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PubMed1955

Paravaginal hematomas; their recognition and management postpartum.

Paravaginal hematoma is an unavoidable obstetrical complication, usually due to the traction and rupture of paravaginal veins by the oncoming presenting part. Pain, swelling, ecchymosis and urinary retention are the usual symptoms if the hematoma is located below the levator plate, while supralevator hematomas give no external manifestations. Early diagnosis could be made more often if digital examination of the pelvis were done routinely after the third stage of labor and before dismissal of the patient from the hospital, and done more frequently in postpartum patients with pelvic complaints. Active surgical intervention is advocated to avert needless destruction of tissue, prolonged morbidity, and delayed recovery.

Ecchymosis↗

PubMed2004

Division of incompetent perforator veins and subfascial interposition of a polypropylene foil in post-thrombotic syndrome. Preliminary results.

AIM: The safety, feasibility and early efficacy of subfascial endoscopic perforator surgery was gradually accepted for patients who had severe chronic venous insufficiency but, in the literature, the recurrence rate of ulceration is about 10-40%, especially in patients with previous deep vein thrombosis (DVT). METHODS: From October 1998 to February 2002, 205 patients with 280 inferior leg ulcers were followed; 115 had venous ulcers but only 20 patients had chronic ulcers with previous DVT; 4 patients were excluded and only 16 patients (9 female, 7 male, mean age 61 years) with 18 chronic ulcers were included. These patients underwent sub-aponeurotic interruption of perforating veins with blind technique in association with subfascial interposition of a hand-made polypropylene foil. Eight of these patients had persistent non-healing ulcers at the time of surgery and 10 had chronic recurrent ulceration healed at the time of the surgical procedure. All patients were assessed clinically and with duplex scanning. RESULTS: The follow-up was done clinically and with eco-Doppler from 6 to 38 months with a mean follow up period of 23.2 months. The healing rate was 100%. The 2-year life table incidence of ulcer recurrence was 0%. Hospital stay ranged from 1-2 days, early operative complications included extensive ecchymosis in 1 patient, oedema in 3 patients. CONCLUSION: The division of perforating veins, with the subfascial support of a polypropylene foil give promising results in the treatment of venous ulcers in post-thrombotic syndrome with low morbidity and short hospital stay.

Angioscopy↗

PubMed1979

"Steroid-phobia" in asthma management.

Excellent clinical results were obtained in 85 patients with chronic asthma who took corticosteroids (mostly triamcinolone) on a long-term basis for periods varying from one to 26 years. There was a minimum of side-effects, none serious; the most discomforting were ecchymosis and a tendency to easy bruising. The results of this and previous studies have convinced the author that corticosteroids, if judiciously used, are the most valuable adjunct we have in the treatment of acute and chronic asthma.

Acne Vulgaris↗

PubMedDate not supplied

Back to the basics: hemorrhage after vaccination: a case report.

A 50-day-old girl with swelling and ecchymosis of right hand dorsum after DTP vaccination on ipsilateral deltoid area was referred to the pediatric infectious disease outpatient unit with a presumed diagnosis of gangrenous cellulites. Physical examination and laboratory evaluation revealed intramuscular bleeding as a result of vitamin K deficiency. We would like to emphasize the importance of both vitamin K prophylaxis in the newborn to prevent hemorrhagic disease of the newborn and of the education of persons administering vaccines about this very basic aspect of pediatrics for early recognition.

Ecchymosis↗

PubMed2005

Seat-belt injuries in children involved in motor vehicle crashes.

BACKGROUND: The efficacy of seat belts in reducing deaths from motor vehicle crashes is well documented. A unique association of injuries has emerged in adults and children with the use of seat belts. The "seat-belt syndrome" refers to the spectrum of injuries associated with lap-belt restraints, particularly flexion-distraction injuries to the spine (Chance fractures). METHODS: We describe the injuries sustained by 8 children, including 2 sets of twins, in 3 different motor vehicle crashes. RESULTS: All children were rear seat passengers wearing lap or 3-point restraints. All had abdominal lap-belt ecchymosis and multiple abdominal injuries due to the common mechanism of seat-belt compression with hyperflexion and distraction during deceleration. Five of the children had lumbar spine fractures and 4 remained permanently paraplegic. CONCLUSIONS: These incidents illustrate the need for acute awareness of the complete spectrum of intra-abdominal and spinal injuries in restrained pediatric passengers in motor vehicle crashes and for rear seat restraints that include shoulder belts with the ability to adjust them to fit smaller passengers, including older children.

Abdominal Injuries↗

PubMed1992

Cullen's sign: it doesn't always mean hemorrhagic pancreatitis.

Periumbilical ecchymosis, Cullen's sign, is most often considered a sign of hemorrhagic pancreatitis. We present a case of splenic rupture secondary to infectious mononucleosis in a middle-aged patient whose presenting complaint was the presence of Cullen's sign, secondary to the hemoperitoneum. The splenic rupture was managed conservatively, and the Cullen's sign resolved within 14 days of presentation.

Acute Disease↗

PubMed1991

Trauma reduction in rhinoplastic surgery.

Operative procedures for bony pyramid surgery of the nose, using micro-osteotomes to reduce surgical trauma, are described. Over the last seven years experience with this refined technique has shown a considerable reduction in postoperative ecchymosis and oedema.

Ecchymosis↗

PubMed1991

Laboratory phlebotomy. College of American Pathologists Q-Probe study of patient satisfaction and complications in 23,783 patients.

Outpatients from 630 institutions participated in a phlebotomy module of Q-Probes, a quality assurance program of the College of American Pathologists, Northfield, Ill. This module assessed patient outcome measurements of complications, discomfort, and satisfaction with the phlebotomy procedure. Of the 29,700 ostensibly healthy individuals registered, 80.1% returned postcards containing measurements and assessments they made about the procedure and information recorded by the phlebotomist. The median time required for phlebotomy was 6 minutes, with 25% of patients requiring less than 5 minutes and 10% more than 21 minutes for completion of the procedure. The average number of phlebotomy attempts per patient was 1.03, with 95 patients (0.4%) experiencing three to 11 attempts. Ecchymoses occurred in 4048 (16.6%) attempts, with the median size of ecchymosis being 15.1 mm. On the average, an outstanding employee was identified by patients 46.6% of the time. The discomfort caused by the needle puncture was more than expected by 35.3% of patients. Although 98.6% of the patients were satisfied, 336 patients were dissatisfied with the procedure. We conclude that the technical skills of phlebotomists and patient satisfaction with phlebotomy are outstanding, but that patient discomfort from the procedure needs to be minimized.

Bloodletting↗

PubMed1990

The lap belt complex: intestinal and lumbar spine injury in children.

The "seatbelt syndrome" describes intestinal and spinal injury caused by lap-style automotive restraints. More than 2,600 children were admitted to Children's National Medical Center with blunt injury in 3 years; 395 were involved in a motor vehicle crash. Ninety-five of the crash occupants (24%) were known to be wearing safety belts. Ten children sustained a "lap belt injury": five with lumbar spine injury, four with combined lumbar spine and intestinal injuries, and one child with intestinal injury. All ten children presented with a characteristic transverse abdominal ecchymosis. The CT scan was unreliable in evaluation of both spinal and intestinal injury. Lateral radiographs were required for definitive diagnosis in eight of nine children with lumbar spinal injury. CT scan was clearly diagnostic in only one of five children with intestinal injury. Children wearing lap belts are at risk of a "lap belt complex." Lateral spine X-rays, peritoneal lavage, and early laparotomy are recommended to establish an accurate diagnosis and to decrease morbidity.

Accidents, Traffic↗

PubMedDate not supplied

[Ecchymotic patches of the fingers and Gardner-Diamond vascular purpura].

Ecchymotic patches on the fingers and vascular purpura in Gardner-Diamond syndrome are two benign but recurrent clinical disorders occurring chiefly in young women. They involve superficial cutaneous hemorrhagic signs. Both disorders testify to microvascular fragility without perturbation of general hemostasis. Diagnosis is easy for those familiar with the disorders. Ecchymotic episodes accompanied by sharp pain begin at the roots of the fingers. Microtraumatism is soon seen to be involved. Ecchymosis develops at the flexor muscles of the fingers but "capillary" resistance is only reduced in one third of cases. The pathogenic explanation involves rupture of a small post-capillary vein due to disorders in the control system of kinins and local metabolites. The autoerythrocyte sensitization syndrome described in 1955 by Gardner and Diamond is characterized by painful and febrile episodes followed by purpuric and ecchymotic lesions of the skin on various parts of the body, but not necessarily on the legs. Dysneurotonic effects are frequent but diagnosis is based upon promotion of the disorder by intradermal or subcutaneous injection of a minimal quantity of autologous blood. Immunological effects are considered but the ailment involves microvascular control disorders, notably of the capillary-vein segment, in particular at Copley's endo-endothelial fibrin film. Imbalance in fibrin formation and lysis is associated with perturbation of the kinin and serotonin systems. In addition to the use of certain bioflavonoids and calcium inhibitors, prevention and treatment should involve consideration of drugs which affect plasticity in the vascular wall and pericapillary interstitial conjunctiva and the rheological properties of blood flow and interstitial tissue.

Ecchymosis↗

PubMed1984

The risks of suction lipectomy. Their prevention and treatment.

All surgical procedures are associated with risks. They may be divided into undesired sequelae, which are normal and expected, and complications, which are not normal or expected. The undesired sequelae of suction lipectomy are contour irregularities, hypesthesia, edema, ecchymosis, and pigmentary deposits. The potential complications are blood loss, hematoma, seroma, infection, greater saphenous vein thrombosis, fat emboli, and skin slough. These are discussed in detail.

Adipose Tissue↗

PubMed1984

Subcutaneous hemorrhage in a patient receiving anticoagulant therapy: an unusual EMG complication.

A 64-year-old man on chronic anticoagulant therapy underwent electromyography (EMG) and six days later noted a 13 X 8cm ecchymotic region on the right flank and a smaller area of ecchymosis along the lower spine. He was found to have significant subcutaneous bleeding (hematocrit decreased from 43% to 29%), which required a two-unit blood transfusion. In light of the location of the hematoma and the temporal relationship to the EMG, it is proposed that this unusual case represents a significant complication of a usually benign procedure. Clinicians need to be aware of the possibility of such a complication in the anticoagulated patient and of the need for a risk-benefit decision prior to EMG.

Ecchymosis↗

PubMed1984

Severe inherited "homozygous" protein C deficiency in a newborn infant.

A relapsing clinical syndrome of skin lesions and disseminated intravascular coagulation (DIC) that showed remission with the infusion of fresh frozen plasma is described in a newborn infant with homozygous deficiency of protein C antigen. This patient presented since birth a recurrent clinical picture of DIC and ecchymotic skin lesions that resembled typical ecchymosis except for the fact that they showed immediate improvement with the administration of fresh frozen plasma. Using an enzyme linked immunosorbent assay method, the determination of protein C antigen levels in the patient, without ingestion of coumarin drugs, showed very low values (less than 1%). No other deficiencies in the vitamin-K-dependent factors or in antithrombin III, antiplasmin, and plasminogen were found. Seven relatives of the infant had heterozygous deficiency in protein C antigen (values between 40-55%), without clinical history of venous thrombosis. The pedigree analysis of this family suggests an autosomal recessive pattern of inheritance for the clinical phenotype, although an autosomal dominant pattern has been postulated until now in other reported families. We conclude that our patient has a homozygous deficiency in protein C and this homozygous state may be compatible with survival beyond the neonatal period.

Blood Coagulation Disorders↗

PubMed1995

[Fracture of the medial wall of the orbit. Apropos of 4 cases].

Fractures or the medial wall of the orbit are uncommon and clinical signs are often discreet. This report was focused on isolated fractures of the medial wall of the orbit. Blow-out trauma is usually the cause. In these cases the clinical signs ranged from simple ecchymosis to blindness by haematoma of the orbital cone. Computed tomography is a major tool for diagnosis and making therapeutic indications for these fractures. Treatment depends on the oculomotor involvements as measured by forced duction tests.

Blindness↗

PubMed1994

Superior orbital fissure syndrome. Secondary to infected dentigerous cyst of the maxillary sinus.

Superior orbital fissure syndrome is a rare condition that presents itself as gross and persistent edema of the periorbital tissues, proptosis, subconjunctival ecchymosis, ptosis, ophthalmoplegia, dilation of the pupil, absence of direct light reflex and presence of consensual light reflex. The corneal reflex is lost, sensation is diminished over the forehead, and it is possible that the dimensions of the superior orbital fissure are reduced. Infection, however, is not often reported as the etiology. The case presented here describes an unusual occurrence of superior orbital fissure syndrome secondary to an infected dentigerous cyst of the maxillary sinus and its management.

Blepharoptosis↗

PubMed1995

Complications and results of 361 hysterectomies performed at laparoscopy.

BACKGROUND: Before the appropriate use of laparoscopy in hysterectomy can be determined, it is necessary to evaluate the results, including complications. There must also be an accepted classification system to facilitate accurate comparison to total abdominal hysterectomy. STUDY DESIGN: We retrospectively evaluated the charts of 361 women who underwent hysterectomy for various benign pathologic conditions. Intraoperative and postoperative complication rates for hysterectomy performed at operative laparoscopy were examined. The hysterectomies were classified as one of four types according to the number of steps performed laparoscopically. All women were candidates for total abdominal hysterectomy, but not vaginal hysterectomy. RESULTS: The overall complication rate for hysterectomy performed at operative laparoscopy was 11.1 percent. Most complications were minor, including cystitis (1.66 percent), transient high fever (1.39 percent), abdominal wall ecchymosis (1.12 percent), and pneumonia and bronchitis (1.12 percent). There was no correlation between the type of laparoscopic hysterectomy performed and the complication rate. CONCLUSIONS: Our rate of intraoperative and postoperative complications associated with laparoscopic hysterectomy compares favorably with published complication rates for vaginal and abdominal hysterectomy.

Abdominal Muscles↗

PubMed1993

[Hematomas of the abdominal rectus muscle].

The authors report their experience in relation to a series of 12 cases of hematoma of the rectus abdominis (ER) observed over the course of 13 years at the 2nd Division of General Surgery at Vicenza Hospital: 7 were spontaneous, 2 post-traumatic, 1 occurred during anti-coagulant treatment, 1 in a patient with altered coagulation levels due to liver cirrhosis, and 1 was post-operative. Clinical symptoms were sub-acute in 8 cases and were characterised by abdominal pain in all cases, the appearance of an abdominal mass in 4 cases and by ecchymosis in 3 cases. Symptoms were acute in 4 cases with signs of impaired general conditions and anemia. Echography made a decisive contribution to the diagnosis in this pathology and, based on the author's experience, when it was used it prevented the use of surgery. Computerised axial tomography, although it contributed a few precise findings to the diagnosis of ER, was rarely useful. Eight patients were operated: 2 due to collapse and anemia, 4 due to failure to identify the disease, 1 due to persistence of the parietal mass, and 1 due to infection of the hematoma. In the 4 cases which were not operated, the course of the disease was more favourable. The sole death was an elderly cardiopathic patient due to postoperative complications following general surgery. The most suitable therapeutic approach, in those cases where an accurate diagnosis of ER has been made, is to refrain from any form of treatment and to monitor symptoms until they resolve, which will occur spontaneously after 20-30 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗

PubMed1995

Ecchymotic Kaposi's sarcoma.

We report two patients with ecchymotic patches that did not suggest the diagnosis of Kaposi's sarcoma. The principal complaint of one patient was facial and periorbital edema with bilateral periorbital ecchymosis. On his trunk were patches resembling pityriasis rosea-like Kaposi's sarcoma. Both types of lesions proved to be Kaposi's sarcoma on histologic examination. The second patient had scattered ecchymotic lesions, with typical lesions of Kaposi's sarcoma elsewhere on his body. The ecchymotic lesions showed a large amount of extravasated red blood cells and no evidence of amyloid. This variant has not been described previously to our knowledge.

Adult↗