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Common Clotting Pathway

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841. Doxorubicin Beads in Treating Patients With Unresectable Liver Metastases From Neuroendocrine Tumors

to accept PVA microporous hydrospheres/doxorubicin hydrochloride No collateral vessel pathways potentially endangering normal territories during embolization No feeding arteries smaller than distal branches from which they emerge Not pregnant Exclusion criteria: See Disease Characteristics Another active primary tumor Any contraindication for hepatic embolization procedures, including any of the following: Porto-systemic shunt Hepatofugal blood flow Impaired clotting tests (i.e., platelet count < 50,000 (...) Institute Common Toxicity Criteria (CTCAE) v3.0. The study was prematurely terminated due to high incidence of biloma and liver abscess. Safety data below is based off of 13 patients enrolled on protocol at 1 month post initial treatment. Secondary Outcome Measures : Tumor Response (Efficacy) - by Response Evaluation Criteria in Solid Tumors (RECIST) and the European Association for the Study of the Liver (EASL) Criteria [ Time Frame: 12 months ] Study was terminated and full outcome not assessed

2008 Clinical Trials

842. Understanding the Role of Genes and Biomarkers in the Blood Clotting Process in Children With Acute Lung Injury

respiratory failure. This study will examine if differences in genes and biomarkers involved in the blood clotting process may affect the severity of and recovery from ALI/ARDS in children hospitalized with the condition. Condition or disease Respiratory Distress Syndrome, Adult Detailed Description: ALI/ARDS is a life-threatening condition that involves inflammation of the lungs and fluid accumulation in the air sacs, which leads to low blood oxygen levels and respiratory failure. Common causes include (...) differ among people. Differences in the genetic basis of protein C and fibrinolysis pathways, which both play a role in preventing blood clots, may be a factor in determining the severity of and recovery from ALI. The purpose of this study is to analyze plasma and DNA from children with ALI/ARDS to identify biomarkers and genetic variations that may be related to clinical outcomes. This study will enroll children who are hospitalized with ALI/ARDS. Participants' medical records will be reviewed

2008 Clinical Trials

843. PT

PT PT - General Practice Notebook This site is intended for healthcare professionals General Practice Notebook | Medical search PT The prothrombin time (PT) and international normalized ratio are ways of measuring of the extrinsic system in the coagulation pathway - factors II, V,VII and X PT measures the extrinsic system (factor VII) as well as factors common to both the intrinsic and extrinsic systems (factors X, V, prothrombin and fibrinogen) the normal clotting time is 10-14 seconds (...) Thromboplastin and plasma are mixed at 37 deg.C. and the time taken for a clot to form after the addition of calcium is measured; this is the prothrombin time. The time to clot is compared to a control - this is the international normalised ratio (INR). The normal range of the INR is 0.9-1.2. Conditions which cause a prolongation of the prothrombin time include: liver disease use of anticoagulants e.g. warfarin Links: General Practice Notebook General Practice Notebook The information provided herein should

2010 GP Notebook

844. prothrombin time

prothrombin time prothrombin time - General Practice Notebook This site is intended for healthcare professionals General Practice Notebook | Medical search prothrombin time The prothrombin time (PT) and international normalized ratio are ways of measuring of the extrinsic system in the coagulation pathway - factors II, V,VII and X PT measures the extrinsic system (factor VII) as well as factors common to both the intrinsic and extrinsic systems (factors X, V, prothrombin and fibrinogen (...) ) the normal clotting time is 10-14 seconds Thromboplastin and plasma are mixed at 37 deg.C. and the time taken for a clot to form after the addition of calcium is measured; this is the prothrombin time. The time to clot is compared to a control - this is the international normalised ratio (INR). The normal range of the INR is 0.9-1.2. Conditions which cause a prolongation of the prothrombin time include: liver disease use of anticoagulants e.g. warfarin Links: General Practice Notebook General Practice

2010 GP Notebook

845. INR

INR INR - General Practice Notebook This site is intended for healthcare professionals General Practice Notebook | Medical search INR The prothrombin time (PT) and international normalized ratio are ways of measuring of the extrinsic system in the coagulation pathway - factors II, V,VII and X PT measures the extrinsic system (factor VII) as well as factors common to both the intrinsic and extrinsic systems (factors X, V, prothrombin and fibrinogen) the normal clotting time is 10-14 seconds (...) Thromboplastin and plasma are mixed at 37 deg.C. and the time taken for a clot to form after the addition of calcium is measured; this is the prothrombin time. The time to clot is compared to a control - this is the international normalised ratio (INR). The normal range of the INR is 0.9-1.2. Conditions which cause a prolongation of the prothrombin time include: liver disease use of anticoagulants e.g. warfarin Links: General Practice Notebook General Practice Notebook The information provided herein should

2010 GP Notebook

846. international normalised ratio

international normalised ratio international normalised ratio - General Practice Notebook This site is intended for healthcare professionals General Practice Notebook | Medical search international normalised ratio The prothrombin time (PT) and international normalized ratio are ways of measuring of the extrinsic system in the coagulation pathway - factors II, V,VII and X PT measures the extrinsic system (factor VII) as well as factors common to both the intrinsic and extrinsic systems (factors (...) X, V, prothrombin and fibrinogen) the normal clotting time is 10-14 seconds Thromboplastin and plasma are mixed at 37 deg.C. and the time taken for a clot to form after the addition of calcium is measured; this is the prothrombin time. The time to clot is compared to a control - this is the international normalised ratio (INR). The normal range of the INR is 0.9-1.2. Conditions which cause a prolongation of the prothrombin time include: liver disease use of anticoagulants e.g. warfarin Links

2010 GP Notebook

847. Sexually Transmitted Disease

diseases see separate article. The HIV test In-depth counselling is not necessary. Emphasise the benefits of testing (earlier diagnosis leads to better prognosis, as effective treatment is now available). Reassure patients that insurance companies do not enquire about negative results. Send 10 mls of clotted blood to Virology, marked 'HIV test'. Document how the patient will be informed of the results. Re-test if within the three-month window period. If negative, discuss risk reduction. If positive (...) , refer according to local pathways - urgency to depend on the clinical status of the patient. Asymptomatic patients Those at high risk of STIs are: Under the age of 25; and/or With a new sexual partner within the previous 12 months. Women Test for Chlamydia trachomatis . In areas of high prevalence of gonorrhoea (or if there is a local outbreak) a test for Neisseria gonorrhoeae should be undertaken in high-risk patients. Trichomonas (should be tested for but relatively uncommon and usually

2008 Mentor

848. Superior Vena Cava Obstruction

and European Guidelines. You may find one of our more useful. In this article In This Article Superior Vena Cava Obstruction In this article Synonym: superior vena cava syndrome Obstruction of the superior vena cava (SVC) can be due to external pressure, involvement of the vessel by tumour tissue, or a blood clot obstructing the lumen. William Hunter first identified the condition in 1757 in a patient with syphilitic aortic aneurysm. [ ] Today, the most common cause is superior mediastinal pressure (...) extremities and the upper thorax. When obstructed, collateral routes are provided by four main pathways: The azygous venous system, which includes the azygous vein, the hemizygous vein and the connecting intercostal veins. The internal mammary venous system plus tributaries and secondary communications to the superior and inferior epigastric veins. The long thoracic venous system connection to the femoral veins. The long thoracic venous system connection to the vertebral veins. Aetiology One American

2008 Mentor

849. Status Epilepticus Management

function, electrolytes, liver function, calcium and magnesium; FBC and clotting; AED levels. 5 ml of serum and 50 ml of urine samples should be saved for future analysis, including toxicology, especially if the cause of the status epilepticus is uncertain. Other therapy Correct hypoglycaemia if present. Parenteral thiamine should be considered if alcohol abuse is suspected. Pyridoxine (vitamin B6) should be given if the status epilepticus is caused by pyridoxine deficiency. Further management Identify (...) and treat any underlying cause. Status is associated with community-acquired bacterial meningitis and seizures. Seizures occurring in the acute phase of the illness are predictors of poor outcome. [ ] Identify and treat medical complications - eg, CXR to evaluate the possibility of aspiration. Regular AEDs should be continued at optimal doses and the reasons for status epilepticus should be investigated. An individual treatment pathway should be formulated for children, young people and adults who have

2008 Mentor

850. Rectal Bleeding

Guidelines. You may find the article more useful, or one of our other . In this article In This Article Rectal Bleeding in Adults In this article The passage of blood per rectum is a very common symptom. It is often attributed by patients to haemorrhoids and they are a common cause of this symptom. However, there are other causes and it is important to know what the possible causes are and when and how to investigate this symptom further. The type and amount of the bleeding as well as the age (...) [ ] Rectal bleeding is a very common symptom. It occurs in adults of all ages. The incidence of rectal bleeding is essentially unknown as it is not well studied and much of it goes unreported. Prevalence has been estimated as high as 10% of adults annually in the UK. Most of this will not be reported. The majority of cases of rectal bleeding are due to benign causes, particularly haemorrhoids and anal fissures. However, there are many other possible causes, some of which are sinister. In particular

2008 Mentor

851. Pipelle Endometrial Sampling (Procedure)

adenocarcinoma, adenosarcoma and leiomyosarcoma). Adenomyosis (usually only symptomatic in later reproductive years). Endometritis. Oestrogen-secreting ovarian cancers. Iatrogenic causes: Tamoxifen. Following smear or treatment to the cervix. Missed oral contraceptive pills. Drugs altering clotting parameters - eg, anticoagulants, selective serotonin reuptake inhibitors (SSRIs), corticosteroids. Alternative remedies when taken with hormonal contraceptives - eg, ginseng, ginkgo, soy supplements, and St John's (...) wort. Causes of breakthrough bleeding Unscheduled vaginal bleeding is common when a new contraceptive method is started and often settles without intervention [ ] . It is important to exclude pregnancy and also any underlying infection. Bleeding problems are more common with progestogen-only methods. Smokers have a greater risk of breakthrough bleeding. : Preparations containing 20 micrograms ethinylestradiol are more likely to be associated with breakthrough bleeding than those containing 30-35

2008 Mentor

852. Noonan's Syndrome

. This is incorrect and misleading and should not be used. Epidemiology It is inherited in an autosomal dominant manner. The incidence of NS is estimated to be between 1 in 1,000 to 1 in 2,500 children. [ ] NS is caused by mutations in the RAS/mitogen-activated protein kinase (MAPK) pathway which is essential for cell cycle differentiation, growth and senescence. A number of mutations have been identified with the four most common being PTPN11 (50% of cases), KRAS, SOS1 and RAF1 genes. [ ] It is characterised (...) find one of our more useful. In this article In This Article Noonan's Syndrome In this article Noonan syndrome (NS) is a common genetic disorder with multiple congenital abnormalities. It is characterised by congenital heart disease, short stature, a broad and webbed neck, sternal deformity, variable degree of developmental delay, cryptorchidism, increased bleeding tendency and characteristic facial features that evolve with age. [ ] The term 'male Turner syndrome' is sometimes used as a synonym

2008 Mentor

853. Paracetamol Poisoning

(in staggered overdoses, the level is not interpretable except to confirm ingestion). U&E, creatinine - to look for renal failure and have a baseline. LFTs: may be normal if the patient presents early but may rise to ALT >1000 IU/L. This is the enzyme level taken to indicate hepatotoxicity. Glucose: hypoglycaemia is common in hepatic necrosis - capillary blood glucose should be checked hourly. Clotting screen: prothrombin time is the best indicator of severity of liver failure and the INR should be checked (...) Guidelines. You may find the article more useful, or one of our other . In this article In This Article Paracetamol Poisoning In this article Synonyms: acetaminophen poisoning Background Paracetamol is widely available and has been around since the 1950s. It is widely prescribed and cheap to buy over the counter, making it a common drug taken in overdose. It is a very useful analgesic (alone or in combination) and also is an antipyretic. It is normally found as a 500 mg tablet but it is often combined

2008 Mentor

854. Haemorrhoids (Piles)

lifting, chronic cough, ageing and hereditary factors [ ] . Presentation Symptoms A person may be asymptomatic. Bright-red, painless rectal bleeding with defecation is the most common symptom [ ] . It may be streaks on the toilet paper or blood dripping into the toilet. Blood may coat stools but is not mixed in. Anal itching and irritation may result from chronic mucous discharge irritating the perianal skin [ ] . A feeling of rectal fullness, discomfort or of incomplete evacuation on bowel movements (...) ', below. Anal cancer may look similar to a prolapsed haemorrhoid. Flexible sigmoidoscopy and possible colonoscopy may be carried out to exclude other pathology. Anorectal physiological studies and anorectal ultrasound may be useful if there is associated soiling or incontinence. FBC may reveal anaemia or infection. Management Treatment depends on the degree of prolapse and the severity of symptoms. Refer using the suspected cancer pathway referral (for an appointment within two weeks) if anal

2008 Mentor

855. Haemolytic Uraemic Syndrome

are sequestered but without the cascade of clotting factors as in disseminated intravascular coagulation (DIC). [ ] Other pathogens may induce HUS - for example: Bacteria such as Streptococcus pneumoniae and Shigella dysenteriae type 1. [ ] Some viruses such as HIV and Coxsackievirus. Atypical HUS can be caused by: Exposure to certain medications (eg, ciclosporin, tacrolimus). Genetic mutations in the complement pathway. [ ] Systemic conditions, including lupus, cancer and pregnancy. Epidemiology [ , ] HUS (...) and European Guidelines. You may find one of our more useful. In this article In This Article Haemolytic Uraemic Syndrome In this article This is a notifiable disease in the UK. See the article for more detail. Haemolytic uraemic syndrome (HUS) was first described in 1955. [ ] It is is a triad of: Microangiopathic haemolytic anaemia (Coombs' test negative). Thrombocytopenia. Acute kidney injury (acute renal failure). It is the most common cause of acute kidney injury in children and its incidence appears

2008 Mentor

856. Haematuria

transient causes). Persistence is defined as 2 out of 3 dipsticks positive for NVH. Epidemiology The prevalence of a-NVH varies from 0.19% to as high as 21%. [ ] There is evidence for an association between glomerular haematuria and adverse renal outcomes. [ ] Aetiology Common causes include UTI, bladder tumours, urinary tract stones, urethritis, benign prostatic hypertrophy (BPH) and prostate cancer. The most common causes of NVH are UTI, BPH and urinary calculi. However, up to 5% of patients (...) proteinuria: send urine for protein:creatinine ratio (PCR) or albumin:creatinine ratio (ACR) on a random sample (according to local practice). 24-hour urine collections for protein are rarely required. An approximation to the 24-hour urine protein or albumin excretion (in milligrams) is obtained by multiplying the ratio (in mg/mmol) x 10. Measurement of blood pressure. Other initial investigations These may include: FBC (anaemia) and clotting screen. Urine red cell morphology: dysmorphic erythrocytes

2008 Mentor

857. Hormone Replacement Therapy

previously. Women can be prescribed continuous combined HRT if: They have received sequential combined HRT for at least one year; or It has been at least one year since their last menstrual period; or It has been at least two years since their last menstrual period if they had a premature menopause. If bleeding is heavy or irregular on sequential combined HRT then the dose of progestogen can be doubled or increased in duration to 21 days. Erratic bleeding can be common in the first 3-6 months after (...) depends partly on patient preference but there are also other advantages to certain delivery routes. By avoiding the first pass metabolism through the liver, non-oral preparations (ie patches or gels): Have less effect on clotting factors. Reduce triglycerides. Are are often more suitable for: Women who experience side-effects such as nausea with oral preparations. Women with liver disease or gallstones. Women with a history of malabsorption. Women who are at risk of thrombosis. Women with diabetes

2008 Mentor

858. Electrical Injuries and Lightning Strikes

the heart. For example, contact of the electrical source with both hands effectively results in a transthoracic pathway which is thought to account for about 60% of mortalities, whereas there is very low mortality related to a pathway passing through one leg and out of the other. Voltage [ ] Generally, the greater the voltage, the greater the damage. The exception is with high-tension voltage: above this level, greater voltage doesn't necessarily influence the degree of electrical injury, although (...) these as an indication of cardiac damage. [ ] Delayed arrhythmias are extremely rare and tend to be found in patients who have a previous history of ECG abnormalities (known or subclinical). [ ] Nervous system Acute complications : these include respiratory arrest, seizures, altered mental state, amnesia, coma and expressive dysphasia. Motor deficits have also been reported. Delayed complications : these include spinal cord injury (common) and . [ , ] Acute ischaemic stroke has also been reported. [ ] Peripheral

2008 Mentor

859. Complement Deficiencies

' followed by a number. There are also two proteins involved in the alternative complement pathway that are known as factors: factor B and factor D. The complement system is activated in a cascade sequence, similar to that of the blood clotting cascade. The complement cascade [ ] The complement cascade has three main pathways which are activated in different ways. They all converge in one final common pathway at C3. This common pathway results in C5 to C9 being assembled into the membrane attack complex (...) complement components in the classic, alternative or MBL pathways (ie above C3 in the cascade). Primary C3 deficiency tends to present in early life with overwhelming infection with encapsulated organisms. There is also a tendency to . MAC deficiencies (C5-C9) Recurrent infections are again a feature. Infection with Neisseria meningitidis is particularly common. More rare serotypes of this organism such as Y and W135 tend to cause the infection. [ , ] Leiner's disease [ ] This is a paediatric condition

2008 Mentor

860. Cirrhosis

find the article more useful, or one of our other . In this article In This Article Cirrhosis In this article See also the separate article. Cirrhosis is a diffuse hepatic process characterised by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules. Cirrhosis represents the final histological pathway for a wide variety of liver diseases. The progression to cirrhosis is very variable and may occur over weeks or many years [ ] . Around 80-90% of the liver (...) (hepatocytes) causes impaired liver function and the liver becomes less able to synthesise important substances such as clotting factors and is also less able to detoxify other substances (see also the separate article). Causes of cirrhosis A number of chronic liver diseases can lead to cirrhosis. The cirrhotic process can take from weeks to many years to develop, depending on the underlying cause and other factors, including patient response to the disease process. For example, chronic hepatitis C

2008 Mentor

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