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PubMed2001

[Pneumocephalus as a complication to sinus surgery].

BACKGROUND: Pneumocephalus is a rare complication of sinus surgery. The complications of sinus surgery are often classified as minor or major. Minor complications are seen as adhesions, scarring, bleeding, development of subcutaneous emphysema, penetration of the orbit without herniation and eyelid ecchymosis. The incidence of major complications is 0 to 3% and include haemorrhage, retrobulbar haematoma, injury to the optic nerve, CSF leaks, meningitis, intracranial penetration with development of tension pneumocephalus, and death. MATERIAL AND METHODS: We present a case of pneumocephalus after endonasal ethmoidectomy. The literature is reviewed. RESULTS: The patient had clinical findings consistent with non-tension pneumocephalus. Development of tension pneumocephalus is a distinct possibility and it is necessary to monitor these patients closely. INTERPRETATION: In order to reduce the risk of injury to the anterior skull base it is important to eliminate certain normal anatomic variations and to assess the individual anatomy thoroughly. This can be done with preoperative nasal endoscopy and CT imaging. This applies even more to patients who have previously undergone sinus surgery.

Aged↗
PubMed2001

Phase II study of direct intralesional gene transfer of allovectin-7, an HLA-B7/beta2-microglobulin DNA-liposome complex, in patients with metastatic melanoma.

Cutaneous melanoma is one of the most rapidly increasing cancers in the United States. Because of the lack of effective treatment options and toxicities of most chemotherapeutic and radiation regimes, immunotherapies such as vaccination therapy represent an attractive approach for patients with advanced melanoma. The purpose of this study was to evaluate the response rate, time to progression, and survival of patients with metastatic melanoma treated by direct intratumoral injection with Allovectin-7 (a plasmid DNA encoding the genes HLA-B7 and beta2-microglobulin complexed with a cationic lipid mixture, DMRIE/DOPE. Fifty-two patients with metastatic melanoma were enrolled in this Phase II study. Therapy consisted of six intratumoral injections of 10 microg of Allovectin-7 over a 9-week period. Treatment was well tolerated. Treatment-related adverse events were mild to moderate, the most frequent of which were ecchymosis, pruritus (and/or discomfort at the injection site), and pneumothoraces. Regression of the injected lesion was observed in 18% of patients, including one complete response, three partial responses, and five minor responses. An overall response rate of 4% (two partial responses) was documented, and nine patients (18%) maintained stable disease for at least 11 weeks. Six patients remained alive 25.1 to 39.4 months from their first injection, including two patients with local (injected tumor) responses and one patient with an overall disease partial response. This study demonstrates that intratumoral administration of Allovectin-7 in metastatic melanoma is safe and can produce both responses in injected lesions and in overall disease. Clinical trials optimizing patient selection and combining Allovectin-7 with other modalities of therapy are currently ongoing in an effort to improve response rates.

Adult↗
PubMed1998

[Complications of nasal endoscopic surgery].

OBJECTIVE: To study the classification, incidence, mechanism and prevention of complications of nasal endoscopic surgery. METHODS: Sixty-two complications among 1,089 cases of nasal endoscopic surgery between February 1991 and October 1995 were analyzed. RESULTS: The types of complication included blindness (n = 1), retrobulbar hemorrhage (n = 1), inflammatory mass in orbit (n = 2), CSF (n = 2), nasolacrimal duct injury (n = 2), nasal septum perforation (n = 2), hemorrhage (n = 3), periorbital emphysema or ecchymosis (n = 14) and adhesion (n = 35). The total incidence was 5.7%, the incidence of major complications was 1.2% and minor complications 4.5%. CONCLUSION: The classification, estimation, mechanism and prevention of complications of nasal endoscopy were discussed, care should be taken to avoid the occurrence of complications and it is important to find and treat complications timely and accurately.

Adolescent↗
PubMed2001

Microsurgical treatment of varicocele in outpatients using the subinguinal approach.

BACKGROUND: The aim of this study is to analyze the results of a group of patients who underwent subinguinal microsurgical varicocelectomy using local anaesthesia in one-day-surgery. METHODS: From 1997 to 1998 150 patients were selected from the whole group of patients who underwent surgical treatment for varicocele. The varicocele was always on the left side and the mean age was 27.1 years (range: 16-43). The diagnosis was based on clinical features (testicular pain or scrotal sensation), physical examination and Doppler ultrasound. Where there was infertility with abnormal semen analysis and/or patient's intolerance to the symptoms, surgery was suggested. The patients underwent varicocelectomy by sub-inguinal approach using local anaesthesia. The microsurgical technique of dissection was performed. RESULTS: All operations were performed on an outpatient basis (post-operative stay: 3-7 hours) and the operating time was 20 to 45 minutes. Follow-up was performed by physical examination, doppler ultrasound and semen analysis. Immediate and long-term complications were: 7 (4.7%) transient pain, 3 (2.0%) ecchymosis, 1 (0.7%) transient hydroceles and 1 (0.7%) permanent hydroceles, 2 (1.3%) palpable recurrence, 2(1.3%) doppler recurrence and 1 (0.7%) long-term recurrence, 0 testicular atrophy. 120/150 (80%) patients showed an improvement of semen analysis and 19/41 (46.3%) patients with infertility achieved a pregnancy with the partner. CONCLUSIONS: Microsurgical treatment of varicocele in outpatients by subinguinal approach is a safe and reliable procedure. It is performed in local anaesthesia, preserves the lymphatics, spermatic artery and vas and in our experience showed an improvement of semen analysis and pregnancy rates with minimal morbidity.

Adolescent↗
PubMed1998

[Clinicopathological and diagnostic study of amyloidosis of oral maxillofacial area].

OBJECTIVE: To study the clinicopathological features of amyloidosis studied in oral maxillofacial area and the diagnostic methods. METHODS: HE staining and staining of alkaline Congo red, Immunohistochemical staining, Sections examined by transmitted and polarized light microscopy, Transmitted electron microscopy. RESULTS: 14 cases of the disease were reported. Clinically, the patients usually had progressive enlargement and solidness of the tongue (macroglossia, 12 cases), hard nodules or cords of the cheek and lip mucosa (8 cases), single or multiple hard masses of submandibular and submental areas (6 cases), and ecchymosis or petechiae of the face, neck, chest or oral mucosa. Microscopically, the disease is characterized by the even pink amyloid protein deposit in the soft tissues and the wall of blood vessles, which shows positive staining of alkaline Congo red, Immunohistochemical staining can differentiate the primary amyloidosis from secondary one. Ultrastructurally, Amyloid protein appeares as felt-like finely filament. CONCLUSION: Amyloidosis involving in oral maxillofacial area mainly arise in tongue, less frequently, in buccal and lip mucosa, salivary glands. It is not difficulty to dignosis the disease by HE staining combining with staining of alkaline Congo red and other specific staining methods. Ultrastructural and immunohistochemical study is helpful to make show the dignosis.

Adult↗
PubMed2001

Hysteroscopy in bitches.

The aim of this study was to determine whether the canine endometrium could be examined by hysteroscopy. Eight German shepherd bitches were used. Two bitches were in dioestrus, five were in anoestrus and one was about 8 weeks post partum. The uterus was exposed through a ventral celiotomy. A 3 mm straight laparoscope or a 4 mm laparoscope with a 30 degrees angle, and a catheter for inflation of the uterus were used. After hysteroscopy the bitches were spayed and the uterus of each bitch was examined macroscopically and histologically. Endometrium and uterotubal junctions were visible in all bitches. The cervix and caudal uterine body could not be visualized in three bitches as two bitches had uterine discharge and air escaped through the cervix in the other bitch. In the post-partum bitch, dark-brown sites of implantation were observed. Four bitches (aged 9, 22, 25 and 31 months) had endometrial cysts (0.5-2.0 mm in diameter). Hysteroscopy caused petechiae and ecchymosis in the endometrium of four bitches. Traumatization of the endometrium affected only the epithelium and the most superficial part of the lamina propria. In conclusion, hysteroscopy appears to be a very sensitive tool for evaluation of the canine endometrium. Further research is necessary to determine the effects of hysteroscopy on subsequent fertility.

Animals↗
PubMed2001

Streptococcus suis infection in northern Thailand.

A ten-case report of Streptococcus suis infection was reported in Lamphun, northern Thailand from 1999 to 2000. Ten patients were admitted to Lampoon Provincial Hospital with a history of high fever, watery diarrhea, severe myalgia and ecchymosis rashes. The disease progressed rapidly and all patients died within 24-48 hours after admission from complications such as disseminated intravascular coagulation (DIC), acute renal failure (ARF) or acute respiratory distress syndrome (ARDS). Epidemiological data revealed that all cases were healthy men aged between 40-49, residing in the same geographical area and had a history of raw pork or uncooked pig's blood consumption prior to their illnesses. Blood culture and genetic investigation (16 s rRNA polymerase chain reaction with restriction enzyme PstII) confirmed diagnoses of the same species of Streptococcus suis infections.

Adult↗
PubMed2001

Incidence of oral tissue trauma after the administration of general anesthesia.

BACKGROUND: Administration of general anesthesia necessitates certain amounts of manipulation or instrumentation within the mouth that may cause some oral tissue injuries. The purpose of this study was to determine the incidence of oral tissue trauma after receiving general anesthesia. Some possible risk factors were explored. METHODS: Four hundred and four adult patients receiving surgical procedures under general anesthesia facilitated by endotracheal intubation were included in this prospective survey. In each patient detailed oral and dental conditions were evaluated and recorded by an oral surgeon before and after operation. The extent of oral tissue trauma were computed and the type and character of the injury were recorded. RESULTS: Twenty-eight patients (6.9%) were found to sustain various degrees of oral trauma that included soft tissue laceration, tooth fracture, prosthesis damage, tooth avulsion, ecchymosis and numbness of tongue. Preexistence of missing tooth, crown, and residual root were some possible risk factors that might predispose to complication. CONCLUSIONS: Oral tissue trauma as it seems to be a common anesthetic complication that should be considered as a recognized hazard of general anesthesia. Understanding and recognizing oral anatomical condition and pathological change before anesthesia may help the anesthesiologists in preventing oral and dental complications and thus to avoid legal suits.

Adolescent↗
PubMed2001

[Pemphigoid and acquired hemophilia].

INTRODUCTION: The association of bullous pemphigoid and acquired haemophilia is reported. CASE-REPORT: A 74 year-old man developed a bullous pemphigoid after decreasing corticotherapy, ecchymosis and haematomas revealing a high level of acquired anti-VIII antibodies (110 Bethesda UB units; TCA 98 s). Immunosuppressive treatment (cyclosporine, prednisone, azathioprine and bolus of cyclophosphamide) did not stop the disease. Perfusion of recombinant factor VIIa, human immunoglobulins and prednisone-azathioprine association permitted clinical and biological remission. DISCUSSION: Acquired haemophilia is idiopathic half the time. It can appear in autoimmmune diseases. Mortality is high. Only 4 cases of association with bullous pemphigoid have been reported in the literature. At the haemorrhagic phase, porcine factor VIII or more recombinant activated factor VII with human immunoglobulins are necessary. Immunosuppressive treatment is used to decrease production of anti-factor VIII antibodies.

Aged↗
PubMed2002

Clinical and laboratory features of congenital factor XIII deficiency.

OBJECTIVE: This is a retrospective analysis of the clinical and laboratory features of 17 cases of factor XIII deficiency that were followed in tertiary care hospitals in Riyadh, Kingdom of Saudi Arabia, over 20 years. Cases were referred to these hospitals from other health care centers in the country. METHODS: We performed a retrospective analysis of 17 cases of factor XIII deficiency comprising 11 males and 6 females, who were seen over a period of 20 years (1978-1998) in Riyadh, Kingdom of Saudi Arabia. Data variables including age, sex, origin, clinical presentation, bleeding time, prothrombin time, partial thromboplastin time, factor XIII screening and assay, hemoglobin, and platelet count were collected and analyzed. The diagnosis of factor XIII deficiency was made by urea clot lysis test alone in one patient and urea clot lysis test in combination with factor XIII quantitative assay in 16 patients. RESULTS: Eleven patients were males and 6 were females. Median age at the time of diagnosis was 9 years (3-29 years). Ten patients (59%) had a family history of excessive bleeding. Presenting symptoms included ecchymosis and recurrent hematomas in 12 patients (71%), bleeding after circumcision in 6 male patients (55%), umbilical stump bleeding in 7 (41%), poor wound healing and keloids in 3 patients (18%), and intracranial bleeding in 3 patients (18%). Other manifestations included cephalohematoma, abortion, abruptio placenta, and intraperitoneal bleeding (one patient each). Laboratory evaluation revealed a normal prothrombin time, partial thromboplastin time, bleeding time and platelet count in all patients. Factor XIII screening test was positive in all 17 patients tested and assay for factors XIII was <0.06 U/ml in 16 patients tested. CONCLUSION: Our data confirms that factor XIII deficiency is a rare bleeding disorder characterized by variable bleeding manifestations but consistent laboratory findings. The occurrence of keloid in our patient group may reflect the poor quality of the clotting, associated with loss of tensile strength of fibrin polymers, caused by factor XIII deficiency and leading to abnormally large scar formation.

Adolescent↗
PubMed2002

Efficacy of celecoxib versus ibuprofen in the treatment of acute pain: a multicenter, double-blind, randomized controlled trial in acute ankle sprain.

Ankle sprain is a common acute soft-tissue injury that often results in pain, inflammation, and ecchymosis. In this multicenter, double-blind, randomized parallel-group study, 445 adult patients received celecoxib 400 mg/day, ibuprofen 2,400 mg/day, or placebo for 10 days. Patients had experienced grade 1 or 2 ankle sprains within 48 hours and had moderate to severe ankle pain. Patient's Global Assessment of Ankle Injury responses, given on days 4 and 8, showed that the celecoxib group improved significantly more than the placebo group did, with 67% of the celecoxib group versus 55% of the placebo group improving at day 4 (P < .05). Patient's Assessment of Ankle Pain Visual Analog Scale on Weight Bearing responses, also given on days 4 and 8, showed that celecoxib was as efficacious in the treatment of ankle sprain as the maximum therapeutic dosage of ibuprofen and that, compared with placebo, it reduced pain significantly more (P < .05). The celecoxib group recovered and returned to function earlier (after 5 days) than did either the placebo group (8 days) or the ibuprofen group (6 days); the celecoxib-placebo difference was significant. Celecoxib, a cyclo-oxygenase-2-specific inhibitor with platelet-function-sparing properties, may be useful as a multimodal adjuvant in the treatment of ankle sprain.

Adolescent↗
PubMedDate not supplied

[Carbamazepine-induced aplastic anaemia: a case report].

INTRODUCTION: The widespread use of carbamazepine in multiple neurological disorders makes it a drug whose most frequent side effects are well known and controlled. Aplastic anaemia is a very rare side effect, although it is the most serious since it presents a high mortality rate. CASE REPORT: We report the case of a 51 year old male patient who suffered brain injury that required daily treatment with 600 mg of carbamazepine. In the sixth month of treatment he was found to have a decrease in the number of platelets, which was confirmed a month later. He was admitted to hospital and diagnosed as having a medullar aplasia. Despite therapy with immunosuppressants, he died 12 weeks later. DISCUSSION: The appearance of aplastic anaemia does not seem to be related to age, the disease treated or to be dose dependent. Most cases are seen 3 4 months after treatment and the risk period is the first year. The choice treatment is a bone marrow transplant in patients under the age of 50; in older patients the recommended treatment is immunosuppressant therapy. The early diagnosis of aplastic anaemia is essential, although the difficulty lies in determining how often haematological controls are to be performed, since some cases have appeared a few days after beginning treatment. The frequency of the controls must be based on the clinical judgement of the doctor with regular check ups to detect haematological problems (infections, high temperature, ecchymosis) and to warn the patient and relatives should any of the symptoms appear.

Anemia, Aplastic↗
PubMedDate not supplied

Outpatient surgery for penile venous patch with the patient under local anesthesia.

Although local anesthesia for penile surgery has been widely reported, its application for penile venous patch, however, has not been published. We evaluated an anesthetic and surgical technique on an outpatient basis. From March 1993 to September 2001, a total of 29 men with penile deformity, aged 27 to 77 years (mean 55 years) received a penile venous patch for morphologic correction. They received autologous grafting of the deep dorsal vein under local anesthesia as an outpatient procedure. The anesthetic effect and postoperative results were satisfactory. The average available area of the deep dorsal vein was 5.7 x 2.5 cm(2). The common immediate side effects included puncture of the vessels, subcutaneous ecchymosis, and transient palpitation, but there were no significant late complications. All patients returned home uneventfully. This has been proven to be a cost-effective, simple, and safe method with fewer complications. It offers the advantages of lower morbidity, protection of privacy, fewer adverse effects of anesthesia, and a more rapid return to activity with minimal complications.

Adult↗
PubMed2003

Management of traumatic abdominal wall hernia.

Traumatic abdominal wall hernia (TAWH) can occur after blunt trauma and can be classified into low- or high-energy injuries. Low energy injuries occur after impact on a small blunt object. High-energy injuries are sustained during motor vehicle accidents or automobile versus pedestrian accidents. We present six cases of high-energy TAWH cases that were treated at our trauma center. All patients presented with varying degrees of abdominal tenderness with either abdominal skin ecchymosis or abrasions, which made physical examination difficult. CT scan confirmed the hernia in each patient. All six patients had associated injuries that required open repair. The abdominal wall defects were repaired primarily. Three patients (50%) in our series developed a postoperative wound infection or abscess. Review of the literature on low-energy TAWH shows no associated abdominal injuries. In conclusion distinction between low- and high-energy injury is imperative in the management of TAWH. Hernias following low-energy injuries can be repaired after local exploration through an incision overlying the defect. TAWHs following high-energy trauma should undergo exploratory laparotomy through a midline incision. The defect should be repaired primarily and prosthetics avoided because of the high incidence of postoperative infection.

Abdominal Injuries↗
PubMed2003

[Rupture of the triceps brachii tendon: a case report].

Triceps tendon rupture is a rare condition. A thirty-three year old man presented with a complaint of pain in his left elbow, which occurred when his motorcycle slid and flipped on one side. Physical examination two days after the accident showed swelling and ecchymosis in the elbow. There was a palpable, slightly tender defect in the triceps tendon just above the olecranon. He had normal supination and pronation. A marked weakness was noted in elbow extension as compared with the other side. A diagnosis of triceps tendon rupture was made. Radiographs revealed osteoarthrosis of the elbow joint and osteophyte formation on the top of the olecranon. Magnetic resonance scans showed a partial tear in the triceps tendon. It was repaired with large, nonabsorbable sutures passed through the holes drilled in the olecranon. The extremity was immobilized for three weeks, followed by progressive active flexion in a controlled-motion brace. Active strengthening of the triceps was begun after three months. At the end of a year, the range of motion of the elbow was full except 10 degrees loss of extension and there was no pain.

Accidents, Traffic↗
PubMed2003

Introducing colposcopy and vulvovaginoscopy as routine examinations for victims of sexual assault.

Victims of sexual assault require appropriate care, follow-up and information regarding their legal rights. Clinicians are faced with the challenging responsibility of identifying victims and providing effective interventive and preventive counselling. The most pressing medical task is to confirm the assault and to undertake correct documentation and exhibition of biological traces. Performing colposcopy and vulvovaginoscopy does not allow us to diagnose a sexual assault trauma, but it can help us to identify those microscopic lesions (due to the enhanced visualization and the higher resolution under which the genital areas are examined) that may not be seen during a normal clinical examination. The colposcopic and vulvovaginoscopic examination starts from the vulvar region looking for superficial lacerations and ecchymosis; the labia majora and minor are examined scrupulously, then the posterior forchette, the perineum and the hymen where it is possible to report microulcerations, contusions and even possible scars due to a precedent defloration. Recent advances in clinical forensic medicine show that trained examiners using colposcopy obtain evidence of genital trauma in 87% to 92% of rape victims. Colposcopy and vulvovaginoscopy must be performed within 48 hours from the sexual assault, because most of the lesions heal rapidly. Colposcopy and vulvovaginoscopy may be seen as a stressful invasion of a woman who is already vulnerable and at risk of the rape trauma syndrome. Prior information about colposcopy may reduce the level of anxiety experienced by many women undergoing this procedure. Incorporating colposcopy and vulvovaginoscopy into the routine assessment of sexual assault victims could be a valid way of identifying genital injuries; moreover the medical report will be more detailed and precise.

Colposcopy↗
PubMed2003

Severe adenovirus infection in children.

During the period from July 1, 1999 to September 30, 2000, 9 children with severe adenovirus infection were treated at Chang Gung Children's Hospital. The mean age was 22 months (range, 5-50 months). All of them had lower respiratory tract infections, which manifested as lobar or segmental pneumonia and pleural effusion. Eight (88.9%) of the 9 patients required intensive care and 4 of them required mechanical ventilation. Abnormal laboratory findings included leukocytosis, elevated C-reactive protein, anemia, and prolonged prothrombin time and partial thromboplastin time. Extrapulmonary complications included hepatitis (6 cases), encephalitis (3), conjunctivitis (3), periorbital ecchymosis (1), and coagulopathy (2). One patient died, resulting in a mortality rate of 12.5%. Follow-up at 3 months postdischarge, 5 patients (62.5% of survivors) had bronchiolitis obliterans and/or organizing pneumonia. Seven patients were infected by serotype 3 adenovirus, 1 patient by serotype 2, and another by serotype 11. In conclusion, the clinical, laboratory, and radiographic features of severe adenovirus infection may mimic bacterial infection. Rapid progression of the clinical course despite antibiotic therapy and the presence of unusual extrapulmonary symptoms are important clinical clues in the diagnosis of severe adenoviral infection.

Adenovirus Infections, Human↗
PubMed2003

[Mastoscopic extirpation of benign breast masses by small and concealing incision].

OBJECTIVE: To investigate the feasibility and effect of the mastoscopic extirpation of benign breast masses by small and concealing incision. METHODS: 72 benign breast masses of 64 patients were mastoscopically extirpated. Transaxillary and transareolar small incisions were selected under local and vein analgesia anaesthesia. RESULTS: Most of patients were operated in clinic, only 28 patients in hospital. The average operation time was 46.1 minutes. The sensation and erection of breast nipples were normal in all patients. 2 patients with the more obvious complications (one with skin burned by electric scalpel, another with wide subcutaneous ecchymosis) complained this kind of operation, other patients were greatly satisfied with the cosmetic outcome of the operation. CONCLUSIONS: The mastoscopic extirpation of benign breast masses by small and concealing incision can be completed in most of the patients under local anesthesia. The incision is small and concealing, which raises the quality of life of the patients. This operation procedure meets the needs of wide women on the treatment of breast disease to a great extent and also alters the routine conception of the excision of benign breast mass.

Adolescent↗