Acute Hemorrhagic Syndrome Research Articles

ПРИОБРЕТЕННАЯ ГЕМОФИЛИЯ А В РЕАЛИЯХ СОВРЕМЕННОЙ МЕДИЦИНЫ: ОПЫТ КЛИНИЧЕСКОЙ ПРАКТИКИ

Abstract. Introduction. Acquired hemophilia A is a rare form of severe coagulopathy with an autoimmune mechanism of development. It occurs due to the formation of circulating inhibitory factor VIII (FVIII) antibodies, which leads to impaired activation of factor X and the occurrence of spontaneous bleeding in patients without previous hemostasis system pathology. In about a half of the cases, FVIII autoantibodies appear in patients without any comorbidities. It should be noted that the average age of patients was 74 years at the time of diagnosis. However, the occurrence of the disease in young women is rare and may be associated with pregnancy and childbirth. Given the rarity of this disease, the management of these patients is a challenging clinical problem. Aim. To describe a clinical case of diagnosis and treatment of a patient with the inhibitor form of acquired hemophilia A (AHA). Materials and Methods. A 38–year–old female patient had acute hemorrhagic syndrome of the hematoma type, manifested by large hematomas in different areas of the body. During the patient’s stay in the hospital, standard lab tests were made, the test results were evaluated over time, and instrumental diagnostics was performed. Results and Discussion. The typical hematoma type of bleeding detected during diagnosing, prolongation of coagulation parameters, presence of factor VIII inhibitor (605 BU), and a decrease in factor VIII level down to 0.5%) verified the AHA diagnosis. Methods of substitution, immunosuppressive therapy, and monoclonal antibodies were successfully used to treat AHA in this patient. The patient is followed up by a hematologist at the place of residence. Hematomas did not recur. Conclusions. This clinical observation demonstrates the peculiarities of the course, diagnostic algorithm, and management of patients with AHA without any concomitant pathology, with a history of only prolonged postpartum uterine bleeding, and with no autoimmune or malignant diseases.

Bracken poisoning

Bracken (Pteridium species) is an ancient, large and very widespread fern that has long been recognised as poisonous. It contains several toxic compounds including ptaquiloside and thiaminase. Bracken toxicosis manifests as different clinical syndromes in different animals. Cattle develop an acute haemorrhagic syndrome leading to widespread haemorrhage and death. With more chronic ingestion enzootic bovine haematuria occurs, which is characterised by tumours of the upper alimentary tract and urinary bladder. Sheep also develop acute haemorrhage syndrome and cancer, but chronic bracken ingestion causes retinal neuropathy, which can lead to permanent blindness. Bracken toxicosis in monogastric animals such as pigs is because of an induced avitaminosis B1. Diagnosis of bracken toxicosis is based on clinical signs, history of exposure and characteristic findings at postmortem. In cattle and sheep the clinical syndromes are progressive and humane euthanasia is usually necessary in animals with advanced disease. In pigs with bracken toxicosis signs are often non-specific and lead to sudden death, but supplementation with thiamine can be effective.

Detection of a novel Pestivirus strain in Java ticks (Amblyomma javanense) and the hosts Malayan pangolin (Manis javanica) and Chinese pangolin (Manis pentadactyla).

Pangolins are endangered animals and are listed in the CITES Appendix I of the Convention International Trade Endangered Species of Wild Fauna and Flora as well as being the national first-level protected wild animal in China. Based on a few reports on pangolins infected with pestiviruses of the Flaviviridae family, Pestivirus infections in pangolins have attracted increasing attention. Pangolin pestivirus is a pathogen that may cause diseases such as acute diarrhea and acute hemorrhagic syndrome. To better understand the epidemiology and genomic characterization of pestiviruses carried by pangolins, we detected pestiviruses in dead Malayan pangolin using metavirome sequencing technology and obtained a Pestivirus sequence of 12,333 nucleotides (named Guangdong pangolin Pestivirus, GDPV). Phylogenetic tree analysis based on the entire coding sequence, NS3 gene or RdRp gene sequences, showed that GDPV was closely related to previously reported pangolin-derived Pestivirus and clustered into a separate branch. Molecular epidemiological investigation revealed that 15 Pestivirus-positive tissues from two pangolins individuals with a positivity rate of 5.56%, and six Amblyomma javanense carried pestiviruses with a positivity rate of 19.35%. Moreover, the RdRp gene of the Pestivirus carried by A. javanense showed a high similarity to that carried by pangolins (93–100%), indicating A. javanense is likely to represent the vector of Pestivirus transmission. This study expands the diversity of viruses carried by pangolins and provides an important reference value for interrupting the transmission route of the virus and protecting the health of pangolins.

Botanical characteristics, toxicity and control of bracken fern (pteridium aquilinum (l.) kuhn)

Bracken (Pteridium aquilinum (L.) Kuhn) is cosmopolitan fern, found at varying altitudes on all continents except Antarctica. It is an aggressive colonizer and can appear in various plant communities, but an important characteristic is its ability to dominate in dense patches. Once establish, the deep-set rhizomes are nearly impossible to eradicate. In Croatia, bracken dominate on specific habitat type called “bujadnice” in Lika region, but can also be found in herbaceous layers in following forest communities: As. Betulo-Quercetum; As. Pteridio-Betuletum; As. Potentillo albae-Quercetum pubescentis; As. Castaneo sativae-Fagetum; As. Helleboro nigri-Piceetum. Bracken fern is significant problem for livestock-based extensive agriculture, because it causes a range of syndromes in farm animals including thiamine deficiency, acute hemorrhagic syndrome, bright blindness, enzootic hematuria and upper alimentary carcinoma. Man may consume the toxins of bracken either directly or indirectly. In terms of the economic loss and suffering caused by bracken, it is clearly that some steps must be taken to control distribution of this fern. Timing is important in any management treatment of bracken fern. The most effective time for bracken control is summer just after the new fronds have fully expanded and starch reserves in the rhizome are at their lowest level. Two or more annual treatments and combinations of cutting and herbicide are more effective than single treatments or even single annual treatments.

Clinical case of an acquired hemophilia

The aimof the work is to describe the clinical case of formation, diagnosis and treatment of the acquired form of blood clotting factor VIII deficiency – of acquired hemophilia A.Material and methods. Patient R., 71 years, from April 2018, was found an acute hemorrhagic syndrome in the hematomic type of large hematomas manifested submandibular region, neck, chest, right breast, pubic and inguinal regions on the right, the anterior-medial surface of the left femur, anterior surface of left tibia. Standard laboratory tests, computed tomography of soft tissues of the neck, lungs, abdomen; coagulogram; blood clotting factors; inhibitor of factor VIII were evaluated in dynamics during the patient’s stay in the hospital; platelet aggregation function.Results. Typical gematomny type of bleeding, prolongation of coagulation indicators, the presence of the inhibitor factor VIII (7,0 BAA), the decrease in factor VIII (2 %) allowed diagnosis of acquired hemophilia A. Anti-inhibitory coagulant complex, fresh frozen plasma was successfully used for treatment. The patient is under observation in the regional Hematology center. The hematomas were not renewed.Conclusion. Our clinical observation demonstrates the features of the course, the algorithm of diagnosis and management of patients with of acquired hemophilia A.

Characterisation of a newly isolated SVCV strain in Ukraine

Spring Viraemia of Carp Virus (SVCV) has been well documented since the 1960s. This virus infection generally results in an acute haemorrhagic syndrome with septicaemia and associated high mortality. During a fish health inspection in carp farms in the Eastern region of Ukraine, SVCV was isolated from yearlings of the common carp Cyprinus carpio. For virus isolation and characterisation, methods of cell culture, EM, PCR, and sequencing were used. Preliminary examination of infected fish revealed a range of lesions, particularly in spleen and kidney tissues. The virus grew in fish cell lines of FHM and EPC with infectious titre of 106.2–6.5 and 106.9–7.4 TCID50/ml, respectively. Investigation by electron microscopy demonstrated that ultrastructurally the isolated virus was similar to rhabdoviruses. Virions were non-enveloped with a typical bullet profile, approximately 80 to 180 nm in length and 60 to 90 nm in diameter. In addition, the nucleotide sequence of the glycoprotein gene G fragment in size of 579 base pairs was analysed. The nucleotide sequence was registered at GenBank under the accession number MH043331. The phylogenetic analysis revealed a close relationship of East Ukrainian isolates of SVCV with sequences that represent the strains from genogroup Ib.

Особенности диагностики ОРВИ на фоне развития острого геморрагического синдрома у детей

Особенности диагностики ОРВИ на фоне развития острого геморрагического синдрома у детей

PP.17.23

Objective: Accurate diagnosis of haemodynamic instability is difficult in the emergency department. We need to rule out immediately the life threatening conditions which could evolve with such clinical findings but after, it could be a “long way” to the correct diagnosis. Design and method: A case report with an unexpected cause of orthostatic hypotension. Results: This is the case of a patient aged 73 with newly diagnosed uncomplicated type II diabetes, without known arterial hypertension, who presented in the emergency department with resting tachycardia, occipital headache and clinically significant orthostatic hypotension (faintness, 60mmHg decrease in SBP). In emergency we ruled out subarachnoid hemorrhage, acute hemorrhagic syndrome and pulmonary embolism by chest CT. We also ruled out acute coronary syndrome, atrioventricular or aortic obstruction by echocardiography and laboratory investigations. Orthostatic hypotension is maintained for 48 hours despite aggressive fluid reppletion, the patient relating intermittent episodes of occipital headache, nonspecific chest pain, sweating and flush occurring especially during emotional stress conditions (venipuncture) or mictionary effort. Monitoring BP/24 h reveals values rising to 220/140mmHg with spontaneous remission which rise the suspicion of pheochromocytoma. The dosage of free plasma metanefrines indicate values more than 10 times the upper limit of normal and abdominal CT identified a tumor on the right adrenal looking compatible with pheochromocytoma. Treatment with alpha and beta blockers was started and, after 2 weeks, the patient was referred to surgery. The pathological examination revealed alveolar growth pattern in anastomosed cords and in difuse, solid areas, marked cytological and nuclear pleomorphism of cells, nuclear inclusions, hipercromatism, confirming the diagnosis of pheochromocytoma. The evolution at 1 month was favorable with normalisation of blood pressure values and glycemia. Conclusions: The typical clinical presentation of pheochromocytomas is constant elevated blood pressure or normal blood pressure with significant paroxysm related to variant stimulus. However, in some undiagnosed situations with long evolution, there is an important constriction of the vascular space leading to significant orthostatic hypotension which can further hide the real diagnosis. We appreciate it is worthy to keep in mind this “edge” diagnosis after excluding the most common causes of orthostatic hypotension.

Acuut hemorragisch syndroom door adelaarsvarenintoxicatie bij runderen in België

In augustus 2007 vertoonden twee Belgisch witblauwe koeien na drie maanden weidegang hoge koorts(41,4°C), epistaxis, melena, bloedingen ter hoogte van de huid, een stijve gang en rode letsels op de uier.Het bloedonderzoek toonde ernstige pancytopenie aan en blauwtongvirus serotype 8 werd aangetoondvia PCR. Ondanks een bloedtransfusie en een ondersteunende behandeling stierven beide dierenbinnen de zes dagen na aanvang van de symptomen. Op autopsie werd een uitgesproken beeld van eenbloedstollingsstoornis aangetoond. Bij inspectie van de weide één week later konden veel jonge bladerenvan adelaarsvaren (Pteridium aquilinum) worden waargenomen. De stijve gang en de rode letsels op deuier waren sterk indicatief voor blauwtongvirusinfectie, terwijl de andere symptomen overeenkwamenmet een acute adelaarsvarenintoxicatie (acuut hemorragisch syndroom). Dit voorval toont aan dat het ookin België, waar de densiteit van adelaarsvarens over het algemeen relatief laag is, van belang is om weidengrondig te inspecteren op de aanwezigheid van jonge adelaarsvarens.

Molecular biology of bovine viral diarrhea virus

Bovine viral diarrhea viruses (BVDV) are arguably the most important viral pathogen of ruminants worldwide and can cause severe economic loss. Clinical symptoms of the disease caused by BVDV range from subclinical to severe acute hemorrhagic syndrome, with the severity of disease being strain dependent. These viruses are classified as members of the Pestivirus genus of the Flaviviridae. BVDV are considered primarily a pathogen of cattle but can infect most ruminant species. The virus particle consists of a lipid bilayer membrane surrounding the encapsidated genomic RNA. Inserted in the outer membrane are two virus-encoded glycoproteins that contain the major antigenic determinants of the virus as well as receptor binding and cell fusion functions. A third glycoprotein is weakly associated with the virion, but also possesses unique features that play important roles in suppression of innate immunity. The viral proteins are encoded in a single, large open reading frame. The viral proteins are proteolytically cleaved from the polyprotein by different proteases. The structural proteins are processed by cellular signal peptidases while the processing of the nonstructural proteins is by the viral serine protease. The virus is assembled and matures in the endoplasmic reticulum and golgi bodies of the cell. The virus is released via exocytosis, where viral proteins are not exposed on the surface of the cell.

Emerging Ferret Diseases

There are a number of newly described and emerging disease syndromes affecting the domestic ferret, and the purpose of this article is to make veterinarians aware of these diseases. A recently described systemic coronavirus infection appears to be a variant of the ferret enteric coronavirus and is currently termed “ferret infectious peritonitis.” Disseminated immunopathologic myositis, aplastic anemia/bone marrow aplasia, acute hemorrhagic syndrome, and oral ulcerations are also described, although the exact etiologies for these diseases have yet to be determined. There appears to be at least 2 important amino acid metabolism deficiencies in ferrets: hindlimb weakness in older ferrets (L-carnitine) and cysteine urolithiasis. Ferrets have recently been found to be susceptible to H1N1 influenza, so knowledge regarding this zoonotic disease is essential for veterinarians working with these animals. A novel Mycoplasma spp. has also recently been identified in ferrets with chronic respiratory problems that originated from one breeding colony. Because these diseases are still being investigated, practitioners who treat a ferret patient exhibiting clinical signs consistent with any of the conditions mentioned are encouraged to contact people who are knowledgeable of that particular illness.

Variation in ptaquiloside content in bracken (Pteridium esculentum (Forst. f) Cockayne) in New Zealand

AIM: To examine stands of bracken fern (Pteridium esculentum) from throughout New Zealand for the presence and concentration of ptaquiloside (Pta), and to compare the presence and/or concentrations of Pta in areas where bovine enzootic haematuria (BEH) and/or acute haemorrhagic syndrome (AHS) has been known to occur with those where BEH/AHS has not been recorded. METHODS: Stands of bracken fern were sampled from 275 sites throughout New Zealand. Sixty-two stands were from a regional survey predominantly from the Waikato and Coromandel regions, 27 were from a farm in the King Country where BEH/AHS had been investigated previously, and 186 were from a national survey of the North and South Islands. Sampling sites were from a mixture of grazed paddocks, roadsides, and forest and bush areas. Samples comprised whole young fronds, the tops of unfurling young fronds, or, for the Regional Survey, mature green fronds from the previous season. Pta was extracted from the samples, and measured using high-performance liquid chromatography. Information on the occurrence of BEH/AHS at specific locations was obtained from published information and records from animal health laboratories in New Zealand. RESULTS: The 275 samples contained widely varying concentrations of Pta. In the Farm Survey, concentrations ranged from 280–13,300 (mean 3,800) µg/g (on a dry-weight basis) in the 63% of samples that contained Pta. A high proportion of samples from the Regional and National Surveys covering large areas of the country contained no detectable levels of Pta. The majority (61%) of samples from these two surveys which contained Pta were from areas where BEH/AHS was reported to occur. Combining data from all surveys, in areas with reported BEH/AHS, 42% of samples collected contained Pta, compared with 6% where BEH/AHS was not known to occur. CONCLUSIONS: Concentrations of Pta in bracken in New Zealand vary greatly, and in a high proportion of stands Pta is not found. A higher incidence of Pta, and some very high concentrations, are found in areas where BEH/AHS was known to occur.

Embolización de sangrados arteriales periféricos con Onyx

This study describes use of ethylene vinyl alcohol copolymer (EVOH) dissolved in anhydrous dimethyl sulfoxide (DMSO) and mixed with tantalum powder to achieve radiopacity as an effective, safe, and manageable embolic agent in endovascular treatment of artery haemorrhages. Twenty patients with pseudoaneurysms secondary to biopsy, or surgery were treated, 11 musculoskeletal arteries, 9 visceral (4 gastroduodenal arteries). A diagnostic angiographic procedure that showed the artery lesion was always performed. Embolization was performed immediately, followed by post-embolization angiographic control. Transcatheter embolization was always performed, using a coaxial system consisting of a 4F hydrophilic guide catheter with 0.038" diameter, a microcatheter compatible with DMSO administration (Rebar microcatheter), and a microguide. All cases progressed with acute hemorrhagic syndrome of variable intensity. There were nine cases with hemorrhagic shock. All cases were satisfactorily resolved without recurrence of bleeding during follow-up. Our experience with selective embolization of spontaneous or traumatic artery bleeding with Onyx has been excellent due to its simple, rapid, and safe use.

Acute haemorrhagic syndrome of bovine trypanosomosis in Uganda

A study was undertaken in July 2005 to investigate an acute haemorrhagic syndrome that caused cattle mortality starting March 2005 in Mifumi, Senda, Kainja and Nyagoke villages of Tororo district in Uganda; areas dominantly infested with Glossina fuscipes fuscipes with scanty G. pallidipes. Four hundred and one (401) cattle belonging to 158 farmers were randomly sampled from a population of 549 and screened using a combination of Haematocrit Centrifugation Technique (HCT) and Buffy Coat Technique (BCT) for trypanosomosis. Of which 49 (12.2%) had trypanosome infection. Clinical cases manifested bleeding through the ears, severe weight loss, anaemia, weakness and enlarged lymph nodes prior to death. Out of an original population of 844 cattle 295 (35%) had died. The prevalence of bovine trypanosomosis in herds experiencing mortality (21.5%) was significantly higher than in those without mortality (2.6%) ( χ 2 = 33.4, P < 0.001). Herd size, number of draught oxen and lactating cows in a given herd significantly influenced the risk of mortality ( P < 0.001). Males had a significantly higher prevalence of trypanosomosis (17.8%) than females (9.5%) ( χ 2 = 5.58, P < 0.05) and significantly lower mean packed cell volume (PCV) (23.7%) than females (25.4%) ( P < 0.05). Older calves (7–12 months), yearlings (13–24 months) and adults (>24 months) with prevalences of 11.1%, 15.4% and 11.8%, respectively, were the most affected age categories. Trypanosome-infected cattle had a significantly lower mean PCV (17.9%) than non-infected ones (25.8%) ( P < 0.001), and a significantly higher proportion of anaemic animals (81.6%) than non-infected ones (37.2%) ( χ 2 = 34.6, P < 0.001). Trypanosoma vivax was the dominant trypanosome species, constituting 82% of trypanosome infections. This work has provided further evidence on the importance of T. vivax-induced acute haemorrhagic syndrome in livestock trypanosomosis.

Isolation and Characterization of an Antifactor VIII Antibody from a Patient with Acquired Hemophilia A and a Severe Hemorrhagic Syndrome.

Patients with hemophilia A usually develop inhibitory antibodies to factor VIII (fVIII) that are directed against epitopes in the A2 and C2 domains of the cofactor and result in increased morbidity and mortality because of an extended hemorrhagic syndrome. However, in some cases individuals spontaneously develop autoantibodies to fVIII resulting in acquired hemophilia A. While the etiology and mechanism of the disorder are still unknown, the study and determination of the properties of the autoantibodies is necessary to provide insights into their mechanism of generation. A 78-year-old woman was admitted to the Internal Medicine Department of the University-Hospital of Padua for severe anaemia and syncope. She developed an acute hemorrhagic syndrome characterized by the development of extended subcutaneous and mild intramuscular haematomas on both legs. The patient's family history was negative for hemorrhagic manifestations. Total body computed tomography (CT) scan confirmed the presence of small intramuscular haematomas. Preliminary laboratory analyses revealed a significant prolongation of the aPTT (activated partial thromboplastin time) to 60 sec and a mild prolongation of the PT (prothrombin time) to 15 sec. Mixing experiments with normal plasma failed to correct the patient's aPTT. Plasma fVIII levels were ~6%. Assay for fVIII inhibitor revealed a level of 6 Bethesda Units (BU). The patient was treated with high dose of steroids and recombinant fVIII (3,000 Units daily). Subsequently, she developed swelling to the neck in the sub maxillary region and symptoms consistent with an acute obstruction to the upper airways requiring oral-tracheal intubations and ventilation. These findings prompted the use of recombinant FVIIa to prevent progression of the hemorrhagic lesion. Three sessions of plasmapheresis were performed, which were followed by the administration of high dose immunoglobulin and the administration of immunosuppressive treatment. After 45 days, treatment was continued with steroids only. The patient recovered completely and no new bleeding episodes developed. The total immunoglobulin fraction was isolated from the patient's plasma and found to induce a prolongation of the clotting time in an aPTT assay using purified reagents. The immunoglobulin fraction was also found to inhibit intrinsic tenase activity in an assay using purified reagents and a chromogenic substrate that detects factor X activation. In contrast, the total immunoglobulin fraction purified from normal pooled plasma didn't prolong the aPTT nor inhibited intrinsic tenase activity. Immunoprecipitation experiments with the total immunoglobulins fraction purified from the patient's plasma revealed that the antibody recognizes epitopes on the light chain of the cofactor. Immunobloting experiments performed with the same material demonstrated that the antibody recognizes fVIII heavy and light chains. Following activation by thrombin it was found that the antibody recognizes the Mr 73,000 light chain and the A2 domain of the cofactor. These data demonstrate that the immunoglobulin fraction isolated from the patient's plasma has more than one epitope on the cofactor. Our findings provide the demonstration of a strong anti-fVIII acquired autoantibody with low titer which is not related to the presence of antiphospholipid antibodies and is responsible for a severe hemorrhagic syndrome.

Degradation of extracellular matrix proteins (fibronectin, vitronectin and laminin) by serine-proteinases isolated from Lonomia achelous caterpillar hemolymph

Lonomia achelous is a caterpillar distributed in southern Venezuela and in northern Brazil that causes an acute hemorrhagic syndrome in people who have contact with its bristles. The effect of the crude hemolymph and its chromatographic fractions (FDII, Lonomin V and Lonomin V-2) on extracellular matrix proteins was studied. The chromatographic fractions show activities similar to plasmin and urokinase. In sodium dodecyl sulfate-polyacrylamide gel electrophoresis, both lonomins appear as a protein band of 25 kDa under reduced conditions. By exclusion chromatography, the molecular weights of Lonomin V and Lonomin V-2 were 26.5 and 24.5 kDa, respectively. Fibronectin, laminin and vitronectin were degraded by all venom components. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis, under reduced conditions, shows that lonomins degrade fibronectin in four main fragments of 116, 60, 50 and 30 kDa. Molecular exclusion chromatography in native conditions shows that the molecular masses of these fragments are > or = 300, 62 and 27 kDa. The proteolytic effect of lonomins was abolished by benzamidine/HCl, iodoacetic acid and aprotinin. The extracellular matrix protein degradation together with the fibrino(geno)lytic activity of hemolymph and its fractions could explain, in part, the hemorrhagic syndrome, and the wound dehiscence in persons who have had contact with the L. achelous caterpillar.

Bracken (Pteridium aquilinum)—toxic effects and toxic constituents

AbstractBracken (Pteridium aquilinum L Kuhn) is one of the most successful weeds of the world. In the UK it covers almost 700 000 ha, and is expanding its area by 1–3 % per annum. Not only does bracken limit the usefulness of marginal land but toxic principles in the plant may cause serious illness and even death in stock animals consuming its rhizomes or fronds. Bracken‐derived acute thiamine deficiency disorders occur in pigs and horses, and acute haemorrhagic syndrome, bovine enzootic haematuria and ‘bright blindness’ are all responsible for significant losses of livestock. A great deal of research has resulted in the isolation and identification of a number of natural components of bracken, and the evaluation of their biological effects using laboratory animal models and farm livestock has been carried out in detail. One compound contributing significantly to the toxicity of bracken is the carcinogenic and mutagenic norsesquiterpene, ptaquiloside. The effects on stock and laboratory animals of bracken, its extracts or ptaquiloside are discussed in this paper; the risk to human health from consumption of bracken fronds, milk and dairy products containing bracken carcinogens or their metabolites and drinking water supplies containing bracken leachates is considered from the standpoint of the UK and beyond. Options for the control of bracken are described briefly, and the final section indicates areas of bracken research deserving of further study.

Hemorrhagic diathesis in carcinoma of the stomach: a case report.

Case Reports1 October 1958HEMORRHAGIC DIATHESIS IN CARCINOMA OF THE STOMACH: A CASE REPORTROBERT L. BIBEN, M.D., MARVIN L. TYAN, M.D.ROBERT L. BIBEN, M.D.Search for more papers by this author, MARVIN L. TYAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-49-4-917 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAcute hemorrhagic syndromes may occasionally develop in association with carcinoma of the stomach,1-4prostate,5pancreas4or gall-bladder.2Tagnon6has demonstrated the presence of a proteolytic enzyme in both normal and malignant prostatic tissue which produces fibrinolysis and bleeding in patients with metastatic carcinoma of the prostate. Recently, Frick4reported four cases of carcinoma—two of the stomach, one of the pancreas and one of the prostate—in which hemorrhagic tendencies involved deficiencies of fibrinogen, prothrombin, labile prothrombin conversion factor, and antihemophilic globulin. It is the purpose of this paper to report a case of carcinoma of the stomach complicated by deficiencies of...Bibliography1. Fleischhacker H: Über die Herkunft der Plasmaeiweis Körper, Wien. Arch. f. inn. Med. 34: 96, 1940. Google Scholar2. BraunHorányi PM: Hämorrhagische Diathese verursacht durch Fibrinopenie bei Knochenmarkkarzinose, Folia haemat. 71: 164, 1951. Google Scholar3. BennikeMullertz TS: Hemorrhagic diathesis associated with fibrinogenopenia and fibrinolysis, Acta haemat. 8: 147, 1952. CrossrefMedlineGoogle Scholar4. Frick P: Acute hemorrhagic syndrome with hypofibrinogenemia in metastatic cancer, Acta haemat. 16: 11, 1956. CrossrefMedlineGoogle Scholar5. 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Author, Article, and Disclosure InformationAffiliations: San Francisco, California*Received for publication May 29, 1957.From the Department of Medicine, University of California School of Medicine, and Franklin Hospital, San Francisco, California.Requests for reprints should be addressed to Editorial Office, Department of Medicine, University of California Medical Center, San Francisco 22, California. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThrombohämorrhagische Phänomene bei KrebserkrankungenHemopoietic SystemCase 10-1964An Analysis of Medical Problems In Cancer 1 October 1958Volume 49, Issue 4Page: 917-922KeywordsEnzymesFibrinogenFibrinolysisGlobulinsHemorrhageHospital medicinePancreasStomach ePublished: 1 December 2008 Issue Published: 1 October 1958 PDF downloadLoading ...

Acute hemorrhagic syndrome with hypofibrinogenemia in metastatic cancer.

Acute hemorrhagic syndrome with hypofibrinogenemia in metastatic cancer.