DISSEMINATED intravascular coagulation (DIC) is a syndrome characterized by hemorrhage, thrombocytopenia, consumption of clotting factors, secondary fibrinolysis with elevated levels of fibrinogen-fibrin degradation products, microangiopathic hemolytic anemia, and fibrin thrombi in blood vessels.1This syndrome occurs in a variety of clinical conditions and is initiated by the liberation of tissue thromboplastin into the circulation, by vascular endothelial damage, by abnormalities of blood flow, or by all three.1Disseminated intravascular coagulation has been recognized as a complication of hypothermia in two series of neonatal infants2,3but has been reported in only one adult patient.4The present report describes a 13-year-old in whom DIC developed during the rewarming phase of accidental hypothermia.
Methods
The prothrombin time was determined using rabbit brain thromboplastin and the activated partial thromboplastin time was performed with a kaolin-activated reagent (Coag-A-Chek). Fibrinogen levels were measured using a standard thrombin reagent (Data-Fi) and fibrinogen determination
A 73-year-old woman with non-Hodgkin's lymphoma had two episodes of severe, bilateral, sensori-neural hearing loss after vincristine therapy. Her hearing gradually, then completely returned 2-3 months after the vincristine therapy was discontinued. Bilateral ear infections, central nervous system lymphoma and infection, or other drug-induced neuropathies were excluded as possible etiologies for the deafness. Bilateral acoustic (VIII) nerve palsy in this patient was most likely a manifestation of vincristine neurotoxicity.
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