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Biomedical subjects

C S Kitchens

Publications and source records attributed to C S Kitchens.

At least 73 records · Page 4Linked to original sources
PubMed1983

Mechanism of defibrination in humans after envenomation by the Eastern diamondback rattlesnake.

We prospectively studied the hemostatic system of ten persons bitten by the Eastern diamondback rattlesnake (Crotalus adamanteus) during 1978-1980. Blood was drawn when the patients arrived in the emergency room and every 6 hr thereafter. All envenomated victims developed incoagulable blood (defined by a thrombin time greater than or equal to 120 sec, normal less than 20 sec). Platelet counts and plasma levels of antithrombin III and factors II and VIII were not drastically altered, which distinguished this disorder from classic disseminated intravascular coagulation. Fibrinogen levels were markedly decreased (mean coagulable level of 0 mg/dl and antigenic levels of 99 mg/dl). Plasminogen levels were 20% of normal, alpha-2-plasminogen inhibitor was 17% of normal, and plasminogen activator was 20 times normal. Levels of fibrin degradation products peaked at a mean of 7,680 micrograms/ml. The magnitude and duration of the coagulopathy were proportional to the clinical severity of envenomation. Treatment with antivenin blunted the coagulopathy. Because venom from the Eastern diamondback rattlesnake does not directly activate plasminogen, we conclude that coagulopathy following envenomation by that reptile appears to be due to partial proteolysis of fibrinogen with secondary activation of plasminogen by released plasminogen activator, probably of endothelial origin.

Antivenins↗
PubMed1983

Pseudo-prolongation of the partial thromboplastin time.

A patient with a negative personal and family history for bleeding was being prepared for bronchoscopy when an extremely long activated partial thromboplastin time was detected. Analyses for the contact phase factors were normal. It was determined subsequently that the prolongation was artifactual. The prolongation was due to a peculiar set of circumstances requiring an intrinsically short partial thromboplastin time, a rapid-acting commercial accelerating agent, and a clot-sensing device having a built-in lag phase longer than the resulting partial thromboplastin time. The authors wish to bring to the attention of laboratory personnel this curiosity.

Aged↗
PubMed1982

Studies of a patient with recurring thrombotic thrombocytopenic purpura.

A young woman with recurring bouts of thrombotic thrombocytopenic purpura presented an opportunity to study a single patient serially and in depth. This patient underwent 12 remissions in response to fresh frozen plasma, and as little as 250 ml of plasma or plasma from which cryoprecipitate had been extracted with efficacious. Neither the Lian factor nor alterations in either cold-insoluble globulin or protein C could be demonstrated. Evidence in support of the concept of "exhausted" platelets was generated, in that immediately before a thrombocytopenic relapse, platelet function was altered as manifested by bruising, prolongation of the bleeding time, and decreased platelet aggregation. The in vitro addition of normal plasma to such platelets did not improve aggregation. The antiplatelet agent sulfinpyrazone did not seem to add efficacy. Serial observations support the hypothesis that the progression of pathophysiologic events in this patient is: exhausted platelets, thrombocytopenia, hemolysis, renal perturbations, and central nervous system dysfunction.

Adolescent↗
PubMed1982

Hematuria unrelated to hemophilia in a hemophiliac.

Whereas painless gross hematuria in the hemophiliac is usually secondary to the basic coagulation defect, it is not always so. An elderly man presented with this clinical situation which, after a protracted course, was ultimately proven to be associated with an infarcted kidney. In retrospect, the patient's age and the presence of an abdominal aortic aneurysm were clues that we were not dealing with hemophilic hematuria.

Aged↗
PubMed1981

Cushing's syndrome secondary to a neuroendocrine tumor: relapse after bilateral adrenalectomy.

Bilateral adrenalectomy results in the removal of the site of glucocorticosteroid production thereby eliminating the signs and symptoms of Cushing's syndrome. A case is reported of a middle-aged man with Cushing's syndrome due to an ACTH-producing tumor. The patient initially responded to adrenalectomy but had a fatal relapse. Autopsy showed that the right adrenal bed containing remnants of adrenal tissue. An islet cell carcinoma of the pancreas was thought to be the primary tumor.

ACTH Syndrome, Ectopic↗
PubMed1981

Menopausal status associated with increased inhibition of blood coagulation.

Postmenopausal women receiving estrogen replacement therapy (ERT) are not as prone to inappropriate venous and arterial thrombosis as are younger women taking oral contraceptives. To establish whether menopausal status per se has any effect on the coagulation-fibrinolytic system normal premenopausal women (mean age 29 years) were compared with younger (mean age 23) and older (mean age 51) surgically menopausal women and a group of naturally postmenopausal women (mean age 53). The results show that in postmenopausal women, irrespective of age or type, the shift is away from clot formatiuon and toward clot inhibition and fibrinolysis as determined by static in vitro analysis. This was characterized by statistically significant increases in antithrombin III antigen, alpha 1-antitrypsin antigen, and plasminogen activity. These changes may help to explain in part why ERT does not appear to cause increased thrombosis in older women.

Adult↗
PubMed1981

Low-dose oral contraceptive usage and coagulation.

A prospective investigation was initiated to assess the effect of a low-dose oral contraceptive containing 35 micrograms of ethinyl estradiol and 0.4 mg of norethindrone on blood coagulation and fibrinolysis. Twenty-four women were studied before, during, and after one year of treatment. Positive results included an accelerated activated partial thromboplastin time and an increase in fibrinolytic and anticoagulation factors as measured by alpha 1-antitrypsin antigen and plasminogen antigen and activity. Antithrombin III antigen was decreased but its activity was unaffected. There was no evidence of ongoing intravascular coagulation. No patient had a detectable thromboembolic event. In short, one year's usage of this low-dose oral contraceptive was not associated with a procoagulant hematologic profile.

Antigens↗
PubMed1981

Prothrombin Gainesville. A dysprothrombinemia in a pair of identical twins.

A pair of identical twins was evaluated for menometrorrhagia and mild post-operative bleeding. Each had a slightly prolonged partial thromboplastin time and prothrombin time. Full hemostatic evaluation was normal, except that plasma prothrombin activity was 23% and 25% of normal with a Russell's viper venom assay. Each twin had 70% of normal plasma prothrombin antigen. Prothrombin kinetic data were obtained before and during hysterectomy. In these twins, infused prothrombin (Konyne) was found to have a volume of distribution of approximately one and one-half times the plasma volume and a half-life of 34 hours. The previously reported dysprothrombins are briefly reviewed. Prothrombin Gainesville is the twelfth such disorder reported.

Adult↗
PubMed1981

Iron studies in hemophilia.

Although iron deficiency is not recognized as a usual complication of hemophilia, we questioned whether intermittent occult loss of blood in urine or stool might predispose hemophiliacs to chronic iron deficiency. Seven men with factor VII and one with factor IX deficiency were studied. Blood studied, bone marrow aspirates, urine and stool samples, and ferrokinetics with total-body counting up to five months were examined. These data showed no excessive loss of blood during the study period; however, marrow iron stores were decidedly decreased, being absent in four subjects. We suggest that in some hemophiliacs, iron deposits in tissues such as synovial membranes may form a high proportion of the body's total iron stores.

Bone Marrow↗
PubMed1980

Aeromonas hydrophila bacteremia in ambulatory immunocompromised hosts.

We observed seven episodes of Aeromonas hydrophila septicemia in five patients. All but one patient had an underlying disease resulting in immunosuppression. All episodes occurred in ambulatory patients whose vocation or avocation had recently caused them to contact water or fish. We hypothesize that infection with this gram-negative bacterium is acquired more frequently from the natural habitat of the organism than from nosocomial sources.

Adolescent↗
PubMed1980

Erythrocytosis associated with carboxyhemoglobinemia in smokers.

During a two-year period, we evaluated 14 patients with erythrocytosis. Carboxyhemoglobinemia secondary to cigarette or cigar smoking or both caused elevated hematocrit values in ten of the patients, and in all 14 either red cell volume was increased or plasma volume was decreased. There was no correlation between the number of cigarettes or cigars reportedly smoked and either the degree of carboxyhemoglobinemia or the hematocrit value, In three patients who stopped smoking permanently, hematocrit values decreased from a mean of 56% to 46%. Even though the high hematocrit value reversed when these patients stopped smoking, we met with limited success in persuading the others to do so.

Adult↗
PubMed1980

Probing the dynamics of Münchausen's syndrome. Detailed analysis of a case.

During a 10-week period we made in-depth observations of a patient with Münchausen's syndrome who had chronic myelogenous leukemia. Probably because he perceived that his life expectancy was brief, he disclosed his wanderings and regularly used methods of deception. These methods were usually based on his knowledge of pathophysiology. He exploited the desire of medical personnel to be helpful. Through interviews with the patient, family members, and previous physicians and review of 14 kg of medical records, we attempted to reconstruct his life to gain insight into his conscious and unconscious motivations. Most features of Münchausen's syndrome appear to be explainable by the patient's attempts to have control over his immediate environment.

Humans↗