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PubMed1997

The lateral nasal osteotomy in rhinoplasty: an anatomic endoscopic comparison of the external versus the internal approach.

A precise and reproducible lateral osteotomy is a requirement for successful rhinoplasty. Two basic techniques have evolved: the external perforated method and the internal continuous method. The literature supporting the external perforated technique maintains that it contributes to a controlled, stable fracture and produces less nasal airway narrowing, hemorrhage, edema, and ecchymosis; however, the continuous internal method is used by many rhinoplasty surgeons. Our study was designed to compare the two techniques in the fresh cadaver nose using a blinded endoscopic evaluation of the nasal mucosa after the osteotomies were performed by one of these two techniques. Nineteen fresh cadaver heads had an external perforated lateral osteotomy performed on one side and an internal continuous lateral osteotomy performed on the alternate side by an investigator with experience in the use of both osteotomies. In a blinded fashion, four different investigators used nasal endoscopy to detect mucosal perforations and bony irregularities. Eleven percent of the perforated osteotomies resulted in mucosal tearing as opposed to 74 percent of the continuous osteotomies (p < 0.001). This anatomic study confirms our clinical experience that the external perforated osteotomy results in a more controlled fracture with less intranasal trauma and can minimize the associated morbidity (hemorrhage, edema, and ecchymosis) in the rhinoplasty patient.

Adult↗
PubMed2004

Incidence of associated events during the performance of invasive procedures in healthy human volunteers.

Metabolic investigations often utilize arteriovenous sampling and muscle biopsy. These investigations represent some risk to the subject. We examined 369 studies performed in the General Clinical Research Center between January 1994 and May 2003 for events related to femoral catheterization and muscle biopsies. Incidents were further examined by age (younger: 18-59 yr, n=133; and older: 60-76 yr, n=28). There were no clinically defined major complications associated with either procedure. The incidence of femoral catheter repositioning or reinsertion was higher in the older group (25.5 vs. 9.7%). There was no difference in the incidence of premature removal of catheters, ecchymosis or hematoma, or the persistence of pain after discharge. The occurrence of all incidents did not increase with multiple catheterizations. Muscle biopsy was associated with infrequent ecchymosis or hematoma in both groups (1.1 and 3.6% in younger and older groups, respectively). Both procedures entail a small likelihood of a vagallike response (3.3% overall), resulting in nausea, dizziness, and rarely a loss of consciousness. These results indicate that, in skilled hands and a defined clinical setting, the incidents associated with femoral catheterization and muscle biopsy in healthy volunteers are reasonable and largely controllable.

Adolescent↗
PubMed1994

Autoerythrocyte sensitization syndrome with thrombocytosis.

A case of autoerythrocyte sensitization syndrome in a 59-year-old female is reported. She had several episodes of circular ecchymoses on her left thigh. Intradermal injection of autoerythrocytes reproduced a similar ecchymosis. Thrombocytosis was detected and treated with busulfan which induced a delayed improvement of the ecchymosis outbreaks over 2 years of follow-up.

Autoimmunity↗
PubMed2000

Closed ankle fractures in the diabetic patient.

Systemic and local manifestations of diabetes mellitus may complicate the treatment of ankle fractures in the diabetic population. We studied 98 patients (73 non-diabetics and 25 diabetics) who were treated for closed ankle fractures by either surgical or non-surgical methods. We found that overall, the risk of infection in the diabetic population (32%) was 4 times higher than in the non-diabetic population (8%). The infection rate in the diabetic group treated surgically more than doubled that in the non-diabetic group. Four out of six diabetic patients treated with cast became infected compared to no infections in the five non-diabetics treated with a cast. Even though the diabetic foot and ankle are well studied, the medical literature is not conclusive regarding the management of ankle fractures in the diabetic patient. Diabetic patients treated conservatively had a tendency to become infected over those treated surgically. Peripherovascular disease, peripheral neuropathy and swelling and/or ecchymosis increased the risk of infection in the diabetic population. Diabetic patients with poor compliance had a tendency to become infected more than those who were compliant. We concluded that the diabetic patient who is poorly compliant with evidence of neuropathic disease, peripherovascular disease and severe swelling and ecchymosis presents the most difficult group to manage. Although these patients are poor surgical candidates, they are also the most difficult to manage and also most prone to infection and complications if treated conservatively. When faced with this difficult scenario a multidisciplinary team approach would probably yield the best possible results by early identification and intervention in these patients.

Adult↗
PubMedDate not supplied

Evaluation of the Radiance FN soft tissue filler for facial soft tissue augmentation.

OBJECTIVE: To evaluate the clinical efficacy and patient satisfaction of Radiance FN (fine needle) (BioForm Inc, Franksville, Wis), a highly biocompatible, calcium hydroxylapatite-based implant, when used for facial soft tissue augmentation. METHODS: Ninety patients aged between 25 and 85 years underwent subdermal injection with Radiance FN. The primary areas treated were lips, nasolabial folds, glabellar rhytids, marionette lines, prejowl depressions, acne scars, and surgical soft tissue defects. Patients were surveyed after treatment and for up to 6 months for pain, ecchymosis, skin erythema, nodules, softness, appearance, and satisfaction. RESULTS: In terms of efficacy, at 6 months, appearance, softness, and overall patient satisfaction were rated good or excellent in 74%, 80%, and 88% of patients, respectively. Moderate or severe pain occurred with injection in 59% of patients but disappeared 2 to 5 minutes after injection. Erythema, edema, and ecchymosis were common immediately after treatment but resolved in all patients within 2 weeks. Seven patients had persistent visible mucosal lip nodules, 4 of whom required intervention. CONCLUSIONS: Radiance FN is highly effective and well tolerated when used for facial soft tissue augmentation. Additional experience with longer follow-up will help determine the most appropriate use and long-term safety for the implant.

Adult↗
PubMed1995

Role of the argon beam coagulator in facial rejuvenation surgery.

OBJECTIVE: To compare the hemostatic effectiveness of a new electrosurgical unit, the argon beam coagulator, with current methods of electrocoagulation. DESIGN: A nonrandomized control trial of 20 patients undergoing rhytidectomy. SETTING: Two academic tertiary referral medical centers. PARTICIPANTS: Twenty male patients having moderate to major degrees of facial ptosis. INTERVENTION: All 20 patients underwent a standard rhytidectomy with hemostasis provided by the argon beam coagulator on the right side and conventional electrocoagulation on the left side. OUTCOME MEASURES: Improved hemostasis with minimal depth of injury, length of procedure, decreased blood loss, edema, and ecchymosis, and the ability to coagulate indiscriminately around and over neural tissue without damage (all listed in the literature as advantages of the argon beam coagulator). RESULTS: Poor hemostatic ability was observed with concomitant increased incidence of blood loss, edema and ecchymosis, major hematoma, and length of surgery. Also noted were increased rates of flap compromise and the potential for damage to vital neural structures. CONCLUSION: Our results do not agree with the list of advantages attributed to the argon beam coagulator in the literature.

Aged↗
PubMed2001

Active chest compression-decompression for cardiopulmonary resuscitation.

BACKGROUND: Active compression-decompression cardiopulmonary resuscitation (ACD CPR) uses a hand-held suction device, applied mid sternum, to compress the chest then actively decompress the chest after each compression. Randomised controlled trials on use of active compression decompression cardiopulmonary resuscitation have results which are discordant. OBJECTIVES: To determine clinical effects and safety of active compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation (STR). SEARCH STRATEGY: We searched the Cochrane Heart Group Specialised register (April 2001), the Cochrane library, MEDLINE and EMBASE. We checked the reference list of retrieved articles and contacted enterprises manufacturing the active decompression devices. SELECTION CRITERIA: All randomized or quasi-randomized studies comparing active compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation in adults with a cardiac arrest who received cardiopulmonary resuscitation by a trained medical or paramedical team. DATA COLLECTION AND ANALYSIS: Data were independently extracted. All data were analysed on an intention-to-treat basis. The authors of the primary studies were contacted for more information when needed. Studies were cumulated, if appropriate, and pooled relative risk (RR) estimated. Subgroup analysis according to setting (out of hospital or in hospital) and attending team composition (with physician or paramedic only) were predefined. MAIN RESULTS: Twelve trials were included: 10 were in out-of-hospital settings, one set in-hospital only and one had both in-hospital and out-of-hospital components. Allocation concealment was adequate in 4 trials. The two in-hospital studies were very different in quality (A and C) and size (773 and 53 patients). Both found no differences between ACD CPR and STR in any outcome. Trials conducted in out-of-hospital settings cumulated 4162 patients. There were no differences between ACD CPR and STR for mortality either immediately (RR 0.98 [95% CI 0.94 - 1.03]) or at hospital discharge (RR 0.99 [95% CI 0.98 - 1.01]). The pooled RR of neurological impairment, any severity, was 1.71 [95% CI 0.90 - 3.25], with a non-significant trend to more frequent severe neurological damage in survivors of ACD CPR (RR 3.11 [95% CI 0.98 - 9.83]). However, assessment of neurological outcome was limited and there were few patients with neurological damage. There was no difference between ACD CPR and STR with regard complications such as rib or sternal fractures, pneumothorax or hemothorax (RR 1.09 [95% CI 0.86 - 1.38]). Skin trauma and ecchymosis were more frequent with ACD CPR. REVIEWER'S CONCLUSIONS: Active chest compression-decompression in patients with cardiac arrest is not associated with clear benefit.

Adult↗
PubMed1982

Use of radio-frequency pulsed energy in the control of postoperative reaction in blepharoplasty.

This is a preliminary report of the use of a device to apply small pulses of radio-frequency energy to surgical wounds in order to improve wound healing. The device was applied to one eye in 21 patients who underwent bilateral blepharoplasty. There were no device-related complications. In 11 patients, edema and ecchymosis were noticeably less on the treated side within 24 hours of surgery. In 6 patients, ecchymosis and swelling were so slight that no difference between treated and untreated sides was visible. Two patients were noticeably worse on the treated side. Further studies will be conducted.

Eyelids↗
PubMed2001

Partial tears of the distal biceps tendon: MR appearance and associated clinical findings.

PURPOSE: To describe the magnetic resonance (MR) appearance and associated clinical findings of partial distal biceps tendon tears. DESIGN: Twenty elbow MR images at 1.5 T, performed over a 7 year period, were reviewed for an appearance of partial tears in the distal biceps. These images were assessed by two musculoskeletal radiologists for the extent of: (a) abnormal signal intensity within the tendon, and the presence of (b) bicipitoradial bursitis, and (c) bony microavulsive injury of the radial tuberosity. Medical records for nine of the 20 cases were reviewed for the clinical findings of ecchymosis, trauma, sensation of a "pop", loss of function, and acuity of onset. RESULTS: Twenty partial distal biceps tendon tears were seen. All displayed an abnormally increased signal in the distal biceps tendon. Three of 20 (15%) showed a 25% to 50% tear, ten of 20 (50%) showed a 50% tear, and seven of 20 (35%) showed a 75% to 90% tear. Bicipitoradial bursitis was seen in 11 of 20 (55%) cases. Bony microavulsive injury of the radial tuberosity was observed in 10 of 20 (50%). Of the nine cases reviewed for associated clinical findings, surprisingly, only three (33%) experienced an acute traumatic episode with an abrupt onset of pain. An insidious onset was reported in four of nine (44%). Sensation of a "pop" was recorded in only two of nine (22%) cases. Ecchymosis and loss of function were not seen in any of the cases. Finally, surgical conformation was obtained for three cases. CONCLUSION: Partial distal biceps tendon tears have a characteristic MR appearance, demonstrate little functional deficit, and may be attritional in their etiology due to the observation of a low number of patients reporting trauma or an acute onset.

Adult↗
PubMed1991

Posterior urethral valves presenting as venous obstruction.

A patient with posterior urethral valves presented with unilateral lower leg ecchymosis and edema. He initially had significant renal function impairment. The ecchymosis and edema resolved after appropriate therapy, and his renal function returned to normal.

Humans↗
PubMed2006

Spontaneous retropharyngeal hematoma: an unusual presentation of thoracic aortic dissection.

A 78-year-old woman presented to the Emergency Department with spontaneous ecchymosis and swelling of the neck. Ecchymosis was also evident on the posterior pharyngeal wall. A lateral soft tissue radiograph demonstrated a retropharyngeal hematoma, which was confirmed by computed tomography (CT). At this time there was no evidence of airway obstruction and she was admitted for observation. One week after admission she became acutely short of breath, and a chest radiograph at this time showed a large pleural effusion. Pleural drainage confirmed this to be a hemothorax. Subsequent CT revealed a thoracic aortic dissection with blood communicating into both the retropharyngeal space and the pleural cavity. The case highlights both an unusual presentation of thoracic aortic dissection, and also the potential for occult hemorrhage in cases of spontaneous retropharyngeal hematoma.

Aged↗
PubMed2006

Is saphenofemoral junction reconstruction necessary during stripping of the saphenous vein?

BACKGROUND: Patients who had undergone complete ankle-to-groin stripping of the greater saphenous vein were evaluated retrospectively to assess the necessity of saphenofemoral junction reconstruction during the stripping procedure. Since 1996, in addition to the conventional complete stripping operation, we routinely perform a saphenofemoral junction reconstruction in patients presenting with greater saphenous vein reflux associated with low-grade (grades I-II) saphenofemoral junctional reflux. In this method, the size of the common femoral vein was adjusted to the desired diameter by a running linear suture technique after division of the greater saphenous vein. METHODS: Retrospective evaluation revealed that 73 limbs in 56 patients treated with this technique (group I). This group of patients was matched to another group of 65 patients (78 limbs) with similar characteristics and symptoms (group II) in whom the conventional complete ankle-to-groin stripping of greater saphenous vein was the treatment. The 2 groups were compared with respect to the incidence of complications, including recurrence of varicosities, ecchymosis, lymphocele, lymphorrhagia, wound infection, and paresthesia in the operated extremity. All patients also were evaluated by Doppler ultrasonography at 6 months, 12 months, and annually thereafter to determine the saphenofemoral junction reflux time (valve reflux time). The mean duration +/- SD of follow-up was 6.7 +/- 1.6 years (range, 2.1-10.8 years). RESULTS: Recurrence of varicosity was noted in 14 patients, 3 in group I and 11 in group II (P = .02). There were no statistically significant differences between the 2 groups in terms of ecchymosis, hematoma, lymphocele, lymphorrhagia, wound infection, and paresthesia. At 6 months, a rapid decrease in valve reflux time was noted in group I (P = .0001). In addition, there was a significant improvement in valve reflux time at each subsequent Doppler examination in group I. Group II showed a decrease in valve reflux time, compared with the preoperative value (P = .068). During subsequent Doppler examinations, a decrease in valve reflux time also was noted in group II; this difference reached statistical significance only at 24 months (P = .04). CONCLUSIONS: We believe that saphenofemoral junction reconstruction is a simple technique to perform and that addition of this method to the conventional stripping provides more durable results with a lesser incidence of recurrence. This method should be considered as a treatment modality in patients with greater saphenous vein reflux associated with low-grade (grades I-II) saphenofemoral junctional reflux.

Adult↗
PubMed2005

Disseminated intravascular coagulopathy: manifestations after a routine dental extraction.

Clinical signs and symptoms of acute disseminated intravascular coagulopathy (DIC) include bleeding from body orifices, such as the nose, mouth, or ear, bleeding from an intravenous (IV) site, areas of ecchymosis, or blood in the urine or stool. The underlying disease triggering DIC usually determines the clinical presentation. However, patients with chronic DIC (compensated DIC) may possess subclinical signs and symptoms, and the bleeding disorder may only be identified through laboratory findings. In this compensated form, the triggering factor is exposed slowly and in small amounts (seen in malignancies and vasculitis), allowing replenishing of the augmented factors by the liver, adequate reticuloendothelial clearance of fibrin degradation products, and increased production of platelets, which prevent secondary fibrinolysis and the signs of bleeding. 1,4 We report a case of an 82-year-old male who presented to the emergency room 24 hours after a routine dental extraction with bleeding from the tooth socket, severe hypotension, and presence of ecchymosis on his chest. Clinical and radiographic exam revealed multiple thoracic and abdominal aortic aneurysms, as well as infrarenal and iliac aneurysms, continuous oral hemorrhage, and a unique presentation rarely documented in the literature: a bleeding tooth socket as the initial clinical sign and presentation of DIC.

Aged↗
PubMed1998

A randomized trial of vascular hemostasis techniques to reduce femoral vascular complications after coronary intervention.

This report details a prospectively randomized clinical trial comparing mechanical clamp compression to hand applied pressure for attaining vascular hemostasis after coronary intervention. Effectiveness was determined by comparing the incidence of femoral vascular complications resulting from each of the 2 techniques. Eligible participants included 778 consecutive patients scheduled for percutaneous coronary intervention over an 8-month period. An unselected cohort of the eligible patients (n = 592), determined by the availability of cross-trained clinicians, underwent follow-up serial physical examinations by blinded observers for the duration of their hospital stay. A second, similarly determined cohort (n = 390), underwent color-duplex ultrasonography within 24 hours of sheath removal. Baseline demographic and clinical characteristics, sheath removal parameters, and subsequent outcomes were collected prospectively. The primary end point was a composite of ultrasound-defined femoral vascular complications: femoral artery thrombosis, echogenic hematoma, pseudoaneurysm, or arteriovenous fistulae formation. Complications diagnosed by physical examination constituted the second fundamental end point and included: persistent oozing, ecchymosis, hematoma, bruit, and pulsatile mass. Compared to manual compression, mechanical clamp hemostasis reduced the primary adverse end point by 63% (p = 0.041). Physical examination detected ecchymosis, oozing, and hematomas at equally high frequencies in the two cohorts. Although 65% of the patients in both treatment groups encountered at least one of these cosmetic complications, the diagnoses made by physical examination did not correlate with ultrasound-defined pathology. Multivariable stepwise logistic regression analysis identified a relationship of advanced age and lower body weight to vascular complications. Utilization of a mechanical clamp rather than conventional hand pressure to attain vascular hemostasis significantly reduces ultrasound-defined femoral vascular pathology. Discrepancies between physical examination and ultrasound diagnoses challenge the utility of clinical assessment alone and establish ultrasound as the diagnostic modality of choice.

Angioplasty, Balloon, Coronary↗
PubMed1998

Low-molecular-weight heparins in non-ST-segment elevation ischemia: the ESSENCE trial. Efficacy and Safety of Subcutaneous Enoxaparin versus intravenous unfractionated heparin, in non-Q-wave Coronary Events.

Combination antithrombotic therapy with heparin plus aspirin decreases the risk of recurrent ischemic events in patients with acute coronary syndromes without persistent ST-segment elevation. Compared with standard unfractionated heparin, low-molecular-weight heparin (LMWH) has a more predictable antithrombotic effect, is easier to administer, and does not require coagulation monitoring. At 176 hospitals in 3 continents, 3,171 patients with rest unstable angina or non-wave myocardial infarction were randomly assigned to either enoxaparin (a LMWH), 1 mg/kg twice daily subcutaneously, or to continuous intravenous unfractionated heparin, for a minimum of 48 hours to a maximum of 8 days. Trial medication was administered in a double-blind, placebo-controlled fashion. At 14 days, the primary endpoint, the composite risk of death, myocardial infarction, or recurrent angina with electrocardiographic changes or prompting intervention, was significantly lower in patients assigned to enoxaparin compared with heparin (16.6% vs 19.8%; odds ratio [OR] 1.24; 95% confidence interval [CI] 1.04-1.49; p = 0.019). At 30 days, the composite risk of death, myocardial infarction, or recurrent angina remained significantly lower in the enoxaparin group compared with the unfractionated heparin group (19.8% vs 23.3%, OR 1.23; 95% CI 1.0-1.46, p = 0.016). The rate of revascularization procedures at 30 days was also significantly lower in patients assigned to enoxaparin (27.1% vs 32.2%, p = 0.001). The 30-day incidence of major bleeding complication was 6.5% versus 7.0% (p = not significant), but the incidence of minor bleeding was significantly higher in the enoxaparin group (13.8% vs 8.8%, p <0.001) due primarily to injection-site ecchymosis. Thus, combination antithrombotic therapy with enoxaparin plus aspirin is more effective than unfractionated heparin plus aspirin in decreasing ischemic outcomes in patients with unstable angina or non-Q-wave myocardial infarction in the early (30 days) phase. The lower recurrent ischemic event rate seen with the LMWH, enoxaparin, is achieved without an increase in major bleeding, but with an increase in minor bleeding complications due mainly to injection-site ecchymosis.

Adolescent↗
PubMed1992

Traumatic asphyxia compounding craniofacial trauma.

Traumatic asphyxia is a condition characterized by cervicofacial petechiae, subconjunctival ecchymosis and other possible accompanying problems particularly ophthalmic, thoracic and cardiovascular injuries. While the facial petechiae per se are of little consequence, the attendant injuries to other organ systems can be serious and even fatal. Craniofacial injuries also present with fatal ecchymosis and haematoma formation due to the underlying skeletal injuries which may require active management. Clinicians managing trauma patients should be well aware of these two different entities which may occur separately or simultaneously so as to ensure correct and adequate treatment.

Accidents, Occupational↗
PubMed2002

Prevention of temporal alopecia following rhytidectomy: the prophylactic use of minoxidil. A study of 60 patients.

BACKGROUND: Temporal hair loss that results from traumatized hair follicles following rhytidectomy is an unsightly complication that can distress both the patient and the operating surgeon. Topical minoxidil is a proven therapy for androgenic alopecia and female senile alopecia. It has also been found to be useful in preventing the hair loss that commonly follows hair transplantation. OBJECTIVE: To analyze through a retrospective study the effect of topical minoxidil on the incidence of temporal hair loss following facelift procedures. To our knowledge this is the first study to investigate the role of minoxidil in preventing post-rhytidectomy temporal alopecia. METHODS: The charts of 60 women with a mean age of 58 years who underwent primary cervicofacial rhytidectomy were studied. Either a standard SMAS/flap technique or pliation was done in all cases. Each patient received either 2% or 5% topical minoxidil for 2 weeks before surgery and for 4 weeks after surgery, with a 5-day break period beginning on the day of surgery. Patients were monitored for complications immediately postoperatively and in 3-6 months of follow-up. RESULTS: Almost 80% of the patients underwent SMAS/flap procedures. Transient temporal alopecia was noted in only one patient, 6 weeks after discontinuing minoxidil. This resolved within 4 weeks of its reintroduction. The only other complications noted included minor hematomas (3.3%), skin slough/infection (1.7%), minor transient and localized edema (8.3%), minor ecchymosis (1.7%), a unilateral neuropraxia of the buccal nerve lasting 3 months (1.7%), and a minor temporary unilateral skin depression (1.7%). Side effects of minoxidil were not observed. CONCLUSION: On comparing our findings to results of larger rhytidectomy series in which minoxidil was not used prophylactically, and our experience before using minoxidil, we conclude that minoxidil plays a role in effectively preventing the temporal hair loss that occurs following primary cervicofacial rhytidectomies. We also found that minoxidil did not negatively impact on the risk of hematoma formation, skin necrosis, edema, or ecchymosis. Side effects of minoxidil did not present a problem.

Administration, Topical↗
PubMed1994

Pseudoaneurysm of the brachial artery: a rare complication of blood donation.

BACKGROUND: Serious complications of blood donation are rare. Reported here is a significant vascular event that resulted from whole-blood phlebotomy and required surgical repair. CASE REPORT: A 49-year-old woman donated whole blood without incident in November 1992, but reported ecchymosis and tenderness in the antecubital area of the right arm immediately following the procedure (her medical history was unremarkable). Over the next several days, the ecchymosis extended to the axilla and she complained of numbness in all her fingers, particularly the thumb and adjacent two fingers of the involved side. Coincident to these findings, an egg-sized lump developed under the skin at the phlebotomy site. Her symptoms and the mass persisted for several weeks. Examination and ultrasound performed in January 1993 demonstrated a pulsatile mass over the brachial artery. The donor underwent an exploratory surgical procedure that revealed a 3.3 x 2.5 x 2.0-cm pseudoaneurysm of the brachial artery. Unlike a true aneurysm, this lesion was composed only of a blood clot that was compressing the outer wall of the artery. A pinpoint-sized hole was seen in the artery when the lesion was excised. The phlebotomy is believed to have caused blood to leak out of the artery, creating the lesion and exerting pressure on the median nerve. CONCLUSION: Pseudoaneurysm of the femoral artery is a well-documented complication of cardiac catheterization and other invasive arterial procedures, but this is the first known reported case following blood donation. Blood collectors should be made aware of this potentially serious complication of blood donation.

Aneurysm↗