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At least 343 records · Page 19Linked to original sources

PubMed2003

Fracture of the penis: nine cases with evaluation of reported cases in Japan.

BACKGROUND: Fracture of the penis is a relatively rare condition that is defined as a rupture of the tumescent corpora cavernosa as a result of blunt trauma, most commonly during sexual intercourse or masturbation. The fracture is easy to recognize but treatment remains controversial. We, therefore, examined the treatment methods for penile fracture. METHODS: Between December 1990 and March 2001, eight patients underwent immediate surgical repair on the first or second day after fracture of the penis, and one patient underwent surgery on the 30th day after fracture, at Kansai Rosai Hospital. Patient age at presentation ranged from 15 to 55 years. Eight patients came to the hospital 2-23 h after the fracture occurred. All patients complained of penile swelling and ecchymosis. Three patients reported hearing a snapping sound. None of the patients demonstrated macroscopic hematuria. RESULTS: We treated all of the patients surgically. All patients showed a unilateral injured corporeal rupture. We took a circumferential coronal incision under the glans and repaired with absorbable stitch. At follow-up, eight of the nine patients who were available reported the achievement of an adequate erection for intercourse without erectile or voiding dysfunction. CONCLUSION: All patients were treated surgically and recovered successfully. Therefore, immediate repair is recommended for the treatment of penile fracture.

Adolescent↗

PubMed1999

Minimally invasive surgery for axillary osmidrosis: combined operation with CO2 laser and subcutaneous tissue remover.

BACKGROUND: Axillary osmidrosis is a distressing problem characterized by unpleasant odor, profuse sweating, and occasionally staining of clothes that may handicap those affected both socially and psychologically. Various types of surgical procedures have been developed for the treatment of axillary hyperhidrosis and osmidrosis. OBJECTIVE: To introduce a new odor measurement method and minimally invasive surgery technique for axillary osmidrosis. METHODS: Eighty-eight patients with axillary osmidrosis were treated by combined operation using a carbon dioxide (CO2) laser and subcutaneous tissue remover. Measurement of axillary odor was done with the cotton-roll method. RESULTS: Eighty-seven of the 88 patients (98.8%) had good to fair results; only one patient (1.2%) had poor results. Complications such as ecchymosis and partial skin necrosis with delayed wound healing occurred in four patients (4.6%). CONCLUSION: A combined technique using a CO2 laser and subcutaneous tissue remover has the advantages of a high success rate, low complication rate, no admission treatment, less scarring, and rapid recovery. This combined approach should become the preferred technique for the treatment of axillary osmidrosis.

Adolescent↗

PubMed2001

Experience of tumescent liposuction in the treatment of osmidrosis.

BACKGROUND: Tumescent liposuction is a safe procedure for removal of subcutaneous fat tissue. Because apocrine glands are located deep in the fat, surgical removal of these glands by nontumescent liposuction has been utilized for treating osmidrosis. OBJECTIVE: To evaluate the effect of tumescent liposuction in the treatment of osmidrosis and to compare the efficacy of simple tumescent liposuction and combined tumescent liposuction and curettage. METHODS: A total of 20 patients with osmidrosis (all female, age 16-44 years) were included in this study. Ten patients were treated by simple tumescent liposuction, the other 10 patients were treated by tumescent liposuction combined with curettage. The aspirates were sent for pathologic examination. At a follow-up visit, the improvement of symptoms was graded by the patient as satisfied when the odor decreased> 75%, partially satisfied when it decreased >/=50% to </=75%, and dissatisfied when it decreased <50%. RESULTS: Among the 10 patients treated with simple tumescent liposuction, 10% were satisfied, 70% were partially satisfied, and 20% were dissatisfied. Eighty percent of patients treated with a combination of tumescent liposuction and curettage were satisfied, while 20% were partially satisfied. No major complications were noted following the procedure except mild ecchymosis and swelling. CONCLUSION: Tumescent liposuction is a simple and safe procedure in the treatment of osmidrosis. Tumescent liposuction combined with curettage is better than simple tumescent liposuction alone. The effect of tumescent liposuction combined with curettage in the treatment of osmidrosis is compatible with traditional surgery or neurosurgery but offers fewer complications.

Adolescent↗

PubMedDate not supplied

Three years of experience with advanced breast biopsy instrumentation (ABBI).

This article reports our experience using the advanced breast biopsy instrument (ABBI) system for excisional biopsy of mammographically visible nonpalpable breast lesions. Patients with nonpalpable mammographically detected breast lesions were evaluated as potential ABBI candidates. Selection criteria included noncystic lesions for which complete removal or large sampling was indicated, compressed thickness of the breast of more than 25 mm, and the patient's ability to lie prone for at least 1 hour. During the period August 1997-April 2000 (33 months), 284 patients were found to be potential ABBI candidates. Sixteen patients were subsequently excluded. Biopsies using the ABBI system were performed in 268 cases, yielding an overall technical success rate of 94.4%. The mammographic abnormalities included mass in 125 cases (46.6%), mass with calcifications in 63 cases (23.5%), and microcalcifications without a mass in 80 cases (29.8%). Histologically 56 specimens (20.9%) were malignant (mass in 30 cases, mass with calcifications in 12, and microcalcifications in 14) and 212 (79.1%) were benign. Carcinoma in situ was found in 17 cases (30.4%), invasive carcinoma in 35 cases (62.5%), tubular carcinoma in 2 cases (3.6%), metastatic intramammary lymph node of previously unknown malignant melanoma in 1 case, and malignant lymphoma in 1 case. Open reexcision was performed in 54 cases with primary breast cancer. The histologic investigation revealed that in 26 (48.15%) cases the mammographic lesion was completely excised and in 28 (51.85%) cases the margins involved malignant residue and/or other foci of carcinoma. There were complications in 17 cases: wound infection in 2, ecchymosis in 9, seroma in 5, and a large immediate hematoma in 1 patient. Only the latter patient required immediate revision and drainage; the remainder underwent successful conservative treatment. Most nonpalpable breast lesions, if selected properly, are accessible for ABBI procedure. The biopsy causes minimal complications and minimal distortion of the breast architecture. Should relumpectomy be needed after the ABBI procedure, the tunnel of the cannula path is easily recognized, leaving no need for needle localization.

Adult↗

PubMed2000

Fiberoptic nasopharyngolaryngoscopy for airway monitoring after obstructive sleep apnea surgery.

PURPOSE: This study evaluated the upper airway characteristics in the early postoperative period after reconstructive surgery for obstructive sleep apnea (OSA). METHODS: During a 24-month period, the upper airway of patients who underwent uvulopalatopharyngoplasty (UPPP) with genioglossus advancement (GA) or hyoid myotomy (HM) or maxillomandibular advancement (MMA) were evaluated with fiberoptic nasopharyngolaryngoscopy (NPG) preoperatively and 24 to 72 hours postoperatively. RESULTS: NPG was performed on 271 patients. One hundred seventy-three patients had UPPP with GA or HM, and the remainder had MMA. All of the patients who underwent UPPP with GA or HM were found to have varying degrees of soft tissue edema involving the soft palate and the tongue base. The patients who underwent tonsillectomies and UPPP with GA or HM had greater soft palate/pharyngeal wall edema. In contrast, patients who underwent MMA had minimal edema involving the soft palate and the base of tongue, but diffuse lateral pharyngeal wall edema throughout the upper airway was identified. Eighteen of the MMA patients had ecchymosis and edema involving the pyriform sinus and aryepiglottic fold; 4 of these patients also had a hypopharyngeal hematoma involving the pyriform sinus, aryepiglottic fold, arytenoid, and false vocal cord, which partially obstructed the airway. These 4 patients were closely monitored for 1 to 2 additional days, and all were discharged without problems. None of the patients in the study had postoperative airway obstruction. CONCLUSION: NPG may be useful in postoperative airway monitoring and assist in discharge planning after upper airway reconstruction in the OSA patients.

Airway Obstruction↗

PubMed1982

Antibiotic-associated colitis: always pseudomembranous?

Among the 14 cases of antibiotic-induced colitis, endoscopic features were: in 9 cases typical pseudomembranes, in 4 cases petechiae or ecchymosis or suggillation-like redness with near-to-normal surrounding mucosa. In one case induced by Spiramycin, a macrolide that had never been previously indicated as being responsible for the disease, the endoscopic picture was 'atypical' and directed us towards a severe ulcerative colitis. These forms are very rare and usually limited to the right or transverse colon which suggests, if possible, a total colonoscopy. The nosographic picture of these cases is not quite clear, since they could represent both the most severe stages within 'non-pseudomembranous' antibiotic-induced colitis and autonomous forms whose evolution does not contribute in any way to the formation of pseudomembranes.

Adult↗

PubMed1996

Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. The Alprostadil Study Group.

BACKGROUND: Erectile dysfunction is a common medical problem affecting many men. Although several intracavernosal therapies are available, their efficacy and safety have not been studied systematically. METHODS: We investigated the efficacy and safety of alprostadil formulated for intracavernosal treatment in three separate multi-institutional, prospective studies in men with erectile dysfunction of vasculogenic, neurogenic, psychogenic, and mixed causes. Clinical and laboratory evaluations of erection and the feasibility of satisfactoriness of sexual activity as assessed both by the men and by their partners were the primary measures of efficacy. RESULTS: In a dose-response study of 296 men, all doses of alprostadil were superior to placebo and there was a significant dose-response relation (P < / = 0.001), resulting in higher response rates with increasing doses of alprostadil (from 2.5 to 20 microg). In a dose-finding study of 201 men, the minimal effective dose was < / = 2 microg in 23, 20, 38 and 23 percent of men with erectile dysfunction of neurogenic, vasculogenic, psychogenic, or mixed causes, respectively. In a six-month self-injection study in 683 men, the participants reported being able to have sexual activity after 94 percent of the injections. The men and their partners rated the sexual activity as satisfactory after 87 and 86 percent of the injections, respectively. Penile pain, usually mild, occurred in 50 percent of the men at some time but after only 11 percent of the injections. Prolonged erections occurred in 5 percent of the men, priapism in 1 percent, penile fibrotic complications in 2 percent, and hematoma or ecchymosis in 8 percent. CONCLUSIONS: In men with erectile dysfunction, intracavernosal injection of alprostadil is an effective therapy with tolerable side effects.

Adult↗

PubMed2001

Efficacy, safety, and use of snake antivenoms in the United States.

The mainstay of hospital treatment for venomous snakebite is antivenom. There is currently only one antivenom available in the United States for the treatment of pit viper envenomation, Antivenin (Crotalidae) Polyvalent (ACP). The general indication for the administration of antivenom is presence of progressive venom injury. Progressive injury is defined as worsening local injury (eg, swelling, ecchymosis), a clinically important coagulation abnormality, or systemic effects (eg, hypotension, altered mental status). Unfortunately, there are no prospective data available regarding the efficacy of ACP. The efficacy of a new antivenom (CroFab; FabAV) composed of purified Fab specific to indigenous snake species has been demonstrated in prospective trials. FabAV appears as effective as IgG antivenoms. However, Fab molecules have a shorter half-life than IgG molecules and may allow recurrence of venom effects, if additional doses are not administered. It has also been found that other antivenoms, including ACP, also allow recurrence of venom effects. The Fab preparation has produced fewer acute or delayed (serum sickness) allergic reactions; however, further experience is needed to confirm this observation. Evaluation of this new antivenom has led to advances in our understanding of antivenoms in terms of solubility and durability. Fab fragments enter solution quickly, thereby shortening the time to antivenom administration and are remarkably stable under extreme conditions of heat and handling.

Animals↗

PubMed2001

Copperhead snakebites: clinical severity of local effects.

STUDY OBJECTIVE: We sought to evaluate the type and extent of local reactions after copperhead snakebites. METHODS: We performed a retrospective evaluation of copperhead snakebites in West Virginia between January 1, 1995, and September 30, 1999. A local effect scoring system was used to define a clinically significant local reaction. A bite was considered clinically significant if the bitten individual's average local effect score was 3 to 4 (range, 0 to 4). RESULTS: Ninety-two patients met the inclusion criteria; an average local effect score of 3 to 4 was documented in 33% (n=30). The foot was the most common bite location (46% of all bites); 87.5% of bites to the finger (n=8) resulted in a score of 3 to 4. Eight (36%) of 22 patients who presented to the emergency department within 2 hours of a bite and whose highest local effect score was 3 to 4 did not have their highest score until greater than 4 hours after the bite. The average length of stay (score 3 to 4) was 3.4 days compared with 1.1 days for those with a score of 3 or less. CONCLUSION: Clinically significant local effects (eg, pain requiring parenteral analgesics, ecchymosis, swelling of over one half of the bitten extremity) occurred in one third of patients in our study. The generalization of copperhead snakebites as mild or of benign clinical significance should be reconsidered.

Adolescent↗

PubMed2002

Immediate hypersensitivity reaction associated with the rapid infusion of Crotalidae polyvalent immune Fab (ovine).

A 16-year-old boy presented to the emergency department with rapidly progressing extremity pain, edema, and ecchymosis after envenomation by a copperhead. Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) was infused. Six vials were placed in 250 mL of normal saline solution, and the infusion was gradually increased. Fifty minutes after beginning, the infusion was increased to 640 mL/h. Within minutes of the rate increase, the patient experienced full-body urticaria, facial edema, voice change, and tachycardia. The infusion was stopped. Hydroxyzine pamoate, famotidine, methylprednisolone, and a 1-L bolus of normal saline solution were administered intravenously. The symptoms abated, and the remaining FabAV was infused at a slower rate without return of this reaction. This immediate hypersensitivity reaction was most likely a rate-related anaphylactoid reaction that has not been previously reported with FabAV.[Holstege CP, Wu J, Baer AB. Immediate hypersensitivity reaction associated with the rapid infusion of Crotalidae polyvalent immune Fab (ovine). Ann Emerg Med. June 2002;39:677-679.]

Adolescent↗

PubMed2001

Inferior alveolar nerve damage after lower third molar surgical extraction: a prospective study of 1117 surgical extractions.

PURPOSE: The purpose of this study was to determine the incidence of inferior alveolar nerve (IAN) damage after surgical removal of lower third molars, to identify the causes, and to construct a predictive model to assess the risk of IAN injury. STUDY DESIGN: We performed a nonrandomized forward prospective study of 946 consecutive outpatients subjected to surgical extraction of 1117 lower molars in the University of Barcelona Oral Surgery Department. Preoperative, intraoperative, and postoperative data were gathered, and suspected causal factors of IAN damage were identified by using nonparametric tests, the Pearson chi-square test, and the Fisher exact test. Logistic regression predicted the risk of IAN injury. RESULTS: Although only 1.3% of the extractions caused temporary nerve damage, 25% of the lesions were permanent. All of the following significantly increased the risk of IAN damage (P < .05): age, the radiologic relationship between the apices and the mandibular canal, deflection of the root when approaching the mandibular canal, distal ostectomy, the distance of the apices of the third molar to the mandibular canal, ostectomy, crown sectioning, pain during root luxation, primary closure of the wound, prolonged operating time, bleeding, exposure of the nerve, and postoperative ecchymosis. The first 4 factors were included in a predictive logit model. CONCLUSIONS: Patient age, ostectomy of the bone distal to the third molar, the radiologic relationship between the roots of the third molar and the mandibular canal, and deflection of the mandibular canal increased the risk of IAN damage. Older patients were at a higher risk for suffering permanent injuries.

Adult↗

PubMed2000

Brachial artery catheterization to facilitate endovascular grafting of abdominal aortic aneurysm: safety and rationale.

PURPOSE: Endovascular treatment of abdominal aortic aneurysms (AAAs) is a technically demanding procedure that is based on the complexity and multiplicity of steps and the guidewire and catheter manipulations required. Brachial artery catheterization is an adjunctive technique that can facilitate the placement of an endoluminal prosthesis. METHODS: Brachial access was used during endoluminal AAA repair in 79 of 103 consecutive patients with a modular-design stent-graft prosthesis at two institutions. RESULTS: Left brachial access facilitated (1) angiography to guide juxtarenal device deployment, (2) antegrade contralateral limb access, (3) device delivery through disadvantaged iliac arteries by means of a brachial femoral wire, (4) access to renal arteries when necessary, and (5) catheter exchanges and a reduction in fluoroscopic positional changes. Complications included one puncture-site pseudoaneurysm, seven hematomas, and 29 patients with extensive ecchymosis. The length of stay was not prolonged in any case. There were no embolic, oculocerebral, or ischemic upper extremity events. CONCLUSIONS: Brachial artery catheterization, as an adjunctive technique to endoluminal AAA repair, offers noteworthy technical advantages with few, but self-limiting complications.

Angiography↗

PubMed2002

Metastatic orbital tumors in Japan: a review of the literature.

A review of reports on metastatic orbital tumors published from 1903 to 1998 in Japan revealed 128 patients, 74 males, 52 females and 2 whose sex was not recorded. The average age was 44.8 years, but varied depending on the primary tumor. Since 1980, metastatic orbital tumors have increased in Japan, especially those from the lung, liver and adrenal gland, while metastasis from the stomach has decreased slightly. Metastasis from the breast is still common. Most metastatic orbital tumors were from the lung, followed, in order, by breast, liver, adrenal gland and stomach. Males had four times as many metastatic orbital tumors from lung cancer than did females; only females had metastases from breast cancer; almost 90% of metastases from hepatoma were in males; metastasis from renal carcinoma was 2-3 times more common in males than in females. Metastasis from the liver and stomach is seen more frequently in Japan than in the United States and Europe. Ocular signs due to orbital metastases from hepatoma, neuroblastoma and gastric cancer were apt to appear earlier than the signs of the primary lesion. Metastases to the orbit were frequently bilateral in patients with neuroblastoma and malignant lymphoma. Specific ocular signs such as ecchymosis and conjunctival hemorrhages were seen in orbital metastasis from neuroblastoma and seminoma, while ocular pain was characteristic of malignant lymphoma. Orbital metastasis was very rare in patients with carcinoma of the uterus, ovaries, bladder, pancreas, colon or rectum in both Japan, the United States and Europe.

Adult↗

PubMed2000

Envenoming by the South American pit viper Bothrops neuwiedi Wagler.

Between 1975 and 1992, 18 cases of envenoming by Bothrops neuwiedi presented at the Hospital Vital Brazil, in São Paulo. Most of these cases were male (67%) and most had been bitten during the day (83%), between November and May (83%), either on the foot/ankle (50%) or hand (39%). Most (72%) of the cases arrived at the hospital 1-6 h after the bite. All presented with pain and most (83%) had oedema, but fewer had ecchymosis (50%), necrosis (17%), abscess (5%) and/or systemic blood-coagulation disorders (12%). Polyspecific Bothrops antivenom was administered to 16 (89%) of the patients. The results of B. neuwiedi bites therefore appear very similar to those of the much better known B. jararaca, even in terms of the gravity of the envenoming. Impairment in blood coagulation, however, seems less frequent among those bitten by B. neuwiedi than in those bitten by B. jararaca.

Adolescent↗

PubMed1976

Office treatment of eye injury. 2. Injury from sharp instruments or blunt trauma.

Eye injuries caused by sharp instruments range from superficial scratches of the corneal epithelium to serious lacerations of the globe of the eye. Scratches, conjunctival lacerations, and some eyelid lacerations can be dealth with by the primary physician in the office, but damage to the globe requires immediate referral to an ophthalmologist. Among possible results of blunt trauma to the area of the eye are ecchymosis, hyphema, blow-out fracture, subluxation or dislocation of the lens, or retinal detachment. Most of thes require thoroguh ophthalmologic examination and specialized treatment. The primary physician may be the first to examine a patient with serious head injury. For future reference the status of each eye should be carefully documented as soon as possible after injury.

Craniocerebral Trauma↗

PubMedDate not supplied

Postinfection purpura fulminans in a patient heterozygous for prothrombin G20210A and acquired protein S resistance.

Purpura fulminans usually consists of large, often symmetrical, spreading ecchymosis, which may later develop into extensive areas of skin necrosis and peripheral gangrene. Postinfectious purpura fulminans associated with an autoantibody directed against protein S has been described. The interaction and the contribution of recently described mutations such as factor V Leiden and prothrombin G20210A to the development and progression of postinfectious purpura fulminans and venous thrombosis is not known. The authors describe a patient heterozygous for prothrombin G20210A who developed purpura fulminans and extensive venous thrombosis secondary to acquired protein S deficiency.

Autoantibodies↗

PubMed2001

Acquired platelet dysfunction with eosinophilia in children in the south of Thailand.

One hundred and sixty-eight children aged 13 months to 12.6 years with acquired platelet dysfunction with eosinophilia (APDE) were studied. The male to female ratio was 1.15:1. All of the children were in good health and no history of any drug ingestion was detected. All of the children had widespread spontaneous bruising on the extremities, body and face off and on. Severe bleeding symptoms were detected in 8% of these patients. The number of platelets in these children was within the normal range but the platelet morphology was abnormal in all of them. Eosinophilia was detected in 86% of these children. Prolonged bleeding time was detected in 53% of these patients. Abnormal platelet adhesiveness was found in 33% of cases. Abnormal platelet aggregation induced by collagen was the most sensitive test in these patients. Abnormal ADP release from the platelets was detected in these patients by the absence of a second wave of aggregation during stimulation of PRP by ADP or epinephrine. Abnormal or no ATP secretion from the platelets during stimulation by ADP, epinephrine or collagen was detected in these patients. Ristocetin-induced platelet aggregation was normal in these children. Decreased or absence of platelet dense granules by TEM study was detected in some patients. These changes in platelet functions and morphology may be due to acquired storage pool deficiency of the platelet. Parasitic infection was detected in 56% of these children. About 83% of these children with APDE had serum total IgE higher than 100 IU/ml. There was no correlation between the number of eosinophils and serum total IgE and the severity of bleeding symptoms. The majority of children with APDE did not receive any treatment except those who had severe bleeding symptoms which required platelet concentrate to stop bleeding. In more than 90% of the patients, the bruising or ecchymosis disappeared within 6 months and the abnormal platelet functions returned to normal within 4 months. Recurrence of these bleeding syndromes was detected in 7% of the children.

Blood Coagulation Tests↗

PubMed2001

Amended final report on the safety assessment of PPG-40 butyl ether with an addendum to include PPG-2, -4, -5, -9, -12, -14, -15, -16, -17, -18, -20, -22, -24, -26, -30, -33, -52, and -53 butyl ethers.

The Polypropylene Glycol (PPG) Butyl Ethers function as skinand hair-conditioning agents in cosmetics. Intestinal absorption of the PPG Butyl Ethers was inversely proportional to the molecular weight. In general, the toxicity of the PPG Butyl Ethers decreased as the molecular weight increased. In acute studies, moderate intraperitoneal (IP) doses of various PPG Butyl Ethers caused convulsive seizures in mice and anesthetized dogs, and large oral doses caused decreased activity, anuria, renal tubular swelling and necrosis, and hepatic swelling and necrosis. PPG-2 Butyl Ether vapors were nontoxic by the inhalation route. PPG-2 Butyl Ether was nontoxic in short-term feeding and dermal exposure studies in rats. In animal irritation studies, PPG-2 Butyl Ether caused minor, transient erythema and desquamation; in addition, erythema, edema, ecchymosis, necrosis, and other changes were observed during an acute percutaneous study. PPG-2 Butyl Ether also caused minor to moderate conjunctival irritation and minor corneal injury. PPG-2 Butyl Ether when dermally applied was nontoxic to pregnant rats and was nonteratogenic at doses up to 1.0 ml/kg/day. PPG BE800 at concentrations of 0.001% to 0.26% in feed was noncarcinogenic to rats after 2 years of treatment. In clinical studies, PPG BE800 was nonirritating and nonsensitizing to the skin when tested using 200 subjects. PPG-40 Butyl Ether was neither an irritant nor a sensitizer in a repeat-insult patch test using 112 subjects. Although clinical testing did not indicate significant skin irritation is produced by these ingredients, the animal test data did indicate the potential that these ingredients can be irritating. Therefore, it was concluded that the PPG Butyl Ethers can be used safely in cosmetic products if they are formulated to avoid irritation. Data on the component ingredients, Propylene Glycol, PPG, and n-Butyl Alcohol, from previous cosmetic ingredient safety assessments were also considered and found to support the safety of PPG Butyl Ethers.

Animals↗