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1.
Facial Plast Surg Clin North Am ; 30(1): 15-22, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809883

RESUMO

Facial trauma accounts of 7% to 10% of emergency department visits in the United States every year. The management of facial soft tissue trauma is an essential skill for the facial plastic surgeon. Understanding preoperative evaluation, repair/management of concomitant injuries, postoperative care, and scar treatment help the facial plastic surgeon obtain the best functional and aesthetic results for the patient. Treating the face by subunit and avoiding common pitfalls is the key to achieving optimal results. This article can serve as a basis for surgical pearls and considerations when evaluating and repairing facial soft tissue trauma.


Assuntos
Traumatismos Faciais , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Cicatriz/cirurgia , Traumatismos Faciais/cirurgia , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Lesões dos Tecidos Moles/cirurgia
2.
Chirurgia (Bucur) ; 116(eCollection): 1-7, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34749846

RESUMO

Background: In this study,we aim to present the clinical features of patients with rectus sheath hematoma(RSH), as well as the condition's therapeutic management and results. Methods: The study included patients who were diagnosed with and received treatment for spontaneous RSH between the years 2010 and 2020. The demographic and clinical features of the patients, as well as follow-up parameters, were analyzed retrospectively. Results: Our study included 53 patients. The number of female patients was twice as many as the number of male patients. The median age was 65.7 +-14.68 years, and 63.3% of the patients were over the age of 65. The most frequently used anticoagulant was warfarin (30.1%), and it was most often used for heart diseases (54.7%). The international normalized ratio value at the time of admission to the hospital was 1.93+1.18, and the hemoglobin value was 11.2 gr/dl. The average hematoma diameter was 74 mm, and the most common stage was typeI (75.6%). Of the patients, 90.6% were followed up conservatively. The average duration of hospital stay was 15.1 days, and mortality occurred in eight patients during their hospital stay. Conclusion: Spontaneous RSH should be consideredfor elderly female patients who have used anticoagulants. Most patients are followed up medically, but mortality is still high.


Assuntos
Hemorragia Gastrointestinal , Hematoma , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Feminino , Hematoma/etiologia , Hematoma/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
3.
Cir Cir ; 89(S1): 62-65, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762626

RESUMO

Achenbach syndrome is a condition of unknown etiology, characterized by changes in the coloration of the skin of the fingers and associated with acute pain. There are few epidemiological data, but it is estimated that it is a rare condition, which exceptionally appears under 40 years of age. We present the case of a young woman who has been diagnosed with Achenbach syndrome thanks to her history and after ruling out rheumatic, vascular, and metabolic pathology. We finalize by discussing data on the pathology and the differences found with the case we describe here.


Assuntos
Dedos , Hematoma , Diagnóstico Diferencial , Feminino , Humanos , Doenças Raras , Síndrome
4.
Emerg Med Pract ; 23(12): 1-28, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34787992

RESUMO

Acute aortic syndromes include aortic dissection, penetrating atherosclerotic ulcer, and intramural hematomas, but aortic dissection is the most common and the deadliest. This review summarizes the latest evidence on developing a differential for aortic dissection when common complaints, such as chest pain, abdominal pain, and syncope are also present. Recent evidence on the optimal uses of emergency department imaging studies and risk stratification tools are reviewed, along with special considerations in the management of penetrating atherosclerotic ulcer and intramural hematoma. Pharmacologic therapies for managing hemodynamic parameters and shock, and indications for operative intervention are also reviewed, along with cutting-edge diagnostic and treatment options on the horizon.


Assuntos
Aneurisma Dissecante , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/terapia , Serviço Hospitalar de Emergência , Hematoma/diagnóstico , Hematoma/terapia , Humanos , Síndrome , Úlcera
5.
J Int Med Res ; 49(11): 3000605211058377, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34786995

RESUMO

OBJECTIVE: To perform a prospective study to determine the risk factors associated with perirenal haematoma development after percutaneous renal biopsy (PRB). METHODS: This multivariate prospective study collected demographic and clinical data from all consecutive adult patients that underwent real-time ultrasound-guided PRB of native kidneys. All biopsies were performed by two well-trained ultrasound physicians using 16G biopsy needles. Routine renal ultrasounds were performed within 12-24 h after biopsies in order to observe post-biopsy perirenal haematoma formation. Patients were stratified based on the occurrence of post-biopsy haematoma development. RESULTS: This prospective study enrolled 218 patients and stratified them into a haematoma group (n = 126) and a non-haematoma group (n = 92). Binary logistic regression analysis identified female patients (odds ratio [OR] 1.990; 95% confidence interval [CI] 1.125, 3.521), patients with a body mass index (BMI) ≥28 kg/m2 (OR 2.660; 95% CI 1.097, 6.449) and patients with immediate post-biopsy active bleeding (IPAB) (OR 2.572; 95% CI 1.422, 4.655) as being more likely to have perirenal haematoma after real-time ultrasound guided PRB of native kidneys. CONCLUSION: Female sex, a BMI ≥28 kg/m2 and IPAB were risk factors for perirenal haematoma after real-time ultrasound-guided PRB of native kidneys.


Assuntos
Hematoma , Rim , Adulto , Biópsia , Feminino , Hemorragia Gastrointestinal , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Rim/diagnóstico por imagem , Estudos Prospectivos , Ultrassonografia de Intervenção
6.
J Clin Neurosci ; 93: 206-212, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34656249

RESUMO

OBJECTIVE: The BAT score is an easy-to-use prediction tool to detect hematoma enlargement after spontaneous intracerebral hemorrhage. Machine learning technique has potential predictive gains in accuracy over regression models. We sought to use machine learning technique to improve the BAT score for the prediction of hematoma enlargement. METHODS: Totally 232 patients with spontaneous intracerebral hemorrhage were enrolled from our hospital between 2015 and 2020. The BAT score was calculated to identify high-risk patients with hematoma enlargement. Using the same variables of the original BAT score and 5 common machine learning algorithms, the modified BAT scores were constructed in the training subset (n = 162) and validated in the testing subset (n = 70). Receiver operating characteristic curves were performed to evaluate the discriminative ability of all BAT scores. RESULTS: Among 5 modified BAT scores, the modified BAT score based on Naive Bayes algorithm performed best, with the area under the receiver operating characteristic curve (AUC) of 0.83 in the training subset and 0.77 in the testing subset. The DeLong test showed that the performances of the modified BAT score based on Naive Bayes algorithm were significantly better than that of the BAT score (AUC = 0.57) in the training and testing subsets (both P < 0.001). CONCLUSIONS: Machine learning technique could improve the identification performance of the original BAT score using the same variables. The modified BAT score based on Naive Bayes algorithm could be used as an effective prediction tool for identifying high-risk patients with hematoma enlargement.


Assuntos
Hemorragia Cerebral , Hematoma , Teorema de Bayes , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Aprendizado de Máquina , Curva ROC
8.
J Med Case Rep ; 15(1): 501, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625114

RESUMO

BACKGROUND: Myeloid sarcoma is a solid tumor that consists of immature myeloid cells occurring at an extramedullary site. It can present before, concurrent with, or after the diagnosis of acute myeloid leukemia or other myeloproliferative diseases, and a proportion of patients never develop bone marrow infiltration. Only a few isolated cases of pediatric orbital myeloid sarcoma have been reported, and they are often associated with a high misdiagnosis rate. CASE REPORT: We report a rare case of pediatric orbital myeloid sarcoma associated with blunt trauma in a 3-year-old Caucasian male patient, which was clinically and radiologically misdiagnosed for orbital subperiostal hematoma. The patient underwent a surgical intervention to drain the hematoma when an orbital mass was found. The microscopic, immunologic, and genetic features of the tumor and the myelogram were in favor of LAM2, and the patient was started with chemotherapy with a favorable evolution within 18 months follow-up. CONCLUSION: Orbital myeloid sarcoma usually exhibits clinical and radiological features that can be easily misleading, especially if it happens de novo or as the first manifestation of acute myeloid leukemia. Only a few isolated cases have reported and proposed trauma as a trigger event of the onset of this type of tumor proliferation, but further investigations and evidence are needed to support this hypothesis.


Assuntos
Neoplasias Orbitárias , Sarcoma Mieloide , Neoplasias de Tecidos Moles , Criança , Pré-Escolar , Erros de Diagnóstico , Hematoma , Humanos , Masculino , Neoplasias Orbitárias/diagnóstico , Sarcoma Mieloide/diagnóstico por imagem
9.
Ugeskr Laeger ; 183(39)2021 09 27.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34596514

RESUMO

Orbital compartment syndrome is an uncommon complication of trauma to the eye and its surroundings or a rare complication to sinus surgery. Nevertheless, it is important to diagnose and treat the condition urgently as it may cause irreversible visual impairment. In this case report, we describe a 29-year-old male suffering from a blunt trauma to the eye. He developed exophthalmus and visual impairment. A blow-out fracture and haematoma in the orbital compartment was diagnosed. Successful bedside urgent lateral canthotomy and cantholysis was performed followed by semi-urgent osteosynthesis of the fracture. The patient recovered without visual impairment.


Assuntos
Síndromes Compartimentais , Ferimentos não Penetrantes , Adulto , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Pálpebras , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Masculino , Órbita/diagnóstico por imagem , Órbita/lesões , Órbita/cirurgia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia
10.
Cardiol Clin ; 39(4): 495-503, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34686262

RESUMO

Acute aortic syndromes, classified into aortic dissection, intramural hematoma, and penetrating aortic ulcer, are associated with high early mortality for which early diagnosis and management are crucial to optimize outcomes. Patients often present with nonspecific clinical symptoms and signs; therefore, it is important for providers to maintain a high index of suspicion for acute aortic syndromes. Electrocardiogram-gated computed tomographic angiography of the chest, abdomen, and pelvis is currently the most practical imaging modality for diagnosis and identification of complications. Evolution in surgical techniques and the development of aortic endografts have improved patient outcomes, but randomized trials are still needed.


Assuntos
Aneurisma Dissecante , Doença Aguda , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/epidemiologia , Aorta , Hematoma/diagnóstico , Hematoma/epidemiologia , Humanos , Síndrome , Úlcera/diagnóstico , Úlcera/epidemiologia , Úlcera/terapia
12.
Tech Vasc Interv Radiol ; 24(2): 100746, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34602269

RESUMO

The incremental understanding of the anatomy and pathophysiology of aortic dissection over the past 250 years has predicated the modern endovascular treatments in use today. Since the early descriptions of aortic dissection, our knowledge of the predisposing factors and hemodynamic disturbances that lead to aortic dissection and overlapping syndromes, including intramural hematoma and penetrating atherosclerotic ulcer, has been fine-tuned, aided by more advanced ultrastructural histopathologic analysis and modern cross-sectional imaging techniques. However, several controversies and ambiguities of the pathophysiology and natural history of aortic dissection persist, leading to ongoing challenges in prevention, clinical diagnosis and treatment. In this review, we aim to describe the anatomy, pathology, and classification of aortic dissection and introduce the pathophysiologic basis for endovascular therapies.


Assuntos
Aneurisma Dissecante , Aneurisma Dissecante/diagnóstico por imagem , Diagnóstico por Imagem , Hematoma , Humanos , Úlcera
13.
Rom J Morphol Embryol ; 62(1): 295-299, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34609435

RESUMO

We report the case of a 62-year-old Caucasian man, an ex-smoker, who presented to the emergency room complaining of intense lower back pain followed by immediate bilateral loss of inferior limbs motor function. Clinical examination showed complete paralysis and paranesthesia in both legs, while pain and temperature sensory examination revealed a sensory level at dermatome T6, with normal touch, vibration, and position senses. His blood pressure was 190∕100 mmHg. Computed tomography demonstrated dilated thoracic aorta (maximum diameter 44 mm) and abdominal aorta (maximum 58 mm), with extended intramural hematoma (IMH), thus establishing the diagnosis of type A aortic IMH complicated with paraplegia through spinal perfusion deficit. Due to the extension of the lesions, surgical intervention for aortic repair was considered at high risk while cerebrospinal fluid drainage was not recommended by the neurologist. The patient remained stable while hospitalized and was released from the hospital with mild improvement of neurological deficiencies.


Assuntos
Aorta , Hematoma , Hematoma/complicações , Hematoma/diagnóstico por imagem , Humanos , Infarto , Masculino , Pessoa de Meia-Idade , Paraplegia/etiologia , Medula Espinal
16.
Stomatologija ; 23(2): 51-55, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34528909

RESUMO

Iatrogenic perforation of the lingual cortical plate of the mandible is uncommon but it may result in injuries to various adjacent structures such as the lingual nerve, sublingual gland, submandibular duct, deep lobe of the submandibular gland, and branches of rich anastomosing plexus supplying the floor of the mouth (FOM). The aim of this article was to highlight an unusual case of protracted postoperative bleeding that was occurred due to a FOM injury during an attempt to extract a mandibular second molar. Various anatomical considerations with clinical relevance were summarized too. Even small and superficial injuries of FOM should be not misjudged but be carefully monitored, since there is a potential risk for significant haemorrhage and hematoma formation leading to airway obstruction.


Assuntos
Mandíbula , Soalho Bucal , Serviço Hospitalar de Emergência , Hematoma , Humanos , Doença Iatrogênica , Dente Molar/cirurgia
17.
Neurol India ; 69(4): 1043-1044, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507441

RESUMO

Hemorrhagic neuropathy is an extremely rare condition. This condition refers to bleed into or around a peripheral nerve, causing either an extra neural or an intraneural hematoma. When they do occur, it is usually due to iatrogenic/inherited coagulopathies or as a consequence of injections targeting nerves. We present a case of sciatic nerve palsy developed secondary to anticoagulant therapy (Warfarin). MRI imaging showed features of sciatic nerve hematoma following which warfarin was withdrawn. The patient showed symptomatic improvement and a follow up ultrasound of left thigh showed resolution of hematoma with normal sciatic nerve diameter. To the best of our knowledge there is limited available literature regarding nerve hematomas secondary to anticoagulation therapy. This complication should be promptly recognized and immediate steps should take place because of the favorable results of the early treatment.


Assuntos
Hematoma , Neuropatia Ciática , Anticoagulantes , Hematoma/induzido quimicamente , Hematoma/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Nervo Isquiático/diagnóstico por imagem , Neuropatia Ciática/induzido quimicamente , Neuropatia Ciática/diagnóstico por imagem , Ultrassonografia
18.
Arch Argent Pediatr ; 119(5): e513-e517, 2021 10.
Artigo em Espanhol | MEDLINE | ID: mdl-34569753

RESUMO

Graft versus host disease is a serious complication that occurs following bone marrow transplant with significant morbidity and mortality. The gold standard to diagnose gastrointestinal graft versus host disease is upper and lower gastrointestinal endoscopy with histological validation. The development of intramural duodenal hematoma is a rare complication associated with this procedure. We present two cases of intramural duodenal haematoma after duodenal biopsies in bone marrow transplant patients that presented clinically with severe abdominal pain and intestinal bleeding. In both cases, CT scans confirmed the diagnosis and they were treated conservatively with favorable outcomes. Final diagnosis of gastrointestinal graft versus host disease was based on the colonic samples with normal duodenal histoarchitecture, which could lead to avoiding duodenal samples in future patients in order to prevent this serious complication and thus diminish morbidity.


Assuntos
Duodenopatias , Doença Enxerto-Hospedeiro , Criança , Duodenopatias/diagnóstico , Duodenopatias/etiologia , Endoscopia Gastrointestinal , Hemorragia Gastrointestinal , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/etiologia , Hematoma/diagnóstico , Hematoma/etiologia , Humanos
19.
Anesth Analg ; 133(5): 1296-1302, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34473654

RESUMO

BACKGROUND: The erector spinae block is an efficacious analgesic option for the management of rib fracture--related pain. Despite there being minimal published data specifically addressing the safety profile of this block, many societies have made statements regarding its safety and its use as an alternative to traditional regional anesthesia techniques in patients at risk of complications. The primary aim of this study was to characterize the safety profile of erector spinae plane block catheters by determining the incidence of early complications. The secondary aim of this study was to characterize the incidence of late adverse events, as well as the erector spinae plane block catheter failure rate. METHODS: We analyzed electronic medical record data of patients who had an erector spinae plane block catheter inserted for the management of rib fractures between November 2017 and September 2020. To assess early adverse events, data collection included hypotension, hypoxemia, local anesthetic systemic toxicity, and pneumothorax thought to be associated with erector spinae plane block catheter insertion. Late complications included catheter site infection and catheter site hematoma. RESULTS: A total of 224 patients received 244 continuous erector spinae catheters during the study period. After insertion of the erector spinae, there were no immediate complications such as hypotension, hypoxia, local anesthetic toxicity, or pneumothorax. Of all blocks inserted, 7.7% were removed due to catheter failure (8.4 per 100 catheters; 95% confidence interval [CI], 5.1-13.9 per 100 catheters). This resulted in a failure rate of 1.9 per 1000 catheter days (95% CI, 1.1-6.7 catheter days). Late complications included 2 erythematous catheter sites and 2 small hematomas not requiring intervention. The incidence of a minor late complication was 16.7 per 1000 catheters (95% CI, 6.1-45.5 per 1000 catheters). CONCLUSIONS: This study supports the statements made by regional anesthesia societies regarding the safety of the erector spinae plane block. Based on the results presented in this population of trauma patients, the erector spinae plane block catheter is a low-risk analgesic technique that may be performed in the presence of abnormal coagulation status or systemic infection.


Assuntos
Anestésicos Locais/administração & dosagem , Cateteres de Demora , Bloqueio Nervoso/instrumentação , Manejo da Dor/instrumentação , Fraturas das Costelas/terapia , Idoso , Anestésicos Locais/efeitos adversos , Infecções Relacionadas a Cateter/etiologia , Cateteres de Demora/efeitos adversos , Remoção de Dispositivo , Registros Eletrônicos de Saúde , Falha de Equipamento , Feminino , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Manejo da Dor/efeitos adversos , Segurança do Paciente , Estudos Retrospectivos , Fraturas das Costelas/diagnóstico por imagem , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
Yonsei Med J ; 62(10): 911-917, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34558870

RESUMO

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic disrupted the emergency medical care system worldwide. We analyzed the changes in the management of intracerebral hemorrhage (ICH) and compared the pre-COVID-19 and COVID-19 eras. MATERIALS AND METHODS: From March to October of the COVID-19 era (2020), 83 consecutive patients with ICH were admitted to four comprehensive stroke centers. We retrospectively reviewed the data of patients and compared the treatment workflow metrics, treatment modalities, and clinical outcomes with the patients admitted during the same period of pre-COVID-19 era (2017-2019). RESULTS: Three hundred thirty-eight patients (83 in COVID-19 era and 255 in pre-COVID-19 era) were included in this study. Symptom onset/detection-to-door time [COVID-19; 56.0 min (34.0-106.0), pre-COVID-19; 40.0 min (27.0-98.0), p=0.016] and median door to-intensive treatment time differed between the two groups [COVID-19; 349.0 min (177.0-560.0), pre-COVID-19; 184.0 min (134.0-271.0), p<0.001]. Hematoma expansion was detected more significantly in the COVID-19 era (39.8% vs. 22.1%, p=0.002). At 3-month follow-up, clinical outcomes of patients were worse in the COVID-19 era (Good modified Rankin Scale; 33.7% in COVID19, 46.7% in pre-COVID-19, p=0.039). CONCLUSION: During the COVID-19 era, delays in management of ICH was associated with hematoma expansion and worse outcomes.


Assuntos
COVID-19 , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/terapia , Hematoma/epidemiologia , Hematoma/terapia , Humanos , Estudos Retrospectivos , SARS-CoV-2
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