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At least 163 records · Page 9Linked to original sources
PubMed1997

Blindness in children with neuroblastoma.

BACKGROUND: Neuroblastoma is the most common extracranial solid tumor among pediatric patients, and orbital metastatic disease is not uncommon in these children. Physical signs as a consequence of orbital metastases, such as proptosis and periorbital ecchymosis, frequently are encountered. However, subsequent blindness is rare. METHODS: A retrospective study was conducted to determine the incidence, related physical findings, treatment, and outcome of children who developed visual loss during treatment for neuroblastoma. Medical records for a 24-year period (1971-1994) were reviewed to identify these patients. The charts, diagnostic imaging studies, and autopsy material of these patients were reviewed. RESULTS: Of the 450 patients treated for neuroblastoma at the study institution during this period, 47 presented with abnormalities in physical examination of the eye. Eight of these 47 patients and 7 others developed visual loss in at least 1 eye during the first week after diagnosis (n = 5), during primary therapy (n = 6), at recurrence (n 2), or after completion of therapy (n = 2). In ten patients the visual loss was a direct consequence of the primary disease process, whereas a direct relationship between loss of vision and neuroblastoma could not be identified in the remaining five patients. Proptosis and periorbital ecchymosis were the most common associated physical findings. Although ten patients received steroids and eight received radiation, visual loss could not be prevented or reversed in these patients. CONCLUSIONS: Early initiation of effective, multiagent chemotherapy remains the primary approach for the treatment of neuroblastoma and its ophthalmologic complications. Radiation therapy and steroids may have benefit but failed to show good effect in this series. The prevention and treatment of blindness is probably most relevant in infants and children age < 2 years because they have the best chance for cure.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Steroids and rhinoplasty. A double-blind study.

Many facial plastic surgeons use perioperative steroids to reduce postoperative edema and morbidity. This use of steroids is based more on theory and anecdotal experience than on controlled studies. We studied 49 patients undergoing rhinoplasty in a randomized, double-blind fashion to evaluate the effects of perioperative and postoperative steroid use. We found significantly less postoperative eyelid and paranasal edema in those patients receiving steroids. In addition, trends toward less ecchymosis, less intranasal edema, and less discomfort in the patients receiving steroids were noted.

Adolescent↗
PubMed1977

Myositis ossificans traumatica. Association with hemophilia (factor XI deficiency) in a football player.

A case report of an outstanding college football halfback with partial factor XI deficiency, recurrent ecchymosis, and myositis ossificans is reviewed. The association of multiple areas of myositis ossificans and partial clotting-factor deficiency has not been noted in the past. The importance of considering this diagnosis in participants in contact sports with the above findings is emphasized.

Adult↗
PubMed1984

Increased releasable vascular plasminogen activator and a bleeding diathesis.

A 66-year-old man with metastatic prostatic carcinoma treated with high-dose (5 mg) diethylstilbestrol therapy underwent orchiectomy to allow discontinuation of estrogen. An extensive ecchymosis developed postoperatively in an area covered by elastic dressing tape; subsequently, it was learned that the patient had a recent history of frequent ecchymoses with mild trauma that proceeded to vesiculation. His alpha2-antiplasmin level was 132 percent, fibrin split products 4 micrograms/ml, and fibrinogen 293 mg/dl; routine coagulation results were normal. However, the level of releasable vascular plasminogen activator in a specimen drawn prior to surgery was 3.6 CTA units/ml, the highest value ever reported in this laboratory.

Aged↗
PubMed1982

Envenomation by the northern blacktail rattlesnake (Crotalus molossus molossus): report of two cases and the in vitro effects of the venom on fibrinolysis and platelet aggregation.

In two cases of human envenomation by the northern blacktail rattlesnake (Crotalus molossus molossus) there was marked swelling and ecchymosis of the bitten extremity and thrombocytopenia and, in one case, hypofibrinogenemia. Treatment consisted of i.v. antivenin, crystalloid solution, fresh frozen plasma and cryoprecipitates, with recovery in each case. In vitro studies showed that the venom had fibrinolytic and platelet aggregating properties; a coagulant effect, although present, was much less marked.

Adult↗
PubMed1985

Neonatal genital trauma.

A neonate with severe scrotal ecchymosis resulting from a breech delivery is presented. The incidence, potential complications, and management are discussed.

Adult↗
PubMed1991

A preliminary report of arthroscopic findings following acute condylar trauma.

Standard therapy in orthopedics dictates that joints with suspected hemarthrosis be considered for irrigation or exploration, especially when immobilization is part of the treatment plan. In this preliminary report, 14 patients who had condylar/subcondylar fractures underwent superior joint space arthroscopy as part of the evaluation and treatment of their fractures. In all but two patients, blood was found in the superior joint space. Length of time from injury to time of examination correlated with the quantities of blood found. The severity and direction of the blow seemed to influence the findings in the joints. Synovial ecchymosis was a consistent finding. The disc appeared to be grossly intact and within the glenoid fossa in all cases, even when the condyle was grossly displaced. These findings raise questions about the role of direct disc injury as a source of postoperative temporomandibular joint (TMJ) symptoms, as well as about the practice of immobilization of fractures immediately after trauma. Further studies will be necessary to compare the treatment results in patients who have had arthroscopy versus those who have not.

Arthroscopy↗
PubMed2006

[Skin lesions from the application of suction cups for therapeutic purposes].

The application of suction cups or cupping is a medicinal practice that is very widespread in Asian countries. The presence of circular areas of erythema, ecchymosis or blood blisters symmetrically distributed on the shoulders, back, thorax or lumbar area should suggest the use of this technique. The number of followers of traditional Chinese medicine is increasing in the Western world, so we should be familiar with these practices in order to prevent social and/or legal conflicts that may arise from mistaken diagnoses of abuse. We present the case of a 65-year-old male with multiple circular, erythematous, bullous lesions, symmetrically distributed, which occurred after the application of suction cups in the context of polymyalgia rheumatica.

Adrenal Cortex Hormones↗
PubMed1995

High-pressure directed water jets as a cause of severe bilateral intraocular injuries.

PURPOSE: To draw attention to the characteristic features of eye injuries caused by high-pressure water jets. METHOD: We examined three patients with bilateral eye injuries caused by directed high-pressure water jets. RESULTS: All three patients had reduced visual acuity bilaterally, extensive eyelid ecchymosis, subconjunctival hemorrhages, hyphema, iris sphincter rupture, transient increase in intraocular pressure, and inferior commotio retinae. These injuries were confined primarily to the lower parts of the eyes. CONCLUSIONS: High-pressure water jets may cause bilateral eye injuries affecting primarily the anterior and inferior parts of the eyes. Because of concern about late effects of injuries, long-term follow-up is recommended.

Adult↗
PubMed1998

Minimally invasive saphenous vein harvesting: endothelial integrity and early clinical results.

BACKGROUND: Endoscopic harvesting of vein grafts may reduce wound complications but the effect on the venous endothelium is unknown. Endothelium-derived vasoactive substances may be important in vein graft disease prevention. We investigated the impact of endoscopic harvesting on the release of these factors and proceeded to evaluate the clinical applicability. METHODS AND RESULTS: Porcine veins were harvested in either an endoscopic or open fashion. Superfusion bioassay from endoscopic veins had a similar basal secretion as control veins (6.5% +/- 1.5% versus 3.2% +/- 2.2%, respectively; n = 5, p = 0.39). Calcium ionophore A23187 stimulation was similar in both groups (24.6% +/- 5.1% versus 27.3% +/- 9.6%; n = 5, p = 0.68). Light and electron microscopy documented a normal endothelial monolayer in both groups with no endothelial cell or connective tissue loss. Encouraged by these results, 38 patients have subsequently undergone this procedure at our institution. Total operative time for harvesting 35 to 45 cm of saphenous vein was 62.3 +/- 5.3 minutes (range, 35 to 120 minutes). The procurement time in the most recent five patients was 41.6 +/- 3.3 minutes. Patients had little incisional pain, but did have mild ecchymosis. CONCLUSIONS: Endothelial release of vasoactive substances after endoscopic harvesting is similar to that after the traditional, extended incision technique, and microscopy confirmed similar histology. These laboratory findings support the satisfactory early clinical experience with endoscopic harvesting of saphenous veins.

Adult↗
PubMed2003

Hemorrhagic activity of the Duvernoy's gland secretion of the xenodontine colubrid Philodryas patagoniensis from the north-east region of Argentina.

Colubrid snakes belonging to Philodryas genus, widespread all over South America, bring about lesions (swelling, ecchymosis, transient bleeding from the bite site punctures), that are similar to those produced by Bothrops species (yarará). In the present work we began the characterization of Philodryas patagoniensis venom. We examined if this venom produces hemorrhagic lesions as those observed in victims bitten by Philodryas olfersii. Hemorrhagic, proteolytic and fibrinogenolytic activities were evaluated, and histological observations in samples of gastrocnemius muscle were carried out. Inhibition studies were carried out in metal chelator (ethylenediaminetetraacetic acid) presence. Our results show a small Minimum Hemorrhagic Dose (MHD=0.035 microg) and a high proteolytic activity (143 U/mg), and prove the capacity of this venom to degrade fibrinogen in vitro rendering it unclottable by thrombin, supporting the presence of proteases, principally metalloproteases, in P. patagoniensis venom that are able to alterate the vascular wall and degrade fibrinogen, being both activities responsible of a high hemorrhagic activity.

Animals↗
PubMed1986

Indications for intravenous pyelography in trauma.

The cornerstone for radiographic evaluation of genitourinary trauma is intravenous pyelography (IVP). Despite its widespread use, however, the indications for emergency IVP in trauma remain controversial. Some authors recommend the use of an IVP for all patients with hematuria, while others are selective, basing their decision on the degree of hematuria or such other factors as the mechanism of injury, physical examination, or the presence of associated injuries. Based on the data reviewed for blunt and penetrating trauma, we recommend that an IVP be performed in: all patients with gross hematuria; all patients who present with pain or tenderness that could be referrable to the genitourinary tract, even in the absence of hematuria; all patients with flank hematoma or ecchymosis; and all patients with penetrating trauma that could reasonably be expected to injure the genitourinary tract. Recently computed tomography (CT) has been proposed for the evaluation of renal trauma. The CT proponents cite superior definition of the extent of renal injury and superior detection of injuries not clinically suspected. Some have proposed the following algorithm, incorporating computed tomography. If an isolated renal injury is suspected clinically, an emergency IVP is performed. If the IVP is normal, expectant conservative treatment follows. If the IVP is abnormal or if the patient has persistent symptoms, an emergency CT scan is performed. Furthermore computed tomography is performed initially in the stable patient with multiple trauma and in the patient with suspected severe renal injury. While this algorithm has not been universally accepted, future studies confirming the theoretical advantages of this approach are anticipated.

Child↗
PubMed1997

Maintenance of hemostasis after invasive cardiac procedures: implications for outpatient catheterization.

OBJECTIVES: This study investigated the efficacy of four different methods of arterial puncture site management during recovery from invasive cardiac procedures. The primary goals were less patient discomfort and improved clinical outcome. BACKGROUND: The increasing use of outpatient catheterization, large interventional devices and potent periprocedural anticoagulation regimens has made the reduction of groin complications a high priority. Despite these trends, there are no randomized trials comparing commonly used techniques in treating the catheter entry site for the first few hours after the procedure. METHODS: Four-hundred consecutive patients undergoing catheterization laboratory procedures were randomly assigned to one of four dressing techniques applied after achieving hemostasis: a sandbag placed over the site; a pressure dressing constructed from surgical gauze and elastic tape; a commercially available compression device; and no use of compressive dressing. Of these 400 patients, 171 would have been eligible for outpatient procedures in the absence of geographic constraints. The dressings were removed, and ambulation was encouraged 5 h after sheath removal. Uniform initial compression times, patient instructions, nursing follow-up and a structured interview and physical examination at 24 h were used. RESULTS: The level of patient discomfort before and after dressing removal, as well as site tenderness at 24-h follow-up, was statistically similar in all four groups. Hematomas (typically small) and areas of ecchymosis were observed in 58 and 122 patients, respectively, but both their frequency and size were equally represented in each group. Important adverse events were confined to bleeding, rated as mild in 5.8%, moderate in 0.8% and severe in 0.6% of patients. Again, all four groups were statistically similar. Comparable findings were observed in the subgroup of patients eligible for outpatient procedures. CONCLUSIONS: Despite an increase in inconvenience and expense, none of the three compression techniques that were investigated improved patient satisfaction or outcome. Therefore, the routine use of compression dressings after invasive cardiac procedures cannot be recommended.

Cardiac Catheterization↗
PubMed2005

Steroids in rhinoplasty: a survey of current UK otolaryngologists' practice.

The use of steroids during rhinoplasty to reduce post-operative periorbital oedema and ecchymosis has been advocated. A number of randomized controlled trials have demonstrated the benefit of steroids in rhinoplasty. The aim of this study was to determine current UK practice in the use of steroids during rhinoplasty performed by otolaryngologists. A postal survey of consultant otolaryngologists in the UK was conducted. We received 203 responses, with 115 consultants performing 12 or more rhinoplasties per year. Only 28 consultants (24 per cent) used steroids routinely in patients undergoing rhinoplasty and of these 11 used a protocol, although this was unpublished. Dexamethasone was the most common steroid used (82 per cent), being administered as a single intravenous dose of 8 mg in the majority of cases (54 per cent). There was no correlation between the use of steroids and the number of rhinoplasties performed by individual consultants. Despite the evidence supporting the use of steroids to reduce post-operative sequelae following rhinoplasty, only a minority of consultants in the UK appear to use them as part of their practice.

Anti-Inflammatory Agents↗
PubMed2002

Clinical results of alveolar ridge augmentation with mandibular block bone grafts in partially edentulous patients prior to implant placement.

A group of 15 partially edentulous patients who needed alveolar ridge augmentation for implant placement, were consecutively treated using a two-stage technique in an outpatient environment. A total of 18 alveolar segments were grafted. During the first operation bone blocks harvested from the mandibular ramus or symphysis were placed as lateral or vertical onlay grafts and fixed with titanium osteosynthesis screws after exposure of the deficient alveolar ridge. After 6 months of healing the flap was re-opened, the screws were removed and the implants placed. Twelve months after the first operation implant-supported fixed bridges could be provided to the patients. Mean lateral augmentation obtained at the time of bone grafting was 6.5 +/- 0.33 mm, that reduced during healing because of graft resorption to a mean of 5.0 +/- 0.23 mm. Mean vertical augmentation obtained in the 9 sites where it was needed was 3.4 +/- 0.66 mm at bone grafting and 2.2 +/- 0.66 mm at implant placement. Mean lateral and vertical augmentation decreased by 23.5% and 42%, respectively, during bone graft healing (before implant insertion). Mandibular sites showed a larger amount of bone graft resorption than maxillary sites. All the 40 implants placed were integrated at the abutment connection and after prosthetic loading (mean follow-up was 12 months). No major complications were recorded at donor or recipient sites. Soft tissue healing was uneventful, and pain and swelling were comparable to usual dentoalveolar procedures. A visible ecchymosis was present for 4 to 7 days when the bone was harvested from the mandibular symphysis. From a clinical point of view this procedure appears to be simple, safe and effective for treating localised alveolar ridge defects in partially edentulous patients.

Alveolar Ridge Augmentation↗
PubMed2006

Neuroblastoma with orbital metastasis: ophthalmic presentation and role of ophthalmologists.

INTRODUCTION: Neuroblastoma is predominantly a tumour of early childhood, which metastasises to the orbits. In such cases, ophthalmologists are involved in the multidisciplinary management. This unique series from a tertiary referral centre is used to elaborate the ophthalmic associations and the ophthalmologist's role in this rare condition. METHODS: A review of case notes was performed on six patients who presented to the paediatric ophthalmology - oncology liaison service at the Leeds teaching hospitals between 1998 and 2003. The ophthalmic outcome and role of the ophthalmologist were assessed. RESULTS: Average age of presentation was 29.8 months (range 15-69 months). Average duration of follow-up was 19.5 months (range 2-58 months). One child died during treatment. Two have completed treatment and are under follow-up. Presenting features of the six children were proptosis in four, periorbital ecchymosis in two, ocular motility restriction in two, and subconjunctival haemorrhage in one. Only one case developed blindness. CONCLUSIONS: The role of the ophthalmologist in patients with metastatic orbital neuroblastoma can vary from a supportive role to one of active intervention and management of ophthalmic complications. The ophthalmologist is involved in diagnosis and staging as well as monitoring response to treatment of both the primary disease and secondary ophthalmic complications.

Child↗
PubMed1993

Complications of Echis colorata snake bites in the Asir region of Saudi Arabia.

Seven Saudi children bitten by Echis colorata, a species of carpet viper encountered mainly in the Middle East, were studied in south-western Saudi Arabia. They all showed severe local signs of swelling, ecchymosis and blisters, and one also had local necrosis. Four children had systemic envenoming with vomiting and hypotension, and one child had acute renal failure. Three of them had prolonged prothrombin and partial thromboplastin times and hypofibrinogenaemia resulting from disseminated intravascular coagulopathy. They were initially managed in the intensive care unit and received intravenous fluids and polyvalent antivenom. Apart from one child who required skin grafting for local necrosis, complete recovery with no sequelae occurred in all cases.

Acute Kidney Injury↗