Monospecific antivenin therapy in Russell's viper bite.

Venom antigenemia was detected in 24 out of 30 Russell's viper bites. Those who suffered clinical bleeding (N = 14) had higher venom antigenemia than those who did not. The mean value of the amount of monospecific antivenin correcting blood incoagulability was 165 +/- 59.3 ml. Consequently, the recommended treatment is 60 ml of antivenin being administered intravenously at 6-hour intervals until blood coagulability is restored. There were no serious complications after antivenin administration. Renal complication (3 cases) was the major problem following this snake bite. One patient with clinical diagnosis of central nervous system bleeding died on admission.

Lupus anticoagulant in Thai systemic lupus erythematosus patients.

In the past decade, interest in the potential clinical significance of lupus anticoagulant (LA) has grown tremendously. Recent reviews from the Western countries have found an average frequency of 34% for LA in patients with systemic lupus erythematosus (SLE). By using various laboratory procedures, namely, standard and diluted activated partial thromboplastin time, kaolin clotting time, tissue thromboplastin inhibition test and platelet neutralization test, we found the frequency of LA in 91 consecutive Thai SLE patients to be 17.5%, compared with 0.8% in the age-matched normal control population. The presence of LA was significantly associated with disease activity (p = 0.01). A statistically significant association was also observed between the presence of LA and convulsive disorders (p = 0.04), thrombocytopenia (p = 0.001) and autoimmune hemolytic anemia (p = 0.02).

Necrotizing fasciitis of previous surgical wound complicating intensive postremission chemotherapy.

Necrotizing fasciitis of previous surgical wound developed in a leukemic patient after receiving intense postremission chemotherapy. A unique feature was profound granulocytopenia and the recovery of Escherichia coli in the blood and necrotic tissue. We believe the hematogenous seeding of the surgical wound during the episode of E. coli septicemia was the cause of our patient's necrotizing fasciitis.

The species of green pit viper in Bangkok.

The aims of this study were to delineate the species of Green pit viper and clinical patterns in Bangkok areas. This study was a blind independent comparison. Among 188 Green pit vipers collected only two species, i.e. Trimeresurus alborabris and T. macrops were found. There were no differences in snake sizes and in clinical patterns of snake bite. The majority of the clinical cases (90.1%) was classified as of mild degree of severity and severe envenomation was observed only in T. alborabris victims. The ratio between T. alborabris and T. macrops victims in Bangkok residents was 1.7:1 but the ratio was reversed in Thonburi residents.

Clinical manifestations of bleeding following Russell's viper and Green pit viper bites in adults.

Clinical features and laboratory investigations following bites by Russell's viper and Green pit viper were described. Bleeding was the most important manifestation of envenomation. Clinically, bleeding patterns were local and systemic. Swelling was the principal local effect. Russell' viper victims showed less local effect but frequently developed renal complication i.e. acute renal failure. The local effects were more marked in Green pit viper victims. Digital bites developed gangrene more frequently than other bitten sites. Haematemesis and bleeding gums were the commonest types of systemic bleeding. The coagulation abnormalities following Russell's viper bite were compatible with DIC. After Green pit viper bites thrombocytopenia and increased fibrinolytic activity were observed in addition to defibrination. Cerebral haemorrhage was the cause of death in one of these victims.