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1.
Medicine (Baltimore) ; 99(4): e18721, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977862

RESUMO

To evaluate the incidence of ecchymosis combined with postinflammatory hyperpigmentation (ECPH) over the course of 10 sessions of acupuncture therapy and to examine associated factors.An observational study was conducted from March 7, 2017 through March 6, 2018. This study included a total of 167 subjects and 326 bodily locations where acupuncture needles had been inserted. A 1-page questionnaire that included 14 items was used to collect patient data. The information collected was used to determine the incidence of ECPH. Chi-square tests were used to observe the associations between ECPH and demographic characteristics, dermatologic features, acupuncture-related factors, and other associated factors. Cox proportional hazards regression models were applied to calculate hazard ratios for ECPH among subjects treated with various frequencies of acupuncture and needles that differed in diameter.Although 186 subjects were initially enrolled, the study ultimately included 167 subjects and 326 bodily locations at which acupuncture needles were inserted. Over 10 sessions of acupuncture, ECPH was observed in 117 (70.06%, 117/167) subjects and 221 (67.79%, 221/326) bodily locations. Factors found to be associated with ECPH included: frequency of acupuncture, diameter of acupuncture needle, total number of acupuncture sessions, and bodily location at which acupuncture was administered (P < .05). Among subjects who received >2 acupuncture sessions per week, a higher frequency of acupuncture was associated with increased incidence of ECPH. Thicker acupuncture needle diameter was associated with a higher incidence of ECPH.The incidence of acupuncture-associated ECPH among the subjects included in the study was high. There were significant associations between ECPH and higher frequency of acupuncture as well as thicker diameter of acupuncture needles. Additional studies are required to confirm the findings.Trial registration number: AMCTR-OOC-17000109.


Assuntos
Terapia por Acupuntura/efeitos adversos , Equimose/etiologia , Hiperpigmentação/etiologia , Terapia por Acupuntura/métodos , Terapia por Acupuntura/estatística & dados numéricos , Adulto , Idoso , Equimose/epidemiologia , Feminino , Humanos , Hiperpigmentação/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Inquéritos e Questionários
2.
Clin Otolaryngol ; 44(6): 968-974, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31436019

RESUMO

OBJECTIVES: This study evaluated the efficacy of piezoelectric osteotomy in reducing oedema and ecchymosis during rhinoplasty via a systematic review with meta-analysis. DESIGN AND SETTING: Two authors independently searched the referenced databases. PubMed, Embase, SCOPUS, the Web of Science, the Cochrane library and Google Scholar databases were systematically searched from inception to January 2019. PARTICIPANTS: Sufficient data were retrieved for a meta-analysis of six trials with a total of 327 patients. MAIN OUTCOME MEASURES: They included studies that compared piezoelectric osteotomy (treatment groups) with conventional osteotomy (control group). The outcomes of interest were operative time, mucosal injury, oedema, ecchymosis and postoperative pain. Baseline study characteristics, quality of study, numbers of patients in the treatment and control groups and outcomes were extracted. RESULTS: Intraoperative mucosal injury was significantly lower in the treatment group vs the control group, but operative time was longer in the treatment group. Eyelid oedema and ecchymosis in the first seven days postoperatively were statistically decreased in the treatment group vs the control group. In addition, pain in the first three days postoperatively was statistically decreased in the treatment group vs the control group. However, in a subgroup analysis according to osteotomy visibility in the control group (blind osteotomy vs osteotomy under direct vision), there was no significant difference in oedema and ecchymosis between treatment and osteotomy under direct vision. CONCLUSIONS: Piezoelectric osteotomy during rhinoplasty can reduce eyelid oedema and eyelid ecchymosis compared to conventional osteotomy. However, piezoelectric osteotomy had no significant advantages in terms of postoperative oedema and ecchymosis compared to osteotomy under direct vision.


Assuntos
Equimose/prevenção & controle , Edema/prevenção & controle , Osteotomia/efeitos adversos , Piezocirurgia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Rinoplastia/efeitos adversos , Equimose/epidemiologia , Edema/epidemiologia , Humanos , Complicações Pós-Operatórias/epidemiologia
3.
J Cosmet Dermatol ; 18(3): 788-797, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29921041

RESUMO

BACKGROUND: Striae distensae are very common cutaneous disorders that produce great psychological stress for women. OBJECTIVE: measure and compare between efficacy and tolerability of three modalities for treatment of striae distensae. PATIENTS AND METHODS: Forty-five female patients with striae distensae were randomly selected from the outpatient dermatology clinics of Al-Zahra university Hospital within 6 months period. Patients divided into three groups according to the therapeutic modalities were used. Group A: treated with carboxytherapy using carbon dioxide (CO2) injection, Group B: where patients were treated with intradermal injection of autologous platelet-rich plasma (PRP), and Group C: where we used tripolar radiofrequency (RF) for treatment. RESULTS: All treated groups showed overall clinical improvement as regards the width, texture, and overall improvement after treatment (P > .05), with no statistically significant differences between the three groups. Patient's satisfaction was statistically significantly better in both group C (93.33%) and group A (80%) while group B (53.33%) was less with minimal side effects such as pain and ecchymosis, which were more frequent in group B than the other two groups; but with no statistically significance differences both groups A and C were effective with no significant differences in both types of striae and in any site of the body but group B is significantly more effective on striae rubra on trunk, with better improvement of lesions texture. CONCLUSION: The three modalities of treatments proved to be effective clinically and histopathologically in treating both types of striae, which were well tolerated by the patients with minimal, transient side effects and our study results gave us guidelines for their clinical application.


Assuntos
Dióxido de Carbono/administração & dosagem , Técnicas Cosméticas/efeitos adversos , Plasma Rico em Plaquetas , Terapia por Radiofrequência , Estrias de Distensão/terapia , Adulto , Dióxido de Carbono/efeitos adversos , Equimose/epidemiologia , Equimose/etiologia , Feminino , Humanos , Injeções Intradérmicas/efeitos adversos , Dor/epidemiologia , Dor/etiologia , Satisfação do Paciente , Ondas de Rádio/efeitos adversos , Resultado do Tratamento , Adulto Jovem
4.
J Cosmet Dermatol ; 18(1): 204-211, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29577562

RESUMO

BACKGROUND: Dermatologic complications are common in patients with end-stage renal disease and also have a high diversity. OBJECTIVES: This meta-analysis reviews prevalence of dermatological manifestations among hemodialysis patients in Iran. MATERIALS AND METHODS: Using PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS as the main international electronic data sources, and Iran-Medex, Irandoc, and Scientific Information Database, as the main domestic databases with systematic search capability, we systematically searched surveys, papers, and reports on the prevalence of dermatological manifestations (until February 2016). Heterogeneity of reported prevalence's between studies was assessed using the Q test; overall prevalence of dermatological manifestations was estimated using random-effect meta-analysis model. RESULTS: We found 1229 records; from them, a total of eight studies comprising 917 hemodialysis patients were included. In all of studies, skin discoloration, pruritus and xerosis have the highest prevalence. According to random-effect meta-analysis model, the pooled prevalence of skin discoloration, pruritus, ecchymosis, xerosis, and half-and-half nail in hemodialysis patients were 48.03% (95% CI: 45.09-51.01), 52.85% (95%CI: 49.23-56.47), 19.88 (95% CI: 17.57-22.19), 51.14% (95% CI: 48.25-54.02), and 18.50% (95% CI: 16.0-21.0), respectively. CONCLUSIONS: his study shows that the prevalence of dermatological manifestations seems high among the hemodialysis patients in Iran, and skin discoloration, pruritus, and xerosis are more common.


Assuntos
Falência Renal Crônica/terapia , Diálise Renal , Dermatopatias/epidemiologia , Equimose/epidemiologia , Humanos , Irã (Geográfico)/epidemiologia , Doenças da Unha/epidemiologia , Transtornos da Pigmentação/epidemiologia , Prevalência , Prurido/epidemiologia
5.
Skeletal Radiol ; 47(2): 215-221, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28983679

RESUMO

PURPOSE: To evaluate the safety of withholding preprocedure international normalized ratio (INR) and platelet testing in patients undergoing musculoskeletal (MSK) core needle biopsy (CNB). MATERIAL AND METHODS: Initially, a retrospective review of 1,162 consecutive patients undergoing MSK CNB with preprocedural INR and platelet testing was performed. Clinical (age, gender, bleeding disorder, liver disease, anticoagulation use, INR > 2, platelet count <50,000/ul) and biopsy factors (imaging modality, lesion type, biopsy needle gauge, number biopsy samples) were tested for association with bleeding complications. During the second phase, an additional 188 biopsies performed without preprocedural coagulation testing were studied. Categorical variables were compared using Chi-squared or Fisher's exact tests, continuous variables with a student t-test. Multivariate analysis was performed using logistic regression. RESULTS: In the first phase, there was a complication rate of 2.6%, 30/1162. Of the 11 clinical and biopsy factors, soft tissue lesions (p = 0.029) and lesions biopsied under ultrasound (p = 0.048) had a higher rate of bleeding than bone lesions or lesions biopsied under CT, respectively. Only three patients had an INR >2, 0.3% (3/1162) and only four patients had platelet count <50,000/ul, 0.3% (4/1162). No patient with a bleeding complication had an abnormal preprocedure bleeding test. In the second phase, there was a bleeding complication rate of 1.1% (2/188). CONCLUSION: Bleeding complications from MSK biopsy are low, even when preprocedure coagulation testing is omitted.


Assuntos
Biópsia com Agulha de Grande Calibre , Neoplasias Ósseas/diagnóstico por imagem , Equimose/epidemiologia , Hematoma/epidemiologia , Hemorragia/epidemiologia , Biópsia Guiada por Imagem , Neoplasias de Tecidos Moles/diagnóstico , Biópsia com Agulha de Grande Calibre/efeitos adversos , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Coeficiente Internacional Normatizado , Masculino , Contagem de Plaquetas , Radiografia Intervencionista , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Ultrassonografia de Intervenção
6.
Ear Nose Throat J ; 96(8): 318-326, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28846787

RESUMO

Our aim for this study was to evaluate and compare the clinical outcomes in patients who underwent lateral osteotomy with a Piezosurgery device or a conventional osteotome in open-technique rhinoplasty. This cohort trial involved 65 patients (36 women and 29 men; average age: 23.6 ± 5.71 yr) who underwent surgery between May 2015 and January 2016. Piezosurgery was used for lateral osteotomy in 32 patients, whereas 33 patients underwent conventional external osteotomy. These 2 groups were compared for duration of surgery, perioperative bleeding, postoperative edema, ecchymosis, pain, and patient satisfaction on the first and seventh postoperative days. The Piezosurgery group revealed significantly more favorable outcomes in terms of edema, ecchymosis, and hemorrhage on the first day postoperatively (p < 0.001 for all). Similarly, edema (p = 0.005) and ecchymosis (p < 0.001) on the seventh postoperative day also were better in the Piezosurgery group. Hemorrhage was similar in both groups on the seventh postoperative day (p = 0.67). The Piezosurgery group not only experienced less pain on the first postoperative day (p < 0.001), but these patients also were more satisfied with their results on both the first and seventh postoperative days. Results of the present study imply that Piezosurgery may be a promising, safe, and effective method for lateral osteotomy, a critical step in rhinoplasty. The time interval necessary for the learning curve is counteracted by the comfort and satisfaction of both patients and surgeons.


Assuntos
Osteotomia/instrumentação , Piezocirurgia/instrumentação , Complicações Pós-Operatórias/etiologia , Rinoplastia/instrumentação , Adolescente , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Equimose/epidemiologia , Equimose/etiologia , Edema/epidemiologia , Edema/etiologia , Feminino , Humanos , Masculino , Duração da Cirurgia , Osteotomia/efeitos adversos , Osteotomia/métodos , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Piezocirurgia/efeitos adversos , Piezocirurgia/métodos , Complicações Pós-Operatórias/epidemiologia , Rinoplastia/efeitos adversos , Rinoplastia/métodos , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
7.
J Wound Care ; 26(Sup2): S32-S36, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28182536

RESUMO

OBJECTIVE: The aim of the study was to determine the prevalence of skin tears in the extremities and explore factors in relation to skin tears in elderly residents at a Danish nursing home. METHOD: The study was designed as a point prevalence survey and conducted at a nursing home with 140 residents >65 years of age. The residents were assessed for presence, number and location of skin tears. Data were collected using a data collection sheet developed for this study. The survey team consisted of four expert nurses from a university hospital (two dermatology and two wound care nurses). Data were collected over a period of 10 hours spread over two days. RESULTS: Of the 128 participating residents six had skin tears, yielding a prevalence of 4.6 %. In total, 10 skin tears were observed in the 6 residents. The frequency of previous skin tears was 19.5 %. This frequency was significantly higher in residents with skin tears than in those without skin tears (83.3 % versus 16.4 %, p<0.001). Analysis of the relation between skin tears or previous skin tears versus without skin tears or previous skin tears showed significant differences related to the presence of ecchymosis (76.9 %versus 14.7 %, p<0.0001). There were no other significant factors observed. CONCLUSION: The low prevalence found in this study may reflect the focus on prevention of skin tears that the nursing home has maintained over the past year. Nevertheless, the appropriate prevention and management of residents with skin tears is an ongoing challenge for health professionals.


Assuntos
Equimose/epidemiologia , Lacerações/epidemiologia , Casas de Saúde , Pele/lesões , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco
8.
Clin Exp Rheumatol ; 35(3): 471-476, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28094753

RESUMO

OBJECTIVES: EULAR guidelines state that adverse effects (AEs) of glucocorticoid (GC) therapy should be considered and discussed with the patient before treatment is initiated. However, reliable quantitative data, especially on cutaneous AEs of low-to-medium dose GCs are lacking. We performed a study assessing the occurrence of cutaneous AEs of GCs and its association with current and cumulative GC doses in patients with rheumatoid arthritis (RA). METHODS: In a cross-sectional study performed in 2 outpatient rheumatology centres, 381 RA patients were enrolled. They were classed into 4 groups, according their mean daily dose during the past 12 months: 0 mg (n=87), <5mg (n=108), 5-7.5 mg (n=130), and >7.5 mg (n=56) of prednisone equivalent. AEs of GC on the skin were assessed by physical examination using a predefined scoring system, and by patients' self-assessments. Data were analysed according GC dose categories and cumulative doses. RESULTS: Cushingoid habitus, easy bruising, skin atrophy, and impaired wound healing as reported by patients occurred significantly more frequently in those using a GC the past 12 months, compared to those not using a GC. At physicians' assessments, only Cushingoid habitus and ecchymosis were more prevalent in GC users. The prevalence of these AEs was statistically significantly positively associated with current and cumulative GC dose. There was low occurrence of abnormal stretch marks, acne, perioral dermatitis, alopecia and hirsutism, which were not correlated with GC use. CONCLUSIONS: Certain GC-associated cutaneous AEs are common in RA, but other AEs of GC occur infrequently at the low-to-medium GC doses used in RA.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Glucocorticoides/efeitos adversos , Dermatopatias/induzido quimicamente , Pele/efeitos dos fármacos , Idoso , Artrite Reumatoide/diagnóstico , Atrofia , Contusões/induzido quimicamente , Contusões/epidemiologia , Estudos Transversais , Síndrome de Cushing/induzido quimicamente , Síndrome de Cushing/epidemiologia , Relação Dose-Resposta a Droga , Equimose/induzido quimicamente , Equimose/epidemiologia , Feminino , Alemanha/epidemiologia , Glucocorticoides/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Autoavaliação , Pele/patologia , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Cicatrização/efeitos dos fármacos
9.
Transfus Clin Biol ; 23(4): 233-239, 2016 Nov.
Artigo em Francês | MEDLINE | ID: mdl-27769684

RESUMO

OBJECTIVES: Delayed adverse reactions to blood donation occur after the donor left donation site. Their intrinsic gravity and possible complications can be increased by the fact the donor is alone. This can also increase bad memories, leading to a donation giving up. Blood transfusion centre is only aware in case of donor feedback, hence an event underrating. We choose to compare our data upon delayed adverse donor reactions with those we could find in past studies. METHODS: A first data level comes from French haemovigilance data while serious adverse reactions declaration is mandatory. But a second level can be reached using blood transfusion centre computerized data because all the donation reactions are saved whatever the gravity is. In both cases, delayed reactions are only those reported by donors. We try to make an exhaustive search of specific studies upon the real delayed reactions incidence so as to compare with our data. RESULTS: There were 1957 serious adverse reactions declared in our regional haemovigilance database between 2011 and 2015: 49 % occurring during donation, 40 % after it but before donor departure, and 11 % delayed events. There were 16,050 adverse reactions recorded during the first trimester of 2016 in mainland France, with 2.7 % delayed ones. Proportion of delayed events rises when gravity rises, until 27.6 % for the most serious ones. It varies between 2.2 % and 2.7 % for vasovagal reactions, haematomas, and other local reactions, and reaches 16.2 % for other general reactions. Data found in other studies with a spontaneous donor notification are of the same kind. But four studies soliciting specifically donor notification give a dramatically higher delayed reactions incidence, with an understatement greater than three out of four. Moreover, these studies found a majority of delayed reactions, which are not included in haemovigilance like fatigue or bruising. CONCLUSIONS: Occurrence of a delayed donor reaction is clearly underrated in standard haemovigilance. It remains to be seen whether it have the same impact on donor return as immediate reactions. Considering that delayed reactions are much larger, it might be interesting to take them into account in the evaluation of strategies dedicated to lower immediate reactions.


Assuntos
Doadores de Sangue , Hematoma/etiologia , Flebotomia/efeitos adversos , Síncope Vasovagal/etiologia , Doadores de Sangue/psicologia , Segurança do Sangue , Equimose/epidemiologia , Equimose/etiologia , Fadiga/epidemiologia , Fadiga/etiologia , França , Hematoma/epidemiologia , Humanos , Índice de Gravidade de Doença , Síncope Vasovagal/epidemiologia , Fatores de Tempo
10.
Hong Kong Med J ; 22(5): 435-44, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27516567

RESUMO

OBJECTIVES: To investigate the clinical predictors and the aetiologies for surgery in patients with Naja atra (Taiwan or Chinese cobra) envenomation. METHODS: This case series was conducted in the only tertiary care centre in eastern Taiwan. Patients who presented to the emergency department with Naja atra bite between January 2008 and September 2014 were included. Clinical information was collected and compared between surgical and non-surgical patients. RESULTS: A total of 28 patients with Naja atra envenomation presented to the emergency department during the study period. Of these, 60.7% (n=17) required surgery. Necrotising fasciitis (76.5%) was the main finding in surgery. Comparisons between surgical and non-surgical patients showed skin ecchymosis (odds ratio=34.36; 95% confidence interval, 2.20-536.08; P=0.012) and a high total dose of antivenin (≥6 vials; odds ratio=14.59; 95% confidence interval, 1.10-192.72; P=0.042) to be the most significant predictors of surgery. The rate of bacterial isolation from the surgical wound was 88.2%. Morganella morganii (76.5%), Enterococcus faecalis (58.8%), and Bacteroides fragilis (29.4%) were the most common pathogens involved. Bacterial susceptibility testing indicated that combined broad-spectrum antibiotics were needed to cover mixed aerobic and anaerobic bacterial infection. CONCLUSIONS: Patients with Naja atra envenomation who present with skin ecchymosis or the need for a high dose of antivenin may require early surgical assessment. Combined broad-spectrum antibiotics are mandatory.


Assuntos
Antivenenos/administração & dosagem , Venenos Elapídicos/toxicidade , Fasciite Necrosante/cirurgia , Mordeduras de Serpentes/cirurgia , Animais , Antibacterianos/administração & dosagem , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Equimose/epidemiologia , Equimose/etiologia , Equimose/cirurgia , Serviço Hospitalar de Emergência , Fasciite Necrosante/epidemiologia , Fasciite Necrosante/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Naja naja , Estudos Retrospectivos , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/terapia , Taiwan
11.
Cephalalgia ; 36(13): 1257-1267, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26611681

RESUMO

Background Head pain is a cardinal feature of primary headache disorders (PHDs) and is often accompanied by autonomic and vasomotor symptoms and/or signs. Spontaneous extracranial hemorrhagic phenomena (SEHP), including epistaxis, ecchymosis, and hematohidrosis (a disorder of bleeding through sweat glands), are poorly characterized features of PHDs. Aim To critically appraise the association between SEHP and PHDs by systematically reviewing and pooling all reports of SEHP associated with headaches. Methods Advanced searches using the PubMed/MEDLINE, Web of Science, Cochrane Library, Google Scholar, and ResearchGate databases were carried out for clinical studies by combining the terms "headache AND ecchymosis", "headache AND epistaxis", and "headache AND hematohidrosis" spanning all medical literature prior to October 10, 2015. Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines were applied. Results A total of 105 cases of SEHP associated with PHDs (83% migraine and 17% trigeminal autonomic cephalgias) were identified (median age 27 years, male to female ratio 1:2.3); 63% had epistaxis, 33% ecchymosis, and 4% hematohidrosis. Eighty-three percent of studies applied the International Classification of Headache Disorders diagnostic criteria. Eighty percent of the reported headaches were episodic and 20% were chronic. Twenty-four percent of studies reported recurrent episodes of SEHP. Conclusions Our results suggest that SEHP may be rare features of PHDs. Future studies would benefit from the systematic characterization of these phenomena.


Assuntos
Equimose/diagnóstico , Equimose/epidemiologia , Epistaxe/diagnóstico , Epistaxe/epidemiologia , Transtornos da Cefaleia Primários/diagnóstico , Transtornos da Cefaleia Primários/epidemiologia , Doenças das Glândulas Sudoríparas/epidemiologia , Adulto , Distribuição por Idade , Causalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Distribuição por Sexo , Doenças das Glândulas Sudoríparas/diagnóstico , Adulto Jovem
12.
Laryngoscope ; 125(6): 1291-5, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25476595

RESUMO

OBJECTIVES/HYPOTHESIS: Septorhinoplasty is one of the most commonly performed plastic surgery procedures in the world. Studies on septorhinoplasty in the literature mainly focus on the surgical procedures and their outcomes, but the general appearance of the nose and nasal skin following surgery is also very important. STUDY DESIGN: Case-control study examining 30 septorhinoplasty patients and 20 septoplasty patients for postoperative skin conditions. RESULTS: There were significant differences identified between the septorhinoplasty group and the septoplasty group with respect to their mean preoperative Global Acne Grading System, Seborrheic Dermatitis Area Severity Index, and visual analog scores (acne, seborrhea, and ecchymosis). CONCLUSIONS: The aim of study was to identify and evaluate postoperative skin conditions among septorhinoplasty patients, as well as the progression and duration of treatment of these conditions. LEVEL OF EVIDENCE: 3b.


Assuntos
Acne Vulgar/epidemiologia , Acne Vulgar/etiologia , Dermatite Seborreica/epidemiologia , Dermatite Seborreica/etiologia , Equimose/epidemiologia , Equimose/etiologia , Septo Nasal/cirurgia , Rinoplastia/efeitos adversos , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Adulto Jovem
13.
Rev Med Interne ; 34(1): 4-11, 2013 Jan.
Artigo em Francês | MEDLINE | ID: mdl-23246283

RESUMO

PURPOSE: Acquired haemophilia A (AHA) is a rare bleeding disorder, due to the presence of an inhibitor directed against factor VIII (FVIII). About 50% of the AHA are idiopathic, while the remaining 50% are related to an underlying disorder or condition (autoimmune diseases, malignancies, postpartum, etc.). PATIENTS AND METHODS: We report on a monocentric retrospective cohort of 39 patients with AHA. Data were collected and compared to recent published data. RESULTS: Thirty-nine patients were admitted for AHA between 1993 et 2011. Mean age at diagnosis was 71.3 years, and we noted a marked male predominance. Although the majority of patients presented a bleeding event at diagnosis (94.9%), the hemorrhagic mortality was low (2.6%). On the contrary, immunosuppressive morbidity and mortality were high in this elderly population. There was a clear correlation between initial FVIII inhibitor titer and complete remission delay. We did not identify prognostic factor for global survival. CONCLUSION: AHA is a rare but potentially fatal disorder. Rapidity of diagnosis and treatment initiation is crucial. Morbidity and mortality, particularly of infectious cause, due to immunosuppressive treatment, should lead to consider other available therapeutical options.


Assuntos
Hemofilia A/epidemiologia , Corticosteroides/uso terapêutico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes/epidemiologia , Estudos de Coortes , Ciclofosfamida/uso terapêutico , Equimose/epidemiologia , Transfusão de Eritrócitos/estatística & dados numéricos , Fator VIII/antagonistas & inibidores , Feminino , França/epidemiologia , Hematoma/epidemiologia , Hematúria/epidemiologia , Hemoglobinas/análise , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doenças Musculares/epidemiologia , Neoplasias/epidemiologia , Hemorragia Bucal/epidemiologia , Paraproteinemias/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores Sexuais , Taxa de Sobrevida
14.
Am J Surg ; 205(1): 39-44, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23040695

RESUMO

BACKGROUND: The aim of this study was to evaluate the clinical outcomes of 1,578 patients with breast benign diseases after excisions and the risk factors. METHODS AND RESULTS: With a median follow-up of 34 months, 69 patients were identified to have recurrence (local recurrence: 45; new lesion: 24). Univariate and multivariate analyses revealed that multiple lesions, a larger lesion size, and a hematoma were independent risk factors for recurrence. Patients with in situ recurrence tended to have fewer lesions and more samples taken per lesion. Patients with new lesions tended to have multiple lesions. After re-excisions, there was no second recurrence events observed in the patients with local recurrence (0/30), whereas 5 patients with new lesions (5/14) were noted to have second recurrence events. CONCLUSIONS: Ultrasound-guided vacuum-assisted biopsy for the complete excision of breast benign diseases is safe and effective. Local recurrence and new lesions may have different clinicopathological features and underlying mechanisms. Different management might be given to patients with a different pattern of recurrence.


Assuntos
Biópsia por Agulha/instrumentação , Doenças Mamárias/terapia , Ultrassonografia de Intervenção , Vácuo , Adolescente , Adulto , Idoso , Doenças Mamárias/patologia , Criança , China , Equimose/epidemiologia , Feminino , Seguimentos , Hematoma/epidemiologia , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Dor/epidemiologia , Medição da Dor , Recidiva , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
15.
J Drugs Dermatol ; 11(9): 1098-103, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23135654

RESUMO

BACKGROUND: Microcannulas with blunt tips for filler injections have recently been developed for use with dermal fillers. Their utility, ease of use, cosmetic outcomes, perceived pain, and satisfaction ratings amongst patients in terms of comfort and aesthetic outcomes when compared to sharp hypodermic needles has not previously been investigated. OBJECTIVE: To compare injections of filler with microcannulas versus hypodermic needles in terms of ease of use, amount of filler required to achieve desired aesthetic outcome, perceived pain by patient, adverse events such as bleeding and bruising and to demonstrate the advantages of single-port injection technique with the blunt-tip microcannula. MATERIALS AND METHODS: Ninety-five patients aged 30 to 76 years with a desire to augment facial, décolleté, and hand features were enrolled in the study. Subjects were recruited in a consecutive manner from patients interested in receiving dermal filler augmentation. Each site was cleaned with alcohol before injection. Anesthesia was obtained with a topical anesthesia peel off mask of lidocaine/tetracaine. Cross-linked hyaluronic acid (20 mg to 28 mg per mL) was injected into the mid-dermis. The microcannula or a hypodermic needle was inserted the entire length of the fold, depression or lip and the filler was injected in a linear retrograde fashion. The volume injected was variable, depending on the depth and the extent of the defect. The injecting physician assessed the ease of injection. Subjects used the Visual Analog Scale (0-10) for pain assessment. Clinical efficacy was assessed by the patients and the investigators immediately after injection, and at one and six months after injection using the Global Aesthetic Improvement Scale (GAIS) and digital photography. RESULTS: Overall, the Global Aesthetic Improvements Scale (GAIS) results were excellent (55%), moderate (35%), and somewhat improved (10%) one month after the procedure, decreasing to 23%, 44%, and 33%, respectively, at the six month evaluation. There was no significant differences in the GAIS score between the microcannula and the hypodermic needle. However, the Visual Analog Scale for pain assessment during the injections was quite different. The pain was described as 3 (mild) for injections with the microcannula, increasing to 6 (moderate) for injections with the hypodermic needle. Bruising and ecchymosis was more marked following use of the hypodermic needle. CONCLUSION: Using the blunt-tip microcannula as an alternative to the hypodermic needles has simplified filler injections and produced less bruising, echymosis, and pain with faster recovery.


Assuntos
Técnicas Cosméticas/instrumentação , Ácido Hialurônico/administração & dosagem , Rejuvenescimento , Envelhecimento da Pele/efeitos dos fármacos , Adulto , Idoso , Cateteres , Contusões/epidemiologia , Contusões/etiologia , Técnicas Cosméticas/efeitos adversos , Reagentes para Ligações Cruzadas , Equimose/epidemiologia , Equimose/etiologia , Feminino , Seguimentos , Humanos , Ácido Hialurônico/efeitos adversos , Masculino , Pessoa de Meia-Idade , Agulhas , Dor/epidemiologia , Dor/etiologia , Medição da Dor , Satisfação do Paciente , Fatores de Tempo , Resultado do Tratamento
16.
Eur Arch Otorhinolaryngol ; 269(2): 407-11, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21626122

RESUMO

The objective of this study was to describe the rarely reported ocular complications following surgery to correct chronic suppurative otitis media. A retrospective analysis was made of 2,318 cases of chronic suppurative otitis media treated with surgery between January 2004 and December 2009 at West China Hospital, Sichuan University, a medical center in Western China. Ninety-two cases of ocular complications were identified, giving an incidence of 3.97%. In 63 of the 92 cases (68.48%), the patients complained of blurred vision and the condition was classified as grade 1. In 24 cases (26.09%), the patients complained of mild periorbital edema and the condition was classified as grade 2. Four cases (4.35%) were classified as grade 3 because of severe edema with erythema on eyelids. One case (1.09%) was classified as grade 4 because of periorbital ecchymosis in addition to edema. The clinical features and the possible etiology were analyzed and are discussed. Ocular complications following chronic suppurative otitis media surgery are rare. Preauricular incision, disturbance of venous and lymphatic drainage, and preseptal cellulitis were the possible etiological factors. Eye injury during surgery and use of an anticholinergic agent might be risk factors for blurred vision after this surgery.


Assuntos
Oftalmopatias/etiologia , Otite Média Supurativa/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , China , Doença Crônica , Estudos de Coortes , Estudos Transversais , Equimose/epidemiologia , Equimose/etiologia , Oftalmopatias/epidemiologia , Doenças Palpebrais/epidemiologia , Doenças Palpebrais/etiologia , Feminino , Humanos , Incidência , Linfedema/epidemiologia , Linfedema/etiologia , Masculino , Processo Mastoide/cirurgia , Doenças Orbitárias/epidemiologia , Doenças Orbitárias/etiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Timpanoplastia , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia
17.
Injury ; 43(9): 1462-5, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21496818

RESUMO

OBJECTIVE: To examine the occurrence and extent of ocular injuries in ATV accidents in southwestern Pennsylvania. METHODS: This was a retrospective chart review of 37 adults and 43 children at UPMC Mercy Hospital, UMPC Presbyterian Hospital, and Children's Hospital of Pittsburgh Trauma Registry. The Trauma Registry was searched for patients sustaining ocular injuries related to an ATV accident. Records were de-identified by an honest broker and analysed in this study. RESULTS: Eighty percent (80%) of patients suffered orbital fracture; 40% had periorbital ecchymoses, and 25% had lid lacerations. Injuries ranged in severity from subconjunctival haemorrhages to traumatic avulsion of the optic nerves. CONCLUSIONS: Ocular trauma frequently accompanies ATV accidents and can have a significant impact on patient outcomes. An educational programme (except 'program' in computers) promoting eye protection could reduce the number of eye injuries associated with these recreational vehicles.


Assuntos
Acidentes de Trânsito/prevenção & controle , Cegueira/prevenção & controle , Equimose/prevenção & controle , Dispositivos de Proteção dos Olhos/estatística & dados numéricos , Veículos Off-Road/estatística & dados numéricos , Fraturas Orbitárias/prevenção & controle , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Cegueira/epidemiologia , Cegueira/etiologia , Criança , Equimose/epidemiologia , Equimose/etiologia , Feminino , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Orbitárias/epidemiologia , Fraturas Orbitárias/etiologia , Pennsylvania/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Assunção de Riscos , Índices de Gravidade do Trauma , Adulto Jovem
18.
J Arthroplasty ; 26(8): 1265-72, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21371856

RESUMO

From individual randomized studies, it is not clear whether a closed suction drainage should be used after total knee arthroplasty. Our meta-analysis compares the clinical outcomes of closed suction drainage with nondrainage after total knee arthroplasty in randomized controlled trials reported between January 1966 and May 2010. Fifteen eligible trials involving 1361 knee incisions (686 knees with closed suction drainage and 675 knees without drainage) satisfied the inclusion criteria for our meta-analysis. The result of the meta-analysis indicates that closed suction drainage reduces the incidence of soft tissue ecchymosis and requirement for dressing reinforcement, but increases the rate of homologous blood transfusion. No significant difference between drainage and nondrainage was observed in the incidence of infection, deep venous thrombosis, or postoperative range of motion.


Assuntos
Artroplastia do Joelho/métodos , Equimose/epidemiologia , Sucção/métodos , Infecção da Ferida Cirúrgica/epidemiologia , Trombose Venosa/epidemiologia , Idoso , Artrite Reumatoide/cirurgia , Feminino , Humanos , Incidência , Articulação do Joelho/fisiologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
19.
J Forensic Nurs ; 6(4): 196-202, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21114761

RESUMO

Little research has addressed the types and meaning of genital injury in sexual assault victims. An even smaller amount of research exists documenting injury to the cervix in sexual assault victims. The purpose of this study was to examine the frequency of cervical injuries in women following sexual assault, the types of injuries seen, the mechanisms that are related to the injuries, and the types of injuries related to each mechanism. A retrospective chart review was conducted. A total of 538 charts were examined, with a final sample size of 114. Within this sample, 87.8% (n= 100) presented with no injury to the cervix, and 12.3% (n= 14) had documented injury. All statistical analyses were nonsignificant; however, clinical implications are noted. Recommendations for future research are made.


Assuntos
Colo do Útero/lesões , Equimose/diagnóstico , Hematoma/diagnóstico , Púrpura/diagnóstico , Estupro/diagnóstico , Ferimentos Penetrantes/diagnóstico , Abreviaturas como Assunto , Adolescente , Adulto , Fenômenos Biomecânicos , Colorado/epidemiologia , Coleta de Dados , Equimose/epidemiologia , Feminino , Enfermagem Forense/métodos , Exame Ginecológico/métodos , Exame Ginecológico/enfermagem , Hematoma/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Púrpura/epidemiologia , Estupro/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Ferimentos Penetrantes/epidemiologia
20.
J Clin Pediatr Dent ; 34(3): 275-9, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20578668

RESUMO

The purpose of this study was to determine the prevalence of oral manifestations in pediatric patients with acute lymphoblastic leukemia (ALL) receiving chemotherapy, and to evaluate the significance of independent risk factors (oral health, gender, age, time and type of treatment, and phase of chemotherapy). A cross-sectional study was made in 49 children with ALL between 2 and 14 years of age. To describe oral manifestations, a clinical diagnosis was made and the following criteria were applied: the OHI-S index to describe oral health and the IMPA index to describe periodontal conditions and to differentiate gingivitis from periodontitis. The prevalence of oral manifestations was: gingivitis, 91.84%; caries, 81.63%; mucositis, 38.77%; periodontitis, 16.32%; cheilitis, 18.36%; recurrent herpes, 12.24%; and primary herpetic gingivostomatitis, 2.04%. Other oral manifestations were: dry lips, mucosal pallor, mucosal petechiae, ecchymoses, and induced ulcers. The prevalence of oral candidiasis was 6.12%. It was observed that high risk ALL and poor oral hygiene were important risk factors for the development of candidiasis and gingivitis. The type of leukemia, gender and phase of chemotherapy were apparently associated with the presence of candidiasis, gingivitis, and periodontitis, and they could be considered risk factors for the development of oral manifestations.


Assuntos
Antineoplásicos/uso terapêutico , Doenças da Boca/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adolescente , Candidíase Bucal/epidemiologia , Queilite/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Cárie Dentária/epidemiologia , Equimose/epidemiologia , Feminino , Gengivite/epidemiologia , Humanos , Doenças Labiais/epidemiologia , Masculino , México/epidemiologia , Higiene Bucal , Úlceras Orais/epidemiologia , Periodontite/epidemiologia , Prevalência , Púrpura/epidemiologia , Fatores de Risco , Fatores Sexuais , Estomatite/epidemiologia , Estomatite Herpética/epidemiologia
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