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1.
Clin Imaging ; 59(1): 8-12, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31715516

RESUMO

BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) is a severe cerebrovascular condition. Some cases present with typical signs of SAH on head computed tomography (CT), whereas other cases have a condition known as pseudo-SAH, with no bleeding actually present. In our clinical experience, we noted that cases of hyperhemoglobinemia often also had pseudo-SAH. Here we investigated the relationship between hyperhemoglobinemia and pseudo-SAH and explored the underlying mechanism. METHODS: We retrospectively collected data for patients who were treated for hyperhemoglobinemia in our hospital and had available brain CT scans. An age-matched control group of patients with normal hemoglobin levels was used to compare the incidence of pseudo-SAH between individuals with elevated versus normal hemoglobin levels. Spearman correlation and logistic regression analyses were performed to identify correlations between pseudo-SAH and hemoglobin level as well as gender, history of chronic obstructive pulmonary disease, and smoking history. RESULTS: The incidence of pseudo-SAH was significantly higher in hyperhemoglobinemia group than in the control group (12.5% vs. 1.6%, respectively, P < 0.001), and within the hyperhemoglobinemia group, it was significantly higher among those with a hemoglobin value ≥210 g/L than among those with a hemoglobin value <210 g/L (29.2% vs. 8.8%, respectively, P < 0.001). Spearman correlation analysis and logistic regression analysis showed a significant correlation between pseudo-SAH and hyperhemoglobinemia but no significant correlation between pseudo-SAH and gender, COPD, or smoking history. CONCLUSION: Hyperhemoglobinemia may be a contributing factor to pseudo-SAH. Clinicians should be aware of this phenomenon and be careful to distinguish pseudo-SAH from SAH, particularly in patients with hyperhemoglobinemia.


Assuntos
Transtornos da Coagulação Sanguínea/complicações , Hemorragia Subaracnóidea/etiologia , Idoso , Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
3.
Am J Emerg Med ; 37(2): 374.e3-374.e4, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30409461

RESUMO

Synthetic cannabinoids contain many different chemicals and compounds, which pose new health risks to the population using these drugs. In May of 2018 the Center for Disease Control issued a health alert providing information on a multistate outbreak of coagulopathy from exposure to synthetic cannabinoid products containing a Vitamin K-dependent antagonistic agent such as brodifacoum. Recognizing signs, symptoms and imaging findings related to this outbreak is essential for clinicians caring for patients with a history or suspicion of using synthetic cannabinoids. To our knowledge, there are no studies that report the imaging findings demonstrating the coagulopathic complications associated with these synthetic compounds.


Assuntos
4-Hidroxicumarinas/efeitos adversos , Transtornos da Coagulação Sanguínea/induzido quimicamente , Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Canabinoides/efeitos adversos , Drogas Desenhadas/efeitos adversos , Hemorragia/induzido quimicamente , Hemorragia/diagnóstico por imagem , Vitamina K/antagonistas & inibidores , Drogas Desenhadas/química , Serviço Hospitalar de Emergência , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
5.
Phlebology ; 34(3): 156-161, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29720044

RESUMO

BACKGROUND: Venous malformations may be complicated by localized intravascular coagulopathy which is a serious condition with hematological sequel. Prediction of localized intravascular coagulopathy is mandatory for prompt anticoagulation therapy. Laboratory and routine magnetic resonance imaging can predict localized intravascular coagulopathy in venous malformations; however, the results are variable. PURPOSE: To predict venous malformations with localized intravascular coagulopathy with diffusion-weighted magnetic resonance imaging. MATERIAL AND METHODS: A retrospective analysis was performed on 55 patients (34 male, 21 female aged 14-64 years: mean 39 years) with venous malformations that underwent diffusion-weighted magnetic resonance imaging. The apparent diffusion coefficient value of venous malformations was calculated. RESULTS: The mean apparent diffusion coefficient value of venous malformations with localized intravascular coagulopathy (n = 26) (1.28 ± 0.18 × 10-3 mm2/s) was significantly different ( P = 0.001) from venous malformations without localized intravascular coagulopathy (n = 29) (1.60 ± 0.18 × 10-3 mm2/s). When apparent diffusion coefficient value of 1.454 × 10-3 mm2/s was used as a threshold value for the prediction of venous malformations with localized intravascular coagulopathy, the best result was obtained with an accuracy of 83.6%, sensitivity of 84.6%, specificity of 82.8%, and area under the curve of 0.895. The apparent diffusion coefficient value of venous malformations was correlated with D-dimer level ( r = -0.59, P = 0.006) and fibrinogen level ( r = 0.73, P = 0.001). CONCLUSION: The apparent diffusion coefficient value is a non-invasive imaging parameter that can be used to predict venous malformations with localized intravascular coagulopathy.


Assuntos
Transtornos da Coagulação Sanguínea , Imagem de Difusão por Ressonância Magnética , Malformações Vasculares , Veias , Adolescente , Adulto , Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Transtornos da Coagulação Sanguínea/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/metabolismo , Veias/diagnóstico por imagem , Veias/metabolismo
6.
Emerg Radiol ; 25(6): 715-718, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30022308

RESUMO

Synthetic marijuana is a dangerous substance due to its potency, ever-changing composition, and unpredictable side effects. Recently, brodifacoum-contaminated synthetic marijuana has led to multiple deaths and morbidity throughout the USA from severe coagulopathy associated with use of this strain of the drug (brodifacoum is a rodenticide and potent Vitamin K antagonist/anticoagulant). We describe the clinical and radiologic findings in two patients who were diagnosed with, and treated for, ingestion of this new strain of synthetic marijuana. The radiologic manifestations were most notable for hemorrhagic pyelitis/ureteritis. Both patients required hospitalization with Vitamin K supplementation. The radiologic and clinical pictures in these patients are important for radiologists to recognize in order to help guide appropriate patient management.


Assuntos
4-Hidroxicumarinas/envenenamento , Transtornos da Coagulação Sanguínea/induzido quimicamente , Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Canabinoides/envenenamento , Surtos de Doenças , Drogas Ilícitas/envenenamento , Envenenamento/diagnóstico por imagem , Rodenticidas/envenenamento , Adulto , Baltimore/epidemiologia , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/tratamento farmacológico , Tomografia Computadorizada por Raios X , Vitamina K/uso terapêutico
8.
J Trauma Acute Care Surg ; 83(4): 628-634, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28930957

RESUMO

INTRODUCTION: The coagulopathy of trauma, illustrated by a short R-time, is common and well understood. The physiology behind this may be early thrombin burst with rapid clot formation. Rapid consumption of fibrinogen, however, may result in weak clot and substrate depletion, resulting in low MA. While these characteristics are interesting, utilizing thromboelastography (TEG) to identify those at risk of subsequent bleeding diathesis, especially in those who do not demonstrate early signs of physiologic derangement, is challenging. We have developed a novel ratio utilizing TEG values to describe patients at specific risk of traumatic coagulopathy. The purpose of this study was to create a single TEG value, which would reflect both the hypercoagulability and hypocoagulability of TIC. We hypothesized that this ratio, at admission, would be indicative of TIC and predictive of both blood product transfusion volumes and subsequent mortality. METHODS: Patients admitted via the highest activation criteria at one of two Level I trauma centers were included if they received at least 1 unit of packed red blood cells in the first 24 hours of admission. The admission TEG was collected, and a ratio was calculated by dividing the MA by the R-time (MA-R). MA-R quartiles were developed, and multivariable logistic regression was utilized to determine odds of mortality. RESULTS: Three hundred thirty patients with admission TEG were included. In all patients, median age was 35 years (interquartile range, 25-54 years), Injury Severity Score (ISS) was 20 (interquartile range, 13-29), 76% were male, and 43% had penetrating trauma. The MA-R groups were based on quartiles. Multivariable analysis, controlling for mechanism of injury, ISS, and admission pH, showed that increasing ratios were associated with decreased odds of death. The lowest MA-R ratios were also significantly associated with higher ISS, higher rates of blunt injury, and higher plasma utilization without a significant difference in packed red blood cell administration. CONCLUSIONS: Patients with the lowest MA-R ratios demonstrated the highest mortality rates. This novel ratio may prove highly useful to predict at-risk patients early, when other physiologic indicators are absent. The mechanism driving this finding may rest in fibrinogen depletion, resulting in weak clot. Patients with low MA-R ratios may benefit from earlier resuscitation with cryoprecipitate, rather than the traditional use of plasma found in current massive transfusion protocols. LEVELS OF EVIDENCE: Prognostic study, Level I.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Transtornos da Coagulação Sanguínea/mortalidade , Tromboelastografia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico por imagem , Adulto , Transtornos da Coagulação Sanguínea/etiologia , Transfusão de Sangue , Feminino , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Centros de Traumatologia , Ferimentos e Lesões/mortalidade
9.
J Clin Gastroenterol ; 51(7): 632-638, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27984401

RESUMO

OBJECTIVE: Traditional coagulopathic indices, including elevated international normalized ratio, do not correlate with bleeding risk in patients with cirrhosis. For this reason, head computed tomography (CT) has a low yield in cirrhotic patients with altered mental status and no trauma history. The initial diagnostic evaluation, however, is often made by nongastroenterologists influenced by the so-called "coagulopathy of cirrhosis." We sought to examine the prevalence, impact, and malleability of this perception in an international, multispecialty cohort. DESIGN: An electronic survey was distributed to internal medicine, surgery, emergency medicine, and gastroenterology physicians. Respondents were presented with a cirrhotic patient with hepatic encephalopathy, no history of trauma, and a nonfocal neurological examination. Respondents rated likelihood to order head CT at presentation, after obtaining labs [international normalized ratio (INR) 2.4 and platelets 59×10/µL], and finally after reading the results of a study demonstrating the low yield of head CT in this setting. RESULTS: In total, 1286 physicians from 6 countries, 84% from the United States. Of these, 62% were from internal medicine, 25% from emergency medicine, 8% from gastroenterology, and 5% from surgery. Totally, 47% of respondents were attending physicians. At each timepoint, emergency physicians were more likely, and gastroenterologists less likely, to scan than all other specialties (P<0.0001). Evidence on the low yield of head CT reduced likelihood to scan for all specialties. Qualitative analysis of open-ended comments confirmed that concern for "coagulopathy of cirrhosis" motivated CT orders. CONCLUSIONS: Perceptions regarding the coagulopathy of cirrhosis, which vary across specialties, impact clinical decision-making. Exposure to clinical evidence has the potential to change practice patterns.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Competência Clínica , Encefalopatia Hepática/diagnóstico por imagem , Cirrose Hepática/complicações , Padrões de Prática Médica/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Transtornos da Coagulação Sanguínea/etiologia , Canadá , Tomada de Decisão Clínica , Estudos Transversais , Europa (Continente) , Pesquisas sobre Serviços de Saúde , Encefalopatia Hepática/etiologia , Humanos , Razão de Chances , Estudos Prospectivos , Estados Unidos
10.
Hematol Oncol Clin North Am ; 30(4): 757-77, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27443996

RESUMO

Hematologic disorders affect the central nervous system in a variety of ways, producing a wide range of neurologic disturbances. Early identification of these complications allows for early intervention and better outcome. Cross-sectional imaging plays an important role in identifying brain abnormalities and helps the clinician in deciding appropriate course of action and treatment. This article discuss in short the basics of hemostasis including the coagulation cascade and the application of basic laboratory tests in evaluation of hematologic function. Imaging features of various neurologic disorders associated with these clotting and bleeding diatheses are discussed in detail with illustrations.


Assuntos
Transtornos da Coagulação Sanguínea , Doenças do Sistema Nervoso Central , Hemorragia , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Doenças do Sistema Nervoso Central/sangue , Doenças do Sistema Nervoso Central/diagnóstico por imagem , Doenças do Sistema Nervoso Central/etiologia , Hemorragia/sangue , Hemorragia/complicações , Hemorragia/diagnóstico por imagem , Humanos
11.
Pediatr Crit Care Med ; 15(2): e44-8, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24201856

RESUMO

OBJECTIVES: To evaluate the safety and effectiveness of ultrasound-guided left brachiocephalic vein cannulation in infants and children with underlying bleeding conditions. DESIGN: Retrospective cohort. SETTING: PICU of a tertiary pediatric hospital. PATIENTS: Thirty-four patients requiring central venous catheterization from January 2011 to January 2012. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two pediatric intensivists, experienced in ultrasound-guided vessel cannulation, performed the ultrasound catheterization of the left brachiocephalic vein. Ultrasound equipment consisted of a standard ultrasound monitor with a linear 6-13 MHz probe. The ultrasound monitor was set on a resolution with a depth of 1.8 cm for infants and 2.2 cm for children. The "in-plane" technique was used for all patients. Thirty-four catheterizations were performed. Patient median age was 12.5 months (5.75-63.5 mo) and median weight was 9.25 kg (7-16.25 kg). The population of infants and children analyzed was composed of 25 patients with hematologic disorder (73%) treated with hematopoietic stem cell transplantation, five patients (15%) supported with extracorporeal membrane oxygenation for viral pneumonias, and four patients (12%) with uremic hemolytic syndrome. A 4F catheter was used in 79% of cases. Left brachiocephalic vein cannulation was successful in all 34 patients. Median time needed for cannulation was 350 seconds (277.5-450 s). The overall complication rate was 9% (3 of 34) and consisted of difficulty in advancing the guidewire after having pierced the vein. The time required for catheter positioning and complications was not associated with both lower body weight and body surface area of the patients (p > 0.05). Mean central venous catheter duration was 32 ± 4 days. CONCLUSIONS: Data reported in this retrospective study confirm the safety and effectiveness of ultrasound-guided left brachiocephalic vein catheterization in infants and children with underlying bleeding disorders.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Veias Braquiocefálicas/diagnóstico por imagem , Cateterismo Venoso Central/métodos , Ultrassonografia de Intervenção/métodos , Transtornos da Coagulação Sanguínea/cirurgia , Veias Braquiocefálicas/cirurgia , Cateterismo Venoso Central/efeitos adversos , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Estudos Retrospectivos , Ultrassonografia de Intervenção/efeitos adversos
12.
Biomed Res Int ; 2013: 685174, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23984395

RESUMO

Posttraumatic cerebral infarction (PTCI) is a severe secondary insult of head injury and often leads to a poor prognosis. Hemocoagulation disorder is recognized to have important effects on hemorrhagic or ischemic damages. We sought to assess if posttraumatic hemocoagulation disorders were associated with cerebral infarction, and evaluate their influence on outcome among patients with moderate or severe head trauma. In this study, PTCI was observed in 28 (10.57%) of the 265 patients within the first week after injury. In multivariate analysis, the thrombocytopenia (odds ratio (OR) 2.210, 95% confidence interval (CI) 1.065-4.674), abnormal prothrombin time (PT) (OR 3.241, 95% CI 1.090-7.648), D-dimer (>2 mg/L) (OR 7.260, 95% CI 1.822-28.076), or disseminated intravascular coagulation (DIC) scores (≥ 5) (OR 4.717, 95% CI 1.778-12.517) were each independently associated with an increased risk of PTCI. Admission Glasgow Coma Scale (GCS) score, abnormal activated partial thromboplastin time (APTT) and fibrinogen, and D-dimer (>2 mg/L) and DIC scores (≥ 5) showed an independent predictive effect on poor outcome. In conclusion, recognition of this important treatable cause of PTCI and the associated risk factors may help identify the group at risk and tailor management of patients with TBI.


Assuntos
Transtornos da Coagulação Sanguínea/complicações , Infarto Cerebral/etiologia , Traumatismos Craniocerebrais/etiologia , Adolescente , Adulto , Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Demografia , Feminino , Escala de Coma de Glasgow , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
13.
Brain Inj ; 26(12): 1464-71, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22721350

RESUMO

PRIMARY OBJECTIVE: To investigate whether the development of coagulopathy at different stages after isolated traumatic brain injury (TBI) is associated with distinct cranial computed tomography characteristics. RESEARCH DESIGN: Retrospective cohort study in 226 patients with moderate-to-severe isolated TBI who were categorized as subjects without coagulopathy or with acute temporary, acute sustained or delayed coagulopathy. METHODS AND PROCEDURES: Coagulopathy was defined as an activated partial thromboplastin time >40 seconds and/or prothrombin time (PT) >1.2 and/or platelet count <120*10(9)l(-1). Cranial CT scans were assigned to the six-point Traumatic Coma Data Bank (TCDB) CT-classification. MAIN OUTCOMES AND RESULTS: Coagulopathy occurred in 44% of patients in the first 24-hours post-trauma. Patients with acute, sustained coagulopathy showed a prolonged PT (1.64 ± 0.89) when compared to patients without (1.03 ± 0.07), acute temporary (1.27 ± 0.22) or delayed coagulopathy (1.08 ± 0.06; p < 0.05). Patients with acute temporary or delayed coagulopathy had the worst TCDB CT classification scores, while mortality rates were the highest in patients with sustained or delayed coagulopathy. CONCLUSIONS: Not only the mere presence of coagulopathy, but also the course of haemostatic alterations following neurotrauma may hold predictive value for patient outcome, irrespective of the severity level of cerebral injury.


Assuntos
Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Lesões Encefálicas/sangue , Lesões Encefálicas/diagnóstico por imagem , Hemostasia , Tomografia Computadorizada por Raios X , Adulto , Transtornos da Coagulação Sanguínea/epidemiologia , Lesões Encefálicas/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Tempo de Tromboplastina Parcial , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
14.
Thromb Res ; 129 Suppl 2: S57-61, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22405050

RESUMO

A validated method for assessing hemostasis in vivo is critical for testing the hemostatic efficacy of therapeutic agents in preclinical animal models and in patients with inherited bleeding disorders, such as von Willebrand disease (VWD) and hemophilia A, or with acquired bleeding disorders such as those resulting from medications or disease processes. In this review, we discuss current methods for assessing hemostasis in vivo and the associated challenges. We also present ARFI-Monitored Hemostatic Challenge; a new, potentially alternate method for in vivo hemostasis monitoring that is in development by our group.


Assuntos
Transtornos da Coagulação Sanguínea/sangue , Hemostasia/fisiologia , Animais , Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Transtornos da Coagulação Sanguínea/terapia , Modelos Animais de Doenças , Cães , Hemofilia A/sangue , Hemofilia A/diagnóstico por imagem , Hemofilia A/terapia , Hemostasia/efeitos dos fármacos , Humanos , Ultrassonografia , Doenças de von Willebrand/sangue , Doenças de von Willebrand/diagnóstico por imagem , Doenças de von Willebrand/terapia
17.
J Matern Fetal Neonatal Med ; 23(7): 601-6, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19757338

RESUMO

BACKGROUND: The association between intraventricular hemorrhage (IVH) and coagulation in infants has been a subject of controversy. Only few publications assessing risk factors for development of IVH reported results of coagulation studies. OBJECTIVES: To evaluate the levels of coagulation and fibrinolysis systems in ELBW infants and determine their influence on IVH. PATIENTS AND METHODS: Following IRB approval coagulation status of 38 ELBW infants was evaluated on first and second day of life. Severity of IVH assessed by cerebral ultrasonography was graded according to Papile classification. Newborns were assigned to either Group A--Grade III or IV, or Group B--Grade I-II, or no IVH. RESULTS: Neonates with Grade III/IV IVH had significantly lower plasma Factor VII (FVII) level on first day of life and FVII differed significantly between Groups A and B with sensitivity of 100%, specificity 41% for a cut-off value of< 7%. In Group A there was no improvement of prothrombin and activated partial thromboplastin times on Day 2. A significant decline of platelet count was also observed. CONCLUSIONS: High-grade IVH coincides with severe derangement of coagulation in ELBW infants with FVII level being the most sensitive, it is not clear what the reason for such low FVII concentration is. Further studies are indicated.


Assuntos
Transtornos da Coagulação Sanguínea/congênito , Transtornos da Coagulação Sanguínea/epidemiologia , Hemorragia Cerebral/congênito , Hemorragia Cerebral/epidemiologia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Índice de Apgar , Peso ao Nascer/fisiologia , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Hemorragia Cerebral/sangue , Hemorragia Cerebral/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Feminino , Fibrinólise/fisiologia , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer/sangue , Recém-Nascido , Doenças do Prematuro/sangue , Doenças do Prematuro/diagnóstico por imagem , Doenças do Prematuro/epidemiologia , Masculino , Contagem de Plaquetas , Ultrassonografia
18.
Fertil Steril ; 85(1): 227, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16412762

RESUMO

OBJECTIVE: To describe two cases of periumbilical hematoma (Cullen's sign) following ultrasound-guided transvaginal oocyte retrieval. DESIGN: Case report. SETTING: University-affiliated teaching hospital. PATIENT(S): Two patients, 34 and 32 years old, who developed Cullen's sign following ultrasound-guided transvaginal oocyte retrieval. INTERVENTION(S): Workup for pancreatitis and coagulopathies. Laparoscopy was preformed in one patient. MAIN OUTCOME MEASURE(S): Resolution of the symptoms. RESULT(S): Pancreatitis, coagulopathy, and massive hemoperitoneum were ruled out. Symptoms resided within two weeks. CONCLUSION(S): The appearance of a periumbilical hematoma (Cullen's sign) following ultrasound-guided transvaginal oocyte retrieval reflects a retroperitoneal hematoma of a benign course.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Fertilização In Vitro , Hematoma/diagnóstico por imagem , Oócitos/citologia , Pancreatite/diagnóstico por imagem , Adulto , Feminino , Humanos , Infertilidade Feminina , Síndrome do Ovário Policístico , Ultrassonografia , Umbigo , Vagina
19.
Tokai J Exp Clin Med ; 30(1): 35-9, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15952297

RESUMO

We treated a 59-year-old woman presenting with hemoptysis, a rare symptom of pheochromocytoma. Multiple factors including hypertension caused by sudden catecholamine release may result in pulmonary edema. It should be noted that the increased activation of coagulation cascade, which was demonstrated by increased thrombin-antithrombin III complex (TAT) and prothrombin fragment factor 1 and 2 (F1 + 2), as well as endothelial or platelet stimulation evidenced by the increased plasma von Willebrand factor, may have contributed to hemoptysis. These abnormalities were normalized after adrenalectomy. Our case indicates the important role of catecholamine in coagulopathy and possibly in vasculopathy.


Assuntos
Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/patologia , Hemoptise/etiologia , Hemoptise/patologia , Feocromocitoma/complicações , Feocromocitoma/patologia , 3-Iodobenzilguanidina , Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Fatores de Coagulação Sanguínea/metabolismo , Catecolaminas/urina , Feminino , Hemoptise/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Feocromocitoma/diagnóstico por imagem , Radiografia , Tomógrafos Computadorizados
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