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International Journal of Surgery... Jan 2015Rectus sheath hematoma (RSH) is a relatively rare clinical condition, strongly associated among others, with abdominal trauma and anticoagulation. Although well... (Review)
Review
Rectus sheath hematoma (RSH) is a relatively rare clinical condition, strongly associated among others, with abdominal trauma and anticoagulation. Although well documented over the years, it still seems to be often misdiagnosed. Estimations of further increase in incidence are made, based on the increasing use of anticoagulants. Thus it was of interest to us to perform a literature review on the available literature of this entity with the aim to facilitate a better understanding and management in primary and secondary care settings. This review intends to present a synthesis on the main topics of this condition such as pathophysiology, epidemiology, predisposing factors, clinical presentation, diagnosis and basic treatment instructions. The initial search resulted in 146 articles. Additional citations from the reference list of the relevant publication were also included. Every physician in the field of primary/emergency medicine and surgery must be familiar with it, as misdiagnosis may lead to unnecessary laparotomy or death. In contrast, faster and more accurate diagnosis can lead to mortality rate reduction and cost containment.
Topics: Anticoagulants; Diagnosis, Differential; Hematoma; Humans; Muscular Diseases; Rectus Abdominis
PubMed: 25529279
DOI: 10.1016/j.ijsu.2014.12.015 -
Neurosurgical Review Oct 2022Postoperative seizures are a frequently occurring yet not well-understood complication in patients undergoing surgical treatment of chronic subdural haematomas (cSDHs)....
Postoperative seizures are a frequently occurring yet not well-understood complication in patients undergoing surgical treatment of chronic subdural haematomas (cSDHs). Therefore, we investigated surgical and non-surgical risk factors that are commonly considered causal in provoking epileptic seizures, paying special attention to the intracranial course of the subdural drain (SDD) and the configuration of the haematoma. Data of patients with a cSDH, that were treated at our neurosurgical department between 2008 and 2014 were analysed. Patients suffering from severe pre-existing conditions and those who have been treated conservatively were excluded. Epidemiologic data as well as relevant clinical data were collected. Pre- and postoperative CT scans were analysed regarding morpho- and volumetric parameters. In order to objectify the influence of the SDD, its intracranial course and localisation (entering angle as well as the angle between drain and brain surface) were measured. For statistical analysis, univariate and multiple logistic regression models as well as Fisher's exact test were used. Two hundred eleven consecutive patients have been included. Mean age was 75.6 years, and 69% were male. Nineteen (9%) patients suffered from postsurgical seizures. Membranes within the haematoma were present in 81.5%. Pre- to postoperative haematoma reduction was significant (mean of difference - 12.76 mm/ - 9.47 mm in coronal/axial CT planes, p = 0.001/ < 0.001). In 77.9%, SDD showed cortical contact with eloquent regions and had an unfavourable course in 30 cases (14.2%). Surgical complications consisted of cortical bleeding in 2.5%, fresh subdural haematoma in 33.5% and wound infections in 1.4% of patients. Neither in univariate nor in multiple regression analyses any of the following independent variates was significantly correlated with postsurgical seizures: pre-existing epilepsy, alcohol abuse, right-sided haematomas, localization and thickness of haematoma, presence of septations, SDD-localization and to-brain angle, subdural air, and electrolyte levels. Instead, in multiple regression analyses, we found the risk of postsurgical seizures to be significantly correlated and increased with left-sided cSDH treated via craniotomy (p = 0.03) and an unfavourable course of the SDD in left-sided cSDH (p = 0.033). Burr hole trepanation should be preferred over craniotomy and care must be taken when placing a SDD to avoid irritating cortical tissue. The configuration of the haematoma does not appear to affect the postoperative seizure rate.
Topics: Aged; Drainage; Electrolytes; Female; Hematoma; Hematoma, Subdural, Chronic; Humans; Male; Postoperative Complications; Risk Factors; Seizures
PubMed: 36097085
DOI: 10.1007/s10143-022-01858-5 -
Neurology Mar 2022To study the relationship between the presence of cerebral microbleeds (CMBs) and acute hematoma characteristics among patients with primary intracerebral hemorrhage...
BACKGROUND AND OBJECTIVES
To study the relationship between the presence of cerebral microbleeds (CMBs) and acute hematoma characteristics among patients with primary intracerebral hemorrhage (ICH).
METHODS
We pooled individual patient data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial and the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation phase 3 (MISTIE III) trial. We included individuals with a brain MRI scan. Exposure was the presence of a CMB. The coprimary outcomes were admission ICH volume and hematoma expansion. Mixed-effects linear and logistic regression models were used, with demographics and comorbid conditions considered fixed effects and the study cohort treated as a random effect. Additional analyses assessed the relationship between CMB topography and number and hematoma characteristics.
RESULTS
Of the 1,499 patients with ICH enrolled in the parent trials, 466 (31.1%) were included in this analysis, and 231 (49.6%) patients had CMBs. In adjusted models, presence of CMBs was associated with smaller ICH volume (β = -0.26, 95% confidence interval [CI] -0.44 to -0.08) and lower odds of hematoma expansion (odds ratio 0.65, 95% CI 0.40-0.95; = 0.04). The strength of association between CMBs and hematoma characteristics increased with increasing number of CMBs. The location of the CMBs and the severity of leukoaraiosis did not modify these results.
DISCUSSION
In a pooled cohort of patients with ICH, our results are consistent with the hypothesis that more severe underlying small vessel disease, as represented by CMBs, leads to smaller baseline hematoma volumes and reduced hematoma expansion. Underlying cerebral small vessel disease may be of prognostic significance after ICH.
TRIAL REGISTRATION INFORMATION
ClinicalTrials.gov Identifier: NCT01176565 and NCT01827046.
CLASSIFICATION OF EVIDENCE
This study provides Class II evidence that the presence of microbleeds on MRI is associated with a smaller ICH volume at presentation and a lower rate of hematoma expansion on follow-up imaging.
Topics: Cerebral Hemorrhage; Cerebral Small Vessel Diseases; Hematoma; Humans; Leukoaraiosis; Magnetic Resonance Imaging
PubMed: 34937780
DOI: 10.1212/WNL.0000000000013247 -
Acta Clinica Croatica Sep 2022Bleeding complications after peripheral nerve blocks (PNBs) in patients treated with an antiplatelet agent and/or an anticoagulant drug are rare, with estimated... (Review)
Review
Bleeding complications after peripheral nerve blocks (PNBs) in patients treated with an antiplatelet agent and/or an anticoagulant drug are rare, with estimated incidence of 0.67% (0.51-0.83%). However, they can result in significant patient morbidity and may require follow-up investigations and interventions. The evidence for bleeding risks and complications after PNB is very low or nonexistent, therefore, recommendations and guidelines are based on retrospective analyses, case reports, expert opinions and expert panel consensus. In the manuscript, an expert panel consensus on classification of PNBs according to the potential risk of serious bleeding complications is presented. The risks of bleeding depend on the location (vicinity of the vessels and critical structures at risk from the mass effect of a hematoma), block depth (which influences needle visibility), associated comorbidities and anticoagulation status, body habitus, site compressibility, whether the bleeding or hematoma are easy or not to assess and how easy or not an intervention may be applied to prevent or treat bleeding. Also, technical factors are considered: type and size of the used needle, technical difficulties, multiple attempts, needle passes and bloody tap, use of catheters and type of nerve location technique (USG versus techniques) and operator experience. In all patients on antithrombotic drugs, benefits vs. risks should be weighted. A bleeding risk should be minimized with the optimization of patient's coagulation: appropriate antithrombotic drug timing before PNB, dose of antithrombotic drug, indication for the drug and risk factors that may influence drug pharmacokinetics (bodyweight, age, renal and hepatic function). Superficial PNBs may be performed in the presence of antithrombotic drug. For deep PNBs, a recommendations for neuraxial procedures should be considered.
Topics: Humans; Fibrinolytic Agents; Retrospective Studies; Anesthesia, Conduction; Anticoagulants; Hematoma; Hemorrhage; Peripheral Nerves
PubMed: 36824631
DOI: 10.20471/acc.2022.61.s2.08 -
Stroke Nov 2022Despite advances in understanding various risk and prognostic factors, spontaneous intracerebral hemorrhage is connected to very high morbidity and mortality, while the...
BACKGROUND
Despite advances in understanding various risk and prognostic factors, spontaneous intracerebral hemorrhage is connected to very high morbidity and mortality, while the therapy is mainly supportive. Understanding of the pathophysiology of initial hematoma expansion is limited due to insufficient clinical data and lack of a suitable animal model.
METHODS
We injected 40 anatomic specimens of the basal ganglia with contrast medium, scanned them with a micro-computed tomography scanner and analyzed the results of radiological studies, direct and histological examinations.
RESULTS
In 9 cases, micro-computed tomography and histological examinations revealed contrast medium extravasations mimicking intracerebral hematomas. The artificial hematomas spread both proximally and distally along the ruptured perforator and its branches in the perivascular spaces and detached the branches from the adjacent neural tissue leading to destruction of the tissue and secondary extravasations. Moreover, some contrast extravasations skipped to the perivascular spaces of unruptured perforators, created further extravasation sites and aggravated the expansion of the artificial hematoma. There was no subarachnoid extension of any artificial hematoma.
CONCLUSIONS
We postulate that a forming basal ganglia intracerebral hematoma spreads initially in the perivascular space, detaches the branches from the neural tissue and causes secondary bleeding. It can also skip to the perivascular space of a nearby perforator. The proposed mechanism of hematoma initiation and formation explains extent of damage to the neural tissue, variability of growth in time and space, creation of secondary bleeding sites, and limited usefulness of surgical interventions. The model is reproducible, the extent of the artificial hematoma can be easily controlled, the rupture sites of the perforating arteries can be determined, and preparation of the model does not require specialized, expensive equipment apart from the micro-computed tomography scanner.
Topics: Animals; X-Ray Microtomography; Cerebral Hemorrhage; Hematoma; Contrast Media; Basal Ganglia
PubMed: 36073367
DOI: 10.1161/STROKEAHA.122.040143 -
Taiwanese Journal of Obstetrics &... Nov 2022
Topics: Pregnancy; Female; Humans; Pregnancy Complications; Hematoma
PubMed: 36427987
DOI: 10.1016/j.tjog.2022.08.013 -
Hong Kong Medical Journal = Xianggang... Jun 2022
Topics: Gallbladder Diseases; Gastrointestinal Hemorrhage; Hematoma; Humans
PubMed: 35765736
DOI: 10.12809/hkmj219569 -
Journal of Medicine and Life 2015A developed society is usually also characterized by an elderly population, which has a continuous percentage growth. This population frequently presents a cumulus of... (Review)
Review
UNLABELLED
A developed society is usually also characterized by an elderly population, which has a continuous percentage growth. This population frequently presents a cumulus of medical pathologies. With the development of the medication and surgical treatment of different affections, the life span has increased and the pathology of an old patient has diversified as far as the cumulus of various pathological diseases in the same person is concerned. Chronic subdural pathologies represent an affection frequently met in neurosurgery practice. Any neurosurgeon, neurologist and not only, has to be aware of the possibility of the existence of a chronic subdural haematoma, especially when the patient is old and is subjected to an anticoagulant or antiaggregant treatment, these 2 causes being by far the etiological factors most frequently met in chronic subdural haematomas. With an adequate diagnosis and treatment, usually surgical, the prognosis is favorable. Although the surgical treatment presents a categorical indication in most of the cases, the fact that there are many surgical techniques, a great relapse rate, as well as the numerous studies, which try to highlight the efficiency of a technique as compared to another, demonstrate that the treatment of these haematomas is far from reaching a consensus among the neurosurgeons. The latest conservatory treatment directions are still being studied and need many years to be confirmed.
ABBREVIATIONS
CT = computerized tomography, MRI = magnetic resonance imaging.
Topics: Hematoma, Subdural, Chronic; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed
PubMed: 26351527
DOI: No ID Found -
Aesthetic Surgery Journal Sep 2023
Topics: Humans; Rhytidoplasty; Hematoma; Surgeons
PubMed: 37437181
DOI: 10.1093/asj/sjad225 -
Diagnostic and Interventional Imaging Sep 2023The purpose of this study was to identify possible association between noncontrast computed tomography (NCCT)-based radiomics features of perihematomal edema (PHE) and...
PURPOSE
The purpose of this study was to identify possible association between noncontrast computed tomography (NCCT)-based radiomics features of perihematomal edema (PHE) and poor functional outcome at 90 days after intracerebral hemorrhage (ICH) and to develop a NCCT-based radiomics-clinical nomogram to predict 90-day functional outcomes in patients with ICH.
MATERIALS AND METHODS
In this multicenter retrospective study, 107 radiomics features were extracted from 1098 NCCT examinations obtained in 1098 patients with ICH. There were 652 men and 446 women with a mean age of 60 ± 12 (SD) years (range: 23-95 years). After harmonized and univariable and multivariable screening, seven of these radiomics features were closely associated with the 90-day functional outcome of patients with ICH. The radiomics score (Rad-score) was calculated based on the seven radiomics features. A clinical-radiomics nomogram was developed and validated in three cohorts. The model performance was evaluated using area under the curve analysis and decision and calibration curves.
RESULTS
Of the 1098 patients with ICH, 395 had a good outcome at 90 days. Hematoma hypodensity sign and intraventricular and subarachnoid hemorrhages were identified as risk factors for poor outcomes (P < 0.001). Age, Glasgow coma scale score, and Rad-score were independently associated with outcome. The clinical-radiomics nomogram showed good predictive performance with AUCs of 0.882 (95% CI: 0.859-0.905), 0.834 (95% CI: 0.776-0.891) and 0.905 (95% CI: 0.839-0.970) in the three cohorts and clinical applicability.
CONCLUSION
NCCT-based radiomics features from PHE are highly correlated with outcome. When combined with Rad-score, radiomics features from PHE can improve the predictive performance for 90-day poor outcome in patients with ICH.
Topics: Male; Humans; Female; Middle Aged; Aged; Retrospective Studies; Cerebral Hemorrhage; Tomography, X-Ray Computed; Hematoma; Edema
PubMed: 37179244
DOI: 10.1016/j.diii.2023.04.008