Absence Of Hemorrhage Research Articles

Incidentally Found Renal Mass

Doctor Petersen confirmed our preoperative suspicion that this lesion might represent a benign proximal tubular adenoma. Tessler and associates found 5 such cases from July 1974 to January 1975 and reviewed all cases of renal carcinoma in their institution from 1952 through 1975. An additional 9 cases were discovered with none before 1964. One must ask if there is an increased incidence now occurring or are we just beginning to recognize this entity with increasing sophistication? The question also must arise whether with a high degree of suspicion a less radical operation is indicated. Certainly, the angiogram is the only possible preoperative tool that can arouse suspicion but this still is far from diagnostic. The spoke-wheel configuration of vessels, a homogeneous nephrogram similar to the normal parenchyma and sharp margination in the absence of marked increased vascular puddling may all be suggestive. In this older patient with a normal contralateral kidney total nephrectomy still is indicated because angiographic patterns are not pathognomonic. Conversely, in the rare younger individual with concomitant unrelated bilateral renal disease or in the solitary kidney with a polar lesion partial nephrectomy should be considered. Although some differential recognition may be possible by gross examination, such as the tan color, sharp demarcation, absence of hemorrhage or necrosis and so forth, it always has been our policy not to violate Gerota's fascia or to biopsy in the treatment of suspected renal carcinoma. Thus, until a specific preoperative diagnosis is possible nephrectomy continues to be the treatment of choice in the proximal tubular adenoma with so-called oncocytic features. Debate will continue in urologic, pathologic and radiologic circles on whether such an entity is universally benign and with increasing recognition only time will tell.

Neurologic complications of bacterial endocarditis.

(1) Neurologic complications remain a significant problem in bacterial endocarditis. Of 218 patients with endocarditis, 84 (39%) had a neurologic complication and 58% of these 84 patients died. In contrast, the mortality rate was only 20% among those endocarditis patients without neurologic complications. (2) Of the neurologic complications, cerebral embolism is the most frequent and important. An embolic stroke occurred in 37 (17%) of our patients, with 30 of these patients dying. Emboli are important not only in terms of the direct morbidity and mortality they cause via cerebral infarction, but also because of their role in the causation of mycotic aneurysms, brain abscesses, and abnormal CSF formulae. (3) Cerebral emboli are particularly common in patients with mitral valve infection, and in patients with infection due to virulent organisms, particularly S. aureus and enteric gram-negative bacilli. (4) Mycotic aneurysms occur more frequently in the course of acute endocarditis rather than late in the course of subacute disease. Management of angiographically demonstrated mycotic aneurysms is dependent upon the presence or absence of hemorrhage, the anatomic location of the aneurysm, and the clinical course of the patient. Healing of mycotic aneurysms can occur during the course of effective antimicrobial therapy, thus obviating the need for neurosurgical intervention in all such patients. (5) Macroscopic brain abscess is a rare complication of bacterial endocarditis. Miliary microscopic abscesses are more common than larger abscesses, particularly in patients with acute disease and miliary infection in other organs of the body. (6) Focal seizures occur most commonly in endocarditis patients with acute embolic disease; generalized seizures are of diverse etiologies, with metabolic factors being most important. Penicillin neurotoxicity should be considered in patients with impaired renal function who are receiving high dose penicillin. (7) With the exception of hemorrhagic complications, lumbar puncture results tend to reflect the nature of the infecting organism rather than the nature of the neurologic complication. Endocarditis due to virulent organisms such as S. aureus is usually associated with a purulent CSF formula while nonvirulent organisms, such as viridans streptococci, susually have aseptic or normal CSF formulae.

Renal artery stenosis due to abdominal aortic aneurysm.

<h3>BACKGROUND AND PURPOSE:</h3> The diagnosis of subacute subarachnoid hemorrhage is important because rebleeding may occur with subsequent life-threatening hemorrhage. Our aim was to determine the sensitivity of the 3D double inversion recovery sequence compared with CT, 2D and 3D FLAIR, 2D T2*, and 3D SWI sequences for the detection of subacute SAH. <h3>MATERIALS AND METHODS:</h3> This prospective study included 25 patients with a CT-proved acute SAH. Brain imaging was repeated between days 14 and 16 (mean, 14.75 days) after clinical onset and included MR imaging (2D and 3D FLAIR, 2D T2*, SWI, and 3D double inversion recovery) after CT (median delay, 3 hours; range, 2–5 hours). A control group of 20 healthy volunteers was used for comparison. MR images and CT scans were analyzed independently in a randomized order by 3 blinded readers. For each subject, the presence or absence of hemorrhage was assessed in 4 subarachnoid areas (basal cisterns, Sylvian fissures, interhemispheric fissure, and convexity) and in brain ventricles. The diagnosis of subacute SAH was defined by the presence of at least 1 subarachnoid area with hemorrhage. <h3>RESULTS:</h3> For the diagnosis of subacute SAH, the double inversion recovery sequence had a higher sensitivity compared with CT (<i>P</i> &lt; .001), 2D FLAIR (<i>P</i> = .005), T2* (<i>P</i> = .02), SWI, and 3D FLAIR (<i>P</i> = .03) sequences. Hemorrhage was present for all patients in the interhemispheric fissure on double inversion recovery images, while no signal abnormality was noted in healthy volunteers. Interobserver agreement was excellent with double inversion recovery. <h3>CONCLUSIONS:</h3> Our study showed that the double inversion recovery sequence has a higher sensitivity for the detection of subacute SAH than CT, 2D or 3D FLAIR, 2D T2*, and SWI.

Afibrinogenemia and Thrombocytopenia in Guinea Pigs Following Injection of Echis Colorata Venom

Abstract Intravenous injection into the guinea pig of lethal doses of Echis colorata venom or of each of its two chromatographic fractions, separately, caused hemorrhage, afibrinogenemia, factor V deficiency and thrombocytopenia. Sublethal venom doses caused afibrinogenemia, factor V deficiency and thrombocytopenia in the absence of hemorrhage. Early intravascular clotting was observed following injection of high lethal doses of both whole venom and of procoagulant-containing fraction II, but not of fraction I which was devoid of procoagulant activity. The afibrinogenemia produced by fraction I was due to its fibrinogenolysin, whereas the afibrinogenemia produced by fraction II, which also had fibrinogenolytic activity, was due chiefly to its procoagulant. Anti-Echis colorata venom rabbit serum inhibited the fibrinogenolytic, the procoagulant and the thrombocytopenic activities of the venom.

Post-Bulbar Duodenal Ulcer with Particular Reference to its Hemorrhagic Tendency

Although there are numerous allusions to post-bulbar duodenal ulcer in the literature, these references for the most part consist of necessarily small series, case reports, statements that ulcer does occur in this location, and that bleeding is a frequent complication. However, even in such comprehensive monographs as that of Ivy, Bachrach, and Grossman, and that published under the auspices of the American Gastroenterological Association, little informa­ tion about the problem is available. I , 2 Bockus' treatise contains a short dis­ cussion of ulcer occurring distal to the duodenal cap.s Since we have been confronted with the existence of post-bulbar ulcer in 11 patients in the last 5 months and since 8 of these bled either for the first time or recurrently, our attention has been focused upon the problem m general and upon the complication of hemorrhage in particular. REVIEW OF THE LITERATURE Necropsy figures disclose an incidence of post-bulbar ulcer varying from 5% to 17%, the average incidence being 9.6%. These reports include 354 duodenal ulcers of which 34 were beyond the cap.4, 5, 6 Ball, Segal and Golden state that the incidence ranges from 5% to 17% in surgical cases of duodenal ulcer. They further estimate the radiographic incidence as 1% to 5%. 7 Review of the available literature from 1910 through 1951 revealed 112 clinical cases of ulcer distal to the bulb. 6 , 8-18 Reference to the presence or absence of hemorrhage was made in 63 of these cases. Thirty-six, or 57% experienced gross bleeding. Roentgenographic evidence of post-bulbar ulcer was present in 91% of the patients who were examined. Fifty-eight per cent of the entire group were submitted to operation. These results are summarized

Absence of hemorrhage inducing activity in phthiocol derivatives with a basic nitrogen in side chain.

SummaryThree phthiocol derivatives containing a side chain with a basic nitrogen have been examined for hemorrhagic activity and found to be inactive. The bearing of these findings on the structural configuration necessary for antivitamin K activity has been discussed.

INTRACAPSULAR OPERATION FOR CATARACT

The series of operations reported on here comprises the fifth hundred successive intracapsular extractions of cataract. The report on the fourth hundred operations was published in theArchives 1 in July 1933. In presenting the present series, the final results are given, for though the vision at first is good, deterioration sometimes sets in later. The cataracts were classified as to type as follows: mature, thirtythree; immature, twelve; nuclear, nine; nuclear and posterior cortical, twenty-seven ; hypermature, seventeen, and morgagnian, two. In thirteen cases preliminary iridectomy was done on account of the presence of a complication or in order to get information on the patient's behavior during operation. Another advantage of preliminary iridectomy is the absence of hemorrhage into the anterior chamber during the operation for cataract, which facilitates the application of the capsule forceps, though the formation of a satisfactory conjunctival flap may suffer and the patient is

BLOOD PRESSURE CHANGES ACCOMPANYING CORONARY OCCLUSION

In those patients, early described by Herrick, 1 who survive the occurrence of coronary thrombosis, a sudden fall of blood pressure is an event both of physiologic interest and of diagnostic significance. Besides the characteristic pain, and the pathognomonic but frequently undetected pericardial friction rub, the importance of a rapid fall in arterial tension was appreciated by Sir Clifford Allbutt, 2 in differentiating thrombosis from ordinary angina pectoris. More recently, the studies of Gorham 3 and of Gordinier 4 illustrate these blood pressure variations, and give them emphasis. If we accept, from a physiologic point of view, 5 the division of hypotension into two groups, one an essential type consequent to cachexia or to habitus or constitution, and the second a functional type, due to transient factors, it will be found that for the latter there are relatively few causes. In the absence of hemorrhage, shock, infectious disease and excessive

STUDIES UPON EXPERIMENTAL MEASLES

In general it may be said that three striking alterations occurred constantly in the animals reacting to intracardiac injections of blood from cases of measles; namely, pyrexia, leucopenia, and nephritis. The elevation in temperature usually began about the 9th day following inoculation, the rise being fairly abrupt from the normal to 104 degrees F. and above, at which height it remained with slight fluctuations for 3 or 4 days, finally subsiding by lysis. During the period of fever, particularly in the animals of first transmission, often no objective signs of illness were to be noted, the guinea pigs remaining lively and eating as usual. When the animals showed any outward signs these were manifested by a loss of appetite, lusterless and ruffled hair, and indisposition to move even when disturbed. The typical exanthematous signs of human measles were not observed in any of the animals. In some there occurred a slight coryza and watering at the eyes; however, no special account was attached to these signs as they were rather indefinite and inconstant, especially for animals of first transmission. Coincident with the rise of temperature there always appeared a fall in the total leucocytic count; in some animals the drop in white cells preceded the rise in temperature by 2 to 3 days. The leucopenia, though well defined, varied for animals of the same series. In some the count was as low as 3,600 cells per c. mm.; in no case did we fail to note at least a moderate fall in the leucocytes. The average time for the appearance of this cellular change was 9 to 10 days following inoculation; in other words, the leucocytic reaction seemed to indicate the end of the incubation period. So constant and striking was the leucopenia that we stress this as the most significant feature of the reaction of the guinea pig to the injection of measles blood, particularly since normal blood produced not the slightest change in these white elements. The greatest leucocytic depression was observed around the 12th to 14th days, which corresponded approximately to the stage of temperature peak. Following the leucopenia, the leucocytic rise was very gradual, taking on the average 8 days to attain the normal level. The animals killed at the height of the reaction, or those dying presumably from the effects of the blood containing virus, showed as the most constant lesion gross evidences of acute nephritis. The kidneys in these cases were swollen, cloudy, and congested. In certain guinea pigs there were in addition well defined petechiae and larger blood extravasations scattered throughout the cortical substance. In the animals dying after inoculation, the kidney alterations were found so constant and characteristic that we regarded them as a special index of the experimental infection. In these animals the hemorrhagic areas were not infrequently 2 to 5 mm. in extent, and when occurring on the surface of the organ produced a separation of the capsule. Occasionally free blood was noted in the pelvis, and in the absence of hemorrhage within the pelvic lining, we assumed that it came from the uriniferous orifices of the calicos. Microscopically the kidney sections revealed evidence of acute hemorrhagic nephritis, the hemorrhages for the most part being related to the capillaries of the tufts and the tubules of the pyramids. In the most pronounced cases practically all glomeruli were affected. Every stage from marked dilatation of the capillary whirl to well defined intercapillary blood extravasations that often filled the capsular space, and in consequence partially or completely obliterated the glomeruli, were found. Whether a destruction of the endothelium occurred, could not be determined. The absence of a neutrophilic reaction was of special significance, these elements of acute inflammation being nowhere found associated with the kidney lesion. The blood in relation to the tubules commonly occurred in the lumen of the collecting tubules and in the form of red blood cell casts. The spleen usually was found enlarged, particularly in the guinea pigs presumably dying as a result of the virus injections. Aside from the usual parenchymatous changes common to toxemias, the other internal organs showed nothing of special note.