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PubMed1993

[Subarachnoid hemorrhage and pontine hemorrhage followed by an embolization procedure of left occipital giant arteriovenous malformation: a case report].

A 42-year-old woman suddenly developed headache and nausea on July 26, 1991, and the computed tomography (CT) scan showed a moderate-sized hematoma in the left occipital lobe. After one month's conservative treatment, she had recovered to a neurologically intact state. Cerebral angiography demonstrated a giant arteriovenous malformation fed by enlarged branches of the left posterior cerebral artery as well as small branches arising from the middle cerebral artery, anterior cerebral artery and the meningeal branches of the middle meningeal artery and the occipital artery. Preoperative embolization was planned on February 24, 1992. During an attempt at catheterization of the basilar artery and the left posterior cerebral artery with a balloon catheter and a Tracker-18 catheter, the patient complained of an intensification of her headache, nausea and vomiting. So the embolization procedure was stopped. The CT scan taken immediately at that time showed a severe subarachnoid hemorrhage (SAH). She became comatose about 40 minutes later. CT scan taken next day revealed also a complication of the pontine hemorrhage. Neurologically, she had gradually recovered and could communicate with some simple words 3 months after SAH. The total removal of the AVM was performed on May 26, 1992. Postoperative course was uneventful. She showed rapid and remarkable improvement in her neurological state suggesting that the blood flow in the surrounding brain area had been corrected. A blood deficit had no doubt been caused when blood had been stolen by the giant AVM.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

[Hereditary hemorrhagic telangiectasia (Osler-Rendu-Weber disease) Management of epistaxis and oral hemorrhage by Nd-Yag laser].

BACKGROUND AND AIMS: The paper reports the use of Nd-Yag laser treatment for some major otolaryngoiatric symptoms in hereditary hemorrhagic teleangectasia (Rendu-Osler-Weber disease), focusing on the importance of epistaxis and oral hemorrhage as a cause of continuous hemoreintegrative treatment, without forgetting the constant psychophysical stress undergone by these patients. MATERIALS AND METHODS: Photocoagulation of teleangectasia in the ENT district has been used by the authors since January 1994. A total of 8 patients, 5 males and 3 females, have been treated aged between 31 and 65 years old. During the first year specialist outpatient controls were performed every two months, after which the follow-up became four-monthly. RESULTS: The authors provide a detailed illustration of the methods used, the choice of power, and the advantages and results obtained, emphasising the outpatient nature of treatment, excellent patient tolerability and the low cost to the health service. CONCLUSIONS: In the light of these results, the Authors underline the unquestionable usefulness of Nd-Yag laser in the treatment of a few of the undoubtedly more stressing symptoms of Rendu-Osler-Weber disease.

Epistaxis↗
PubMed1982

Toxicity of hemorrhagic ascitic fluid associated with hemorrhagic pancreatitis.

Hemorrhagic pancreatitis was induced in dogs by a retrograde infusion of the pancreatic duct with a mixture of taurocholate sodium and trypsin. Seven of the 13 dogs were pretreated with antibiotics. The hemorrhagic ascitic fluid (HAF) recovered from the dogs' abdomens was injected intraperitoneally into mice in volumes of 2.5, 5, 10, 15, and 20 mL. The mice were divided into two groups depending on whether the HAF received was from dogs given antibiotics. The mortality among the mice was proportional to the volume of HAF injected. The mortality among mice receiving the sterile HAF was 79.4% at 20 mL, 55.8% at 15 mL, 29.4% at 10 mL, 26% at 5 mL, and 17% at 2.5 mL. There were no deaths among mice receiving 25 mL and saline solution and the mortality was 15% among mice receiving 20 mL of dog plasma.

Animals↗
PubMed2002

Cell death in experimental intracerebral hemorrhage: the "black hole" model of hemorrhagic damage.

Intracerebral hemorrhage (ICH) has a poor prognosis that may be the consequence of the hematoma's effect on adjacent and remote brain regions. Little is known about the mechanism, location, and severity of such effects. In this study, rats subjected to intracerebral blood injection were examined at 100 days. Stereology (neuronal count and density) and volume measures in the perihematoma rim, the adjacent and overlying brain, and the substantia nigra pars reticulata (SNr) were compared with contralateral brain regions at 100 days and the perihemorrhage region at 24 hours and 7 days. In addition, cytochrome c release was investigated at 24 hours, 3 days, and 7 days. At 100 days, post-ICH rats showed no difference in neuronal density in the perihemorrhagic scar region or regions of the striatum immediately surrounding and distal to the perihemorrhage scar. The cell density index in the ipsilateral field was 16.2 +/- 3.8 versus the contralateral control field of 15.6 +/- 3.2 (not significant). Volume measurements of the ipsilateral striatum revealed a 20% decrease that was compensated by an increase in ipsilateral ventricular size. The area of the initial ICH as measured by magnetic resonance imaging correlated with the degree of atrophy. In the region immediately surrounding the hematoma, cytochrome c immunoreactivity increased at 24 hours and 3 days, and returned toward baseline by day 7. At 24 hours, stereology in the peri-ICH region showed decreased density in the region where cytochrome c immunoreactivity was the highest. Neuronal density of the ipsilateral SNr was significantly less than the contralateral side (9.6 +/- 1.9 vs 11.6 +/- 2.3). Histologic damage from ICH occurred mainly in the immediate perihemorrhage region. Except for SNr, we found no evidence of neuronal loss in distal regions. We have termed this continued destruction of neurons, which occurs over at least 3 days as the neurons come into proximity to the hematoma, the "black hole" model of hemorrhagic damage.

Animals↗
PubMed1981

Upper digestive tract hemorrhage in cirrhotic patients. Contribution of multidimensional analysis to the study of variables related to the cause of the hemorrhage.

Sixteen clinical and biological variables were recorded in 116 episodes of upper digestive tract hemorrhage of known cause in cirrhotic patients. One-dimensional analysis reveals a significant correlation between six variables and the rupture of esophagogastric varices, whereas multiple linear regression and partial correlation analysis reduces the significant variables to two: a history of digestive hemorrhage and the nonalcoholic etiology of the cirrhosis. A value of the discriminant function exists for which the specificity and, consequently, the positive predictive value are equal to 100%, but with a sensitivity of 39%. These results mean that, in an explanatory approach, partial correlation analysis seems to constitute an indispensable complement to analysis of clinical and biological variables, since it reduces the chances of unwarranted explanatory interpretation. However, in a pragmatic approach, the recording of 16 variables does not permit a clear discrimination between ruptured varices and nonruptured varices; this suggests that either other factor(s) remain to be discovered or else that those related to ruptured varices and to acute ulcerations are the same.

Alcoholism↗
PubMed1994

Ultrasound diagnosis of thymic hemorrhage in an infant with late-onset hemorrhagic disease.

Thymic hemorrhage related to coagulopathy by vitamin K deficiency is a rare condition. We report a case in a 4-week-old boy presenting with acute onset of respiratory distress and anemia. Ultrasound examination of a compressive anterior mediastinal mass established the diagnosis of thymic hemorrhage and allowed us to follow resolution under medical treatment.

Acute Disease↗
PubMed1983

Acute cerebellar hemorrhage with brainstem compression in contrast with benign cerebellar hemorrhage.

Twenty six cases of cerebellar hemorrhages were reviewed and analyzed. Two patients were comatose on admission and showed clinical evidence of brainstem compression; they were successfully revived after evacuation of the hematomas. This was in contrast with six other comatose patients who did not have evacuation and subsequently died within 48 hours. The other eight cases of so-called benign cerebellar hemorrhage ran a more benign course and recovered without any operative procedures. It is suggested that prompt diagnosis with computed tomography, even in comatose patients, and immediate removal of the hematoma in this group, might result in a better prognosis with this highly lethal condition.

Acute Disease↗
PubMed2005

Phenylpropanolamine and hemorrhagic stroke in the Hemorrhagic Stroke Project: a reappraisal in the context of science, the Food and Drug Administration, and the law.

The report of the Hemorrhagic Stroke Project (HSP), a case-control study of phenylpropanolamine (PPA) was the primary reason that the US Food and Drug Administration (FDA) requested that PPA-containing products voluntarily be withdrawn from the market. In subsequent litigation, scientific information emerged that was not available during the deliberations of the FDA and its advisory committee. Our reappraisal leads us to conclude that chance, bias, and confounding are plausible alternative explanations for the observed findings. Thus, we believe that it is not possible to conclude that there is any valid statistical association between PPA and hemorrhagic stroke, let alone make any judgment of causality. Our reappraisal suggests the FDA's regulatory request may have been premature.

Adolescent↗
PubMed2005

Subarachnoid hemorrhage diagnosis by computed tomography and lumbar puncture: are fifth generation CT scanners better at identifying subarachnoid hemorrhage?

This study sought to determine the sensitivity and specificity of modern computed tomography (CT) scans for the diagnosis of subarachnoid hemorrhage (SAH). No studies have been done recently with fifth generation CT scanners to look at the diagnosis of SAH. A retrospective chart review was done of Emergency Department (ED), laboratory, and hospital records at Pitt County Memorial Hospital in Greenville, North Carolina over 1 year from January 1, 2002 to December 31, 2002. Patients presented with headache and had a CT scan of the head with a fifth generation multi-detector CT scanner followed by a lumbar puncture (LP) to rule out SAH. There were 177 patients who presented to the ED with headache and went on to have a CT scan and an LP to rule out SAH. No patients who had a negative CT were found to have a subarachoid hemorrhage. It is concluded that fifth generation CT scanners are probably more sensitive than earlier scanners at detecting SAH.

Emergency Medicine↗
PubMed2006

Intracranial hemorrhage due to late hemorrhagic disease in two siblings.

Deficiency of vitamin K predisposes to early, classic or late hemorrhagic disease of the newborn (HDN); late HDN may be associated with serious and life-threatening intracranial hemorrhage. Late HDN is characterized by intracranial bleeding in infants aged 1 week to 6 months due to severe vitamin K deficiency, occurring particularly in exclusively breastfed infants. Late HDN is still an important cause of mortality and morbidity in developing countries where vitamin K prophylaxis is not routinely practiced. In this study, we report on two siblings with intracranial bleeding who were fully breastfed without a routine supplementation of vitamin K. Vitamin K should be given to all newborns as a single, intramuscular dose of 1 mg.

Diagnosis, Differential↗
PubMed2003

Pathogenesis of Ebola hemorrhagic fever in primate models: evidence that hemorrhage is not a direct effect of virus-induced cytolysis of endothelial cells.

Ebola virus (EBOV) infection causes a severe and often fatal hemorrhagic disease in humans and nonhuman primates. Whether infection of endothelial cells is central to the pathogenesis of EBOV hemorrhagic fever (HF) remains unknown. To clarify the role of endothelial cells in EBOV HF, we examined tissues of 21 EBOV-infected cynomolgus monkeys throughout time, and also evaluated EBOV infection of primary human umbilical vein endothelial cells and primary human lung-derived microvascular endothelial cells in vitro. Results showed that endothelial cells were not early cellular targets of EBOV in vivo, as viral replication was not consistently observed until day 5 after infection, a full day after the onset of disseminated intravascular coagulation. Moreover, the endothelium remained relatively intact even at terminal stages of disease. Although human umbilical vein endothelial cells and human lung-derived microvascular endothelial cells were highly permissive to EBOV replication, significant cytopathic effects were not observed. Analysis of host cell gene response at 24 to 144 hours after infection showed some evidence of endothelial cell activation, but changes were unremarkable considering the extent of viral replication. Together, these data suggest that coagulation abnormalities associated with EBOV HF are not the direct result of EBOV-induced cytolysis of endothelial cells, and are likely triggered by immune-mediated mechanisms.

Animals↗
PubMed1997

Transient lupus anticoagulants associated with hemorrhage rather than thrombosis: the hemorrhagic lupus anticoagulant syndrome.

Lupus anticoagulants (LAs) represent a diverse group of antibodies directed against phospholipids. Patients with LAs may be free of symptoms but can have thrombotic complications including stroke, placental infarction, and fetal loss. Rarely hemorrhagic symptoms have been reported. We describe six previously healthy children who were first seen with clinical bleeding and prolonged activated partial thromboplastin time. Laboratory evaluation revealed positive results on mixing studies and evidence of phospholipid dependence of the anticoagulant, suggesting LAs. Four of six patients had anticardiolipin antibodies, and all four who were tested had reduced factor II activity levels. In all patients, bleeding symptoms resolved spontaneously within 3 months, and laboratory findings returned to normal within 6 months. The hemorrhagic LA syndrome should be considered in previously healthy children with new-onset bleeding and prolonged activated partial thromboplastin time. This clinical entity probably represents pathogenic mechanism distinct from thrombotic LA syndromes.

Brain↗
PubMed1983

Etiologic studies of epidemic hemorrhagic fever (hemorrhagic fever with renal syndrome).

Two strains of epidemic hemorrhagic fever (EHF) virus were isolated from the lung tissues of Apodemus agrarius mice that were captured in an area where EHF is endemic. The strains were isolated by passages in A. agrarius mice from a nonendemic area. Identification of the isolates by usual procedures was confirmed by repeated blind tests with coded sera. Contamination with certain known viruses such as reovirus, adenovirus (types 3 and 7), and other pathogens, such as murine typhus rickettsiae and Leptospira, which may be naturally present in wild rodents, appeared to have been ruled out. The antigen slides made from these isolates are in use in the specific diagnosis and seroepidemiologic studies of EHF. The first successful application is the serodiagnosis of a mild type of hemorrhagic fever that occurs with characteristic epidemiologic features in certain provinces of China.

Animals↗
PubMed2005

Diagnosis and treatment of orbit posttraumatic subperiosteal hemorrhage in a child, associated with a subdural intracranial hemorrhage.

We describe a rare case of traumatic subperiosteal orbital hematoma in a child, with intracranial hemorrhagic complication. Subperiosteal hematoma are the more infrequent occurrences among intraorbital hemorrhagic lesions and can be also associated with intracranial extradural hematoma in patients with orbital roof fracture. Here, we describe a case without roof fracture but with a never-before described intracranial subdural hematoma. The patient underwent computed tomography and magnetic resonance imaging, in an acute state, and later, a radiologic diagnosis of percutaneous drainage of the hematoma was mad. MRI was more sensitive and specific in the evaluation of the intracranial and intraorbital complication.

Bicycling↗
PubMed2006

Immune effects of resuscitation with HBOC-201, a hemoglobin-based oxygen carrier, in swine with moderately severe hemorrhagic shock from controlled hemorrhage.

HBOC-201, a hemoglobin-based oxygen carrier, improved physiologic parameters and survival in hemorrhagic shock (HS) animal models. However, resuscitation from HS and the properties of different fluids influence immune responses. The aim of this study was to determine if HBOC-201 significantly alters immune function in traumatic HS. Anesthetized pigs underwent soft tissue injury, controlled hemorrhage of 40% of blood volume, and resuscitation with HBOC-201 or Hextend, or no resuscitation. Sequential whole-blood samples were collected for analyses of leukocyte differential (hematology analyzer), T-lymphocyte subsets (CD3, CD4, and CD8) (FACS), lymphocyte adhesion marker CD49d (alpha4-integrin) expression (FACS), plasma cytokines-tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-10-(ELISA), and lymphocyte apoptosis (annexin-V/propidium iodide staining) (FACS). Statistical analyses were performed by the mixed procedure. Total WBC counts decreased posthemorrhage in both resuscitation groups. Lymphocyte percentages decreased and PMN percentages increased around 4 h posthemorrhage in all groups. CD3 cells decreased in all groups, but CD4 and CD8 cells decreased only in the resuscitation groups. TNF-alpha levels were not detectable in any groups. IL-6 levels were similar across treatment groups (P > 0.05); however, IL-10 levels were higher in the HBOC group, as early as 1 h posthemorrhage (P = 0.04). Increases in lymphocytic CD49d expression levels and apoptosis occurred only in nonresuscitation and Hextend groups, respectively (P < or = 0.01). In comparison with Hextend, HBOC-201 had no significant adverse or beneficial effects on immune function in this model of moderately severe HS in swine, suggesting that it may be safe as a resuscitation fluid in HS patients.

Animals↗
PubMed2006

Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma.

BACKGROUND: To develop a simple scoring system that allows an early and reliable estimation for the probability of mass transfusion (MT) as a surrogate for life threatening hemorrhage following multiple trauma. METHODS: Potential clinical and laboratory variables documented in the Trauma Registry of the German Trauma Society (DGU) (1993-2003; n=17,200) were subjected to univariate and multivariate logistic regression analysis to predict the probability for MT. RESULTS: Clinical and laboratory variables available from data sets were screened for their association with mass transfusion. MT was defined by transfusion requirement of >or=10 units of packed red blood cells from emergency room (ER) to intensive care unit admission. Seven independent variables were identified to be significantly correlated with an increased probability for MT: systolic blood pressure (<100 mm Hg=4 pts, <120 mm Hg=1 pt), hemoglobin (<7 g/dL=8 pts, <9 g/dL=6 pts, <10 g/dL=4 pts, <11 g/dL=3 pts, and <12 g/dL=2 pts), intra-abdominal fluid (3 pts), complex long bone and/or pelvic fractures (AIS 3/4=3 pts and AIS 5=6 pts), heart rate (>120=2 pts), base excess (<-10 mmol/L=4 pts, <-6 mmol/L=3 pts, and <-2 mmol/L=1 pt), and gender (male=1 pt). These variables were incorporated into a risk score, the Trauma Associated Severe Hemorrhage Score (TASH-Score, 0-28 points). Performance of the score was tested with respect to discrimination, precision, and calibration. Increasing TASH-Score points were associated with an increasing probability for MT. CONCLUSION: The TASH-Score is an easy-to-use scoring system that reliably predicts the probability for MT after multiple trauma. Taken as a surrogate for life threatening bleeding calculation may focus attention on relevant variables indicative for risk and impact strategies to stop bleeding and stabilize coagulation in acute trauma care.

Adult↗