An Elderly Man with a Swollen Knee,Significant Ecchymosis, and Minimal Knee Pain.

A 72-year-old man presents with left knee pain and swelling over several days. The pain and swelling started after he felt a "pop" when bending to pick up an object off the floor. His past medical history is significant for type 2 diabetes mellitus. Physical exam revealed significant ecchymosis on the anterolateral aspect of the thigh. There was a minimal amount pain upon knee flexion.

Prolonged Coagulopathy, Ecchymoses, and Microangiopathic Hemolytic Anemia Following Hump-Nosed Pit Viper (Hypnale hypnale) Bite in Sri Lanka.

A 74-year-old previously healthy woman was bitten by a hump-nosed pit viper (Hypnale hypnale) at dusk causing incoagulable blood lasting for 6 days. Further, she developed ecchymoses over her forearms, upper arms, hands, and lower back on day 4 after the snakebite, and microangiopathic hemolytic anemia (MAHA). Features of this nature are rare after hump-nosed pit viper bite.

Numerical analysis of the change in skin color due to ecchymosis and petechiae generated by cupping: a pilot study.

Cupping is one of the various treatment methods used in traditional oriental medicine. Cupping is also used as a diagnostic method and it may cause skin hyperpigmentation. Quantitative measurements and analysis of changes in skin color due to cupping are critical. The purpose of this study is to suggest an optical technique to visualize and identify changes in skin color due to cupping. We suggest the following analysis methods: digital color spaces [red, green, and blue (RGB) and L∗a∗b], the Erythema Index (E.I.), and the Melanin Index (M.I.). For experiments, we selected and stimulated 10 acupoints at 80 kilopascals (kPa) per minute. The RGB and L∗a∗b color spaces were observed to be decreased (p < 0.05) after cupping. The E.I. and M.I. were observed to be increased significantly (p < 0.05) after cupping. To assess various changes in skin color, we observed the changes for 72 hours. We also obtained the color changes by using the recovery pattern during the recovery period (p < 0.01). We propose that this method can be useful for visual identification and as a way to improve the identification of skin color changes.

The effectiveness of steroids for edema, ecchymosis, and intraoperative bleeding in rhinoplasty.

BACKGROUND: The aim of this study was to investigate the dose-related effectiveness of steroids on periorbital edema, ecchymosis, and intraoperative bleeding in patients who underwent open rhinoplasty with osteotomy. METHODS: Forty patients were divided into three groups: those in group 1 (n = 15) were given a single dose of 1-mg/kg intravenous (i.v.) methylprednisolone, those in group 2 (n = 15) were given a single dose of 3-mg/kg i.v. methylprednisolone preoperatively, and group 3 (n = 10) was the control group. Eyelid edema and periorbital soft-tissue ecchymosis were evaluated separately using a scale of 0-4. RESULTS: In groups using the steroid preoperatively, periorbital edema and ecchymosis were significantly lower compared with the control group (p < 0.05). No significant differences were seen clinically or statistically in preventing or reducing either the periorbital ecchymosis or the periorbital edema between groups 1 and 2. Also, there was no significant difference among the groups in terms of bleeding (p > 0.05). No complications with regard to the operation or steroid use were observed. CONCLUSION: Our results support that steroids significantly decrease periorbital ecchymosis and periorbital edema in open rhinoplasty with osteotomy. Additionally, our results suggest that if the dose of steroids is adjusted according to body weight, there is no significant benefit in a single dose of 3 mg/kg of methylprednisolone over a lower dose of 1 mg/kg and there is no need for higher doses of methylprednisolone administration.

Abdominal migraine associated with ecchymosis of the legs and buttocks: does the symptom imply an unknown mechanism of migraine?

Abdominal migraine is one subcategory of migraine-related syndromes. Migraine is sometimes associated with facial ecchymosis, which may be accounted for by trigeminovascular activation. However, the precise mechanism of this concurrence remains unknown. Here, we describe a 9-year-old girl, who presented ecchymosis of the legs and buttock associated with recurrent, severe, non-localized midline abdominal pain. The patient has positive family history of migraine. Investigations during an attack revealed no obvious abnormalities. According to the International Classification of Headache Disorders (Second Edition), she was diagnosed with abdominal migraine. Her abdominal pain was relieved with sumatriptan, a migraine-specific serotonin(1B/1D) agonist. The ecchymosis always occurred in conjunction with abdominal pain and tended to regress after pain relief. In contrast to the local trigeminovascular activation theory that explains the ecchymosis in a migraine-related condition, the findings gained from the presented patient suggest a mechanism that involves the initial activation of the visceral nerves responsible for abdominal nociception under the predisposition of visceral hypersensitivity associated with abdominal migraine. Subsequently, ecchymosis developed in the skin region innerved by the activated nerves, possibly involving dichotomizing afferent fibers and afferent-afferent interactions via sacral spinal cord pathway or a sympathetic reflex. Taken together with the probable common mechanism of migraine and abdominal migraine, we suggest that the skin changes in migraine are associated with somatic referral of migraine headache via the trigeminal nerve pathway.

Quebec platelet disorder: features, pathogenesis and treatment.

Quebec platelet disorder (QPD) is a rare, autosomal-dominant, inherited bleeding disorder that is associated with unique abnormalities in fibrinolysis. Its hallmark features are delayed-onset bleeding following hemostatic challenges that responds to fibrinolytic inhibitor therapy and increased expression and storage of the fibrinolytic enzyme urokinase plasminogen activator in platelets, without increased plasma urokinase plasminogen activator or systemic fibrinolysis. The increased urokinase plasminogen activator in QPD platelets is only partially inhibited, and, as a result, there is intraplatelet generation of plasmin, and secondary degradation of many platelet alpha-granule proteins. During clot formation, the urokinase plasminogen activator released by QPD platelets leads to platelet-dependent increased fibrinolysis, and this is postulated to be a major contributor to QPD bleeding. The focus of the present review is to summarize the current state of knowledge on QPD, including the history of this disorder, its clinical and laboratory features, and recommended approaches for its diagnosis and treatment.

A randomized, controlled comparison between arnica and steroids in the management of postrhinoplasty ecchymosis and edema.

BACKGROUND: Both arnica and corticosteroids have been suggested for reducing the postoperative edema and bruising associated with rhinoplasty. This study compared the efficacy of these products following rhinoplasty. METHODS: Forty-eight primary rhinoplasty patients were randomized into three groups: group P received 10 mg of dexamethasone (intravenously) intraoperatively followed by a 6-day oral tapering dose of methyl-prednisone; group A received arnica three times a day for 4 days; and group C received neither agent and served as the control. Three blinded panelists rated the extent of ecchymosis, the intensity of the ecchymosis, and the severity of the edema. RESULTS: On postoperative day 2, there were no significant differences in the ratings of extent and intensity of ecchymosis among the groups. There was a significant difference for the edema rating (p < 0.0001), with group C demonstrating more swelling compared with groups A and P. In addition, on postoperative day 8, group P demonstrated a significantly larger extent of ecchymosis (p < 0.05) and higher intensity of ecchymosis (p < 0.01) compared with groups A and C. There were no differences in the magnitude of edema by postoperative day 8 among the three groups. When the differences between day 2 and day 8 ratings were considered, groups A and C exhibited significantly more resolution of ecchymosis by day 8 compared with group P (p < 0.05). CONCLUSIONS: This study suggests that both arnica and corticosteroids may be effective in reducing edema during the early postoperative period. Arnica does not appear to provide any benefit with regard to extent and intensity of ecchymosis. The delay in resolution of ecchymosis for patients receiving corticosteroids may outweigh the benefit of reducing edema during the early postoperative period.

Trauma ocular en niños: experiencia en el Instituto Nacional de Pediatría / Ocular trauma in children: the experience in the Instituto Nacional de pediatria

Revisión retrospectiva de casos de trauma ocular pediátrico, determinando causas, características y asociaciones.Las caídas y el involucro de objetos metálicos fueron el origen más común, ocasionando equimosis palpebral, hifema y herida corneal, principalmente. Asociación con traumatismo craneoencefálico, abuso infantil y neoplasias preexistentes.

Hematoma de la vaina de los rectos: aportación de cuatro nuevos casos / Hematoma of the rectus sheath: four new cases

El hematoma de la vaina de los rectos es un proceso infrecuente que puede simular una enfermedad intraabdominal. El embarazo y las terapias anticoagulantes han sido señaladas como factores predisponentes y la tos como el principal factor precipitante. Se presentan cuatro casos de pacientes intervenidos quirúrgicamente por hematoma de la vaina de los rectos. Entre ellos, se describe una presentación excepcional de disección del espacio pélvico por el hematoma, ocasionando anuria por compresión vesical. Se discuten los factores etiopatogénicos, los métodos diagnósticos y las opciones terapéuticas (AU)

[Necrotizing fasciitis of the upper limb. Apropos of 4 cases]. / La fasciite nécrosante du membre supérieur. A propos de quatre cas.

This article is based on the retrospective study of 4 cases of necrotic fasciitis of the upper extremity, in adult patients with a mean age of 57 years (range: 36 to 78 years) and with a male predominance (3 M/1 F). Presenting signs were variable: pain, febrile and inflammatory oedema, ecchymoses with inflammatory masses containing clear or haemorrhagic fluid. Treatment with antibiotics and anti-inflammatory drugs did not prevent progression to painless, necrotic ulcers. Rapid medical and surgical treatment constitutes an element essential of the prognosis and must include wide large debridement, antibiotics and intensive care.

Ophthalmic complications of endoscopic ethmoid surgery and their management.

PURPOSE: The proximity of the paranasal sinuses to the orbit puts the anterior visual pathways at risk during sinus surgery. Although the ophthalmic complications of sinus surgery are well known to the otolaryngologist, they are rarely encountered in clinical practice. Several recommendations will help the surgeon performing intranasal sinus surgery. MATERIALS AND METHODS: To study the incidence of orbital complications of intranasal ethmoid surgery, a retrospective review of 372 cases, most of them bilateral, was performed. RESULTS: Our series of 372 patients who underwent endoscopic sinus surgery showed five orbital complications. CONCLUSION: several recommendations may help the surgeon to avoid any ophthalmic complication. When orbital wall dehiscence is suspected, either by CT scan or at surgery, especially in a previously operated case, extreme care should be taken not to penetrate the periorbita. If orbital fat protrudes into the operative field, it should not be pulled or twisted in an attempt to remove it. The surgeon should seek the cooperation of the anesthesiologist working the case. A knowledge of the variable anatomy is essential to avoid iatrogenic injury. The surgeon should be aware of the different complications for early recognition and management.

Hemopatías: sus manifestaciones orales / Hemopathies: it's oral manifestations

La mucosa oral es frecuentemente asiento de lesiones vinculadas a enfermedades sistémicas, y dentro de éstas destacamos las discrasias sanguíneas. Se estudiaron en el Hospital de Clínicas José de San Martín, 15 pacientes con patologías de la mucosa oral cuyas enfermedades de base fueron leucemia, aplasia medular y linfoma. De estos, 10 presentaron manifestaciones hemorragíparas, 7 pacientes con lesiones ulceronecróticas y 2 casos de hipertrofia gingival por infiltración neoplásica

Hemopatías: sus manifestaciones orales / Hemopathies: its oral manifestations

La mucosa oral es frecuentemente asiento de lesiones vinculadas a enfermedades sistémicas, y dentro de éstas destacamos las discrasias sanguíneas. Se estudiaron en el Hospital de Clínicas José de San Martín, 15 pacientes con patologías de la mucosa oral cuyas enfermedades de base fueron leucemia, aplasia medular y linfoma. De estos, 10 presentaron manifestaciones hemorragíparas, 7 pacientes con lesiones ulceronecróticas y 2 casos de hipertrofia gingival por infiltración neoplásica

The blue scrotum sign of Bryant: a diagnostic clue to ruptured abdominal aortic aneurysm.

A 73-year-old man presented to the emergency department twice with nonspecific abdominal pain. He was diagnosed as having mild diverticulitis and was discharged. Four days later he presented to the emergency department in severe abdominal pain with scrotal and penile ecchymoses. After an initial urologic consultation the correct diagnosis of ruptured abdominal aortic aneurysm was made. We discuss the pathogenesis of the genital discoloration and make the correct historical attribution of this sign to John Henry Bryant, a turn-of-the-century physician at Guy's Hospital.