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PubMedDate not supplied

Endoscopic resection of inverted papilloma: University of Miami experience.

BACKGROUND: The aim of this study was to evaluate the efficacy and safety of endoscopically resecting paranasal sinus inverted papillomas at a tertiary medical center. METHODS: Over a 9-year period, 51 patients with a diagnosis of inverted papilloma underwent endoscopic resection at the University of Miami/Jackson Memorial Medical Center. The study group consisted of 14 women and 37 men with a mean age of 59 years (range, 20-88 years) enrolled in a clinical data base. All of the patients were followed endoscopically at regular intervals on an outpatient basis. RESULTS: Endoscopic evidence of extensive papillomas involving the anterior and posterior ethmoid sinuses and at least one (usually the maxillary) dependent sinus was found in 60% of the cases. Extensive radiological disease (varying degrees of mucoperiosteal thickening or opacification of all five cavities) was evident in 50% of the cases. All but two had unilateral disease. An association with chronic inflammatory polyps (clinically and pathologically) was observed in 25 of 51 patients (49%). Follow-up ranged from 6 to 99 months (mean, 30 months). There have been seven recurrences (14%). Four of these have been managed in the office under topical anesthesia. Three recurrences were managed surgically in the operating room. All of the patients have been free of disease. Complications included an intraoperative CSF leak (three patients); temporary infraorbital hypesthesia (three patients); periorbital ecchymosis, hematoma, or cheek edema (four patients); and orbital symptoms (two patients). Carcinoma was found in four patients (8%) who received postoperative radiotherapy and remain free of disease. CONCLUSION: The endoscopic approach continues to provide at least equivalent short-term results as compared with external techniques for the removal of paranasal sinus inverted papilloma. The final cavity should allow for adequate postoperative surveillance and potential resection of recurrences in the office setting, without the need for a return to the operating room in most patients. The association of inverted papilloma with chronic inflammatory polyps and tobacco use warrants additional study.

Academic Medical Centers↗
PubMed2003

Hemorrhagic fever with renal syndrome presenting with intrauterine fetal death. A case report.

BACKGROUND: Hantavirus infection in pregnancy is rare. Only 2 cases of hantavirus pulmonary syndrome have been reported in the English-language literature. We report a case of hemorrhagic fever with renal syndrome (HFRS) complicating pregnancy to alert clinicians to this rare possibility. CASE: A 29-year-old woman had experienced persistent, high fever for 6 days, no fetal movement for 2 days and frequent vomiting for 1 day before being referred to our department with the additional symptoms of headache, lumbodynia and orbital pain. On examination, she had a normal body temperature, flushing of the face, conjunctive congestion, pharyngeal congestion, bulbar conjunctive edema, severe jaundice, petechiae and ecchymosis at sites of venipuncture, deranged liver and renal function tests, heavy proteinuria and hematuria, and coagulation disturbance. The diagnosis of HFRS complicating pregnancy was made on account of the clinical picture and antihantavirus IgM titer of 1:20. The patient's condition quickly deteriorated, with frank hematuria, oliguria and finally anuria, together with shock. Hemodialysis was immediately commenced, and a stillborn, male infant, of 3,200 g, was delivered vaginally following combined induction 12 hours after hemodialysis. The fetus showed no obvious abnormalities, but the parents declined an autopsy. After hemodialysis and delivery, the patient recovered and was discharged 3 weeks later. The repeat titer for antihantavirus IgM was 1:80 10 days after presentation. CONCLUSION: HFRS is a rare complication of pregnancy. The symptoms are nonspecific. Early diagnosis and appropriate management are necessary to improve the maternal and fetal outcome. Clinicians should include this condition in the differential diagnoses when a combination of hematologic, hepatic, renal and gastrointestinal problems presents in pregnancy.

Adult↗
PubMed1960

Snake venom poisoning in Southern California.

The annual incidence of rattlesnake bite in Southern California is approximately 1 per 75,000 population. The case fatality rate is 1.5 per cent. The snakes implicated in the greatest number of injuries are the southern Pacific rattlesnake, the red diamond rattlesnake and the sidewinder. Rattlesnake venom produces deleterious changes in the blood cells, defects in blood coagulation, injury to the intimal linings of vessels, damage to the heart muscle, alterations in the respiratory cycle and, to a lesser extent, changes in neuromuscular conduction. The most frequently observed symptoms and signs following ophidiasis in this area are swelling and edema, pain, ecchymosis, swelling of the regional lymph nodes, weakness, sweating, increased body temperature, faintness, and hemorrhagic vesiculations. First aid treatment consists of immobilization of the affected part, application of a constriction band, incision and suction with subsequent local application of ice packs. Treatment in hospital consists of administration of antivenin, antitetanus agent and antibiotic. Transfusions, oxygen and a corticosteroid may be indicated in some cases.

Animals↗
PubMed1992

Postoperative course after total hip arthroplasty: wound drainage versus no drainage.

This retrospective study of 364 patients with total hip replacements performed between 1985 and 1990 showed no benefit in the use of drains and found an increased rate of transfusion associated with the use of drains. The two study groups (171 patients with two closed-wound suction drains in the wound and 193 patients closed without drains) differed in the type but not in the rate of wound problems; the drained group had more drainage at the port site, whereas the undrained group had more ecchymosis and swelling. There was no significant difference between the groups in operative blood loss; however, the drained group did require transfusions significantly more often than the undrained group (98 of 171 [57.3%] as opposed to 83 of 193 [43%], respectively). Of the patients requiring transfusions, patients with wound drains required significantly more blood than those without drains (1.12 versus 0.62 transfusions per patient for men; 1.73 versus 1.03 transfusions per patient for women).

Analysis of Variance↗
PubMed2004

Simple clinical risk stratification and the safety of ambulation two hours after 6 French diagnostic heart catheterization.

Heart catheterization is frequently applied in patients with coronary artery disease for diagnostic and therapeutic implications. Using the femoral approach, post-procedure bed rest of 4 to 6 hours is recommended to prevent groin complications. This extended strict bed rest is associated with patient discomfort and increased medical costs, and interferes with more efficient catheterization laboratory management of referred outpatients. Accordingly, we tested a simple clinical approach to identify low-risk patients who may benefit from ambulation within two hours after sheath removal. Ninety-eight outpatients were stratified to early (time=1.5 to 2.0 hours; n=74) or conventional ambulation (time=4 to 5 hours; n=24) based on difficulties in obtaining arterial access, presence of oozing or hematoma after completing manual compression. Ecchymosis was the most frequent complication, noted in one early ambulated and three conventionally ambulated patients at hospital discharge and in eleven early ambulated and six conventionally ambulated patients at one-week follow-up. No large hematomas, retroperitoneal bleeding or need for blood transfusion occurred in any patients. Using simple clinical parameters, most outpatients who undergo elective diagnostic catheterization may benefit from safe early ambulation.

Ambulatory Care↗
PubMed2004

Hair-thread tourniquet syndrome. A case report.

The authors report the case of a 3-month-old boy with hair-thread tourniquet syndrome, seen just distal to the MP joint on the right fourth toe. The patient was brought to the hospital with a history of irritability and weeping. On examination there was swelling, ecchymosis and a hair fibre was found wrapped around his right fourth toe. After the hair fibre was removed there was a fast healing period and no signs of tissue necrosis were seen.

Constriction, Pathologic↗
PubMed2004

Diagnosis of Henoch-Schönlein purpura by sonography and radionuclear scanning in a child presenting with bilateral acute scrotum.

Acute scrotum presenting as the only initial manifestation of Henoch-Schönlein purpura (HSP) is so unusual that the diagnosis can easily be missed. We report this condition in a 4-year-old boy admitted with bronchopneumonia. Bilateral painful scrotal swelling with ecchymosis occurred on the second day of hospitalization. Scrotal sonography was performed and a good blood supply was documented. Scrotal nuclear scanning was performed and was consistent with bilateral epididymoorchitis. Multiple purpuric lesions over the lower extremities and perineal region developed on the third day of hospitalization. Intermittent abdominal pain and knee pain developed thereafter. HSP was diagnosed and steroids were prescribed. The symptoms subsided gradually and no complication was noted. This case reminds us that an acute scrotum may be the only initial manifestation of HSP. Sonography and nuclear scanning can help rule out other diseases.

Acute Disease↗
PubMed2002

Possible subdural hematoma associated with Ginkgo biloba.

A 78-year-old Caucasian man developed headache, confusion and progressive right-sided weakness following a fall resulting in ecchymosis over the left eye orbit five days prior to admission. A subdural hematoma was diagnosed upon CAT scan. Upon evacuation, a very large left frontoparietal subdural hematoma with the appearance of mixed elements of hemorrhage and older fluid was noted. The finding was chronic subdural hematoma described as "crankcase oil." The patient's only prior medications were lisinopril 20 mg daily and ginkgo biloba 50 mg three times a day. Ginkgo biloba is advocated to augment cerebral blood flow to enhance memory and improve dementia. One of Ginkgo biloba's components is ginkgolide B, a potent inhibitor of platelet activating factor essential for induction of arachidonate-independent platelet aggregation. We believe Ginkgo biloba either caused or predisposed this patient to subdural hematoma and is of concern given ginkgo's widespread use with minimal or no monitoring.

Journal Article↗
PubMed2004

[Meningococcal purpura fulminans in children].

In France, the incidence of meningococcal infections is increasing and the most severe presentation, called purpura fulminans, has still a death rate of 20-25%. Diagnosis of invasive meningococcal infection must be evoked in any child presenting with febrile purpura (vasculitic rash not disappearing with "tumbler test"); a fulminating form must be suspected in the presence of only one ecchymosis and signs of infection, remembering that recognition of shock is difficult in children. The Health Authority recommend to administer a third generation cephalosporin promptly for any child with signs of infection and an ecchymotic purpura (>3 mm of diameter), and then to refer the patient to the hospital. Children with purpura fulminans should be referred to a paediatric intensive care unit. Management includes antibiotics, steroids, fluid resuscitation and catecholamines (be aware of hypoglycaemia, particularly in infants, and hypocalcaemia). Treatment of cutaneous necrosis and distal ischemia is difficult and still controversial: antithrombin, protein C, tissue plasminogen activator and vasodilator infusion have no proved efficacy. Cases must be rapidly notified to the Public Health Service who will institute chemoprophylaxis for close contacts. Given the predominance of serogroup B in France, we hope that an efficient vaccine will soon become available.

Adolescent↗
PubMed1997

[Ocular injuries from strangulation].

Female patient, forty-two years old, was assaulted during sleep. She was strangulated with a rubber hose. After that, she presents one horizontal strangulation trace by 1.5 cm length at the base of the neck. Under this cyanotic trace she presents one cyanotic area by 3/3 cm. The skin of face presents, several petechial areas, swelling eyelids with ecchymosis more pronounced at right eye than left eye and subconjunctival hemorrhages. The left eye presents diminuation of ocular motility. The ophthalmoscopy shows a slow passing retinal edema which recovers at treatment. The visual acuity becomes normal. It is an interesting case due rarity of lesions.

Adult↗
PubMed2004

Systemic lupus erythematosus and calciphylaxis.

Calciphylaxis, a rare condition seen in association with endstage renal disease, is characterized by the appearance of painful, indurated plaques, ecchymosis, ulceration, and eschar formation. We describe a patient with systemic lupus erythematosus, endstage renal disease, and skin lesions first diagnosed as lupus profundus with vasculitis. Further investigation confirmed the diagnosis of extensive calciphylaxis.

Adult↗
PubMed2004

[Case report: a Fusarium fungaemia].

In this report, a case of Fusarium fungaemia developed in an acute lymphoblastic leukemia (ALL) patient was presented. A seven year old girl who had weakness, loss of appetite, paleness and ecchymosis on legs applied to Pediatric Hematology Service and cytotoxic chemotherapy was started after she had been diagnosed as ALL-L1. Her chemotherapy was stopped because of increase in fever, leukopenia and neutropenia. Central venous catheter and peripheral blood cultures were obtained. Fusarium thapsinum was recovered from blood cultures, obtained in two consecutive days. Thereupon central venous catheter of the patient was removed and intravenous amphotericin B was added to the therapy. On the fifth day of febrile neutropenia attack, her fever was decreased after the onset of antifungal therapy. Radiological examinations were normal and no fungal growth was observed in the later blood cultures. On the 21st day of amphotericin B therapy, chemotherapy was started again and amphotericin B was changed to peroral itraconazole (200 mg/day) at the fifth week. The patient whose itraconazole therapy was stopped after three months, was still in remission and continued receiving her prolonged therapy. In conclusion, Fusarium infections which manifest with fungaemia and fever as the only symptoms, should be taken into consideration in neutropenic patients receiving immunosuppressive therapy.

Amphotericin B↗
PubMed2001

Bilateral eye injury caused by a high-pressure water jet from a fire hose.

We present a case of bilateral eye injury caused by a high-pressure water jet from a fire hose. Eye injury secondary to high-pressure water jets are relatively rare, but invariably result in severe damage to all ocular structures. A 51-year-old woman was admitted to our ophthalmologic department for treatment following a direct hit in the face by a water jet from a fire hose from a distance of about one meter. The patient had bilateral extensive eyelid edema and ecchymosis, conjunctival chemosis with hemorrhage, vitreous hemorrhages in the right eye and iridodialysis with hyphema in the left eye, a transient decrease in intraocular pressure, bilateral superior commotio retinae with macular edema, and bilateral impairment of vision. The patient was treated with topical corticosteroids. Four months later she was re-admitted to our department for surgical repair of iridodialysis in the left eye. Iridodialysis had affected the entire superior nasal portion of the iris, and the pupil was displaced downward temporally. The iris partly obscured the visual axis. After surgical repair the visual axis was free. At a follow-up examination two years later, the ocular findings were the same. The best corrected visual acuity was 0.1 in the right eye and 0.3 in the left eye. Visual impairment was a consequence of permanent posttraumatic posterior fundus changes, particularly of the macula in both eyes. Intraocular pressure was within normal limits in both eyes. Injuries caused by high-pressure water jets are usually bilateral. The injuries are mainly confined to the lower anterior portions of the eye (Bell's phenomenon). Our patient had bent forward during the accident, therefore the central and upper chorioretinal portions were also affected. Such injuries usually cause severe damage to the anterior and posterior portions of the eyes and greatly reduce visual acuity in both eyes. Because of the risk of late complications (cataract, glaucoma, retinal detachment), long-term follow-up is recommended in such patients.

Eye Injuries↗
PubMed2004

Recurrent pulmonary embolism in an elderly patient with Cushing's syndrome, adrenocortical adenoma, pheochromocytoma and prostate adenocarcinoma.

Pulmonary embolism (PE) is a major health problem. Mortality in untreated PE is high, but with adequate (anticoagulant) treatment, can be reduced. Multiple primary and secondary risk factors are responsible for PE. But there is rare association of mixed adrenal tumor with PE. Here, we report a case of adrenocortical adenoma with Cushing's syndrome coexistent with pheochromocytoma with recurrent PE in an elderly patient with prostate adenocarcinoma. A 78-year-old Taiwanese retired veteran was admitted in July, 2002 with the presentation of syncope. Three years before, he was diagnosed with prostate adenocarcinoma and had received Androcur therapy since then. Five months later, he was admitted with Cushingoid appearance and hypertension. Abdominal imaging studies revealed a left adrenal tumor. Laparoscopic adrenalectomy revealed an adrenocortical adenoma. Two years later, a recurrent left adrenal tumor was found. Repeated laparoscopic adrenalectomy revealed pheochromocytoma. One month after the repeat laparoscopic surgery, the patient was admitted due to syncope. Chest X-ray revealed cardiomegaly with pulmonary venous congestion. Echocardiogram showed impaired right ventricle global systolic function. Perfusion lung scan showed a high probability of PE. Heparin and coumadin were given but stopped 5 weeks later due to the development of severe skin ecchymosis. In December 2002, the patient was admitted again with consciousness disturbance. Chest computed tomography (CT) revealed bilateral PE, and he died 5 hours later due to cardiogenic shock. In conclusion, in elderly patients with Cushing's syndrome with pheochromocytoma and prostate carcinoma, there is probability of pulmonary embolism.

Adenocarcinoma↗
PubMedDate not supplied

[Usefulness of establishing diagnosis and severity of the most frequent signs and symptoms in preeclamptic patients].

OBJECTIVE: Our aim was to determine that signs and symptoms are tools in establishing diagnosis and severity of preeclampsia. MATERIALS AND METHODS: Our study design was prolective, comparative, cross-sectional for evaluation of diagnosis. Our sample included 408 patients. The study employed classification criteria of the American College of Obstetricians and Gynecologists. One blinded family physician interrogated and examined each patient. The sample included patients with recent diagnosis and without treatment. Patients with HELLP syndrome, eclampsia, and those in Intensive Care were excluded. Clinical signs evaluated included headache, Phosphenes, acuphenes, tinnitus, vomiting, epigastric pain, right hypochondrium pain, ecchymosis, hematomas,and hyperreactive reflexes. RESULTS: A total of 192 patients without preeclampsia, 63 with mild, and 153 with severe preeclampsia were included. Clinical manifestations were absent in 60, 21 and 8% respectively of patients in each group. Presence of three or more signs or symptoms had sensitivity of 60% (CI95% 53-67), specificity of 84% (CI95% 79-89), and positive likelihood ratio of 3.8 and negative, 0.48. Most usefulness data for diagnosis of preeclampsia are hyperreactive reflexes, phosphenes, acuphenes, right hypochondrium pain, and epigastric pain. CONCLUSIONS: The symptoms and signs taken alone are tools for evaluation of severity but not for detection of preeclampsia. There is necessary to develop new way for it's diagnosis during prenatal care.

Cross-Sectional Studies↗
PubMed2004

[Endovenous holmium laser treatment for varicose veins].

OBJECTIVE: To discuss the technical points, advantages, follow-up results and mechanism of endovenous holmium laser treatment for varicose veins. METHODS: Endovenous holmium laser procedures were performed for 96 patients (99 legs) with primary varicosity of lower extremities. Perioperative Duplex was used for preoperative diagnosis, intraoperative guide and postoperative follow-up. The time of procedure and clinical results were observed. The mean follow-up time was 7 months. RESULTS: Sixty-seven in 99 legs with saphenous vein occluded immediately during operation. All saphenous veins were confirmed to be occluded 7 days after the procedure. There was no recanalization with Duplex finding during the follow-up period. No wound complications. Two cases were with minor skin burn. One case was with saphenous nerve injury. Three cases were with thigh ecchymosis. CONCLUSION: Preliminary results show endovenous holmium laser treatment for varicose veins is safe and effective in treating varicose veins with cosmetic appearance and quicker recovery.

Adult↗
PubMed2005

Rattlesnake envenomation to the face of an infant.

BACKGROUND: Mortality from rattlesnake envenomation in the United States is rare. Despite approximately 8000 crotaline (pit vipers) bites annually, it is estimated that only 10 to 15 deaths occur. Besides direct intravascular envenomation and anaphylaxis, bites to the head and neck may account for some of these rare fatalities. We report a pediatric case of severe facial envenomation requiring emergent intubation and antivenom administration. CASE REPORT: A 14-month-old female toddler was envenomated by a Southern Pacific rattlesnake (Crotalus viridis helleri) above the right upper lip while playing in her backyard. Rapid swelling and ecchymosis developed, and the patient was airlifted to a pediatric tertiary care hospital. Within 3 hours, stridorous respirations complicated by significant facial and oropharyngeal edema necessitated emergent orotracheal intubation. A total of 16 vials of FabAV [Crotalidae Polyvalent Immune Fab (ovine) antivenom] were administered over the next 24 hours. The child gradually improved and was successfully extubated 5 days later. A 3-month follow-up demonstrated no significant cosmetic facial abnormalities. CONCLUSION: Crotaline bites to the head and neck have the potential for significant swelling and airway compromise. Facial bites, anaphylaxis, and rare intravascular envenomation may account for many of the fatalities from rattlesnake envenomation. Early intubation may be required to maintain airway patency.

Animals↗
PubMed1992

Blepharoplasty. A refined technique emphasizing accuracy and control.

Although these techniques may seem demanding in controlling bleeding and avoiding use of local anesthetic, they provide distinct advantages: (1) Morbidity of tissue staining and subsequent ecchymosis is dramatically reduced. (2) Although edema still occurs, additional resolution time for breakdown of hemoglobin in the tissues is reduced, and the patient can resume normal activities with less camouflage makeup more rapidly. (3) Intraoperatively, lack of tissue staining and lack of distortion by local infiltration enable the surgeon to see anatomic structures, detail, and contour irregularities that are simply not visible or identifiable when infiltration has been performed, increasing both the accuracy and safety of the procedure. (4) Strict adherence to the principles of avoiding any dissection and of controlling bleeding deep to the plane of the orbital septum avoids the most dangerous potential complications of blepharoplasty while improving aesthetic results by avoiding overresection of soft-tissue components of the eyelids. (5) All of these techniques increase the accuracy, control, predictability, and safety of blepharoplasty.

Adult↗