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Exp Hematol. 2001 Jan;29(1):30-40.
Single administration of thrombopoietin to lethally irradiated mice prevents infectious and thrombotic events leading to mortality.
Mouthon MA, Gaugler MH, Van der Meeren A, Vandamme M, Gourmelon P, Wagemaker G.
Institut de Protection et de Surete Nucleaire, IPSN, Fontenay-aux-Roses Cedex, France. marc-andre.mouthopsn.fr
A sufficiently high dose of thrombopoietin to overcome initial c-mpl-mediated clearance stimulates hematopoietic reconstitution following myelosuppressive treatment. We studied the efficacy of thrombopoietin on survival after supralethal total body irradiation (9 Gy) of C57BL6/J mice and the occurrence of infectious and thrombotic complications in comparison with a bone marrow graft or prophylactic antibiotic treatment. Administration of 0.3 microg thrombopoietin, 2 hours after irradiation, protected 62% of the mice as opposed to no survival in placebo controls. A graft with a supraoptimal number of syngeneic bone marrow cells (10(6) cells) fully prevented mortality, whereas antibiotic treatment was ineffective. Blood cell recovery was observed in the thrombopoietin-treated mice but not in the placebo or antibiotic-treated group. Bone marrow and spleen cellularity as well as colony-forming unit granulocyte-macrophage and burst-forming unit erythroid were considerably increased in thrombopoietin-treated mice relative to controls. Histologic examination at day 11 revealed numerous petechiae and vascular obstructions within the brain microvasculature of placebo-treated mice, which was correlated with hypercoagulation and hypofibrinolysis. Thrombopoietin treatment prevented coagulation/fibrinolysis disorder and vascular thrombosis. High fibrinogen levels were related to bacterial infections in 67% of placebo-treated mice and predicted mortality, whereas the majority of the thrombopoietin-treated mice did not show high fibrinogen levels and endotoxin was not detectable in plasma.We conclude that thrombopoietin administration prevents mortality in mice subjected to 9-Gy total body irradiation both by interfering in the cascade leading to thrombotic complications and by amelioration of neutrophil and platelet recovery and thus protects against infections and hemorrhages.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11164103&dopt=Abstract hemorrhage
Ann Epidemiol. 2001 Jan;11(1):7-12.
Adverse outcomes in pregnancies of asthmatic women: results from a Canadian population.
Wen SW, Demissie K, Liu S.
Bureau of Reproductive and Child Health, Laboratory Center for Disease Control, Health Canada, Ottawa, Ontario.
PURPOSE: There has been little attention paid to asthma complicating pregnancy. This study is among the few studies that investigated this issue in a large Canadian population (more than two millions of Canadian pregnant women). METHODS: We carried out a historical cohort study using hospital discharge data collected by the Canadian Institute for Health Information for fiscal years 1989/90 to 1995/96. RESULTS: A total 2,017,553 obstetric deliveries were included in the analysis. Overall prevalence of asthma among these Canadian women were 0.43%, yielding a total of 8672 cases of asthmatic mothers. Maternal asthma was associated with all of the adverse pregnancy outcomes examined (including fetal death, preterm labour, hypertensive disorders of pregnancy, gestational diabetes, antepartum hemorrhage, infection of the amniotic cavity, premature rupture of membrane, cesarean delivery, as well as postpartum hemorrhage), and adjustment for important confounding factors by multiple logistic regression analysis did not change the overall results. These associations were consistently observed in teenage and adult mothers, although the associations in teenage mothers tended to be stronger than in adult mothers. CONCLUSIONS: This study confirms that pregnant women with asthma are at substantially increased risk for many adverse pregnancy outcomes. For this reason, pregnant women with asthma are a particularly high-risk group to which extra attention, including increased efforts at education, monitoring, and optimal asthma management, may be appropriate.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11164114&dopt=Abstract hemorrhage
Urology. 2001 Jan;57(1):168.
Recurrent metastatic renal cell carcinoma presenting as a bleeding gastric ulcer after a complete response to high-dose interleukin-2 treatment.
Mascarenhas B, Konety B, Rubin JT.
Department of Surgical Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Immunotherapy with high-dose recombinant interleukin-2 is an effective therapy for selected patients with metastatic renal cell carcinoma (RCC). Objective responses (complete or partial) are observed in about 15% of treated patients. The overall and disease-free survival of patients with a complete response are significantly prolonged. Although RCC is known to spread hematogenously, isolated RCC metastasis to the stomach is a rare event. Recurrent RCC, after a complete response to interleukin-2, presenting clinically as an isolated gastric metastasis, has not been reported to date. In this report, we describe the clinical course of a patient with metastatic RCC who had a complete response to high-dose interleukin-2 and was disease free for 4 years before presenting with massive upper gastrointestinal hemorrhage due to an isolated gastric metastasis. The patient remained disease free for 3 years after resection of the metastasis. Metastatic RCC to the stomach, although rare, should be suspected in any patient with a history of RCC who presents with gastrointestinal symptoms. In the absence of diffuse disease, aggressive therapy, including surgical resection, is appropriate for isolated gastric metastasis, because prolonged survival is possible.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11164169&dopt=Abstract hemorrhage
Injury. 2001 Jan;32(1):17-21.
Radioisotope blood volume measurement in uncontrolled retroperitoneal haemorrhage induced by a transfemoral iliac artery puncture.
Cruz RJ, Perin D, Silva LE, Valerio FB, Branco MC, Poli de Figueiredo LF, Rocha e Silva M.
Research Division, Heart Institute, InCor, University of Sao Paulo Medical School, Av Eneas de Carvalho Aguiar 44, 05403-000 SP, Sao Paulo, Brazil. expruzjncor.usp.br
Standard-of-care, large volume crystalloid infusion, in the setting of uncontrolled bleeding, has been challenged and it is not known if fluid resuscitation increases retroperitoneal hemorrhage. We developed an experimental model of retroperitoneal haemorrhage to correlate haemodynamic and metabolic alterations with the blood volume loss. Anaesthetised, spontaneously breathing dogs (17.1+/-0.56 kg) were randomised to unilateral (UL, n=11) or bilateral (BL, n=11) iliac artery puncture, using a metallic device introduced through the femoral arteries and followed for 120 min. Initial and final blood volumes were determined using radioactive tracers, 99mTC and 51Cr, respectively. UL was associated with a stable arterial pressure and a moderate decrease in cardiac output and oxygen delivery. BL induced an abrupt and sustained decrease in mean arterial pressure, from 131.9+/-5.9 to 88.6+/-10.8 mmHg, and a much greater reduction in cardiac output, oxygen delivery and consumption than UL throughout the experiment. Total retroperitoneal blood loss after BL was 36.8+/-3.2 ml/kg, while after UL was 25.1+/-3.4 ml/kg (P=0.0262). We conclude that a transfemoral bilateral iliac artery puncture produces a clinically relevant model of uncontrolled retroperitoneal haemorrhage, with hypotension and low flow state, while a unilateral iliac artery lesion causes a compensated shock state.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11164396&dopt=Abstract hemorrhage
Obstet Gynecol. 2001 Feb;97(2):178-83.
Racial variation in the frequency of intrapartum hemorrhage.
Rathore SS, McMahon MJ.
Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, North Carolina, USA.
OBJECTIVE: To evaluate racial variation in the frequency of intrapartum hemorrhage. METHODS: Using information from birth certificates of live singleton births in North Carolina from 1990 to 1997 (n = 807,759), we evaluated the frequency of intrapartum hemorrhage and its association with maternal race. Logistic regression models were used to evaluate the risk of any intrapartum hemorrhage, placental abruption, placenta previa, and unspecified hemorrhage in each racial group, adjusted for other risk factors. RESULTS: Black women had the highest rates of any hemorrhage (1.52% black, 1.47% white, 1.33% other race, P =.006) and placental abruption (0.79% black, 0.68% white, 0.56% other race, P =.001) but had lower rates of unspecified hemorrhage (0.37% black, 0.42% white, 0.42% other race, P =.001). Race was not associated with placenta previa. Maternal race remained associated with intrapartum hemorrhage after multivariable analysis, but the direction of the association was reversed. Black women were less likely to have any intrapartum hemorrhage (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.77, 0.85), placental abruption (OR 0.76, 95% CI 0.70, 0.82), placenta previa (OR 0.89, 95% CI 0.81, 0.98), or other unspecified hemorrhage (OR 0.84, 95% CI 0.76, 0.92) compared with white women. Women of other minority races were at lower risk for placental abruption (OR 0.76, 95% CI 0.67, 0.87) but were comparable to white women for risk of placenta previa (OR 1.06, 95% CI 0.91, 1.24) and other unspecified hemorrhage (OR 1.02, 95% CI 0.88, 1.19). CONCLUSION: Although black women had higher rates of intrapartum hemorrhage than whites, the increased frequency was attributable to differences in clinical presentation and other risk factors.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11165578&dopt=Abstract hemorrhage
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