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At least 235 records · Page 13Linked to original sources

PubMed1994

Progress report on multicenter study of laser-assisted liposuction.

Fifty-one patients underwent an FDA-approved study of laser-assisted liposuction in five plastic surgery centers. The YAG laser fiber is contained within the cannula and shears off the fat cleanly and coagulates blood vessels as the fat is drawn into the cannula. The drop in hemoglobin was relatively modest after surgery. Patients were able to return to work at six days and to light exercise at seven days. Contralateral studies showed a slight benefit for the laser side at both one and eight weeks for ecchymosis, pain/discomfort, and edema. Lipocrit studies were inconsistent.

Adult↗

PubMed1994

Laparoscopic disk excision and primary repair of the anterior rectal wall for the treatment of full-thickness bowel endometriosis.

We used a new laparoscopic technique to treat infiltrative symptomatic intestinal endometriosis. Eight women, ages 29-38, with extensive symptomatic pelvic endometriosis were included in this series. All were diagnosed as having severe pelvic endometriosis and had not responded to previous conservative surgical and hormonal therapy. In a 5-18-month postoperative followup, six women have reported complete relief of the symptoms. Two have right lower quadrant pain and menstrual cramping. Second-look laparoscopy was offered to all patients and so far, two have accepted. These procedures were performed 6 weeks postoperatively. At that surgery, we found that the anastomotic site had healed completely with filmy adhesions between the posterior aspect of the uterus and the rectosigmoid colon in one patient. The second woman had undergone extensive adhesiolysis at the first surgery, and these adhesions recurred; however, the anastomotic site had healed completely. One of the two infertility patients has achieved pregnancy. The only complications was one patient with ecchymosis of the anterior abdominal wall. Sigmoidoscopy was performed 6 weeks postoperatively, and has been or will be performed at 6 months postoperatively. To date, all anastomotic sites have healed well with no sign of stricture. Our results with this technique in a small series were positive, and it appears that, in the hands of experienced laparoscopists, it may prove useful in treating symptomatic infiltrative endometriosis.

Adult↗

PubMed1990

The surgical implications of purpura fulminans.

Purpura fulminans is an uncommon catastrophic syndrome that occurs in children, typically one to four weeks after a seemingly benign infectious process. The child usually presents with a high fever, purpuric ecchymosis, hypotension, disseminated intravascular coagulation, and gangrene of the extremities. We have recently treated six children, whose mean age was 22 months; three were male and three were female. Five of the six had a change of mental status upon initial examination. Their mean temperature was 104 degrees F. All six children had purpuric involvement of their extremities; three had involvement of their hands, two had involvement of their faces, and two had involvement of their trunks. All had absent palpable pulses and sluggish capillary refill in the involved hands and feet. Two patients died shortly after admission as a result of severe end-stage sepsis. The platelet counts in these two patients, and the white blood cell counts were markedly depressed. The mean platelet count of the survivors was 370,000 and the mean white blood cell count was 25,000. Lumbar punctures were positive for bacterial meningitis in five patients and viral meningitis in one patient. All patients were treated with intravenous heparin. Of the four survivors, two lost significant tissue and required multiple plastic reconstructive procedures, and two improved on heparin alone with no tissue loss. In addition to systemic support and intravenous antibiotics, the mainstay of treatment is one of immediate heparinization and a continuous heparin drip. Heparin prevents subsequent small vessel thrombosis and limits tissue loss due to ongoing purpura. Conservative management of the purpuric lesions is the treatment of choice until final demarcation occurs.

Anti-Bacterial Agents↗

PubMed1996

The tumescent technique facilitates hair micrografting.

Micrografting for hair restoration has become increasingly popular because of the natural results it can achieve. The procedure is often performed under local anesthesia or local anesthesia with sedation. To achieve adequate anesthesia, supraorbital and supratrochlear nerve blocks are often performed as well as infiltration of the donor and recipient areas via multiple needle injections. These nerve blocks and multiple injections are associated with significant discomfort and may need to be repeated if anesthesia is inadequate. In addition, because of the rich vascularity of the scalp, donor site and recipient bed bleeding are often encountered, making the procedure more difficult and increasing postoperative bruising and morbidity. In an attempt to alleviate these difficulties and increase patient comfort, the tumescent technique was employed in 50 consecutive micrografting procedures. The ability to achieve anesthesia in the donor and recipient beds without the need for additional nerve blocks was evaluated. The ability of the tumescent technique to minimize bleeding and subsequent postoperative ecchymosis and morbidity was analyzed. The findings of this study suggest the tumescent technique is useful in facilitating hair micrografting. It consistently achieves excellent anesthesia in both donor and recipient sites without the need for multiple needle injections or nerve blocks. The duration of anesthesia is significant, allowing completion of the procedure and offering prolonged postoperative anesthesia as well. Bleeding can be minimized using the tumescent technique for both donor site harvesting and the micrografting procedure itself.

Anesthesia, Local↗

PubMed2006

Acute osteomyelitis in congenital hypofibrinogenemia.

A 10-month-old female child presented with intermittent high grade fever, pain and diffuse swelling in the left knee joint with history of ecchymosis in different areas of the body. There was radiological features of acute osteomyelitis, low fibrinogen level and bacteremia due to the presence of coagulase positive staphylococcus aureus. The child responded nicely to the treatment for acute osteomyelitis and congenital hypofibrinogenemia. So, in congenital hypofibrinogenemia, a joint swelling might be a resultant of an acute osteomyelitis, not mere hemarthrosis.

Acute Disease↗

PubMed2002

Spontaneous parathyroid adenoma hemorrhage.

We report a case of spontaneous parathyroid adenoma hemorrhage. A 50-year-old man with a sore throat, and swelling and ecchymosis of the entire anterior neck was found in cervical and chest computed tomography revealed to have a low-density area extending from the parapharyngeal region to below the carina, Suspecting descending necrotizing mediastinitis secondary to a peritonsillar abscess, we conducted mediastinal and cervical drainage, but found no abscess. No evidence was found, either, in bacteriological culture of sputum and pleural effusion. After the hematoma disappeared, cervical ultrasonography indicated parathyroid adenoma. Serum calcium was marginally increased, indicating that serum calcium should be determined if cervical or mediastinal hematoma develops without an obvious cause.

Adenoma↗

PubMed2001

Skin disorders and thyroid diseases.

Thyroid disorders have a high prevalence in medical practice; they are associated with a wide range of diseases with which they may or may not share etiological factors. One of the organs which best show this wide range of clinical signs is the skin. This review is an attempt to approach most of the dermopathies reflecting several degrees of harmfulness, coming directly or indirectly from thyroid abnormalities, as well as to update current knowledge on the relationship between the thyroid and skin. We have proposed a primary classification of skin disorders, regarding thyroid involvement, into two main groups: 1) dermopathies associated with thyroid abnormalities, mainly with autoimmune thyroid diseases, like melasma, vitiligo, Sjogren's syndrome, alopecia, idiopathic hirsutism, pre-menstrual acne, bullous diseases, connective tissue diseases, hamartoma syndrome, atopy, leprosy and DiGeorge anomaly; and 2) dermopathies depending on the nature of the thyroid disorder, in which the evolution and outcome of the skin disorder depend on the thyroidal treatment in most cases, such as trophism and skin blood flow, myxedema, alopecia, onychodystrophy, hypo- and hyperhidrosis, xanthomas, intraepidermal bullae, carotenodermia, pruritus, flushing, pyodermitis, palmoplantar keratoderma, ecchymosis, etc. In some other cases, the skin disease which developed as a consequence of the thyroid abnormality can remain unaltered despite functional treatment of the thyroid problem, such as pretibial myxedema, thyroid acropachy and some cutaneous manifestations of multiple endocrine neoplasia types 2A and 2B.

Humans↗

PubMed1996

[Purpura fulminans with extensive skin necroses].

Purpura fulminans must be treated as an emergency in internal medicine and dermatology. Its characteristic features are the sudden development of progressively enlarging haemorrhagic skin necrosis, severe disseminated intravascular coagulation with consumption of anticoagulant factors, and signs of shock. Purpura fulminans can be classified into a neonatal form with inherited protein C deficiency and an acquired type for which multiple causes are known. Clinically it is characterized by massive ecchymosis with haemorrhagic blebs and acral necrosis. Histologically the lesions show widespread extravasation of erythrocytes and thrombosis of small vessels. Thrombocytopenia, decrease of coagulation factors, the presence of fibrinogen split products and fragmented erythrocytes in the blood smear help to confirm the diagnosis. The therapy includes fresh-frozen plasma, heparin, antibiotics and surgical debridement of necrotic areas. It is important to recognize the disease promptly because the mortality rate is about 30-40% and only quick intervention helps to save the life of the patient.

Aged↗

PubMedDate not supplied

Full-face undermining using progressive dilators.

The application of a new and simple method of facial cutaneous detachment using specially designed bifaceted rigid steel wands called Dilson Luz Vascular Dilation Wands is described. These wands considerably reduce the bleeding during face-lift surgery, reducing both postoperative hematomas and the risk of facial nerve injury. This technique involves stretching the blood vessels to the point of rupture by inserting progressively larger wands. At the point of rupture, a spontaneous coagulation within the vascular extremities occurs. This is attributable to a significant blood platelet migration induced by the stimulation from the rupture of the vascular intima. The wands, varying in dimension from 1.5 to 20 mm, and are used for cutaneous facial detachment. This method has been found to result in minimal bleeding across the detached surface as well as an excellent perfusion of the overlying skin. With the use of these Dilson Luz Vascular Dilation Wands in combination with this new technique, the authors have obtained improved cutaneous detachment; reduced postoperative swelling, edema, and ecchymosis; prophylaxis of facial nerve damage; reduced procedural time; and above all, greater reduction in immediate and late postoperative hematoma formation.

Adult↗

PubMedDate not supplied

Use of aerosolized bovine-prepared fibrin glue for skin fixation after primary open rhinoplasty: a prospective randomized and controlled trial.

BACKGROUND: Fibrin glue has been used in diverse areas of plastic surgery. To the authors' knowledge, no clinical controlled trial studies have reported its use for open rhinoplasty. METHODS: A prospective, randomized, masked clinical trial was designed to demonstrate that aerosolized bovine-prepared fibrin glue used in open rhinoplasty controls skin fixation (flap movement), edema, hematomas, ecchymosis, bleeding, and cosmetic results 1 and 12 months postoperatively. The results were reviewed by two blinded plastic surgeons who assessed postoperative photographs using the Strasser score. Other items such as columella scar, pain, surgery/recovery time, and patient satisfaction also were evaluated. RESULTS: A computer system was used to randomize 22 consecutive open primary rhinoplasties. Cosmetic analysis did not differ significantly between the group redraped with fibrin glue and the control group. Patient satisfaction was the only outcome that significantly favored the active group. None of the other items or adverse events significantly differed between the two groups, including operative time and pain. CONCLUSIONS: Fibrin glue is believed to reduce bleeding and to improve the adherence of tissues. The only statistical difference in this study favored the patient satisfaction cosmetic score of the group that received fibrin glue.

Adult↗

PubMedDate not supplied

Serial plication facelift.

In over 3,700 facelifts in the last 40 years, the author has evolved a simple technique with a natural look. All cases were done with conscious sedation and local anesthesia. Patients are ambulatory immediately following surgery and have a rapid recovery with little edema or ecchymosis. Nerve injuries are avoided, and the temple hairline and earlobe clefts are preserved. There are no ridges, dimples, or "joker lines." The superficial musculocutaneous system (SMAS) is tenuous or absent in older patients and one has difficulty in elevating heavy jowls and outer canthal tissues with the usual SMAS technique. Therefore, a serial plication starting low in the jowl and extending up the cheek, spaced 12-15 mm apart, laces the face up just like lacing a shoe, making the entire face firm and youthful. Neck plication pulls the tissues up behind the ear and a platysmal sling keeps the earlobe up in its normal position (Figs. 1-2). The deep tissues are tightened in the temple, the temple hair flap can actually be pushed forward and preserved. This adapts well with ancillary procedures and most patients return to work in 7-10 days.

Aged↗

PubMed2003

Extracorporeal shock-wave lithotripsy for treatment of ureteral calculi in paediatric patients.

Our objective was to determine the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of paediatric ureteral calculous disease. We reviewed the records of 41 (23 boys, 18 girls) paediatric patients admitted to our clinic for the treatment of ureteral calculi between between 1989-2001. Patients' age varied between 4-16 years. The majority of the patients, 38 (92.7%) cases were treated initially with ESWL whereas 3 (7.3%) cases were subjected to ureterolithotomy. The mean age of the patients was found as 12.8+/-3.86 (4-16) years. Most calculi were located at either upper or lower ureter. The mean stone burden was 45.16+/-30.65 mm2 and the mean shock wave number per session and power as 2826.72+/-605.18 and 17.69+/-1.11 kV respectively. Minor complications included skin ecchymosis at the site of entry of shock waves in all cases and renal colic that responded to analgesics and emetics in 3 (7.9%) patients. The overall stone-free rate after ESWL was found to be 81.6%. Two (5.3%) cases have residual fragments that escaped to lower calices after lithotripsy for upper ureteral calculi and are still followed. There were 5 (13.2%) failures who were treated with ureterolitotomy for 1 upper and 1 lower ureteral calculi and with ureteroscopy for the rest. It appears that ESWL is still a good option for the initial treatment of most ureteral calculi in children as it is less invasive than ureteroscopy and has a high success rate as a first-line therapy.

Adolescent↗

PubMed1997

Laparoscopic pancreaticoduodenectomy in the porcine model.

BACKGROUND: Minimally invasive techniques offer theoretical advantages for treating resectable periampullary neoplasms. Laparoscopic pancreaticoduodenectomy (LPD) was first reported in 1992 and has been performed clinically despite lack of animal data to support the operation. The purpose of this study was to develop LPD in an acute porcine model and to assess safety and efficacy before considering clinical trials. METHODS: LPD was initiated in six domestic pigs under general anesthesia. Once pneumoperitoneum was created, five 10-mm access ports were placed (one central and two in each flank). After cholecystectomy, the duodenum was mobilized and the proximal jejunum was divided distal to the ligament of Treitz. The neck of the pancreas was separated from the superior mesenteric vein, and the midstomach was divided by a stapler. Pancreaticojejunostomy (PJ), choledochojejunostomy (CDJ), and gastrojejunostomy (GJ) were performed using interrupted sutures. The animals were immediately sacrificed and the operative site was examined. RESULTS: LPD was aborted in three animals due to complications: intestinal perforation with fecal contamination (one) and prolonged resection time >/= 2.5 h (two). LPD was completed in three animals (operative time ranged from 5.0 to 7.5 h, blood loss < 200 cc); however, at sacrifice one PJ and two CDJs had small posterior leaks. The efferent loop of the GJ was narrowed by the staple line in one pig. All animals had extensive ecchymosis of the jejunal serosa due to excessive manipulation. CONCLUSION: Despite a significant number of anastomotic leaks in the immediate postoperative period, laparoscopic pancreaticoduodenectomy is feasible in a porcine model. Further studies and technical development are necessary before laparoscopic pancreatic resection can be performed on a more widespread basis.

Anastomosis, Surgical↗

PubMed2005

Association of pseudomembranous colitis with Henoch-Schönlein purpura.

A 79-year-old man was admitted because of cholecystitis that occurred about 40 days after sigmoidectomy had been performed for colonic cancer. Though antibiotics improved his condition, the patient had hematochezia, diarrhea, and left lower abdominal pain. Colonoscopic findings showed multiple ring-like areas of redness and petechiae in the rectosigmoid colon and marked edema from the descending to the transverse colon. The patient then developed purpura on the extensor surfaces of the legs and bilateral gonalgia, and exacerbation of the hematochezia. A second colonoscopy (CS) showed multiple ring-like areas of redness and ecchymosis throughout the colon. The patient was diagnosed with Henoch-Schönlein purpura (HSP), and the symptoms were attenuated after the administration of prednisolone. However, diarrhea recurred in about a week; stool culture confirmed Clostridium difficile, and a third CS revealed pseudomembranes throughout the colon. The patient was diagnosed with pseudomembranous colitis (PMC), and the administration of vancomycin attenuated the symptoms. In conclusion, we have reported a rare adult case of PMC that occurred during prednisolone treatment for HSP. The PMC may have been caused by changes in the intestinal bacterial flora after the sigmoidectomy and by the intestinal lesions of HSP, as well as by the administration of antibiotics after the sigmoidectomy and for the treatment of cholecystitis, and by the use of prednisolone for the treatment of the HSP.

Aged↗

PubMed2004

External tissue expansion successfully achieved using negative pressure.

The practice of internal tissue expansion by implanting a silicone balloon into the soft tissue under the skin is now known to be associated with a significant risk of complications. Therefore, we designed and developed a new technique of mechanical external tissue expansion achieved by using negative pressure created through special valved cups. The subjects were 60 patients suffering from postburn scar contractures in different parts of their bodies. A valved cup was applied to the healthy skin on both sides of the scar and negative pressure of -100 to -200 mbar was connected to the cup through a special valve for 5 h out of every 12 h for 2-3 weeks preoperatively. During the subsequent operation, the scar was excised, and then the expanded skin was dissected followed by wound closure. We were able to excise the scars and close the wounds directly in 14 patients, but needed to perform Z-plasty in the other 46 patients. Some ecchymosis appeared on the skin at the site of application of the cup in the initial stages, when the negative pressure exceeded the upper limits of -100 to -200 mbar. The clinical application of external tissue expansion achieved by creating negative pressure shows great promise.

Adolescent↗

PubMed2001

Spontaneous rupture of a parathyroid adenoma presenting as a massive cervical hemorrhage: report of a case.

We report an unusual case of spontaneous rupture of a parathyroid adenoma causing cervical hemorrhage. A 60-year-old woman presented to our hospital after the sudden development of extensive ecchymosis of her neck and upper anterior chest wall. Computed tomography (CT) scanning revealed a hematoma in the left retrotracheal space, and laboratory examinations revealed significant hypercalcemia, hypophosphatemia, and a high level of intact parathyroid hormone. Primary hyperparathyroidism was diagnosed, but it was not until the hematoma had subsided, 4 months after her initial presentation, that a parathyroid adenoma was revealed by CT. An operation was performed, and a parathyroid adenoma with hemosiderin deposition was histologically diagnosed. Although this phenomenon is unusual, all endocrine surgeons should be well aware of the possibility of its occurrence.

Adenoma↗

PubMed2003

Spontaneous retropharyngeal hematoma of a parathyroid cyst: report of a case.

A 41-year-old woman presented with severe and sudden anterior neck swelling, pain, and dysphagia. Computed tomography (CT) scan and ultrasound of the neck showed a giant mass in the retropharyngeal space, displacing the trachea and esophagus anteriorly. Aspiration cytology was done, following which extensive cervical and chest ecchymosis occurred and her symptoms immediately improved. A repeat CT scan demonstrated that the cervical giant mass had vanished, but there was a residual mass in the left paratracheal space. Exploratory surgery of the neck revealed a parathyroid cyst with severe adhesion to the surrounding tissues. We considered that a ruptured parathyroid cyst had induced massive hemorrhage into the cervical tissues and mediastinum, but that the hemorrhage had been absorbed. Extracapsular hemorrhage from a parathyroid adenoma or cyst is rare, especially from a parathyroid cyst. In fact, to our knowledge, this represents only the third case of symptomatic spontaneous bleeding of a parathyroid cyst. Nevertheless, this entity should still be considered in the differential diagnosis of all rapidly progressing retropharyngeal masses.

Adenoma↗

PubMed2005

A review of morbidity associated with bone harvest from the proximal tibial metaphysis.

AIM: The proximal tibia has become a well-accepted donor site for autologous bone, but there are few reports of complications with its use in maxillofacial reconstruction. Our retrospective study quantifies incidence and type of complications related to the proximal tibia bone harvest. PATIENTS AND METHOD: Sixty-three surgeries performed from March 2000 to March 2004 were reviewed; 23 male and 38 female patients underwent unilateral proximal tibia metaphysis harvest. No additives were used to increase the volume of the grafts. All patients were allowed to ambulate as tolerated on the 2nd postoperative day. RESULTS: All patients developed ecchymosis and edema on the donor limb, which resolved quickly. All patients reported minor gait disturbances. Complications were seen in 12 patients (19%) and included prolonged pain at the donor site and prolonged gait disturbances well beyond 2 weeks, seroma formation, paresthesia around the skin incision, bleeding, scar formation after wound breakdown, and knee joint perforation. CONCLUSION: Harvesting bone from the proximal tibial metaphysis is a safe procedure associated with a low incidence of overall complications. However, prolonged pain and gait disturbances are to be expected in 10% of the patients.

Adult↗