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The most common complications of vasectomy are ecchymosis and sperm granuloma. A sperm granuloma may increase the chance of spontaneous recanalization. Orchitis and epididymitis generally respond best to treatment with anti-inflammatory drugs and antibiotics. Although antibodies frequently develop against different portions of the sperm, long-term studies have not shown any adverse effects of these antibodies.
The case of a patient with ecchymosis, hepatomegaly, leukocytosis, thrombocytopenia, and anemia at birth is presented. Throughout his course, thrombocytopenia, anemia, and leukocytosis without a marked increase in the number of blast forms in either peripheral blood or bone marrow persisted until the patient developed a blast crisis shortly before his death at age 4 months. This patient is the youngest reported to have the juvenile form of chronic myelogenous leukemia and the first that in the present era can be considered congenital in origin.
At Harrison County Hospital in Corydon, Indiana, hypothermia and transcutaneous electrical nerve stimulators (TENS) have greatly decreased the use of postoperative analgesics and narcotics in controlling postoperative pain. There was a significant reduction in ecchymosis and edema of the foot and ankle as well as postoperative pain under the program used at this hospital.
Blunt trauma to the eye occurs frequently, and the aftereffects may be devastating. Traumatic injuries range from simple ecchymosis of the eyelid and subconjunctival hemorrhage to more serious lesions, including hyphema, choroidal or retinal rupture, optic nerve contusion and rupture of the globe. The diagnosis and management of this type of injury is not difficult if approached in an organized way. The family physician can treat most cases and should recognize those that require further consultation.
The classical symptoms of malabsorption syndrome are diarrhea, steatorrhea, weight loss, and fatigue. Tetany, ecchymosis, anorexia, bone pain, pallor, muscle wasting, hyperpigmentation, apathy, digital clubbing, abdominal distention which contrasts in view of the reduced common statement are other signs of malabsorption. Long before the onset of these symptoms there may be a disinterest in regular daily activities often associated with the passage of three soft stools per day and with the remarkable sign of difficulties in flushing bulky stools. Anamnesia, clinical examination in connection with common laboratory findings, small intestinal x-rays and endoscopic investigations associated with biopsies of the small (and large) bowel as well as estimation of stool fat excretion, xylose- and Schilling-test allow the diagnosis in most of the cases.
Disseminated intravascular coagulation is relatively common as initial clinical presentation of certain myeloblastic leukemias, particularly acute promyelocytic leukemia, occurring less frequently in association with acute non-myeloid leukemias. The occurrence of such coagulopathy as presenting feature of a lymphoblastic leukemia is exceptional as demonstrated by the scarcity of reports in the literature and by the authors experience, having encountered only one case out of 86 consecutive patients with acute lymphoblastic leukemia. The laboratory findings in this case are commented upon, and particular emphasis is made on the measurement of coagulation factors II, V, VII-X, and VIII, the study of fibrin formation and fibrinolysis, and the changes in these parameters brought about by therapy with heparin, coagulation factors (fibrinogen, platelets), and cytostatic drugs. The coagulation abnormalities were corrected once the blast population was destroyed by chemotherapy, with the exception of persisting fibrinopenia secondary to the corticosteroid treatment included in the chemotherapy protocol. Disseminated intravascular coagulation was manifested in this case by gingivorrhagia, ecchymosis and hematuria. The probable etiological role of lymphoblasts in the development of disseminated intravascular coagulation is discussed.
A study of snake bites in 72 children admitted to Department of Paediatrics Chulalongkorn Hospital, during January 1972 to December 1977, was investigated in depth. In 29 cases, snakes were definitely identified as green pit viper. Nature of the bite was demonstrated. Their two main clinical manifestations were local swelling and bleeding diathesis. The former was graded I to IV in increasing severity. The latter consisted of ecchymosis, haematoma, haematemesis, haematuria, bleeding gums, epistaxis and bloody stool. Each of these two clinical signs seemed to be caused by a different component of the venom as they did not always manifest in association. Swelling, though not a specific sign, was however generally the sign that heralded the envenomization. 88.1% and 94.5% of systemic bleeding episodes occurred respectively within 24 and 48 hours after the bite. Only 6 episodes, 5.5%, occurred beyond 48 hours.
Prolidase deficiency, transmitted on an autosomic recessive mode upsets skin healing and facilitates the occurrence of chronic cutaneous ulcerations. A 36-year-old woman has been followed since the age of 12 for ulcerations and erythematous erysipelatoid plaques of the lower limbs. Two episodes of agranulocytosis were induced by intake of sulfonamides at the age of 17. The same accident had been observed in her aunt. As the aetiological research of ulcers was negative, a prolidase deficit was suspected. The diagnosis is ascertained by the existence of an immunopeptiduria of 5 mmol/24 hours (normally absent). The predominating dipeptides are glycilproline and phenylalanine proline. R-hydroxyproline dipeptide were present at a lesser degree. Urinary hydrolysis showed elevation of free proline (x 10) and hydroxyproline (x 6). Dosage of erythrocytes prolidase evidenced an activity 2 p. 100 of the normal in one case and 55 p. 100 and 49 p. 100 in the parents. Treatment by cofactors of prolidase (vitamine C and manganese) reduced immunopeptiduria, suppressed inflammatory outbreaks and allowed a transient cicatrisation. This tenth case of prolidase deficiency underlines the character of the disease: recurrent ulcers (7/10), erysipelatoid plaques (3/10), ecchymosis (4/10), telangiectatic scars (7/10), edema (1/10), early canitias (1/10). Partial correction by cofactors evokes a prolidase deficiency by inactivation of the enzymes activating systems.
True isolated traumatic aneurysms are very rarely observed, and have to be differentiated from false aneurysms. They correspond to unrecognized arterial contusions following closed shoulder injuries. The presence of a large hematoma in the axillohumeral region, associated with an early ecchymosis, should suggest the possibility of an arterial lesion, and arteriography should be conducted. Difficulty in diagnosing the lesion clinically arises from the particular location of such lesions and the richness of the brachial and axillary artery collaterals. This latter fact explains why an ischemic syndrome is rarely observed. Treatment of true traumatic aneurysms is always surgical.
The incidence of physical injury to the head, face, mouth, and neck of 266 suspected cases of child abuse was studied at Texas Children's Hospital in Houston, Texas, from January 1993 through December 1994. While there was an even distribution of physical abuse by gender, 74.8 percent of the children were under the age of three. A hospital physician performed every examination. The most frequently occurring injury was contusion or ecchymosis of soft tissue, while the face was the part of the body injured most often. Although 66.2 percent of the children reviewed had some type of injury to the head, face, mouth, or neck, only seven cases (2.6 percent) of intraoral injury were mentioned. These results point out the need for dentists to become active participants on multidisciplinary child maltreatment teams.
Of five patients in who sciatic paresis developed as the result of hemorrhage and hematoma following hip surgery, four were receiving prophylactic or therapeutic anticoagulants. The patient who was managed expectantly still had disabling motor and sensory deficity at follow-up. Three patients who had early operative decompression showed more complete return of nerve function. The fifth patient died three weeks after onset with the neuropathy still present. Severe low-back and buttock pain, ecchymosis over these regions, marked swelling in the thigh, sciatic-nerve tenderness, and a distal sciatic neural deficit in the ipsilateral lower limb of a patient who has had hip surgery are evidence of hemorrhage in the vicinity of the sciatic nerve. Early recognition and prompt surgical decompression can prevent irreversible nerve damage.
A new approach to the use of topical medications to induce penile erections is suggested. Many impotent patients treat erectile dysfunction with injected vasoactive drugs like papaverine, phentolamine and PGE-1. However, many patients fear using needles and the possible side effects from injections are well known (pain, ecchymosis, priapism, fibrosis of corpora cavernosa). In six patients with erectile impotence who sought an alternative to pharmacologic injection therapy, a 1 cm square window was created in Buck's fascia and tunica albuginea and covered with a piece of the deep dorsal vein of the penis. The penile skin overlying the window was marked with India ink and vasoactive medication was applied to this area. The goal of this procedure was to enable the topical erection-inducing medication to pass through the skin of the penis, through the window and into the corpus. All of the patients experienced a satisfactory erectile response after application of nitroglycerin cream as documented by penile Doppler ultrasound evaluation. Two of the six patients currently use only the nitroglycerin cream to induce erections satisfactory for sexual intercourse. Three patients alternate the use of the cream and injections. One patient prefers injection. This procedure may offer a desirable alternative to injection therapy for selected patients with impotence.
Thirty-four males aged 16-40 (mean 25) years in the period from August 1991 to February 1993 presented in acute renal failure (ARF), 3-14 (mean 5) days after they had been apprehended and allegedly tortured in Police interrogation centres in Kashmir. All were beaten involving muscles of the body, in addition 13 were beaten on soles, 11 were trampled over and 10 had received repeated electric shocks. Patients were studied in three groups: group I, those with evidence of only myoglobinuria (n = 21); group II, those with both myoglobinuria and haemoglobinuria (n = 10); and group III, those with evidence of only haemoglobinuria (n = 3). All had varying degrees of ecchymotic patches on the body and patients in groups II and III were beaten on soles had ecchymosis of soles. Hypertension was present in 11 and pulmonary oedema in five. Mean haemoglobin, BUN and serum creatinine were not significantly different in the three groups. Creatine phosphokinase in groups I, II and III were 985-7516 (1358 +/- 368), 917-5277 (1431 +/- 188), and 517-816 (772 +/- 69) and lactic dehydrogenase levels were 757-3727 (2191 +/- 56), 592-3454 (1923 +/- 164), and 446-958 (632 +/- 115) respectively. All the cases had metabolic acidosis, 20 had hyperkalaemia. Plasma haemoglobin was 11-48 (mean 26) mg/dl in group II and 26-56 (mean 35) mg/dl in group III. Urine test for haemoglobin was positive in seven cases in group II and two cases in group III. Pigment casts were present in 10, eight and two cases in groups I, II, and III respectively. Only those who were beaten on soles had evidence of haemoglobinuria.(ABSTRACT TRUNCATED AT 250 WORDS)
The comparative study of the efficacy of coumadin and aspirin in primary cardioembolic stroke prevention of chronic rheumatic heart disease (mitral stenosis) with atrial fibrillation was conducted at Siriraj Hospital, Mahidol University, Bangkok, Thailand. Seventy-nine patients were enrolled in the trial. Allocation of patients into coumadin or aspirin groups depended upon the patients' choice. Nineteen patients were given coumadin at the adjusted dosage to maintain the therapeutic range of International Normalised Ratio between 1.5-3. Sixty patients were given aspirin at the fixed dosage of 75 mg per day. Six patients were lost to follow-up over the 3 yr period; four in the aspirin group and 2 in the coumadin group. There were three patients with nonfatal cardioembolic stroke in the aspirin group but none in the coumadin group after three years of follow-up. Six patients had mitral valve replacement during the study (i.e. three patients in each group). There were complications in 12 patients, 10 in the aspirin (16.6 per cent) and 2 in the coumadin (10.5 per cent) group. The complications in coumadin group were minor bleeding over the thigh in one patient and generalised ecchymosis over the whole body in one other. In the aspirin group, the complication was gastrointestional symptoms, mainly epigastric pain, but no frank bleeding was observed. Primary prevention of cardioembolic stroke in chronic rheumatic heart disease was found to be more effective with coumadin than aspirin. Our study does not support the use of aspirin in primary prevention of cardiac embolism in chronic rheumatic heart disease.
The holmium:YAG laser has many advantages over conventional surgical instrumentation and techniques in ankle arthroscopy. These include minimal mechanical damage to surrounding tissue structures, better access to tight recesses, and the ability to coagulate, smooth, ablate, and weld tissues. The laser also offers improved contouring of damaged articular surfaces, all with a single instrument. The holmium:YAG laser uses a wavelength of 2.1 microns, which is strongly absorbed by water, the major component of tissue. This wavelength allows the laser to deliver a consistent tissue effect to both pigmented and nonpigmented tissues. It currently may transmit up to 60 watts of power to tissue in high-energy, short-duration pulses. The holmium:YAG laser also operates in a fluid medium, which provides a near physiologic environment and maintains continual irrigation. The holmium:YAG laser beam is transmitted through a flexible fiberoptic handpiece, which greatly increases maneuverability. A variety of angled laser tips are available, depending on the pathology type and location. Different tissue effects can be created by varying the tip to target distance. All these qualities provide precise control without significant thermal damage and make the laser ideal for application to articular structures of the ankle joint. The holmium:YAG laser is a safe and effective arthroscopic instrument with a promising future. We have used it, along with traditional shavers and abraders, to effectively treat numerous pathologies of the ankle joint. The laser's versatility in cutting, ablation, and coagulation has been uniformly successful. Patients surveyed postoperatively have reported less overall symptoms and faster healing. They have reported a decrease in ecchymosis, edema, and postoperative pain. Patients' return to full activity has appeared to be quicker with the use of holmium:YAG laser therapy. Although our results have thus far been very encouraging, further research and clinical applications in the use of the holmium:YAG laser need to be continued.
Vibrio vulnificus is a halophilic Vibrio that has been isolated repeatedly from sea-water and shellfish during the warm months of the year. It's a virulent pathogen for men and is frequently associated with overwhelming infections including sepsis, gangrene of extremities and high mortality rate. We encountered a 13-year-old boy who had a history of beta-thalassemia major with secondary hemochromatosis, suffering from vomiting, diarrhea, fever and hypotension. Physical examination revealed that ecchymosis, bullae and ulceration were noted over the left leg. Vibrio vulnificus was isolated from the blood. Initially, the patient did not respond to the appropriate antibiotics treatment, subsequently surgical debridement was performed. After that, the patient recovered gradually, and discharged home after 17 days of admission. In conclusion, when patients present with sepsis and/or characteristic skin lesion-hemorrhagic bullae, particularly those with thalassemia major, hemochromatosis or underlying liver disease and a history of marine exposure, clinicians should be alerted to this potentially fatal infection and should commence appropriate assessment and treatment immediately.
We present a new local anesthetic technique for ophthalmic surgery that reduces the risks associated with retrobulbar and peribulbar anesthesia. This method uses topical proparacaine plus 1.5 mL of prilocaine (3%) with felypressin injected into the subconjunctival (sub-Tenon's) space. Of 5210 consecutive adult patients in whom the technique was used, all demonstrated adequate analgesia. Sixty-three (1.2%) of the eyes required supplemental analgesia, provided by a single injection of prilocaine (0.5 mL). Ecchymosis and subconjunctival hemorrhage developed in 63 (1.2%) of the eyes. There were no instances of ptosis.
Pulmonary edema (PE) which is similar to the neurogenic type was induced by adrenaline (AD) administration (0.1 mg/kg) in rats. Acute progressive respiratory distress, cyanosis and dyspnea occurred. All the experimental animals in the PE group died within 20 min after AD injection, with a pulmonary index (PI) of 1.70 +/- 0.47 (mean +/- S) which was much higher than that in the normal group. The mortality rate was 100%. It was found that in rats with PE, a protein-rich fluid filled the alveolar and interstitial spaces, and ecchymosis occurred. The capillary permeability as estimated by Evans blue injection showed that Evans blue from extraction fluid and bronchoalveolar lavage (BAL) in the PE rats was at a much higher level than that in the normal control (NC) rats. In anisodamine (ADM, 654-2) and tetramethylpyrazine (TMP) treated rats, almost all the damage was diminished or absent, and the mortality rates were decreased from 100% to 4.4% and 20%, respectively. 654-2 and TMP could significantly inhibit the increase of pulmonary permeability.