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PubMed1992

[Hemorrhagic myocardial infarct. An analysis of the distribution of the hemorrhage and of the permeability of the artery related to the infarct].

PURPOSE: To study the extent of hemorrhagic myocardial infarction (HMI) and patency of the infarct related artery. METHODS: Forty seven cases of HMI diagnosed by necropsy (patient age range 30-81 years, mean 59) were studied retrospectively. Hemorrhagic extent was evaluated by microscopic analysis of myocardial sections of the infarcted areas and coronary patency was studied by angiography and by serial coronary sections at necropsy. RESULTS: In 12 cases hemorrhage extended outside the infarcted area and in the remaining cases it was restricted to the necrotic zone. Coronary patency was spontaneous in 8 of 24 cases, secondary to thrombolytic therapy or angioplasty in 8 and post coronary artery bypass in 15. Recent occlusive thrombus was diagnosed in 26 of 44 cases. Grouping all cases according to angiographic or macro and microscopic evidences of coronary patency, it was found that 35 of 47 studies cases (74.4%) had the infarct related coronary artery free of occlusion. In most cases of HMI myocardial hemorrhage restricted to the infarcted necrotic zone but in almost 25% it could reach areas beyond the infarcted necrotic zone probably resulting in deleterious consequences. CONCLUSION: Reperfusion is frequent and it plays a role in the hemorrhagic event but it was not seen in 25% of these studied cases. These findings suggest that other mechanisms could participate of the pathogenesis of HMI.

Adult↗
PubMed1989

[Clinical significance of intracranial hemorrhage caused by cerebral arteriovenous malformations: with special reference to intraventricular hemorrhage].

Forty-two cases with intracranial hemorrhage caused by cerebral arteriovenous malformation (AVM), which was diagnosed by CT scan, were reviewed with regard to the clinical significance of intracranial hemorrhage, especially intraventricular hemorrhage (IVH). Twenty-one patients were defined as poor risk cases whose level of consciousness at admission was 100 to 300 according to the Japan Coma Scale, whereas the remaining 21 patients were defined as good risk cases. Surgical excision of AVM was undertaken in 35 out of the 42 cases. Urgent surgical removal of intracerebral hematoma and AVM within 24 hours following onset was undertaken in 11 cases. In 14 patients, urgent continuous ventricular drainage was carried out. The effects of the following factors on the level of consciousness at admission, and on the result of AVM treatment were investigated to clarify the clinical significance of intracranial hemorrhage; 1) cast formation of 3rd and/or 4th ventricle, 2) volume of intraventricular hematoma, 3) accompanying intracerebral hematoma and 4) acute hydrocephalus. It was confirmed that all these factors significantly contributed to the development of serious disturbance of consciousness in the acute stage following intracranial hemorrhage. For good risk cases, the rate of patients who showed a good recovery or only moderate disability according to the Glasgow Outcome Scale reached 91%, whereas for poor risk cases, it was only 43%. The presence of large intracerebral hematomas of more than 4 cm in diameter accompanied with IVH was significantly correlated with the result of AVM treatment. The presence or absence of cast formation of 3rd and/or 4th ventricle, volume of intraventricular hematoma and acute hydrocephalus were not significantly related to the result of AVM treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMedDate not supplied

[Splenic vein thrombosis as cause of digestive hemorrhage: ruptured esophageal varices or hemorrhagic gastritis secondary to portal hypertension?].

The clinical evolution and treatment of two patients with alcoholic chronic pancreatitis complicated with digestive hemorrhage localized in the gastric corpus and fundus are discussed. The clinical picture and the endoscopic features suggested that the hemorrhage was due to hemorrhagic gastritis and not to rupture of varicose veins. Hemorrhagic gastritis as a consequence of segmentary portal hypertension may be responsible for the difficulty in establishing the etiology of digestive hemorrhage in such cases.

Adult↗
PubMed1979

Etiological relation between Korean hemorrhagic fever and epidemic hemorrhagic fever in Japan.

The first case of epidemic hemorrhagic fever in Japan was seen in Osaka in 1960. The etiologic agent of this disease has not yet been isolated, but a close etiologic relation between Korean hemorrhagic fever and epidemic hemorrhagic fever in Japan has been suspected because of similarities in the clinical and pathological pictures of the two diseases. This relation has now been confirmed serologically by demonstrating specific immunofluorescent antibodies to Korean hemorrhagic fever virus in 19 of 20 sera obtained from subjects 7 to 17 years after an acute attack of epidemic hemorrhagic fever.

Adolescent↗
PubMed2006

A large animal fatal extremity hemorrhage model and evaluation of a polymeric dressing (fatal extremity hemorrhage).

BACKGROUND: Extremity hemorrhage is a contributor to preventable battlefield mortality. The Army has liberalized tourniquet use guidelines in an attempt to prevent these deaths. To evaluate wound hemostatic agents that might allow for early tourniquet removal while maintaining hemorrhage control, a model of lethal extremity hemorrhage in the goat (Capra hircus) was developed and a polymeric dressing agent (BioFoam) tested. METHODS: After administration of a spinal block, animals were placed in lateral recumbancy with a head-up tilt of 6 degrees, 500 mL crystalloid was injected and 600 u/Kg of heparin was administered. After tourniquet application to the thigh, a soft tissue and vascular injury was created by transecting muscles and the femoral artery. The polymeric wound dressing was applied and the tourniquet was released. RESULTS: In testing, the primary endpoint was mortality within the first hour after tourniquet release. None of the control animals survived the full hour. Two out of five (40%) of the treated animals survived. With survivors' survival time calculated as 60 minutes, survival time was found not to differ between treated (34 +/- 19 minutes) and untreated (29 +/- 18 minutes) animals (p = 0.77). CONCLUSION: The physical characteristics of tissue injury, need for anticoagulation, and manipulation of blood pressure are vital factors contributing to the lethality of a large animal fatal extremity hemorrhage model. BioFoam was successful in preventing fatal arterial extremity hemorrhage after the release of an effective tourniquet in some cases. An agent that can reliably allow for safe tourniquet removal and restoration of collateral circulation is a potential solution to tourniquet-associated morbidity in traumatic extremity injury. The model developed will serve as a rigorous test for such agents.

Animals↗
PubMed1989

A continuous hemorrhage model of fatal hemorrhagic shock in swine.

We studied the effect of bleed rate on survival time and hemodynamics in a continuous hemorrhage model of fatal hemorrhagic shock in lightly anesthetized swine. Fasted immature swine (12-16 kg) were sedated with intramuscular (i.m.) ketamine, endotracheally intubated, anesthetized with halothane (0.75%), nitrous oxide, and oxygen, and then prepared for experimentation by placement of a pulmonary artery thermodilution catheter, femoral arterial and venous catheters, and by splenectomy. After instrumentation, halothane was discontinued and sedation was maintained with nitrous oxide and intravenous lorazepam. Thirty minutes later, the animals were bled continuously at 1.0 ml/kg per min (n = 8, Group I) or 1.25 ml/kg per min (n = 8, Group II) by a roller pump connected to the femoral arterial catheter. Hemodynamic parameters were recorded every 15 min until death occurred. Mean survival time was 50.2 +/- 3.0 min in Group I and 39.8 +/- 3.2 min in Group II (P less than 0.001). There was a stepwise decrease in blood pressure and cardiac index consistent with progressive hemorrhagic shock. This model results in reproducible survival times with small standard deviations. Although the animals are lightly anesthetized and the experiments are performed acutely, the hemodynamic responses and survival times observed are similar to those reported in previous studies of chronically instrumented, unanesthetized swine. This model may be more practical than unanesthetized, chronically instrumented swine models for evaluating the effects of various interventions on survival time and hemodynamics in acute hemorrhagic shock.

Animals↗
PubMed1993

Subarachnoid hemorrhage, cerebral hemorrhage, and serum cholesterol concentration in men and women.

The role of serum cholesterol in predicting the risk of stroke is unclear and may depend on the subtype of the disease. In 1964 to 1965, 54,385 Swedish men and women participated in a health survey with serum cholesterol and diastolic blood pressure determinations. The Swedish mortality register was used to identify causes of death in this cohort during 20.5 years of follow-up (1964 to 1985). A person-year-based Poisson model was used for multivariate analysis. Relative risk increased with decreasing serum cholesterol level for subarachnoid hemorrhage in men and for cerebral hemorrhage in women but not for subarachnoid hemorrhage in women. For cerebral hemorrhage in men, the risk function was U-shaped. Adjustment for diastolic blood pressure did not significantly change the relation between the risk for any of the different stroke types and the cholesterol level. A low cholesterol level predicts death from intracranial bleeding, but the data suggest that there is differing risk pattern for men and women.

Adult↗
PubMedDate not supplied

Delayed suprachoroidal hemorrhage mimicking acute retrobulbar hemorrhage.

The signs and symptoms of an acute retrobulbar hemorrhage include sudden ocular pain, explosive unilateral proptosis, limitation of extraocular movements and loss of vision. Retrobulbar hemorrhage is a well-described complication of retrobulbar anesthetic injection. We report an unusual case of a presumed acute retrobulbar hemorrhage following intraocular surgery which, on further testing, was found to be a delayed suprachoroidal hemorrhage.

Blindness↗
PubMed2005

Does apolipoprotein E genotype influence the risk of ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage? Systematic review and meta-analyses of 31 studies among 5961 cases and 17,965 controls.

BACKGROUND AND PURPOSE: Apolipoprotein E genotype (APOE) is associated with cholesterol metabolism, ischemic heart disease, and cerebral amyloid angiopathy, and so may affect risk of both ischemic and hemorrhagic stroke. METHODS: We comprehensively sought and identified studies of the association of apoE with ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). We did meta-analyses to assess the evidence for an association between APOE and the various pathological types and subtypes of stroke, and assessed the effects of several methodological criteria. RESULTS: We analyzed data from 31 eligible studies (26 IS, 8 ICH, and 3 SAH) in 5961 cases and 17 965 controls. epsilon4 allele-containing (epsilon4+) genotypes were significantly associated with IS (odds ratio [OR], 1.11; 95% CI, 1.01 to 1.22) and SAH (OR, 1.42; 95% CI, 1.01 to 1.99) and nonsignificantly with ICH (OR, 1.16; 95% CI, 0.93 to 1.44), whereas epsilon2+ genotypes were associated with ICH (OR, 1.32; 95% CI, 1.01 to 1.74). Associations appeared stronger with epsilon4+ genotypes for large artery compared with other IS subtypes and for Asian compared with white populations, and with epsilon2+ genotypes for lobar compared with deep hemorrhages. However, we found no association between epsilon4+ genotypes and IS when we analyzed only larger studies (>200 cases; OR, 0.99; 95% CI, 0.88 to 1.11) or studies without control selection bias (OR, 0.99; 95% CI, 0.85 to 1.17). CONCLUSIONS: Publication and selection biases make existing studies of APOE and stroke unreliable. Further, very large, methodologically rigorous studies are needed.

Adult↗
PubMed1999

[Vitreous hemorrhage and pre-retinal hemorrhage "without obvious point of origin" in diabetic patients. Apropos of 5 cases].

Five diabetic patients with nonproliferative retinopathy or controlled retinopathy after photocoagulation developed intravitreous or preretinal hemorrhages of unknown origin. Intravitreous hemorrhage of unknown origin is characterized by the absence of angiographic hyperfluorescence suggestive of neovascularization. Examination of the retinal periphery with a three mirror lens reveals the absence of tears and an normally appearing arteriovenous network with no sign of bleeding. The clinical cases reported here demonstrated: 1) the significance of posterior vitreous detachment in the genesis of hemorrhage, 2) the difficulty encountered in assessing the seriousness of the hemorrhage and providing optimal treatment, 3) the importance of initiating treatment early.

Adult↗
PubMedDate not supplied

[The laboratory diagnosis of an outbreak of hemorrhagic fever at Oblivskaya village, Rostov Province: proof of the etiological role of the Crimean-Congo hemorrhagic fever virus].

The results of the molecular biological detection of the etiologic agent of hemorrhagic fever in Rostov Province are presented. The role of the causative agents of Astrakhan rickettsial fever, hemorrhagic fever with the renal syndrome, Q fever, leptospirosis and listeriosis has been excluded by means of such immunochemical reactions as the direct and indirect immunofluorescent tests, the solid-phase immunoenzyme assay, the complement fixation test and the agglutination test. The relationship between the cases of hemorrhagic fever in the focus of the outbreak and Crimean-Congo hemorrhagic fever virus has been demonstrated due to the use of the polymerase chain reaction with preliminary reverse transcription.

Antibodies, Viral↗
PubMed1994

[Measurement of serum neuron-specific enolase levels after subarachnoid hemorrhage and intracerebral hemorrhage].

Neuron-specific enolase (NSE) is an enzyme involved in glycolysis and has a gamma-subunit. It is localized in neurons and axonal processes, and escapes into the blood and cerebrospinal fluid at the time of neural injury. In this study, the serum NSE levels in cases of subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (HIH) were measured. The subjects were 20 patients with subarachnoid hemorrhage (mean age; 53.4 +/- 14.5, 12 men and 8 women) and 20 with hypertensive intracerebral hemorrhage (mean age; 57.9 +/- 13.6, 11 men and 9 women). Although the serum NSE levels of all of these patients were measured on admission, measurement in patients with SAH were serially measured for an additional three weeks. There was no correlation between the serum NSE levels on admission in patients with SAH and consciousness level or clinical grade on admission, or prognosis. However, in Fisher's CT group 3 or 4, patients showed significantly higher levels of NSE than patients in group 2. Seven patients in whom vasospasm was observed by cerebral angiography during the course of treatment demonstrated elevated serum NSE levels from the 5th to the 15th days. In cases of HIH, there was also no correlation between the serum NSE levels from admission and consciousness level on admission or prognosis. However, the relationship between the size of the hematoma and serum NSE level on admission was significantly higher in patients in whom the maximum diameter was 5cm or more in comparison to those in whom the maximum diameter was less than 5cm.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral Hemorrhage↗
PubMed1984

Cooperative study of intracranial aneurysms and subarachnoid hemorrhage: a long-term prognostic study. III. Subarachnoid hemorrhage of undetermined etiology.

Among 6,638 cases reported to the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage were 477 cases in which the cause of hemorrhage could not be determined after carotid and vertebral angiography. These patients were followed up for up to 24 years after hemorrhage. Twenty patients were subsequently found to have an aneurysm or arteriovenous malformation missed by the first angiographic survey. After six-month survival, the rate of recurrent hemorrhage was a maximum 0.86% per year. Survival was significantly better than that of patients with verified ruptured aneurysms managed conservatively in this cooperative study. For normotensive patients who survived the first six months, the life expectancy for the next 20 years equaled that of an age- and sex-matched US population. Hypertensive patients had a higher mortality than normotensive patients.

Adult↗
PubMed2006

Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial.

INTRODUCTION: Intraventricular hemorrhage (IVH), either independent of or as an extension of intracranial bleed, is thought to carry a grave prognosis. Although the effect of IVH on outcome in patients with subarachnoid hemorrhage has been extensively reviewed in the literature, reports of spontaneous intracerebral hemorrhage (ICH) in similar situations have been infrequent. The association of hydrocephalus in such situations and its influence on outcome is also uncertain. PATIENTS AND METHODS: As a sub-analysis of data obtained through the international Surgical Trial in Intracerebral Hemorrhage (STICH), the impact of IVH, with or without the presence of hydrocephalus, on outcome in patients with spontaneous ICH was analyzed. CT scans of randomized patients were examined for IVH and/or hydrocephalus. Other characteristics of hematoma were evaluated to see if they influenced outcome, as defined by the STICH protocol. RESULTS: Favorable outcomes were more frequent when IVH was absent (31.4% vs. 15.1%; p < 0.00001). The presence of hydrocephalus lowered the likelihood of favorable outcome still further to 11.5% (p = 0.031). In patients with IVH, early surgical intervention had a more favorable outcome (17.8%) compared to initial conservative management (12.4%) (p = 0.141). CONCLUSION: The presence of IVH and hydrocephalus are independent predictors of poor outcome in spontaneous ICH. Early surgery is of some benefit in those with IVH.

Cerebral Hemorrhage↗
PubMed1993

Nonaneurysmal subarachnoid hemorrhage: prevalence of perimesencephalic hemorrhage in a consecutive series.

The perimesencephalic type of nonaneurysmal subarachnoid hemorrhage (SAH) is a recently described clinical and radiological entity, with a good outcome. We carried out a retrospective analysis of 294 patients with subarachnoid hemorrhage, of whom 62 had a negative four-vessel angiography. We identified 20 cases with the typical computed tomographic (CT) pattern of perimesencephalic hemorrhage, in whom the prognosis was invariably good. However, five cases of aneurysmal subarachnoid hemorrhage had a more or less similar CT appearance: the diagnosis cannot be made on the CT image only and angiography remains mandatory. The use of bed rest, antifibrinolytics, and calcium antagonists is discussed.

Female↗
PubMed2002

Effect of a platelet-activating factor antagonist, E5880, on cerebrovasospasm following subarachnoid hemorrhage in a canine double-hemorrhage model.

We investigated the effects of a platelet-activating factor (PAF) antagonist, E5880 (1-ethyl-2-[N-(2-methoxy)benzoyl-N-[(2)-2-methoxy-3-(4-octadecycarbamoylox)piperidinocarbonyloxy-propyloxy]carbonyl]aminomethyl-pyridiniumchloride), on subarachnoid hemorrhage-induced prolongation of cerebral circulation time and decrease in the basilar artery diameter in a canine double-hemorrhage model. Animals were assigned to three groups, control (saline), E5880 1.2 mg/kg and E5880 2.4 mg/kg. For measurement of cerebral circulation time, regions of interest were chosen at the basilar artery and the straight sinus in order to obtain time-density curves. Cerebral circulation time was defined as the difference between the arterial and venous peaks. Cerebral circulation time and basilar artery diameter were assessed by intra-arterial digital subtraction angiography (IA-DSA) on Days 0, 2 and 7. The prolongation of cerebral circulation time following subarachnoid hemorrhage was significantly inhibited by intravenous administration of 2.4 mg/kg of E5880. Basilar artery constriction was also reduced by E5880. Thus, E5880 had preventive effects on the prolongation of cerebral circulation time and the vasoconstriction of basilar artery in this model. These results suggest that E5880 may have a preventive effect on neurological symptoms aggravated by cerebrovascular lesions following subarachnoid hemorrhage.

Animals↗
PubMed1981

Hemorrhagic corneal pannus simulating a spontaneous expulsive hemorrhage.

An elderly, Spanish-speaking patient, who was a poor historian, presented with a hemorrhagic corneal condition that was mistakenly diagnosed as a spontaneous expulsive choroidal hemorrhage leading to enucleation of the globe. The enucleation specimen revealed pathologically a diffuse hemorrhagic pannus without corneal perforation in an eye with end-stage chronic angle closure glaucoma. The absence of clear-cut antecedent trauma, corneal ulceration, and pain at the time of presentation should have militated against the mistaken diagnosis. Diagnostic tests to establish more securely the diagnosis of expulsive hemorrhage are summarized.

Aged↗
PubMed1999

Bactericidal/permeability-increasing protein (rBPI21) in patients with hemorrhage due to trauma: results of a multicenter phase II clinical trial. rBPI21 Acute Hemorrhagic Trauma Study Group.

BACKGROUND: Infection and organ failure are the most common causes of death or serious complication in trauma patients surviving initial resuscitation and operation. Of the many possible causes of these complications, bacterial translocation and release of harmful cytokines and oxygen free radicals may play an important role in the pathogenesis of the complications associated with traumatic hemorrhage. Recombinant human bactericidal/permeability-increasing protein (rBPI21) has antibacterial and antiendotoxin properties, reduces cytokine levels, and increases survival in animal models of hemorrhagic shock. The primary objective of this study was to evaluate the safety and efficacy of prophylactic rBPI21 infusion in patients with hemorrhage due to trauma. METHODS: This was a phase II, multicenter, randomized, double-blind, placebo-controlled trial. Patients who required at least 2 U of blood were randomized to receive rBPI21 (4 mg x kg(-1) x d(-1) for 2 consecutive days) or an equivalent volume of placebo by continuous infusion within 12 hours of injury. The primary efficacy end point was mortality or serious complication occurring during the first 15 days of the study. Safety was monitored clinically and by laboratory panels during the study period. RESULTS: A total of 401 patients were treated (202 in the rBPI21 group and 199 in the placebo group). The composite end point rate of mortality or serious complication through day 15 was 46% in the placebo group and 39% in the rBPI21 group (hazard ratio = 0.79; p = 0.13). Secondary analysis, which adjusted for age, mechanism of injury, Injury Severity Score (1990 version), and units of blood received before study drug infusion showed similar results (hazard ratio = 0.79; p = 0.14). The proportion of patients who developed at least one serious organ dysfunction was 22% in the placebo group and 16% in the rBPI21 group (hazard ratio = 0.71; p = 0.14). The proportion of patients who developed either pneumonia or acute respiratory distress syndrome was 32% in the placebo group and 22% in the rBPI21 group (hazard ratio = 0.66; post hocp = 0.03). The beneficial trends of rBPI21 were observed in both blunt and penetrating trauma and were generally observed across different age groups, Injury Severity Scores, and units of blood transfused. No treatment difference was observed in mortality or resource utilization in this phase II study. CONCLUSION: rBPI21 was well-tolerated and demonstrated a favorable trend in reducing the composite primary end point of mortality or serious complication through day 15, especially respiratory complications, in patients with hemorrhage due to trauma. A phase III study is currently in progress.

Adolescent↗