-
Therapeutic Advances in Urology Oct 2018The kidneys are the most vulnerable genitourinary organ in trauma, as they are involved in up to 3.25% of trauma patients. The most common mechanism for renal injury is... (Review)
Review
The kidneys are the most vulnerable genitourinary organ in trauma, as they are involved in up to 3.25% of trauma patients. The most common mechanism for renal injury is blunt trauma (predominantly by motor vehicle accidents and falls), while penetrating trauma (mainly caused by firearms and stab wound) comprise the rest. High-velocity weapons impose specifically problematic damage because of the high energy and collateral effect. The mainstay of renal trauma diagnosis is based on contrast-enhanced computed tomography (CT), which is indicated in all stable patients with gross hematuria and in patients presenting with microscopic hematuria and hypotension. Additionally, CT should be performed when the mechanism of injury or physical examination findings are suggestive of renal injury (e.g. rapid deceleration, rib fractures, flank ecchymosis, and every penetrating injury of the abdomen, flank or lower chest). Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. The lion's share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of minimally invasive procedures. These procedures include angioembolization in cases of active bleeding and endourological stenting in cases of urine extravasation.
PubMed: 30186367
DOI: 10.1177/1756287218785828 -
Clinical Practice and Cases in... Aug 2023We describe the case of a 38-year-old female patient with a history of lupus presenting with atraumatic abdominal pain and ecchymosis. The ultimate diagnosis of...
CASE PRESENTATION
We describe the case of a 38-year-old female patient with a history of lupus presenting with atraumatic abdominal pain and ecchymosis. The ultimate diagnosis of abdominal lupus erythematous panniculitis was determined based on physical exam and imaging findings.
DISCUSSION
Lupus erythematous panniculitis is a rare diagnosis, but consideration is important as early recognition and treatment is important to reduce pain and lessen the possibility of irreversible disfigurement and unnecessary costs to affected patients.
PubMed: 37595308
DOI: 10.5811/cpcem.1247 -
Plastic Surgery (Oakville, Ont.) May 2022Post-rhinoplasty edema and ecchymosis can influence patient satisfaction with surgery as well as result in poor quality of life. Methods to quantify such edema and... (Review)
Review
BACKGROUND
Post-rhinoplasty edema and ecchymosis can influence patient satisfaction with surgery as well as result in poor quality of life. Methods to quantify such edema and ecchymosis have been described in the literature. Despite this, there is currently no collective understanding of which methods are the most effective. Hence, this systematic review aims to describe and analyze the literature on post-rhinoplasty edema and ecchymosis measurement techniques.
METHODS
Standard bibliographic databases (OVID Medline, EMBASE, and PubMed) were searched from their inception to December 2019 for the terms: "rhinoplasty", "postoperative", "edema", and "ecchymosis". Descriptive analysis was completed.
RESULTS
The search revealed 1116 articles of which 33 met inclusion criteria and were included for qualitative synthesis. A total of 1801 patients from all studies were included. Of the 33 included studies, there were 57 unique ecchymosis/edema measurements. The majority of studies measured edema/ecchymosis on post-operative day 1, 2, 3 and 7. Ninety-three percent of measurements described were taken subjectively from a human rater. Other techniques described included magnetic resonance imaging, ultrasound, 3-dimensional imaging, and digital analysis. Less than half of the subjective ecchymosis/edema gradings were completed by a blinded rater.
CONCLUSION
There are a wide variety of post-rhinoplasty edema and ecchymosis techniques being used by rhinoplasty surgeons. The majority of post-rhinoplasty edema and ecchymosis measurements are completed by unblinded subjective raters. It is important that facial plastic surgeons select an accurate measurement tool so they may be able to initiate precise patient-specific management of edema and ecchymosis.
PubMed: 35572083
DOI: 10.1177/22925503211003836 -
Cureus Oct 2023This case report presents a 33-year-old woman who presented to the emergency department with abdominal pain and gingival and vaginal bleeding. She admitted to using...
This case report presents a 33-year-old woman who presented to the emergency department with abdominal pain and gingival and vaginal bleeding. She admitted to using synthetic cannabinoids, and contamination with brodifacoum was suspected, for which qualitative testing was positive. The patient was discharged with an improved international normalized ratio (INR) seven days later with oral vitamin K. Fourteen days after discharge, she re-presented with widespread ecchymosis, leg swelling, and intermittent gingival and vaginal bleeding. Her INR was again elevated. She was controlled with oral vitamin K therapy, stabilized, and discharged three days later. Twenty-eight days following the second discharge, the patient re-presented with oral swelling, right eye ecchymosis, and vaginal bleeding after abstaining from vitamin K therapy for two weeks. A bedside nasopharyngolaryngoscopy showed the base of the tongue, epiglottis, aryepiglottic (AE) folds, arytenoids, and false vocal folds were all edematous with ecchymosis. Due to the diffuse epiglottic and supraglottic edema, the patient was intubated to avoid further decompensation. After receiving IV and oral vitamin K, she was extubated two days later. Her INR fully normalized, and she was then discharged on day 4. Our case of epiglottitis could demonstrate thermal injury associated with smoking synthetic cannabinoids, but given diffuse ecchymosis and severe coagulopathy, hematoma associated with brodifacoum poisoning was considered the most likely etiology. The patient's coagulopathy was rapidly reversed, empiric antibiotic coverage was provided, and she rapidly improved. Brodifacoum exposure has been known to cause increased bleeding, as seen in this case. However, it should also be considered that exposure can lead to epiglottitis. If a similar patient is presented in the future, it is important to consider that coagulopathy may be caused by the adulteration of drugs of abuse, specifically brodifacoum with synthetic cannabinoids.
PubMed: 38021700
DOI: 10.7759/cureus.47286 -
The Pan African Medical Journal 2021This manuscript concerns the case of a patient hospitalized and diagnosed with Evans syndrome. She was hospitalized with signs of thrombocytopenia induced purpura,...
This manuscript concerns the case of a patient hospitalized and diagnosed with Evans syndrome. She was hospitalized with signs of thrombocytopenia induced purpura, petechiae, ecchymosis and anemia. She was successfully treated with corticoids and blood transfusions. Our purpose is to explain her clinical presentation and the exams, we used in order to make the diagnosis of Evans syndrome, which requires great suspicion. Moreover, other diseases causing hemolytic anemia and thrombocytopenia must be excluded. We used laboratory tests (blood samples, Coombs examination and virologic test). Bone marrow examination took place twice. Evans syndrome is an autoimmune disease which is characterized by the coexistence of hemolytic anemia and immune-mediated thrombocytopenia. There is no typical clinical presentation. Its etiology is unknown and its therapy is generally poor. Diagnosis of Evans syndrome is very difficult and requires the exclusion of other diseases causing anemia and thrombocytopenia.
Topics: Aged, 80 and over; Anemia, Hemolytic, Autoimmune; Blood Transfusion; Diagnosis, Differential; Female; Glucocorticoids; Humans; Thrombocytopenia
PubMed: 34285737
DOI: 10.11604/pamj.2021.38.314.22410 -
Psychiatria Danubina 2021
Topics: Ecchymosis; Humans; Methylphenidate; Postoperative Complications
PubMed: 33857043
DOI: 10.24869/psyd.2021.65 -
Journal of Education & Teaching in... Apr 2022Early identification and intervention of Fournier's gangrene in the Emergency Department (ED) requires a high index of suspicion and is critical in improved patient...
UNLABELLED
Early identification and intervention of Fournier's gangrene in the Emergency Department (ED) requires a high index of suspicion and is critical in improved patient outcomes. We present a case of a 64-year-old male with two months of progressively worsening buttock and rectal pain found to have extensive black eschar and ecchymosis on exam. In addition, this patient displayed marked leukocytosis, lactic acidosis, and elevated inflammatory markers. A preoperative computed tomography (CT) scan of the abdomen and pelvis revealed multiple perirectal abscesses and subcutaneous fluid and gas in the perineum and scrotum concerning for Fournier's Gangrene. He was started on broad spectrum antibiotics while in the ED and taken to the operating room for urgent surgical debridement with clinical improvement and was discharged home on day nine. This case report reviews the clinical presentation and interventional modalities, and aims to provide new images to better help visualize a diagnosis of Fournier's Gangrene.
TOPICS
Fournier's gangrene, necrotizing soft tissue infection, necrotizing fasciitis.
PubMed: 37465438
DOI: 10.21980/J8Z356 -
Annals of Medicine and Surgery (2012) Oct 2023Intraoperative and postoperative bleeding is considered one of the most common risks in rhytidectomy. Recently, the use of antifibrinolytic agents in facial plastic and... (Review)
Review
BACKGROUND
Intraoperative and postoperative bleeding is considered one of the most common risks in rhytidectomy. Recently, the use of antifibrinolytic agents in facial plastic and reconstructive surgeries has been evaluated, but their use in rhytidectomy remains a topic of ongoing discussion. Tranexamic acid (TXA) is an antifibrinolytic agent that prevents enzymatic degradation of the fibrin clot by blocking the conversion of plasminogen to plasmin, improves platelet function, and has a direct anti-inflammatory effect. This review covers pertinent literature to elucidate whether the use of TXA in rhytidectomy confers intraoperative and postoperative benefits.
METHODS
A systematic literature search was conducted in online databases: PubMed, Google Scholar, Cochrane, Scopus, and Web of Science for all articles on the topic of TXA in facelift published up to and including June, 2023 using the following terms: "TXA," "tranexamic acid," "plastic surgery," "aesthetic surgery," "facelift," "rhytidectomy". They were either searched individually or in combination. All relevant original research articles, of any study design were included and narratively discussed in this review. Studies not carried out in humans and studies centred on the use of TXA in other specialties were excluded. English Language was included.
RESULTS
Eight articles were reviewed in this paper. Through these articles, the authors provided in detail the possible beneficial effects of TXA in facelift patients in evaluating several clinical outcomes: intraoperative blood loss, postoperative drain output, postoperative oedema, ecchymosis, operative time, and surgical field quality.
CONCLUSION
Although there is still a lack of information on TXA in facelift patients, we are not able to deny the beneficial effects of TXA on this topic. Therefore, further investigations including prospective, case-controlled multi-institutional studies comparing routes of delivery should be performed until reaching, at the end, an evidence-based guideline providing a clear protocol in terms of the administration and dosage of TXA in facelift.
PubMed: 37811108
DOI: 10.1097/MS9.0000000000001224