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Journal of Cerebral Blood Flow and... Apr 2018Despite the absence of an intervention shown to improve outcomes in intracerebral hemorrhage, preclinical work has led to a greater understanding of the pathologic... (Review)
Review
Despite the absence of an intervention shown to improve outcomes in intracerebral hemorrhage, preclinical work has led to a greater understanding of the pathologic pathways of brain injury. Methods targeting hematoma clearance through both macroscopic (surgical) and microscopic (endogenous phagocytosis) means are currently under investigation, with multiple clinical trials ongoing. Macroscopic methods for removal involve both catheter- and endoscope-based therapies to remove the hematoma through minimally invasive surgery. Microscopic methods targeting hematoma clearance involve augmenting endogenous clearance pathways for red blood cells and altering the balance between phagocytosis and red blood cell lysis with the release of potentially harmful constituents (e.g. hemoglobin and iron) into the extracellular space.
Topics: Animals; Cerebral Hemorrhage; Hematoma; Humans; Minimally Invasive Surgical Procedures; Neurosurgical Procedures; Phagocytosis
PubMed: 29350086
DOI: 10.1177/0271678X17753590 -
Journal of Neurology, Neurosurgery, and... Nov 1979A case of haematoma in the pineal region is reported in a patient whose initial symptom was subarachnoid haemorrhage. The encapsulated haematoma and surrounding blood...
A case of haematoma in the pineal region is reported in a patient whose initial symptom was subarachnoid haemorrhage. The encapsulated haematoma and surrounding blood clots were removed surgically. Haemorrhage into a pineal cyst may have been the cause of this particular intracranial mass.
Topics: Cerebrovascular Disorders; Female; Hematoma; Humans; Middle Aged; Pineal Gland; Subarachnoid Hemorrhage
PubMed: 501370
DOI: 10.1136/jnnp.42.11.1050 -
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 -
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 -
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 -
Australian Family Physician Oct 2017
Topics: Aged; Combined Modality Therapy; Diagnosis, Differential; Hematoma; Humans; Magnetic Resonance Imaging; Male; Sarcoma; Thigh
PubMed: 29036774
DOI: No ID Found -
International Journal of Surgery... Mar 2023This study aimed to develop a prediction score named inflammatory score based on proper integration of several inflammatory markers and investigate whether it was...
BACKGROUND
This study aimed to develop a prediction score named inflammatory score based on proper integration of several inflammatory markers and investigate whether it was associated with hematoma expansion and poor outcomes in patients with intracerebral hemorrhage (ICH).
METHODS
This study involved a consecutive series of spontaneous ICH patients of two cohorts admitted within 24 hours after symptom onset. Inflammatory score (0-9) was developed with the combination of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, lactate dehydrogenase, and C-reactive protein. The authors investigated the association between inflammatory score and hematoma expansion and poor outcomes by using univariate and multivariate logistic regression analyses. The optimal cutoff point of inflammatory score was determined by receiver operating characteristic analysis in the development cohort and then validated.
RESULTS
A total of 301 and 154 ICH patients were enrolled in the development and validation cohorts. Inflammatory score was significantly higher in patients with hematoma expansion and poor outcomes. The multivariate logistic regression analysis revealed inflammatory score was independently associated with hematoma expansion, secondary neurological deterioration within 48 hours, 30-day mortality, and 3-month poor modified Rankin scale (4-6). The diagnostic accuracy of inflammatory score exhibited by area under the curve showed numerically or statistically higher than most of the individual indicators. Moreover, inflammatory score greater than or equal to 5 was selected as the optimal cutoff point, which was further prospectively validated with high diagnostic accuracy.
CONCLUSIONS
The inflammatory score is a reliable predictor for early hematoma expansion and short-term and long-term poor outcomes with good diagnostic accuracies in ICH patients.
Topics: Humans; Hematoma; Cerebral Hemorrhage; Biomarkers; Lymphocytes; Neutrophils; Prognosis
PubMed: 37093070
DOI: 10.1097/JS9.0000000000000191 -
The Neuroradiology Journal Jun 2015Cerebral arteriovenous malformation (AVM) in pregnancy is a complex situation and there is no agreement on its hemorrhage risk and treatment. Although studies on... (Review)
Review
Cerebral arteriovenous malformation (AVM) in pregnancy is a complex situation and there is no agreement on its hemorrhage risk and treatment. Although studies on bleeding risk of cerebral AVMs in pregnancy are very few, and they provide different results, pregnancy will increase the hemorrhagic risk of AVM and ruptured cerebral AVM in pregnancy should be actively treated. After intracranial hemorrhage, cerebral angiography should be performed for pregnant women shielded correctly. Cerebral angiography could clearly demonstrate the characteristics of cerebral AVM. Results from the literature show that the radiation dose of endovascular and stereotactic radiotherapy for cerebral AVM in pregnancy was below the safety value and was safe. For an unruptured AVM in pregnancy, if there are no bleeding factors, e.g. no coexisting aneurysm, smooth venous drainage, no venous ectasia, or high risk of treatment, then it should be observed conservatively.
Topics: Cerebral Angiography; Decompression, Surgical; Embolization, Therapeutic; Encephalocele; Endovascular Procedures; Female; Hematoma; Humans; Intracranial Arteriovenous Malformations; Intracranial Hemorrhages; Pregnancy; Pregnancy Complications, Cardiovascular; Radiosurgery
PubMed: 26246089
DOI: 10.1177/1971400915589692 -
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