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Wilderness & Environmental Medicine Sep 2020We report a case of a 42-y-old female patient who sustained a sting to the neck from a Trachinus draco fish. She subsequently developed complications including arytenoid...
We report a case of a 42-y-old female patient who sustained a sting to the neck from a Trachinus draco fish. She subsequently developed complications including arytenoid membrane edema secondary to either the local anesthetic agent administered to the wound or the dracotoxin itself. The patient was examined in the emergency department after the sting. Local anesthesia with lidocaine was administered to the areas of injury at another hospital before presenting to our hospital emergency department. The patient reported that her pain partially decreased but hoarseness developed and she had difficulty breathing after the local anesthetic was administered. Laryngeal examination by our hospital's otolaryngologist revealed edema of the patient's right arytenoid membrane without evidence of vocal cord swelling. Computed tomography of the neck revealed edema in the right arytenoid membrane on the side of the neck where the local anesthetic had been injected. The patient, who was given supplementary treatment, was discharged without any complications on the seventh day of hospitalization. The principle treatment for these types of stings includes immersion in hot water, analgesic therapy, and observation for signs of local and systemic envenomation. We recommend using caution when injecting local anesthetic agents in the neck because of underlying vital structures.
Topics: Adult; Analgesics; Animals; Bites and Stings; Edema; Female; Fish Venoms; Fishes; Humans; Injections, Subcutaneous; Pain Management; Vocal Cords
PubMed: 32800447
DOI: 10.1016/j.wem.2020.04.008 -
Journal of Clinical Nursing Sep 2023To map current literature on bedside clinicians' use of point-of-care subepidermal moisture devices to identify increased pressure injury risk. (Review)
Review
AIMS AND OBJECTIVES
To map current literature on bedside clinicians' use of point-of-care subepidermal moisture devices to identify increased pressure injury risk.
BACKGROUND
Pressure injuries are a substantial healthcare burden. Localised oedema occurs before visible or palpable changes, and therefore is a biomarker of increased pressure injury risk. Novel bedside technologies that detect localised oedema may aid early pressure injury preventative practices.
DESIGN
A scoping review.
METHODS
Arksey and O'Malley's six-step framework and the PRISMA-ScR guidelines guided this scoping review. CINAHL Complete, Embase, SCOPUS, Cochrane (wounds) and PubMed databases were searched for primary research and quality improvement projects published in English between 2008-2022. Included studies focused on clinicians' bedside use of subepidermal moisture devices to quantify localised oedema and pressure injury risk. The PAGER framework supported narrative synthesis of the extracted data.
RESULTS
Nine studies were selected from 1676 sources. Two point-of-care subepidermal moisture devices were identified in clinical use, largely by nurses. Inconsistent use and interpretations revealed significant knowledge gaps in clinical practice. Additionally, no included studies engaged patients or the public in their design.
CONCLUSIONS
Nurses recognise the value of objective measures in determining the risk of pressure injury and are the primary end-users of point-of-care subepidermal moisture devices. However, standardising procedural instructions and interpretive criteria to guide preventative measures requires further research.
RELEVANCE TO CLINICAL PRACTICE
International pressure injury clinical practice guidelines advocate for subepidermal moisture devices as an adjunct to routine clinical skin assessment, although little is known about bedside use. This scoping review reveals low adoption of such devices and the need to develop standardised procedures in their use and interpretation.
REGISTRATION
Open Science DOI https://doi.org/10.17605/OSF.IO/AB6Y5-7th of March 2022.
Topics: Humans; Pressure Ulcer; Point-of-Care Systems; Skin; Edema; Skin Care
PubMed: 36717978
DOI: 10.1111/jocn.16630 -
Journal of the American Academy of... Jul 1996Chronic edema in venous insufficiency is associated with leg ulceration, whereas in lymphedema skin ulceration is less frequent and edema from cardiac failure does not...
BACKGROUND
Chronic edema in venous insufficiency is associated with leg ulceration, whereas in lymphedema skin ulceration is less frequent and edema from cardiac failure does not cause major skin changes. The reason for these differences is unclear.
OBJECTIVE
Our purpose was to investigate, by means of ultrasound, the distribution of intradermal fluid in patients with edema associated with lipodermatosclerosis, lymphedema, or cardiac insufficiency.
METHODS
Sixteen patients with lipodermatosclerosis, 10 with lymphedema, 16 with leg edema from heart insufficiency, and 16 healthy control subjects were studied. Ultrasound images were obtained with a 20 MHz scanner. The echogenicity of the dermis was quantified by image analysis and the echogenicity of the upper (subepidermal) and lower portions of the dermis were measured.
RESULTS
In any type of edema the dermal echogenicity was lower than that of the control group, indicating intradermal edema. In normal skin the upper dermis was only slightly less echogenic than the lower dermis. In patients with lipodermatosclerosis a low-echogenic area was present in the upper dermis, which suggests the papillary dermis as a preferential site of edema formation. In contrast, in lymphedema dermal echogenicity was uniformly distributed, whereas in patients with heart failure the lower portion of the dermis was less echogenic than the upper dermis.
CONCLUSION
This study demonstrates that intradermal echogenicity shows characteristic patterns in different types of edema, which indicates that localization of fluid varies in the dermis, from subepidermal (lipodermatosclerosis), uniform (lymphedema), to deep dermal (heart failure). These differences may help in understanding the origin of different skin sequelae of edema.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Body Water; Cardiac Output, Low; Edema; Humans; Image Processing, Computer-Assisted; Leg; Leg Ulcer; Lymphedema; Middle Aged; Scleroderma, Localized; Skin; Skin Diseases; Ultrasonography; Venous Insufficiency
PubMed: 8682961
DOI: 10.1016/S0190-9622(96)90493-4 -
JBJS Case Connector 2019Focal periphyseal edema (FOPE) zones have only recently been described as a cause of joint pain in adolescence. The literature is limited to a few case reports and...
CASE
Focal periphyseal edema (FOPE) zones have only recently been described as a cause of joint pain in adolescence. The literature is limited to a few case reports and radiologic studies describing this symptomatic physeal pathology. This series describes 3 adolescent patients with magnetic resonance imaging (MRI) confirmed FOPE zones of the distal femur. Repeat MRI of 2 of the 3 patients showed improvement yet incomplete resolution of the bone edema, corresponding with persistent knee pain.
CONCLUSIONS
FOPE zones usually improve with conservative treatment, but may be a cause of persistent knee pain in adolescents.
Topics: Adolescent; Arthralgia; Bone Diseases; Edema; Female; Humans; Knee Joint; Radiography
PubMed: 31365360
DOI: 10.2106/JBJS.CC.18.00391 -
Journal of the American Podiatric... Aug 1990This work attempts to determine the influence of vitamin C on locally induced inflammation and arthritis in rat paws, as measured by rat paw swelling, polymorphonuclear...
This work attempts to determine the influence of vitamin C on locally induced inflammation and arthritis in rat paws, as measured by rat paw swelling, polymorphonuclear leukocyte infiltration, pain, and surface skin temperature. Daily subcutaneous administration of 150 mg/kg of vitamin C over 20 days reduced arthritic swelling, increased pain tolerance, and decreased polymorphonuclear leukocyte infiltration, with no significant change in surface temperature. Vitamin C may provide podiatrists with a supplemental or alternative treatment for patients with rheumatoid arthritis.
Topics: Animals; Arthritis, Rheumatoid; Ascorbic Acid; Body Temperature; Disease Models, Animal; Edema; Male; Pain; Rats; Rats, Inbred Strains
PubMed: 2376830
DOI: 10.7547/87507315-80-8-414 -
Journal of the American Academy of... Dec 1979Fiddler's neck is a dermatosis of violinists and violists. It characteristically presents as focal lichenification and pigmentation on the left side of the neck. Edema...
Fiddler's neck is a dermatosis of violinists and violists. It characteristically presents as focal lichenification and pigmentation on the left side of the neck. Edema may also occur in the same area and lead to cosmetic concern or fear of malignancy. The edema apparently results from pressure on the patient's neck by the base of the violin or viola and is worsened by holding the instrument in a drooping position.
Topics: Dermatitis, Occupational; Edema; Humans; Male; Middle Aged; Music; Neck
PubMed: 160919
DOI: 10.1016/s0190-9622(79)80098-5 -
La Radiologia Medica Oct 2017To assess the diagnostic confidence in detecting and localizing areas of bone marrow edema in the sacroiliac joint of patients with suspected spondyloarthritis using a...
OBJECTIVES
To assess the diagnostic confidence in detecting and localizing areas of bone marrow edema in the sacroiliac joint of patients with suspected spondyloarthritis using a single-plane method and comparing it with multiplanar unenhanced and enhanced methods.
MATERIALS AND METHODS
Patients with clinical suspicion of spondyloarthritis undergoing an MRI of the sacroiliac joint were included in this retrospective study. To assess sacroiliitis, three methods were applied: single-plane (i.e., para-coronal STIR alone), multiplanar unenhanced (i.e., para-coronal STIR and para-axial PD-fs), and multiplanar enhanced method (i.e., para-coronal and para-axial post-contrast T1-fs). Two 4-point scales were used to evaluate, respectively, the diagnostic confidence in detection and localization of bone marrow edema. The distribution of certain and uncertain rating according to signal intensity and size of the lesions was also calculated.
RESULTS
Seventy-four patients met the inclusion criteria. Both multiplanar methods increased the diagnostic confidence in detection (p < 0.001) and localization (p < 0.001) of sacroiliitis; no significant difference occurred between the multiplanar unenhanced and enhanced methods (p = 0.405 and p = 1.00, respectively, for detection and localization). A statistically significant difference between the distributions of certain and uncertain rating for detection based on the size and signal intensity of each lesion emerged (p = 0.006 and p < 0.001, respectively), whereas no statistically significant difference occurred for the confidence of localization (p = 0.452 and p = 0.694, respectively).
CONCLUSIONS
The multiplanar methods increased the diagnostic confidence in detection and localization of sacroiliitis. The absence of a significant difference between the proposed unenhanced and enhanced methods suggests that contrast medium is not mandatory for the detection of sacroiliitis.
Topics: Adult; Bone Marrow; Contrast Media; Diagnosis, Differential; Edema; Female; Humans; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging; Male; Retrospective Studies; Sacroiliitis; Spondylarthritis
PubMed: 28593478
DOI: 10.1007/s11547-017-0778-y -
Journal of the American Academy of... Dec 1998Lipodermatosclerosis is a sequela of deep venous insufficiency and a risk factor for the occurrence of venous leg ulceration. Medical compression stockings facilitate... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Lipodermatosclerosis is a sequela of deep venous insufficiency and a risk factor for the occurrence of venous leg ulceration. Medical compression stockings facilitate leg ulcer healing and prevent occurrence of ulcers resulting from removal of edema. Although the exact level of compression necessary for removal of dermal edema in patients with deep venous insufficiency has not been established, garments providing high compressive values of 30 to 40 mm Hg have been recommended. Dermal edema can be visualized by high-frequency ultrasonography.
OBJECTIVE
We used ultrasound imaging to study whether a lower level of compression (class I 18 to 26 mm Hg vs class II 26 to 36 mm Hg) is effective in removal of dermal edema. This question is important because the use of hosiery with a lower compression class would enhance compliance and enable treatment of patients with mixed arteriovenous disease.
METHODS
In 11 patients skin images were obtained with 20 MHz ultrasound from the malleolar region in lipodermatosclerotic skin and corresponding normal skin of the contralateral leg. The ratio of low echogenic pixel number to total pixel number (LEP/TP), which correlates with dermal water, was measured before and after 5 days of applied compression in two treatment courses where classes of compression were switched randomly. Ankle circumference was also measured.
RESULTS
We found that LEP/TP was 33% higher in lipodermatosclerotic skin than in the matched normal skin indicating presence of skin edema. Application of class I and II compressive hosiery resulted in LEP/TP decrease by 17% (95% confidence interval, 0.07 to 0.26) and 14% (95% confidence interval, 0.04 to 0.21), respectively, suggestive of dermal edema reduction. No statistically significant difference in efficacy of dermal edema removal between class I and II was found. No changes in ankle circumference after application of both classes of compression was observed.
CONCLUSION
Application of light and moderate compression results in a partial edema removal from the dermis in lipodermatosclerosis in the absence of measurable reduction in leg circumference. Class I compression is as effective as class II for elimination of dermal edema. These data indicate that light compression may be a useful modality for patients with deep venous insufficiency and lipodermatosclerosis who are not eligible for treatment with garments having higher compressive forces.
Topics: Adult; Aged; Bandages; Edema; Female; Humans; Leg; Leg Ulcer; Male; Middle Aged; Scleroderma, Localized; Ultrasonography; Venous Insufficiency
PubMed: 9843010
DOI: 10.1016/s0190-9622(98)70271-3 -
Journal of the American Academy of... Feb 2000
Topics: Bandages; Compressive Strength; Edema; Humans; Leg; Leg Ulcer; Scleroderma, Localized; Venous Insufficiency; Venous Thrombosis
PubMed: 10642701
DOI: 10.1016/s0190-9622(00)90155-5 -
Journal of Pediatric Orthopedics. Part B Jan 2018Focal periphyseal edema (FOPE) zones were first described in 2011. The aim of this report was to investigate the clinical course of patients with FOPE zones. Three...
Focal periphyseal edema (FOPE) zones were first described in 2011. The aim of this report was to investigate the clinical course of patients with FOPE zones. Three adolescent patients with a FOPE zone in the knee were treated and observed for a maximum of 2 years. No symptoms or leg-length discrepancy developed at the final follow-up after conservative therapies. This is the first report on the follow-up of FOPE zones with a maximum of 2 years. The results suggest that observation of FOPE zones may be sufficient without invasive examinations and treatment.
Topics: Adolescent; Bone Marrow Diseases; Conservative Treatment; Edema; Female; Humans; Knee Joint; Leg Length Inequality; Male
PubMed: 27606713
DOI: 10.1097/BPB.0000000000000388