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American Family Physician Apr 2012Knowledge of the anatomy and function of the nail apparatus is essential when performing the physical examination. Inspection may reveal localized nail abnormalities... (Review)
Review
Knowledge of the anatomy and function of the nail apparatus is essential when performing the physical examination. Inspection may reveal localized nail abnormalities that should be treated, or may provide clues to an underlying systemic disease that requires further workup. Excessive keratinaceous material under the nail bed in a distal and lateral distribution should prompt an evaluation for onychomycosis. Onychomycosis may be diagnosed through potassium hydroxide examination of scrapings. If potassium hydroxide testing is negative for the condition, a nail culture or nail plate biopsy should be performed. A proliferating, erythematous, disruptive mass in the nail bed should be carefully evaluated for underlying squamous cell carcinoma. Longitudinal melanonychia (vertical nail bands) must be differentiated from subungual melanomas, which account for 50 percent of melanomas in persons with dark skin. Dystrophic longitudinal ridges and subungual hematomas are local conditions caused by trauma. Edema and erythema of the proximal and lateral nail folds are hallmark features of acute and chronic paronychia. Clubbing may suggest an underlying disease such as cirrhosis, chronic obstructive pulmonary disease, or celiac sprue. Koilonychia (spoon nail) is commonly associated with iron deficiency anemia. Splinter hemorrhages may herald endocarditis, although other causes should be considered. Beau lines can mark the onset of a severe underlying illness, whereas Muehrcke lines are associated with hypoalbuminemia. A pincer nail deformity is inherited or acquired and can be associated with beta-blocker use, psoriasis, onychomycosis, tumors of the nail apparatus, systemic lupus erythematosus, Kawasaki disease, and malignancy.
Topics: Carcinoma, Squamous Cell; Hematoma; Hemorrhage; Humans; Nail Diseases; Nails; Nails, Malformed; Skin Neoplasms
PubMed: 22534387
DOI: No ID Found -
Scandinavian Journal of Pain Apr 2017Bleeding into the vertebral canal causing a spinal haematoma (SH) is a rare but serious complication to central neuraxial blocks (CNB). Of all serious complications to... (Review)
Review
BACKGROUND
Bleeding into the vertebral canal causing a spinal haematoma (SH) is a rare but serious complication to central neuraxial blocks (CNB). Of all serious complications to CNBs, neurological injury associated with SH has the worst prognosis. Around the turn of the millennium, the first guidelines aiming to reduce the risk of this complication were published. These guidelines are based on known risk factors for SH, rather than evidence from randomized, controlled trials (RCTs). RCTs, and hence meta-analysis of RCTs, are not appropriate for identifying rare events. Analysing data from a significant number of published case reports of rare complications may reveal risk factors and patterns undetectable in reports on occasional cases, and can thereby help to improve management of CNBs. The aims of the present review were to analyse case reports of SH after CNBs published between 1994 and 2015 with regard to diagnosis, treatment, and outcome of SH after CNB.
METHODS
MEDLINE and EMBASE were utilized to find case reports published in English, German, or Scandinavian languages between 1994 and end of 2015, using appropriate search terms. Reference lists were also scrutinized for case reports. We documented initial and worst symptoms and signs of SH, diagnostic methods, treatment, and outcome of the SH. We calculated occurrences in per cent using the number of informative reports as denominator.
RESULTS
One hundred and sixty-six case reports on spinal hematomas after CNB published during the years between 1994 and 2015 were identified. Eighty per cent of the patients had severe neurological symptoms (paresis or paralysis). When compared over time, outcomes have improved significantly. Among patients subjected to surgical evacuation of the hematoma, outcomes were best if surgery was performed within 12hours from the first sign of motor dysfunction. However, even patients operated after more than 24hours had relatively favourable outcomes. Whereas the outcomes after surgical evacuation of the epidural haematomas were quite satisfactory, only one of the operations for subdural haematoma (SSDH) resulted in a favourable outcome.
CONCLUSIONS AND IMPLICATIONS
Suspicion of a spinal hematoma calls for the consultation of an orthopaedic or neurological surgeon without delay. MRI is the recommended diagnostic tool. Surgical evacuation within 12h from the first sign of motor dysfunction seems to lead to the best outcome, although many patients operated as late as after more than 24hours did regain full motor function. Despite the poor prognosis after surgical evacuation of SSDH, the outcomes after post-CNB spinal haematoma in general have improved significantly over time.
Topics: Anesthesia; Diagnosis, Differential; Hematoma; Humans; Spinal Cord Diseases
PubMed: 28850336
DOI: 10.1016/j.sjpain.2016.11.009 -
Diagnostic and Interventional Imaging Mar 2019Hemarthroses and muscle bleeds are well-known and well-documented complications in pediatric and young adult hemophilia patients. In contrast, deep bleeds in atypical... (Review)
Review
Hemarthroses and muscle bleeds are well-known and well-documented complications in pediatric and young adult hemophilia patients. In contrast, deep bleeds in atypical locations can be a diagnostic challenge, since clinicians and radiologists are often unfamiliar with their clinical and radiological features. Some atypical bleeds, however, can be life-threatening or severely disabling, highlighting the need for prompt, accurate diagnosis. Rare bleeds include central nervous system bleeds (including intracranial and spinal hematomas), urogenital bleeds, intra-abdominal bleeds (mesenteric and gastrointestinal wall hematomas) and pseudo tumors in unusual locations like the sinonasal cavities. Because clinical assessment can be difficult, clinicians and radiologists should be aware of the possibility of these rare complications in their hemophilia patients, so that they can avoid unnecessary invasive diagnostic and surgical procedures and institute prompt, appropriate treatment. The purpose of this review is to illustrate the imaging features of bleeds that occur in rare locations in young (i.e., children and young adults) patients with hemophilia to make the reader more familiar with these conditions.
Topics: Adolescent; Child; Child, Preschool; Female; Female Urogenital Diseases; Gastrointestinal Hemorrhage; Hemarthrosis; Hematoma; Hematoma, Epidural, Spinal; Hematoma, Subdural, Spinal; Hemoperitoneum; Hemophilia A; Hemophilia B; Hemorrhage; Humans; Infant; Intracranial Hemorrhages; Magnetic Resonance Imaging; Male; Male Urogenital Diseases; Muscular Diseases; Tomography, X-Ray Computed; Young Adult
PubMed: 30559038
DOI: 10.1016/j.diii.2018.11.010 -
Clinical Neuroradiology Dec 2022The methodology of measuring chronic subdural hematoma (cSDH) extent and its effect on intracranial structures is relevant for patient classification and outcome... (Review)
Review
BACKGROUND
The methodology of measuring chronic subdural hematoma (cSDH) extent and its effect on intracranial structures is relevant for patient classification and outcome measurements and affects the external validity of cSDH studies. With embolization of the middle meningeal artery (MMA) as a possible treatment of cSDHs, the topic has gained substantial interest. We sought to summarize the heterogeneity of radiologic measurements, specifically in the evaluation of cSDHs based on literature review.
METHODS
In this review, we identified and described the most common radiological methodologies for measurements of cSDH thickness, cSDH volume and of midline shift.
CONCLUSION
There are numerous published methods on how to evaluate cSDH thickness, cSDH volume and midline shift but no common standard. The definition of measurement methods and reporting standards for MMA embolization in cSDH patients and their validation needs to be addressed.
Topics: Humans; Hematoma, Subdural, Chronic; Meningeal Arteries; Embolization, Therapeutic; Radiography; Tomography, X-Ray Computed
PubMed: 35157088
DOI: 10.1007/s00062-022-01138-1 -
Annals of Neurology Aug 2020The aim was to investigate whether intensive blood pressure treatment is associated with less hematoma growth and better outcome in intracerebral hemorrhage (ICH)... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The aim was to investigate whether intensive blood pressure treatment is associated with less hematoma growth and better outcome in intracerebral hemorrhage (ICH) patients who received intravenous nicardipine treatment ≤2 hours after onset of symptoms.
METHODS
A post-hoc exploratory analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial was performed. This was a multicenter, international, open-label, randomized clinical trial, in which patients with primary ICH were allocated to intensive versus standard blood pressure treatment with nicardipine ≤4.5 hours after onset of symptoms. We have included 913 patients with complete imaging and follow-up data in the present analysis.
RESULTS
Among the 913 included patients, 354 (38.7%) had intravenous nicardipine treatment initiated within 2 hours. In this subgroup of patients treated within 2 hours, the frequency of ICH expansion was significantly lower in the intensive blood pressure reduction group compared with the standard treatment group (p = 0.02). Multivariable analysis showed that ultra-early intensive blood pressure treatment was associated with a decreased risk of hematoma growth (odds ratio, 0.56; 95% confidence interval [CI], 0.34-0.92; p = 0.02), higher rate of functional independence (odds ratio, 2.17; 95% CI, 1.28-3.68; p = 0.004), and good outcome (odds ratio, 1.68; 95% CI, 1.01-2.83; p = 0.048) at 90 days. Ultra-early intensive blood pressure reduction was associated with a favorable shift in modified Rankin Scale score distribution at 3 months (p = 0.04).
INTERPRETATION
In a subgroup of ICH patients with elevated blood pressure given intravenous nicardipine ≤2 hours after onset of symptoms, intensive blood pressure reduction was associated with reduced hematoma growth and improved functional outcome. ANN NEUROL 2020;88:388-395.
Topics: Administration, Intravenous; Aged; Antihypertensive Agents; Blood Pressure; Cerebral Hemorrhage; Female; Hematoma; Humans; Male; Middle Aged; Time-to-Treatment; Treatment Outcome
PubMed: 32453453
DOI: 10.1002/ana.25793 -
Annals of Surgery Feb 1990The management of retroperitoneal hematomas remains confusing to many surgeons because the available literature frequently groups patients with blunt and penetrating... (Review)
Review
The management of retroperitoneal hematomas remains confusing to many surgeons because the available literature frequently groups patients with blunt and penetrating etiologies together. Because the underlying injuries and their treatment may differ considerably, the nonoperative or operative approach to the common hematomas is based on mechanism of injury coupled with hemodynamic status of the patient and extent of associated injuries. After blunt trauma, selected retroperitoneal hematomas in the lateral perirenal and pelvic areas do not require operation and should not be opened if discovered at operation. Midline, lateral paraduodenal, lateral pericolonic not associated with pelvic, and portal hematomas are opened after proximal vascular control has been obtained, if appropriate. Retrohepatic hematomas without obvious active hemorrhage are not opened. After penetrating trauma, most retroperitoneal hematomas are still opened. Exceptions include isolated lateral perirenal hematomas that have been carefully staged by CT and some lateral pericolonic hematomas. As with blunt trauma, retrohepatic hematomas without obvious active hemorrhage are not opened.
Topics: Abdominal Injuries; Hematoma; Humans; Retroperitoneal Space; Therapeutic Irrigation; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 2405790
DOI: 10.1097/00000658-199002000-00001 -
Experimental and Clinical... May 2022Transcatheter arterial embolization is used to control active hemorrhage at different anatomic locations. Because hematomas can suddenly deteriorate and become life...
OBJECTIVES
Transcatheter arterial embolization is used to control active hemorrhage at different anatomic locations. Because hematomas can suddenly deteriorate and become life threatening for transplant patients, they require prompt diagnosis and intervention rather than conservative management. Here, we evaluated computed tomography in treatment planning and transcatheter embolization effectiveness for hematoma management in pediatric liver transplant patients.
MATERIALS AND METHODS
Between June 2012 and December 2021, 10 pediatric liver transplant patients were referred to our interventional radiology unit. Computed tomography and angiograms were reviewed for hematoma location and presence of extravasation. We analyzed correlations between computed tomography and angiography findings and technical and clinical success of the endovascular interventions.
RESULTS
Active leak of contrast material during arterial phase was detected on 9/10 CT scans. Although there was no active bleeding on CT in 1 patient, active arterial bleeding was detected on angiography. On the contrary, in 2 patients, although active bleeding was observed on computed tomography, it was not detected on angiography. Source of bleeding was superior mesenteric artery branches in 4, hepatic artery branch in 2, superior epigastric artery in 1, and phrenic artery in 1 patient. Six of 8 patients with active bleeding were treated with endovascular procedures. The remaining 2 patients received surgery: 1 had bleeding from liver cut surface originating from a hepatic artery branch and received open surgery because the bleeding branch was too thin for catheterization, and 1 was hemodynamically unstable and selective catheterization of the internal thoracic artery would take time. Two patients received embolization procedures with N-butyl 2-cyanoacrylate (glue) diluted with iodized oil, and 1 patient had coil and glue with iodized oil. Embolization with coils was performed in 3 patients. Rate of success with transcatheter arterial embolization was 75%. No complications related to patient comorbidities or embolization procedures were shown. No deaths occurred due to progression of the hematoma.
CONCLUSIONS
Transcatheter arterial embolization is effective and safe for treatment of pediatric liver transplant patients with hematomas. Computed tomography has value in identifying the bleeding source and its anatomic relationships and may enhance our intervention abilities to become quicker, more effective, and more secured.
Topics: Child; Embolization, Therapeutic; Enbucrilate; Endovascular Procedures; Hematoma; Hemorrhage; Humans; Iodized Oil; Retrospective Studies; Treatment Outcome
PubMed: 35570602
DOI: 10.6002/ect.PediatricSymp2022.O19 -
European Journal of Vascular and... May 2000
Topics: Blood Transfusion; Cardiac Catheterization; Femoral Artery; Hematoma; Humans; Iliac Artery; Punctures; Retroperitoneal Space; Tomography, X-Ray Computed; Vascular Surgical Procedures
PubMed: 10896449
DOI: No ID Found -
The Bone & Joint Journal Jul 2016Our aim was to perform a systematic review of the literature to assess the incidence of post-operative epidural haematomas and wound infections after one-, or two-level,... (Review)
Review
AIMS
Our aim was to perform a systematic review of the literature to assess the incidence of post-operative epidural haematomas and wound infections after one-, or two-level, non-complex, lumbar surgery for degenerative disease in patients with, or without post-operative wound drainage.
PATIENTS AND METHODS
Studies were identified from PubMed and EMBASE, up to and including 27 August 2015, for papers describing one- or two-level lumbar discectomy and/or laminectomy for degenerative disease in adults which reported any form of subcutaneous or subfascial drainage.
RESULTS
Eight papers describing 1333 patients were included. Clinically relevant post-operative epidural haematomas occurred in two (0.15%), and wound infections in ten (0.75%) patients. Epidural haematomas occurred in two (0.47%) patients who had wound drainage (n = 423) and in none of those without wound drainage (n = 910). Wound infections occurred in two (0.47%) patients with wound drainage and in eight (0.88%) patients without wound drainage.
CONCLUSION
These data suggest that the routine use of a wound drain in non-complex lumbar surgery does not prevent post-operative epidural haematomas and that the absence of a drain does not lead to a significant change in the incidence of wound infection. Cite this article: Bone Joint J 2016;98-B:984-9.
Topics: Diskectomy; Drainage; Hematoma, Epidural, Spinal; Humans; Laminectomy; Lumbar Vertebrae; Postoperative Care; Postoperative Complications; Surgical Wound Infection
PubMed: 27365478
DOI: 10.1302/0301-620X.98B7.37190 -
The Journal of International Medical... Mar 2022Spinal epidural hematomas are rare, with trauma being the most common cause. Spinal epidural hematomas caused by coagulation dysfunction are even rarer; however,...
Spinal epidural hematomas are rare, with trauma being the most common cause. Spinal epidural hematomas caused by coagulation dysfunction are even rarer; however, long-term warfarin therapy increases the risk. The clinical manifestations of spinal epidural hematoma are neurological deficits below the corresponding spinal cord segment level. Magnetic resonance imaging (MRI) is the preferred method for diagnosis, and the main treatment for epidural hematoma with typical symptoms is urgent decompression of the lumbar spine. We describe an almost 80-year-old female patient who received long-term oral warfarin therapy for atrial fibrillation. She developed sudden onset waist pain, and 2 days later, she developed pain and weakness in both lower limbs. Computed tomography (CT) of the thoracolumbar spine showed no obvious hematoma. Eight days after admission, contrast-enhanced CT of the thoracolumbar spine showed intraspinal hematomas at T5-T8 and T12-L2 levels. We performed T3-T7 laminectomy, T5-T8 hematoma removal, and spinal dural repair. The clinical symptoms did not improve significantly, postoperatively. The low incidence of spinal epidural hematoma after anticoagulation treatment means this condition is not recognized timely, and it is misdiagnosed easily. Clinicians should consider this condition when patients treated with anticoagulants have neurological deficits below a spinal segmental plane.
Topics: Aged, 80 and over; Anticoagulants; Female; Hematoma, Epidural, Spinal; Humans; Laminectomy; Magnetic Resonance Imaging; Warfarin
PubMed: 35317631
DOI: 10.1177/03000605221082891