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1.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 53(3): 511-516, 2022 May.
Artigo em Chinês | MEDLINE | ID: mdl-35642163

RESUMO

Objective: To establish a brain hematoma CT image segmentation method based on watershed and region-growing algorithm so as to measure hematoma volume quickly and accurately, to explore the consistency between the results of this segmentation method and those of manual segmentation, the clinical gold standard, and to compare the results of this method with the calculation of the two Tada formulas commonly used in clinical practice. Methods: The preoperative CT images of 152 patients who were treated for spontaneous cerebral hemorrhage at the Department of Neurosurgery, West China Hospital, Sichuan University between January 2018 and June 2019 were retrospectively collected. The CT images were randomly assigned, by using a random number table, to the training set, the test set and the validation set, which contained 100 patients, 22 patients and 30 patients, respectively. The labeling results of the training set and the test set were used in algorithm training and testing. Four methods, namely, manual segmentation, algorithm segmentation, i.e., segmentation calculation based on watershed and regional growth algorithm, Tada formula, i.e., the traditional Tada formula calculation, and accurate Tada formula, i.e., accurate Tada formula calculation based on 3D-Slicer, were applied on the validation set to measure the hematoma volume. The Digital Imaging and Communications in Medicine (DICOM) data of subjects meeting the selection criteria of the study were manually segmented by two experienced neurosurgeons. The hematoma segmentation model was built based on watershed algorithm and regional growth algorithm. Seed point selected by neurosurgeons was taken as the starting point of growth. Regional grayscale difference criterion combined with manual segmentation validation were adopted to determine the regional growth threshold that met the segmentation precision requirements for intracranial hematoma. Using manual segmentation as the gold standard, Bland-Altman consistency analysis was used to verify the consistency of the three other methods for measuring hematoma volume. Results: With manual segmentation as the gold standard, among the three methods of measuring hematoma volume, algorithm segmentation had the smallest percentage error, the narrowest range of difference, the highest intra-group correlation coefficient (0.987), good consistency, and the narrowest 95% limits of agreement ( LoA). The percentage error of its segmentation was not statistically significant for hematomas of different volumes. Conclusion: The segmentation method of spontaneous intracerebral hemorrhage based on watershed and regional growth algorithm shows stable measurement performance and good consistency with the clinical gold standard, which has considerable clinical significance, but it still needs further validation with more clinical samples.


Assuntos
Hematoma , Tomografia Computadorizada por Raios X , Algoritmos , Hemorragia Cerebral/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Humanos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
2.
Int J Clin Pract ; 2022: 7436827, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35685571

RESUMO

Background: Rectus sheath hematoma is a rare self-limited presentation that has become a concern in hospitalized COVID-19 patients receiving anticoagulant therapies. Method: A retrospective multicentric study was conducted in referral hospitals affiliated with the Tehran University of Medical Science, Tehran, Iran, between June and August 2021. Patients with a confirmed diagnosis of COVID-19 that were complicated with rectus sheath hematoma during hospitalization were included. Median (lower quartile to upper quartile) was used to report the distribution of the results. Result: This study was conducted on nine patients with confirmed COVID-19 pneumonia, including eight females and one male. The severity of viral pneumonia was above average in eight patients. The median age and median body mass index were 65 (55.5 to 78) years and 29.38 (23.97 to 31.71) kg/m2. The duration of anticoagulant therapy was 10 (6 to 14) days, and the median length of hospital stay was 20 (10 to 23.5) days. Rectus sheath hematoma occurred after a median reduction of 4 (2.7 to 6.6) units in blood hemoglobin. Although 66.7% received ICU care and all of them were under full observation in well-equipped hospitals, the mortality rate was 55.6%. Conclusion: In summary, increased levels of inflammatory markers such as lactic acid dehydrogenase along with an abrupt decrease in blood hemoglobin in COVID-19 patients should be considered as predisposing factors for rectus sheath hematoma, especially in patients with moderate to severe COVID-19 pneumonia under anticoagulant therapy. This complication had been considered a self-limited condition; however, it seems to be fatal in patients with COVID-19 pneumonia. Further studies in larger sample sizes should be conducted to find out suitable management for this complication.


Assuntos
COVID-19 , Anticoagulantes/efeitos adversos , COVID-19/complicações , Feminino , Hematoma/complicações , Hematoma/diagnóstico , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Estudos Retrospectivos
3.
BMJ Case Rep ; 15(6)2022 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-35680279

RESUMO

This is a case presentation of a man in his late 80s who presented to emergency department with a sublingual haematoma secondary to warfarin usage for atrial fibrillation. His international normalised ratio was rapidly reversed, and he was taken to theatre for successful surgical drainage of the haematoma. He was kept intubated and ventilated for 48 hours postoperatively to allow swelling to settle then extubated and rehabilitated prior to discharge home.


Assuntos
Fibrilação Atrial , Varfarina , Fibrilação Atrial/complicações , Drenagem , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Coeficiente Internacional Normatizado , Masculino , Varfarina/efeitos adversos
4.
BMC Musculoskelet Disord ; 23(1): 609, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35739487

RESUMO

BACKGROUND: A chronic expanding hematoma (CEH) is a rare complication caused by surgery or trauma; it mostly affects the soft tissues, such as those in the trunk or extremities. We present the first case of a large intraosseous CEH presenting with chronic disseminated intravascular coagulation (DIC), 22 years after total hip arthroplasty (THA); the CEH was treated with a single-stage excision and revision THA. CASE PRESENTATION: A 67-year-old man presented to our hospital with left thigh pain and an enlarging mass. He had no history of trauma, anticoagulant use, or a collagen vascular disorder. The patient initially declined surgery. Two years later, radiographs and computed tomography images revealed progressive osteolysis, marginal sclerosis, and calcification in the left femur, in addition to loosening of the femoral component. Laboratory data revealed anemia and chronic DIC of unknown causes. Magnetic resonance imaging revealed a "mosaic sign" on the mass, indicating a mix of low- and high-signal intensities on T2-weighted images. Needle biopsy prior to surgery revealed no infection or malignant findings. An intraosseous CEH was suspected due to extensive osteolysis and loosening of the femoral component. No other factors that could induce chronic DIC were identified, such as sepsis, leukemia, cancer, trauma, liver disease, aneurysms, or hemangiomas. Therefore, we speculated that the anemia and chronic DIC were caused by the large intraosseous CEH. A single-stage revision THA with surgical excision was performed to preserve the hip function and improve the chronic DIC. The postoperative histopathological findings were consistent with an intraosseous CEH. The anemia and chronic DIC improved after 7 days. There was no recurrence of intraosseous CEH or chronic DIC at the 6-month follow-up. The left thigh pain improved, and the patient could ambulate with the assistance of a walking frame. CONCLUSIONS: The loosening of the femoral component caused persistent movement, which may have caused intraosseous CEH growth, anemia, and chronic DIC. It is important to differentiate CEHs from malignant tumors with hematomas. Furthermore, the "mosaic sign" noted in this case has also been observed on magnetic resonance images in other cases of CEH.


Assuntos
Artroplastia de Quadril , Coagulação Intravascular Disseminada , Osteólise , Idoso , Artroplastia de Quadril/efeitos adversos , Doença Crônica , Dacarbazina , Coagulação Intravascular Disseminada/complicações , Coagulação Intravascular Disseminada/etiologia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Masculino , Osteólise/cirurgia , Dor/cirurgia
5.
Breast J ; 2022: 7339856, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35711891

RESUMO

Background: Immediate breast reconstruction following nipple-sparing mastectomy (NSM) is widely used for its cosmetic benefits. Due to the lack of guidelines, the types of incisions in NSM vary and which method is superior remains a debate. In this study, we hypothesized that the periareolar incision has a higher risk of complications, such as nipple-areolar complex (NAC) necrosis, than other incisions. Methods: A retrospective chart review was conducted and divided into three groups: the periareolar, radial, and lateral incision groups. The reconstruction method and complications of NAC necrosis, wound dehiscence, seroma, hematoma, infection, and reconstruction failure were investigated. Results: A total of 103 patients (periareolar incision (33%, n = 34), radial incision (39.8%, n = 41), and lateral incision (27.2%, n = 28)) who underwent NSM and immediate breast reconstruction from 2018 to 2020 were included. The reconstruction methods were direct-to-implant, DIEP flap, LD flap, and PAP flap, and there was all of which had no statistically significant difference between the groups regarding the reconstruction method (p=0.257). In terms of complications, there was no significant difference in NAC necrosis (29.4%, 19.5%, and 21.4%, in the periareolar, radial, and lateral groups, respectively; p=0.578), wound dehiscence, seroma or hematoma, infection, and reconstruction failure. Conclusion: Breast reconstruction following NSM through periareolar incision does not increase the incidence of complications, including NAC necrosis. However, since only Asian patients with low BMI were included, if an appropriate patient group is selected for immediate reconstruction after NSM, reconstruction can be safely performed through the periareolar incision, and good cosmetic results can be obtained.


Assuntos
Neoplasias da Mama , Mamoplastia , Neoplasias da Mama/complicações , Neoplasias da Mama/cirurgia , Feminino , Hematoma , Humanos , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Mastectomia/efeitos adversos , Mastectomia/métodos , Necrose/etiologia , Mamilos/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Seroma/cirurgia
6.
Pan Afr Med J ; 41: 219, 2022.
Artigo em Francês | MEDLINE | ID: mdl-35721655

RESUMO

Subperiosteal haematoma of the orbit associated with frontal extradural hematoma is very rare. We here report a case treated in our Department with a literature review. The study involved a 15-year-old boy, victim of head injury from white weapon, a week before his admission to the emergency room. He had inflammatory and painful exophthalmos on the left side, associated with left ophthalmoplegia and blindness. Brain scanner showed left frontal extradural hematoma associated with subperiosteal hematoma of the ipsilateral orbit. Frontal craniotomy associated with fracture orbitotomy allowed evacuation of the extradural hematoma, and then, of the subperiosteal hematoma. Patient´s outcome was favorable. Simultaneous occurrence of frontal extradural hematoma and subperiosteal hematoma of the orbit is extremely rare. Generally, attention is drawn by exophthalmos and visual disturbances. Emergency brain scan without contrast agent injection can be used to make a diagnosis. Prognosis depends on visual function, then adequate management helps to safeguard the eye and vision.


Assuntos
Doenças Ósseas , Traumatismos Craniocerebrais , Exoftalmia , Hematoma Epidural Craniano , Doenças Orbitárias , Adolescente , Traumatismos Craniocerebrais/complicações , Exoftalmia/etiologia , Hematoma/complicações , Hematoma/cirurgia , Hematoma Epidural Craniano/complicações , Hematoma Epidural Craniano/diagnóstico , Hematoma Epidural Craniano/cirurgia , Humanos , Masculino , Órbita , Doenças Orbitárias/complicações , Doenças Orbitárias/etiologia
7.
World J Gastroenterol ; 28(20): 2243-2247, 2022 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-35721883

RESUMO

BACKGROUND: Intramural duodenal hematoma is a rare condition described for the first time in 1838. This condition is usually associated with blunt abdominal trauma in children. Other non-traumatic risk factors for spontaneous duodenal haematoma include several pancreatic diseases, coagulation disorders, malignancy, collagenosis, peptic ulcers, vasculitis and upper endoscopy procedures. In adults the most common risk factor reported is anticoagulation therapy. The clinical presentation may vary from mild abdominal pain to acute abdomen and intestinal obstruction or gastrointestinal bleeding. CASE SUMMARY: The aim of this case summary is to show a case of intramural spontaneous hematoma with symptoms of intestinal obstruction that was properly drained endoscopically by an innovative system lumen-apposing metal stent Hot AXIOS™ stent (Boston Scientific Corp., Marlborough, MA, United States). CONCLUSION: Endoscopic lumen-apposing metal stent Hot AXIOS™ stent is a safe and feasible treatment of duodenal intramural hematoma in our case.


Assuntos
Duodenopatias , Obstrução Intestinal , Adulto , Criança , Duodenopatias/diagnóstico por imagem , Duodenopatias/etiologia , Duodenopatias/cirurgia , Endoscopia/efeitos adversos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Obstrução Intestinal/complicações
8.
Tomography ; 8(3): 1228-1240, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35645387

RESUMO

(1) Background: Spontaneous retroperitoneal hematomas are a relatively common occurrence in hospitalized patients with COVID-19 related pneumonia, and endovascular treatment of trans-arterial embolization (TAE) may be a life-saving procedure after failure of medical and supportive therapy. The aim of our study was to evaluate spontaneous retroperitoneal hematomas in the COVID-19 era, focusing on their imaging features at CTA and DSA and on the safety, as well as technical and clinical success, of TAE, comparing patients affected by COVID-19 and non-COVID-19 patients. (2) Materials and Methods: We retrospectively enrolled 24 patients with spontaneous retroperitoneal hematoma who underwent TAE; of these, 10 were hospitalized for COVID-19-related pneumonia, while the other 14 were without COVID-19 infection. We evaluated the demographic data, hemoglobin values before and after the procedure, preprocedural aPTT, preprocedural INR, diagnostic and interventional imaging findings, procedural outcome (technical success) and survival periprocedural (clinical success), and major and minor complications. (3) Results: The mean age of the study population was 72.7 ± 11.2 years. CTA revealed signs of active bleeding in 20 patients (83%). DSA showed signs of active bleeding in 20 patients (83%). In four patients (17%), blind embolization was performed. The overall technical success rate was 100%. Clinical success was achieved in 17 patients (71%), while seven patients (29%) rebled within 96 h, and all of them were retreated. No major periprocedural complication was reported. The comparison between the two groups did not show statistically significant differences for gender, mean age, mean pre- and postprocedural hemoglobin, aPTT and INR, mean hematoma volume (cm3), or mean delay between CT and DSA. Active bleeding at CTA was detected in 90% of COVID-19 patients and 79% of non-COVID-19 patients (p = 0.61). At DSA, active bleeding was assessed in eight out of 10 (80%) patients in the COVID-19 group and 12 out of 14 (86%) patients in the non-COVID-19 group (p = 1). Technical success was obtained in 100% of patients in both groups. Clinical success rates were 70% for COVID-19 group and 71% for the non-COVID-19 group. We found no statistical significance between the clinical success rates of retroperitoneal spontaneous hematoma embolization in patients with or without SARS-CoV-2 infection. (4) Conclusions: We suggest that, similar to what has been reported in other studies in non-COVID-19 patients, TAE should be considered an important safe, effective, and potentially life-saving option for the management and the treatment of patients affected by COVID-19 who present with spontaneous retroperitoneal hematoma and who could not benefit from conservative treatment.


Assuntos
COVID-19 , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/terapia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , SARS-CoV-2 , Resultado do Tratamento
10.
Comput Math Methods Med ; 2022: 5863082, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35747135

RESUMO

The aim of this study was to explore the application value of brain computed tomography (CT) images under intelligent segmentation algorithm and serological indexes in the early prediction of hematoma enlargement in patients with intracerebral hemorrhage (ICH). Fuzzy C-means (FCM) intelligence segmentation algorithm was introduced, and 150 patients with early ICH were selected as the research objects. Patient cerebral CT images were intelligently segmented to assess the diagnostic value of this algorithm. According to different hematoma volumes during CT examination, patients were divided into observation group (hematoma enlargement occurred, n = 48) and control group (no hematoma enlargement occurred, n = 102). The predicative value of hematoma enlargement after ICH was investigated by assessing CT image quality and measuring intracerebral edema, hematoma volume, and serological indicators of the patients of the two groups. The results demonstrated that the sensitivity, specificity, and accuracy of CT images processed by intelligence segmentation algorithm amounted to 0.894, 0.898, and 0.930, respectively. Besides, early edema enlargement and hematoma of patients in the observation group were more significant than those of patients in the control group. Relative edema volume was 0.912, which was apparently lower than that in the control group (1.017) (P < 0.05). In terms of CT signs of ICH patients, the incidence of blend sign, low density sign, and stroke of the observation group was evidently higher than those of the control group (P < 0.05). Besides, absolute lymphocyte count (ALC) and hemoglobin (HGB) concentration of the patients in the observation group were 6.23 × 109/L and 6.29 × 109/L, respectively, both of which were higher than those of the control group (6.08 × 109/L and 4.25 × 109/L). Neutrophil to lymphocyte ratio (NLR) was 0.99 × 109/L, which was apparently lower than that in the control group (1.43 × 109/L) (P < 0.05). To sum up, cerebral CT images processed by FCM algorithm showed good diagnostic effect on ICH and high clinical values in the early prediction of hematoma among ICH patients.


Assuntos
Hemorragia Cerebral , Hematoma , Algoritmos , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Inteligência , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
11.
Sultan Qaboos Univ Med J ; 22(2): 291-294, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35673281

RESUMO

Intraperitoneal haemorrhage during pregnancy or postpartum without any history of trauma (spontaneous haemoperitoneum in pregnancy [SHiP]) is a rare condition, causing significant morbidity and mortality for the mother and the neonate. We report a 27-year-old female patient with SHiP at 31 weeks of gestation who was referred to a tertiary care hospital in Muscat, Oman, in 2019, with right iliac fossa pain, pallor and tachycardia. Radiological investigations revealed intraperitoneal bleeding and a right adnexal haematoma. She was managed conservatively with blood transfusion and supportive care. At 36 weeks of gestation, lower segment caesarean section was done and a live baby with good Apgar score was delivered. Pre-operatively, she was found to have a bicornuate uterus, placenta percreta at the junction of the horns and a right adnexal haematoma. This case highlights the significance of thorough evaluation of acute abdominal pain in pregnancy in avoiding unnecessary surgical intervention and iatrogenic prematurity.


Assuntos
Placenta Acreta , Adulto , Cesárea , Feminino , Hematoma , Hemoperitônio/etiologia , Humanos , Lactente , Recém-Nascido , Placenta Acreta/cirurgia , Gravidez , Anormalidades Urogenitais , Útero/anormalidades
13.
Am J Case Rep ; 23: e935472, 2022 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-35704516

RESUMO

BACKGROUND A flare, or flare-up, of systematic lupus erythematosus (SLE) is diagnosed by an increase in disease activity in one or more organs, new symptoms, or changes in laboratory measurements. A hematoma can occur in the sheath of the rectus abdominis following muscle trauma or rupture of an epigastric vessel, or it can occur spontaneously. This report is of a 28-year-old woman who presented with a clinical flare of SLE and abdominal pain due to rectus sheath hematoma. CASE REPORT A 28-year-old woman had been suspected of having SLE 9 years ago and had received glucocorticoid therapy combined with hydroxychloroquine. However, lupus flared after she discontinued glucocorticoids, and she was admitted with a 1-month history of marked generalized edema, abdominal distension, frothy urine, and massive ascites. During hospitalization, she abruptly developed a continuous, stabbing abdominal pain and a bulge over the right abdomen as a result of straining during a bowel movement. On examination, a well-demarcated round mass that measured 121 mm × 96 mm was detected in the right quadrant. Abdominal emergency computed tomography revealed a right rectus sheath hematoma (21.4×4.7 cm). After her condition improved, the patient underwent an ultrasound-guided renal biopsy and was diagnosed with class III (A/C) and class V lupus nephritis. CONCLUSIONS This case has shown that spontaneous rectus sheath hematoma can occur without a history of trauma in a patient with an exacerbation of SLE. This association appears to be rare, and the cause is unknown.


Assuntos
Lúpus Eritematoso Sistêmico , Doenças Musculares , Dor Abdominal/etiologia , Adulto , Feminino , Hematoma/complicações , Hematoma/etiologia , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Doenças Musculares/etiologia , Reto do Abdome
14.
J Clin Neurosci ; 101: 204-211, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35642832

RESUMO

AIM: This study was conducted to evaluate clinical outcomes after fibrinogen administration in hypofibrinogenemia following severe traumatic brain injury. BACKGROUND: Post traumatic coagulopathy (PTC) is a common but devastating medical condition in patients with severe head injury. Hypofibrinogenemia is considered as an indicator for poor clinical outcomes in traumatic brain injury (TBI). METHODS: In this randomized clinical trial (RCT), primarily 137 patients with severe traumatic brain injury (Glasgow coma scale score: GCS < 9) were enrolled. Thereafter, their plasma fibrinogen level was measured. The patients with primary hypofibrinogenemia (<200 mg/dL) with no concurrent coagulopathy were randomly allocated into fibrinogen-receiving (n = 50) and control (n = 54) groups. P-value < 0.05 was considered as statistically significant. RESULTS: Seventy-one patients were analyzed in the final step of the study. The mean value for age in fibrinogen and control groups was 25.64 ± 10.71 and 28.91 ± 12.25 years old, respectively. Male - female patients in both groups were equally distributed. In the fibrinogen receiving group, GCS scores were significantly higher after 24, 48, and 72 h compared to the control group (p = 0.000). Hematoma expansion was better controlled in the fibrinogen receiving group (p = 0.000). Notably, the number needed to treat (NNT) for fibrinogen infusion and hematoma expansion control was 2.3. Glasgow outcome scale-extended (GOSE) was significantly better in the fibrinogen group (p = 0.25). Multiple regression tests showed intracerebral hematoma (ICH) and severe brain edema had the most detrimental effect on GOSE outcomes. The need for cranial surgery, hospital stay duration, mechanical ventilator dependency, in hospital and 90-day post discharge mortality rates were similar in both study groups. CONCLUSION: In severe TBI, hypofibrinogenemia correction (>200 mg/dL) could improve GOSE, GCS score progression within 3 days after primary head injury and hematoma expansion controllability.


Assuntos
Afibrinogenemia , Lesões Encefálicas Traumáticas , Adolescente , Adulto , Afibrinogenemia/complicações , Afibrinogenemia/tratamento farmacológico , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/tratamento farmacológico , Feminino , Fibrinogênio/uso terapêutico , Escala de Coma de Glasgow , Hematoma , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
16.
J Clin Neurosci ; 101: 259-263, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35660959

RESUMO

INTRODUCTION: Patients with spontaneous intracerebral hemorrhage (SICH) face the worse functional and vital prognosis among all stroke subtypes. In cases of severe SICH, therapeutic inertia or nihilism complicates meaningful identification of outcome predictors. Therefore, we sought to investigate clinic-radiological and process of care predictors of short-term mortality in patients with mild to moderate SICH. PATIENTS AND METHODS: Observational retrospective community representative consecutive case series of patients from Algarve, southern Portugal. Logistic regression was used to identify predictors of short-term (30-day) death. RESULTS: Mortality was 23.9% (111/464). Most important predictors of death were unconsciousness at admission (OR = 12.392, 95% CI = 3.816-40.241, p < 0.001), hospital arrival ≥ 6 h after stroke onset (OR = 2.842, 95% CI = 1.380-5.852, p =.005), hematoma volume > 30 cc/cm3 (OR = 3.295, 95% CI 0 1.561-6.953, p =.002), intraventricular extension (OR = 2.885, 95% CI = 1.457-5.712, p =.002) and ≥ 24 h in the Emergency Department (OR = 19.675, 95% CI = 3.682-34.125, p =.009). Stroke Unit (SU) admission reduced the likelihood of death (OR = 0.293, 95% CI = 0.137-0.682, p =.002). CONCLUSION: The observed mortality is high. Apart from the traditional clinic-radiological factors, in mild to moderate SICH, process of care related factors have strong impact on mortality. These results highlight the need of continuous improvement of SICH care to improve the prognosis.


Assuntos
Hemorragia Cerebral , Acidente Vascular Cerebral , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/terapia , Hematoma/complicações , Humanos , Portugal/epidemiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações
17.
Can J Urol ; 29(3): 11190-11193, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35691043

RESUMO

Subcapsular renal hematoma (SRH) is an infrequent complication of urologic interventions but can lead to serious consequences in patients with a solitary kidney. We present our experience with conservative management of a patient with a solitary kidney and multiple medical comorbidities who developed a SRH and subsequent renal failure after nephroureteral catheter placement. Literature on the management of this unique clinical scenario is limited. Herein, we share our experience with supportive care and temporary dialysis in a medically complex patient whose outcome is complete renal recovery.


Assuntos
Injúria Renal Aguda , Nefropatias , Rim Único , Injúria Renal Aguda/etiologia , Tratamento Conservador , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/terapia , Humanos , Rim , Nefropatias/complicações , Nefropatias/terapia , Rim Único/complicações
18.
MMW Fortschr Med ; 164(11): 30-31, 2022 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-35650489
19.
Schweiz Arch Tierheilkd ; 164(6): 447-455, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35652255

RESUMO

INTRODUCTION: Aural hematoma is the most common injury of the pinna in dogs. Treatment options are various. More recently, medical therapy has been more commonly pursued than surgical options. Therefore, our hypothesis was that monotherapy with oral prednisolone for one month is sufficient to successfully treat dogs diagnosed with aural hematoma. In this open prospective experimental study without control group, clinicians treated 24 privately-owned dogs suffering from aural hematoma with oral prednisolone at 1 mg / kg / day for 14 days, followed by 0,5 mg / kg / day for another 14 days. In case of strong side effects, the dose reduction was already initiated after 7 days of treatment. The success was assessed subjectively after 14 days by the owner and after 28 days by a clinician or specialist. In addition, before and after treatment the thickness of the swelling was measured. In 21 of 24 dogs, oral prednisolone treatment for 28 days lead to a subjective clinical improvement of at least 80 %. The ear thickness was reduced by at least 50 %. This study showed that treating dogs suffering from aural hematoma for four weeks with oral prednisolone used as a monotherapy leads to promising results and could be considered as an economical, non-invasive and safe treatment alternative for aural hematoma in dogs.


INTRODUCTION: L'hématome auriculaire est la lésion la plus fréquente du pavillon de l'oreille chez le chien. Les options de traitement sont diverses. Depuis un certain temps, la thérapie médicale a été plus souvent proposée que les options chirurgicales. Par conséquent, notre hypothèse était qu'une monothérapie avec de la prednisolone orale pendant un mois est suffisante pour traiter avec succès les chiens souffrant d'un hématome auriculaire. Dans cette étude expérimentale prospective ouverte sans groupe de contrôle, les cliniciens ont traité 24 chiens privés souffrant d'un hématome auriculaire avec de la prednisolone orale à raison de 1 mg / kg / jour pendant 14 jours, suivie de 0,5 mg / kg / jour pendant 14 autres jours. En cas de forts effets secondaires, la réduction de la dose était déjà amorcée après 7 jours de traitement. Le succès du traitement a été évalué subjectivement après 14 jours par le propriétaire et après 28 jours par un clinicien ou un spécialiste. En outre, l'épaisseur de l'enflure a été mesurée avant et après le traitement. Chez 21 des 24 chiens, le traitement oral à la prednisolone pendant 28 jours a entraîné une amélioration clinique subjective d'au moins 80 %. L'épaisseur de l'oreille a été réduite d'au moins 50 %. Cette étude a montré que le traitement des chiens souffrant d'un hématome auriculaire pendant quatre semaines avec de la prednisolone orale utilisée en monothérapie conduit à des résultats prometteurs et pourrait être considéré comme une alternative de traitement économique, non invasive et sûre pour l'hématome auriculaire chez les chiens.


Assuntos
Doenças do Cão , Animais , Doenças do Cão/tratamento farmacológico , Doenças do Cão/cirurgia , Cães , Hematoma/tratamento farmacológico , Hematoma/cirurgia , Hematoma/veterinária , Prednisolona/uso terapêutico , Estudos Prospectivos
20.
J Med Case Rep ; 16(1): 213, 2022 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-35644613

RESUMO

BACKGROUND: Spontaneous spinal cord hemorrhage is extremely rare in dengue fever. We report a case of spontaneous spinal intradural hemorrhage in dengue fever associated with severe thrombocytopenia. CASE PRESENTATION: A 48-year-old Indian woman presented with fever and body aches followed by acute onset of paraplegia with bladder and bowel dysfunction and loss of sensations below the level of the umbilicus. She had severe thrombocytopenia and positive dengue serology. Magnetic resonance imaging of the spine showed compression of the spinal cord due to intradural hematoma at the D7-D8 vertebral level. The patient received symptomatic treatment for dengue fever and steroids. Emergency D7-D8 laminectomy with excision of the clot and dural repair was done after stabilizing the platelet count with multiple platelet transfusions. The constitutional symptoms responded well to the treatment. There was good improvement in sensory symptoms but negligible improvement in paraplegia with a change in muscle power from grade 0/5 to grade 1/5 in the postoperative period. The patient was discharged from the hospital in a stable condition, but paraplegia showed little improvement during follow-up of 1 year. CONCLUSIONS: Spontaneous spinal cord hemorrhage can present as acute paraplegia in dengue fever. Failure to recognize this complication can delay initiating appropriate treatment with permanent loss of neurologic function.


Assuntos
Dengue , Trombocitopenia , Dengue/complicações , Feminino , Hematoma , Humanos , Pessoa de Meia-Idade , Paraplegia/etiologia , Coluna Vertebral , Trombocitopenia/complicações
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