Microangiopathy

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Thomas R. Spitzer - One of the best experts on this subject based on the ideXlab platform.

Geoffrey K. Isbister - One of the best experts on this subject based on the ideXlab platform.

  • Thrombotic Microangiopathy in two tiger snake envenomations.
    Anaesthesia and intensive care, 2011
    Co-Authors: Andrew Casamento, Geoffrey K. Isbister
    Abstract:

    Thrombotic microangiopathies are a rare group of disorders with features such as microangiopathic haemolytic anaemia, thrombocytopenia and renal failure. Thrombotic Microangiopathy has been previously reported in association with envenomation from a number of snake species. We present the first two reported cases of thrombotic Microangiopathy caused by envenomation from the common tiger snake (Notechis scutatus). Both patients had classical features of thrombotic Microangiopathy with microangiopathic haemolytic anaemia, thrombocytopenia and renal failure commencing in the first 48 hours after envenomation. The presentations and recovery were similar to case presentations of other snakebite envenomation associated thrombotic microangiopathies. Normal ADAMTS13 activity suggests that plasmapharesis may not be beneficial, although this needs further investigation.

  • snakebite doesn t cause disseminated intravascular coagulation coagulopathy and thrombotic Microangiopathy in snake envenoming
    Seminars in Thrombosis and Hemostasis, 2010
    Co-Authors: Geoffrey K. Isbister
    Abstract:

    The most common coagulopathy associated with snake envenoming worldwide is venom-induced consumption coagulopathy (VICC), which results from activation of the coagulation pathway by snake toxins including thrombin-like enzymes, prothrombin activators, and factor X activators. VICC has often been likened to disseminated intravascular coagulation (DIC) because of the elevated D-dimer, prolonged prothrombin time, and low fibrinogen. However, VICC is not characterized by other important features of DIC, such as evidence of systemic microthrombi and end-organ failure. In addition, the time course of VICC differs with rapid onset and resolution, and the mechanism of initiation of coagulation activation differs because thrombin generation in DIC is mediated by the tissue factor/factor VIIa pathway. In a proportion of patients with VICC, a clinical syndrome consistent with thrombotic Microangiopathy has been reported and is characterized by acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia. This thrombotic Microangiopathy appears to only occur in conjunction with VICC but in several different snakes worldwide including vipers and elapids. Consistent with thrombotic Microangiopathy, it progresses despite the resolution of the coagulopathy, suggesting a distinct but related process. The existence of the overlapping clinical syndromes of VICC and thrombotic Microangiopathy in snake envenoming is the likely reason for the mistaken idea that snakebite causes DIC.

Munehide Matsuhisa - One of the best experts on this subject based on the ideXlab platform.

  • Postprandial hyperglycemia is a better predictor of the progression of diabetic retinopathy than HbA1c in Japanese type 2 diabetic patients.
    Diabetes care, 2005
    Co-Authors: Toshihiko Shiraiwa, Hideaki Kaneto, Takeshi Miyatsuka, Ken Kato, Kaoru Yamamoto, Ayaha Kawashima, Tsutomu Kanda, Masaaki Suzuki, Eiichi Imano, Munehide Matsuhisa
    Abstract:

    It is well known that postchallenge and postprandial hyperglycemia are related to the progression of diabetic macroangiopathy (1–6). However, there is little information regarding the association between diabetic Microangiopathy and postprandial hyperglycemia in human subjects. In this study, we performed a follow-up study to elucidate the relationship between diabetic retinopathy and postprandial glycemia or insulinemia. We recruited 151 Japanese patients with type 2 diabetes (74 men, aged 58.1 ± 10.2 years, and 77 women, aged 57.9 ± 9.2 years) who were admitted to Osaka Prefectural General Hospital between 1 January 1995 and 31 December 1999. The mean …

  • post prandial hyperglycemia is an important predictor of the incidence of diabetic Microangiopathy in japanese type 2 diabetic patients
    Biochemical and Biophysical Research Communications, 2005
    Co-Authors: Toshihiko Shiraiwa, Hideaki Kaneto, Takeshi Miyatsuka, Ken Kato, Kaoru Yamamoto, Ayaha Kawashima, Tsutomu Kanda, Masaaki Suzuki, Eiichi Imano, Munehide Matsuhisa
    Abstract:

    Diabetic Microangiopathy is often observed in diabetic patients, but there is little evidence regarding the relationship between post-prandial glycemia or insulinemia and the incidence of diabetic Microangiopathy. In this study, to elucidate the relationship between post-prandial glycemia (or insulinemia) and diabetic Microangiopathy, we performed a cross-sectional study of 232 subjects with type 2 diabetes mellitus who were not being treated with insulin injections. A multiple regression analysis showed that post-prandial hyperglycemia independently correlated with the incidence of diabetic retinopathy and neuropathy. Post-prandial hyperglycemia also correlated, although not independently, with the incidence of diabetic nephropathy. In addition, interestingly, post-prandial hypoinsulinemia independently correlated with the incidence of diabetic retinopathy, although not correlated with diabetic neuropathy or nephropathy. In conclusion, post-prandial hyperglycemia, rather than fasting glycemia or hemoglobin A1c levels, is an important predictor of the incidence of diabetic Microangiopathy in Japanese type 2 diabetic patients.

Laurence Simon - One of the best experts on this subject based on the ideXlab platform.

J Khosla - One of the best experts on this subject based on the ideXlab platform.

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