| The surgical implications of purpura fulminans. | |
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MedLine Citation:
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PMID: 2340249 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Purpura fulminans is an uncommon catastrophic syndrome that occurs in children, typically one to four weeks after a seemingly benign infectious process. The child usually presents with a high fever, purpuric ecchymosis, hypotension, disseminated intravascular coagulation, and gangrene of the extremities. We have recently treated six children, whose mean age was 22 months; three were male and three were female. Five of the six had a change of mental status upon initial examination. Their mean temperature was 104 degrees F. All six children had purpuric involvement of their extremities; three had involvement of their hands, two had involvement of their faces, and two had involvement of their trunks. All had absent palpable pulses and sluggish capillary refill in the involved hands and feet. Two patients died shortly after admission as a result of severe end-stage sepsis. The platelet counts in these two patients, and the white blood cell counts were markedly depressed. The mean platelet count of the survivors was 370,000 and the mean white blood cell count was 25,000. Lumbar punctures were positive for bacterial meningitis in five patients and viral meningitis in one patient. All patients were treated with intravenous heparin. Of the four survivors, two lost significant tissue and required multiple plastic reconstructive procedures, and two improved on heparin alone with no tissue loss. In addition to systemic support and intravenous antibiotics, the mainstay of treatment is one of immediate heparinization and a continuous heparin drip. Heparin prevents subsequent small vessel thrombosis and limits tissue loss due to ongoing purpura. Conservative management of the purpuric lesions is the treatment of choice until final demarcation occurs. |
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Authors:
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J R Cohen; R Lackner; A Keller; B Douglas |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Annals of vascular surgery Volume: 4 ISSN: 0890-5096 ISO Abbreviation: Ann Vasc Surg Publication Date: 1990 May |
Date Detail:
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Created Date: 1990-06-27 Completed Date: 1990-06-27 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8703941 Medline TA: Ann Vasc Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 276-9 Citation Subset: IM |
Affiliation:
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Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York 11042. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anti-Bacterial Agents
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therapeutic use Blood Platelets / analysis Child, Preschool Disseminated Intravascular Coagulation / blood, drug therapy, etiology* Female Gangrene Heparin / therapeutic use Humans Infant Infection / complications* Leukocyte Count Male Purpura / complications*, etiology, pathology |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents; 9005-49-6/Heparin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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