to a pathogen relevant to invariant natural killer T cells (iNKT cells). Immobilized Kupffer cells with highly ramified extended processes into multiple sinusoids could effectively capture blood-borne, disseminating Borrelia burgdorferi, creating a highly efficient surveillance and filtering system. After ingesting B. burgdorferi, Kupffer cells induced chemokine receptor CXCR3–dependent clustering of iNKT cells. Kupffer cells and iNKT cells formed stable contacts via the antigen-presenting molecule CD1d, which led to iNKT cell activation. An absence of iNKT cells caused B. burgdorferi to leave the blood and enter the joints more effectively. B. burgdorferi that escaped Kupffer cells entered the liver parenchyma and survived despite Ito cell responses. Kupffer cell–iNKT cell interactions induced a key intravascular immune response that diminished the dissemination of B. burgdorferi. PMID:20228796

  13. Intravascular probe for detection of vulnerable plaque

    NASA Astrophysics Data System (ADS)

    Patt, Bradley E.; Iwanczyk, Jan S.; MacDonald, Lawrence R.; Yamaguchi, Yuko; Tull, Carolyn R.; Janecek, Martin; Hoffman, Edward J.; Strauss, H. William; Tsugita, Ross; Ghazarossian, Vartan

    2001-12-01

    Coronary angiography is unable to define the status of the atheroma, and only measures the luminal dimensions of the blood vessel, without providing information about plaque content. Up to 70% of heart attacks are caused by minimally obstructive vulnerable plaques, which are too small to be detected adequately by angiography. We have developed an intravascular imaging detector to identify vulnerable coronary artery plaques. The detector works by sensing beta or conversion electron radiotracer emissions from plaque-binding radiotracers. The device overcomes the technical constraints of size, sensitivity and conformance to the intravascular environment. The detector at the distal end of the catheter uses six 7mm long by 0.5mm diameter scintillation fibers coupled to 1.5m long plastic fibers. The fibers are offset from each other longitudinally by 6mm and arranged spirally around a guide wire in the catheter. At the proximal end of the catheter the optical fibers are coupled to an interface box with a snap on connector. The interface box contains a position sensitive photomultiplier tube (PSPMT) to decode the individual fibers. The whole detector assembly fits into an 8-French (2.7 mm in diameter) catheter. The PSPMT image is further decoded with software to give a linear image, the total instantaneous count rate and an audio output whose tone corresponds to the count rate. The device was tested with F-18 and Tl-204 sources. Spectrometric response, spatial resolution, sensitivity and beta to background ratio were measured. System resolution is 6 mm and the sensitivity is >500 cps / micrometers Ci when the source is 1 mm from the detector. The beta to background ratio was 11.2 for F-18 measured on a single fiber. The current device will lead to a system allowing imaging of labeled vulnerable plaque in coronary arteries. This type of signature is expected to enable targeted and cost effective therapies to prevent acute coronary artery diseases such as: unstable angina

  14. Bioresorbable vascular scaffold restenosis: intravascular imaging evaluation.

    PubMed

    Fabris, Enrico; Kilic, Ismail Dogu; Caiazzo, Gianluca; Serdoz, Roberta; Foin, Nicolas; Sinagra, Gianfranco; Di Mario, Carlo

    2015-11-21

    The mechanism of restenosis in bioresorbable vascular scaffold (BVS) may be different from that of metallic stents and it is still poorly investigated. Intravascular imaging techniques are useful tools for corroborating or excluding possible mechanisms of intra-scaffold restenosis. In these novel devices intravascular imaging should be systematically used for a better comprehension of the in-scaffold restenosis mechanism.

  15. Thrombotic thrombocytopenic purpura: a syndrome of intravascular platelet consumption.

    PubMed Central

    Neame, P. B.; Hirsh, J.; Browman, G.; Denburg, J.; D'Souza, T. J.; Gallus, A.; Brain, M. C.

    1976-01-01

    In four of five patients with thrombotic thrombocytopenic purpura (TTP) in whom serial tests of hemostatic function were performed, severe thrombocytopenia, normal plasma fibrinogen concentrations and mildly increased concentrations of fibrinogen/fibrin degradation products were observed. Widespread platelet thrombi were found in arterioles and capillaries. Fibrin could be seen around some of the platelet clumps and was the main component in a small number of the thrombi in two patients. The observations show that TTP is a disorder in which intravascular platelet consumption results in disseminated platelet thrombosis. The coagulation system is apparently activated secondarily to platelet aggregation and variable quantities of fibrin are incorporated into the thrombi. Clinical improvement resulted from combined therapy with corticosteroids, heparin and drugs that suppress platelet function. Images FIG. 3 FIG. 4 FIG. 5 FIG. 6 PMID:1084215

  16. Intravascular lymphoma and thyroid gland.

    PubMed

    Katalinić, Darko; Valković, Toni; Lucin, Ksenija; Rudez, Josip

    2006-03-01

    Intravascular lymphoma (IVL) is a rare disease characterized by the proliferation of neoplastic cells in the small blood vessels that frequently goes undiagnosed until the time of autopsy. The neoplastic cells are usually of B-cell origin. The clinical course was examined to determine factors that would facilitate antemortem diagnosis. IVL is observed with clinical, histopathological and immunohystochemical methods. This is a unique case because the thyroid gland is a rare place for IVL. Accent is given on immunohystochemical methods and tissue biopsy in the differential diagnosis of IVL when nervous system and thyroid gland dysfunction occur This report indicates that micro-ecosystem of multinodular goitrous might influence the expression of chemokines and/or adhesion moleculs on endothelial and lymphoma cells, leading to heavy infiltration of thyroid gland. Concurrently, that may guide the physician to tissue biopsy facilitating antemortem diagnosis and institution of appropriate therapy.

  17. Ultrastructural observations on a variant of acute promyelocytic leukemia.

    PubMed

    Djaldetti, M; Gardyn, J; Maran, R; Floru, S; Mittelman, M

    1993-03-01

    A patient with acute leukemia is presented in whom the leukemic cells, as seen by light microscopy were typical promyelocytes. The cells had normal or slightly invaginated nuclei with typical cytoplasmic granules and the diagnosis was confirmed by cytochemistry. The clinical course was rapid and the patient died of disseminated intravascular coagulation and urosepsis within a few days of diagnosis. However, electron microscopic examination showed cells with extremely convoluted and lobulated nuclei with nuclear pockets and cytoplasmic bridges as well as the complete absence of cytoplasmic granules in the majority of the cells. Furthermore, the urine lysozyme (muramidase) was elevated. These findings suggest that the leukemia in this patient may be classified as a hypogranular variant of acute promyelocytic leukemia (APL), with monocytoid ultrastructural appearances.

  18. Hyponatremia and hypoglycemia in acute Sheehan's syndrome.

    PubMed

    Bunch, T J; Dunn, W F; Basu, A; Gosman, R I

    2002-10-01

    We report the case of a 23-year-old Saudi Arabian woman who presented to the medical intensive care unit with severe hyponatremia and hypoglycemia following a Cesarean section delivery complicated by hemorrhage due to disseminated intravascular coagulopathy. She was treated successfully for adrenal insufficiency acutely, and was later discharged on hormone replacement therapy. To our knowledge, this is the first case report of acute Sheehan's syndrome presenting with both hyponatremia and suggestive hypoglycemia. Pituitary necrosis is an uncommon complication of peripartum hemorrhagic shock. Since the initial description by Sheehan in 1937, the incidence of the syndrome has gradually declined through improved management of hemodynamic complications leading to the infarction of the gland. There are many studies describing complications of late Sheehan's syndrome; however, relatively few contain descriptions of the acute phase. In addition, the diagnosis of this syndrome is often determined after resolution of the acute process with resultant lack of data regarding immediate endocrine and imaging abnormalities. In this report, we describe the complete endocrine and imaging assessment of a patient presenting in critical condition due to necrosis of the pituitary gland in the immediate postpartum period.

  19. Fatal disseminated toxoplasmosis during primary HIV infection.

    PubMed

    Signorini, Liana; Gulletta, Maurizio; Coppini, Davide; Donzelli, Carla; Stellini, Roberto; Manca, Nino; Carosi, Giampiero; Matteelli, Alberto

    2007-03-01

    Toxoplasmosis is a well recognized manifestation of AIDS, but the disseminated disease is a rare condition and it has not been associated to HIV seroconversion to our knowledge. We describe a fatal episode of disseminated T. gondii acute infection with massive organ involvement during primary HIV infection. The serological data demonstrate primary T. gondii infection. The avidity index for HIV antibodies supports recent HIV-1 infection.

  20. Intravascular papillary endothelial hyperplasia of the foot.

    PubMed

    Cisco, R W; McCormac, R M

    1994-01-01

    Intravascular papillary endothelial hyperplasia is a rare benign reactive lesion usually found in thrombosed subcutaneous blood vessels. The lesion resembles malignant angiosarcoma clinically and histopathologically, and must be diagnosed correctly to avoid inappropriate treatment. The following is a case presentation involving the foot.

  1. Case report: anesthetic management of acute fatty liver of pregnancy in the postpartum period.

    PubMed

    Spence, Dennis

    2010-06-01

    Acute fatty liver of pregnancy (AFLP) is a potentially fatal metabolic disorder that manifests during the third trimester. Early diagnosis, termination of pregnancy, and treatment of complications associated with AFLP significantly reduce maternal morbidity and mortality. While most cases of AFLP occur before delivery, some may occur after vaginal delivery. Anesthesia providers should have a high level of suspicion for AFLP in a patient with altered mental status and elevated liver function test results in the postpartum period. Anesthetic implications include early recognition of liver dysfunction and aggressive resuscitation and treatment of hypoglycemia, disseminated intravascular coagulopathy, and other associated complications and reduction or avoidance of medications with substantial hepatic metabolism. This is a case report describing the management of a woman with AFLP in whom acute liver failure rapidly developed after a vaginal delivery with epidural analgesia at a small overseas hospital.

  2. Improved hepatic transduction, reduced systemic vector dissemination, and long-term transgene expression by delivering helper-dependent adenoviral vectors into the surgically isolated liver of nonhuman primates.

    PubMed

    Brunetti-Pierri, Nicola; Ng, Thomas; Iannitti, David A; Palmer, Donna J; Beaudet, Arthur L; Finegold, Milton J; Carey, K Dee; Cioffi, William G; Ng, Philip

    2006-04-01

    Helper-dependent adenoviral vectors (HDAds) are attractive vectors for liver-directed gene therapy because they can mediate sustained, high-level transgene expression without chronic toxicity. However, high vector doses are required to achieve efficient hepatic transduction by systemic delivery because of a nonlinear dose response. Unfortunately, such high doses result in systemic vector dissemination and dose-dependent acute toxicity with potentially severe and lethal consequences. We hypothesize that the threshold to efficient hepatic transduction may be circumvented by delivering the vector into the surgically isolated liver via the portal vein. Total hepatic isolation was achieved by occluding hepatic inflow from the portal vein and hepatic artery and by occluding hepatic venous outflow at the inferior vena cava. We demonstrate in nonhuman primates that this approach resulted in significantly higher efficiency hepatic transduction with reduced systemic vector dissemination compared with systemic intravascular delivery. This method of delivery was associated with transient acute toxicity, the severity of which was variable. Importantly, stable, high levels of transgene expression were obtained for at least 665 days for one baboon and for at least 560 days for two baboons with no evidence of long-term toxicity.

  3. Disseminated histoplasmosis (image)

    MedlinePlus

    Histoplasmosis is a fungal infection caused by inhaling dust from spore-infected bird droppings. In the disseminated ... fairly high for people with untreated widespread (disseminated) histoplasmosis, but is reduced significantly with treatment.

  4. Disseminated Zygomycosis Due to Rhizopus schipperae after Heatstroke

    PubMed Central

    Anstead, Gregory M.; Sutton, Deanna A.; Thompson, Elizabeth H.; Weitzman, Irene; Otto, Randal A.; Ahuja, Sunil K.

    1999-01-01

    A 21-year-old woman suffered heatstroke and developed diarrhea while trekking across south Texas. The heatstroke was complicated by seizures, rhabdomyolysis, pneumonia, renal failure, and disseminated intravascular coagulation. The patient’s stool and blood cultures grew Campylobacter jejuni. The patient subsequently developed paranasal and gastrointestinal zygomycosis and required surgical debridement and a prolonged course of amphotericin B. The zygomycete cultured was Rhizopus schipperae. This is only the second isolate of R. schipperae that has been described. R. schipperae is characterized by the production of clusters of up to 10 sporangiophores arising from simple but well-developed rhizoids. These asexual reproductive propagules are produced on Czapek Dox agar but are absent on routine mycology media, where only chlamydospores are observed. Despite multiorgan failure, bacteremia, and disseminated zygomycosis, the patient survived and had a good neurological outcome. Heatstroke has not been previously described as a risk factor for the development of disseminated zygomycosis. PMID:10405417

  5. Dissemination Activities Report

    ERIC Educational Resources Information Center

    Barclay, Hanna; Batatia, Hudj; Bauters, Merja; Ben Ami, Zvi; Drachman, Raul; Flouris, Giorgos; Jadin, Tanja; Jalonen, Satu; Karlgren, Klas; Karpati, Andrea; Kotzinos, Dimitris; Lakkala, Minna; Lallimo, Jiri; Moen, Anne; Nygard, Kathrine; Paavola, Sami; Padiglia, Sheila; Scapolla, Marina; Sins, Patrick; Vasileva, Tania

    2008-01-01

    In the first 24 months of the project, KP-Lab members were highly dedicated to dissemination and were engaged in various dissemination activities that contributed to the prime objective of the KP-Lab dissemination efforts which is "to make the project widely known to a variety of prospective users and, at a later stage, to promote the…

  6. Disseminated encephalomyelitis-like central nervous system neoplasm in childhood.

    PubMed

    Zhao, Jianhui; Bao, Xinhua; Fu, Na; Ye, Jintang; Li, Ting; Yuan, Yun; Zhang, Chunyu; Zhang, Yao; Zhang, Yuehua; Qin, Jiong; Wu, Xiru

    2014-08-01

    A malignant neoplasm in the central nervous system with diffuse white matter changes on magnetic resonance imaging (MRI) is rare in children. It could be misdiagnosed as acute disseminated encephalomyelitis. This report presents our experience based on 4 patients (3 male, 1 female; aged 7-13 years) whose MRI showed diffuse lesions in white matter and who were initially diagnosed with acute disseminated encephalomyelitis. All of the patients received corticosteroid therapy. After brain biopsy, the patients were diagnosed with gliomatosis cerebri, primitive neuroectodermal tumor and central nervous system lymphoma. We also provide literature reviews and discuss the differentiation of central nervous system neoplasm from acute disseminated encephalomyelitis.

  7. Effective dissemination strategies.

    PubMed

    Scullion, Philip A

    2002-01-01

    Dissemination of research findings or other key messages is increasingly acknowledged as a vital yet complex process. In this paper, Philip Scullion sets out to explore and disentangle some of these complexities, examine examples of successful dissemination strategies and provide valuable insights. It is argued that the process of dissemination needs to be afforded greater emphasis by project-funding bodies, research supervisors, researchers, and those responsible for implementing changes in clinical practice. Important initiatives are acknowledged before the concept of dissemination is explored. The source, message, medium and target groups, all key elements in the dissemination process, are then examined. It is argued that dissemination needs to be carefully considered at the design stage of research projects in relation to each of these elements. This paper concludes that the current commitment to research and evidence-based practice will have limited impact on patient care until a similar commitment to dissemination is evident at both corporate and individual levels.

  8. Successful combined use of tranexamic acid and unfractionated heparin for life-threatening bleeding associated with intravascular coagulation in a patient with chronic myelogenous leukemia in blast crisis.

    PubMed

    Koseki, Mihoko; Asada, Noboru; Uryu, Hidetaka; Takeuchi, Masami; Asakura, Hidesaku; Matsue, Kosei

    2007-12-01

    The current therapeutic strategy for disseminated intravascular coagulation (DIC) is limited to control of the underlying disease, and methods for the effective management of DIC have not been established. We report the successful use of tranexamic acid (TA) combined with unfractionated heparin in a patient with life-threatening bleeding from the sigmoid colon caused by DIC. A 35-year-old man who had undergone allogeneic bone marrow transplantation for chronic myelogenous leukemia was referred for relapse of his leukemia. The patient was first treated with imatinib at 600 mg/day. Although the disappearance of leukemic cells and a decrease in the BCR/ABL fusion gene were observed, he developed massive bleeding from the sigmoid colon after defecation. A laboratory diagnosis of DIC with prominent fibrinolysis was based on elevated levels of both plasmin-alpha2-plasmin inhibitor complex and thrombin-antithrombin III complex. Despite vigorous supportive therapy, including multiple transfusions and aggressive fluid resuscitation, the patient developed hypovolemic shock due to the uncontrollable bleeding. TA combined with unfractionated heparin was instituted to inhibit excessive fibrinolysis. A prompt response was observed soon after the commencement of therapy. No organ dysfunction was observed throughout TA and heparin use. To our knowledge, this report is the first to describe successful treatment with TA combined with heparin for life-threatening intestinal bleeding due to acute DIC associated with hematologic malignancy.

  9. Mapping Intravascular Ultrasound Controversies in Interventional Cardiology Practice

    PubMed Central

    Maresca, David; Adams, Samantha; Maresca, Bruno; van der Steen, Antonius F. W.

    2014-01-01

    Intravascular ultrasound is a catheter-based imaging modality that was developed to investigate the condition of coronary arteries and assess the vulnerability of coronary atherosclerotic plaques in particular. Since its introduction in the clinic 20 years ago, use of intravascular ultrasound innovation has been relatively limited. Intravascular ultrasound remains a niche technology; its clinical practice did not vastly expand, except in Japan, where intravascular ultrasound is an appraised tool for guiding percutaneous coronary interventions. In this qualitative research study, we follow scholarship on the sociology of innovation in exploring both the current adoption practices and perspectives on the future of intravascular ultrasound. We conducted a survey of biomedical experts with experience in the technology, the practice, and the commercialization of intravascular ultrasound. The collected information enabled us to map intravascular ultrasound controversies as well as to outline the dynamics of the international network of experts that generates intravascular ultrasound innovations and uses intravascular ultrasound technologies. While the technology is praised for its capacity to measure coronary atherosclerotic plaque morphology and is steadily used in clinical research, the lack of demonstrated benefits of intravascular ultrasound guided coronary interventions emerges as the strongest factor that prevents its expansion. Furthermore, most of the controversies identified were external to intravascular ultrasound technology itself, meaning that decision making at the industrial, financial and regulatory levels are likely to determine the future of intravascular ultrasound. In light of opinions from the responding experts', a wider adoption of intravascular ultrasound as a stand-alone imaging modality seems rather uncertain, but the appeal for this technology may be renewed by improving image quality and through combination with complementary imaging

  10. Robust intravascular optical coherence elastography driven by acoustic radiation pressure

    NASA Astrophysics Data System (ADS)

    van Soest, Gijs; Bouchard, Richard R.; Mastik, Frits; de Jong, Nico; van der Steen, Anton F. W.

    2007-07-01

    High strain spots in the vessel wall indicate the presence of vulnerable plaques. The majority of acute cardiovascular events are preceded by rupture of such a plaque in a coronary artery. Intracoronary optical coherence tomography (OCT) can be extended, in principle, to an elastography technique, mapping the strain in the vascular wall. However, the susceptibility of OCT to frame-to-frame decorrelation, caused by tissue and catheter motion, inhibits reliable tissue displacement tracking and has to date obstructed the development of OCT-based intravascular elastography. We introduce a new technique for intravascular optical coherence elastography, which is robust against motion artifacts. Using acoustic radiation force, we apply a pressure to deform the tissue synchronously with the line scan rate of the OCT instrument. Radial tissue displacement can be tracked based on the correlation between adjacent lines, instead of subsequent frames in conventional elastography. The viability of the method is demonstrated with a simulation study. The root mean square (rms) error of the displacement estimate is 0.55 μm, and the rms error of the strain is 0.6%. It is shown that high-strain spots in the vessel wall, such as observed at the sites of vulnerable atherosclerotic lesions, can be detected with the technique. Experiments to realize this new elastographic method are presented. Simultaneous optical and ultrasonic pulse-echo tracking demonstrate that the material can be put in a high-frequency oscillatory motion with an amplitude of several micrometers, more than sufficient for accurate tracking with OCT. The resulting data are used to optimize the acoustic pushing sequence and geometry.

  11. Techniques for Intravascular Foreign Body Retrieval

    SciTech Connect

    Woodhouse, Joe B.; Uberoi, Raman

    2013-08-01

    As endovascular therapies increase in frequency, the incidence of lost or embolized foreign bodies is increasing. The presence of an intravascular foreign body (IFB) is well recognized to have the potential to cause serious complications. IFB can embolize and impact critical sites such as the heart, with subsequent significant morbidity or mortality. Intravascular foreign bodies most commonly result from embolized central line fragments, but they can originate from many sources, both iatrogenic and noniatrogenic. The percutaneous approach in removing an IFB is widely perceived as the best way to retrieve endovascular foreign bodies. This minimally invasive approach has a high success rate with a low associated morbidity, and it avoids the complications related to open surgical approaches. We examined the characteristics, causes, and incidence of endovascular embolizations and reviewed the various described techniques that have been used to facilitate subsequent explantation of such materials.

  12. Rectal Cancer With Disseminated Carcinomatosis of the Bone Marrow: Report of a Case

    PubMed Central

    Nakashima, Yuichiro; Takeishi, Kazuki; Guntani, Atsushi; Tsujita, Eiji; Yoshinaga, Keiji; Matsuyama, Ayumi; Hamatake, Motoharu; Maeda, Takashi; Tsutsui, Shinichi; Matsuda, Hiroyuki; Fujihara, Megumu; Ishida, Teruyoshi

    2014-01-01

    We report a rare case of disseminated carcinomatosis of the bone marrow from rectal cancer with disseminated intravascular coagulation (DIC). A 65-year-old man was admitted with melena and low back pain at rest. X-ray examination showed rectal cancer with multiple bone metastases. Laboratory examination showed severe anemia and DIC. Histologic examination showed disseminated carcinomatosis of the bone marrow. The DIC was considered to be caused by disseminated carcinomatosis of the bone marrow from rectal cancer, and we immediately started treatment with anti-DIC therapy and anticancer chemotherapy with the modified FOLFOX6 regimen (mFOLFOX6). After some response to therapy, the patient's general condition deteriorated, and he died 128 days after admission. This is the first English report showing disseminated carcinomatosis of the bone marrow from colorectal cancer treated with mFOLFOX6. PMID:25216414

  13. Technology-based dissemination.

    PubMed

    Jennett, P A; Premkumar, K

    1996-01-01

    Health care reform and restructuring, changes in the scope and definitions of 'health', 'health care' and 'health research', along with a continued emphasis on multidisciplinary health promotion and prevention, all indicate the need for information dissemination, exchange and management. Technology can be a tool to help meet this need, as it can help us disseminate, as well as understand the process of dissemination. Rapid advances in, and reduced costs of technology, permit the integration of this tool. This paper provides a definition for dissemination, along with a background and rationale as to why now is the time and place to harness technology to assist with the dissemination process. In addition, it presents well-designed studies on the effective use of technology as an aid to dissemination. Concrete examples of innovative technology that are being tested are also examined. Finally, the challenge and strategies for technology integration are addressed.

  14. Intravascular haemolysis in the recreational runner.

    PubMed Central

    Deitrick, R W

    1991-01-01

    Intravascular haemolysis has been found to result from prolonged endurance competition, rigorous military training and participation in impact sports. Haematological research involving the recreational runner is sparse. Recreational runners frequently vary their training to avoid monotony and improve endurance capacity. This study investigated the haematological effects of a typical day of increased distance training in 15 male recreational runners (62.4(3.1) ml kg-1 min-1 treadmill VO2max; 44.6(8.4) km per week training (means(s.d.)). Venous blood samples were collected before, immediately after, 1 day, 4 days, and 10 days after a 13-km training run (about twice the subjects' typical running distance) and analysed for changes in bilirubin, serum potassium, haematocrit, haemoglobin, red blood cell count, haptoglobin, poikilocytosis and reticulocytosis. Urine samples were collected at the same times as the blood samples and analysed for urobilinogen. Significant (P less than 0.05) 1-day and 4-day decreases in mean haemoglobin, red blood cell count, and haptoglobin values, compared to before training venous blood values and significant (P less than 0.05) post-training increases in bilirubin, serum potassium, urobilinogen and poikilocytosis provided evidence for increased intravascular haemolysis. After 10 days the values for haematocrit, bilirubin, serum potassium, red blood cell count, urobilinogen and poikilocytosis were not significantly (P less than 0.05) different from pre-training values while haemoglobin remained significantly (P less than 0.05) lower, exhibiting a constant but not significant increase over the period from 1 to 10 days. The results indicate that mild intravascular 'footstrike' haemolysis can occur in the recreational runner when typical training distance is increased. This condition appears to be transient and benign. PMID:1810610

  15. [An autopsy case of periarteritis nodosa associated with disseminated strongyloidiasis].

    PubMed

    Kiyuna, M; Toda, T; Tamamoto, T; Shimajiri, S; Shingaki, Y; Hokama, M; Ohwan, I

    1994-08-01

    An autopsy case of periarteritis nodosa associated with disseminated strongyloidiasis in a 59-year-old woman is reported. The patient had unknown fever of 38 degrees C and marked impairment of renal function, for which pulse therapy of steroid was performed. Electromyogram showed myogenic pattern, and biopsy of the biceps presented necrotizing angitis of small arteries. Renal biopsy showed marked infiltration of lymphocytes in the stroma, and frequent hyalinosis and crescent formation of the glomeruli. Two months after admission, the patient died of respiratory failure associated with sepsis and disseminated intravascular coagulopathy. Postmortem examination disclosed strongyloides stercolaris and fungi in both lungs with extensive hemorrhage. Terminal ileum and ascending colon had multiple erosions, extensive hemorrhage, numerous strongyloides stercolaris, and frequent necrotizing angitis in the mucosa. Necrotizing angitis was also demonstrated in both kidneys.

  16. Coexpression of Tim-3 and PD-1 identifies a CD8+ T-cell exhaustion phenotype in mice with disseminated acute myelogenous leukemia.

    PubMed

    Zhou, Qing; Munger, Meghan E; Veenstra, Rachelle G; Weigel, Brenda J; Hirashima, Mitsuomi; Munn, David H; Murphy, William J; Azuma, Miyuki; Anderson, Ana C; Kuchroo, Vijay K; Blazar, Bruce R

    2011-04-28

    Tumor-associated immune suppression can lead to defective T cell-mediated antitumor immunity. Here, we identified a unique phenotype of exhausted T cells in mice with advanced acute myelogenous leukemia (AML). This phenotype is characterized by the coexpression of Tim-3 and PD-1 on CD8(+) T cells in the liver, the major first site of AML metastases. PD-1 and Tim-3 coexpression increased during AML progression. PD-1(+)Tim-3(+) CD8(+) T cells were deficient in their ability to produce IFN-γ, TNF-α, and IL-2 in response to PD-1 ligand (PDL1) and Tim-3 ligand (galectin-9) expressing AML cells. PD-1 knockout (KO), which were partially resistant to AML challenge, up-regulated Tim-3 during AML progression and such Tim-3(+)PD-1- KO CD8(+) T cells had reduced cytokine production. Galectin-9 KO mice were more resistant to AML, which was associated with reduced T-regulatory cell accumulation and a modest induction of PD-1 and Tim-3 expression on CD8(+) T cells. Whereas blocking the PD-1/PDL1 or Tim-3/galectin-9 pathway alone was insufficient to rescue mice from AML lethality, an additive effect was seen in reducing-albeit not eliminating-both tumor burden and lethality when both pathways were blocked. Therefore, combined PD-1/PDL1 and Tim-3/galectin-9 blockade may be beneficial in preventing CD8(+) T-cell exhaustion in patients with hematologic malignancies such as advanced AML.

  17. Pulsed liquid microjet for intravascular injection

    NASA Astrophysics Data System (ADS)

    Palanker, Daniel V.; Fletcher, Daniel A.; Miller, Jason; Huie, Philip; Marmor, Michael; Blumenkranz, Mark S.

    2002-06-01

    Occlusions of the retinal veins and arteries are associated with common diseases such as hypertension and arteriosclerosis and usually cause severe and irreversible loss of vision. Treatments for these vascular diseases have been unsatisfactory to date in part because of the difficulty of delivering thrombolytic drugs locally within the eye. In this article we describe a pulsed liquid microjet for minimally invasive intra-vascular drug delivery. The microjet is driven by a vapor bubble following an explosive evaporation of saline, produced by a microsecond-long electric discharge in front of the 25 micrometers electrode inside the micronozzle. Expansion of the transient vapor bubble produces a water jet with a diameter equal to the diameter of the nozzle, and with a velocity and duration that are controlled by the pulse energy. We found that fluid could be injected through the wall of a 60-micrometers -diameter artery in choriallantoic membrane using a 15-micrometers diameter liquid jet traveling at more than 60 m/s. Histological analysis of these arteries showed that the width of the perforation is limited to the diameter of the micronozzle, and the penetration depth of the jet is controlled by the discharge energy. The pulsed liquid microjet offers a promising technique for precise and needle-free intravascular delivery of thrombolytic drugs for localized treatment of retinal vascular occlusions.

  18. Display Considerations For Intravascular Ultrasonic Imaging

    NASA Astrophysics Data System (ADS)

    Gessert, James M.; Krinke, Charlie; Mallery, John A.; Zalesky, Paul J.

    1989-08-01

    A display has been developed for intravascular ultrasonic imaging. Design of this display has a primary goal of providing guidance information for therapeutic interventions such as balloons, lasers, and atherectomy devices. Design considerations include catheter configuration, anatomy, acoustic properties of normal and diseased tissue, catheterization laboratory and operating room environment, acoustic and electrical safety, acoustic data sampling issues, and logistical support such as image measurement, storage and retrieval. Intravascular imaging is in an early stage of development so design flexibility and expandability are very important. The display which has been developed is capable of acquisition and display of grey scale images at rates varying from static B-scans to 30 frames per second. It stores images in a 640 X 480 X 8 bit format and is capable of black and white as well as color display in multiplevideo formats. The design is based on the industry standard PC-AT architecture and consists of two AT style circuit cards, one for high speed sampling and the other for scan conversion, graphics and video generation.

  19. Acute viral hepatitis E presenting with haemolytic anaemia and acute renal failure in a patient with glucose-6-phosphate dehydrogenase deficiency.

    PubMed

    Tomar, Laxmikant Ramkumarsingh; Aggarwal, Amitesh; Jain, Piyush; Rajpal, Surender; Agarwal, Mukul P

    2015-10-01

    The association of acute hepatitis E viral (HEV) infection with glucose-6-phosphate dehydrogenase (G6PD) deficiency leading to extensive intravascular haemolysis is a very rare clinical entity. Here we discuss such a patient, who presented with acute HEV illness, developed severe intravascular haemolysis and unusually high levels of bilirubin, complicated by acute renal failure (ARF), and was later on found to have a deficiency of G6PD. The patient recovered completely with haemodialysis and supportive management.

  20. Acute fatty liver of pregnancy associated with fetal mitochondrial trifunctional protein deficiency.

    PubMed

    Kobayashi, Tomoko; Minami, Sawako; Mitani, Ayuki; Tanizaki, Yuko; Booka, Mina; Okutani, Takahiro; Yamaguchi, Seiji; Ino, Kazuhiko

    2015-05-01

    Acute fatty liver of pregnancy (AFLP) is a devastating disorder of the maternal liver in the third trimester. Recent studies have demonstrated an association between AFLP and fetal fatty acid oxidation disorders. Here, we report a case of AFLP caused by fetal mitochondrial trifunctional protein (TFP) deficiency. A 21-year-old parous woman presented with nausea, genital bleeding and abdominal pain at 33 weeks of gestation. Laboratory data revealed hepatic failure and disseminated intravascular coagulopathy. The patient underwent emergency cesarean section and was diagnosed with AFLP from the clinical characteristics. She was successfully treated with frequent plasma exchange. The newborn presented severe heart failure and died on the 39th day after birth. Tandem mass spectrometry indicated long-chain fatty acid oxidation disorder. Gene analysis demonstrated homozygous mutation in exon 13 of HADHB, the gene responsible for mitochondrial TFP deficiency. The parents carried a heterozygous mutation at the same location in HADHB.

  1. Bilateral femoral neuropathy associated with disseminated intravascular coagulopathy: a case report.

    PubMed

    Cheok, C Y; Merican, A; Ng, W M

    2006-02-01

    We report a case of 20-year-old man who presented with bilateral femoral nerve palsy following resuscitation for traumatic massive blood loss and its consequence. A high suspicious index for this complication may lead to its early recognition. Its related pathoanatomy is discussed based on the described evidences in the literature. Nonoperative treatment remains as a recommended option for coagulopathy-related neuropathy.

  2. Disseminated intravascular coagulation in catastrophic antiphospholipid syndrome: clinical and haematological characteristics of 23 patients

    PubMed Central

    Asherson, R; Espinosa, G; Cervera, R; Gomez-Puerta, J; Musuruana, J; Bucciarelli, S; Ramos-Casals, M; Martinez-Gonzalez, A; Ingelmo, M; Reverter, J; Font, J; Triplett, D; t for

    2005-01-01

    Objective: To analyse the clinical and laboratory characteristics of catastrophic APS patients with DIC features. Methods: The web site based international registry of patients with catastrophic APS (CAPS registry) (http://www.med.ub.es/MIMMUN/FORUM/CAPS.HTM) was analysed and the cases with DIC features selected. Results: In 173 patients with catastrophic APS, 23 (13%) were found with DIC features. The clinical and immunological characteristics were similar in catastrophic APS patients with and without DIC features; a significant difference was found only in the prevalence of thrombocytopenia (100% in patients with DIC features v 59% in those without DIC features). Conclusions: DIC features are not rare in catastrophic APS, supporting the need for systematic screening of antiphospholipid antibodies in all patients with DIC features without precipitating factors. The presence of DIC features in the context of an APS makes it imperative to rule out the catastrophic variant of this syndrome. PMID:15897312

  3. Intravascular disorders of microcirculation in patients with chronic obstructive pulmonary disease: the results of clinical and morphological examination

    NASA Astrophysics Data System (ADS)

    Fiodorova, Tatiana A.

    1999-05-01

    We have evaluated the results of clinical and morphological study of microcirculation and its intravascular factors in 120 patients with chronic obstructive pulmonary diseases (COPD). Conjunctival biomicroscopy with quantitative evaluation of microcirculatory changes we performed. This data were compared with the results of laboratory study of erythrocytes and thrombocytes aggregation, some plasma hemostasis indices and morphological examination of microcirculation. The results of conjunctival biomicroscopy showed the close correlation between the clinical severity of the disease, the degree of respiratory failure and the degree of microcirculatory disorders. Progress of the disease with the development of respiratory failure and cor pulmonale was characterized by the expansion of the process of erythrocytes aggregation to the whole parts of the microcirculatory bad and was associated with perivascular hemorrhages. In some patients with severe COPD laboratory data showed chronic disseminated intravascular microcoagulation (DVS-syndrome). Intravascular platelets, erythrocytes and mixed aggregates which completely cork the vessels and compressed endothelium were uncovered by electron microscopy. Platelets membrane injuring with its degranulation was seen. This discovered correlation between microcirculatory abnormalities in lungs and in conjunctiva in patients with COPD demonstrate that this abnormalities of microcirculation are prevalent. This allows to use in clinical accessible and informative method of conjunctival biomicroscopy to estimate the condition of microcirculation in this pathology.

  4. Pulmonary intravascular talcosis mimicking miliary tuberculosis in an intravenous drug addict

    PubMed Central

    Altraja, Alan; Jürgenson, Katre; Roosipuu, Retlav; Laisaar, Tanel

    2014-01-01

    Pulmonary foreign body granulomatosis following intravenous administration of medications meant for oral use among drug addicts has been occasionally reported. This condition is often misdiagnosed because of its rarity, but rather due to its similarity to other pulmonary diseases that are more common. Here we report a case of pulmonary intravascular talcosis mimicking miliary tuberculosis in a young male intravenous drug addict from North-Eastern Estonia, known as a hotspot for tuberculosis and drug misuse. The condition was caused by intravenous administration of crushed tablets of diphenhydramine, but miliary tuberculosis was misdiagnosed on patient's demographical, clinical and radiological grounds and a decision to start treatment with four first-line antituberculosis drugs followed. The current report refers to the importance of considering rare causes of pulmonary disseminations with attempts to identify the causative agent and warns against the use of antituberculosis treatment without confirmation of microbiological diagnosis of tuberculosis. PMID:24713715

  5. Pulmonary intravascular talcosis mimicking miliary tuberculosis in an intravenous drug addict.

    PubMed

    Altraja, Alan; Jürgenson, Katre; Roosipuu, Retlav; Laisaar, Tanel

    2014-04-08

    Pulmonary foreign body granulomatosis following intravenous administration of medications meant for oral use among drug addicts has been occasionally reported. This condition is often misdiagnosed because of its rarity, but rather due to its similarity to other pulmonary diseases that are more common. Here we report a case of pulmonary intravascular talcosis mimicking miliary tuberculosis in a young male intravenous drug addict from North-Eastern Estonia, known as a hotspot for tuberculosis and drug misuse. The condition was caused by intravenous administration of crushed tablets of diphenhydramine, but miliary tuberculosis was misdiagnosed on patient's demographical, clinical and radiological grounds and a decision to start treatment with four first-line antituberculosis drugs followed. The current report refers to the importance of considering rare causes of pulmonary disseminations with attempts to identify the causative agent and warns against the use of antituberculosis treatment without confirmation of microbiological diagnosis of tuberculosis.

  6. Intravascular ultrasound for angiographically indeterminant left main coronary artery disease.

    PubMed

    Parashara, D K; Jacobs, L E; Ledley, G S; Yazdanfar, S; Oline, J; Kotler, M N

    1994-01-01

    The precise diagnosis of the presence of significant left main coronary artery disease has profound prognostic and therapeutic implications. Coronary cineangiography has shown to be imprecise and inaccurate to determine the percent stenosis of the left main coronary artery. We report a case with significant left main coronary artery disease in whom coronary cineangiography was in discordance with the clinical data and intravascular ultrasonography. Based on the intravascular ultrasound findings, the patient underwent coronary artery bypass graft surgery. Therefore, the intravascular ultrasonography may be the procedure of choice for assessing indeterminant left main coronary artery lesions by coronary angiography.

  7. Comparison of acute and long-term results and underlying mechanisms from sirolimus-eluting stent implantation for the treatment of in-stent restenosis and recurrent in-stent restenosis in patients in whom intracoronary radiation failed as assessed by intravascular ultrasound.

    PubMed

    Schiele, Thomas M; Rieber, Johannes; König, Andreas; Leibig, Marcus; Erhard, Isabelle; Theisen, Karl; Siebert, Uwe; Klauss, Volker

    2004-10-01

    In-stent restenosis (ISR), especially after vascular brachytherapy, is a therapeutic challenge. Sirolimus-eluting stent implantation is a promising new option for the treatment of patients with ISR. The efficacy of sirolimus-eluting stent implantation for the treatment of patients with their first episodes of ISR and with recurrent ISR due to the failure of vascular brachytherapy was compared using intravascular ultrasound imaging.

  8. Disseminated cutaneous sporotrichosis.

    PubMed

    Chang, Shurong; Hersh, Andrew M; Naughton, Greg; Mullins, Kevin; Fung, Maxwell A; Sharon, Victoria R

    2013-11-15

    The dimorphic fungus Sporothrix schenckii commonly causes localized cutaneous disease with lymphocutaneous distribution. However, disseminated sporotrichosis occurs predominantly in immunocompromised patients. We report a case of disseminated cutaneous sporotrichosis in a patient with newly diagnosed HIV with a CD4 count of 208. The patient presented with multiple cutaneous and subcutaneous nodules as well as fever and malaise. Tissue culture and skin biopsy confirmed the diagnosis of sporotrichosis. He was started on itraconazole 200mg twice a day with rapid resolution of fever along with cessation of the development of new lesions.

  9. Disseminated Balamuthia mandrillaris Infection

    PubMed Central

    Shah, Neil; Almira-Suarez, M. I.; Reese, Jennifer M.; Hoke, George M.; Mandell, James W.; Roy, Sharon L.; Visvesvara, Govinda

    2015-01-01

    Balamuthia mandrillaris is a rare cause of human infection, but when infections do occur, they result in high rates of morbidity and mortality. A case of disseminated Balamuthia infection is presented. Early diagnosis and initiation of recommended therapy are essential for increased chances of successful outcomes. PMID:26135864

  10. Improved dosimetry techniques for intravascular brachytherapy

    NASA Astrophysics Data System (ADS)

    Sehgal, Varun

    Coronary artery disease leads to the accumulation of atheromatous plaque leading to coronary stenosis. Coronary intervention techniques such as balloon angioplasty and atherectomy are used to address coronary stenosis and establish a stable lumen thus enhancing blood flow to the myocardium. Restenosis or re-blockage of the arteries is a major limitation of the above mentioned interventional techniques. Neointimal hyperplasia or proliferation of cells in response to the vascular injury as a result of coronary intervention is considered to be one of the major causes of restenosis. Recent studies indicated that irradiation of the coronary lesion site, with radiation doses ranging from 15 to 30 Gy, leads to diminishing neointimal hyperplasia with subsequent reduction in restenosis. The radiation dose is given by catheter-based radiation delivery systems using beta-emitters 90Sr/90Y, 32P and gamma-emitting 192Ir among others. However the dose schema used for dose prescription for these sources are relatively simplistic, and are based on calculations using uniform homogenous water or tissue media and simple cylinder geometry. Stenotic coronary vessels are invariably lined with atheromatous plaque of heterogeneous composition, the radiation dose distribution obtained from such dosimetry data can cause significant variations in the actual dose received by a given patient. Such discrepancies in dose calculation can introduce relatively large uncertainties in the limits of dose window for effective and safe application of intravascular brachytherapy, and consequently in the clinical evaluation of the efficacy of this modality. In this research study we investigated the effect of different geometrical and material heterogeneities, including residual plaque, catheter non-centering, lesion eccentricity and cardiac motion on the radiation dose delivered at the lesion site. Correction factors including dose perturbation factors and dose variation factors have been calculated

  11. Elastase mediated fibrinolysis in acute promyelocytic leukemia.

    PubMed

    Oudijk, E J; Nieuwenhuis, H K; Bos, R; Fijnheer, R

    2000-06-01

    The bleeding syndrome of acute promyelocytic leukemia (APL) is complex and consists of disseminated intravascular coagulation (DIC) and hyperfibrinolysis. Elastase, derived from malignant promyelocytes, is believed to mediate the fibrinogeno- and fibrinolysis by aspecific proteolysis. In this study we measured the role of elastase in fifteen patients with APL by using an assay for elastase degraded fibrin(ogen) and the results were compared with those obtained in patients with sepsis induced DIC. High levels of elastase were observed in sepsis and APL. The levels of fibrinogen and fibrin degradation products were significantly higher in APL patients compared to patients with sepsis induced DIC. Nevertheless, the level of elastase degraded fibrin(ogen) was higher in the sepsis group (635.3 ng/ml, compared to 144.3 ng/ml in APL; p <0.0001). So, the enormous increase in fibrin and fibrinogen degradation products in APL cannot be explained by elastase activity. This study suggests a minor role for elastase mediated proteolysis in the hemorrhagic diathesis in APL patients.

  12. Post-partum acute kidney injury.

    PubMed

    Pahwa, Naresh; Bharani, Rajesh; Kumar, Ravindra

    2014-11-01

    To determine the risk factors, course of hospital stay and mortality rate among women with post-partum acute kidney injury (AKI), we studied (of 752 patients with AKI admitted to a tertiary care center during the study period between November 2009 and August 2012) 27 (3.59%) women with post-partum AKI. The data regarding age, parity, cause of renal failure, course of hospital stay and requirement of dialysis were recorded. Sepsis was the major cause (70.3%) of post-partum AKI. Other causes included disseminated intravascular coagulation (55.5%), pre-eclampsia/eclampsia (40.7%), ante- and post-partum hemorrhage (40.7% and 22.2%) and hemolytic anemia and elevated liver enzymes and low platelet count syndrome (29.6%); most patients had more than one cause of AKI. We found a very high prevalence (18.5%) of cortical necrosis in our study patients. A significant correlation was also found between the creatinine level on admission and the period of onset of disease after delivery. In conclusion, several factors are involved in causing post-partum AKI in our population, and sepsis was the most common of them.

  13. Toward a Continuous Intravascular Glucose Monitoring System

    PubMed Central

    Beier, Brooke; Musick, Katherine; Matsumoto, Akira; Panitch, Alyssa; Nauman, Eric; Irazoqui, Pedro

    2011-01-01

    Proof-of-concept studies that display the potential of using a glucose-sensitive hydrogel as a continuous glucose sensor are presented. The swelling ratio, porosity, and diffusivity of the hydrogel increased with glucose concentration. In glucose solutions of 50, 100, 200, and 300 mg/dL, the hydrogel swelling ratios were 4.9, 12.3, 15.9, and 21.7, respectively, and the swelling was reversible. The impedance across the hydrogel depended solely on the thickness and had an average increase of 47 Ω/mm. The hydrogels exposed to a hyperglycemic solution were more porous than the hydrogels exposed to a normal glycemic solution. The diffusivity of 390 Da MW fluorescein isothiocyanate in hydrogels exposed to normal and hyperglycemic solutions was examined using fluorescence recovery after photobleaching and was found to be 9.3 × 10−14 and 41.4 × 10−14 m2/s, respectively, compared to 6.2 × 10−10 m2/s in glucose solution. There was no significant difference between the permeability of hydrogels in normal and hyperglycemic glucose solutions with averages being 5.26 × 10−17 m2 and 5.80 × 10−17 m2, respectively, which resembles 2–4% agarose gels. A prototype design is presented for continuous intravascular glucose monitoring by attaching a glucose sensor to an FDA-approved stent. PMID:22344366

  14. Heterogeneous Intravascular Ultrasound Findings of Stent Thrombosis

    PubMed Central

    Morofuji, Toru; Inaba, Shinji; Aisu, Hiroe; Takahashi, Kayo; Saito, Makoto; Higashi, Haruhiko; Yoshii, Toyofumi; Sumimoto, Takumi

    2017-01-01

    Objective The underlying mechanisms of stent thrombosis are not completely understood. Methods We experienced 12 definite stent thrombosis cases (1 early, 1 late, and 10 very late) at our hospital from July 2011 to April 2016 and evaluated the possible causes of stent thrombosis by intravascular ultrasound (IVUS). Results Five different potential morphological causes of stent thrombosis (neoatherosclerosis, stent malapposition, stent fracture, edge dissection, and stent underexpansion) were detected by IVUS in 10 cases (83.3%); in 1 of the remaining 2 cases, the discontinuation of antithrombotic drugs resulted in early stent thrombosis without abnormal IVUS findings. Of the 12 stent thrombosis cases, 4 occurred at a bare-metal stent (average time from stent implantation, 106 months); in all 12, significant neointimal hyperplasia was observed on IVUS, and 2 had plaque ruptures at an in-stent or proximal reference. Malapposed stent struts were observed in three very-late stent thromboses, and all of these underwent sirolimus-eluting stent implantation. Stent thrombosis due to mechanical (stent fracture) or procedure-related complications (edge dissection and stent underexpansion) was observed in three cases. Conclusion In patients with stent thrombosis, heterogeneous findings were observed in IVUS. This IVUS case series illustrates the possible mechanisms of stent thrombosis. PMID:28154268

  15. Immunological characterization of pulmonary intravascular macrophages

    NASA Technical Reports Server (NTRS)

    Chitko-McKown, C. G.; Reddy, D. N.; Chapes, S. K.; McKown, R. D.; Blecha, F.; Spooner, B. S. (Principal Investigator)

    1992-01-01

    Pulmonary intravascular macrophages (PIMs) are lung macrophages found apposed to the endothelium of pulmonary capillaries. In many species, they are responsible for the clearance of blood-borne particulates and pathogens; however, little else is known about their roles as immunologic effector cells. We compared PIMs with pulmonary alveolar macrophages (PAMs) to determine the relative immunological activities of these two cell populations. Our results suggested that both populations possess similar phagocytic and bactericidal activities. In assays measuring cytotoxicity, PIMs were more cytotoxic than PAMs against virally infected target cells; however, differences between these macrophage populations were not as marked when noninfected targets were used. LPS-stimulated PIMs produced more T-cell proliferative cytokines than PAMs, and both populations of nonstimulated macrophages produced similar amounts of the cytokines. In contrast, PAMs produced more TNF alpha and NO2- than PIMs when both populations were stimulated with LPS; however, nonstimulated PAMs and PIMs produced similar amounts of TNF alpha and NO2. These data suggest that bovine PIMs are immunologically active. Differences between the degrees of activity of PIMs and PAMs indicate that these macrophage populations may have different roles in lung surveillance.

  16. Case report: Rapid improvement of crossed cerebellar diaschisis after intravascular laser irradiation of blood in a case of stroke

    PubMed Central

    Yang, Wan-Hua; Lin, Shiou-Ping; Chang, Shin-Tsu

    2017-01-01

    Abstract Rationale: Crossed cerebellar diaschisis (CCD) is a poor prognostic factor after stroke because without immediate cerebral reperfusion no further improvements in the patient's condition can be achieved. We investigated the clinical effects of intravascular laser irradiation therapy (ILIB) on CCD and evaluated the therapeutic effect in the sub-acute post-stroke stage. Patient concerns: The 77-year-old male with cerebral infarction in the territory of the right anterior cerebral artery only underwent conservative treatment including hydration and aspirin in the acute post-stroke stage. Diagnosis: He was diagnosed as stroke based on the clinical presentations and imaging findings. Intervention: Once the patient was in stable condition, he underwent a daily hour-long ILIB (He-Ne laser) for ten consecutive days during the sub-acute post-stroke stage. Outcomes: We used single-photon emission computed tomography (SPECT) before and after intravascular laser irradiation to detect changes in cerebral and cerebellar perfusion. Then, we compared the two images. CCD was detected using the first SPECT. After intervention by ILIB, the second SPECT showed greater perfusion in the affected cerebellar hemisphere. Lessons: We found that ILIB helped eliminate CCD, which was previously shown to be an untreatable condition using any intervention during the sub-acute post-stroke stage. Stroke patients could therefore greatly benefit from ILIB. PMID:28079797

  17. Malarial acute kidney injury in a paediatric intensive care unit.

    PubMed

    Kapoor, Kapil; Gupta, Shalu

    2012-10-01

    Acute kidney injury (AKI) is a serious complication of malaria which has a very high mortality rate. A retrospective analysis of medical record data of children treated for malarial AKI in a paediatric intensive care unit (PICU) was performed in order to evaluate the incidence, poor prognostic factors and outcome of AKI with malaria. Eighteen (48.6%) malarial patients had AKI (11 Plasmodium vivax positive, six P. falciparum positive and one mixed infection) with a male-to-female ratio of 1:2. The mean age was 75 ± 32 months (range, 1 month to 10 years). Oliguria was present in 61.1% and 55.5% required renal replacement therapy. Mortality was noted in 33.3% of patients and full recovery was achieved in 50% of patients. Oliguria, shock, central nervous system involvement, jaundice, disseminated intravascular coagulopathy and acute respiratory distress syndrome emerged as bad prognostic factors in simple univariate analysis. Malaria patients with and without AKI differ significantly in terms of shock, ventilator requirement, mortality and length of PICU stay.

  18. Developing an Effective Dissemination Plan.

    ERIC Educational Resources Information Center

    Southwest Educational Development Laboratory, Austin, TX. National Center for the Dissemination of Disability Research.

    This booklet offers guidelines for the development of dissemination strategies, especially those concerned with research and programs. Individual sections address: the importance of including sound dissemination plans in grant proposals, factors found to be closely related to information utilization in the dissemination process, a philosophical…

  19. Imminent Cardiac Risk Assessment via Optical Intravascular Biochemical Analysis

    SciTech Connect

    Wetzel, D.; Wetzel, L; Wetzel, M; Lodder, R

    2009-01-01

    Heart disease is by far the biggest killer in the United States, and type II diabetes, which affects 8% of the U.S. population, is on the rise. In many cases, the acute coronary syndrome and/or sudden cardiac death occurs without warning. Atherosclerosis has known behavioral, genetic and dietary risk factors. However, our laboratory studies with animal models and human post-mortem tissue using FT-IR microspectroscopy reveal the chemical microstructure within arteries and in the arterial walls themselves. These include spectra obtained from the aortas of ApoE-/- knockout mice on sucrose and normal diets showing lipid deposition in the former case. Also pre-aneurysm chemical images of knockout mouse aorta walls, and spectra of plaque excised from a living human patient are shown for comparison. In keeping with the theme of the SPEC 2008 conference Spectroscopic Diagnosis of Disease this paper describes the background and potential value of a new catheter-based system to provide in vivo biochemical analysis of plaque in human coronary arteries. We report the following: (1) results of FT-IR microspectroscopy on animal models of vascular disease to illustrate the localized chemical distinctions between pathological and normal tissue, (2) current diagnostic techniques used for risk assessment of patients with potential unstable coronary syndromes, and (3) the advantages and limitations of each of these techniques illustrated with patent care histories, related in the first person, by the physician coauthors. Note that the physician comments clarify the contribution of each diagnostic technique to imminent cardiac risk assessment in a clinical setting, leading to the appreciation of what localized intravascular chemical analysis can contribute as an add-on diagnostic tool. The quality of medical imaging has improved dramatically since the turn of the century. Among clinical non-invasive diagnostic tools, laboratory tests of body fluids, EKG, and physical examination are

  20. Extramedullary relapse in lumbar spine of patient with acute promyelocytic leukemia after remission for 16 years: a case report and literature review

    PubMed Central

    He, Zhengmei; Tao, Shandong; Deng, Yuan; Chen, Yue; Song, Lixiao; Ding, Banghe; Chen, Kankan; Yu, Liang; Wang, Chunling

    2015-01-01

    Acute promyelocytic leukemia (APL) is a common myeloid leukemia. At the newly diagnosed stage, it can be fatal because of the serious complication-disseminated intravascular coagulation. With the advent and early application of all-trans retinoic acid, most APL patients can achieve a long-term survival, and only a minority of patients will develop extramedullary relapse after remission. The most common site of extramedullary relapse is central nervous system, while other sites are relatively rare. Here, we report a particularly rare APL patient who experienced extramedullary relapse with lumbar spine as the isolated site after a rather long time of remission for 16 years. At the time of relapse, the main clinical manifestations of the patient are obvious low back pain, weakness in lower limbs and limitation of activity. After treatment of local radiotherapy combined with ATRA and arsenic trioxide, the patient achieved and maintained a second complete remission by now. PMID:26885224

  1. A Review of Intravascular Ultrasound–Based Multimodal Intravascular Imaging: The Synergistic Approach to Characterizing Vulnerable Plaques

    PubMed Central

    Ma, Teng; Zhou, Bill; Hsiai, Tzung K.; Shung, K. Kirk

    2015-01-01

    Catheter-based intravascular imaging modalities are being developed to visualize pathologies in coronary arteries, such as high-risk vulnerable atherosclerotic plaques known as thin-cap fibroatheroma, to guide therapeutic strategy at preventing heart attacks. Mounting evidences have shown three distinctive histopathological features—the presence of a thin fibrous cap, a lipid-rich necrotic core, and numerous infiltrating macrophages—are key markers of increased vulnerability in atherosclerotic plaques. To visualize these changes, the majority of catheter-based imaging modalities used intravascular ultrasound (IVUS) as the technical foundation and integrated emerging intravascular imaging techniques to enhance the characterization of vulnerable plaques. However, no current imaging technology is the unequivocal “gold standard” for the diagnosis of vulnerable atherosclerotic plaques. Each intravascular imaging technology possesses its own unique features that yield valuable information although encumbered by inherent limitations not seen in other modalities. In this context, the aim of this review is to discuss current scientific innovations, technical challenges, and prospective strategies in the development of IVUS-based multi-modality intravascular imaging systems aimed at assessing atherosclerotic plaque vulnerability. PMID:26400676

  2. 21 CFR 880.5965 - Subcutaneous, implanted, intravascular infusion port and catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Subcutaneous, implanted, intravascular infusion... Hospital and Personal Use Therapeutic Devices § 880.5965 Subcutaneous, implanted, intravascular infusion port and catheter. (a) Identification. A subcutaneous, implanted, intravascular infusion port...

  3. 21 CFR 880.5970 - Percutaneous, implanted, long-term intravascular catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Percutaneous, implanted, long-term intravascular... and Personal Use Therapeutic Devices § 880.5970 Percutaneous, implanted, long-term intravascular catheter. (a) Identification. A percutaneous, implanted, long-term intravascular catheter is a device...

  4. 21 CFR 880.5965 - Subcutaneous, implanted, intravascular infusion port and catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Subcutaneous, implanted, intravascular infusion... Hospital and Personal Use Therapeutic Devices § 880.5965 Subcutaneous, implanted, intravascular infusion port and catheter. (a) Identification. A subcutaneous, implanted, intravascular infusion port...

  5. 21 CFR 880.5965 - Subcutaneous, implanted, intravascular infusion port and catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Subcutaneous, implanted, intravascular infusion... Hospital and Personal Use Therapeutic Devices § 880.5965 Subcutaneous, implanted, intravascular infusion port and catheter. (a) Identification. A subcutaneous, implanted, intravascular infusion port...

  6. [Fulminant visceral disseminated varicella-zoster virus infection without skin involvement in a patient with autoimmune hemolytic anemia on prednisolone therapy].

    PubMed

    Akiyama, Megumi; Yoshifuji, Kota; Fukuda, Tetsuya; Tohda, Shuji; Miki, Tohru; Miura, Osamu; Yamamoto, Masahide

    2016-04-01

    An 80-year-old man with autoimmune hemolytic anemia (AIHA) received immunosuppressive therapy with prednisolone (1 mg/kg). One month later, his hemoglobin level had normalized, and the prednisolone dose was tapered. The next day, he complained of acute and progressive back pain. He was admitted to our hospital for further examination approximately 24 h after the pain had started. Computed tomography revealed only localized pneumonia. However, he showed signs of severe disseminated intravascular coagulation (DIC), liver dysfunction, and respiratory failure. Empiric broad-spectrum antibacterial therapy was started with a presumptive diagnosis of severe bacterial infection. However, his condition rapidly deteriorated, and he died 17 h after admission. Varicella-zoster virus (VZV) was detected by quantitative PCR in the peripheral blood sample and by immunohistochemistry in all organs except for the brain at autopsy. Visceral VZV infection is a severe disease with a high mortality rate. Although appropriate diagnosis and treatment is crucial, in cases without the characteristic skin rash the diagnosis is difficult. The possibility of visceral VZV infection should be taken into consideration when administering prednisolone to patients with AIHA.

  7. Incidental Intravascular Lipoleiomyomatosis in A Hysterectomy Specimen: How To Manage?

    PubMed Central

    Aslanova, Rakhshanda; Can, Nuray; Okten, Sabri Berkem; Aslan, Mehmet Musa

    2015-01-01

    Leiomyomas are common benign tumors in female gynaecologic surgery. They are originated from smooth muscle cells of the uterus and/or sometimes of the uterine vessels. Intravascular lipoleiomyomatosis is a very rare form of leiomyomas which grow within veins and can extend up to vena cava inferior and right heart chamber with cardiac symptoms and is diagnosed by cardiovascular surgeons. We report a case of incidental intravascular lipoleiomyomatosis which was confined to the uterus being diagnosed after a total abdominal hysterectomy by pathology and its management strategy. PMID:25738043

  8. [Thrombotic microangiopathy and intravascular hemolysis in pregnancy-induced hypertension. The lie of HELLP syndrome].

    PubMed

    Díaz de León-Ponce, Manuel Antonio; Briones-Garduño, Jesús Carlos; Meneses-Calderón, José; Moreno-Santillán, Armando Alberto

    2006-01-01

    We reviewed the literature regarding pregnancy-induced hypertension and its relation with thrombotic microangiopathy and intravascular hemolysis (TMIH). In the present work we described the background, frequency, mortality, clinical picture, classification, diagnosis, complications and treatment. In addition, we analyzed Weinstein's report of 1982, and we concluded that the reported data of the HELLP syndrome is not conclusive because the presence of TMIH is not demonstrable in his group of patients. Also, we retrospectively reviewed the medical charts from three Intensive Care Units from two specialized gyneco-obstetrics hospitals and from one General Hospital. From all the patients with pregnancy-induced hypertension and who developed TMIH confirmed clinically and by laboratory findings, we described the incidence of acute renal failure and the mortality in this group of patients.

  9. Delusions of Disseminated Fungosis

    PubMed Central

    Griffin, Paul Matthew

    2014-01-01

    Introduction. Delusional infestation is a rare monosymptomatic hypochondriacal psychosis according to The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). It can be a primary disorder or associated with an underlying psychological or physical disorder. It commonly presents as delusional parasitosis, and less than 1% may be fungi related. We present this case as it is a rare presentation of a rare condition. Case Presentation. Our patient is a 60-year-old Caucasian man who presented with a 7-year history of delusional infestation manifested as a disseminated fungal infection. He had previously been reviewed by multiple physicians for the same with no systemic illness diagnosed. After multiple reviews and thorough investigation we diagnosed him with a likely delusional disorder. As is common with this patient cohort he refused psychiatric review or antipsychotic medication. Conclusion. A delusion of a disseminated fungal infestation is a rare condition. It is exceedingly difficult to treat as these patients often refuse to believe the investigation results and diagnosis. Furthermore, they either refuse or are noncompliant with treatment. Multidisciplinary outpatient evaluation may be the best way to allay patient fears and improve treatment compliance. PMID:25610675

  10. 21 CFR 870.3375 - Cardiovascular intravascular filter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiovascular intravascular filter. 870.3375 Section 870.3375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices §...

  11. 21 CFR 870.3375 - Cardiovascular intravascular filter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Cardiovascular intravascular filter. 870.3375 Section 870.3375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices §...

  12. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  13. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  14. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  15. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  16. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Intravascular occluding catheter. 882.5150 Section 882.5150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5150...

  17. 21 CFR 880.5210 - Intravascular catheter securement device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Intravascular catheter securement device. 880.5210 Section 880.5210 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal...

  18. 21 CFR 880.5210 - Intravascular catheter securement device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Intravascular catheter securement device. 880.5210 Section 880.5210 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal...

  19. 21 CFR 870.3375 - Cardiovascular intravascular filter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Cardiovascular intravascular filter. 870.3375 Section 870.3375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... side of the heart and the pulmonary circulation. (b) Classification. Class II. The special controls...

  20. 21 CFR 870.3375 - Cardiovascular intravascular filter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Cardiovascular intravascular filter. 870.3375 Section 870.3375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... side of the heart and the pulmonary circulation. (b) Classification. Class II. The special controls...

  1. 21 CFR 870.3375 - Cardiovascular intravascular filter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Cardiovascular intravascular filter. 870.3375 Section 870.3375 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... side of the heart and the pulmonary circulation. (b) Classification. Class II. The special controls...

  2. A Prognostic Dilemma of Basal Cell Carcinoma with Intravascular Invasion

    PubMed Central

    Niumsawatt, Vachara; Castley, Andrew

    2016-01-01

    Summary: Basal cell carcinoma is the most common malignancy; however, it very rarely metastasizes. Despite the low mortality caused by this cancer, once it spreads, it has dim prognosis. We report a case of basal cell carcinoma with rare intravascular invasion and review the literature for risk factors and management of metastasis. PMID:27757356

  3. Pathogenesis of infections related to intravascular catheterization.

    PubMed Central

    Goldmann, D A; Pier, G B

    1993-01-01

    Over the past few decades, there have been major technological improvements in the manufacture of intravenous solutions and the manufacture and design of catheter materials. However, the risk of infection in patients receiving infusion therapy remains substantial, in part because of host factors (for example, increased use of immunosuppressive therapy, more aggressive surgery and life support, and improved survival at the extremes of life) and in part because of the availability of catheters that can be left in place for very long periods. Microbial components of normal skin flora, particularly coagulase-negative staphylococci, have emerged as the predominant pathogens in catheter-associated infections. Therefore, efforts to prevent skin microorganisms from entering the catheter wound (such as tunnelling of catheters and use of catheter cuffs and local antimicrobial agents) are logical and relatively effective. The specific properties of microorganisms that transform normally harmless commensals such as coagulase-negative staphylococci into formidable pathogens in the presence of a plastic foreign body are being explored. For example, Staphylococcus epidermidis elaborates a polysaccharide adhesin that also functions as a capsule and is a target for opsonic killing. However, the interactions between microorganism and catheter that lead to adherence, persistence, infection, and dissemination appear to be multifactorial. Images PMID:8472248

  4. Selected Dissemination/Diffusion Strategies.

    ERIC Educational Resources Information Center

    Schmitt, Marshall L.

    This analysis of selected diffusion and dissemination methods used by developer-demonstrator projects in the National Diffusion Network discusses strategies under the following headings: managing the project, developing materials, disseminating information, conducting awareness sessions, training personnel, using certified trainers, providing…

  5. Lingual ulceration in disseminated histoplasmosis.

    PubMed

    Guttal, Kruthika S; Naikmasur, Venkatesh G; Bathi, Renuka J; Rao, Ravikala

    2010-03-01

    Histoplasmosis is a rare systemic fungal infection commonly presenting as mucosal ulceration of the oral cavity. It has been increasingly reported in India as disseminated disease with lesions in the oral cavity as a consequence of rapid spread of HIV infection. The authors report a case of disseminated histoplasmosis with oral manifestation in a 40-year-old male patient.

  6. Image dissemination and archiving.

    PubMed

    Robertson, Ian

    2007-08-01

    Images generated as part of the sonographic examination are an integral part of the medical record and must be retained according to local regulations. The standard medical image format, known as DICOM (Digital Imaging and COmmunications in Medicine) makes it possible for images from many different imaging modalities, including ultrasound, to be distributed via a standard internet network to distant viewing workstations and a central archive in an almost seamless fashion. The DICOM standard is a truly universal standard for the dissemination of medical images. When purchasing an ultrasound unit, the consumer should research the unit's capacity to generate images in a DICOM format, especially if one wishes interconnectivity with viewing workstations and an image archive that stores other medical images. PACS, an acronym for Picture Archive and Communication System refers to the infrastructure that links modalities, workstations, the image archive, and the medical record information system into an integrated system, allowing for efficient electronic distribution and storage of medical images and access to medical record data.

  7. D Dimer in acute care

    PubMed Central

    Sathe, Prachee M.; Patwa, Urvil D.

    2014-01-01

    Pulmonary embolism, Deep Vein Thrombosis (DVT) and Disseminated intravascular coagulation (DIC) are important sources of mortality and morbidity in intensive care unit (ICU). And every time D-dimer remains the the commonest investigation. Many times D-dimer is erroneously considered as a diagnostic test in above mentioned conditions. Its interpretation requires cautions. To circumvent this source of error it is necessary to understand D-dimer test and its significance in various disorder. This article review some basic details of D-dimer, condition associated with its increased level and some prognostic value in intracranial hemorrhage and gastrointestinal (GI) bleed. PMID:25337485

  8. Intravascular near-infrared fluorescence molecular imaging of atherosclerosis

    PubMed Central

    Thukkani, Arun K; Jaffer, Farouc A

    2013-01-01

    Novel imaging modalities are required to better identify vulnerable atherosclerotic plaques before their dire consequences of myocardial infarction, sudden death, and stroke. Moving beyond traditional diagnostic methods, the field of molecular imaging offers an innovative approach to report upon critical in vivo biological features of high-risk plaques. Molecular imaging employs engineered, targeted imaging agents in conjunction with sophisticated, high-resolution detection systems. While various modalities have been investigated for this purpose, intravascular near infrared fluorescence imaging (NIRF) strategies are uniquely poised to provide high-resolution readouts of human coronary artery plaques. To date, preclinical animal studies have demonstrated feasibility of both standalone NIRF intravascular imaging as well as dual-modality approaches detecting inflammation and fibrin deposition in coronary-sized arteries. This translatable catheter-based approach is positioned to advance the identification of biologically vulnerable coronary plaques and coronary stents at risk of thrombosis. PMID:23638334

  9. Integrated intravascular optical coherence tomography ultrasound imaging system.

    PubMed

    Yin, Jiechen; Yang, Hao-Chung; Li, Xiang; Zhang, Jun; Zhou, Qifa; Hu, Changhong; Shung, K Kirk; Chen, Zhongping

    2010-01-01

    We report on a dual-modality optical coherence tomography (OCT) ultrasound (US) system for intravascular imaging. To the best of our knowledge, we have developed the first integrated OCT-US probe that combines OCT optical components with an US transducer. The OCT optical components mainly consist of a single-mode fiber, a gradient index lens for light-beam focusing, and a right-angled prism for reflecting light into biological tissue. A 40-MHz piezoelectric transducer (PZT-5H) side-viewing US transducer was fabricated to obtain the US image. These components were integrated into a single probe, enabling both OCT and US imaging at the same time. In vitro OCT and ultrasound images of a rabbit aorta were obtained using this dual-modality imaging system. This study demonstrates the feasibility of an OCT-US system for intravascular imaging, which is expected to have a prominent impact on early detection and characterization of atherosclerosis.

  10. Characterization of coronary atherosclerosis by intravascular imaging modalities

    PubMed Central

    Honda, Satoshi; Kanaya, Tomoaki; Noguchi, Teruo; Ogawa, Hisao; Yasuda, Satoshi

    2016-01-01

    Coronary artery disease (CAD) is highly prevalent in Western countries and is associated with morbidity, mortality, and a significant economic burden. Despite the development of anti-atherosclerotic medical therapies, many patients still continue to suffer from coronary events. This residual risk indicates the need for better risk stratification and additional therapies to achieve more reductions in cardiovascular risk. Recent advances in imaging modalities have contributed to visualizing atherosclerotic plaques and defining lesion characteristics in vivo. This innovation has been applied to refining revascularization procedure, assessment of anti-atherosclerotic drug efficacy and the detection of high-risk plaques. As such, intravascular imaging plays an important role in further improvement of cardiovascular outcomes in patients with CAD. The current article reviews available intravascular imaging modalities with regard to its method, advantage and disadvantage. PMID:27500094

  11. Intravascular magnetic resonance imaging using a loopless catheter antenna.

    PubMed

    Ocali, O; Atalar, E

    1997-01-01

    Recently, intravascular catheter probes have been developed to increase signal-to-noise ratio (SNR) for MR imaging of blood vessels. Miniaturization of these catheter probes without degrading their performances is very critical in imaging small vessels such as coronary arteries. Catheter coils have a loop incorporated in their structure and have limitations in physical dimensions and electromagnetic properties. The use of a loopless intravascular catheter antenna is proposed to overcome these problems. The catheter antenna is essentially a dipole, which makes a very thin diameter possible, and its electronic circuitry can be placed outside the blood vessels without performance degradation. The theoretical foundation for the design and operation of the catheter antenna is presented. Several catheter antennae, as small as 1.5 French, were constructed and tested on phantoms and rabbits with great success. The catheter antenna has a simple structure and is easy to design, implement, and operate.

  12. Integrated intravascular optical coherence tomography ultrasound imaging system

    PubMed Central

    Yin, Jiechen; Yang, Hao-Chung; Li, Xiang; Zhang, Jun; Zhou, Qifa; Hu, Changhong; Shung, K. Kirk; Chen, Zhongping

    2010-01-01

    We report on a dual-modality optical coherence tomography (OCT) ultrasound (US) system for intravascular imaging. To the best of our knowledge, we have developed the first integrated OCT-US probe that combines OCT optical components with an US transducer. The OCT optical components mainly consist of a single-mode fiber, a gradient index lens for light-beam focusing, and a right-angled prism for reflecting light into biological tissue. A 40-MHz piezoelectric transducer (PZT-5H) side-viewing US transducer was fabricated to obtain the US image. These components were integrated into a single probe, enabling both OCT and US imaging at the same time. In vitro OCT and ultrasound images of a rabbit aorta were obtained using this dual-modality imaging system. This study demonstrates the feasibility of an OCT-US system for intravascular imaging, which is expected to have a prominent impact on early detection and characterization of atherosclerosis. PMID:20210424

  13. Look away: arterial and venous intravascular embolisation following shotgun injury.

    PubMed

    Vedelago, John; Dick, Elizabeth; Thomas, Robert; Jones, Brynmor; Kirmi, Olga; Becker, Jennifer; Alavi, Afshin; Gedroyc, Wladyslaw

    2014-01-01

    We describe two cases of intravascular embolization of shotgun pellets found distant to the entry site of penetrating firearm injury. The cases demonstrate antegrade embolization of a shotgun pellet from neck to right middle cerebral artery, and antegrade followed by retrograde venous embolization through the left lower limb to pelvis. Radiologists and Trauma Physicians should be aware that post shotgun injury, the likelihood of an embolised shot pellet is increased compared to other types of firearm missile injury, and should therefore search away from the site of injury to find such missiles. Shotgun pellets may travel in an antegrade or a retrograde intravascular direction - both were seen in these cases - and may not be clinically obvious. This underscores the importance of a meticuluous search through all images, including CT scout images, for evidence of their presence.

  14. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction.

    PubMed

    Roldan, Carlos J; Paniagua, Linda

    2015-09-01

    Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for "Central line malposition" and then for "Central venous catheters intravascular malposition," we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient's body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.

  15. Treatment of Vertebro-Basilar Dissecting Aneurysms Using Intravascular Stents

    PubMed Central

    Yamasaki, S.; Hashimoto, K.; Kawano, Y.; Yoshimura, M.; Yamamoto, T.; Hara, M.

    2006-01-01

    Summary Endovascular surgery is an established primary therapeutic modality for dissecting aneurysms at vertebro-basilar arteries. Intravascular stents can be used to treat the dissecting aneurysms for which simple obliteration procedures cannot be used. In such cases, stent implantation alone or a combination of stents and coils need to be selected properly by taking into consideration the site and shape of dissections. In this report, three patterns of stent application are described and their method of selection is discussed. PMID:20569619

  16. Spider Bite: A Rare Case of Acute Necrotic Arachnidism with Rapid and Fatal Evolution

    PubMed Central

    Giglio, Anna Maria; Scozzafava, Annamaria; Filippelli, Orazio; Serafino, Giuseppe; Verre, Mario

    2016-01-01

    The spider bites are quite frequent and often resolve quickly without leaving outcomes; only some species are capable of causing necrotic and systematic lesions in humans. Among them, we should mention the genus Loxosceles. The venom released from the spider bite of Loxosceles species is composed of proteins, enzymes, and nonenzymatic polypeptides. The phospholipase D family was identified as the active component of the venom. This family of enzymes is responsible for the local and systemic effects observed in loxoscelism. Phospholipases D interact with cell membranes triggering alterations which involve the complement system and activation of neutrophils and they cause the dermonecrotic skin lesions and systemic effects. We describe a fatal case of acute intoxication caused by a spider bite probably belonging to the species Loxosceles. The initial lesion was localized to a finger of a hand. Clinical course was worsening with deep necrotic lesions on limb, shock, hemolysis, acute kidney failure, and disseminated intravascular coagulation. All therapies were ineffective. This is the first fatal case described in Europe. PMID:27651958

  17. Pattern of Brain Injury in the Acute Setting of Human Septic Shock

    PubMed Central

    2013-01-01

    Background Sepsis-associated brain dysfunction has been linked to white matter lesions (leukoencephalopathy) and ischemic stroke. Our objective was to assess the prevalence of brain lesions in septic shock patients requiring magnetic resonance imaging (MRI) for an acute neurologic change. Method Seventy-one septic shock patients were included in a prospective observational study. Patients underwent daily neurological examination. Brain MRI was obtained in patients who developed focal neurological deficit, seizure, coma, or delirium. Electroencephalogy was performed in case of coma, delirium, or seizure. Leukoencephalopathy was graded and considered present when white matter lesions were either confluent or diffuse. Patient outcome was evaluated at 6 months with the Glasgow Outcome Scale (GOS). Results We included 71 patients with median age of 65 years (56 to 76) and SAPS II at admission of 49 (38 to 60). MRI was indicated on focal neurological sign in 13 (18%), seizure in 7 (10%), coma in 33 (46%), and delirium in 35 (49%). MRI was normal in 37 patients (52%) and showed cerebral infarcts in 21 (29%), leukoencephalopathy in 15 (21%), and mixed lesions in 6 (8%). EEG malignant pattern was more frequent in patients with ischemic stroke or leukoencephalopathy. Ischemic stroke was independently associated with disseminated intravascular coagulation (DIC), focal neurologic signs, increased mortality, and worse GOS at 6 months. Conclusions Brain MRI in septic shock patients who developed acute brain dysfunction can reveal leukoencephalopathy and ischemic stroke, which is associated with DIC and increased mortality. PMID:24047502

  18. Vascular wall stress during intravascular optical coherence tomography imaging

    NASA Astrophysics Data System (ADS)

    Sun, Cuiru; Yang, Victor

    2015-03-01

    Biomechanical properties of arterial wall is crucial for understanding the changes in the cardiovascular system. Catheters are used during intravascular optical coherence tomography (IVOCT) imaging. The presence of a catheter alters the flow field, pressure distribution and frictional resistance to flow in an artery. In this paper, we first study the transmural stress distribution of the catheterized vessel. COMSOL (COMSOL 4.4) was used to simulate the blood flow induced deformation in a catheterized vessel. Blood is modeled as an incompressible Newtonian fluid. Stress distribution from an three-layer vascular model with an eccentric catheter are simulated, which provides a general idea about the distribution of the displacement and the stress. Optical coherence elastography techniques were then applied to porcine carotid artery samples to look at the deformation status of the vascular wall during saline or water injection. Preliminary simulation results show nonuniform stress distribution in the circumferential direction of the eccentrically catheterized vascular model. Three strain rate methods were tested for intravascular OCE application. The tissue Doppler method has the potential to be further developed to image the vascular wall biomechnical properties in vivo. Although results in this study are not validated quantitatively, the experiments and methods may be valuable for intravascular OCE studies, which may provide important information for cardiovascular disease prevention, diagnosis and treatment.

  19. Intravascular foreign bodies: danger of unretrieved fragmented medical devices.

    PubMed

    Tateishi, Minori; Tomizawa, Yasuko

    2009-01-01

    A warning on the danger of unretrieved device fragments and recommendations to mitigate the danger were issued by the Food and Drug Administration in January 2008. The causes of intravascular foreign bodies are classified into three main categories: improper manipulation and usage, device defects, and others, such as patient and anatomical factors. Device failure after long-term use is rarely predicted at the time of approval, since device abnormality is rarely experienced in animal studies and clinical trials conducted during development of the device. Stent fracture due to metal fatigue is one example. Complex complications could occur from simultaneous use of two or more devices with diverse characteristics. The success rate of percutaneous retrieval of intravascular foreign bodies has improved with the advances in commercially available devices. However, the procedure is not always successful and sometimes surgical removal becomes necessary. Appropriate device selection and acquisition of experience in using the device are important. When an intravascular foreign body cannot be retrieved, the risk of complication could be high. Magnetic resonance imaging examination sometimes causes adverse events, including burns due to the heat generated by metal movement. Such information should be correctly recorded. Furthermore, it is necessary to provide patients with adequate information about the characteristics of implanted devices and unretrieved fragments. We reviewed the literature on unretrieved medical device fragments and include articles that describe the Japanese experience.

  20. Combined frequency domain photoacoustic and ultrasound imaging for intravascular applications

    PubMed Central

    Castelino, Robin F.; Hynes, Michael; Munding, Chelsea E.; Telenkov, Sergey; Foster, F. Stuart

    2016-01-01

    Intravascular photoacoustic (IVPA) imaging has the potential to characterize lipid-rich structures based on the optical absorption contrast of tissues. In this study, we explore frequency domain photoacoustics (FDPA) for intravascular applications. The system employed an intensity-modulated continuous wave (CW) laser diode, delivering 1W over an intensity modulated chirp frequency of 4-12MHz. We demonstrated the feasibility of this approach on an agar vessel phantom with graphite and lipid targets, imaged using a planar acoustic transducer co-aligned with an optical fibre, allowing for the co-registration of IVUS and FDPA images. A frequency domain correlation method was used for signal processing and image reconstruction. The graphite and lipid targets show an increase in FDPA signal as compared to the background of 21dB and 16dB, respectively. Use of compact CW laser diodes may provide a valuable alternative for the development of photoacoustic intravascular devices instead of pulsed laser systems. PMID:27895986

  1. Renal denervation by intravascular ultrasound: Preliminary in vivo study

    NASA Astrophysics Data System (ADS)

    Sinelnikov, Yegor; McClain, Steve; Zou, Yong; Smith, David; Warnking, Reinhard

    2012-10-01

    Ultrasound denervation has recently become a subject of intense research in connection with the treatment of complex medical conditions including neurological conditions, development of pain management, reproduction of skin sensation, neuropathic pain and spasticity. The objective of this study is to investigate the use of intravascular ultrasound to produce nerve damage in renal sympathetic nerves without significant injury to the renal artery. This technique may potentially be used to treat various medical conditions, such as hypertension. The study was approved by the Institutional Animal Care and Use Committee. Ultrasound was applied to renal nerves of the swine model for histopathological evaluation. Therapeutic ultrasound energy was delivered circumferentially by an intravascular catheter maneuvered into the renal arteries. Fluoroscopic imaging was conducted pre-and post-ultrasound treatment. Animals were recovered and euthanized up to 30 hours post procedure, followed by necropsy and tissue sample collection. Histopathological examination showed evidence of extensive damage to renal nerves, characterized by nuclear pyknosis, hyalinization of stroma and multifocal hemorrhages, with little or no damage to renal arteries. This study demonstrates the feasibility of intravascular ultrasound as a minimally invasive renal denervation technique. Further studies are necessary to evaluate the long-term safety and efficacy of this technique and its related clinical significance.

  2. Intravascular Talcosis due to Intravenous Drug Use Is an Underrecognized Cause of Pulmonary Hypertension

    PubMed Central

    Griffith, Christopher C.; Raval, Jay S.; Nichols, Larry

    2012-01-01

    Intravenous injection of illegal drugs or medications meant for oral administration can cause granulomatous disease of the lung. This intravascular talcosis results in pulmonary fibrosis and pulmonary hypertension. Nine cases of histologically confirmed intravascular talcosis were reviewed with specific attention given to the clinical histories in these patients. Five autopsy cases were included in this series with detailed investigation in the anatomic features associated with intravascular talcosis and pulmonary hypertension. All nine patients showed perivascular and/or intravascular deposition of polarizable foreign material in their lungs. Intravascular talcosis as a result of previous intravenous drug use was not clinically suspected in any patient despite clinically diagnosed pulmonary hypertension in five. All patients showed dilatation of the right and left heart, but none had dilatation of the aortic valve. Congestive heart failure with hepatosplenomegaly was also common. We conclude that intravascular talcosis is an underdiagnosed cause of pulmonary hypertension in patients with known history of intravenous drug use. PMID:22645680

  3. Intravascular Talcosis due to Intravenous Drug Use Is an Underrecognized Cause of Pulmonary Hypertension.

    PubMed

    Griffith, Christopher C; Raval, Jay S; Nichols, Larry

    2012-01-01

    Intravenous injection of illegal drugs or medications meant for oral administration can cause granulomatous disease of the lung. This intravascular talcosis results in pulmonary fibrosis and pulmonary hypertension. Nine cases of histologically confirmed intravascular talcosis were reviewed with specific attention given to the clinical histories in these patients. Five autopsy cases were included in this series with detailed investigation in the anatomic features associated with intravascular talcosis and pulmonary hypertension. All nine patients showed perivascular and/or intravascular deposition of polarizable foreign material in their lungs. Intravascular talcosis as a result of previous intravenous drug use was not clinically suspected in any patient despite clinically diagnosed pulmonary hypertension in five. All patients showed dilatation of the right and left heart, but none had dilatation of the aortic valve. Congestive heart failure with hepatosplenomegaly was also common. We conclude that intravascular talcosis is an underdiagnosed cause of pulmonary hypertension in patients with known history of intravenous drug use.

  4. Herpes zoster (shingles) disseminated (image)

    MedlinePlus

    Herpes zoster (shingles) normally occurs in a limited area that follows a dermatome (see the "dermatome" picture). In individuals with damaged immune systems, herpes zoster may be widespread (disseminated), causing serious illness. ...

  5. Guidelines for the management of intravascular catheter-related infections.

    PubMed

    Mermel, L A; Farr, B M; Sherertz, R J; Raad, I I; O'Grady, N; Harris, J S; Craven, D E

    2001-01-01

    These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications. Intravascular catheter-related infections are a major cause of morbidity and mortality in the United States. Coagulase-negative staphylococci, Staphylococcus aureus, aerobic gram-negative bacilli, and Candida albicans most commonly cause catheter-related bloodstream infection. Management of catheter-related infection varies according to the type of catheter involved. After appropriate cultures of blood and catheter samples are done, empirical i.v. antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient's acute illness, underlying disease, and the potential pathogen(s) involved. In most cases of nontunneled CVC-related bacteremia and fungemia, the CVC should be removed. For management of bacteremia and fungemia from a tunneled catheter or implantable device, such as a port, the decision to remove the catheter or device should be based on the severity of the patient's illness, documentation that the vascular-access device is infected, assessment of the specific pathogen involved, and presence of complications, such as endocarditis, septic thrombosis, tunnel infection, or metastatic seeding. When a catheter-related infection is documented and a specific pathogen is identified, systemic antimicrobial

  6. The effects of carbogen and nicotinamide on intravascular oxyhaemoglobin saturations in SCCVII and KHT murine tumours.

    PubMed

    Fenton, B M

    1995-05-01

    Considerable effort has been focused on devising methods for manipulating tumour oxygenation and thereby improving tumour radiosensitivity. The combination of nicotinamide and carbogen has been proposed to oxygenate both chronically and acutely hypoxic cells in tumours. However, results have varied markedly with both tumour model and measurement technique. The current objectives were (1) to determine whether changes in radiosensitivity following oxygen manipulation correlated with changes in tumour oxygenation and (2) to assess whether oxygenation was preferentially improved in specific tumour micro-regions. Using two murine tumour lines, the SCCVII carcinoma and the KHT sarcoma, tumour intravascular HbO2 saturations were measured cryospectrophotometrically following nicotinamide, carbogen or the combination. Generally, nicotinamide had minor effects on oxygenation, arguing against a substantial effect on acute hypoxia, while carbogen and the combination produced marked and equivalent improvements in oxygen availability. These results demonstrate that changes in tumour radiosensitivity may not agree with corresponding changes in oxygenation, even within a given tumour model, and that the efficacy of a given manipulative agent may vary substantially with tumour line. One possible explanation for these findings is that different subpopulations of clonogenic vs non-clonogenic cells may be oxygenated by alternative treatments.

  7. Aerogenic Dissemination of Aphtae Epizooticae

    DTIC Science & Technology

    1980-03-14

    FTD-ID(RS)T-0112-80 FOREIGN TECHNOLOGY DIVISION AEROGENIC DISSEMINATION OF APHTAE EPIZOOTICAE by Jerzy Wisniewski DTIC A Approved for public release...0112-8o Date14 Mar 19.80 AEROGENIC DISSEMINATION oF APHTAE EPIZOOTICAE Jerzy Wisniewski During aphtae epizooticae the principal cause of the virus...8217 e saliva foam assists in spreading the virus nn the air. The aerosol containing the virus can also be found in evaporation from wet floors, as well

  8. Design, construction, and validation of a rotary multifunctional intravascular diagnostic catheter combining multispectral fluorescence lifetime imaging and intravascular ultrasound

    PubMed Central

    Bec, Julien; Xie, Hongtao; Yankelevich, Diego R.; Zhou, Feifei; Sun, Yang; Ghata, Narugopal; Aldredge, Ralph

    2012-01-01

    Abstract. We report the development and validation of an intravascular rotary catheter for bimodal interrogation of arterial pathologies. This is based on a point-spectroscopy scanning time-resolved fluorescence spectroscopy technique enabling reconstruction of fluorescence lifetime images (FLIm) and providing information on arterial intima composition and intravascular ultrasound (IVUS) providing information on arterial wall morphology. The catheter design allows for independent rotation of the ultrasonic and optical channels within an 8 Fr outer diameter catheter sheath and integrates a low volume flushing channel for blood removal in the optical pathways. In the current configuration, the two channels consist of (a) a standard 3 Fr IVUS catheter with single element transducer (40 MHz) and (b) a side-viewing fiber optic (400 μm core). Experiments conducted in tissue phantoms showed the ability of the catheter to operate in an intraluminal setting and to generate coregistered FLIm and IVUS in one pull-back scan. Current results demonstrate the feasibility of the catheter for simultaneous bimodal interrogation of arterial lumen and for generation of robust fluorescence lifetime data under IVUS guidance. These results facilitate further development of a FLIm-IVUS technique for intravascular diagnosis of atherosclerotic cardiovascular diseases including vulnerable plaques. PMID:23224011

  9. Design, construction, and validation of a rotary multifunctional intravascular diagnostic catheter combining multispectral fluorescence lifetime imaging and intravascular ultrasound

    NASA Astrophysics Data System (ADS)

    Bec, Julien; Xie, Hongtao; Yankelevich, Diego R.; Zhou, Feifei; Sun, Yang; Ghata, Narugopal; Aldredge, Ralph; Marcu, Laura

    2012-10-01

    We report the development and validation of an intravascular rotary catheter for bimodal interrogation of arterial pathologies. This is based on a point-spectroscopy scanning time-resolved fluorescence spectroscopy technique enabling reconstruction of fluorescence lifetime images (FLIm) and providing information on arterial intima composition and intravascular ultrasound (IVUS) providing information on arterial wall morphology. The catheter design allows for independent rotation of the ultrasonic and optical channels within an 8 Fr outer diameter catheter sheath and integrates a low volume flushing channel for blood removal in the optical pathways. In the current configuration, the two channels consist of (a) a standard 3 Fr IVUS catheter with single element transducer (40 MHz) and (b) a side-viewing fiber optic (400 μm core). Experiments conducted in tissue phantoms showed the ability of the catheter to operate in an intraluminal setting and to generate coregistered FLIm and IVUS in one pull-back scan. Current results demonstrate the feasibility of the catheter for simultaneous bimodal interrogation of arterial lumen and for generation of robust fluorescence lifetime data under IVUS guidance. These results facilitate further development of a FLIm-IVUS technique for intravascular diagnosis of atherosclerotic cardiovascular diseases including vulnerable plaques.

  10. Design, construction, and validation of a rotary multifunctional intravascular diagnostic catheter combining multispectral fluorescence lifetime imaging and intravascular ultrasound.

    PubMed

    Bec, Julien; Xie, Hongtao; Yankelevich, Diego R; Zhou, Feifei; Sun, Yang; Ghata, Narugopal; Aldredge, Ralph; Marcu, Laura

    2012-10-01

    We report the development and validation of an intravascular rotary catheter for bimodal interrogation of arterial pathologies. This is based on a point-spectroscopy scanning time-resolved fluorescence spectroscopy technique enabling reconstruction of fluorescence lifetime images (FLIm) and providing information on arterial intima composition and intravascular ultrasound (IVUS) providing information on arterial wall morphology. The catheter design allows for independent rotation of the ultrasonic and optical channels within an 8 Fr outer diameter catheter sheath and integrates a low volume flushing channel for blood removal in the optical pathways. In the current configuration, the two channels consist of (a) a standard 3 Fr IVUS catheter with single element transducer (40 MHz) and (b) a side-viewing fiber optic (400 μm core). Experiments conducted in tissue phantoms showed the ability of the catheter to operate in an intraluminal setting and to generate coregistered FLIm and IVUS in one pull-back scan. Current results demonstrate the feasibility of the catheter for simultaneous bimodal interrogation of arterial lumen and for generation of robust fluorescence lifetime data under IVUS guidance. These results facilitate further development of a FLIm-IVUS technique for intravascular diagnosis of atherosclerotic cardiovascular diseases including vulnerable plaques.

  11. Disseminated toxoplasmosis presenting as sepsis in two AIDS patients.

    PubMed

    Barbosa, Carlos José Dornas Gonçalves; Molina, Rodrigo Juliano; de Souza, Murilo Barcelos; Silva, Ana Cristina A; Micheletti, Adilha Rua; dos Reis, Marlene Antonia; de Paula Antunes Teixeira, Vicente; Silva-Vergara, Mario León

    2007-01-01

    This report describes two patients who presented acute disseminated and severe toxoplasmosis as the first opportunistic disease related to acquired immunodeficiency syndrome. At admission, clinical and laboratory findings were similar to sepsis or septic shock and a fast evolutive course to death occurred in both cases. At necropsy, an inflammatory reaction and presence of a great number of Toxoplasma gondii cysts and tachyzoites were observed in most organs examined.

  12. Bothrops jararaca envenomation: Pathogenesis of hemostatic disturbances and intravascular hemolysis

    PubMed Central

    Senise, Luana V; Yamashita, Karine M

    2015-01-01

    To attain fully functional biological activity, vitamin-K dependent coagulation factors (VKDCF) are γ-carboxylated prior to secretion from liver. Warfarin impairs the γ-carboxylation, and consequently their physiological function. Bothrops jararaca snake venom (BjV) contains several activators of blood coagulation, especially procoagulant enzymes (prothrombin and factor X activators) and thrombin-like enzymes. In order to clarify the relative contribution of prothrombin and factor X activators to the hemostatic disturbances occurring during experimental B. jararaca envenomation, warfarin was used to deplete VKDCF, prior to BjV administration. Male Wistar rats were pretreated with saline (Sal) or warfarin (War) and inoculated subsequently with BjV or saline, thus forming four groups: Sal + Sal (negative control), Sal + BjV (positive control), War + Sal (warfarinization control), and War + BjV. Three hours after inoculation, prothrombin and factor X levels fell 40% and 50%, respectively; levels of both factors decreased more than 97% in the War + Sal and War + BjV groups. Platelet counts dropped 93% and 76% in Sal + BjV and War + BjV, respectively, and plasma fibrinogen levels decreased 86% exclusively in Sal + BjV. After 6 and 24 h, platelet counts and fibrinogen levels increased progressively. A dramatic augmentation in plasma hemoglobin levels and the presence of schizocytes and microcytes in the Sal + BjV group indicated the development of intravascular hemolysis, which was prevented by warfarin pretreatment. Our findings show that intravascular thrombin generation has the foremost role in the pathogenesis of coagulopathy and intravascular hemolysis, but not in the development of thrombocytopenia, in B. jararaca envenomation in rats; in addition, fibrinogenases (metalloproteinases) may contribute to coagulopathy more than thrombin-like enzymes. PMID:26080462

  13. Ethnicity and hazard information dissemination

    NASA Astrophysics Data System (ADS)

    Perry, Ronald W.; Nelson, Lisa

    1991-07-01

    Citizens from two communities were questioned regarding the sources from which they have previously obtained information about environmental hazards and their preferences for different communication channels. Three ethnic groups—whites, blacks, and Mexican-Americans—were represented among those questioned. While all three ethnic groups described similar patterns of past information receipt, it was found that Mexican-Americans obtained more information through social network contacts than whites or blacks. Ethnic differentials emerged when citizens were asked about preferred sources for information receipt. While radio was identified as desirable by all three groups, only minority citizens expressed a preference for local television as a dissemination mode and only Mexican-Americans favored neighborhood meetings. Mailed dissemination and newspapers were preferred primarily by whites and blacks. The implications of the results for the conduct of hazard information dissemination are examined.

  14. Why Have So Many Intravascular Glucose Monitoring Devices Failed?

    PubMed Central

    Smith, John L.; Rice, Mark J.

    2015-01-01

    Secondary to the inherent limitations of both point-of-care and central laboratory glucose technologies, continuous glucose measurement has recently enjoyed a high level of investment. Because of the perceived advantages by some of measuring in the intravascular space compared to the subcutaneous tissue, a number of technologies have been developed. In this review, we evaluate nine systems that have shown promise, although only one of these has been cleared for sale in the United States. The detection methodology, regulatory status, technical issues, and company circumstance surrounding each technology are examined. PMID:26129733

  15. Implantable ventricular assist device exchange with focused intravascular deairing techniques.

    PubMed

    Woo, Y Joseph; Acker, Michael A

    2011-01-01

    As ventricular assist devices are increasingly adopted and widely implemented as a highly effective therapy for end-stage heart disease, extended utilization periods for destination therapy or bridge-to-transplantation have created the possibility of device failure, infection, or thrombosis, requiring challenging implant exchanges. A major problem in these operations is the risk of air embolization, particularly in a nonsternotomy approach that precludes access to the outflow aortic graft and to the ascending aorta. We report a minimally invasive, nonsternotomy HeartMate II implantable left ventricular assist device (LVAD) exchange, using peripheral cardiopulmonary support and a novel approach to continuous intravascular ascending aortic air removal.

  16. Adhesive Tape and Intravascular-Catheter-Associated Infections

    PubMed Central

    Redelmeier, Donald A; Livesley, Nigel J

    1999-01-01

    Adhesive tape is placed in close contact with intravascular catheters for extended periods and could theoretically contribute to local infections. We found that 74% of specimens of tape collected in one hospital were colonized by pathogenic bacteria. However, only 5% of specimens had significant growth from an inner layer obtained by discarding the outside layer from each roll. We suggest that adhesive tape is a potential source of pathogenic bacteria and that discarding the outer layer from a partially used roll might be a simple method for reducing the risk of infection to patients. PMID:10354258

  17. Laser-activated shape memory polymer intravascular thrombectomy device

    NASA Astrophysics Data System (ADS)

    Small, Ward, IV; Wilson, Thomas S.; Benett, William J.; Loge, Jeffrey M.; Maitland, Duncan J.

    2005-10-01

    A blood clot (thrombus) that becomes lodged in the arterial network supplying the brain can cause an ischemic stroke, depriving the brain of oxygen and often resulting in permanent disability. As an alternative to conventional clot-dissolving drug treatment, we are developing an intravascular laser-activated therapeutic device using shape memory polymer (SMP) to mechanically retrieve the thrombus and restore blood flow to the brain. Thermal imaging and computer simulation were used to characterize the optical and photothermal behavior of the SMP microactuator. Deployment of the SMP device in an in vitro thrombotic vascular occlusion model demonstrated the clinical treatment concept.

  18. Removal of Chronic Intravascular Blood Clots using Liquid Plasma

    NASA Astrophysics Data System (ADS)

    Jung, Jae-Chul; Choi, Myeong; Koo, Il; Yu, Zengqi; Collins, George

    2011-10-01

    An electrical embolectomy device for removing chronic intravascular blood clots using liquid plasma under saline environment was demonstrated. We employed a proxy experimental blood clot model of deep vein thrombosis (DVT) and actual equine blood clot. Thermal damage to contiguous tissue and the collagen denaturing via the plasma irradiation were investigated by histological analysis using birefringence of the tissue and verified by FT-IR spectroscopic study, respectively, which showed the high removal rate up to 2 mm per minute at room temperature and small thermal damage less than 200 μm.

  19. [Intravascular large B-cell lymphoma with massive pulmonary lesions].

    PubMed

    Higashiyama, Asumi; Hashino, Satoshi; Onozawa, Masahiro; Takahata, Mutsumi; Okada, Kohei; Kahata, Kaoru; Taniguchi, Natsuko; Nasuhara, Yasuyuki; Kubota, Kanako; Fujimoto, Nozomu; Matsuno, Yoshihiro; Nishimura, Masahiro; Asaka, Masahiro

    2010-05-01

    A 61-year-old man was admitted to our hospital with dyspnea on effort. Neither computed tomography scan nor chest X-ray film detected any specific findings that could explain hypoxemia. Since (67)Ga scintigraphy showed abnormal uptake in the bilateral lungs, transbronchial lung biopsy (TBLB) was performed. The TBLB specimen was diagnosed as intravascular large B-cell lymphoma (IVLBCL). There was no involvement of any other organ considered typical of IVLBCL. In cases showing clinical findings such as hypoxia despite mild pulmonary radiographic changes, a definitive diagnosis should be made using methods such as TBLB with consideration given to the possibility of IVLBCL.

  20. Kentucky Information Dissemination System. Fall Dissemination Conference Follow-Up.

    ERIC Educational Resources Information Center

    Kentucky State Dept. of Education, Frankfort. Office of Communication Services.

    Describing a state conference on information dissemination held in November 1979 in Frankfort, Kentucky, this report contains conference materials and evaluations of the mini-seminars and awareness sessions conducted there. Materials include a final agenda, seminar and roundabout topics, a description of the Kentucky Department of Education…

  1. Quinine allergy causing acute severe systemic illness: report of 4 patients manifesting multiple hematologic, renal, and hepatic abnormalities

    PubMed Central

    2003-01-01

    Quinine is widely used for the common symptom of leg cramps. Quinine tablets require a prescription, but quinine and the product from which it is derived, cinchona, are also available without prescription. They are components of over-the-counter remedies for many common symptoms, of nutrition products, and of beverages such as tonic water and bitter lemon. Although quinine has been used for centuries, initially as an extract from the bark of the cinchona tree, allergic reactions to quinine can be severe and can affect multiple organs. These allergic reactions can cause thrombocytopenia, neutropenia, anemia, disseminated intravascular coagulation, acute renal failure, liver toxicity, and neurological abnormalities. Because quinine use is often intermittent, defining quinine as a cause of an acute disorder may be difficult. Moreover, since quinine use is often self-regulated, patients may not mention it in response to direct questions about medication use, adding to diagnostic difficulty. The diversity and severity of quinine-associated disorders and the difficulties of diagnosis are illustrated by the presentation of 4 case histories. Awareness of the variety of potential quinine-associated reactions is important for accurate diagnosis and critical for prevention of recurrent illness. PMID:16278718

  2. Rapidly progressing, fatal and acute promyelocytic leukaemia that initially manifested as a painful third molar: a case report

    PubMed Central

    2009-01-01

    Introduction Acute promyelocytic leukaemia, an uncommon and devastating subtype of leukaemia, is highly prevalent in Latin American populations. The disease may be detected by a dentist since oral signs are often the initial manifestation. However, despite several cases describing oral manifestations of acute promyelocytic leukaemia and genetic analysis, reports of acute promyelocytic leukaemia in Hispanic populations are scarce. The identification of third molar pain as an initial clinical manifestation is also uncommon. This is the first known case involving these particular features. Case presentation A 24-year-old Latin American man without relevant antecedents consulted a dentist for pain in his third molar. After two dental extractions, the patient experienced increased pain, poor healing, jaw enlargement and bleeding. A physical examination later revealed that the patient had pallor, jaw enlargement, ecchymoses and gingival haemorrhage. Laboratory findings showed pancytopaenia, delayed coagulation times, hypoalbuminaemia and elevated lactate dehydrogenase. Splenomegaly was detected on ultrasonography. Peripheral blood and bone marrow analyses revealed a hypercellular infiltrate of atypical promyelocytic cells. Cytogenetic analysis showing genetic translocation t(15;17) further confirmed acute promyelocytic leukaemia. Despite early chemotherapy, the patient died within one week due to intracranial bleeding secondary to disseminated intravascular coagulation. Conclusion The description of this unusual presentation of acute promyelocytic leukaemia, the diagnostic difficulties and the fatal outcome are particularly directed toward dental surgery practitioners to emphasise the importance of clinical assessment and preoperative evaluation as a minimal clinically-oriented routine. This case may also be of particular interest to haematologists, since the patient's cytogenetic analysis, clinical course and therapeutic response are well documented. PMID:19946580

  3. Intravascular eosinophilic deposits-when common knowledge is insufficient to render a diagnosis.

    PubMed

    Resnik, Kenneth S

    2009-05-01

    In the course of daily sign-out, the diagnoses within a histopathologist's armamentarium are limited by the scope of the histopathologist's knowledge, that is, one cannot diagnose what one does not know. The subject of homogeneous intravascular eosinophilic deposits is used to illustrate this point. A histopathologist unaware that a tick bite reaction can induce intravascular eosinophilic deposits may misdiagnose the specimen as representing a manifestation of cryoglobulinemia. Furthermore, conventional teaching imparts that monoclonal cryoglobulinemia shows intravascular eosinophilic deposits (cryoprecipitates) histopathologically, whereas mixed cryoglobulinemia is histopathologically manifested as leukocytoclastic vasculitis. Although it is not well known, this is not always the case because mixed cryoglobulinemia may histopathologically present itself as intravascular eosinophilic deposits without leukocytoclastic vasculitis. In addition, it is not common knowledge that intravascular cryoprecipitates, when present, may be associated with an increased number of blood vessels. Examples of these phenomena are presented in conjunction with a discussion of relevant issues/lessons learned from such cases.

  4. Disseminating an Effective Educational Technology.

    ERIC Educational Resources Information Center

    Axelrod, Saul

    1992-01-01

    Reasons for the failure to adopt behavior-analytic teaching strategies include the perception that behavior analysis is coercive and controlling, difficulties in implementation, university factors, and marketing problems. The goal of dissemination of these strategies could be met through creating motivational conditions and devising marketing…

  5. The Dissemination of Pedagogical Patterns

    ERIC Educational Resources Information Center

    Bennedsen, Jens

    2006-01-01

    Pedagogical patterns have been around since 1995, but several authors claim their impact is limited. However, these claims are based on authors' own observations and not on methodical evaluations of the use and dissemination of pedagogical patterns. This claim is in contrast to the vision of the creators of pedagogical patterns--they think…

  6. Development of catheters for combined intravascular ultrasound and photoacoustic imaging

    NASA Astrophysics Data System (ADS)

    Karpiouk, Andrei B.; Wang, Bo; Emelianov, Stanislav Y.

    2009-02-01

    Coronary atherosclerosis is a complex disease accompanied by the development of plaques in the arterial wall. Since the vulnerability of the plaques depends on their composition, the appropriate treatment of the arteriosclerosis requires a reliable characterization of the plaques' geometry and content. The intravascular ultrasound (IVUS) imaging is capable of providing structural details of the plaques as well as some functional information. In turn, more functional information about the same plaques can be obtained from intravascular photoacoustic (IVPA) images since the optical properties of the plaque's components differ from that of their environment. The combined IVUS/IVPA imaging is capable of simultaneously detecting and differentiating the plaques, thus determining their vulnerability. The potential of combined IVUS/IVPA imaging has already been demonstrated in phantoms and ex-vivo experiments. However, for in-vivo or clinical imaging, an integrated IVUS/IVPA catheter is required. In this paper, we introduce two prototypes of integrated IVUS/IVPA catheters for in-vivo imaging based on a commercially available single-element IVUS imaging catheter. The light delivery systems are developed using multimode optical fibers with custom-designed distal tips. Both prototypes were tested and compared using an arterial mimicking phantom. The advantages and limitations of both designs are discussed. Overall, the results of our studies suggest that both designs of integrated IVUS/IVPA catheter have a potential for in-vivo IVPA/IVUS imaging of atherosclerotic plaques.

  7. Focused intravascular ultrasonic probe using dimpled transducer elements.

    PubMed

    Chen, Y; Qiu, W B; Lam, K H; Liu, B Q; Jiang, X P; Zheng, H R; Luo, H S; Chan, H L W; Dai, J Y

    2015-02-01

    High-frequency focused intravascular ultrasonic probes were fabricated in this study using dimple technique based on PMN-PT single crystal and lead-free KNN-KBT-Mn ceramic. The center frequency, bandwidth, and insertion loss of the PMN-PT transducer were 34 MHz, 75%, and 22.9 dB, respectively. For the lead-free probe, the center frequency, bandwidth, and insertion loss were found to be 40 MHz, 72%, and 28.8 dB, respectively. The ultrasonic images of wire phantom and vessels with good resolution were obtained to evaluate the transducer performance. The -6 dB axial and lateral resolutions of the PMN-PT probe were determined to be 58 μm and 131 μm, respectively. For the lead-free probe, the axial and lateral resolutions were found to be 44 μm and 125 μm, respectively. These results suggest that the mechanical dimpling technique has good potential in preparing focused transducers for intravascular ultrasound applications.

  8. Dual-element needle transducer for intravascular ultrasound imaging

    PubMed Central

    Yoon, Sangpil; Kim, Min Gon; Williams, Jay A.; Yoon, Changhan; Kang, Bong Jin; Cabrera-Munoz, Nestor; Shung, K. Kirk; Kim, Hyung Ham

    2015-01-01

    Abstract. A dual-element needle transducer for intravascular ultrasound imaging has been developed. A low-frequency element and a high-frequency element were integrated into one device to obtain images which conveyed both low- and high-frequency information from a single scan. The low-frequency element with a center frequency of 48 MHz was fabricated from the single crystal form of lead magnesium niobate-lead titanate solid solution with two matching layers (MLs) and the high frequency element with a center frequency of 152 MHz was fabricated from lithium niobate with one ML. The measured axial and lateral resolutions were 27 and 122  μm, respectively, for the low-frequency element, and 14 and 40  μm, respectively, for the high-frequency element. The performance of the dual-element needle transducer was validated by imaging a tissue-mimicking phantom with lesion-mimicking area, and ex vivo rabbit aortas in water and rabbit whole blood. The results suggest that a low-frequency element effectively provides depth resolved images of the whole vessel and its adjacent tissue, and a high-frequency element visualizes detailed structure near the surface of the lumen wall in the presence of blood within the lumen. The advantages of a dual-element approach for intravascular imaging are also discussed. PMID:26158118

  9. TOPICAL REVIEW: Intravascular brachytherapy of the coronary arteries

    NASA Astrophysics Data System (ADS)

    Fox, R. A.

    2002-02-01

    This is a review of the relatively recently developed field of intravascular brachytherapy of coronary arteries. It presents a brief overview of the discipline of coronary angioplasty describing the problem of restenosis and discusses the potential for ionizing radiation to overcome this problem. It examines the various methods that have been used to irradiate the coronary arteries comparing their advantages and disadvantages. Special consideration is given to seeds and wires in the artery, radioactive liquids in the angioplasty balloon and radioactive stents. Passing reference is made to a number of other methods that have also been proposed, but which are not commonly used to irradiate the coronary arteries at present. The dosimetry of each of the major techniques is discussed and the data from different laboratories compared. Specific consideration is given to the need for centring of the radioactive source and the factors affecting the selection of a dose prescription. A brief review of recent clinical trials is followed by an examination of possible future directions in this field including the use of intravascular ultrasound to improve dosimetry, the use of gas-filled balloons to enhance the penetration of beta-emitting sources and the use of gamma-emitting stents to overcome the problems associated with edge restenosis.

  10. High speed intravascular photoacoustic imaging of atherosclerotic arteries (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Piao, Zhonglie; Ma, Teng; Qu, Yueqiao; Li, Jiawen; Yu, Mingyue; He, Youmin; Shung, K. Kirk; Zhou, Qifa; Kim, Chang-Seok; Chen, Zhongping

    2016-02-01

    Cardiovascular disease is the leading cause of death in the industrialized nations. Accurate quantification of both the morphology and composition of lipid-rich vulnerable atherosclerotic plaque are essential for early detection and optimal treatment in clinics. In previous works, intravascular photoacoustic (IVPA) imaging for detection of lipid-rich plaque within coronary artery walls has been demonstrated in ex vivo, but the imaging speed is still limited. In order to increase the imaging speed, a high repetition rate laser is needed. In this work, we present a high speed integrated IVPA/US imaging system with a 500 Hz optical parametric oscillator laser at 1725 nm. A miniature catheter with 1.0 mm outer diameter was designed with a 200 μm multimode fiber and an ultrasound transducer with 45 MHz center frequency. The fiber was polished at 38 degree and enclosed in a glass capillary for total internal reflection. An optical/electrical rotary junction and pull-back mechanism was applied for rotating and linearly scanning the catheter to obtain three-dimensional imaging. Atherosclerotic rabbit abdominal aorta was imaged as two frame/second at 1725 nm. Furthermore, by wide tuning range of the laser wavelength from 1680 nm to 1770 nm, spectroscopic photoacoustic analysis of lipid-mimicking phantom and an human atherosclerotic artery was performed ex vivo. The results demonstrated that the developed IVPA/US imaging system is capable for high speed intravascular imaging for plaque detection.

  11. The potential value of intravascular ultrasound imaging in diagnosis of aortic intramural hematoma

    PubMed Central

    Hu, Wei; Schiele, Francois; Meneveau, Nicolas; Seronde, Marie-France; Legalery, Pierre; Bonneville, Jean-Francois; Chocron, Sidney; Bassand, Jean-Pierre

    2011-01-01

    Objective To evaluate the potential value of intravascular ultrasound (IVUS) imaging in the diagnosis of aortic intramural hematoma (AIH). Methods From September 2002 to May 2005, a consecutive series of 15 patients with suspected aortic dissection (AD) underwent both IVUS imaging and spiral computed tomography (CT). Six patients diagnosed as acute type B AIH by CT or IVUS composed the present study group. Results The study group consisted of five males and one female with mean age of 66 years old. All of them had chest or back pain. In one patient, CT omitted a localized AIH and an associated penetrating atherosclerotic ulcer (PAU), which were detected by IVUS. In another patient, CT mistaken a partly thrombosed false lumen as an AIH, whereas IVUS detected a subtle intimal tear and slow moving blood in the false lumen. In the four rest patients, both CT and IVUS made the diagnosis of AIH, however, IVUS detected three PAUs in three of them, only one of them was also detected by CT, and two of them escaped initial CT and were confirmed by follow up CT or magnetic resonance imaging. Conclusions IVUS imaging is a safe examination and has high accuracy in the diagnosis of AIH, particularly for diagnosing localized AIH, distinguishing AIH with thrombosed classic AD and detecting accompanied small PAUs. PMID:22783309

  12. [DISSEMINATION BY H. PYLORI IN PATIENTS, SUFFERING VARIOUS FORMS OF CHOLECYSTITIS].

    PubMed

    Kyazimov, I L; Takhmazova, Ch T

    2015-05-01

    Comparative analysis of dissemination by H. pylori of the bile portions in patients of a control group, suffering an acute calculous cholecystitis (ACCH), was performed. Dissemination of H. pylori in a control group was significantly less, than in a bile portions of patients, suffering ACCH. While analyzing the rate and degree of dissemination by H. pylori of the gastic and gallbladder mucosa biopsies of patients, suffering chronic non-calculous cholecystitis, associated with duodenogastric reflux and gastroduodenitis, bacteria were revealed trustworthy more often and in more number, than in a gallbladder mucosa in patients, suffering ACCH.

  13. [Analysis of dissemination pathways for poliovirus].

    PubMed

    Ohka, Seii

    2009-06-01

    Poliomyelitis is an acute disease of the central nervous system (CNS) caused by poliovirus (PV). In humans, an infection is initiated by oral ingestion of the virus, followed by multiplication in the alimentary mucosa, from which the virus spreads through the bloodstream. Paralytic poliomyelitis initiates from the invasion of the central nervous system by circulating poliovirus, probably via the blood-brain barrier. After the virus enters the central nervous system, it replicates in neurons, especially in motor neurons, inducing the cell death that causes paralytic poliomyelitis. Along with this route of dissemination, a neuron-specific pathway has been reported in humans, monkeys, and PV-sensitive transgenic (Tg) mice carrying the PV receptor (hPVR/CD155) gene. It is important for the efficient virus dissemination to overcome the barriers as follows; i) to access the target tissue, ii) to enter the cells, iii) to reach the place for the replication, iv) to replicate efficiently. PV is easily transferred to humans orally; however, no rodent model for oral infections has been developed. We analyzed the each barrier above, and showed that PV is inactivated by the low pH of the gastric contents in mice. We also demonstrated that type 1 interferon signaling plays an important role in determining permissivity in the alimentary tract. As for the neural pathway, we demonstrated that direct efficient interaction between the cytoplasmic domain and cytoplasmic dynein is essential for the efficient retrograde transport of PV-containing vesicles along microtubules for the hPVR-dependent PV transport. On the other hand, we found that hPVR-independent axonal transport of PV was also observed in hPVR-Tg and non-Tg mice, indicating that several different pathways for PV axonal transport exist.

  14. Intravascular Ultrasound Imaging of Peripheral Arteries as an Adjunct to Balloon Angioplasty and Atherectomy

    SciTech Connect

    Korogi, Yukunori; Hirai, Toshinori; Takahashi, Mutsumasa

    1996-11-15

    This article reviews many of the applications of intravascular ultrasound (US) imaging for peripheral arterial diseases. In vitro studies demonstrate an excellent correlation between ultrasound measurements of lumen and plaque crossectional area compared with histologic sections. In vivo clinical studies reveal the enhanced diagnostic capabilities of this technology compared with angiography. Intravascular US imaging can provide valuable information on the degree, eccentricity, and histologic type of stenosis before intervention, and on the morphological changes in the arterial wall and the extent of excision after intervention. Intravascular US may also serve as a superior index for gauging the diameter of balloon, stent, laser probe, and/or atherectomy catheter appropriate for a proposed intervention. Significant new insights into the mechanisms of balloon angioplasty and atherectomy have been established by intravascular US findings. Intravascular US imaging has been shown to be a more accurate method than angiography for determining the cross-sectional area of the arterial lumen, and for assessing severity of stenosis. Quantitative assessment of the luminal cross-sectional area after the balloon dilatation should be more accurate than angiography as intimal tears or dissections produced by the dilatation may not be accurately evaluated with angiography. At the present time, intravascular US is still a controversial imaging technique. Outcome studies are currently being organized to assess the clinical value and cost effectiveness of intravascular ultrasound in the context of these interventional procedures.

  15. Creating new realities: program development and dissemination.

    PubMed Central

    Fixsen, D L; Blase, K A

    1993-01-01

    Program development and dissemination in human services present challenges and opportunities for social scientists. Over the past 27 years the Teaching-Family Model of group home treatment has moved from prototype development to widespread dissemination across North America. Reviewing concepts in industry related to product development and dissemination, the application of these concepts to a human services delivery system, and program replication and dissemination data offer information about how innovative human services can be widely adapted and adopted. PMID:8307838

  16. Outcomes of fasciotomy in patients with crush-induced acute kidney injury after Bam earthquake.

    PubMed

    Safari, Saeed; Najafi, Iraj; Hosseini, Mostafa; Sanadgol, Houshang; Sharifi, Ali; Alavi Moghadam, Mostafa; Abdulvand, Ali; Rashid Farrokhi, Farin; Borumand, Behrooz

    2011-01-01

    INTRODUCTION. Fasciotomy may increase the morbidity and mortality in patients with crush-induced acute kidney injury (AKI), by creating an open wound, increasing the risk of bleeding, coagulopathy, and potentially fatal sepsis. This study evaluates the outcomes of fasciotomy in these patients after Bam earthquake in Iran. MATERIALS AND METHODS. We reviewed medical records of victims of Bam earthquake complicated with crush-induced AKI. Demographic, biochemical, and clinical data of patients who underwent fasciotomy were evaluated and compared with other patients with AKI. RESULTS. Fasciotomy was performed for 70 of 200 patients with crush-induced AKI (35.0%). There were no significant differences regarding sex, age, time under the rubble, and muscle enzymes level between these patients and those without fasciotomy. They did not experience higher rates of disseminated intravascular coagulopathy, sepsis, adult respiratory distress syndrome, amputation, and dialysis session. Neither did they have a longer hospitalization period or higher death rate. CONCLUSIONS. This study showed that fasciotomy did not have any deteriorating effect on morbidity and mortality of patients with crush-induced AKI after Bam earthquake.

  17. Analysis of factors affecting hemorrhagic diathesis and overall survival in patients with acute promyelocytic leukemia

    PubMed Central

    Lee, Ho Jin; Kim, Dong Hyun; Lee, Seul; Koh, Myeong Seok; Kim, So Yeon; Lee, Ji Hyun; Lee, Suee; Oh, Sung Yong; Han, Jin Yeong; Kim, Hyo-Jin; Kim, Sung-Hyun

    2015-01-01

    Background/Aims: This study investigated whether patients with acute promyelocytic leukemia (APL) truly fulfill the diagnostic criteria of overt disseminated intravascular coagulation (DIC), as proposed by the International Society on Thrombosis and Haemostasis (ISTH) and the Korean Society on Thrombosis and Hemostasis (KSTH), and analyzed which component of the criteria most contributes to bleeding diathesis. Methods: A single-center retrospective analysis was conducted on newly diagnosed APL patients between January 1995 and May 2012. Results: A total of 46 newly diagnosed APL patients were analyzed. Of these, 27 patients (58.7%) showed initial bleeding. The median number of points per patient fulfilling the diagnostic criteria of overt DIC by the ISTH and the KSTH was 5 (range, 1 to 7) and 3 (range, 1 to 4), respectively. At diagnosis of APL, 22 patients (47.8%) fulfilled the overt DIC diagnostic criteria by either the ISTH or KSTH. In multivariate analysis of the ISTH or KSTH diagnostic criteria for overt DIC, the initial fibrinogen level was the only statistically significant factor associated with initial bleeding (p = 0.035), but it was not associated with overall survival (OS). Conclusions: Initial fibrinogen level is associated with initial presentation of bleeding of APL patients, but does not affect OS. PMID:26552464

  18. Risk Factors for Disseminated Coccidioidomycosis, United States

    PubMed Central

    Odio, Camila D.; Marciano, Beatriz E.; Galgiani, John N.

    2017-01-01

    Of 150,000 new coccidioidomycosis infections that occur annually in the United States, ≈1% disseminate; one third of those cases are fatal. Immunocompromised hosts have higher rates of dissemination. We identified 8 patients with disseminated coccidioidomycosis who had defects in the interleukin-12/interferon-γ and STAT3 axes, indicating that these are critical host defense pathways. PMID:28098554

  19. Disseminated sporotrichosis in an immunocompetent patient

    PubMed Central

    Hassan, Kareem; Turker, Tolga; Zangeneh, Tirdad

    2016-01-01

    Abstract Sporothrix schenckii, the causative agent of sporotrichosis, is a relatively rare infection. Local infection usually occurs through direct inoculation of the organism through the skin; disseminated disease is rarely seen. This article describes a case of disseminated sporotrichosis in a middle-aged man without the commonly seen risk factors for dissemination. PMID:27583270

  20. Pemphigus vulgaris and disseminated nocardiosis.

    PubMed

    Martín, F J; Pérez-Bernal, A M; Camacho, F

    2000-09-01

    Infectious diseases, in particular septicaemia from Staphylococcus aureus, Proteus vulgaris and Pseudomonas aeruginosa, are the most severe and frequent complications for the immunosuppressive therapy of pemphigus. Infection by Nocardia asteroides in subjects with pemphigus vulgaris is rare. We report the sixth case found of such an association; the subject died of disseminated nocardiosis while receiving steroids and immunosuppressive drugs, 4 years after being diagnosed with chronic pemphigus vulgaris.

  1. Acute cerebellar ataxia, acute cerebellitis, and opsoclonus-myoclonus syndrome.

    PubMed

    Desai, Jay; Mitchell, Wendy G

    2012-11-01

    Acute cerebellar ataxia and acute cerebellitis represent a process characterized by parainfectious, postinfectious, or postvaccination cerebellar inflammation. There is considerable overlap between these entities. The mildest cases of acute cerebellar ataxia represent a benign condition that is characterized by acute truncal and gait ataxia, variably with appendicular ataxia, nystagmus, dysarthria, and hypotonia. It occurs mostly in young children, presents abruptly, and recovers over weeks. Neuroimaging is normal. Severe cases of cerebellitis represent the other end of the spectrum, presenting with acute cerebellar signs often overshadowed by alteration of consciousness, focal neurological deficits, raised intracranial pressure, hydrocephalus, and even herniation. Neuroimaging is abnormal and the prognosis is less favorable than in acute cerebellar ataxia. Acute disseminated encephalomyelitis may be confused with acute cerebellitis when the clinical findings are predominantly cerebellar, but lesions on neuroimaging are usually widespread. Paraneoplastic opsoclonus-myoclonus syndrome is often initially misdiagnosed as acute cerebellar ataxia, but has very specific features, course, and etiopathogensis.

  2. [Management of intravascular catheters for prevention of perioperative cross infections].

    PubMed

    Okubo, Takashi; Ohara, Eiko; Nakamura, Akishige; Takeyama, Hiromitsu; Manabe, Tadao

    2004-11-01

    Bloodstream infection derived from an intravascular catheter occupies an important position among the various types of nosocomial infection. It is therefore necessary to establish a system for preventing catheter infection not only as measures for each separate infection, but also for the entire hospital. Catheter infections are mainly caused by contamination of the connecting part of a transfusion line during the infusion of drug solution as well as by contamination of the part of the catheter inserted. Consequently, the greatest possible care should be taken in the preparation of aseptic transfusion and the prevention of contamination when connecting a transfusion line. In particular, there are problems with three-way stopcocks, management of hubs, frequency of transfusion line exchange, fat emulsion injection method, and blood preparation. It is most important to consider effective nutritional management methods that do not require the insertion of a central venous catheter.

  3. Adaptive Estimation of Intravascular Shear Rate Based on Parameter Optimization

    NASA Astrophysics Data System (ADS)

    Nitta, Naotaka; Takeda, Naoto

    2008-05-01

    The relationships between the intravascular wall shear stress, controlled by flow dynamics, and the progress of arteriosclerosis plaque have been clarified by various studies. Since the shear stress is determined by the viscosity coefficient and shear rate, both factors must be estimated accurately. In this paper, an adaptive method for improving the accuracy of quantitative shear rate estimation was investigated. First, the parameter dependence of the estimated shear rate was investigated in terms of the differential window width and the number of averaged velocity profiles based on simulation and experimental data, and then the shear rate calculation was optimized. The optimized result revealed that the proposed adaptive method of shear rate estimation was effective for improving the accuracy of shear rate calculation.

  4. Mathematical Modeling of Intravascular Blood Coagulation under Wall Shear Stress

    PubMed Central

    Rukhlenko, Oleksii S.; Dudchenko, Olga A.; Zlobina, Ksenia E.; Guria, Georgy Th.

    2015-01-01

    Increased shear stress such as observed at local stenosis may cause drastic changes in the permeability of the vessel wall to procoagulants and thus initiate intravascular blood coagulation. In this paper we suggest a mathematical model to investigate how shear stress-induced permeability influences the thrombogenic potential of atherosclerotic plaques. Numerical analysis of the model reveals the existence of two hydrodynamic thresholds for activation of blood coagulation in the system and unveils typical scenarios of thrombus formation. The dependence of blood coagulation development on the intensity of blood flow, as well as on geometrical parameters of atherosclerotic plaque is described. Relevant parametric diagrams are drawn. The results suggest a previously unrecognized role of relatively small plaques (resulting in less than 50% of the lumen area reduction) in atherothrombosis and have important implications for the existing stenting guidelines. PMID:26222505

  5. Automatic classification of atherosclerotic plaques imaged with intravascular OCT

    PubMed Central

    Rico-Jimenez, Jose J.; Campos-Delgado, Daniel U.; Villiger, Martin; Otsuka, Kenichiro; Bouma, Brett E.; Jo, Javier A.

    2016-01-01

    Intravascular optical coherence tomography (IV-OCT) allows evaluation of atherosclerotic plaques; however, plaque characterization is performed by visual assessment and requires a trained expert for interpretation of the large data sets. Here, we present a novel computational method for automated IV-OCT plaque characterization. This method is based on the modeling of each A-line of an IV-OCT data set as a linear combination of a number of depth profiles. After estimating these depth profiles by means of an alternating least square optimization strategy, they are automatically classified to predefined tissue types based on their morphological characteristics. The performance of our proposed method was evaluated with IV-OCT scans of cadaveric human coronary arteries and corresponding tissue histopathology. Our results suggest that this methodology allows automated identification of fibrotic and lipid-containing plaques. Moreover, this novel computational method has the potential to enable high throughput atherosclerotic plaque characterization. PMID:27867716

  6. Intravascular Optical Imaging Technology for Investigating the Coronary Artery

    PubMed Central

    Suter, Melissa J.; Nadkarni, Seemantini K.; Weisz, Giora; Tanaka, Atsushi; Jaffer, Farouc A.; Bouma, Brett E.; Tearney, Guillermo J.

    2012-01-01

    There is an ever-increasing demand for new imaging methods that can provide additional information about the coronary wall to better characterize and stratify high-risk plaques, and to guide interventional and pharmacologic management of patients with coronary artery disease. While there are a number of imaging modalities that facilitate the assessment of coronary artery pathology, this review paper focuses on intravascular optical imaging modalities that provide information on the microstructural, compositional, biochemical, biomechanical, and molecular features of coronary lesions and stents. The optical imaging modalities discussed include angioscopy, optical coherence tomography, polarization sensitive-optical coherence tomography, laser speckle imaging, near-infrared spectroscopy, time-resolved laser induced fluorescence spectroscopy, Raman spectroscopy, and near-infrared fluorescence molecular imaging. Given the wealth of information that these techniques can provide, optical imaging modalities are poised to play an increasingly significant role in the evaluation of the coronary artery in the future. PMID:21920342

  7. Real-time simulator for intravascular ultrasound (IVUS)

    NASA Astrophysics Data System (ADS)

    Abkai, Ciamak; Becherer, Nico; Hesser, Jürgen; Männer, Reinhard

    2007-03-01

    Intravascular Ultrasound (IVUS) plays a significant role in diagnostics of atherosclerotic diseases. Simulation of imaging techniques promises a better understanding of the physical background and segmentation strategies. Most simulation approaches describe ultrasonic backscattering using wave-equation based simplifications. More complicated real-time simulation techniques are not available so far. In this paper, we present an empirical model derived from wave-equations given by the Rayleigh integration method. According to boundary conditions and weak scatterers, a hybrid approach including the Beer-Lambert law to model attenuation is introduced. Scatterers are described by a 4D vessel-system model based on elastic tubes. Sophisticated discretization and numerical simplifications in addition to a highly optimized implementation of the model yields a real-time and realistic IVUS simulation with 20 frames/s on a 3.2 GHz Pentium 4 PC.

  8. Basic studies on intravascular low-intensity laser therapy

    NASA Astrophysics Data System (ADS)

    Liu, Timon Cheng-Yi; Duan, Rui; Wang, Shuang-Xi; Liu, Jiang; Cui, Li-Ping; Jin, Hua; Liu, Song-Hao

    2006-09-01

    Intravascular low intensity laser therapy (ILILT) was originally put forward in USA in 1982, but popularized in Russia in 1980s and in China in 1990s, respectively. A randomized placebo-controlled study has shown ILILT clinical efficacy in patients suffering from rheumatoid arthritis. As Chinese therapeutic applications of ILILT were the most widely in the world, its basic research, such as intracellular signal transduction research, blood research in vitro, animal blood research in vivo, human blood research in vivo and traditional Chinese medicine research, was also very progressive in China. Its basic studies will be reviewed in terms of the biological information model of photobiomodulation in this paper. ILILT might work in view of its basic studies, but the further randomized placebo-controlled trial and the further safety research should be done.

  9. Asian-variant intravascular large B-cell lymphoma

    PubMed Central

    Pasch, Whitney; Costales, Cristina; Siddiqi, Imran; Mohrbacher, Ann

    2017-01-01

    Intravascular large B-cell lymphoma (IVLBCL) is a rare and deadly malignancy involving the growth of lymphoma cells within vessel lumina of all organ types. IVLBCL is further divided into the hemophagocytic Asian variant and a classical Western variant. Both variants are difficult to diagnose by imaging, and although diagnostic criteria have been developed to guide workup, histopathological examination remains imperative. Treatment of IVLBCL remains difficult given the high mortality of the disease, but rituximab has emerged as a promising therapeutic option when combined with various cytotoxic regimens. The two main variants of IVLBCL generally manifest in their respective Asian or Western populations, and crossover between ethnicities is rare. We present the second described case of Asian-variant IVLBCL in an African American individual.

  10. The Development of a Continuous Intravascular Glucose Monitoring Sensor

    PubMed Central

    Crane, Barry C.; Barwell, Nicholas P.; Gopal, Palepu; Gopichand, Mannam; Higgs, Timothy; James, Tony D.; Jones, Christopher M.; Mackenzie, Alasdair; Mulavisala, Krishna Prasad; Paterson, William

    2015-01-01

    Background: Glycemic control in hospital intensive care units (ICU) has been the subject of numerous research publications and debate over the past 2 decades. There have been multiple studies showing the benefit of ICU glucose control in reducing both morbidity and mortality. GlySure Ltd has developed a glucose monitor based on a diboronic acid receptor that can continuously measure plasma glucose concentrations directly in a patient’s vascular system. The goal of this study was to validate the performance of the GlySure CIGM system in different patient populations. Methods: The GlySure Continuous Intravascular Glucose Monitoring (CIGM) System was evaluated in both the Cardiac ICU (33 patients) and MICU setting (14 patients). The sensor was placed through a custom CVC and measured the patients’ blood glucose concentration every 15 seconds. Comparison blood samples were taken at 2 hourly then 4 hourly intervals and measured on a YSI 2300 STAT Plus or an i-STAT. Results: Consensus error grid analysis of the data shows that the majority of the data (88.2% Cardiac, and 95.0% MICU) fell within zone A, which is considered to be clinically accurate and all data points fell within zones A and B. The MARD of the Cardiac trial was 9.90% and the MICU trial had a MARD of 7.95%. Data analysis showed no significant differences between data generated from Cardiac and MICU patients or by time or glucose concentration. Conclusions: The GlySure CIGM System has met the design challenges of measuring intravascular glucose concentrations in critically ill patients with acceptable safety and performance criteria and without disrupting current clinical practice. The accuracy of the data is not affected by the patients’ condition. PMID:26033921

  11. Disseminated gestational choriocarcinoma presenting with hepatic and uveal metastases, hook effect, and choriocarcinoma syndrome

    PubMed Central

    Aswani, Yashant; Thakkar, Hemangini; Hira, Priya

    2016-01-01

    Choriocarcinoma is a human chorionic gonadotrophin (HCG)-secreting tumor that comprises vascular channels. It has a tendency for widespread metastasis, common sites for which include the lung, vagina, brain, liver, bone, intestine, and kidney. We describe a 30-year-old female who presented with hepatitis-like features and bilateral diminution of vision, and subsequently developed hemothorax and hemoperitoneum—all rare and seemingly unrelated manifestations which were finally attributable to metastases from gestational choriocarcinoma. To further complicate the clinical scenario, the serum HCG of the patient was mildly raised (due to a phenomenon called hook effect). Subsequently, the patient developed disseminated intravascular coagulation and succumbed to her illness. In this report, we discuss the imaging findings of choriocarcinoma, its potential sites of metastases, and the hook effect. PMID:28104943

  12. [Disseminated mucormycosis in immunocompetent patients: A disease that also exists].

    PubMed

    Pozo Laderas, Juan Carlos; Pontes Moreno, Antonio; Pozo Salido, Carmen; Robles Arista, Juan Carlos; Linares Sicilia, María José

    2015-01-01

    Mucormycosis is usually an acute angioinvasive infections, which leads to non-suppurative necrosis and significant tissue damage. It represents 1.6% of all the invasive fungal infections and predominates in immunosuppressed patients with risk factors. Incidence has been significantly increased even in immunocompetent patients. Due to finding a case of disseminated mucormycosis caused by Rhizomucor pusillus in a young immunocompetent patient, a systematic review was carried out of reported cases in PubMed of mucormycosis in immunocompetent adults according to the main anatomic locations, and especially in disseminated cases. A review of the main risk factors and pathogenicity, clinical manifestations, techniques of early diagnosis, current treatment options, and prognosis is presented. Taxonomy and classification of the genus Mucor has also been reviewed.

  13. Disseminated pheochromocytoma in a North American river otter (Lontra canadensis).

    PubMed

    Schlanser, Justin R; Patterson, Jon S; Kiupel, Matti; Hencken, Christy; Sikarskie, James G; Harrison, Tara M

    2012-06-01

    A 21-yr-old male North American river otter (Lontra canadensis) with a chronic history of degenerative osteoarthritis was evaluated for acute posterior paralysis. Because no definitive cause was identified and a poor prognosis was expected, the otter was euthanatized. A malignant neoplasm of adrenal gland origin with disseminated metastases to the central nervous system, lymph nodes, diaphragm, pancreas, spleen, and liver was diagnosed on postmortem examination. No clinical signs of disseminated neoplasia had been noted throughout the otter's history. The adrenal neoplasm was composed of nests of epithelial cells surrounded by a fine fibrovascular stroma. Neoplastic cells were immunohistochemically positive for chromogranin A, PGP9.5, metencephalin, and endorphin and negative for melan A and inhibin, confirming a diagnosis of a malignant pheochromocytoma. On the basis of the necropsy finding, metastasis of the pheochromocytoma might have contributed to the observed clinical signs.

  14. Study to Improve Cardiovascular Outcomes in high-risk older patieNts (ICON1) with acute coronary syndrome: study design and protocol of a prospective observational study

    PubMed Central

    Kunadian, Vijay; Neely, R Dermot G; Sinclair, Hannah; Batty, Jonathan A; Veerasamy, Murugapathy; Ford, Gary A; Qiu, Weiliang

    2016-01-01

    Introduction The ICON1 study (a study to Improve Cardiovascular Outcomes in high-risk older patieNts with acute coronary syndrome) is a prospective observational study of older patients (≥75 years old) with non-ST-elevation acute coronary syndrome managed by contemporary treatment (pharmacological and invasive). The aim of the study was to determine the predictors of poor cardiovascular outcomes in this age group and to generate a risk prediction tool. Methods and analysis Participants are recruited from 2 tertiary hospitals in the UK. Baseline evaluation includes frailty, comorbidity, cognition and quality-of-life measures, inflammatory status assessed by a biomarker panel, including microRNAs, senescence assessed by telomere length and telomerase activity, cardiovascular status assessed by arterial stiffness, endothelial function, carotid intima media thickness and left ventricular systolic and diastolic function, and coronary plaque assessed by virtual histology intravascular ultrasound and optical coherence tomography. The patients are followed-up at 30 days and at 1 year for primary outcome measures of death, myocardial infarction, stroke, unplanned revascularisation, bleeding and rehospitalisation. Ethics and dissemination The study has been approved by the regional ethics committee (REC 12/NE/016). Findings of the study will be presented in scientific sessions and will be published in peer-reviewed journals. Trial registration number NCT01933581: Pre-results. PMID:27554105

  15. Federal Mechanisms to Support Intervention Dissemination.

    PubMed

    Diana, Augusto; Bennett, Nicole

    2015-01-01

    This paper examines federal mechanisms that support program developers and researchers in disseminating effective interventions for public benefit. The purpose of this paper is not to discuss the dissemination of intervention research (i.e., how to inform stakeholders about research findings), nor is it intended to discuss the research of intervention dissemination (i.e., what is the best approach to disseminate an intervention). Rather, the paper discusses the challenges specific to finding pathways to disseminate an intervention and describes federal opportunities to support intervention dissemination. Three specific mechanisms are discussed: Federal Registries of Evidence-Based Programs, the Tiered Evidence Grant Programs, and the Small Business Innovative Research (SBIR) and the Small Technology Transfer Research (STTR) programs. The article presents some limitations associated with federal mechanisms for dissemination of effective interventions, but is intended to highlight current and future opportunities they may offer.

  16. Early Effects of Intensive Lipid-Lowering Treatment on Plaque Characteristics Assessed by Virtual Histology Intravascular Ultrasound

    PubMed Central

    Lee, Jung-Hee; Shin, Dong-Ho; Kim, Byeong-Keuk; Ko, Young-Guk; Choi, Donghoon; Jang, Yangsoo

    2016-01-01

    Purpose The effects of short-term intensive lipid-lowering treatment on coronary plaque composition have not yet been sufficiently evaluated. We investigated the influence of short-term intensive lipid-lowering treatment on quantitative and qualitative changes in plaque components of non-culprit lesions in patients with acute coronary syndrome. Materials and Methods This was a prospective, randomized, open-label, single-center trial. Seventy patients who underwent both baseline and three-month follow-up virtual histology intravascular ultrasound were randomly assigned to either an intensive lipid-lowering treatment group (ezetimibe/simvastatin 10/40 mg, n=34) or a control statin treatment group (pravastatin 20 mg, n=36). Using virtual histology intravascular ultrasound, plaque was characterized as fibrous, fibro-fatty, dense calcium, or necrotic core. Changes in plaque components during the three-month lipid-lowering treatment were compared between the two groups. Results Compared with the control statin treatment group, there was a significant reduction in low-density lipoprotein cholesterol in the intensive lipid-lowering treatment group (-20.4±17.1 mg/dL vs. -36.8±17.4 mg/dL, respectively; p<0.001). There were no statistically significant differences in baseline, three-month follow-up, or serial changes of gray-scale intravascular ultrasound parameters between the two groups. The absolute volume of fibro-fatty plaque was significantly reduced in the intensive lipid-lowering treatment group compared with the control group (-1.5±3.4 mm3 vs. 0.8±4.7 mm3, respectively; p=0.024). A linear correlation was found between changes in low-density lipoprotein cholesterol levels and changes in the absolute volumes of fibro-fatty plaque (p<0.001, R2=0.209). Conclusion Modification of coronary plaque may be attainable after only three months of intensive lipid-lowering treatment. PMID:27401638

  17. Massive intravascular hemolysis with mechanical rheolytic thrombectomy of a hemodialysis arteriovenous fistula.

    PubMed

    Carrera, Louis A; Reddy, Rachita; Pamoukian, Vicken N; Michelis, Michael F; DeVita, Maria V; Rosenstock, Jordan

    2013-01-01

    A 57-year-old man with chronic kidney disease stage 5 presented for ambulatory evaluation of his arteriovenous fistula. He underwent rheolytic thrombectomy with tissue plasminogen activator infusion, angioplasty, and brachial artery stenting under local sedation. His immediate postoperative course was complicated by hypotension, cardiac dysrhythmias and hyperkalemia requiring emergent hemodialysis, due to severe intravascular hemolysis. This case illustrates that mechanical thrombectomy can cause clinically significant intravascular hemolysis, thus careful postoperative monitoring is recommended.

  18. Cryptococcus neoformans myositis without dissemination.

    PubMed

    Sharma, Mamta; Khatib, Riad; Jones, Bruce A; Fakih, Mohamad G

    2002-01-01

    We report a case of isolated cryptococcal myositis involving the paraspinal muscle without evidence of disseminated disease in a patient with a large B-cell lymphoma diagnosed at the time of presentation. Biopsy of the muscle involved grew a pure culture of Cryptococcus neoformans and periodic acid-Schiff staining showed numerous budding yeast consistent with Cryptococcus spp. The patient responded to systemic antifungal therapy with complete resolution of his infection. We also present a review of 5 previously published cases of cryptococcal myositis.

  19. Intravascular Large B-Cell Lymphoma: A Difficult Diagnostic Challenge.

    PubMed

    Khan, Maria S; McCubbin, Mark; Nand, Sucha

    2014-01-01

    Case Presentation. A 69-year-old Hispanic male, with a past history of diabetes and coronary disease, was admitted for fever, diarrhea, and confusion of 4 weeks duration. Physical examination showed a disoriented patient with multiple ecchymoses, possible ascites, and bilateral scrotal swelling. Hemoglobin was 6.7, prothrombin time (PT) 21.4 seconds with international normalized ratio 2.1, partial thromboplastin time (PTT) 55.6 seconds, fibrin split 10 µg/L, and lactate dehydrogenase (LDH) 1231 IU/L. Except for a positive DNA test for Epstein-Barr virus (EBV) infection, extensive diagnostic workup for infections, malignancy, or a neurological cause was negative. Mixing studies revealed a nonspecific inhibitor of PT and PTT but Factor VIII levels were normal. The patient was empirically treated with antibiotics but developed hypotension and died on day 27 of admission. At autopsy, patient was found to have intravascular diffuse large B-cell lymphoma involving skin, testes, lung, and muscles. The malignant cells were positive for CD20, CD791, Mum-1, and Pax-5 and negative for CD3, CD5, CD10, CD30, and Bcl-6. The malignant cells were 100% positive for Ki-67. Discussion. Intravascular large cell B-cell lymphoma (IVLBCL) is rare form of diffuse large B-cell lymphoma and tends to proliferate within small blood vessels, particularly capillaries and postcapillary venules. The cause of its affinity for vascular bed remains unknown. In many reports, IVLBCL was associated with HIV, HHV8, and EBV infections. The fact that our case showed evidence of EBV infection lends support to the association of this diagnosis to viral illness. The available literature on this subject is scant, and in many cases, the diagnosis was made only at autopsy. The typical presentation of this disorder is with B symptoms, progressive neurologic deficits, and skin findings. Bone marrow, spleen, and liver are involved in a minority of patients. Nearly all patients have elevated LDH, and about 65% are

  20. Intravascular laser speckle imaging for the mechanical analysis of coronary plaques (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Hosoda, Masaki; Wang, Jing; Tsikudi, Diane; Nadkarni, Seemantini

    2016-02-01

    Acute myocardial infarction is frequently caused by the rupture of coronary plaques with severely compromised viscoelastic properties. We have developed a new optical technology termed intravascular laser speckle imaging (ILSI) that evaluates plaque viscoelastic properties, by measuring the time scale (time constant, τ) of temporally evolving laser speckle fluctuations. To enable coronary evaluation in vivo, an optical ILSI catheter has been developed that accomplishes omni-directional illumination and viewing of the entire coronary circumference without the need for mechanical rotation. Here, we describe the capability of ILSI for evaluating human coronary atherosclerosis in cadaveric hearts. ILSI was conducted in conjunction with optical coherence tomography (OCT) imaging in five human cadaveric hearts. The left coronary artery (LCA), left anterior descending (LAD), left circumflex artery (LCx), and right coronary artery (RCA) segments were resected and secured on custom-developed coronary holders to enable accurate co-registration between ILSI, OCT, and histopathology. Speckle time constants, τ, calculated from each ILSI section were compared with lipid and collagen content measured from quantitative Histopathological analysis of the corresponding Oil Red O and Picrosirius Red stained sections. Because the presence of low viscosity lipid elicits rapid speckle fluctuations, we observed an inverse correlation between τ measured by ILSI and lipid content (R= -0.64, p< 0.05). In contrast, the higher viscoelastic modulus of fibrous regions resulted in a positive correlation between τ and collagen content (R= 0.54, p< 0.05). These results demonstrate the feasibility of conducting ILSI evaluation of arterial mechanical properties using a miniaturized omni-directional catheter.

  1. Intracerebroventricular and Intravascular Injection of Viral Particles and Fluorescent Microbeads into the Neonatal Brain.

    PubMed

    Kawasaki, Hideya; Kosugi, Isao; Sakao-Suzuki, Makiko; Meguro, Shiori; Tsutsui, Yoshihiro; Iwashita, Toshihide

    2016-07-24

    In the study on the pathogenesis of viral encephalitis, the infection method is critical. The first of the two main infectious routes to the brain is the hematogenous route, which involves infection of the endothelial cells and pericytes of the brain. The second is the intracerebroventricular (ICV) route. Once within the central nervous system (CNS), viruses may spread to the subarachnoid space, meninges, and choroid plexus via the cerebrospinal fluid. In experimental models, the earliest stages of CNS viral distribution are not well characterized, and it is unclear whether only certain cells are initially infected. Here, we have analyzed the distribution of cytomegalovirus (CMV) particles during the acute phase of infection, termed primary viremia, following ICV or intravascular (IV) injection into the neonatal mouse brain. In the ICV injection model, 5 µl of murine CMV (MCMV) or fluorescent microbeads were injected into the lateral ventricle at the midpoint between the ear and eye using a 10-µl syringe with a 27 G needle. In the IV injection model, a 1-ml syringe with a 35 G needle was used. A transilluminator was used to visualize the superficial temporal (facial) vein of the neonatal mouse. We infused 50 µl of MCMV or fluorescent microbeads into the superficial temporal vein. Brains were harvested at different time points post-injection. MCMV genomes were detected using the in situ hybridization method. Fluorescent microbeads or green fluorescent protein expressing recombinant MCMV particles were observed by fluorescent microscopy. These techniques can be applied to many other pathogens to investigate the pathogenesis of encephalitis.

  2. Angioplasty Guided by Intravascular Ultrasound: Meta-Analysis of Randomized Clinical Trials

    PubMed Central

    de Figueiredo, José Albuquerque; Nogueira, Iara Antonia Lustosa; Figueiro, Mabel Fernandes; Buehler, Anna Maria; Berwanger, Otavio

    2013-01-01

    Background The impact of intravascular ultrasound (IVUS) use on stenting has shown inconclusive results. Objective Systematic review and meta-analysis of the impact of IVUS on stenting regarding the clinical and angiographic evolution. Methods A search was performed in Medline/Pubmed, CENTRAL, Embase, Lilacs, Scopus and Web of Science databases. It included randomized clinical trials (RCTs) that evaluated the implantation of stents guided by IVUS, compared with those using angiography alone (ANGIO). The minimum follow-up duration was six months and the following outcomes were assessed: thrombosis, mortality, myocardial infarction, percutaneous and surgical revascularization, major adverse cardiovascular events (MACE) and restenosis. The binary outcomes were presented considering the number of events in each group; the estimates were generated by a random effects model, considering Mantel-Haenszel statistics as weighting agent and magnitude of effect for the relative risk (RR) with its respective 95% confidence interval (95%CI). Higgins I2 test was used to quantify the consistency between the results of each study. Results A total of 2,689 articles were evaluated, including 8 RCTs. There was a 27% reduction in angiographic restenosis (RR: 0.73, 95% CI: 0.54-0.97, I2 = 51%) and statistically significant reduction in the rates of percutaneous revascularization and overall (RR: 0.88; 95% CI: 0.51 to 1.53, I2 = 61%, RR: 0.73, 95% CI: 0.54 to 0.99, I2 = 55%), with no statistical difference in surgical revascularization (RR: 0.95, 95% CI: 0.52-1.74, I2 = 0%) in favor of IVUS vs. ANGIO. There were no differences regarding the other outcomes in the comparison between the two strategies. Conclusion Angioplasty with stenting guided by IVUS decreases the rates of restenosis and revascularization, with no impact on MACE, acute myocardial infarction, mortality or thrombosis outcomes. PMID:23821407

  3. Acute Kidney Injury and Rhabdomyolysis after Protobothrops flavoviridis Bite: A Retrospective Survey of 86 Patients in a Tertiary Care Center

    PubMed Central

    Nishimura, Hiroaki; Enokida, Hideki; Kawahira, Shuichirou; Kagara, Ichiro; Hayami, Hiroshi; Nakagawa, Masayuki

    2016-01-01

    Acute kidney injury (AKI) is the main cause of death for victims of hematoxic snakebites. A few studies have described improvement in AKI rates in snakebite cases, but the reasons for the improvement have not been investigated. Eighty-six patients with Protobothrops flavoviridis bites admitted to a single center from January 2003 through March 2014 were included in the study. Clinical variables, including age, sex, blood pressure (BP), and serum creatinine (S-Cre), on admission were compared between patients with and without AKI. One patient died of disseminated intravascular coagulation following AKI (mortality rate 1.1%). Six patients developed AKI with rhabdomyolysis. Systolic BP, S-Cre, serum creatine kinase, white blood cell count, and platelet count differed significantly between the AKI and non-AKI groups (P = 0.01). Three of the six patients were physically challenged to a degree that made it difficult for them to move or communicate, and these difficulties likely exacerbated the severity of snakebite complications. Our study demonstrated that the risk of snakebite-induced AKI for physically challenged patients was high. To further reduce mortality due to snakebite-induced AKI, we need to make it possible for physically challenged patients to receive first aid sooner. PMID:26643529

  4. Disseminated necrotic mediastinitis spread from odontogenic abscess: our experience

    PubMed Central

    Filiaci, Fabio; Riccardi, Emiliano; Mitro, Valeria; Piombino, Pasquale; Rinna, Claudio; Agrillo, Alessandro; Ungari, Claudio

    2015-01-01

    Summary Aims Deep neck infections are rare but potentially fatal complication of pulpal abscess of the teeth. If an infection can progress rapidly from a toothache to a life threatening infection, then it is critical that dentists be able to recognize the danger signs and identify the patients who are at risk. Mediastinitis is a severe inflammatory process involving the connective tissues that fills the intracellular spaces and surrounds the organs in the middle of the chest. This pathology has both an acute and a chronic form and, in most cases, it has an infectious etiology. This study want to expose the experience acquired in the Oral and Maxillo-facial Sciences Department, Policlinico Umberto I, “Sapienza” University of Rome, regarding two clinical cases of disseminated necrotizing mediastinitis starting from an odontogenic abscess. Methods We report two clinical cases of disseminated necrotic mediastinitis with two different medical and surgical approaches. The radiographic and photographic documentation of the patients was collected in the pre-and post-operatively. All patients underwent a CT scan and MRI. Results Mediastinitis can result from a serious odontogenic abscess, and the extent of its inflammation process must be never underestimated. Dental surgeons play a key role as a correct diagnosis can prevent further increasing of the inflammation process. Conclusions A late diagnosis and an inadequate draining represent the major causes of the elevated mortality rate of disseminated necrotizing mediastinitis. PMID:26330907

  5. Acoustic determination of early stages of intravascular blood coagulation.

    PubMed

    Uzlova, Svetlana G; Guria, Konstantin G; Guria, Georgy Th

    2008-10-13

    The blood coagulation system (BCS) is a complex biological system playing a principal role in the maintenance of haemostasis. Insufficient activity of the BCS may lead to bleeding and blood loss (e.g. in the case of haemophilia). On the other hand, excessive activity may cause intravascular blood coagulation, thromboses and embolization. Most of the methods currently used for BCS monitoring suffer from the major disadvantage of being invasive. The purpose of the present work is to demonstrate the feasibility of using ultrasonic methods for non-invasive registration of the early stages of blood coagulation processes in intensive flows. With this purpose, a special experimental set-up was designed, facilitating the simultaneous detection of optical and acoustic signals during the clotting process. It was shown that (i) as microemboli appear in the flow during the early stage of blood coagulation, the intensity of the Doppler signal increases twofold, and (ii) microemboli formation in the early stages of blood clotting always reveals itself through an acoustic contrast. Both of these effects are well defined, so we hope that they may be used for non-invasive BCS monitoring in clinical practice.

  6. Monolithic CMUT on CMOS Integration for Intravascular Ultrasound Applications

    PubMed Central

    Zahorian, Jaime; Hochman, Michael; Xu, Toby; Satir, Sarp; Gurun, Gokce; Karaman, Mustafa; Degertekin, F. Levent

    2012-01-01

    One of the most important promises of capacitive micromachined ultrasonic transducer (CMUT) technology is integration with electronics. This approach is required to minimize the parasitic capacitances in the receive mode, especially in catheter based volumetric imaging arrays where the elements need to be small. Furthermore, optimization of the available silicon area and minimized number of connections occurs when the CMUTs are fabricated directly above the associated electronics. Here, we describe successful fabrication and performance evaluation of CMUT arrays for intravascular imaging on custom designed CMOS receiver electronics from a commercial IC foundry. The CMUT on CMOS process starts with surface isolation and mechanical planarization of the CMOS electronics to reduce topography. The rest of the CMUT fabrication is achieved by modifying a low temperature micromachining process through the addition of a single mask and developing a dry etching step to produce sloped sidewalls for simple and reliable CMUT to CMOS interconnection. This CMUT to CMOS interconnect method reduced the parasitic capacitance by a factor of 200 when compared with a standard wire bonding method. Characterization experiments indicate that the CMUT on CMOS elements are uniform in frequency response and are similar to CMUTs simultaneously fabricated on standard silicon wafers without electronics integration. Experiments on a 1.6 mm diameter dual-ring CMUT array with a 15 MHz center frequency show that both the CMUTs and the integrated CMOS electronics are fully functional. The SNR measurements indicate that the performance is adequate for imaging CTOs located 1 cm away from the CMUT array. PMID:23443701

  7. Heartbeat OCT: in vivo intravascular megahertz-optical coherence tomography.

    PubMed

    Wang, Tianshi; Pfeiffer, Tom; Regar, Evelyn; Wieser, Wolfgang; van Beusekom, Heleen; Lancee, Charles T; Springeling, Geert; Krabbendam, Ilona; van der Steen, Antonius F W; Huber, Robert; van Soest, Gijs

    2015-12-01

    Cardiac motion artifacts, non-uniform rotational distortion and undersampling affect the image quality and the diagnostic impact of intravascular optical coherence tomography (IV-OCT). In this study we demonstrate how these limitations of IV-OCT can be addressed by using an imaging system that we called "Heartbeat OCT", combining a fast Fourier Domain Mode Locked laser, fast pullback, and a micromotor actuated catheter, designed to examine a coronary vessel in less than one cardiac cycle. We acquired in vivo data sets of two coronary arteries in a porcine heart with both Heartbeat OCT, working at 2.88 MHz A-line rate, 4000 frames/s and 100 mm/s pullback speed, and with a commercial system. The in vivo results show that Heartbeat OCT provides faithfully rendered, motion-artifact free, fully sampled vessel wall architecture, unlike the conventional IV-OCT data. We present the Heartbeat OCT system in full technical detail and discuss the steps needed for clinical translation of the technology.

  8. Heartbeat OCT: in vivo intravascular megahertz-optical coherence tomography

    PubMed Central

    Wang, Tianshi; Pfeiffer, Tom; Regar, Evelyn; Wieser, Wolfgang; van Beusekom, Heleen; Lancee, Charles T.; Springeling, Geert; Krabbendam, Ilona; van der Steen, Antonius F.W.; Huber, Robert; van Soest, Gijs

    2015-01-01

    Cardiac motion artifacts, non-uniform rotational distortion and undersampling affect the image quality and the diagnostic impact of intravascular optical coherence tomography (IV-OCT). In this study we demonstrate how these limitations of IV-OCT can be addressed by using an imaging system that we called “Heartbeat OCT”, combining a fast Fourier Domain Mode Locked laser, fast pullback, and a micromotor actuated catheter, designed to examine a coronary vessel in less than one cardiac cycle. We acquired in vivo data sets of two coronary arteries in a porcine heart with both Heartbeat OCT, working at 2.88 MHz A-line rate, 4000 frames/s and 100 mm/s pullback speed, and with a commercial system. The in vivo results show that Heartbeat OCT provides faithfully rendered, motion-artifact free, fully sampled vessel wall architecture, unlike the conventional IV-OCT data. We present the Heartbeat OCT system in full technical detail and discuss the steps needed for clinical translation of the technology. PMID:26713214

  9. Intra-Vascular Neural Interface with Nano-Wire Electrode

    NASA Astrophysics Data System (ADS)

    Watanabe, Hirobumi; Takahashi, Hirokazu; Nakao, Masayuki; Walton, Kerry; Llinás, Rodolfo R.

    A less-invasive recording technique capable of simultaneously monitoring the activity of significant number (103 ∼ 104) of neurons is a vital step in developing an effective brain-machine interface. Although there are many excellent techniques for recording activities of a single neuron or a group of neurons, there is no methodology for accessing large number of cells in a behaving experimental animal or human individual. Brain vascular parenchyma offers the promising candidate to solve this problem. We have proposed the use of myriad of nano-wire-electrodes that are introduced into the Central Nervous System through the vascular system to address any brain area. In this study we design a microcatheter for ex vivo experiments. Using a Wollaston platinum wire we design a submicron-scale electrode, and develop the fabrication method. We then evaluate the mechanical property of the electrode to flow into the intricacies of the capillary bed in ex vivo Xenopus laevis. Furthermore, we demonstrate the feasibility of intravascular recording in the spinal cord of Xenopus laevis.

  10. Light intensity matching between different intravascular optical coherence tomography systems

    NASA Astrophysics Data System (ADS)

    Liu, Shengnan; Eggermont, Jeroen; Nakatani, Shimpei; Lelieveldt, Boudewijn P. F.; Dijkstra, Jouke

    2016-02-01

    Currently two commercial intravascular optical coherence tomography (IVOCT) systems are available: Illumien Optis from St. Jude Medical (SJM) and Lunawave from Terumo. Both systems store the light intensity data in a raw vendor specific polar format. However, whereas SJM uses 16-bits per pixel Terumo uses 8-bits meaning the intensity values are in different ranges. This complicates quantitative light intensity based analysis when comparing results based on data from both systems. Therefore, this work aims to find an intensity transformation function from Terumo's 8-bit OFDI data to SJM's 16-bit range. The data consists of 8 pullbacks, 4 acquired with each system in the same arteries of 2 different patents pre- and post-stenting implantation. A total of 133 matching sections without stent struts from the two sets of pullbacks were identified based on landmarks such as side-branches and calcified regions. Since the main region of interest in the image is the tissue region only the pixels within 2mm behind the lumen border are used. In order to match the SJM data range, the Terumo data was rescaled and cumulative distribution functions (CDF) were calculated based on the histogram distributions. Comparing these CDFs, the transformation function can be determined. Application of this transformation function not only improves the visual similarity of matching slices it can also be used for further quantitative analysis.

  11. Cerebral Blood Volume MRI with Intravascular Superparamagentic Iron Oxide Nanoparticles

    PubMed Central

    Kim, Seong-Gi; Harel, Noam; Jin, Tao; Kim, Tae; Lee, Phil; Zhao, Fuqiang

    2013-01-01

    Cerebral blood volume (CBV) is a crucial physiological indicator of tissue viability and vascular reactivity. Thus, non-invasive CBV mapping has been of great interest. For this, ultrasmall superparamagnetic iron oxide nanoparticles (USPIO) including monocrystalline iron oxide nanoparticles (MION) can be used as long half-life, intravascular susceptibility agents of CBV MRI measurements. Also, CBV-weighted fMRI with USPIO provides enhanced sensitivity, reduced large vessel contribution, and improved spatial specificity compared to conventional blood oxygenation-level dependent (BOLD) fMRI, and measures a single physiological parameter that is easily interpretable. We review physiochemical and magnetic properties as well as pharmacokinetics of USPIO in brief. We then extensively discuss quantifications of baseline CBV, vessel size index, and functional CBV change. We also provide reviews of dose-dependent sensitivity, vascular filter function, specificity, characteristics, and impulse response function of CBV fMRI. Examples of CBV fMRI specificity at the laminar and columnar resolution are provided. Finally, we briefly review application of CBV measurements to functional and pharmacological studies in animals. Overall, the use of USPIO can determine baseline CBV and its changes induced by functional activity and pharmacological interventions. PMID:23208650

  12. Biochemistry and pathophysiology of intravascular and intracellular lipolysis

    PubMed Central

    Young, Stephen G.; Zechner, Rudolf

    2013-01-01

    All organisms use fatty acids (FAs) for energy substrates and as precursors for membrane and signaling lipids. The most efficient way to transport and store FAs is in the form of triglycerides (TGs); however, TGs are not capable of traversing biological membranes and therefore need to be cleaved by TG hydrolases (“lipases”) before moving in or out of cells. This biochemical process is generally called “lipolysis.” Intravascular lipolysis degrades lipoprotein-associated TGs to FAs for their subsequent uptake by parenchymal cells, whereas intracellular lipolysis generates FAs and glycerol for their release (in the case of white adipose tissue) or use by cells (in the case of other tissues). Although the importance of lipolysis has been recognized for decades, many of the key proteins involved in lipolysis have been uncovered only recently. Important new developments include the discovery of glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1 (GPIHBP1), the molecule that moves lipoprotein lipase from the interstitial spaces to the capillary lumen, and the discovery of adipose triglyceride lipase (ATGL) and comparative gene identification-58 (CGI-58) as crucial molecules in the hydrolysis of TGs within cells. This review summarizes current views of lipolysis and highlights the relevance of this process to human disease. PMID:23475957

  13. Procoagulant activity of extracellular vesicles as a potential biomarker for risk of thrombosis and DIC in patients with acute leukaemia.

    PubMed

    Gheldof, Damien; Haguet, Hélène; Dogné, Jean-Michel; Bouvy, Céline; Graux, Carlos; George, Fabienne; Sonet, Anne; Chatelain, Christian; Chatelain, Bernard; Mullier, François

    2017-02-01

    Haemostatic complication is common for patients with hematologic malignancies. Recent studies suggest that the procoagulant activity (PCA) of extracellular vesicles (EV) may play a major role in venous thromboembolism and disseminated intravascular coagulation (DIC) in acute leukaemia. To study the impact of EVs from leukaemic patients on thrombin generation and to assess EV-PCA as a potential biomarker for thrombotic complications in patients with acute leukaemia. Blood samples from a cohort of patients with newly diagnosed acute leukaemia were obtained before treatment (D-0), 3 and 7 days after treatment (D-3 and D-7). Extracellular vesicles were isolated and concentrated by ultracentrifugation. EV-PCA was assessed by thrombin generation assay, and EV-associated tissue factor activity was measured using a commercial bio-immunoassay (Zymuphen MP-TF®). Of the 53 patients, 6 had increased EV-PCA at D-0 and 4 had a thrombotic event. Patients without thrombotic events (n = 47) had no elevated EV-PCA. One patient had increased EVs with procoagulant activity at D-3 and developed a DIC at D-5. This patient had no increased EVs-related tissue factor activity from D-0 to D-7 (<2 pg/ml). Eight patients had increased EVs with tissue factor activity (>2 pg/ml), of these, four had a thrombosis and two had haemorrhages. Procoagulant activity of extracellular vesicles could have a predictive value in excluding the risk of thrombotic events. Our findings also suggest a possible association between thrombotic events and EV-PCA.

  14. Weather dissemination and public usage

    NASA Technical Reports Server (NTRS)

    Stacey, M. S.

    1973-01-01

    The existing public usage of weather information was examined. A survey was conducted to substantiate the general public's needs for dissemination of current (0-12 hours) weather information, needs which, in a previous study, were found to be extensive and urgent. The goal of the study was to discover how the general public obtains weather information, what information they seek and why they seek it, to what use this information is put, and to further ascertain the public's attitudes and beliefs regarding weather reporting and the diffusion of weather information. Major findings from the study include: 1. The public has a real need for weather information in the 0-6 hour bracket. 2. The visual medium is preferred but due to the lack of frequent (0-6 hours) forecasts, the audio media only, i.e., telephone recordings and radio weathercasts, were more frequently used. 3. Weather information usage is sporadic.

  15. NIST Mechanisms for Disseminating Measurements

    PubMed Central

    Gills, T. E.; Dittman, S.; Rumble, J. R.; Brickenkamp, C. S.; Harris, G. L.; Trahey, N. M.

    2001-01-01

    The national responsibilities assigned to the National Bureau of Standards (NBS) early in the last century for providing measurement assistance and service are carried out today by the four programs that comprise the National Institute of Standards and Technology (NIST) Office of Measurement Services (OMS). They are the Calibration Program (CP), the Standard Reference Materials Program (SRMP), the Standard Reference Data Program (SRDP), and the Weights and Measures Program (W&MP). Organized when the U.S. Congress changed the NBS name to NIST, the OMS facilitates access to the measurement and standards activities of NIST laboratories and programs through the dissemination of NIST products, data, and services. A brief historical introduction followed by a perspective of pivotal measurement developments from 1901 to the present and concluding with a look to the future of NIST measurement services in the next decade of the new millennium are presented for each OMS program. PMID:27500025

  16. Acute Arterial Thrombosis of the Hand.

    PubMed

    Iannuzzi, Nicholas P; Higgins, James P

    2015-10-01

    Arterial thrombosis of the hand occurs infrequently but may result in considerable morbidity and compromise of hand function. The hand surgeon may be called upon to direct management in cases of acute arterial thrombosis of the hand and should have an understanding of the available diagnostic tools and treatment modalities. This article discusses the vascular anatomy of the hand and clinical manifestations of arterial thrombosis. Differences between isolated thrombosis and diffuse intravascular injury are detailed, and treatment options for these conditions are described. Appropriate care often requires coordination with interventional radiologists or vascular surgeons. Outcomes after treatment of arterial thrombosis of the hand are variable, and prognosis may be related to whether isolated thrombosis or diffuse intravascular injury is present.

  17. Acute Inhalation Toxicity of Pyrotechnically Disseminated Terephthalic Acid

    DTIC Science & Technology

    1988-07-01

    calcium concentrations in the bladder, followed by urolithiasis with irritation induced hyperplasia and neoplasms. However, these effects only occur...R.W., Popp, J.A., Heck, H., "Chemical Urolithiasis , 1. Characteristics of Bladder Stone Induction by Terephthalic Acid and Dimethyl Terephthalate in

  18. Acute Inhalation of Explosively Disseminated Carbon Fibers in Rats

    DTIC Science & Technology

    1994-05-01

    test), rodent bone marrow micronucleus assay, and the chromosome aberrations assay in Chinese hamster ovary (CHO) cells. 2.10 Data Analysis Plan...Pathology Associates. 3.6 Mutagenicitv Assays. Extracts of the exploded carbon fibers were tested in the Ames, Mouse Micronucleus, and the CHO Chromosome ...the last decade, the analysis of micronuclei (HN) has gained increased popularity as an alternative to classical chromosomal aberration analysis for

  19. STUDIES ON ACUTE DISSEMINATED ENCEPHALOMYELITIS PRODUCED EXPERIMENTALLY IN RHESUS MONKEYS

    PubMed Central

    Lumsden, Charles E.; Kabat, Elvin A.; Wolf, Abner; Bezer, Ada E.

    1950-01-01

    1. Animals injected with emulsions of monkey brain with adjuvants show a complex pattern of antibody response as determined by complement fixation tests. 2. Organ-specific complement-fixing antibodies to constituents of brain tissue may be formed which fix complement with brain tissues of various animal species but fail to react with other organs or with rabbit placenta. 3. Antibodies may be formed to some constituent of brain other than nervous tissue. It would seem that these can be detected by the strong complement fixation given with rabbit placenta. 4. Sera from individual animals may contain antibodies to the brain or placenta constituents, to both, or to neither. Occasional individual sera show unique patterns of antibody response as determined with various additional antigens such as fetal brain, posterior pituitary, or peripheral nerves. 5. No evidence of any etiological relationship between the development of encephalomyelitis and the complement-fixing antibodies to brain demonstrable in the sera could be found. The complement-fixing antibody to the placental constituent was unrelated to the encephalomyelitis. PMID:15436935

  20. Calculation of intravascular signal in dynamic contrast enhanced-MRI using adaptive complex independent component analysis.

    PubMed

    Mehrabian, Hatef; Chopra, Rajiv; Martel, Anne L

    2013-04-01

    Assessing tumor response to therapy is a crucial step in personalized treatments. Pharmacokinetic (PK) modeling provides quantitative information about tumor perfusion and vascular permeability that are associated with prognostic factors. A fundamental step in most PK analyses is calculating the signal that is generated in the tumor vasculature. This signal is usually inseparable from the extravascular extracellular signal. It was shown previously using in vivo and phantom experiments that independent component analysis (ICA) is capable of calculating the intravascular time-intensity curve in dynamic contrast enhanced (DCE)-MRI. A novel adaptive complex independent component analysis (AC-ICA) technique is developed in this study to calculate the intravascular time-intensity curve and separate this signal from the DCE-MR images of tumors. The use of the complex-valued DCE-MRI images rather than the commonly used magnitude images satisfied the fundamental assumption of ICA, i.e., linear mixing of the sources. Using an adaptive cost function in ICA through estimating the probability distribution of the tumor vasculature at each iteration resulted in a more robust and accurate separation algorithm. The AC-ICA algorithm provided a better estimate for the intravascular time-intensity curve than the previous ICA-based method. A simulation study was also developed in this study to realistically simulate DCE-MRI data of a leaky tissue mimicking phantom. The passage of the MR contrast agent through the leaky phantom was modeled with finite element analysis using a diffusion model. Once the distribution of the contrast agent in the imaging field of view was calculated, DCE-MRI data was generated by solving the Bloch equation for each voxel at each time point. The intravascular time-intensity curve calculation results were compared to the previously proposed ICA-based intravascular time-intensity curve calculation method that applied ICA to the magnitude of the DCE-MRI data

  1. Fatal disseminated toxoplasmosis in an immunocompetent cat.

    PubMed

    Nagel, Susanna S; Williams, June H; Schoeman, Johannes P

    2013-02-14

    A 10-year-old domestic short hair cat was referred for investigation of anorexia and polydipsia of 3 days' duration. Clinically the cat was obese, pyrexic (39.8 °C), had acute abdominal pain and severe bilirubinuria. Haematology and serum biochemistry revealed severe panleukopenia, thrombocytopenia, markedly elevated alanine aminotransferase (ALT) and five-fold increased pre-prandial bile acids. Ultrasonographic evaluation of the abdomen did not identify any abnormalities. Serum tests for feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) were negative. Broad-spectrum antibiotic treatment for infectious hepatitis was to no avail; the cat deteriorated and died 72 h after admission. Necropsy revealed mild icterus and anaemia, severe multifocal hepatic necrosis, serofibrinous hydrothorax, pulmonary oedema and interstitial pneumonia. Histopathology confirmed the macroscopic findings and revealed multifocal microgranulomata in the brain and myocardium, as well as areas of necrosis in lymph nodes and multifocally in splenic red pulp. Long bone shaft marrow was hyperplastic with a predominance of leukocyte precursors and megakaryocytes and splenic red pulp showed mild extramedullary haemopoiesis. Immunohistochemical staining for Toxoplasma gondii was strongly positive, with scattered cysts and tachyzoites in the liver, lymph nodes, spleen, lungs, brain, salivary glands and intracellularly in round cells in occasional blood vessels. Immunohistochemical staining for corona virus on the same tissues was negative, ruling out feline infectious peritonitis (FIP). Polymerase chain reaction (PCR) on formalin-fixed paraffin-wax embedded tissues was positive for Toxoplasma sp., but attempts at sequencing were unsuccessful. This was the first case report of fulminant disseminated toxoplasmosis in South Africa, in which detailed histopathology in an apparently immunocompetent cat was described.

  2. 14 CFR 1203.303 - Dissemination considerations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Dissemination considerations. 1203.303... PROGRAM Classification Principles and Considerations § 1203.303 Dissemination considerations. The degree... effective security control impractical are considerations during the classification process. These...

  3. 14 CFR 1203.303 - Dissemination considerations.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Dissemination considerations. 1203.303 Section 1203.303 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION INFORMATION SECURITY PROGRAM Classification Principles and Considerations § 1203.303 Dissemination considerations. The...

  4. 14 CFR 1203.303 - Dissemination considerations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Dissemination considerations. 1203.303 Section 1203.303 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION INFORMATION SECURITY PROGRAM Classification Principles and Considerations § 1203.303 Dissemination considerations. The...

  5. 14 CFR 1203.303 - Dissemination considerations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Dissemination considerations. 1203.303 Section 1203.303 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION INFORMATION SECURITY PROGRAM Classification Principles and Considerations § 1203.303 Dissemination considerations. The...

  6. The Tenth National Dissemination Conference. A Report.

    ERIC Educational Resources Information Center

    Herlig, Richard K.

    This report on the Tenth National Dissemination Conference of 1977 outlines the purposes of the conference and summarizes the present state of educational information dissemination. National programs are described, including the National Institute of Education State Capacity Building Program, the National Diffusion Network, the Dissemination…

  7. Curriculum Dissemination as Planned Cultural Diffusion.

    ERIC Educational Resources Information Center

    Rudduck, Jean

    The author traces the change from the use of the term "diffusion" to the term "dissemination" with reference to curriculum projects in Britain and discusses implications of the change. Although at one time the two terms were used interchangeably, the term "dissemination" now emphasizes techniques of effective management rather than the educational…

  8. Producing Dissemination Materials. Final Draft Version.

    ERIC Educational Resources Information Center

    Degener, David, Comp.; And Others

    This manual is intended to help projects approved by the Joint Dissemination Review Panel produce materials that will support their dissemination activities. Specifically directed toward career education projects, it should be equally useful for other projects. Section 1 discusses diffusion/adoption and these topics regarding materials: purpose,…

  9. Federal Mechanisms to Support Intervention Dissemination

    ERIC Educational Resources Information Center

    Diana, Augusto; Bennett, Nicole

    2015-01-01

    This paper examines federal mechanisms that support program developers and researchers in disseminating effective interventions for public benefit. The purpose of this paper is not to discuss the dissemination of intervention research (i.e., how to inform stakeholders about research findings), nor is it intended to discuss the research of…

  10. 34 CFR 75.192 - Dissemination.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... of Curricula Or Instructional Materials § 75.192 Dissemination. If an applicant proposes to publish and disseminate curricula or instructional materials under a grant, the applicant shall include an assurance in its application that the curricula or materials will reach the populations for which...

  11. Disseminated Mycobacterium chimaera Infection After Cardiothoracic Surgery.

    PubMed

    Tan, Nicholas; Sampath, Rahul; Abu Saleh, Omar M; Tweet, Marysia S; Jevremovic, Dragan; Alniemi, Saba; Wengenack, Nancy L; Sampathkumar, Priya; Badley, Andrew D

    2016-09-01

    Ten case reports of disseminated Mycobacterium chimaera infections associated with cardiovascular surgery were published from Europe. We report 3 cases of disseminated M chimaera infections with histories of aortic graft and/or valvular surgery within the United States. Two of 3 patients demonstrated ocular involvement, a potentially important clinical finding.

  12. Wisconsin Dissemination Planning Project. Final Report.

    ERIC Educational Resources Information Center

    Harmatuck, Loretta

    Activities of the final year are reported as they relate to the objectives of the Wisconsin Dissemination Planning (WDP) Project: (1) to develop a plan for coordination among the dissemination functions in the Department of Public Instruction (DPI) through a state-wide steering committee; (2) to complete a needs assessment for dissemination…

  13. HHV-8 and EBV-positive intravascular lymphoma: an unusual presentation of extracavitary primary effusion lymphoma

    PubMed Central

    Crane, Genevieve M.; Ambinder, Richard F.; Shirley, Courtney M.; Fishman, Elliot K.; Kasamon, Yvette L.; Taube, Janis M.; Borowitz, Michael J.; Duffield, Amy S.

    2014-01-01

    Intravascular lymphomas are rare and aggressive hematolymphoid tumors. Here we describe a human herpesvirus type-8/Kaposi sarcoma-associated herpesvirus (HHV-8/KSHV) and Epstein-Barr virus (EBV) positive intravascular lymphoma. The patient was a 59 year-old HIV-positive man who presented with diarrhea, abdominal pain, fevers, night sweats, and weight loss. Radiographic studies of the abdomen and pelvis revealed numerous subcentimeter nodules within the subcutaneous fat that lacked connection to the skin. An excisional biopsy demonstrated large atypical cells within vessels in the deep subcutaneous fat, and many of the vessels contained extensive organizing thrombi. The atypical cells lacked strong expression of most B-cell markers but were positive for MUM-1 and showed partial expression of several T-cell markers. An immunohistochemical stain for HHV-8 and an in situ hybridization for EBV were both positive in the neoplastic cells. The disease had a rapidly progressive and fatal course. This lymphoma appears to represent an entirely intravascular form of primary effusion lymphoma, and highlights the propensity for HHV-8 and EBV-positive lymphoid neoplasms to show aberrant expression of T-cell markers, illustrates the utility of skin biopsies for the diagnosis of intravascular lymphoma, and suggests that biopsies to evaluate for intravascular lymphoma should be relatively deep and include subcutaneous fat. PMID:24525514

  14. Platelets and neutrophil extracellular traps collaborate to promote intravascular coagulation during sepsis in mice.

    PubMed

    McDonald, Braedon; Davis, Rachelle P; Kim, Seok-Joo; Tse, Mandy; Esmon, Charles T; Kolaczkowska, Elzbieta; Jenne, Craig N

    2017-03-09

    Neutrophil extracellular traps (NETs; webs of DNA coated in antimicrobial proteins) are released into the vasculature during sepsis where they contribute to host defense, but also cause tissue damage and organ dysfunction. Various components of NETs have also been implicated as activators of coagulation. Using multicolor confocal intravital microscopy in mouse models of sepsis, we observed profound platelet aggregation, thrombin activation, and fibrin clot formation within (and downstream of) NETs in vivo. NETs were critical for the development of sepsis-induced intravascular coagulation regardless of the inciting bacterial stimulus (gram-negative, gram-positive, or bacterial products). Removal of NETs via DNase infusion, or in peptidylarginine deiminase-4-deficient mice (which have impaired NET production), resulted in significantly lower quantities of intravascular thrombin activity, reduced platelet aggregation, and improved microvascular perfusion. NET-induced intravascular coagulation was dependent on a collaborative interaction between histone H4 in NETs, platelets, and the release of inorganic polyphosphate. Real-time perfusion imaging revealed markedly improved microvascular perfusion in response to the blockade of NET-induced coagulation, which correlated with reduced markers of systemic intravascular coagulation and end-organ damage in septic mice. Together, these data demonstrate, for the first time in an in vivo model of infection, a dynamic NET-platelet-thrombin axis that promotes intravascular coagulation and microvascular dysfunction in sepsis.

  15. Percutaneous Retrieval of Misplaced Intravascular Foreign Objects with the Dormia Basket: An Effective Solution

    SciTech Connect

    Sheth, Rahul Someshwar, Vimal; Warawdekar, Gireesh

    2007-02-15

    Purpose. We report our experience of the retrieval of intravascular foreign body objects by the percutaneous use of the Gemini Dormia basket. Methods. Over a period of 2 years we attempted the percutaneous removal of intravascular foreign bodies in 26 patients. Twenty-six foreign bodies were removed: 8 intravascular stents, 4 embolization coils, 9 guidewires, 1 pacemaker lead, and 4 catheter fragments. The percutaneous retrieval was achieved with a combination of guide catheters and the Gemini Dormia basket. Results. Percutaneous retrieval was successful in 25 of 26 patients (96.2%). It was possible to remove all the intravascular foreign bodies with a combination of guide catheters and the Dormia basket. No complication occurred during the procedure, and no long-term complications were registered during the follow-up period, which ranged from 6 months to 32 months (mean 22.4 months overall). Conclusion. Percutaneous retrieval is an effective and safe technique that should be the first choice for removal of an intravascular foreign body.

  16. Extraforaminal needle tip position reduces risk of intravascular injection in CT-fluoroscopic lumbar transforaminal epidural steroid injections

    PubMed Central

    Yu, Robinson K.; Ghodadra, Anish; Agarwal, Vikas

    2016-01-01

    Background Lumbar transforaminal epidural steroid injection is a common and effective tool for managing lumbar radicular pain, although accidental intravascular injection can rarely result in paralysis. The purpose of this study is to determine the safest needle tip position for computed tomography (CT)-guided lumbar transforaminal epidural steroid injections as determined by incidence of intravascular injection. Methods Three radiologists, in consensus, reviewed procedural imaging for consecutive CT-fluoroscopic lumbar transforaminal epidural steroid injections performed during a 16-month period. Intravascular injections were identified and categorized by needle tip position, vessel type injected, intravascular injection volume and procedural phase containing the intravascular injection. Pearson chi-square and logistic regression testing were used to assess differences between groups, as appropriate. Results Intravascular injections occurred in 9% (52/606) of injections. The intravascular injection rate was significantly lower (P<0.001) for extraforaminal needle position (0%, 0/109) compared to junctional (8%, 27/319) and foraminal (14%, 25/178) needle tip positions. Of the intravascular injections, 4% (2/52) were likely arterial, 35% (18/52) were likely venous, and 62% (32/52) were indeterminate for vessel type injected. 46% (24/52) of intravascular injections were large volume, 33% (17/52) were small volume, and 21% (11/52) were trace volume. 56% (29/52) of intravascular injections occurred with the contrast trial dose, 29% (15/52) with the steroid/analgesic cocktail, and 15% (8/52) with both. Conclusions An extraforaminal needle position for CT-fluoroscopic lumbar transforaminal epidural steroid injections decreases the risk of intravascular injection and therefore may be safer than other needle tip positions. PMID:28097241

  17. Acute renal failure in pregnancy: our experience.

    PubMed

    Aggarwal, Rohina S; Mishra, Vineet V; Jasani, Anil F; Gumber, Manoj

    2014-03-01

    Acute renal failure (ARF) is a serious medical complication during pregnancy, and, in the post-partum period, is associated with significant maternal morbidity and mortality as well as fetal loss. The objective of our study is to find the etiology and maternal outcome of ARF during pregnancy. The study was conducted at the Obstetrics and Gynecology Department of the Institute of Kidney Disease and Research Center, Ahmedabad, India from January 2009 to January 2011. Fifty previously healthy patients who developed ARF, diagnosed on oliguria and serum creatinine >2 mg%, were included in the study. Patients with a known history of renal disease, diabetes and hypertension were excluded from the study. All patients were followed-up for a period of six months. Patient re-cords, demographic data, urine output on admission and preceding history of antepartum hemorrhage (APH), post-partum hemorrhage (PPH), septicemia, operative interventions and retained product of conception were noted and need for dialysis was considered. Patients were thoroughly examined and baseline biochemical investigations and renal and obstetrical ultrasound were performed on each patient and bacterial culture sensitivity on blood, urine or vaginal swabs were performed in selected patients. The age range was 19-38 years (mean 26 ± 3.8). The first trimester, second trimester and puerperal groups comprised of four (8%), 25 (50%) and 21 patients (42%), respectively. Hemorrhage was the etiology for ARF in 15 (30%), APH in ten (20%) and PPH in five (10%) patients. Eleven (22%) patients had lower segment cesarian section (LSCS) while 36 (78%) patients had normal vaginal delivery. In 20 (40%) patients, puerperal sepsis was the etiological factor, while pre-eclampsia, eclampsia and HELLP syndrome accounted for 18 (36%) patients. Two (4%) patients had disseminated intravascular coagulation on presentation while one (2%) patient was diagnosed with hemolytic uremic syndrome. Maternal mortality was 12% (n = 6

  18. Mechanotransductional Basis of Endothelial Cell Response to Intravascular Bubbles

    PubMed Central

    Klinger, Alexandra L.; Pichette, Benjamin; Sobolewski, Peter; Eckmann, David M.

    2011-01-01

    Vascular air embolism resulting from too rapid decompression is a well-known risk in deep-sea diving, aviation and space travel. It is also a common complication during surgery or other medical procedures when air or other endogenously administered gas is entrained in the circulation. Preventive and post-event treatment options are extremely limited for this dangerous condition, and none of them address the poorly understood pathophysiology of endothelial response to intravascular bubble presence. Using a novel apparatus allowing precise manipulation of microbubbles in real time fluorescence microscopy studies, we directly measure human umbilical vein endothelial cell responses to bubble contact. Strong intracellular calcium transients requiring extracellular calcium are observed upon cell-bubble interaction. The transient is eliminated both by the presence of the stretch activated channel inhibitor, gadolinium, and the transient receptor potential vanilliod family inhibitor, ruthenium red. No bubble induced calcium upsurge occurs if the cells are pretreated with an inhibitor of actin polymerization, cytochalasin-D. This study explores the biomechanical mechanisms at play in bubble interfacial interactions with endothelial surface layer (ESL) macromolecules, reassessing cell response after selective digestion of glycocalyx glycosoaminoglycans, hyaluran (HA) and heparin sulfate (HS). HA digestion causes reduction of cell-bubble adherence and a more rapid induction of calcium influx after contact. HS depletion significantly decreases calcium transient amplitudes, as does pharmacologically induced sydencan ectodomain shedding. The surfactant perfluorocarbon oxycyte abolishes any bubble induced calcium transient, presumably through direct competition with ESL macromolecules for interfacial occupancy, thus attenuating the interactions that trigger potentially deleterious biochemical pathways. PMID:21931900

  19. Central respiratory and circulatory depression caused by intravascular saxitoxin

    PubMed Central

    Borison, H.L.; Culp, W.J.; Gonsalves, S.F.; McCarthy, L.E.

    1980-01-01

    1 In cats anaesthetized with pentobarbitone and vagotomized, observations were made on the phrenic nerve action potential and the diaphragm electromyogram (EMG) at constant end-tidal Pco2. Arterial blood pressure was stabilized by intravenous infusions of noradrenaline. 2 Intravenous administration of saxitoxin (STX) initially abolished respiratory activity in the EMG and caused a slowing of oscillation in the central phrenic neurogram. Additional STX produced apneustic phrenic discharges followed by a progressive loss of nerve action potentials. 3 The inspiratory centre in the medulla oblongata was stimulated electrically to evoke a sustained phrenic nerve discharge. STX, given intravenously, resulted in the elimination of spontaneous nerve activity without interfering with the evoked response. 4 The cephalic intravascular infusion of STX into a carotid or vertebral artery depressed spontaneous respiratory activity while sparing EMG activity evoked by electrical stimulation of the intact phrenic nerve. 5 Spontaneous respiratory discharge in the phrenic nerve was eliminated by smaller doses of STX administered intra-arterially than were required intravenously. In addition, onset of and recovery from neural silence occurred faster following intra-arterial injection of STX. 6 Depressant effects on arterial blood pressure coincided with those on respiration when STX was given intra-arterially. 7 An electrophysiological assay on frog sartorius muscle was used to measure STX in the cerebrospinal fluid. Levels of STX detected were proportional to amounts of the toxin infused intra-arterially. 8 It is concluded that STX exchanges rapidly between blood and brain to bring about central depression and this adds to its peripheral paralytic actions. PMID:7357210

  20. Protection against high intravascular pressure in giraffe legs.

    PubMed

    Petersen, Karin K; Hørlyck, Arne; Ostergaard, Kristine H; Andresen, Joergen; Broegger, Torbjoern; Skovgaard, Nini; Telinius, Niklas; Laher, Ismael; Bertelsen, Mads F; Grøndahl, Carsten; Smerup, Morten; Secher, Niels H; Brøndum, Emil; Hasenkam, John M; Wang, Tobias; Baandrup, Ulrik; Aalkjaer, Christian

    2013-11-01

    The high blood pressure in giraffe leg arteries renders giraffes vulnerable to edema. We investigated in 11 giraffes whether large and small arteries in the legs and the tight fascia protect leg capillaries. Ultrasound imaging of foreleg arteries in anesthetized giraffes and ex vivo examination revealed abrupt thickening of the arterial wall and a reduction of its internal diameter just below the elbow. At and distal to this narrowing, the artery constricted spontaneously and in response to norepinephrine and intravascular pressure recordings revealed a dynamic, viscous pressure drop along the artery. Histology of the isolated median artery confirmed dense sympathetic innervation at the narrowing. Structure and contractility of small arteries from muscular beds in the leg and neck were compared. The arteries from the legs demonstrated an increased media thickness-to-lumen diameter ratio, increased media volume, and increased numbers of smooth muscle cells per segment length and furthermore, they contracted more strongly than arteries from the neck (500 ± 49 vs. 318 ± 43 mmHg; n = 6 legs and neck, respectively). Finally, the transient increase in interstitial fluid pressure following injection of saline was 5.5 ± 1.7 times larger (n = 8) in the leg than in the neck. We conclude that 1) tissue compliance in the legs is low; 2) large arteries of the legs function as resistance arteries; and 3) structural adaptation of small muscle arteries allows them to develop an extraordinary tension. All three findings can contribute to protection of the capillaries in giraffe legs from a high arterial pressure.

  1. Fast treatment planning with IVUS imaging in intravascular brachytherapy

    NASA Astrophysics Data System (ADS)

    Novario, Raffaele; Bianchi, Carla; Lorusso, Rita; Sampietro, Chiara; Tanzi, Fabio; Conte, Leopoldo; Vescovi, Mario; Caccia, Massimo; Alemi, Mario; Cappellini, Chiara

    2004-05-01

    The planned target volume in intracoronary brachytherapy is the vessel wall. The success of the treatment is based on the need of delivering doses possibly not lower than 8 and not higher than 30 Gy. An automatic procedure in order to acquire intravascular ultrasound images of the whole volume to be irradiated is pointed out; a motor driven pullback device, with velocity of the catheter of 0.5 and 1 mm/s allows to acquire the entire target volume of the vessel with a number of slices normally ranging from 400 to 1600. A semiautomatic segmentation and classification of the different structures in each slice of the vessel is proposed. The segmentation and the classification of the structures allows the calculation of their volume; this is very useful in particular for plaque volume assessment in the follow-up of the patients. A 3D analyser tool was developed in order to visualize the walls and the lumen of the vessel. The knowledge, for each axial slice, of the position of the source (in the centre of the catheter) and the position of the target (vessel walls) allows the calculation of a set of source-target distances. Given a time of irradiation, and a type of source a dose volume histogram (DVH) describing the distribution of the doses in the whole target can be obtained. The whole procedure takes few minutes and then is compatible with a safe treatment of the patient, giving an important indication about the quality of the radiation treatment selected.

  2. Monolithic CMUT-on-CMOS integration for intravascular ultrasound applications.

    PubMed

    Zahorian, Jaime; Hochman, Michael; Xu, Toby; Satir, Sarp; Gurun, Gokce; Karaman, Mustafa; Degertekin, F Levent

    2011-12-01

    One of the most important promises of capacitive micromachined ultrasonic transducer (CMUT) technology is integration with electronics. This approach is required to minimize the parasitic capacitances in the receive mode, especially in catheter-based volumetric imaging arrays, for which the elements must be small. Furthermore, optimization of the available silicon area and minimized number of connections occurs when the CMUTs are fabricated directly above the associated electronics. Here, we describe successful fabrication and performance evaluation of CMUT arrays for intravascular imaging on custom-designed CMOS receiver electronics from a commercial IC foundry. The CMUT-on-CMOS process starts with surface isolation and mechanical planarization of the CMOS electronics to reduce topography. The rest of the CMUT fabrication is achieved by modifying a low-temperature micromachining process through the addition of a single mask and developing a dry etching step to produce sloped sidewalls for simple and reliable CMUT-to-CMOS interconnection. This CMUT-to-CMOS interconnect method reduced the parasitic capacitance by a factor of 200 when compared with a standard wire-bonding method. Characterization experiments indicate that the CMUT-on-CMOS elements are uniform in frequency response and are similar to CMUTs simultaneously fabricated on standard silicon wafers without electronics integration. Ex- periments on a 1.6-mm-diameter dual-ring CMUT array with a center frequency of 15 MHz show that both the CMUTs and the integrated CMOS electronics are fully functional. The SNR measurements indicate that the performance is adequate for imaging chronic total occlusions located 1 cm from the CMUT array.

  3. Hepatic abscess-associated Clostridial bacteraemia presenting with intravascular haemolysis and severe hypertension

    PubMed Central

    Lim, Andrew George; Rudd, Kristina Elizabeth; Halliday, Melissa; Hess, John Rider

    2016-01-01

    Summary Clostridium perfringens bacteraemia is a potentially fatal condition, and its early identification is paramount to maximise chances of survival. Prompt recognition of intravascular haemolysis, a known complication of C. perfringens bacteraemia, can help guide clinical decision-making before microbiology data becomes available. We present a novel finding of severe hypertension in a fatal case of Clostridial bacteraemia with massive haemolysis. A 58-year-old man with no known medical history presented to the emergency department with malaise, fever and hypertension. He developed abdominal pain and a hepatic abscess was identified on CT imaging. Within 4 h of presentation, he developed massive intravascular haemolysis, extreme hypertension, pulmonary oedema and respiratory failure. He died less than 8 h after presentation. His blood cultures subsequently grew C. perfringens. This case underscores the importance of early recognition of intravascular haemolysis complicating C. perfringens bacteraemia, and discusses the rare complication of hypertensive emergency in this setting. PMID:26823354

  4. Nonlinear dynamic characteristics of SMA intravascular stent under radial stochastic loads.

    PubMed

    Zhu, Zhiwen; Zhang, Qingxin; Xu, Jia

    2014-01-01

    Nonlinear dynamic characteristics of shape memory alloy (SMA) intravascular stent under radial stochastic loads were studied in this paper. Von de Pol item was improved to interpret the hysteretic phenomena of SMA, and the nonlinear dynamic model of SMA intravascular stent under radial stochastic loads was developed. The conditions of stochastic stability of the system were obtained in singular boundary theory. The steady-state probability density function of the dynamic response of the system was given, and the stochastic Hopf bifurcation characteristics of the system were analyzed. Theoretical analysis and numerical simulation show that the stability of the trivial solution varies with bifurcation parameters, and stochastic Hopf bifurcation appears in the process, which can cause stent fracture or loss. The results of this paper are helpful to application of SMA intravascular stent in biomedical engineering fields.

  5. Intracoronary optical coherence tomography: Clinical and research applications and intravascular imaging software overview.

    PubMed

    Tenekecioglu, Erhan; Albuquerque, Felipe N; Sotomi, Yohei; Zeng, Yaping; Suwannasom, Pannipa; Tateishi, Hiroki; Cavalcante, Rafael; Ishibashi, Yuki; Nakatani, Shimpei; Abdelghani, Mohammad; Dijkstra, Jouke; Bourantas, Christos; Collet, Carlos; Karanasos, Antonios; Radu, Maria; Wang, Ancong; Muramatsu, Takashi; Landmesser, Ulf; Okamura, Takayuki; Regar, Evelyn; Räber, Lorenz; Guagliumi, Giulio; Pyo, Robert T; Onuma, Yoshinobu; Serruys, Patrick W

    2017-01-21

    By providing valuable information about the coronary artery wall and lumen, intravascular imaging may aid in optimizing interventional procedure results and thereby could improve clinical outcomes following percutaneous coronary intervention (PCI). Intravascular optical coherence tomography (OCT) is a light-based technology with a tissue penetration of approximately 1 to 3 mm and provides near histological resolution. It has emerged as a technological breakthrough in intravascular imaging with multiple clinical and research applications. OCT provides detailed visualization of the vessel following PCI and provides accurate assessment of post-procedural stent performance including detection of edge dissection, stent struts apposition, tissue prolapse, and healing parameters. Additionally, it can provide accurate characterization of plaque morphology and provides key information to optimize post-procedural outcomes. This manuscript aims to review the current clinical and research applications of intracoronary OCT and summarize the analytic OCT imaging software packages currently available. © 2017 Wiley Periodicals, Inc.

  6. High-sensitivity intravascular photoacoustic imaging of lipid–laden plaque with a collinear catheter design

    PubMed Central

    Cao, Yingchun; Hui, Jie; Kole, Ayeeshik; Wang, Pu; Yu, Qianhuan; Chen, Weibiao; Sturek, Michael; Cheng, Ji-Xin

    2016-01-01

    A highly sensitive catheter probe is critical to catheter-based intravascular photoacoustic imaging. Here, we present a photoacoustic catheter probe design on the basis of collinear alignment of the incident optical wave and the photoacoustically generated sound wave within a miniature catheter housing for the first time. Such collinear catheter design with an outer diameter of 1.6 mm provided highly efficient overlap between optical and acoustic waves over an imaging depth of >6 mm in D2O medium. Intravascular photoacoustic imaging of lipid-laden atherosclerotic plaque and perivascular fat was demonstrated, where a lab-built 500 Hz optical parametric oscillator outputting nanosecond optical pulses at a wavelength of 1.7 μm was used for overtone excitation of C-H bonds. In addition to intravascular imaging, the presented catheter design will benefit other photoacoustic applications such as needle-based intramuscular imaging. PMID:27121894

  7. Disseminated Scedosporium prolificans infection in an 'extensive metaboliser': navigating the minefield of drug interactions and pharmacogenomics.

    PubMed

    Trubiano, J A; Paratz, E; Wolf, M; Teh, B W; Todaro, M; Thursky, K A; Slavin, M A

    2014-09-01

    We report a case of non-fatal disseminated Scedosporium prolificans infection, including central nervous system disease and endophthalmitis, in a relapsed acute myeloid leukaemia patient with extensive CYP2C19 metabolism. Successful treatment required aggressive surgical debridement, three times daily voriconazole dosing and cimetidine CYP2C19 inhibition. In addition, the unique use of miltefosine was employed due to azole-chemotherapeutic drug interactions. Prolonged survival following disseminated S. prolificans, adjunctive miltefosine and augmentation of voriconazole exposure with cimetidine CYP2C19 inhibition has not been reported.

  8. Disseminated Cryptococcosis with Rapidly Growing Lung Nodules in an End-stage Renal Disease Patient

    PubMed Central

    Inaba, Atsushi; Okada, Akira; Yoshida, Taiko; Itoyama, Satoshi; Nakai, Tatsuro; Hisada, Tetsuya; Takano, Hideki

    2017-01-01

    A 73-year-old man with type 2 diabetes mellitus and end-stage renal disease was diagnosed with acute myocardial infarction. He required continuous dialysis after percutaneous coronary intervention. Subsequently, multiple nodules were discovered in both lungs for the first time, and Cryptococcus neoformans was isolated from the patient's sputum, blood, bilateral pleural fluid, and cerebrospinal fluid cultures, resulting in a diagnosis of disseminated cryptococcosis. This case represents an invaluable example of disseminated cryptococcosis with rapidly growing lung nodules in a dialysis patient, and illustrates that dialysis causes innate immune disorder and the reactivation of cryptococcosis. PMID:28154287

  9. Disseminated Mycobacterium bovis Infection Complicating Intravesical BCG Instillation for the Treatment of Superficial Transitional Cell Carcinoma of the Bladder

    PubMed Central

    Elzein, Fatehi; Albogami, Nada; Saad, Mustafa; El Tayeb, Nazik; Alghamdi, Abdullah; Elyamany, Ghaleb

    2016-01-01

    BACKGROUND Intravesical instillation of Bacillus Calmette–Guérin (BCG) remains a first-line treatment for superficial transitional cell carcinoma of the bladder. Although its use is relatively safe, severe complications such as granulomatous hepatitis, osteomyelitis, pneumonitis, and sepsis occur in few patients. Complications of intravesical instillation of BCG can be local or systemic, with early or late presentation. CASE PRESENTATION Here, we report an 88-year-old man who developed fever, rigors, and episodes of syncope following fourth intravesical BCG instillation for the treatment of superficial transitional cell carcinoma of the bladder. Pancytopenia, disseminated intravascular coagulation, ground glass appearance on computerized tomography of the chest scan in addition to multiple bone marrow granulomas, suggested the diagnosis of disseminated BCG infection. All these features recovered on antituberculosis treatment. CONCLUSION Our case study highlights the importance of early recognition and prompt treatment of patients with disseminated BCG infection following intravesical instillation. Although isolation of mycobacterium is desirable to make the diagnosis, it is not unusual to have negative smears and cultures and this should not be used to dismiss the possibility of BCG infection. PMID:27559301

  10. A case of intravascular lymphoma complicated with Fournier's syndrome due to multidrug-resistant Pseudomonas aeruginosa.

    PubMed

    Kaya, Hiroyasu; Yoshida, Takashi

    2011-01-01

    Fournier's syndrome is the fulminant necrotizing fasciitis of the external genitalia. The occurrence of Fournier's syndrome in patients with hematologic malignancies has been reported. Here we report a case of an intravascular lymphoma complicated with Fournier's syndrome due to multidrug-resistant Pseudomonas aeruginosa (MDRP). A 71-year-old Japanese man received intensive chemotherapy for recurring intravascular lymphoma. Blood culture revealed MDRP, and physical examination led to the diagnosis of Fournier's syndrome. Aggressive treatment that comprised granulocyte transfusion, granulocyte stimulating factor, endotoxin filtration, appropriate antibiotic coverage, and aggressive surgical therapy was administered, and this lead to the successful recovery from sepsis and Fournier's syndrome.

  11. Leiomyosarcoma of the Uterus with Intravascular Tumor Extension and Pulmonary Tumor Embolism

    SciTech Connect

    McDonald, Douglas K.; Kalva, Sanjeeva P. Fan, C.-M.; Vasilyev, Aleksandr

    2007-02-15

    We report the case of a 48-year-old woman presenting with recurrent uterine leiomyosarcoma (LMS) associated with right iliac vein and inferior vena cava (IVC) invasion and left lower lobe pulmonary tumor embolus. Because the prognosis and treatment differ from that of thrombotic pulmonary emboli, the differentiating imaging characteristics of intravascular tumor embolism are reviewed. To our knowledge, only two other cases of intravenous uterine leiomyosarcomatosis have been described in the existing literature, and this is the first reported case of the entity with associated intravascular tumor embolism.

  12. 45 CFR 1388.7 - Program criteria-dissemination.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    .... (a) Introduction to dissemination: The UAP disseminates information and research findings, including... contributes to the development of new knowledge. Dissemination activities promote the independence... the knowledge base through publications and presentations, including those based on research...

  13. [Superior sagittal sinus thrombosis after intrathecal chemotherapy and intravenous high-dose cytarabine in an acute myeloid leukemia case with t(8;21)(q22;q22)].

    PubMed

    Kawakami, Keiki; Ito, Ryugo; Kageyama, Yuki; Nagaharu, Keiki; Yamaguchi, Takanori; Ito, Nobuo

    2016-04-01

    Superior sagittal sinus thrombosis (SSST) is a very rare but life-threatening complication in leukemia patients. SSST is very rare in acute myeloid leukemia (AML). In leukemia patients, several risk factors for SSST have been reported such as administration of L-asparaginase, disseminated intravascular coagulation, congenital thrombophilia, meningeal leukemia, and intrathecal chemotherapy (IT). Lumbar puncture itself and corticosteroid administration have also been acknowledged as risk factors. We describe herein our clinical experience with SSST in a 29-year-old Japanese man suffering from AML with t(8;21)(q22;q22), who presented with abrupt onset of loss of consciousness, left hemiplegia, and seizure soon after IT and high-dose cytarabine (HD-AraC) with dexamethasone for post remission consolidation. Despite the presence of intracranial hemorrhage (ICH) due to SSST rupture, we conducted anticoagulant therapy with heparin. Although ICH worsened temporarily, his clinical condition gradually improved with resolution of the SSST, and he eventually became fully ambulatory. There were no deficiencies of natural anticoagulants. Three additional cycles of HD-AraC without IT therapy were conducted, but no neurological complications recurred with the concomitant use of warfarin. He was discharged free of neurological deficits. In our case, there is a possibility that IT and the administration of corticosteroids along with HD-AraC triggered SSST.

  14. Meta-analysis on intravascular low energy laser therapy

    NASA Astrophysics Data System (ADS)

    Zhao, Shu-Dong; Liu, Timon Cheng-Yi; Wang, Yan-Fang; Liu, Song-Hao

    2008-12-01

    Intravascular low energy laser therapy (ILELT) was put forward for cardiocirculatory diseases in USA in 1982, was popular in Russia in 1980s, and then in China in 1990s. The therapeutic effects of ILELT and drugs in comparison with drugs only on Chinese patients and their blood parameters were analyzed with meta-analyses and reported as (OR, 95%CI) for patient improvement and (WMD, 95% CI) for blood parameter improvement, where 95%CI, OR and WMD denoted 95% confidence intervals, odds ratio and weighted mean difference, respectively. It was found that the patients of cerebral infarction (2.39, 2.09~2.74) and cerebrovascular diseases (2.97, 1.69~2.53) were cured, respectively, (P < 0.01), and the symptom improvement of patients of cerebral infarction, cerebrovascular diseases and diabetes were significant (3.13, 2.79~3.51), (4.92, 3.39~7.14) , and (3.80, 2.79~5.18), and mild (3.66, 3.15~4.24), (4.95, 2.77~8.84), and (7.11, 4.54~11.13), respectively, (P < 0.01). It was also found that the blood parameters such as cholesterol (-0.78, -1.32~-0.24), total cholesterol (-1.08, -1.80~-0.36), low density lipoprotein cholesterol (-0.6, -1.01~-0.19), triacylglycerol (0.63, -0.83~-0.42), high density lipoprotein (0.34, 0.10~0.59), erythrocyte aggregation index (-0.24, -0.27~-0.21), erythrocyte Sedimentation Rate (-4.57, -7.26~-1.89), fibrinogen (-0.76, -1.31~-0.21), whole blood contrast viscosity (-0.40, -0.69~-0.12), low cut blood viscosity (-1.2, -1.93~-0.48), high cut blood viscosity (-0.62, -0.92~-0.32), whole blood viscosity(-1.2, -1.85~-0.54) and plasma blood contrast viscosity(-0.07, -0.12~-0.03) were found improved (P < 0.05). It is concluded that the patients of cerebral infarction, cerebrovascular diseases and diabetes might be improved with ILELT, which might be mediated by blood parameter improvement.

  15. Catheter-related infections: diagnosis and intravascular treatment.

    PubMed

    Bouza, E; Burillo, A; Muñoz, P

    2001-11-01

    catheter infections, diagnosed without catheter withdrawal, can be handled nowadays with the so-called "antibiotic lock-in technique", which consists in locking the infected catheter lumen with a solution containing antibiotics. A high proportion of infected catheters, mainly those with coagulase-negative staphylococci, can be maintained in place and sterilized with this technique, including catheters in patients with therapeutic failure after receiving conventional intravenous antibiotic therapy. New diagnostic and therapeutic techniques may avoid the unnecessary withdrawal of thousands of efficient, difficult to replace and expensive intravascular lines.

  16. Relation between baseline plaque features and subsequent coronary artery remodeling determined by optical coherence tomography and intravascular ultrasound.

    PubMed

    Xie, Zulong; Dong, Nana; Sun, Rong; Liu, Xinxin; Gu, Xia; Sun, Yong; Du, Hongwei; Dai, Jiannan; Liu, Youbin; Hou, Jingbo; Tian, Jinwei; Yu, Bo

    2017-01-17

    Atherosclerosis often leads to myocardial infarction and stroke. We examined the influence of baseline plaque characteristics on subsequent vascular remodeling in response to changes in plaque size. Using optical coherence tomography (OCT) and intravascular ultrasound (IVUS), we examined 213 plaques from 138 patients with acute coronary syndrome at baseline and repeated IVUS at the 12-month follow-up. The change in external elastic membrane (EEM) area for each 1 mm2 change in plaque area (i.e., the slope of the regression line) was calculated as a measure of vascular remodeling capacity. In plaques with static positive remodeling, the slope was smaller than in plaques without static positive remodeling. In addition, the slope of the regression line for lesions with a large plaque burden was much smaller than that for lesions with a small plaque burden. Multivariate linear regression analysis showed that diabetes, calcification and static positive remodeling were inversely and independently associated with the level of change in EEM area/change in plaque area. Lesions with a large plaque burden, calcifications or static positive remodeling had less remodeling capacity, and calcification and static positive remodeling were independent predictors of reduced subsequent remodeling. Therefore, calcifications and static positive remodeling could be used as morphological biomarkers to predict decreased subsequent arterial remodeling.

  17. Integrin activation by P-Rex1 is required for selectin-mediated slow leukocyte rolling and intravascular crawling.

    PubMed

    Herter, Jan M; Rossaint, Jan; Block, Helena; Welch, Heidi; Zarbock, Alexander

    2013-03-21

    Integrin activation is essential for the function of leukocytes. Impaired integrin activation on leukocytes is the hallmark of the leukocyte adhesion deficiency syndrome in humans, characterized by impaired leukocyte recruitment and recurrent infections. In inflammation, leukocytes collect different signals during the contact with the microvasculature, which activate signaling pathways leading to integrin activation and leukocyte recruitment. We report the role of P-Rex1, a Rac-specific guanine nucleotide exchanging factor, in integrin activation and leukocyte recruitment. We find that P-Rex1 is required for inducing selectin-mediated lymphocyte function-associated antigen-1 (LFA-1) extension that corresponds to intermediate affinity and induces slow leukocyte rolling, whereas P-Rex1 is not involved in the induction of the high-affinity conformation of LFA-1 obligatory for leukocyte arrest. Furthermore, we demonstrate that P-Rex1 is involved in Mac-1-dependent intravascular crawling. In vivo, both LFA-1-dependent slow rolling and Mac-1-dependent crawling are defective in P-Rex1(-/-) leukocytes, whereas chemokine-induced arrest and postadhesion strengthening remain intact in P-Rex1-deficient leukocytes. Rac1 is involved in E-selectin-mediated slow rolling and crawling. In vivo, in an ischemia-reperfusion-induced model of acute kidney injury, abolished selectin-mediated integrin activation contributed to decreased neutrophil recruitment and reduced kidney damage in P-Rex1-deficient mice. We conclude that P-Rex1 serves distinct functions in LFA-1 and Mac-1 activation.

  18. Could hydroxyethyl starch be a therapeutic option in management of acute aluminum phosphide toxicity?

    PubMed

    Marashi, Sayed Mahdi; Arefi, Mohammad; Behnoush, Behnam; Nasrabad, Mahdi Ghazanfari; Nasrabadi, Zeynab Nasri

    2011-04-01

    Acute aluminum phosphide poisoning is a serious toxicity and results in high mortality rate despite the progress of critical care. After ingestion, phosphine gas is released and absorbed quickly, causing systemic poisoning and cell hypoxia. Excessive thirst, severe hypotension, arrhythmias, tachypnea, and severe metabolic acidosis are the common clinical manifestations. We think acute metabolic response which characteristically occurs in severe injury also happens in aluminum phosphide poisoning. Necropsy examinations indicate congestion in almost all vital organs because of leakage of fluids from intravascular to extravascular space. The most favorable type of fluid for intravascular volume resuscitation persists and is disputed. Colloids remain in the intravascular space rather than crystalloids, and provide more rapid hemodynamic stabilization. Furthermore, hydroxyethyl starch solution may have other benefits e.g. it can reduce the extra vascular leak of albumin and fluids from an endothelial injury site. As refractory hypotension and cardiovascular collapse, because leakage of fluids from intravascular to extravascular space are common cause of death in this toxicity, we propose that hydroxyethyl starch can dominate this refractory hypotension and consequently acute metabolic response.

  19. Fatal disseminated cryptococcosis following intraocular involvement.

    PubMed Central

    Schulman, J A; Leveque, C; Coats, M; Lawrence, L; Barber, J C

    1988-01-01

    A 33-year-old man was treated with systemic steroids for a retinal inflammatory lesion before the diagnosis of cryptococcal retinitis and meningitis was suspected. He died from central nervous system disease despite treatment with parenteral antifungals. Histopathological studies demonstrated ocular and disseminated systemic infection with Cryptococcus neoformans. Direct cryptococcal involvement of the eye is rare and is usually associated with disseminated disease. Systemic steroids must be used with caution, and patients who take these drugs require frequent monitoring. Images PMID:3355803

  20. Low-level He-Ne laser in intravascular irradiation treatment of schizophrenia

    NASA Astrophysics Data System (ADS)

    Zhou, Yu-Xue; Fu, Zheng-Hua

    1998-11-01

    Intravascular low level He-Ne laser irradiation is a new therapy developed in recent years. In our hospital it was applied in the treatment and observation of 220 cases of schizophrenia, among which certain effect was achieved and about which the detail was collated and elaborated.

  1. Recanalized chronic coronary thrombus: unraveling a hazy coronary lesion by intravascular ultrasound

    PubMed Central

    Chotai, Shayna; Khokhar, Azhar A.; Kelly, Paul A.

    2016-01-01

    Hazy lesions in coronary angiography can often be a puzzle for the interventional cardiologist. Recanalized chronic coronary thrombus, although rare, is one of the potential diagnoses. Intracoronary imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are tools that can guide to the correct diagnosis. We present the images of a case where IVUS was used to unravel such a lesion. PMID:27054109

  2. Research of epidermal cellular vegetal cycle of intravascular low level laser irradiation in treatment of psoriasis

    NASA Astrophysics Data System (ADS)

    Zhu, Jing; Bao, Xiaoqing; Zhang, Mei-Jue

    2005-07-01

    Objective: To research epidermal cellular vegetal cycle and the difference of DNA content between pre and post Intravascular Low Level Laser Irradiation treatment of psoriasis. Method: 15 patients suffered from psoriasis were treated by intravascular low level laser irradiation (output power: 4-5mw, 1 hour per day, a course of treatment is 10 days). We checked the different DNA content of epidermal cell between pre and post treatment of psoriasis and 8 natural human. Then the percentage of each phase among the whole cellular cycle was calculated and the statistical analysis was made. Results: The mean value of G1/S phase is obviously down while G2+M phase increased obviously. T test P<0.05.The related statistical analysis showed significant difference between pre and post treatments. Conclusions: The Intravascular Low Level Laser Irradiation (ILLLI) in treatment of psoriasis is effective according to the research of epidermal cellular vegetal cycle and the difference DNA content of Intravascular Low Level Laser Irradiation between pre and post treatment of psoriasis

  3. Microfluidics in the Undergraduate Laboratory: Device Fabrication and an Experiment to Mimic Intravascular Gas Embolism

    ERIC Educational Resources Information Center

    Jablonski, Erin L.; Vogel, Brandon M.; Cavanagh, Daniel P.; Beers, Kathryn L.

    2010-01-01

    A method to fabricate microfluidic devices and an experimental protocol to model intravascular gas embolism for undergraduate laboratories are presented. The fabrication process details how to produce masters on glass slides; these masters serve as molds to pattern channels in an elastomeric polymer that can be adhered to a substrate, resulting in…

  4. Multi-mode Intravascular RF Coil for MRI-guided Interventions

    PubMed Central

    Kurpad, Krishna N.; Unal, Orhan

    2011-01-01

    Purpose To demonstrate the feasibility of using a single intravascular RF probe connected to the external MRI system via a single coaxial cable to perform active tip tracking and catheter visualization, and high SNR intravascular imaging. Materials and Methods A multi-mode intravascular RF coil was constructed on a 6F balloon catheter and interfaced to a 1.5T MRI scanner via a decoupling circuit. Bench measurements of coil impedances were followed by imaging experiments in saline and phantoms. Results The multi-mode coil behaves as an inductively-coupled transmit coil. Forward looking capability of 6mm is measured. Greater than 3-fold increase in SNR compared to conventional imaging using optimized external coil is demonstrated. Simultaneous active tip tracking and catheter visualization is demonstrated. Conclusions It is feasible to perform 1) active tip tracking, 2) catheter visualization, and 3) high SNR imaging using a single multi-mode intravascular RF coil that is connected to the external system via a single coaxial cable. PMID:21448969

  5. Asian variant of intravascular large B cell lymphoma causes patients to frequently develop the syndrome of inappropriate antidiuretic hormone secretion.

    PubMed

    Onishi, Chie; Ikejiri, Fumiyoshi; Kawakami, Koshi; Miyake, Takaaki; Kumanomido, Satoshi; Inoue, Masaya; Takahashi, Tsutomu; Tanaka, Junko; Yamamoto, Masahiro; Sugimoto, Toshitsugu; Suzumiya, Junji

    2011-11-01

    The Asian variant of intravascular large B cell lymphoma is a special type of intravascular lymphoma with hemophagocytic syndrome and hypercytokinemia including interleukin-6, which stimulates antidiuretic hormone synthesis in the hypothalamus. We present here that the syndrome of inappropriate antidiuretic hormone secretion frequently occurs in patients with the Asian variant of intravascular large B cell lymphoma. The syndrome of inappropriate antidiuretic hormone secretion was found in eight of 118 (6.8%) lymphoma patients at the first diagnosis. Although there were six (5.1%) among 118 lymphoma patients with the Asian variant of intravascular large B cell lymphoma, four of the six patients (66.7%) developed the syndrome of inappropriate antidiuretic hormone secretion. In four patients with the Asian variant of intravascular large B cell lymphoma with the syndrome of inappropriate antidiuretic hormone secretion, elevated serum interleukin-6 and low sodium levels were almost normalized after chemotherapy. The Asian variant of intravascular large B cell lymphoma patients frequently develop the syndrome of inappropriate antidiuretic hormone secretion, and interleukin-6 might play a role in the occurrence of this disease. We should pay attention to hyponatremia caused by the syndrome of inappropriate antidiuretic hormone secretion in patients with the Asian variant of intravascular large B cell lymphoma.

  6. Thermal injury, intravascular hemolysis, and toxic oxygen products.

    PubMed Central

    Hatherill, J R; Till, G O; Bruner, L H; Ward, P A

    1986-01-01

    Acute thermal injury of rat skin produces an early, acute hemoglobinemia that is associated with the presence in blood of osmotically fragile red cells (RBC) that do not contain on their surfaces measurable amounts of complement components. The hemoglobinemia and the appearance in blood of osmotically fragile RBC appear to be the result of complement activation, which leads to oxygen radical production by neutrophils and damage of RBC. This has been demonstrated in vitro as well as in vivo by the ability of antioxidant interventions or neutrophil or complement depletion procedures to prevent the appearance of osmotically fragile RBC and the release of hemoglobin. These data may be relevant to the complications of hemoglobinemia and hemoglobinuria accompanying thermal injury in humans. PMID:3745430

  7. Disseminated mast cell tumor infiltrating the sphenoid bone and causing blindness in a dog.

    PubMed

    Beltran, Elsa; de Stefani, Alberta; Stewart, Jennifer; De Risio, Luisa; Johnson, Victoria

    2010-05-01

    Mast cell tumors are found in most organs and tissues with variable biologic behavior in dogs. This case illustrates the clinical and magnetic resonance imaging (MRI) findings in a dog with disseminated mast cell tumor infiltrating the sphenoid bones. A 6-year-old male neutered Greyhound presented with a 3-day history of acute onset of blindness. General physical examination was normal. Neurological examination revealed mildly disorientated mental status, absent menace response in both eyes, bilaterally decreased vestibulo-oculocephalic reflexes and absent direct and consensual pupillary light reflex in both eyes. An electroretinogram indicated normal retinal function in both eyes. A lesion involving the middle and rostral cranial fossa was suspected. Hematology and serum biochemistry were normal except decreased urea (1.2 mmol/L). MRI of the head revealed heterogeneous signal intensity of the sphenoid bones on T2-weighted images and loss of their normal internal architecture. Cerebrospinal fluid analysis was normal. Abdominal ultrasound revealed hepatosplenomegaly and mesenteric lymphadenopathy. Fine needle aspirates were taken from the jejunal lymph nodes and the spleen. Results were consistent with disseminated mast cell tumor. The owner declined any treatment and the dog was euthanatized. Postmortem examination confirmed disseminated mast cell tumor affecting multiple organs, including the sphenoid bones. To our knowledge, this is the first case describing MRI features of disseminated mast cell tumor affecting the sphenoid bones and causing acute onset of blindness in a dog.

  8. Evaluation of Intravascular Hemolysis With Erythrocyte Creatine in Patients With Aortic Stenosis.

    PubMed

    Sugiura, Tetsuro; Okumiya, Toshika; Kubo, Toru; Takeuchi, Hiroaki; Matsumura, Yoshihisa

    2016-07-27

    Chronic intravascular hemolysis has been identified in patients with cardiac valve prostheses, but only a few case reports have evaluated intravascular hemolysis in patients with native valvular heart disease. To detect intravascular hemolysis in patients with aortic stenosis, erythrocyte creatine was evaluated with hemodynamic indices obtained by echocardiography.Erythrocyte creatine, a marker of erythrocyte age, was assayed in 30 patients with aortic stenosis and 10 aged matched healthy volunteers. Peak flow velocity of the aortic valve was determined by continuous-wave Doppler echocardiography. Twenty of 30 patients with aortic stenosis had high erythrocyte creatine levels (> 1.8 µmol/g Hb) and erythrocyte creatine was significantly higher as compared with control subjects (1.98 ± 0.49 versus 1.52 ± 0.19 µmol/g Hb, P = 0.007). Peak transvalvular pressure gradient ranged from 46 to 142 mmHg and peak flow velocity ranged from 3.40 to 5.95 m/second. Patients with aortic stenosis had a significantly lower erythrocyte count (387 ± 40 versus 436 ± 42 × 10(4) µL, P = 0.002) and hemoglobin (119 ± 11 versus 135 ± 11 g/L, P < 0.001) as compared with control subjects. Erythrocyte creatine had a fair correlation with peak flow velocity (r = 0.55, P = 0.002).In conclusion, intravascular hemolysis due to destruction of erythrocytes was detected in patients with moderate to severe aortic stenosis and the severity of intravascular hemolysis was related to valvular flow velocity of the aortic valve.

  9. Disseminated necrotizing myeloencephalitis: a herpes-associated neurological disease of horses.

    PubMed

    Little, P B; Thorsen, J

    1976-01-01

    Equine viral rhinopneumonitis type I virus was isolated from spinal cord and brain of a paraparetic horse with disseminated necrotizing myeloencephalitis. Necrotic arteriolitis,nonsuppurative necrotizing myeloencephalitis and Gasserian ganglioneuritis were present. On record were 12 more cases of horses with similar lesions. The horses had been ataxic or paretic for up to several weeks. A field survey indicated that 14 of 24 horses with acute myelitic signs developed them after recent exposure to respiratory disease.

  10. Suspected disseminated histiocytic sarcoma in a 3-year-old Perro de Presa Canario dog.

    PubMed

    Denstedt, Emily

    2014-02-01

    A 3-year-old intact male Perro de Presa Canario dog was presented with acutely inflamed and edematous right hind limb, scrotum, prepuce, and an enlarged left carpus. Two weeks later the dog returned with weight loss, draining tracts in the right hind limb, dermal nodules, a palpable abdominal mass, and uveitis in the left eye. The dog succumbed to his illness 2 days later and a widely disseminated round cell tumor compatible with histiocytic sarcoma was diagnosed following postmortem examination.

  11. Successful Treatment of Refractory Hypoxemia Secondary to Disseminated Histoplasmosis Using Extracorporeal Membrane Oxygenation Support.

    PubMed

    Wanta, Brendan T; Tyner, Harmony L; Bohman, John K; Baddour, Larry M

    2016-10-15

    Refractory hypoxemia secondary to acute respiratory distress syndrome (ARDS) is associated with high mortality. Extracorporeal membraneoxygenation (ECMO) is an accepted strategy for treating refractory hypoxemia in patients with ARDS but is relatively contraindicated in the setting of systemic infections. We present a case of successful ECMO use in a host with refractory hypoxemia secondary to disseminated histoplasmosis with fungemia and discuss our management approach to this difficult patient.

  12. Comprehensive analysis of information dissemination in disasters

    NASA Astrophysics Data System (ADS)

    Zhang, N.; Huang, H.; Su, Boni

    2016-11-01

    China is a country that experiences a large number of disasters. The number of deaths caused by large-scale disasters and accidents in past 10 years is around 900,000. More than 92.8 percent of these deaths could be avoided if there were an effective pre-warning system deployed. Knowledge of the information dissemination characteristics of different information media taking into consideration governmental assistance (information published by a government) in disasters in urban areas, plays a critical role in increasing response time and reducing the number of deaths and economic losses. In this paper we have developed a comprehensive information dissemination model to optimize efficiency of pre-warning mechanics. This model also can be used for disseminating information for evacuees making real-time evacuation plans. We analyzed every single information dissemination models for pre-warning in disasters by considering 14 media: short message service (SMS), phone, television, radio, news portals, Wechat, microblogs, email, newspapers, loudspeaker vehicles, loudspeakers, oral communication, and passive information acquisition via visual and auditory senses. Since governmental assistance is very useful in a disaster, we calculated the sensitivity of governmental assistance ratio. The results provide useful references for information dissemination during disasters in urban areas.

  13. Snakebite mediated acute kidney injury, prognostic predictors, oxidative and carbonyl stress: A prospective study

    PubMed Central

    Mukhopadhyay, P.; Mishra, R.; Mukherjee, D.; Mishra, R.; Kar, M.

    2016-01-01

    Snake bite is an occupational hazard in India and important preventable cause of acute kidney injury (AKI). This study was done to estimate the magnitude of snakebite-induced AKI (SAKI) who required renal replacement therapy, prognostic predictors, and final outcome, and to measure the oxidative and carbonyl stress (CS) level in SAKI patient who underwent hemodialysis (HD). All SAKI patients dialyzed between April 2010 and July 2011 in NRS Medical College were included. Demographical, clinical, and biochemical data were analyzed, and patients are followed to discharge or death. Oxidative and CS markers (advanced oxidation protein product [AOPP], advanced glycation end product, pentosidine, dityrosine, thioberbituric acid reactive substance, and methylglyoxal [MG]) were measured in 48 SAKI patient requiring HD. About 155 SAKI patients (M: F 2.2:1) received HD. Of them. The age was 36.2 (range 4–74) years. The most common site of the bite was lower limb (88.7%). Oliguria and bleeding manifestation were the common presentation. Hypotension was found in 52 (33.5%) cases, cellulitis and inflammation were found in about 63%. Mean creatinine was 4.56 ± 0.24 mg/dl. About 42 (27.1%) had disseminated intravascular coagulation (DIC). 36 (78.2%) had cellulites, 24 (52.2%) had hypotension or shock at initial presentation (P < 0.05), bleeding manifestation was found in 37 (80.4%), and 22 (47.8%) had DIC (P < 0.05). Forty-six (29.7%) patient died. DIC and hypotension/shock at initial presentation came out as an independent predictor of death. Among all markers measured for oxidative and CS (n = 48) AOPP and MG came out as an independent predictor (P < 0.05) of adverse outcome. Hypotension, DIC, AOPP, and MG were a poor prognostic marker in SAKI patients requiring dialysis. PMID:27942175

  14. Anti-CD45 radioimmunotherapy using 211At with bone marrow transplantation prolongs survival in a disseminated murine leukemia model

    SciTech Connect

    Orozco, Johnnie J.; Back, Tom; Kenoyer, Aimee L.; Balkin, Ethan R.; Hamlin, Donald K.; Wilbur, D. Scott; Fisher, Darrell R.; Frayo, Shani; Hylarides, Mark; Green, Damian J.; Gopal, Ajay K.; Press, Oliver W.; Pagel, John M.

    2013-05-15

    Anti-CD45 Radioimmunotherapy using an Alpha-Emitting Radionuclide 211At Combined with Bone Marrow Transplantation Prolongs Survival in a Disseminated Murine Leukemia Model ABSTRACT Despite aggressive chemotherapy combined with hematopoietic cell transplant (HCT), many patients with acute myeloid leukemia (AML) relapse. Radioimmunotherapy (RIT) using antibodies (Ab) labeled primarily with beta-emitting radionuclides has been explored to reduce relapse.

  15. Intravascular contrast agents suitable for magnetic resonance imaging. [Dogs

    SciTech Connect

    Runge, V.M.; Clanton, J.A.; Herzer, W.A.; Gibbs, S.J.; Price, A.C.; Partain, C.L.; James, A.E. Jr.

    1984-10-01

    Two paramagnetic chelates, chromium EDTA and gadolinium DTPA, were evaluated as potential intravenous contrast agents for magnetic resonance imaging. After evaluating both agents in vitro, in vivo studies were conducted in dogs to document changes in renal appearance produced by contrast injection. Acute splenic and renal infarction were diagnosed with contrast-enhanced MR and confirmed by gamma camera imaging following administration of Tc-99m-labeled DMSA and sulfur colloid. The authors conclude that intravenous paramagnetic contrast agents presently offer the best mechanism for assessment of tissue function and changes in perfusion with MR.

  16. Disseminated cutaneous sporotrichosis in an immunocompetent individual.

    PubMed

    Yap, Felix Boon-Bin

    2011-10-01

    Sporotrichosis is a subacute or chronic fungal infection caused by the ubiquitous fungus Sporothrix schenckii. Disseminated cutaneous sporotrichosis is an uncommon entity and is usually present in the immunosuppressed. Here, a case of disseminated cutaneous sporotrichosis in an immunocompetent patient is reported. This 70-year-old healthy woman presented with multiple painful ulcerated nodules on her face and upper and lower extremities of 6-month duration, associated with low-grade fever, night sweats, loss of appetite, and loss of weight. Histopathological examination of the skin biopsy revealed epidermal hyperplasia and granulomatous inflammation in the dermis, with budding yeast. Fungal culture identified S. schenckii. She had total resolution of the lesions after 2 weeks of intravenous amphotericin B and 8 months of oral itraconazole. All investigations for underlying immunosuppression and internal organ involvement were negative. This case reiterates that disseminated cutaneous sporotrichosis, although common in the immunosuppressed, can also be seen in immunocompetent patients.

  17. Precise time dissemination via portable atomic clocks

    NASA Technical Reports Server (NTRS)

    Putkovich, K.

    1982-01-01

    The most precise operational method of time dissemination over long distances presently available to the Precise Time and Time Interval (PTTI) community of users is by means of portable atomic clocks. The Global Positioning System (GPS), the latest system showing promise of replacing portable clocks for global PTTI dissemination, was evaluated. Although GPS has the technical capability of providing superior world-wide dissemination, the question of present cost and future accessibility may require a continued reliance on portable clocks for a number of years. For these reasons a study of portable clock operations as they are carried out today was made. The portable clock system that was utilized by the U.S. Naval Observatory (NAVOBSY) in the global synchronization of clocks over the past 17 years is described and the concepts on which it is based are explained. Some of its capabilities and limitations are also discussed.

  18. Public information, dissemination, and behavior analysis

    PubMed Central

    Morris, Edward K.

    1985-01-01

    Behavior analysts have become increasingly concerned about inaccuracies and misconceptions in the public, educational, and professional information portraying their activities, but have done little to correct these views. The present paper has two purposes in this regard. First, the paper describes some of the conditions that have given rise to these concerns. Second, and more important, the paper surveys various procedures and programs for the dissemination of public information that may correct inaccuracies and misconceptions. Special consideration is also given to issues involving (a) the assessment of the problem, (b) the content and means of dissemination, (c) the possible contributions of behavior analysts to current misunderstandings, and (d) relationships between behavior analysts and the media. The dissemination of accurate and unbiased information constitutes an important new undertaking for behavior analysis. The future of the field may depend in part on such activity. PMID:22478623

  19. European Society of Cardiology-Acute Cardiovascular Care Association Position paper on acute heart failure: A call for interdisciplinary care.

    PubMed

    Mueller, Christian; Christ, Michael; Cowie, Martin; Cullen, Louise; Maisel, Alan S; Masip, Josep; Miro, Oscar; McMurray, John; Peacock, Frank W; Price, Susanna; DiSomma, Salvatore; Bueno, Hector; Zeymer, Uwe; Mebazaa, Alexandre

    2017-02-01

    Acute heart failure (AHF) continues to have unacceptably high rates of mortality and morbidity. This position paper highlights the need for more intense interdisciplinary cooperation as one key element to overcome the challenges associated with fragmentation in the care of AHF patients. Additional aspects discussed include the importance of early diagnosis and treatment, options for initial treatment, referral bias as a potential cause for treatment preferences among experts, considerable uncertainty regarding patient disposition, the diagnosis of accompanying acute myocardial infarction, the need for antibiotic therapy, as well as assessment of intravascular volume status.

  20. Multispectral fluorescence lifetime imaging system for intravascular diagnostics with ultrasound guidance: in vivo validation in swine arteries.

    PubMed

    Bec, Julien; Ma, Dinglong M; Yankelevich, Diego R; Liu, Jing; Ferrier, William T; Southard, Jeffrey; Marcu, Laura

    2014-05-01

    Fluorescence lifetime technique has demonstrated potential for analysis of atherosclerotic lesions and for complementing existing intravascular imaging modalities such as intravascular ultrasound (IVUS) in identifying lesions at high risk of rupture. This study presents a multimodal catheter system integrating a 40 MHz commercial IVUS and fluorescence lifetime imaging (FLIm) using fast helical motion scanning (400 rpm, 0.75 mm/s), able to acquire in vivo in pulsatile blood flow the autofluorescence emission of arterial vessels with high precision (5.08 ± 0.26 ns mean average lifetime over 13 scans). Co-registered FLIm and IVUS data allowed 3D visualization of both biochemical and morphological vessel properties. Current study supports the development of clinically compatible intravascular diagnostic system integrating FLIm and demonstrates, to our knowledge, the first in vivo intravascular application of a fluorescence lifetime imaging technique.

  1. Visibility of Histoplasma within histiocytes on hematoxylin and eosin distinguishes disseminated histoplasmosis from other forms of pulmonary histoplasmosis.

    PubMed

    Mukhopadhyay, Sanjay; Doxtader, Erika E

    2013-10-01

    The visibility of Histoplasma within histiocytes on hematoxylin and eosin is a well-known feature of disseminated histoplasmosis. However, it is unclear whether this finding can be used to differentiate disseminated histoplasmosis involving the lung from other forms of pulmonary histoplasmosis. The aim of this study was to determine whether the visibility of Histoplasma within histiocytes on hematoxylin and eosin in lung biopsies suggests disseminated disease. Lung biopsies in which Histoplasma was identified were re-examined to determine whether organisms were visible within histiocytes on hematoxylin and eosin. Clinical findings were reviewed retrospectively to determine the type of histoplasmosis. Histoplasma was visible within histiocytes on hematoxylin and eosin in lung biopsies from 4 patients (2 men, 2 women, 50-74 years) who presented with pulmonary manifestations without definite evidence of disseminated disease at the time of biopsy. Subsequently, all 4 manifested clinical and/or microbiologic features of disseminated disease (positive extrapulmonary cultures and fatal outcome in 2, positive extrapulmonary cultures in 1, and multiorgan failure and fatal outcome in 1). In contrast, organisms were identified on silver stains but could not be visualized on hematoxylin and eosin in 42 patients, none of whom showed clinical or microbiologic evidence of disseminated disease (pulmonary histoplasmoma, 38; acute pulmonary histoplasmosis, 4). In lung biopsies, the visibility of Histoplasma within histiocytes on hematoxylin and eosin suggests disseminated disease. Recognition of the significance of this finding is helpful in diagnosing disseminated disease in patients who present primarily with pulmonary manifestations without definite clinical evidence of dissemination at the time of biopsy.

  2. Acute effects of solar particle event radiation

    PubMed Central

    Kennedy, Ann R.; Weissman, Drew; Sanzari, Jenine K.; Krigsfeld, Gabriel S.; Wan, X. Steven; Romero-Weaver, Ana L.; Diffenderfer, Eric S.; Lin, L.; Cengel, K.

    2014-01-01

    A major solar particle event (SPE) may place astronauts at significant risk for the acute radiation syndrome (ARS), which may be exacerbated when combined with other space flight stressors, such that the mission or crew health may be compromised. The National Space Biomedical Research Institute (NSBRI) Center of Acute Radiation Research (CARR) is focused on the assessment of risks of adverse biological effects related to the ARS in animals exposed to space flight stressors combined with the types of radiation expected during an SPE. The CARR studies are focused on the adverse biological effects resulting from exposure to the types of radiation, at the appropriate energies, doses and dose-rates, present during an SPE (and standard reference radiations: gamma rays or electrons). All animal studies described have been approved by the University of PA IACUC. Some conclusions from recent CARR investigations are as follows: (i) the relative biological effectiveness (RBE) values for SPE-like protons compared with standard reference radiations (gammas or electrons) for white blood cells (WBCs) vary greatly between mice, ferrets and pigs, with the RBE values being greater in ferrets than those in mice, and considerably greater in pigs compared with those in ferrets or mice [1, 2]. This trend for the data suggests that the RBE values for WBCs in humans could be considerably greater than those observed in small mammals, and SPE proton radiation may be far more hazardous to humans than previously estimated from small animal studies. (ii) Very low doses of SPE proton radiation (25 cGy) increase blood clotting times in ferrets, and the low SPE-like dose rate has more severe effects than high dose rate radiation [3]. (iii) Results from pig and ferret studies suggest that disseminated intravascular coagulation is a major cause of death at doses near the LD50 level for SPE-like proton and gamma radiation. (iv) Exposure to SPE-like proton or gamma radiation, in combination with

  3. A Whitacre-type spinal needle does not prevent intravascular injection during cervical nerve root injections.

    PubMed

    Candido, Kenneth D; Ghaly, Ramsis F; Mackerley, Sara; Knezevic, Nebojsa Nick

    2010-07-01

    We present a case of intravascular injection in a 41-year-old female during cervical selective nerve root injection using a 22-gauge 3.5-inch Whitacre-type pencil-point subarachnoid needle with a curve placed at the distal tip positioned using continual live fluoroscopic guidance. After negative aspiration for blood and cerebrospinal fluid and no elicited paresthesias during the procedure, 1 mL of contrast was injected. Initial imaging at C6 captured the outline of the nerve root along with a significant amount of transient vascular runoff. This case report demonstrates that Whitacre-type spinal needles do not prevent vascular injection, and that aspiration of the needle is not a reliable sign of intravascular injection.

  4. [Decision-making while implantation of biodegradable vascular scaffolds ABSORB based on methods of intravascular visualization].

    PubMed

    Buzaev, I V; Plechev, V V; Nikolaeva, I E; Zagitov, I G; Oleĭnik, B A

    A series of studies demonstrated comparability of the incidence rate of major adverse cardiac events (MACE) in the middle-term postoperative period following implantation of last-generation drug-coated stents and biodegradable intravascular scaffolds. It was noted observed that these complications may be associated with malposition and inadequate inappropriate preparation of the lesion. We carried out a total of 16 percutaneous coronary interventions (PCI) with implantation of absorbable vascular scaffolds (Absorb, Abbott Vascular) under the guidance of optical coherent tomography. Besides, a further 16 PCIs were performed without intravascular visualization (control group). As experience was gathered, the algorithm of carrying out optical coherent tomography was subjected to changes, resulting in proposal of an optimal algorithm for choice of intraoperative policy based on the findings obtained in optical coherent tomography.

  5. Enhanced glucose tolerance by intravascularly administered piceatannol in freely moving healthy rats.

    PubMed

    Oritani, Yukihiro; Okitsu, Teru; Nishimura, Eisaku; Sai, Masahiko; Ito, Tatsuhiko; Takeuchi, Shoji

    2016-02-12

    Piceatannol is a phytochemical in the seeds of passion fruit that has a hypoglycemic effect when orally administered. To elucidate the contribution of intact and metabolites of piceatannol after gastro-intestinal absorption to hypoglycemic effect, we examined the influence of piceatannol and isorhapontigenin on blood glucose concentrations during fasting and glucose tolerance tests by administering them intravascularly to freely moving healthy rats. We found that intravascularly administered piceatannol reduced the blood glucose concentrations during both fasting and glucose tolerance tests, but isorhapontigenin did not during either of them. Furthermore, we found that piceatannol increased the insulinogenic index during glucose tolerance tests and that piceatannol had no influence on insulin sensitivity by performing hyperinsulinemic euglycemic clamping tests. These results suggest that piceatannol orally intaken may enhance glucose tolerance by the effect of intact piceatannol through enhanced early-phase secretion of insulin. Therefore, oral intake of piceatannol might contribute to proper control of postprandial glycemic excursions in healthy subjects.

  6. CHRONIC DISSEMINATED HISTOPLASMOSIS WITH PROLONGED LATENCY

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A case of chronic disseminated histoplasmosis in an ex-serviceman is described. Evidence is presented to support a latency period of over sixty years between acquisition of infection and clinical manifestation. This is the longest latency period for histoplasmosis described in the medical literature...

  7. The Hawaii Educational Dissemination Diffusion System Plan.

    ERIC Educational Resources Information Center

    Min, Kellet; And Others

    Hawaii's endeavor to use information technology to improve educational practices within the state is described in four major sections: (1) the framework of the plan, including a brief history of dissemination, the goals of the plan, and philosophic statements on resources, linkages, and leadership; (2) the resource component, including an…

  8. ESEA III Evaluation and Dissemination: An Assessment.

    ERIC Educational Resources Information Center

    Balyeat, Ralph R.; Norman, C. Douglas

    This study surveyed evaluation and dissemination/diffusion practices of ESEA III projects funded in the 1969 fiscal year, which projects are nearing the end of their operations as federally supported programs. The study attempted to discover if (1) the projects were evaluated in accordance with generally accepted procedures, (2) the project…

  9. Evolution of diffusion and dissemination theory.

    PubMed

    Dearing, James W

    2008-01-01

    The article provides a review and considers how the diffusion of innovations Research paradigm has changed, and offers suggestions for the further development of this theory of social change. Main emphases of diffusion Research studies are compared over time, with special attention to applications of diffusion theory-based concepts as types of dissemination science. A considerable degree of paradigmatic evolution is observed. The classical diffusion model focused on adopter innovativeness, individuals as the locus of decision, communication channels, and adoption as the primary outcome measures in post hoc observational study designs. The diffusion systems in question were centralized, with fidelity of implementation often assumed. Current dissemination Research and practice is better characterized by tests of interventions that operationalize one or more diffusion theory-based concepts and concepts from other change approaches, involve complex organizations as the units of adoption, and focus on implementation issues. Foment characterizes dissemination and implementation Research, Reflecting both its interdisciplinary Roots and the imperative of spreading evidence-based innovations as a basis for a new paradigm of translational studies of dissemination science.

  10. Disseminated Tuberculosis Presenting as Baker's Cyst Infection

    PubMed Central

    Akram, Sami; Waqar, Sana

    2017-01-01

    In the absence of coexisting immunocompromised state and lack of specific symptoms a reactivation of treated mycobacterial tuberculosis (MTB) infection is generally not considered in the differential diagnosis of leg pain. We present a unique case of disseminated tuberculosis presenting as an infected Baker's cyst in a 73-year-old immunocompetent male. PMID:28163945

  11. Disseminated granulomatous meningoencephalomyelitis in a dog

    PubMed Central

    Fisher, Margaret

    2002-01-01

    A 6-year-old, intact, female miniature Doberman pinscher was evaluated for lethargy, intermittent back pain, and unstable gait. Physical and neurological findings included bradycardia, hypothermia, hyperesthesia, progressive and ascending ataxia, and proprioceptive deficits in all limbs. Laboratory findings and magnetic resonance imaging were consistent with disseminated granulomatous meningoencephalomyelitis, confirmed later by microscopy. PMID:11802671

  12. Computer software management, evaluation, and dissemination

    NASA Technical Reports Server (NTRS)

    1983-01-01

    The activities of the Computer Software Management and Information Center involving the collection, processing, and distribution of software developed under the auspices of NASA and certain other federal agencies are reported. Program checkout and evaluation, inventory control, customer services and marketing, dissemination, program maintenance, and special development tasks are discussed.

  13. Macrophages and the Viral Dissemination Super Highway

    PubMed Central

    Klepper, Arielle; Branch, Andrea D

    2016-01-01

    Monocytes and macrophages are key components of the innate immune system yet they are often the victims of attack by infectious agents. This review examines the significance of viral infection of macrophages. The central hypothesis is that macrophage tropism enhances viral dissemination and persistence, but these changes may come at the cost of reduced replication in cells other than macrophages. PMID:26949751

  14. Knowledge Management and Global Information Dissemination

    ERIC Educational Resources Information Center

    Umunadi, Ejiwoke Kennedy

    2014-01-01

    The paper looked at knowledge management and global information dissemination. Knowledge is a very powerful tool for survival, growth and development. It can be seen as the information, understanding and skills that you gain through education or experience. The paper was addressed under the following sub-headings: Knowledge management knowledge…

  15. Active Tools for Better Knowledge Dissemination.

    ERIC Educational Resources Information Center

    Mikulecky, Peter; Mikulecka, Jaroslava

    1999-01-01

    Suggests that a solution to the inadequacy and passivity problems with push and pull technologies could be in a combination of both, with an active component, adding more intelligence to the whole process of information and knowledge dissemination and supply. Describes basic principles of activity components in intelligent systems, and some…

  16. Indigenous Case of Disseminated Histoplasmosis, Taiwan

    PubMed Central

    Lai, Chung-Hsu; Huang, Chun-Kai; Chin, Chuen; Yang, Ya-Ting

    2007-01-01

    We report the first indigenous case of disseminated histoplasmosis in Taiwan diagnosed by histopathology of bone marrow, microbiologic morphology, and PCR assay of the isolated fungus. This case suggests that histoplasmosis should be 1 of the differential diagnoses of opportunistic infections in immunocompromised patients in Taiwan. PMID:17370526

  17. A Proposed Framework for Educational Innovation Dissemination

    ERIC Educational Resources Information Center

    Hazen, Benjamin T.; Wu, Yun; Sankar, Chetan S.; Jones-Farmer, L. Allison

    2012-01-01

    Although the need for new educational technologies is increasing, the process for disseminating these innovations remains a challenge. A literature review shows that few studies have thoroughly investigated this area. Furthermore, there is no comprehensive framework or coordinated research agenda that may be used to guide such investigation. This…

  18. Factors that Influence Dissemination in Engineering Education

    ERIC Educational Resources Information Center

    Hazen, B. T.; Wu, Yun; Sankar, C. S.

    2012-01-01

    Although the need for new educational materials and methods in engineering education is increasing, the process of disseminating (making target groups become aware of, accept, and use) these innovations remains a challenge. A literature review shows that few studies have thoroughly investigated this area. The purpose of this article is to identify…

  19. A case of disseminated blastomycosis in Vermont.

    PubMed

    Monaco, William E; Batsis, John A

    2013-04-01

    Blastomyces dermatitides is increasingly found in Canada along the St. Lawrence River. However, there are only rare reports of this disease in New England. We describe a case of disseminated blastomycosis in a patient from northern Vermont who acquired the fungus while gardening.

  20. Disseminated Mycobacterium avium infection in a cat

    PubMed Central

    Barry, Maureen; Taylor, Judith; Woods, Paul

    2002-01-01

    A domestic shorthair cat was presented for lethargy and ataxia. Clinical findings included an abdominal mass, lumbosacral pain, ataxia. Aspirates from the liver and lymph nodes revealed intracellular, negative-staining rods. Treatment for presumptive mycobacterium infection was unsuccessful and the cat was euthanized. Disseminated Mycobacterium avium was confirmed on culture. PMID:12001504

  1. Dissemination and School Improvement in Educational Organizations.

    ERIC Educational Resources Information Center

    McKibbin, Sue, Ed.; Malkas, Mark, Ed.

    Updating a 1978 literature review, this document assembles five articles analyzing recent research on how various types of educational agencies disseminate information for school improvement. Each article summarizes literature relevant to one type of educational agency, discusses interrelationships among the research findings, and assesses the…

  2. A Primer on Disseminating Applied Quantitative Research

    ERIC Educational Resources Information Center

    Bell, Bethany A.; DiStefano, Christine; Morgan, Grant B.

    2010-01-01

    Transparency and replication are essential features of scientific inquiry, yet scientific communications of applied quantitative research are often lacking in much-needed procedural information. In an effort to promote researchers dissemination of their quantitative studies in a cohesive, detailed, and informative manner, the authors delineate…

  3. Disseminated Enteroviral Infection Associated with Obinutuzumab.

    PubMed

    Dendle, Claire; Gilbertson, Michael; Korman, Tony M; Golder, Vera; Morand, Eric; Opat, Stephen

    2015-09-01

    Two cases of disseminated enteroviral infection occurred in patients who received the CD20 monoclonal antibody obinutuzumab. Clinical features included hepatitis, edema, and a dermatomyositis-like syndrome. These manifestations may be unfamiliar to clinicians and are possibly responsive to intravenous immunoglobulin. Clinicians should remain vigilant for enteroviral infections in patients receiving obinutuzumab.

  4. Automatic lumen contour detection in intravascular OCT images using Otsu binarization and intensity curve.

    PubMed

    Kim, Hye Min; Lee, Seung Hwan; Lee, Chungkeun; Ha, Jong-Won; Yoon, Young-Ro

    2014-01-01

    This paper proposes an automatic method for the detection of lumen contours in intravascular OCT images with guide wire shadow artifacts. This algorithm is divided into five main procedures: pre-processing, an Otsu binarization approach, an intensity curve approach, a lumen contour position correction, and image reconstruction and contour extraction. The 30 IVOCT images from six anonymous patients were used to verify this method and we obtained 99.2% sensitivity and 99.7% specificity with this algorithm.

  5. Evaluation of intravascular microdialysis for continuous blood glucose monitoring in hypoglycemia: an animal model.

    PubMed

    Schierenbeck, Fanny; Wallin, Mats; Franco-Cereceda, Anders; Liska, Jan

    2014-07-01

    We have previously shown that intravascular microdialysis in a central vein is an accurate method for continuous glucose monitoring in patients undergoing cardiac surgery. However, no hypoglycemia occurred in our earlier studies, prompting further evaluation of the accuracy of intravascular microdialysis in the hypoglycemic range. Thus, this animal study was performed. A porcine model was developed; hypoglycemia was induced using insulin injections. The pigs were monitored with intravascular microdialysis integrated in a triple-lumen central venous catheter. As reference, venous blood gas samples were taken every 5 minutes and analyzed in a blood gas analyzer. Ethical permission for the animal experiments was obtained from the Stockholm Regional Ethical Committee, reference no N397/09. A total of 213 paired samples were obtained for analysis, and 126 (59.2%) of these were in the hypoglycemic range (<74 mg/dl). Using Clarke error grid analysis, 100% of the paired samples were in region AB and 99% in region A. The ISO standard (ISO15197) was met. Bland-Altman analysis showed bias (mean difference) ± limits of agreement was -0.18 ± 16.2 mg/dl. No influence from glucose infusions was seen. The microdialysis monitoring system was found to be very responsive in rapid changes in blood glucose concentration. This study shows that intravascular microdialysis in a central vein is an accurate method for continuous glucose monitoring in hypoglycemia in a porcine experimental model. Furthermore, the system was not influenced by glucose administration and was found to be responsive in rapid blood glucose fluctuations.

  6. Effect of intravascular irradiation of He-Ne laser on cerebral infarction: Hemorrheology and apoptosis

    NASA Astrophysics Data System (ADS)

    Zhu, Jian; Liang, Min-yi; Cao, Hao-cai; Li, Xiao-Yuan; Li, Shao-ming; Li, Shun-hao; Li, Wen-qi; Zhang, Jin-hong; Liu, Lei; Lai, Jian-hong

    2005-07-01

    Objective: To explore the efficacy of He-Ne laser intravascular irradiation on infarction and hemorrheology. To observe the effects of intravascular low level He-Ne laser irradiation (ILLLI) of blood on cell proliferation, apoptosis and chromosome in lymphocyte from cerebral infarction Methods: Seventy cases with cerebral infarction were randomly divided into groups control group (35 cases) treated only with common drugs and therapeutic group (35 cases) treated besides common drugs also by He-Ne laser intravascular irradiation. Their hemorrheology index and treatment results were observed and compared. The blood lymphocytes of cerebral infarction were cultured before and after treatment. After that, the mitosis index (MI), cell kinetics index (CKI), sister-chromatid exchanges (SCE) frequencies and apoptosis were determined. Results The therapeutic group was better than the control one. The effective rate in the therapeutic group was 88.6%, in the control one was 65.7%. The viscosity and fibrinogen, etc were better than that in the control group with significant difference (P<0.01). The lymphocyte proliferation index was significantly two increased than the control one (P>0.05) in cerebral infarction patients after treatment; The CKI of lymphocytes had no obvious difference among groups (P>0.05) SCE frequencies of lymphocytes had no statistic significance between control group and ILLLI on (P>0.05). It showed the apoptosis rate of lymphocytes in cerebral infarction patients after ILLLI treatment increased significantly compared with the control group, (P<0.001). There was a significant difference of apoptosis rate of lymphocytes in cerebral infarction patients than the control (P<0.001). Conclusions: During the He-Ne laser intravascular irradiation of the cerebral infarction, the low level He-Ne by ILLLI can increase the proliferation of lymphocytes, and can induce lymphocytes to apoptosis, but has no mutagenicity of cells.

  7. Laparoscopic manipulation of a probe-based confocal laser endomicroscope using a steerable intravascular catheter.

    PubMed

    Schneider, Crispin; Desjardins, Adrien E; Gurusamy, Kurinchi; Hawkes, David J; Davidson, Brian R

    2015-04-01

    Probe-based confocal laser endomicroscopy is an emerging imaging modality that enables visualization of histologic details during endoscopy and surgery. A method of guiding the probe with millimeter accuracy is required to enable imaging in all regions of the abdomen accessed during laparoscopy. On the basis of a porcine model of laparoscopic liver resection, we report our experience of using a steerable intravascular catheter to guide a probe-based confocal laser endomicroscope.

  8. Laparoscopic Manipulation of a Probe-based Confocal Laser Endomicroscope Using a Steerable Intravascular Catheter

    PubMed Central

    Desjardins, Adrien E.; Gurusamy, Kurinchi; Hawkes, David J.; Davidson, Brian R.

    2015-01-01

    Probe-based confocal laser endomicroscopy is an emerging imaging modality that enables visualization of histologic details during endoscopy and surgery. A method of guiding the probe with millimeter accuracy is required to enable imaging in all regions of the abdomen accessed during laparoscopy. On the basis of a porcine model of laparoscopic liver resection, we report our experience of using a steerable intravascular catheter to guide a probe-based confocal laser endomicroscope. PMID:25807277

  9. Surgical management of Wilms tumor with intravascular extension: a single-institution experience.

    PubMed

    Aspiazu, Diego; Fernandez-Pineda, Israel; Cabello, Rosa; Ramirez, Gema; Alvarez-Madrid, Antonio; De Agustin, Juan Carlos

    2012-02-01

    The purpose of this study was to retrospectively analyze the clinical presentation, treatment, and outcomes of children with Wilms tumor (WT) and intravascular extension who were treated at a single institution. A retrospective review was conducted of medical records of all children with Wilms tumor and intravascular extension treated at Virgen del Rocio Children's Hospital between 1992 and 2010. Seven patients (median age 3.4 years, range 2-8.1 years) were identified. At diagnosis, 6 of the 7 patients (85.7%) presented with tumor thrombus that reached the right atrium (RA) and 1 patient with infrahepatic inferior vena cava (IVC) thrombus. All patients received neoadjuvant chemotherapy (SIOP 2001 protocol) with vincristine, doxorubicin, and actinomycin D. Regression of the intravascular extension of the tumor was documented in all patients. Postchemotherapy level of extension was suprahepatic IVC in 1 patient, infrahepatic IVC in 2 patients, renal vein (RV) in 1 patient, and RA in 3 patients. Nephrectomy and thrombectomy were performed in all cases, requiring cardiopulmonary bypass for the 4 patients who presented with suprahepatic IVC and RA thrombus. The other 3 patients with infrahepatic IVC and RV involvement underwent cavotomy and thrombus extraction. Computed tomography, ultrasonography, and echocardiography were used for diagnosis and follow-up. All patients remain disease-free with a median follow-up of 6.3 years (range, 2-19 years). Neoadjuvant chemotherapy for WT with intravascular extension may facilitate the resection by decreasing the extent of the tumor thrombus. Cardiopulmonary bypass is indicated for suprahepatic IVC and RA involvement. Accurate diagnostic imaging is necessary.

  10. [Interest of an intensive chemotherapy for intravascular large B cell lymphoma].

    PubMed

    Baldolli, Aurélie; Chuffart, Marie; Geffray, Loik; Verneuil, Laurence; Reman, Oumédaly

    2013-04-01

    We describe three cases of intravascular lymphoma B with different clinical presentation: one case of a cutaneous variant and two cases with surrenal and cutaneous localisation. All patients are in complete remission after chemotherapy alone or after chemotherapy and autologous stem cells transplantation. The review of the literature as well as our cases specify the interest of an aggressive chemotherapy with autologous of peripheral stem cells if it was possible.

  11. Intravascular haemolysis during prolonged running on asphalt and natural grass in long and middle distance runners.

    PubMed

    Janakiraman, Kamal; Shenoy, Shweta; Sandhu, Jaspal Singh

    2011-09-01

    Surface features such as uneven playing surfaces, low impact absorption capacity and inappropriate friction/traction characteristics are connected with injury prevalence whereas force impact during foot strike has been suggested to be an important mechanism of intravascular haemolysis during running. We aimed to evaluate intravascular haemolysis during running and compare the effect of running on two different types of surfaces on haemolysis. We selected two surfaces (asphalt and grass) on which these athletes usually run. Participants were randomly assigned to group A (asphalt) or group B (grass) with 10 athletes in each group. Each athlete completed one hour of running at the calculated target heart rate (60-70%). Venous blood samples were collected before and immediately after running. We measured unconjugated bilirubin (UBR) (mg · dl(-1)), lactate dehydrogenase (LDH) (μ · ml(-1)), haemoglobin (g · l(-1)) and serum ferritin (ng · ml(-1)) as indicators of haemolysis. Athletes who ran on grass demonstrated an increase in the haematological parameters (UBR: P < 0.01, LDH: P < 0.05) when compared to athletes who ran on asphalt (UBR: P < 0.05, LDH: P = 0.241). Our findings indicate that intravascular haemolysis occurs significantly after prolonged running. Furthermore, we conclude that uneven grass surface results in greater haemolysis compared to asphalt road.

  12. Intravascular near-infrared fluorescence catheter with ultrasound guidance and blood attenuation correction

    NASA Astrophysics Data System (ADS)

    Dixon, Adam J.; Hossack, John A.

    2013-05-01

    Intravascular near-infrared fluorescence (NIRF) imaging offers a new approach for characterizing atherosclerotic plaque, but random catheter positioning within the vessel lumen results in variable light attenuation and can yield inaccurate measurements. We hypothesized that NIRF measurements could be corrected for variable light attenuation through blood by tracking the location of the NIRF catheter with intravascular ultrasound (IVUS). In this study, a combined NIRF-IVUS catheter was designed to acquire coregistered NIRF and IVUS data, an automated image processing algorithm was developed to measure catheter-to-vessel wall distances, and depth-dependent attenuation of the fluorescent signal was corrected by an analytical light propagation model. Performance of the catheter sensing distance correction method was evaluated in coronary artery phantoms and ex vivo arteries. The correction method produced NIRF estimates of fluorophore concentrations, in coronary artery phantoms, with an average root mean square error of 17.5%. In addition, the correction method resulted in a statistically significant improvement in correlation between spatially resolved NIRF measurements and known fluorophore spatial distributions in ex vivo arteries (from r=0.24 to 0.69, p<0.01, n=6). This work demonstrates that catheter-to-vessel wall distances, measured from IVUS images, can be employed to compensate for inaccuracies caused by variable intravascular NIRF sensing distances.

  13. The lateral neostriatum is necessary for compensatory ingestive behaviour after intravascular dehydration in female rats.

    PubMed

    Lelos, M J; Harrison, D J; Rosser, A E; Dunnett, S B

    2013-12-01

    Aberrant striatal function results in an array of physiological symptoms, including impaired consummatory and regulatory behaviours, which can lead to weight loss and dehydration. It was hypothesised, therefore, that cell loss in the neostriatum may contribute to altered fluid intake by regulating physiological signals related to dehydration status. To test this theory, rats with lesions of the lateral neostriatum and sham controls underwent a series of physiological challenges, including the experimental induction of intracellular and intravascular dehydration. No baseline differences in prandial or non-prandial drinking were observed, nor were differences in locomotor activity evident between groups. Furthermore, intracellular dehydration increased water intake in lesion rats in a manner comparable to sham rats. Interestingly, a specific impairment was evident in lesion rats after subcutaneous injection of poly-ethylene glycol was used to induce intravascular dehydration, such that lesion rats failed to adapt their water intake to this physiological change. The results suggest that the striatal lesions resulted in regulatory dysfunction by impairing motivational control over compensatory ingestive behaviour after intravascular hydration, while the physiological signals related to dehydration remain intact. Loss of these cells in neurodegenerative disorders, such Huntington's disease, may contribute to regulatory changes evident in the course of the disease.

  14. High frame-rate intravascular optical frequency-domain imaging in vivo

    PubMed Central

    Cho, Han Saem; Jang, Sun-Joo; Kim, Kyunghun; Dan-Chin-Yu, Alexey V.; Shishkov, Milen; Bouma, Brett E.; Oh, Wang-Yuhl

    2013-01-01

    Intravascular optical frequency-domain imaging (OFDI), a second-generation optical coherence tomography (OCT) technology, enables imaging of the three-dimensional (3D) microstructure of the vessel wall following a short and nonocclusive clear liquid flush. Although 3D vascular visualization provides a greater appreciation of the vessel wall and intraluminal structures, a longitudinal imaging pitch that is several times bigger than the optical imaging resolution of the system has limited true high-resolution 3D imaging, mainly due to the slow scanning speed of previous imaging catheters. Here, we demonstrate high frame-rate intravascular OFDI in vivo, acquiring images at a rate of 350 frames per second. A custom-built, high-speed, and high-precision fiber-optic rotary junction provided uniform and high-speed beam scanning through a custom-made imaging catheter with an outer diameter of 0.87 mm. A 47-mm-long rabbit aorta was imaged in 3.7 seconds after a short contrast agent flush. The longitudinal imaging pitch was 34 μm, comparable to the transverse imaging resolution of the system. Three-dimensional volume-rendering showed greatly enhanced visualization of tissue microstructure and stent struts relative to what is provided by conventional intravascular imaging speeds. PMID:24466489

  15. Use of an oxygen-carrying blood substitute to improve intravascular optical coherence tomography imaging

    NASA Astrophysics Data System (ADS)

    Hoang, Khiet C.; Edris, Ahmad; Su, Jianping; Mukai, David S.; Mahon, Sari; Petrov, Artiom D.; Kern, Morton; Ashan, Chowdhury; Chen, Zhongping; Tromberg, Bruce J.; Narula, Jagat; Brenner, Matthew

    2009-05-01

    Optical coherence tomography (OCT) is a catheter-based imaging technology with powerful resolution capable of identifying vulnerable plaques and guiding coronary intervention. However, a significant limitation of intravascular OCT imaging is its attenuation by blood. We propose that the use of an oxygen-carrying blood substitute could potentially optimize OCT image quality. Surgical isolation of the descending thoracic aorta of six rabbits is performed, followed by intravascular OCT imaging of the abdominal aorta. Perfluorodecalin (PFD) is oxygenated using a bubble-through technique with 100% oxygen. OCT imaging is performed and compared using three different flushing modalities: PFD; saline; and blood. OCT imaging of the rabbit abdominal aorta is successful in all of the subjects. In each of the six studied subjects, flushing with PFD consistently provides dramatically better imaging of the vessel wall tissue structures. OCT image quality is highly dependent on the ability of the flushing modality to remove blood from the imaging field. From this proof-of-concept study, we demonstrate that endovascular flushing with an oxygen-carrying blood substitute (PFD) is optically superior to saline flushing for intravascular imaging.

  16. A novel dual-frequency imaging method for intravascular ultrasound applications.

    PubMed

    Qiu, Weibao; Chen, Yan; Wong, Chi-Man; Liu, Baoqiang; Dai, Jiyan; Zheng, Hairong

    2015-03-01

    Intravascular ultrasound (IVUS), which is able to delineate internal structures of vessel wall with fine spatial resolution, has greatly enriched the knowledge of coronary atherosclerosis. A novel dual-frequency imaging method is proposed in this paper for intravascular imaging applications. A probe combined two ultrasonic transducer elements with different center frequencies (36 MHz and 78 MHz) is designed and fabricated with PMN-PT single crystal material. It has the ability to balance both imaging depth and resolution, which are important imaging parameters for clinical test. A dual-channel imaging platform is also proposed for real-time imaging, and this platform has been proven to support programmable processing algorithms, flexible imaging control, and raw RF data acquisition for IVUS applications. Testing results show that the -6 dB axial and lateral imaging resolutions of low-frequency ultrasound are 78 and 132 μm, respectively. In terms of high-frequency ultrasound, axial and lateral resolutions are determined to be as high as 34 and 106 μm. In vitro intravascular imaging on healthy swine aorta is conducted to demonstrate the performance of the dual-frequency imaging method for IVUS applications.

  17. The intravascular low level laser irradiation (ILLLI) in treatment of psoriasis clinically

    NASA Astrophysics Data System (ADS)

    Zhu, Jing; Nie, Fan; Shi, Hong-Min

    2005-07-01

    Objective: The title is research curative effect of intravascular low level laser irradiation (ILLLI) in treatment of psoriasis. Method: 478 patients with psoriasis from five groups to observe their efficacy. Group1 were treated by He-Ne laser combined with drug. Group 2 were treated by semi-conductor laser combined with drug. Group 3 were treated only by He-He laser. Group 4 were treated by semi-conductor laser. Group 5 were treated only by drug. The Ridit statistical analysis was applied to all of these data. The treatment of intravascular low level laser irradiation is as follow: laser power:4-5mw, 1 hour per day and 10 days as a period combined with vit C 2.0 g iv and inhalation of O2. Results: The clinical results: the near efficient rate was 100%, in group1-4, if combined with drugs it would be better. Ridit statistical analysis showed no significant difference between group1-4, p>0.05. The efficient rate 72.97% in group5.There were showed very significant difference with group1-4, p<0.01. 2.There were no significant differences between He-Ne laser (632.8nm) and semiconductor laser(650nm); 3.The efficacy of ILLLI in psoriasis was positive correlation to the ILLLI times. Conclusions: It can improve curative effect of intravascular low levellaser irradiation (ILLLI) in treatment of psoriasis.

  18. Stochastic bifurcation characteristics of SMA intravascular stent subjected to radial and axial excitations.

    PubMed

    Zhu, Zhiwen; Zhang, Wendi; Xu, Jia

    2014-01-01

    A kind of shape memory alloy (SMA) hysteretic nonlinear model is developed, and the stochastic bifurcation characteristics of SMA intravascular stents subjected to radial and axial excitations are studied in this paper. A new nonlinear differential item is introduced to interpret the hysteretic phenomena of SMA strain-stress curves, and the dynamic model of SMA intravascular stent subjected to radial and axial stochastic excitations is established. The conditions of the system's stochastic stability are determined, and the probability density function of the system response is obtained. Finally, the stochastic Hopf bifurcation characteristics of the system are analyzed. Theoretical analysis and numerical simulation show that the system stability varies with bifurcation parameters, and stochastic Hopf bifurcation occurs in the process; there are two limit cycles in the stationary probability density of the system response in some cases, which means that there are two vibration amplitudes whose probability are both very high; jumping phenomena between the two vibration amplitudes appears with the change of conditions, which may cause stent fracture or loss. The results of this paper are helpful for application of SMA intravascular stent in biomedical engineering fields.

  19. Invasive evaluation of plaque morphology of symptomatic superficial femoral artery stenoses using combined near-infrared spectroscopy and intravascular ultrasound.

    PubMed

    Zacharias, Sibin K; Safian, Robert D; Madder, Ryan D; Hanson, Ivan D; Pica, Mark C; Smith, James L; Goldstein, James A; Abbas, Amr E

    2016-08-01

    The purpose of this study is to characterize the plaque morphology of severe stenoses in the superficial femoral artery (SFA) employing combined near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS). Atherosclerosis is the most common cause of symptomatic peripheral arterial disease. Plaque composition of SFA stenoses has been characterized as primarily fibrous or fibrocalcific by non-invasive and autopsy studies. NIRS has been validated to detect lipid-core plaque (LCP) in the coronary circulation. We imaged severe SFA stenoses with NIRS-IVUS prior to revascularization in 31 patients (46 stenoses) with Rutherford claudication ⩾ class 3. Angiographic parameters included lesion location and stenosis severity. IVUS parameters included plaque burden and presence of calcium. NIRS images were analyzed for LCP and maximum lipid-core burden index in a 4-mm length of artery (maxLCBI4mm). By angiography, 38 (82.6%) lesions were calcified and 9 (19.6%) were chronic total occlusions. Baseline stenosis severity and lesion length were 86.0 ± 11.0% and 36.5 ± 46.5 mm, respectively. NIRS-IVUS identified calcium in 45 (97.8%) lesions and LCP in 17 (37.0%) lesions. MaxLCBI4mm was 433 ± 244. All lesions with LCP also contained calcium; there were no non-calcified lesions with LCP. In conclusion, this is the first study of combined NIRS-IVUS in patients with PAD. NIRS-IVUS demonstrates that nearly all patients with symptomatic severe SFA disease have fibrocalcific plaque, and one-third of such lesions contain LCP. These findings contrast with those in patients with acute coronary syndromes, and may have implications regarding the pathophysiology of atherosclerosis in different vascular beds.

  20. A Novel Mechanical Thrombectomy Device for Retrieval of Intravascular Thrombus

    SciTech Connect

    Monsky, Wayne L.; Finitsis, Stephanos; Cicco, Dino De; Brock, John M.; Kucharczyk, John; Latchaw, Richard E.

    2011-04-15

    Purpose: Thrombotic and embolic vascular occlusion represents a leading cause of morbidity and mortality. Currently available thrombectomy devices have limitations, including difficulty removing organized thrombus and clot fragmentation with distal embolization. A novel mechanical thrombectomy device (MTD), designed to remove both hard and soft thrombus without trauma to the blood vessel, was tested in preclinical porcine models evaluating efficacy, safety, and ease of use. Materials and Methods: A total of 26 vessels in 14 pigs underwent mechanical thrombectomy with MTD. Thrombectomy was performed in nine superficial femoral arteries, eight subclavian arteries, five primary branches of the subclavian artery, lateral thoracic artery or the thyrocervical trunk, and four external carotids. Subacute organized fibrin-laden thrombus was injected into the arteries producing vascular occlusion. The MTD was then used for thrombectomy to restore patency and blood flow. Results: Intact thrombus was retrieved from 24 of 26 of the vessels with a single pass of the MTD, resulting in complete restoration of patency in 21 vessels and partial patency in 4 vessels. In 8 cases that used an early design, the embolic material fragmented during withdrawal from the access sheath. In 4 procedures that used an early design, the MTD failed to deploy fully and the embolus was not completely captured. No intraprocedural complications or vascular damage occurred. Conclusions: The present pilot studies demonstrate basic safety and efficacy of a novel MTD with design attributes suitable for retrieval of intact acute and organized chronic thrombus. The device has potential intracranial and peripheral utility.

  1. Localized toxoplasmosis in a ring-tailed lemur (Lemur catta) causing placentitis, stillbirths, and disseminated fetal infection.

    PubMed

    Juan-Sallés, Carles; Mainez, Mireia; Marco, Alberto; Sanchís, Ana M Malabia

    2011-09-01

    Localized, myocardial toxoplasmosis contributed to the death of a female ring-tailed lemur (Lemur catta) 1 week after the delivery of 4 stillborn offspring with disseminated toxoplasmosis; the diagnosis was obtained by histopathology and immunohistochemistry in all 5 lemurs. Varying degrees of placentitis and placental edema with intralesional Toxoplasma gondii immunolabeling were observed in the 3 available placentas. The dam had severe myocarditis, and T. gondii antigen was only detected in the myocardial lesions. Disseminated toxoplasmosis with mild encephalitis was noted in all 4 fetuses, and 2 of the fetuses had mild acute multifocal hepatic necrosis. Fetal death was attributed to placental insufficiency with subsequent hypoxia and amniotic fluid aspiration.

  2. Disseminating hypnosis to health care settings: Applying the RE-AIM framework

    PubMed Central

    Yeh, Vivian M.; Schnur, Julie B.; Montgomery, Guy H.

    2014-01-01

    Hypnosis is a brief intervention ready for wider dissemination in medical contexts. Overall, hypnosis remains underused despite evidence supporting its beneficial clinical impact. This review will evaluate the evidence supporting hypnosis for dissemination using guidelines formulated by Glasgow and colleagues (1999). Five dissemination dimensions will be considered: Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM). Reach In medical settings, hypnosis is capable of helping a diverse range of individuals with a wide variety of problems. Efficacy There is evidence supporting the use of hypnosis for chronic pain, acute pain and emotional distress arising from medical procedures and conditions, cancer treatment-related side-effects and irritable bowel syndrome. Adoption Although hypnosis is currently not a part of mainstream clinical practices, evidence suggests that patients and healthcare providers are open to trying hypnosis, and may become more so when educated about what hypnosis can do. Implementation Hypnosis is a brief intervention capable of being administered effectively by healthcare providers. Maintenance Given the low resource needs of hypnosis, opportunities for reimbursement, and the ability of the intervention to potentially help medical settings reduce costs, the intervention has the qualities necessary to be integrated into routine care in a self-sustaining way in medical settings. In sum, hypnosis is a promising candidate for further dissemination. PMID:25267941

  3. 45 CFR 1388.7 - Program criteria-dissemination.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    .... (a) Introduction to dissemination: The UAP disseminates information and research findings, including..., productivity, integration and inclusion of individuals with developmental disabilities and their families. (b) The UAP must be a resource for information for individuals with developmental disabilities and...

  4. 45 CFR 1388.7 - Program criteria-dissemination.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    .... (a) Introduction to dissemination: The UAP disseminates information and research findings, including..., productivity, integration and inclusion of individuals with developmental disabilities and their families. (b) The UAP must be a resource for information for individuals with developmental disabilities and...

  5. 45 CFR 1388.7 - Program criteria-dissemination.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    .... (a) Introduction to dissemination: The UAP disseminates information and research findings, including..., productivity, integration and inclusion of individuals with developmental disabilities and their families. (b... the knowledge base through publications and presentations, including those based on research...

  6. Pulmonary Hemorrhage Secondary to Disseminated Strongyloidiasis in a Patient with Systemic Lupus Erythematosus

    PubMed Central

    Plata-Menchaca, Erika P.; de Leon, V. M. De la Puente-Diaz; Peña-Romero, Adriana G.; Rivero-Sigarroa, Eduardo

    2015-01-01

    Introduction. Pulmonary hemorrhage secondary to disseminated strongyloidiasis is an unusual, well-recognized entity in immunocompromised patients with autoimmune disease, which is associated with the hyperinfection syndrome, sepsis, and a high mortality rate. Case Presentation. We present a case of a 44-year-old Mexican woman with systemic lupus erythematosus and acute bacterial meningitis who developed pulmonary hemorrhage with acute respiratory failure requiring mechanical ventilation, treated with broad spectrum systemic antibiotics and high dose methylprednisolone, who subsequently developed a characteristic purpuric skin eruption and septic shock and died two days later of refractory hypoxemia caused by massive pulmonary bleeding. The postmortem examination reports filariform larvae of S. stercolaris in lung, skin, and other organs. Conclusion. This case highlights the importance of considering disseminated strongyloidiasis in the differential diagnosis of diffuse alveolar hemorrhage in systemic lupus erythematosus, and screening for S. stercolaris infection before initiation of immunosuppressive therapy should be considered, especially in endemic areas. Disseminated strongyloidiasis has a high mortality rate, explained in part by absence of clinical suspicion. PMID:26101672

  7. Effect of acute pericardial tamponade on the relative contributions of systolic and diastolic pulmonary venous return: a transesophageal pulsed Doppler study.

    PubMed

    Louie, E K; Hariman, R J; Wang, Y; Hwang, M H; Loeb, H S; Scanlon, P J

    1995-01-01

    The effect of acute pericardial tamponade on pulmonary venous return was assessed by transesophageal pulsed Doppler echocardiography. In 14 open-chest anesthetized dogs peak pulmonary venous flow velocities in systole (VJ) and in diastole (VK) were measured during apnea and atrial pacing while acute tamponade was induced by intrapericardial instillation of 0.9% sodium chloride solution. Before intravascular volume expansion, induction of acute tamponade resulted in a significant decline in VK (43 +/- 17 to 19 +/- 8 cm/sec; p < 0.05) but no change in VJ or the ratio VJ/VK. After intravascular volume expansion, induction of acute tamponade resulted in significant reductions in VJ (43 +/- 9 to 29 +/- 10 cm/sec; p < 0.001) and VK (37 +/- 19 to 15 +/- 11 cm/sec; p < 0.001). The effect was disproportionately greater on VK, however, resulting in a significant increase in VJ/VK (1.51 +/- 0.84 to 2.58 +/- 1.41; p < 0.001). The disproportionate effect of acute tamponade on VK suggests that increased pericardial pressure directly constrains diastolic filling of the left atrium as a conduit to the left ventricle and that it does not decrease the systolic and diastolic phases of pulmonary venous return uniformly. Intravascular volume expansion increases cardiac output before acute tamponade, but during acute tamponade it amplifies the disproportionate impact of increased pericardial pressure on left ventricular diastolic filling as the left ventricle is constrained within the fluid-filled pericardial sac.

  8. Acute toxicity from baking soda ingestion.

    PubMed

    Thomas, S H; Stone, C K

    1994-01-01

    Sodium bicarbonate is an extremely well-known agent that historically has been used for a variety of medical conditions. Despite the widespread use of oral bicarbonate, little documented toxicity has occurred, and the emergency medicine literature contains no reports of toxicity caused by the ingestion of baking soda. Risks of acute and chronic oral bicarbonate ingestion include metabolic alkalosis, hypernatremia, hypertension, gastric rupture, hyporeninemia, hypokalemia, hypochloremia, intravascular volume depletion, and urinary alkalinization. Abrupt cessation of chronic excessive bicarbonate ingestion may result in hyperkalemia, hypoaldosteronism, volume contraction, and disruption of calcium and phosphorus metabolism. The case of a patient with three hospital admissions in 4 months, all the result of excessive oral intake of bicarbonate for symptomatic relief of dyspepsia is reported. Evaluation and treatment of patients with acute bicarbonate ingestion is discussed.

  9. Massive Hemolysis Causing Renal Failure in Acute Hepatitis E Infection

    PubMed Central

    Karki, Pragya; Malik, Sarthak; Mallick, Bipadabhanjan; Sharma, Vishal; Rana, Surinder S

    2016-01-01

    Abstract Acute viral hepatitis is usually a self-limiting illness. However, it can lead to complications that can be life-threatening, such as acute liver failure. Glucose 6 phosphate dehydrogenase (G6PD) deficiency in the setting of acute viral hepatitis can lead to a massive hemolysis, manifesting as acute kidney injury and markedly raised bilirubin levels; although cases are rare. Here, we report such a case. The patient had a viral hepatitis E infection and presented with kidney injury requiring dialysis. Examination showed very high mixed hyperbilirubinemia due to massive intravascular hemolysis. The patient experienced a long, protracted course of illness, requiring renal replacement therapy with other supportive management, which led to improvement over a period of four weeks. This case highlights the importance of recognizing associated hemolysis in a patient with viral hepatitis who presents with very high bilirubin levels or associated kidney injury. Such patients will require aggressive supportive care with prompt fluid and electrolyte management. PMID:28097104

  10. Dissemination of Educational Tools and Programs

    NASA Astrophysics Data System (ADS)

    Christian, C.

    1998-05-01

    The IDEAS program is oriented towards innovative approaches to education and therefore result in a wide range of programs including Astro Capella (the creation of a capella astronomy songs written and performed by a group from NASA/GSFC, Smale, Boyd, and Granger), video kiosks in the Air and Space Museum (SAO, Dow), teaching astronomy in the parks (U of Wisconsin, Bjorkman, Wilcots), as well as the more bread and butter programs of teacher training and curriculum development. In addition to describing some of the diverse programs to come out of the IDEAS programs, I will discuss the dissemination of the results of those programs, and especially the role of the broker/facilitator in that dissemination. The audience is invited to participate in this discussion.

  11. 48 CFR 2905.101 - Methods of disseminating information.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Methods of disseminating information. 2905.101 Section 2905.101 Federal Acquisition Regulations System DEPARTMENT OF LABOR ACQUISITION PLANNING PUBLICIZING CONTRACT ACTIONS Dissemination of Information 2905.101 Methods of disseminating information. Contracting officers...

  12. Twiddlenet: Metadata Tagging and Data Dissemination in Mobile Device Networks

    DTIC Science & Technology

    2007-09-01

    METADATA TAGGING AND DATA DISSEMINATION IN MOBILE DEVICE NETWORKS by Christopher T. Clotfelter Jonathon E. Towle September 2007 Thesis...Metadata Tagging and Data Dissemination in Mobile Device Networks 6. AUTHOR(S) Clotfelter, Christopher T. Towle , Jonathon E. 5. FUNDING NUMBERS 7...DISSEMINATION IN MOBILE DEVICE NETWORKS Jonathan E. Towle Captain, United States Maine Corps B.S., California State University Humboldt

  13. Disseminated adiaspiromycosis in a patient with AIDS.

    PubMed

    Echavarria, E; Cano, E L; Restrepo, A

    1993-01-01

    A case of disseminated adiaspiromycosis in an AIDS patient is described. The most notable characteristic of the infection was the extensive osteomyelitis exhibited by the patient. Positive cultures for Chrysosporium parvum var. parvum were obtained from pus taken from a lesion of the wrist during surgery as well as from sputum samples and a bone marrow aspirate. Treatment with amphotericin B controlled the fungal infection.

  14. Disseminated nocardiosis masquerading as metastatic malignancy

    PubMed Central

    Arjun, Rajalakshmi; Padmanabhan, Arjun; Reddy Attunuru, Bhanu Prakash; Gupta, Prerna

    2016-01-01

    Nocardiosis is an uncommon gram-positive bacterial infection caused by aerobic actinomycetes of the genus Nocardia. It can be localized or systemic and is regarded as an opportunistic infection that is commonly seen in immunocompromised hosts. We report a case of disseminated nocardiosis caused by Nocardia cyriacigeorgica in a patient with underlying malignancy in whom the clinical presentation was highly suggestive of a metastatic disease. PMID:27578940

  15. Antibody response that protects against disseminated candidiasis.

    PubMed Central

    Han, Y; Cutler, J E

    1995-01-01

    We previously showed that surface mannans of Candida albicans function as adhesins during yeast cell attachment to mouse splenic marginal zone macrophages. The mannan adhesin fraction was encapsulated into liposomes and used to vaccinate mice over a 5- to 6-week period. Circulating agglutinins specific for the fraction correlated with increased resistance to disseminated candidiasis. Antiserum from vaccinated animals protected naive BALB/cByJ mice against C. albicans serotype A and B strains and Candida tropicalis. Antiserum also protected SCID mice against disseminated disease. The serum protective ability was stable at 56 degrees C, but this ability was adsorbed by C. albicans cells. The antiserum was divided into three fractions after separation by high-performance liquid chromatography. One fraction contained all of the agglutinin activity and transferred resistance to naive mice. A second fraction also transferred resistance. Two monoclonal antibodies (MAbs) specific for candidal surface determinants were obtained. MAb B6.1 is specific for a mannan epitope in the adhesin fraction, and MAb B6 is specific for a different epitope in the fraction. Both MAbs are immunoglobulin M, and both strongly agglutinate candidal cells, but only MAb B6.1 protected both normal and SCID mice against disseminated candidiasis. In one experiment, 10 normal mice were given MAb B6.1 and challenged with yeast cells. Six mice survived the 67-day observation period; 4 of the survivors were cured as evidenced by the lack of CFU in the kidney and spleen. Our studies show that antibodies against certain cell surface antigens of C. albicans help the host resist disseminated candidiasis. PMID:7790089

  16. Time dissemination in the Hydro Quebec network

    NASA Technical Reports Server (NTRS)

    Missout, G.; Lefrancois, W.; Laroche, L.

    1979-01-01

    The ever increasing complexity of electrical networks combined with the increasing cost of power losses during a network failure has led public utilities to become equipped with more powerful and precise tools for pinpointing the causes of such a fault. Hydro Quebec has developed and is now using a time dissemination system which uses a modified IRIG B code transmitted on its own telecommunication network. The reasons for using such a system and the way it was carried out are discrete.

  17. Dissemination: bringing translational research to completion.

    PubMed

    Clark, Florence; Park, Daniel J; Burke, Janice P

    2013-01-01

    Despite the availability of innovative health care research, a gap exists between research-generated knowledge and the utilization of that knowledge in real-world practice settings. This article examines the transition from research to implementation in the context of the dissemination of A. Jean Ayres' sensory integration procedures and of the challenges currently facing the University of Southern California Well Elderly Studies research team. Drawing from the emerging field of implementation science, this article discusses how researchers can develop an implementation plan to more easily translate evidence into practice. Such plans should address the intervention's reach (i.e., its capacity to penetrate into the intended target population), the settings for which it is applicable, the leaders who will encourage practitioner uptake, stakeholder groups, and challenges to dissemination. By taking action to ensure the more effective dissemination of research-generated knowledge, researchers can increase the likelihood that their interventions will lead to improvements in practice and more effective care for consumers.

  18. Evidence-based radiology: review and dissemination.

    PubMed

    Medina, L Santiago; Blackmore, C Craig

    2007-08-01

    Evidence-based radiology (EBR) is an important tool for the practice of radiology. The user of the EBR approach identifies evidence in a systematic fashion and then assimilates information through in-depth, explicit critical review of the best-designed and most recent literature on the subject in question. Clinical decision making is then based on the best current evidence, clinical expertise, and patient values. Substantial progress has been made in the review and dissemination of EBR. Dissemination of EBR within radiology has two critical aspects. The first is increased understanding of the methods required for EBR and of the appropriate use of EBR. The second important component is the dissemination of the data and critical literature reviews necessary to allow use of the EBR approach. Resources available for both EBR methods and EBR data in radiology include societies, journals, medical meetings, Web sites, and textbooks. Although radiology has made important progress in this field in recent years, the specialty is still behind other specialties that have been at the forefront of evidence-based medicine in the past decade.

  19. Impact of gender and age on in vivo virtual histology-intravascular ultrasound imaging plaque characterization (from the global Virtual Histology Intravascular Ultrasound [VH-IVUS] registry).

    PubMed

    Qian, Jie; Maehara, Akiko; Mintz, Gary S; Margolis, M Pauliina; Lerman, Amir; Rogers, Jason; Banai, Shuel; Kazziha, Samer; Castellanos, Celia; Dani, Lokesh; Fahy, Martin; Stone, Gregg W; Leon, Martin B

    2009-05-01

    Virtual histology intravascular ultrasound (VH-IVUS) analyses were performed in the first 990 patients enrolled in the 3,000+ patient global VH-IVUS Registry to assess the impact of gender and age on in vivo VH-IVUS plaque characterization. The 990 patients were divided into 3 age group terciles (<58, 58 to 68, and >68 years) and again divided according to gender. In conclusion, (1) both women and men had an increase in plaque with increasing age; (2) at any age, men had more plaque than women; (3) percentages of dense calcium and necrotic core increased with increasing patient age in both men and women; and (4) gender differences were lowest in the oldest tercile (>68 years).

  20. Cystitis - acute

    MedlinePlus

    Uncomplicated urinary tract infection; UTI - acute cystitis; Acute bladder infection; Acute bacterial cystitis ... cause. Menopause also increases the risk for a urinary tract infection. The following also increase your chances of having ...