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1.
BMJ Case Rep ; 17(7)2024 Jul 08.
Article in English | MEDLINE | ID: mdl-38977316

ABSTRACT

This case report describes a man in his mid 40s, with a history of chronic smoking, who presented with dysphonia. He underwent microlaryngoscopy and biopsy for a suspicious lesion on the anterior right vocal cord. Mask ventilation proved difficult on induction of general anaesthesia due to a solid lesion acting as a ball valve into the glottis. This mass was LASER debulked and sent for histopathology. This demonstrated a haematoma, likely traumatic in origin, with some polypoidal features, consistent with advanced Reinke's oedema. Reinke's oedema is a benign condition where chronic inflammation causes fluid accumulation within the vocal cords. Long-standing inflammation leads to disarrangement of the vocal cord lamina propria, causing fluid accumulation and thereby resulting oedema of the vocal cords. This process can subsequently lead to polyp formation and can cause gravelly voice. This case report describes the potential airway sequelae of this benign condition.


Subject(s)
Dysphonia , Laryngoscopy , Vocal Cords , Humans , Male , Vocal Cords/pathology , Dysphonia/etiology , Laryngeal Edema/etiology , Laryngeal Edema/diagnosis , Edema/etiology , Adult , Laryngeal Diseases/surgery , Laryngeal Diseases/diagnosis , Hematoma/surgery
2.
J Coll Physicians Surg Pak ; 34(7): 771-774, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38978238

ABSTRACT

OBJECTIVE: To compare different types of genioplasty techniques (chin advancement, rotation and advancement, setback, and reduction) in terms of neurosensory deficit and haematoma formation. STUDY DESIGN: Comparative analytical study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from January 2022 to April 2023. METHODOLOGY: Patients requiring genioplasty and fulfilling the inclusion criteria i.e. both genders aged 16-60 years were included and divided into 4 groups according to the type of genioplasty performed. Genioplasty was planned as per the ortho treatment plan and performed under general anaesthesia. Setback genioplasty was performed on 8 patients, advancement genioplasty on 11 patients, reduction genioplasty on 3, and advancement with rotation genioplasty on 16 patients. Postoperatively neurosensory deficit was recorded on follow-up after 1 month by subjective and objective assessments, and haematoma formation was assessed clinically on the 7th day after the procedure. RESULTS: Advancement with rotation genioplasty showed the highest frequency of neurosensory deficit (almost 50%) and reduction type genioplasty showed the least frequency of neurosensory deficit (<1%, p = 0.49). The frequency of haematoma formation was maximum in the advancement with rotation genioplasty (62.5%) and minimum in equal setback genioplasty (25%, p = 0.61). CONCLUSION: Advancement with rotation genioplasty had the highest rate of postoperative neurosensory deficit and haematoma formation when compared with other techniques of genioplasty. KEY WORDS: Genioplasty, Neurosensory deficit, Haematoma, Advancement with rotation genioplasty, Setback genioplasty.


Subject(s)
Genioplasty , Hematoma , Humans , Male , Female , Adult , Hematoma/etiology , Adolescent , Young Adult , Genioplasty/methods , Middle Aged , Postoperative Complications/epidemiology , Pakistan/epidemiology , Treatment Outcome
3.
Med Sci Monit ; 30: e943937, 2024 Jul 09.
Article in English | MEDLINE | ID: mdl-38978275

ABSTRACT

BACKGROUND Spontaneous intracerebral hemorrhage has a high fatality rate within the initial month after onset. This study determined the safety and therapeutic efficacy of minimally invasive puncture for supra-tentorial intracranial hematoma under C-arm computed tomography (CT) 4-dimensional navigation. MATERIAL AND METHODS We retrospectively analyzed 64 patients with supra-tentorial cerebral hemorrhage from June 2020 to May 2023; 31 patients were assigned to the study group (C-arm CT navigation puncture) and 33 patients were in the control group (conventional CT-guided puncture). The analysis focused on assessment of puncture error, postoperative complication rate, and the Glasgow Outcome Scale (GOS) and National Institute of Health Stroke Scale (NIHSS) scores 30 and 90 days after surgery. RESULTS C-arm CT navigation puncture had improved precision, with significantly reduced transverse (3.17±1.75 mm) and longitudinal (1.83±1.21 mm) deviations, compared with the control group (7.88±1.74 mm and 5.50±1.84 mm, respectively; P<0.05). The overall postoperative complication rate was significantly lower in the study group than in the control group (12.90% vs 36.36%, P<0.05). The mean GOS score was higher in the study group than in the control group 30 and 90 days postoperatively (3.42±0.96 and 3.97±0.95 vs 2.94±0.79 and 3.46±0.90, respectively; P<0.05), while the mean NIHSS score was lower in the study group than in the control group 30 and 90 days postoperatively (10.58±6.52 and 5.97±4.55 vs 14.42±8.13 and 9.55±8.31, respectively; P<0.05). CONCLUSIONS Supra-tentorial intracranial hematoma puncture under C-arm CT 4-dimensional navigation is accurate, safe, and beneficial.


Subject(s)
Punctures , Tomography, X-Ray Computed , Humans , Male , Female , Tomography, X-Ray Computed/methods , Middle Aged , Retrospective Studies , Punctures/methods , Punctures/adverse effects , Aged , Hematoma , Cerebral Hemorrhage/diagnostic imaging , Postoperative Complications , Adult , Treatment Outcome
4.
Medicine (Baltimore) ; 103(28): e38930, 2024 Jul 12.
Article in English | MEDLINE | ID: mdl-38996111

ABSTRACT

RATIONALE: Intramuscular injections are routine outpatient procedure performed at healthcare institutions worldwide. In the current literature, there have been very few reports of gluteal superior artery injuries due to incorrect injection techniques. However, no one has ever reported a healthy middle-aged man with systemic inflammatory response syndrome with possible injection-related bleeding from the gluteus superior artery, followed by a hematoma, and then a deep abscess after 3 weeks of not receiving treatment. PATIENT CONCERNS: A 40-year-old man presented with pain in his buttock, a fever of 40°, and a lump after a dorso-gluteal injection. (November, 2022) The patient was diagnosed with systemic inflammatory response syndrome due to a deep abscess related to a hematoma caused by a possible superior gluteal artery branch injury. DIAGNOSES: He was admitted to our institution with a lump, pain in his buttock, and a fever of 40° after a dorso-gluteal injection. The patient had diffuse swelling and tenderness in the upper-posterior aspect of the gluteal region. Systemic examination revealed yellow sclera and icteric skin appearance. Blood tests showed low hemoglobin levels and increased pre-sepsis parameters (procalcitonin and indirect bilirubin). Pelvic MRI and ultrasonography revealed a gluteal abscess. INTERVENTIONS: The patient was transferred to the operating theater, where a curved incision was made behind the trochanter. The gluteus maximus was bluntly dissected, and abscess fluid was drained from the muscle. Continuous bleeding was detected, suggesting iatrogenic superior gluteal artery branch injury at the time of the injection. OUTCOME: After drainage and antibiotic treatment, the patient's parameters normalized within 5 days, and the patient was discharged. The patient's weekly follow-up examinations were normal, and he was able to walk without a limp. A postoperative visit to the outpatient clinic 2 months after the operation and a telephone call 17 months later showed that the patient was completely healthy and able to work. LESSONS: The dorso-gluteal technique has potential risks, including possible injury to the sciatic nerve and superior gluteal artery and irritation of the subcutaneous adipose tissue. This article aims to highlight the potential risks of a particular technique and advocate the use of the ventrogluteal technique instead of the traditional dorso-gluteal technique.


Subject(s)
Abscess , Hematoma , Systemic Inflammatory Response Syndrome , Humans , Male , Adult , Buttocks , Hematoma/etiology , Systemic Inflammatory Response Syndrome/etiology , Abscess/etiology , Injections, Intramuscular/adverse effects
5.
Sci Rep ; 14(1): 16465, 2024 Jul 16.
Article in English | MEDLINE | ID: mdl-39013990

ABSTRACT

Hematoma expansion occasionally occurs in patients with intracerebral hemorrhage (ICH), associating with poor outcome. Multimodal neural networks incorporating convolutional neural network (CNN) analysis of images and neural network analysis of tabular data are known to show promising results in prediction and classification tasks. We aimed to develop a reliable multimodal neural network model that comprehensively analyzes CT images and clinical variables to predict hematoma expansion. We retrospectively enrolled ICH patients at four hospitals between 2017 and 2021, assigning patients from three hospitals to the training and validation dataset and patients from one hospital to the test dataset. Admission CT images and clinical variables were collected. CT findings were evaluated by experts. Three types of models were developed and trained: (1) a CNN model analyzing CT images, (2) a multimodal CNN model analyzing CT images and clinical variables, and (3) a non-CNN model analyzing CT findings and clinical variables with machine learning. The models were evaluated on the test dataset, focusing first on sensitivity and second on area under the receiver operating curve (AUC). Two hundred seventy-three patients (median age, 71 years [59-79]; 159 men) in the training and validation dataset and 106 patients (median age, 70 years [62-82]; 63 men) in the test dataset were included. Sensitivity and AUC of a CNN model were 1.000 (95% confidence interval [CI] 0.768-1.000) and 0.755 (95% CI 0.704-0.807); those of a multimodal CNN model were 1.000 (95% CI 0.768-1.000) and 0.799 (95% CI 0.749-0.849); and those of a non-CNN model were 0.857 (95% CI 0.572-0.982) and 0.733 (95% CI 0.625-0.840). We developed a multimodal neural network model incorporating CNN analysis of CT images and neural network analysis of clinical variables to predict hematoma expansion in ICH. The model was externally validated and showed the best performance of all the models.


Subject(s)
Cerebral Hemorrhage , Hematoma , Neural Networks, Computer , Tomography, X-Ray Computed , Humans , Cerebral Hemorrhage/diagnostic imaging , Cerebral Hemorrhage/pathology , Male , Aged , Female , Hematoma/diagnostic imaging , Middle Aged , Tomography, X-Ray Computed/methods , Retrospective Studies , Aged, 80 and over , Machine Learning , ROC Curve
6.
BMC Neurol ; 24(1): 231, 2024 Jul 03.
Article in English | MEDLINE | ID: mdl-38961337

ABSTRACT

BACKGROUND: Trans-radial (TRA) access has become increasingly prevalent in neurointervention. Nonetheless, mediastinal hematoma after TRA is an infrequent yet grave complication associated with a notably elevated mortality rate. While our review found no reported mediastinal hematoma cases managed conservatively within neuro-interventional literature, similar complications are documented in cardiac and vascular interventional radiology, indicating its potential occurrence across disciplines. CASE PRESENTATION: Carotid computed tomography angiography (CTA) showed calcified plaques with stenosis (Left: Severe, Right: Moderate) in the bilateral internal carotid arteries (ICAs) of an 81-year-old male presented with paroxysmal weakness in the right upper limb. Dual antiplatelet therapy with aspirin and clopidogrel was administered. On day 7, DSA of the bilateral ICAs was performed via TRA. Post-DSA, the patient experienced transient loss of consciousness, chest tightness, and other symptoms without ECG or MRI abnormalities. Hemoglobin level decreased from 110 g/L to 92 g/L. Iodinated contrast-induced laryngeal edema was suspected, and the patient was treated with intravenous methylprednisolone. Neck CT indicated a possible mediastinal hemorrhage, which chest CTA confirmed. The patient's treatment plan involved discontinuing antiplatelet medication as a precautionary measure against the potential occurrence of an ischemic stroke instead of the utilization of a covered stent graft and surgical intervention. Serial CTs revealed hematoma absorption. Discharge CT showed a reduced hematoma volume of 35 × 45 mm. CONCLUSIONS: This case underscores the need for timely identification and precise manipulation of guidewires and guide-catheters through trans-radial access. The critical components of successful neuro-interventional techniques include timely examination, rapid identification, proper therapy, and diligent monitoring.


Subject(s)
Hematoma , Humans , Male , Aged, 80 and over , Hematoma/diagnostic imaging , Hematoma/etiology , Cerebral Angiography/adverse effects , Cerebral Angiography/methods , Mediastinal Diseases/diagnostic imaging , Mediastinal Diseases/etiology , Radial Artery/diagnostic imaging , Platelet Aggregation Inhibitors/adverse effects , Platelet Aggregation Inhibitors/therapeutic use , Carotid Stenosis/diagnostic imaging
7.
Adv Tech Stand Neurosurg ; 52: 119-128, 2024.
Article in English | MEDLINE | ID: mdl-39017790

ABSTRACT

Cerebral hemorrhage is a frequent disease and one of the main causes of disabilities. Even in the case of cerebral hemorrhage, if there were a treatment that would improve the functional prognosis, the benefits would be immeasurable. Although there are limited reports with a high level of evidence in past studies, it has been found that surgery can be effective if a large amount of hematoma can be removed in a minimally invasive manner. Also, it has become clear that the control of bleeding becomes a problem when surgery is performed within 2 days after the onset of stroke and that the therapeutic time window might be longer. In Japan, since the introduction of the transparent sheath by Nishihara et al., endoscopic hematoma removal has been widely performed and has become the standard surgical procedure. The three basic equipment needed for this surgery are a rigid scope, a suction coagulator, and a transparent sheath. The key point of the surgery is to search for hematomas and bleeding points through a transparent sheath and coagulate the bleeding vessels. In this chapter, we will introduce surgical techniques using these devices, but it is important to carefully decide on surgical options by considering your own technique, the condition of each patient, and the devices available in the area.


Subject(s)
Neuroendoscopy , Humans , Neuroendoscopy/methods , Hematoma/surgery , Cerebral Hemorrhage/surgery , Cerebral Hemorrhage/diagnostic imaging , Cerebral Hemorrhage/etiology
8.
Diving Hyperb Med ; 54(2): 133-136, 2024 Jun 30.
Article in English | MEDLINE | ID: mdl-38870956

ABSTRACT

Hyperbaric oxygen treatment (HBOT) can be utilised for necrotising soft tissue infections, clostridial myonecrosis (gas gangrene), crush injuries, acute traumatic ischaemia, delayed wound healing, and compromised skin grafts. Our case was a 17-month-old male patient with Noonan syndrome, idiopathic thrombocytopenic purpura, and bilateral undescended testicles. Haematoma and oedema developed in the scrotum and penis the day after bilateral orchiopexy and circumcision. Ischaemic appearances were observed on the penile and scrotal skin on the second postoperative day. Enoxaparin sodium and fresh frozen plasma were started on the recommendation of haematology. Hyperbaric oxygen treatment was initiated considering the possibility of tissue necrosis. We observed rapid healing within five days. We present this case to emphasise that HBOT may be considered as an additional treatment option in patients with similar conditions. To our knowledge, no similar cases have been reported in the literature.


Subject(s)
Circumcision, Male , Hematoma , Hyperbaric Oxygenation , Noonan Syndrome , Orchiopexy , Humans , Male , Hyperbaric Oxygenation/methods , Hematoma/etiology , Hematoma/therapy , Circumcision, Male/adverse effects , Noonan Syndrome/complications , Noonan Syndrome/therapy , Infant , Orchiopexy/methods , Cryptorchidism/complications , Cryptorchidism/surgery , Cryptorchidism/therapy , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/therapy , Scrotum/injuries , Penile Diseases/etiology , Penile Diseases/therapy , Postoperative Complications/therapy , Postoperative Complications/etiology , Enoxaparin/therapeutic use , Enoxaparin/administration & dosage , Plasma , Edema/etiology , Edema/therapy
9.
BMJ Case Rep ; 17(6)2024 Jun 13.
Article in English | MEDLINE | ID: mdl-38871642

ABSTRACT

Neonatal adrenal haemorrhage (NAH) is more frequently described in neonates due to their relatively larger size and increased vascularity. While most are asymptomatic, they can present with anaemia, jaundice, abdominal mass, scrotal haematoma or more severe complications such as shock and adrenal insufficiency. Scrotal haematoma seen with NAH may be mistaken for other more serious conditions causing acute scrotum. Prompt sonographic examination that includes the bilateral adrenal glands may help to detect NAH early and to avoid unnecessary interventions. Cases of NAH causing ipsilateral inguinal ecchymosis and scrotal haematoma have been reported, but contralateral haematomas are very rare. In this report, we present a unique case of a neonate with an antenatally acquired adrenal haematoma complicated with an acute peripartum rebleeding manifesting as a contralateral scrotal haematoma and inguinal ecchymosis. The NAH was treated conservatively and resolved on follow-up imaging.


Subject(s)
Adrenal Gland Diseases , Ecchymosis , Hematoma , Hemorrhage , Scrotum , Humans , Ecchymosis/etiology , Scrotum/diagnostic imaging , Hematoma/complications , Hematoma/diagnostic imaging , Hematoma/diagnosis , Hematoma/etiology , Male , Infant, Newborn , Adrenal Gland Diseases/complications , Adrenal Gland Diseases/diagnosis , Adrenal Gland Diseases/diagnostic imaging , Hemorrhage/etiology , Hemorrhage/diagnosis , Hemorrhage/diagnostic imaging , Female , Ultrasonography , Genital Diseases, Male/complications , Genital Diseases, Male/diagnostic imaging , Genital Diseases, Male/etiology , Genital Diseases, Male/diagnosis , Pregnancy
10.
J Med Case Rep ; 18(1): 280, 2024 Jun 16.
Article in English | MEDLINE | ID: mdl-38879573

ABSTRACT

BACKGROUND: Intercostal artery bleeding often occurs in a single vessel; in rare cases, it can occur in numerous vessels, making it more difficult to manage. CASE PRESENTATION: A 63-year-old Japanese man was admitted to the emergency department owing to sudden chest and back pain, dizziness, and nausea. Emergency coronary angiography revealed myocardial infarction secondary to right coronary artery occlusion. After intra-aortic balloon pumping, percutaneous coronary intervention was performed in the right coronary artery. At 12 hours following percutaneous coronary intervention, the patient developed new-onset left anterior chest pain and hypotension. Contrast-enhanced computed tomography revealed 15 sites of contrast extravasation within a massive left extrapleural hematoma. Emergency angiography revealed contrast leakage in the left 6th to 11th intercostal arteries; hence, transcatheter arterial embolization was performed. At 2 days after transcatheter arterial embolization, his blood pressure subsequently decreased, and contrast-enhanced computed tomography revealed the re-enlargement of extrapleural hematoma with multiple sites of contrast extravasation. Emergency surgery was performed owing to persistent bleeding. No active arterial hemorrhage was observed intraoperatively. Bleeding was observed in various areas of the chest wall, and an oxidized cellulose membrane was applied following ablation and hemostasis. The postoperative course was uneventful. CONCLUSION: We report a case of spontaneous intercostal artery bleeding occurring simultaneously in numerous vessels during antithrombotic therapy with mechanical circulatory support that was difficult to manage. As bleeding from numerous vessels may occur during antithrombotic therapy, even without trauma, appropriate treatments, such as transcatheter arterial embolization and surgery, should be selected in patients with such cases.


Subject(s)
Embolization, Therapeutic , Humans , Male , Middle Aged , Embolization, Therapeutic/methods , Hemorrhage/therapy , Hemorrhage/chemically induced , Percutaneous Coronary Intervention , Hematoma/therapy , Intra-Aortic Balloon Pumping , Coronary Angiography , Tomography, X-Ray Computed , Fibrinolytic Agents/therapeutic use , Myocardial Infarction/therapy , Myocardial Infarction/complications , Coronary Occlusion/therapy , Coronary Occlusion/complications
11.
J Vasc Surg ; 79(3): 514-525, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38941265

ABSTRACT

OBJECTIVE: The outcomes of the best medical treatment (BMT) and intervention treatment (INT) in a single-center experience were reported in type B intramural hematoma (IMH). METHODS: From February 2015 to February 2021, a total of 195 consecutive patients with type B IMH were enrolled in the study. The primary end point was mortality, and the secondary end points included clinical and imaging outcomes. The clinical outcomes were aortic-related death, retrograde type A aortic dissection, stent graft-induced new entry tear, endoleak, and reintervention. The imaging outcome was evaluated through the latest follow-up computed tomography angiography, which included aortic rupture, aortic dissection, aortic aneurysm, rapid growth of aortic diameter, newly developed or enlarged penetrating aortic ulcer or ulcer-like projection (ULP) and increased aortic wall thickness. Kaplan-Meier curves were used to assess the association between different treatments. RESULTS: Among the enrolled patients, 115 received BMT, and 80 received INT. There was no significant difference in early (1.7% vs 2.5%; P = 1.00) and midterm all-cause death (8.3% vs 5.2%; P = .42) between the BMT and INT groups. However, patients who underwent INT were at risk of procedure-related complications such as stent graft-induced new entry tear and endoleaks. The INT group was associated with a profound decrease in the risk of ULP, including newly developed ULP (4.3% vs 26.9%; P < .05), ULP enlargement (6.4% vs 31.3%; P < .05), and a lower proportion of high-risk ULP (10.9% vs 45.6%; P < .05). Although there was no significant difference in the incidence of IMH regression between the two groups, the maximum diameter of the descending aorta in patients receiving INT was larger compared with those treated with BMT. CONCLUSIONS: Based on our limited experience, patients with type B IMH treated with BMT or INT shared similar midterm clinical outcome. Patients who underwent INT may have a decreased risk of ULPs, but a higher risk of procedure-related events and patients on BMT should be closely monitored for ULP progression.


Subject(s)
Blood Vessel Prosthesis Implantation , Endovascular Procedures , Hematoma , Humans , Male , Female , Hematoma/diagnostic imaging , Hematoma/etiology , Hematoma/therapy , Aged , Middle Aged , Retrospective Studies , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/mortality , Treatment Outcome , Endovascular Procedures/adverse effects , Endovascular Procedures/mortality , Endovascular Procedures/instrumentation , Risk Factors , Time Factors , Stents , Computed Tomography Angiography , Aortic Diseases/diagnostic imaging , Aortic Diseases/mortality , Aortic Diseases/therapy , Aortic Dissection/diagnostic imaging , Aortic Dissection/mortality , Aortic Dissection/surgery , Aortic Dissection/therapy , Risk Assessment , Postoperative Complications/etiology , Blood Vessel Prosthesis , Aortic Intramural Hematoma
12.
BMC Musculoskelet Disord ; 25(1): 485, 2024 Jun 20.
Article in English | MEDLINE | ID: mdl-38902664

ABSTRACT

BACKGROUND: Arterial injury caused by heterotopic ossification (HO) following fractures is rarely reported, yet it can have catastrophic consequences. This case report presents a unique instance of femoral artery injury and hematoma organization, occurring a decade after intramedullary nail fixation for a femoral shaft fracture complicated by HO. CASE PRESENTATION: A 56-year-old male presented with right femoral artery injury and organized hematoma, a decade after suffering bilateral femoral shaft fractures with mild head injury in a traffic accident. He had received intramedullary nailing for the right femoral shaft fracture and plate fixation for the left side in a local hospital. Physical examination revealed two firm, palpable masses with clear boundaries, limited mobility, and no tenderness. Peripheral arterial pulses were intact. Radiography demonstrated satisfactory fracture healing, while a continuous high-density shadow was evident along the inner and posterior aspect of the right thigh. Computed tomography angiography identified a large mixed-density mass (16.8 × 14.8 × 20.7 cm) on the right thigh's medial side, featuring central calcification and multiple internal calcifications. The right deep femoral artery coursed within this mass, with a smaller lesion noted on the posterior thigh. Surgical consultation with a vascular surgeon led to planned intervention. The smaller mass was completely excised, but the larger one partially, as it encased the femoral artery. The inability to remove all HO was due to excessive bleeding. Postoperatively, the patient experienced no complications, and one-year follow-up revealed a favorable recovery with restoration of full right lower limb mobility. CONCLUSION: This case underscores the potential gravity of vascular injury associated with heterotopic ossification. Surgeons should remain vigilant regarding the risk of vascular injury during HO excision.


Subject(s)
Femoral Artery , Femoral Fractures , Ossification, Heterotopic , Humans , Ossification, Heterotopic/surgery , Ossification, Heterotopic/etiology , Ossification, Heterotopic/diagnostic imaging , Ossification, Heterotopic/complications , Male , Femoral Artery/surgery , Femoral Artery/injuries , Femoral Artery/diagnostic imaging , Middle Aged , Femoral Fractures/surgery , Femoral Fractures/etiology , Femoral Fractures/diagnostic imaging , Femoral Fractures/complications , Fracture Fixation, Intramedullary , Vascular System Injuries/etiology , Vascular System Injuries/surgery , Vascular System Injuries/diagnostic imaging , Hematoma/etiology , Hematoma/surgery , Hematoma/diagnostic imaging , Computed Tomography Angiography
13.
Breast Dis ; 43(1): 187-191, 2024.
Article in English | MEDLINE | ID: mdl-38875024

ABSTRACT

An 85-year-old Chinese lady presented with a 5-day history of a painless left breast lump. There was no fever, nipple discharge, or history of trauma. She had a past medical history of atrial fibrillation that was managed with an oral anticoagulant. Mammography demonstrated a dense mass in the upper outer quadrant of the left breast. Ultrasound showed an irregular, heterogeneous 4.7 cm lesion containing debris and cystic spaces with raised peripheral vascularity at the 2 o'clock position, 3 cm from nipple. No internal vascularity was detected. This was managed as a haematoma and rivaroxaban was withheld. Follow-up imaging 3-weeks later showed persistence of the lesion. Bedside needle aspiration yielded haemoserous fluid with immediate reduction in size of the lesion. However, 2 weeks after aspiration, there was recurrence of the 'haematoma'. Multidisciplinary review of the clinical history, examination and imaging was sought, and biopsy of the irregularly thickened areas with vascularity along the periphery of the lesion was recommended. Vacuum-assisted biopsy was performed, and histology returned as metaplastic carcinoma. A recurring 'haematoma' should always prompt a search for a secondary cause, with features such as irregular thickened walls and papillary/nodular components requiring further evaluation with biopsy for histopathological correlation.


Subject(s)
Breast Neoplasms , Hematoma , Humans , Female , Hematoma/diagnostic imaging , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Aged, 80 and over , Diagnosis, Differential , Mammography , Metaplasia , Recurrence
14.
J Cardiothorac Surg ; 19(1): 339, 2024 Jun 21.
Article in English | MEDLINE | ID: mdl-38902781

ABSTRACT

BACKGROUND: Acute Stanford type- A aortic dissections make up a large part of emergency cardiac surgery. They also carry a significant burden of morbidity. New techniques to aid aortic remodelling include the Ascyrus Medical Dissection Stent (AMDS): Its increasing use, looks to present a potential problem in cases where surgery involving the aortic arch may be required. CASE REPORT: We present the case of a 49-year-old male who underwent urgent redo-surgery for total arch replacement and de-branching following recent replacement of the ascending aorta for acute type-A dissection, where an AMDS stent was deployed. The patient underwent total arch replacement with a stented tri-furcate prosthesis and de-branching of arch vessels with the stent landed inside the previous AMDS, to good effect. CONCLUSION: This case highlights a possible approach to aortic arch surgery in patients who have previous had AMDS insertion.


Subject(s)
Aorta, Thoracic , Aortic Aneurysm, Thoracic , Aortic Dissection , Hematoma , Stents , Humans , Male , Middle Aged , Aortic Dissection/surgery , Aorta, Thoracic/surgery , Hematoma/surgery , Hematoma/etiology , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/methods , Reoperation , Blood Vessel Prosthesis
15.
BMC Med Inform Decis Mak ; 24(1): 172, 2024 Jun 19.
Article in English | MEDLINE | ID: mdl-38898499

ABSTRACT

Hematoma expansion (HE) is a high risky symptom with high rate of occurrence for patients who have undergone spontaneous intracerebral hemorrhage (ICH) after a major accident or illness. Correct prediction of the occurrence of HE in advance is critical to help the doctors to determine the next step medical treatment. Most existing studies focus only on the occurrence of HE within 6 h after the occurrence of ICH, while in reality a considerable number of patients have HE after the first 6 h but within 24 h. In this study, based on the medical doctors recommendation, we focus on prediction of the occurrence of HE within 24 h, as well as the occurrence of HE every 6 h within 24 h. Based on the demographics and computer tomography (CT) image extraction information, we used the XGBoost method to predict the occurrence of HE within 24 h. In this study, to solve the issue of highly imbalanced data set, which is a frequent case in medical data analysis, we used the SMOTE algorithm for data augmentation. To evaluate our method, we used a data set consisting of 582 patients records, and compared the results of proposed method as well as few machine learning methods. Our experiments show that XGBoost achieved the best prediction performance on the balanced dataset processed by the SMOTE algorithm with an accuracy of 0.82 and F1-score of 0.82. Moreover, our proposed method predicts the occurrence of HE within 6, 12, 18 and 24 h at the accuracy of 0.89, 0.82, 0.87 and 0.94, indicating that the HE occurrence within 24 h can be predicted accurately by the proposed method.


Subject(s)
Algorithms , Cerebral Hemorrhage , Hematoma , Humans , Cerebral Hemorrhage/diagnostic imaging , Hematoma/diagnostic imaging , Tomography, X-Ray Computed , Male , Machine Learning , Aged , Middle Aged , Female
17.
Ned Tijdschr Tandheelkd ; 131(6): 257-261, 2024 Jun.
Article in Dutch | MEDLINE | ID: mdl-38860655

ABSTRACT

A 28-year-old patient with severe haemophilia A presented to the emergency department with significant and painful swelling of the left cheek, an extensive haematoma extending from the left ear to the anterior thoracic region, an intraoral haematoma over the soft palate with deviation of the uvula to the right, and complaints of shortness of breath when lying down. Three days prior, his dentist had performed a restoration of the 36 molar under local anaesthesia. Due to pain, the general practitioner had administered an intramuscular injection of a non-steroidal anti-inflammatory drug (NSAID) two days post-procedure. The patient was admitted for treatment with coagulation factors and pain management. Dental procedures and local anaesthesia in patients with a severe coagulation disorder require specific preparatory measures, such as administration of coagulation factors. Collaboration and consultation with a patient's haematologist or haemophilia treatment centre are essential requirements for safe dental care.


Subject(s)
Hemophilia A , Humans , Hemophilia A/complications , Hemophilia A/drug therapy , Male , Adult , Hematoma/etiology , Dental Care for Chronically Ill
18.
PeerJ ; 12: e17556, 2024.
Article in English | MEDLINE | ID: mdl-38860211

ABSTRACT

Hematoma expansion (HE) is an important risk factor for death or poor prognosis in patients with hypertensive intracerebral hemorrhage (HICH). Accurately predicting the risk of HE in patients with HICH is of great clinical significance for timely intervention and improving patient prognosis. Many imaging signs reported in literatures showed the important clinical value for predicting HE. In recent years, the development of radiomics and artificial intelligence has provided new methods for HE prediction with high accuracy. Therefore, this article reviews the latest research progress in CT imaging, radiomics, and artificial intelligence of HE, in order to help identify high-risk patients for HE in clinical practice.


Subject(s)
Intracranial Hemorrhage, Hypertensive , Tomography, X-Ray Computed , Humans , Intracranial Hemorrhage, Hypertensive/diagnostic imaging , Tomography, X-Ray Computed/methods , Artificial Intelligence , Prognosis , Hematoma/diagnostic imaging , Hematoma/pathology
19.
A A Pract ; 18(6): e01803, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38864537

ABSTRACT

The ultrasound-guided erector spinae plane (ESP) block is an emerging fascial plane block, first described in 2016 for treating thoracic neuropathic pain. Since its introduction, it has been incorporated into multiple surgical procedures and has demonstrated proven benefits such as postoperative analgesia and reduction in opioid consumption. Being a superficial plane block, it avoids complications such as pneumothorax and hematoma, making it a safe mode of analgesia. We report a rare case of hematoma formation following ESP block in a patient who underwent mitral valve repair under cardiopulmonary bypass.


Subject(s)
Hematoma , Nerve Block , Humans , Nerve Block/adverse effects , Hematoma/etiology , Male , Ultrasonography, Interventional , Paraspinal Muscles/innervation , Pain, Postoperative/drug therapy , Middle Aged , Cardiopulmonary Bypass , Mitral Valve/surgery
20.
Eur J Radiol ; 176: 111533, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38833770

ABSTRACT

PURPOSE: To develop and validate an end-to-end model for automatically predicting hematoma expansion (HE) after spontaneous intracerebral hemorrhage (sICH) using a novel deep learning framework. METHODS: This multicenter retrospective study collected cranial noncontrast computed tomography (NCCT) images of 490 patients with sICH at admission for model training (n = 236), internal testing (n = 60), and external testing (n = 194). A HE-Mind model was designed to predict HE, which consists of a densely connected U-net for segmentation process, a multi-instance learning strategy for resolving label ambiguity and a Siamese network for classification process. Two radiomics models based on support vector machine or logistic regression and two deep learning models based on residual network or Swin transformer were developed for performance comparison. Reader experiments including physician diagnosis mode and artificial intelligence mode were conducted for efficiency comparison. RESULTS: The HE-Mind model showed better performance compared to the comparative models in predicting HE, with areas under the curve of 0.849 and 0.809 in the internal and external test sets respectively. With the assistance of the HE-Mind model, the predictive accuracy and work efficiency of the emergency physician, junior radiologist, and senior radiologist were significantly improved, with accuracies of 0.768, 0.789, and 0.809 respectively, and reporting times of 7.26 s, 5.08 s, and 3.99 s respectively. CONCLUSIONS: The HE-Mind model could rapidly and automatically process the NCCT data and predict HE after sICH within three seconds, indicating its potential to assist physicians in the clinical diagnosis workflow of HE.


Subject(s)
Cerebral Hemorrhage , Hematoma , Tomography, X-Ray Computed , Humans , Cerebral Hemorrhage/diagnostic imaging , Cerebral Hemorrhage/complications , Male , Tomography, X-Ray Computed/methods , Retrospective Studies , Hematoma/diagnostic imaging , Female , Middle Aged , Aged , Deep Learning , Support Vector Machine , Disease Progression , Predictive Value of Tests
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