-
Journal of Wound Care Feb 2020The objective of this article is to explain the biophysical principles underlying the design of the subepidermal moisture (SEM) scanner, commercially known as the 'SEM...
The objective of this article is to explain the biophysical principles underlying the design of the subepidermal moisture (SEM) scanner, commercially known as the 'SEM scanner'. We also describe the mode of operation of the SEM scanner in monitoring tissue health and detecting subtle abnormal changes in tissue physiology in patients and anatomical sites at a risk of a pressure ulcer (PU: also known as a pressure injury). The technology of the SEM scanner was approved last year for sales in the US by the Food and Drug Administration (FDA). The SEM scanner detects changes in fluid contents of human skin and subdermal tissues, to a tissue depth of several millimetres, by measuring 'capacitance', an electrical property of the locally examined tissue site to store electric charge. The capacitance of tissues, called 'biocapacitance', is strongly affected by the amount of fluid (water) in the tissue. When the first cells die in a forming PU, inflammatory signalling causes the permeability of blood vessel walls to increase and oedema to develop. Simply, the scanner detects the early appearance of oedema, which is called 'micro-oedema.' Calculation of a 'SEM-delta' value, which compares biocapacitance measurements, acquired across several tissue sites, some of which are healthy and others where the PU may evolve, eliminates potential effects of systemic changes in tissue fluid contents and provides a consistent quantitative measure of the tissue health conditions at the monitored anatomical site. Here, we describe SEM scanner technology, how it operates and has been laboratory tested (in computer simulations, ) before commercial launch. We explain why targeting the physical biomarker of oedema leads to the documented success of the SEM scanner in the multiple published clinical trials, proving its ability to early detect PUs that form under intact skin.
Topics: Dermis; Early Diagnosis; Edema; Electric Capacitance; Humans; Pressure Ulcer; Skin; Subcutaneous Fat
PubMed: 32058838
DOI: 10.12968/jowc.2020.29.Sup2c.S10 -
Advances in Peritoneal Dialysis.... 2009In addition to local causes--for example, leak of dialysate into an inguinal hernia sac or into the anterior abdominal wall through the track of the catheter for...
In addition to local causes--for example, leak of dialysate into an inguinal hernia sac or into the anterior abdominal wall through the track of the catheter for continuous peritoneal dialysis (CPD)--scrotal edema in CPD patients may result from generalized volume retention. We present 2 CPD patients with scrotal edema, illustrating the diagnosis and management of the mechanisms of volume retention. A man with hypertensive nephrosclerosis developed isolated scrotal edema 14 months after an uneventful course of continuous ambulatory peritoneal dialysis (CAPD). After repair of a ventral hernia and of a communicating hydrocele, he started continuous cycling peritoneal dialysis (CCPD), plus 2 daytime CAPD exchanges. After 4 months, he again developed isolated scrotal edema, which decreased at night. Peritoneal scintigraphy showed no dialysate leaks, and peritoneal equilibration test (PET) revealed high-average transport with a residual volume above, and an ultrafiltration volume below, the expected range. Abdominal radiography revealed migration of the CPD catheter. Malposition of the CPD catheter with positional retention of dialysate was diagnosed. The patient was treated with nightly peritoneal dialysis and no daytime exchanges. On this regimen, ultrafiltration improved and the scrotal edema disappeared with no recurrence for 5 months, at which point the patient underwent kidney transplantation. A man with diabetic nephropathy developed poor dialysate return, volume gain, and pronounced edema of the scrotum, penis, and both legs soon after starting CAPD. Peritoneal scintigraphy was negative, and abdominal radiography confirmed the appropriate position of the CPD catheter tip in the right lower abdominal quadrant. PET revealed high peritoneal solute transport, appropriate residual volume, and appropriate for the transport category, but relatively low (0.1 L), ultrafiltration volume. He was treated with a change in the CPD procedure to CCPD, plus 1 daytime icodextrin exchange and instruction to reduce salt intake. This patient has remained free of scrotal edema for 6 months. In men on CPD, scrotal edema can develop from generalized volume gain secondary to either CPD catheter malfunction or imbalance between total fluid removal and salt and water intake. Proper interpretation of PET findings is critical in the evaluation of scrotal edema not resulting from internal dialysate leaks in CPD.
Topics: Edema; Genital Diseases, Male; Humans; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Scrotum; Water-Electrolyte Imbalance
PubMed: 19886320
DOI: No ID Found -
Seminars in Pediatric Infectious... Jul 2003Extensive local reactions are recognized to occur after administration of the fourth and fifth booster doses of diphtheria-tetanus-acellular pertussis (DTaP) vaccines.... (Review)
Review
Extensive local reactions are recognized to occur after administration of the fourth and fifth booster doses of diphtheria-tetanus-acellular pertussis (DTaP) vaccines. The incidence of these reactions is being delineated by prospective studies. Retrospective evaluations suggest that entire proximal limb swelling occurs in 2 to 6 percent of children given booster doses of DTaP vaccines. The reactions subside without sequelae, but they may be misdiagnosed as cellulitis and lead to unnecessary medical intervention. The pathogenesis of these reactions probably is multifactorial. Evidence suggests that both antigen content and prevaccination immunity have roles. Important, unanswered questions are the safety of revaccinating a child who previously has had an extensive local reaction and the safety of introducing further DTaP boosters into the adolescent and adult populations.
Topics: Child; Diphtheria-Tetanus-acellular Pertussis Vaccines; Edema; Extremities; Humans; Immunization, Secondary; Prevalence
PubMed: 12913831
DOI: 10.1016/s1045-1870(03)00033-5 -
AJR. American Journal of Roentgenology Oct 1978Analysis of airway radiographs of 20 children with proven acute epiglottitis revealed that five (25%) had, in addition to supraglottic edema, localized subglottic edema...
Analysis of airway radiographs of 20 children with proven acute epiglottitis revealed that five (25%) had, in addition to supraglottic edema, localized subglottic edema radiographically indistinguishable from that seen in croup. In all five patients the etiologic organism was Hemophilus influenzae type B.
Topics: Acute Disease; Child; Edema; Epiglottis; Haemophilus influenzae; Humans; Laryngitis; Radiography
PubMed: 102148
DOI: 10.2214/ajr.131.4.603 -
Radiology Jun 1988Ten patients with debilitating hip or knee pain were examined with magnetic resonance (MR) imaging. All had conventional radiographs that were either normal or showed...
Ten patients with debilitating hip or knee pain were examined with magnetic resonance (MR) imaging. All had conventional radiographs that were either normal or showed nonspecific osteopenia. Nine patients had bone scintigrams that showed focal increased radionuclide uptake in the region of the painful joint. In each case, MR images of the affected joint showed regional decreased signal intensity of the bone marrow on T1-weighted images and increased signal intensity on T2-weighted images. Biopsy results of four patients excluded ischemic necrosis and metastases. The symptoms resolved spontaneously in all cases. The ten patients were followed up for 12-36 months, and there were no recurrences. The authors believe that the findings on MR images represent a transient increase in bone marrow water content. The focal findings on scintigrams confirmed the periarticular distribution of the process and provided evidence of accompanying hyperemia and increased bone mineral metabolism. For lack of a better term and to emphasize the generic character of the condition, the authors termed this condition "the transient marrow edema syndrome."
Topics: Bone Marrow; Bone Marrow Diseases; Edema; Hip Joint; Humans; Knee Joint; Magnetic Resonance Imaging; Osteoporosis; Radiography; Radionuclide Imaging
PubMed: 3363136
DOI: 10.1148/radiology.167.3.3363136 -
Journal de Radiologie Jun 2011Transient bone marrow edema of the hip is characterized by moderate homogeneous low MR signal intensity with ill-defined margins that involves at least a portion of the...
Transient bone marrow edema of the hip is characterized by moderate homogeneous low MR signal intensity with ill-defined margins that involves at least a portion of the femoral head. Spin echo T1-weighted images are helpful to exclude other underlying diseases (tumor, infection, necrosis from systemic origin…), for which marrow edema is secondary or no epiphyseal in location. High-resolution fat-suppressed T2-weighted or proton density images allow evaluation of the articular cartilage, subchondral bone and subchondal marrow: if the articular cartilage is abnormal, the lesion is irreversible (arthrosis or necrosis); if the subchondral bone is focally interrupted and/or if the femoral is no longer spherical, the lesion is irreversible (necrosis); if a focal linear fluid collection is present under the subchondral bone, the lesion is irreversible (necrosis). Finally, subchondral changes may provide useful prognostic information: the absence of any abnormality other than marrow edema typically indicates that complete resolution is likely; the presence of a focal T2-weighted hypointense lesion immediately next to the subchondral bone suggests an irreversible lesion, especially if it is equal to or thicker than 4mm or the joint space. In some instances, prognosis cannot be reliably determined requiring the need for follow-up imaging.
Topics: Bone Marrow Diseases; Decision Trees; Edema; Femur Head; Hip Joint; Humans; Magnetic Resonance Imaging
PubMed: 21704251
DOI: 10.1016/j.jradio.2011.05.002 -
Der Unfallchirurg Mar 2015Morphologically, bone marrow edema (BME) is an accumulation of fluid in the bone marrow. The BME is per se non-specific but can be identified at an early stage with...
BACKGROUND
Morphologically, bone marrow edema (BME) is an accumulation of fluid in the bone marrow. The BME is per se non-specific but can be identified at an early stage with magnetic resonance imaging (MRI). The underlying pathomechanism remains unclear. The BME can occur as an individual entity and as an accompanying condition of many diseases. The BME can be divided into three groups, ischemic, reactive and mechanical BME. Mechanical BME occurs after trauma or repetitive strain. Typical histological changes are present and there is no clear boundary between edema and microfracture. Some forms of trauma show BME in typical localizations. Both the trauma and the possible accompanying injuries can be indirectly indicated in this way in cases with an unknown trauma mechanism.
CONCLUSION
The BME can be present as an isolated entity or as a comorbidity. For initiation of therapy, a comprehensive medical history and targeted diagnostics are indispensable. In some cases BME is indicative of the trauma mechanism and possible further accompanying injuries.
Topics: Bone Marrow; Diagnosis, Differential; Edema; Fractures, Bone; Humans
PubMed: 25783688
DOI: 10.1007/s00113-014-2688-y -
HNO Apr 1979Enlargement of the cheeks may be due to a multitude of disorders, congenital, neoplastic, and in particular inflammatory. Congenital facial anomalies include cutaneous... (Review)
Review
Enlargement of the cheeks may be due to a multitude of disorders, congenital, neoplastic, and in particular inflammatory. Congenital facial anomalies include cutaneous (and osseous) hemihypertrophy of the face and unilateral angiomatous malformations (e.g. Sturge-Weber-Krabbe Syndrome). Buccal enlargement due to dermal tumours include localized haemangiomas and lymphangiomas, lipomas and other benign connective tissue neoplasms, generalized disorders of the lymphatic or reticuloendothelial system including mycosis fungoides, reticulum cell sarcoma and other soft tissue malignancies, and cutaneous manifestations of malignant haemoblastoses, in particular chronic lymphatic leukaemia. Within the very large group of inflammatory skin swellings of the face a review is made of some bacterial pyodermias, severe forms of acne vulgaris, herpes zoster, lupus vulgaris, erysipelas, rosacea, steroid dermatitis, lupus erythematosus (discoid and systemic), toxic dermatitis, allergic eczema, urticaria, Quincke's oedema, and the Melkersson-Rosenthal syndrome. The importance of prevention and early detection of steroid-induced dermatitis is emphasized. This disorder, which is a pseudo-inflammatory disfiguring complication of prolonged topical steroid abuse, ranks in frequency with the skin problems most often seen in dermatological practice.
Topics: Adult; Cheek; Congenital Abnormalities; Diagnosis, Differential; Edema; Face; Facial Dermatoses; Facial Neoplasms; Female; Hemangioma; Humans; Lymphangioma; Lymphoma; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged
PubMed: 374316
DOI: No ID Found -
The British Journal of Ophthalmology Nov 1994
Topics: Adult; Edema; Eyelid Diseases; Humans; Male; Recurrence
PubMed: 7848988
DOI: 10.1136/bjo.78.11.881 -
Scandinavian Journal of Rheumatology 1988Sixteen patients with painful tender swelling in the region of the sternocostal joint (SCJ) are reported and analysed against the background of a review of 106... (Review)
Review
Sixteen patients with painful tender swelling in the region of the sternocostal joint (SCJ) are reported and analysed against the background of a review of 106 previously reported patients with Tietze's syndrome. Seven patients fulfilled all the diagnostic criteria for Tietze's syndrome. The radiographic findings and/or the history of these patients suggested that local strain generated by respiration is a pathogenetic factor. Nine patients had a systemic arthritic disorder, skin disease, or psoriasis in their family. They differed from the 7 patients with local involvement and from those reviewed, by the rather frequent bilateral involvement, a frequent affection of the first SCJ and the manubriosternal joint, and a female predominance. Their SCJ swellings may be viewed as part of a seronegative arthritis.
Topics: Arthritis; Arthrography; Blood Sedimentation; Edema; Female; HLA Antigens; HLA-B Antigens; Humans; Joint Diseases; Male; Pain; Skin Diseases; Sternocostal Joints; Tietze's Syndrome; Tomography
PubMed: 3285453
DOI: 10.3109/03009748809098757