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At least 469 records · Page 26Linked to original sources
PubMed1991

Indications for radiography in patients with acute ankle injuries: role of the physical examination.

A prospective study was performed to test the hypothesis that a thorough physical examination can eliminate the need for a large number of radiographs obtained in patients with acute ankle trauma. Two hundred one patients were seen in the emergency department for acute ankle trauma and referred to the department of radiology for ankle radiographs. Radiology residents performed a brief but thorough physical examination of the ankle in all 201 patients. Solely on the basis of a strict set of physical examination criteria (examination for gross deformity, instability, crepitation, focal bony tenderness, severe soft-tissue tenderness, moderate or severe soft-tissue swelling, and ecchymosis), the radiologists determined whether or not the radiographs were indicated. All patients, irrespective of the physical examination, underwent ankle radiography, and the results were correlated with those of the physical examination. On the basis of the results of the physical examinations, 101 (50%) of the radiologic studies were not indicated. In only one of these patients was a fracture seen on radiographs. The radiograph in this case showed a small avulsion fracture of the dorsal aspect of the talus that was clinically insignificant (no cast or surgery was required). Our results suggest that a brief but thorough physical examination can eliminate the need for a large percentage of radiographs ordered in patients with acute ankle trauma.

Adolescent↗
PubMed2005

Endovenous treatment of the great saphenous vein using a 1,320 nm Nd:YAG laser causes fewer side effects than using a 940 nm diode laser.

BACKGROUND: Limited data are available about treatment-related side effects with respect to laser wavelength in endovenous laser treatment (ELT) of the great saphenous vein (GSV). OBJECTIVE: To compare the results and side effects of a 940 nm diode and a 1,320 nm neodymium:yttium-aluminum-garnet (Nd:YAG) laser. METHODS: Three patient cohorts (A, B, and C) received ELT of the GSV using a 940 nm diode laser at 15 W (group A) or 30 W (group B) or using a 1,320 nm laser at 8 W (group C). In all cases, energy was administered continuously with constant pullback of the laser fiber under perivenous tumescent local anesthesia. RESULTS: The GSVs of group A (n = 113), group B (n = 136), and group C (n = 33) received ELT. An average linear endovenous energy density of 24, 63, and 62 J/cm and an average endovenous fluence equivalent of 12, 30, and 33 J/cm2 were administered to the vein. Occlusion rates were 95% (group A), 100% (group B), and 100% (group C) at day 1 after ELT and 90.3% (group A), 100% (group B), and 97% (group C) at 3 months after ELT. With the 1,320 nm laser ELT (group C), treatment-related pain (50%) and the need for analgesics (36%) were significantly reduced (p < .005) in comparison with treatment-related pain (81%) and the need for analgesics (67%) after the 30 W 940 nm laser ELT (group B). Ecchymosis was also significantly reduced (p < .05) in group C (1,320 nm) compared with group B (30 W, 940 nm). CONCLUSION: ELT of the GSV using a 1,320 nm Nd:YAG laser causes fewer side effects compared with 940 nm diode laser ELT.

Adolescent↗
PubMed1997

A case of coagulation factor V deficiency complicated with intracranial hemorrhage.

Factor V deficiency is a relatively uncommon disorder, inherited as an autosomal recessive trait that manifests clinically only in individuals who inherit the defective gene from both parents. The hemorrhage of nasal and oral cavity and ecchymosis are common but intracranial hemorrhage is very rare. We experienced a 53 year old male patient with intracranial hemorrhage due to factor V deficiency. The laboratory tests showed prolongation of APTT and PT, normal bleeding time and normal thrombin time. The levels of the coagulation profiles on the patient revealed a significant decrease factor V, below 1% of normal range (60-140%). Other coagulation factors were normal. He was treated with fresh frozen plasma and completely recovered 3 weeks after treatment.

Cerebral Hemorrhage↗
PubMedDate not supplied

Ocular manifestations of child abuse.

The ocular manifestations of the "battered baby" or the physically abused child are numerous and play a prominent role in the recognition of this syndrome where the ophthalmologist is sufficiently informed concerning the characteristic features. Nonaccidental trauma must always be considered when examining a child under three years of age exhibiting intraocular hemorrhages, leukocoria, cataract or subluxated lens, retinal detachment or dialysis, Coats' disease, chorioretinal scarring, macular scarring, or periorbital ecchymosis. In addition, certain guidelines including the history, socioeconomic circumstances, general condition of the patient and disproportionate soft tissue injury compared to external signs may help stimulate the awareness of the physician toward the actual etiology. Ophthalmologists may be among the first to examine these traumatized infants so that prompt recognition is urgent since there is a known high incidence of morbidity and mortality. Reporting suspected nonaccidental injuries is required by law in every state. Any district attorney's office or child welfare agency can inform a physician about legal details. Failure to report a suspected case can be a serious misdemeanor in most states.

Adult↗
PubMed2004

Open lateral internal anal sphincterotomy under local anesthesia as the gold standard in the treatment of chronic anal fissures. A prospective clinical and manometric study.

BACKGROUND: Chronic anal fissure is one of the most frequent proctological disorders in Western populations. Open lateral internal sphincterotomy is one of the therapeutic options accepted as the treatment of choice for chronic anal fissure, since it reduces the hypertonia of the internal anal sphincter (the main etiopathogenic mechanism of fissures), decreases anal pain, and allows the fissure to heal. MATERIAL AND METHODS: We carried out a prospective study of 120 patients operated on for chronic anal fissure with open sphincterotomy under local anesthesia at our Proctology Outpatient Unit from 1998 to 2001. No preoperative studies, bowel preparation, or antibiotic prophylaxis were carried out. All patients were followed up after 1 week, 2 months, 6 months, and 1 year, and underwent an anal manometry before and after surgery. RESULTS: Early complications: 3 hematoma-ecchymosis of the wound (2.5%), 3 self-limited hemorrhage events (2.5%). No hemorrhoidal thrombosis, fistulas, or perianal abscesses occurred. Fissures recurred in nine patients (7.5%) within one year. The initial rate of incontinence of 7.5% at two months dropped down to 5% at six months. The mean resting pressure (MRP) in incontinent patients was lower than in continent patients (55 +/- 7 mmHg versus 80.7 +/- 21 mmHg). The difference in mean squeeze pressure (MSP) between incontinent patients and continent patients was not statistically significant. CONCLUSIONS: Open sphincterotomy under local anesthesia has a long-term rate of healing and a morbidity rate similar to other techniques. It may therefore be considered an effective treatment for chronic anal fissure.

Adult↗
PubMed2001

Immune thrombocytopenia in an elderly patient treated successfully by pulse therapy with cyclophosphamide.

Thrombocytopenia due to immune mechanisms is rare and difficult to manage in elderly patients. We describe a case of an 89-year-old female with severe immune thrombocytopenia (ITP) who rapidly improved by pulse therapy with cyclophosphamide. She was admitted to our hospital because she had arthralgia in both sides of her femoral region since January 1999, aphthous stomatitis and ecchymosis of the leg since April 1999, and bloody phlegm in July 1999. On admission, her peripheral blood count revealed severe thrombocytopenia (0.1 x 10(4)/microl). Her megakaryocyte count from bone marrow was increased to 512/microl without abnormal cells. Systemic lupus erythematosus was suspected because of strong positive protein in the urine in addition to the clinical and hematological findings described above, but she was negative for all the autoantibodies examined. Finally, she was diagnosed as having ITP on the basis of high platelet associated immunoglobulin G in addition to hematological and physical findings and she was treated with prednisolone. It was difficult to maintain her platelet count with only prednisolone, but 600 mg of cyclophosphamide rapidly increased her platelet count in spite of tapering the prednisolone. In September 2000, her platelet count was kept within normal limits by administration of 15 mg/day of prednisolon. It is suggested that immunosuppressive therapy for ITP using high-dose cyclophosphamide is useful in elderly patients as well as in juvenile adult patients.

Aged↗
PubMedDate not supplied

Pectoralis major muscle injuries: evaluation and management.

Pectoralis major muscle tears are relatively rare injuries that primarily occur while lifting weights, particularly when doing a bench press. Complete ruptures are most commonly avulsions at or near the humeral insertion. Ruptures at the musculo-tendinous junction and intramuscular tears usually are caused by a direct blow. The patient may hear a snap at the time of injury and report pain, weakness, swelling, or muscular deformity. Physical examination can reveal ecchymosis, a palpable defect, asymmetric webbing of the axillary fold, and weakness on resisted shoulder adduction and internal rotation. A detailed history and physical examination can be augmented by radiologic studies, including magnetic resonance imaging. Nonsurgical treatment is now recommended only for the older, sedentary patient or for proximal muscle belly tears. Surgery, whether early or delayed, consistently yields superior results compared with nonsurgical management. Prompt diagnosis and timely intervention likely will produce improved results.

Athletic Injuries↗
PubMed1989

[Clinical application of third generation extracorporeal shock wave lithotriptor (TRIPTER X-1) to upper urinary tract stones].

Clinical trials of the third generation extracorporeal shock wave lithotriptor (TRIPTER X-1) on 30 patients with upper urinary tract calculi were performed from May to July, 1988. Eighteen patients (60%) were free from stones and 5 (16.7%) had stone fragments less than 5 mm, the effective rate of treatment which is sum of both group being 76.7 per cent, at one month after the treatment. The effective rate was 72.7 per cent for stones in the kidney and 87.5 per cent for those in the upper ureter. And the effective rate as to stone size was 100, 66.7 and 71.4 per cent, in stones less than 1 cm, 1 cm to less than 2 cm and 2 to 2.5 cm, respectively. Although gross hematuria skin ecchymosis, pain and fever were observed as side effects, none was serious enough to be mentioned. And post operative changes in blood chemistry were mild and transient. We confirmed extracorporeal shock wave lithotripsy using this machine for upper urinary tract stones is an effective treatment without any serious side effects.

Adult↗
PubMed1996

Anesthesia blocks of the lower extremity. Comparing the Biojector with needle and syringe.

Podiatric surgical procedures frequently involve administration of preoperative local anesthesia, and because of the nature of these blocks, it is believed that needle-free injection could greatly enhance this aspect of clinical practice. The object of the study was to determine if needle-free injections with the Biojector were equivalent to needle and syringe injections for ankle, Mayo, neuroma, hallux, and digital anesthetic blocks. The results indicate that needle-free injection with the Biojector is equal to needle and syringe for some anesthesia blocks. More research in this area is needed to determine if technique with the Biojector has an impact on time of anesthesia onset or on level of discomfort and ecchymosis.

Adult↗
PubMed1997

Brachial plexopathy secondary to anticoagulant-induced hematoma as a complication of axillary arteriography.

In the patient described, brachial plexopathy was caused by a large anticoagulant-induced hematoma and pseudoaneurysm. The patient was seen at the hospital 2 weeks postarteriography with weakness, numbness, and pain in the left arm, as well as diffuse left-sided ecchymosis. Noncontrast computed tomographic scans of the axilla confirmed the diagnosis by showing an organized hematoma in the axillary compartment. Color-flow Doppler ultrasound studies showed blood flow in a pseudoaneurysm. This is a rare complication of arteriography that requires surgical intervention to remove the hematoma, decompress the brachial plexus, and repair the puncture site responsible for the pseudoaneurysm. Even if there is a delayed diagnosis, surgery should be performed urgently. Prognosis is based on prompt recognition and timely surgical intervention.

Aged↗
PubMed2006

Chicken pox associated thrombocytopenia in adults.

OBJECTIVE: To determine the frequency and magnitude of thrombocytopenia associated with chicken pox in adults. DESIGN: Observational descriptive study. PLACE AND DURATION OF STUDY: Combined Military Hospital, Attock, from July 2003 to June 2004. PATIENTS AND METHODS: All patients of age 15 years and above with history of fever, followed by appearance of the typical vesicular chicken pox rash, were inducted after informed consent. Two milliliters of whole blood was collected on day 1 of admission, and blood counts were performed. Patients were admitted and given 800 mg oral acyclovir, 5 times/day, for 7 days, in addition to symptomatic treatment. Patients were followed till 8 weeks. RESULTS: A total of 410 patients of chicken pox were received, out of which 270 were included. Age of patients ranged between 15 and 40 years with median age of 21 years. Platelet count on the day of admission ranged between 29 x 10(9)/L to 513 x 10(9)/L, mean platelet count 178 x 10(9)/L. Platelet count < 150 x 10(9)/L was detected in 80/270 (30%) patients. Platelet count in thrombocytopenia patients was from 29 x 10(9)/L to 149 x 10(9)/L with mean 121 x 10(9)/L. Thrombocytopenia recovered within 02 weeks in 78/80 (97%) patients. In 2 patients, thrombocytopenia recovered in 3 weeks. None of the patients developed purpuric spots, ecchymosis or bleeding manifestations. CONCLUSION: Thrombocytopenia in chicken pox is a common entity. Platelet count remains above 25 x 10(9) /L, which is usually not associated with bleeding manifestations. None of the patients in this series developed purpura. No specific pattern of total leukocyte counts was predictive of the progression or regression in platelet count.

Adolescent↗
PubMed1999

Use of botulinum toxin A in the treatment of hemifacial spasm and blepharospasm.

BACKGROUND: Hemifacial spasm and blepharospasm are both dystonic disorders. They may seriously affect individuals' lifestyle and social activities. In 1990, the Food and Drug Administration of the USA approved botulinum toxin A as a therapeutic agent in the treatment of hemifacial spasm and blepharospasm. We present a therapeutic review of botulinum toxin A in 80 patients in Taiwan. METHODS: Fifty-eight patients with hemifacial spasm and 22 with blepharospasm. Botulinum toxin A was prepared and injected into the facial and eyelid muscles. Patients were monitored every two weeks and classified into four groups (excellent, moderate, mild and no improvement) according to the clinical improvement scale. Complications were also recorded. RESULTS: A total of 86.2% of hemifacial spasm patients and 81.8% of blepharospasm patients had excellent improvement on the spasm intensity scale, while 6.8% of hemifacial spasm and 9.0% of blepharospasm patients had moderate improvement. The complication rate was low and included transient mild facial weakness (5%), ptosis (3.8%), eyelid swelling and/or ecchymosis (3.8%), nausea/vomiting (2.5%) and transient severe facial weakness (1.3%). CONCLUSION: Botulinum toxin A is an excellent therapeutic agent to improve spasm intensity and has a low complication rate.

Adult↗
PubMed1999

Life-threatening bleeding in a case of autoantibody-induced factor VII deficiency.

A male patient presented with life-threatening bleeding induced by autoantibody-induced factor VII (F.VII) deficiency. This patient had macroscopic hematuria, skin ecchymosis, gastrointestinal bleeding, and a neck hematoma that was causing disturbed respiration. He developed acute renal failure and acute hepatic failure, probably due to obstruction of the ureters and the biliary tract, respectively. Although activated partial thromboplastin time was normal, prothrombin time (PT) was remarkably prolonged at 71.8 seconds compared to 14.0 seconds in a normal control. Both the immunoreactive level of F.VII antigen and the F.VII activity of the patient's plasma samples were < 1.0% of normal. Although an equal part of normal plasma was added to the patient's plasma, PT was not corrected. The patient's plasma inhibited F.VII activity. These findings suggested the presence of a plasma inhibitor for F.VII. After administration of large doses of methylprednisolone, PT was gradually shortened and plasma levels of F.VII increased over time. Bleeding, acute renal failure, and acute hepatic failure improved markedly following the steroid treatment. These observations suggest that life-threatening bleeding can be induced by autoantibody-induced F.VII deficiency and that immunosuppressive therapy using large doses of steroid can be successful in inhibiting the production of the autoantibody.

Aged↗
PubMedDate not supplied

[Self-strangulation?].

A sixty year old man was found stangled to death with a part-elastic belt. As the ecchymosis, which are typically found above the mark of strangling, were missing, considerable doubt emerged at first as to the cause of death and to a suicide by strangling. Measurements of the elasticity of the instrument of strangulation, of the size of the neck and the head, as well as self-experiments aimed at reconstruction the circumstances had, in pathophysiological respect, the result of a method of self-strangulation similar to a typical hanging. The remaining circumstances also point to a suicide.

Forensic Medicine↗
PubMed1999

Spontaneous cervical hematoma: a report of two cases.

Cervical hematomas are generally associated with trauma, surgery, and tumors. Although they are rare, they can be life-threatening because they put the patient at risk for great-vessel compression and upper airway obstruction. We describe two cases of spontaneous cervical hematoma--one in an 81-year-old man and the other in a 30-year-old woman. The man reported dysphonia, dysphagia, and neck swelling of 5 hours' duration. He had been taking 100 mg/day of aspirin for a cardiovascular condition. Examination revealed that the man had polycythemia vera. The woman was found to have neck ache, odynophagia, and cervical ecchymosis; portal hypertension, schistosomiasis, and blood dyscrasia were also found. Both patients denied trauma. A suspected diagnosis of cervical hematoma was confirmed by computed tomography, and treatment was instituted. The hematomas resolved in about 2 weeks. The treatment of cervical hematoma is controversial, although it is agreed that the evaluation of upper airway obstruction and its permeability is mandatory. Surgical treatment is generally reserved for complicated cases because of the risk of infection or bleeding.

Adult↗
PubMed1999

Early experience in the use of the Advanced Breast Biopsy Instrumentation: a report of one hundred twenty-seven patients.

BACKGROUND: Recently there has been a great interest in developing alternative breast biopsy techniques that yield the appropriate histologic information in the least invasive and most cost-effective manner. The objective of this study was to evaluate the efficacy and results with the Advanced Breast Biopsy Instrumentation (ABBI) method for stereotactic excisional biopsies of nonpalpable mammographically detected breast lesions. METHODS: All patients with nonpalpable mammographic abnormalities who fulfilled the selection criteria for the ABBI procedure were studied. Pathologic diagnosis, the size of the specimen, the length of the procedure, postoperative complications, patient satisfaction, and the cost of the ABBI procedure were analyzed. RESULTS: One hundred twenty-seven of 139 patients (94.2%) underwent the ABBI procedure. Twelve patients (8.61%) required conversion to the needle localization procedure. Mammographically, 64 lesions revealed microcalcifications, 51 showed nodular densities, and 12 demonstrated both findings. Histologically, 21 lesions (16.5%) were malignant, whereas 106 were benign (83.5%). The mean operative time for the procedures was 62.5 minutes. Postoperatively 5 patients had local ecchymosis and 1 had a hematoma. The average cost per patient was found to be $1000, considerably less than for needle localization biopsy. CONCLUSION: With proper patient selection the ABBI procedure has proved to be a valuable tool in the armamentarium of the breast surgeon. Its efficiency, accuracy, and patient acceptance have been well documented in our hands.

Anesthesia, Local↗
PubMed1999

Wetting solutions in ultrasound-assisted lipoplasty.

Wetting solutions play a crucial role in traditional lipoplasty by reducing blood loss in the aspirate and diminishing postoperative ecchymosis and edema. From the inception of ultrasound-assisted lipoplasty a "wet environment" has been considered essential for efficient fat emulsification and for control of thermal side effects. This article reviews the historical role of wetting solutions in lipoplasty and examines the risks of their use in an overzealous manner. The authors provide safety guidelines for maximizing the benefits of wetting solutions in traditional and ultrasound-assisted lipoplasty while minimizing their side effects and complications.

Humans↗
PubMed1999

Copperhead envenomations: clinical profiles of three different subspecies.

Copperhead envenomation cases reported in the literature frequently lack identification of the subspecies of copperhead responsible for the envenomation. Whether subspecific identity would be useful in predicting possible different toxicity profiles may have clinical relevance. We report here the clinical profiles from envenomations involving 3 different subspecies of captive adult copperhead snakes--the southern copperhead (Agkistrodon contortrix contortrix), the northern copperhead (Agkistrodon contortrix mokasen), and the broad-banded copperhead (Agkistrodon contortrix laticinctus). The bites occurred in the north-central region of the US where none of these subspecies are endemic and involved a professional and 2 amateur herpetologists. The victims were adult males with no previous history of venomous snake bite, and all bites were evidenced by fang puncture marks to their index finger or thumb. Envenomations from the broad-banded and northern copperhead subspecies caused localized symptoms of pain, edema and ecchymosis. In addition to these symptoms, southern copperhead envenomation resulted in a more severe clinical toxicity profile as evidenced by propulsive emesis, diarrhea and hematuria. Whether these differences in observed clinical toxicity were the result of unique subspecific venom pharmacological actions is an interesting question. However, independent of the copperhead subspecies involved, conservative medical management was effective in each case.

Adult↗