Disseminated intravascular coagulation as the presenting sign of metastatic prostate cancer

Disseminated intravascular coagulation (DIC) is an acquired coagulation disorder that may occur in a wide variety of clinical conditions. Suspicion of DIC should lead to a differential diagnosis that includes primary fibrinolysis and other bleeding diatheses such as thrombocytopenias of diverse etiology. Confirmation of the diagnosis of DIC should always prompt a search for an underlying medical disorder, including sepsis, severe trauma, solid and hematological malignancies, obstetrical complications, and vascular disorders. Here, we describe an unusual case of acute bleeding and DIC as the presenting manifestation of metastatic prostate cancer in a 60-year-old man. Treatment with a luteinizing hormone-releasing hormone (LHRH) agonist and a short course of an antiandrogen, together with supportive measures (i.e., clotting factors, heparin, and platelets), led to normalization of all coagulation parameters within 1 week, and to clinical improvement and decline in the serum level of prostate-specific antigen (PSA). We discuss the pathogenesis, differential diagnosis, and association of DIC with prostate cancer along with the management of this condition.     

产科DIC的临床诊断与治疗

目的探讨产科DIC的临床诊断和治疗方法。方法回顾性分析泰安市妇幼保健院自2006年1月至2009年12月收治的56例产科DIC患者的临床资料。结果本组56例患者中胎盘早剥27例,稽留流产9例,妊娠期高血压12例,羊水栓塞3例,其余患者诱发原因不明。本组患者均行抗休克、抗凝、改善微循环的治疗,成功救治54例,死亡2例(3.6%)。结论产科DIC是产科的危急重症之一,临床需要及时明确诊断并采取及时有效的治疗方法,其中尤以及时止血和防止凝血障碍的发展为重要,是减少病死率的重要措施。     

产妇急性DIC的临床表现及护理措施

目的探讨产妇急性弥漫性血管内凝血（DIC）的临床表现和护理措施。方法对本院2006年至2009年发生的35例产妇急性DIC进回顾性分析,总结。结果任何引起血管内细胞损伤、组织损伤及有促凝物质进入母体血循环都有可能激发DIC。而防止羊水及其内含有形物质进入母体血液循环是抢救成功的关键。早期诊断,及时治疗,精心护理是急性DIC取得良好预后的关键。因此,及时而正确的护理措施显得十分重要。结论必须做好围产期的保健和护理,熟练掌握本病的症状、体征,才能及时纠正诱发DIC的因素。     

Assessment of cytocompatibility of surface-modified CdSe/ZnSe quantum dots for BALB/3T3 fibroblast cells

With the widespread use of quantum dots (QDs), the likelihood of exposure to QDs has been assumed to have increased substantially. Recently, QDs have been employed in numerous biological and medical applications. However, there is a lack of toxicological data pertaining to QDs. In this study, we aimed to investigate the cytocompatibility of surface-modified CdSe/ZnSe QDs for BALB/3T3 fibroblast cells. The ligands used for surface modification are mercaptopropionic acid (MPA) and Gum arabic (GA)/tri-n-octylphosphine oxide (TOPO). Cells were exposed to different concentrations of QDs followed by illustrative cytotoxicity analyses. Furthermore, we used a confocal microscope to assess intracellular uptake of QDs. Confocal images showed that MPA-coated QDs were distributed inside the cytoplasmic region of cells. In contrast, GA/TOPO-coated QDs were not found inside cells. MPA-coated QDs were highly cytocompatible, whereas GA/TOPO-coated QDs were toxic to the cells. Cells treated with GA/TOPO-coated QDs showed altered morphology, decreased viability, significant concentrations of intracellular free cadmium, detectable reactive oxygen species (ROS) formation, depolymerized cytoskeleton, and irregular-shaped nuclei. This study suggests that surface modification by ligands plays a significant role in the prevention of cytotoxicity of QDs.     

多发伤患者出现DIC的早期诊断和治疗

目的观察52例多发伤患者弥散性血管内凝血的早期诊断及早期给予血小板、冷沉淀、凝血酶原复合物、血浆、肝素治疗的临床效果。方法对多发伤患者早期进行血小板计数、凝血功能、D-二聚体检查,对合并DIC的52例患者根据其血小板计数、凝血功能给予血小板、冷沉淀、凝血酶原复合物、血浆、肝素治疗并观察治疗后1天患者的血小板计数、凝血功能。结果治愈46例,死亡6例,治愈率88．5％。52例患者输注血小板、冷沉淀、凝血酶原复合物、血浆、肝素治疗后1天与输注前相比,患者的血小板计数明显增加,凝血酶原时间（PT）明显缩短,纤维蛋白原（Fbg）含量增加。结论对多发伤并发DIC患者早期输注血小板、冷沉淀、凝血酶原复合物、血浆、肝素等综合治疗可有效阻止DIC的继续发展,重建凝血机制,恢复机体功能。     

Infant death after nose-horned viper (Vipera ammodytes ammodytes) bite in Croatia: A case report

A case of a 45-day-old male infant, bitten on the neck by nose-horned viper (Vipera ammodytes ammodytes), is reported. This episode occurred while the baby was on a picnic with his parents in a hill near a town in southern Croatia. In spite of immediate arrival at hospital, where antivenom was administrated and all the necessary treatment measures were carried out, the infant died 6 h following the bite. The cause of death was severe and progressive hyperkalaemia, massive intravascular haemolysis, severe coagulopathy and myocardial dysfunction.     

Severe coagulopathy after Vipera ammodytes ammodytes snakebite in Bulgaria: A case report

The case report presents a severe coagulopathy in a 56-year-old man following envenomation by the snake (Vipera ammodytes ammodytes) on his left hand. Initially the man was in shock, with an extremely low blood pressure and tachycardia. Local signs included a painful blister formation on the envenomation site. Twenty-four hours later, the man developed acute thrombocytopenia (platelets number 10 × 10⁹/l) and ecchimoses formation on the affected limb and on the left side of his body due to a disseminated intravascular coagulation syndrome, which lasted 13 days and required repeated administration of blood products, antivenin and supportive treatment. The patient was discharged from the hospital after 18 days in a good condition. The case report indicates that the coagulopathy may be a serious life-threatening complication after V. ammodytes ammodytes snakebite.     

Beta-2-glycoprotein I and urinary trypsin inhibitor levels in the plasma of pregnant and postpartum women

Annexins (Anx) are a family of structurally related proteins that all bind to anionic phospholipids in a Ca(2+)-dependent manner. Some biological properties of beta-2-glycoprotein I (beta(2)-GPI) are similar to those of Anx IV and Anx V. Urinary trypsin inhibitor (UTI) helps to maintain normal pregnancy and prevent preterm delivery by inhibiting uterine contraction. However, plasma beta(2)-GPI and UTI levels have not been measured in normal pregnancy. The aim of this study is to clarify the levels of these parameters. Subjects were nonpregnant women (n=50), 120 pregnant women, and maternal subjects just after delivery (n=53) or postpartum (n=67). All of the subjects were healthy. Plasma levels of beta(2)-GPI, UTI, Anx IV, Anx V and other coagulation and fibrinolysis markers were measured by ELISA. The mean plasma level of beta(2)-GPI was significantly increased during the third trimester of pregnancy and 3 to 5 days after delivery. The mean plasma level of UTI was unchanged from the first trimester of pregnancy to the postpartum period. The mean plasma UTI level in vaginal delivery group was significantly higher than that in cesarean section group. beta(2)-GPI protein was expressed in some of the syncytiotrophoblasts. These data suggest that beta(2)-GPI might act to prevent blood clotting on the placental surfaces and also prevents disseminated intravascular coagulation in the microcirculation and maternal plasma. UTI levels might be kept constant by increased urinary excretion despite overproduction during pregnancy.     

Novel monoclonal antibody that recognizes new neoantigenic determinant of D-dimer

Our novel monoclonal antibody (mAb) B4 reacted with only D-dimer but not intact fibrinogen, or fibrinogen degradation products (FgDP) such as D-monomer, E fragment on ELISA. B4 didn't react with denatured D-dimer, while it reacted well with denatured D-monomer rather than the native form, indicating that B4 recognizes some neoconformational epitope in D-dimer. In our epitope study, B4 recognized the N-terminal (Bbeta134-142) of D-dimer, which corresponds to the most flexible segment of coiled coil backbone. It was confirmed by inhibition assay of B4 binding to D-dimer using the synthesized peptides with this sequence. As the other evidence, B4 didn't bind to some D-dimer species produced from a particular fibrinogen variant. This fibrinogen variant is mutated BbetaLys133 residue to Gln133 thus it doesn't produce the particular N-terminal epitope of D134 approximately by plasmin. Finally, our mAb was useful for clinical application. ELISA using our mAbs was well correlated with other commercial D-dimer ELISAs and in some clinical samples it was preferable to them. These results suggest that the epitope for B4 is another neoantigenic determinant in native D-dimer as distinct from native D-monomer.     

A combination of a thrombin inhibitor and dexamethasone prevents the development of experimental disseminated intravascular coagulation in rats

INTRODUCTION: Disseminated intravascular coagulation (DIC) is a serious and potentially lethal complication of severe sepsis. DIC is characterised primarily by widespread platelet aggregation and fibrin deposition, followed by consumption of platelets, coagulation factors, and inhibitors. The aim of the study was to evaluate the efficacy of the active-site thrombin inhibitor melagatran, the active form of the oral direct thrombin inhibitor ximelagatran, in reducing fibrinogen and platelet consumption in blood and fibrin deposition in organs, in an experimental endotoxinaemia rat model. MATERIALS AND METHODS: In this model, DIC was induced by an intravenous injection of endotoxin (1 mg/kg). Melagatran was compared with unfractionated heparin and the synthetic glucocorticoid analogue dexamethasone. Animals were divided into 16 treatment groups in which high and low doses of each agent were tested alone and in combination with melagatran. RESULTS: Fibrinogen consumption was reduced by melagatran, dexamethasone, and heparin, and was completely prevented by melagatran in combination with dexamethasone. Platelet consumption was partially reduced by melagatran, unfractionated heparin, and dexamethasone, but complete protection was observed only with melagatran in combination with dexamethasone. Melagatran in combination with dexamethasone or heparin protected the liver and spleen from fibrin deposition. CONCLUSION: In this experimental DIC rat model, the direct thrombin inhibitor melagatran given together with dexamethasone protected against the consequences of activated haemostasis.