ABSTRACT
Coagulation studies (plasma fibrinogen, ethanol gelation test, and fibrin-fibrinogen degradation product concentration) and computerized tomography (CT) scan examinations were performed in 55 patients with blunt head injury. The frequency of abnormalities in both coagulation study results and CT scans was higher in patients with severe clinical features and clinical course than in less severely injured patients; in these same patients the coagulation results were abnormal (64%) more frequently than the CT scans (40%). Very high fibrin-fibrinogen degradation product (FDP) concentrations were found to be associated with combined hemorrhagic lesions and mass effect on CT scans, but not with a specific localization of brain-tissue damage. It was concluded that: 1) FDP concentration reflects the amount of brain-tissue damage rather than its location, and 2) in the absence of other possible causes of disseminated intravascular coagulation, coagulation studies may be more sensitive than CT scanning in demonstrating brain contusion.
Subject(s)
Craniocerebral Trauma/blood , Hemostasis , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Blood Coagulation Tests , Child , Child, Preschool , Consciousness , Craniocerebral Trauma/diagnostic imaging , Craniocerebral Trauma/physiopathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Nervous System/physiopathologyABSTRACT
A new method is introduced for the rapid detection of vitamin K deficiency. The method is based on the direct measurement of the precursor factor II molecules that enter the blood in cases of vitamin K deficiency. The practical use of the new method has been evaluated on the basis of the results obtained in 28 plasma samples of patients suspected of liver disease and/or vitamin K deficiency.
Subject(s)
Spectrophotometry/methods , Vitamin K Deficiency/diagnosis , Double-Blind Method , Humans , Liver Diseases/diagnosis , Prothrombin/metabolism , Prothrombin TimeABSTRACT
Coagulation studies (plasma fibrinogen, ethanol gelation test, and fibrin/fibrinogen degradation product concentration) were done in 150 patients who were admitted after blunt head injury. Results were abnormal in 60 patients and were found to be correlated with the level of consciousness and with the presence of neurological signs. Many of these patients had fractures, but findings in a control group of 26 patients with major fractures without head injury indicate that fractures were not of paramount importance in causing clotting changes. Conclusive evidence of disseminated intravascular coagulation was found in 12 patients. Cases with a fatal clinical course were mostly associated with very high fibrin/fibrinogen degradation product concentrations. Some case histories are reported, confirming the hypothesized correlation between coagulation results and brain tissue destruction rather than brain compression. It was concluded that some degree of disseminated intravascular coagulation in patients with blunt head injury occurs more often than expected and that coagulation studies might have both diagnostic and prognostic value.
Subject(s)
Blood Coagulation Disorders/etiology , Brain Injuries/complications , Adolescent , Adult , Aged , Blood Coagulation Disorders/mortality , Blood Coagulation Disorders/physiopathology , Blood Coagulation Tests , Brain Injuries/mortality , Child , Child, Preschool , Craniocerebral Trauma/physiopathology , Disseminated Intravascular Coagulation/etiology , Disseminated Intravascular Coagulation/physiopathology , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Male , Middle Aged , Skull Fractures/physiopathologyABSTRACT
Because of its fibrinolytic action, streptokinase is believed to reduce the severity of the postthrombotic syndrome in patients with deep vein thrombosis. A prospective and a retrospective study have been undertaken in an attempt to determine when this therapy is useful for patients with deep vein thrombosis. The prospective study included 15 patients with deep vein thrombosis: 5 were treated in the hospital with streptokinase and heparin and 5 only with heparin, 5 were treated at home with only phenprocoumon. All the patients received oral anticoagulant therapy for at least 6 months. Three to four months after the acute episode, phlebography and venous pressure measurements were carried out. Streptokinase appeared to give the best results but with more side-effects. In the retrospective study, 51 patients who had had deep vein thrombosis in 1969 were reexamined 31-47 months later. It was found that more than 50% of the patients with a thrombosis in the femoral and/or iliac vein developed a severe postthrombotic syndrome, in contrast to only 9% of those with a thrombosis in the popliteal vein or lower. It is recommended, on the basis of both the prospective and the retrospective study, that patients with a thrombosis in the femoral and/or iliac vein should be treated with either heparin or streptokinase during the early stage. It is probable that streptokinase will significantly decrease the frequency and severity of the postthrombotic syndrome in these patients in particular, although this has not yet been proven.
