Sample records for delayed hematoma caused

  1. Traumatic and alternating delayed intracranial hematomas

    Lesoin, F.; Redford, H.; Jomin, M.; Viaud, C.; Pruvo, J.


    Repeat computed tomography has enabled us to confirm the concept of delayed hematomas. With this in mind we report two cases of alternating, post-traumatic intracranial hematomas; confirming also the role of tamponade after surgical removal of an intracranial hematoma.

  2. Delayed extradural hematoma : a case report.

    Alappat J


    Full Text Available Three patients of delayed extradural hematoma (EDH were seen in the last one year among forty eight consecutively treated cases of EDH. All the three hematomas were evacuated. Awareness of this entity and a high degree of vigilance are strongly recommended to detect such cases. Repeat CT should always be done, especially after decompression by either surgical or medical means, recovery from shock or whenever there is evidence of even minimal bleeding under a skull fracture on initial CT scan.

  3. Delayed epidural hematoma after mild head injury

    Radulović Danilo


    Full Text Available Background. Traumatic delayed epidural hematoma (DEH can be defined as insignificant or not seen on the initial CT scan performed after a trauma but seen on the subsequent CT scan as a “massive” epidural bleeding. Case report. We presented two cases of traumatic DEH after mild head injury. Both patients were conscious and without neurological deficit on the admission. Initial CT scan did not reveal intracranial hematoma. Repeated CT scan, that was performed after neurological deterioration, revealed epidural hematoma in both cases. The patients were operated with a favorable surgical outcome. Conclusion. Traumatic DEH could occur in the patients with head injuries who were conscious on the admission with a normal initial CT scan finding. Early detection of DEH and an urgent surgical evacuation were essential for a good outcome.

  4. Delayed intracranial hematoma following stereoelectroencephalography for intractable epilepsy: case report.

    Derrey, Stéphane; Lebas, Axel; Parain, Dominique; Baray, Marie Gilles; Marguet, Christophe; Freger, Pierre; Proust, François


    Intracranial bleeding following stereoelectroencephalography (sEEG) is rare and commonly occurs early after electrode implantation. The authors report the case of a delayed intracranial hematoma following sEEG. This 10-year-old boy was referred to the authors' department to undergo an sEEG study for intractable epilepsy, with the hypothesis of a single localized epileptic zone in the left precentral region. To perform the exploration, 14 depth electrodes were implanted under stereotactic conditions. The results of a postoperative CT scan performed routinely at the end of the surgical procedure were normal. Eight days later, following an epileptic seizure, the child's condition worsened. The neurological examination revealed a left hemiparesis, agitation, and coma due to a right subdural hematoma with intraparenchymal bleeding. Despite a surgical evacuation followed by a decompressive craniectomy, the curative treatments were stopped 1 week later due to severe diffuse ischemic lesions found on MRI studies. This is the first observation of a delayed hematoma following an sEEG procedure. The mechanism underlying this complication remains unclear, but the rupture of a growing pseudoaneurysm caused by the electrode's implantation or the tearing of a neighboring vessel by an electrode were suspected. In consequence, physicians must remain vigilant during the entire sEEG recording period and probably also several days after electrode removal.

  5. Delayed duodenal hematoma and pancreatitis from a seatbelt injury.

    Deambrosis, Katherine; Subramanya, Manjunath S; Memon, Breda; Memon, Muhammed A


    Traumatic duodenal hematoma is a rare condition that is encountered in the paediatric age group following blunt abdominal trauma. It poses both a diagnostic and therapeutic challenge. The main concern is increased morbidity secondary to delayed diagnosis and associated occult injuries to the adjacent structures. Most of these hematomas resolve spontaneously with conservative management, and the prognosis is good. We present a case of a 15-year-old boy who had a delayed presentation of duodenal hematoma and acute pancreatitis, which was treated conservatively with complete resolution.

  6. Delayed Duodenal Hematoma and Pancreatitis from a Seatbelt Injury

    DeAmbrosis, Katherine


    Full Text Available Traumatic duodenal hematoma is a rare condition that is encountered in the paediatric age group following blunt abdominal trauma. It poses both a diagnostic and therapeutic challenge. The main concern is increased morbidity secondary to delayed diagnosis and associated occult injuries to the adjacent structures. Most of these hematomas resolve spontaneously with conservative management, and the prognosis is good. We present a case of a 15-year-old boy who had a delayed presentation of duodenal hematoma and acute pancreatitis, which was treated conservatively with complete resolution. [West J Emerg Med. 2011;12(1:128-130.

  7. Delayed onset of a spinal epidural hematoma after facet joint injection

    Mirko Velickovic


    Full Text Available The treatment of chronic back pain is a challenging problem. Facet joint infiltration is an established treatment for chronic low back pain caused by arthrosis of the lumbar facet joints. Due to the increasing number of patients with chronic low back pain, this therapy has become more frequent. We treated a 51-year-old male patient, who developed an epidural hematoma 2 months after infiltration therapy. Our case shows that even a delayed onset of spinal epidural hematoma is possible and should be kept in mind as a possible cause of acute myelopathy after spinal intervention.

  8. Delayed Femoral Nerve Palsy Associated with Iliopsoas Hematoma after Primary Total Hip Arthroplasty

    Sandeep Kumar


    Full Text Available Femoral nerve neuropathy after total hip arthroplasty is rare but catastrophic complication. Pain and quadriceps muscle weakness caused by this complication can significantly affect the functional outcome. Here we present a case report, describing delayed onset femoral nerve palsy associated with iliopsoas hematoma following pseudoaneurysm of a branch of profunda femoris artery after 3 months of primary total hip arthroplasty in an 80-year-old female patient with single kidney. Hip arthroplasty was done for painful primary osteoarthritis of left hip. Diagnosis of femoral nerve palsy was made by clinical examination and computed tomography imaging of pelvis. Patient was managed by surgical evacuation of hematoma and physiotherapy. The patient’s clinical symptoms were improved after surgical evacuation of hematoma. This is the first case report of its kind in English literature regarding delayed onset femoral nerve palsy after primary total hip arthroplasty due to pseudoaneurysm of a branch of profunda femoris artery without any obvious precipitating factor.

  9. Delayed spinal extradural hematoma following thoracic spine surgery and resulting in paraplegia: a case report

    Parthiban Chandra JKB


    Full Text Available Abstract Introduction Postoperative spinal extradural hematomas are rare. Most of the cases that have been reported occured within 3 days of surgery. Their occurrence in a delayed form, that is, more than 72 hours after surgery, is very rare. This case is being reported to enhance awareness of delayed postoperative spinal extradural hematomas. Case presentation We report a case of acute onset dorsal spinal extradural hematoma from a paraspinal muscular arterial bleed, producing paraplegia 72 hours following surgery for excision of a spinal cord tumor at T8 level. The triggering mechanism was an episode of violent twisting movement by the patient. Fresh blood in the postoperative drain tube provided suspicion of this complication. Emergency evacuation of the clot helped in regaining normal motor and sensory function. The need to avoid straining of the paraspinal muscles in the postoperative period is emphasized. Conclusion Most cases of postoperative spinal extradural hematomas occur as a result of venous bleeding. However, an arterial source of bleeding from paraspinal muscular branches causing extradural hematoma and subsequent neurological deficit is underreported. Undue straining of paraspinal muscles in the postoperative period after major spinal surgery should be avoided for at least a few days.

  10. Myocardial Ischemia Caused by Subepicardial Hematoma

    Grieshaber, Philippe; Nef, Holger; Böning, Andreas; Niemann, Bernd


    Background Bleeding from bypass anastomosis leakage occurs early after coronary artery bypass grafting. Later, once the anastomosis is covered by intima, spontaneous bleeding is unlikely. Case Description A 63-year-old male patient developed a pseudoaneurysm-like, subepicardial late-term bleeding resulting in a hematoma that compromised coronary artery flow by increasing extracoronary pressure. This resulted in severe angina pectoris (Canadian Cardiovascular Society IV) and myocardial ischemia within the affected area. After surgical removal of the hematoma and repair of the anastomosis, the patient's symptoms disappeared and no signs of myocardial ischemia were present. Conclusion Surgical removal is an efficient therapy for subepicardial hematoma inducing myocardial ischemia.

  11. A Rare Cause of Acute Pancreatitis: Intramural Duodenal Hematoma

    Hemant Goyal


    Full Text Available We describe an interesting case of intramural duodenal hematoma in an otherwise healthy male who presented to emergency room with gradually progressive abdominal pain, nausea, and vomiting. This condition was missed on initial evaluation and patient was discharged from emergency room with diagnosis of acute gastritis. After 3 days, patient came back to emergency room and abdominal imaging studies were conducted which showed that patient had intramural duodenal hematoma associated with gastric outlet obstruction and pancreatitis. Hematoma was the cause of acute pancreatitis as pancreatic enzymes levels were normal at the time of first presentation, but later as the hematoma grew in size, it caused compression of pancreas and subsequent elevation of pancreatic enzymes. We experienced a case of pancreatitis which was caused by intramural duodenal hematoma. This case was missed on initial evaluation. We suggest that physicians should be more vigilant about this condition.

  12. Spontaneous Meckel's cave hematoma: A rare cause of trigeminal neuralgia

    Concetta Alafaci; Giovanni Grasso; Francesca Granata; Daniele Marino; Salpietro, Francesco M.; Francesco Tomasello


    Background: The most common etiology of classic trigeminal neuralgia (TN) is vascular compression. However, other causes must be considered. Among these, spontaneous hematoma of the Meckel′s cave (MC) causing symptomatic TN is very rare. Case Description: We present the case of a 60-year-old woman with a 2-month history of left TN and diplopia. Neuroradiological examinations revealed a well-defined hematoma in the left MC. The patient underwent surgical decompression with a progressive ne...

  13. [An operated case of a meningioma causing acute subdural hematoma].

    Chonan, Masashi; Niizuma, Kuniyasu; Koyama, Shinya; Kon, Hiroyuki; Sannohe, Seiya; Kurotaki, Hidekachi; Midorikawa, Hiroshi; Sasaki, Tatsuya; Nishijima, Michiharu


    We report a rare case of a meningioma causing acute hematoma. A 67-year-old woman presented with sudden headache. No evidence of trauma was seen. CT demonstrated a subdural hematoma in the convexity of the fronto-temporal lobe. Magnetic resonance imaging showed marked signal heterogeneity in the convexity of the frontal lobe. One week later, the patient underwent hematoma evacuation and tumor resection including the attached dura mater. The histological diagnosis was meningothelial meningioma. The clot was connected directly to the tumor and the origin of the subdural hematoma was identified as the meningioma. Postoperative course was uneventful, and the headache improved. Meningiomas have a relatively benign course but rarely present with hemorrhage. Surgical exploration is the effective and recommended treatment.

  14. Blunt Facial Trauma Causing Isolated Optic Nerve Hematoma

    R. Parab


    Full Text Available Traumatic optic neuropathy is an uncommon, yet serious, result of facial trauma. The authors present a novel case of a 59-year-old gentleman who presented with an isolated blunt traumatic left optic nerve hematoma causing vision loss. There were no other injuries or fractures to report. This case highlights the importance of early recognition of this rare injury and reviews the current literature and management of traumatic optic neuropathy.

  15. Postoperative epidural hematoma contributes to delayed upper cord tethering after decompression of Chiari malformation type I

    Antonio Lopez-Gonzalez


    Full Text Available Background: Symptomatic arachnoiditis after posterior fossa surgical procedures such as decompression of Chiari malformation is a possible complication. Clinical presentation is generally insidious and delayed by months or years. It causes disturbances in the normal flow of cerebrospinal fluid and enlargement of a syrinx cavity in the upper spinal cord. Surgical de-tethering has favorable results with progressive collapse of the syrinx and relief of the associated symptoms. Case Description: A 30-year-old male with Chiari malformation type I was treated by performing posterior fossa bone decompression, dura opening and closure with a suturable bovine pericardium dural graft. Postoperative period was uneventful until the fifth day in which the patient suffered intense headache and progressive loose of consciousness caused by an acute posterior fossa epidural hematoma. It was quickly removed with complete clinical recovering. One year later, the patient experienced progressive worsened of his symptoms. Upper spinal cord tethering was diagnosed and a new surgery for debridement was required. Conclusions: The epidural hematoma compressing the dural graft against the neural structures contributes to the upper spinal cord tethering and represents a nondescribed cause of postoperative fibrosis, adhesion formation, and subsequent recurrent hindbrain compression.

  16. 术中非手术区迟发性颅内血肿致急性脑膨出的高危因素及抢救体会40例%The high risk factors and emergency treatments to the patients with in-traoperative acute encephalocele caused by delayed intracranial hematomas at non operating region:An investigate of 40 cases

    赵刚; 刘帅; 李俊; 王宇; 孙继程; 张义; 王铂


    目的:探讨术中非手术区迟发性颅内血肿致急性脑膨出患者的临床高危因素及抢救经验。方法对2000年1月~2013年12月40例术中非手术区迟发性颅内血肿致急性脑膨出患者的临床资料进行回顾性分析,总结其高危因素及抢救经验。结果对冲伤22例。术前合并广泛脑挫裂伤14例,合并颅骨骨折16例,合并颅内小血肿(<15 mL)10例。致急性脑膨出的颅内血肿中对侧32例,其中硬膜外血肿24例。再手术32例,存活16例,总死亡率60%。结论术中非手术区迟发性颅内血肿致急性脑膨出高危因素为广泛脑挫裂伤、对侧颅骨骨折、非手术区的颅内小血肿。掌握其临床高危因素,有足够的预见性,充分的术前准备,正确的术中处理,术后科学系统的综合治疗才能最大限度地挽救患者生命。%Objective To investigate the high risk factors and emergency treatments to the patients with intraoperative acute encephalocele caused by delayed intracranial hematomas at non operating region. Methods The clinical data of 40 patients with intraoperative acute encephalocele caused by delayed intracranial hematomas at non operating region from January 2000 to December 2013 were analyzed retrospectively. Summarized the high risk factors and emergency treatments in this case. Results The 22 cases with contrecoup injury. 14 cases with extensive contusion of brain,16 cases with skull fracture and 10 cases with small intracranial hematoma (Volume <15mL).The delayed intracranial hematomas to the acute encephalocele include,32 cases at the offside. And 24 cases with epidural hematoma. 32 cases had to undergo reoperation, survived 16 cases. The total death rate was 60%. Conclusion The high risk factors are ex-tensive contusion of brain, offside skull fracture and the delayed intracranial hematomas at non operating region. Under-standing Its high risk factors in clinical, with much more foreseeability, and

  17. Pelvic compartment syndrome caused by retroperitoneal hematoma of pelvic fracture

    ZHANG Feng-qi; ZHANG Ying-ze; PAN Jin-she; PENG A-qin; WANG Hui-juan


    @@ Retroperitoneal hematoma is an obligatory complication in pelvic ring fracture.1 In most cases, the bleeding originates from venous vessels of the presacral plexus, small arteries and veins from fracture fragments. External fixation of the pelvis can control blood loss by reducing diastasis and dramatically decreasing the volume of the pelvis. But this tamponade effect can not prevent the presence of hematoma in the adjoining retroperitoneal space. It is well known that complication of retroperitoneal hematoma is infection and sepsis.

  18. Axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report

    Yajima Hiroshi


    Full Text Available Abstract Introduction Axillary artery injury in the shoulder region following blunt trauma without association with either shoulder dislocation or fracture of the humeral neck has been previously reported. Axillary artery injury might also be accompanied with brachial plexus injury. However, delayed onset of brachial plexus palsy caused by a compressive hematoma associated with axillary injury after blunt trauma in the shoulder region has been rarely reported. In previous reports, this condition only occurred in old patients with sclerotic vessels. We present a case of a young patient who suffered axillary artery injury associated with brachial plexus palsy that occurred tardily due to compressive hematoma after blunt trauma in the shoulder region without association of either shoulder dislocation or humeral neck fracture. Case presentation A 16-year-old male injured his right shoulder in a motorbike accident. On initial physical evaluation, the pulses on the radial and ulnar arteries in the affected arm were palpable. Paralysis developed later from 2 days after the injury. Functions in the right arm became significantly impaired. Angiography showed complete occlusion of the axillary artery. Magnetic resonance imaging demonstrated a mass measuring 4 × 5 cm that was suspected to be a hematoma compressing the brachial plexus in a space between the subscapular muscle and the pectoralis minor muscle. Surgery was performed on the third day after injury. In intraoperative observations, the axillary artery was occluded with thrombus along 5 cm; a subscapular artery was ruptured; the brachial plexus was compressed by the hematoma. After evacuation of the hematoma, neurolysis of the brachial plexus, and revascularization of the axillary artery, the patient had an excellent functional recovery of the affected upper limb, postoperatively. Conclusion Surgeons should be aware that axillary artery injuries may even occur in young people after severe blunt

  19. Delayed duodenal obstruction after intramural hematoma in a patient with paroxysmal nocturnal hemoglobinuria: A case report

    Tugan Tezcaner


    CONCLUSION: We report a rare intestinal obstruction case caused by stricture at the level of ligamentum Treitz with PNH. The possibility simply has to be borne in mind that strictures can be occurring at hematoma, ischemia or inflammation site of gastrointestinal tract.

  20. 颅脑损伤术后非手术区迟发血肿再手术临床分析%Clinical Analysis of Reoperation for Nonsurgical Area Delayed Hematoma from Postoperative Intracranial Hematoma

    许悦; 张瑜; 沈旭明; 舒张; 孙晓全; 徐清; 冯晓东; 陆小军


    Objective To explore the causes, mechanism, diagnosis and treatment of postoperative delayed traumatic intracranial hematoma. Methods The clinical information of 54 cases with postoperative delayed traumatic intracranial hematoma from 2005 to 2013 were retrospectively analyzed and studied. Results Of 54 cases, there were 11 cases of gradeⅠ, 10 cases of gradeⅡ, 11 cases of gradeⅢ, 13 cases of gradeⅣ, 9 cases of gradeⅤ. Conclusion Early diagnosis and treatment can improve prognosis and efficacy of the postoperative delayed traumatic intracranial hematoma. Intracranial pressure monitoring and timely review CT contribute to early detection of partially delayed traumatic intracranial hematoma for patients with risk factors.%目的:探讨颅脑损伤术后非手术区迟发性血肿的形成原因、发生机制及临床诊治。方法回顾性分析2005年1月~2013年12月54例颅脑损伤患者术后出现非手术区迟发性颅内血肿并再次手术的临床资料。结果54例患者伤后6个月时GOS评分:Ⅰ级11例,Ⅱ级10例,Ⅲ级11例,Ⅳ级13例,Ⅴ级9例。结论颅脑损伤术后发生非手术区迟发性血肿患者的预后取决于早期预防、早期发现,及早治疗。对存在高危因素者进行颅内压监测并动态复查CT,能够早期发现部分迟发性颅内血肿,改善预后。

  1. Delayed Diagnosis of Pelvic Hematoma without Fracture Due to Military Parachuting.

    Cunningham, Cord W; Kotwal, Russ S; Kragh, John F


    The U.S. military has been conducting static-line parachute jumps for nearly a century. Beginning with World War II, military forces have also employed full-scale airborne operations as a method for insertion into combat. Through the years, injuries from blunt trauma as a result of static-line parachute jumps have evolved little with the refinement of equipment, training, and tactics. Parachute jumps continue to invoke primarily musculoskeletal injuries, especially to the lower extremities, back, neck, and head. These injuries are usually straightforward in their presentation and diagnosis. We describe the delayed diagnosis of a pelvic hematoma due to an uncommon blunt trauma jump injury. The purpose of this case report is to increase awareness of injury patterns during paratrooper operations, as well as to review the diagnosis and management of occult hemorrhage. Specific objectives for the readers are to (1) know the common injury types and patterns for airborne operations, (2) know the descent rate of T-10C/D parachutes and factors influencing the rate, (3) recognize signs and symptoms associated with a pelvic hematoma, and (4) recognize common complications resulting from a pelvic hematoma.

  2. An oblique muscle hematoma as a rare cause of severe abdominal pain: a case report

    Shimodaira Masanori


    Full Text Available Abstract Background Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed. They are more common in elderly individuals, particularly in those under anticoagulant therapy. Most abdominal wall hematomas occur in the rectus sheath, and hematomas within the oblique muscle are very rare and are poorly described in the literature. Here we report the case of an oblique muscle hematoma in a middle-aged patient who was not under anticoagulant therapy. Case presentation A 42-year-old Japanese man presented with a painful, enlarging, lateral abdominal wall mass, which appeared after playing baseball. Abdominal computed tomography and ultrasonography showed a large soft tissue mass located in the patient’s left internal oblique muscle. A diagnosis of a lateral oblique muscle hematoma was made and the patient was treated conservatively. Conclusion Physicians should consider an oblique muscle hematoma during the initial differential diagnosis of pain in the lateral abdominal wall even in the absence of anticoagulant therapy or trauma.

  3. [A case of acute intracranial epidural hematoma caused by chronic nasal sinusitis].

    Kihara, Kazunori; Sato, Motoki; Kado, Ken; Fukuda, Kazumasa; Nakamura, Takao; Yamakami, Iwao


    Non-traumatic intracranial acute epidural hematoma(EDH)is rare. It is mostly caused by coagulation disorders, dural metastasis, or vascular malformations of the dura. We report a case of non-traumatic acute EDH caused by chronic nasal sinusitis and review the literature comprising 10 cases of acute EDH caused by chronic nasal sinusitis. A 16-year-old boy visited our outpatient clinic with a 2-day history of severe headache. He did not have fever or neurological abnormalities and showed no evidence of head trauma. Cranial computed tomography(CT)revealed sphenoid sinusitis and a small amount of epidural air in the middle fossa, but no other intracranial abnormalities. After eight days with no subsequent history of trauma, radiological exams showed a massive acute epidural hematoma in the left middle fossa and temporal convexity without any vascular lesion or skull fracture. The patient underwent a hematoma evacuation that revealed neither a skull fracture nor a vascular abnormality. In this adolescent, chronic nasal sinusitis caused fragility of the meningeal artery wall, an air collection in the epidural space, and the detachment of the dura mater from the inner surface of the skull, thereby resulting in a non-traumatic acute EDH.

  4. Pelvic hematoma following angiography: another cause of elevated serum CA-125.

    Eddy, G L


    The presence of a pelvic mass in a patient with an elevated serum CA-125 suggests the possibility of a gynecologic malignancy. However, an increasing number of nonneoplastic causes of elevated serum CA-125 have been reported. This is the first report of a pelvic hematoma associated with elevated serum CA-125. Two weeks following cardiac catheterization at time of myocardial infarction a patient was noted to have a complex pelvic mass on ultrasound and serum CA-125 of 53 units per milliliter. Abdominal-pelvic CT-scan showed a small left pleural effusion, minimal ascites, left lower quadrant abdominal wall masses consistent with omental metastases, and a 9.4 x 10.3 x 9.0-cm complex left adnexal mass. At exploratory laparotomy a large organized hematoma in the left paravesical space was adherent to both the left external iliac artery and the left bladder wall. This mass could have been managed expectantly with percutaneous aspiration if a nonmalignant diagnosis had been more strongly considered.

  5. 急性颅内血肿术后迟发性血肿临床诊治分析%Analysis of clinical diagnosis and treatment of delayed hematoma after the surgery for acute intracranial hematoma

    吴世强; 骆安林; 方挺; 关惠东; 沈才锋


      目的:通过观察急性颅内血肿术后发生迟发性血肿现象,探讨分析其临床诊治方法。方法:选择34例急性颅内血肿术后出现迟发性血肿现象的患者,对患者的临床资料进行分析研究,决定再次手术清除还是保守治疗。结果:34例患者中有18例患者进行再次手术清除颅内血肿,4例家属拒绝再次手术治疗,其余12例采用保守治疗。有15例恢复较好,6例中度残废,6例重度残废,3例植物生存,4例死亡。结论:急性颅内血肿术后迟发性血肿的原因一般与头部钝挫伤、颅内压发生较大变化以及颅骨骨折有关,对病情恢复情况应给予严密监控以及定时定期复查头颅CT,早发现早治疗以便保证预后恢复。%Objective To explore the clinical diagnosis and treatment for delayed hematoma after the surgery for acute intracranial hematoma through observation.Methods Clinical data of 34 delayed hematoma patients after the surgery of acute intracranial hematoma who were treated in our hospital were analyzed and studied first and then whether they were treated with another dissection or conservative treatment was confirmed. Results Of the 34 patients,18 needed another surgery for dissecting intracranial hematoma,4 got their families refused a second surgery,and the rest 12 patients adopted conservative treatment.15 patients well recovered,6 patients were moderately disabled,6 patients were severely disabled,3 survived in vegetative state and 4 patients were dead.Conclusion The reasons for delayed hematoma after the surgery for acute intracranial hematoma are usually related to head blunt trauma,big changes of intracranial pressure,and skull fracture and it is required to closely monitor the recovery of disease and carry out periodic reexamination for skull CT,ensuring that the prognosis for recovery is good through early discovery and early treatment.

  6. Subdural Hematoma


    presence of and severity of other associated brain injuries. As many patients can experience rapid clinical improvement after successful...greater than 21 days old. They have a tendency to present in older patients and after non-accidental trauma in children and may be associated with... whiplash force caused by violent shaking. Subdural hematomas in infants are only rarely caused by accidental injury. A heterogeneous subdural

  7. Suprarrenal hematoma Hematoma suprarrenal


    Neonatal asymptomatic suprarrenal hemorrhage is relatively frequent; sometimes it is detected only after resolution when a calcification is found; symptomatic forms are rare; most times hemorrhage and hematoma are due to an obstetric trauma and are related to macrosomia, breech presentation, maternal diabetes and neonatal hypoxia. Clinical picture is characterized by abdominal mass and anemia; diagnosis is confirmed by imagenology. Two patients with suprarrenal hematoma from the University Ho...

  8. A 92-year-old man with retropharyngeal hematoma caused by an injury of the anterior longitudinal ligament

    Seiji Morita; Shinichi lizuka; Haruna Hirakawa; Shigeo Higami; Takeshi Yamagiwa; Sadaki Inokuchi


    Traumatic retropharyngeal hematoma is a rare condition and may be lethal in some cases.In patients with this condition, the absence of a vertebral fracture or a major vascular injury is extremely rare.We present the case of a 92-year-old man who hit his forehead by slipping on the floor in his house.He had no symptoms at the time; however, he experienced throat pain and dyspnea at 6 hours after the injury.On arrival, he complained of severe dyspnea; therefore, an emergency endotracheal intubation was performed.A lateral neck roentgenogram after intubation showed dilatation of the retropharyngeal and retrotracheal space and no evidence of a cervical vertebral fracture.Cer-vical computed tomography (CT) with contrast medium re-vealed a massive hematoma extending from the retropharyngeal to the superior mediastinal space but no evidence of contrast medium extravasation or a vertebral fracture.However, sagittal magnetic resonance imaging (MRI) revealed an anterior longitudinal ligament (C levels)injury.We determined that the cause of the hematoma was an anterior longitudinal ligament injury and a minor vascu-lar injury around the injured ligament.Therefore, we recom-mend that patients with retropharyngeal hematoma undergo sagittal cervical MRI when roentgehography and CT reveal no evidence of injury.

  9. Hypovolemic Shock Caused by Massive Renal Hematoma After a Third Consecutive Extracorporeal Shockwave Lithotripsy Session: A Case Report.

    Sermeus, Loic; Vander Eeckt, Kathy; Ost, Dieter; Van Den Branden, Marcel


    Extracorporeal shockwave lithotripsy (SWL) is a commonly used technique for treating urinary calculi. Although noninvasive, highly effective, and widely accepted, SWL is not without complications. Next to fragmenting the calculi, the surrounding tissue is damaged, which can result in renal hematoma, a well-described complication. In most cases, the collateral tissue damage is mild and resolves with conservative treatment. However, rarely, severe complications may arise. Here we present a case of a 46-year-old male who developed a massive hematoma, both subcapsular and retroperitoneal, after a third consecutive SWL session, resulting in hypovolemic shock. Different probable causes are proposed, of which one cause, the length of the interval between SWL sessions, is not yet studied properly. Probably, short intervals keep the damaged tissue from healing sufficiently, as proposed in our case. Possibly, life-threatening situations can be avoided if more evidence-based guidelines are available.

  10. Suprarrenal hematoma Hematoma suprarrenal

    Concepción Guardo B.


    Full Text Available Neonatal asymptomatic suprarrenal hemorrhage is relatively frequent; sometimes it is detected only after resolution when a calcification is found; symptomatic forms are rare; most times hemorrhage and hematoma are due to an obstetric trauma and are related to macrosomia, breech presentation, maternal diabetes and neonatal hypoxia. Clinical picture is characterized by abdominal mass and anemia; diagnosis is confirmed by imagenology. Two patients with suprarrenal hematoma from the University Hospital at Cartagena, Colombia, are presented. Both were related with traumatic delivery and cephalohematoma; one of them had oral and gastric bleeding and the othersuffered hematoma infection; diagnosis was done with abdominal ecography and CAT. Both patients recovered with medical treatment. La hemorragia suprarrenal asintomática del neonato es relativamente frecuente y muchas veces se detecta como una calcificación local después de que se resuelve el hematoma. La forma sintomática es rara y, a menudo, se debe a un trauma obstétrico relacionado con la macrosomía fetal, la presentación podálica, la diabetes materna o la hipoxia perinatal. Las manifestaciones clínicas son, principalmente, una masa abdominal y anemia importante; el diagnóstico se confirma con la imaginología. Se presentan dos casos de hematoma suprarrenal derecho tratados en el Hospital Universitario de Cartagena, ambos relacionados con un parto traumático y acompañados de cefalohematomas; uno de ellos presentó sangrado gastrointestinal alto y el otro infección del hematoma suprarrenal. El diagnóstico se comprobó con la ecografía abdominal y se verificó con la tomografía. El tratamiento fue médico y no se requirió cirugía a pesar de la anemia severa que presentó uno de los pacientes.

  11. Drug interaction as cause of spontaneously resolving epidural spinal hematoma on warfarin therapy

    Amitabh Sagar


    Full Text Available We present a case of a 42-year-old male, an old case of deep vein thrombosis on warfarin and other drugs like quetiapine, aspirin, diclofenac sodium, fenofibrate, atorvastatin, propanolol and citalopram for concurrent illnesses, who presented with widespread mucocutaneous bleeding and epidural spinal hematoma. The epidural bleed presented clinically as a nontraumatic, rapidly improving myeloradiculopathy. Magnetic resonance imaging (MRI of the spine revealed an epidural hematoma at D12-L1 level. The case was managed conservatively due lack of neurosurgical facilities. The patient gained full neurological recovery on conservative management alone. This case highlights the problem of drug interaction on warfarin therapy and also an unusual spontaneous recovery of spinal hematoma. Our case was anticoagulated in the recommended therapeutic INR range of 2.2 to 2.4. Most of the similar cases reported in literature were also anticoagulated in the therapeutic range. Thus intraspinal hemorrhage is a rare but dangerous complication of anticoagulant therapy. It must be suspected in any patient on anticoagulant agents who complains of local or referred spinal pain associated with neurological deficits. Drug interactions with warfarin are common. High suspicion and immediate intervention are essential to prevent complications from intraspinal hemorrhage.

  12. Hemophilia and child abuse as possible causes of epidural hematoma: case report Hemofilia e abuso infantil como possíveis causas de hematoma extradural: relato de caso

    Fernando Campos Gomes Pinto


    Full Text Available INTRODUCTION: Head trauma is an important consequence of child abuse. Specific pathophysiological mechanisms in child abuse are responsible for the ''whiplash shaken-baby syndrome'', which would favour the occurrence of intracranial hemorrhages. CASE REPORT: We report the case of a child who developed epidural hematoma following minor-intensity head trauma. Initial diagnosis of child abuse was made, but subsequent investigation led to the diagnosis of hemophilia A. CONCLUSION: Even though epidural hematoma is not closely associated with child abuse, this aethiology must always be considered when the reported trauma mechanism is out of proportion to the magnitude of the encountered lesions.INTRODUÇÃO: Traumatismo crânio-encefálico é importante conseqüência de abuso infantil. Mecanismos fisiopatológicos específicos do abuso infantil são responsáveis pela ''whiplash shaken-baby syndrome'', o que favoreceria o aparecimento de hemorragias intracranianas. RELATO DE CASO: Relatamos o caso de uma criança que desenvolveu hematoma extradural após trauma de pequena intensidade. Foi feito diagnóstico inicial de abuso infantil, mas investigações subseqüentes levaram ao diagnóstico de hemofilia A. CONCLUSÃO: Embora o hematoma extradural não esteja intimamente relacionado com abuso infantil, esta etiologia deve ser sempre considerada quando o mecanismo de trauma relatado estiver fora de proporção com as lesões encontradas.

  13. Does hypernatremia cause subdural hematoma in children?: two case reports and a meta-analysis of the literature.

    Ali, Syed Adnaan; Jaspan, Timothy; Marenah, Christine; Vyas, Harish


    Hypernatremia has been causally linked with subdural hematoma (SDH), but more recently this has been called into question. Conversely, there is a well-established link between SDH and injury. We wish to examine the evidence base that hypernatremia in infants and young children causes SDH.We present 2 cases of children with severe hypernatremia whose intracranial contents were assessed by imaging in the first case and postmortem examination in the second. Neither demonstrated SDH. The first case was important as the hypernatremia was iatrogenic occurring in a controlled hospital environment.We also searched the literature from 1950 to 2007, collecting data on all reported cases of hypernatremia in children younger than 7 years whose intracranial contents were examined by imaging, surgery, and/or postmortem examination. Of 124 cases reported in 31 articles, 112 cases developed hypernatremia in the community, and 12 in the hospital. Subdural hematoma was demonstrated in 7 cases, all of which had developed hypernatremia in the community under circumstances that would make it difficult to exclude nonaccidental injury. None of the 12 cases that developed hypernatremia in a controlled hospital environment had SDH.The evidence base supporting the hypothesis that hypernatremia causes SDH is poor, depending on isolated reports with uncertain histories.

  14. A rare cause of acute abdomen-Spontaneous rectus sheath hematoma

    Hock Chin Chong; Feng Yih Chai; Yew Eng Tan; Sophia Si Ling Heng; Siti Asilah Mohd Desa


    Spontaneous rectus sheath hematoma (SRSH) is a rare entity that mimics acute abdomen. Rectus sheath hematoma is the accumulation of blood in rectus sheath due to muscle or epigastric vessel injury. However, SRSH without a trauma or anticoagulation is rare. It frequently mimics acute abdomen and it may lead to misdiagnosis and unnecessary laparotomy. In this article, we described two cases of SRSH with their diagnostic and therapeutic strategy. Both of our patients in report were neither consumed antiplatelet nor coagulopathy. They both had abdominal muscle straining before their symptoms pre-sentation. We hypothesized that the SRSH may be induced by rectus muscle injury secondary to inappropriate straining or posture. To diagnose SRSH, clinical findings are important but radiologic imaging such as computed tomography, can be diagnostic. In expanding SRSH, percutaneous arterial embolization of epigastric artery is useful to secure the bleeding. If embolization is not feasible, surgical exploration hemostasis is curative. In non-expanding SRSH, it can be managed nonoperatively. SRSH is an important initial differential for acute abdomen. Radiologic imaging helps in diagnosis. Stable SRSH can be managed conservatively with good outcome.

  15. 外伤性迟发性颅内血肿常规CT研究%Study on delayed traumatic intracranial hematoma using conventional CT



    目的 探讨常规CT如何尽早而准确地测出外伤性迟发性颅内血肿.方法 搜集常规CT复查证实的外伤性迟发性颅内血肿39例,对其首次常规CT检查及复查的CT图像特点进行分析.结果 39例迟发性颅内血肿首次常规CT检查主要异常表现包括:①局限性蛛网膜下腔出血30例.②局限性脑密度减低,灰白质分界不清15例.③局部轻度占位效应18例.④颅骨骨折5例.结论 外伤性迟发性颅内血肿的发生率与伤后首次常规CT检查表现密切相关,应在24h以内复查,以6~12h最佳.%Objective To determine how early and reliably delayed traumatic intracranial hematoma can be detected on conventional CT scanning. Methods The manifestations of the initial conventional CT studies and follow up CT examinations of 39 delayed traumatic intracranial hematoma were analyzed. Results The abnormal findings of conventional CT studies of the 39 delayed traumatic intracranial hematoma included:①Local subarachnoid space hemorrhage in 30 cases:②Decreased density of the local brain parenchyma and disappeared difference between gray and white matter of the same area in 15 cases: ③Slight space occupying effect in 18 cases:④skull bone fracture in 5 cases. Conclusion The morbidity of delayed traumatic intracranial hematoma is closely related to the manifestation of the first cranial conventional CT after injury, The time of observation should be within 24 hours of injury, and within 6 - 12 hours was the beat.

  16. 颅脑损伤患者术后迟发性颅内血肿的影响因素研究%Influencing Factors of Delayed Traumatic Intracranial Hematoma in Postoperative Traumatic Brain Injury Patients



    Objective To analyze the influencing factors of delayed traumatic intracranial hematoma in postoperative traumatic brain injury patients. Methods A total of 264 traumatic brain injury patients were selected in the Second people′s Hospital of Neijiang from June 2010 to June 2015,all of them received emergency evacuation of intracranial hematoma,thereinto 37 patients complicated with delayed traumatic intracranial hematoma were served as observation group,other 227 patients did not complicated with delayed traumatic intracranial hematoma were served as control group. Self - made EXCEL table was used to collect related clinical data,including gender,age,injury mechanism(including accelerated injury and decelerated injury), the first examination time of CT,severity of traumatic brain injury,incidence of patulous injury,incidence of contusion and laceration of brain,incidence of skull fracture,hematoma locations( including epidural hematoma,subdural hematoma and intracerebral hematoma ), hematoma volume, blood pressure ( including SBp and DBp ), FBG, coagulation markers (including pT,TT,ApTT,FIB and pLT),duration between admission and operation,and the proportion of decompressive craniectomy,unconditional multivariate logistic regression analysis was used to analyze the influencing factors of delayed traumatic intracranial hematoma in postoperative traumatic brain injury patients. Results Univariate analysis showed that,no statistically significant differences of gender,age,injury mechanism,the first examination time of CT,incidence of patulous injury, incidence of intracerebral hematoma,hematoma volume,SBp,pT,FIB or pLT was found between the two groups;severity of traumatic brain injury of observation group was statistically significantly more severe than that of control group,incidence of contusion and laceration of brain, of skull fracture, of epidural hematoma, of subdural hematoma, DBp, FBG andthe proportion of decompressive craniectomy of observation group were

  17. 去大骨瓣减压术后迟发性血肿的临床研究进展%Clinical Research of Delayed Intracranial Hematoma after Decompressive Craniectomy

    陈俊琛(综述); 赖润龙(审校)


    去大骨瓣减压术后迟发性血肿因其高致死率及致残率而受到重视。目前迟发性血肿的发病机制主要有填塞效应解除及微血管功能障碍两种假说,而术前颅内压增高、中线结构偏移及颅骨骨折等则是迟发性血肿发生的危险因素。及时对去大骨瓣减压术后迟发性血肿进行早期预测、诊断及治疗对改善患者预后可能有帮助,但是目前尚无明确定论,有待建立前瞻性研究和实验模型进行确定。%The delayed intracranial hematoma after decompressive craniectomy is highly attended because of its high mortality and disability .The mechanisms of delayed intracranial hematoma include the release of tamponade effect and dysfunction of microvascular circulation .Increased intracranial pressure,mid-line shift of the brain,cranial fracture are the risk factors of delayed intracranial hematoma .Early prediction, diagnosis and therapy of delayed intracranial hematoma are critical and may improve the prognosis .However perspective study and experimental model are still needed for confirmation .

  18. 术中迟发性硬膜外血肿防治体会(附10例报告)%Intraoperative Prevention and Treatment of Delayed Epidural Hematoma (Report of 10 cases)

    俞辉; 李高义; 杨文进; 何斌; 郑平; 郭义君; 童武松


    Objective: To investigate the emergence of delayed surgery in the epidural hematoma (DEDH) the causes and preventive measures. Methods: A retrospective analysis of 10 cases of surgical procedures DEDH the causes, the phenomenon, treatment, clinical outcome and prognosis. Results: 10 cases DEDH occurred within 72h after injury, after surgical decompression, six cases with skull fractures, 3 cases with venous sinus injury. Seven cases more than the amount of preoperative mannitol 500ml, after surgical removal and conservative treatment, 1 died. Conclusion: The skull fracture and intracranial venous sinus injury is the pathological basis of the occurrence DEDH, decompression surgery and mannitol dehydration treatment is a strong contributing factor to its occurrence, GCS score and hematoma duration and prognosis.%目的:探讨颅脑外伤手术中出现迟发性硬膜外血肿(DEDH)的原因及预防对策.方法:回顾性分析10例手术过程中DEDH发生的原因、现象,治疗过程、结果及预后等临床资料.结果:10例DEDH发生于伤后72h以内、手术减压后,6例伴有颅骨骨折,3例伴静脉窦损伤.7例术前甘露醇用量超过500ml,经手术清除和保守治疗,死亡1例.结论:颅骨骨折和颅内静脉窦损伤是DEDH发生的病理基础,减压手术和甘露醇强力脱水治疗是其发生的促进因素,GCS评分和血肿持续时间与预后密切相关.

  19. Exploring delay causes of road construction projects in

    Remon F. Aziz


    Full Text Available Construction delays are a common phenomenon in civil engineering projects in Egypt including road construction projects. Therefore, it is essential to study and analyze causes of road construction delays. This paper studied a list of construction delay causes gathered from literature having different types of construction, different countries, different periods and different numbers of delay causes and delay groups. A questionnaire and personal interviews have formed the basis of this paper listing 293 delay causes. The questionnaire survey was distributed to 500 construction participants and 389 were received who represent consultants, contractors and site/design engineers excluding the owner representing the government in road projects as one party only. Relative Importance Index (RII is calculated and according to the highest values the top twenty and the least twenty delay causes of construction projects in Egypt are determined. A case study is analyzed and compared to the most important delay causes in the paper. The test results reveal good correlation of causes and groups between contractors and site/design engineers and between consultants and site design engineers and a somewhat low correlation between contractors and consultants. So there are no root causes that can be taking for granted to be most or least effective delay causes. Proposed model for predicting actual road construction project duration was developed; a real case study tested the accuracy of proposed model. According to the analysis of case study, the most contributing causes and groups to delays were discussed, and some future recommendations were proposed in order to control and minimize delays in road construction projects. These findings can be helpful for project managers to mitigate the road construction delays in Egypt. In order to effectively overcome the road construction delays in developing countries, suggestions are made for fundamental and large

  20. A giant abdominal hematoma caused by seatbelt injury led to the development of shock.

    Nishino, Tomoya; Morita, Seiji; Sakurai, Keiji; Watanabe, Yasue


    Trauma to soft tissues is an important consideration in cases of seatbelt injury, as soft-tissue injury can cause shock. Careful observation for hours in the clinic at least, along with appropriate imaging studies, is necessary if signs of a seatbelt injury exist.

  1. Hematoma Vulvar

    Andrea W. Choque Campero


    Full Text Available Paciente de Sexo femenino de 29 anos de edad acudio a consulta externa del Hospital “German Urquidi” por dolor y molestia en region peri vulvar, diagnosticándose “hematoma vulvar” de causa obstétrica (Laceracion de trayecto, mala técnica de sutura de episiotomia.

  2. 外伤性迟发性颅内血肿临床特点及首次CT的影像学特征分析%Clinical manifestations and initial CT imaging features of delayed traumatic intracerebral hematoma

    葛培林; 刘华明; 刘仁忠; 易伟; 杨振兴; 连海伟; 邵灵敏


    目的 分析外伤性迟发性颅内血肿临床特点及首次CT影像学特征,早期诊断外伤性迟发性颅内血肿,提高疗效.方法 回顾性分析我院2005年至2009年经CT证实的外伤性迟发性颅内血肿患者的临床资料,总结临床特点和首次CT影像学特征.结果 迟发性血肿多发生在伤后3d内,额颞部好发,老年人容易发生,进行性的意识水平下降或出现新的神经系统体征往往意味着迟发性血肿;首次CT发现头皮血肿、颅骨骨折、气颅、脑挫伤、蛛网膜下腔出血、外侧裂血肿等预警征象时,要警惕迟发性血肿的发生.结论 如果首次CT扫描有头皮血肿、颅骨骨折、脑挫伤、蛛网膜下腔出血、外侧裂血肿者,或颅内血肿成功清除后,但临床症状和特征未改善甚至加重者,进行性的意识水平下降者,伤后应将头部CT动态扫描作为常规检查,做到早期诊断、及时治疗.%Objective To examine the clinical manifestations and initial CT imaging features of delayed traumatic intracranial hematoma. Methods Clinical data of 236 patients who were proved to have delayed traumatic intracranial hematoma by CT imaging in our hospital from 2005 to 2009 were retrospectively analyzed. The clinical and CT imaging features were summarized. Results Delayed hematomas usually occurred within 3 days after injury and had frontotemporal predilection. It was more common in the elderly. Progressive decline in consciousness and nerve system signs newly found were more indicative of delayed hematoma. When initial CT imaging showed scalp hematoma, skull fractures, gas skull, brain contusion, subarachnoid hemorrhage, hematoma of lateral fissure and other early warning signs, clinicians would be alert to delayed hematomas. Conclusion If the first CT scanning reveals scalp hematoma, cranial fracture,brain contusion, subarachnoid hemorrhage or lateral fissure hematoma, and the clinical symptoms fail to be alleviated and the patients

  3. Rapid natural resolution of intracranial hematoma

    吴明灿; 刘建雄; 罗国才; 张志文; 闵杰; 余辉; 姚远


    Objective:To investigate the clinical characteristics of intracranial hematoma and the mechanism involved in its rapid natural resolution. Methods:Seventeen cases of intracranial hematoma with typical clinical and CT manifestations were retrospectively studied. Results: Intracranial hematoma was found obviously decreased in size within 72 h after its occurrence in 8 cases. The rest 9 cases presented complete resolution. Conclusions: Rapid natural resolution of acute epidural hematoma is mostly found in teenagers and the resolution is correlated with cranial fracture at the hematoma site. As for acute subdural hematoma, its rapid resolution is associated with the transfer of cerebrospinal fluid toward subdural space, the lavage effect, and the compression caused by the increased intracranial pressure or the space left resulting from redistribution of the hematoma in brain atrophy.

  4. Epidural hematomas after the implantation of thoracic paddle spinal cord stimulators.

    Moufarrij, Nazih A


    OBJECTIVE There is little information on the frequency of symptomatic epidural hematomas after the implantation of paddle spinal cord stimulators (SCSs) in the thoracic spine. The purpose of this paper is to provide this metric and compare it to the frequency of symptomatic epidural hematomas for all other thoracic laminectomies combined. METHODS This study involved retrospectively analyzing the experience of a single surgeon in a consecutive series of patients who underwent the implantation of a thoracic paddle SCS with respect to the occurrence of a symptomatic epidural hematoma. For comparison, the occurrence of a symptomatic epidural hematoma in non-SCS thoracic laminectomies done during the same period of time was determined. RESULTS One hundred fifty-four thoracic paddle SCSs were implanted between May 2002 and February 2015. Despite perfect hemostasis and no preoperative risk factors, 4 of 154 patients (2.60%) developed postoperative lower-extremity weakness caused by an epidural hematoma. There were no other causes of a neurological deficit. In 3 of the 4 patients, the symptoms were delayed. Over the same time period, only 1 of 119 patients (0.84%) developed a postoperative motor deficit from a symptomatic epidural hematoma after a non-SCS laminectomy. CONCLUSIONS The occurrence of epidural hematomas after thoracic paddle SCS implantation may be underreported. Suggestions are given to decrease its incidence. It seems paradoxical that an epidural hematoma occurred 3 times more often after small SCS thoracic laminectomies than after larger non-SCS thoracic laminectomies. If confirmed by future studies, this finding may suggest that the intrusion of instruments into a confined epidural sublaminar space or the presence of a paddle and a hematoma in this restricted space may account for this differential.

  5. 重型颅脑损伤术后迟发性颅内血肿的危险因素观察%The risk factors of delayed intracranial hematoma after severe braininjury



    目的:探讨颅脑损伤术后迟发性颅内血肿发生的危险因素。方法选取2012年6月~2016年2月我院行急性外伤性颅脑血肿清除术患者200例作为研究对象,将其按照术后是否发生迟发性颅内血肿进行分组,其中术后发生迟发性颅内血肿者30例(血肿组),未发生迟发性颅内血肿者170例(非血肿组)。对比两组患者的临床基线特征与颅内血肿发生的危险因素。结果多因素logistic回归分析结果显示:颅骨骨折(OR=1.864,95%CI 1.162~3.465,P=0.021)、脑挫裂伤(OR=2.874,95%CI 1.574~4.264, P=0.018)、重度颅脑损伤(OR=3.757,95%CI 2.475~5.797,P=0.001)及血浆TT水平(OR=1.964,95%CI 1.254~4.038,P=0.015)是迟发性颅内血肿的独立危险因素。结论颅骨骨折、脑挫裂伤、重度颅脑损伤及血浆TT水平是颅脑损伤术后迟发性颅内血肿的独立危险因素。%Objective To investigate the risk factors of delayed intracranial hematoma after craniocerebral injury operation.Methods Delayed intracranial hematoma occurred in 30 patients (hematoma group), 170 cases of delayed intracranial hematoma (non hematoma group). The clinical baseline characteristics of the two groups were compared with the risk factors of the occurrence of intracranial hematoma.Results Multivariate logistic regression analysis showed that skull fracture (OR=1.864,95%CI 1.162~7.095 3.465, P=0.021), cerebral contusion and laceration (OR=2.874,95%CI 157.4 ~ 4.264, P=0.018), severe craniocerebral injury (OR=3.757, 95% CI 2.475 to 5.797, P=0.001) and plasma TT levels (or=196.4, 95% CI 125.4 ~ 4.038, P= 0.015) is delayed intracranial hematoma of independent risk factors.Conclusion Skull fracture, brain contusion severe traumatic brain injury and plasma TT level are the independent risk factors of delayed intracranial hematoma after craniocerebral injury operation.

  6. Clinical Analysis of CT in the Diagnosis of Traumatic Delayed Intracranial Hematoma%CT诊断外伤性迟发性颅内血肿临床分析



    目的:分析CT诊断外伤性迟发性颅内血肿患者的临床价值。方法回顾性分析我院35例外伤性迟发性颅内血肿患者采用CT诊断及治疗的相关临床资料。结果本次经过CT检查表明,3例患者硬膜下血肿,3例患者硬膜外血肿,6例患者蛛网膜下腔出血,9例患者颅内骨折,14例患者脑挫裂伤。35例外伤性迟发性颅内血肿患者中有21例患者受伤后24 h以内发生颅内血肿。其中有11例患者选择保守治疗(31.4%),而有24例患者选择手术治疗(68.6%)。所有患者经过治疗后均取得相对满意的治疗效果,24例手术治疗恢复良好患者中,6例患者中度残疾,1例患者重度残疾,2例患者死亡。结论 CT检查可早期诊断外伤性迟发性颅内血肿,以便临床及时采取有效的治疗措施,降低患者的致残率、死亡率,改善患者预后。%Objective To analyze the clinical value of CT in the diagnosis of traumatic delayed intracranial hematoma.Methods Retrospective analysis of 35 patients with traumatic delayed intracranial hematoma in patients with CT diagnosis and treatment of clinical data.Results The CT examination showed that 3 cases of subdural hematoma, 3 cases of patients with epidural hematoma, 6 cases of subarachnoid hemorrhage, 9 cases of patients with intracranial fractures, 14 cases of brain contusion and laceration. In 35 patients with delayed traumatic intracranial hematoma, 21 patients had intracranial hematoma within 24 h after injury. Among them, 11 patients were treated with conservative therapy (31.4%), and 24 patients were selected for surgical treatment (68.6%). All patients achieved satisfactory results after treatment, 24 cases of patients with good recovery, 6 patients with moderate disability, 1 patients with severe disability, 2 patients died. Conclusion CT examination can be early diagnosis of traumatic delayed intracranial hematoma, in order to take effective treatment

  7. Mutations in KPTN Cause Macrocephaly, Neurodevelopmental Delay, and Seizures

    Baple, Emma L.; Maroofian, Reza; Chioza, Barry A.; Izadi, Maryam; Cross, Harold E.; Al-Turki, Saeed; Barwick, Katy; Skrzypiec, Anna; Pawlak, Robert; Wagner, Karin; Coblentz, Roselyn; Zainy, Tala; Patton, Michael A.; Mansour, Sahar; Rich, Phillip; Qualmann, Britta; Hurles, Matt E.; Kessels, Michael M.; Crosby, Andrew H.


    The proper development of neuronal circuits during neuromorphogenesis and neuronal-network formation is critically dependent on a coordinated and intricate series of molecular and cellular cues and responses. Although the cortical actin cytoskeleton is known to play a key role in neuromorphogenesis, relatively little is known about the specific molecules important for this process. Using linkage analysis and whole-exome sequencing on samples from families from the Amish community of Ohio, we have demonstrated that mutations in KPTN, encoding kaptin, cause a syndrome typified by macrocephaly, neurodevelopmental delay, and seizures. Our immunofluorescence analyses in primary neuronal cell cultures showed that endogenous and GFP-tagged kaptin associates with dynamic actin cytoskeletal structures and that this association is lost upon introduction of the identified mutations. Taken together, our studies have identified kaptin alterations responsible for macrocephaly and neurodevelopmental delay and define kaptin as a molecule crucial for normal human neuromorphogenesis. PMID:24239382

  8. P- and S-wave delays caused by thermal plumes

    Maguire, Ross; Ritsema, Jeroen; van Keken, Peter E.; Fichtner, Andreas; Goes, Saskia


    Many studies have sought to seismically image plumes rising from the deep mantle in order to settle the debate about their presence and role in mantle dynamics, yet the predicted seismic signature of realistic plumes remains poorly understood. By combining numerical simulations of flow, mineral-physics constraints on the relationships between thermal anomalies and wave speeds, and spectral-element method based computations of seismograms, we estimate the delay times of teleseismic S and P waves caused by thermal plumes. Wave front healing is incomplete for seismic periods ranging from 10 s (relevant in traveltime tomography) to 40 s (relevant in waveform tomography). We estimate P-wave delays to be immeasurably small (20 s), measurements of instantaneous phase misfit may be more useful in resolving narrow plume conduits. To detect S-wave delays of 0.4-0.8 s and the diagnostic frequency dependence imparted by plumes, it is key to minimize the influence of the heterogeneous crust and upper mantle. We argue that seismic imaging of plumes will advance significantly if data from wide-aperture ocean-bottom networks were available since, compared to continents, the oceanic crust and upper mantle are relatively simple.

  9. P and S wave delays caused by thermal plumes

    Maguire, Ross; Ritsema, Jeroen; van Keken, Peter E.; Fichtner, Andreas; Goes, Saskia


    Many studies have sought to seismically image plumes rising from the deep mantle in order to settle the debate about their presence and role in mantle dynamics, yet the predicted seismic signature of realistic plumes remains poorly understood. By combining numerical simulations of flow, mineral-physics constraints on the relationships between thermal anomalies and wave speeds, and spectral-element method based computations of seismograms, we estimate the delay times of teleseismic S and P waves caused by thermal plumes. Wavefront healing is incomplete for seismic periods ranging from 10 s (relevant in traveltime tomography) to 40 s (relevant in waveform tomography). We estimate P wave delays to be immeasurably small ( 20 s), measurements of instantaneous phase misfit may be more useful in resolving narrow plume conduits. To detect S wave delays of 0.4-0.8 s and the diagnostic frequency dependence imparted by plumes, it is key to minimize the influence of the heterogeneous crust and upper mantle. We argue that seismic imaging of plumes will advance significantly if data from wide-aperture ocean-bottom networks were available since, compared to continents, the oceanic crust and upper mantle is relatively simple.

  10. Drought in Africa caused delayed arrival of European songbirds.

    Tøttrup, A P; Klaassen, R H G; Kristensen, M W; Strandberg, R; Vardanis, Y; Lindström, Å; Rahbek, C; Alerstam, T; Thorup, K


    Despite an overall advancement in breeding area arrival, one of the latest spring arrivals in northwest Europe since 1950 of several trans-Saharan songbird species occurred in 2011. Year-round tracking of red-backed shrikes and thrush nightingales revealed that the cause of the delay was a prolongation of stopover time during spring migration at the Horn of Africa, which was affected by extreme drought. Our results help to establish a direct link at the individual level between changes in local climate during migration and arrival and breeding condition in Europe thousands of kilometers further north.

  11. A Pilot Survey on Causes of Delay in Malaysian Construction Project

    Tawil Norngainy Mohd


    Full Text Available Construction delay is a common problem in the construction industry all over the world. Many researchers seeking the causes of delay in order to reduce the probability of delay to occur. Most researcher identified causes of delay in construction to reduce the possibility of construction project to continued delay. This study is to obtain the holistic delay categories base on Drewin Open Conversion System (DOCS for the development of a theoretical framework delay and to get the most significant causes of delay in construction industries. There are three main factor of construction delay based on DOCS; input factor, internal factor and external factor. There are130 items on causes of delay and it is divided into 31 categories. This pilot survey is distributed to students and fresh graduates that have educational background in construction. The result shown the main factor that contributes to construction delay are mistakes during construction and unrealistic project durations.

  12. Endoscopic appearance of esophageal hematomas

    Rodica Ouatu-Lascar; Gayatri Bharadhwaj; George Triadafilopoulos


    @@INTRODUCTION Esophageal hematomas develop from the dissection of the mucosa from the muscular layers of the esophageal wall and represent an uncommon condition affecting all ages[t-3]. Although the most common cause of esophageal hematomas is iatrogenic mechanical injury-induced by prolonged nasogastric intubation, difficult or forceful endoscopic intubation, or the result of variceal injection sclerotherapy- some may be spontaneous,particularly in patients receiving anticoagulants[3-6]. Presenting symptoms most commonly include dysphagia, hematemesis, and sub-sternal or epigastric pain[5,9].

  13. Hematoma subperiosteal de órbita: relato de caso Subperiosteal hematoma of the orbit: case report

    Jacinto Barbosa Lay Chaves


    Full Text Available Descrevemos um paciente de 16 anos que após traumatismo crânio-encefálico leve evoluiu com dor ocular, hematoma palpebral unilateral e proptose do olho esquerdo. Tomografia computadorizada de órbitas evidenciou hematoma subperiosteal em órbita esquerda. Foi realizada drenagem cirúrgica da coleção. O hematoma subperiosteal de órbita, apesar de raro, deve ser incluído como etiologia de proptose ocular e seu diagnóstico deve ser precoce a fim de evitar a morbidade associada.We describe a sixteen years old male patient that suffered a craniocerebral trauma and presented at the emergency room, with ocular pain, palpebral hematoma and left eye proptosis. Orbital computed tomography showed left subperiosteal orbital hematoma. A surgical drainage was performed. Subperiosteal hematoma of the orbit is a rare cause of proptosis; its early diagnosis must be made in order to avoid possible complications.

  14. Postoperative extradural hematomas.

    Pichierri, Angelo; Ruggeri, Andrea; Donnarumma, Pasquale; Delfini, Roberto


    Postoperative extradural hematoma (POEH) is a possible complication after head surgery, often neglected in the literature. In a single surgeon experience we found 13 cases of POEH (0.8%). We distinguished two subtypes: (1) larger hematomas (>40 cc) with typical features and overt clinical picture that always needed evacuation, and (2) smaller hematomas (<40 cc) with insidious clinical onset and different radiological features compared with traumatic and spontaneous extradural hematomas. On the basis of our experience, we propose that clinical picture and radiologic appearance lead the decision between conservative or interventional treatment of type II hematomas.

  15. Cervical Ligamentum Flavum Hematoma: A Case Report.

    Haghnegahdar, Ali; Sedighi, Mahsa; Rahmanian, Abdolkarim; Baghban, Fahim


    Study Design Case report. Objective To report the first case of ligamentum flavum hematoma after cervical spine instrumentation 11 years after the index surgery. Methods After performing bilateral C3 and C4 laminectomy, we observed a dark greenish discoloration over the ligamentum flavum, which was opened. We evacuated 15 mL of subacute hematoma. Results The first ligamentum flavum hematoma of the cervical spine that occurred after spinal instrumentation with sublaminar hooks. Conclusion Ligamentum flavum hematoma might happen even after a long delay (in our case, 11 years) from spinal instrumentation (sublaminar hooks). In symptomatic patients, evacuation is the treatment of choice. In cases of instrument adhesion to the surrounding intracanal tissues, removal should be done meticulously after performing a complete release.

  16. Epidural hematomas of posterior fossa

    Radulović Danilo


    Full Text Available Background. Posterior fossa epidural hematomas represent 7-14% of all traumatic intracranial epidural hematomas. They are most frequently encountered posttraumatic mass lesions in the posterior fossa. The aim of this study was to identify clinical features that could lead to the early diagnosis of posterior fossa epidural hematoma. Methods. Between 1980 and 2002, 28 patients with epidural hematoma of the posterior fossa were operated on at the Institute for Neurosurgery, Belgrade. Clinical course neuroradiological investigations, and the results of surgical treatment of the patients with posterior fossa epidural hematomas were analyzed retrospectively. Results. Almost two thirds of patients were younger than 16 years of age. In 20 cases injury was caused by a fall, in 6 cases by a traffic accident, and in 2 by the assault. Clinical course was subacute or chronic in two thirds of the patients. On the admission Glasgow Coma Scale was 7 or less in 9 injured, 8-14 in 14 injured, and 15 in 5 injured patients. Linear fracture of the occipital bone was radiographically evident in 19 patients, but was intraoperatively encountered in all the patients except for a 4-year old child. In 25 patients the diagnosis was established by computer assisted tomography (CAT and in 3 by vertebral angiography. All the patients were operated on via suboccipital craniotomy. Four injured patients who were preoperatively comatose were with lethal outcome. Postoperatively, 24 patients were with sufficient neurologic recovery. Conclusion. Posterior fossa epidural hematoma should be suspected in cases of occipital injury, consciousness disturbances, and occipital bone fracture. In such cases urgent CAT-scan is recommended. Early recognition early diagnosis, and prompt treatment are crucial for good neurological recovery after surgery.

  17. Delayed diagnosis of a heterotopic pregnancy as a cause of acute abdomen: A case report

    Fatma Turkan Ayan


    Full Text Available Introduction: Heterotopic pregnancy is a life threating condition of intrauterine and extrauterine gestations which occur at the same time. We report a delayed diagnosed case of heterotopic pregnancy. Case: A 31 year-old primigravida was referred to our Emergency Gynaecology Service complicated by acute abdomen. She had been treated with clomiphene citrate and on admission intrauterine a missed abortus of about 8 weeks complicated by a large subchorionic hematoma was detected. Emergency laparotomy was performed because of diffuse intra-abdominal haemorrhage. A right-sided ectopic focus was recognized and excised, and dilatation - curettage was performed. Coclusion: Delay in diagnosing the condition can be fatal to both the mother and the intrauterine fetus. [J Contemp Med 2013; 3(3.000: 207-208

  18. Bilateral assymetric epidural hematoma

    Edmundo Luis Rodrigues Pereira


    Full Text Available Background: Acute bilateral extradural hematoma is a rare presentation of head trauma injury. In sporadic cases, they represent 0.5-10% of all extradural hematomas. However, higher mortality rates have been reported in previous series. Case Description: The authors described the case of a 28-year-old male presenting head injury, comatose, Glasgow Coma Scale of 6, anisocoric pupils without puppilary light reflex. Computed tomography showed asymmetric bilateral epidural hematomas, effacement of the lateral ventricles and sulci, midline shift and a bilateral skull fracture reaching the vertex. Surgical evacuation was performed with simultaneous hematoma drainage. Patient was discharged on the 29 th postoperative day with no neurological deficit. Conclusion: The correct approach on bilateral epidural hematomas depends on the volume, moment of diagnosis, and neurological deficit level. Simultaneous drainage of bilateral hematomas has been demonstrated to be an effective technique for it, which soon decreases the intracranial pressure and promotes an efficient resolution to the neurological damage.

  19. 急性外伤性颅内血肿患者术后发生迟发性脑出血的临床分析%Clinical analysis of acute traumatic intracranial hematoma with postoperative delayed cerebral hemorrhage



    目的:探讨急性外伤性颅内血肿患者的临床特征与术后迟发性脑出血发生的相关性,寻找防治措施。方法:回顾分析58例急性外伤性颅内血肿患者开颅血肿清除术后再出血的临床资料,其中23例患者术后发生迟发性脑出血( DTIH组),35例未发生( NDTIH)组。对2组患者的临床特征进行总结归纳,分析寻找再出血原因,对迟发性脑出血患者行再次手术治疗,并随访行GOS评分。结果:与NDTIH组比较DTIH组有如下特征:术前GCS评分<8分(p<0.05);术前头颅CT提示多有多发脑挫伤,对冲伤,合并颅骨骨折等,并予及时再次手术治疗,术后随访行GOS评估≥4分18例。结论:根据急性外伤性颅内血肿开颅术后患者的临床特征,及时发现迟发性脑出血,并清除迟发性颅内血肿,是提高疗效的关键。%Objective:To explore the corelation between the clinical features of patients with incidence of acute traumatic intracranial hematoma and late postoperative hemorrhage occurs and to make prevention and control measures .Methods:The clinical data of 58 cases divided two groups,postoperative delayed cerebral hemorrhage (DTIH,n=23) and did not occur (NDTIH,n=35),of acute traumatic in-tracranial hematoma in patients with invasive hematoma removal were retrospectively analyzed ,which to invastigate the reason of rehaemor-rhagia and did surgical treatment again ,to follow up through GOS score .Results:Compared with the NDTIH group ,the DTIH had the fol-lowing characteristics:preoperative GCS score <8 points ( p <0.05);Preoperative skull CT indicated that multiple cerebral contusion , hedge, skull fractures, etc,which to timely surgery again , there were18 cases those value of GOS evaluation were four points or more . Conclusion:According to the clinical features of patients with acute traumatic intracranial hematoma after craniotomy , timely detected the late-onset cerebral


    Rubén Sabogal Barrios


    Full Text Available Treatment of subdural cronic hematoma in all ages is a therapeutic challenge. Chronic subdural hematoma is a disease that can be fatal without surgical treatment. A variety of treatment options like subdural tapping, endoscopic washout, shunting and craniotomy have been discussed. In chronic subdural hematoma, spontaneous resolution with conservative treatment is not an common therapeutic method because it has causes high mortality, requires long periods of time, and finally, many patients need surgical treatment. The etiology, physiopathology and surgical alternatives in the treatment of subdural chronic hematoma is discussed.

  1. Postoperative epidural hematoma. Five cases of epidural hematomas developed after supratentorial craniotomy on the contralateral side

    Sato, M. (Shiga Univ. of Medical Science, Ohtsu (Japan)); Mori, K.; Handa, H.


    Postoperative epidural hematomas developed far from the operative field are generally recognized as a complication of ventriculo-peritoneal shunt, ventricular drainage or suboccipital craniotomy. It is very rare but may occur after supratentorial craniotomy on the contralateral side. Five such cases are presented with a review of the relevant literature. The mechanism of this complication is not clearly understood. In hydrocephalus, these massive epidural hematomas are probably caused by dura-skull detachment when the brain volume is strikingly reduced by a decompressive procedure. On rare occasions, pins of head rest may detach the dura and cause epidural hematomas. When sudden brain swelling during craniotomy is encountered, attention should be directed not only to intracerebral hemorrhage but also epidural hematoma developed on the contralateral side.

  2. Causes of delay in the adequate treatment of childhood illness in India.

    Primhak, R; Coates, S; Hosking, G; Benakappa, D G; Benakappa, D B


    A retrospective study of children attending a government hospital in Bangalore was performed to assess the causes of delay in providing appropriate treatment. Delay had occurred in 59% of children with significant illness, and in over half the cases the primary cause of delay was inappropriate treatment or delayed referral by a doctor trained in Western-style medicine. It is concluded that there are a large number of ill children in Bangalore whose parents are seeking the help of such doctors but where management is at fault.

  3. Chronic constipation causing obstructive nephropathy in a delayed toddler.

    Barrett, Michael Joseph


    Chronic constipation causing obstructive nephropathy is very rare in children. However, it can cause urinary tract obstruction with acute impairment of renal function with a need for emergent disimpaction. The authors discuss a 2 years 4 months old child who presented to our emergency department with acute renal failure due to faecal impaction.




    Full Text Available ABSTRACT: Delayed recovery from anaesthesia poses a challenge to the anaesthesiologists. We report a case of 45-year-old lady, a known diabetic on oral hypoglycaemics posted for buttress plating for fracture tibia. On patient’s request gene ral anaesthesia was administered. She was haemodynamically stable throughout the procedure. At the end of the procedure, patient was apnoeic and unresponsive. She was investigated thorou ghly and a diagnosis of severe hypothyroidism was made with low free T 4 and T 3 and high TSH levels. The patient was successfully resuscitated after treating with oral T 4 , gradual rewarming, and inotropic support. KEY WORDS: Diabetes mellitus, Myxedema coma, Recovery from ana esthesia

  5. 老年人迟发性外伤性颅内血肿的早期诊治%Diagnosis and treatment of elderly with delayed traumatic intracranial hematoma at earliest period

    戴新连; 李志强; 吴彬


    目的 探讨老年人迟发性外伤性颅内血肿(DTIH)的早期诊疗方案.方法 对老年人DTIH 171例的临床资料进行回顾性分析.结果 原发性昏迷125例,占73.1%;意识障碍一度好转又恶化49例,占28.7%;意识障碍进行性加重109例,占63.7%.首次头颅CT征像:未见异常9例,颅骨骨折15例;硬膜外血肿9例;硬膜外血肿伴对冲部脑挫裂伤4例;脑挫裂伤伴蛛网膜下腔出血83例,占48.5%;硬膜外血肿伴脑挫裂伤11例;蛛网膜下腔出血64例,占37.4%;上述征像均伴有不同程度脑受压.复查头颅CT征象:DTIH发生于首次CT无异常处25例,硬膜外6例;脑挫裂伤和/或蛛网膜下腔出血162例占94.7%;血肿量20~130mL,50mL以上87例,占50.9%.手术治疗122例,恢复良好83例,中残7例,重残4例,植物状态2例,死亡26例;非手术治疗49例,恢复良好36例,死亡8例,自动出院5例.结论 掌握老年人的病理生理特点及其DTIH的临床表现与头颅CT征像等特征,严密观察意识演变等病情变化,头颅CT追踪动态观察颅脑损伤病灶变化,是早期诊断的关键.血肿占位效应及意识状态是选择手术或非手术治疗的主要指标.%Objective It is to approach the diagnosis and treatment of elderly with delayed traumatic intracranial hematoma ( DTIH ) at earliest period. Methods The clinical data of 171 elderly with DTIH was analyzed retrospectively. Results Primary coma was 125 cases for 73. 1% . Consciousness disorders transient better and worse was 49 cases for 28. 7% . Consciousness disorders progressive exacerbation was 109 cases for 63. 7% . The first head CT signs: normal was 9 cases, skull fractures was 15 cases, epidural hematoma was 9 cases, epidural hematoma with hedge contusion and laceration of brain was 4 cases, contusion and laceration of brain with suharachnoid hemorrhage was 83 cases for 48. 5% , epidural hematoma with contusion and laceration of brain was 11 cases and subarachnoid hemorrhage was 64 cases

  6. 外伤性迟发性颅内血肿的危险因素及其预测价值%Risk factors and predictive value of delayed traumatic intracranial hematoma



    目的:探讨外伤性迟发性颅内血肿(DTICH)的危险因素及其预测价值。方法:收集95例急性颅脑外伤患者的临床资料,分为迟发血肿组(62例)和无血肿复发对照组(33例)。比较两组临床资料,采用Logistic回归模型分析DTICH的危险因素,并以受试者工作特征曲线(ROC)评价相关危险因素的预测价值。结果:与无血肿复发组比较,迟发血肿组患者年龄[(46.72±6.45)岁比(52.18±7.13)岁]明显较大,血肿量[(51.21±11.25) ml比(56.89±12.37) ml]、空腹血糖[(8.13±1.55) mmol/L比(10.62±1.73) mmol/L]、活化部分凝血活酶时间[APTT ,(25.27±6.19) s比(27.35±7.45) s]、凝血酶时间[TT ,(17.53±5.14) s比(21.26±7.31) s ]均明显增加,基底池受压(24.2%比46.8%)、脑挫伤(42.4%比69.4%)、去除骨瓣(45.5%比67.7%)、Babinski征阳性(39.4%比61.3%) 等比例均明显增大, GCS评分[(9.46±3.29)分比(7.63±3.07)分]、收缩压[(146.57±18.23) m m H g比(132.18±17.18) m m H g ]、手术时机[(12.74±4.39) h比(5.47±2.16) h ]等均明显减少, P<0.05或<0.01;Logistic回归分析显示,凝血功能(APTT、TT)、颅骨骨折和手术时机为术后迟发血肿的危险因素(OR=4.076~5.430, P<0.05或<0.01),其 ROC曲线下面积分别为0.826、0.748和0.661。结论:凝血功能、颅骨骨折及手术时机是颅脑外伤患者术后迟发性颅脑血肿的危险因素,有较大预测价值。%Objective:To explore the risk factors its predictive value of delayed traumatic intracranial hematoma (DTICH) . Methods:Clinical data of 95 patients with acute craniocerebral trauma were collected .All patients were divided into DTICH group (n=62) and no recurrent hematoma control group (n=33) .Clinical data were compared between two groups ,Lo‐gistic regression model was used to analyze risk factors

  7. Mozart's chronic subdural hematoma.

    Drake, M E


    No commemoration of the bicentennial of Mozart's death would be complete without some consideration of that premature yet predictable demise. Mozart's premonitions of death are well known and apparently played a role in the composition of the K.626 Requiem and perhaps other works. His death has traditionally been ascribed to infectious causes, chiefly rheumatic fever or post-streptococcal glomerulonephritis, exacerbated by intemperance and chronic penury. Pathology has been difficult because of his supposed burial in a pauper's grave, the location and contents of which were later supposedly lost. Mozart's burial place in St. Mark's Cemetery in Vienna was known and, in the parlance of the day, "reorganized" a decade later, as the occupants of plots were disinterred to make room for the more recently decreased. A skull believed to the Mozart's was saved by the successor of the gravedigger who had supervised Mozart's burial, and then passed into the collections of the anatomist Josef Hyrtl, the municipality of Salzburg, and the Mozarteum museum (Salzburg). Forensic reconstruction of soft tissues related to this skull reveals substantial concordance with Mozart's portraits. The skull suggests premature closure of the metopic suture, which has been suggested on the basis of his physiognomy. A left temporal fracture and concomitant erosions raise the question of chronic subdural hematoma, which would be consistent with several falls in 1789 and 1790 and could have caused the weakness, headaches, and fainting he experienced in 1790 and 1791. Aggressive bloodletting to treat suspected rheumatic fever could have decompensated such a lesion to produce his death on December 5, 1791.

  8. [Targeted small craniotomy and evacuation for subscute subdural hematomas: technical report of two cases].

    Tanaka, Masaki; Kurita, Hiroki; Shiokawa, Yoshiaki


    The etiology and proper treatment of symptomatic subacute subdural hematomas remains to be elucidated. We describe two cases of this entity successfully treated with small craniotomy and evacuation. Both patients initially treated conservatively for traumatic thin subdural hematomas because of poor medical condition and mild neurological symptoms, but suffered abrupt neurological deterioration between 2 and 3 weeks after the admission. CT scan showed decreased density of hematomas with minimal increase in volume, and significant swelling of ipsilateral cerebral hemisphere. Urgent two-burr-hole small craniotomy was effective for evacuation of partially organized hematoma. During surgery, definite hematoma membrane was not confirmed. Postoperatively, brain swelling rapidly disappeared and both patients discharged ambulatory without neurological deficit. The present cases are a reminder of this peculiar type of hematoma in patients with delayed neurological deterioration after nonsurgical management of acute subdural hematoma. The rationale for use of small craniotomy is discussed in terms of current understanding of pathogenetic mechanism for this unusual condition.

  9. Pulsative hematoma: A penile fracture complication

    Nale Đorđe


    Full Text Available Background. Fracture of the penis is a direct blunt trauma of the erect or semi-erect penis. It can be treated by conservative or surgical means. Retrospective analyses of conservative penile fracture treatment reveal frequent immediate and later complications. Case report. We presented a 41- year-old patient with pulsative hematoma caused by an unusual fracture of the penis. Fracture had appeared 40 days before the admittance during a sexual intercourse. The patient was treated surgically. Conclusion. Pulsative hematoma (pulsative diverticulum is a very rare, early complication of a conservatively treated penile fracture. Surgical treatment has an advantage over surgical one, which was confirmed by our case report.

  10. Subcorneal hematomas in excessive video game play.

    Lennox, Maria; Rizzo, Jason; Lennox, Luke; Rothman, Ilene


    We report a case of subcorneal hematomas caused by excessive video game play in a 19-year-old man. The hematomas occurred in a setting of thrombocytopenia secondary to induction chemotherapy for acute myeloid leukemia. It was concluded that thrombocytopenia subsequent to prior friction from heavy use of a video game controller allowed for traumatic subcorneal hemorrhage of the hands. Using our case as a springboard, we summarize other reports with video game associated pathologies in the medical literature. Overall, cognizance of the popularity of video games and related pathologies can be an asset for dermatologists who evaluate pediatric patients.

  11. Construction delays causing risks on time and cost - a critical review

    Chidambaram Ramanathan


    Full Text Available There is an increase in the number of construction projects experiencing extensive delays leading to exceeding initial time and cost budget.  This paper reviews 41 studies around the world which surveyed the delay factors and classified them into Groups.  The main purpose of this paper is to review literature, each of which have categorized the causes that are responsible for time delays and cost overrun in projects. The collected list has 113 causes for delays categorized in to 18 different groups.  Most of the researches have analysed the responses from the Questionnaire survey.    The collected data are used to rank the problem.  The data are further used to investigate and analyse Important Index, Frequency Index, Severity Index, Relative Important Index, Relative Importance Weight, Weighted Average, Mean, Standard Deviation and Variance.  The collective comparison has revealed that the ranking given by all the researchers is not the same.  Further each and every study has different rank ratings for the different group of the delays.  This review paper attempts to provide an updated compilation of the earlier studies on ranking of the delay causers, which are never similar and constant for universal projects.  It is concluded that a separate study is required for identifying the factors causing delay for projects operated in Sabah, East Malaysia.

  12. Postdural puncture subdural hematoma or postdural puncture headache?: two cases report

    Kale, Aydemir; Emmez, Hakan; Pişkin, Özcan; Durdağ, Emre


    Spinal anesthesia is widely used for many obstetric, gynecological, orthopedic, and urological operations. Subdural hematomas may occur after trauma and are associated with high morbidity and mortality rates. Postdural puncture headache (PDPH) is a benign condition and the most frequent complication of spinal anesthesia. The high rate of headache after spinal anesthesia may mask or delay the diagnosis of subdural hematoma. The true incidence of postdural puncture subdural hematoma (PDPSH) is ...

  13. Traumatic epidural hematoma in children.

    Rocchi, Giovanni; Caroli, Emanuela; Raco, Antonino; Salvati, Maurizio; Delfini, Roberto


    The purpose of this study was to investigate the characteristics of childhood acute epidural hematoma and to report our experience in recent years. A series of 35 patients below the age of 15 years treated for acute epidural hematoma at our institution between June 1991 and December 2000 was analyzed in detail. Pediatric epidural hematoma presents both age-related and atypical features when compared with epidural hematoma in adults. In selected cases, prompt surgical evacuation of the hematoma results in an excellent outcome. Outcomes seem to be directly related to the patient's preoperative neurologic status and the presence of associated intracranial lesions.

  14. Spontaneous ligamentum flavum hematoma in the lumbar spine

    Keynan, Ory; Ashkenazi, Ely; Floman, Yizhar [Israel Spine Center at Assuta Hospital, Tel Aviv (Israel); Smorgick, Yossi [Israel Spine Center at Assuta Hospital, Tel Aviv (Israel); Assaf Harofeh Medical Center, Department of Orthopedic Surgery, Zerifin (Israel); Schwartz, Allan J. [Hadassah University Hospital, Department of Radiology, Section of Neuroradiology, Jerusalem (Israel)


    Lumbar or sacral nerve root compression is most commonly caused by intervertebral disc degeneration and/or herniation. Less frequently, other extradural causes may be implicated, such as infection, neoplasm, epidural hematoma, or ligamentum flavum pathology. We present the case of a patient with spontaneous ligamentum flavum hematoma compressing the L4 nerve root, without antecedent trauma. Although exceedingly rare, the diagnosis of ligamentum flavum pathology in general, and that of ligamentum flavum hematoma in particular, should be considered on those rare occasions when the etiology of lumbar or sacral nerve root compressions appears enigmatic on radiological studies. Usually surgical treatment produces excellent clinical outcome. (orig.)

  15. Risk Matrix for Delay Causes in Construction Projects in Saudi Arabia

    Ibrahim Mahamid


    Full Text Available Time performance of a project is usually a particularly important consideration for the construction parties. Often, the most troublesome construction disputes involve delay and failure to complete the work in the specified time frame. Many variables have an impact upon construction delay in Saudi Arabia. This study aims at identifying the risk matrix for delay causes in construction projects in Saudi Arabia from consultants’ viewpoint. A questionnaire survey was undertaken of 51 consultants working on construction projects in the Northern Province of Saudi Arabia. Thirty five delay causes were identified through literature review. The study concluded that the top delay causes in construction projects in Saudi Arabia from consultants’ perspective are: bid award for lowest price, changes in material types and specifications during construction, contract management, duration of contract period, fluctuation of prices of materials, frequent changes in design, improper planning, inflationary pressure, lack of adequate manpower, long period between design and time of implementation, payments delay, poor labor productivity and rework.

  16. Conservative management of a cervical ligamentum flavum hematoma: Case report

    Hanna Algattas


    Conclusion: Spontaneous epidural hematoma arising from ligamentum flavum is a rare cause of spinal cord compression. Previous reports have described success with surgical decompression. However, initial observation and conservative management may be successful as illustrated in this case.

  17. A case of acute spinal intradural hematoma due to spinal anesthesia

    Josu M Avecillas-Chasn; Jordi A Matias-Guiu; Gustavo Gomez; Javier Saceda-Gutierrez


    Spinal intradural hematoma is a rare complication of diagnostic lumbar puncture or spinal anesthesia. This complication could be overlooked with devastating neurological consequences due to a delay in diagnosis. Here, we reported a case of a patient with a lumbar spinal intradural hematoma as a result of a difficult spinal anesthesia.

  18. Systemic 5-fluorouracil treatment causes a syndrome of delayed myelin destruction in the central nervous system

    Han Ruolan


    Full Text Available Abstract Background Cancer treatment with a variety of chemotherapeutic agents often is associated with delayed adverse neurological consequences. Despite their clinical importance, almost nothing is known about the basis for such effects. It is not even known whether the occurrence of delayed adverse effects requires exposure to multiple chemotherapeutic agents, the presence of both chemotherapeutic agents and the body's own response to cancer, prolonged damage to the blood-brain barrier, inflammation or other such changes. Nor are there any animal models that could enable the study of this important problem. Results We found that clinically relevant concentrations of 5-fluorouracil (5-FU; a widely used chemotherapeutic agent were toxic for both central nervous system (CNS progenitor cells and non-dividing oligodendrocytes in vitro and in vivo. Short-term systemic administration of 5-FU caused both acute CNS damage and a syndrome of progressively worsening delayed damage to myelinated tracts of the CNS associated with altered transcriptional regulation in oligodendrocytes and extensive myelin pathology. Functional analysis also provided the first demonstration of delayed effects of chemotherapy on the latency of impulse conduction in the auditory system, offering the possibility of non-invasive analysis of myelin damage associated with cancer treatment. Conclusions Our studies demonstrate that systemic treatment with a single chemotherapeutic agent, 5-FU, is sufficient to cause a syndrome of delayed CNS damage and provide the first animal model of delayed damage to white-matter tracts of individuals treated with systemic chemotherapy. Unlike that caused by local irradiation, the degeneration caused by 5-FU treatment did not correlate with either chronic inflammation or extensive vascular damage and appears to represent a new class of delayed degenerative damage in the CNS.

  19. Bilateral chronic subdural hematoma

    Andersen-Ranberg, Nina Christine; Poulsen, Frantz Rom; Bergholt, Bo


    OBJECTIVE Bilateral chronic subdural hematoma (bCSDH) is a common neurosurgical condition frequently associated with the need for retreatment. The reason for the high rate of retreatment has not been thoroughly investigated. Thus, the authors focused on determining which independent predictors...... are associated with the retreatment of bCSDH with a focus on surgical laterality. METHODS In a national database of CSDHs (Danish Chronic Subdural Hematoma Study) the authors retrospectively identified all bCSDHs treated in the 4 Danish neurosurgical departments over the 3-year period from 2010 to 2012....... Univariate and multivariate analyses were performed to determine the relationship between retreatment of bCSDH and clinical, radiological, and surgical variables. RESULTS Two hundred ninety-one patients with bCSDH were identified, and 264 of them underwent unilateral (136 patients) or bilateral (128 patients...

  20. First report of hepatic hematoma after presumed Bothrops envenomation

    Fernanda Cristina Cunha


    Full Text Available ABSTRACTIn Latin America, Bothrops envenomation is responsible for the majority of accidents caused by venomous snakes. Patients usually present local edema, bleeding and coagulopathy. Visceral hemorrhage is extremely rare and considered a challenge for diagnosis and management. We report the first case of hepatic hematoma owing to the bothropic envenomation in a 66-year-old man who was bitten in the left leg. He presented local edema, coagulopathy, and acute kidney injury. Radiological findings suggested hepatic hematoma, with a volume of almost 3 liters. The hepatic hematoma was gradually absorbed without the need for surgical intervention with complete resolution in 8 months.

  1. Endoscopic evacuation of cerebellar hematoma in a term newborn.

    Tanriverdi, Sema Rala; Turhan, Tuncer; Uygur, Ozgun; Koroglu, Ozge Altun; Yalaz, Mehmet; Kultursay, Nilgun


    Intracerebellar hemorrhage is very rare in term infants and only severe cases with massive intracranial hemorrhage, posthemorrhagic hydrocephalus and clinical deterioration due to increased intracranial pressure require neurosurgical evacuation. In recent adult studies endoscopic hematoma evacuation has been shown as a rapid, effective, and safe technique. A term newborn hospitalized for meconium aspiration syndrome showed hypertonia, jitteriness and abnormal amplitude integrated electroencephalogram findings. He was diagnosed with cerebellar hematoma which caused hydrocephalus by cranial magnetic resonance imaging (MRI). The hematoma was successfully evacuated neuroendoscopically as the first case in literature to our knowledge. Neurologic, a-EEG and MRI findings resolved.

  2. Importance of cell damage causing growth delay for high pressure inactivation of Saccharomyces cerevisiae

    Nanba, Masaru; Nomura, Kazuki; Nasuhara, Yusuke; Hayashi, Manabu; Kido, Miyuki; Hayashi, Mayumi; Iguchi, Akinori; Shigematsu, Toru; Hirayama, Masao; Ueno, Shigeaki; Fujii, Tomoyuki


    A high pressure (HP) tolerant (barotolerant) mutant a2568D8 and a variably barotolerant mutant a1210H12 were generated from Saccharomyces cerevisiae using ultra-violet mutagenesis. The two mutants, a barosensitive mutant a924E1 and the wild-type strain, were pressurized (225 MPa), and pressure inactivation behavior was analyzed. In the wild-type strain, a proportion of the growth-delayed cells were detected after exposure to HP. In a924E1, the proportion of growth-delayed cells significantly decreased compared with the wild-type. In a2568D8, the proportion of growth-delayed cells increased and the proportion of inactivated cells decreased compared with the wild-type. In a1210H12, the growth-delayed cells could not be detected within 120 s of exposure to HP. The proportion of growth-delayed cells, which incurred the damage, would affect the survival ratio by HP. These results suggested that cellular changes in barotolerance caused by mutations are remarkably affected by the ability to recover from cellular damage, which results in a growth delay.

  3. Pulmonary hypoplasia on preterm infant associated with diffuse chorioamniotic hemosiderosis caused by intrauterine hemorrhage due to massive subchorial hematoma: report of a neonatal autopsy case.

    Yamada, Sohsuke; Marutani, Takamitsu; Hisaoka, Masanori; Tasaki, Takashi; Nabeshima, Atsunori; Shiraishi, Mika; Sasaguri, Yasuyuki


    A male infant born prematurely at 31 weeks of gestation weighed 789 g and had mildly brown-colored oral/tracheal aspirates at delivery. The amniotic fluid was also discolored, and its index was below 5. The patient died of hypoxemic respiratory and cardiac failure 2 hours after birth. The maternal profiles showed placenta previa and intrauterine growth restriction (IUGR) at 22 weeks of gestation, and revealed recurrent episodes of antenatal and substantial vaginal bleeding and oligohydramnios, indicating chronic abruption-oligohydramnios sequence. The thickened placenta, weighing 275 g, grossly displayed unevenness and diffuse opacity with green to brown discoloration in the chorioamniotic surface, and revealed chronic massive subchorial hematomas (Breus' mole) with old peripheral blood clot, circumvallation, and infarction. Microscopically, diffuse Berlin-blue staining-positive hemosiderin deposits were readily encountered in the chorioamniotic layers of the chorionic plate, consistent with diffuse chorioamniotic hemosiderosis (DCH) due to Breus' mole, accompanied by diffuse amniotic necrosis. At autopsy, an external examination showed several surface anomalies and marked pulmonary hypoplasia, 0.006 (less 0.012) of lung:body weight ratio. Since Breus' mole has a close relationship with intrauterine hemorrhage, resulting in DCH, IUGR, and/or pulmonary hypoplasia of the newborn, the present features might be typical.

  4. 术中窦汇区迟发性硬膜外血肿致急性脑膨出的治疗%The treatment of malignant encephalocele caused by acute epidural hematoma around confluens sinuum in operation

    徐勤义; 董吉荣; 蔡学见; 王玉海; 刘斌; 时忠华; 金东; 冯毅; 何建青


    目的 探讨颅脑损伤患者术中窦汇区迟发性硬膜外血肿所致急性脑膨出的临床特点及诊治经验.方法 回顾我院2007年5月至2009年5月收治的10例颅脑损伤患者,均为开颅术中发现急性脑膨出,术中复查头颅CT明确窦汇区迟发性硬膜外血肿的诊断后,取顶枕部"U"形切口,做窦汇区骨瓣成形加自体筋膜加压修补术.结果 根据GOS评分判断愈后:中残2例,重残1例,植物生存1例,死亡6例.结论 窦汇区硬膜外血肿做跨窦骨瓣成形术,骨瓣足够大,出血点完全暴露,再用自体筋膜加压修补术彻底止血,是理想的手术方法 .早期诊断及正确的手术方法 是救治成功的关键.%Objective To investigate the characteristics of malignant encephalocele caused by acute epidural hematoma around confluens sinuum during operation. Method Ten patients admitted from May 2007 to May 2009 in our hospital was reviewed. All cases presented malignant encephalocele during operation and acute epidural hematoma around confluens sinuum after CT scan. We made craniotomy with a bone flap under U - shape incision and self - fascia was used to patch compressively for hemostasis. Results According to the GOS score 2 cases had satisfactory outcome with moderately disability, 1 severe disability, 1 vegetative state, 6 dead.Conclusion Patients with acute epidural hematoma around confluens sinuum might be made craniotomy in a big enough bone - flap so that bleeding point exposed wholly and stopped bleeding by self - fascia patch repair compressively. Early diagnosis and correct operative technique might be key point for successful remedy.

  5. 创伤性侧裂区血肿术后再发血肿50例临床分析%Clinical analysis of rehematoma after operation of traumatic hematoma of peri-sylvian area in 50 cases

    曾昭明; 郭予大; 邵强; 吴波; 冯志铁


    Objective To study the causes of rehematomas after operations of traumatic hematomas of perisylvian area.Methods The causes of 50 cases of rehematoma after operation were analyzed retrospectively.Results The big hematoma in primary contusion and laceration of brain happened in 19 cases(38%),delayed epidural hematoma in opposite side in 15 cases(30%),increased intracerebral hematoma in 9 cases(18%),epidural hematoma in primary area in 3 cases(6%),subdural hematoma caused by postoperative lumbaropuncture in 3 cases(6%),hematoma in encephalonecrosis in 1 case(2%).Conclusion Insuitable operation and hemostasis are the main causes of rehemorrhage,and fracture line in the opposite side,and thrombocytopenia are high risk factors of rehematoma.%目的 探讨创伤性侧裂区血肿术后再发血肿的原因,提高抢救成功率.方法 回顾性分析50例创伤性侧裂区血肿术后再发血肿的情况,分析其原因.结果 在原脑挫裂伤部位出现大块血肿19例(38%),出现对侧迟发性硬膜外血肿15例(30%),脑内血肿扩大9例(18%),原术区硬膜外血肿3例(6%),术后腰椎穿刺致硬膜下血肿3例(6%),脑组织坏死区血肿1例(2%).结论 手术操作和止血不利是再发血肿的主要原因,首次手术对侧存在骨折线和患者血小板减少是再出血的高危因素.

  6. An Induced Hematoma in Caudoputamen Nuclei in Rats Causes Central Pain when the Thalamus is also Implicated and the Central Sensitization is Reversed with Gabapentin

    P. P. Lema


    Full Text Available Problem statement: The objective of this study was to evaluate pain sensitisation in rats following the induction of an intracerebral hemorrhage by injecting a collagenase solution in the caudoputamen nucleus of the right basal ganglia and to evaluate gabapentin as an analgesic for central pain. Approach: Thirty male Sprague-Dawley rats weighing between 175-300 g were used. In a first experiment, 3 groups of 6 animals were used to evaluate pain threshold using the Hargreaves test (thermal sensitivity only. Following 3 days of behavioral testing (baseline values, animals in each group were injected intracerebrally either with 0.5, 1 or 2 μL of a collagenase solution (0.5 U 2 μL-1 Type VII collagenase inducing a hematoma in the right caudoputamen nucleus and/or thalamus. They were then tested for the next 9 consecutive days. In a second experiment, gabapentin was evaluated for the reversal of thermal hyperalgesia and mechanical allodynia (using von Frey filaments following the intracerebral injection of 3 μL of the collagenase solution. Results: No pain-related behavioral changes were observed following injections with 0.5 and 1 μL of the collagenase solution. However with 2 μL, reaction times were significantly faster on days 3-7 in the right and left hind paws compared to baseline values. The lesion was localized only in the caudoputamen nucleus for animals receiving 0.5 and 1 μL of collagenase whereas lesions extended in the ipsilateral thalamic nuclei (lateral-dorsal and lateral-posterior nuclei for animals receiving 2 μL of collagenase. Gabapentin reversed mechanical allodynia and thermal hyperalgesia in animals with caudoputamen and thalamic lesions. Conclusion: These preliminary results suggest that central pain was induced in rats with a collagenase-induced intracerebral hemorrhage localized in the thalamus and that mechanical allodynia and thermal hyperalgesia were reduced with gabapentin treatment.

  7. A delayed frontorbital abscess caused by a penetrating nonmissile foreign body a bamboo stick

    Liu Wen-ke


    Full Text Available We report an interesting case of delayed frontal abscess caused by a penetrating nonmissile foreign body, a bamboo stick in a 1.5-year-old male child. A parietal craniotomy was performed, and the brain abscess was resected along with the foreign body without any damage to the surrounding brain tissue. He also received the appropriate antibiotics. The child made a good recovery.

  8. Patient delay is the main cause of treatment delay in acute limb ischemia: an investigation of pre- and in-hospital time delay

    Londero, Louise Skovgaard; Nørgaard, Birgitte; Houlind, Kim Christian


    Abstract BACKGROUND: The prognosis of acute limb ischemia is severe, with amputation rates of up to 25% and in-hospital mortality of 9-15%. Delay in treatment increases the risk of major amputation and may be present at different stages, including patient delay, doctors´ delay and waiting time...... in the emergency department. It is important to identify existing problems in order to reduce time delay. The aim of this study was to collect data for patients with acute limb ischemia and to evaluate the time delay between the different events from onset of symptoms to specialist evaluation and further treatment...... with focus on pre-hospital and in-hospital time delays. METHODS: We conducted a prospective cross-sectional cohort study including all patients suspected with acute limb ischemia who were admitted to the emergency department of a community hospital in a six months period. Temporal delay in the different...

  9. Muscle hematoma: A critically important complication of alcoholic liver cirrhosis

    Chiyo Sugiyama; Akifumi Akai; Noriyoshi Yamakita; Tsuneko Ikeda; Keigo Yasuda


    An iliopsoas hematoma can occur either spontaneously or secondary to trauma or bleeding tendency due to hemophilia and anticoagulant therapy. Although liver cirrhosis is commonly associated with coagulopathy, iliopsoas hematoma is very rare. We herein, present a case of bilateral iliopsoas hematoma in a patient with alcoholic cirrhosis, and review the literature on muscle hematoma associated with cirrhosis. A 56-year-old man with alcoholic cirrhosis was admitted in a state of shock with anemia. The cause of anemia could not be detected, and the patient was treated conservatively. The site of bleeding was not detected with either gastroduodenal endoscopy or upper abdominal computed tomography, the latter of which did not include the iliopsoas muscle. He died on the 10th day of admission and bilateral iliopsoas hematomas were found on autopsy. An iron stain was positive in the iliopsoas muscle. Eight cases of muscle hematoma associated with cirrhosis, including the present case, were found in a review of the literature. Four of these cases involved the rectus abdominis muscle, 3 involved the iliopsoas muscle and 1 involved combined muscles. Alcoholic cirrhosis accounted for 75% of the cases. One case (12.5%) was associated with virus-related cirrhosis, and another with combined virus-and alcohol-related cirrhosis. The mortality rate was 75% despite early diagnosis and low risk scores for cirrhosis. Muscle hematoma in patients with cirrhosis isclosely related to alcoholism, and the mortality rate of the condition is extremely high. In conclusion, muscle hematoma should be recognized as an important complication of cirrhosis.

  10. MRI findings in spinal subdural and epidural hematomas

    Braun, Petra [Department of Radiology, Hospital La Plana, Ctra. De Vila-real a Borriana km. 0.5, 12540 Vila-real (Castello) (Spain)], E-mail:; Kazmi, Khuram [Department of Radiology, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033 (United States); Nogues-Melendez, Pablo; Mas-Estelles, Fernando; Aparici-Robles, Fernando [Department of Radiology, La Fe Hospital, Avenida Campanar, 21, 46009 Valencia (Spain)


    Background: Spinal hematomas are rare entities that can be the cause of an acute spinal cord compression syndrome. Therefore, an early diagnosis is of great importance. Patients and Methods: From 2001 to 2005 seven patients with intense back pain and/or acute progressive neurological deficit were studied via 1.5 T MRI (in axial and sagittal T1- and T2-weighted sequences). Follow-up MRI was obtained in six patients. Results: Four patients showed the MRI features of a hyperacute spinal hematoma (two spinal subdural hematoma [SSH] and two spinal epidural hematoma [SEH]), isointense to the spinal cord on T1- and hyperintense on T2-weighted sequences. One patient had an early subacute SEH manifest as heterogeneous signal intensity with areas of high signal intensity on T1- and T2-weighted images. Another patient had a late subacute SSH with high signal intensity on T1- and T2-weighted sequences. The final patient had a SEH in the late chronic phase being hypointense on T1- and T2-weighted sequences. Discussion: MRI is valuable in diagnosing the presence, location and extent of spinal hematomas. Hyperacute spinal hematoma and the differentiation between SSH and SEH are particular diagnostic challenges. In addition, MRI is an important tool in the follow-up in patients with conservative treatment.

  11. Spontaneous intraorbital hematoma: case report

    Vinodan Paramanathan


    Full Text Available Vinodan Paramanathan, Ardalan ZolnourianQueen's Hospital NHS Foundation Trust, Burton on Trent, Staffordshire DE13 0RB, UKAbstract: Spontaneous intraorbital hematoma is an uncommon clinical entity seen in ophthalmology practice. It is poorly represented in the literature. Current evidence attributes it to orbital trauma, neoplasm, vascular malformations, acute sinusitis, and systemic abnormalities. A 65-year-old female presented with spontaneous intraorbital hematoma manifesting as severe ocular pains, eyelid edema, proptosis, and diplopia, without a history of trauma. Computer tomography demonstrated a fairly well defined extraconal lesion with opacification of the paranasal sinuses. The principal differential based on all findings was that of a spreading sinus infection and an extraconal tumor. An unprecedented finding of a spontaneous orbital hematoma was discovered when the patient was taken to theater. We discuss the rarity of this condition and its management.Keywords: hemorrhage, ophthalmology, spontaneous, intra-orbital, hematoma

  12. Rectal colonic mural hematoma following enema for constipation while on therapeutic anticoagulation

    Rentea, Rebecca M.; Fehring, Charles H.


    Causes of colonic and recto-sigmoid hematomas are multifactorial. Patients can present with a combination of dropping hemoglobin, bowel obstruction and perforation. Computed tomography imaging can provide clues to a diagnosis of intramural hematoma. We present a case of rectal hematoma and a review of current management literature. A 72-year-old male on therapeutic anticoagulation for a pulmonary embolism, was administered an enema resulting in severe abdominal pain unresponsive to blood transfusion. A sigmoid colectomy with end colostomy was performed. Although rare, colonic and recto-sigmoid hematomas should be considered as a possible diagnosis for adults with abdominal pain on anticoagulant therapy. PMID:28108634

  13. Unrecognized catatonia as a cause for delayed weaning in Intensive Care Unit

    Rupesh Gupta


    Full Text Available The cause of altered sensorium in critical care settings includes metabolic derangements, drug and toxin overdose, central nervous system infections, neurodegenerative disorders, vascular events, hypo-perfusion states, and septic encephalopathy. Here, we present a case of an elderly woman who presented to us with altered sensorium with respiratory failure requiring mechanical ventilation. Her metabolic parameters, imaging, and cerebrospinal fluid study were all normal despite that she continued to remain in altered sensorium and had an unrecognized behavioral state that delayed her weaning.

  14. Idiopathic Retroperitoneal Hematoma

    Tomoyuki Abe


    Full Text Available A 34-year-old female presented with sudden onset of severe abdominal pain in a flank distribution. A large mass was palpable in the right upper quadrant on physical examination. Abdominal contrast-enhanced computed tomography showed a well-defined, right-sided, retroperitoneal cystic lesion located between the abdominal aorta and the inferior vena cava (IVC. The tumor size was 55 × 58 mm, and it compressed the gallbladder and the duodenum. Upper gastrointestinal radiography revealed a stricture of the second portion of the duodenum by the tumor. T2-weighted magnetic resonance imaging showed that the whole part was hyperintense with hypointense rims, but the inner was partially hypointense. Based on the radiological findings, the preoperative differential diagnosis included retroperitoneal teratoma, Schwannoma, abscess, and primary retroperitoneal tumor. On laparotomy, the tumor was located in the right retroperitoneal cavity. Kocher maneuver and medial visceral rotation, which consists of medial reflection of the upper part of right colon and duodenum by incising their lateral peritoneal attachments, were performed. Although a slight adhesion to the IVC was detected, the tumor was removed safely. Thin-section histopathology examination detected neither tumor tissues nor any tissues such as adrenal gland, ovarian tissue, or endometrial implants. The final pathological diagnosis was idiopathic retroperitoneal hematoma; the origin of the bleeding was unclear. The patient was discharged without any complication 5 days after the operation.

  15. Recurrence of chronic subdural hematoma after trepanation and drainage

    张建平; 许文辉; 朱立平; 张翔


    Objective: To sum up the causes of recurrence of chronic subdural hematoma (CSDH) from failure of trepanation and drainage and explore its prevention and treatment.Methods: From October 1988 to June 2002 a total of 358 patients with CSDH were treated with trepanation and drainage in our hospital. Among them 15 patients had recurrence of CSDH after operation. The data of the 15 patients were reviewed retrospectively.Results: Of the 15 patients, 13 were cured by retrepanation and redrainage, one cured by removal of hematoma by craniotomy with bone flap, and one, a 1-year old child, gave up reoperation due to severe encephalatrophy. Conclusions: Most CSDHs which recur after trepanation and drainage can be cured by retrepanation and redrainage. For the patients with repeated recurrence of CSDH removal of hematoma capsule can be considered. The causes of recurrence of CSDH are related to disease course, the thickness of hematoma capsule, the severity of encephalatraphy and whether the hematoma cavity is drained or irrigated completely, and operation methods.

  16. Subcapsular renal hematoma after ureterorenoscopy: An unknown complication of a known procedure

    Bansal Ujjwal


    Full Text Available Renal subcapsular hematoma is not an uncommon complication after extracorporeal short wave lithotripsy, trauma, renal angiographic procedures and spontaneously in patients of malignancy and in patients on anticoagulation. We present a patient who developed renal subcapsular hematoma after ureterorenoscopy, which has not been mentioned in literature ever. Clinical spectrum varies from spontaneous resolution through acute renal failure to Page kidney. Page kidney is the external compression of a kidney usually caused by a subcapsular hematoma associated with high blood pressure and occasional renal failure. It is named after Dr. Irvin Page who first demonstrated in 1939 that wrapping cellophane tightly around animal kidneys could cause hypertension. Various management options are mentioned in literature and depend upon the severity of hematoma. Percutaneous drainage is a successful option for the management of subcapsular hematoma in hemodynamic stable patients.

  17. Bannayan-Riley-Ruvalcaba syndrome: a cause of extreme macrocephaly and neurodevelopmental delay.

    Lynch, N E


    BACKGROUND: Bannayan-Riley-Ruvalcaba syndrome (BRRS) is an autosomal dominant condition characterised by macrocephaly, developmental delay and subtle cutaneous features. BRRS results from mutations in the PTEN gene. In adults, PTEN mutations cause Cowden syndrome where, in addition to the macrocephaly, there is a higher risk of tumour development. Diagnosis of BRRS is often delayed as presentation can be variable, even within families. AIMS: To identify characteristics of this condition which might facilitate early diagnosis. Prompt diagnosis not only avoids unnecessary investigations in the child but potentially identifies heterozygote parents who are at risk of tumour development. METHODS AND RESULTS: Six children with a PTEN mutation were identified. All had extreme macrocephaly. Four parents and a male sibling were found to have a PTEN mutation on subsequent testing. Affected parents had extreme macrocephaly and a history of thyroid adenoma, or breast or skin lesions. All six children had presented to medical attention before the age of 2.5 years (3\\/6 were investigated as neonates), but the median age at diagnosis was 5 years. Four of the children had multiple investigations prior to identification of a PTEN mutation. CONCLUSION: BRRS should be considered in children with extreme macrocephaly as it is the most consistent clinical feature seen, particularly where there is a family history of macrocephaly.

  18. Donepezil: A cause of inadequate muscle relaxation and delayed neuromuscular recovery

    Alka Bhardwaj


    Full Text Available A 74-year-old female with diabetes mellitus type II and Alzheimer′s disease, taking donepezil for 4 months was operated for right modified radical mastectomy under general anesthesia. During the procedure a higher dose of non-depolarizing muscle relaxant was required than those recommended for her age yet the muscle relaxation was inadequate intra-operatively. Residual neuromuscular blockade persisted postoperatively, due to the cumulative effect of large doses of non-depolarizing muscle relaxant, needing post-operative ventilatory assistance. After ruling out other causes of resistance to non-depolarizing muscle relaxants, we concluded that acetylcholinesterase inhibitor donepezil was primarily responsible for inadequate muscle relaxation and delayed post-operative neuromuscular recovery.

  19. A Case of Delayed Myelopathy Caused by Atlantoaxial Subluxation without Fracture

    Ryo Takamatsu


    Full Text Available We report a case of delayed myelopathy caused by atlantoaxial subluxation without fracture. The patient was a 38-year-old male who became aware of weakness in extremities. The patient had a history of hitting his head severely while diving into a swimming pool at the age of 14 years old. At that time, cervical spine plain X-ray images showed no fracture, and the cervical pain disappeared after use of a collar for several weeks. At his first visit to our department, X-ray images showed an unstable atlantoaxial joint. After surgery, weakness of the extremities gradually improved. At 6 months after surgery, bone union was completed and the symptoms disappeared. This case shows that atlantoaxial ligament injuries are difficult to diagnose and may easily be missed. A high level of suspicion is important in such cases, since neurological compromise or deterioration may occur many years after the injury.

  20. De novo MEIS2 mutation causes syndromic developmental delay with persistent gastro-esophageal reflux.

    Fujita, Atsushi; Isidor, Bertrand; Piloquet, Hugues; Corre, Pierre; Okamoto, Nobuhiko; Nakashima, Mitsuko; Tsurusaki, Yoshinori; Saitsu, Hirotomo; Miyake, Noriko; Matsumoto, Naomichi


    MEIS2 aberrations are considered to be the cause of intellectual disability, cleft palate and cardiac septal defect, as MEIS2 copy number variation is often observed with these phenotypes. To our knowledge, only one nucleotide-level change-specifically, an in-frame MEIS2 deletion-has so far been reported. Here, we report a female patient with a de novo nonsense mutation (c.611C>G, p.Ser204*) in MEIS2. She showed severe intellectual disability, moderate motor/verbal developmental delay, cleft palate, cardiac septal defect, hypermetropia, severe feeding difficulties with gastro-esophageal reflux and constipation. By reviewing this patient and previous patients with MEIS2 point mutations, we found that feeding difficulty with gastro-esophageal reflux appears to be one of the core clinical features of MEIS2 haploinsufficiency, in addition to intellectual disability, cleft palate and cardiac septal defect.

  1. Bruising of the esophagus as a cause of gastrointestinal bleeding in a case of heatstroke Hematomas esofágicos como causa de hemorragia digestiva en un caso de golpe de calor

    A. J. Lucendo Villarín


    Full Text Available Alterations in blood clotting are a frequent complication of serious heatstroke and may result in gastrointestinal bleeding. We report the case of a 26-year-old man who was admitted to our hospital with symptoms of hyperthermia associated with encephalopathy and disseminated intravascular coagulation (DIC after prolonged exposure to sunlight. He presented hematemesis, after which he was diagnosed with having a bruising of the esophagus that took up the upper and lower thirds, there being no other lesions in the stomach or duodenum. After supportive treatment and following the resolution of the underlying pathology, the endoscopy-revealed injuries healed with a complete normalization of the esophageal mucosa. Esophageal submucosal bruising is an exceptional cause of hematemesis in serious heatstroke not previously described in the literature.Las alteraciones de la coagulación son una complicación frecuente en el golpe de calor grave, y pueden ser causa de hemorragia digestiva. Presentamos el caso de un varón de 26 años que fue admitido en nuestro hospital por un cuadro de hipertermia, asociado con encefalopatía y coagulación intravascular diseminada tras exposición solar prolongada. Presentó hematemesis por la que fue diagnosticado de múltiples hematomas esofágicos que ocupaban los tercios superior e inferior del órgano, en ausencia de otras lesiones en estómago y duodeno. Tras el tratamiento de soporte y la resolución de la patología subyacente, desaparecieron las lesiones endoscópicas, normalizándose la mucosa esofágica.

  2. Sickle cell disease with orbital infarction and epidural hematoma

    Naran, A.D.; Fontana, L. [Dept. of Diagnostic Radiology, New York Methodist Hospital, Brooklyn, NY (United States)


    Although bone infarction is a common feature in sickle cell disease, the involvement of the orbit is an unusual complication. Intracranial bleeding is another uncommon and serious complication. Few cases of orbital infarction alone have been reported. We report imaging findings (CT, bone scan, MRI) in a 16-year-old boy with sickle cell disease with orbital infarction and epidural hematoma. The precise cause of epidural hematoma is not well known, but it is probably related to vaso-occlusive episodes and the tearing of small vessels. (orig.)

  3. Spontaneous retropharynegeal hematoma: A case report and literature overview

    Ryu, Ji Hwa [Dept. of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)


    A spontaneous retropharyngeal hematoma is a rare condition with a difficult diagnostic. This disease may rapidly progress to an airway obstruction. The author reports about a case of a 56-year-old man with an acute onset of sore throat, dysphonia and dyspnea. A retropharyngeal high attenuated soft tissue density could be seen on the neck CT. A rapid improvement of the retropharyngeal abnormality was seen on the 3 days follow-up MR imaging. Signal changes caused by blood products which were visible on the MRI images suggested the diagnosis of retropharyngeal hematoma. The patient was conservatively managed.

  4. Retroperitoneal hematoma after manual reduction of indirect inguinal hernia.

    Xu, Xiequn; Hong, Tao; Li, Binglu; Liu, Wei; Zheng, Chaoji; He, Xiaodong


    This report presents the case of a 59-year-old man with sudden severe pain in the right lower abdomen after manually reducing the right indirect inguinal hernia who had bilateral indirect inguinal hernia for 5 years. A subsequent contrast computed tomography scan with contrast of the abdomen and pelvis revealed a significant extensive retroperitoneal hematoma at the abdomen and pelvis of the right side. There was contrast leaked out, which was suspected from inferior epigastric artery. He underwent successful laparotomy. The bleeding ruptured inferior epigastric artery at the interior side of the deep inguinal ring was found, the deep inguinal ring was avulsed, ligature of the inferior epigastric artery and removal of the retroperitoneal hematoma were done, and the patient was discharged from hospital on the seventh postoperative day. This is the first report in the literature on retroperitoneal hematoma caused by manual reduction of indirect inguinal hernia.

  5. Subserosal hematoma of the sigmoid colon after vaginal delivery

    Bacalbașa, N; Bohîlțea, RE; Dumitru, M; Turcan, N; Cîrstoiu, MM


    Postpartum hemorrhage is an obstetrical emergency that represents the leading cause of maternal mortality. Severe hemorrhagic complications that could appear postpartum are the abdomino-pelvic hematomas, which result from the rupture of the pelvic vessels. We reported a very rare case of puerperal retroperitoneal subserosal hematoma of sigmoid colon following vaginal delivery, which was successfully managed by conservative methods. As far as we know, there are only a few case reports of intramural hematoma of sigmoid colon in literature, having other etiologies than vaginal delivery trauma. The particularities of the case consisted in the association of hemangiomas and the low risk thrombophilia. Diagnosis was based on the clinical exam and the paraclinical founding. Laparotomy is generally considered the last choice, in life threatening cases with hemodynamic instability, compression signs, and presence of contrast leakage on noninvasive imaging methods, but avoiding colonic resection after dissection represented the true challenge of the case. PMID:28255383

  6. Medicolegal cases for spinal epidural hematoma and spinal epidural abscess.

    French, Keisha L; Daniels, Eldra W; Ahn, Uri M; Ahn, Nicholas U


    Spinal epidural hematoma and spinal epidural abscess are rare surgical emergencies resulting in significant neurologic deficits. Making the diagnosis for spinal epidural hematoma and spinal epidural abscess can be challenging; however, a delay in recognition and treatment can be devastating. The objective of this retrospective analysis study was to identify risk factors for an adverse outcome for the provider. The LexisNexis Academic legal search database was used to identify a total of 19 cases of spinal epidural hematoma and spinal epidural abscess filed against medical providers. Outcome data on trial verdicts, age, sex, initial site of injury, time to consultation, time to appropriate imaging studies, time to surgery, and whether a rectal examination was performed or not were recorded. The results demonstrated a significant association between time to surgery more than 48 hours and an unfavorable verdict for the provider. The degree of permanent neurologic impairment did not appear to affect the verdicts. Fifty-eight percent of the cases did not present with an initial deficit, including loss of bowel or bladder control. All medical professionals must maintain a high level of suspicion and act quickly. Physicians who are able to identify early clinical features, appropriately image, and treat within a 48 hour time frame have demonstrated a more favorable medicolegal outcome compared with their counterparts in filed lawsuits for spinal epidural hematoma and spinal epidural abscess cases.

  7. Sciatica due to pelvic hematoma: case report

    Kocaman Umit


    Full Text Available Sciatica is defined as pain in the sciatic nerve distribution. The most common reason of sciatica is radiculopathy due to lumbar disc hernia. Other causes can be congenital, acquired, infectious, neoplastic, or inflammatory. The piriformis syndrome is another cause. The pain starts in an insidious manner when the cause of sciatica is an extraspinal tumor. It is intermittent at first but a constant and progressive pain that does not decrease with position or rest gradually develops in all patients. The possibility of an intraabdominal or pelvic mass should always be considered and the relevant tests requested when the cause of the sciatica cannot be explained. We present an 83-year-old male who presented with non-traumatic and non-vascular lumbosacral plexopathy due to a large hematoma in the left adductor muscle following the use of warfarin sodium.

  8. Cerebral atrophy after acute traumatic subdural orextradural hematomas in adults

    冯海龙; 谭海斌; 黄光富; 廖晓灵


    @@ Cerebral atrophy is one of the serious sequelae ofsevere head injury. 1 Neuropathologicalinvestigation has revealed that cerebral atrophy iscaused by either diffuse axonal injury or cerebralhypoxia and ischemia. Secondary ipsilateral cerebralatrophy caused by acute subdural hematomas in infantshas been reported recently, but this unilateral cerebralatrophy after head injury in adult patients has rarelybeen reported.

  9. Self-Administered Cocaine Causes Long-Lasting Increases in Impulsive Choice in a Delay Discounting Task

    Mendez, Ian A.; Nicholas W Simon; Hart, Nigel; Mitchell, Marci R.; Nation, Jack R.; Wellman, Paul J.; Setlow, Barry


    Cocaine use is associated with high levels of impulsive choice (preference for immediate over delayed rewards), but it is not clear whether cocaine use causes elevated impulsive choice, or whether elevated impulsive choice is solely a predisposing factor for cocaine use. This study examined the effects of prior cocaine self-administration on rats performing a delay discounting task commonly used to measure impulsive choice. Male Long-Evans rats were implanted with intravenous catheters, and f...

  10. Renal Cell Carcinoma Metastasis from Biopsy Associated Hematoma Disruption during Robotic Partial Nephrectomy

    Christopher Caputo


    Full Text Available We describe a case in which a patient with a past medical history of ovarian cancer received a diagnostic renal biopsy for an incidentally discovered renal mass. During left robotic partial nephrectomy (RPN, a perinephric hematoma was encountered. The hematoma was not present on preoperative imaging and was likely a result of the renal biopsy. The renal cell carcinoma (RCC and the associated hematoma were widely excised with negative surgical margins. On follow-up imaging at five months postoperatively, a recurrent renal mass at the surgical resection bed and several new nodules in the omentum were detected. During completion left robotic total nephrectomy and omental excision, intraoperative frozen sections confirmed metastatic RCC. We believe that a hematoma seeded with RCC formed as a result of the renal biopsy, and subsequent disruption of the hematoma during RPN caused contamination of RCC into the surrounding structures.

  11. Ruptured pseudoaneurysm of the middle meningeal artery presenting with a temporal lobe hematoma and a contralateral subdural hematoma

    Eric Marvin


    Conclusions: The presence of a fracture over the MMA and intraparenchymal hematoma should prompt suspicion for a traumatic pseudoaneurysm. Pseudoaneurysms of the MMA can cause catastrophic bleeding, and prompt treatment is necessary. Endovascular embolization is an effective method that decreases the hemorrhage risk of MMA pseudoaneurysms.

  12. Endovascular treatment of intramural hematoma of internal carotid artery after blunt trauma of neck inflicted with the seatbelt.

    Stanisic, M; Winckiewicz, M; Juszkat, R; Gabriel, M; Jawien, A; Staniszewski, R


    Blunt trauma of the neck caused by a seatbelt may cause dissection with intramural hematoma of the internal carotid artery. The following case report discusses the differential diagnosis and the potential of endovascular treatment of symptomatic intramural hematoma of the internal carotid artery.


    Chang Patricia


    Full Text Available Background: The proximal fold is an important part of the nail apparatus it contributes to the formation of the nail plate and through the cuticle acts as an impermeable barrier protecting it from any cause.Objective: To know the proximal nail fold hematoma caused by the use of pulse oximeter.Material and Methods: A descriptive study was conducted in 41 patients with proximal nail hematoma secondary to the use of oximetry in patients hospitalized in the Intermediate and Intensive Care Unit at the Hospital General de Enfermedades from December 1, 2007 to December 31, 2010.Results: We studied 41 patients with proximal nail fold hematoma secondary to the use of oximeter, 30 (73.1% were males and 11 (26.8% females. The numbers of fingers affected by pulse oximeter were in one digit. 30 (73.1% cases, in two digits 6 (14.6%, in three digits 3 (7.3%, in 4 digits 1 (2.4% and in 5 digits 1 (2.4% case. The most affected proximal nail fold was right index: 24 (58.5%, right middle 11 (26.8%, right ring 6 (14.6%, left index 12 (29.2%, and left middle 6 (14.6% cases.Conclusions: Hematomas of the proximal nail fold may be caused by different traumatisms. The use of pulse oximeter is one of them.

  14. Cervical spontaneous epidural hematoma as a complication of non-Hodgkin's lymphoma.

    Mastronardi, L; Carletti, S; Frondizi, D; Spera, C; Maira, G


    Epidural hematoma is a rare cause of spinal cord compression, which usually provokes severe neurological deficits. It is presumed to originate from venous or, more probably, arterial bleeding. Thrombocytopenia and other disorders of coagulation may precipitate the onset of epidural hematoma and facilitate the evolution of the disease. We report the case of a patient suffering from a non-Hodgkin's lymphoma with severe thrombocytopenia during a MACOP-B schedule, who presented with a spontaneous cervical epidural hematoma. We discuss the etiopathological aspects, diagnosis, and treatment of this rare cause of acute cervical spinal cord compression.

  15. Auditory Brainstem Response Wave Amplitude Characteristics as a Diagnostic Tool in Children with Speech Delay with Unknown Causes

    Susan Abadi


    Full Text Available Speech delay with an unknown cause is a problem among children. This diagnosis is the last differential diagnosis after observing normal findings in routine hearing tests. The present study was undertaken to determine whether auditory brainstem responses to click stimuli are different between normally developing children and children suffering from delayed speech with unknown causes. In this cross-sectional study, we compared click auditory brainstem responses between 261 children who were clinically diagnosed with delayed speech with unknown causes based on normal routine auditory test findings and neurological examinations and had >12 months of speech delay (case group and 261 age- and sex-matched normally developing children (control group. Our results indicated that the case group exhibited significantly higher wave amplitude responses to click stimuli (waves I, III, and V than did the control group (P=0.001. These amplitudes were significantly reduced after 1 year (P=0.001; however, they were still significantly higher than those of the control group (P=0.001. The significant differences were seen regardless of the age and the sex of the participants. There were no statistically significant differences between the 2 groups considering the latency of waves I, III, and V. In conclusion, the higher amplitudes of waves I, III, and V, which were observed in the auditory brainstem responses to click stimuli among the patients with speech delay with unknown causes, might be used as a diagnostic tool to track patients’ improvement after treatment.

  16. Leaf Downward Curvature and Delayed Flowering Caused by AtLH Overexpression in Arabidopsis thaliana

    WUHao; YULin; TANGXiang-Rong; SHENRui-Juan; HEYu-Ke


    AtLHgene of Arabidopsis is a BcpLH(leafy head) homolog of Chinese cabbage, which encodes a double-stranded RNA-binding protein related to the curvature of folding leaf leading to the formation of leafy head. In order to elucidate the regulatory function of AtLH in the development of leaf curvature, we made a construct of 35S::AtLHand transformed it to Arabidopsis. In transgenic plants for sense-AtLH, transcripts of AtLH gene were increased significantly in leaves and flowers, giving rise to the AtLH-overexpressed plants in which the rosette leaves curved downward or outward in a manner of enhanced epinastic growth. Compared with normal plants, bolting and flowering time of the transgenic plants was significantly delayed. Moreover, the apical dominance of transgenic plants was weaker in vegetative shoots since more axillary shoots emerged from axil of rosette leaves, while stronger in flowering shoots because fewer cauline inflorescences were observed on the main inflorescence. In other aspects, these transgenic plants exhibited an increase in root-stimulating response to IAA and decrease in root-inhibitory reaction on ABA. It indicates that overexpression of AtLH causes downward curvature of transgenic plants.

  17. Causes and effects of delayed treatment of spine deformation in children and youth.

    Modrzewski, Krzysztof; Skwarcz, Andrzej


    Background. Delays and negligence in the treatment of spinal deformations have both objective and subjective causes and often occur simultaneously. The aim of our study was to evaluate and analyze the pathomorphological features of spine deformation in young patients following the program suggested by Karski, especially flexion-rotations exercises. Material and methods. We analyzed 36 post-surgical patients who performed flexion-rotation exercises for varying lengths of time. In additional to information regarding the course and manner of treatment with flexion-rotation exercises obtained from anamnesis, clinical and X-ray examinations were carried out. Results. Upon analysis of the progress of treatment with flexion-rotation exercises, correction of deformityof presumed abduction contracture of the right hip, and forced positions, we observed exceptionally rapid progression of scoliosis. Conclusions. Flexion-rotation exercises do not reduce the extent of spinal deformities, and may even accelerate the process of scoliosis. Unexpectedly rapid progress of sciolosis was confirmed in 3 patients treated by this method using complete radiological examination. Prolonging flexion-rotation exercises in progressive scoliosis is harmful, since it contributes to postponing the proper surgical treatment and reduces its effectiveness by giving the changes a permanent character.

  18. Absorbing aerosols: are they causing a delayed sunrise? A comparison between plain and plateau IGB stations

    Kumari, Lipi


    Current study tries to compare black carbon radiative effects at densely populated plain station Varanasi and lesser populated plateau station Ranchi with large forest cover but with numerous open coal mines. While average black carbon mass density (BC) reduced from February to March at Ranchi following an increase in convective instability, it was observed to increase by 150% from Feb to March at Varanasi, as transport from NE forest fires increases. It is observed that absorption due to black carbon of non-fossil fuel origin is prevalent throughout the day at Varanasi, while this contribution is most significant during post sunset hours at Ranchi. Radiative forcing, estimated hourly using chemical model (to derive BC-aod ) and radiative transfer model, indicated that at least 5% of the incoming radiation is always cut-off during any time of the day at Varanasi while this is about 4% at Ranchi. BC effectively causes a delayed sunrise by reducing the incoming radiation at plains of IGB by around 25% which may be crucial for bionetwork.

  19. 重型颅脑损伤患者行开颅手术后发生迟发性颅内血肿的危险因素分析%Clinical Research of Risk Factors of the Delayed Intracranial Hematoma Followed by Craniotomy in Severe Head Injury Patients

    沈佳; 杨渭林; 裘申忠; 毛伟; 殷怀明


    目的:探讨重型颅脑损伤患者行开颅手术后发生迟发性颅内血肿的危险因素,以期能够改善患者预后质量。方法选取2010年3月-2014年3月富阳市人民医院收治的行开颅手术治疗的重型颅脑损伤患者102例,依据患者术后是否发生迟发性颅内血肿将其分为迟发组和非迟发组,记录两组患者临床资料,包括性别、年龄、发病至手术时间、颅骨骨折、蛛网膜下腔出血、Babinski 征阳性、基底池受压、血浆凝血酶原时间、活化部分凝血活酶时间、血浆凝血酶时间、格拉斯哥昏迷量表(GCS)评分、收缩压、舒张压、血小板计数、纤维蛋白原、血肿量等。采用多因素 Logistic 回归分析探讨影响患者行开颅手术后发生迟发性颅内血肿的危险因素。结果依据患者术后是否发生迟发性颅内血肿将其分为迟发组41例和非迟发祖61例。两组性别、年龄、蛛网膜下腔出血发生率、血浆凝血酶原时间、收缩压、血小板计数、血肿量比较,差异均无统计学意义(P >0.05);两组发病至手术时间、颅骨骨折发生率、Babins-ki 征阳性发生率、基底池受压发生率、活化部分凝血活酶时间、血浆凝血酶时间、GCS 评分、舒张压、纤维蛋白原水平比较,差异均有统计学意义(P 0. 05). The time from onset to operation,inci-dence of fracture of skull,incidence of positive Babinski symptoms and compression of basilar cistern,activated partial thrombo-plastin time,plasma thrombin time,GCS score,diastolic pressure and fibrinogen level showed statistically significant differences between the two groups(P < 0. 05). Multivariate Logistic regression analysis showed that the time from onset to operation,frac-ture of skull,positive Babinski symptoms and plasma thrombin time were independent factors for delayed intracranial hematoma followed by craniotomy in severe head injury patients(P < 0. 05). Conclusion

  20. Is human fracture hematoma inherently angiogenic?

    Street, J


    This study attempts to explain the cellular events characterizing the changes seen in the medullary callus adjacent to the interfragmentary hematoma during the early stages of fracture healing. It also shows that human fracture hematoma contains the angiogenic cytokine vascular endothelial growth factor and has the inherent capability to induce angiogenesis and thus promote revascularization during bone repair. Patients undergoing emergency surgery for isolated bony injury were studied. Raised circulating levels of vascular endothelial growth factor were seen in all injured patients, whereas the fracture hematoma contained significantly higher levels of vascular endothelial growth factor than did plasma from these injured patients. However, incubation of endothelial cells in fracture hematoma supernatant significantly inhibited the in vitro angiogenic parameters of endothelial cell proliferation and microtubule formation. These phenomena are dependent on a local biochemical milieu that does not support cytokinesis. The hematoma potassium concentration is cytotoxic to endothelial cells and osteoblasts. Subcutaneous transplantation of the fracture hematoma into a murine wound model resulted in new blood vessel formation after hematoma resorption. This angiogenic effect is mediated by the significant concentrations of vascular endothelial growth factor found in the hematoma. This study identifies an angiogenic cytokine involved in human fracture healing and shows that fracture hematoma is inherently angiogenic. The differences between the in vitro and in vivo findings may explain the phenomenon of interfragmentary hematoma organization and resorption that precedes fracture revascularization.

  1. Delayed Hepatic Adaptation to Weaning in ACBP(-/-) Mice Is Caused by Disruption of the Epidermal Barrier

    Neess, Ditte; Bek, Signe; Bloksgaard, Maria


    We previously reported that mice deficient in acyl-CoA-binding protein (ACBP) display a delayed metabolic adaptation to weaning. This includes a delayed activation of the hepatic lipogenic gene program, which may result from hepatic accumulation of triacylglycerol and/or cholesteryl esters in the...

  2. Do cranial subdural hematomas migrate to the lumbar spine?

    Moscovici, S; Paldor, I; Ramirez de-Noriega, F; Itshayek, E; Shoshan, Y; Spektor, S; Attia, M


    We report a patient with minor head trauma-related bilateral hemispheric subdural hematoma (SDH) and subsequent delayed spinal SDH or presumed migration to the lumbar spine. An acutely confused 88-year-old man presented to the Emergency Department after minor head trauma. Head CT scan revealed a small hemispheric SDH. The patient was admitted for observation. CT scan 6 hours later showed bilateral SDH with extension to the tentorium. Three days later SDH had resolved leaving bilateral subdural hygromas. Local leg weakness localized to the lumbar spine developed on day 6; spinal CT scan and MRI revealed a posterior L5-S1 collection. A pure subacute subdural hematoma compressing the cauda equina was drained after an L5 laminectomy. His lower leg weakness improved. The patient was discharged to rehabilitation two weeks after surgery. Patients with traumatic SDH who develop late-onset neurological deterioration attributable to any region of the spine should be evaluated for spinal SDH.

  3. Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report

    Choi, Hee Seok; Lee, Yong Seok; Lim, Ji Hyon; Kim, Kyung Soo; Yoon, Yup [Dongguk University College of Medicine, Goyang (Korea, Republic of); Hwang, Jae Cheol [Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (Korea, Republic of)


    Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization. Hemorrhagic fever with renal syndrome (HFRS) is an acute infectious disease caused by hantavirus. HFRS is clinically characterized by fever, renal failure and hemorrhage in organs such as lung, kidney, spleen and the pituitary gland. Renal medullary hemorrhage is a well-known complication in the kidney, but spontaneous rupture of the kidney and perirenal hematoma in HFRS is rare, and patients showing continuous bleeding and massive perirenal hematoma have often been surgically treated. We report here on a case of HFRS complicated by massive perirenal hematoma, and the patient was treated with transcatheter arterial embolization. In summary, spontaneous rupture of the kidney and perirenal hematoma is a rare complication of HFRS. We report here on a case of HFRS that caused massive perirenal hematoma, and this was treated with superselective renal artery embolization.

  4. Ethmoid Hematoma of the Equine

    Etherington, W G; Vasey, J. R.; Horney, F. D.


    Two cases of ethmoid hematoma of the equine are reported. Clinically both horses had intermittent unilateral epistaxis unassociated with exercise. In one horse, diagnosis was based on the use of an endoscope for visualization and for biopsy of a mass associated with the ethmoid turbinates. In the other horse, exploratory trephination of the posterior maxillary sinus was necessary to obtain a diagnostic biopsy specimen. Radiography was helpful in the diagnosis of one case. Surgical removal of ...

  5. Interventricular septum hematoma during cineventriculography

    Melzer Christoph


    Full Text Available Abstract Background Intraseptal hematoma and subsequent myocardial infarction due to accidental contrast agent deposition complicating diagnostic cineventriculography is a previously undescribed complication of angiography. Case presentation A 61 year old man was admitted at intensive care unit because of unstable angina pectoris 1 hour after coronary angiography. Transthoracic contrast echocardiography showed a non-perfused area in the middle of interventricular septum with an increase of thickening up to 26 mm. Review of cineventriculography revealed contrast enhancement in the interventricular septum after contrast medium injection and a dislocation of the pigtail catheter tip. Follow up by echocardiography and MRI showed, that intramural hematoma has resolved after 6 weeks. After 8 weeks successful stent implantation in LAD was performed and after 6 month the patient had a normal LV-function without ischemic signs or septal thickening demonstrated by stressechocardiography. Conclusion A safe and mobile position of the pigtail catheter during ventriculography in the middle of the LV cavity should be ensured to avoid this potentially life-threatening complication. For assessment and absolute measurement of intramural hematoma contrast-enhanced echocardiography is more feasible than MRI and makes interchangeable results.

  6. Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed

    Cincu Rafael


    Full Text Available Spinal subdural hematoma is a rare disorder and can be caused by abnormalities of coagulation, blood dyscrasias, lumbar puncture, trauma, underlying neoplasm, and arteriovenous malformation. We discuss an unusual case of an elderly woman who presented with spontaneous spinal subdural hematoma and developed massive rebleeding on the third day following initial evacuation of hematoma. This case illustrates that a patient with routine normal coagulation profile and adequate hemostasis can still harbor platelet dysfunction (in present case due to polycythemia and later on can manifest as rebleeding and neurological deterioration.

  7. Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed

    Cincu, Rafael; de Asis Lorente, Francisco; Rivero, David; Eiras, José; Ara, José Ramón


    Spinal subdural hematoma is a rare disorder and can be caused by abnormalities of coagulation, blood dyscrasias, lumbar puncture, trauma, underlying neoplasm, and arteriovenous malformation. We discuss an unusual case of an elderly woman who presented with spontaneous spinal subdural hematoma and developed massive rebleeding on the third day following initial evacuation of hematoma. This case illustrates that a patient with routine normal coagulation profile and adequate hemostasis can still harbor platelet dysfunction (in present case due to polycythemia) and later on can manifest as rebleeding and neurological deterioration. PMID:19838395

  8. Intraoperative contralateral extradural hematoma during evacuation of traumatic acute extradural hematoma

    Sharma Anand


    Full Text Available Introduction: Extradural hematomas (EDHs accounts for approximately 2% of patients following head trauma and 5-15% of patients with fatal head injuries. When indicated, the standard surgical management consists of evacuation of the hematoma via craniotomy. Intraoperative development of acute extradural hematoma (AEDH on the contralateral side following evacuation of acute extradural hematoma is uncommon and very few cases have been reported.

  9. Inactivation of IL11 signaling causes craniosynostosis, delayed tooth eruption, and supernumerary teeth

    Nieminen, Pekka; Morgan, Neil V; Fenwick, Aimée L


    Craniosynostosis and supernumerary teeth most often occur as isolated developmental anomalies, but they are also separately manifested in several malformation syndromes. Here, we describe a human syndrome featuring craniosynostosis, maxillary hypoplasia, delayed tooth eruption, and supernumerary...

  10. Large coronary intramural hematomas

    Antonsen, Lisbeth; Thayssen, Per; Jensen, Lisette Okkels


    coronary vessel wall pathology, with poorly understood underlying pathogenic mechanisms. Affected individuals may present with a broad spectrum of symptoms ranging from acute coronary syndromes (ACS) to cardiogenic shock or even sudden cardiac death. The disease entity causes challenges in terms of both......, no randomized, controlled trials exist to guide treatment, and no consensus regarding management is available. Currently, treatment strategies are based on a case-by-case clinical assessment, and experiences described in previous, limited retrospective studies and case reports....

  11. MR imaging and clinical findings of spontaneous spinal epidural hematoma

    Kim, Sam Soo [Seoul City Boramae Hospital, Seoul (Korea, Republic of); Han, Moon Hee; Kim, Hyun Beom [College of Medicine, Seoul National University, Seoul (Korea, Republic of)] [and others


    To describe the MR imaging and clinical findings of spontaneous spinal epidural hematoma. The MR and clinical findings in six patients (M:F=3D4:2;adult:child=3D3:3) with spontaneous spinal epidural hematoma were reviewed. Five patients without any predisposing factor which might cause the condition and one with acute myelogenous leukemia were included. Emergency surgery was performed in two patients, and the other four were managed conservatively. The epidural lesion involved between three and seven vertebrae (mean:4.5), and relative to the spinal cord was located in the posterior-lateral (n=3D4), anterior (n=3D1), or right lateral (n=3D1) area. The hematoma was isointense (n=3D1) or hyperintense (n=3D5) with spinal cord on T1-weighted images, and hypointense (n=3D2) or hyperintense (n=3D4) on T2-weighted images. It was completely absorbed in four of five patients who underwent follow-up MR imaging, but not changed in one. The clinical outcome of these patients was complete recovery (n=3D4), spastic cerebral palsy (n=3D1), or unknown (n=3D1). Because of the lesion's characteristic signal intensity; MR imaging is very useful in the diagnosis and evaluation of spontaneous spinal epidural hematoma. (author)

  12. Presacral retroperitoneal hematoma after blunt trauma presents with rectal bleeding - A case report

    Dich, Sanne Jensen; El-Hussuna, Alaa Abdul-Hussein Hmood


    INTRODUCTION: We present a case of a presacral hematoma, which penetrated into the rectum resulting in rectal bleeding. This is an unusual presentation of a presacral hematoma. PRESENTATION OF THE CASE: A 76-year-old woman, using warfarin anticoagulant prophylaxis, presented with a rectal bleed t......: Rectal bleed after trauma, in a patient receiving anticoagulant treatment, should raise suspicion of a penetrating hematoma, and such patients should be managed at highly specialized facilities....... in the gastrointestinal tract. In this report the patient's anticoagulant treatment has likely contributed to bleeding and the formation of the hematoma. To our knowledge, this is the first case report of a presacral hematoma acutely penetrating into the rectum and causing lower gastrointestinal bleeding. CONCLUSION......INTRODUCTION: We present a case of a presacral hematoma, which penetrated into the rectum resulting in rectal bleeding. This is an unusual presentation of a presacral hematoma. PRESENTATION OF THE CASE: A 76-year-old woman, using warfarin anticoagulant prophylaxis, presented with a rectal bleed two...

  13. [The pathophysiological analysis of cerebrolysin therapy of children with mental developmental delay caused by ecological factors].

    Govorin, N V; Zlova, T P; Akhmetova, V V; Tarasova, O A


    The treatment with cerebrolysin combined with psychological correction was conducted in 24 children, aged 4-6 years, with mental developmental delay. The effect of this drug was compared to placebo (20 patients with mental development delay) and control groups (35 healthy children). After cerebrolysin therapy effect of cerebrolysin (0,1 mg/1kg of body mass during 42 day) was assessed using neuropsychological data and a set of different pathophysiological indices which reflected the biochemical, immunological and neurophysiological status of patients. After cerebrolysin therapy significant improvement of the mental state, including preconditions of intellect, and motor functions specific for mental development delay was found. These changes were correlated with the positive dynamics of some indices - lipid peroxidation, immune status, hormonal shifts and parameters of neurodegeneration-neuroprotection processes.

  14. Ogura-CMS in Chinese cabbage (Brassica rapa ssp. pekinensis) causes delayed expression of many nuclear genes.

    Dong, Xiangshu; Kim, Wan Kyu; Lim, Yong-Pyo; Kim, Yeon-Ki; Hur, Yoonkang


    We investigated the mechanism regulating cytoplasmic male sterility (CMS) in Brassica rapa ssp. pekinensis using floral bud transcriptome analyses of Ogura-CMS Chinese cabbage and its maintainer line in B. rapa 300-K oligomeric probe (Br300K) microarrays. Ogura-CMS Chinese cabbage produced few and infertile pollen grains on indehiscent anthers. Compared to the maintainer line, CMS plants had shorter filaments and plant growth, and delayed flowering and pollen development. In microarray analysis, 4646 genes showed different expression, depending on floral bud size, between Ogura-CMS and its maintainer line. We found 108 and 62 genes specifically expressed in Ogura-CMS and its maintainer line, respectively. Ogura-CMS line-specific genes included stress-related, redox-related, and B. rapa novel genes. In the maintainer line, genes related to pollen coat and germination were specifically expressed in floral buds longer than 3mm, suggesting insufficient expression of these genes in Ogura-CMS is directly related to dysfunctional pollen. In addition, many nuclear genes associated with auxin response, ATP synthesis, pollen development and stress response had delayed expression in Ogura-CMS plants compared to the maintainer line, which is consistent with the delay in growth and development of Ogura-CMS plants. Delayed expression may reduce pollen grain production and/or cause sterility, implying that mitochondrial, retrograde signaling delays nuclear gene expression.

  15. 颅脑创伤开颅术中、术后对侧迟发性硬膜外血肿诊治探讨(附26例分析)%Discuss of the diagnosis and treatment of contralateral delayed epidural hematoma in and after the operation of ;traumatic brain injury:reports of 26 cases

    孙宇; 袁从华; 吴良发; 潘耀华; 王经发; 王海伟; 厉进辉; 惠晓伟


    目的:探讨颅脑创伤开颅术中、术后对侧迟发性硬膜外血肿的发生机制与处理方法。方法分析2008-01—2014-04颅脑创伤开颅术中、术后发生对侧迟发性硬膜外血肿26例患者的临床资料。结果随访3~6个月,按格拉斯哥预后评分( GOS)判定预后,恢复良好15例,轻残4例,重残2例,植物生存1例,死亡4例。结论颅脑创伤开颅术前应仔细研究患者的受伤机制,分析影像学资料,及时诊断并处理对侧迟发性硬膜外血肿,能提高其治愈率,减少死残率,改善患者预后。%Objective To discuss the occurring mechanism and therapeutic method of contralateral delayed epidural hematoma ( DEDH) in and after traumatic brain injury .Methods The clinical and radiological data and outcome of 26 patients were reviewed retrospec-tively between January ,2008 and January 2014.Results All the patients were followed up in 3-6 months after discharge and were analyzed the prognosis according the Glasgow Outcome Scale ( GOS) .There were 15 cases in Low disability , 4 in Moderate disability ,2 in Severe disa-bility,1 in Persistent vegetative state and 4 in Death.Conclusion The brain injury mechanisms and radiological datas of the patients should be deliberately analyzed before the brain surgery and early diagnosis and evacuation of the contralateral epidural hematoma may contribute to im -provement of its cure rate and prognosis , decrease of the death and disability .

  16. Spontaneous Ventral Spinal Epidural Hematoma in an Infant: An Unusual Presentation

    Asad ABBAS


    Full Text Available How to Cite This Article: Abbad A, Afzal K, Mujeeb AA, Shahab T, Khalid M. Spontaneous Ventral Spinal Epidural Hematoma in an Infant: An Unusual Presentation. Iran J Child Neurol. 2013  Spring;7(2:47-50.Abstract Spontaneous ventral spinal epidural hematomas are extremely rare in children and clinically recognized by the appearance of acute asymmetric focal motor and sensory involvement. In infants, the initial presenting symptoms are very non-specific and irritability is often the only initial manifestation. Appearance of other neurological signs may be delayed up to hours or even days later. In the absence of significant precipitating factors such as severe trauma or previously known coagulopathies,the diagnosis is usually delayed until the full picture of severe cord compression is developed. The diagnosis is finally made by performing magnetic resonance imaging. We report a 5-month-old infant with spinal epidural hematoma who presented with symmetrical upper limb weakness and diaphragmatic involvement to highlight the importance of recognizing the atypical manifestations for early diagnosis andintervention. References:1. Phillips TW, Kling TF Jr, McGillicuddy JE. Spontaneous ventral spinal epidural hematoma with anterior cordsyndrome: report of a case. Neurosurgery 1981;9:440-3.2. Patel H, Boaz JC, Phillips JP, Garg BP. Spontaneous spinal epidural hematoma in children. Pediatr Neurol1998;19:302-7. Review.3. Penar PL, Fischer DK, Goodrich I, Bloomgarden GM, Robinson F. Spontaneous spinal epidural hematoma. IntSurg 1987;72:218-21.4. Noth I, Hutter JJ, Meltzer PS, Damiano ML, Carter LP. Spinal epidural hematoma in a hemophilic infant. Am JPediatr Hematol Oncol 1993;15:131-4. Review.5. Beatty RM, Winston KR. Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg1984;61:143-8.6. Alva NS. Traumatic spinal epidural hematoma of a 10-month-old male: a clinical note. Pediatr Neurol2000;23:88-9. Review.7. Aminoff MJ: Vascular

  17. [Computed tomographic semiotics of chronic subdural hematomas].

    El'-Kadi, Kh A; Likhterman, L B; Kornichenko, V N


    Analysis of the results of investigation of 72 patients with verified chronic subdural hematomas (CSH) has revealed their CT dense characteristics, the peculiarities of their structure compared with the time of their formation, the patients' age, the clinical stage of disease, and operative findings. Direct and indirect CT signs of uni- and bilateral hemispherical chronic subdural hematomas were described.

  18. Intra-uterine hematoma in pregnancy

    Glavind, K; Nøhr, S; Nielsen, P H;


    In 60 patients with a live fetus and an intra-uterine hematoma (IUH) proven by ultrasonic scanning the outcome of pregnancy was spontaneous abortion in 12% and premature delivery in 10%. No correlation between the outcome of the pregnancy and the maximum size of the hematoma or the week...

  19. Spontaneous extracranial decompression of epidural hematoma

    Neely, John C. [Marshall University School of Medicine, Huntington, WV (United States); Jones, Blaise V. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Crone, Kerry R. [Cincinnati Children' s Hospital Medical Center, Division of Neurosurgery, Cincinnati, OH (United States)


    Epidural hematoma (EDH) is a common sequela of head trauma in children. An increasing number are managed nonsurgically, with close clinical and imaging observation. We report the case of a traumatic EDH that spontaneously decompressed into the subgaleal space, demonstrated on serial CT scans that showed resolution of the EDH and concurrent enlargement of the subgaleal hematoma. (orig.)

  20. Chronic expanding hematoma extending over multiple gluteal muscles associated with piriformis syndrome.

    Kitagawa, Yasuyuki; Yokoyama, Munehiro; Tamai, Kensuke; Takai, Shinro


    We report on a patient with an unusual, slowly enlarging hematoma of the left buttock. A 62-year-old man presented with a 6-year history of an enlarging mass of the left buttock. He had first noted the mass 6 years earlier and had had sciatica of the left lower limb for the last 2 months. He denied any history of antecedent trauma. The lesion extended over 3 gluteal muscles (the gluteus medius, gluteus minimus, and piriformis). On microscopic examination, the lesion showed typical signs of chronic expanding hematoma. The sciatica was relieved after surgical removal of the lesion. The lesion had not recurred at the last follow-up 4 years after the operation. The present case suggested that chronic expanding hematoma can extend into multiple muscles due, perhaps, to long-term growth and the anatomical and functional conditions of the affected muscles. Our case also suggests that chronic expanding hematoma can be a cause of piriformis syndrome.

  1. Delayed mutation as a cause of retinoblastoma: application to genetic counseling.

    Herrmann, J


    The genealogic and genetic data on retinoblastoma were reviewed and interpreted according to the model of delayed mutation; then applications of the model to specific situations in genetic counseling were considered. Patients with multiple congenital abnormalities and systemic chromosome aberrations are regarded as belonging to a different category of retinoblastoma cases than the more common patients without such abnormalities. The model of delayed mutation is considered for the latter group of patients. According to the model, mutation at the retinoblastoma locus can be delayed or complete and can occur during meiotic or mitotic cell division. Genotypically, three clases of individuals can be identified in retinoblastoma families: homozygous normal, heterozygous for the premutated allele, and heterozygous for the (fully) mutated allele; the other possible combinations of individuals have apparently not been observed. There is to date no evidence to suggest incomplete penetrance of the mutant allele, but 14% of individuals who have the mutant gene are "only" unilaterally affected. Carriers produce normal, affected and carrier offspring in the empiric proportion of, respectively, 54.5%, 36.4% and 9.1%. Most difficulties in genetic counseling arise because affected individuals may have inherited the premutated or the mutated allele and because unaffected individuals may have inherited the normal or the premutated allele. These aspects were considered for individuals presenting as sporadic-unilateral, sporadic-bilateral, familial-unilateral and familial-bilateral cases, and the empiric risk figures for various situations were quoted from the literature.

  2. Antiplatelet antibody may cause delayed transfusion-related acute lung injury

    Torii Y


    Full Text Available Yoshitaro Torii1, Toshiki Shimizu1, Takashi Yokoi1, Hiroyuki Sugimoto1, Yuichi Katashiba1, Ryotaro Ozasa1, Shinya Fujita1, Yasushi Adachi2, Masahiko Maki3, Shosaku Nomura11The First Department of Internal Medicine, Kansai Medical University, Osaka, 2Department of Clinical Pathology, Toyooka Hospital, Hyogo, 3First Department of Pathology, Kansai Medical University, Osaka, JapanAbstract: A 61-year-old woman with lung cancer developed delayed transfusion-related acute lung injury (TRALI syndrome after transfusion of plasma- and leukoreduced red blood cells (RBCs for gastrointestinal bleeding due to intestinal metastasis. Acute lung injury (ALI recurred 31 days after the first ALI episode. Both ALI episodes occurred 48 hours after transfusion. Laboratory examinations revealed the presence of various antileukocyte antibodies including antiplatelet antibody in the recipient's serum but not in the donors' serum. The authors speculate that antiplatelet antibodies can have an inhibitory effect in the recipient, which can modulate the bona fide procedure of ALI and lead to a delay in the onset of ALI. This case illustrates the crucial role of a recipient's platelets in the development of TRALI.Keywords: delayed TRALI syndrome, recurrence, anti-platelet antibody

  3. [Effect of diazepam on delayed nausea and vomiting caused by anticancer agents].

    Tong, F Z; Zhang, J Q; Qiao, X M; Mao, Y C; Meng, F Y; Liu, H J; Hui, S; Zhu, F X; Shu, W; Hong, J


    We conducted an evaluation of the usefulness of antiemetics (5-Hydroxy-tryptamine 3 receptor antagonism, 5HT3RA) combined with diazepam for delayed nausea and vomiting due to anticancer agents in 17 patients with various malignancies (such as lung Ca, breast Ca, esophagus Ca, gastric Ca, colon Ca, and non Hodgkin's disease) for whom chemotherapy was performed with different regimens in the Dept. of Oncologic Chemotherapy, People's Hospital, Beijing Medical University. Antiemetics (5HT3RA) combined with diazepam were given only to cases that had symptoms of nausea and vomiting induced by anticancer agents in the 1st course and invalidity with antiemetics (5HT3RA) alone in this study. Antiemetic (5HT3RA) agents + Dexamethasone were dosed before chemotherapy and also diazepam 5 mg orally after 24 hours (namely, when nausea was observed). Nausea was reduced and vomiting decreased after the antiemetic treatment with 5HT3RA + Dexamethasone and diazepam. These results indicated that 5HT3RA and diazepam combination therapies were more effective than 5HT3 RA + Dexamethasone alone for delayed nausea and vomiting. Further, the antiemetics had characters that a short adminiter time, few times and a take not over dose. The only side effect related to this antiemetic therapy was light somnolence. Antiemetics combined with diazepam might be a useful therapy against delayed nausea and vomiting induced by anticancer agents.

  4. Vertex extradural hematoma in association with Paget′s disease of the skull

    Ramesh V


    Full Text Available Paget′s disease of skull usually causes neurological complications such as basilar invagination, cranial neuropathies, etc. Occurrence of extradural hematoma in association with Paget′s disease of skull is rare. A 48 year old man presented with headache and right upper limb weakness, two days after a fall from scooter. CT Scan of brain showed a large extradural hematoma at the vertex with the cranial vault showing features of Paget′s disease. At surgery, no skull fracture or injury to the superior sagittal sinus was evident. There was diffuse oozing from the inner table of the skull, which showed features of Paget′s disease. The extradural hematoma was evacuated and the patient made good recovery.He deteriorated a few hours after surgery. Follow up CT Scan showed diffuse brain swelling with minimal recollection of hematoma. Re-exploration showed a small recollection which was evacuated and the part of the oozing diseased skull was excised. The patient recovered completely. This is the first reported case of vertex extradural hematoma in association with the Paget′s disease of skull. The unusual features are the absence of skull fracture and injury to the superior sagittal sinus. The increased vascularity of the skull due to Paget′s disease has caused the hematoma by diffuse oozing from the inner table.

  5. Hematoma da aorta ascendente Intramural hematoma of the ascending aorta

    Noedir Antônio G. Stolf


    Full Text Available É relatado o caso de um paciente do sexo masculino com idade de 71 anos, dando entrada no pronto-atendimento com palidez cutaneomucosa, acompanhada de hipertensão arterial sistêmica e dor torácica. Na investigação diagnóstica não foi evidenciada alteração compatível com isquemia miocárdica aguda. A radiografia de tórax evidenciava alargamento importante do mediastino. Ao ecocardiograma, a aorta ascendente media 47 mm, no nível do tronco pulmonar. Um dia após o eco, o paciente foi submetido a exame de ressonância magnética (RNM, quando se evidenciou aorta ascendente de 62 mm, sem evidenciar fluxo em falsa luz ou "flap" intimal, mas mostrando hematoma intramural da aorta ascendente, estendendo-se da raiz da aorta até um terço proximal do arco aórtico. Procedeu-se a correção cirúrgica, sendo realizada substituição da aorta ascendente e parte do arco aórtico (hemiarco, com preservação da valva aórtica pela suspensão das comissuras. Paciente evolui bem sem intercorrência, recebendo alta no nono dia de pós-operatório. Enfatizamos nesse relato de caso a semelhança do quadro clínico do hematoma intramural da aorta com o quadro de dissecção da aorta, a importância de se estabelecer diagnóstico correto e o melhor tratamento.It is reported the case of a 71 year old male patient admitted to the emergency service pale and with systemic arterial hypertension and thoracic pain. In the diagnostic investigation, there was no evidence of compatible with acute myocardial ischemia. The thorax x-ray showed important enlargement of the mediastinum. In the echocardiogram the ascending aorta measured 47mm, at the level of the pulmonary artery. One day after the echo, submitted to exam of magnetic resonance (RNM, the ascending aorta had a diameter of 62mm, without false lumen flow or intimal "flap", but showing intramural hematoma envolving the ascending aorta and the proximal portion of the aorta. It was submitted to the surgical

  6. A blackhole over brain: Interdural hematoma - A challenging diagnosis.

    Babayev, Rasim; Ekşi, Murat Şakir


    Hematoma in between two dura leaves, named as 'interdural hematoma', is a very rare entity in adulthood. Interdural hematoma may emerge spontaneously or secondary to coagulopathies. A 61-year-old male patient, who had a medical history of alcoholic cirrhosis, presented with interdural hematoma. The case has been discussed with a literature review about diagnostic and therapeutic approaches in this pathology.

  7. Recurrent Respiratory Papillomatosis Causing Chronic Stridor and Delayed Speech in an 18-Month-Old Boy

    Adel Alharbi


    Full Text Available Recurrent respiratory papillomatosis is a relatively uncommon disease that presents clinically with symptoms ranging from hoarseness to severe dyspnea. Human papilloma virus types 6 and 11 are important in the etiology of papillomas and are most probably transmitted from mother to child during birth. Although spontaneous remission is frequent, pulmonary spread and/or malignant transformation resulting in death has been reported. CO2 laser evaporation of papillomas and adjuvant drug therapy using lymphoblastoid interferon-alpha are the most common treatments. However, several other treatments have been tried, with varying success. In the present report, a case of laryngeal papillomatosis presenting with chronic stridor and delayed speech is described.

  8. Spontaneous cervical epidural hematoma: Report of a case managed conservatively

    Halim Tariq


    Full Text Available Spontaneous spinal epidural hematoma is a rare cause of acute spinal cord compression. A 25-year-old male presented with a history of sudden onset of complete quadriplegia with sensory loss below the neck along with loss of bowel and bladder control. He had no history of any constitutional symptoms. He reported 10 days later. He was managed conservatively and after two weeks of intensive rehabilitation he had complete neural recovery. The spontaneous recovery of neurological impairment is attributed to the spreading of the hematoma throughout the epidural space, thus decreasing the pressure with partial neural recovery. Conservative treatment is a fair option in young patients who present late and show neurological improvement. The neurological status on presentation will guide the further approach to management.

  9. Delay in Diagnosis of Adrenal Insufficiency Is a Frequent Cause of Adrenal Crisis

    Lucyna Papierska


    Full Text Available Delay of diagnosis of primary adrenal insufficiency (PAI leads to adrenal crisis which is potentially lethal complication. The objective of our work was an assessment whether the establishment of diagnosis of adrenocortical insufficiency in Poland is so much delayed as assessed in the past. We have analysed data from 60 patients with diagnosis of PAI established in our department during the past 12 years and who are still under our care. We found that the time to diagnosis of primary adrenal insufficiency in Poland exceeds 3 months in every patient and 6 months in patients admitted with symptoms of adrenal crisis. Forty-four percent of patients were diagnosed only just after the hospitalisation due to crisis, despite the evident signs and symptoms of PAI. Lack of appetite and loss of body weight occurred in all patients and for that reason a diagnosis of chronic gastric and duodenal ulcer disease was the most often incorrect diagnosis. After the proper diagnosis and treatment, in the course of 1–11 years of observation, there was only 6 imminent adrenal crises in 5 patients. Our results indicated that training of primary care physicians in the field of recognising and treatment of adrenal insufficiency is still essential.

  10. An unusual cause of intestinal obstruction in an adolescent: a case report

    Victor Hip Wo Yeung


    Full Text Available A 15-year-old boy presented with intestinal obstruction two weeks following a blunt abdominal trauma. He had progressive bilious vomiting without abdominal distension or peritonitis. The contrast computed tomography (CT scan of the abdomen provided the definitive diagnosis: there was an obstructing duodenal hematoma, which might have been slowly progressing or have arisen from secondary hemorrhage after the initial injury. The boy remained stable over a ten-day period of conservative treatment, and his obstructive symptoms and signs were resolved completely. A follow-up CT scan of the abdomen (16 days after admission showed an almost complete resolution of the hematoma. Delayed duodenal hematoma causing intestinal obstruction has been reported rarely in previous literature. Occasionally a significant secondary hemorrhage resulting in intestinal obstruction can become life threatening. Clinical follow-up is paramount after initial recovery. Although conservative treatment suffices in most cases, the surgeon should be wary of the need for definitive surgical intervention if there is evidence of ongoing acute hemorrhage or of the obstructing hematoma failing to resolve. Laparoscopic drainage of the hematoma provides optimistic results for patients failing conservative management.

  11. Delayed-onset enzootic bovine leukosis possibly caused by superinfection with bovine leukemia virus mutated in the pol gene.

    Watanabe, Tadaaki; Inoue, Emi; Mori, Hiroshi; Osawa, Yoshiaki; Okazaki, Katsunori


    Bovine leukemia virus (BLV) is the causative agent of enzootic bovine leucosis (EBL), to which animals are most susceptible at 4-8 years of age. In this study, we examined tumor cells associated with EBL in an 18-year-old cow to reveal that the cells carried at least two different copies of the virus, one of which was predicted to encode a reverse transcriptase (RT) lacking ribonuclease H activity and no integrase. Such a deficient enzyme may exhibit a dominant negative effect on the wild-type RT and cause insufficient viral replication, resulting in delayed tumor development in this cow.

  12. Delayed-onset bilateral abducens paresis after head trauma

    Pravin Salunke


    Full Text Available Bilateral sixth nerve paresis following closed head injury, though rare, is a known entity. However, delayed-onset post-traumatic bilateral abducens paresis is extremely rare. We present two cases. The first patient had onset of bilateral abducens paresis 2 weeks after closed head injury and the second patient after 3 days. The cause in the former was detected to be chronic subdural hematoma and in the latter is speculated to be edema/ischemia due to injury to soft tissue structures housing these nerves. The delayed onset of bilateral abducens paresis following head injury may vary according to the cause. There may be another mechanism of injury apart from direct trauma. Though rare, it needs to be evaluated and may have a treatable cause like elevated intracranial pressure.

  13. A Case of Spontaneous Spinal Epidural Hematoma Mimicking Stroke

    Emine Rabia Koç


    Full Text Available Spontaneous spinal epidural hematoma is an uncommon cause of acute non-traumatic myelopathy and may present with various clinical phenotypes. Focal neurological symptoms can result in overlooking this differential diagnosis in patients presenting with neurological deficits and assuming the diagnosis of a stroke. Therefore, a thorough documentation of patient history is of great importance, since this can reveal symptoms suggestive of a different etiology. Here, we present a case of an 80-year-old female who was admitted with a hemiparesis without cortical or cranial neurological abnormalities. She mentioned of preceding shoulder and neck pain. Diagnosis of epidural hematoma was made by cervical magnetic resonance imaging. Symptoms resolved partially after surgical intervention. Our case illustrates the variation in the clinical presentation of spontaneous spinal epidural hematoma which can be misdiagnosed as stroke. Therefore, in patients with preceding neck, shoulder or interscapular pain and focal neurological deficits, this diagnosis should be included in the differential, particularly when cortical and cranial signs are lacking.

  14. Delayed effects of obese and overweight population conditions on all-cause adult mortality rate in the USA

    Albert A Okunade


    Full Text Available Currently, there are few studies separating the linkage of pathological obese and overweight body mass indices (BMI to the all-cause mortality rate in adults. Consequently, this paper, using annual Behavioral Risk Factor Surveillance System (BRFSS data of the 50 US states and the District of Columbia (DC estimates empirical regression models linking the US adult population overweight and obesity rates separately to the all-cause mortality rate. The biochemistry of multi-period cumulative adiposity (saturated fatty acid from unexpended caloric intakes (net energy storage provides the natural theoretical foundation for tracing unhealthy BMI to all-cause mortality. Cross-sectional and panel data regression models are separately estimated for the delayed effects of obese and overweight BMIs on the all-cause mortality rate. Controlling for the independent effects of economic, socio-demographic and other factors on the all-cause mortality rate, our findings confirm that the estimated panel data models are more appropriate. The panel data regression results reveal that the obesity-mortality link strengthens significantly after multiple years in the condition. The faster mortality response to obesity detected here is conjectured to arise from the significantly more obese. Compared with past studies postulating a static (rather than delayed effects, the statistically significant lagged effects of adult population BMI pathology in this study are novel and insightful. And, as expected, these lagged effects are more severe in the obese than overweight population segment. Public health policy implications of this social science study findings agree with those of the clinical sciences literature advocating timely lifestyle modification interventions (e.g., smoking cessation to slow premature mortality linked to unhealthy BMIs.

  15. Delayed-Onset Post-Keratoplasty Endophthalmitis Caused by Vancomycin-Resistant Enterococcus faecium

    Julio C. Hernandez-Camarena


    Full Text Available Background: Vancomycin-resistant Enterococcus (VRE endophthalmitis after penetrating keratoplasty (PKP is very rare, the management is a challenge due to both the pattern of antibiotic resistance and the aggressive nature of the infectious process. We report the first delayed-onset case of VRE endophthalmitis after PKP. Materials and Methods: Case report of a 51-year-old female with a 7-week history of PKP who arrived at the emergency room with signs and symptoms of endophthalmitis. Initial visual acuity was light perception, and a posterior pole exam was not possible due to the intense vitreous reaction. Mode B ultrasound was used to assess the posterior pole. The patient underwent pars plana vitrectomy and received intravitreous antibiotics. Results: Vitreous stains and cultures were positive for Enterococcus faecium resistant to vancomycin. Donor rim cultures and viral PCR were negative. Treatment was carried out by repeated intravitreal antibiotics and systemic linezolid. Clinical improvement was seen after the second dose of intravitreous antibiotics and systemic linezolid, but visual acuity remained at light perception consistent with the ischemic changes observed in the posterior pole. Conclusion: VRE endophthalmitis might be associated with positive donor rim cultures. Prompt use of systemic linezolid in addition to intravitreous antibiotics is recommendable, but even with prompt treatment, visual prognosis is guarded.

  16. Capsella rubella TGA4, a bZIP transcription factor, causes delayed flowering in Arabidopsis thaliana

    Li Maofu


    Full Text Available Flowering time is usually regulated by many environmental factors and endogenous signals. TGA family members are bZIP transcription factors that bind to the octopine synthase element, which has been closely linked to defense/stress responses. Most TGA factors interact with non-expressor of PR1 (NPR1 and plant defense responses are strengthened by this interaction. TGA1and TGA4factors bind to NPR1 only in salicylic acid (SA-induced leaves, suggesting that TGA4 has another function during plant development. Here, we isolated a bZIP transcription factor gene, TGA4, from Capsella rubella. TGA4transcripts were detected in most tissues, with high expression in leaves, low expression in stems and flowering buds, and undetectable in siliques. CruTGA4was over expressed in Arabidopsis thaliana wild typeCol-0 plants. Flowering time and total leaf number in the transgenic plants showed that overexpression of CruTGA4could delay flowering in A. thaliana. Our findings suggest that TGA4 may act as flowering regulator that controls plant flowering.

  17. Delayed-Onset Post-Keratoplasty Endophthalmitis Caused by Vancomycin-Resistant Enterococcus faecium

    Hernandez-Camarena, Julio C.; Bautista-de Lucio, Victor M.; Navas, Alejandro; Ramirez-Miranda, Arturo; Graue-Hernandez, Enrique O.


    Background Vancomycin-resistant Enterococcus (VRE) endophthalmitis after penetrating keratoplasty (PKP) is very rare, the management is a challenge due to both the pattern of antibiotic resistance and the aggressive nature of the infectious process. We report the first delayed-onset case of VRE endophthalmitis after PKP. Materials and Methods Case report of a 51-year-old female with a 7-week history of PKP who arrived at the emergency room with signs and symptoms of endophthalmitis. Initial visual acuity was light perception, and a posterior pole exam was not possible due to the intense vitreous reaction. Mode B ultrasound was used to assess the posterior pole. The patient underwent pars plana vitrectomy and received intravitreous antibiotics. Results Vitreous stains and cultures were positive for Enterococcus faecium resistant to vancomycin. Donor rim cultures and viral PCR were negative. Treatment was carried out by repeated intravitreal antibiotics and systemic linezolid. Clinical improvement was seen after the second dose of intravitreous antibiotics and systemic linezolid, but visual acuity remained at light perception consistent with the ischemic changes observed in the posterior pole. Conclusion VRE endophthalmitis might be associated with positive donor rim cultures. Prompt use of systemic linezolid in addition to intravitreous antibiotics is recommendable, but even with prompt treatment, visual prognosis is guarded. PMID:23185179

  18. Dengue Fever with rectus sheath hematoma: a case report.

    Sharma, Anurag; Bhatia, Sonia; Singh, Rajendra Pratap; Malik, Gaurav


    Dengue fever, also known as breakbone fever, is an infectious tropical disease caused by the Dengue virus. It is associated with a number of complications, which are well documented. However, Dengue fever associated with rectus sheath hematoma (RSH) is a very rare complication. Only one case report has been published prior supporting the association of Dengue fever with RSH. We report a case of Dengue fever who presented with RSH and was successfully treated conservatively. RSH is also an uncommon cause of acute abdominal pain. It is accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear.

  19. Acute cervical epidural hematoma: case report



    Full Text Available A 74 year-old patient with a nocturnal onset of neck and chest pain was brought to an emergency clinic. Physical examination and cardiac assessment were normal. Three hours after the addmittance, a flaccid paralysis of the four limbs supervened. Suspecting of an unusual onset of central nervous system infection, a lumbar puncture was performed, yielding 20 ml of normal cerebrospinal fluid. Thirty oinutes after the puncture, the patient completely regained neurological funcion. He was then referred to a General Hospital where a computed tomography (CT scan was done showing a large cervical epidural bleeding in the posterolateral region of C4/C5 extending to C7/Th1, along with a C6 vertebral body hemangioma. A magnetic resonance imaging revealed the same CT findings. A normal selective angiography of vertebral arteries, carotid arteries and thyreocervical trunk was carried out. Spontaneous spinal epidural hematoma (ASSEH is a rare but dramatic cause of neurological impairment. In this article we report a fortunate case of complete recovery after an unusual spine cord decompression. We also review the current literature concerning diagnosis and treatment of ASSEH.

  20. Full thickness burn caused by exposure to giant hogweed: delayed presentation, histological features and surgical management.

    Chan, Jeffrey C Y


    We report the case of a 10-year-old boy with a full thickness chemical burn on his right pretibial area due to phytophotodermatitis (PPD) following contact with giant hogweed (Heracleum mantegazzianum). Although cutaneous burns due to plants are a well-established cause of chemical burn, previous reports described partial thickness burns that healed with conservative measures. This patient presented to our unit two weeks after the initial injury with an established full thickness burn. Debridement and split thickness skin grafting was required. We presented the histological features of the debrided skin specimen and discussed potential factors leading to this unexpected full thickness injury.

  1. Delayed aortic regurgitation caused by a right coronary stent protruding into the aorta.

    Quintana, Eduard; Mestres, Carlos A; Congiu, Stefano; Josa, Miguel; Cartañá, Ramon


    Aortic valve perforation is an extremely rare complication after percutaneous coronary intervention. The case is presented of a 49-year-old male with aortic valve regurgitation secondary to the intra-aortic protrusion of a right coronary stent. The patient had undergone an apparently successful rescue percutaneous transluminal coronary angioplasty with a drug-eluting stent following failed fibrinolysis, but one month later was readmitted for acute pulmonary edema. Further investigations demonstrated new-onset aortic regurgitation. Medical stabilization was achieved and an elective aortic valve replacement and coronary revascularization performed. Intraoperatively, the stent was found to be partially deployed within the aortic lumen, causing perforation to the non-coronary cusp.

  2. A test of reactive scope: Reducing reactive scope causes delayed wound healing.

    DuRant, S E; Arciniega, M L; Bauer, C M; Romero, L M


    Reactive scope predicts that all animals have an adaptive ability to respond to stressors in their environment, termed reactive homeostasis, and that only when an animal's response to stressful stimuli exceeds a certain threshold (homeostatic overload) will stress have pathological effects. While this framework has successfully helped interpret effects of stressors on wildlife, no study has designed an experiment to directly test this framework. This study was designed to expose house sparrows (Passer domesticus) to treatments that would result in varying ranges of reactive homeostasis during chronic stress, which based on the reactive scope model should cause birds with the lowest reactive homeostasis range to exhibit signs of pathology during a subsequent challenge. To modulate the reactive homeostasis range, we altered allostatic load of birds by exposing them to chronic stress while either elevating, blocking, or not manipulating corticosterone. After concluding chronic stress treatments, birds were exposed to the subsequent challenge of a superficial wound. Individuals treated with corticosterone during chronic stress (high allostatic load) experienced the most pathology, including both weight loss and slower wound healing. Unmanipulated birds (medium allostatic load) also experienced weight loss but had normal healing rates, while birds with blocked corticosterone (low allostatic load) had minimal weight loss and normal healing rates. Our results indicate that increased allostatic load reduces the reactive homeostasis range, thereby causing individuals to cross the homeostatic overload threshold sooner, and thus support the reactive scope framework.

  3. Elucidation of the role of biological factors and device design in cerebral NIRS using an in vivo hematoma model based on high-intensity focused ultrasound

    Wang, Jianting; Huang, Stanley; Myers, Matthew; Chen, Yu; Welle, Cristin; Pfefer, Joshua


    Near-Infrared Spectroscopy (NIRS) is an emerging medical countermeasure for rapid, field detection of hematomas caused by traumatic brain injury (TBI). Bench and animal tests to determine NIRS sensitivity and specificity are needed. However, current animal models involving non-invasively induced, localized neural damage are limited. We investigated an in vivo murine hematoma model in which cerebral hemorrhage was induced noninvasively by high-intensity focused ultrasound (HIFU) with calibrated positioning and parameters. To characterize the morphology of induced hematomas, we used skull-intact histological evaluation. A multi-wavelength fiber-optic NIRS system with three source-detector separation distances was used to detect hematoma A 1.1 MHz transducer produced consistent small-to-medium hematoma localized to a single hemisphere, along with bruising of the scalp, with a low mortality rate. A 220 kHz transducer produced larger, more diffuse hematomas, with higher variability in size and a correspondingly higher mortality rate. No skin bruising or blood accumulation between the skin and skull was observed following injury application with the 220 kHz transducer. Histological analysis showed higher sensitivity for larger hematomas (>4x4 mm2). NIRS optical density change after HIFU was able to detect all hematomas, with sensitivity dependent on wavelength and separation distance. While improvements in methods for validating cerebral blood distribution are needed, the HIFU hematoma model provided useful insights that will inform development of biologically relevant, performance test methods for cerebral NIRS systems.

  4. Subdural hematoma in a teenager related to roller-coaster ride.

    Roldan-Valadez, Ernesto; Facha, M T; Martinez-Lopez, Manuel; Herrera-Mora, Patricia


    Reports about neurological injury related to roller-coaster rides mostly involve adults; we present a case of subdural hematoma in a pediatric patient presented 14 days after a roller-coaster ride. These rides show extreme up-and-down, to-and-fro, and rotatory acceleration/deceleration forces that could produce tensile and shearing stresses with tearing of bridging cerebral veins resulting in subdural hemorrhage. Pediatricians should consider roller-coaster riding a modern cause of subdural hematoma, as well as a possible cause of unexplained neurologic events in otherwise healthy adolescents.

  5. Non-contact hematoma damage and healing assessment using reflectance photoplethysmographic imaging

    Amelard, Robert; Pfisterer, Kaylen J.; Clausi, David A.; Wong, Alexander


    Impact trauma may cause a hematoma, which is the leakage of venous blood into surrounding tissues. Large hematomas can be dangerous as they may inhibit local blood ow. Hematomas are often diagnosed visually, which may be problematic if the hematoma leaks deeper than the visible penetration depth. Furthermore, vascular wound healing is often monitored at home without the aid of a clinician. We therefore investigated the use of near infrared (NIR) re ectance photoplethysmographic imaging (PPGI) to assess vascular damage resulting from a hematoma, and monitor the healing process. In this case study, the participant experienced internal vascular damage in the form of a hematoma. Using a PPGI system with dual-mode temporally coded illumination for ambient-agnostic data acquisition and mounted optical elements, the tissue was illuminated with a spatially uniform irradiance pattern of 850 nm wavelength light for increased tissue penetration and high oxy-to-deoxyhemoglobin absorption ratio. Initial and follow-up PPGI data collection was performed to assess vascular damage and healing. The tissue PPGI sequences were spectrally analyzed, producing spectral maps of the tissue area. Experimental results show that spatial differences in spectral information can be observed around the damaged area. In particular, the damaged site exhibited lower pulsatility than the surrounding healthy tissue. This pulsatility was largely restored in the follow-up data, suggesting that the tissue had undergone vascular healing. These results indicate that hematomas can be assessed and monitored in a non-contact visual manner, and suggests that PPGI can be used for tissue health assessment, with potential extensions to peripheral vascular disease.

  6. Rapamycin treatment causes developmental delay, pigmentation defects, and gastrointestinal malformation on Xenopus embryogenesis

    Moriyama, Yuki [Graduate School of Science and Technology, Shizuoka University, 836 Ohya, Suruga-ku, Shizuoka 422-8529 (Japan); Ohata, Yoshihisa [Department of Education (Sciences), Shizuoka University, 836 Ohya, Suruga-ku, Shizuoka 422-8529 (Japan); Mori, Shoko [Graduate School of Science and Technology, Shizuoka University, 836 Ohya, Suruga-ku, Shizuoka 422-8529 (Japan); Matsukawa, Shinya [Department of Education (Sciences), Shizuoka University, 836 Ohya, Suruga-ku, Shizuoka 422-8529 (Japan); Michiue, Tatsuo [Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo 153-8902 (Japan); Asashima, Makoto [Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo 153-8902 (Japan); Research Center for Stem Cell Engineering, National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Baien, Tsukuba, Ibaraki 305-8562 (Japan); Kuroda, Hiroki, E-mail: [Graduate School of Science and Technology, Shizuoka University, 836 Ohya, Suruga-ku, Shizuoka 422-8529 (Japan); Department of Education (Sciences), Shizuoka University, 836 Ohya, Suruga-ku, Shizuoka 422-8529 (Japan)


    Research highlights: {yields} Does famous anti-aging drug rapamycin work from the beginning of life? The answer is yes. {yields} This study shows that developmental speed of frog embryo was dose-dependently decreased by rapamycin treatment. {yields} In additions, morphogenetic effects such as less pigmentations and gut malformation are occurred by rapamycin. -- Abstract: Rapamycin is a drug working as an inhibitor of the TOR (target of rapamycin) signaling pathway and influences various life phenomena such as cell growth, proliferation, and life span extension in eukaryote. However, the extent to which rapamycin controls early developmental events of amphibians remains to be understood. Here we report an examination of rapamycin effects during Xenopus early development, followed by a confirmation of suppression of TOR downstream kinase S6K by rapamycin treatment. First, we found that developmental speed was declined in dose-dependent manner of rapamycin. Second, black pigment spots located at dorsal and lateral skin in tadpoles were reduced by rapamycin treatment. Moreover, in tadpole stages severe gastrointestinal malformations were observed in rapamycin-treated embryos. Taken together with these results, we conclude that treatment of the drug rapamycin causes enormous influences on early developmental period.

  7. Expression of a kinase-dead form of CPK33 involved in florigen complex formation causes delayed flowering.

    Kawamoto, Nozomi; Endo, Motomu; Araki, Takashi


    Regulation of flowering time is crucial for reproductive success of plants. FLOWERING LOCUS T (FT) protein is a central component of florigen and forms a ternary complex with 14-3-3 and FD, a basic leucine zipper transcription factor, in the shoot apex and promotes flowering. This complex formation requires phosphorylation of threonine residue at position 282 of FD. A calcium-dependent protein kinase CPK33 is responsible for the phosphorylation. However, possibly due to functional redundancy among calcium-dependent protein kinases, impact of the loss of CPK33 reported in the previous study was rather limited. Here, we report that expression of a kinase-dead form of CPK33 caused a clear delayed-flowering phenotype, supporting for an important role of CPK33 in florigen function through FD phosphorylation.

  8. Azimilide causes reverse rate-dependent block while reducing both components of delayed-rectifier current in canine ventricular myocytes.

    Gintant, G A


    Most class III antiarrhythmic drugs reduce the rapidly activating component of delayed-rectifier current (IKr) without affecting the slowly activating component (IKs). Recently the novel antiarrhythmic agent azimilide (NE-10064) was reported to enhance IKs at low (nanomolar) concentrations and to block both IKr and IKs at higher (micromolar) concentrations. Further to understand the electrophysiologic effects of azimilide, we compared its effects on IKr and IKs (by using whole cell clamp techniques) and action potentials (microelectrode and perforated-patch techniques) on canine ventricular myocytes. A lower azimilide concentration (50 nM) did not enhance IKs. In contrast, a therapeutic azimilide concentration (2 microM) was equieffective in reducing IKr (300-ms isochrones) and IKs (3-s isochrones) by approximately 40% during depolarizing test pulses, as well as reducing IKr (38% decrease) and IKs (33% decrease) tail currents on repolarization. Block of IKs was independent of voltage at positive test potentials. In action-potential studies, 50 nM azimilide had no effect on the action-potential duration (APD), whereas 2 microM azimilide delayed repolarization and caused reverse rate-dependent effects on the APD. Whereas the extent of APD prolongation by azimilide was not correlated with the drug-free APD, azimilide preferentially exaggerated the APD-rate relationship of myocytes displaying the steepest APD-rate relationship under drug-free conditions. In conclusion, therapeutic concentrations of azimilide that cause comparable reduction of canine ventricular IKr and IKs exert reverse rate-dependent effects, which are dependent on the steepness of the APD-rate relationship.

  9. Pontine tegmentum hematoma: report of a case with pure hemiplegia



    Full Text Available The authors report the case of a 50 year-old hypertensive male patient with a pontine hematoma. The clinical presentation was characterized by pure pyramidal deficit signs (no other signs or symptoms were present. A pure hemiplegia syndrome, although common in supratentorial lesions, is considered to be a rare event in pontine vascular lesions. The pathophysiologic mechanisms of these neurological findings are unclear. The exclusive involvement of the pyramidal tract in this case is likely due to a variation in the vascular anatomy of the pons but, in some cases, a vascular malformation may be the cause.

  10. Massive expanding hematoma of the chin following blunt trauma

    K Thanvir Mohamed Niazi


    Full Text Available Posttraumatic hematoma of the face is common and usually self-limiting in nature. We report an unusual massive expanding hematoma of the chin within 9 h following a blunt trauma with no associated injuries or fracture.

  11. Spinal epidural hematoma; Spinales epidurales Haematom

    Papanagiotou, P. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)


    Spinal epidural hematoma is an accumulation of blood in the potential space between the dura and bone. On unenhanced computed tomography epidural hemorrhage appears as a high-density spinal canal mass with variable cord compression. Magnetic resonance imaging is the modality of choice for evaluating spinal epidural hematoma and can demonstrate the extent of the hematoma and degree of cord compression. When treated surgically the outcome depends on the extent of preoperative neurological deficits and on the operative timing interval. (orig.) [German] Das spinale epidurale Haematom ist eine Blutansammlung zwischen Dura und Knochen. Die klinische Praesentation ist aehnlich dem akuten Bandscheibenvorfall, die Symptomatik ist allerdings in der Regel progredient. In der CT stellt sich ein frisches Haematom hyperdens dar. Die MRT ist die Methode der Wahl zur Diagnose spinaler epiduraler Haematome und kann die Ausdehnung sowie auch das Ausmass der Kompression darstellen. Die wichtigste Differenzialdiagnose vom epiduralen Haematom ist das epidurale Empyem. (orig.)

  12. Traumatic cervical epidural hematoma in an infant

    Vithal Rangarajan


    Full Text Available An 8-month-old male infant had presented with a history of a fall from the crib a fortnight ago. He had developed progressive weakness of both lower limbs. On examination, the infant had spastic paraplegia. Magnetic resonance (MR imaging of the cervical spine showed an epidural hematoma extending from the fourth cervical (C4 to the first dorsal (D1 vertebral level with cord compression. The patient had no bleeding disorder on investigation. He underwent cervical laminoplasty at C6 and C7 levels. The epidural hematoma was evacuated. The cervical cord started pulsating immediately. Postoperatively, the patient′s paraplegia improved dramatically in 48 hours. According to the author′s literature search, only seven cases of post-traumatic epidural hematoma have been reported in pediatric patients, and our patient is the youngest. The present case report discusses the etiopathology, presentation, and management of this rare case.

  13. Hematoma subperiosteal de órbita: relato de caso Subperiosteal hematoma of the orbit: case report


    Descrevemos um paciente de 16 anos que após traumatismo crânio-encefálico leve evoluiu com dor ocular, hematoma palpebral unilateral e proptose do olho esquerdo. Tomografia computadorizada de órbitas evidenciou hematoma subperiosteal em órbita esquerda. Foi realizada drenagem cirúrgica da coleção. O hematoma subperiosteal de órbita, apesar de raro, deve ser incluído como etiologia de proptose ocular e seu diagnóstico deve ser precoce a fim de evitar a morbidade associada.We describe a sixteen...

  14. A case of acoustic neurinoma associated with chronic subdural hematoma after gamma knife radiosurgery

    Sho, Atsuko; Asaeda, Masahiro; Ohtake, Minoru [Tottori Univ., Yonago (Japan). Inst. of Neurological Sciences] [and others


    A 72-year-old female presented with a unique case of acoustic neurinoma with a cystic component followed by the chronic subdural hematoma manifesting as trigeminal neuralgia, facial palsy and trunchal ataxia 7 months after gamma knife radiosurgery. Magnetic resonance imaging demonstrated a loss of central contrast enhancement at the postoperative residual tumor mass and a large cyst associated with a hematoma in the subdural space. A right suboccipital craniectomy was performed. A biopsy of the mass and the membrane was performed following aspiration of the brown-reddish fluid collection. The histological diagnosis was acoustic neurinoma with a hemorrhagic necrosis. The membranous tissue mimicked an outer membrane obtained from chronic subdural hematoma. The postoperative course was satisfactory and preoperative symptom have been alleviated. In this case, the chronic subdural hematoma occurred at posterior fossa during the development of cysts caused by the radiosurgery, because the subdural space had been connected with the subarachnoid space after the first operation. The development of cysts or hematoma should be taken into consideration as possible complications following treatment with gamma knife radiosurgery for acoustic neurinomas. (author)

  15. Hematoma in the cervical ligamentum flavum. Report of a case and review of the literature

    Tamura, Tatsuya; Sakai, Toshinori; Sairyo, Koichi; Katoh, Shinsuke; Yasui, Natsuo [The University of Tokushima Graduate School, Department of Orthopedics, Institute of Health Biosciences, Tokushima (Japan); Takao, Shoichiro [The University of Tokushima Graduate School, Department of Radiology, Institute of Health Biosciences, Tokushima (Japan); Kagawa, Seiko [The University of Tokushima Graduate School, Department of Human Pathology, Institute of Health Biosciences, Tokushima (Japan)


    Hematoma of the cervical ligamentum flavum is very rare, and its pathogenesis is unknown. We describe a case of ligamentum flavum hematoma in the cervical spine causing severe myelopathy. Postoperative histological examination suggested it was the result of the rupture of a hemangioma or of an arteriovenous malformation in the ligamentum flavum. After removal of the lesion, the patient's condition immediately improved. Review of all three reported cases, including this one, showed that complete resection of the mass resulted in immediate relief of symptoms of incomplete paraplegia. The findings of magnetic resonance imaging (MRI) of the hematoma may vary with time, and they may show no characteristic intensity. However, MRI of this case revealed that the tissues surrounding the mass were enhanced with gadolinium diethylene triamine penta-acetic acid, and an area of homogeneous iso-intensity was clearly surrounded by a low-intensity area (flavum) on T2-weighed short-tau inversion recovery images. These findings could be characteristic of the ligamentum flavum hematoma and might help in the differentiation from a cervical epidural hematoma. (orig.)

  16. Lateral abdominal wall hematoma as a rare complication after carotid artery stenting: a case report

    Satomi Jyunichiro


    Full Text Available Abstract Abdominal wall hematoma is a rare and life-threatening complication after carotid artery stenting (CAS, but it can occur when activated clotting time is prolonged. We report a right lateral abdominal wall hematoma caused by rupture of the superficial circumflex iliac artery after CAS in a 72-year-old man with severe stenosis of the origin of the right internal carotid artery. We performed CAS for the targeted lesion while activated clotting time exceeded 300 seconds. After 2 hours, he complained of right lateral abdominal pain. Abdominal computed tomography revealed an extensive hematoma in the right lateral abdominal wall. Activated clotting time was 180 seconds at this point. Seven hours later, he developed hypotension and hemoglobin level dropped to 11.3 g/dl. Subsequent computed tomography showed enlargement of the hematoma. Emergent selective angiography of the external iliac artery revealed active bleeding from the right superficial circumflex iliac artery. Transcatheter arterial embolization with Gelfoam and microcoils was performed successfully. With more CAS procedures being performed, it is important for endovascular surgeons and radiologists to consider the possibility of abdominal wall hematoma in this situation.

  17. Spontaneous spinal epidural hematoma presenting as paraplegia after cardiac surgery.

    Kin, Hajime; Mukaida, Masayuki; Koizumi, Junichi; Kamada, Takeshi; Mitsunaga, Yoshino; Iwase, Tomoyuki; Ikai, Akio; Okabayashi, Hitoshi


    An 86-year-old woman was scheduled to undergo aortic valve replacement and coronary artery bypass graft. On postoperative day 3, she developed sudden-onset neck pain followed by weakness in the right arm. Her symptoms worsened with time, and she developed paraplegia. At 60 h after the first complaint, spontaneous spinal epidural hematoma (SSEH) from C2 to C6 with spinal cord compression was diagnosed from a magnetic resonance image of the cervical region. We decided on conservative therapy because operative recovery was impossible. Delayed diagnosis led to grievous results in the present case. When neurological abnormalities follow neck or back pain after open heart surgery, SSEH must be considered in the differential diagnosis. Further, if it is suspected, early cervical computed tomography/magnetic resonance imaging and surgery should be considered.

  18. Spontaneous Epiglottic Hematoma Secondary to Supratherapeutic Anticoagulation

    Cody A. Koch


    Full Text Available Hemorrhage into the soft tissues of the airway represents a potentially life-threatening complication of long-term anticoagulation. We report the case of a chronically anticoagulated 37-year-old male who developed a spontaneous hematoma of the epiglottis secondary to a supra-therapeutic INR. Epiglottic hematoma should be considered in the differential of any anticoagulated patient presenting with upper airway compromise. The airway should be secured in a controlled fashion, and the coagulopathy should be rapidly corrected.

  19. Hematoma of the rectus abdominis caused by the application of warfarin sodium and other medicine%华法林钠与多药联用致腹直肌内血肿

    冉明月; 毛敏; 李春岩; 黄力


    was a cystic structure in the left abdominal rectus muscle with the size of 4.5 cm × 2.7 cm × 1.5 cm, and the internal circular high density shadow in the left rectus muscle was found on abdominal ultrasonography.Left abdominal rectus muscle hematoma was considered.Intramuscular injection of vitamin K1 10 mg once daily was given immediately, and ceftazidime was used instead of piperacillin sodium and tazobactam sodium.Two days later, the patient's symptoms of abdominal pain disappeared, PT fell to 16 s, INR fell to 1.11.One week later, oral warfarin sodium (initial dose 2.25 mg once daily)was given, and adjusted the dose according to INR.One month later, the abdominal ultrasound examination showed that the size of hematoma significantly decreased (3.5 cm × 0.8 cm).

  20. Simultaneous Intracranial and Spinal Subdural Hematoma: Two Case Reports

    Yoon, Chung Dae; Song, Chang Joon; Lee, Jeong Eun; Choi, Seung Won [Chungnam National University, Daejeon (Korea, Republic of)


    Spinal subdural hematoma is a rare disease. Simultaneous intracranial and spinal subdural hematoma is extremely rare and only 14 such cases have been reported. We report here on two cases of simultaneous intracranial and spinal subdural hematoma that occurred following a fall-down head injury and intracranial surgery, and we discuss the pathogenesis of the disease.

  1. Subperiosteal hematomas of the orbit: angiographic and computed tomographic diagnosis

    Seigel, R.S. (Univ. of New Mexico, Albuquerque); Williams, A.G.; Hutchison, J.W.; Wolter, J.R.; Carlow, T.J.; Rogers, D.E.


    Subperiosteal hematomas of the orbit are a rare complication of blunt head trauma that may on occasion occur spontaneously. Angiography and computed tomography (CT) were used in the diagnosis of three cases of subperiosteal hematoma. In the proper clinical setting, orbital CT can give a precise delineation of the size and extent of this hematoma.

  2. Delayed allergic dermatitis presenting as a keloid-like reaction caused by sting from an Indo-Pacific Portuguese man-o'-war (Physalia utriculus).

    Guevara, B E K; Dayrit, J F; Haddad, V


    Cnidarian envenomations are common occurrences in the tropics that can affect holidaymakers. The cutaneous reactions are classified as immediate or delayed types. Delayed allergic reactions are persistently recurring dermatitis, which can occur within 1-4 weeks from the initial sting, and may last for several months. Hypertrophic scar-like or keloid-like reactions are rare, and are believed to be a type IV hypersensitivity reaction to sequestered antigens from stinging filaments. We report an unusual case of delayed allergic dermatitis with keloid-like presentation caused by Physalia utriculus.

  3. A retropharyngeal-mediastinal hematoma with supraglottic and tracheal obstruction: The role of multidisciplinary airway management

    Birkholz Torsten


    Full Text Available A 77-year-old man suffered hypoxemic cardiac arrest by supraglottic and tracheal airway obstruction in the emergency department. A previously unknown cervical fracture had caused a traumatic retropharyngeal-mediastinal hematoma. A lifesaving surgical emergency tracheostomy succeeded. Supraglottic and tracheal obstruction by a retropharyngeal-mediastinal hematoma with successful resuscitation via emergency tracheostomy after hypoxemic cardiac arrest has never been reported in a context of trauma. This clinically demanding case outlines the need for multidisciplinary airway management systems with continuous training and well-implemented guidelines. Only multidisciplinary staff preparedness and readily available equipments for the unanticipated difficult airway solved the catastrophic clinical situation.

  4. Urgent-setting magnetic resonance imaging allows triage of extensive penoscrotal hematoma following blunt trauma

    Massimo Tonolini


    Full Text Available Although uncommon, blunt trauma to the perineum may cause serious injury to the penis. Differentiation between penile fracture with torn tunica albuginea versus extratunical or cavernosal hematomas is crucial because the former condition needs early surgical repair to avoid future deformity and erectile dysfunction, whereas approach is conservative with even large penoscrotal hematomas with albugineal integrity. Urgent-setting magnetic resonance imaging including multiplanar images of the injured penoscrotal region allows precise identification or exclusion of presence, site, and extent of tears of the tunica albuginea, providing a consistent basis for therapeutic choice.

  5. Subarachnoid hemorrhage and intracereebral hematoma following lumboperitoneal shunt for pseudotumor cerebri : a rare complication.

    Suri A


    Full Text Available Placement of lumboperitoneal (LP shunt as a surgical treatment for benign intracranial hypertension (BIH is generally a safe procedure, with complications like mechanical failure, overdrainage and infections. Subarachnoid hemorrhage and intracerebral hematoma were seen after lumboperitoneal shunt in a patient having BIH. These complications were the cause of the patient′s deterioration. After removal of the hematoma and performing a decompressive procedure, patient′s neurological condition improved. The clinical features, investigations and clinical course are described and the literature reviewed.

  6. A retropharyngeal–mediastinal hematoma with supraglottic and tracheal obstruction: The role of multidisciplinary airway management

    Birkholz, Torsten; Kröber, Stefanie; Knorr, Christian; Schiele, Albert; Bumm, Klaus; Schmidt, Joachim


    A 77-year-old man suffered hypoxemic cardiac arrest by supraglottic and tracheal airway obstruction in the emergency department. A previously unknown cervical fracture had caused a traumatic retropharyngeal–mediastinal hematoma. A lifesaving surgical emergency tracheostomy succeeded. Supraglottic and tracheal obstruction by a retropharyngeal–mediastinal hematoma with successful resuscitation via emergency tracheostomy after hypoxemic cardiac arrest has never been reported in a context of trauma. This clinically demanding case outlines the need for multidisciplinary airway management systems with continuous training and well-implemented guidelines. Only multidisciplinary staff preparedness and readily available equipments for the unanticipated difficult airway solved the catastrophic clinical situation. PMID:21063569

  7. Hematoma of the proximal nail fold due to oximeter in a child

    Patricia Chang


    Full Text Available Boy 4 years old, hospitalized due to hemorrhagic chickenpox and sepsis during his clinical examination besides hemorrhagic crust, vesicles and bullous he has also a cutaneous red lesion localized at the right proximal nail fold of the big toenail (Fig. 1, dermatoscopic view of the lesion (Fig. 2. The diagnosis of hematoma of the proximal nail fold due to oximeter was done. The proximal nail fold hematomas due to oximeter are uncommon dermatoses at this level that are caused for the pressure of the oximeter and it has been seeing in patient in Unit Intensive or Intermediate Unit Care since 2007.

  8. Retropharyngeal hematoma secondary to whiplash injury in childhood: a case report.

    Nurata, Hakan; Yilmaz, Muhammet Bahadır; Borcek, Alp Ozgun; Oner, Ali Yusuf; Baykaner, M Kemali


    Whiplash Associated Disorders (WAD) has been reported as an adult phenomenon. Whiplash injury has classically been described as a cervical soft tissue hyperextension- flexion injury after a trauma such as a rear end impact car crash, contact sport injuries, blows to the head from a falling object or a punch and shaken baby syndrome and is mostly seen in adults . It is important as it may cause severe disability due to spinal cord injury, decrease work productivity and even retropharyngeal hematoma resulting airway obstruction and mortality due to bleeding amongst deep cervical fascias. We describe a case of retropharyngeal hematoma after whiplash injury in a childhood.

  9. Dissecting Sub-epicardial Hematoma Due to Coronary Perforation and Non-developing Stent

    Guo Hangyuan; Xing Yangbo; Lee JongDae


    We report a 65-year-old man who presented with anastomotic perforation of the distal right coronary artery due to stent deployment, complicated by a small and stable dissecting sub-epicardial hematoma,and non-developing stent. The cause was unknown.

  10. Spinal Epidural Hematoma Following Cupping Glass Treatment in an Infant With Hemophilia A.

    Fruchtman, Yariv; Dardik, Rima; Barg, Assaf Arie; Livnat, Tami; Feldman, Zeev; Rubinstein, Marina; Grinberg, Gahl; Rosenberg, Nurit; Kenet, Gili


    A 6 months old infant, diagnosed with a rare mutation causing severe hemophilia A, presented with spinal epidural hematoma. Parents later admitted the infant had glass cupping therapy performed within 2 weeks of the onset of symptoms. The rare mutation, rare bleeding complication, and the eventual course of therapy applied in this case will be discussed in our case report.

  11. Endoscopic Surgery for Traumatic Acute Subdural Hematoma

    Hiroyuki Kon


    Full Text Available Traumatic acute subdural hematoma (ASDH is generally addressed by craniotomy under general anesthesia. We report a patient whose traumatic ASDH was treated under local anesthesia by one-burr-hole endoscopic surgery. This 87-year-old woman had undergone coil embolization for a ruptured right middle-cerebral artery aneurysm and placement of a ventriculoperitoneal shunt for normal pressure hydrocephalus 5 years earlier. Upon admission, she manifested consciousness disturbance after suffering head trauma and right hemiplegia. Her Glasgow Coma Scale score was 8 (E2V2M4. Computed tomography (CT demonstrated a thick, left-frontotemporal ASDH. Due to her advanced age and poor condition, we performed endoscopic surgery rather than craniotomy to evacuate the ASDH. Under local anesthesia, we made a burr hole in her left forehead and increased its size to 15 mm in diameter. After introducing a transparent sheath into the hematoma cavity with a rigid endoscope, the clot was evacuated with a suction tube. The arterial bleeding point was electrically coagulated. A postoperative CT scan confirmed the reduction of the hematoma. There was neither brain compression nor brain swelling. Her consciousness disturbance and right hemiplegia improved immediately. Endoscopic surgery may represent a viable method to address traumatic intracranial hematomas in some patients.

  12. Silencing of the ACC synthase gene ACACS2 causes delayed flowering in pineapple [Ananas comosus (L.) Merr.].

    Trusov, Yuri; Botella, José Ramón


    Flowering is a crucial developmental stage in the plant life cycle. A number of different factors, from environmental to chemical, can trigger flowering. In pineapple, and other bromeliads, it has been proposed that flowering is triggered by a small burst of ethylene production in the meristem in response to environmental cues. A 1-amino-cyclopropane-1-carboxylate synthase (ACC synthase) gene has been cloned from pineapple (ACACS2), which is induced in the meristem under the same environmental conditions that induce flowering. Two transgenic pineapple lines have been produced containing co-suppression constructs designed to down-regulate the expression of the ACACS2 gene. Northern analysis revealed that the ACACS2 gene was silenced in a number of transgenic plants in both lines. Southern hybridization revealed clear differences in the methylation status of silenced versus non-silenced plants by the inability of a methylation-sensitive enzyme to digest within the ACACS2 DNA extracted from silenced plants, indicating that methylation is the cause of the observed co-suppression of the ACACS2 gene. Flowering characteristics of the transgenic plants were studied under field conditions in South East Queensland, Australia. Flowering dynamics studies revealed significant differences in flowering behaviour, with transgenic plants exhibiting silencing showing a marked delay in flowering when compared with non-silenced transgenic plants and control non-transformed plants. It is argued that the ACACS2 gene is one of the key contributors towards triggering 'natural flowering' in mature pineapples under commercial field conditions.

  13. Successful disintegration, dissolution and drainage of intracholedochal hematoma by percutaneous transhepatic intervention

    Jian-Jie Qin; Yong-Xiang Xia; Ling Lv; Zhao-Jing Wang; Feng Zhang; Xue-Hao Wang; Bei-Cheng Sun


    Hemobilia is a rare biliary complication of liver transplantation.The predominant cause of hemobilia is iatrogenic,and it is often associated with traumatic operations,such as percutaneous liver intervention,endoscopic retrograde cholangiopancreatography,cholecystectomy,biliary tract surgery,and liver transplantation.Percutaneous transhepatic cholangiography and liver biopsy are two major causes of hemobilia in liver transplant recipients.Hemobilia may also be caused by coagulation defects.It can form intracholedochal hematomas,causing obstructive jaundice.Herein we describe a patient with an intracholedochal hematoma resulting in significant obstructive jaundice after liver transplantation for fulminant hepatic failure.Previous studies have shown that percutaneous transhepatic manipulation is a major cause of hemobilia after liver transplantation,but in our case,percutaneous transhepatic intervention was used to relieve the biliary obstruction and dissolve the biliary clot,with a good outcome.

  14. Delayed Presentation of Isolated Complete Pancreatic Transection as a Result of Sport-Related Blunt Trauma to the Abdomen

    Andrew J. Healey


    Full Text Available Introduction: Blunt abdominal trauma is a rare but well-recognized cause of pancreatic transection. A delayed presentation of pancreatic fracture following sport-related blunt trauma with the coexisting diagnostic pitfalls is presented. Case Report: A 17-year-old rugby player was referred to our specialist unit after having been diagnosed with traumatic pancreatic transection, having presented 24 h after a sporting injury. Despite haemodynamic stability, at laparotomy he was found to have a diffuse mesenteric hematoma involving the large and small bowel mesentery, extending down to the sigmoid colon from the splenic flexure, and a large retroperitoneal hematoma arising from the pancreas. The pancreas was completely severed with the superior border of the distal segment remaining attached to the splenic vein that was intact. A distal pancreatectomy with spleen preservation and evacuation of the retroperitoneal hematoma was performed. Discussion/Conclusion: Blunt pancreatic trauma is a serious condition. Diagnosis and treatment may often be delayed, which in turn may drastically increase morbidity and mortality. Diagnostic difficulties apply to both paraclinical and radiological diagnostic methods. A high index of suspicion should be maintained in such cases, with a multi-modality diagnostic approach and prompt surgical intervention as required.

  15. Loss of epithelial FAM20A in mice causes amelogenesis imperfecta, tooth eruption delay and gingival overgrowth

    Li, Li-Li; Liu, Pei-Hong; Xie, Xiao-Hua; Ma, Su; Liu, Chao; Chen, Li; Qin, Chun-Lin


    FAM20A has been studied to a very limited extent. Mutations in human FAM20A cause amelogenesis imperfecta, gingival fibromatosis and kidney problems. It would be desirable to systemically analyse the expression of FAM20A in dental tissues and to assess the pathological changes when this molecule is specifically nullified in individual tissues. Recently, we generated mice with a Fam20A-floxed allele containing the beta-galactosidase reporter gene. We analysed FAM20A expression in dental tissues using X-Gal staining, immunohistochemistry and in situ hybridization, which showed that the ameloblasts in the mouse mandibular first molar began to express FAM20A at 1 day after birth, and the reduced enamel epithelium in erupting molars expressed a significant level of FAM20A. By breeding K14-Cre mice with Fam20Aflox/flox mice, we created K14-Cre;Fam20Aflox/flox (conditional knock out, cKO) mice, in which Fam20A was inactivated in the epithelium. We analysed the dental tissues of cKO mice using X-ray radiography, histology and immunohistochemistry. The molar enamel matrix in cKO mice was much thinner than normal and was often separated from the dentinoenamel junction. The Fam20A-deficient ameloblasts were non-polarized and disorganized and were detached from the enamel matrix. The enamel abnormality in cKO mice was consistent with the diagnosis of amelogenesis imperfecta. The levels of enamelin and matrix metalloproteinase 20 were lower in the ameloblasts and enamel of cKO mice than the normal mice. The cKO mice had remarkable delays in the eruption of molars and hyperplasia of the gingival epithelium. The findings emphasize the essential roles of FAM20A in the development of dental and oral tissues. PMID:27281036

  16. Loss of epithelial FAM20A in mice causes amelogenesis imperfecta, tooth eruption delay and gingival overgrowth.

    Li, Li-Li; Liu, Pei-Hong; Xie, Xiao-Hua; Ma, Su; Liu, Chao; Chen, Li; Qin, Chun-Lin


    FAM20A has been studied to a very limited extent. Mutations in human FAM20A cause amelogenesis imperfecta, gingival fibromatosis and kidney problems. It would be desirable to systemically analyse the expression of FAM20A in dental tissues and to assess the pathological changes when this molecule is specifically nullified in individual tissues. Recently, we generated mice with a Fam20A-floxed allele containing the beta-galactosidase reporter gene. We analysed FAM20A expression in dental tissues using X-Gal staining, immunohistochemistry and in situ hybridization, which showed that the ameloblasts in the mouse mandibular first molar began to express FAM20A at 1 day after birth, and the reduced enamel epithelium in erupting molars expressed a significant level of FAM20A. By breeding K14-Cre mice with Fam20A(flox/flox) mice, we created K14-Cre;Fam20A(flox/flox) (conditional knock out, cKO) mice, in which Fam20A was inactivated in the epithelium. We analysed the dental tissues of cKO mice using X-ray radiography, histology and immunohistochemistry. The molar enamel matrix in cKO mice was much thinner than normal and was often separated from the dentinoenamel junction. The Fam20A-deficient ameloblasts were non-polarized and disorganized and were detached from the enamel matrix. The enamel abnormality in cKO mice was consistent with the diagnosis of amelogenesis imperfecta. The levels of enamelin and matrix metalloproteinase 20 were lower in the ameloblasts and enamel of cKO mice than the normal mice. The cKO mice had remarkable delays in the eruption of molars and hyperplasia of the gingival epithelium. The findings emphasize the essential roles of FAM20A in the development of dental and oral tissues.

  17. Haploinsufficiency of HDAC4 causes brachydactyly mental retardation syndrome, with brachydactyly type E, developmental delays, and behavioral problems.

    Williams, Stephen R; Aldred, Micheala A; Der Kaloustian, Vazken M; Halal, Fahed; Gowans, Gordon; McLeod, D Ross; Zondag, Sara; Toriello, Helga V; Magenis, R Ellen; Elsea, Sarah H


    Brachydactyly mental retardation syndrome (BDMR) is associated with a deletion involving chromosome 2q37. BDMR presents with a range of features, including intellectual disabilities, developmental delays, behavioral abnormalities, sleep disturbance, craniofacial and skeletal abnormalities (including brachydactyly type E), and autism spectrum disorder. To date, only large deletions of 2q37 have been reported, making delineation of a critical region and subsequent identification of candidate genes difficult. We present clinical and molecular analysis of six individuals with overlapping deletions involving 2q37.3 that refine the critical region, reducing the candidate genes from >20 to a single gene, histone deacetylase 4 (HDAC4). Driven by the distinct hand and foot anomalies and similar cognitive features, we identified other cases with clinical findings consistent with BDMR but without a 2q37 deletion, and sequencing of HDAC4 identified de novo mutations, including one intragenic deletion probably disrupting normal splicing and one intragenic insertion that results in a frameshift and premature stop codon. HDAC4 is a histone deacetylase that regulates genes important in bone, muscle, neurological, and cardiac development. Reportedly, Hdac4(-/-) mice have severe bone malformations resulting from premature ossification of developing bones. Data presented here show that deletion or mutation of HDAC4 results in reduced expression of RAI1, which causes Smith-Magenis syndrome when haploinsufficient, providing a link to the overlapping findings in these disorders. Considering the known molecular function of HDAC4 and the mouse knockout phenotype, taken together with deletion or mutation of HDAC4 in multiple subjects with BDMR, we conclude that haploinsufficiency of HDAC4 results in brachydactyly mental retardation syndrome.

  18. Orbital subperiosteal hematoma from scuba diving.

    Rosenberry, Clark; Angelidis, Matthew; Devita, Diane


    Only a few cases of nontraumatic orbital subperiosteal hematoma due to scuba diving have been reported, and this is the first of such cases that underwent surgical intervention. This injury results from negative pressure within the face mask, suctioning orbital tissues into the mask after incomplete equilibration of pressure on descent. Valsalva maneuver is a second mechanism implicated in the etiology of this injury. Recognition of this injury is of the utmost importance because vision loss is a possible complication if there is compression of the optic nerve or increased intraocular pressure. In many cases of nontraumatic orbital hematoma, conservative management is adequate; however, this case was an exception due to worsening exam findings. Divers may be able to prevent this injury by frequent and gentle equilibration of mask pressure on descent.

  19. Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor

    Khaled M Krisht


    Full Text Available Background: Malignant peripheral nerve sheath tumors (MPNSTs of the brachial plexus have unique radiographic and clinical findings. Patients often present with progressive upper extremity paresthesias, weakness, and pain. On magnetic resonance (MR imaging, lesions are isointense on T1-weighted and hyperintense on T2-weighted sequences, while also demonstrating marked enhancement on MR studies with gadolinium diethylenetriamine pentaacetic acid. On the basis of their characteristic MR imaging features and rapid clinical progression, two brachial plexus lesions proved to be organizing hematomas rather than MPNST. Methods: A 51-year-old male and a 31-year-old female were both assessed for persistent and worsened left-sided upper extremity pain, paresthesias, and weakness. In both cases, the MR imaging of the brachial plexus demonstrated an extraspinal enhancing lesion located within the left C7-T1 neuroforamina. Results: Although the clinical and radiographic MR features for these 2 patients were consistent with MPNSTs, both lesions proved to be benign organizing hematomas. Conclusions: These two case studies emphasize that brachial plexus hematomas may mimic MPNSTs on MR studies. Accurate diagnosis of these lesions is critical for determining the appropriate management options and treatment plans. Delaying the treatment of a highly aggressive nerve sheath tumor can have devastating consequences, whereas many hematomas resolve without surgery. Therefore, if the patient has stable findings on neurological examination and a history of trauma, surgical intervention may be delayed in favor of repeat MR imaging in 2-3 months to re-evaluate the size of the mass.

  20. Subcapsular hepatic hematoma. Serious complication during pregnancy

    María Teresa Pérez Hernández


    Full Text Available Subcapsular hepatic hematoma is a rare complication during pregnancy, but potentially lethal and usually related to severe pre-eclampsia or HELLP syndrome (hemolysis, elevated liver enzymes and diminished platelets. Maternal and perinatal mortality in these cases is high, hence the importance of early diagnosis and timely and multidisciplinary treatment. This paper is a review on the subject, held in Ebsco, Hinari and Sci databases.

  1. Urologic manifestations of the iliacus hematoma syndrome.

    Colapinto, V; Comisarow, R H


    Anticoagulated patients may have a characteristic syndrome of femoral neuropathy from an iliacus muscle hematoma. They may present with urologic signs and symptoms, including groin, flank and thigh pain, groin tenderness, an iliac fossa mass and hematuria. Urography may reveal an enlarged psoas shadow and hydronephrosis from ureteral obstruction. Prompt diagnosis is essential so that early operative decompression of the femoral nerve can be done. The urologist has an important role in the diagnosis and treatment of this syndrome.

  2. Idiopathic Adrenal Hematoma Masquerading as Neoplasm

    Kazuki Sasaki


    Full Text Available We report herein a case of idiopathic adrenal hematoma. A 59-year-old Japanese man was referred to our hospital for evaluation of a 7.0 cm mass in the right upper abdominal cavity. The tumor was suspected to originate from either the posterior segment of the liver or the right adrenal gland. His chief complaint was weight loss of 8 kg over the previous 6 months. He had no past medical history and took no medications, including no anticoagulants. Laboratory data were almost normal except for a slight elevation of PIVKA-II. The origin of the tumor was found to be the adrenal gland, as angiography revealed the blood supply to the mass to derive from the right superior and inferior adrenal arteries. A fine needle biopsy of the lesion was unable to confirm the diagnosis. Open right adrenalectomy was performed. The histopathological findings of the surgical specimen revealed a hematoma with normal adrenal tissue. In the absence of any obvious etiology, the diagnosis was idiopathic adrenal hematoma.

  3. Association of Antithrombotic Drug Use With Subdural Hematoma Risk

    Gaist, David; Rodríguez, Luis Alberto García; Hellfritzsch, Maja


    Importance: Incidence of subdural hematoma has been reported to be increasing. To what extent this is related to increasing use of antithrombotic drugs is unknown. Objectives: To estimate the association between use of antithrombotic drugs and subdural hematoma risk and determine trends in subdural...... with antithrombotic drug use, subdural hematoma incidence rate, and annual prevalence of treatment with antithrombotic drugs. Results: Among 10 010 patients with subdural hematoma (mean age, 69.2 years; 3462 women [34.6%]), 47.3% were taking antithrombotic medications. Current use of low-dose aspirin (cases: 26...... hematoma incidence and antithrombotic drug use in the general population. Design, Setting, and Participants: Case-control study of 10 010 patients aged 20 to 89 years with a first-ever subdural hematoma principal discharge diagnosis from 2000 to 2015 matched by age, sex, and calendar year to 400...

  4. Chronic lumbar epidural hematoma in a patient suffering with spondylolytic spondylolisthesis at the L4-5 level: a case report

    Park, Hyeon Seon; Lee, Sang Ho; Lie, Wei Chiang; Park, Jee Young [Wooridul Spine Hospital, Seoul (Korea, Republic of); Lee, Sang Yeun [Chuk Spine Hospital, Seoul (Korea, Republic of)


    Nontraumatic spinal epidural hematoma (SEH) is a rare condition and the exact cause of the hemorrhage in SEH had never been established. However, there have been a few recent reports on some types of the epidural hematoma with a detectable origin of hemorrhage. We encountered a case of chronic SEH in a patient who had spondylolytic spondylolisthesis, which is also a rare condition to be associated with SEH. We report here on the radiologic findings of a case of chronic epidural hematoma in a patient who had spondylolytic spondylolisthesis at the L4-5 level, and we include a review of the related literatures.

  5. Hematoma shape, hematoma size, Glasgow coma scale score and ICH score: which predicts the 30-day mortality better for intracerebral hematoma?

    Chih-Wei Wang

    Full Text Available To investigate the performance of hematoma shape, hematoma size, Glasgow coma scale (GCS score, and intracerebral hematoma (ICH score in predicting the 30-day mortality for ICH patients. To examine the influence of the estimation error of hematoma size on the prediction of 30-day mortality.This retrospective study, approved by a local institutional review board with written informed consent waived, recruited 106 patients diagnosed as ICH by non-enhanced computed tomography study. The hemorrhagic shape, hematoma size measured by computer-assisted volumetric analysis (CAVA and estimated by ABC/2 formula, ICH score and GCS score was examined. The predicting performance of 30-day mortality of the aforementioned variables was evaluated. Statistical analysis was performed using Kolmogorov-Smirnov tests, paired t test, nonparametric test, linear regression analysis, and binary logistic regression. The receiver operating characteristics curves were plotted and areas under curve (AUC were calculated for 30-day mortality. A P value less than 0.05 was considered as statistically significant.The overall 30-day mortality rate was 15.1% of ICH patients. The hematoma shape, hematoma size, ICH score, and GCS score all significantly predict the 30-day mortality for ICH patients, with an AUC of 0.692 (P = 0.0018, 0.715 (P = 0.0008 (by ABC/2 to 0.738 (P = 0.0002 (by CAVA, 0.877 (P<0.0001 (by ABC/2 to 0.882 (P<0.0001 (by CAVA, and 0.912 (P<0.0001, respectively.Our study shows that hematoma shape, hematoma size, ICH scores and GCS score all significantly predict the 30-day mortality in an increasing order of AUC. The effect of overestimation of hematoma size by ABC/2 formula in predicting the 30-day mortality could be remedied by using ICH score.

  6. Spontaneous acute subdural hematoma in a patient with multiple myeloma

    Abrar Ahad Wani


    Full Text Available Acute spontaneous subdural hematoma in a patient of multiple myeloma receiving chemotherapy is an unknown event, needing an urgent neurosurgical management. We report this patient who presented with progressive neurological deterioration and a low platelet count. She was successfully managed by craniotomy and evacuation of subdural hematoma with intraoperative transfusion of platelets. The acute spontaneous subdural hematoma in her was probably related to the bleeding diathesis due to thrombocytopenia associated with chemotherapy.

  7. Minimally Invasive Surgical Treatment of Acute Epidural Hematoma: Case Series

    Weijun Wang


    Full Text Available Background and Objective. Although minimally invasive surgical treatment of acute epidural hematoma attracts increasing attention, no generalized indications for the surgery have been adopted. This study aimed to evaluate the effects of minimally invasive surgery in acute epidural hematoma with various hematoma volumes. Methods. Minimally invasive puncture and aspiration surgery were performed in 59 cases of acute epidural hematoma with various hematoma volumes (13–145 mL; postoperative follow-up was 3 months. Clinical data, including surgical trauma, surgery time, complications, and outcome of hematoma drainage, recovery, and Barthel index scores, were assessed, as well as treatment outcome. Results. Surgical trauma was minimal and surgery time was short (10–20 minutes; no anesthesia accidents or surgical complications occurred. Two patients died. Drainage was completed within 7 days in the remaining 57 cases. Barthel index scores of ADL were ≤40 (n=1, 41–60 (n=1, and >60 (n=55; scores of 100 were obtained in 48 cases, with no dysfunctions. Conclusion. Satisfactory results can be achieved with minimally invasive surgery in treating acute epidural hematoma with hematoma volumes ranging from 13 to 145 mL. For patients with hematoma volume >50 mL and even cerebral herniation, flexible application of minimally invasive surgery would help improve treatment efficacy.

  8. Acrolein inhalation causes myocardial strain delay and decreased cardiac performance as detected by high-frequency echocardiography in mice

    Acrolein, an unsaturated aldehyde found in air pollution, impairs Ca2+ flux and contraction in cardiomyocytes in vitro. To better define direct and delayed functional cardiac effects, we hypothesized that a single exposure to acrolein would modify myocardial strain and performanc...

  9. Immediate Extinction Causes a Less Durable Loss of Performance than Delayed Extinction following Either Fear or Appetitive Conditioning

    Woods, Amanda M.; Bouton, Mark E.


    Five experiments with rat subjects compared the effects of immediate and delayed extinction on the durability of extinction learning. Three experiments examined extinction of fear conditioning (using the conditioned emotional response method), and two experiments examined extinction of appetitive conditioning (using the food-cup entry method). In…

  10. [Renal angiomyolipoma complicated by retroperitoneal hematoma].

    Rabii, R; Fekak, H; Moufid, K; Joual, A; Benjelloun, S; Khaleq, K; Idali, B; Harti, A; Barrou, L


    Renal angiomyolipoma (AML) is a benign tumor, they are generally asymptomatic or can manifested by abdominal pain, palpable mass or hematuria. We report an uncommoun case of 65 years old women who consulted for retroperitoneal hemorrhage by spontaneous rupture of renal AML with palpable mass. The ultrasound and CT abdominopelvic scan were performed in the preoperative diagnosis and showed a typical right renal AML with retroperitoneal hematoma. The right nephrectomy by transperitoneal approach was performed with a good follow-up. The histological examination confirmed the diagnosis for renal AML. About this case, the authors discuses the diagnosis and the management for AML with retroperitoneal hemorrhage.

  11. Immediate extinction causes a less durable loss of performance than delayed extinction following either fear or appetitive conditioning

    Woods, Amanda M.; Bouton, Mark E.


    Five experiments with rat subjects compared the effects of immediate and delayed extinction on the durability of extinction learning. Three experiments examined extinction of fear conditioning (using the conditioned emotional response method), and two experiments examined extinction of appetitive conditioning (using the food-cup entry method). In all experiments, conditioning and extinction were accomplished in single sessions, and retention testing took place 24 h after extinction. In both f...

  12. Delay in diagnosis of cancer as a patient safety issue - a root cause analysis based on a representative case report

    Mansour Paul


    Full Text Available Abstract Background It is well known in the literature that imaging has almost no value for diagnosis of superficial bladder cancer. However, wide gap exists between knowledge on diagnosis of bladder cancer and actual clinical practice. Case presentation Delay in diagnosis of bladder cancer in a male person with tetraplegia occurred because of reliance on negative flexible cystoscopy and single biopsy, negative ultrasound examination of urinary bladder, and computerised tomography of pelvis. Difficulties in scheduling cystoscopy also contributed to a delay of nearly ten months between the onset of haematuria and establishing a histological diagnosis of vesical malignancy in this patient. The time interval between transurethral resection and cystectomy was 42 days. This delay was mainly due to scheduling of surgery. Conclusion We learn from this case that doctors should be aware of the limitations of negative flexible cystoscopy and single biopsy, cytology of urine, ultrasound examination of urinary bladder, and computed tomography of pelvis for diagnosis of bladder cancer in spinal cord injury patients. Random bladder biopsies must be considered under general anaesthesia when there is high suspicion of bladder cancer. Spinal cord injury patients with lesions above T-6 may develop autonomic dysreflexia; therefore, one should be extremely well prepared to prevent or manage autonomic dysreflexia when performing cystoscopy and bladder biopsy. Spinal cord injury patients, who pass blood in urine, should be accorded top priority in scheduling of investigations and surgical procedures.

  13. Extramedullary Hematopoiesis: An Unusual Finding in Subdural Hematomas

    Rong Li


    Full Text Available We present a case of a 59-year-old man who was found to have clusters of hyperchromatic, small, round nucleated cells within a subdural hematoma removed after a skull fracture. Immunohistochemistry study confirmed that the cells were hematopoietic components predominantly composed of normoblasts. In this paper, we describe the clinical and pathological findings. A brief review of published information on extramedullary hematopoiesis in subdural hematoma and the mechanisms of pathogenesis are also discussed. While extramedullary hematopoiesis is seen anecdotally by neuropathologists in chronic subdural hematomas, only a few cases are documented in the literature. Furthermore, extramedullary hematopoiesis in subdural hematoma can pose a diagnostic challenge for general pathologists who encounter subdural hematoma evacuations seldom in their surgical pathology practices.

  14. [Spontaneous epidural hematoma after open heart surgery: case report].

    Anegawa, S; Hayashi, T; Furukawa, Y; Nagashima, T; Kumate, M


    Acute epidural hematoma not associated with head injury is rarely encountered and is known as spontaneous epidural hematoma. To our knowledge, only five cases with epidural hematoma after open-heart surgery have been published. Pathogenesis and preventive measures have not yet been determined. We report a case of such spontaneous epidural hematoma and consider the possible pathogenesis. A 12-year-old female received a radical operation for severe subaortic stenosis. The intraoperative course was uneventful except for massive hemorrhage which was adequately controlled. Postoperatively, she was moved to the CCU still not having aroused from anesthesia. Eleven hours later, it was found that her pupils were fixed and dilated. CT scan demonstrated a huge bifrontal epidural hematoma with disappearance of the basal cistern. Even though immediate emergency evacuation was performed, the patient died of acute brain swelling four days after the operation.

  15. Cerebral venous sinus thrombosis complicated by subdural hematomas: Case series and literature review

    Akins, Paul T.; Axelrod, Yekaterina K; Ji, Cheng; Ciporen, Jeremy N.; Arshad, Syed T.; Hawk, Mark W.; Guppy, Kern H.


    Background: Cerebral venous sinus thrombosis (CVST) can cause elevated intracranial pressure, hemorrhagic venous infarct, and cortical subarachnoid hemorrhage. We present a case series and literature review to illustrate that CVST can also present with subdural hematoma (SDH). Case Description: Chart review was completed on a retrospective case series of CVST with spontaneous SDH. We also conducted a literature search. Over a 6 year interval, three patients with CVST and SDH were admitted to ...

  16. Longterm surgery of posttraumatic intracranial hematoma

    Babochkin D.S.


    Full Text Available Purpose. Research objective — studying of consequences of the operated traumatic intracranial hematomas in the remote period. Material. The nearest and remote results of the operated traumatic intracranial hematomas at 105 patients in terms from 6 months till 3 years are analyzed. During research the anamnesis was studied, neurologic investigation, and also research cognitive functions by means of scale MMSE, the test of drawing of hours, a scale of studying of alarm/depression HADS, learning of 5 words, scale quality of life SF-36. Results. It is established, that in the remote period the condition of the majority of patients gradually improves, at the same time, frequent enough and expressed consequences which are necessary for analyzing with the purpose of optimization of outcomes and the forecast at the given disease are observed. The special attention should be given again developing complications to which it is possible to carry epileptic seizures and behavioral-memorable infringements. Conclusion. Studying of the remote consequences of this heavy kind of craniocereberal trauma allows to optimize results of treatment and to provide complex medical, labor, social and family adaptation

  17. Acute Spontaneous Posterior Fossa Subdural Hematoma

    Osama Shukir Muhammed Amin


    Full Text Available Acute posterior fossa subdural hematomas are rare and most of them are trauma-related. Non-traumatic ones have been reported in patients who had idiopathic thrombocytopenic purpura or those who had been receiving anticoagulant therapy. We report on the case of 57-year-old Iranian man who developed sudden severe occipital headache, drowsiness, repeated vomiting, and instability of stance and gait. He was neither hypertensive nor diabetic. No history of head trauma was obtained and he denied illicit drug or alcohol ingestion. A preliminary diagnosis of acute intra-cerebellar hemorrhage was made. His CT brain scan revealed an acute right-sided, extra-axial, crescent-shaped hyperdense area at the posterior fossa. His routine blood tests, platelets count, bleeding time, and coagulation profile were unremarkable. The patient had spontaneous acute infratentorial subdural hematoma. He was treated conservatively and discharged home well after 5 days. Since then, we could not follow-up him, clinically and radiologically because he went back to Iran. Our patient’s presentation, clinical course, and imaging study have called for conservative management, as the overall presentation was relatively benign. Unless the diagnosis is entertained and the CT brain scan is well-interpreted, the diagnosis may easily escape detection.

  18. [Unilateral spontaneous adrenal hematoma: an unusual cause of retroperitoneal hemorrhage].

    Vendrell, J R; Alcover, J; Alcaraz, A; Llopis, J; Gutierrez, R; Barranco, M A; Carretero, P


    Presentation of one case of spontaneous retroperitoneal haemorrhage in a 72 year-old male, his first symptom being a left retrothoracic pain of sudden onset. The supplementary studies performed (ultrasound, CAT and MNR) pointed to the adrenal gland as the origin of the haemorrhage. Faced eith the uncertainty of the etiological diagnosis, a left supra-renalectomy was conducted which confirmed the pathological anatomy of the piece and the presence of massive haematoma of the suprarenal gland with no other pathological data. The clinical, diagnostic and therapeutical aspects are discussed.

  19. Clinical characteristics and prognosis of traumatic basal ganglia hematomas: A retrospective analysis of 40 cases

    Jialiang Li; Chunjiang Yu


    AIM: To retrospectively analyze the pathogenesis, clinical characteristics, treatment and prognostic characteristics in patients with traumatic basal ganglia hematomas (TBGH).METHODS: A retrospective analysis of the clinical data was performed in 40 patients with TBGH who were selected from 1 250 patients with closed brain injury, who admitted to the Department of Neurosurgery of Shangqiu First People's Hospital from January 1990 to January 2004. The pathogenesis, clinical characteristics and signs, results of radiological examination, treatment and prognostic characteristics were analyzed. The patients all had definite history of brain injury, manifested by neurological functional disturbance to different extent after brain injury, and basal ganglia hemorrhage was identified by CT after brain injury, and hemorrhagic volume were more than or equal to 2 mL. Totally 34 males and 6 females were enrolled, aged 16-72 years and 28 cases of them were younger than 40 years old. The prognosis of the patients was evaluated with Glasgow outcome scale (GOS) at 6 months after injury, and GOS scoring standard was 1-5 points (1 for dead; 2 for vegetative survival, long-term coma, manifestations of decorticate rigidity or decerebrate rigidity; 3 for severely disabled, should be look after by others; 4 for moderately disabled, be able in self-care; 5 for good recovery, adults can work and study).RESULTS: The enrolled cases accounted for 3.20% of the 1250 patients with closed brain injury admitted at the same period. ① The causes of injury included traffic accident in 36 cases, fall in 2 cases, and assault in 2 cases. ② At admission, the Glasgow coma scale (GCS) scores were as follow: 13-15 scores (mild) in 10 cases,9-12 scores (moderate)in 20 cases, and 3-8 scores (severe) in 10 cases. Hemiplegia presented in 37 cases,aphasia in 20 cases, conscious disturbance in 10 cases, unilateral mydriasis in 6 cases, and decerebrate rigidity in 2 cases. ③ TBGH was detected by CT within

  20. Delayed low frequency hearing loss caused by cochlear implantation interventions via the round window but not cochleostomy.

    Rowe, David; Chambers, Scott; Hampson, Amy; Eastwood, Hayden; Campbell, Luke; O'Leary, Stephen


    Cochlear implant recipients show improved speech perception and music appreciation when residual acoustic hearing is combined with the cochlear implant. However, up to one third of patients lose their pre-operative residual hearing weeks to months after implantation, for reasons that are not well understood. This study tested whether this "delayed" hearing loss was influenced by the route of electrode array insertion and/or position of the electrode array within scala tympani in a guinea pig model of cochlear implantation. Five treatment groups were monitored over 12 weeks: (1) round window implant; (2) round window incised with no implant; (3) cochleostomy with medially-oriented implant; (4) cochleostomy with laterally-oriented implant; and (5) cochleostomy with no implant. Hearing was measured at selected time points by the auditory brainstem response. Cochlear condition was assessed histologically, with cochleae three-dimensionally reconstructed to plot electrode paths and estimate tissue response. Electrode array trajectories matched their intended paths. Arrays inserted via the round window were situated nearer to the basilar membrane and organ of Corti over the majority of their intrascalar path compared with arrays inserted via cochleostomy. Round window interventions exhibited delayed, low frequency hearing loss that was not seen after cochleostomy. This hearing loss appeared unrelated to the extent of tissue reaction or injury within scala tympani, although round window insertion was histologically the most traumatic mode of implantation. We speculate that delayed hearing loss was related not to the electrode position as postulated, but rather to the muscle graft used to seal the round window post-intervention, by altering cochlear mechanics via round window fibrosis.

  1. [Could phimosis have been the cause of sexual difficulties and delayed fertility of Louis XVI (1754-1793)?].

    Androutsos, Georges


    The great majority of historians agree that the marriage of Louis XVI and Marie-Antoinette was only consumated seven years after the official ceremony. This delay could have been due to a genital malformation (phimosis) of Louis XVI, a strict religious education, a traumatic childhood and the young age of the two spouses, factors that may have inhibited their sexuality. In this article, the authors try to determine whether Louis XVI was able to overcome his sexual difficulties following an operation (circumcision) or as a result of spontaneous cure.

  2. Delayed CO2 emissions from mid-ocean ridge volcanism as a possible cause of late-Pleistocene glacial cycles

    Huybers, Peter; Langmuir, Charles H.


    The coupled 100,000 year variations in ice volume, temperature, and atmospheric CO2 during the late Pleistocene are generally considered to arise from a combination of orbital forcing, ice dynamics, and ocean circulation. Also previously argued is that changes in glaciation influence atmospheric CO2 concentrations through modifying subaerial volcanic eruptions and CO2 emissions. Building on recent evidence that ocean ridge volcanism responds to changes in sea level, here it is suggested that ocean ridges may play an important role in generating late-Pleistocene 100 ky glacial cycles. If all volcanic CO2 emissions responded immediately to changes in pressure, subaerial and ocean-ridge volcanic emissions anomalies would oppose one another. At ocean ridges, however, the egress of CO2 from the mantle is likely to be delayed by tens-of-thousands of years, or longer, owing to ascent time. A simple model involving temperature, ice, and CO2 is presented that oscillates at ∼100 ky time scales when incorporating a delayed CO2 contribution from ocean ridge volcanism, even if the feedback accounts for only a small fraction of total changes in CO2. Oscillations readily become phase-locked with insolation forcing associated with changes in Earth's orbit. Under certain parameterizations, a transition from ∼40 ky to larger ∼100 ky oscillations occurs during the middle Pleistocene in response to modulations in orbital forcing. This novel description of Pleistocene glaciation should be testable through ongoing advances in understanding the circulation of carbon through the solid earth.

  3. Gigantic retroperitoneal hematoma as a complication of anticoagulation therapy with heparin in therapeutic doses: a case report

    Daliakopoulos Stavros I


    Full Text Available Abstract Introduction Spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present as a rare life-threatening event characterized by sudden onset of bleeding into the retroperitoneal space, occurring in association with bleeding disorders, intratumoral bleeding, or ruptures of any retroperitoneal organ or aneurysm. The spontaneous form is the most infrequent retroperitoneal hemorrhage, causing significant morbidity and representing a diagnostic challenge. Case presentation We report the case of a patient with coronary artery disease who presented with transient ischemic attack, in whom anticoagulant therapy with heparin precipitated a massive spontaneous atraumatic retroperitoneal hemorrhage (with international normalized ratio 2.4, which was treated conservatively. Conclusion Delay in diagnosis is potentially fatal and high clinical suspicion remains crucial. Finally, it is a matter of controversy whether retroperitoneal hematomas should be surgically evacuated or conservatively treated and the final decision should be made after taking into consideration patient's general condition and the possibility of permanent femoral or sciatic neuropathy due to compression syndrome.

  4. [Chronic subdural hematoma with a markedly fibrous hypertrophic membrane. Case report].

    Sato, M; Kuwana, N; Kojima, Y; Tanaka, N; Kitamura, H


    A 40-year-old female, who had taken low-dose oral contraceptives for 2 months before onset, developed transient dysarthria, left hemiparesis, and left hemihypesthesia. One month later, a computed tomography (CT) scan revealed a uniformly enhanced, convex-shaped, hypertrophic membrane with a lobulated lumen in the subdural space of the right parietal region. A right parietal craniotomy was performed. The membrane, consisting of elastic-hard, hypertrophic granulation tissue and yellowish, sticky fluid in the lumen, was readily freed and totally extirpated. Subsequently, the patient recovered without persistent symptoms. Light microscopic examination detected the sinusoidal channel layer and the fibrous layer in an alternating configuration, along with intramembranous hemorrhagic foci. Such hypertrophy must have been caused by repeated intramembranous hemorrhages and reactive granulation. Such findings of hematoma membrane have never previously been reported. Thus, this is an interesting case, clearly distinguished from typical chronic subdural hematoma.

  5. [Hematoma of the abdominal wall. A case report: pitfall of Seldinger method via femoral artery].

    Hiramatsu, Hisaya; Sugiura, Yasushi; Takeda, Ririko; Nanba, Hiroki


    We reported a case of an abdominal wall hematoma which caused by Seldinger method via the femoral artery. A 48-year-old female, suffered from direct carotid cavernous fistula, was treated by transfemoral transvenous embolization (TVE). The whole procedure was completed without difficulty except minor resistance of guide wire manipulation during left femoral artery catheterization. Four hours later, the patient became hypotensive and showed the sign of impending shock without definitive causes. Nine hours after the embolization a huge hematoma of the abdominal wall was found. It required the total 1200 m/ of blood transfusion before her blood pressure returned to normal. She recovered fully from this event and discharged uneventfully. There is a speculation that a deep circumflex iliac artery (DCIA) was injured with an angle-shaped guide wire and bled into the abdominal wall. And subsequent systemic heparinization prevented the coagulation process, resulting a large hematoma. Anatomically, an angle-shaped guide wire is easily able to migrate into DCIA. To prevent a vascular injury, it is very important to manipulate a guide wire under fluoroscopic control and to select a J-shaped guide wire instead of an angle-shaped one.

  6. Hematoma extradural intrarraquidiano espontâneo: relato de caso Spontaneous extradural spinal hematoma: case report



    Full Text Available Relatamos o caso de uma mulher de 55 anos, hipertensa leve, em uso de beta bloqueador, que apresentou quadro súbito de síndrome de compressão medular, caracterizado por dor cervical intensa, evoluindo para tetraplegia com nível de sensibilidade em C4. Foi diagnosticado, por ressonância magnética, hematoma intrarraquidiano extradural cervical , que foi aspirado cirurgicamente através de laminectomia. A paciente encontra-se em acompanhamento fisioterápico e evolui com melhora da motricidade e sensibilidade.We report a case of a 55-year-old woman, that has a mild hypertension, in use of a betablocker drugs, who had a sudden spinal cord compression syndrome with intense cervical pain, tetraplegia and sensitivity level in C4. Extradural spinal hematoma of the cervical spine was diagnosed by magnetic resonance. The patient underwent a laminectomy and aspiration of the hematoma. The patient is on physiotherapy and presents progressive motor and sensivity improvement.

  7. Hematoma subperiosteal de órbita: relato de caso


    Descrevemos um paciente de 16 anos que após traumatismo crânio-encefálico leve evoluiu com dor ocular, hematoma palpebral unilateral e proptose do olho esquerdo. Tomografia computadorizada de órbitas evidenciou hematoma subperiosteal em órbita esquerda. Foi realizada drenagem cirúrgica da coleção. O hematoma subperiosteal de órbita, apesar de raro, deve ser incluído como etiologia de proptose ocular e seu diagnóstico deve ser precoce a fim de evitar a morbidade associada.

  8. Life-threatening paraspinal muscle hematoma after percutaneous vertebroplasty

    Chang-Hoon Jeon


    Full Text Available Bleeding and hematoma formation is rarely reported in percutaneous vertebroplasty procedure. An 84 year old male presented with a large paraspinal muscle hematoma after a percutaneous vertebroplasty. The patient had neither any prior bleeding disorder nor any anticoagulant treatment. Vital signs of the patient were unstable, and his hemoglobin level decreased daily. After a month of conservative treatment, including transfusion, cryotherapy, pain control and bed rest, his hemoglobin level remained stable and he showed relief from pain. Four months later, hematoma resolved spontaneously and he could walk without back pain.

  9. Early diagnosis and treatment of acute or subacute spinal epidural hematoma

    YU Hang-ping; FAN Shun-wu; YANG Hui-lin; TANG Tian-si; ZHOU Feng; ZHAO Xing


    Background Despite low morbidity, acute or subacute spinal epidural hematoma may develop quickly with a high tendency to paralysis. The delay of diagnosis and therapy often leads to serious consequences. In this study we evaluated the effects of a series of methods for the diagnosis and treatment of the hematoma in 11 patients seen in our hospital.Methods Of the 11 patients (8 males and 3 females), 2 had the hematoma involving cervical segments, 2 cervico-thoracic, 4 thoracic, 1 thoraco-lumbar, and 2 lumbar. Three patients had quadriplegia, including one with central cord syndrome; another had Brown-Sequard's syndrome; and the other seven had paraplegia. Five patients were diagnosed at our hospitals within 3-48 hours afterappearance of symptoms, and 6 patients were transferred from community hospitals within 21-106 hours after development of symptoms. Key dermal points, key muscles and the rectal sphincter were determined according to the American Spinal Injury Society Impairment Scales as scale A in two patients,B in 5 and C in 4. Emergency MRI in each patient confirmed that the dura mater was compressed in the spinal canal, with equal intensity or hyperintensity on T1 weighted image and mixed hyperintensity on T2 weighted image. Preventive and curative measures were taken preoperatively and emergency operation was performed in all patients. Open laminoplasty was done at the cervical and cervico-thoracic segments, laminectomy at the thoracic segments, laminectomy with pedicle screw fixation at the thoraco-lumbar and lumbar segments involving multiple levels, and double-sided laminectomy with the integrity of articular processes at the lumbar segments involving only a single level. During the operation, special attention was given to hematoma evacuation, hemostasis and drainage tube placement.Results Neither uncontrollable hemorrhage nor postoperative complications occurred. All patients were followed up for 1-6 years. A marked difference was noted between

  10. Changes in signal intensity of cerebral hematoma in magnetic resonance. Claves en la semiologia del hematoma cerebral en resonancia magnetica

    Galant, J.; Poyatos, C.; Marti-Bonmarti, L.; Martinez, J.; Ferrer, D.; Dualde, D.; Talens, A. (Universidad de Valencia (Spain). Facultad de Ciencias Quimicas)


    Magnetic resonance is highly sensitive for the detection of intraparenchymatous hemorrhage. The evolution of hematoma over time translates into changes in signal intensity. This means that we can determine when the hematoma presented and, in addition. follow its course. On the other hand, many intracranial processes developing association with hemorrhage, the recognition of which is, in some cases, of importance. We have studied 60 cerebral hematomas and have described the changes that will take place in their signal and the reasons for them. (author)

  11. Thrombospondin-1 deficiency causes a shift from fibroproliferative to inflammatory kidney disease and delays onset of renal failure.

    Zeisberg, Michael; Tampe, Björn; LeBleu, Valerie; Tampe, Desiree; Zeisberg, Elisabeth M; Kalluri, Raghu


    Thrombospondin-1 (TSP1) is a multifunctional matricellular protein known to promote progression of chronic kidney disease. To gain insight into the underlying mechanisms through which TSP1 accelerates chronic kidney disease, we compared disease progression in Col4a3 knockout (KO) mice, which develop spontaneous kidney failure, with that of Col4a3;Tsp1 double-knockout (DKO) mice. Decline of excretory renal function was significantly delayed in the absence of TSP1. Although Col4a3;Tsp1 DKO mice did progress toward end-stage renal failure, their kidneys exhibited distinct histopathological lesions, compared with creatinine level-matched Col4a3 KO mice. Although kidneys of both Col4a3 KO and Col4a3;Tsp1 DKO mice exhibited a widened tubulointerstitium, predominant lesions in Col4a3 KO kidneys were collagen deposition and fibroblast accumulation, whereas in Col4a3;Tsp1 DKO kidney inflammation was predominant, with less collagen deposition. Altered disease progression correlated with impaired activation of transforming growth factor-β1 (TGF-β1) in vivo and in vitro in the absence of TSP1. In summary, our findings suggest that TSP1 contributes to progression of chronic kidney disease by catalyzing activation of latent TGF-β1, resulting in promotion of a fibroproliferative response over an inflammatory response. Furthermore, the findings suggest that fibroproliferative and inflammatory lesions are independent entities, both of which contribute to decline of renal function.

  12. High Mortality Rate of Stomach Cancer Caused Not by High Incidence but Delays in Diagnosis in Aomori Prefecture, Japan

    Matsuzaka, Masashi; Tanaka, Rina; Sasaki, Yoshihiro


    Background: There are substantial differences in the mortality rates of stomach cancer among the 47 prefectures in Japan, and Aomori prefecture is one of the most severely impacted. The aims of this study were to determine the incidence and mortality rates of stomach cancer in Aomori prefecture in comparison with Japan as a whole and cast light on reasons underlying variation. Methods: Data on stomach cancer cases were extracted from the Aomori Cancer Registry Database. Incidence rates for specific stages at the time of diagnosis were cited from Monitoring of Cancer Incidence in Japan, and mortality rates for stomach cancer in Aomori prefecture and the whole of Japan were obtained from Vital Statistics. Age-standardised incidence and mortality rates were calculated using the direct method. Results: The age-standardised incidence rate of stomach cancer in Aomori prefecture was higher than in the whole of Japan for males but lower for females. However, the age-standardised mortality rates were higher in Aomori prefecture in both sexes. The proportion of localised cancers was lower in Aomori prefecture than in the whole of Japan for most age groups. Conclusions: The lower rate for localised cancer suggests that higher age-standardised mortality rates are due to delays in diagnosis, despite an attendance rate for stomach cancer screening was higher in Aomori prefecture than in the whole of Japan. One plausible explanation for the failure of successful early detection might be poor quality control during screening implementation that impedes early detection.

  13. Acute cervical spinal subdural hematoma not related to head injury.

    Kim, Hee Yul; Ju, Chang Il; Kim, Seok Won


    We report an extremely rare case of traumatic cervical spinal subdural hematoma not related to intracranial injury. There has been no report on traumatic cervical spinal subdrual hematoma not related to intracranial injury. A 27-year-old female patient was admitted to our emergency room due to severe neck pain and right arm motor weakness after car collision. On admission, she presented with complete monoplegia and hypoesthesia of right arm. Magnetic resonance imaging (MRI) revealed subdural hematoma compressing spinal cord. Lumbar cerebrospinal fluid (CSF) analysis revealed 210,000 red blood cells/mm(3). She was managed conservatively by administrations of steroid pulse therapy and CSF drainage. Her muscle power of right arm improved to a Grade III 16 days after admission. Follow-up MRI taken 16th days after admission revealed almost complete resolution of the hematoma. Here, the authors report a traumatic cervical spinal SDH not associated with intracranial injury.

  14. Acute femoral neuropathy secondary to an iliacus muscle hematoma.

    Seijo-Martínez, M; Castro del Río, M; Fontoira, E; Fontoira, M


    We present a patient with a spontaneous iliacus muscle hematoma, appearing immediately after a minor physical maneuver, presenting with pain and femoral neuropathy initially evidenced by massive quadriceps muscle fasciculations. A magnetic resonance imaging (MRI) study of the pelvic area confirmed the diagnosis, showing a hematoma secondary to a partial muscle tear. The patient was managed conservatively, and the continuous muscle activity ceased in 3 days, with progressive improvement of the pain and weakness. The recovery was complete. Femoral neuropathy is uncommon and usually due to compression from psoas muscle mass lesions of diverse nature, including hematomas. Usually subacute, femoral neuropathy may present acutely in cases of large or strategically placed compressive femoral nerve lesions, and may require surgical evacuation. The case presented herein is remarkable since the muscle hematoma appeared after a nonviolent maneuver, fasciculations were present at onset, and conservative management was sufficient for a full recovery.

  15. Idiopathic intraparenchymal hematoma of the liver in a neonate

    Amodio, John; Fefferman, Nancy; Rivera, Rafael; Pinkney, Lynne; Strubel, Naomi [Division of Pediatric Radiology, Department of Radiology, New York University Medical Center, 560 1st Avenue, New York, NY 10016 (United States)


    Hepatic hematomas in newborn infants are not frequently detected clinically, but are often found at perinatal autopsies. These hematomas of the liver are usually subcapsular in location. A variety of etiologies for such hematomas has been implicated, such as trauma, sepsis, and coagulopathies. We present a neonate who presented with jaundice and abdominal distention. Initial imaging studies revealed a large intraparenchymal lesion of the liver, which was at first thought to be suspicious for neoplasm; however, MRI showed the lesion to be hemorrhagic and follow-up sonographic studies showed total resolution of this lesion, compatible with hematoma. The intraparenchymal location and the idiopathic nature of this lesion distinguish this case from others previously reported. (orig.)

  16. Novel TK2 mutations as a cause of delayed muscle maturation in mtDNA depletion syndrome.

    Termglinchan, Thanes; Hisamatsu, Seito; Ohmori, Junko; Suzumura, Hiroshi; Sumitomo, Noriko; Imataka, George; Arisaka, Osamu; Murakami, Nobuyuki; Minami, Narihiro; Akihiko, Ishiyama; Sasaki, Masayuki; Goto, Yuichi; Noguchi, Satoru; Nonaka, Ikuya; Mitsuhashi, Satomi; Nishino, Ichizo


    Recessive mutations in TK2 cause a severe mitochondrial DNA depletion syndrome (MDS),(1) characterized by severe myopathy from early infancy. Recent reports have suggested a wider clinical spectrum including encephalomyopathic form.(1,2) We report a patient with infantile-onset fatal encephalomyopathy presenting with extreme muscle fiber immaturity.

  17. Drought-caused delay in nesting of Sonoran Desert birds and its facilitation of parasite- and predator-mediated variation in reproductive success

    Chris McCreedy,; Van Riper, Charles


    As our understanding of climate change has increased, so has our awareness of the impacts of these changes on biotic systems. Climate models are nearly unanimous in their predictions for increased drought frequency in southwestern North America, and delays in nest initiation due to drought may influence nesting success and productivity for many Sonoran Desert bird species. In southeastern California and western Arizona in 2004–2009, we found negative correlations for 13 of 13 species between nest initiation date and rainfall accumulation during the preceding 4-month winter rainy season. Nesting was delayed more than 3 weeks for some species during extreme droughts in 2006 and 2007. During 2004–2009, we found a significant negative effect of nest initiation date on nest survival probability (β̂ = −0.031 ± 0.005 SE, P causes of nest failure, we conclude that the impacts of climate change–caused drought on annual reproductive output in the Sonoran Desert will be further compounded by parasitism and predation for Black-tailed Gnatcatchers and by predation for Verdins.

  18. Low-amplitude, high-frequency electromagnetic field exposure causes delayed and reduced growth in Rosa hybrida.

    Grémiaux, Alexandre; Girard, Sébastien; Guérin, Vincent; Lothier, Jérémy; Baluška, František; Davies, Eric; Bonnet, Pierre; Vian, Alain


    It is now accepted that plants perceive high-frequency electromagnetic field (HF-EMF). We wondered if the HF-EMF signal is integrated further in planta as a chain of reactions leading to a modification of plant growth. We exposed whole small ligneous plants (rose bush) whose growth could be studied for several weeks. We performed exposures at two different development stages (rooted cuttings bearing an axillary bud and 5-leaf stage plants), using two high frequency (900MHz) field amplitudes (5 and 200Vm(-1)). We achieved a tight control on the experimental conditions using a state-of-the-art stimulation device (Mode Stirred Reverberation Chamber) and specialized culture-chambers. After the exposure, we followed the shoot growth for over a one-month period. We observed no growth modification whatsoever exposure was performed on the 5-leaf stage plants. When the exposure was performed on the rooted cuttings, no growth modification was observed on Axis I (produced from the elongation of the axillary bud). Likewise, no significant modification was noted on Axis II produced at the base of Axis I, that came from pre-formed secondary axillary buds. In contrast, Axis II produced at the top of Axis I, that came from post-formed secondary buds consistently displayed a delayed and significant reduced growth (45%). The measurements of plant energy uptake from HF-EMF in this exposure condition (SAR of 7.2 10(-4)Wkg(-1)) indicated that this biological response is likely not due to thermal effect. These results suggest that exposure to electromagnetic field only affected development of post-formed organs.

  19. Unilateral proptosis and extradural hematoma in a child with scurvy

    Verma, Sumit; Sivanandan, Sindhu; Seth, Rachna; Kabra, Shushil [All India Institute of Medical Sciences (AIIMS), Department of Pediatrics, New Delhi (India); Aneesh, Mangalasseril K.; Gupta, Vaibhav [All India Institute of Medical Sciences (AIIMS), Department of Radiodiagnosis, New Delhi (India)


    We report a 3-year-old boy with unilateral proptosis, painful swelling of the right thigh and aphasia. He had radiographic evidence of scurvy in the limbs and bilateral frontal extradural hematomas with a mass lesion in the left orbit on MRI. He was treated with vitamin C and on follow-up 8 weeks later had recovered with no evidence of the orbital mass on clinical or radiological study. Scurvy manifesting as proptosis and extradural hematoma is rare. (orig.)

  20. Spinal subarachnoid hematoma in a woman with HELLP syndrome: a case report

    Fujimaki Hisako


    Full Text Available Abstract Introduction Subarachnoid hemorrhages of spinal origin are extremely rare during pregnancy. We present the case of a patient with hemolytic anemia, elevated liver enzymes and low platelet count (the so-called HELLP syndrome, a potentially life-threatening complication associated with pre-eclampsia, who presented with an idiopathic spinal subarachnoid hematoma. Case presentation At 29 gestational weeks, a 35-year-old Japanese woman was diagnosed with HELLP syndrome based on bilateral leg paralysis, diminished sensation and reflexes, and laboratory findings. The pregnancy was immediately brought to an end by Cesarean delivery. Post-operatively, an MRI scan revealed a space-occupying lesion in her thoracic spinal canal. Emergency decompression was followed by total laminectomy. A subarachnoid hematoma, partially extending as far as the ventral side, was removed. After thorough washing and drain placement, the operation was completed with the suturing of artificial dura mater. Eight months post-operatively, her lower extremity sensation had improved to a score of 8 out of 10, but improvements in her muscular strength were limited to slight gains in her toes. MRI scans taken two months post-operatively revealed edematous spinal cord changes within her medulla. Conclusions A subarachnoid hematoma during pregnancy is extremely rare, possibly due to increased coagulability during pregnancy. However, this complication is potentially devastating should a clot compress the spinal cord or cauda equina. While several causes of hematoma have been proposed, we speculate that the factors underlying hemorrhagic diathesis in our case were the decreased platelet count characteristic of HELLP syndrome and vascular fragility due to elevated estrogen levels, in addition to increased abdominal pressure during pregnancy and pressure from the gravid uterus resulting in ruptured vessels around the spinal cord. In cases displaying a progressive lesion and severe

  1. Optimal management of hemophilic arthropathy and hematomas

    Lobet S


    Full Text Available Sébastien Lobet,1,2 Cedric Hermans,1 Catherine Lambert1 1Hemostasis-Thrombosis Unit, Division of Hematology, 2Division of Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Brussels, Belgium Abstract: Hemophilia is a hematological disorder characterized by a partial or complete deficiency of clotting factor VIII or IX. Its bleeding complications primarily affect the musculoskeletal system. Hemarthrosis is a major hemophilia-related complication, responsible for a particularly debilitating chronic arthropathy, in the long term. In addition to clotting factor concentrates, usually prescribed by the hematologist, managing acute hemarthrosis and chronic arthropathy requires a close collaboration between the orthopedic surgeon and physiotherapist. This collaboration, comprising a coagulation and musculoskeletal specialist, is key to effectively preventing hemarthrosis, managing acute joint bleeding episodes, assessing joint function, and actively treating chronic arthropathy. This paper reviews, from a practical point of view, the pathophysiology, clinical manifestations, and treatment of hemarthrosis and chronic hemophilia-induced arthropathy for hematologists, orthopedic surgeons, and physiotherapists. Keywords: hemophilia, arthropathy, hemarthrosis, hematoma, physiotherapy, target joint

  2. Mechanism of blood-brain barrier impairment after mild traumatic brain injury caused by blast shock waves and its relationship with delayed nerve dysfunction

    Zhao-xi XU


    Full Text Available Mild traumatic brain injury (mTBI caused by blast shock waves (BSWs is one of the most common injuries among soldiers in the war. Such mTBI can also happen in civilians if exposed to shock waves of accidental explosion disasters, bomb attacks by terrorists and so on. This injury often results in cognitive problems, memory dysfunction and emotional disorder, and these neurological deficits are closely related to the dysfunction or disruption of the blood-brain barrier (BBB. The present paper discusses mainly the relationship between dysfunction or disruption of BBB and inflammatory reaction in mild brain injury associated with explosive shock wave and effects of early intervention of oxidative stress injury, repairing the BBB and blocking inflammation on relieving delayed neurological deficits. DOI: 10.11855/j.issn.0577-7402.2016.05.15

  3. 浅谈延迟性肌肉酸痛的原因及预防%The Cause and Prevention of Delayed-type Muscle Soreness



    超过习惯强度的运动练习会产生延迟性肌肉酸痛,其致痛原因有损伤假说、痉挛假说和自由基假说。根据以上假说,采取相应的预防和减轻肌肉酸痛的措施,对于学校体育教育来说,具有现实的意义。%The exercise of more than habit strength may produce delayed-type muscle soreness, the cause of its induced pain include damage hypothesis, spasm hypothesis and the free radical hypothesis. According to the above hypothesis, the corresponding preventive measures are taken and can reduce muscle soreness. For school physical education, it has very practical significance.

  4. A case of anemia caused by combined vitamin B12 and iron deficiency manifesting as short stature and delayed puberty Anemia

    Seung Min Song


    Full Text Available Anemia caused by vitamin B12 deficiency resulting from inadequate dietary intake is rare in children in the modern era because of improvements in nutritional status. However, such anemia can be caused by decreased ingestion or impaired absorption and/ or utilization of vitamin B12. We report the case of an 18-year-old man with short stature, prepubertal sexual maturation, exertional dyspnea, and severe anemia with a hemoglobin level of 3.3 g/dL. He had a history of small bowel resection from 50 cm below the Treitz ligament to 5 cm above the ileocecal valve necessitated by midgut volvulus in the neonatal period. Laboratory tests showed deficiencies of both vitamin B12 and iron. A bone marrow examination revealed dyserythropoiesis and low levels of hemosiderin particles, and a cytogenetic study disclosed a normal karyotype. After treatment with parenteral vitamin B12 and elemental iron, both anemia and growth showed gradual improvement. This is a rare case that presented with short stature and delayed puberty caused by nutritional deficiency anemia in Korea.

  5. Inflammatory responses are not sufficient to cause delayed neuronal death in ATP-induced acute brain injury.

    Hey-Kyeong Jeong

    Full Text Available BACKGROUND: Brain inflammation is accompanied by brain injury. However, it is controversial whether inflammatory responses are harmful or beneficial to neurons. Because many studies have been performed using cultured microglia and neurons, it has not been possible to assess the influence of multiple cell types and diverse factors that dynamically and continuously change in vivo. Furthermore, behavior of microglia and other inflammatory cells could have been overlooked since most studies have focused on neuronal death. Therefore, it is essential to analyze the precise roles of microglia and brain inflammation in the injured brain, and determine their contribution to neuronal damage in vivo from the onset of injury. METHODS AND FINDINGS: Acute neuronal damage was induced by stereotaxic injection of ATP into the substantia nigra pars compacta (SNpc and the cortex of the rat brain. Inflammatory responses and their effects on neuronal damage were investigated by immunohistochemistry, electron microscopy, quantitative RT-PCR, and stereological counting, etc. ATP acutely caused death of microglia as well as neurons in a similar area within 3 h. We defined as the core region the area where both TH(+ and Iba-1(+ cells acutely died, and as the penumbra the area surrounding the core where Iba-1(+ cells showed activated morphology. In the penumbra region, morphologically activated microglia arranged around the injury sites. Monocytes filled the damaged core after neurons and microglia died. Interestingly, neither activated microglia nor monocytes expressed iNOS, a major neurotoxic inflammatory mediator. Monocytes rather expressed CD68, a marker of phagocytic activity. Importantly, the total number of dopaminergic neurons in the SNpc at 3 h (∼80% of that in the contralateral side did not decrease further at 7 d. Similarly, in the cortex, ATP-induced neuron-damage area detected at 3 h did not increase for up to 7 d. CONCLUSIONS: Different cellular

  6. Spontaneous rupture of pedunculate gastric gastrointestinal stromal tumor into the gastrocelic ligament presenting as a stalked mass surrounded by loculated hematoma

    Kim, Hyun Soo; Ahn, Sung Eun; Park, Seong Jin; Moon, Sung Kyoung; Lim, Joo Won; Lee, Dong Ho; Kim, Yong Ho [Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul (Korea, Republic of)


    Gastric gastrointestinal stromal tumor (GIST) is one of the most common mesenchymal tumors of the stomach, which may be asymptomatic or cause symptoms such as pain, gastrointestinal bleeding, and obstruction. Hemoperitoneum due to spontaneous rupture of the tumor is an extremely rare complication. We described a case of a 52-year-old man with a large pedunculated GIST causing loculated hematoma within the gastrocolic ligament. The patient visited our hospital due to a 3 week history of epigastric pain. A computed tomography scan revealed a 10.3 x 7.5 x 9.4 cm sized mass that was growing exophytically from the greater curvature of the stomach and was surrounded by loculated hematoma within the gastrocolic ligament. Laparotomy revealed a large stalked gastric mass surrounded by loculated hematoma within the gastrocolic ligament and blood fluid in the peritoneal cavity. Pathologic examination confirmed a GIST, of the high risk group.

  7. Bilateral Traumatic Intracranial Hematomas and its Outcome: a Retrospective Study.

    Pandey, Sharad; Sharma, Vivek; Singh, Kulwant; Pandey, Deepa; Sharma, Mukesh; Patil, Deepak Bhanudas; Shende, Neeraj; Chauhan, Richa Singh


    The objective of this study was to evaluate the age distribution, mode of injury, type of hematomas, and their surgical outcome in patients with bilateral traumatic head injuries. The present study included 669 cases of traumatic head injury who presented at the neurosurgery emergency out of which 94 cases had bilateral head injuries from the period of August 2009 to April 2014. The data from the hospital computerized database were retrospectively analysed. Cases of bilateral traumatic head injury included 94 patients out of which 88.29 % (n = 83) were males and 11.70 % (n = 11) were females. Commonest mode of injury was road traffic accident in 56.38 % (n = 53) followed by fall from height in 29.78 % (n = 28). In our study, 25.53 % patients had epidural hematoma (EDH) with intracerebral hematoma (ICH) or contusion (n = 24), followed by EDH with subarachnoid hemorrhage (SAH) in 18.08 % (n = 17). At the time of discharge, all those patients managed conservatively had good Glasgow outcome scale (GOS) while with surgical intervention 58 % patients had good GOS, 19 % had moderate disability, and 9 % remained with severe disability. In cases of bilateral hematomas, EDH is most common and should be managed in neurosurgical emergency. Other combinations of bilateral intracranial hematomas should be managed according to the surgical indication and serial CT imaging.

  8. Splenic hematoma in acute pancreatitis. Role of coagulation disorders.

    Clavé, P; Guillaumes, S; Blanco, I; Martínez de Hurtado, J; Esquius, J; Marruecos, L; Fontcuberta, J; Pérez, C; Farré, A; Lluís, F


    Splenic hematomas are infrequent complications of acute pancreatitis. In some cases, local factors that may play a role in the pathogenesis of the hematoma (thrombosis of the splenic artery or veins, intrasplenic pseudocysts, perisplenic adhesions, enzymatic digestion) are found. In the absence of local factors, the etiology of splenic hemorrhage remains unknown. We report two cases of splenic hematoma occurring during an acute necro-hemorrhagic pancreatitis associated with renal failure that required renal replacement therapy (hemodialysis and continuous arteriovenous hemodialysis). In both cases, more than half of splenic parenchyma was affected by multiple infarctions. No local factors responsible for the splenic abnormalities were detected in either case. Thrombosis of the splenic arterial microcirculation and a coagulation disorder consistent with disseminated intravascular coagulation was detected in one patient. In the second patient, coagulation disorders secondary to either liver disease, pancreatitis and its septic complications, or extracorporeal circuit heparinization for renal replacement therapy were present. Coagulation disorders should be considered whenever a splenic hematoma is found in a patient with acute pancreatitis. Disseminated intravascular coagulation may be the etiology of a splenic hematoma in acute pancreatitis.

  9. A tale of two acute extradural hematomas

    Adeleye, Amos Olufemi; Jite, Ikechi E.; Smith, Omolara A.


    Background: In much of the Western hemisphere, mortality from traumatic acute extradural hematomas (AEDH) has been drastically brought down toward 0%. This is still not the case however in most developing countries. Case Description: This report represents a tragi-comic tale of two cases of traumatic AEDH managed by an academic neurosurgeon in a neurosurgically ill-resourced private health facility during a nationwide industrial strike action preventing clinical-surgical care in the principal author's University Teaching Hospital. A young man presented with altered consciousness, Glasgow Coma Score (GCS) 14/15, following a road accident. The cranial computed tomography (CT) scan was obtained only 9 h after its request, long after the man had actually deteriorated to GCS 7/15 with pupillary changes. The neurosurgeon, summoned from the nearby University Teaching Hospital for the operative care of this man, arrived on-site and was about moving the patient into the operative room when he took the final breaths and died, all within 2 h of the belated neuroimaging. This scenario repeated itself in the same health facility just 24 h later with another young man who presented GCS 7/15 and another identical CT evidence of traumatic AEDH. With more financially able relations, the diagnostic/surgical care of this second patient was much more prompt. He made a very brisk recovery from neurosurgical operative intervention. He is alive and well, 5-month postoperative. Conclusions: In most low-resourced health systems of the developing countries, a significant proportion of potentially salvageable cases of AEDH still perish from this disease condition. PMID:27213108

  10. Intramural aortic hematomas; Intramurale Haematome der Aorta

    Raab, B.W.; Vosshenrich, R.; Fischer, U.; Funke, M.; Grabbe, E. [Goettingen Univ. (Germany). Abt. fuer Roentgendiagnostik


    Intramural hematomas (IMH) are regarded as a hemorrhage into the aortic wall. In general a traumatic form can be differentiated from a spontaneous non-traumatic. There is a predisposition of IMH with arterial hypertension and mesoectodermal dysplastic syndromes. The diagnosis is established with the clinical presentation in combination with the findings of different imaging modalities. Acute and subacute discomfort associated with a tendency of collaps are considered as typical presenting complaints. A semicircular or concentric thickening of the aortic wall with the absence of blood flow or a dissection membran are typical findings in transesophageal echocardiography, computed tomography and magnetic resonance tomography. From a differential diagnostic point of view a distinction from atherosclerotic wall changes, intraluminal thrombi and inflammatory aortic diseases is essential. The IMH is considered as an early presentation of aortic dissection, put into and treated according to the Stanford classification. In the course of natural history an IMH can disappear, rupture or progress into a classic aortic dissection. (orig.) [German] Das intramurale Haematom (IMH) ist eine Einblutung in die Aortenwand. Grundsaetzlich kann zwischen traumatischer Genese und einer atraumatischen spontanen Form unterschieden werden. Praedisponierend sind arterielle Hypertension und mesoektodermale Dysplasiesyndrome. Die Diagnose ergibt sich aus der Klinik und den Befunden in den bildgebenden Verfahren. Zu den klinischen Symptomen zaehlen akut oder subakut auftretende Schmerzen, assoziiert mit einer Kollapsneigung. Typische Befunde in der transoesophagealen Echokardiographie, der Computer- oder der Magnetresonanztomographie sind eine halbmondfoermige oder konzentrische Wandverdickung der Aorta ohne Nachweis von Blutfluss oder einer Dissektionsmembran mit Dichtewerten bzw. Signalintensitaeten in Abhaengigkeit vom Alter der Einblutung. Differenzialdiagnostisch ist eine Abgrenzung

  11. Delayed presentation of traumatic intraperitoneal bladder rupture

    Brown, D.; Magill, H.L.; Black, T.L.


    A child with urine ascites as a delayed manifestation of post-traumatic intraperitoneal bladder rupture is presented. The diagnosis was suggested by abdominal CT scan and confirmed with a cystogram. While uncommon, late presentation of intraperitoneal bladder rupture following trauma may occur from masking of a primary laceration or development of secondary rupture at the site of a hematoma in the bladder wall. Since CT may be a primary diagnostic study performed following abdominal trauma, the radiologist should be aware of CT findings suggesting bladder rupture and of the possibility of delayed presentation of this injury.

  12. Challenging the Pathophysiologic Connection between Subdural Hematoma, Retinal Hemorrhage and Shaken Baby Syndrome

    Gabaeff, Steven C


    Full Text Available Child abuse experts use diagnostic findings of subdural hematoma and retinal hemorrhages as near-pathognomonic findings to diagnose shaken baby syndrome. This article reviews the origin of this link and casts serious doubt on the specificity of the pathophysiologic connection. The forces required to cause brain injury were derived from an experiment of high velocity impacts on monkeys, that generated forces far above those which might occur with a shaking mechanism. These forces, if present, would invariably cause neck trauma, which is conspicuously absent in most babies allegedly injured by shaking. Subdural hematoma may also be the result of common birth trauma, complicated by prenatal vitamin D deficiency, which also contributes to the appearance of long bone fractures commonly associated with child abuse. Retinal hemorrhage is a non-specific finding that occurs with many causes of increased intracranial pressure, including infection and hypoxic brain injury. The evidence challenging these connections should prompt emergency physicians and others who care for children to consider a broad differential diagnosis before settling on occult shaking as the de-facto cause. While childhood non-accidental trauma is certainly a serious problem, the wide exposure of this information may have the potential to exonerate some innocent care-givers who have been convicted, or may be accused, of child abuse. [West J Emerg Med. 2011;12(2:144-158.

  13. Retroplacental hematoma associated to tubo ovarian abscess in 23 weeks of pregnancy. A case report.

    Neysi Chávez Rodríguez


    Full Text Available A 30 year-old female patient with 23 weeks of pregnancy and with asthma antecedent is presented. She had treatment with bronchodilators. She came to the provincial medical emergency centre due to an intense pain with a sudden appearance in the lower abdomen, vomiting, shortness of breath, and sweating. The presence of a retroplacental hematoma caused due to a tubo-ovarian abscess associated to an abdominal peritonitis was corroborated. The way in which the disease was manifested and evolved is described.

  14. A case of right renal infarction and subcapsular hematoma that simultaneously developed after cardiac angiography.

    Kwon, S H; Cho, H C; Lee, S W; Kim, D Y; Joo, W C; Lee, W H; Song, J H; Kim, M-J


    Of the several complications known to develop after cardiac catheterization, simultaneous acute renal infarction and renal subcapsular hematoma is rare. Here, the authors report a case of acute renal infarction with subcapsular hematoma that developed 4 hours after cardiac catheterization.

  15. Intra-bleb hematoma and hyphema following digital ocular compression

    Sagar Bhargava


    Full Text Available We report successful outcome of a huge post- trabeculectomy intra-bleb hematoma and hyphema that occurred following digital ocular compression. The patient was a 64-year-old lady suffering from bilateral primary angle closure glaucoma and cataract. She was on anti-platelet therapy. She underwent single-site phacoemulsification, intra-ocular lens implantation and trabeculectomy with mitomycin C in the right eye. The trabeculectomy was under-filtering. She was asked to perform digital ocular compression thrice daily. On 15 th post-operative day, she presented with a huge intra-bleb hematoma and hyphema. The hematoma did not respond to conservative measures and was drained to prevent bleb failure. We recommend caution in the consideration of digital ocular compression in patients on prophylactic anti-coagulation.

  16. Administration of L-arginine reduces the delay of the healing process caused by ibuprofen. Implication of COX and growth factors expression.

    Sánchez-Fidalgo, S; Martín-Lacave, I; Illanes, M; Bruseghini, L; Esteras, A; Motilva, V


    The objective of the present study has been to advance knowledge of the gastric role played by the amino acid L-Arginine (L-Arg) in the evolution of a chronic gastric ulcer. In order to clarify it, L-Arg alone or together with Ibuprofen have been administrated in an experimental acetic acid chronic ulcer, analysing characteristic parameters of an active curative process, such as PGE2 production, COX expression, and also angiogenesis, proliferation/apoptosis and growth factors expression. Our results reveal that L-Arg is favourable in the healing process improving the curative course. Ibuprofen caused a delay in ulcer healing, more evident 14 days after ulcer induction; COX-2 expression was increased at the 7th day although no signal of protein could be detected after 14 days; PGE2 production was inhibited in intact and ulcerated areas at both times assayed. In contrast, treatment with L-Arg reduced the delay of the lesion, the increment in COX-2 expression induced by Ibuprofen, and was able to maintain PGE2 levels similar to the control group after 14 days. Additionally, the histological study showed that the healing effects of L-Arg might be associated with an increased angiogenesis and FGF-2 expression. These actions could be considered key factors in the healing response associated with L-Arg administration. However, the proliferation study assayed with the PCNA-immunostaining method did not reveal significant differences, as the same as the apoptosis analysis. In conclusion, the coupling of L-Arg to Ibuprofen is an attractive alternative to Ibuprofen administration alone because it not only attenuates but also improves the evolution of chronic lesions through mechanisms that implicate endogenous PG and FGF-2-associated pathways, which allow an increase of angiogenesis process.

  17. A Lethal Complication of Endoscopic Therapy: Duodenal Intramural Hematoma

    Turan Calhan


    Full Text Available Duodenal intramural hematoma (DIH usually occurs in childhood and young adults following blunt abdominal trauma. It may also develop in the presence of coagulation disorders and may rarely be an iatrogenic outcome of endoscopic procedures. Management of DIH is usually a conservative approach. A case of intramural duodenal hematoma that developed following endoscopic epinephrine sclerotherapy and/or argon plasma coagulation and that was nonresponsive to conservative therapy in a patient with chronic renal failure who died from sepsis is being discussed in this report. Clinicians should be aware of such possible complications after endoscopic hemostasis in patients with coagulation disorders.

  18. Retrobulbar Hematoma in Blow-Out Fracture after Open Reduction

    Ji Seon Cheon


    Full Text Available Retrobulbar hemorrhage, especially when associated with visual loss, is a rare but significant complication after facial bone reconstruction. In this article, two cases of retrobulbar hematoma after surgical repair of blow-out fracture are reported. In one patient, permanent loss of vision was involved, but with the other patient, we were able to prevent this by performing immediate decompression after definite diagnosis. We present our clinical experience with regard to the treatment process and method for prevention of retrobulbar hematoma using a scalp vein set tube and a negative pressure drainage system.

  19. Scrotal hematoma as a sign of adrenal hemorrhage in newborns

    Renata Gonçalves

    Full Text Available CONTEXT: Bluish discoloration and swelling of the scrotum in newborns can arise from a number of diseases, including torsion of the testes, orchitis, scrotal or testicular edema, hydrocele, inguinal hernia, meconium peritonitis, hematocele, testicular tumor and traumatic hematoma. Forty-two cases of scrotal abnormalities as signs of neonatal adrenal hemorrhage were found in the literature. CASE REPORT: We present a case of scrotal hematoma due to adrenal hemorrhage in a newborn. Conservative treatment with clinical follow-up was adopted, with complete resolution within 10 days. The possible differential diagnoses are reviewed and discussed.

  20. Hematoma epidural secundario a anestesia espinal: Tratamiento conservador Epidural hematoma secondary to spinal anesthesia: Conservative treatment

    M. Bermejo


    Full Text Available Introducción: El hematoma epidural secundario a una anestesia neuroaxial es una complicación poco frecuente, pero de gran trascendencia tanto por sus implicaciones clínicas como por las médico legales; según algunos autores su incidencia puede oscilar entre 1/190.000-1/200.000 para las punciones peridurales y 1/320.000 en el caso de las espinales. El aspecto prioritario en su manejo terapéutico es el del diagnóstico y tratamiento precoz, antes de las 6-12 primeras horas. No obstante, en determinados pacientes como en el caso que presentamos puede no ser precisa la cirugía, resolviéndose el cuadro con tratamiento conservador. Caso clínico: Varón de 73 años, ASA IV, con antecedentes de cirrosis con hipertensión portal, hiperesplenismo, EPOC, obesidad, cardiopatía hipertensiva e insuficiencia tricuspídea. Se programa para alcoholización prostática al haber sido desechada la cirugía. En la analítica preoperatoria destacaba una actividad de protrombina del 80% y 90.000 plaquetas. Se realizaron varios intentos fallidos de punción espinal, finalmente fue precisa una anestesia general con ventilación espontánea mediante mascarilla laríngea, propofol, fentanilo y sevoflurano. A las 36 horas, comienza la clínica en forma de dolor intenso lumbar, sin irradiación y arreflexia cutáneo plantar, confirmándose en la RMN la presencia de un hematoma epidural de L1 a L4. Ante la ausencia de paraparesia flácida, afectación esfinteriana u otros signos sensitivo-motores y tras consulta con la Unidad de Raquis y con el Servicio de Neurología se decide tratamiento conservador y actitud expectante en forma de analgesia y monitorización neurológica estricta, clínica y radiológica. Evolucionando favorablemente en los siguientes días. Discusión: Determinadas condiciones clínicas pueden influir en la aparición de un hematoma tras la realización de un bloqueo regional central: heparinas de bajo peso molecular, punciones dificultosas

  1. Delayed emergence after anesthesia.

    Tzabazis, Alexander; Miller, Christopher; Dobrow, Marc F; Zheng, Karl; Brock-Utne, John G


    In most instances, delayed emergence from anesthesia is attributed to residual anesthetic or analgesic medications. However, delayed emergence can be secondary to unusual causes and present diagnostic dilemmas. Data from clinical studies is scarce and most available published material is comprised of case reports. In this review, we summarize and discuss less common and difficult to diagnose reasons for delayed emergence and present cases from our own experience or reference published case reports/case series. The goal is to draw attention to less common reasons for delayed emergence, identify patient populations that are potentially at risk and to help anesthesiologists identifying a possible cause why their patient is slow to wake up.

  2. Expression of flowering locus T2 transgene from Pyrus communis L. delays dormancy and leaf senescence in Malus×domestica Borkh, and causes early flowering in tobacco.

    Freiman, Aviad; Golobovitch, Sara; Yablovitz, Zeev; Belausov, Eduard; Dahan, Yardena; Peer, Reut; Avraham, Lior; Freiman, Zohar; Evenor, Dalia; Reuveni, Moshe; Sobolev, Vladimir; Edelman, Marvin; Shahak, Yosepha; Samach, Alon; Flaishman, Moshe A


    Annual and perennial plants represent two different evolutionary strategies based on differential synchronization of their reproductive development. The mobile signal protein FLOWERING LOCUS T (FT) plays a central role in mediating the onset of reproduction in both plant types. Two novel FT-like genes from pear (Pyrus communis)-PcFT1 and PcFT2-were isolated, and their expression profiles were determined for one annual cycle. The effects of PcFT2 on flowering were investigated in annual (tobacco) and perennial (apple) plants by means of grafting and generating transgenic plants. Long-distance graft transmission of PcFT2 in both annual and perennial plants was confirmed using a 35S::PcFT2-YFP construct. Ectopic overexpression of PcFT2 caused early flowering in tobacco but not in apple. Transgenic apples were less sensitive to short-day-induced dormancy, and this phenotype was also observed in wild-type apples grafted onto the transgenic plants. Comparison of PcFT2 protein structure to the paralogous FT proteins from apple and pear showed alterations that could influence protein structure and thus the florigen-activation complex. PcFT2 protein seems to function by promoting flowering as all other FT proteins in the annual plant tobacco while in the perennial plant apple PcFT2 does not promote flowering but delays senescence. This observation may hint to a modified function of FT2 in perennial plants.

  3. Intramural hematoma of the esophagus : Appearance on magnetic resonance imaging

    Kamphuis, AGA; Baur, CHJCM; Freling, NJM


    A 73-yr-old woman on anticoagulant therapy experienced progressive dyspnea and dysphagia due to a large compressing mass in the posterior mediastinum. Because her clinical condition deteriorated rapidly surgery was performed. A large intramural hematoma along the full length of the esophagus with di

  4. Spontaneous Cervico-Thoracic Spinal Epidural Hematoma in an Elderly Patient: A Rare Presentation

    Reyaz Ahmed Para,Muzamil Latief,Huma Noor


    Full Text Available Spontaneous spinal epidural hematoma (SSEH is a rare entity.SSEH is an accumulation of blood in the vertebral epidural space in the absence of trauma or iatrogenic procedure like lumbar puncture.The incidence of SSEH has been estimated at 0.1 patients per 100,000 individuals and represents less than 1% of spinal space-occupying lesions .Here we are presenting case of a 65year old female hypertensive on treatment with controlled blood pressure, who presented with sudden onset paraplegia and weakness of muscles of hand, associated with urinary and bowel incontinence that started 6 hours before presenting to Emergency Room .Patient was subjected to MRI spine that revealed a collection in spinal epidural space ,hypointense in T1W images and hyperintense in T2W images, extending from C6-C7 to T1-T2 suggestive of acute / subacute epidural hematoma (fig 1.In our case all possible causes of an epidural haematoma were ruled out by relevant investigations.Patient was subjected to surgical evacuation of hematoma after 48 hours of presentation.Perioperative and Postoperative period was uneventfull . Sensations over involved areas improved. Motor weakness also improved from Grade III to Grade IV+ in bilateral lower limbs and from Grade II to Grade IV in small muscles of hand and triceps, however Patient persisited with urinary incontinence.CONCLUSION: When a patient receiving anticoagulant therapy complains of sudden and unexplained neck or back pain, we should suspect the possibility of SSEH. For early diagnosis, immediate MRI is essential .In addition, we should consider SSEH as one of the important differential diagnoses in elderly patients who have developed acute myelopathy. [Natl J Med Res 2013; 3(4.000: 424-427

  5. Acute posterior fossa epidural hematoma in a newborn infant with Menkes disease.

    Takeuchi, Satoru; Horikawa, Masahiro; Wakamatsu, Hajime; Hashimoto, Jyunya; Nawashiro, Hiroshi


    Epidural hematoma (EDH) in newborn infants is rare compared with other types of intracranial hemorrhages. Furthermore, posterior fossa EDH is extremely rare. We present a case of posterior fossa EDH in an infant with Menkes disease with accessory bones in the occiput. A male infant with a condition diagnosed with Menkes disease by prenatal testing was born at 39 weeks via vacuum extraction. The patient presented with a mild tremor at 2 days after delivery. A brain computed tomography (CT) scan showed an acute EDH in the posterior fossa, extending into the occipitoparietal area. Three-dimensional CT and bone window CT scan revealed several accessory bones, diastasis of 1 accessory suture, a communicated fracture, and a linear fracture in the occipital bone. Furthermore, a bone fragment from a communicated fracture displaced toward the inside. The patient was treated conservatively for EDH because of his good general condition. The hematoma gradually resolved, and his tremor did not recur. We suggest the following mechanism of posterior fossa EDH development in our patient: (1) external force was applied to the occiput inside the birth canal during delivery, resulting in diastasis; (2) a communicated fracture occurred, and a bone fragment displaced toward the inside (linear fracture was caused indirectly by the force); (3) a transverse sinus was injured by the fragment; and (4) EDH developed in both the posterior fossa and supratentorial region. Copper deficiency can also cause fragility of connective tissues, vessels, and bones.

  6. In vivo polymerization of poly(3,4-ethylenedioxythiophene) in the living rat hippocampus does not cause a significant loss of performance in a delayed alternation task

    Ouyang, Liangqi; Shaw, Crystal L.; Kuo, Chin-chen; Griffin, Amy L.; Martin, David C.


    After extended implantation times, traditional intracortical neural probes exhibit a foreign-body reaction characterized by a reactive glial sheath that has been associated with increased system impedance and signal deterioration. Previously, we have proposed that the local in vivo polymerization of an electronically and ionically conducting polymer, poly(3,4-ethylenedioxythiophene) (PEDOT), might help to rebuild charge transport pathways across the glial scar between the device and surrounding parenchyma (Richardson-Burns et al 2007 J. Neural Eng. 4 L6-13). The EDOT monomer can be delivered via a microcannula/electrode system into the brain tissue of living animals followed by direct electrochemical polymerization, using the electrode itself as a source of oxidative current. In this study, we investigated the long-term effect of local in vivo PEDOT deposition on hippocampal neural function and histology. Rodent subjects were trained on a hippocampus-dependent task, delayed alternation (DA), and implanted with the microcannula/electrode system in the hippocampus. The animals were divided into four groups with different delay times between the initial surgery and the electrochemical polymerization: (1) control (no polymerization), (2) immediate (polymerization within 5 min of device implantation), (3) early (polymerization within 3-4 weeks after implantation) and (4) late (polymerization 7-8 weeks after polymerization). System impedance at 1 kHz was recorded and the tissue reactions were evaluated by immunohistochemistry. We found that under our deposition conditions, PEDOT typically grew at the tip of the electrode, forming an ˜500 µm cloud in the tissue. This is much larger than the typical width of the glial scar (˜150 µm). After polymerization, the impedance amplitude near the neurologically important frequency of 1 kHz dropped for all the groups; however, there was a time window of 3-4 weeks for an optimal decrease in impedance. For all surgery

  7. Subdural and Cerebellar Hematomas Which Developed after Spinal Surgery: A Case Report and Review of the Literature

    Ufuk Utku


    Full Text Available Cerebellar hemorrhage following a spinal surgery is extremely rare; however, considering the localization, it can cause major clinical manifestations. While it is considered that these types of bleedings occur secondary to a venous infarct, the pathogenesis is still unclear. A 57-year-old male patient who underwent a laminectomy by exposing T12-L5 and had pedicle screws placed for ankylosing spondylitis developed a CSF leak due to a 2 mm dural tear. A hemorrhage with parallel streaks on the left cerebellar hemisphere was seen in CT scan, and a thin subdural hematoma at right frontotemporal region was seen on cranial MRI, performed after the patient developed intense headache, nausea, vomiting, and stiff neck in the early postoperative period. In this paper, a case of cerebellar and subdural hematomas following a spinal surgery is discussed with its clinical and radiologic findings.

  8. Subdural hematoma decompression model: A model of traumatic brain injury with ischemic-reperfusional pathophysiology: A review of the literature.

    Yokobori, Shoji; Nakae, Ryuta; Yokota, Hiroyuki; Spurlock, Markus S; Mondello, Stefania; Gajavelli, Shyam; Bullock, Ross M


    The prognosis for patients with traumatic brain injury (TBI) with subdural hematoma (SDH) remains poor. In accordance with an increasing elderly population, the incidence of geriatric TBI with SDH is rising. An important contributor to the neurological injury associated with SDH is the ischemic damage which is caused by raised intracranial pressure (ICP) producing impaired cerebral perfusion. To control intracranial hypertension, the current management consists of hematoma evacuation with or without decompressive craniotomy. This removal of the SDH results in the immediate reversal of global ischemia accompanied by an abrupt reduction of mass lesion and an ensuing reperfusion injury. Experimental models can play a critical role in improving our understanding of the underlying pathophysiology and in exploring potential treatments for patients with SDH. In this review, we describe the epidemiology, pathophysiology and clinical background of SDH.

  9. 儿童外伤性颅内血肿某些临床特点(附145例分析)%Some Clinical Characteristics of Traumatic Intracranial Hematoma in Children

    岳武; 杨世春; 李毅


    1.Among traumatic intracranial hematomas,epidural hematoma which is often seen in cases of skull fracture,has a higher incidence and is more frequent in older children than in infants.The incidence of subdural hematoma which is higher in infants decreases progressively with the advance of age.Intracerebral hematoma is a condition which dep.ressed skull fracture is often complicated with.2.As intracranial hematoma displays few haracteristics,diagnosis is mainly based on the progressive disturbance of consciousness.Its early manifestations include severe posttraumatic headache,frequent vomiting,rest Iness,progressive deterioration of consciousness,and early changes of vital signs.3.The mortality rate in this series is 31% (45 cases).The main factors are the tempo of formation of intracranial hematoma,preoperative condition of consciousness,compound injury,types of hematoma,the delay of operation,postoperative duration and complications.%@@ 我院自1960~1983年5月共收治小儿外伤性颅内血肿145例,占同期外伤性颅内血肿的12.7%.本组死亡率为31%(45例).本文就儿童外伤性颅内血肿某些临床特点:颅内血肿类型与年龄关系,临床特征及影响死亡率主要因素进行讨论.

  10. To Explore the 20 Cases of the Birth Canal Hematoma%浅谈20例产道血肿清除术的临床体会



    目的:探讨产道血肿形成的原因和处理方法。方法选取2013年1月~2014年6月收治的产道血肿患者20例临床处理方法进行分析。结果发生产道血肿患者经处理疼痛及坠胀症消失,无二次血肿形成,切口愈合良好。结论产道血肿发生于分娩后数小时内,绝大多数在产后12小时内发生。应切开血肿,清除血块,确切止血,关闭死腔,纠正贫血。如出血多伴有休克时,应同时予以抗休克并预防感染。%Objective To explore the causes and treatment of the birth canal hematoma formation.Methods Selected 20 cases of birth canal hematoma from 2013 January to 2014 June and analysis the clinical treatment methods.ResultsPatients of hematoma pain and bulge symptoms disappeared, no secondary hematoma formation and wound healing well after treated.Conclusion Birth canal hematoma appears within hours, most of them occur in the postpartum 12 hours after delivery. We can incision hematoma, remove blood clots, exact of hemostasis, closed die cavity, correct poor blood. If bleeding associated with shock should be anti-shock and prevent infection.

  11. Detection of travel time delay caused by dilation of an artificial fracture due to pressurization; Jinko chika kiretsu kaatsu ni tomonau toka danseiha denpa jikan henka no kenshutsu

    Tanaka, K.; Moriya, H.; Asanuma, H.; Niitsuma, H. [Tohoku University, Sendai (Japan). Faculty of Engineering


    By revealing the relation between dilation of a subsurface fracture due to pressurization and travel time delay, it may be possible to measure the information as to the subsurface fracture system as a geothermal reservoir. In this study, field experiment was conducted to clarify the relation between the travel time delay of elastic waves and the dilation of fracture, pressure, and incident angles. The travel time delay of P-wave and S-wave tended to increase with the pressurization. When incident angle was about 90{degree} against the fracture, the increase was ranging between 0 and 0.2 ms. The magnitude of this delay could not be explained only by the opening of main fracture. It was considered that there were micro-crack zones around the main fracture. The difference of P-S delay depended on the pressurization and change of the pressure. The delay depended on the incident angle against the fracture. The delay of S-wave showed the polarized wave direction dependency. However, the obtained results might greatly depend on the analytical method and parameters. 4 refs., 10 figs.

  12. Deletion of exon 20 of the Familial Dysautonomia gene Ikbkap in mice causes developmental delay, cardiovascular defects, and early embryonic lethality.

    Paula Dietrich

    Full Text Available Familial Dysautonomia (FD is an autosomal recessive disorder that affects 1/3,600 live births in the Ashkenazi Jewish population, and leads to death before the age of 40. The disease is characterized by abnormal development and progressive degeneration of the sensory and autonomic nervous system. A single base pair substitution in intron 20 of the Ikbkap gene accounts for 98% of FD cases, and results in the expression of low levels of the full-length mRNA with simultaneous expression of an aberrantly spliced mRNA in which exon 20 is missing. To date, there is no animal model for the disease, and the essential cellular functions of IKAP--the protein encoded by Ikbkap--remain unknown. To better understand the normal function of IKAP and in an effort to generate a mouse model for FD, we have targeted the mouse Ikbkap gene by homologous recombination. We created two distinct alleles that result in either loss of Ikbkap expression, or expression of an mRNA lacking only exon 20. Homozygosity for either mutation leads to developmental delay, cardiovascular and brain malformations, accompanied with early embryonic lethality. Our analyses indicate that IKAP is essential for expression of specific genes involved in cardiac morphogenesis, and that cardiac failure is the likely cause of abnormal vascular development and embryonic lethality. Our results also indicate that deletion of exon 20 abolishes gene function. This implies that the truncated IKAP protein expressed in FD patients does not retain any significant biological function.

  13. Psychiatric manifestation of chronic subdural hematoma: The unfolding of mystery in a homeless patient

    Sujita Kumar Kar


    Full Text Available The clinical manifestation of chronic subdural hematoma is not limited to neurological deficits or cognitive impairment. It may present with behavioral abnormalities. When the behavioral abnormalities present without obvious neurological deficits and in the absence of trauma, it leads to misdiagnosis. A trivial trauma may cause intracranial bleed that is either missed or ignored in the clinical history. This case report highlights the clinical picture of a homeless patient who presented with withdrawn and disorganized behavior, apathy and poverty of speech in the absence of any neurological deficit. His clinical presentation led to a possibility of psychosis and he was started on antipsychotics. He had developed extrapyramidal side effects in low dose of antipsychotic without any clinical benefit in his clinical picture. Neuroimaging done to rule out any possible organicity-revealed bilateral subdural hematoma, which was later evacuated by neurosurgical intervention in multiple settings and the patient had improved. This case report unfolds the mystery behind the psychotic presentation in a homeless adult.

  14. Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture

    Minato, Tsuyoki; Miyagi, Masayuki; Saito, Wataru; Shoji, Shintaro; Nakazawa, Toshiyuki; Inoue, Gen; Imura, Takayuki; Minehara, Hiroaki; Matsuura, Terumasa; Kawamura, Tadashi; Namba, Takanori; Takahira, Naonobu; Takaso, Masashi


    We present a rare case of spinal epidural hematoma (SEH) after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case. PMID:26989542

  15. Progressive Epidural Hematoma in Patients with Head Trauma: Incidence, Outcome, and Risk Factors

    Hao Chen


    Full Text Available Progressive epidural hematoma (PEDH after head injury is often observed on serial computerized tomography (CT scans. Recent advances in imaging modalities and treatment might affect its incidence and outcome. In this study, PEDH was observed in 9.2% of 412 head trauma patients in whom two CT scans were obtained within 24 hours of injury, and in a majority of cases, it developed within 3 days after injury. In multivariate logistic regression, patient gender, age, Glasgow Coma Scale (GCS score at admission, and skull fracture were not associated with PEDH, whereas hypotension (odds ratio (OR 0.38, 95% confidence interval (CI 0.17–0.84, time interval of the first CT scanning (OR 0.42, 95% CI 0.19–0.83, coagulopathy (OR 0.36, 95% CI 0.15–0.85, or decompressive craniectomy (DC (OR 0.46, 95% CI 0.21–0.97 was independently associated with an increased risk of PEDH. The 3-month postinjury outcome was similar in patients with PEDH and patients without PEDH (χ2=0.07, P=0.86. In conclusion, epidural hematoma has a greater tendency to progress early after injury, often in dramatic and rapid fashion. Recognition of this important treatable cause of secondary brain injury and the associated risk factors may help identify the group at risk and tailor management of patients with TBI.

  16. Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture

    Tsuyoki Minato


    Full Text Available We present a rare case of spinal epidural hematoma (SEH after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case.

  17. Effect of Maixuekang enteric coated tablets on absorption of hematoma and treatment of acute cerebral hemorrhage patients with cerebral edema

    Bing-Ding Lu; Chuan Wang


    Objective:To study the clinical efficacy of Maixuekang in treating acute cerebral hemorrhage hematomas and promoting brain hemorrhage.Methods: A total of 192 patients with acute intracerebral hemorrhage treated within 3 hours in our hospital during April 2013 to February 2015 were selected. After admission immediately apply brain CT, blood, coagulation function tests were carried out. They were randomly divided into 2 groups. Both groups had anti-infective, mannitol and other conventional treatment. Observation group were treated with enteric-coated tablets Maixuekang on this basis. Clinical efficacy, various stages of treatment of cerebral hematoma volume, brain edema volume, NIHSS score were compared.Results: Before treatment, difference in edema volume and HIHSS scores were not statistically significant (P>0.05). After14 d and 28 d treatment, edema volume of observation group were significantly smaller than those of control group (P<0.01); NIHSS score of observation group were significantly lower than those of control group (P<0.01); 28 d after treatment total effective rate of observation group was significantly higher than that of the control group (P<0.01).Conclusions:Maixuekang enteric-coated tablets as a thrombin inhibitor, can effectively reduce a series of pathological changes after acute cerebral hemorrhage caused by partial thrombin content, promote absorption of hematoma and neurological recovery. The side effects is small, safe and worthy of promotion.

  18. Rapid resolution of subdural hematoma after targeted epidural blood patch treatment in patients with spontaneous intracranial hypotension

    Wang Jin; Zhang Dan; Gong Xiangyang; Ding Meiping


    Background Subdural hematoma (SDH) is a common complication of spontaneous intracranial hypotension (SIH).To date,the management of SDH caused by SIH remains controversial.In this paper,we reviewed the clinical course of SDH in patients with SIH,and discuss the underlying mechanism and attributing factors for rapid resolution of subdural hematomas after epidural blood patch (EBP) surgery.Methods We retrospectively reviewed a cohort of seventy-eight SIH patients diagnosed and treated with targeted EBP in our neurology center.Patients who received early CT/MRI follow-up after EBP operation were included.Results A series of four cases of SIH complicated with SDHs were evaluated.Early follow-up neuroimages of these patients revealed that SDHs could be partially or totally absorbed just two to four days after targeted epidural blood patch treatment.Conclusion Targeted epidural blood patch can result in rapid hematoma regression and good recovery in some patients with a combination of SDH and SIH.

  19. [MRI semiotics features of experimental acute intracerebral hematomas].

    Burenchev, D V; Skvortsova, V I; Tvorogova, T V; Guseva, O I; Gubskiĭ, L V; Kupriianov, D A; Pirogov, Iu A


    The aim of this study was to assess the possibility of revealing intracerebral hematomas (ICH), using MRI, within the first hours after onset and to determine their MRI semiotics features. Thirty animals with experimental ICH were studied. A method of two-stage introduction of autologous blood was used to develop ICH as human spontaneous intracranial hematomas. Within 3-5h after blood introduction to the rat brain. The control MRI was performed in the 3rd and 7th days after blood injections. ICH were definitely identified in the first MRI scans. The MRI semiotics features of acute ICH and their transformations were assessed. The high sensitivity of MRI to ICH as well as the uniform manifestations in all animals were shown. In conclusion, the method has high specificity for acute ICH detection.

  20. [A Case of Spinal Epidural Hematoma Presenting with Transient Hemiplegia].

    Komai, Takanori; Nakashima, Kazuya; Tominaga, Takashi; Nogaki, Hidekazu


    We report a rare case of a patient with spinal epidural hematoma who presented with transient hemiplegia. A 90-year-old man awakened from sleep due to sudden neck pain. Fifteen minutes later, the man experienced progressively worsening weakness in his left hand, and was transported in an ambulance to our hospital. At the hospital, he presented with hemiplegia, and we suspected intracranial disease. Therefore, we performed magnetic resonance imaging (MRI), which revealed no intracranial lesions. Shortly after the MRI, the patient showed no signs of hemiplegia. However, since the severe neck pain persisted, we performed cervical MRI, which showed a high-intensity area at the C2-C5 level, predominantly on the left side. Despite recovery from hemiplegia, we performed a laminectomy of C3-C5 with evacuation of a hematoma at the C2-C6 level. After the surgery, the patient had no neck pain.

  1. Advances in surgical treatment of chronic subdural hematoma

    张作洪; 刘建雄


    @@ Chronic subdural hematoma (CSDH) represents one of the most frequent types of intracranial hemorrhage. Management of the patients with CSDH has been evolved through a vast variety of methods and techniques. Although there is general agreement that surgical therapy is usually the preferred treatment, there are few other neurosurgical conditions that spark such strong discussions and differences of opinion concerning the optimal surgical technique.1,2 In this paper, we review advances in surgical treatment of CSDH.

  2. Acutely calcified hematoma mimicking a displaced medial epicondyle fracture

    Majed Addie


    Full Text Available We present an interesting and unusual case of an acutely calcified pin-site infection hematoma mimicking a displaced cartilaginous medial epicondyle, in a child with a Gartland type III fracture. The treatment of such pathology could be confusing and may interfere with the correct clinical decision-making process. To our knowledge, this is the first presentation of such a case.

  3. Traumatic tentorial hematoma in two-wheeler riders: Correlation with helmet use

    Agrawal, Deepak; Dawar, Pankaj


    Background: Tentorial hematoma is frequently seen in traumatic brain injury (TBI) patients, especially in motorized two-wheeler riders following head injury. However its relevance and prognostic significance are not known. Objective: To evaluate patients of TBI with tentorial hematoma using a simple grading system and attempt to correlate this grading with factors like helmet use and neurological outcome. Materials and Methods: This prospective study over a 1-year period included patients with TBI who had tentorial hematoma in the initial plain head. Patients were divided into three grades based on the initial CT findings: Grade I: Isolated tentorial hematoma, grade II: tentorial hematoma with midline shift but open cisterns and grade III: Tentorial hematoma with effaced cisterns. Clinical and radiological records of patients including admission GCS and GOS at discharge were assessed in all cases. Observations: A total of 1786 patients of TBI were admitted during the study period. Of these, 106 (5.9%) patients had tentorial hematoma. 84.9% (n = 90) were male and 15.1% (n = 16) were female with the mean age being 36.5 years (range 2-66 years). The mean admission GCS was 13, 11 and 8 in patients with grade I, II and III tentorial hematoma respectively. 43.4% (n = 46) of the patients had grade I, 32.1% (n = 34) had grade II and 24.5% (n = 26) patients had grade III tentorial hematoma. Seventy-one patients (84.5%) were riding motorized two wheelers with 63 (89%) wearing helmets. The majority of the patients wearing helmets (58.8%) had grade I hematoma with 35% (n = 22) having grade II hematoma and only 6.3% (n = 4) having grade III hematoma. Overall, there were 20 deaths. 50% (n = 10) of the deaths were in patients with grade III hematoma and 40% (n = 8) of the deaths were in patients with grade II hematoma. There were two (10%) deaths in patients with grade I hematoma (both unrelated to head injury). The mean GOS at the time of discharge was 5, 4.1 and 2.2 in patients

  4. CT angiography in patients with spontaneous intracerebral hematoma

    Yoon, Dae Young; Shim, Joo Eun; Yi, Jeong Geun; Kim, Ho Chul; Choi, Chul Soon; Bae, Sang Hoon [Hallym University College of Medicine, Choonchun (Korea, Republic of)


    The purpose of this study was to assess the usefulness of CT angiography (CTA) in patients with intracerebral hematoma. Eighteen patients with spontaneous intracerebral hematoma underwent CTA; 20-30 seconds after the onset of an injection of contrast media (100mL), with the use of a power injector, at a rate of 3mL/sec, scanning (30-second continuous exposure and 60-90mm length) was performed with a table speed of 2-3 mm/sec and section thickness of 2mm. The starting point selected was the floor of the sella turcica. The resulting data were reformatted by maximum intensity projection (MIP) after reconstruction at 1-mm intervals, and CTA findings were compared with those of conventional angiography (n=17), surgery (n=6), and postcontrast CT(n=10). The diagnostic findings of CTA included five arteriovenous malformations, two aneurysms, one venous angioma, and one venous sinus occlusion, while the remaining nine patients had no vascular lesion. In all cases, CTA findings correlated well with those of postcontrast CT. In one cases of arteriovenous malformation, however, the feeding artery and draining vein were not definite on CTA, and in one case of sinus occlusion, the full length of the superior sagittal sinus could not be delineated. In patients with spontaneous intracerebral hematoma, CTA is a valuable screening method. (author). 15 refs., 4 figs.

  5. [Acute epidural hematoma with extravasation on cerebral angiogram in an infant (author's transl)].

    Oseki, J; Oana, K; Kobayashi, T; Kawada, Y; Kanaya, H


    The authors recently operated on a boy four years of age with acute epidural hematoma showing an extravasation on the cerebral angiogram. The hematoma (hematoma volume 125 ml) was evacuated 7 hours after the head injury. The postoperative course was quite uneventful, and he was discharged a month after surgery without any neurologic deficits. The authors reviewed the literature and found 4 cases of acute epidural hematoma with extravasations in infants and children. In all cases the operative results were good. The age incidence and frequency of occurence overall for acute epidural hematomas, extravasations on cerebral angiograms and their mechanism, and the length of time from injury to operation were also discussed. It should be emphasized that, for acute epidural hematoma in infants and children, the early diagnosis and early surgery are essential to save the patients.

  6. Kernohan-Woltman notch phenomenon and intention tremors in case of chronic subdural hematoma

    Sasikala P.


    Full Text Available Movement disorders are atypical and rare presentation of chronic subdural hematomas. We report a case of 60 year man who presented with intention tremors and altered sensorium. The patient had Kernohan-Woltman notch phenomenon on clinical examination. CT scan brain showed a large left fronto-temporo-parietal chronic subdural hematoma with significant mass effect and midline shift. His symptoms relieved completely after surgical evacuation of the hematoma.

  7. Difficult Airway due to Retropharyngeal Hematoma after Stabbing to the Neck

    Kouhei Iwashita


    Full Text Available Reports of retropharyngeal hematoma have been scarce in the anesthesiology literature. We report a patient whose trachea was difficult to intubate due to retropharyngeal hematoma after stabbing to the neck. A woman with a knife injury to the common carotid artery required emergency carotid arterioplasty. When tracheal intubation was attempted, marked swelling of the posterior pharyngeal wall made the vocal cords impossible to visualize. Preoperative computed tomography showed a retropharyngeal hematoma. The patient required mechanical ventilation for 2 days.

  8. Hematoma epidurale in patients with delirium tremens

    S. Kasper


    Full Text Available In this report we presented a case of diagnostic and therapeutic treatment of the patient with delirium tremens in the Psychiatric Ward of the Cantonal Hospital in Zenica. Neuroradiologic diagnostics had shown existance of epiduralhematoma. The patient was transfered to the Neurosurgery Ward for observation and treatment. Difficultieswith differential diagnostics were caused by already present state of delirium as well as an old neurological deficitrelated to right side hemiparesis.

  9. In-hospital mortality after pre-treatment with antiplatelet agents or oral anticoagulants and hematoma evacuation of intracerebral hematomas.

    Stein, Marco; Misselwitz, Björn; Hamann, Gerhard F; Kolodziej, Malgorzata; Reinges, Marcus H T; Uhl, Eberhard


    Pre-treatment with antiplatelet agents is described to be a risk factor for mortality after spontaneous intracerebral hemorrhage (ICH). However, the impact of antithrombotic agents on mortality in patients who undergo hematoma evacuation compared to conservatively treated patients with ICH remains controversial. This analysis is based on a prospective registry for quality assurance in stroke care in the State of Hesse, Germany. Patients' data were collected between January 2008 and December 2012. Only patients with the diagnosis of spontaneous ICH were included (International Classification of Diseases 10th Revision codes I61.0-I61.9). Predictors of in-hospital mortality were determined by univariate analysis. Predictors with Panticoagulants or antiplatelet agents was documented in 16.3% and 25.1%, respectively. Overall in-hospital mortality was 23.2%. In-hospital mortality was decreased in operatively treated patients compared to conservatively treated patients (11.6% versus 24.0%; Pantiplatelet pre-treatment had a significantly higher risk of death during the hospital stay after hematoma evacuation (odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.24-4.97; P=0.010) compared to patients without antiplatelet pre-treatment treatment (OR: 0.9; 95% CI: 0.79-1.09; P=0.376). In conclusion a higher rate of in-hospital mortality after pre-treatment with antiplatelet agents in combination with hematoma evacuation after spontaneous ICH was observed in the presented cohort.

  10. Immediate versus Delayed Sarcoma Reconstruction: Impact on Outcomes

    Kyle J. Sanniec


    Full Text Available Background. Sarcoma is a rare malignancy, and more recent management algorithms emphasize a multidisciplinary approach and limb salvage, which has resulted in an increase in overall survival and limb preservation. However, limb salvage has resulted in a higher rate of wound complications. Objective. To compare the complications between immediate and delayed (>three weeks reconstruction in the multidisciplinary limb salvage sarcoma patient population. Methods. A ten-year retrospective review of patients who underwent sarcoma resection was performed. The outcome of interest was wound complication in the postoperative period based on timing of reconstruction. We defined infection as any infection requiring intravenous antibiotics, partial flap failure as any flap requiring a debridement or revision, hematoma/seroma as any hematoma/seroma requiring drainage, and wound dehiscence as a wound that was not completely intact by three weeks postoperatively. Results. 70 (17 delayed, 53 immediate patients who underwent sarcoma resection and reconstruction met the inclusion criteria. Delayed reconstruction significantly increased the incidence of postoperative wound infection and wound dehiscence. There was no difference in partial or total flap loss, hematoma, or seroma between the two groups. Discussion and Conclusion. Immediate reconstruction results in decreased wound complications may reduce the morbidity associated with multidisciplinary treatment in the limb salvage sarcoma patient.

  11. Presacral retroperitoneal hematoma after blunt trauma presents with rectal bleeding — A case report

    Sanne Jensen Dich


    Conclusion: Rectal bleed after trauma, in a patient receiving anticoagulant treatment, should raise suspicion of a penetrating hematoma, and such patients should be managed at highly specialized facilities.

  12. Chronic nontraumatic spinal epidural hematoma of the lumbar spine: MRI diagnosis

    Vazquez-Barquero, A.; Pinto, J.I. [Univ. Hospital ' ' Marques de Valdecilla' ' , Santander (Spain). Dept. of Neurosurgery; Abascal, F.; Garcia-Valtuille, R.; Cerezal, L. [Hospital Mompia, Cantabria, (Spain). Dept. of Radiology; Figols, F.J. [Univ. Hospital Marques de Valdecilla, Santander (Spain). Dept. of Pathology


    An uncommon case of chronic nontraumatic spinal epidural hematoma of the lumbar spine in a 75-year-old woman is reported. The patient presented with a 7-month history of low back pain and bilateral sciatica. Magnetic resonance imaging enabled a correct preoperative diagnosis revealing a nodular, well-circumscribed epidural mass with peripheral enhancement and signal intensities consistent with chronic hematoma, which extended from L2 to L3. Laminectomy of L2-L3 was performed and the hematoma was totally resected. Histological examination of the surgical specimen demonstrated a chronic encapsulated hematoma. No evidence of vascular malformation was found. The patient recovered fully after surgical treatment. (orig.)

  13. Drosophila CENP-A mutations cause a BubR1-dependent early mitotic delay without normal localization of kinetochore components.

    Michael D Blower


    Full Text Available The centromere/kinetochore complex plays an essential role in cell and organismal viability by ensuring chromosome movements during mitosis and meiosis. The kinetochore also mediates the spindle attachment checkpoint (SAC, which delays anaphase initiation until all chromosomes have achieved bipolar attachment of kinetochores to the mitotic spindle. CENP-A proteins are centromere-specific chromatin components that provide both a structural and a functional foundation for kinetochore formation. Here we show that cells in Drosophila embryos homozygous for null mutations in CENP-A (CID display an early mitotic delay. This mitotic delay is not suppressed by inactivation of the DNA damage checkpoint and is unlikely to be the result of DNA damage. Surprisingly, mutation of the SAC component BUBR1 partially suppresses this mitotic delay. Furthermore, cid mutants retain an intact SAC response to spindle disruption despite the inability of many kinetochore proteins, including SAC components, to target to kinetochores. We propose that SAC components are able to monitor spindle assembly and inhibit cell cycle progression in the absence of sustained kinetochore localization.

  14. Delayed fission

    Hatsukawa, Yuichi [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment


    Delayed fission is a nuclear decay process that couples {beta} decay and fission. In the delayed fission process, a parent nucleus undergoes {beta} decay and thereby populates excited states in the daughter. If these states are of energies comparable to or greater than the fission barrier of the daughter, then fission may compete with other decay modes of the excited states in the daughter. In this paper, mechanism and some experiments of the delayed fission will be discussed. (author)

  15. Mechanical Recanalization following i.v. Thrombolysis: A Retrospective Analysis regarding Secondary Hemorrhagic Infarctions and Parenchymal Hematomas

    Höltje, J.; Bonk, F.; Anstadt, A.; Terborg, C.; Pohlmann, C.; Urban, P. P.; Brüning, R.


    Introduction. In acute stroke by occlusion of the proximal medial cerebral artery (MCA) or the distal internal carotid artery, intravenous thrombolysis is an established treatment. Another option is mechanical recanalization. It remains unclear if the combination of both methods poses an additional bleeding risk. The aim of this retrospective analysis is to determine the proportion of hemorrhagic infarctions and parenchymal hematomas. Methods. Inclusion criteria were an occlusion of the carotid T or proximal MCA treated with full dose thrombolysis and mechanical recanalization. 31 patients were selected. Devices used were Trevo, Penumbra Aspiration system, Penumbra 3D Retriever, and Revive. The initial control by computed tomography was carried out with a mean delay to intervention of 10.9 hours (SD: 8.5 hours). Results. A slight hemorrhagic infarction (HI1) was observed in 2/31 patients, and a more severe HI2 occurred in two cases. A smaller parenchymal hematoma (PH1) was not seen and a space-occupying PH2 was seen in 2/31 cases. There was no significant difference in the probability of intracranial bleeding after successful (thrombolysis in cerebral infarctions 2b and 3) or unsuccessful recanalization. Conclusion. The proportion of intracranial bleeding using mechanical recanalization following intravenous thrombolysis appears comparable with reports using thrombolysis alone. PMID:26640710

  16. Mechanical Recanalization following i.v. Thrombolysis: A Retrospective Analysis regarding Secondary Hemorrhagic Infarctions and Parenchymal Hematomas

    J. Höltje


    Full Text Available Introduction. In acute stroke by occlusion of the proximal medial cerebral artery (MCA or the distal internal carotid artery, intravenous thrombolysis is an established treatment. Another option is mechanical recanalization. It remains unclear if the combination of both methods poses an additional bleeding risk. The aim of this retrospective analysis is to determine the proportion of hemorrhagic infarctions and parenchymal hematomas. Methods. Inclusion criteria were an occlusion of the carotid T or proximal MCA treated with full dose thrombolysis and mechanical recanalization. 31 patients were selected. Devices used were Trevo, Penumbra Aspiration system, Penumbra 3D Retriever, and Revive. The initial control by computed tomography was carried out with a mean delay to intervention of 10.9 hours (SD: 8.5 hours. Results. A slight hemorrhagic infarction (HI1 was observed in 2/31 patients, and a more severe HI2 occurred in two cases. A smaller parenchymal hematoma (PH1 was not seen and a space-occupying PH2 was seen in 2/31 cases. There was no significant difference in the probability of intracranial bleeding after successful (thrombolysis in cerebral infarctions 2b and 3 or unsuccessful recanalization. Conclusion. The proportion of intracranial bleeding using mechanical recanalization following intravenous thrombolysis appears comparable with reports using thrombolysis alone.

  17. Optoacoustic detection and monitoring of blast-induced intracranial hematomas in rats

    Petrov, Andrey; Wynne, Karon E.; Prough, Donald S.; Dewitt, Douglas S.; Petrov, Yuriy; Petrov, Irene Y.; Parsley, Margaret A.; Esenaliev, Rinat O.


    Patients with acute intracranial hematomas often require surgical drainage within the first four hours after traumatic brain injury (TBI) to avoid death or severe neurologic disability. CT and MRI permit rapid, noninvasive diagnosis of hematomas, but can be used only at a major health-care facility. At present, there is no device for noninvasive detection and characterization of hematomas in pre-hospital settings. We proposed to use an optoacoustic technique for rapid, noninvasive diagnosis and monitoring of hematomas, including intracranial hematomas. Unlike bulky CT and MR equipment, an optoacoustic system can be small and easily transported in an emergency vehicle. In this study we used a specially-designed blast device to inflict TBI in rats. A near-infrared OPO-based optoacoustic system developed for hematoma diagnosis and for blood oxygenation monitoring in the superior sagittal sinus (SSS) in small animals was used in the study. Optoacoustic signals recorded simultaneously from the SSS and hematomas allowed for measurements of their oxygenations. The presence of hematomas was confirmed after the experiment in gross pictures of the exposed brains. After blast the hematoma signal and oxygenation increased, while SSS oxygenation decreased due to the blastinduced TBI. The increase of the oxygenation in fresh hematomas may be explained by the leakage of blood from arteries which have higher blood pressure compared to that of veins. These results indicate that the optoacoustic technique can be used for early diagnosis of hematomas and may provide important information for improving outcomes in patients with TBI or stroke (both hemorrhagic and ischemic).

  18. Absorption fever characteristics due to percutaneous renal biopsy-related hematoma.

    Hu, Tingyang; Liu, Qingquan; Xu, Qin; Liu, Hui; Feng, Yan; Qiu, Wenhui; Huang, Fei; Lv, Yongman


    This study aims to describe the unique characteristics of absorption fever in patients with a hematoma after percutaneous renal biopsy (PRB) and distinguish it from secondary infection of hematoma.We retrospectively studied 2639 percutaneous renal biopsies of native kidneys. We compared the clinical characteristics between 2 groups: complication group (gross hematuria and/or perirenal hematoma) and no complication group. The axillary temperature of patients with a hematoma who presented with fever was measured at 06:00, 10:00, 14:00, and 18:00. The onset and duration of fever and the highest body temperature were recorded. Thereafter, we described the time distribution of absorption fever and obtained the curve of fever pattern.Of 2639 patients, PRB complications were observed in 154 (5.8%) patients. Perirenal hematoma was the most common complication, which occurred in 118 (4.5%) of biopsies, including 74 small hematoma cases (thickness ≤3 cm) and 44 large hematoma cases (thickness >3 cm). Major complications were observed in only 6 (0.2%) cases resulting from a large hematoma. Of 118 patients with a perirenal hematoma, absorption fever was observed in 48 cases. Furthermore, large hematomas had a 5.23-fold higher risk for absorption fever than the small ones.Blood pressure, renal insufficiency, and prothrombin time could be risk factors for complications. Fever is common in patients with hematoma because of renal biopsy and is usually noninfectious. Evaluation of patients with post-biopsy fever is necessary to identify any obvious infection sources. If no focus is identified, empiric antibiotic therapy should not be initiated nor should prophylactic antibiotics be extended for prolonged durations. Absorption fevers will resolve in time without specific therapeutic interventions.

  19. Delayed Bleeding and Pelvic Haematoma after Low-Energy Osteoporotic Pubic Rami Fracture in a Warfarin Patient: An Unusual Cause of Abdominal Pain

    Andrea Sandri


    Full Text Available Introduction. Acute abdominal pain may be the presenting symptom in a wide range of diseases in the elderly. Acute abdominal pain related to a delayed bleeding and pelvic haematoma after a low-energy pubic rami fracture is rare and can have important consequences; to the best of our knowledge, only one case has been previously described. Case Report. We present an unusual case of an 83-year-old woman taking warfarin for atrial fibrillation, admitted to the Emergency Department (ED with acute abdominal pain and progressive anemia related to a delayed bleeding and pelvic haematoma 72 hours after a low-energy osteoporotic pubic rami fracture. Warfarin was withheld, anticoagulation was reversed by using fresh frozen plasma and vitamin K, and concentrated red blood cells were given. Haemoglobin level gradually returned to normal with a progressive resorption of the haematoma. Conclusion. Delayed bleeding and pelvic haematoma after osteoporotic pubic rami fracture should be considered in the differential diagnosis of acute abdominal pain in the elderly. This case indicates the need for hospital admission, careful haemodynamic monitoring, and early identification of bleeding in patients with “benign” osteoporotic pubic rami fracture, especially those receiving anticoagulants, to provide an adequate management and prevent severe complications.

  20. Hemobilia, intrahepatic hematoma and acute thrombosis with cavernomatous transformation of the portal vein after percutaneous thermoablation of a liver metastasis

    Francica, G.; Marone, G.; D' Angelo, V. [Divisione di Gastroenterologia, Ospedale ' ' Cardinale Ascalesi' ' , Naples (Italy); Solbiati, L. [Divisione di Ecografia e Radiologia Interventistica, Ospedale Generale Busto Arsizio (Italy); Siani, A. [Servizio di Radiologia, Ospedale Civile ' ' S. Maria Delle Grazie' ' , Pozzuoli (Italy)


    A 53-year-old-man underwent US-guided percutaneous thermal ablation with a cooled-tip needle of three liver metastases from gastric cancer. Six days later, the patient was re-admitted for melena, scleral jaundice, and anemia. Abdominal US disclosed echogenic material in the gallbladder lumen (hemobilia) and a focal lesion with mixed echotexture in segment III (hepatic hematoma). On day 5 portal cavernomatosis was diagnosed at US and confirmed by color Doppler and a helical CT exam. The case described emphasizes that radio-frequency interstitial hyperthermia may cause not only traumatic injury of the liver parenchyma but also thermally mediated damage of vascular structures. (orig.)

  1. A newly developed open-end intracranial hematoma drainage tube

    Chao He; Nongnaphat Wanussakul; Dong Yang; Tianya Wu; Ming Zhao


    Methods:The newly developed device consists of two parts:the plunger and barrel. On one side, the barrel is bullet shaped with an opening tip. The plunger is located in the middle cavity of the tube barrel and extended out at the open-end. It was designed for strengthening the tube barrel and for convenience in performing the drainage procedure. It can be used by inserting the drainage tube into the lesion and pulling out the plunger, whereby blood will forcefully rise up inside the barrel, providing a satisfactory outcome. It is made for effusion drainage purposes. During the procedure, the drainage tip is placed at the deepest part of the intracranial hematoma to completely drain the blood. Moreover, the plunger fits tightly in the tube, preventing leakage during the operation. With the use of the device, brain can be separated. In addition, the device can help reduce the risk of cerebral damage because of the small operating area. The barrel sidewall has matching opening holes bilaterally and equally for exchanging substances between the inner and outer parts. The overlapping ratio in each horizontal pair is around 1/3–1/2. Each pair on the opposite side will form a different pressure. Thus, the opening holes will not easily get blocked with blood clot. Results: Blood and accumulated liquid from the deepest part of the intracranial hematoma can be directly drawn through the drainage tube without damaging a large area. The tube does not get blocked easily and allows for complete removal of the hematoma. Conclusions:The device is asuitable instrument for clinical application.

  2. 再论哈姆莱特犹豫和延宕的根源%Title Second exploration on the cause of Hamlet’ s indecision and delay



    Human behavior is governed by human mind .Mind is neither a static nor horizontal prefigure of single element, but a dynamic and multidimensional prefigure of multi -elements.Before Renaissance, Christianity which had ruled the Europe more than one thousand years , has entered not only the conscious-ness, but also the unconsciousness of the European people , Christianity has become a deeply seated member in the unconsciousness of the European minds .In the epoch of Renaissance , the lifestyle of the Bourgeoisie industry and commerce emerged with the development of bourgeoisie industry and commerce .Humanism, the core idea of the lifestyle of Bourgeoisie industry and commerce began to enter the consciousness of the individ -ual.However, humanism failed to enter the unconsciousness of the individual .Therefore, it was impossible for the newly rising humanism to restructure the original mind .In the time when the lifestyle transited from the Christianity natural economy to the bourgeoisie industry and commerce , Hamlet could not remove the influence of Christianity in the depth of his soul .The Christianity spirit and the God -centered value orientation in the unconsciousness of Hamlet is in contradict with the humanism and man -centered value orientation in con-sciousness .It is evident that Hamlet ’ s value paralysis , cognitive stagnation and indecision in the course of a-venging his uncle for the death of his father and putting the nation in the right course again was caused by his contradict in mind in the form of value orientation and his delay was caused by his Christianity spirit and God-centered value orientation.%行为受心理支配。心理不是一个由单一因素组成的静态的和水平的结构,而是一个由多元素组成的动态的和多层次的结构。在文艺复兴之前,统治欧洲一千多年的基督教不仅获得主体同意已经进入意识,而且进入无意识心理,并且,成为在无意识中隐藏得最深的因

  3. Dolor abdominal y hematoma cutáneo



    Mujer de 83 años portadora de cardiopatía isquémica, insuficiencia mitral moderada, fibrilación auricular crónica. A tratamiento con nitroglicerina transdérmica, diuréticos, calcioantagonistas, estatinas y anticoagulantes orales (acenocumarol).Ingresa en nuestro Servicio por infección respiratoria e insuficiencia respiratoria, con tos frecuente y expectoración amarillenta en los 4 días previos. En el noveno día de su ingreso refiere la presencia de un hematoma espontáneo a nivel abdominal aco...

  4. Dolor abdominal y hematoma cutáneo



    Full Text Available Mujer de 83 años portadora de cardiopatía isquémica, insuficiencia mitral moderada, fibrilación auricular crónica. A tratamiento con nitroglicerina transdérmica, diuréticos, calcioantagonistas, estatinas y anticoagulantes orales (acenocumarol.Ingresa en nuestro Servicio por infección respiratoria e insuficiencia respiratoria, con tos frecuente y expectoración amarillenta en los 4 días previos. En el noveno día de su ingreso refiere la presencia de un hematoma espontáneo a nivel abdominal acompañado de dolor a dicho nivel.

  5. Extensive spinal epidural hematoma: a rare complication of aortic coarctation

    Zizka, J.; Elias, P.; Michl, A. [Dept. of Radiology, Charles University Hospital, Hradec Kralove (Czech Republic); Harrer, J. [Dept. of Cardiac Surgery, Charles University Hospital, Hradec Kralove (Czech Republic); Cesak, T. [Dept. of Neurosurgery, Charles University Hospital, Hradec Kralove (Czech Republic); Herman, A. [1. Dept. of Internal Medicine, Charles University Hospital, Hradec Kralove (Czech Republic)


    Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported. (orig.)

  6. Late onset of subdural hematoma after bifrontal contusion

    Gürer, Bora; Kertmen, Hayri; Dolgun, Habibullah; Sekerci, Zeki


    Cerebral cortical contusions are one of the most common computed tomography findings in head-injured patients and common sequel of traumatic brain injury. These contusions tend to show a progressive increase in mass effect on repeated imaging, most small contusions do not require surgical evacuation. However, progression to subdural hematoma (SDH) in a late aspect is unique. Here we present a 71-year-old man with bifrontal contusion, who deteriorated 43 days after initial trauma with sudden onset of acute SDH. This unusual case suggests that neurosurgeons should be alert for the possibility of very late onset of acute SDH after bifrontal contusions.

  7. Non-traumatic acute epidural spinal hematomas diagnosed by magnetic resonance; Hematomas espinales epidurales agudos no traumaticos: diagnostico por resonancia magnetica

    Rovira, A.; Grive, E.; Pedraza, S.; Capellades, J.; Nos, C.; Alarcon, M.; Rovira, A. [Hospital Universitari Vall d' Hebron. Barcelona (Spain)


    The non-traumatic spinal epidural hematoma (NTSEH) is a rare entity that can be the cause of an acute spinal compression syndrome. the objective of this review is to identify the characteristics by MRI and NTSEH and to analyze the factors that influence in its prognosis. In the years 1994 and 1999, 12 patients with NTSEH have been diagnosed in our hospital, and a MRI was performed during the acute phase. the characteristics of the lesions have been analyzed by MRI, with special emphasis on the topographic data and resonance signal and the factors that can influence in the clinical prognosis of the patients. Initially, all of the patients presented pain in the cervical dorsal or interscapular site, followed by a sensitive-motor deficit picture. The MRI showed a lesion of expansive character and posterior epidural location in every case that would produce varying degrees of compression on the spinal cord. The NTSEH should be considered as one of the causes of acute spinal cord compression. The clinical association of intense cervical, dorsal or interscapular pain followed by a sensomotor deficit picture should lead to the suspicion of this entity, that would require an immediate examination with MRI to verify its diagnosis. Both the clinical manifestations as well as the characteristics observed by MRI of the NTSEH have a prognostic value and determine the therapeutic decision. (Author) 34 refs.

  8. CT findings and clinical analysis of subcortical hematomas in elderly patients

    Ueno, Yasushi; Tanaka, Akira; Yoshinaga, Shinya; Kimura, Masato (Fukuoka Univ., Chikushino (Japan). Chikushi Hospital)


    Ten elderly patients (73-87 years, 78.4 years on the average) with subcortical hematomas were divided into two groups according to the shape of the hematoma on a CT scan: a lobulated group (6 patients) and a global group (4 patients). The lobulated group had a history of hypertension in one patient. The hematomas extended widely around the parietal lobe and were accompanied by perifocal edema, brain shifts and subarachnoid hemorrhages, deep consciousness disturbances, and poor prognosis of life and function. Amyloid depositions in the arteries around the hematomas were confirmed histologically in one patient. The global group had a history of hypertension in two patients. The hematomas were localized in the parietal, temporal, or occipital lobe without perifocal edema, brain shift and subarachnoid hemorrhages, and accompanied by mild consciousness disturbances. The life prognosis was good, but the functional prognosis was poor, with a subsequent development of dementia. A lobulated subcortical hematoma is thought to be due to amyloid angiopathy, while a global subcortical hematoma is thought to be due to hypertension. A surgical evacuation is seldom indicated for either type of subcortical hematoma in elderly patients. (author).

  9. Operative treatment of spontaneous spinal epidural hematomas : a study of the factors determining postoperative outcome

    Groen, R J; van Alphen, H A


    OBJECTIVE: We clarify the factors affecting postoperative outcomes in patients who have suffered spontaneous spinal epidural hematomas. METHODS: We review 330 cases of spontaneous spinal epidural hematomas from the international literature and three unpublished cases of our own. Attention was focuse

  10. Sharp tooth induced sublingual hematoma in a patient with elevated international normalized ratio

    John Baliah


    Full Text Available Sublingual hematoma secondary to anticoagulation is a rare fatal condition. Hemorrhagic complications of warfarin are well-known. This particular case is unique because the patient was on warfarin for the past 2 years but did not develop the sublingual hematoma. However, a trauma by an attrited sharp cusp triggered the episode of the sublingual hematoma in this patient. Being a medical emergency, patient was promptly hospitalized in cardiac care unit and managed by medical team. The patient was transfused with 2 units of fresh frozen plasma and warfarin was temporarily stopped for 4 days. Alternate day regimen of warfarin was started after 4 days, and international normalized ratio dropped to 3. In dental management, enameloplasty of the mandibular first molar tooth was done to prevent trauma and ulcer development in the floor of the mouth. The hematoma resolved, and no new hematoma formation was observed for a period of 6 months.

  11. Volume of blood suctioned during vacuum-assisted breast biopsy predicts later hematoma formation

    Panopoulou Effrosyni


    Full Text Available Abstract Background To evaluate whether the volume of blood suctioned during vacuum-assisted breast biopsy (VABB is associated with hematoma formation and progression, patient's age and histology of the lesion. Findings 177 women underwent VABB according to standardized protocol. The volume of blood suctioned and hematoma formation were noted at the end of the procedure, as did the subsequent development and progression of hematoma. First- and second-order logistic regression was performed, where appropriate. Cases with hematoma presented with greater volume of blood suctioned (63.8 ± 44.7 cc vs. 17.2 ± 32.9 cc; p Conclusion The likelihood of hematoma is increasing along with increasing amount of blood suctioned, reaching a plateau approximately at 80 cc of blood lost.

  12. Endoscopic therapy for esophageal hematoma with blue rubber bleb nevus syndrome

    Mika; Takasumi; Takuto; Hikichi; Tadayuki; Takagi; Masaki; Sato; Rei; Suzuki; Ko; Watanabe; Jun; Nakamura; Mitsuru; Sugimoto; Yuichi; Waragai; Hitomi; Kikuchi; Naoki; Konno; Hiroshi; Watanabe; Katsutoshi; Obara; Hiromasa; Ohira


    A 57-year-old woman previously diagnosed with blue rubber bleb nevus syndrome(BRBNS) reported hematemesis. BRBNS is a rare vascular anomaly syndrome consisting of multifocal hemangiomas of the skin and gastrointestinal(GI) tract but her GI tract had never been examined. An upper gastrointestinal endoscopy revealed a large bleeding esophageal hematoma positioned between the thoracic esophagus and the gastric cardia. An endoscopic injection of polidocanol was used to stop the hematoma from bleeding. The hematoma was incised using the injectionneedle to reduce the pressure within it. Finally, argon plasma coagulation(APC) was applied to the edge of the incision. The esophageal hematoma disappeared seven days later. Two months after the endoscopic the rapy, the eso phage alulcerhealed and the hemangioma did not relapse. This rare case of a large esophageal hematoma originating from a hemangioma with BRBNS was treated using a combination of endoscopic therapy with polidocanol injection, incision, and APC.

  13. Subacute subdural hematoma in a 45-year-old woman with no significant past medical history after a roller coaster ride.

    Williams, Kim A; Kouloumberis, Pelagia; Engelhard, Herbert H


    Amusement park ride injuries have been newsworthy events for many years. The multitude and severity of these injuries has been reported many times over the past 20 years and includes spinal cord and vertebral injuries, subarachnoid hemorrhage, internal and vertebral artery dissections, and even a few cases of subdural hematoma (SDH). There has also been as many theories to explain these injuries as there have been injuries themselves including how G forces and rotational acceleration can cause both neuroparenchymal and neurovascular injury.

  14. Neuroprotective effect of suppression of astrocytic activation by arundic acid on brain injuries in rats with acute subdural hematomas.

    Wajima, Daisuke; Nakagawa, Ichiro; Nakase, Hiroyuki; Yonezawa, Taiji


    Acute subdural hematoma (ASDH) can cause massive ischemic cerebral blood flow (CBF) underneath the hematoma, but early surgical evacuation of the mass reduces mortality. The aim of this study was to evaluate whether arundic acid improves the secondary ischemic damage induced by ASDH. Our results confirmed that arundic acid decreases the expression of S100 protein produced by activated astrocytes around ischemic lesions due to cytotoxic edema after ASDH as well as reducing infarction volumes and numbers of apoptotic cells around the ischemic lesions. In this study, we also evaluate the relationship of brain edema and the expression of Aquaporin 4 (AQP4) in an ASDH model. The expression of AQP4 was decreased in the acute phase after ASDH. Cytotoxic edema, assumed to be the main cause of ASDH, could also cause ischemic lesions around the edema area. Arundic acid decreased the infarction volume and number of apoptotic cells via suppression of S100 protein expression in ischemic lesions without changing the expression of AQP4.

  15. Overexpression of the dynein light chain km23-1 in human ovarian carcinoma cells inhibits tumor formation in vivo and causes mitotic delay at prometaphase/metaphase.

    Pulipati, Nageswara R; Jin, Qunyan; Liu, Xin; Sun, Baodong; Pandey, Manoj K; Huber, Jonathan P; Ding, Wei; Mulder, Kathleen M


    km23-1 is a dynein light chain that was identified as a TGFβ receptor-interacting protein. To investigate whether km23-1 controls human ovarian carcinoma cell (HOCC) growth, we established a tet-off inducible expression system in SKOV-3 cells in which the expression of km23-1 is induced upon doxycycline removal. We found that forced expression of km23-1 inhibited both anchorage-dependent and anchorage-independent growth of SKOV-3 cells. More importantly, induction of km23-1 expression substantially reduced the tumorigenicity of SKOV-3 cells in a xenograft model in vivo. Fluorescence-activated cell sorting analysis of SKOV-3 and IGROV-1 HOCCs demonstrated that the cells were accumulating at G2/M. Phospho-MEK, phospho-ERK and cyclin B1 were elevated, as was the mitotic index, suggesting that km23-1 suppresses HOCCs growth by inducing a mitotic delay. Immunofluorescence analyses demonstrated that the cells were accumulating at prometaphase/metaphase with increases in multipolar and multinucleated cells. Further, although the mitotic spindle assembly checkpoint protein BubR1 was present at the prometaphase kinetochore in Dox+/- cells, it was inappropriately retained at the metaphase kinetochore in Dox- cells. Thus, the mechanism by which high levels of km23-1 suppress ovarian carcinoma growth in vitro and inhibit ovary tumor formation in vivo appears to involve a BubR1-related mitotic delay.

  16. Differential diagnosis of isolated calf muscle vein thrombosis and gastrocnemius hematoma by high-frequency ultrasound

    SU Li-ya; GUO Fa-jin; XU Guang; HAN Xiu-jie; SUN Chang-kun; ZHANG Zheng; JING Qing-hong


    Background Differential diagnosis of isolated calf muscle vein thrombosis (ICMVT) and gastrocnemius hematoma is essential for early identification of deep vein thrombosis (DVT).This study aimed to investigate the diagnostic value of high-frequency color Doppler ultrasound for differential diagnosis of ICMVT and gastrocnemius hematoma.Methods A retrospective case series of 35 ICMVT (M∶F,21∶14; mean age (64.5±10.6) years) and 23 gastrocnemius hematoma (M∶F,16∶7; mean age (75.4±11.8) years) patients with bilateral/unilateral lower limb pain was conducted between January 2006 and September 2012.Characteristics and the morphology of high-frequency color Doppler ultrasonography of the lower limb deep vein,great saphenous vein,calf muscles,skin,and soft tissue were examined.Results ICMVT hypoechoic signals were characterized by long,tube-like masses on longitudinal sections and oval masses on transverse sections,with apparent muscle thrombosis boundaries,distal and proximal venous connections,and,often,lower limb DVT.Gastrocnemius hematoma hypoechoic signals were characterized by large volumes,enhanced posterior hematoma echo,hyperechoic muscle boundaries,no hematoma blood flow,and no DVT,and clear differences in trauma/exercise-and oral anticoagulant-induced hematomas were readily apparent.According to the measurement,the ratio of long diameter/transverse diameter (D/T) in ICMVT patients was about less than 2.0,whereas in gastrocnemius hematoma patients the ratio was more than 2.0.Early stage isoechoic and hypoechoic signals were detected with gradually increasing ovular anechoic areas.Partial muscle fibers in the hematoma due to muscle fractures were apparent.Conclusion High-frequency color Doppler ultrasound was found to be a sensitive and reliable method for differential diagnosis of ICMVT and gastrocnemius hematoma due to trauma and exercise or prolonged oral anticoagulant use.

  17. Spontaneous pharyngo-laryngeal hematoma and anticoagulation. A case report



    Full Text Available Introduction and Objective: Spontaneous pharyngeal-laryngeal hematoma shows the importance of a complete ENT examination in the face of symptoms of banal appearance and a correct history that, in the case reported, unveiled the therapeutic use of anticoagulants. Case description: A 55 year old woman comes to emergency because of unexplained dysphagia. The inspection shows the presence of a hematoma in the pharyngeal-laryngeal region that, after the anticoagulant therapy was reversed, evolved favorably with conservative treatment. Discussion: In this case, apart from medical management performed by the hematology department, we focus our therapeutic approach in the protection of the airway and the prevention of a possible massive bleeding. Determining which patients require endotracheal intubation or tracheostomy and hemostatic surgery is the key to treatment. Conclusions: The anticoagulant therapy involves several complications that ENT specialists must consider in the face of clinical symptoms of dysphagia, dysphonia, dyspnea or signs of bleeding and they must know the possibilities of performance depending on the severity of each case.

  18. Chronic subdural hematomas: a review of 94 cases

    Murat Yilmaz


    Material and Methods: Consecutive patients operated with a diagnosis of chronic subdural hematoma between January 2003 and December 2012 were reviewed retrospectively. Etiology and medical status of the patients at the time of admission were noted. Exact localization of the chronic subdural hematoma was detected by computed tomography scans and follow-up was maintained with magnetic resonance imaging. The outcome of the patients was evaluated one month after injury, by assesing activities of daily living. Results: Ninety-four consecutive patients met the eligibility criteria for the study. The mean age was 65 (range 45 to 85 years. In 74 (78.7% patients, head injury was the supposed origin. In 20 (21.3% patients, no trauma was evident. Most common symptom reported at the time of admission was headache (100%, and the most common neurological finding was confusion (87.2%. The majority of the patients had a mild neurological deficit with a Glascow Coma Scale score over eight. In general, 90.4% of cases were sufficiently treated by a single operation, while 9.6% needed a second procedure. During the follow-up, 91.5% of the patients returned to daily living activities on the first month kontrol. Conclusion: Surgical treatment of chronic subdural haematoma can give a high rate of complete recovery to normal life. [Cukurova Med J 2015; 40(1.000: 22-27

  19. Concurrent Delay in Construction Disputes

    Cavaleri, Sylvie Cécile

    period of delay can potentially be attributed to several events falling within both parties' spheres of responsibility, commonly termed concurrent delay, is rarely regulated in construction contracts in spite of its common occurrence. This book analyses both the theoretical foundations and the practical......Delay is one of the issues most frequently encountered in today’s construction industry; it causes significant economic damage to all parties involved. Construction contracts, standard and bespoke, almost invariably consider delay from a perspective of single liability. If the event causing...

  20. Analysis of delay cause to wake up after general anesthesia in elderly patients%老年患者全身麻醉后苏醒延迟病因分析



    目的:探究老年患者全身麻醉后苏醒延迟的病因及护理措施。方法选取我院2011年1月至2014年1月间发生全麻后苏醒延迟的老年患者40例,并对苏醒延迟的原因及护理措施开展回顾性分析。结果40例老年患者均安全度过全麻恢复阶段,未出现任何严重的并发疾病。全麻后苏醒延迟的主要原因是麻醉用药代谢缓慢,其次还有肝肾功能减退、药物分布容积下降及术前睡眠时长较短,术后体温偏低等。结论40例老年病患全麻后苏醒延迟的病因较复杂,需及时查明原因,并采取有效的处理手段,避免并发疾病的出现。%Objective: To explore the causes of delay recovery after general anesthesia in aged patients and nursing measure. Methods: Select the hospital from January 2011 to January 2014 I woke up after a delay of 40 cases senile patients undergoing general anesthesia, wake up and retrospective analysis of causes and nursing measures of the delay. Results:In 40 senile patients have survived during the recovery phase, without any serious concurrent il ness. Recovery after delayed mainly due to anesthesia general anesthesia drug metabolism is slow, fol owed by liver and kidney dysfunction, the decline in volume of drug distribution and preoperative sleep time shorter, postoperative low body temperature. Conclusion: 40 cases of elderly patients after general anesthesia wake delay causes more complex, needs identified, and effective means of treatment, appeared to avoid concurrent disease.

  1. A missed injury leading to delayed diagnosis and postoperative infection of an unstable thoracic spine fracture - case report of a potentially preventable complication

    Stahel Philip F


    Full Text Available Abstract Background Patients suffering from polytrauma often present with altered mental status and have varying levels of examinability. This makes evaluation difficult. Physicians are often required to rely on advanced imaging techniques to make prompt and accurate diagnoses. Occasionally, injury detection on advanced imaging studies can be challenging given the subtle findings associated with certain conditions, such as diffuse idiopathic skeletal hyperostosis (DISH. Delayed or missed diagnoses in the setting of spinal fracture can lead to catastrophic neurological injury. Case presentation A man struck by a motor vehicle suffered multiple traumatic injuries including numerous rib fractures, a mechanically unstable pelvic fracture, and also had suspicion for an aortic injury. Unfortunately, the upper thoracic segment (T1-5 was only visualized with axial images based on the electronic data. Several days later, a contrast CT scan obtained to check the status of suspected aortic injury revealed T3-T4 subluxation indicative of an unstable extension-type fracture in the setting of DISH. Due to the missed injury and delay in diagnosis, surgery was not performed until eight days after the injury. At surgery, the patient was found to have left T3-T4 facet joint infection as well as infected hematoma surrounding a left T4 transverse process fracture and a traumatic T4 costo-transverse joint fracture-subluxation. Despite presence of infection, an instrumented posterior spinal fusion from T1-T6 was performed and the patient recovered well after antibiotic treatment. Conclusion A T3-T4 unstable DISH extension-type fracture was initially missed in a polytrauma patient due to inadequate imaging acquisition, which caused a delay in treatment and bacterial seeding of fracture hematoma. Complete imaging is especially needed in obtunded patients that cannot be thoroughly examined.

  2. Neuroendoscopic Removal of Acute Subdural Hematoma with Contusion: Advantages for Elderly Patients

    Ryota Tamura


    Full Text Available Background. Large craniotomy for acute subdural hematoma is sometimes too invasive. We report good outcomes for two cases of neuroendoscopic evacuation of hematoma and contusion by 1 burr hole surgery. Case Presentation. Both patients arrived by ambulance at our hospital with disturbed consciousness after falling. Case 1 was an 81-year-old man who took antiplatelet drugs for brain infarction. Case 2 was a 73-year-old alcoholic woman. CT scanning showed acute subdural hematoma and frontal contusion in both cases. In the acute stage, glycerol was administered to reduce edema; CTs after 48 and 72 hours showed an increase of subdural hematoma and massive contusion of the frontal lobe. Disturbed consciousness steadily deteriorated. The subdural hematoma and contusion were removed as soon as possible by neuroendoscopy under local anesthesia, because neither patient was a good candidate for large craniotomy considering age and past history. 40%~70% of the hematoma was removed, and the consciousness level improved. Conclusion. Neuroendoscopic removal of acute subdural hematoma and contusion has advantages and disadvantages. For patients with underlying medical issues or other risk factors, it is likely to be effective.

  3. [17p13.3 duplication as a cause of psychomotor developmental delay in an infant - a further case of a new syndrome].

    Przybylska-Kruszewska, Amanda; Kutkowska-Kaźmierczak, Anna; Krzywdzińska, Amanda; Smyk, Marta; Nowakowska, Beata; Gryglicka, Halina; Obersztyn, Ewa; Hozyasz, Kamil K


    17p13.3 duplication is a rare and heterogeneous genetic syndrome. Microdeletions of this region are responsible for the symptoms of Miller-Dieker syndrome. We present a case of 17p13.3 duplication consisting of about 730kb in a patient with psychomotor developmental delay, concerning eye-hand coordination, posture, locomotion and speech. Among other symptoms, we found excessive physical development in relation to age, hypotonia, dysmorphic facial features (high and prominent forehead, low-set ears, hypertelorism, short nose, small upturned nose, narrow lips and pointed chin) and discrete changes in the CNS - enhanced frontal horns of the lateral ventricles and quite narrow corpus callosum. These symptoms overlap with phenotype of previously described patients with 17p13.3 duplication. The aberration has been identified by array comparative genomic hybridization (aCGH) and confirmed by fluorescence in situ hybridization (FISH). This publication presents a detailed, comparative characteristic of clinical fetures expression in discussed patient with 17p13.3 duplication and patients previously described in medical literature. Further cases with different variants of 17p13.3 duplication may contribute to characterise the specific genotypephenotype correlation.

  4. Subdural hematoma cases identified through a Danish patient register

    Poulsen, Frantz Rom; Halle, Bo; Pottegård, Anton;


    PURPOSE: This study aimed to assess the usefulness of Danish patient registers for epidemiological studies of subdural hematoma (SDH) and to describe clinical characteristics of validated cases. METHODS: Using a patient register covering a geographically defined area in Denmark, we retrieved...... moderate for patients recorded under code I620 (62%). cSDH represented 57% of verified cases, and aSDH the remaining 43%. cSDH differed markedly from aSDH with regard to a number of clinical characteristics, including a much lower mortality (OR 0.2, 95%CI 0.1-0.3). However, preadmission antithrombotic drug...... hospital contacts recorded under SDH International Classification of Diseases version 10 codes S065 and I620 in 2000-2012. Neurosurgeons reviewed medical records of all potential cases. Based on brain scan results, verified cases were classified by SDH type (chronic SDH (cSDH) or acute SDH (aSDH)). Thirty...

  5. Intracranial extradural hematoma: Spontaneous rapid decompression - not resolution

    Abdul Rashid Bhat


    Full Text Available The surgical option to evacuate an intracranial extradural hematoma (EDH was postponed in a 2-year-old female child who appeared fully alert and active after a brief spell of unconsciousness following a fall from height. The child was received, with a swelling on and around the right parietal eminence, by the emergency staff just half an hour after the time of injury. The immediate X-ray skull and first computed tomography (CT scan head showed a parietal bone fracture, EDH, and cephalhematoma. However, follow-up CT scan head after about 4΍ h revealed the dramatic absence of EDH but increased size and bogginess of cephalhematoma. The EDH had transported into subgaleal space resulting in a decompression of intracranial compartment in <5 h, thereby preventing surgical intervention but necessitating monitoring, though there was no back flow intracranially.

  6. Hematoma extradural da fossa posterior: relato de sete casos

    Mauro A. Oliveira


    Full Text Available Hematomas da fossa posterior são complicação incomum de traumatismo cra-nioencefálico. Quase invariavelmente eles ocorrem após traumatismo da região occipital e estão associados com fraturas de crânio. O diagnóstico e tratamento dessa patologia tem sido grandemente favorecido pela tomografia computadorizada. Na presente série, a maioria dos pacientes teve evolução aguda, indicando o risco potencial de um tratamento conservador. Nossos resultados (29% de mortalidade são similares àqueles previamente relatados para outras séries dessas lesões.

  7. Imaging management of spontaneous giant esophageal intramural hematoma

    Hagel, J. [Univ. of British Columbia, Dept. of Radiology, Vancouver, British Columbia (Canada); Bicknell, S.G.; Haniak, W. [Lions Gate Hospital, Dept. of Radiology, Vancouver, British Columbia (Canada)]. E-mail:


    A woman, aged 84 years, presented to our emergency department with posteriorly radiating chest pain that began following dinner. She reported no change in bowel habits, hematochezia, or melena. She had previous peptic ulcer disease and a long-standing history of gastroesophageal reflux disease. Her medications included acetylsalicylic acid and rabeprazole. Electrocardiogram and troponin analyses were negative for ischemic heart disease. The emergency physician suspected an aortic dissection, and computed tomography (CT) chest and abdomen scans were performed with and without IV and oral contrast. The aorta was normal and the noncontrast images demonstrated a hyperdense mass (not shown) that did not enhance consistent with a large intramural hematoma extending from the upper esophagus (level of T2 vertebral body) to the fundus of the stomach (Figures 1A and B). (author)

  8. Hematomas intracerebral espontâneos estudo de 121 casos

    Lineu Cesar Werneck; Rosana Hermínia Scola; Leila Elizabeth Ferraz


    Foram analisados retrospectivamente 121 pacientes com hematomas intracerebrais espontâneos (HIE): com média de idade de 53,4 ±14,8 anos, 62,8% do sexo masculino, tempo médio de sangramento na admissão de 36 horas (3 horas a 12 dias); 63,5% estavam acima de 7 na escala de Glasgow e 81,9% com grau igual ou maior que 3 na escala de Botterel. Os HIE eram: em gânglios da base em 45,5%, multilobares em 14,7%, lobares em 22,8%, no tronco cerebral em 4% e cerebelares em 2%. Seus diâmetros médios eram...

  9. Different perceived foreign accents in one patient after prerolandic hematoma.

    Christoph, D H; de Freitas, G R; Dos Santos, D P; Lima, M A S D; Araújo, A Q C; Carota, A


    Foreign accent syndrome (FAS), a rare disorder characterized by the emergence of a new accent perceived as foreign by listeners, is usually reported with left brain damage. We here report the case of a 28-year-old native Brazilian who appeared, to the examiner, to show a North American accent during recovery from Broca's aphasia. The lesion was due to a frontal hematoma. Without referring specifically to speech, we asked 10 independent observers to comment on a videotape of the patient's interview. Seven reported that the patient had a foreign accent, while 3 simply noted a 'strange' accent. The observers did not agree on the origin of the accent, 5 identifying it as Spanish, 1 as German, and 1 as south Brazilian. These findings suggest that FAS is not due to the acquisition of a specific foreign accent, but to impairment of the suprasegmental linguistic abilities (tone, accent, pauses, rhythm, and vocal stress) that make it possible to distinguish native language.

  10. Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma

    Lee, K.-W. [Department of Pediatrics, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); McLeary, M.S. [Div. of Pediatric Radiology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Zuppan, C.W. [Dept. of Pathology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Won, D.J. [Div. of Pediatric Neurosurgery, Loma Linda University Children' s Hospital, Loma Linda, CA (United States)


    An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma. (orig.)

  11. Idiopathic Scrotal Hematoma in Neonate: A Case Report and Review of the Literature

    Bioku Muftau Jimoh


    Full Text Available Neonatal scrotal hematoma is a rare genitourinary emergency. Some cases have underlining aetiologic factors such as testicular torsion, adrenal hemorrhage, or birth trauma, and others are idiopathic. Previously, immediate scrotal exploration was considered imperative for diagnosis and treatment. With good imaging techniques, some patients are managed nonoperatively. We report a case of idiopathic scrotal hematoma in a neonate. He was managed conservatively with clinical and radiological follow-up. There was complete resolution of hematoma within two months, thus, avoiding unnecessary exploration.

  12. [Giant retroperitoneal hematoma in the peripartum of a normal delivery, "expectative attitude"].

    Vanlieferinghen, S; Piketty, M; Blumental, Y; Jouannic, J-M; Desfeux, P; Benifla, J-L


    We describe a case involving spontaneous retroperitoneal hematoma complicating a normal delivery in a context of a Disseminated Intravascular Coagulation (DIVC) at the end of the pregnancy. Given the defaced symptomatology, an abdomino-pelvic scanner and an examination with a general anaesthesia made it possible to diagnose and to monitor the hematoma in intensive care. The correction of the hemostasis troubles and of the anemia, without another invasive intervention, allowed a return to home at the eighth day. The pathophysiological mechanisms underlying development and practicable treatments of this post-partum hematoma are discussed.

  13. Treatment of thoracic hemorrhage due to rupture of traumatic mediastinal hematoma

    Hui-Jie Yu; Ling-Fang Zhang; Wei-Zhong Cao


    Patients in traffic accidents are usually presented with pain and bleeding due to fractures or soft tissue injury.On some occasions,more severe complications may be triggered by the trauma.A review of the published English language literature reveals no survival case once the traumatic mediastinal hematoma is ruptured.In our case,a 54-year-old man suffering motorcycle accident was admitted to emergency department.Computed tomography scan revealed subdural hematoma combined with posterior mediastinal hematoma.The patient was saved and discharged with a satisfactory outcome.Here we hope to share our treatment experience in dealing with the patient with severe multiple trauma.

  14. Neonatal adrenal hematoma with urinary tract infection: Risk factor or a chance association?

    Abdelhadi M Habeb


    Full Text Available Neonatal adrenal hematoma is a rare finding that can be discovered incidentally or presents with various symptoms. However, urinary tract infection (UTI has not been reported in association with this condition. We report on a 4-week old child with massive unilateral adrenal hematoma discovered incidentally during a routine abdominal ultrasound scan for UTI. The mass resolved spontaneously after several months with no complications. The diagnosis and ma-nagement of infantile suprarenal mass and the possible link between this child′s UTI and the adrenal hematoma are discussed.

  15. Acute Scrotum Following Traumatic Spermatic Cord Hematoma: A Case Report and Review

    Pietro Pepe


    Full Text Available Acute scrotum constitutes the most common urological emergency secondary to spermatic cord torsion, testicular trauma, orchiepididymitis and hernias. We report a very rare case of unique traumatic spermatic cord hematoma following scrotum injury occurred during a football match. Clinical exam showed an increased volume of the left spermatic cord; the color Doppler ultrasound (CDU demonstrated left testicular ischemia secondary to a large spermatic cord hematoma that needs surgical exploration. Spermatic cord hematoma rarely induces acute scrotum, however it could be treated conservatively surgery is mandatory when pain is persistent or testicular ischemia is confirmed by CDU.

  16. Meningioma associated with acute subdural hematoma: A review of the literature

    Di Vitantonio Hambra


    Full Text Available Background: Classically meningiomas present with a gradual onset of symptoms and their acute presentation with hemorrhagic events seems to be a rare event. A review of the literature shows only 18 cases of meningioma associated with acute subdural hematoma. The possible mechanisms of hemorrhage are not yet fully understood. Case Description: We report a case of sphenoid wing meningioma associated with acute subdural hematoma, without history of trauma. The presence of meningioma was discovered during the surgery. The tumor and hematoma were removed without postoperative complications. Conclusions: The authors have discussed the etiology of an acute subdural hemorrhage and reviewed the pertinent literature.

  17. Hematoma epidural lombar pós-cirurgico em paciente com leucemia: relato de caso Hematoma epidural lumbar posquirúrgico en paciente con leucemia: relato de caso Postoperative lumbar epidural hematoma in a patient with leukemia: case report

    Wagner Pasqualini


    Full Text Available A ocorrência de hematoma epidural como complicação pós-cirúrgica é relativamente baixa. O reconhecimento dessa patologia no diagnóstico diferencial nas paraplegias pós-cirúrgicas imediatas e o tratamento precoce por meio de intervenção cirúrgica com a descompressão do canal são fatores que estão diretamente relacionados à melhora do quadro neurológico. Este relato de caso é de um hematoma epidural no pós-operatório imediato de descompressão por estenose do canal vertebral lombar em paciente com leucemia.La ocurrencia de hematoma epidural, como complicación posquirúrgica, es relativamente baja. El reconocimiento de esa patología, en el diagnóstico diferencial en las paraplejías posquirúrgicas inmediatas y el tratamiento precoz por medio de intervención quirúrgica con la descompresión del canal, son factores que se relacionan directamente con la mejoría del cuadro neurológico. Este relato de caso es de un hematoma epidural en el posoperatorio inmediato, después de descompresión, por estenosis, del canal vertebral lumbar en paciente con leucemia.The occurrence of epidural hematoma as a postoperative complication is relatively low. The recognition of this condition in the differential diagnosis in the immediate postoperative paraplegia and the early surgical decompression are directly related with neurological improvement. We report a case of epidural hematoma in the early postoperative period of surgical decompression of the lumbar spinal canal, in a patient with leukemia.

  18. MR imaging of epidural hematoma in the lumbar spine

    Dorsay, Theodore A.; Helms, Clyde A. [Duke University Medical Center, Department of Radiology, Erwin Road, Room 1504, Durham, NC 27710 (United States)


    To bring attention to the MR imaging appearance of epidural hematoma (EDH) in the lumbar spine as a small mass often associated with disk herniation or an acute event. This paper will show our experience with this entity and describe criteria for its MR imaging appearance. Design and patients. Thirteen cases of prospectively diagnosed EDH of the lumbar spine were compared with 12 cases of prospectively diagnosed prominent epidural extrusion. Our criteria were retrospectively evaluated by the two authors for their presence or absence in each case. The chi-square test for nominal data was applied. MR imaging criteria utilized to distinguish EDH from disk herniation at our institution include: (1) signal different from disk, (2) high signal on T1-weighted images, either centrally or peripherally, (3) teardrop- or egg-shaped mass, in the sagittal plane, (4) size greater than half the vertebral body height in a craniocaudal dimension, (5) primarily retrosomatic epidural location, (6) plasticity - the mass is seen to conform closely to the contours of bone (e.g., in the lateral recess), (7) little or no disk space narrowing unless associated with disc herniation. Chi-square analysis demonstrated each criterion to significantly differentiate between EDH and extrusion. Only six of 13 EDH cases went to surgery in spite of their relatively large size. Two of six patients were diagnosed as having epidural clot consistent with hematoma at the time of surgery. The four patients who were not diagnosed at surgery revealed only small disk herniations or fragments of disk. The occurrence of EDH is more frequent than previously suspected. Spontaneous EDH is frequently associated with disk herniation and acute events such as sneezing or coughing. Most cases of spontaneous EDH will resolve prior to surgery with only the minority becoming chronic in order to be seen at surgery as an encapsulated mass. MR imaging can reliably identify EDH and distinguish between EDH and large disk

  19. Recessive mutations in SLC13A5 result in a loss of citrate transport and cause neonatal epilepsy, developmental delay and teeth hypoplasia

    Hardies, Katia; de Kovel, Carolien G F; Weckhuysen, Sarah; Asselbergh, Bob; Geuens, Thomas; Deconinck, Tine; Azmi, Abdelkrim; May, Patrick; Brilstra, Eva; Becker, Felicitas; Barisic, Nina; Craiu, Dana; Braun, Kees P J; Lal, Dennis; Thiele, Holger; Schubert, Julian; Weber, Yvonne; van 't Slot, Ruben; Nürnberg, Peter; Balling, Rudi; Timmerman, Vincent; Lerche, Holger; Maudsley, Stuart; Helbig, Ingo; Suls, Arvid; Koeleman, Bobby P C; De Jonghe, Peter


    The epileptic encephalopathies are a clinically and aetiologically heterogeneous subgroup of epilepsy syndromes. Most epileptic encephalopathies have a genetic cause and patients are often found to carry a heterozygous de novo mutation in one of the genes associated with the disease entity. Occasion

  20. 晚发性维生素K缺乏致颅内出血与低血钙的关系%The relation between the intracranial hemorrhage caused by delayed vitamin k deficiency and hypocalcemia



    目的:探讨16例晚发性维生素K缺乏所致颅内出血(其中10例伴有低血钙)的诊治方法。方法:观察其临床表现、血常规、出凝血时间、头部CT或MRI进行综合分析。结果:本组治愈14例,2例自动出院。结论:低血钙惊厥可诱发或加剧维生素K缺乏所致颅内出血、在治疗时应给予补充钙剂。%Objective To explore the diagnosis and treatment of the intracranial hemorrhage and hypocalcemia by researching 16 intracranial hemorrhage children caused by delayed vitamin k deficiency with 10 children found hypocalcemia. Methods The results wound be got by analyzing the clinical manifestation ,blood routine, PT , APTT , brain CT or MRI. Results 14 children clinical cured, 2 children discharged voluntarily during therapy. Conclusion The hypocalcemia can induce or aggravate the intracranial hemorrhage caused by delayed vitamin k deficiency.

  1. Retroplacental hematoma associated to tubo ovarian abscess in 23 weeks of pregnancy. A case report. Hematoma retroplacentario asociado con absceso tubovárico en embarazo de 23 semanas. Reporte de un caso.

    Alberto Jorge Fernández

    Full Text Available A 30 year-old female patient with 23 weeks of pregnancy and with asthma antecedent is presented. She had treatment with bronchodilators. She came to the provincial medical emergency centre due to an intense pain with a sudden appearance in the lower abdomen, vomiting, shortness of breath, and sweating. The presence of a retroplacental hematoma caused due to a tubo-ovarian abscess associated to an abdominal peritonitis was corroborated. The way in which the disease was manifested and evolved is described.

    Se presenta el caso de una paciente de 30 años, con edad gestacional de 23 semanas y antecedentes de asma bronquial para lo cual llevaba tratamiento con broncodilatadores. Acude al centro provincial de emergencia médica por presentar dolor de aparición súbita e intenso en bajo vientre, vómitos con restos de alimentos, falta de aire y sudoraciones. Se comprobó la presencia de un hematoma retroplacentario causado por un absceso tubovárico asociado a una peritonitis abdominal. Se describe la forma en que se manifestó la enfermedad y su evolución.

  2. #FakeNobelDelayReasons


    Tuesday’s hour-long delay of the Nobel Prize in Physics announcement was (and still is) quite the cause for speculation. But on the Twittersphere, it was simply the catalyst for some fantastic puns, so-bad-they're-good physics jokes and other shenanigans. Here are some of our favourite #FakeNobelDelayReasons.    

  3. Pola Kejadian Hematoma Subdural Pada Bayi Yang dirawat di Ruang Rawat Intensif Anak Rumah Sakit Dr. Hasan Sadikin

    Enny Harliany Alwi


    Full Text Available Subdural hematoma (SDH is a common condition in infancy and young children with a poor prognostic. The more studies related SDH with nonaccidental injury. With the aim to identify the characteristics of SDH in infants below 1 year, a retrospective study of infants below 1 year diagnosed as subdural hematoma who were admitted to PICU Hasan Sadikin General Hospital from Januari 2000 to Desember 2003 has been conducted. Infants less than 1 month and SDH developed after neurosurgery intervention were excluded. Fourteen infants met the inclusion criteria's, consisted of 5 (36% girls and 9 (64% boys, most of them were on 1 month of age (57%. Anemia was found on all cases, thrombocyte normal except in 1 case thrombocytopenia (53,000/mm3. PT prolonged in 9 (100% cases and PTT in 5 (56% from 9 cases. Bilirubin total/direct elevated in 4 (80% from 5 cases, SGOT/SGPT elevated in 5 (83% from 6 cases. From 11 cases, 9 (82% cases were IgG anti-CMV positive and 6 (55% cases were IgM anti CMV positive. Conclusions, SDH can be caused by various etiologies, thus a comprehensive examinations to exclude child abuse are needed. The role of CMV infection should be considered as one of SDH etiology.


    S. N. Heryak


    application of natural micronized progesterone 100 mg three times a day sublingually and 500 mg of Tranexamic acid dissolved in 200 ml normal saline solution improves the dynamics of the main hormonal, haemostatic and ultrasound markers of abortion and significantly reduces reproductive losses. Tranexamic acid treatment proved a rapid and effective action on hematoma and absence of embryotoxical and сoagulopathyc influence. Tranexamic acid does not cause any significant disorders of hemostatic system. This is very important at the early gestation because of intravascular coagulation, physiological hypercoagulable condition during pregnancy that can cause microthrombosis and disrupt placentation. On the other hand, it is dangerous for the mother’s health because of the increased risk of thrombosis.

  5. Acute subdural hematoma with swirl signs: clinical analysis of 15 cases

    CAI Yong; ZHONG Xing-ming; WANG Yi-qi; YANG Jian-guo; ZHENG Hui-min


    From July 2003 to July 2009, 15 cases of subdural hematoma with swirl signs were treated in our hospital and their clinical data were retrospectively analysed.The mortality was compared between these patients and those with typical acute subdural hematoma who were treated at the same time in our hospital. Among the 15 cases, full recovery was achieved in 4 cases, slight disability in 2, gave disability in 2 and death in 7 (46.7%). The mortality of these patients was conspicuously higher than that of typical subdural hematoma (14/83, 16.9%, P<0.01). Subdural hematoma with swirl signs is often suggestive of hazardous pathogenetic condition and early diagnosis and prompt surgical intervention is essential to reduce mortality.

  6. CD163 promotes hematoma absorption and improves neurological functions in patients with intracerebral hemorrhage

    Wen-jing Xie; Hong-quan Yu; Yu Zhang; Qun Liu; Hong-mei Meng


    Clinical outcomes are positively associated with hematoma absorption. The monocyte-macrophage scavenger receptor, CD163, plays an important role in the metabolism of hemoglobin, and a soluble form of CD163 is present in plasma and other tissue lfuids;therefore, we speculated that serum CD163 affects hematoma absorption after intracerebral hemorrhage. Patients with intracerebral hemorrhage were divided into high-and low-level groups according to the average CD163 level (1,977.79 ± 832.91 ng/mL). Compared with the high-level group, the low-level group had a signiifcantly slower hematoma absorption rate, and signiifcantly increased National Institutes of Health Stroke Scale scores and modiifed Rankin Scale scores. These results suggest that CD163 promotes hematoma absorption and the recovery of neurological function in patients with intracerebral hemorrhage.

  7. Alcohol Abuse and Alcoholic Liver Cirrhosis Leading to Spontaneous Muscle Hematoma: An Event Fraught with Danger

    Ankit Mangla


    Full Text Available Alcohol abuse is associated with both potentiating and antagonizing hemostatic states. Liver cirrhosis is an independent causal factor for many bleeding complications. The long-term effects of alcohol abuse coupled with advanced liver cirrhosis are additive in favor of bleeding. We report the case of a patient with a history of alcohol abuse who presented with liver cirrhosis and nontraumatic muscle hematoma diagnosed as a spontaneous hematoma of the gastrocnemius muscle. He was managed conservatively with infusions of fresh frozen plasma and platelets, which resulted in resolution of the hematoma. The pathogenesis of ‘spontaneous' muscle hematoma remains anecdotal, but since it is reported in patients on anticoagulant therapy or with hemostatic disorders, it is hypothetically related to severely deranged coagulation. Here we review the relevant literature pertaining to the pathogenesis, presentation and treatment options available for treating this often fatal complication of bleeding diatheses.

  8. Posttraumatic retroclival acute subdural hematoma: Report of two cases and review of literature

    Sridhar Krishnamurthy


    Full Text Available Traumatic retroclival hematomas are uncommon lesions usually associated with significant trauma. Majority of the reported hematomas are epidural; and in the pediatric population. Retroclival acute subdural hematomas (RSDH are very rare, with only two previous cases reported in English literature. An 18-year-old man presented with headache and no deficits following an accident. Computer tomography (CT scan and magnetic resonance imaging (MRI showed an acute RSDH extending into the spinal subdural space. He developed bilateral sixth nerve palsies, with symptoms of raised intracranial pressure within the next 24 hours. He underwent evacuation of hematoma with a good outcome. Another 19-year-old man presented with neck pain following a fall from a moving bus. He had no neurological deficits. CT scan showed a RSDH extending across the craniovertebral junction. He was managed conservatively with good outcome.

  9. Delayed childbearing.

    Francis, H H


    In many Western nations, including England and Wales, Sweden, and the US, there is a current trend towards delayed childbearing because of women's pursuit of a career, later marriage, a longer interval between marriage and the 1st birth, and the increasing number of divorcees having children in a 2nd marriage. Wives of men in social classes I and II in England and Wales are, on average, having their 1st child at 27.9 years, 1.6 years later than in 1973, and in social classes IV and V, 1.0 years later than in 1973, at a mean age of 23.7 years. Consequently, the total period fertility rate for British women aged 30-34 years, 35-39 years, and 40 and over increased by 4%, 2%, and 4%, respectively, between 1982-83, in contrast to reductions of 2% and 3%, respectively, in the 15-19 year and 20-24 year age groups, with the 25-29-year-olds remaining static. The average maternal mortality for all parties in England and Wales during 1976-78 was 106/million for adolescents, 70.4/million for 20-24 year-olds, and 1162/million for those aged 40 years and older. The specific obstetric and allied conditions which increase with age are the hypertensive diseases of pregnancy, hemorrhage, pulmonary embolism, abortion, cardiac disease, caesarean section, ruptured uterus, and amniotic fluid embolism. The Swedish Medical Birth Registry of all live births and perinatal deaths since 1973 has shown that the risk of late fetal death is significantly greater in women aged 30-39 years than in those of the same parity and gravidity aged 20-24 years. The risk of giving birth to low birth weight babies preterm and at term and of premature labor are similarly increased. The early neonatal death rate also was increased for primigravidas and nulliparas in the 30-39 year age group but not in parous women. This is, in part, due to the rise in incidence of fetal abnormalities with advancing maternal age because of chromosomal and nonchromosomal anomalies. These also appear to be the cause of the

  10. A case report of primary ciliary dyskinesia, laterality defects and developmental delay caused by the co-existence of a single gene and chromosome disorder.

    Casey, Jillian P


    Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disorder characterised by abnormal ciliary motion and impaired mucociliary clearance, leading to recurrent respiratory infections, sinusitis, otitis media and male infertility. Some patients also have laterality defects. We recently reported the identification of three disease-causing PCD genes in the Irish Traveller population; RSPH4A, DYX1C1 and CCNO. We have since assessed an additional Irish Traveller family with a complex phenotype involving PCD who did not have any of the previously identified PCD mutations.

  11. Endoscopic removal of subgaleal hematoma in a 7-year-old patient treated with anticoagulant and antiplatelet agents

    Yasuhiko Hayashi


    Full Text Available Background: Subgaleal hematomas frequently occur in children after head trauma and extend over the cranial sutures. Although conservative treatment suffices in most cases, surgical removal of a subgaleal hematoma is indicated when the patient presents with anemia and headache associated with its progressive enlargement. Case Description: We present the case of a 7-year-old boy who was medicated with warfarin and aspirin due to a hypoplastic left ventricle and fell from a rock wherein he hit his head in the frontal region. Although a computed tomography scan of the head revealed no intracranial lesion, an extracranial hematoma was found to extend over the cranial sutures, leading to the diagnosis of subgaleal hematoma. The hematoma continued to grow gradually despite the cessation of warfarin and aspirin therapy immediately after the head trauma. Since the patient′s headache and anemia were progressing as the hematoma enlarged, removal of the hematoma was performed 3 days after admission. Endoscopic hematoma removal was planned to enable accurate coagulation of the sites of bleeding and removal of the maximal amount of hematoma through minimal incision. The hematoma was completely removed, and the patient′s postoperative course was excellent with alleviation of both the anemia and the headache. No sign of hematoma recurrence could be detected during 2 years follow-up. Conclusion: An angled endoscope can allow visualization of the deep subgaleal space, and this technique enabled direct visualization of the bleeding sites and accurate coagulation to prevent recurrence of hematoma. Endoscopic techniques, such as minimally invasive techniques, can allow sufficient removal of subgaleal hematoma with minimal morbidity, especially in patients such as ours.

  12. Anticoagulation therapy a risk factor for the development of chronic subdural hematoma

    Aspegren, Oskar P.; Åstrand, Ramona; Lundgren, Maria I.


    Chronic subdural hematoma (CSDH) is a common disease among the elderly and with increasing incidence we have chosen to focus on associations between development and recurrence of CSDH and anticoagulation and/or antiplatelet agent therapy.......Chronic subdural hematoma (CSDH) is a common disease among the elderly and with increasing incidence we have chosen to focus on associations between development and recurrence of CSDH and anticoagulation and/or antiplatelet agent therapy....

  13. Interventricular Septal Hematoma and Coronary-Ventricular Fistula: A Complication of Retrograde Chronic Total Occlusion Intervention

    Abdul-rahman R. Abdel-karim


    Full Text Available Interventricular septal hematoma is a rare complication of retrograde chronic total occlusion (CTO percutaneous coronary interventions (PCI with a typically benign course. Here we report two cases of interventricular septal hematoma and coronary-cameral fistula development after right coronary artery (RCA CTO-PCI using a retrograde approach. Both were complicated by development of ST-segment elevation and chest pain. One case was managed actively and the other conservatively, both with a favorable outcome.

  14. Treatment of cranial epidural hematoma in a neonate by needle aspiration of a communicating cephalhematoma.

    Smets, Koenraad Jan; Vanhauwaert, Dimitri


    A newborn presented on day 15 of life with an epidural hematoma, extending through a diastatic sutura squamosa in an external cephalhematoma. There was no skull fracture. The cephalhematoma was punctured twice with 24-h interval, reducing both the cephalhematoma and the epidural component. In the absence of neurological signs or symptoms, aspirating a cephalhematoma to evacuate the communicating epidural hematoma in a newborn infant may avoid more invasive surgical intervention.

  15. Interventricular Septal Hematoma and Coronary-Ventricular Fistula: A Complication of Retrograde Chronic Total Occlusion Intervention

    Abdel-karim, Abdul-rahman R.; Main, Michael L.


    Interventricular septal hematoma is a rare complication of retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCI) with a typically benign course. Here we report two cases of interventricular septal hematoma and coronary-cameral fistula development after right coronary artery (RCA) CTO-PCI using a retrograde approach. Both were complicated by development of ST-segment elevation and chest pain. One case was managed actively and the other conservatively, both with a favorable outcome. PMID:27668097

  16. Time Course of Early Postadmission Hematoma Expansion in Spontaneous Intracerebral Hemorrhage

    Ovesen, Christian; Christensen, Anders Fogh; Krieger, Derk W


    BACKGROUND AND PURPOSE: Early hematoma expansion (EHE) in patients with intracerebral hematoma is a promising treatment target. To date, the time course of EHE has remained poorly described. We prospectively investigated the time course of EHE. METHODS: We included consecutive patients presenting...... occurred within the first 7 to 8 hours after symptom onset. CLINICAL TRIAL REGISTRATION URL: Unique identifier: NCT01472224....

  17. Chronic subdural hematoma associated with moyamoya phenomenon after radiotherapy for medulloblastoma; A case report

    Fuse, Takahisa; Takagi, Takuji; Fukushima, Tsuneyuki; Mizuno, Shiroh; Hashimoto, Nobukazu; Suzuki, Osamu (Nagoya City Higashi General Hospital (Japan))


    A 9-year-old boy had been diagnosed at the age of 9 months as having a cerebellar medulloblastoma and had received 40 Gy of radiation therapy to the brain after removal of the tumor. Cerebral angiography at the time of initial diagnosis did not show any evidence of occlusive disease involving the internal carotid circulation. At the age of 6 years, the patient developed generalized seizures. On examination, he was drowsy and had right hemiparesis. CT scan demonstrated a low-density area in the left frontal lobe. Cerebral angiography showed a marked narrowing of the bilateral internal carotid arteries with moyamoya vessels. The patient was treated medically with aspirin (100 mg/day) and anticonvulsants. His neurological deficits improved gradually. At the age of 8 years, there was no recurrence of the tumor although a slight left subdural hematoma was seen on CT scan. On August 10, 1993, at the age of 9 years, he was admitted for treatment of a developing subdural hematoma. MRI showed a chronic subdural hematoma with thick outer and inner membranes. Cerebral angiography showed occlusion of the left internal carotid artery which fed the right frontal lobe through moyamoya vessels, marked narrowing of the right internal carotid artery distal to the ophthalmic artery, moyamoya vessels at the base, and cortical revascularization througth the ophthalmic, posterior cerebral and middle meningeal arteries. Trepanation and aspiration of the hematoma were performed. The outer membrane of the hematoma was about 2 mm thick and the hematoma cavity was filled with a partially organized hematoma. In this case, we speculate that development of the chronic subdural hematoma involved the following factors: (1) transdural external-internal carotid anastomosis after radiation-induced cerebrovasculopathy; (2) repeated mild head trauma due to gait disturbance after removal of the cerebellar tumor; and (3) administration of acetylsalicylic acid. (author).

  18. Hypertensive intracranial hematomas: endoscopic-assisted keyhole evacuation and application of patent viewing dissector

    邱永明; 林毅兴; 田鑫; 罗其中


    Objective To study the effect of endoscopic-assisted keyhole operation (EAKO) on treating hypertensive intracranial hematomas and the value of our patent dissector appli ed during the operation.Methods A total of 25 patients with hypertensive intracranial hematomas underwent endos copic-assisted keyhole evacuation, during which, the viewing dissector, which h ad recently achieved national patent, was connected to the tip of endoscope and used to help dissect hematomas. The outcome of this procedure were compared wit h those of 22 comparable cases undergone conventional surgical treatment (large or smaller craniotomy). The items for comparison included the volum e of remaining hematoma, the duration of operation, postsurgical Glasgow Coma Sc ale (GCS) and Glasgow Outcome Scale (GOS).Results Remaining hematoma was ascertained 48 h after operation with the use of computerized tomography (CT) scans. In the case of EAKO, nearly complete evacuation (>84%) was achieved in 21 cases; GCS was evaluated at 7 d postsurgery result ing in GCS >12 in 9 patients, GCS 9-12 in 12 patients and GCS <9 in 4 patients. The follow-up period ranged from 6 to 21 mon. GOS was estimated at half a year and good recovery rate as defined by GOS was assigned to 76% of the EAKO pa tients. There are significant differences in the volumes of remaining hematomas and the duration of operation between the EAKO and craniotomy group (P<0.0 5). In addition, better clinical outcomes were obtained in EAKO. Conclusion EAKO has the advantage of being minimally invasive, improving surgical results and the prognosis of hypertensive intracranial hematoma patients. We conclude th at keyhole operation is a safe, effective alternative for removal of hypertensiv e intracranial hematoma, particularly during acute stages.

  19. PPARγ-induced upregulation of CD36 enhances hematoma resolution and attenuates long-term neurological deficits after germinal matrix hemorrhage in neonatal rats.

    Flores, Jerry J; Klebe, Damon; Rolland, William B; Lekic, Tim; Krafft, Paul R; Zhang, John H


    Germinal matrix hemorrhage remains the leading cause of morbidity and mortality in preterm infants in the United States with little progress made in its clinical management. Survivors are often afflicted with long-term neurological sequelae, including cerebral palsy, mental retardation, hydrocephalus, and psychiatric disorders. Blood clots disrupting normal cerebrospinal fluid circulation and absorption after germinal matrix hemorrhage are thought to be important contributors towards post-hemorrhagic hydrocephalus development. We evaluated if upregulating CD36 scavenger receptor expression in microglia and macrophages through PPARγ stimulation, which was effective in experimental adult cerebral hemorrhage models and is being evaluated clinically, will enhance hematoma resolution and ameliorate long-term brain sequelae using a neonatal rat germinal matrix hemorrhage model. PPARγ stimulation (15d-PGJ2) increased short-term PPARγ and CD36 expression levels as well as enhanced hematoma resolution, which was reversed by a PPARγ antagonist (GW9662) and CD36 siRNA. PPARγ stimulation (15d-PGJ2) also reduced long-term white matter loss and post-hemorrhagic ventricular dilation as well as improved neurofunctional outcomes, which were reversed by a PPARγ antagonist (GW9662). PPARγ-induced upregulation of CD36 in macrophages and microglia is, therefore, critical for enhancing hematoma resolution and ameliorating long-term brain sequelae.

  20. 10 Levels thoracic no-intrumented laminectomy for huge spontaneous spinal subdural hematoma removal. Report of the first case and literature review

    Visocchi, Massimiliano; La Rocca, Giuseppe; Signorelli, Francesco; Roselli, Romeo; Jun, Zhong; Spallone, A.


    Introduction Spontaneous idiopathic acute spinal subdural hematoma (SSDH) is a rare cause of acute back pain followed by signs and symptoms of nerve root and/or spinal cord compression, frequently associated with coagulopathies, blood dyscrasias and arterio-venous malformations. Standard management includes non-operative treatment and timely (within 24 h) surgical decompression. Presentation of case We report on the case of a huge 10 levels SSDH treated with decompressive thoracic no-instrumented laminectomy in a 45-year-old woman with good neurological recovery (from ASIA A to D). Discussion Spontaneous SSDHs without detectable structural lesion or anticoagulant therapy are very rare. Among 26 cases documented the literature harbouring SSDHs, the thoracic spine was found to be the preferred site, and the compression was usually extending over several vertebral levels. Nonoperative treatment for SSDH may be justified in presence of minimal neurologic deficits, otherwise, early decompressive laminectomy along with evacuation of hematoma are considered the treatment of choice in presence of major deficits. Conclusion To our knowledge, the present case is the most extensive laminectomy for a SSDH removal never described before. No postoperative instability occurs in 10 levels thoracic laminectomy in case the articular processes are spared. When major neurological deficits are documented, early decompressive laminectomy with evacuation of hematoma should be considered the best treatment for SSDH. PMID:26318128




    Full Text Available A retrospective study of 28 1 cases of traumatic posterior fossa Extra dural hematoma 2,3 in K ing George Hospital, V isakhapatnam from A ugust 2012 to February 2015 . This study was aimed to present the experience in treating patients with traumatic posterior fossa extra dural hematoma 2 and to discuss the clinical features, risk factors 4 and outcome . 5 Posterior fossa e xtradural hematoma 2,3 uncommon but potentially fatal condition. The incidence of posterior fossa extra dural hematoma 2,3 among intracranial extra dural hematomas has been reported 4% to 7%. Occipital skull bone fracture with venous sinus bleeding that resulted in a posterior fossa extradural haematoma . 2 low Gcs [or] hematoma more than 10ml were subjected to evacuation . Since the volume of the posterior fossa 6 is small, patients deteriorate early because of compression of vital structures in the brain stem, development of obstructive hydrocephalus, which is visible in the CT scan in only thirty percent of cases

  2. Nasalseptal hematoma/abscess: management and outcome in a tertiary hospital of a developing country

    Nwosu JN


    Full Text Available Jones N Nwosu, Peter C NnadedeDepartment of Otolaryngology, University of Nigeria Teaching Hospital, Enugu, NigeriaBackground: Nasal hematoma/abscess is an uncommon entity, but capable of leading to serious consequences if not handled meticulously, and with urgency.Objective: To present the management, and outcome of nasal septal hematoma/abscess in a Nigerian tertiary institution.Method: Consecutive patients diagnosed with nasal septal hematoma/abscess over a 10-year period, treated at the University of Nigeria Teaching Hospital, Enugu, Nigeria, were prospectively studied. The processes leading to diagnosis, treatment, and outcome were sequentially evaluated.Results: Fifty-three patients (37 males and 16 females, age 5–65 years (with mean age of 23.10 years, were included. Surgical drainage of the hematoma/abscess, intranasal packing with insertion of drain was performed with total resolution of problem in all the cases.Conclusion: Incision and drainage, and intranasal packing with insertion of drain was effective in treating nasal septal hematoma/abscess.Keywords: septal hematoma, abscess, facial deformity

  3. Delayed ejaculation

    ... partner Conditioning caused by a habit of excessive masturbation Traumatic events (such as being discovered masturbating or ... cause. (Examples of stimulation may include wet dreams, masturbation, or intercourse.) See a therapist who specializes in ...

  4. Hematomas intracerebral espontâneos estudo de 121 casos

    Lineu Cesar Werneck


    Full Text Available Foram analisados retrospectivamente 121 pacientes com hematomas intracerebrais espontâneos (HIE: com média de idade de 53,4 ±14,8 anos, 62,8% do sexo masculino, tempo médio de sangramento na admissão de 36 horas (3 horas a 12 dias; 63,5% estavam acima de 7 na escala de Glasgow e 81,9% com grau igual ou maior que 3 na escala de Botterel. Os HIE eram: em gânglios da base em 45,5%, multilobares em 14,7%, lobares em 22,8%, no tronco cerebral em 4% e cerebelares em 2%. Seus diâmetros médios eram de 46,6 mm (16 a 33 e a área média de 1422,9 mm2 (60 a 4818. O LCR em 67 casos revelou pressão inicial média de 234 mmH20 (30 a 700 e concentrarão proteica média de 416,9 mg/dl (30 a 1960. O tratamento foi conservador em 107 casos e cirúrgico em 14. Sobreviveram 55,8% dos pacientes; a maioria dos que faleceram estava em grau acima de 3 na escala de Boterell e abaixo de 9 na de Glasgow. Houve correlação estatística entre a sobrevida e óbito com a escala de Glasgow e com a de Boterell, paralisia de músculos oculares, déficit motor, sinais de descerebração, broncopneumonia, diâmetro e área do hematoma; não houve relação estatística com uso de dexametasona, antifibrinolítico, anticonvulsivantes e diuréticos. O uso de manitol e a queda da pressão arterial nos primeiros dias tiveram relação com maior mortalidade Dos 14 casos submetidos a cirurgia, 11 faleceram. A principal complicação que levou a óbito foi broncopneumonia. São feitos comentários sobre a patogenia dos HIE, incidência atual, sinais clínicos» localização, tamanho, causas de óbito e tratamento empregado em relação ao prognóstico.

  5. [Delayed asthma bronchiale due to epoxy resin].

    Authried, Georg; Al-Asadi, Haifaa; Møller, Ulla; Sherson, David Lee


    Epoxy resin is a low molecular weight agent, which can cause both acute and delayed allergic reactions. However, it is known causing skin reactions with direct or airborne contact. Rarely it can cause airway reactions like asthma bronchiale. We describe a case of a windmill worker who developed delayed asthma bronchiale due to airborne contact with epoxy resin.

  6. Clinical analysis of 28 children suffering from intracranial hematoma and multiple injuries following traffic accidents

    李江山; 程成; 江勇豪


    Objective: To evaluate the result of diagnosis and treatment of intracranial hematoma and multiple injuries caused by road traffic accidents. Methods: Twenty-eight patients, aged from 1 to 14 years, receiving craniotomy and other surgical treatments were retrospectively reviewed. Results: Among the 28 cases, 23 cured with the recovery rate of 82.3%, 2 had a sequel of moderate disability, and 3 died from severe brain injury, hemorrhagic shock, and other visceral complications. The clinical sympotoms and signs were severe and perplexing. The major characters included: severe head injury, usually combined by multiple injuries, and easy of access to missed diagnosis and misdiagnosis. Conclusions: The occurrence of infection is high after traffic accidents as a result of depression of humoral and cellular immunity, long-term bed rest, and fractures of limbs. Hence, on the basis of maintaining vital signs, the management of primary wound is essential to reduce infection and underlying death. In addition to the management of brain injury, concurrent injuries should also be highlighted so as to reach a good result for their patients.

  7. Acute intramural hematoma of ascending aorta. CT findings and clinical outcome

    Yamaguchi, Toshio; Sakuyama, Keiko; Hiekata, Tomizou; Yamanaka, Ikuo [St. Marianna Univ., Kanagawa (Japan). Yokohama Seibu Hospital; Kuroki, Kazunori; Ohyama, Yukio; Ishikawa, Tohru; Kawada, Tadanori; Akashi, Katsuya


    The purpose of this study was to describe the CT findings and clinical outcomes of nineteen patients with acute intramural hematoma (IMH) of the ascending aorta. Six patients underwent surgery on the emergency basis (3 patients) due to cardiac tamponade (n=2) and dilated aorta (n=1), and on the elective basis (3 patients) due to patent and enlarging false lumen. Among the 13 patients with medical management, four patients died from complications of IMH during the follow-up period (2 days-2.5 years). Transition to aortic dissection or enlargement of an intimal tear was noted in 5 patients (31%) in 1 to 6 weeks after onset. Three patients died of causes not related to IMH. Six patients had been alive 2 to 9 years after onset. Retrospective review revealed 10 patients (53%) as possible surgical candidates, and the other 9 patients as medically treated patients in the long-term follow-up. The surgical group showed cardiac tamponade or shock in 6 patients on admission and had pericardial effusion in all the patients on the initial CT scan. In the patients with acute IMH of the ascending aorta, surgery should be considered for severe clinical symptoms, pericardial effusion and large size of the ascending aorta (more than 4 cm) on CT scan, and for converting to a typical type A aortic dissection. CT scan had a major role in making an early diagnosis, in depicting a dangerous sign, and in monitoring its progression or resolution of IMH. (author)

  8. A new minimally invasive tubular brain retractor system for surgery of deep intracerebral hematoma

    Yad R Yadav


    Full Text Available Access to deep-seated brain lesions with traditional fixed and rigid brain retractors can be difficult without causing significant trauma to the surrounding brain. Tubular retractors offer an advantage of low retracting pressure. We developed a new inexpensive and simple tubular retractor which requires very small cortisectomy. The new tubular retractor was made up of silicone with inner diameter of 15, 18 and 23 mm and outer diameter of 17, 20 and 25 mm, respectively. This tube (1 mm thick was cut in longitudinal direction. It was folded to make a small-diameter tube so that it could be introduced through a small cortisectomy. Margins of cortisectomy were gently and slowly retracted by Killian nasal speculum. Folded retractor, held by tissue forceps, was introduced inside the opened Killian nasal speculum. Tissue forceps and nasal speculum were removed leaving tubular retractor in place, which comes back to its normal tubular configuration after release. Surgery was performed using rigid Karl Storz 0° telescope (30 cm long and 4 mm in diameter or microscope. Near-total removals of intracerebral hematomas, 37 hypertensive and 3 traumatic, was done using this retractor without any complication.

  9. Prenatal diagnosis of a placental infarction hematoma associated with fetal growth restriction, preeclampsia and fetal death: clinicopathological correlation.

    Aurioles-Garibay, Alma; Hernandez-Andrade, Edgar; Romero, Roberto; Qureshi, Faisal; Ahn, Hyunyoung; Jacques, Suzanne M; Garcia, Maynor; Yeo, Lami; Hassan, Sonia S


    The lesion termed 'placental infarction hematoma' is associated with fetal death and adverse perinatal outcome. Such a lesion has been associated with a high risk of fetal death and abruption placentae. The fetal and placental hemodynamic changes associated with placental infarction hematoma have not been reported. This paper describes a case of early and severe growth restriction with preeclampsia, and progressive deterioration of the fetal and placental Doppler parameters in the presence of a placental infarction hematoma.

  10. Microwave Hematoma Detector for the Rapid Assessment of Head Injuries

    Hadded, W.; Chang, J.; Rosenbury, T.; Dallum, G.; Welsch, P.; Scott, D.; Duarte, D.; Acevedo-Bolton, V.


    A non-invasive microwave device for the detection of epi/subdural hemorrhaging (hematoma) is under current development. The final device will be highly portable and allow real time assessment of head injuries, thereby satisfying early detection needs of the field technician as well as providing a tool for repetitious monitoring of high-risk individuals. The device will adopt the advanced technology of micropower impulse radar (MIR) which is a state of the art low cost ultra wide band (UWB) microwave radar developed here at LLNL. It will consist of a MIR transmitting and receiving module, a computer based signal processing module, and a device-to-patient signal coupling module--the UWB antenna. The prototype design is being guided by the needs of the patient and the practitioner along with the prerequisites of the technology including issues such as the specificity of the device, efficacy of diagnosis, accuracy, robustness, and patient comfort. The prototype development follows a concurrent approach which .includes experiments designed to evaluate requirements of the radar and antenna design, phantom development to facilitate laboratory investigations, and investigation into the limits of adapting pre-existing non-medical MIR devices to medical applications. This report will present the accomplishments and project highlights to date in the fiscal year 1999. Future project projections will also be discussed.

  11. Time Delay of CGM Sensors

    Schmelzeisen-Redeker, Günther; Schoemaker, Michael; Kirchsteiger, Harald; Freckmann, Guido; Heinemann, Lutz; del Re, Luigi


    Background: Continuous glucose monitoring (CGM) is a powerful tool to support the optimization of glucose control of patients with diabetes. However, CGM systems measure glucose in interstitial fluid but not in blood. Rapid changes in one compartment are not accompanied by similar changes in the other, but follow with some delay. Such time delays hamper detection of, for example, hypoglycemic events. Our aim is to discuss the causes and extent of time delays and approaches to compensate for these. Methods: CGM data were obtained in a clinical study with 37 patients with a prototype glucose sensor. The study was divided into 5 phases over 2 years. In all, 8 patients participated in 2 phases separated by 8 months. A total number of 108 CGM data sets including raw signals were used for data analysis and were processed by statistical methods to obtain estimates of the time delay. Results: Overall mean (SD) time delay of the raw signals with respect to blood glucose was 9.5 (3.7) min, median was 9 min (interquartile range 4 min). Analysis of time delays observed in the same patients separated by 8 months suggests a patient dependent delay. No significant correlation was observed between delay and anamnestic or anthropometric data. The use of a prediction algorithm reduced the delay by 4 minutes on average. Conclusions: Prediction algorithms should be used to provide real-time CGM readings more consistent with simultaneous measurements by SMBG. Patient specificity may play an important role in improving prediction quality. PMID:26243773

  12. Prehospital delay in acute coronary syndrome--an analysis of the components of delay

    Ottesen, Michael Mundt; Dixen, Ulrik; Torp-Pedersen, Christian;


    more frequently atypical symptoms and increased prehospital delay caused by prolonged physician and transportation delay. Physician delay among women and men were 69 and 16 min, respectively. Patients with prior myocardial infarction had reduced prehospital delay, which was caused by shorter decision...... admitted with acute coronary syndrome is warranted. METHODS: A structured interview was conducted on 250 consecutive patients admitted alive with acute coronary syndrome. RESULTS: Median prehospital, decision, physician and transportation delays were 107, 74, 25 and 22 min, respectively. Women (n=77) had...... of acute coronary syndrome among women, and thereby contributes to unnecessary long delay to treatment. The patient's prior experience and interpretation has a significant influence on behaviour....

  13. Intramural esophageal hematoma after elective injection sclerotherapy Hematoma intramural esofágico após escleroterapia eletiva de varizes

    Hannah Pitanga Lukashok


    Full Text Available CONTEXT: Although endoscopic esophageal variceal sclerotherapy has been largely supplanted by variceal band ligation, it is still performed routinely in many institutions, especially in developing countries. Intramural esophageal hematoma has been described as a rare complication of sclerotherapy. Risk factors have not been completely established. OBJECTIVE: To demonstrate the incidence of post-sclerotherapy intramural esophageal hematoma in our hospital and discuss the possible factors involved. Methods - This is a retrospective observational study made at the "Hospital Universitário Clementino Fraga Filho", Rio de Janeiro, RJ, Brazil, reviewing the medical records of all esophageal variceal sclerotherapy procedures performed from April 2000 to November 2005. The evaluation of the clinical, laboratorial and endoscopic features in our patients and those reported in the literature was also done. Review of literature was performed through MEDLINE search. RESULTS: A total of 1,433 esophageal variceal sclerotherapy procedures were performed in 397 patients, with an intramural esophageal hematoma incidence of 4 cases (0.28%. Three of our patients developed additional complications, and one death was a direct consequence of a rupture of the hematoma. Nineteen well described cases were reported in the literature. Intramural esophageal hematoma occurred mostly after the forth esophageal variceal sclerotherapy session. Coagulation disturbances were present in the majority of cases. CONCLUSION: Intramural esophageal hematoma is a rare complication of esophageal variceal sclerotherapy and its incidence in our institution was similar to those observed in the literature. Our study suggests that this complication occurs as a result of a fragile esophageal mucosa after previous esophageal variceal sclerotherapy sessions. Impaired coagulation, although not essential, could contribute to hematoma formation and extension through esophageal submucosa

  14. Individual idea about the micro-invasive aspiration and drainage of intracranial hematoma


    AIM:This study aimed to expound the individual idea of micro-invasive surgery from pre-operative preparation,intra-operative processing and post-operative management.METHODS:Pre-operative preparation was improved by analyzing pathological factors and hematoma property,and considering patients' age,basic disease,blood pressure control,with persistent haemorrhagia/rehaemorrhagia or not,operative occasion choice,positioning and other procedures.In the surgery,positioner was used.Initial aspiration volume was cautiously controlled.After operation,vital signs of patients were kept stable by cautiously using hematoma liquefacient and combining with free radical scavenger.RESULTS:The core content of individual micro-invasive surgery was mainly to relieve intracranial pressure.Under the condition of sufficient pre-operative preparation known by patients' family members,precise positioning was determined and individual therapeutic regimen was made.Meanwhile,caution should be taken in hematoma aspiration.Liquefaction and drainage should be paid more attention,and complications were processed actively.CONCLUSION:During the process of micro-invasive evacuation of intracranial hematoma for treating cerebral hemorrhage,attention should be paid to analyzing cerebral hematoma etiology and pathophysiological mechanism,and individual idea should be considered in surgical treatment aiming at patients' concrete disease condition.

  15. [Acute epidural hematoma of the posterior fossa in a case of von Willebrand's disease].

    Takenaka, N; Mine, T; Ikeda, E; Iwai, H; Kusano, S


    A rare case of acute epidural hematoma of the posterior fossa associated with von Willebrand's disease is reported. A 9-year-old boy fell down and hit his occipital region against a floor. Soon after he came home and slept, but three hours later he began to vomit and became drowsiness. He visited our hospital and his Glasgow Coma Scale showed 13 points. CT scan on admission showed acute epidural hematoma of left posterior fossa and contusional hematoma in the right temporal lobe. The bleeding time was over 18 minutes. He had been suspected to be suffering from von Willebrand's disease two years ago. Then fresh blood, fresh frozen plasma and anti-hemophilic globulin were prepared. Ten hours after injury, the operation was begun. Fresh epidural hematoma existed as a clot beyond transverse sinus. During the procedure of dural tenting suture, diffuse bleeding from bone, muscle, subcutaneous tissue and dura occurred and it was difficult to stop the bleeding. By using fresh blood and anti-hemophilic globulin, the bleeding was controlled, and then the operation was achieved. In the postoperative course a new epidural hematoma was found in the left temporal region and a new but asymptomatic retinal hemorrhage was found in his right eye. He was discharged without any neurological deficits 25 days after operation.

  16. Total Hip Arthroplasty Complicated by a Gluteal Hematoma Resulting in Acute Foot Drop.

    Khattar, Nicolas K; Parry, Phillip V; Agarwal, Nitin; George, Hope K; Kretz, Eric S; Larkin, Timothy M; Gruen, Gary S; Abla, Adnan A


    Total hip arthroplasty is a prevalent orthopedic intervention in the United States. Massive postoperative hematomas are a rare albeit serious complication of the procedure. Sequelae of these hematomas can include lower extremity paralysis from compression of the sciatic nerve. A 66-year-old woman taking aspirin and clopidogrel for coronary stents presented with a complete foot drop, paresthesias, and lower extremity pain 10 days after a total hip arthroplasty. The patient was initially seen by a neurology service at another hospital and thought to have lateral recess stenosis. At the authors' center, magnetic resonance imaging of the lumbar spine failed to show lateral recess stenosis. Urgent pelvic computed tomography showed a large hematoma and raised suspicion of sciatic nerve compression. Hip magnetic resonance imaging showed a right gluteal hematoma compressing the sciatic nerve. The patient was then taken to the operating room for the clot to be evacuated and was later referred for rehabilitation. Massive hematomas after total hip arthroplasty are an important consideration in the differential diagnosis of nontraumatic acute foot drop. Prompt diagnosis may correlate with improved neurological outcome and help reduce overall morbidity.

  17. Predictors for outcome after surgery for traumatic acute subdural hematoma

    Atanasov Vladimir A.


    Full Text Available Introduction: Acute traumatic subdural hematoma (ASDH is one of the most frequent conditions in neurosurgery demanding emergency surgery. The aim of the study was to identify factors influencing outcome in patients who had surgery for evacuation of ASDH. Methods: From 2005 to 2012 eighty-five patients at age above 18 years had surgery for evacuation of ASDH. Outcome was measured according GOS at discharge and was dichotomized as “favorable outcome” (GOS 4 to 5 and “unfavorable outcome” (GOS 1 to 3. These factors were evaluated with univariate and logistic regression analysis for significance with outcome. Results: The mean age of the 85 patients was 62.7 years (SD±18.5. 45.9% patients were with favorable outcome and 54.1% had unfavorable outcome. Patients with GCS score 3-8 (54.1% had 80.4% unfavorable outcome whereas 78.6% of patients with GCS score 13-15 (32.9% had favorable outcome. All patients with nonreactive pupils (bilaterally or unilaterally - 31.8% had unfavorable outcome whereas patients (36.5% with both reactive pupils (36.5% had in 80.6% favorable outcome. All patients (40% with Rotterdam CT scores 5 and 6 had unfavorable outcome. The factors determining outcome were admission GSC score, Rotterdam CT scores, and prothrombin time. Conclusion: Patients who have GSC score of 3, unresponsive pupil(s or have Rotterdam CT scores 5 and 6 have little chance of survival. Patients with coagulopathy have two times more unfavorable outcome. The patients with ASDH should have surgery as soon as possible after correction of vital parameters in order to avoid deterioration which can be very rapid and irreversible.

  18. Treatment of bronchial ruptures by delayed surgery


    Objective:To study the causes that resulted in delayed surgery for bronchial ruptures and the results.Methods:The cases with the bronchial ruptures by the delayed surgery last decade were retrospectively reviewed.The causes and unsatisfactory results were analysed.Results:The severe complications usually occurred after the delayed surgery and the results were not as satisfactory as those by early surgery.Conclusion:The bronchial ruptures ought to be operated in the early stage after being wounded.

  19. Hematoma epidural espinal espontâneo durante a gravidez: registro de um caso

    Ivan Hack


    Full Text Available Registro de caso de paciente no oitavo mês de gestação que desenvolveu hematoma epidural espinal espontâneo dorsolombar. A gravidez, determinando aumento da pressão intra-abdominal e, como consequência, aumento da pressão venosa no plexo epidural, poderia ter sido o fator desencadeante no hematoma- A paciente foi submetida a cirurgia precocemente, porém não apresentou recuperação do déficit sensitivo-motor. São discutidos aspectos clínicos, do tratamento cirúrgico, da evolução e da etiologia dos hematomas epidurals espinais espontâneos.

  20. Brain abscess in a non-penetrating traumatic intracerebral hematoma: Case report and review of literature

    Thomas Santhosh


    Full Text Available We report a 57-year-old man who presented one month after sustaining a traumatic right temporal intracerebral hematoma with history of headache, left hemiparesis and altered sensorium of two days duration. A diagnosis of right temporal resolving hematoma was made on computed tomography scan. However, his sensorium progressively deteriorated and he underwent craniotomy and partial excision of an abscess. He was treated with appropriate antibiotics for six weeks despite of which he did not improve and died nine months later. We conclude that there should be a high index of suspicion for brain abscess in patients with traumatic intracerebral hemorrhage if the clinical and radiological picture is different from the expected course of a resolving hematoma.

  1. A “Pseudo-cavernoma” – an encapsulated Hematoma of the Choroid Plexus

    Dey, Mahua; Turner, Michael S.; Pytel, Peter; Awad, Issam A.


    We present the first report of an intraventricular encapsulated hematoma, mimicking cavernous malformation on imaging and gross lesion appearance. A 47-year-old female on anticoagulation therapy for atrial fibrillation presented with left upper extremity apraxia, neglect, and mild gait imbalance. Her brain CT scan and MRI revealed multilobulated lesions involving the choroid plexus in the atria of both lateral ventricles. The intraoperative appearance was that of encapsulated mass, with blood clots at different stages of liquefaction and organization, all consistent with the gross appearance of a cavernous malformation. However, histopathologic examination demonstrated hematoma with components at different ages, and normal vessel infiltration without any hint of cavernous malformation histology, or underlying neoplasia. Encapsulated hematoma should be considered in the differential diagnosis of hemorrhagic intraventricular masses. PMID:21435884

  2. A "pseudo-cavernoma" - an encapsulated hematoma of the choroid plexus.

    Dey, Mahua; Turner, Michael S; Pytel, Peter; Awad, Issam A


    We present the first report of an intraventricular encapsulated hematoma, mimicking cavernous malformation on imaging and gross lesion appearance. A 47-year-old female on anticoagulation therapy for atrial fibrillation presented with left upper extremity apraxia, neglect, and mild gait imbalance. Her brain CT scan and MRI revealed multilobulated lesions involving the choroid plexus in the atria of both lateral ventricles. The intraoperative appearance was that of encapsulated mass, with blood clots at different stages of liquefaction and organization, all consistent with the gross appearance of a cavernous malformation. However, histopathologic examination demonstrated hematoma with components at different ages, and normal vessel infiltration without any hint of cavernous malformation histology, or underlying neoplasia. Encapsulated hematoma should be considered in the differential diagnosis of hemorrhagic intraventricular masses.

  3. The hematoma block: a simple, effective technique for closed reduction of ankle fracture dislocations.

    Ross, Adrianne; Catanzariti, Alan R; Mendicino, Robert W


    Management of a dislocated ankle fracture can be challenging because of instability of the ankle mortise, a compromised soft tissue envelope, and the potential neurovascular compromise. Every effort should be made to quickly and efficiently relocate the disrupted ankle joint. Within the emergency department setting, narcotics and benzodiazepines can be used to sedate the patient before attempting closed reduction. The combination of narcotics and benzodiazepines provides relief of pain and muscle guarding; however, it conveys a risk of seizure as well as respiratory arrest. An alternative to conscious sedation is the hematoma block, or an intra-articular local anesthetic injection in the ankle joint and the associated fracture hematoma. The hematoma block offers a comparable amount of analgesia to conscious sedation without the additional cardiovascular risk, hospital cost, and procedure time.

  4. [Transformation from chronic subdural hematoma into subdural empyema following cat bites: a case report].

    Konno, Takuya; Yamada, Kei; Kasahara, Sou; Umeda, Yoshitaka; Oyake, Mutsuo; Fujita, Nobuya


    A 69-year-old man developed motor aphasia and right hemiparesis with severe headache, during the treatment of cellulitis and sepsis due to cat bites. Brain CT showed a low density, crescent-shaped lesion in the left subdural space, which was hypointense on brain diffusion-weighted imaging (DWI). One week later, when his neurological symptoms had worsened, the signal of the subdural lesion had changed to hyperintense on DWI. The lesion was capsule-shaped when enhanced by Gadolinium. The signal changes on DWI of the lesion indicated the existing hematoma had changed to an empyema, or so-called infected subdural hematoma, due to a hematogenous bacterial infection. Pasteurella multocida, a resident microbe in the oral cavity of cats, could be the responsible pathogen in this case. The patient recovered completely after treatment with intravenous high dose antibiotics. This is an important case report describing the transformation from a chronic subdural hematoma into a subdural empyema by DWI.

  5. Want to operate an abdominal lump? Think twice; it might be spontaneous rectus sheath hematoma: a case report

    Manisha Sarkar


    Full Text Available Rectus sheath hematoma is a rare, but potentially misdiagnosed clinical entity. It occurs when there is direct tear in the rectus abdominis muscle fibres or in the supplying blood vessels. It may be associated with trauma, raised intra-abdominal pressure, or muscle weakness. When non-traumatic, the condition is termed as spontaneous rectus sheath hematoma. Because of its rarity, spontaneous rectus hematoma can be easily missed, endangering patient management. With progressively increasing use of anticoagulant and antiplatelet agents, the incidence of this pathology is rising. We are reporting a case of spontaneous rectus sheath hematoma in a 56 year old female, known diabetic, hypertensive with dyslipidaemia on combination drug therapy but not on anticoagulant/antiplatelet medications, that was clinically misdiagnosed as omental hernia. The main presenting complaint was swelling in abdomen for 1 month. There was no history of trauma. Radiologic findings showed hypoechoic multiloculated complex cystic lesion. Cytological findings showed features of old hematoma. This case report intends to increase awareness in considering rectus sheath hematoma as an important differential diagnosis of lump abdomen. Rectus sheath hematoma, a rarely seen pathology, often confuses clinicians leading to unnecessary negative laparotomies. Definitive operative procedure should not be undertaken depending on sonographic findings alone, as the images are prone to subjective error. The main treatment modality of rectus sheath hematoma is conservative management. [Int J Res Med Sci 2016; 4(9.000: 4208-4211

  6. 床旁超声在外伤性肌肉血肿急诊处理中的应用%Bedside ultrasound scan in emergency treatment of traumatic muscle hematoma

    何黎; 赵蕊; 黄相


    目的:探讨床旁超声对外伤致肌肉血肿的评估和治疗的应用价值。方法回顾性分析2011年10月~2014年8月我院收治的外伤性肌肉血肿54例患者资料,分析比较不同类型肌肉血肿的形成原因、临床超声表现及相应的处理对策。结果根据病情将肌肉血肿分为动脉性血肿、静脉性血肿和血肿腔内有异物残留三类,对出血量较大的动脉性血肿应及时清创止血;对静脉性血肿大多可采取局部加压包扎;发现血肿腔内有异物残留时应予超声定位或超声引导下清创取出异物。结论床旁超声的应用对外伤后肌肉血肿的评估和治疗有重要指导意义,有利于帮助急诊外科医生更准确地判断病情和制定及时有效的处理方案,对于急诊外伤的患者也能缩短诊治时间,减少患者搬动和促进伤情的恢复。%Objective To discusses the applied value of bedside ultrasound scan in assessment and treat-ment of traumatic muscle hematoma. Methods A retrospective analysis was performed on records of 54 pa-tients with traumatic muscle hematoma cared by our hospital from October 2011 to August 2014.Analyzed and compared of disease cause,clinical and sonographic findings,and corresponding treatment measures in different types of muscle hematoma. Results According to the illness status patients with muscle hematoma could be divided into three kinds of arterial haematoma,vein hematoma and residual foreign body in hematoma cavity. Timely debridement and hemostasis should be done for arterial hematoma with large volume bleeding.Most patients with vein hematoma was given local compression bandage;ultrasound-guided or -located debride-ment should be done for removing foreign body which was detected out residual in hematoma cavity. Conclu-sion Bedside ultrasound has important guiding significance in assessment and treatment of traumatic muscle hematoma,it will help emergency surgeon to make more accurate

  7. 急性硬膜下血肿短时自动消散现象及相关分析%Short-term auto-dissipation phenomena and related analysis of acute subdural hematoma

    李强; 赵佃林


    目的 剖析外伤性急性硬脑膜下血肿短时自动消散现象的伤因、病理及其相关因素.方法 对2006年2月~2012年1月我院12例短时自动消散急性硬脑膜下血肿的临床特点、动态CT扫描结果、治疗方法及预后效果进行分析.结果 12例患者均采取非手术治疗,头颅CT显示血肿均在3 d内消失,4例患者伤后5 h以内血肿完全吸收,5~24 h以内血肿吸收患者3例,第2天血肿吸收患者3例,第3天血肿吸收患者2例,吸收时间最短为4 h,中线结构恢复,脑室、脑池清楚,出院后无神经系统功能障碍.结论 急性硬脑膜下血肿短时自动消散是血液的重新分布,不但跟血肿形态、部位、密度和血肿量有关,而且受蛛网膜破裂、适当的高颅压、脑萎缩和伴有硬膜破裂的颅骨骨折等相关因素影响.%Objective To analyze the cause of injury, pathology and relevant factors of the phenomenon of traumatic acute subdural hematoma short term automatic lift. Methods 12 patients with traumatic acute subdural hematoma short term automatic lift were analysed on clinical characteristics, dynamic CT scans, treatment and prognosis effect. Results 12 patients were adopted in the nonoperative treatment, the CT scan showed the hematoma disappeared within 3 days, 4 patients within 5 h after injury had hematoma absorption, 3 cases within 5-24 hours after injury had hematoma absoiplion, 3 cases had hematoma absorption on the next day, 2 cases had hematoma absorption on the third day, the shortest time of absorption were 4 h, the midline structures were recovered, the vutricle and cisternal were cleared. All patients had no autonomic nervous system after hospital. Conclusion The acute subdural hematoma short-term automatic lift is a redistribution of blood, not only with the hematoma shape, location, density, and hematoma volume, but also by the arachnoid rupture, high in-tracranial pressure, cerebral atrophy and associated subdural rupture of

  8. Effect of Shenlingbaizhu San on Delayed-onset Diarrhea Caused by Irinotecan in Rats%参苓白术散对伊立替康化疗后大鼠迟发性腹泻的作用研究

    丁军利; 许隽颖; 刘超英


    目的:研究参苓白术散对模型大鼠伊立替康(Irinotecun,CPT-11)所致迟发性腹泻的预防作用.方法:健康雄性SD大鼠40只,随机分为正常对照组,腹泻模型组,中药低剂量组+腹泻模型组,中药中剂量组+腹泻模型组,中药高剂量组+腹泻模型组.尾静脉注射CPT-11 150mg/kg·d,连续两天,复制迟发性腹泻模型;中药十腹泻模型组于注射CPT-11前3天开始,每天一次用参苓白术散灌胃,共用10天;对各组大鼠腹泻情况进行评分;光镜下对大鼠肠黏膜损伤程度进行分级;ELISA法检测大鼠血清中IL-6,TNF-a,IL-10的水平.结果:中药各剂量组+腹泻模型组大鼠迟发性腹泻发生率均低于腹泻模型组(P<0.05);光镜下中药各剂量组+腹泻模型组大鼠肠黏膜损伤分级亦较模型组轻微(P<0.05);中药各剂量组+腹泻模型组大鼠的IL-6,TNF-a水平均比模型组低(P<0.05),而IL-10水平比模型组高(P<0.05).结论:参苓白术散可调节大鼠免疫功能,抑制炎症反应,预防迟发性腹泻的发生.%Objective:To study the effect of Shenlingbaizhu San on delayed-onset diarrhea caused by Irinotecan in rats models. Methods:40 healthy male SD rats were randomly divided into normal control group,diarrhea model group,low dose + diarrhea model group,middle dose group + diarrhea model group,high dose group + diarrhea model group.A model of delayed-onset diarrhea was established through injection with 150mg/kg body weigh/day CPT-11 for consecutive days into the tail vein. Herb groups were treated with Shenlingbaizhu San three days before CPT-11 injected and kept for 9 days.Scoring of delayed-onset diarrhea,histological studies of intestinal tissues under high power microscope,Elisa measuring the serum levels of IL-6,TNF-α and IL-10.Results:Scores of diarrhea in each herb dose + diarrhea model group were significantly lower than those of diarrhea model group (P<0.05);the severity of intestinal injury in each herb dose + diarrhea model group

  9. [A rare cause of postpartum hemorrhage: a genital thrombus].

    Riethmuller, D; Pequegnot-Jeannin, C; Rabenja, C A; Koeberle, P; Schaal, J P; Maillet, R


    Puerperal hematoma is a grave but fortunately rare hemorrhagic post-partum complication (occurring in less than 1:1000 deliveries). The hematoma arises due to detachment of para-vaginal conjunctive tissue. In this type of tissue, no natural hemostasis take place and the hematoma may spread into the retroperitoneal cavity. The different risk factors include primiparity, instrumental extraction of the foetus, pre-eclampsia, twin pregnancy and the presence of vulvo-vaginal varicose veins. External bleeding may not always be evident and other clinical symptoms may be delayed. Despite this, rapid course may still occur with drastic consequences. When a case is referred, an examination of the vulvo-vaginal region is mandatory, resuscitation and surgery performed immediately. If this fails angiographic embolization should be carried out. The prognostic outcome of this rare case of post-partum hemorrhagia is highly dependent on early diagnosis and rapid treatment involving close cooperation between obstetricians and anesthetists, and also of rapid embolization to prevent possible intractable hematomas.

  10. Delayed Puberty

    Kolby, Nanna; Busch, Alexander Siegfried; Juul, Anders


    of diagnostic evaluation today remain in distinguishing the benign CDGP from underlying pathological causes such as hypogonadotropic hypogonadism (HH) and hypergonadotropic hypogonadism. Several techniques have been investigated for this purpose and are reviewed in this chapter; however, no single test is yet...

  11. Sonographic diagnosis of spontaneous intramural small bowel hematoma in a case of warfarin overdose.

    Hou, Sheng-Wen; Chen, Chien-Chih; Chen, Kuo-Chih; Ko, Shih-Yu; Wong, Chung-Shun; Chong, Chee-Fah


    A 38-year-old man who had been treated with warfarin since mitral valve replacement 10 years earlier presented with acute onset of epigastralgia and melena. Coagulation tests were abnormal with a prolonged prothrombin time of >60 seconds and a prolonged activated partial thromboplastin time of >120 seconds. Abdominal sonographic examination revealed duodenal intramural hematoma that was confirmed on CT. Warfarin therapy was stopped and the patient was treated conservatively with vitamin K and fresh frozen plasma. Recovery was uneventful, and the patient was re-warfarinized 2 weeks later. Duodenal hematoma can be readily diagnosed with bedside sonography.

  12. Clinical features and management of posttraumatic subperiosteal hematoma of the orbit

    Kim Usha


    Full Text Available Traumatic subperiosteal hematoma (SpH usually presents late, after the initial trauma. It is generally seen in young males. Computed tomography is the best mode of imaging and helps to rule out orbital fracture or associated subdural hematoma. We present the clinical features and management of four patients seen at the orbit clinic with SpH. Management is based on time of presentation, visual acuity and any communicating bleed. The prognosis of traumatic SpH is excellent if treated with an individualized patient approach.

  13. PET/CT imaging of abdominal aorta with intramural hematomas, penetrating ulcer, and saccular pseudoaneurysm.

    Nguyen, Vien X; Nguyen, Ba D


    Acute aortic syndromes, encompassing intramural hematoma, penetrating ulcer, and pseudoaneurysm, are best demonstrated by angiographic CT and magnetic resonance imaging. These imaging modalities provide an accurate evaluation and allow timely therapies of these frequently symptomatic lesions, thus reducing their morbidity and mortality. The inflammatory pathogenesis of these acute aortic syndromes may exhibit positive PET findings predictive of prognosis and outcomes of these vascular events. The authors present a case of PET/CT imaging showing asymptomatic intramural hematomas with penetrating ulcer and saccular pseudoaneurysm of the proximal abdominal aorta.

  14. Nontraumatic subperiosteal orbital hematoma associated with ethmoid sinusitis: a case report

    Lee, Sung Soo; Han, Jong Kyu; Baek, Byoung Joon; Oh, Mee Hye; Jou, Sung Shick; Kim, Hyung Hwan; Bae, Won Kyung; Kim, Il Young [Soonchunhyang University, Cheonan Hospital, Cheonan (Korea, Republic of)


    Subperiosteal hematoma of the orbit is a rare disease and most of the cases occur in young adult males as a result of direct facial or orbital trauma. In the absence of direct facial or orbital trauma, nontranmatic subperiosteal orbital hematoma has rarely been reported in association with a sudden elevation of cranial venous pressure or venous congestion, systemic diseases associated with a bleeding diathesis and paranasal sinusitis. We report here on a rare case of subperiosteal orbital hemaboma associated with ethmoid sinusitis, as was seen on CT imaging.


    Carlos Fernando Lozano-Tangua; Luis Rafael Moscote-Salazar; Gabriel Alcala-Cerra; Sandra Milena Castellar Leones; Diego Batero


    El hematoma subdural cronico se define como una colección sanguíneo fibrinoide en el espacio existente entre las meninges duramadre y aracnoides, debido a traumas, infecciones (empiema y meningitis), coagulopatías u otras causas. En este se puede precisar durante la intervención quirúrgica la presencia de cápsula o membranas. Entre las diversas causas de hematoma subdural crónico se encuentra la leucemia mieloide crónica que es un síndrome mieloproliferativo, donde se ve una acentuada prolife...

  16. Importancia del hematoma en las fracturas de los hueso s largos: estudio experimental en ratas

    Barros, T. E. P. de; Pires Camargo, O.; Guarniero, R.; Mazzariol, A. Q.; Reis, José T.A.B.; Thomazin, W. T.; Rodrigues, C.J.


    Los autores han estudiado la importancia del hematoma en la consolidación de las fracturas de los hueso s largos. Para ello, han realizado un estudio experimental en 50 ratas Wistar, en las cuales se producía una fractura a nivel de sus tibias, siendo estabilizadas posteriormente, mediante agujas intramedulares. El hematoma era aspirado del foco de fractura en el miembro derecho, mientras que el miembro izquierdo servía como control. Los animale s fueron sacrificados tras difer...

  17. Outcomes and management of type A intramural hematoma

    Sandhu, Harleen K.; Tanaka, Akiko; Charlton-Ouw, Kristofer M.; Afifi, Rana O.; Miller, Charles C.; Safi, Hazim J.


    Background Initial optimal management of acute type A aortic dissection (ATAAD) with intramural hematoma (ATAIMH) remains controversial, especially between centers in the Eastern vs. Western worlds. We examined the literature and our experience to report outcomes after repair of ATAIMH. Methods We reviewed the hospital, follow-up clinic records and online mortality databases for all patients who presented to our center for open repair of ATAAD between 1999 and 2014. Preoperative characteristics, early and long-term outcomes were compared between classic ATAAD vs. ATAIMH. Survival was analyzed using Kaplan-Meier and log-rank statistics. Results Of the 523 repaired ATAAD, 101 patients (19%) presented with IMH and 422 (81%) had classic dissection. ATAIMH were significantly older (64.8±12.9 vs. 56.8±14.6 years; P<0.001), more commonly females (39% vs. 26%; P=0.010), had poor baseline renal function (i.e., glomerular filtration rate) (P<0.017), more retrograde dissections (27% vs. 8.3%; P<0.001), and less distal malperfusion (5% vs. 15%; P<0.001). Age greater than 60 years, female sex, retrograde dissection, and Marfan syndrome were strongly correlated with ATAIMH. Time to repair for ATAIMH was longer (median, 55.3 vs. 9.8 hours; P<0.001) with one death in ATAIMH within three days of presentation (0.9% vs. 6%; P=0.040). In all, 30-day mortality in ATAIMH was not different from classic ATAAD (12% vs.16%; P=0.289). A significantly lower incidence of postoperative dialysis in ATAIMH was noted (10% vs. 19%; P=0.034). When adjusted for age and renal function, late survival was improved with IMH (P<0.039). Conclusions ATAIMH continues to be associated with significant morbidity and mortality, comparable to classic aortic dissection. A multidisciplinary management approach involving aggressive medical management and risk stratification for timely surgical intervention, along with genetic profiling, is recommended for optimal care. Long-term monitoring is mandatory to assess

  18. Role of Matrix Metalloproteinase-2, Matrix Metalloproteinase-9, and Vascular Endothelial Growth Factor in the Development of Chronic Subdural Hematoma.

    Hua, Cong; Zhao, Gang; Feng, Yan; Yuan, Hongyan; Song, Hongmei; Bie, Li


    Chronic subdural hematoma (CSDH) is an inflammatory and angiogenic disease. Vascular endothelial growth factor (VEGF) has an important effect on the pathological progression of CSDH. The matrix metalloproteinases (MMPs) and VEGF also play a significant role in pathological angiogenesis. Our research was to investigate the level of MMPs and VEGF in serum and hematoma fluid. Magnetic Resonance Imaging (MRI) shows the characteristics of different stages of CSDH. We also analyzed the relationship between the level of VEGF in subdural hematoma fluid and the appearances of the patients' MRI. We performed a study comparing serum and hematoma fluid in 37 consecutive patients with primary CSDHs using enzyme-linked immunosorbent assay (ELISA). MMP-2 and MMP-9 activity was assayed by the gelatin zymography method. The patients were divided into five groups according to the appearance of the hematomas on MRI: group 1 (T1-weighted low, T2-weighted low, n=4), group 2 (T1-weighted high, T2-weighted low, n=11), group 3 (T1-weighted mixed, T2-weighted mixed, n=9), group 4 (T1-weighted high, T2-weighted high, n=5), and group 5 (T1-weighted low, T2-weighted high, n=8). Neurological status was assessed by Markwalder score on admission and at follow-up. The mean age, sex, and Markwalder score were not significantly different among groups. The mean concentration of VEGF, MMP-2, and MMP-9 were significantly higher in hematoma fluid than in serum (pMMP-2 was higher in hematoma fluid (pMMP-2 and MMP-9 are significantly elevated in hematoma fluid, suggesting that the MMPs/VEGF system may be involved in the angiogenesis of CSDH. We also demonstrate a significant correlation between the concentrations of VEGF and MRI appearance. This finding supports the hypothesis that high VEGF concentration in the hematoma fluid is of major pathophysiological importance in the generation and steady increase of the hematoma volume, as well as the determination of MRI appearance.

  19. Mutation of EMG1 causing Bowen-Conradi syndrome results in reduced cell proliferation rates concomitant with G2/M arrest and 18S rRNA processing delay.

    Armistead, Joy; Hemming, Richard; Patel, Nehal; Triggs-Raine, Barbara


    Bowen-Conradi syndrome (BCS) is a lethal autosomal recessive disorder caused by a D86G substitution in the protein, Essential for Mitotic Growth 1 (EMG1). EMG1 is essential for 18S rRNA maturation and 40S ribosome biogenesis in yeast, but no studies of its role in ribosome biogenesis have been done in mammals. To assess the effect of the EMG1 mutation on cell growth and ribosomal biogenesis in humans, we employed BCS patient cells. The D86G substitution did not interfere with EMG1 nucleolar localization. In BCS patient lymphoblasts, cells accumulated in G2/M, resulting in reduced proliferation rates; however, patient fibroblasts showed normal proliferation. The rate of 18S rRNA processing was consistently delayed in patient cells, although this did not lead to a difference in the levels of 40S ribosomes, or a change in protein synthesis rates. These results demonstrate that as in yeast, EMG1 in mammals has a role in ribosome biogenesis. The obvious phenotype in lymphoblasts compared to fibroblasts suggests a greater need for EMG1 in rapidly dividing cells. Tissue-specific effects have been seen in other ribosomal biogenesis disorders, and it seems likely that the impact of EMG1 deficiency would be larger in the rapidly proliferating cells of the developing embryo.

  20. Mutation of EMG1 causing Bowen–Conradi syndrome results in reduced cell proliferation rates concomitant with G2/M arrest and 18S rRNA processing delay

    Joy Armistead


    Full Text Available Bowen–Conradi syndrome (BCS is a lethal autosomal recessive disorder caused by a D86G substitution in the protein, Essential for Mitotic Growth 1 (EMG1. EMG1 is essential for 18S rRNA maturation and 40S ribosome biogenesis in yeast, but no studies of its role in ribosome biogenesis have been done in mammals. To assess the effect of the EMG1 mutation on cell growth and ribosomal biogenesis in humans, we employed BCS patient cells. The D86G substitution did not interfere with EMG1 nucleolar localization. In BCS patient lymphoblasts, cells accumulated in G2/M, resulting in reduced proliferation rates; however, patient fibroblasts showed normal proliferation. The rate of 18S rRNA processing was consistently delayed in patient cells, although this did not lead to a difference in the levels of 40S ribosomes, or a change in protein synthesis rates. These results demonstrate that as in yeast, EMG1 in mammals has a role in ribosome biogenesis. The obvious phenotype in lymphoblasts compared to fibroblasts suggests a greater need for EMG1 in rapidly dividing cells. Tissue-specific effects have been seen in other ribosomal biogenesis disorders, and it seems likely that the impact of EMG1 deficiency would be larger in the rapidly proliferating cells of the developing embryo.

  1. Delayed diagnosed intermuscular lipoma causing a posterior interosseous nerve palsy in a patient with cervical spondylosis: the “priceless” value of the clinical examination in the technological era



    Background Posterior interosseous nerve (PIN) palsy may present with various symptoms, and may resemble cervical spondylosis. Case report We report about a 59-year-old patient with cervical spondylosis which delayed the diagnosis of posterior interosseous nerve (PIN) palsy due to an intermuscular lipoma. Initial right hand paraesthesias and clumsiness, together with MR findings of right C5–C6 and C6–C7 foraminal stenosis, misled the diagnostic investigation. The progressive loss of extension of all right hand fingers brought to detect a painless mass compressing the PIN. Electrophysiological studies confirmed a right radial motor neuropathy at the level of the forearm. Results Surgical tumor removal and nerve decompression resulted in a gradual motor deficits recovery. Conclusions A thorough clinical examination is paramount, and electrophysiology may differentiate between cervical and peripheral nerve lesions. Ultrasonography and MR offer an effective evaluation of lipomas, which represent a rare cause of PIN palsy. Surgical decompression and lipoma removal generally determine excellent prognoses, with very few recurrences. PMID:27142825

  2. Hematoma subdural agudo traumático: estudo de 110 pacientes Acute traumatic subdural haematomas: study of 110 cases

    Nicandro de Figueiredo Neto


    . There was a predominance of males (79%, with ages ranging from 14 to 70, being car accidents (20% and car-pedestrian accidents (34% the most frequent causes The majority of patients (85.7% was admitted in very serious condition, with a score of 8 points on the Glasgow Coma Scale (GCS or lesser, which directly influenced the mortality rates. CT scan was the diagnostic procedure of choice, and it showed contusion and brain swelling to be the most frequent associated intracranial lesions. Surgery was carried out in 45.1% of cases and, in most instances, through an ample fronto-temporo-parietal craniotomy, with hematoma drainage and dural reconstitution. In 54.9% of cases, clinical conditions did not allow surgery and in this group, 69.6%

  3. Spontaneous sublingual and intramural small-bowel hematoma in a patient on oral anticoagulation

    Mohamed Moftah


    Full Text Available Spontaneous sublingual hematoma and intramural small bowel hematoma are rare and serious complications of anticoagulant therapy. Though previously reported individually, there has been no previous report of the same two complications occurring in a single patient. A 71-year-old Caucasian man, who was on warfarin for atrial fibrillation, presented with difficulty in swallowing due to a sublingual hematoma. He was observed in our intensive care unit, his warfarin was held and he recovered with conservative management. He represented two months later with a two day history of abdominal pain and distension. An abdominopelvic computed tomography (CT scan now showed small bowel obstruction due to intramural small bowel hematoma and haemorrhagic ascites. Again, this was treated expectantly with a good outcome. In conclusion, life threatening haemorrhagic complications of oral anticoagulant therapy can recur. Conservative treatment is successful in most cases, but an accurate diagnosis is mandatory to avoid unnecessary surgery. CT scan is the investigation of choice for the diagnosis of suspected haemorrhagic complications of over coagulation.

  4. Management for traumatic chronic subdural hematoma patients with well-controlled shunt system for hydrocephalus.

    Yamada, Shoko Mitrrt; Tomia, Yusuke; Murakami, Hideki; Nakane, Makoto


    Traumatic CSDH enlarged in two cases with VP or LP shunt system although the shunt valve pressure was increased to 200 mmH2O. In surgery, the hematoma cavity pressure was found to be 130 and 140 mmH2O, suggesting that to raise the shunt valve pressure is not effective for decreasing CSDH volume.

  5. Comparing twist-drill drainage with burr hole drainage for chronic subdural hematoma

    LIN Xin


    Full Text Available 【Abstract】Objective: The surgical management of chronic subdural hematoma (CSDH is still a controver- sial issue, and a standard therapy has not been established because of the unclear pathogenic mechanisms in CSDH. The intention of this paper is to find a simple and efficient surgical procedure for CSDH. Methods: A retrospective study of 448 patients with CSDH by surgical treatment during 2005 to 2009 was con- ducted in order to compare the efficiency between two dif- ferent primary surgical methods, i.e. twist-drill drainage with- out irrigation in Group A (n=178 and one burr-hole with irrigation in Group B (n=270. The results were statistically analyzed. Results: The reoperation rates in Group A and Group B were 7.9% and 11.9% respectively. The good outcome rate was 88.8% and 75.5%, the complication was 7.9% and 20.7% in Group A and Group B, respectively. Conclusions: The burr-hole drainage with irrigation of the hematoma cavity is not beneficial to the outcome and prognosis. Irrigation is not important in the surgical treat- ment for CSDH. Thus in initial treatment, twist-drill drainage without irrigation of the hematoma cavity is recommended because it is relatively safe, time-saving and cost-effective. Key words: Hematoma, subdural; Brain injury, chronic; Drainage

  6. Isolated oculomotor nerve palsy resulting from acute traumatic tentorial subdural hematoma

    Cui V


    Full Text Available Victoria Cui,1 Timur Kouliev2 1Washington University School of Medicine, St Louis, MO, USA; 2Emergency Department, Beijing United Family Hospital, Beijing, China Abstract: Acute subdural hematoma (SDH resulting from head trauma is a potentially life-threatening condition that requires expedient diagnosis and intervention to ensure optimal patient outcomes. Rapidly expanding or large hematomas, elevated intracranial pressure, and associated complications of brain herniation are associated with high mortality rates and poor recovery of neurological function. However, smaller bleeds (clot thickness <10 mm or hematomas occurring in infrequent locations, such as the tentorium cerebelli, may be difficult to recognize and patients may present with unusual or subtle signs and symptoms, including isolated cranial nerve palsies. Knowledge of neuroanatomy supported by modern neuroimaging can greatly aid in recognition and diagnosis of such lesions. In this report, we present a case of isolated oculomotor nerve palsy resulting from compressive tentorial SDH following blunt head trauma, review the literature concerning similar cases, and make recommendations regarding the diagnosis of SDH in patients presenting with isolated cranial nerve palsies. Keywords: head injury, oculomotor, palsy, subdural hematoma, trauma, tentorium, cerebral herniation, intracranial hemorrhage

  7. Scrotal hematoma, anemia, and jaundice as manifestations of adrenal neuroblastoma in a newborn

    Kreeftenberg, HG; Zeebregts, CJAM; Tamminga, RYJ; de Langen, ZJ; Zijlstra, RJ


    Clinically, a neuroblastoma presents mostly as an abdominal mass. Within the tumor, bleeding can be present, sometimes extending in to its surroundings. This case report describes a neuroblastoma, presenting as scrotal hematoma in a newborn boy, which initially raised the suspicion of a torsio testi

  8. Very low cerebral blood volume predicts parenchymal hematoma in acute ischemic stroke

    Hermitte, Laure; Cho, Tae-Hee; Ozenne, Brice;


    BACKGROUND AND PURPOSE: Parenchymal hematoma (PH) may worsen the outcome of patients with stroke. The aim of our study was to confirm the relationship between the volume of very low cerebral blood volume (CBV) and PH using a European multicenter database (I-KNOW). A secondary objective was to exp...

  9. Neurological and functional outcomes of subdural hematoma evacuation in patients over 70 years of age

    Patrick Mulligan


    Full Text Available Background: Subdural hematoma (SDH is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. Objectives: To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. Materials and Methods: We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. Results: Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005, yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44% were discharged home, 16 (36% discharged to nursing home or rehab, 6 (13% to hospice and 3 (7% died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. Conclusion: Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.

  10. Successful treatment of combined vaginal and broad ligament hematoma using pelvic pressure pack and arterial embolization

    Ma Runmei; Lao Terence T; Feng Yukun; Zhao Wei; Huang Jianqiang; Liang GuoHua; Li Hongyu; Chen Zhuo


    Objective:To assess using the pelvic pressure pack as temporizing treatment for combined vaginal and broad ligament hematoma before selective arterial embolization could be undertaken.Methods:A 29-year-old woman was transferred because of a 10cm right upper vaginal hematoma found shortly after the spontaneous delivery of a 3400g infant at term.Following evacuation of the clots,the patient's condition deteriorated with the appearance of a painful right pelvic mass,displacing the uterus.At laparotomy,the hematoma extended between the folds of the broad ligament into the pelvic sidewall.After evacuation of the clots,hemostasis failed despite subtotal hysterectomy.Eventually a pressure pack created from joined gauze rolls was used to fill up the pelvic cavity and achieved hemostasis before abdominal closure.When the vaginal pack was removed 30 hours later,vaginal bleeding recurred,and bilateral hypogastric embolization was performed with Gianturco coils.Results:The patient was successfully treated by this way and discharged uneventfully.Conclusion:In combined vaginal and broad ligament hematoma,pelvic pressure pack can be used to ensure maternal survival until definitive treatment with angiographic embolization.

  11. Natural history and outcome of patients with intramural hematomas and penetrating aortic ulcers.

    Mousa, Albeir Y; Bozzay, Joseph; AbuRahma, Ali F


    All pathologies of acute aortic syndromes should be precisely diagnosed for prompt therapy. Intramural hematomas, as well as penetrating ulcers can be encountered in these patients. Presentations, clinical scenarios, and proper management are outlined in this review, which sums up available current literature to provide the vascular specialist with an adequate understanding of these unique syndromes.

  12. Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism

    Kohei Tsukahara


    Conclusion: Although hemorrhage from the thyroid gland without blunt trauma is rare, emergency physicians should regard possible thyroid gland rupture in patients with swelling of the neck or acute respiratory failure after direct/indirect trauma to the neck. Observation or operative management for limited or expanding hematoma are appropriately based on fundamental neck trauma principles.

  13. Intramural hematoma or aortic dissection – a diagnostic and therapeutic problem. A case report

    Suder, Bogdan; Wasilewski, Grzegorz; Sadowski, Jerzy; Kapelak, Bogusław


    The authors present a case report of a 60-year-old patient with an ascending aortic aneurysm along with the associated diagnostic and therapeutic problems. The choice of therapy in patients with aortic intramural hematoma is difficult and should be based on comprehensive evaluation of the patient's status as well as on the experience of the radiologist and surgeon. PMID:26702280

  14. Emergent Median Sternotomy for Mediastinal Hematoma: A Rare Complication following Internal Jugular Vein Catheterization for Chemoport Insertion—A Case Report and Review of Relevant Literature

    Saptarshi Biswas


    Full Text Available Mediastinal hematoma is a rare complication following insertion of a central venous catheter with only few cases reported in the English literature. We report a case of a 71-year-old female who was admitted for elective chemoport placement. USG guided right internal jugular access was attempted using the Seldinger technique. Resistance was met while threading the guidewire. USG showed a chronic clot burden in the RIJ. A microvascular access was established under fluoroscopic guidance. Rest of the procedure was completed without any further issues. Following extubation, the patient complained of right-sided chest pain radiating to the back. Chest X-ray revealed a contained white out in the right upper lung field. She became hemodynamically unstable. Repeated X-ray showed progression of the hematoma. Median Sternotomy showed posterior mediastinal hematoma tracking into right pleural cavity. Active bleeding from the puncture site at RIJ-SCL junction was repaired. Patient had an uneventful recovery. Injury to the central venous system is the result of either penetrating trauma or iatrogenic causes as in our case. A possible explanation of our complication may be attributed to the forced manipulation of the dilator or guidewire against resistance. Clavicle and sternum offer bony protection to the underlying vital venous structures and injuries often need sternotomy with or without neck extension. Division of the clavicle and disarticulation of the sternoclavicular joint may be required for optimum exposure. Meticulous surgical technique, knowledge of the possible complications, and close monitoring in the postprocedural period are of utmost importance. Chest X-ray showed to be routinely done to detect any complication early.

  15. Sleep-disordered breathing as a delayed complication of iatrogenic vocal cord trauma.

    Faiz, Saadia A; Bashoura, Lara; Kodali, Lavanya; Hessel, Amy C; Evans, Scott E; Balachandran, Diwakar D


    A case of a 55-year-old woman with iatrogenic vocal cord trauma and sleep-related symptoms is reported. In particular, this case highlights sleep-disordered breathing as a delayed complication after iatrogenic vocal cord trauma. The patient developed acute stridor from a contralateral vocal cord hematoma following vocal fold injection for right vocal cord paralysis. Acute respiratory symptoms resolved with oxygen, steroids, and nebulized therapy, but nocturnal symptoms persisted and polysomnography revealed sleep-related hypoventilation and mild obstructive sleep apnea. Positive pressure therapy was successfully used to ameliorate her symptoms and treat sleep-disordered breathing until her hematoma resolved. In addition to the typically acute respiratory symptoms that may result from vocal cord dysfunction, sleep-disordered breathing may also present as a significant subacute or chronic problem. Management of the acute respiratory symptoms is relatively well established, but clinicians should be alert for more subtle nocturnal symptoms that may require further study with polysomnography.

  16. Subperiosteal hematoma of the iliac bone: imaging features of acute and chronic stages with emphasis on pathophysiology

    Guillin, Raphael [Rennes University Hospital, Department of Musculoskeletal Imaging, Rennes Cedex 2 (France); Moser, Thomas [Montreal University Hospital, Department of Musculoskeletal Imaging, Montreal (Canada); Koob, Meriam [Strasbourg University Hospital, Department of Pediatric Imaging, Strasbourg (France); Khoury, Viviane [Mc Gill University Health center, Department of Radiology, Montreal (Canada); Chapuis, Madeleine [Rennes University Hospital, Department of Pediatric Orthopedic Surgery, Rennes (France); Ropars, Mickael [Rennes University Hospital, Department of orthopedic surgery, Rennes (France); Cardinal, Etienne [Radiologie Laennec, Montreal (Canada)


    The goal of this work is to describe the radiological appearance and clinical presentation of subperiosteal iliac hematoma and present a review of the literature. We retrospectively reviewed the radiological and clinical files of 19 patients (age range: 12-75; mean: 47) who presented with acute or chronic subperiosteal iliac hematomas. Imaging findings and relevant clinical information were recorded. A thorough literature search was performed to find additional cases of this rare condition. Three young patients presented with acute subperiosteal iliac hematoma following a fall. Clinical presentation was characterized by pain and gait disturbance presumed to result from crural nerve compression. Unilateral or bilateral lenticular hematomas deep in the iliacus muscle were demonstrated by CT for all patients while MRI was also available for two of them. In 16 asymptomatic patients, chronic ossified subperiosteal iliac hematomas were incidentally detected by CT. Progressive ossification of acute hematoma was demonstrated at follow-up in two patients. Subperiosteal iliac hematoma is rare but has typical imaging findings that may present acutely in adolescents or chronically in asymptomatic adults. (orig.)

  17. The extent of the perihemorrhagic perfusion zone correlates with hematoma volume in patients with lobar intracerebral hemorrhage

    Beseoglu, Kerim; Etminan, Nima; Steiger, Hans-Jakob; Haenggi, Daniel [Heinrich-Heine-Universitaet Duesseldorf, Department of Neurosurgery, Medical Faculty, Duesseldorf (Germany); Turowski, Bernd [Heinrich-Heine-Universitaet Duesseldorf, Department of Diagnostic and Interventional Radiology, Medical Faculty, Duesseldorf (Germany)


    Existing data on perfusion imaging assumes the perihemorrhagic zone (PHZ) in patients with intracerebral hemorrhage (ICH) to be size steady. This study investigates the size of the perihemorrhagic zone (PHZ) in patients with lobar ICH in relation to hematoma volume during the course of treatment using perfusion CT (PCT). The present analysis is based on a previously reported cohort of 20 patients undergoing surgical evacuation for lobar SICH, with pre- and early postoperative PCT scanning. Time to peak of the residue function (T{sub max}) was measured based on the 360 cortical banding method and singular value decomposition. The size of PHZ was determined before and after treatment and correlated with hematoma volume. Preoperative mean hematoma volume constituted 63.0 ml (interquartile ranges (IQR) 39.7-99.4 ml), which correlated significantly (r = 0.563, p = 0.010) with mean PHZ size (5.67 cm, IQR 5.44-8.17 cm). Following a surgical hematoma evacuation, mean hematoma volume was reduced to 2.5 ml IQR 0.0-9.5 ml, which also resulted in a significant reduction of PHZ size to 0.45 cm(IQR 0.0-1.36 cm; p < 0.001). There was no association between postoperative hematoma volume and size of the PHZ. Our findings illustrate that the extent of the PHZ cannot be generally assumed to be constant in size and that this differs significantly following hematoma reduction in patients with space occupying lobar SICH. (orig.)

  18. Hematoma de músculo iliopsoas na vigência de tratamento com varfarina Hematoma de músculo iliopsoas en la vigencia de tratamiento con warfarina Iliopsoas muscle hematoma during treatment with warfarin

    Gabriel Zago


    Full Text Available A varfarina é droga amplamente utilizada na prevenção de fenômenos tromboembólicos e o conhecimento de seus efeitos adversos faz-se necessário para o acompanhamento dos pacientes. Embora o desenvolvimento de discrasias sanguíneas seja complicação potencial nesses pacientes, a ocorrência de sangramento retroperitoneal é rara. Este artigo discute o caso de um paciente que evoluiu com hematoma do músculo iliopsoas durante tratamento com a referida droga, pós-implante de prótese aórtica metálica, com quadro clínico envolvendo importantes diagnósticos diferenciais.La warfarina es un fármaco ampliamente utilizado en la prevención de fenómenos tromboembólicos, y el conocimiento de sus efectos adversos se hace necesario para el seguimiento de los pacientes. Aunque el desarrollo de discrasias sanguíneas es la complicación potencial en estos pacientes, la ocurrencia de sangrado retroperitoneal es rara. Este artículo discute el caso de un paciente que evolucionó con hematoma del músculo ileopsoas durante tratamiento con el referido fármaco en el postimplante de prótesis mitral metálica, con cuadro clínico implicando importantes diagnósticos diferenciales.Warfarin is a widely used drug for the prevention of thromboembolic events. Knowledge of its adverse effects is necessary for patient follow-up. Although the development of blood dyscrasias is a potential complication in these patients, retroperitoneal bleeding is rare. This article reports the case of a patient who developed iliopsoas muscle hematoma during treatment with warfarin after implantation of a metallic prosthetic aortic valve. The clinical manifestations involved important differential diagnoses.

  19. Influence of different hematoma clearance rates on patients with hypertensive intracerebral hemorrhage

    Cheng Zhong; Jing-Zhu Shi; Yu Liu; Tao Ou; Guo-Jing Liu; Bin Wang


    Objective:To evaluate the influence of different hematoma clearance rates patients with hypertensive intracerebral hemorrhage.Methods: A total of 94 cases with hypertensive intracerebral hemorrhage treated with operation from June 2012 to June 2015 were selected. According to theirhematoma clearance rates, they were divided into groups A (50%-70%, 28 cases), B (70%-90%,48 cases) and C (90%, 18 cases). The recovery and perioperative levels of serum neuron-specific enolase (NSE) and soluble S-100 protein of the three groups were compared.Results: The perioperative mortality and the rates of postoperative rebleeding, intracranial infection and other complications of the three groups showed no statistical significant difference (P>0.05). With the increase of the hematoma clearance rate, the drainage tube removal time and hematoma complete absorption time reduced significantly (P<0.05). In the groups B and C, the grade levels of ADL in postoperative 3 months were significantly superior to those in the group A (P<0.05). The levels of serum NSE and S-100 in the three groups increased in the initial stage and then declined after surgery. In the group B and C, the serum levels of NSE and S-100 were significantly higher than those in the group A on the 7th day after surgery (P<0.05). With the increase of the hematoma clearance rate, the serum levels of NSE and S-100 were significantly reduced on the 14th day after surgery (P<0.05). Conclusions:High level of hematoma clearance rate can help to increase the operation efficacy and prognosis of patients with hypertensive intracerebral hemorrhage.

  20. 儿童后颅窝硬膜外血肿35例临床分析%Posterior fossa epidural hematomas in children: a clinical analysis of 35 cases

    王子德; 于如同; 祁正磊; 沈志刚; 苗发安; 谢满意; 纪培志; 王强


    Objective To investigate the clinical features,imaging findings,treatment and prognosis of posterior fossa epidural hematomas in children.Methods From August 2010 to April 2015,the clinical data of 35 children with traumatic posterior fossa epidural hematoma admitted to the Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical College were analyzed retrospectively.Eighteen of them were treated conservatively 8 were treated with skull drilling and drainage.Three of which received urokinase therapy because part of residual hematoma after procedure,and 9 were treated by craniotomy.Results In 18 children treated with the conservative treatment,CT revealed that their hematomas were absorbed about 1 month or so after symptom onset.The residual hematomas < 5 ml after procedure in 8 children were treated with skull drilling and drainage,and 9 were treated with craniotomy,their hematomas were removed completely after procedure.They were followed up for 4 months to 5 years.All children recovered well,without operation death and disability.Conclusions The occurrence of posterior fossa epidural hematomas in children are relatively more common.Most of them are falling and slipping injuries.The lambdoid suture separation fracture and occipital fracture are the main causes of bleeding.Headache,vomiting and disturbance of consciousness are more important for identifying the disease.Hemotomas in acute phase are easy to be liquefied.Drilling skull and drainage are safe and effective for the treatment of liquefied hematomas.The early diagnosis and appropriate treatment of posterior fossa epidural hematomas in children have good prognosis.%目的 探讨儿童后颅窝硬膜外血肿的临床特点、影像学表现、治疗方法及预后.方法 回顾性分析2010年8月至2015年4月徐州医学院附属医院神经外科收治的35例儿童外伤性后颅窝硬膜外血肿患儿的临床资料.采用保守治疗18例;钻孔引流治疗8例,其中3例因术后血

  1. The role of CT in pelvic fracture. CT finding of retro-peritoneal hematoma and indication of transcatheter arterial embolization

    Igarashi, Tsuneo; Hoshikawa, Yoshikazu; Saeki, Mitsuaki; Nakajima, Yasuo [St. Marianna Univ., Kawasaki, Kanagawa (Japan). School of Medicine


    Although retro-peritoneal hematoma accompanying a pelvic fracture has been treated by arterial ligation formerly, it is associated with a high mortality rate and a transcatheter arterial embolization has now become the first choice of treatment. Meanwhile, the usefulness of computed tomography (CT) in traumatized patient has been reported frequently. Our hospital also employs CT positively as an examination following plain radiography in the cases with pelvic fracture. However, while indication of angiography is seen in several reports, the amount of retro-peritoneal hematoma as an index has not been reported. In the present study, we examined 112 patients given CT at the time of examination at the emergency center of our hospital between April 1, 1988, and June 30, 1997, and classified the amount of retro-peritoneal hematoma on CT into 5 groups to discuss indication of angiography. In the cases with moderate or massive amount of retro-peritoneal hematomas, cases with shock state exceeded 60% and the amount of hematoma was considered to reflect the circulation profile to a certain extent. As the amount of retro-peritoneal hematoma increased, the number of cases given embolization also increased; embolization was performed in 29 cases (61.7%) among those which had moderate or massive amount of hematoma. From the above findings, it was predicted that the amount of retro-peritoneal hematoma could be one of the deciding factors for indication of angiography. However, as there are cases falling into a shock state due to gradual increase of hematoma or associated with injuries in other organs, careful observation is needed for the cases judged out of indication. (author)

  2. Ligamentum flavum hematoma: a case report and literature review Hematoma del ligamento amarillo: caso clínico y revisión de la literatura Hematoma de ligamento amarelo: relato de caso e revisão da literatura

    Ericson Sfreddo


    Full Text Available The aim is to present a rare case of ligamentum flavum hematoma in the lumbar region, discuss its physiopathology and treatment and review the literature. A woman aged 68 presented with neurogenic claudication due to degenerative lumbar spondylolisthesis that evolved into a sudden worsening with cauda equina syndrome. The magnetic resonance imagining (MRI showed signs of degeneration of the lumbar spine, with a narrow spinal canal from L2 to S1, anterolisthesis L4 L5 and an expansive lesion hyperintense on T1-weighted and hypointense on T2-weighted images considered compatible with hematoma in the topography of the yellow ligament in L1-L2. The patient underwent laminectomy and lumbar fixation. Her evolution was good in the postoperative period and at 18 months of follow-up hse walked alone, despite the pain that is controlled with simple medications. Even though rare, it seems that ligamentum flavum hematoma has a relationship with the degeneration and rupture of small vessels associated with micro trauma to the spine. Its physiopathology is not well defined and treatment is similar to other spine compression processes.El objetivo es presentar un caso raro de un hematoma ligamento flavum en la región lumbar, discutir su fisiopatología y el tratamiento y revisión de la literatura. Una mujer de 68 años presentó claudicación neurogénica debido a la espondilolistesis lumbar degenerativa y que se convirtió en un repentino empeoramiento con el síndrome de cauda equina. Una imagen de resonancia magnética (RM mostró signos de degeneración de la columna lumbar, con canal espinal estrecho de L2 a S1, anterolistesis L4 L5 y en la L1-L2, un proceso expansivo redondeado e hiperintenso en T1 y hipointenso en los bordes en T2, compatible con hematoma en la topografía del ligamento amarillo. La paciente fue sometida a laminectomía y fijación lumbar. Su evolución fue buena en el postoperatorio y, a los 18 meses de seguimiento caminaba sola, a

  3. Research on the Adjustment in Contract Sum Caused by the Price Fluctuation during the Project Delay:Based on the Code of Valuation with Bill of Quantity of Construction Works (2013)%工期延误期间物价波动引起的合同价款调整研究--基于13清单规范

    孙娜; 杜亚灵; 李淑湘


    Dispute about adjustment in contract sum caused by price fluctuation during the project delay is gradually increasing. Firstly, the division of responsibility on delay is determined under single event delay and common delay. Secondly, it is proposed that the divide of responsibility on price fluctuation during delay is determined based on the principle of "default not to benefit", and it is pointed out that determine of price indices under delay is different from normal construction progress when applying the formula of adjustment in contract sum. Thirdly, analysis of the determination of price indices under single event delay and common delay respectively based on above principle.%工期延误期间因物价波动引起的价款调整容易引起纠纷。首先,对单事件延误和共同延误这两种情况进行责任划分;其次,提出基于违约者不受益原则对工期延误期间物价波动进行责任划,并指出调价公式中价格指数在工期延误情况下的确定方法与施工进度正常情况下的确定方法有所不同;最后,基于上述原则分别在单事件延误和共同延误两种情况下对价格指数的确定进行详细分析。

  4. 婴幼儿急性创伤性硬膜下血肿%Treatment of acute traumatic subdural hematomas in infants

    周建军; 梁平; 李映良; 翟瑄; 周渝冬; 李禄生; 于增鹏; 夏佐中


    Objective To investigate the clinical features of acute traumatic subdural hematomas (SDH) in infants and discuss the treatment methods. Methods The clinical features of 48 infants under three years old with acute traumatic SDH admitted from 2002 to 2008 were retrospectively analyzed.Results There were 31 infants under one year old (65%). The most popular injury cause was accidental fall in 37 patients (77%). Of all patients, 12 patients (25%) had disturbance of consciousness,eight ( 17% ) had convulsion and eight ( 17% ) were combined with skull fractures. The treatment methods included craniotomy and evacuation of the blood clot in 18 patients ( including 13 patients underwent instant operation after admission ), burr hole craniotomy and external drainage of the chronic subdural hematoma in seven and conservative management in 23 with small subdural hematomas. All patients obtained good outcome except that two patients had motor dysfunction and one death. Conclusions The incidence of acute traumatic SDH in infants is high, especially in infants under one year old. It is easy to be disregarded at early stage and may deteriorate to chronic subdural hematoma or hydropsy. Early diagnosis and active surgical treatment may attain sound prognosis.%目的 探讨婴幼儿急性创伤性硬膜下血肿临床特点及治疗方法.方法 回顾分析2002-2008年期间收治的年龄<3岁的48例婴幼儿急性创伤性硬膜下血肿的临床特点.结果 婴儿31例,占65%;跌伤37例,占77%;12例(25%)有原发意识障碍,8例(17%)出现抽搐,8例(17%)合并颅骨骨折.18例行开颅血肿清除术(13例入院立即手术),7例行钻孔外引流,23例行保守治疗.1例因脑疝死亡,2例伴肢体运动功能减退,45例治愈.结论 婴幼儿急性创伤性硬膜下血肿发病率较高,尤其是婴儿,早期易被忽视,易转变为慢性硬膜下血肿或积液,早期诊断、积极外科治疗,预后良好.

  5. Modeling of Random Delays in Networked Control Systems

    Yuan Ge


    Full Text Available In networked control systems (NCSs, the presence of communication networks in control loops causes many imperfections such as random delays, packet losses, multipacket transmission, and packet disordering. In fact, random delays are usually the most important problems and challenges in NCSs because, to some extent, other problems are often caused by random delays. In order to compensate for random delays which may lead to performance degradation and instability of NCSs, it is necessary to establish the mathematical model of random delays before compensation. In this paper, four major delay models are surveyed including constant delay model, mutually independent stochastic delay model, Markov chain model, and hidden Markov model. In each delay model, some promising compensation methods of delays are also addressed.

  6. Hematoma após raquianestesia tratado conservadoramente: relato de caso e revisão da literatura Hematoma después de raquianestesia tratado conservadoramente: relato de caso y revisión de la literatura Conservative treatment of hematoma after spinal anesthesia: case report and literature review

    Daniel Segabinazzi


    objetivo de este trabajo fue describir un caso de hematoma después raquianestesia tratado de forma conservadora y revisar los trabajos en la literatura. RELATO DEL CASO: Paciente del sexo masculino, 73 años, 65 kg, 1,67 m, estado físico ASA III. Fue sometido a raquianestesia para retirada de catéter de diálisis peritoneal. Durante la realización de la punción hubo parestesias en el miembro inferior derecho. Se inyectaron 15 mg de bupivacaína hiperbárica a 0,5% sin vasoconstrictor. Veinte y cuatro horas después de la realización del bloqueo el paciente permanecía con anestesia en silla de montar y con dolor lumbar, y 48 horas después del procedimiento presentó una incontinencia urinaria. La resonancia nuclear magnética demostró la existencia de un proceso expansivo subaracnoideo, con compresión de raíces nerviosas (L4 a S1. Después de la evaluación del neurocirujano, se empieza el tratamiento conservador. El paciente recibió alta hospitalaria el 18° día de postoperatorio asintomático. CONCLUSIÓN: El caso presentado mostró una buena evolución con el tratamiento conservador.BACKGROUND AND OBJECTIVES: Spinal anesthesia caries the risk of bleeding. Compression of nervous tissue secondary to the formation of a hematoma can cause neurological damage, which, if not diagnosed and treated in a timely fashion, can be permanent. The identification of risk factors, diagnosis, and early treatment are important for the prognosis. The objective of this report was to describe the case of a hematoma after spinal anesthesia treated conservatively, and review the literature. CASE REPORT: Male patient, 73 years old, 65 kg, 1.67 m, and ASA physical status III, underwent spinal anesthesia for removal of a peritoneal dialysis catheter. During the puncture, the patient experienced paresthesia of the right lower limb. Fifteen milligrams of 0.5% hyperbaric bupivacaine without vasoconstrictor were administered. Twenty-four hours later, saddle anesthesia and lumbar pain

  7. The Outcomes of Salvage Surgery for Vascular Injury in The Extremities: A Special Consideration For Delayed Revascularization

    Jagdish Krishnan


    Full Text Available A seven years retrospective study was performed in 45 consecutive vascular injuries in the extremities to investigate the pattern of injuries, managements and outcomes. Motor-vehicle accidents were the leading cause of injuries (80%, followed by industrial injuries (11.1% and iatrogenic injuries (4.4%. Popliteal and brachial artery injuries were commonly involved (20%. Fifteen (33.3% patients had fractures, dislocation or fracture dislocation around the knee joint and 6 (13.3% patients had soft tissue injuries without fracture. Traumatic arterial transection accounted for 34 (75.6% cases, followed by laceration in 7 (15.6% and 9 (6.7% contusions. Associated nerve injuries were seen in 8 (17.8 % patients using intra-operative findings as the gold standard, both conventional angiogram (CA and computerized tomography angiogram (CTA had 100% specificity and 100% sensitivity in determining the site of arterial injuries. The mean ischemic time was 25.31 hours (4 - 278 hours. Thirty-three (73.3 % patients were treated more than 6 hours after injury and 6 patients underwent revascularization after 24 hours; all had good collateral circulation without distal pulses or evidence of ischemic neurological deficit. The mean ischemic time in 39 patients who underwent revascularization within 24 hours was 13.2 hours. Delayed amputation was performed in 5 patients (11.1%. Of the 6 patients who underwent delayed revascularization, one patient had early amputation, one -had delayed amputation following infection and multiple flap procedures while the rest of the patients’ limbs survived. Joint stiffness was noted in 10 patients (22.2% involving the knee joint, elbow and shoulder in two patients each. Infection was also noted in 5 patients (11.1% with two of them were due to infected implants. Other complications encountered included nonunion (2 patients, 4.4%, delayed union (1 patient, 2.2%, limb length discrepancy (1 patient, 2.2%, hematoma (1 patient, 2.2% and

  8. 急性外伤性颅内血肿开颅血肿清除术后继发血肿的相关因素分析%Analysis of related factors of secondary hematoma of acute traumatic intracranial hematoma after hematoma removal by craniotomy



    目的 探讨急性外伤性颅内血肿患者行开颅血肿清除术后继发血肿的相关危险因素.方法 回顾性分析我院126例行开颅血肿清除术急性外伤性颅内血肿患者的临床资料,单因素分析影响术后继发血肿发生的相关因素,多因素Logistic回归分析影响继发血肿发生的独立危险因素.结果 开颅血肿清除术后继发血肿发生率为19.05%.多因素Logistic回归分析表明:手术时机、血浆凝血酶时间、颅骨骨折为术后继发血肿的独立危险因素.结论 血浆凝血酶时间、手术时机、颅骨骨折是影响开颅血肿清除术后继发血肿发生的独立危险因素,临床中应采取相应的预防措施,以提高患者康复期间的治疗效果,降低继发颅内血肿的发生率.%Objective To investigate the related factors of secondary hematoma of acute traumatic intracranial hematoma after hematoma removal by craniotomy.Methods Retrospectively analyzed clinical data of 126 patients with acute traumatic intracranial hematoma underwent hematoma removal by craniotomy in our hospital.Carried out single factor analysis of related factors of secondary hematoma,and multi-factor Logistic regression analysis of independent risk factors of secondary hematoma.Results The incidence of secondary hematoma after hematoma removal by craniotomy was 19.05%.Multi-factor Logistic regression analysis showed that operation opportunity,plasma thrombin time,and skull fracture were independent risk factors of secondary hematoma.Conclusion Operation opportunity,plasma thrombin time,and skull fracture are independent risk factors of secondary hematoma.We should take preventive measures to improve the treatment effect and reduce the incidence of secondary hematoma.

  9. Delays in Building Construction Projects in Ghana

    Adwoa B Agyakwah-Baah


    Full Text Available This study investigates the causes of delay of building construction projects in Ghana to determine the most important according to the key project participants; clients, consultants, and contractors. Thirty-two possible causes of delay were identified from the literature and semi-structured interviews of 15 key players in the implementation process. These delay factors were further categorised into nine major groups. The list of delay causes was subjected to a questionnaire survey for the identification of the most important causes of delay. The field survey included 130 respondents made up of 39 contractors, 37 clients and 54 consultants. The relative importance of the individual causes and the groups were calculated and ranked by their relative importance index. The overall results of the study indicate that the respondents generally agree that financial group factors ranked highest among the major factors causing delay in construction projects in Ghana. The financial group factors were delay in honouring payment certificates, difficulty in accessing credit and fluctuation in prices. Materials group factors are second followed by scheduling and controlling factors.

  10. Delayed breast implant reconstruction

    Hvilsom, Gitte B.; Hölmich, Lisbet R.; Steding-Jessen, Marianne;


    the period 1999 to 2006; 239 one-stage procedures and 353 two-stage procedures. The postoperative course through November 2009 was evaluated by cumulative incidence adjusting for competing risks for the selected outcomes; hematoma, infection, seroma, implant rupture, severe capsular contracture (modified.......7% for severe capsular contracture, 32.3% for displacement/asymmetry of the implant and 38.6% for reoperation. When comparing one- and two-stage procedures, we observed significantly higher risk estimates for infection, seroma and extrusion of the implant following two-stage procedures, whereas the risk...

  11. [Comparative assessment of MR-semiotics of acutest intracerebral hematomas in low- and extra high-field frequency magnetic resonance tomography].

    Skvortsova, V I; Burenchev, D V; Tvorogova, T V; Guseva, O I; Prokhorov, A V; Smirnov, A M; Kupriianov, D A; Pirogov, Iu A


    An objective of the study was to compare sensitivity of low- and extra high-field frequency magnetic resonance (MR) tomography of acutest intracerebral hematomas (ICH) and to assess differences between symptoms in obtained images. A study was conducted using experimental ICH in rats (n=6). Hematomas were formed by two injections of autologic blood into the brain. MR-devices "Bio Spec 70/30" with magnetic field strength of 7 T and "Ellipse-150" with magnetic field strength of 0,15 T were used in the study. MR-tomography was carried out 3-5 h after the injections. Both MR-devices revealed the presence of pathological lesion in all animals. Extra highfield frequency MR-tomography showed the specific signs of ICH caused by the paramagnetic effect of deoxyhemoglobin in T2 and T2*-weighted images (WI) and low frequency MR-tomography - in T2*-WI only. The comparable sensitivity of low- and extra high-field frequency MR-devices in acutest ICH was established.

  12. Blood constituents trigger brain swelling, tissue death, and reduction of glucose metabolism early after acute subdural hematoma in rats.

    Baechli, Heidi; Behzad, Melika; Schreckenberger, Matthias; Buchholz, Hans-Georg; Heimann, Axel; Kempski, Oliver; Alessandri, Beat


    Outcome from acute subdural hematoma is often worse than would be expected from the pure increase of intracranial volume by bleeding. The aim was to test whether volume-independent pathomechanisms aggravate damage by comparing the effects of blood infusion with those of an inert fluid, paraffin oil, on intracranial pressure (ICP), cerebral perfusion pressure (CPP), local cerebral blood flow (CBF), edema formation, glucose metabolism ([18F]-deoxyglucose, MicroPET ), and histological outcome. Rats were injured by subdural infusion of 300 muL venous blood or paraffin. ICP, CPP, and CBF changes, assessed during the first 30 mins after injury, were not different between the injury groups at most time points (n=8 per group). Already at 2 h after injury, blood caused a significantly more pronounced decrease in glucose metabolism in the injured cortex when compared with paraffin (P<0.001, n=5 per group). Ipsilateral brain edema did not differ between groups at 2 h, but was significantly more pronounced in the blood-treated groups at 24 and 48 h after injury (n=8 per group). These changes caused a 56.2% larger lesion after blood when compared with paraffin (48.1+/-23.0 versus 21.1+/-11.8 mm(3); P<0.02). Blood constituent-triggered pathomechanisms aggravate the immediate effects due to ICP, CPP, and CBF during hemorrhage and lead to early reduction of glucose metabolism followed by more severe edema and histological damage.

  13. Intracranial hematoma and SAH: actual aspects in its interpretation with magnetic resonance. Hematoma intracraneal y hemorragia subaracnoidea: aspectos actuales en su interpretacion mediante resonancia magnetica

    Muoz Gonzalez, A. (Hospital 12 de Octubre. Servicio de Radiodiagnostico. Madrid (Spain))


    A basic understanding of the magnetic properties of Hb degradation products explains the mechanisms and production of the signals occurring at the different stages of the formation and degradation of intracranial hematoma and SAH. Despite the interaction among complex phenomena and the fact that their explanations are not univocal, since many phenomena remain to be understood even in the light of those theories that, at present, most closely agree, the proposed models permit the comprehension and diagnosis of a pathology which, in addition to being common, is diagnostically relevant and serves as paradigm in Radiological research. (Author) 44 refs.

  14. Epidemiology of delayed ejaculation.

    Di Sante, Stefania; Mollaioli, Daniele; Gravina, Giovanni Luca; Ciocca, Giacomo; Limoncin, Erika; Carosa, Eleonora; Lenzi, Andrea; Jannini, Emmanuele A


    A large body of literature on diminished ejaculatory disorders has been generated without the use of a clear diagnostic definition. Many studies have not distinguished between the orgasm and ejaculation disorders leading to doubtful results. Delayed ejaculation (DE) is one of the diminished ejaculatory disorders, which range from varying delays in ejaculatory latency to a complete inability to ejaculate. The present review is aimed at providing a comprehensive overview of the current knowledge on the definition and epidemiology of diminished ejaculatory disorders. We focus on the acquired diseases, such as benign prostatic hyperplasia (BPH) and specific drug regimens that may cause an iatrogenic form of ejaculatory disorder. In addition, the impact of aging is discussed since the prevalence of DE appears to be moderately but positively related to age. Finally, we also focus on the importance of the hormonal milieu on male ejaculation. To date, evidence on the endocrine control of ejaculation is derived from small clinical trials, but the evidence suggests that hormones modulate the ejaculatory process by altering its overall latency.

  15. Hematoma subdural intracraneal: una rara complicación después de la raquianestesia: relato de caso

    Flora Margarida Barra Bisinotto; Roberto Alexandre Dezena; Daniel Capucci Fabri; Tania Mara Vilela Abud; Livia Helena Canno


    BACKGROUND AND OBJECTIVES: Intracranial subdural hematoma is a rare complication following spinal anesthesia. The diagnosis is usually difficult because initial symptoms are the same of post-dural puncture headache. The objective was to report a case of early diagnosed subdural hematoma after spinal anesthesia performed with a fine-gauge needle and single puncture. CASE REPORT: 48-year old female patient, ASA I, undergoing spinal anesthesia for surgery to correct urinary incontinence. The spi...

  16. Clinical features and outcome of eight patients with mediastinal and neck hematoma after transradial cardiac catheterization approach



    Objective The clinical features of patients with mediastinal and/or neck hematoma after transradial cardiac catheterization were reviewed and analyzed to help the clinicians to recognize this complication,and try their best to avoid the complication and treat the complication properly.Methods A total of 8 patients with mediastinal and/or neck hematoma after right transradial cardiac catheterization in Fuwai hospital from January 1,2005 to the end of 2012 were included in this study.Among

  17. Warfarin-induced sublingual hematoma mimicking Ludwig angina: Conservative management of a potentially life-threatening condition.

    Cashman, Emma


    Sublingual hematoma secondary to excessive anticoagulation is a rare, life-threatening condition. Reports in the literature have emphasized the importance of a prompt reversal of the causative coagulopathy by intravenous administration of vitamin K and fresh frozen plasma. In the event of an unstable airway, surgical intervention via tracheostomy or cricothyroidectomy is advocated. We report a case of sublingual hematoma that was treated conservatively, and we discuss the presentation and management of this entity.

  18. Warfarin-induced sublingual hematoma mimicking Ludwig angina: Conservative management of a potentially life-threatening condition.

    Cashman, Emma


    Sublingual hematoma secondary to excessive anticoagulation is a rare, life-threatening condition. Reports in the literature have emphasized the importance of a prompt reversal of the causative coagulopathy by intravenous administration of vitamin K and fresh frozen plasma. In the event of an unstable airway, surgical intervention via tracheostomy or cricothyroidectomy is advocated. We report a case of sublingual hematoma that was treated conservatively, and we discuss the presentation and management of this entity.

  19. 婴儿颅内血肿的早期诊断和手术治疗(附3例报告)%Early Diagnosis and Operation on Intracranial Hematoma in Infancy: A Report of 3 Cases

    张源; 张慧玲; 李秀莲; 辛骥


    本文报道3例婴儿颅内血肿,均早期作出诊断,皆施行开颅术,手术获得成功.文中对婴儿颅内出血的原因、诊断和手术问题进行了分析和讨论.%This article reports 3 infants with intracranial hematoma. All cases got an early diagnosis and operation and a successful recovery. The main causes of intracranial hematoma are trauma,asphyxia or hypoxia during delivery,hemorrhagic disease,Vit. K deficiency and congenital malformation of cerebral vessels. Plateau anoxia is a predisposition. The diagnosis is based on the history,lumbar puncture,CT and B-ultrasonography of the fontanel,CT being the first of chioce. Craniotomy is attempted to the treatment via a U-shaped skin flap to elear and drain the hematoma. One of the 3 cases was operated on at 3 days after birth. The 2 year follow-up of these patients has showed normal intelligence and a developing nerve system.

  20. 慢性肾功能衰竭并发肌间血肿1例分析及文献复习%Chronic Renal Failure Complicated by Intramuscular Hematoma in One Case Analysis and Literature Review

    李莹; 欧三桃


    Objective To investigate the occurrence of chronic renal failure in patients with muscle hematoma between the causes and mechanisms. Methods To report one case of chronic renal failure in patients with intramuscular hematoma clinical manifestations, laboratory tests, treatment and outcome, and related literature was reviewed. Results The patients did not receive any invasive procedures and local history of trauma, coagulation normal circumstances intramuscular hematoma occurs spontaneously, after limb braking, deactivate blood circulation drugs, two weeks after the self-absorption of the hematoma. Conclusion Chronic renal failure patients with spontaneous bleeding tendency, should be actively prevented.%目的:探讨慢性肾功能衰竭患者发生肌间血肿的原因及机制。方法报道1例慢性肾功能衰竭患者发生肌间血肿的临床表现、实验室检查、治疗及转归,并对相关文献进行复习。结果该患者在未接受任何局部外伤,凝血功能正常的情况下出现自发性的肌间血肿,经患肢制动,停用活血化瘀药物,2周后自行吸收。结论慢性肾功能衰竭患者存在自发出血倾向,应积极预防。


    Carlos Fernando Lozano-Tangua


    Full Text Available El hematoma subdural cronico se define como una colección sanguíneo fibrinoide en el espacio existente entre las meninges duramadre y aracnoides, debido a traumas, infecciones (empiema y meningitis, coagulopatías u otras causas. En este se puede precisar durante la intervención quirúrgica la presencia de cápsula o membranas. Entre las diversas causas de hematoma subdural crónico se encuentra la leucemia mieloide crónica que es un síndrome mieloproliferativo, donde se ve una acentuada proliferación de glóbulos blancos de la serie granulocítica, que infiltran la sangre, médula ósea, cerebro entre otros tejidos. Presentamos brevemente un caso de esta interesante y no infrecuente asociación.

  2. Extradural hematoma surgery in a child with Hutchinson-Gilford progeria syndrome: Perioperative concerns.

    Hansda, Upendra; Agarwal, Jyotsna; Patra, Chitralekha; Ganjoo, Pragati


    Hutchinson-Gilford progeria syndrome (HGPS) is a very rare genetic disorder characterized by premature ageing, severe growth failure, and very early onset atherosclerosis. Psychologically and emotionally child-like, these patients suffer from physiological changes of old age. Early and progressive atherosclerosis of intra-cranial vessels in HGPS patients, along with a thin skin and fragile vessels, make these patients susceptible to intra-cranial hematomas following relatively trivial injuries and to severe intra-cranial disease. Anesthetizing HGPS patients for surgery can be challenging due to the presence of a possible difficult airway, multi-system derangements, and associated skin, bone and joint disease. We report here one such child with HGPS who underwent craniotomy and evacuation of an extradural hematoma that developed after minor head trauma. Securing his airway during surgery was difficult.

  3. Extradural hematoma surgery in a child with Hutchinson–Gilford progeria syndrome: Perioperative concerns

    Hansda, Upendra; Agarwal, Jyotsna; Patra, Chitralekha; Ganjoo, Pragati


    Hutchinson–Gilford progeria syndrome (HGPS) is a very rare genetic disorder characterized by premature ageing, severe growth failure, and very early onset atherosclerosis. Psychologically and emotionally child-like, these patients suffer from physiological changes of old age. Early and progressive atherosclerosis of intra-cranial vessels in HGPS patients, along with a thin skin and fragile vessels, make these patients susceptible to intra-cranial hematomas following relatively trivial injuries and to severe intra-cranial disease. Anesthetizing HGPS patients for surgery can be challenging due to the presence of a possible difficult airway, multi-system derangements, and associated skin, bone and joint disease. We report here one such child with HGPS who underwent craniotomy and evacuation of an extradural hematoma that developed after minor head trauma. Securing his airway during surgery was difficult. PMID:24082942

  4. A case of idiopathic gastroesophageal submucosal hematoma and its disappearance observed by endoscopy.

    Oe, Shinji; Watanabe, Tatsuyuki; Kume, Keiichiro; Shibata, Michihiko; Hiura, Masaaki; Yoshikawa, Ichiro; Harada, Masaru


    A 74-year-old man was hospitalized due to hematemesis. Upper gastrointestinal endoscopy revealed a very large and dark red mass in the cardiac region of the stomach that extended from the upper esophagus. A biopsy specimen showed hemorrhagic tissue and no malignant cells. The tumor-like region ulcerated at 5 days after the administration of intravenous lansoprazole at a dose of 30 mg twice a day and resolved with scar formation at 2 months after a change to oral rabeprazole at a dose of 10 mg/day.We diagnosed the patient with gastroesophageal submucosal hematoma. Gastroesophageal submucosal hematoma is a rare complication. In this case, we could follow the process of its disappearance by endoscopy.

  5. Low pressure traumatic epidural hematoma in a child with a prior hemispherectomy: Case report

    Fassil B Mesfin


    Full Text Available A 2½-year-old male child with a prior history of a left anatomic hemispherectomy to treat refractory epilepsy fell down two steps, striking his head on the ipsilateral side of the hemispherectomy. He presented with non-consolable crying and emesis. CT scan of the head demonstrated a left frontal epidural hematoma beneath the site of his prior craniectomy. The patient was initially treated by close observation. However, due to an increase in the hematoma from 29.5 to 49.3 ml over a 12-hour period along with the patient′s lack of clinical improvement, surgical evacuation was performed. Intraoperatively, the source of the hemorrhage was found to be the skull fracture. Postoperatively, he returned to his neurologic baseline and was discharged home on postoperative day 3.

  6. Primary report of noninvasive impedance monitoring of cerebral hematoma and edema in patients with intracerebral hemorrhage

    Xia Yi Lu; Dong Wei-Wei; Yang Hao; Long Men; Yang Hua


    Background and Objective Brain edema is one of the most important clinical process in many diseases. Tissue impedance monitoring offers a non-invasive, bedside, rapid, and reliable technique for the monitoring of the brain edema. Methods We use a bioelectrical impedance(BEI) monitoring unit to record the brain impedance in the healthy volunteer and the patients with intracerebral hemorrhage. Percent of BEI variations were calculation. Results and Conclusions Brain BEI haven f any difference between both hemispheres in normal ones. In 48hrs, BEI value at hematoma-side was obviously decreased; after 48hrs, BEI value was obviously increased and continue to tenth day. Brain bioelectrical impedance monitoring, particularly noninvasively, is a first time in this field. The primary results show brain BEI could reflect the evolution of cerebral hematoma and edema.

  7. Aspiration of coagulated hematoma in the third and fourth ventricles via paracele anterior horn puncture

    Zhi-Qiang Tao; Sheng-Hong Ding


    Intraventricular hemorrhage (IVH) is a neurological urgency with a high mortality and unfavorable prognosis.Fast removal of intraventricular blood should be considered as a priority.The current treatments of IVH mainly focus on external ventricular drain and endoscopic aspiration,but neither way can remove the blood in the fourth ventricle easily and relieve the compression of brainstem.Here we report a unique procedure to solve this problem.A 41-year-old male patient who had suffered sudden attack of headache and disturbance of consciousness for 2 h was diagnosed as having high density lesion in thewhole ventricular system by computed tomographic (CT) imaging.An emergent bilateral ventriculopuncture and intraventricular hematoma removal under non-line-of-sight was performed immediately;the catheter was extended to the fourth ventricle to maximally remove the hematoma.Postoperative CT scan demonstrated total removal of IVH and no sign of extra brain damage.

  8. Extradural hematoma surgery in a child with Hutchinson-Gilford progeria syndrome: Perioperative concerns

    Upendra Hansda


    Full Text Available Hutchinson-Gilford progeria syndrome (HGPS is a very rare genetic disorder characterized by premature ageing, severe growth failure, and very early onset atherosclerosis. Psychologically and emotionally child-like, these patients suffer from physiological changes of old age. Early and progressive atherosclerosis of intra-cranial vessels in HGPS patients, along with a thin skin and fragile vessels, make these patients susceptible to intra-cranial hematomas following relatively trivial injuries and to severe intra-cranial disease. Anesthetizing HGPS patients for surgery can be challenging due to the presence of a possible difficult airway, multi-system derangements, and associated skin, bone and joint disease. We report here one such child with HGPS who underwent craniotomy and evacuation of an extradural hematoma that developed after minor head trauma. Securing his airway during surgery was difficult.

  9. Traumatic pelvic hematoma after a military static-line parachute jump: a case series.

    Barbee, George A; Booms, Zachary


    The authors report five cases of pelvic hematoma without associated pelvic fracture after military static-line parachute operations, a significantly underreported injury. The case reports and discussion include initial emergency department presentation, stabilization requirements, and imaging, disposition, and management recommendations. Data were collected retrospectively through review of medical records from a single institution over the course of a single calendar year, 2012-2013. Pelvic hematoma should be strongly considered in the patient with lower abdominal, hip, or pelvic pain after blunt injury from parachute landing fall even in the absence of associated fracture. The cases discussed display this underreported injury and highlight the frequent necessity for admission to a high-acuity care center for close monitoring.

  10. Recurrent massive bleeding due to dissecting intramural hematoma of the esophagus: Treatment with therapeutic angiography

    Jaejun Shim; Jae Young Jang; Young Hwangbo; Seok Ho Dong; Joo Hyeong Oh; Hyo Jong Kim; Byung-Ho Kim; Young Woon Chang; Rin Chang


    Spontaneous or traumatic intramural bleeding of the esophagus, which is often associated with overlying mucosal dissection, constitutes a rare spectrum of esophageal injury called dissecting intramural hematoma of the esophagus (DIHE). Chest pain, swallowing difficulty, and minor hematemesis are common, which resolve spontaneously in most cases. This case report describes a patient with spontaneous DIHE with recurrent massive bleeding which required critical management and highlights a potential role for therapeutic angiography as an alternative to surgery.

  11. Ultrasonographic evaluation of neck hematoma and block salvage after failed neurostimulation-guided interscalene block.

    Howell, Stephen M; Unger, M W Todd; Colson, James D; Serafini, Mario


    Ultrasound-guided regional anesthetic techniques have shown some advantages over conventional paresthesia and neurostimulation techniques. We report the case of a neurostimulation-guided continuous interscalene block that would have ended in complication were it not for experience with ultrasound-guided regional anesthesia. Familiarity with ultrasound-guided block techniques permitted assessment of a neck hematoma during interscalene block and ultimately allowed successful peripheral nerve block.

  12. Spinal subarachnoid hematoma in a woman with HELLP syndrome: a case report

    Fujimaki Hisako; Nakazawa Toshiyuki; Ueno Masaki; Imura Takayuki; Saito Wataru; Takahira Naonobu; Takaso Masashi


    Abstract Introduction Subarachnoid hemorrhages of spinal origin are extremely rare during pregnancy. We present the case of a patient with hemolytic anemia, elevated liver enzymes and low platelet count (the so-called HELLP syndrome), a potentially life-threatening complication associated with pre-eclampsia, who presented with an idiopathic spinal subarachnoid hematoma. Case presentation At 29 gestational weeks, a 35-year-old Japanese woman was diagnosed with HELLP syndrome based on bilateral...

  13. The role of subgaleal suction drain placement in chronic subdural hematoma evacuation

    Yadav, Yad Ram; Parihar, Vijay; Chourasia, Ishwar D.; Bajaj, Jitin; Namdev, Hemant


    Introduction: There is lack of uniformity about the preferred surgical treatment, role of drain, and type of drain among various surgeons in chronic subdural hematoma (CSDH). The present study is aimed to evaluate role of subgaleal drain. Materials and Methods: This was a prospective study of 260 patients of CSDH treated surgically. Burr-hole irrigation with and without suction drain was done in 140 and 120 patients, respectively. Out of 120 patients without suction drain 60 each were managed...

  14. Hematoma após anestesia peridural: tratamento conservador. Relato de caso Hematoma posterior a la anestesia peridural: tratamiento conservador. Relato de caso Hematoma after epidural anesthesia: conservative treatment. Case report

    Edno Magalhães


    Full Text Available JUSTIFICATIVA E OBJETIVOS: O hematoma associado à compressão espinhal após anestesia peridural é uma complicação neurológica grave, apesar da pequena incidência relatada (1:150.000. É um episódio agudo, e o tratamento tradicionalmente aplicado é a descompressão cirúrgica de urgência. Mais recentemente, em casos específicos, o tratamento com corticosteróide tem sido aplicado como alternativa, com boa recuperação neurológica. O objetivo deste relato foi expor um caso de hematoma peridural com tratamento conservador e recuperação neurológica completa. RELATO DO CASO: Paciente do sexo feminino, 34 anos, estado físico ASA I, sem qualquer histórico de coagulopatia ou terapia anticoagulante, submetida à anestesia peridural com punção única, em L2-L3, para tratamento cirúrgico de varizes nos membros inferiores. Oito horas após a anestesia regional, ela ainda apresentava bloqueio motor completo (escala de Bromage, redução das sensibilidades térmica e dolorosa abaixo do nível L3, hiperalgesia na região plantar esquerda, preservação dos reflexos tendinosos e ausência de dor lombar. A tomografia computadorizada revelou hematoma peridural em L2 com compressão do saco dural. Dez horas após a punção peridural não havia progressão dos sinais e sintomas neurológicos. Optou-se, então, pelo tratamento com metilprednisolona em infusão venosa contínua (5,3 na primeira hora e 1,4 nas 23 horas subseqüentes. Oito horas após o início do tratamento, a paciente recuperou as sensibilidades térmica e dolorosa, e houve regressão total do bloqueio motor. Na 12ª hora, deambulava e referia dor na ferida operatória. O hematoma peridural não foi visualizado em nova tomografia computadorizada na 14ª hora após o início do tratamento. A paciente recebeu alta hospitalar 86 horas depois do início do tratamento conservador, sem comprometimento neurológico. Uma tomografia computadorizada de controle, ap

  15. Massive Intrapelvic Hematoma after a Pubic Ramus Fracture in an Osteoporotic Patient

    Haruki, Funao, E-mail:; Takahiro, Koyanagi [Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, Kanagawa, 210-0013 (Japan)


    An 88-year-old female presented with a left thigh pain and dysuria. She visited our hospital 2 week after she noticed her symptoms. She stated that she might have a low-energy fall, but she could not identify the exact onset. Her radiograph of the pelvis (Figure 1) showed displaced left pubic ramus fracture. Her computed tomographic scanning of the pelvis (Figure 2) showed massive intrapelvic hematoma (axial size, 11 cm by 5 cm) around the fracture site, although she did not use any anticoagulants. Because her bone mineral density was 0.357 g/cm{sup 2}, and T score was -4.8 SD, she started a bisphosphonate therapy. She received a bed-rest physical therapy for 6 weeks, and the hematoma regressed spontaneously. She started full weight bearing after 6 weeks, and walked by a walker after 8 weeks. Although it is extremely rare to develop massive chronic intra-pelvic hematoma after a lowenergy pubic ramus fracture without any use of anticoagulants, it may occur in elderly and severely osteoporotic patient.

  16. Intramural hematoma of the esophagus in a woman with chronic renal failure and prophylactic heparin therapy

    Francesco Serafini


    Full Text Available CASE REPORT An 86 year-old woman experienced chest pain, dyspnea, and dysphagia two days following orthopaedic surgery for a bimalleolus fracture of the right ankle. The patient was on prophylactic low weight molecular heparin and was affected by chronic renal failure. The chest computed tomography (CT ruled out a pulmonary embolism but showed an intramural esophageal mass involving the entire esophagus. The lesion exhibited a blood like CT attenuation content that did not enhance after contrast administration. The esophagogram with gastrografin did not reveal filling defects nor communications between lumen and mucosa. Magnetic resonance confirmed CT results and excluded an aortic dissection. All radiological findings were suggestive of intramural hematoma of the esophagus. DISCUSSION AND CONCLUSIONS Intramural hematoma of the esophagus (IHE is part of the spectrum of esophageal injuries that includes Mallory-Weiss tear and Boerhaave’s syndrome. IHE is the result of a hemorrhage within the submucosal layer. Predisposing conditions are abnormal hemostasis, traumatic events, aortic diseases. It can also occur spontaneously (idiopathic. Treatment should be conservative and includes risk factors withdrawal. The hematoma usually resolves in 1 to 3 weeks.

  17. Rare complication after a transrectal ultrasound guided prostate biopsy: a giant retroperitoneal hematoma.

    Chiancone, Francesco; Mirone, Vincenzo; Fedelini, Maurizio; Meccariello, Clemente; Pucci, Luigi; Carrino, Maurizio; Fedelini, Paolo


    Common complications related to transrectal ultrasound (TRUS) guided prostatic needle biopsy are hematuria, hematospermia, and hematochezia. To the best of our knowledge, we report the second case of a very large hematoma extending from the pelvis into the retroperitoneal space in literature.A 66-year-old man with a serum prostate-specific antigen (PSA) of 5.4 ng/ml was admitted to our department for a TRUS-guided prostatic needle biopsy. Laboratory values on the day before biopsy, including coagulation studies, were all normal. The patients did not take any anticoagulant drugs. No immediate complications were encountered. Nevertheless, 7 hours after the biopsy, the patient reached our emergency department with severe diffuse abdominal pain, hypotension, tachycardia, and confusional state. He underwent an ultrasonography and then a computed tomography (CT) scan that showed "a blood collection in the pelvis that extending to the lower pole of left kidney associated with a focus of active contrast extravasation, indicating active ongoing prostate bleeding." Consequently, he underwent a diagnostic angiography that showed no more contrast extravasation, without the need of embolization. Management of hematoma has been conservative and hematoma was completely reabsorbed 4 months later.

  18. Gastric intramural hematoma accompanied by severe epigastric pain and hematemesis after endoscopic mucosal resection

    Peng Sun; Shi-Yun Tan; Guo-Hai Liao


    Gastric intramural hematoma is a rare injury of the stomach,and is most often seen in patients with underlying disease.Such injury following endoscopic therapy is even rarer,and there are no universally accepted guidelines for its treatment.In this case report,we describe a gastric intramural hematoma which occurred within 6 h of endoscopic mucosal resection (EMR).Past medical history of this patient was negative,and laboratory examinations revealed normal coagulation profiles and platelet count.Following EMR,the patient experienced severe epigastric pain and vomited 150 mLof gastric contents which were bright red in color.Subsequent emergency endoscopy showed a 4 cm × 5 cm diverticulum-like defect in the anterior gastric antrum wall and a 4 cm × 8 cm intramural hematoma adjacent to the endoscopic submucosal dissection lesion.Following unsatisfactory temporary conservative management,the patient was treated surgically and made a complete recovery.Retrospectively,one possible reason for the patient's condition is that the arterioles in the submucosa or muscularis may have been damaged during deep and massive submucosal injection.Thus,endoscopists should be aware of this potential complication and improve the level of surgery,especially the skills required for submucosal injection.

  19. Mast cell blocking reduces brain edema and hematoma volume and improves outcome after experimental intracerebral hemorrhage.

    Strbian, Daniel; Tatlisumak, Turgut; Ramadan, Usama Abo; Lindsberg, Perttu J


    Intracerebral hemorrhage (ICH) is associated with high mortality and disability, and there is no widely approved clinical therapy. Poor outcome after ICH results mostly from a mass effect owing to enlargement of the hematoma and brain swelling, leading to displacement and disruption of brain structures. Cerebral mast cells (MC) are resident inflammatory cells that are located perivascularly and contain potent vasoactive, proteolytic, and fibrinolytic substances. We previously found pharmacological MC stabilization and genetic MC deficiency to be associated with up to 50% reduction of postischemic brain swelling in rats. Here, we studied the role of MC and MC stabilization in ICH using in vivo magnetic resonance imaging and ex vivo digital imaging for calculating brain edema and hematoma volume. In a rat ICH model of autologous blood injection into the basal ganglia, four groups of Wistar rats received either saline or sodium cromoglycate (MC stabilizer, two groups) or compound 48/80 (MC degranulator). Evaluated 24 h later, MC stabilization had resulted in highly significantly better neurologic scores (Pbrain swelling (Pbrain swelling (P<0.05), and smaller hematoma growth (P<0.05) than WT. The role of MC deserves a close evaluation as a potential target in the development of novel forms of ICH therapy.

  20. Spontaneous Rectus Sheath Hematoma in the Elderly: An Unusual Case and Update on Proper Management

    George Galyfos


    Full Text Available Spontaneous rectus sheath hematoma (SRSH is an uncommon medical emergency in the elderly. We present a case of SRSH with an atypical clinical presentation and discuss literature regarding diagnosis and proper management. A 75-year-old female patient was transferred to the emergency department due to acute dyspnoea and confusion. Her medical history revealed a viral infection of the upper respiratory tract, and no coughing or use of anticoagulants. The clinical examination showed tenderness of the left lower abdomen, although palpation was misleading due to patient’s obesity. Laboratory investigations showed light anaemia. Ultrasonography and computed tomography revealed a large rectus sheath hematoma of the left abdominal wall. Despite further deterioration of the patient, conservative management including bed rest, fluid replacement, blood products transfusion, and proper analgesia was successful. No surgical intervention was needed. Prompt diagnosis and management of SRSH plays significant role in the prognosis, especially in elder patients. Independently of size and severity, conservative management remains the first therapeutic choice. Only by failure of supportive management, progressive and large hematoma or uncontrollable hemodynamic patients, interventional management including surgery or less invasive newer techniques is indicated.

  1. Chronic Subdural Hematoma Associated with Thrombocytopenia in a Patient with Human Immunodeficiency Virus Infection in Cameroon

    Clovis Nkoke


    Full Text Available Hematological abnormalities including thrombocytopenia are common in patients living with HIV infection. Patients with HIV infection related thrombocytopenia present generally with only minor bleeding problems. But cases of subdural hematoma are very rare. A 61-year-old female with a history of HIV infection of 9 years’ duration presented with a 3-month history of generalized headache associated with visual blurring and anterograde amnesia. There was no history of trauma or fever. She was treated empirically for cerebral toxoplasmosis for 6 weeks without any improvement of the symptoms. One week prior to admission, she developed weakness of the left side of the body. Clinical examination revealed left-sided hemiparesis. Computed tomography scan of the brain showed a 25 mm chronic right frontoparietotemporal subdural hematoma compressing the lateral ventricle with midline shift. There was no appreciable cerebral atrophy. A complete blood count showed leucopenia and thrombocytopenia at 92,000 cells/mm3. Her CD4-positive cell count was 48 cells/mm3 despite receiving combination antiretroviral therapy for 9 years. A complete blood count analysis suggestive of thrombocytopenia should raise suspicion of possibilities of noninfectious focal brain lesions like subdural hematoma amongst HIV infected patients presenting with nonspecific neurological symptoms. This will enable prompt diagnosis and allow early appropriate intervention.

  2. The Right Delay

    Datadien, A.H.R.; Haselager, W.F.G.; Sprinkhuizen-Kuyper, I.G.


    Axonal conduction delays should not be ignored in simulations of spiking neural networks. Here it is shown that by using axonal conduction delays, neurons can display sensitivity to a specific spatio-temporal spike pattern. By using delays that complement the firing times in a pattern, spikes can ar

  3. Metabolic and clinical markers of prognosis in the era of CT imaging in children with acute epidural hematomas.

    Ben Abraham, R; Lahat, E; Sheinman, G; Feldman, Z; Barzilai, A; Harel, R; Barzilay, Z; Paret, G


    Acute epidural hematoma (AEH), a relatively common complication of head injury in children, persists in bearing high morbidity and mortality. Early establishment of prognosis could guide optimal patient allocation, and early identification of predictive signs could assist in choosing appropriate therapeutic interventions. This study aimed to delineate expeditiously obtainable prognostic markers for determining outcome in a subset of children with AEH. We reviewed our 11-year experience with 61 consecutive children <16 years old with head trauma and isolated AEH. Treatment followed a standard advanced trauma life support protocol. A medical history was obtained, and all patients underwent neurosurgical and physical evaluations. CT scans were performed, as were laboratory tests which included arterial blood gases, glucose, electrolytes (K(+), Na(+)), hemoglobin and coagulation studies. Evaluation of the data collected on cause of injury, interval between trauma occurrence and presentation, clinical symptoms, Glasgow Coma Scale (GCS) scores, vital signs, laboratory test results, physical findings and surgical versus conservative management revealed that the best single predictors of outcome following AEH were the GCS and focal neurological deficits. Of all laboratory data obtained on admission, the blood potassium, pH and glucose test results correlated significantly with prognosis. Prognosis can be adequately and expeditiously estimated by selected markers within a comprehensive evaluation of children with AEH.

  4. Bowel obstruction from intramural hematoma in two children treated with low molecular weight heparin: Case report and review of the literature

    Richard M. Schroeder


    Full Text Available Low molecular weight heparin (LMWH is frequently employed in children to prevent extension of intravascular thrombosis. However, this therapy can result in pathologic bleeding, including spontaneous intramural hematoma of the intestinal wall. In this report, we describe two cases of intestinal obstruction resulting from intramural hematomas during therapeutic LMWH therapy in children. The diagnostic studies and management of spontaneous intramural hematoma in children are discussed.

  5. Low-Density Lipoprotein and Intracerebral Hematoma Expansion in Daily Alcohol Users

    Gayle R. Pletsch


    Full Text Available Background: Epidemiological studies suggest that the intracerebral hemorrhage (ICH rate correlates with alcohol consumption. Alcohol leads to elevated blood pressure (BP and inhibition of platelet aggregation. These factors could promote excessive bleeding. To our knowledge, in the setting of normal liver function tests, there are no studies that have systematically evaluated the relationship between daily alcohol use and hematoma expansion. The aim of this study is to compare the baseline ICH characteristics, frequency of hematoma expansion, and outcomes in patients with ICH who are daily alcohol users with those who are not daily alcohol users. Methods: A retrospective chart review was performed on consecutive patients who presented from July 2008 to July 2013 to the Tulane University Hospital in New Orleans, La., USA, with a spontaneous ICH. Ninety-nine patients who met these criteria were admitted. Patients who underwent hematoma evacuation were excluded. Hemorrhage volumes were calculated based on the ABC/2 method. Low-density lipoprotein (LDL was dichotomized into low (2 and nonparametric equivalents where appropriate. ICH growth in 24 h and LDL were evaluated using linear regression. Results: Of the 226 patients who met inclusion criteria, 20.4% had a history of daily alcohol use. The average age was 61 years (range 19-94, 55.6% of the patients were males, and 67.1% were of African American origin. Daily alcohol use was associated with male gender, lower rate of home antihypertensive, higher presenting BP, and lower platelet counts, but there was no difference in ICH characteristics, ICH growth, or clinical outcome. Daily alcohol use in patients with a low LDL level was associated with supratentorial location and trends for lower baseline Glasgow Coma Scale score, higher ICH score, and follow-up ICH volume, but no significant difference in significant hematoma expansion or clinical outcome except for a trend for higher mortality was found

  6. Delayed intracerebellar hemorrhage secondary to lumboperitoneal shunt insertion

    Er, Uygur; Akyol, Çetin; Bavbek, Murad


    Aim of this paper is to present and discuss a case of a delayed cerebellar parenchymal hemorrhage developing after L/P shunt placement with a NPH patient. A hypertensive patient admitted to our clinic with a diagnosis of NPH. The patient was placed a pressure adjustable L/P shunt without any surgical complication. He was discharged with an uneventful period. The patient was admitted to the emergency clinic of our hospital with a 1.5 × 1.5 cm diameter hematoma at the left cerebellar hemisphere on 2 days after his discharge. CSF drainage by an L/P shunt can generate intracerebellar hemorrhages especially in hypertensive patients. PMID:27695558

  7. The level of circulating endothelial progenitor cells may be associated with the occurrence and recurrence of chronic subdural hematoma

    Yan Song


    Full Text Available OBJECTIVES: The onset of chronic subdural hematoma may be associated with direct or indirect minor injuries to the head or a poorly repaired vascular injury. Endothelial progenitor cells happen to be one of the key factors involved in hemostasis and vascular repair. This study was designed to observe the levels of endothelial progenitor cells, white blood cells, platelets, and other indicators in the peripheral blood of patients diagnosed with chronic subdural hematoma to determine the possible relationship between the endothelial progenitor cells and the occurrence, development, and outcomes of chronic subdural hematoma. METHOD: We enrolled 30 patients with diagnosed chronic subdural hematoma by computer tomography scanning and operating procedure at Tianjin Medical University General Hospital from July 2009 to July 2011. Meanwhile, we collected 30 cases of peripheral blood samples from healthy volunteers over the age of 50. Approximately 2 ml of blood was taken from veins of the elbow to test the peripheral blood routine and coagulation function. The content of endothelial progenitor cells in peripheral blood mononuclear cells was determined by flow cytometry. RESULTS: The level of endothelial progenitor cells in peripheral blood was significantly lower in preoperational patients with chronic subdural hematomas than in controls. There were no significant differences between the two groups regarding the blood routine and coagulation function. However, the levels of circulating endothelial progenitor cells were significantly different between the recurrent group and the non-recurrent group. CONCLUSIONS: The level of circulating endothelial progenitor cells in chronic subdural hematoma patients was significantly lower than the level in healthy controls. Meanwhile, the level of endothelial progenitor cells in recurrent patients was significantly lower than the level in patients without recurrence. Endothelial progenitor cells may be related to the

  8. Clinical Analysis of the Fracture Hematoma Recycling 106 Case%骨折血肿回收再利用106例临床分析

    褚鹏飞; 马国栋; 孙英伦


      目的探讨血肿回收再利用对骨痂形成的影响.方法对106例闭合性长骨骨折患者,按常规术前无菌针管回收大约有18~22mL的血肿,先放置在准备好的无菌盘内为复位后的使用做好准备,在为患者成功复位之后,为了保持骨折断端复位后能够稳定,要选择合适的内固定物进行固定,为患者进行止血,并且止血药彻底,对患者的伤口进行冲洗以后将无菌盘内的骨折血肿用凝胶海绵回收,约2.5~3mL每块,将4~5块180°放在患者骨折部位的间隙的周围,然后将患者的骨膜及软组织进行缝合.结果对所有的研究对象进行定期的随访,随访时间总为1~3年.进行手术之后,所有患者的愈合时间在6~12周之间,没有1例患者的愈合时间延后,也没有1例患者手术之后出现异物反应和其他的并发症.结论避免骨折后局部内环境受干扰和破坏,是对骨折血肿吸收和机化的有利因素,对保证骨折的早期愈合具有重要意义.%Objective To explore the relationship between the recycling hematoma and callus formation. Methods 106 closed long bone fracture cases were aspirated hematoma about 15-20mL with sterile needle before their surgeries. After normal operative fixation, use gelfoam to recycle the aforementioned hematoma and put them into the space among the fracture. Suture the periosteum and soft tissue. Results The 106 cases all received follow-up of 1-3 years. The clinic healing time was 6-12 weeks. Delayed union, foreign body reaction and other complication didn’t happen. Conclusion Protecting local internal environment from disturbance and destruction is a favorable factor for hematoma absorption and organization, and have important implications for the early fracture healing.

  9. An Analytical Delay Model

    MIN Yinghua; LI Zhongcheng


    Delay consideration has been a majorissue in design and test of high performance digital circuits. Theassumption of input signal change occurring only when all internal nodesare stable restricts the increase of clock frequency. It is no longertrue for wave pipelining circuits. However, previous logical delaymodels are based on the assumption. In addition, the stable time of arobust delay test generally depends on the longest sensitizable pathdelay. Thus, a new delay model is desirable. This paper explores thenecessity first. Then, Boolean process to analytically describe thelogical and timing behavior of a digital circuit is reviewed. Theconcept of sensitization is redefined precisely in this paper. Based onthe new concept of sensitization, an analytical delay model isintroduced. As a result, many untestable delay faults under thelogical delay model can be tested if the output waveforms can be sampledat more time points. The longest sensitizable path length is computedfor circuit design and delay test.

  10. Using a Contradictory Approach to Treat a Wound Induced by Hematoma in a Patient With Antiphospholipid Antibody Syndrome Using Negative Pressure Wound Therapy: Lessons Learnt.

    Jang, Min Young; Hong, Joon Pio; Bordianu, Anca; Suh, Hyun Suk


    A 48-year-old woman with antiphospholipid syndrome (APS) had multiple skin necrosis caused by massive bleeding and hematoma collection at the right lower leg, left thigh, and abdomen. During the first month, we did surgical debridement every 2 to 3 days with meticulous coagulation and applied negative pressure wound therapy (NPWT). Then as the base showed initial granulation, we changed the NPWT every 4 days. NPWT was used with lower pressure and cyclic mode (-40 to -75 mm Hg) to minimize trauma and to reduce the possibility of bleeding from the wounds. After 2 months of NPWT treatment, all the wounds eventually healed with secondary intension despite the patient's condition with diabetes, hemodialysis, anticoagulant use, and corticosteroid therapy. This report supports the idea that if accompanied by conservative debridement with meticulous bleeding control, application of NPWT in low pressures and close monitoring of the patient, NPWT is possible to use even in wounds of patients with risk for bleeding.

  11. Three Cases of Organized Hematoma of the Maxillary Sinus: Clinical Features and Immunohistological Studies for Vascular Endothelial Growth Factor and Vascular Endothelial Growth Factor Receptor 2 Expressions

    Shoichiro Imayoshi


    Full Text Available Objectives. Organized hematoma (OH is a rare, nonneoplastic, hemorrhagic lesion causing mucosal swelling and bone thinning, mainly in the maxillary sinus. We aimed to clarify the clinical presentation and treatment of OH. Methods. Three cases of maxillary sinus OH and a literature review are presented. Results. Three men aged 16–40 years complained of nasal obstruction, frequent epistaxis, and/or headache. Clinical and radiological examinations revealed a maxillary sinus OH. They were cured in a piecemeal fashion via endoscopic middle meatal antrostomy. Furthermore, vascular endothelial growth factor and its receptor were expressed in the lesion. Conclusions. The pathogenesis of OH is unclear and it presents various histological and imaging findings; however, it is not difficult to rule out malignant tumors. Minimally invasive surgery such as endoscopic sinus surgery can cure it completely. Thus, it is important to determine the diagnosis using CT and MRI and to quickly provide surgical treatment.

  12. Incidence of pocket hematoma after electrophysiological device placement:dual antiplatelet therapy versus low-molecular-weight heparin regimen

    Yan CHEN; Xin-Cun YANG; Kang MENG; Yun-Tao LI; Ming-Dong GAO; Ze-Chun ZENG; Jin-Rong ZHANG; Hong-Liang CONG; Yin LIU; Ru ZHAO; Le-Feng WANG


    Background Given the increasing number of patients who require dual antiplatelet (DAP) therapy and electrophysiological device (EPD) placement, perioperative antiplatelet management is a current challenge. In this study, we investigated the incidence of pocket hema-toma formation after EPD placement in patients undergoing DAP therapy or an alternative low-molecular-weight heparin (LMWH) regimen. Methods This clinical observational study was performed from July 2010 to July 2012. In total, 171 patients were enrolled in the analysis after meeting the inclusion criteria. These patients were divided into two groups: 86 patients were treated with DAP therapy at the time of device implantation, and the DAP therapy was discontinued for 5 to 7 days and replaced with enoxaparin before device implantation in the other 85 patients. Adenosine phosphate (ADP)-mediated platelet aggregation and arachidonic acid-induced platelet aggregation were tested preoperatively. We compared the incidence of pocket hematoma between the two groups and the association of pocket hematoma develop-ment with ADP-mediated platelet aggregation and arachidonic acid-induced platelet aggregation.Results The incidence of pocket hema-toma in the patients who continued DAP was lower than that in the patients who replaced the dual antiplatelet regimen with LMWH (3.49%vs. 16.47%, respectively;X2 = 6.66,P < 0.01). Among the patients who continued DAP therapies, the rate of ADP-mediated platelet aggre-gation inhibition in patients with pocket hematomas was higher than that in patients without pocket hematomas. None of the patients under-going DAP or enoxaparin therapy developed pocket infection, thromboembolic events, or other serious complications. Multiple logistic re-gression analysis revealed that LMWH therapy was an independent risk factor for the development of pocket hematoma (RR = 0.054, 95%CI = 0.012-0.251). Furthermore, patients undergoing LMWH therapy were 5.1-fold more likely to develop pocket

  13. Blunt traumatic superior gluteal artery pseudoaneurysm presenting as gluteal hematoma without bony injury: A rare case report

    Annu Babu; Amit Gupta; Pawan Sharma; Piyush Ranjan; Atin Kumar


    Blunt traumatic injuries to the superior gluteal artery are rare in clinic.A majority of injuries present as aneurysms following penetrating trauma,fracture pelvis or posterior dislocation of the hip joint.We reported a rare case of superior gluteal artery pseudoaneurysm following blunt trauma presenting as large expanding right gluteal hematoma without any bony injury.The gluteal hematoma was suspected clinically,confirmed by ultrasound and the arterial injury was diagnosed by CT angiography that revealed a large right gluteal hematoma with a focal contrast leakage forming a pseudoaneurysm within the hematoma.Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery,which was successfully angioembolized.The patient was discharged on day 4 of hospitalization with resolving gluteal hematoma.This report highlighted the importance of considering an arterial injury following blunt trauma to the buttocks with subsequent painful swelling.Acknowledgment of this rare injury pattern was necessary to facilitate rapid diagnosis and appropriate treatment.

  14. Complementary role of CT and In-111 leukocyte scans in the diagnosis of infected hematoma and thrombosis

    Kim, E.E.; Pjura, G.A.; Floyd, W.; Raval, B.; Sandler, C.; Gobuty, A.H.


    Patients with traumatic hematomas or those with indwelling catheters who subsequently develop fever and sepsis without clinical localizing signs to indicate an inflammatory focus can present a diagnostic dilemma. Early diagnosis of an infected hematoma or thrombus is important to optimal management. CT can provide, exquisite delineation of anatomy identifying and localizing a post-traumatic fluid collection but cannot reliably distinguish hematoma from abscess in all cases. A thrombus at a catheter tip may be too small to be resolved; when identified, the question of infection again remains. In-111 leukocyte scanning provides a method for identifying or ruling out infection in these situations. The authors performed In-111 leukocyte scans on 15 patients with indwelling catheters. Five of these patients were febrile with positive blood cultures. In-111 leukocyte scans showed positive findings in 8 patients: 5 showed surgically confirmed infected hematomas in the abdomen (3 in the pelvis, 1 in a kidney, 1 in the splenic bed), and 3 showed infected thrombosis in catheter tips. The authors conclude that CT scanning and In-111 leukocyte scanning play complementary roles in the evaluation of traumatic hematomas and thrombosis, the former providing precise anatomic delineation and the latter providing evidence of inflammation.

  15. Spontaneous Neck Hematoma in a Patient with Fibromuscular Dysplasia: A Case Report and a Review of the Literature

    Oded Cohen


    Full Text Available Background. Fibromuscular dysplasia (FMD is a vascular disease that may present as aneurysms in the cervical arteries. Spontaneous neck hematoma is a rare life threatening medical condition. This is the first report of neck hematoma in a patient with FMD. Methods and Results. We present a case of a 69-year-old woman, with diagnosed cervical FMD and a 3-day history of sore throat and neck pain, who presented with enlarging neck hematoma. No active bleeding was noticed on CT angiography, airway was not compromised, and patient was managed conservatively. Next day, invasive angiography was performed, and no bleeding vessel was demonstrated. Patient has improved and was discharged after 5 days of hospitalization. We have discussed the different etiology of this condition, focusing on systemic vascular diseases. Conclusion. Complaint of neck pain in a patient with a FMD should raise suspicion for possible neck hematoma. Conversely, spontaneous neck hematoma without clear etiology should raise suspicion for a systemic vascular disease.

  16. Comparison of ImageJ software numeration and Pullicino formula for cerebrum hematoma cerebrum hematoma.%ImageJ测量颅内血肿体积与多田公式的比较评价

    符鹏程; 陈继华; 夏明万; 雷生锁


    目的 比较颅内血肿的两种测定方法.方法 分别应用多田公式及ImageJ软件测量50例脑内血肿的体积,并对两组体积结果进行统计学分析.结果 脑内血肿的两种计算方法差异有统计学意义.结论 ImageJ软件算法较多田公式更具准确性.%To compare two numeration of cerebrum hematoma. Methods The volume of cerebrum hematoma in 50 cases was measured by the methods of Pullicino formula and lmageJ software, and then the resuits were compared by statistics analyses. Results There was a significant difference between two numeration of cerebrum hematoma. Conclusion ImageJ software numeration is more accurate than Pullicino formula.

  17. Recessive loss-of-function mutations in AP4S1 cause mild fever-sensitive seizures, developmental delay and spastic paraplegia through loss of AP-4 complex assembly

    Hardies, Katia; May, Patrick; Djémié, Tania


    We report two siblings with infantile onset seizures, severe developmental delay and spastic paraplegia, in whom whole-genome sequencing revealed compound heterozygous mutations in the AP4S1 gene, encoding the σ subunit of the adaptor protein complex 4 (AP-4). The effect of the predicted loss...... in reported patients, highlighting that seizures are part of the clinical manifestation of the AP-4 deficiency syndrome. We also hypothesize that endosomal trafficking is a common theme between heritable spastic paraplegia and some inherited epilepsies....

  18. Hematoma subdural de medula espinhal associada ao uso de anticoagulante oral Hematoma subdural de la médula espinal asociado al uso de anticoagulante oral Spine subdural hematoma: a rare complication associated with vitamin K antagonist (VKA

    Uri Adrian Prync Flato


    Full Text Available O hematoma subdural de medula espinhal (HSDME é uma complicação rara decorrente do uso de antagonistas de vitamina K (AVK e de diagnostico difícil. Este artigo apresenta um caso com complicação ameaçadora à vida: um paciente octogenário portador de fibrilação atrial de início recente em uso de AVK. A história e o exame físico inicialmente se apresentavam normais, associados com a elevação dos valores de coagulograma supraterapêuticos (INR > 10. Após 24 horas da admissão hospitalar, o paciente apresentou tetraparesia progressiva, evidenciando na ressonância nuclear magnética (RNM de medula espinhal um HSDME (Figura 1. Após reversão completa da hipocoagulação e intervenção neurocirúrgica o paciente obteve melhora do quadro neurológico.El hematoma subdural espinal (HSE es una complicación rara proveniente del uso de antagonistas de vitamina K (AVK y de diagnostico difícil. Este artículo presenta un caso con complicación amenazadora para la vida: un paciente octogenario portador de fibrilación auricular de inicio reciente, en uso de AVK. Inicialmente, la historia y el examen físico se presentaban normales, asociados a la elevación de los valores de coagulograma supra terapéuticos (INR > 10. Tras 24 horas del ingreso hospitalario, el paciente presentó tetraparesia progresiva. Al realizarse una resonancia nuclear magnética (RNM de médula espinal, se evidenció un HSE (Figura 1. Tras reversión completa de la hipocoagulación e intervención neuroquirúrgica el paciente obtuvo mejora del cuadro neurológico.Spinal subdural hematoma (SSDH is a rare condition, which is difficult to diagnose, related to Vitamin K Antagonist. This a case report of a life-threatening situation in a octogenarian patient with a history of recent atrial fibrillation that received K-Vitamin Antagonist (KVA therapy. The history and the clinical assessment were normal at the admission, associated with increase in the coagulation parameters

  19. On-site Rapid Diagnosis of Intracranial Hematoma using Portable Multi-slice Microwave Imaging System

    Mobashsher, Ahmed Toaha; Abbosh, A. M.


    Rapid, on-the-spot diagnostic and monitoring systems are vital for the survival of patients with intracranial hematoma, as their conditions drastically deteriorate with time. To address the limited accessibility, high costs and static structure of currently used MRI and CT scanners, a portable non-invasive multi-slice microwave imaging system is presented for accurate 3D localization of hematoma inside human head. This diagnostic system provides fast data acquisition and imaging compared to the existing systems by means of a compact array of low-profile, unidirectional antennas with wideband operation. The 3D printed low-cost and portable system can be installed in an ambulance for rapid on-site diagnosis by paramedics. In this paper, the multi-slice head imaging system’s operating principle is numerically analysed and experimentally validated on realistic head phantoms. Quantitative analyses demonstrate that the multi-slice head imaging system is able to generate better quality reconstructed images providing 70% higher average signal to clutter ratio, 25% enhanced maximum signal to clutter ratio and with around 60% hematoma target localization compared to the previous head imaging systems. Nevertheless, numerical and experimental results demonstrate that previous reported 2D imaging systems are vulnerable to localization error, which is overcome in the presented multi-slice 3D imaging system. The non-ionizing system, which uses safe levels of very low microwave power, is also tested on human subjects. Results of realistic phantom and subjects demonstrate the feasibility of the system in future preclinical trials.

  20. Pin-site epidural hematoma: A catastrophic complication of cranial fixation in a child

    Prasad Krishnan


    Full Text Available Cranial fixation with pins is a routine adjunct in neurosurgery and is usually considered safe. A rarely reported complication is skull fracture at the pin site and consequent epidural hematoma. Usually, these are picked up only postoperatively and rarely, intraoperatively if there is unexplained “brain bulge” in which case the operation should be terminated and urgent imaging has to be done. We describe such a complication that occurred while operating on a 12-year-old child with a posterior fossa tumor and review the available literature dealing with such events.

  1. [Hematoma of the psoas. Comparative diagnostic contributions of ultrasonography and x-ray computed tomography].

    Rivasseau, T; Vandermarcq, P; Boissonnot, L; Drouineau, J; Gil, R


    A 11 cases study of hematoma of the iliacus muscle underlines better results obtained by C.T. Scanner compared to those of ultrasonography examination in term of definite diagnoses. Comparison of density values and repeated examination were useful to assert diagnosis and to appreciate the course of the illness. Only C.T. Scanner was able to show which portion of the muscle was concerned. Authors correlated the C.T. Scanner results to the nature of the entrapment neuropathy clinically found: an isolated femoral nerve palsy or association with an obturator nerve dysfunction.

  2. HELLP Syndrome Complicated with Postpartum Subcapsular Ruptured Liver Hematoma and Purtscher-Like Retinopathy

    Daniela Cernea


    Full Text Available Purtscher's retinopathy is usually associated with trauma, acute pancreatitis, vasculitis, lupus, and bone fractures. It was rarely described postpartum in patients with preeclampsia as well as associated with HELLP syndrome. We present a case of a multiparous patient aged 44 with severe preeclampsia and postpartum HELLP syndrome complicated with Purtscher-like retinopathy and large ruptured subcapsular liver hematoma that required emergency abdominal surgery after premature delivery of a dead fetus. Postsurgical outcome was favorable regarding both liver function and visual acuity.

  3. Renal Subcapsular Hematoma after Intravenous Thrombolysis in a Patient with Acute Cerebral Infarction.

    La, Yun Kyung; Kim, Ji Hwa; Lee, Kyung-Yul


    A 74-year-old female with acute cerebral infarction was treated with intravenous recombinant tissue plasminogen activator. Subsequent percutaneous transfemoral angiography and mechanical thrombectomy were performed due to a right middle cerebral artery occlusion, which was successfully recanalized. Two days after treatment, the patient complained of vague right abdominal pain and a laboratory test showed anemia. Abdominal computed tomography showed a right renal subcapsular hematoma. After conservative management, the patient was discharged without complications. We report a rare complication after intravenous thrombolysis in a patient with acute cerebral infarction.

  4. Intracranial subdural hematoma after spinal anesthesia for cesarean section: Case report and review of literature

    Uma Srivastava


    Full Text Available Subdural hematoma (SDH is a rare but serious complication of spinal anesthesia. We report a case of intracranial SDH in a patient developing 11 days after spinal anesthesia for cesarean section. The patient complained of headache on the 2nd post-operative day that was relieved by analgesics, bed rest and hydration. Later she presented with severe headache, vomiting, dizziness, dysarthria, irritability and somnolence. Diagnosis of the left sided SDH was confirmed radiologically and treated surgically. The patient recovered completely. The report highlights the need of considering the possibility of SDH in patients when postdural puncture headache is prolonged or recurs after a headache free period with neurological symptoms.

  5. The Economic Promise of Delayed Aging.

    Goldman, Dana


    Biomedicine has made enormous progress in the last half century in treating common diseases. However, we are becoming victims of our own success. Causes of death strongly associated with biological aging, such as heart disease, cancer, Alzheimer's disease, and stroke-cluster within individuals as they grow older. These conditions increase frailty and limit the benefits of continued, disease-specific improvements. Here, we show that a "delayed-aging" scenario, modeled on the biological benefits observed in the most promising animal models, could solve this problem of competing risks. The economic value of delayed aging is estimated to be $7.1 trillion over 50 years. Total government costs, including Social Security, rise substantially with delayed aging--mainly caused by longevity increases--but we show that these can be offset by modest policy changes. Expanded biomedical research to delay aging appears to be a highly efficient way to forestall disease and extend healthy life.

  6. An Uncommon Presentation of Spontaneous Rectus Sheath Hematoma with Acute Kidney Injury due to Obstructive Uropathy and Prerenal Azotemia

    Eleni Paschou


    Full Text Available Rectus Sheath Hematoma (RSH represents an unusual entity which is characterized by acute abdominal pain and tender palpable abdominal mass usually, among elderly patients receiving anticoagulant therapy. We report the case of an 81-year-old woman admitted to our department due to acute abdominal pain and oligoanuria. The patient had recently been hospitalized due to acute myocardial infarction (AMI and atrial fibrillation (AF and received both anticoagulant and antiplatelet therapies. The radiological assessments revealed an extended Rectus Sheath Hematoma and bilateral hydronephrosis. Treatment of the hematoma required cessation of anticoagulants and antiplatelet agents, immobilization, blood and fresh frozen plasma transfusion, and administration of vasopressors. The patient recovered gradually and was discharged home fifteen (15 days later.

  7. First aid treatment of critically acute epidural hematoma complicated by cerebral hernia using cranial trepanation and drainage decompression: a report of 16 cases



    @@From October 1997 to February 2000, 16 cases of critically acute epidural hematoma (CAEH) complicated by cranial hernia were treated with cranial trepanation and drainage decompression (CTDD), which was used as the first aid treatment before craniotomy and evacuation of hematoma. Satisfactory results were obtained.

  8. Anatomic and radiologic correlations in spontaneous hematomas of the rectus abdomninis muscles; Correlazioni anatomo-radiologiche negli ematomi spontanei dei muscoli retti dell'addome

    Cavagna, E.; Carubia, G.; Schiavon, F. [Ospedale di S. Martino, Unita' Operativa Autonoma di Radiologia, Belluno (Italy)


    Rectus sheath hematomas are a frequent but sometimes misdiagnosed disease in patients under anticoagulative drugs, hemodialysis, or simply in the elderly. The most frequent localization is in the lower part of the abdomen: the explanation lies in the anatomy of the abdominal wall, especially in the arcuate line of the rectus sheath. Aim of this work is to explain the reason of the almost constant location correlating the anatomy with the CT features. The rectus abdominis muscle lies between the aponeuroses of the transverse and oblique muscles which form the so called rectus sheath. This arrangement is found from the costal arch to a level approximately between the umbilicus and the pubic symphisis, where the rear layer of the rectus sheath ends with a curved edge, called the arcuate or semicircular line of Douglas. Beneath this line the aponeuroses of the three muscles pass in front of the rectus which is separated from the peritoneum only by the fascia trasversalis, a thin connective layer between the rectus and the preperitoneal fat. In this lower aspect of the muscle the perforating branches of the inferior epigastric artery running in the preperitoneal fat may rupture causing a large hematoma widely spreading in this loose space. 11 cases of rectus sheath hematoma diagnosed over 5 years were reviewed. They were referred to US because of a rapidly growing palpable mass o painful swelling of the abdominal wall with acute anemia. Sonography was performed in 11 patients and CT in 7. 10 hematomas were located in the lower third of the rectus muscle below the arcuate line in the pelvis, 1 was in the upper third of the muscle: the vast majority of pelvic hematomas is easily accounted for by the peculiar anatomy of the region. The diagnosis of hematoma of the rectus abdominis, sometimes misleading, should be included as a differential in all the patients who present with acute abdominal pain and blood loss. The anatomy of abdominal wall correlates well with CT

  9. Stabilization of a Nonlinear Delay System

    Walid Arouri


    Full Text Available Problem statement: The analysis and control of delayed systems are becoming more and more research topics in progress. This is mainly due to the fact that the delay is frequently encountered in technological systems. This can affect their significantly operations. Most control command laws are based on current digital computers and delays are intrinsic to the process or in the control loop caused by the transmission time control sequences, or computing time. The delay may affect one or more states of the considered system. It may also affect the establishment of the command. Several studies have investigated the stability of delay systems under the assumption that the delay is a variable phenomenon; such variation is considered to be bounded or limited to facilitate analysis of the system. In this study we propose a modelling of delayed system by using the multimodels and switched system theory. The analysis of stability is based on the use of second Lyapunov method. The issued stability conditions are expressed as Bilinear Matrix Inequalities impossible to resolve. That’s why we propose the same original relaxations to come over this difficulty, an example of induction machine is given to illustrate over approach. Approach: We propose to use the control theory developed for switched systems to synthesis a control laws for the stabilisation of delays system. Results: We stabilize the induction machine around many operating points despite the non linearities. Conclusion: The developed method is less conservative and less pessimistic than the used classical methods.

  10. Is Subdural Peritoneal Shunt Placement an Effective Tool for the Management of Recurrent/Chronic Subdural Hematoma?

    Alvarez-Pinzon, Andres M; Valerio, Jose E; Delgado, Victor; Escalante, Jennifer A; Lopez, Nithia; Wolf, Aizik L


    Objective  To describe a surgical technique and to report using a retrospective study the efficacy of peritoneal shunts for the treatment of recurrent/chronic subdural hematoma (CSDH). We describe the considerations, complications, and outcomes related to this technique. Methods  In a retrospective cohort study, 125 charts with a diagnosis of subacute/chronic subdural hematoma were assigned for evaluation. Of the charts reviewed, 18 charts were found from subjects with a diagnosis of recurrent sub-acute or chronic subdural hematoma. All patients had undergone initial surgical treatment of their condition followed by peritoneal shunt placement to help alleviate intracranial pressure. Factors including the age, size of subdural hematoma, number of previous events, BMI, complications, survival, and clinical course were analyzed. Results  After subdural peritoneal shunt placement all patients had full neurological recovery with no complaints of headaches, lethargy, weakness, confusion or seizures. None of the cases had new subdural hematoma episodes after placement for a minimum of a two-year period (mean 26.1 months) (range 24.3-48.6 months). No postoperative complications were reported. The rates of postoperative hemorrhage, infection, distal catheter revision, and perioperative seizures was found to be zero percent. Shunt drainage was successful in all cases, draining 85% of the blood in the first 48 hours. There was no significant relationship between complications and the use of anticoagulants four weeks after surgery. Conclusions Peritoneal shunts, though rarely used, are a viable option in the treatment of sub-acute/chronic subdural hematomas. When pursuing this treatment, this technique is recommended to mitigate the risks of repeat surgical intervention and lessen perioperative time in high-risk patients. PMID:27335718

  11. 慢性硬膜下血肿196例诊治%Experience of Treatment of Chronic Subdural Hematoma

    宋志旺; 祁震宇


    目的 探讨慢性硬膜下血肿的临床特征及其诊治.方法 对2002年~2011年收治的196例慢性硬膜下血肿患者的临床资料进行回顾性分析.结果 慢性硬膜下血肿的临床表现以头昏头痛、肢体肌力下降、精神症状、大小便失禁、癫痫症状为主.治疗上167例采取钻孔引流术,29例采取开瓣血肿清除术.术后症状明显缓解,复查CT示血肿消失或明显减少.结论 慢性硬膜下血肿临床表现缺乏特异性,早期正确诊断并行钻孔引流术或开瓣血肿清除术是治疗慢性硬膜下血肿的主要方法,效果确切.%Objective To evaluate clinical character and diagnosis and treatment on chronic subdural hematoma(CSDH).Methods 196 cases of chronic subdural hematoma were analyzed.Results The classical presentation of CSDH included dizzy,hedache,body strength down,mental symptoms,incontinence and epilepsy symptoms.Of 196 patients,there were 167 cases treated with drilling drainage and 29 cases with open-flap hematoma.Postoperative symptoms were improved,head CT review showed hematoma decreased significantly or disappeared.Conclusion Typical presentation is still lacking for CSDH.Early correct diagnosis and conduct drilling drainage or open-flap hematoma is the main therapy of chronic subdural hematoma.

  12. Intravenous fluid administration may improve post-operative course of patients with chronic subdural hematoma: a retrospective study.

    Miroslaw Janowski

    Full Text Available BACKGROUND: The treatment of chronic subdural hematoma (cSDH is still charged of significant risk of hematoma recurrence. Patient-related predictors and the surgical procedures themselves have been addressed in many studies. In contrast, postoperative management has infrequently been subjected to detailed analysis. Moreover variable intravenous fluid administration (IFA was not reported in literature till now in the context of cSDH treatment. METHODOLOGY/PRINCIPAL FINDINGS: A total of 45 patients with cSDH were operated in our department via two burr hole craniostomy within one calendar year. Downward drainage was routinely left in hematoma cavity for a one day. Independent variables selected for the analysis were related to various aspects of patient management, including IFA. Two dependent variables were chosen as measure of clinical course: the rate of hematoma recurrence (RHR and neurological status at discharge from hospital expressed in points of Glasgow Outcome Scale (GOS. Univariate and multivariate regression analyses were performed. Hematoma recurrence with subsequent evacuation occurred in 7 (15% patients. Univariate regression analysis revealed that length of IFA after surgery influenced both dependent variables: RHR (p = 0.045 and GOS (p = 0.023. Multivariate regression performed by backward elimination method confirmed that IFA is a sole independent factor influencing RHR. Post hoc dichotomous division of patients revealed that those receiving at least 2000 ml/day over 3 day period revealed lower RHR than the group with less intensive IFA. (p = 0.031. CONCLUSIONS/SIGNIFICANCE: IFA has been found to be a sole factor influencing both: RHR and GOS. Based on those results we may recommend administration of at least 2000 ml per 3 days post-operatively to decrease the risk of hematoma recurrence.

  13. Natural history of spontaneous aortic intramural hematoma progression: Six years follow-up with cardiovascular magnetic resonance

    Zhao Lei


    Full Text Available Abstract We described a 6 years follow-up of a spontaneous aortic intramural hematoma (IMH with cardiovascular magnetic resonance (CMR examination. Since multiple factors may play roles in the natural history of IMH, the patient experienced the course of progression, which included hematoma absorption, ulcer-like lesion, aneurysm and limited dissection. The initial and follow-up CMR examination included 3D CE MRA and non-enhanced "bright blood" pulse sequence. The inherent advantage of outstanding contrast with plain scan, which shorten the scan time and avoid potential risk of contrast agent, might make the fast gradient echo sequence as an alternative method when following stable IMH.

  14. 维生素K缺乏所致硬脑膜下血肿%Subdural Hematoma due to Vitamin K Deficiency

    沈玉成; 金惠明


    @@ 新生儿晚期及婴儿期可由维生素K缺乏引起出血性疾病,往往伴有颅内出血,造成严重后遗症,总结我院23例新生儿及婴儿因维生素K缺乏所致硬脑膜下血肿病因,提出预防性治疗的重要性.%The authors present 23 cases of acute intracranial hemorrhage due to vitamin K deficiency in neonatea and infants.Its causes can be grouped as:(1)insufficient intake of vitamin K,characteristically seen in infants who are breast-fed or fed with rice water ete,(2)disturbance in adequate bacterial synthesis in the intestinal tract likely due to medication of tetracycline for upper respiratory infection,diarrhea or pneumonia,(3)that secondary to some other liver disease,and(4)lipolytic disturbance in absorption of vitamin K.In principle,the treatment is by means of puncture to drain the hematoma of its contents.When this fails,surgical removal of the hematoma by craniotomy is recommended.Decompression through excision of bone flap is suggested if necessary.While subdural hemorrhage arising from vitamin K deficiency is curable,its sequaiae are not.Therefor,timely preventive measures should be taken,which include prescription of oral vitamin K for the mother one week prior to delivery,for premature babies,as well as for neonates and infants with daily dosage of 1 mg/kg to prevent the disease at the critical juncture when the level of physiological thrombinogen begins to decline.

  15. Hematoma subdural crónico: Análisis de 95 casos

    Miguel Esquivel Miranda


    Full Text Available El Hematoma Subdural crónico es una patología relativamente frecuente que predomina en adultos  mayores. Es de inicio insidioso, su diagnóstico se basa en el cuadro clínico y estudios radiológicos como la tomografía axial computarizada (TAC, el manejo es predominantemente quirúrgico y su pronóstico es bueno. Se analiza en el presente estudio, una muestra de 95 expedientes clínicos de pacientes con dicho diagnóstico, síntomas iniciales, TAC pre y post diagnóstico, tratamiento y evoluciónChronic subdural hematoma is a relatively common disease prevalent in elderly patients. It has an insidious onset, and its diagnosis is based on clinical and radiologic studies like computalized tomography( CT. Its´ management is usually surgical and it has a good prognosis. This study, analyzed a sample of 95 medical records of patients with this diagnosis, initial symptoms, pre and post CT diagnosis, treatment and outcome

  16. Local Inflammation in Fracture Hematoma: Results from a Combined Trauma Model in Pigs

    K. Horst


    Full Text Available Background. Previous studies showed significant interaction between the local and systemic inflammatory response after severe trauma in small animal models. The purpose of this study was to establish a new combined trauma model in pigs to investigate fracture-associated local inflammation and gain information about the early inflammatory stages after polytrauma. Material and Methods. Combined trauma consisted of tibial fracture, lung contusion, liver laceration, and controlled hemorrhage. Animals were mechanically ventilated and under ICU-monitoring for 48 h. Blood and fracture hematoma samples were collected during the time course of the study. Local and systemic levels of serum cytokines and diverse alarmins were measured by ELISA kit. Results. A statistical significant difference in the systemic serum values of IL-6 and HMGB1 was observed when compared to the sham. Moreover, there was a statistical significant difference in the serum values of the fracture hematoma of IL-6, IL-8, IL-10, and HMGB1 when compared to the systemic inflammatory response. However a decrease of local proinflammatory concentrations was observed while anti-inflammatory mediators increased. Conclusion. Our data showed a time-dependent activation of the local and systemic inflammatory response. Indeed it is the first study focusing on the local and systemic inflammatory response to multiple-trauma in a large animal model.

  17. Peri-Hemorrhagic Edema and Secondary Hematoma Expansion after Intracerebral Hemorrhage: From Benchwork to Practical Aspects

    Babi, Marc-Alain; James, Michael L.


    Spontaneous intracerebral hemorrhage (SICH) is the most lethal type of stroke. Half of these deaths occur within the acute phase. Frequently observed deterioration during the acute phase is often due to rebleeding or peri-hematomal expansion. The exact pathogenesis that leads to rebleeding or peri-hemorrhagic edema remains under much controversy. Numerous trials have investigated potential predictor of peri-hemorrhagic edema formation or rebleeding but have yet to come with consistent results. Unfortunately, almost all of the “classical” approaches have failed to show a significant impact in regard of significant clinical outcome in randomized clinical trials. Current treatment strategies may remain “double-edged swords,” for inherent reasons to the pathophysiology of sICH. Therefore, the right balance and possibly the combination of current accepted strategies as well as the evaluation of future approaches seem urgent. This article reviews the role of disturbed autoregulation following SICH, surgical and non-surgical approaches in management of SICH, peri-hematoma edema, peri-hematoma expansion, and future therapeutic trends. PMID:28154550

  18. Hematoma cerebelar espontâneo: análise de 23 casos

    J. P. Rial


    Full Text Available Uma série de 23 pacientes com hematoma espontâneo de cerebelo é analisada retrospectivamente, mostrando que: todos apresentavam algum grau de diminuição do nível de consciência e cefaléia; 12 apresentavam déficits motores dentre os sinais clínicos mais importantes. Dos antecedentes patológicos destacam-se hipertensão arterial (69,5% e diabetes (34%, havendo associação de ambos em 30% dos casos. Dos aspectos da tomografia computadorizada (TC mais relevantes a dilatação ventricular aguda, encontrada em 69,5% dos pacientes, associada ou não a presença de sangue intraventricular, é considerada sinal de mau prognóstico, indicando por si só terapêutica de urgência. A melhor abordagem cirúrgica para a maioria desses casos é a drenagem ventricular externa de urgência, reservando a craniectomia da fossa posterior para esvaziamento do hematoma para casos específicos. A mortalidade e a morbidade desta patologia é alta; porém, pela TC o diagnóstico se tornou mais rápido e eficiente. Os pacientes desta série puderam beneficiar-se deste procedimento, como se verifica quando comparados a pacientes de outras séries, diagnosticados por outros métodos.

  19. Embolization of the Middle Meningeal Artery Effectively Treats Refractory Chronic Subdural Hematoma: A Systematic Review

    Gobran Alfotih


    Full Text Available Chronic subdural hematoma (CSDH formation mechanism is very complex, and has not entirely understood. It represents a frequent type of intracranial hemorrhage, and is very common disease in Neurosurgery practice, especially in older patients. Various surgical treatments have been proposed for the treatment of CSDH. The rate of recurrence in CSDH after surgery ranges from 5% to 30%, repeated surgery must be considered. But in some cases subdural collections are still persistent. Endovascular embolization of the middle meningeal artery (MMA is an option for treatment of refractory CSDH. We review all cases that were treated with embolization to assess the effect of this intervention. Our review revealed 6 papers with a total enrollment of 14 patients were treated with MMA embolization for refractory chronic subdural hematoma without any postoperative complication or recurrence. In this study we suggest MMA embolization as an alternative for treatment of non-curable CSDH, especially for old people with systematic diseases, who cannot tolerate repeat surgery.

  20. Contrast extravasation into an acute spontaneous intracerebral hematoma: multidetector CT angiographic findings and clinical implications

    Kim, Seong Eun; Yu, Hyeon; Baik, Hye Won; Lee, Hwa Yeon; Kwak, Byung Kook; Lee, Jong Beum; Kim, Yang Soo; Lee, Yong Chul [Chung-Ang University Hospital, Seoul (Korea, Republic of)


    The purpose of this study was to evaluate multidetector row CT (MDCT) angiographic findings and their clinical significance for contrast extravasation into a spontaneous intracerebral hematoma (ICH). MDCT angiographic studies and clinical records of 115 patients with spontaneous ICH were retrospectively reviewed. Cases were divided into two groups according to the presence or absence of contrast extravasation. The cases in the two groups were compared to determine the differences in radiological and clinical findings. The contrast extravasation group was divided into two subgroups according to radiological findings as follows: single or multiple dot-like contrast extravasation (Type A) and beaded-tubular (with or without dot-like extravasation) contrast extravasation (Type B). Contrast extravasation was seen in 38 patients (33%). It was associated with a larger hematoma volume, more frequent intraventricular hemorrhage (IVH) and subarachnoid hemorrhage (SAH), a shorter time interval from onset to the time of the CT scan, lower Glasgow coma scale (GCS), and a higher mortality rate. Type A and B contrast extravasation were observed in 16 (42%) and 22 (58%) patients, respectively. The rate of IVH and the clinical outcome of patients with Type B showed a significant correlation. Two types of contrast extravasation into an ICH show a significant difference in the rate of IVH and in clinical outcome. Detecting the presence of contrast extravasation and classifying them according to the morphologic patterns are important in predicting a prognosis.