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At least 253 records · Page 14Linked to original sources

PubMed2003

The Shouldice herniorrhaphy in the treatment of inguinal hernias: a prospective study on 775 patients.

The authors present a study of 775 patients who underwent a Shouldice herniorrhaphy between 1987 and 2000, as performed by one surgeon. Average patient age was 52 years, and 93% of patients were male. Local anesthesia with sedation was used in 643 cases (83%) and regional anesthesia in 13%. The length of the incision was 9.5 cm. The average duration of surgery was 57.5 min (40-75). Tolerance to local anesthesia with sedation was 93%, a similar percentage to that of general anesthesia. The most significant postoperative complications were: urinary retention 8%, headache 7%, and ecchymosis 6%. Hospitalization time in 76% of the cases was 1 day, while 20% of interventions were undertaken on an outpatient basis. The average absence from work was 20 days. The recurrence rate at 7 years was 2%.

Ambulatory Surgical Procedures↗

PubMed2003

Isolated severe renal injuries after minimal blunt trauma to the upper abdomen and flank: CT findings.

Renal injuries caused by blunt abdominal trauma are common in children. Serious renal trauma is associated with insult to other organs, whereas isolated renal injuries are usually minor. We present the cases of six male children (aged 7-17 years) with major isolated renal injuries due to minimal blunt trauma to the upper adbomen and/or the flank, out of a total of 21 children admitted with renal trauma in a 5-years period. On physical examination all patients had a painful, tender abdomen and/or flank with ipsilateral bruises and ecchymosis. Hematuria, either macro ( n=4) or micro ( n=2), was found in all. The injuries were left-sided in five and were of a variable severity (grade III: n=2; grade IV: n=3; grade V: n=1 according to the kidney injury scale of the American Association for the Surgery of Trauma). Four children underwent nephrectomy. This small series underlines that major kidney insult can occur after a minimal blunt trauma localized to the flank or upper abdomen. Abdominal CT should be performed when clinical or laboratory findings or the mechanism of trauma suggest renal injury.

Abdominal Injuries↗

PubMed2006

Bilateral orbital emphysema and pneumocephalus as a result of accidental compressed air exposure.

Orbital emphysema is a rare condition in the absence of trauma or sinus disease. A 22-year-old man suffering from left orbital trauma due to sudden exposure to compressed air tube was admitted with severe pain in the left eye, swelling, and mild periorbital ecchymosis. Physical examination revealed a large conjunctival laceration in the left orbit. Multislice computed tomographic scanning of the head and orbits showed extensive radiolucencies consistent with the air in both orbits, more prominent in the left. There was also subcutaneous air in the left periorbital soft tissue extending through fronto-temporal and zygomatic areas. Air was also demonstrated adjacent to the left optic canal and within the subarachnoid space intracranially. There was no evidence of any orbital, paranasal sinus, or cranial fracture. Visual acuity was minimally decreased bilaterally. The conjunctiva was sutured under local anesthesia. After 3 weeks of follow-up, the patient completely recovered without visual loss. Bilateral orbital emphysema with pneumocephalus can occur from a high-pressure compressed air injury after unilateral conjunctival trauma without any evidence of fracture.

Adult↗

PubMed1976

Purpura fulminans.

Purpura fulminans is a rare disease characterized by cutaneous ecchymosis, hypotension and fever associated with disseminated intravascular coagulation. It usually follows a preparatory infectious illness. A case in a 55 year old woman challenges the concept that this disease is limited to childhood. A review of 100 case reports is presented in which the often quoted high mortality of 90 per cent is found to be no longer tenable.

Age Factors↗

PubMed1991

Incidental appendectomy during videolaseroscopy.

One hundred incidental appendectomies were performed in patients undergoing operative laparoscopy (videolaseroscopy) for evaluating and treating various major diseases of the reproductive organs. Except for a fever resolving within 24 hours in one case and mild periumbilical ecchymosis, there were no intraoperative or postoperative complications. All patients were discharged within 24 hours of surgery. Average hospital stay was 14 hours. All cases have been followed up for a minimum of 8 months. We believe any risk associated with elective appendectomy as reported here is minimal and outweighed by the benefits of eliminating future emergency appendectomy, simplifying future differential diagnosis of pelvic pain and removing unsuspected abnormality found in the appendix.

Adolescent↗

PubMed1992

Colposcopy to establish physical findings in rape victims.

OBJECTIVE: Conventional rape examination protocols have been poor in yielding genital findings (10% to 30% typically). We report our experience with a revised protocol employing colposcopy to perform genital examinations of victims and to document findings. STUDY DESIGN: Physical examinations were performed on rape victims seen by San Luis Obispo County's Suspected Abuse Response Team between 1985 and 1990, and the results were reviewed for this study. RESULTS: Of 131 patients seen within 48 hours and who experienced penile penetration, 114 (87%) had positive findings. Colposcopic magnification allowed examiners to characterize these findings as acute mounting injuries, typically seen at 3, 6, and 9 o'clock on the posterior fourchette and consisting chiefly of lacerations, ecchymosis, and swelling. CONCLUSIONS: An examination protocol that includes colposcopy may be the most reliable means to document and characterize genital findings in rape victims and to evaluate whether findings may be linked to a reported sexual assault.

Colposcopy↗

PubMed1979

Orbital hemorrhage.

Seventeen patients had spontaneous orbital hemorrhages. The usual symptoms were acute onset of pain, proptosis, and vomiting with decreased vision, limitation of motility, and ecchymosis of the eyelids occurring in some patients. The children often developed a progressive space occupying lesion that simulated a neoplasm. Most patients had underlying venous anomalies, although several elderly patients with atherosclerosis developed arterial hemorrhages with more abrupt and dramatic symptoms. Other associated conditions included hypertension, anemia, labor, and von Willebrand's disease. The visual outcome was good except in the elderly patients, half of whom had severe and permanent visual loss.

Adolescent↗

PubMed1994

Face lifts and sprayed fibrin glue: an outcome analysis of 200 patients.

The use of aerosolised fibrin glue has been evaluated in a group of 100 consecutive patients undergoing face lift procedures and compared to a similar group of 100 consecutive patients who had face lifts but received no fibrin glue. There was a statistically significant decrease in the rate of major haematoma formation and presentation of ecchymosis associated with the use of fibrin glue. The incidence of total complications was unchanged between the two groups, despite the fact that there were no drains or postoperative dressings used in the fibrin glue treated group. Patients found the omission of drains and dressings to be most convenient.

Adult↗

PubMed1991

Comparison of local signs and symptoms after the insertion of Norplant implants with and without a scalpel.

The study compares NORPLANT subdermal implants acceptors enrolled randomly for two different insertion procedures. One group (420 women) received the implants with the use of a scalpel according to the manufacturer's instructions. The other group (423 women) received the implant without an incision, directly through a sharpened trocar. The local signs and symptoms were observed at 7 and 30 days after insertion. Pain, tenderness, edema/swelling, ecchymosis and defective scar were considered. Complication rates were low and no significant differences were found between the two procedures. Based on the data of this study, we recommend inserting NORPLANT implants without the use of a scalpel.

Drug Administration Routes↗

PubMed1983

Envenomation by the Mojave rattlesnake (Crotalus scutulatus scutulatus) in southern Arizona, U.S.A.

Fifteen cases of envenomation by the Mojave rattlesnake (Crotalus scutulatus scutulatus) are reviewed. Systemic effects were observed in eight patients, consisting of early hypotension (3), decreased plasma fibrinogen (3) and platelets (2), elevated fibrinolytic split products (3) and eyelid ptosis (1). Local venom effects were most common and included swelling (15), ecchymosis (10), bleb formation (6) and necrosis (3). Effects upon neuromuscular transmission were neither common nor a clinical problem. Treatment consisted of i.v. crystalloid solution (15) and antivenin (12).

Adult↗

PubMed1985

Human envenomation from the bite of the eastern garter snake, Thamnophis s. sirtalis (Serpentes: Colubridae).

A 13-yr-old victim of a prolonged eastern garter snake (Thamnophis s. sirtalis) bite was hospitalized following development of coolness, edema and ecchymosis of the bitten hand. Although lymphatic involvement was noted, vital signs and laboratory tests were normal and rapid recovery followed. Subsequent asymptomatic Thamnophis bites of the subject indicate that these clinical changes were not allergic. This case from Delaware suggests that widespread toxicity within the genus is likely.

Adolescent↗

PubMed1986

Gastric mucosal damage induced by endotoxin shock and its prevention by naloxone and anti-ulcer drugs in rats.

Administration of endotoxin (20 mg/kg i.p.) produced a moderate degree of gastric mucosal damage in rats. The lesions remained confined to the glandular mucosa and consisted of small punctiform lesions, erosions and petechial hemorrhage. The characteristic feature of these lesions was a typical submucosal ecchymosis in the glandular stomach observed in about 30% of the animals. Pretreatment with ranitidine, pirenzepine, proglumide, sucralfate and naloxone produced varying degrees of protection. The ulcerogenic effect of endotoxin shock is apparently mediated through the release of endorphins.

Animals↗

PubMed1984

Diagnosis, prevention, and treatment of adverse reactions to aspirin and nonsteroidal anti-inflammatory drugs.

Aspirin (ASA) and nonsteroidal anti-inflammatory drugs (NSAIDs) share common pharmacologic effects in the prevention of inflammation, at least in part through inhibition of prostaglandin formation. ASA and NSAIDs have predictable side effects such as gastric pain, ecchymosis, and tinnitus. They also cause anaphylactoid shock, urticaria/angioedema, nephropathy, and hepatitis in individuals who appear to be normal and in whom prediction of such reactions cannot be made. Two selected populations of patients are likely to experience hypersensitivity reactions to both ASA and NSAIDs. Patients with asthma have an 8% to 20% chance of experiencing asthmatic attacks after ingesting ASA and NSAID. If such patients have associated rhinosinusitis (polyps), prevalence increases to 30% to 40%. Patients with chronic urticaria/angioedema have a 21% to 30% chance of experiencing an urticarial flare after ingesting ASA and NSAIDs.

Angioedema↗

PubMed1993

Stanozolol causes rapid pain relief and healing of cutaneous ulcers caused by cryofibrinogenemia.

BACKGROUND: Cutaneous manifestations of cryofibrinogenemia include purpura, ecchymosis, and ulcerations. The histology of these lesions is characterized by intravascular thrombi. OBJECTIVE: Our purpose was to test the efficacy of stanozolol, a drug capable of fibrinolytic enhancement, in treating cutaneous ulcers caused by cryofibrinogenemia. METHODS: Eight patients with cutaneous ulcerations from cryofibrinogenemia were treated with stanozolol. Plasma cryofibrinogen was measured before and during treatment with stanozolol. Histologic evaluation was also performed before treatment and in selected patients during treatment. RESULTS: After treatment, seven of the eight patients had healing of their ulcers, prompt reduction in their pain, and improvement in livedo reticularis and purpura. Four of the eight patients had no detectable plasma cryofibrinogen after treatment. In addition, dermal intravascular thrombi resolved. Stanozolol was well tolerated and had minimal side effects. CONCLUSION: We conclude that stanozolol is a safe and effective treatment of the cutaneous manifestations of cryofibrinogenemia.

Adult↗

PubMedDate not supplied

Hyponatremic seizures as a presenting symptom of child abuse.

Poisoning is an uncommon manifestation of child abuse. The intentional administration of water to a child as a form of punishment has rarely been reported as the responsible substance among children who have been poisoned. We describe a case of a 5-year-old girl presenting with severe hyponatremia due to acute water intoxication. The patient was brought to the emergency room in status epilepticus. A history was obtained from the child's mother stating that the patient had been playing outside when she collapsed. She had had no known prior illnesses. Laboratory evaluation included a hemoglobin of 10.1 mg%, glucose of 60 mg%, serum sodium of 107 mEq/l, potassium of 3.2 mEq/l and chloride of 71 mEq/l. A CAT scan obtained approximately 1 h after admission revealed generalized cerebral edema. Careful examination of the skin revealed multiple linear ecchymosis of varying ages on the back and thighs and a hand print on the right flank. In addition, the child demonstrated severe failure to thrive with height, weight and bone age compatible with a 2.5-year-old girl. Appropriate therapy for severe hyponatremia was successfully instituted. For the next 12 h she was deeply somnolent, but the following morning was alert and conversant. She stated that she "would be good if she didn't have to drink any more water". The child's mother subsequently admitted that she frequently used water ingestion as a form of punishment. The child stabilized metabolically and demonstrated rapid in-hospital weight gain. She was placed in foster care at discharge and has had no further hyponatremia or seizures.(ABSTRACT TRUNCATED AT 250 WORDS)

Child Abuse↗

PubMed1992

Interobserver agreement in the examination of acute ankle injury patients.

The authors' objective was to describe a method for measuring interobserver agreement and to determine the reliability of physical findings used by emergency physicians to assess ankle injury patients. A 3-month prospective survey was designed for use in the emergency departments of two university hospitals. Participants were a convenience sample of 100 adult blunt ankle injury patients. Pairs of emergency staff physicians assessed 22 standardized physical findings in each patient without knowledge of the other assessment. Agreement for each variable was measured by the kappa coefficient, the ratio of actual agreement to potential agreement beyond chance. The variables with the highest interobserver agreement and their kappa values were ability to bear weight (.83); bone tenderness at the base of the fifth metatarsal (.78), at the posterior edge of lateral malleolus (.75), and at the tip of the medial malleolus (.66); and combinations of bone tenderness (.76). Less reliable variables included soft tissue tenderness (.41) or degree of swelling (.18) of the anterior talofibular ligament, ecchymosis (.39), range of motion (.33), bone tenderness at the proximal fibula (-.01), and the anterior drawer sign (-.03). High kappa values indicate that several physical findings, including ability to bear weight and selected sites of bone tenderness, may be reliably assessed in ankle injury patients. This knowledge may give physicians more confidence in their physical examination and allow development of reliable clinical guidelines to diminish the reliance on radiography in ankle injuries.

Adult↗

PubMed2005

Olanzapine-induced vasculitis.

INTRODUCTION: Elderly patients are particularly vulnerable to adverse drug reactions as a result of polypharmacy and metabolic changes associated with aging. We present a case of leukocytoclastic vasculitis induced by olanzapine, a medication commonly used in elderly patients. CASE SUMMARY: An 82-year-old woman was admitted to the extended-care center for short-term rehabilitation after prolonged hospitalization for a pulmonary embolism requiring mechanical ventilation. The pulmonary problem resolved, but her hospitalization and subsequent rehabilitation were complicated by agitated delirium, which was treated with olanzapine and modification of contributory factors. At the time of admission to the rehabilitation facility, the patient had been receiving warfarin for 2 weeks and olanzapine for 6 days. On the eighth day after initiation of olanzapine, erythematous skin lesions developed on dependent areas. The international normalized ratio for warfarin was within the acceptable range; however, because warfarin has been associated with subcutaneous bleeding presenting as petechiae and ecchymosis, subcutaneous enoxaparin was substituted for warfarin. The skin lesions continued to worsen over the next week and developed into palpable lesions. Biopsy of the rash revealed leukocytoclastic vasculitis. In the absence of another cause, olanzapine was discontinued and the rash improved significantly. When the agitation recurred, risperidone was initiated, but the patient experienced dizziness with this agent. Olanzapine was resumed and the skin lesions recurred. Olanzapine was then changed to quetiapine, and the skin lesions improved over the next few weeks. DISCUSSION: Olanzapine is commonly used in elderly patients to control behavioral disturbances associated with dementia, delirium, and other psychiatric disorders. Leukocytoclastic vasculitis is an infrequently reported adverse drug reaction with olanzapine. Its exact pathogenic mechanism is unknown, but both cell-mediated and humoral immunity appear to play important roles. Because drug-induced vasculitis has an identical clinical presentation and identical serologic/pathologic parameters to idiopathic forms of vasculitis, a high index of suspicion is necessary for its accurate diagnosis. CONCLUSIONS: Because adverse drug reactions are common in elderly patients taking multiple medications, physicians should be vigilant when starting new medications and should attempt to eliminate unnecessary medications. Clinicians should be aware of the potential for leukocytoclastic vasculitis in association with olanzapine.

Aged↗

PubMed2004

A prospective, randomized, controlled trial of primary wound closure after lateral internal sphincterotomy.

BACKGROUND: Much of the lateral internal sphincterotomy (LIS) complications is related to LIS incision. In this study, incisions sutured primarily or left to secondary healing after open LIS procedure are compared regarding the wound healing and complications associated with wounds. METHODS: Planning a prospective, randomized clinical study, 39 patients were separated into two groups. Open LIS was performed on both of the groups. While the incisions of the patients in group 1 (n = 22) were closed with two interrupted sutures using 3-0 chromic catgut, the incisions of the patients in group 2 (n = 17) were left open. The patients were followed up for 90 days postoperatively. RESULTS: Hematoma in 1 (4.5%), ecchymosis in 7 (31.8%), and wound infection in 1 (4.5%) developed in patients of group 1. In this group no significant external bleeding was seen. Wound healing duration was 15.05 +/- 5.60 days. In group 2 no hematoma developed (P = 0.98), but 2 (11.7%) ecchymoses (P = 0.25), 4 (23.5%), wound infections (P = 0.14), and 3 (17.6%) postoperative significant external bleedings (P = 0.07) were seen. Wound healing duration was 33.94 +/- 6.67 days (P <0.001). CONCLUSIONS: To achieve early wound healing, primary closure of open LIS incision is useful, but this technique has no significant effect on wound-related complications in comparison with secondary healing.

Adolescent↗