Ketoconazole and Flutamide in the treatment of disseminated intravascular clotting from prostate cancer: a case report and review.

Disseminated intravascular clotting (DIC) is a well-recognized complication of malignancy. Prostatic cancer can produce chronic DIC as well as acute severe DIC. Treatment of DIC are general supportive measures including heparin, transfusion of blood, platelets and clotting factors, but the most important aspect is correction of underlying malignant diseases i.e. cancer of the prostate gland. For metastatic prostatic cancer presenting with an emergency oncologic condition, the treatment of choice is surgical orchiectomy, but surgery may not be possible in the presence of severe DIC. Ketoconazole and Flutamide are drugs with different mechanisms for hormonal manipulation of this cancer. Due to severe DIC, we combined both drugs trying to put maximum therapeutic effect on this life threatening profound DIC patient.

Significance of blood coagulation and platelet profiles in relation to pulmonary thrombosis in beta-thalassemia/Hb E.

In beta-Thalassemia hemoglobin E (beta-thal Hb E), hypoxemia with abnormal lung function was described and postmortem examination in these patients showed organized pulmonary trombi with thickened arterial wall, particularly in post-splenectomized cases. Coagulation and platelet profiles were studied in 58 beta-thal Hb E patients. In 35 cases with intact spleen, the fibrinolytic activity was significantly decreased with high antithrombin III activity, while coagulation tests revealed mild abnormality. The platelet aggregation to ADP, adrenaline, collagen and ristocretin were defective and platelet 5-hydroxytryptamine content was lower than normal. Twenty-three patients who had been splenectomized for 5-18 years, decreased fibrinolytic activity and high antithrombin III activity were also observed. The coagulation profiles and platelet aggregation in response to ADP, adrenaline and collagen showed better results. Fourteen cases exhibited thrombocytosis and their thrombin generation was in the hypercoagulable range. Platelet aggregation in response to ristocetin remained defective and platelet 5-hydroxytryptamine content was lower than in cases with intact spleens. Defective aggregation to ristocetin would indicate abnormal von Willebrand's factor (vWF). Decreased fibrinolysis should very likely have a role in the occurrence of thrombosis and the better hemostatic profiles in post-splenectomized cases would contribute to the more frequent thrombotic incidence in these cases.

Therapy of chronic idiopathic thrombocytopenic purpura in adults: experiences from Thailand.

Results of different types of treatment in 416 adults with chronic idiopathic thrombocytopenic purpura (ITP) were analyzed. Of 368 patients treated with corticosteroids, 278 (77%) achieved complete response (CR ie, normalization of platelet count). However, only 18% of patients had continued complete response (CCR). Results of splenectomy was analyzed in 126 patients, 49% of them achieved CCR and 76% of them had beneficial effects from the operation. Emergency splenectomy was a life saving procedure in 8 of 11 patients with life-threatening hemorrhage. Vinca alkaloids gave a 50% transient CR. Immunosuppressive agents (cyclophosphamide, azathioprine) resulted in only 11% CCR.

Factor VIII, factor IX and fibrinogen content in cryoprecipitate, fresh plasma and cryoprecipitate-removed plasma.

In order to provide accurate information for physicians, factor VIII, factor IX and fibrinogen content were determined in 40 bags of cryoprecipitate, fresh plasma and cryoprecipitate-removed plasma. A cryoprecipitate bag with a volume of 21.8 +/- 5.3 ml contained 139.5 +/- 42.9 units of factor VIII and 200.0 +/- 80.0 mg of fibrinogen. Fresh plasma with a volume of 208.0 +/- 22.5 ml contained 180.9 +/- 45.3 of factor IX, significantly higher than in cryoprecipitate-removed plasma. It was also found in this study that group O blood showed a significantly lower level of factor VIII.

Outcomes of pregnancy in adult idiopathic thrombocytopenic purpura.

The outcomes of 39 pregnancies in 36 idiopathic thrombocytopenic purpura (ITP) patients were analysed. Among the 36 pregnant patients, 23 had active ITP (platelet count < 100,000 per mm3), 12 had inactive ITP, during pregnancies, while one patient had active and inactive ITP during each of her two pregnancies. Maternal bleeding during delivery occurred more commonly in thrombocytopenic patients and was more frequent by cesarean section than by vaginal delivery. There was a 56 per cent incidence of neonatal thrombocytopenia. Maternal platelet count had no predictive value for neonatal thrombocytopenia. There was no serious bleeding among neonates born from thrombocytopenic mothers. In our experience, vaginal delivery was a relatively safe procedure for delivering small neonates from multiparous ITP mothers. Cesarean section should be used to deliver relatively big neonates especially from primigravida ITP mothers and splenectomy should be done at the same time.

Severe cases of green pit viper snake venom poisoning.

Two severe cases of green pit viper bites were reported. The clinical manifestations were severe bleeding and diarrhea. The first patient had acute renal failure complicated from severe diarrhea and hypovolemia. Hematological findings showed hypofibrinogenemia and thrombocytopenia. Renal biopsy performed in the first case showed a picture compatible with that of the recovery phase of acute tubular necrosis. Green pit viper antivenine serum together with symptomatic and supportive treatment was given. Both patients recovered uneventfully.

Increased fibrinolysis and changes in blood coagulation during epidural block for transurethral prostatectomy.

Epidural analgesia is the choice of anesthesia for transurethral prostatectomy (TURP). Unfortunately, this technique may increase fibrinolysis as well as decrease in fibrinogen and platelets count, which might cause deleterious bleeding problem during the procedure performed under epidural block. The present study was therefore undertake to assess the degree of increased fibrinolysis and changes in coagulation profiles during epidural anesthesia for TURP. Twenty patients aged from 57 to 83 years were studied. Group 1 of 7 patients did not receive antifibrinolysin (transamin) after 20 minutes following epidural block. Group 11 of 13 patients did not receive transamin intravenously. Blood samples were drawn for euglobulinlysis time (ELT), fibrinogen, platelets, haemoglobin, prothrombin time (PT) and partial thromboplastin time (PTT). The sampling periods included pre-epidural block as baseline values, 10 and 45 minutes after epidural block and the last was obtained immediately after the completion of surgery. The study revealed the same degree of increased fibrinolysis in both groups tested ten minutes after epidural analgesia and throughout the entire operation. There were no statistical significant changes in fibrinogen level, PT and PTT. The platelet counts decreased from the baseline values in group 1 more than group 11, but the quantities were within normal ranges. The results indicated that fibrinolysis following epidural analgesia for TURP increased in the same degree in all patients if either they received transamin or not. Furthermore, the increased fibrinolytic activity did not lead to a problem of blood loss in this study.