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Biomedical subjects

C S Kitchens

Publications and source records attributed to C S Kitchens.

At least 55 records · Page 3Linked to original sources
PubMed1985

Recurring thromboembolic disease and pulmonary hypertension associated with severe hypoplasminogenemia.

In a patient with pulmonary hypertension and a history of recurrent venous thrombosis, plasma concentrations of all known coagulant and inhibitor proteins were normal except for severe deficiency of plasminogen. Repeated analyses showed the circulating plasma plasminogen level to be 30% of normal by either functional or immunologic methods. We sought evidence for either increased activation of plasminogen or for dysplasminogen. There was no evidence for the former. Purified plasminogen studies disclosed a normal number of active sites and normal activation. Generated plasmin had normal catalytic activity. Isoelectric focusing disclosed normal distribution of isoforms. Affinity chromatography with lysine-sepharose showed the presence of the two variant forms; however, an increased proportion of the protein eluted in the first peak. Danazol administration induced an increase in circulating plasminogen, but the differences in affinity chromatography elution profile remained. We conclude that this patient has a deficiency of normally functioning plasminogen, probably due to decreased synthesis.

Adult↗
PubMed1985

Concept of hypercoagulability: a review of its development, clinical application, and recent progress.

There exist multiple clinical conditions, situations, and diseases in which persons appear to be at increased risk for thromboembolic phenomena, such as venous thrombosis and pulmonary embolus. Within this group of conditions, situations, or diseases, some are more clearly linked to thromboembolism that others. Similarly, for some, there exist clear biochemical reasons to support a proposed causal mechanism. A categorization of these risk factors has been constructed, taking into account both the apparent association of the risk factor with thromboembolism and the credibility of the proposed mechanism. Forty-eight factors have been so stratified. It is predicted that both more factors will be identified and especially that mechanisms proposed will strengthen as this area of medicine is further investigated.

Blood Coagulation Disorders↗
PubMed1985

Spontaneous hemothorax in a patient with Osler-Weber-Rendu disease.

We have reported a case of spontaneous hemothorax as a rare complication of Osler-Weber-Rendu disease (hereditary hemorrhagic telangiectasia). Because of the possibility of confusion with pulmonary infarction and its attendant treatment with anticoagulants, physicians should be aware of possible hemothorax in Osler-Weber-Rendu disease.

Arteriovenous Malformations↗
PubMed1985

Intensive short-term chemotherapy for patients with acute myelogenous leukemia: long-term follow-up.

Our pilot study addresses the problem of early relapse from complete remission in young adults with acute myelogenous leukemia (AML). Twelve patients with AML, 16-58 years of age, were entered in a study of four intense courses of cytotoxic chemotherapy using the following drugs: cytarabine, daunorubicin, 5-azacitidine, and 6-thioguanine. They received no maintenance therapy. Nine of 12 patients achieved complete response. With a minimum follow-up of 35 months, the observed disease-free survival at 2 years was 67% (14 +/- SE) and the actuarial disease-free survival at 4 years was 38% (17 +/- SE). It appears that brief intensive chemotherapy early in the management of AML can produce prolonged remission without the need for maintenance therapy.

Actuarial Analysis↗
PubMed1985

A comparison between two commercially available activators for determining the partial thromboplastin time.

Activators that are used to determine the activated partial thromboplastin time should be sensitive enough to detect mild deficiencies of coagulation factors in a reproducible fashion. We compared two commercially available activators--a newly modified preparation of ellagic acid activator and a silica activator. Both reagents produced results that were reproducible over a broad range of concentrations of factors involved in the intrinsic coagulation pathway. The ellagic acid activator was more sensitive in detecting a partial deficiency of nearly all of these factors.

Adult↗
PubMed1984

Intravenous immunoglobulin administration in the treatment of severe chronic immune thrombocytopenic purpura.

Human immunoglobulin was administered intravenously to nine adult patients having severe chronic immune thrombocytopenia purpura. The response in three patients was an increase in the platelet count to greater than 50,000/mm3, a hemostatically adequate level. Response was associated with a pretreatment platelet-associated immunoglobulin level of more than 5,000 molecules per platelet, and successful treatment resulted in a decrease in that level. In those patients with pretreatment platelet-associated immunoglobulin levels less than 5,000 molecules per platelet, there was neither a significant decrease in that level nor an increase in their platelet count. Immunoglobulin infusion may prove useful for selected patients with severe chronic immune thrombocytopenia.

Adult↗
PubMed1984

Spontaneous disappearance of an IgA anti-factor IX inhibitor in a child with Christmas disease.

The few inhibitors to blood coagulation factor IX in patients with Christmas disease (hemophilia B) that have been studied have been shown to belong to the IgG class of immunoglobulins. We report the first case in which a factor IX inhibitor was of the IgA class. Additionally, he appears to be the youngest patient with hemophilia B to have developed an inhibitor. His inhibitor complicated treatment of the patient for several years because of its anamnestic rise following factor IX concentrate administration. It then spontaneously vanished and has not returned in spite of repeated factor IX complex administration.

Antibodies↗
PubMed1984

Microvascular alterations in thrombin-induced experimental disseminated intravascular coagulation in the dog.

Disseminated intravascular coagulation is often characterized by organ failure and bleeding. By use of light microscopy, previous studies have shown extensive fibrin deposition in vessels. However, quantification of fibrin deposition using ultrastructural methods has not been reported. In this study dogs were infused with thrombin, and disseminated intravascular coagulation developed. Using a blinded morphometric analysis method, we observed deposition of fibrin in nearly half of the microvascular vessels. Such deposition probably accounts at least for part of the organ dysfunction. Almost half the vessels also had altered endothelial structure including thinning of the endothelial membrane, formation of extremely thin spots, fenestrations, and even a few ruptured areas. These findings at least in part explain the extravasation of blood in disseminated intravascular coagulation.

Animals↗
PubMed1984

Coagulation and fibrinolysis in estrogen-treated surgically menopausal women.

The short-term effects of different types and doses of estrogen therapy on coagulation and fibrinolysis were studied in 35 surgically menopausal women. Dynamic tests of the coagulation cascade, tests indicative of ongoing, intravascular coagulation, and assessments of coagulation inhibition and fibrinolysis were performed. No clinically abnormal responses were found with the tested regimens--1 and 2 mg of 17 beta-estradiol and 0.625 and 1.25 mg of conjugated equine estrogens. Increased plasminogen antigen and activity were found with the conjugated estrogens but not with the 17 beta-estradiol preparations. The age of the woman had no effect on either the direction or magnitude of response to treatment. Estrogen therapy at the reported doses does not appear to adversely affect the coagulation-fibrinolysis systems of surgically menopausal women. Based on their ability to enhance plasminogen activity, conjugated estrogens may be preferred over the 17 beta-estradiol preparations for this clinical population.

Adult↗
PubMed1984

Spontaneous intra-abdominal hemorrhage in hemophilia.

Intra-abdominal hemorrhage in patients with hemophilia is uncommon but represents a major cause of death in hemophiliacs. The manifestations are protean and may mimic other intra-abdominal processes. We present seven episodes of hemophilic intra-abdominal hemorrhage in which the initial diagnoses were incorrect in five of the seven cases. The mean time from seeking medical assistance to correct diagnoses was two days (range, zero to five days). Computed tomography proved useful, particularly when the diagnosis was uncertain or needed to be differentiated from other possibilities, such as aneurysm, tumor, or abscess. Delay in diagnosis and diagnostic and therapeutic misadventures can be minimized only by a knowledge of the nature of such hemorrhage.

Adult↗
PubMed1983

High-dose intravenous immunoglobulin therapy in patients with immune thrombocytopenic purpura.

Four patients with severe chronic immune thrombocytopenic purpura who were refractory to all conventional therapy for that disorder were initially seen with either refractory bleeding or the necessity for an operation. We treated each of these patients with intravenous human serum immunoglobulin, and three of the four patients had a rapid and substantial increase in their platelet counts. This new method for ameliorating chronic immune thrombocytopenic purpura deserves further study and consideration.

Aged↗