Multiple cerebral infarctions in the context of malignancy

Coagulation disorders are common in patients with malignancy, sometimes leading to arterial and venous thrombosis. Such patients are therefore at increased risk for ischaemic stroke. Though usually occurring in advanced stages of cancers, sometimes stroke can be the first manifestation of a hidden, yet undiagnosed, malignancy. This report presents a case of recurrent strokes secondary to malignancy-related thromboembolism in a 63-year old gentleman.peer-reviewe

Hypoxic-ischemic encephalopathy: facts and insights

Asphyxia may cause a hypoxic-ischemic encephalopathy due to an insufficient supply of oxygenated blood to the brain, which leads to a cerebral palsy. The transition state between both is called neonatal encephalopathy. However, there are many other causes for neonatal encephalopathy, such as developmental abnormalities, metabolic abnormalities, autoimmune disorders, coagulation disorders, infections, trauma, IUGR, and chromosomal abnormalities. Therefore, the American College of Obstetricians and Gynecologists defined criteria, sufficient for an acute intrapartum event to cause a cerebral palsy. Asphyxia itself causes a redistribution of the blood flow towards the central organs, the brain and heart, but in a further stage the cerebral energy metabolism may breakdown and a cascade of events will occur: energy, i.e. ATP, fails for Na+/K+ pumps, the gradients of Na+/K+ across the cell membranes cannot any longer be maintained and cell oedema develops, furthermore, glutamate is released and exerts a neurotoxic influence, Ca2+ overflows the cells and activates lipases, proteases and nucleases, the cellular protein synthesis decreases, after the insult reperfusion of the tissue occurs, but oxygen radicals with a nefast influence are formed, interleukins are released and an inflammatory reaction takes place and proto-oncogenes are expressed. Cell death is an inevitable consequence, leading to the hypoxic-ischemic encephalopathy

Management of coagulation disorders in severe inflammation

Take home messages To understand the main interplay between coagulation system and inflammation and to recognize the key invasive infectious agents causing typical abnormalities in activation of blood platelets, coagulation and fibrinolysis. To capture, monitor and follow-up the clinical and laboratory phenotype and the management related to the pathophysiology of inflammation.Peer reviewe

PERIOPERATIVE COAGULATION DISORDERS

Detaljnom prijeoperacijskom obradom bolesnika mogu se identifi cirati poremećaji koagulacije i modifi cirati rizici prije kirurškog zahvata. Prijeoperacijski preporučuje se korištenje standardiziranog upitnika koji sadrži upite bolesniku o sklonosti epistaksi, pojavi hematoma, krvarenja u zglobove, gastrointestinalnom krvarenju, postoperativnom krvarenju, postpartalnom krvarenju i slično. Ovisno o procjeni zdravstvenog stanja bolesnika i opsežnosti kirurškog zahvata (operacijskom riziku) postoje preporuke o prijeoperativnim laboratorijskim testovima. U današnje vrijeme mnogi bolesnici kojima predstoji kirurški zahvat, elektivni ili hitni, koriste lijekove koji djeluju na zgrušavanje krvi. Kako bi bolesnike liječili optimalno potrebno je balansirati između rizika od krvarenja i tromboembolijskih komplikacija, kako bi se poboljšao ishod bolesnika. Poseban pristup je potreban kod intraoperativnog masivnog krvarenja i kod politraumatiziranih bolesnika. Ključan čimbenik dobrog ishoda bolesnika s perioperativnom koagulopatijom je iskusan anesteziolog koji dobro poznaje patofi ziologiju koagulopatije kod pojedinih bolesti i stanja te djelovanje raznih lijekova na koagulacijski sustav.Precise preoperative management of patients can identify coagulation disorders and risks prior to operative surgery, so it can be modifi ed. The use of a standardized questionnaire is preoperatively recommended and, depending on the American Society of Anesthesiologists status and the extent of surgical procedure, there are recommendations for preoperative laboratory tests. Nowadays, many patients undergoing a surgical procedure, elective or urgent, use drugs that act on blood clotting. In order to treat patients optimally, it is necessary to balance the risk of bleeding and thromboembolic complications. Specifi c approach is needed in case of intraoperative massive bleeding and in patients with polytrauma. A key factor for good outcome of patients with perioperative coagulopathy is an experienced anesthesiologist who understands the pathophysiology of coagulopathy in particular diseases and conditions, as well as the effects of various drugs on the coagulation system

PERIOPERATIVE COAGULATION DISORDERS

Detaljnom prijeoperacijskom obradom bolesnika mogu se identifi cirati poremećaji koagulacije i modifi cirati rizici prije kirurškog zahvata. Prijeoperacijski preporučuje se korištenje standardiziranog upitnika koji sadrži upite bolesniku o sklonosti epistaksi, pojavi hematoma, krvarenja u zglobove, gastrointestinalnom krvarenju, postoperativnom krvarenju, postpartalnom krvarenju i slično. Ovisno o procjeni zdravstvenog stanja bolesnika i opsežnosti kirurškog zahvata (operacijskom riziku) postoje preporuke o prijeoperativnim laboratorijskim testovima. U današnje vrijeme mnogi bolesnici kojima predstoji kirurški zahvat, elektivni ili hitni, koriste lijekove koji djeluju na zgrušavanje krvi. Kako bi bolesnike liječili optimalno potrebno je balansirati između rizika od krvarenja i tromboembolijskih komplikacija, kako bi se poboljšao ishod bolesnika. Poseban pristup je potreban kod intraoperativnog masivnog krvarenja i kod politraumatiziranih bolesnika. Ključan čimbenik dobrog ishoda bolesnika s perioperativnom koagulopatijom je iskusan anesteziolog koji dobro poznaje patofi ziologiju koagulopatije kod pojedinih bolesti i stanja te djelovanje raznih lijekova na koagulacijski sustav.Precise preoperative management of patients can identify coagulation disorders and risks prior to operative surgery, so it can be modifi ed. The use of a standardized questionnaire is preoperatively recommended and, depending on the American Society of Anesthesiologists status and the extent of surgical procedure, there are recommendations for preoperative laboratory tests. Nowadays, many patients undergoing a surgical procedure, elective or urgent, use drugs that act on blood clotting. In order to treat patients optimally, it is necessary to balance the risk of bleeding and thromboembolic complications. Specifi c approach is needed in case of intraoperative massive bleeding and in patients with polytrauma. A key factor for good outcome of patients with perioperative coagulopathy is an experienced anesthesiologist who understands the pathophysiology of coagulopathy in particular diseases and conditions, as well as the effects of various drugs on the coagulation system

Unexplained severe portal hypertension in HIV-infected patients: a new clinical entity?

Cases of non-cirrhotic portal hypertension have been reported in HIV-negative patients as a result from exposure to adenosine analogues (e.g. azathioprine), bacterial infections, trace metals and chemicals, genetic coagulation disorders and/or autoimmune diseases. More recently, reports of similar cases in HIV-positive individuals have attracted much attention