Rectus sheath hematoma
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Journal Article↗
Biomedical subjects
J Burstein
Publications and source records attributed to J Burstein.
Rectus sheath hematoma.
We describe 3 patients with rectus sheath hematoma presenting to the emergency department. Prompt consideration of this uncommon cause of abdominal pain may prevent more expensive and invasive diagnostic tests and, in some cases, unnecessary hospitalization and laparotomy.
Abdomen, Acute↗
Predictors of underlying coronary artery disease in cocaine associated myocardial infarction: a meta-analysis of case reports.
Age, number of cardiac risk factors, inferior infarction and bradyarrhythmias predicted underlying coronary artery disease (CAD) in patients with cocaine associated myocardial infarction. We sought to validate these criteria through a meta-analysis of published case reports. Cocaine associated myocardial infarctions reported in the English language literature were retrospectively identified. Data abstracted included patient demographics; cardiac risk factors, history of myocardial infarctions, last use of cocaine and complications during hospital course, and the presence or absence of CAD. Patients with CAD (> 50% stenosis on cardiac catheterization or autopsy) were compared to patients without CAD (normal coronaries of cardiac catheterization). In all cases of incomplete information, the authors were contacted for missing results. We identified 66 patients with cocaine associated myocardial infarction in whom the presence or absence of CAD was known: 41% had CAD. Of the 27 patients with CAD, 14 (52%) had 1 vessel disease, 7 (26%) had 2 vessel and 6 (22%) had 3 vessel disease. CAD was associated with the presence of 2 or more cardiac risk factors (18% vs 0%, p = 0.03), however the sensitivity for detection of CAD was only 18%. Bradyarrhythmias were uncommon but only occurred in patients with CAD (8% vs 0%, p = 0.17), however the sensitivity for detection of CAD was only 8%. Patients with and without CAD did not differ in terms of the other criteria (age > 40 y and infarct location) previously found associated with a higher likelihood of CAD. In this meta-analysis of published case reports, patients with cocaine associated myocardial infarction and 2 or more traditional cardiac risk factors were more likely to have underlying CAD, but only 18% of patients with underlying CAD would be detected through this screening criteria. Larger prospective trials are needed to better determine criteria predictive of underlying CAD in patients with cocaine associated myocardial infarction.
Adult↗
Urine pregnancy tests from antiquity to the present.
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Chorionic Gonadotropin↗
Complaints and compliments in the pediatric emergency department.
We conducted an analysis of all communications received from patients or their families by the director of a pediatric emergency department over a three-year period, during which approximately 150,000 visits occurred. Communications were characterized as complaint or compliment and subclassified by type: waiting time, staff attitude, quality of medical care, and billing. Chi 2 analysis was used to identify factors that predisposed to complaint or compliment and to identify the subtype. After quality-of-care issues, complaints stemmed most often from billing issues or waiting time for care for nonurgent disorders (especially medical problems), while complimentary letters most frequently addressed staff attitude and quality of care. The problems that we identified might be addressed by providing families improved access to non-emergency department care sources, education regarding the role of an emergency department, and better explanation of billing procedures during the registration process. Additionally, our findings serve as a reminder that many parents appreciate the care given to their children, particularly for life-threatening emergencies.
Accounts Payable and Receivable↗
Asplenia syndrome with atypical cardiac anomalies.
Two infants with asplenia and complex cyanotic congenital heart disease showed unusual findings at cardiac catheterization. Each had a patent pulmonary outflow tract and a severe obstructive lesion of the aortic arch. These cases emphasize the heterogeneity of the asplenia-polysplenia syndromes. Pulmonary atresia or critical pulmonic stenosis is not an invariable accompaniment of the asplenia syndrome. Obstructive lesions of the aortic outflow tract, which occur in about 1/3 of patients with the polysplenia syndrome, also can occur with asplenia.
Blood Gas Analysis↗
Vascular ring due to left aortic arch and right descending aorta.
Two children presented with symptoms suggestive of a vascular ring. Barium esophagrams in each case showed a posterior impression caused by a retroesophageal aortic arch. Angiographic studies defined a rare form of vascular ring resulting from an ascending left-sided aorta, a descending right-sided aorta and a right-sided ligamentum arteriosum. At surgery, the diagnosis was confirmed and the anomaly was corrected in each patient. Left pulmonary anomalies were present in each patient.
Aorta, Thoracic↗
Aberrant systemic arterial supply to the left lung with congestive heart failure.
A six-month-old girl with an aberrant systemic arterial supply from the descending thoracic aorta to the left lower lobe had congestive heart failure. Although the pulmonary parenchyma was normal, there was an absence of normal pulmonary arterial supply to the left lower lobe. Main pulmonary arterial and aortic cineangiograms led to the correct diagnosis. Left lower lobectomy was performed and resulted in clinical and hemodynamic improvement.
Aorta, Thoracic↗
Posthemorrhagic hydrocephalus in low-birth-weight infants: treatment by serial lumbar punctures.
We have performed weekly computed tomographic brain scans on 28 surviving low-birth-weight infants with cerebral intraventricular hemorrhage and acute ventricular dilatation. Evolving hydrocephalus was observed in 15 infants. Twelve of the 15 infants were treated by removing large volumes of cerebrospinal fluid with serial lumbar punctures. Arrest in the progression of hydrocephalus was evident in 11 of the 12. Clinical hydrocephalus requiring surgical intervention occurred in one of the treated infants and in all three untreated infants. No complications of serial lumbar punctures were noted, whereas shunt-related morbidity was 100%. Our results suggest that serial lumbar punctures are effective in arresting the development of posthemorrhagic hydrocephalus.
Brain↗
Intestinal obstruction due to colonic stricture following neonatal necrotizing enterocolitis.
After resolution of acute necrotizing enterocolitis (NEC), six of 31 surviving infants (19%) developed late ischemic stricture of the colon. Stricture occurred after both medical and surgical treatment for NEC, and in both functional and defunctionalized bowel. In medically-treated infants, the symptoms of intestinal obstruction usually began six to eight weeks after NEC. Surgically-treated infants developed asymptomatic strictures distal to an enterostomy. Barium enema was the appropriate diagnostic study for both groups. Operative management consisted of segmental colonic resection with frequent use of enterostomy. On histopathologic examination, resected strictures showed a spectrum of the reparative process after intestinal ischemia, ranging from obliterative scar to near-normal colon. Because delayed diagnosis led to the death of one of our infants, we recommend a barium enema for early diagnosis of stricture about six weeks after NEC, whether initial treatment was medical or surgical. In a recent infant, two colonic strictures were thus diagnosed and resected prior to development of symptoms of intestinal obstruction.
Colonic Diseases↗
Indications for operation in acute necrotizing enterocolitis of the neonate.
A study to evaluate criteria for operation was carried out in 61 infants with acute necrotizing enterocolitis (NEC). A total of 10 clinical, roentgenographic, and laboratory criteria were considered. Each proposed operative criterion was correlated with the documented presence or absence of intestinal gangrene in these infants. Indications for operation verified by this study were (1) pneumoperitoneum, (2) paracentesis findings positive for gangrenous intestine, (3) erythema of the abdominal wall, (4) a fixed abdominal mass, and (5) a persistently dilated loop of intestine on serial abdominal radiographs. The first two signs occurred frequently; the latter three were rare. Operative indications which proved to be invalid in this study were (1) clinical deterioration, (2) persistent abdominal tenderness, (3) profuse lower gastrointestinal hemorrhage, (4) the roentgenographic finding of gasless abdomen with ascites, and (5) severe thrombocytopenia. Twenty-four of the infants were operated on. The mortality rate among the infants operated on after free intestinal perforation had occurred (64%) was double that of infants operated on for intestinal gangrene without perforation (30%). Paracentesis may identify infants with intestinal gangrene prior to the development of perforation and may permit advantagenous timing of operation. This analysis of the frequency and reliability of proposed operative criteria may aid the surgical decision.
Ascites↗
Radiological case of the month. Scimitar syndrome.
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Abnormalities, Multiple↗
Intraventricular hemorrhage and hydrocephalus in premature newborns: a prospective study with CT.
In a prospective study, 100 premature infants were studied with computed tomography (CT) brain scans within the first week of life. In 44 of these,hemorrhages originated from the subependymal germinal matrix, and ranged in severity from isolated germinal matrix hemorrhages to blood-filled, dilated ventricles with extension of hemorrhage into the brain parenchyma. A system of grading the severity of hemorrhage was developed. Grades I and II hemorrhages resolved spontaneously and grades III and IV were associated with progressive hydrocephalus. Asymptomatic hemorrhages that would not have been diagnosed on clinical grounds were detected by CT. This study offers a clearer understanding of the true incidence and natural history of cerebroventricular hemorrhage and associated hydrocephalus in premature neonates and may clarify etiologic factors and identify children at risk for subsequent neurologic abnormalities.
Cerebral Hemorrhage↗
A new look at young brains.
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Brain Diseases↗
Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm.
We have performed brain scanning by computed tomography on 46 consecutive live-born infants whose birth weights were less than 1,500 gm; 20 of them had evidence of cerebral intraventricular hemorrhage. Nine of the 29 infants who survived had IVH. Four grades of IVH were identified. Grade I and II lesions resolved spontaneously, but there was prominence of the interhemispheric fissue on CT of the infants at six months of age. Hydrocephalus developed in infants with Grade III and IV lesions. Seven of the surviving infants with IVH did not have clinical evidence of hemorrhage. There were no significant differences between the infants with and without IVH in birth weight, gestational age, one- and five-minute Apgar scores, or the need for resuscitation at birth or for subsequent respiratory assistance.
Cerebral Hemorrhage↗
Relationship of intravenous sodium bicarbonate infusions and cerebral intraventricular hemorrhage.
The incidence of cerebral intraventricular hemorrhage was determined by computed tomography in 100 infants with birth weights less than or equal to 1,500 gm. A comparison of IVH with serum sodium concentrations and the amount of intravenous sodium bicarbonate administered did not reveal a significant relationship. Analysis of the method of infusion of sodium bicarbonate indicated that the rapid infusion of hyperosmolar (M to M/12) sodium bicarbonate is associated with a significantly increased incidence of IVH.
Bicarbonates↗
Long injection time and biplane oblique patient positioning in femoral arteriography.
We have made several important changes in femoral arteriography, including a slower rate, longer injection time, and the use of biplane oblique views. The long injection time has resulted in fewer repeat examinations. Biplane oblique filming of the pelvis has increased our ability to demonstrate stenoses and abnormalities, although it has not significantly increased the information content of the studies.
Angiography↗
Malignant hemorrhagic renal cyst with occult neoplasm.
An asymptomatic hemorrhagic renal cyst was benign at angiography, nephrotomography, cystography, and cytologic examination. Malignancy was found at surgery. Malignancy cannot be excluded in a hemorrhagic cyst which is benign by all other criteria.
Hemorrhage↗