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At least 559 records · Page 31Linked to original sources

[The use of a closed-suction drain in total knee arthroplasty: a prospective, randomized study].

OBJECTIVE: To determine the value of using a closed-suction drain in cemented knee arthroplasty. METHODS: One hundred patients were prospectively randomized into two groups, one group underwent cemented total knee replacement with a single deep closed-suction drain, and the other group (n = 50) no drain. RESULTS: The total blood loss was significantly greater in those with a drain although those without lost more blood into the dressings. There was no statistical difference in the postoperative swelling or pain score, ecchymosis, deep vein thromboses (DVT), time at which flexion was regained or the incidence of infection at a minimum of two years after surgery in the two groups. CONCLUSION: There is no evidence to support the use of a closed-suction drain in cemented knee arthroplasty.

Aged↗

Cutaneous aging: effect of intrinsic changes on surgical considerations.

Intrinsic age-related structural and functional changes in the skin, independent of sun-induced damage, directly affect wound healing in the elderly. These alterations, as well as concomitant medical illness, pharmaceutical intake, and dietary changes, result in delayed wound healing, decreased ultimate tensile strength, and increased rates of wound dehiscence, ecchymosis, tape-strip injuries, infection, and persistent contact dermatitis.

Adult↗

[Clinical application of extracorporeal shock wave lithotripter (SD-3) to upper urinary tract stones].

The extracorporeal shock wave lithotripter (SD-3) was used on 30 patients with upper urinary tract calculi from December, 1988 to March, 1989. At one month after the treatment, 11 patients (36.7%) were free from stones and 9 (30.0%) had stone fragments than 5 mm in diameter, making an effective rate of treatment of 66.7%. Gross hematuria, skin ecchymosis, pain and fever were observed as side effects, but none of them were serious. We concluded that extracorporeal shock wave lithotripsy using SD-3 for upper urinary tract stones is an effective treatment without any serious side effects.

Adult↗

Cutaneous lymphangiosarcoma of Stewart-Treves.

Lymphangiosarcoma of an edematous extremity is a highly malignant cutaneous neoplasm seen most often ten years after a successful radical mastectomy. The sarcoma presents with an ecchymosis and/or purplish cutaneous nodules on the edematous arm; it spreads through the bloodstream and is fatal in most cases. A case is presented which shows some typical and some unusual features of this disease.

Aged↗

[A primary report on thrombolytic therapy of acute myocardial infarction in 40 cases].

Forty cases with acute myocardial infarction were treated by thrombolysis from June, 1989 through September, 1990. 32 males and 8 females. Age 44-76 (60 +/- 7.1) years. Coronary angiography was performed in 19 patients 10 days after intravenous thrombolysis on average. With intravenous thrombolysis the reperfusion rates were 69.2% (9/13) for streptokinase and 53.8% (7/13) for urokinase (Green Cross Company, Japan) according to the clinical criteria. No reperfusion was observed in 8 cases treated by China-made urokinase. The reperfusion rate of intracoronary thrombolysis was 85.7% (6/7). 5 cases had hemorrhagic complications, skin ecchymosis in 2 and mild gastrointestinal bleeding in 3, and no transfusion was necessary. No intracranial hemorrhage was noticed.

Adult↗

[Examination of the inhibitor to factor VIII in non-haemophilic patient].

We examined an inhibitor to factor VIII in non-haemophilic patient who had been developed widely spread ecchymosis and intramuscular bleeding. He had no previous personal or family history of abnormal bleeding tendency. His laboratory data was all normal except examination for blood coagulation. Coagulation studies showed prolonged activated partial thromboplastin time (48 sec) and decreased factor VIII activity (8%). The activity of the inhibitor to factor VIII was demonstrated to be 4.0 Bethesda unit. By the studies of dilution and time response curve, this inhibitor was found to inhibit up to 90% of factor VIII activity but not 100%. This inhibitor was shown to be IgG by protein-A affinity chromatography. In addition, bleeding time was prolonged in the patient. The value of von Willebrand factor antigen was 200%, but that of Ristocetin cofactor was 93%. Since the gel filtration analysis indicated that this inhibitor also suppressed Ristocetin cofactor activity, the relatively low value of Ristocetin cofactor might occur through the action of the inhibitor. These data suggest that patient's inhibitor react to factor VIII high molecular subunit.

Blood Coagulation Disorders↗

Emergency excretory urography in blunt abdominal trauma.

In a prospective study the authors correlated the degree of hematuria and of blunt abdominal trauma with the results of emergency excretory urography. Urograms were obtained for 37 patients who presented with blunt abdominal trauma, no gross hematuria and at least five erythrocytes per high-power field (hpf) on microscopic urinalysis. Microscopic hematuria was defined as an erythrocyte count of more than 5 and fewer than 50 per hpf. Major trauma was defined as shock (systolic blood pressure of less than 90 mm Hg), fracture of the lumbar spine, the pelvis or the lower ribs, ecchymosis in the flank or acute abdominal injury. Contusions and small subcapsular hematomas were defined as nonsignificant renal injuries; all other renal injuries were defined as significant. Of 17 patients with minor blunt abdominal trauma 14 had fewer than 50 erythrocytes per hpf; none of these had a significant renal injury, whereas 1 of the 3 with more than 50 erythrocytes per hpf did have a significant injury. Of 20 patients with major trauma 5 had a significant renal injury. The authors conclude that microscopic hematuria associated with blunt abdominal trauma but without shock or major nongenitourinary injury does not warrant routine excretory urography.

Abdominal Injuries↗

Treatment of flexor tenosynovitis of the hand ('trigger finger') with corticosteroids. A prospective study of the response to local injection.

We developed a protocol to maximize medical therapy for "trigger finger." Fifty-eight patients with 77 episodes of flexor tenosynovitis of the hand that was resistant to rest, therapy with nonsteroidal anti-inflammatory drugs, and/or splinting were treated with single or multiple injections of depo-methylprednisolone acetate or triamcinolone acetonide. Patients were prospectively followed up for an average of 4.6 years. Results showed that symptoms and signs resolved in 61% after a single injection. Recurrent episodes, after prolonged pain-free intervals, occurred in 27% and were effectively re-treated with injection. In 12% of cases, either injection failed or early recurrence required surgical release. Local adverse reactions to injection, including pain at the injection site, stiffness, ecchymosis, or atrophy of subcutaneous fat, were self-limited. No episodes of postinjection infection or tendon rupture occurred. The medical management of flexor tenosynovitis with local corticosteroid injection(s) is effective in nearly 90% of cases and is free from serious adverse reactions.

Anti-Inflammatory Agents↗

[Idiopathic thrombocytopenic purpura in children treated with replenishing qi and tonifying kidney and the changes in thrombocyte aggregative function].

UNLABELLED: Forty-one children with idiopathic thrombocytopenic purpura (ITP) were reported in this paper. Of all, 36 with petechia and ecchymosis, 28 with nasal hemorrhage, 5 with hematochezia and 1 with subcutaneous hematoma. According to the TCM differentiation, 24 and 17 of all belonged to the type of impairment of Yin due to blood-heat and both deficiencies of Qi and tonifying Kidney and its basic prescriptions were: dried Radix Rehmanniae, Radix Angelicae Sinensis, Radix Paeoniae Rubra, Radix Rubiae, Fructus Psoraleae, stir-frying Radix Astragali, Semen Cuscutae, Caulis Spatholob; Chinese Jujubae, Radix et Rhizoma Rhei. The average treating duration was 5.02 months. RESULTS: 24 cases cured, 6 recovered, 10 improved, 1 failed, with a total effective rate of 97.6%. 22 of the cured were followed-up without recurrence in average 10.4 months after withdrawal. In 32 cases, the thrombocyte aggregative function was tested with ADP induction, meanwhile in 20 of 32 cases aggregation with adrenaline induction was tested. The results before and after treatment showed an evident difference, with low function before treatment and normal after treatment. It is concluded that the replenishing Qi and tonifying Kidney may have a better effect on both acute and chronic children ITP without recurrence after withdrawal.

Child↗

[Tongue picture of blood stasis symptom-complex].

The objective indices of tongue picture of blood stasis symptom-complex in 400 patients with portal hypertension, primary hepatic carcinoma, coronary heart disease, pulmonary heart disease, intermediate and advanced gastric carcinoma were observed during the period of past 6 years. Pale purplish tongue, purplish tongue, bluish purplish tongue, deep-red purplish tongue, dark tongue, yellow purplish tongue etc. were found in these patients. All these were the tongue colour of blood stasis. Ecchymosis, patechiae, streaks, the width of sublingual vein, the appearance of veins and prominences, B mode ultrasonic examination displaying the width of intralingual vein and tissue sound transmission of the tongue body, the blood stasis changes of tongue tip microcirculation, the wave form changes of tongue rheogram had an important significance for diagnosis of blood stasis. There were significant differences in these variables between the subject group and the healthy group or the subject group and the blood non-stasis group statistically (P less than 0.001).

Adult↗

[Clinical studies on treatment of fractures of the zygomatic bone].

The author has made clinical studies on treatment of fractures of the zygomatic bone in terms of frequency of fractures according to sex, age, fracture type, main manifestations and treatment methods from 106 patients with zygomatic bone fractures among 969 patients with maxillofacial bone fractures. The results obtained were as follow: 1. The frequency of malar bone fracture was 4 times more in male than that in female. 2. The most prevalent age of malar bone fracture was 21-30 years of age, and the nexts were followed 11-20, 31-40, 0-10, 41-50, 51-60, 61-70, and over 71 in the orders. 3. Among maxillofacial bone fractures, mandibular fracture was most prevalent as 76.3%, and the nexts were followed by the maxilla (10.8%), the molar bone (9.7%) and the nasal bone (3.3%). 4. Among 106 fractures of the malar bone, zygomatic bone fracture only was occupied 48.1%, but the rests were accomplished by another maxillofacial bone fractures. 5. In classification of molar bone fractures according to Knight and North's, group 3 fractures were most prevalent, and followed by group 2, 1, 4 and 6 in the orders. 6. Main manifestations were upper cheek flattening, lower eyelid ptosis, subconjunctival ecchymosis, epistaxis, difficulty of mouth opening, pain during mouth opening and others in the orders. 7. 93.4% of malar bone fracture has been treated surgically, but the rests treated conservatively, and [symbol: see text] shaped elastic stapler wire has been effectively used to get fixation at zygomatico-maxillary fractures.

Adolescent↗

[33 cases of hematoma of the rectus abdominis muscle in a surgical department].

The authors report a series of 33 hematomas of the recti-abdominis muscles from a surgery department: 15 occurred under anticoagulants 6 were spontaneous, 5 followed trauma and 6 a surgical procedure. The clinical picture was subacute in 24 cases, combining an abdominal pain (32 cases) a mass (10 cases) and an extensive ecchymosis (6 cases). The picture was acute in 6 extensive hematomas with collapse and anemia. In 3 cases an isolated mass was the first symptom. Echography has represented, since 1977, a decisive advance in the diagnosis, which was found to be accurate in 5 out of 10 cases before its introduction, and in 19 out of 20 when it was resorted to in the 23 cases recorded later. TDM is useful only in few cases. 23 patients were have been operated on: 6 for cardiovascular collapse, 3 because the diagnosis had not been made, 8 on order to confirm the diagnosis, 3 because of an increase in size of the hematoma and 3 owing to infection. In the 10 cases not submitted to surgery, the evolution was favourable. The therapeutic approach must be lanced according to the patient's condition, the size, side effect and evolution of hematoma. The aim of the operation is to evacuate the hematoma, to drain it and sometimes to tie up the bleeding vessel.

Abdominal Injuries↗

[Intra-arterial digital angiography using a trans-humeral approach in the assessment of ambulatory patients].

The authors report their experience with intraarterial digital subtraction angiography (DSA) performed on outpatients via brachial artery catheterization. A total of 120 outpatients were studied for cerebral and lower limbs vascular diseases. Transbrachial catheterization was performed with 5F or, preferably, with 4F angiographic catheters. Success rate was high and the transbrachial approach was always easy. In the course of cerebral examination (18/120 cases) the catheter was always easily positioned in the ascending thoracic aorta, through right transbrachial approach. In the course of abdominal aorta and lower extremities examination (102/120 cases), the ideal catheter positioning--in the descending aorta--was performed in 95/102 cases, by left transbrachial approach, while in 7/102 patients the catheter was placed in the ascending aorta. The complication rate was low: 7/120 ecchymosis, 4/120 small hematomas spontaneously resorbed, and 2/120 transient spasms of brachial artery. The authors suggest trasbrachial intraarterial DSA as an alternative to intravenous DSA in outpatients.

Ambulatory Care↗

[Lipedema: clinical and diagnostic criteria].

Lipedema is a common disease in the usual clinical practice. None organic description about the clinical symptoms and signs associated to this condition has been published. Fifty women with lipedema have been examined by the authors, and incidence rates of symptoms and signs have been emphasized. The following signs and symptoms were constantly reported: "Egyptian column", elastic edema, negative Stemmer's sign, alterated plantar support, cutaneous hypothermia. Some others were frequently found: ecchymosis, spontaneous pain, liposclerosis on the thigh, hypodermic hyperalgesia and pain on the internal face of the knee. Moreover, the two most relevant differential diagnosis as well as their two variant's clinical features (mixed lipedema and "thin women" lipedema) have been described.

Adipose Tissue↗

[A differential diagnosis of sural phlebitis: popliteal cysts. Value of ultrasonography (author's transl)].

Two cases are reported of popliteal cysts simulating sural phlebitis, one in a patient with lupus, the other during the course of rheumatoid arthritis. Diagnosis is based upon the following signs: sudden onset of pain, sometimes after effort, and in the knee rather than in the calf, and more especially ecchymosis occurring in the internal supramalleolar region. The decision as to whether anticoagulant treatment should be instituted must be based on the certitude of the diagnosis, and this can be obtained in an atraumatic manner by ultrasonography of the popliteal fossa as shown by iconography.

Adult↗

[Value of Varady percutaneous microsurgical phlebologic extraction of varicose veins].

Varicectomy is a particularly useful procedure in the surgical treatment of varicose branch veins and perforating veins, since it allows selective estirpation without affecting the main trunk of the long saphenous vein (LSV). At the same time, there is usually no need of further sclerotherapy. The operation can be performed under local anaesthesia in the outpatient's department or, if a saphenofemoral junction insufficiency has to be simultaneously removed, during a short stay in hospital. The aesthetic results are remarkable. With the help of the new delicate instruments devised by Varady, the incisions are very small, making sutures unnecessary. All the varicose veins can be removed at once, there is no loss of blood and no need for prophylaxis against thrombosis and the postoperative ecchymosis is minimal. Thus the method can also be applied in elderly patients.

Anesthesia, Local↗

[Histopathologic and cytochemical studies of the kidneys of guinea pigs infected with larvae of Ascaris suum Goeze, 1782].

The material consisted of 20 male guinea pigs of body weight 300 +/- 50 g. Fifteen of them were infected per os with a dose of 5000 invasive eggs of A. suum. At the 4th, 7th and 20th days of infection the animals were dissected and sections of kidney were taken for histopathological and histochemical studies. The sections were stained with hematoxylin and eosin. The presence of mucopolisachcarides was detected with the paS method, the activity of acid and alkaline phosphatases--with Gomori's method. At the 4th and 7th day of infection an active congestion of the kidney, dilation of blood vessels and changes in the size of epithelial cells of proximal concoluted tubules were observed. The epithelium of the tubules was high, often closing their lumen. Moreover, at the 7th day of infection small ecchymosis was noted. On the sections stained with the paS method a distinct thickening of the basement membrane of the parietal lamellat of Bowman sac was found at the 4th and 7th day of infection, as well as a weaker staining of brush border in main parts of nephrons. A tightening of the vasculary loop of some glomeruli was also noted at the 7th day. At the 20th day of the experiment changes were observed only in single glomeruli in the vasculary loop. At the 4th day of infection an increase in the activity of the acid and alkaline phosphatases was observed in the kidney, followed by a decrease in the activity of both these enzymes at the 7th and 20th day.

Acid Phosphatase↗

[Differential diagnosis of bluish and pigmented lesions of the oral mucosa].

The clinical features of the most common bluish and pigmented lesions of the oral mucosa are discussed in this paper. Considerable attention is given to the findings from the medical and dental history of the patient, in the methodology of the clinical examination (inspection, palpation, digital pressure, aspiration) in the clinical characteristics of the lesions (location, size duration, consistency, prognosis) in the laboratory findings (radiographs and other supplementary examinations) and in the differential diagnosis. The bluish and pigmented lesions which are discussed include: melanoma, Albright's syndrome, Addison's diseases, Peutz-Jeghers's syndrome, arsening poisoning, hemangioma, hematoma, petechia and ecchymosis, Sturge-Weber syndrome, amalgam tatoo, heavy metal lines, mucocele and eruption cyst.

Diagnosis, Differential↗