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Four neonates with adrenal hemorrhage are presented. The clinical manifestations included most often an abdominal mass but also anemia, jaundice, hypotension, bluish discoloration of the scrotum, and abdominal calcification. The diagnosis was established in each case upon abdominal sonographic findings. The review of these patients emphasizes the subtle and diverse clinical presentation of adrenal hemorrhage in a neonate and stresses the importance of abdominal sonography in establishing the diagnosis. Clin Pediatr. 2001;40:545-548, Introduction Adrenal hemorrhage is a relatively uncommon clinical problem of the newborn period. The incidence ranges from approximately 1.7 per 1000 of autopsied newborn infants to approximately 3% of infants [...]

A relatively recent advance in the treatment of acute myocardial infarction (MI, heart attack) is the use of thrombolytic drugs to dissolve the clot blocking the coronary artery. One thrombolytic agent is tissue plasminogen activator (tPA). While tPA is effective at dissolving the clot in 70 to 89 percent of patients, it can induce hemorrhage as a side effect. Clinical studies of tPA have noted bleeding in 15 to 33 percent of patients, with a serious form of bleeding, intracranial (brain) hemorrhage, occurring in 0.6 to 1.6 percent. The cases of six patients who were treated with tPA after an MI and developed intracranial hemorrhage are discussed. Hemorrhage began between two and 14 hours after the infusion of tPA was finished; all patients also received heparin, an anticoagulant drug. Four of the patients died from massive intracranial hemorrhage, and it was concluded that several factors may have contributed to this response. The medication tPA, or the combination of tPA and heparin, was considered a potential cause, as was a possible vascular abnormality at the site of the bleeding. Hypertension was not implicated as a contributing factor. In theory, tPA should be less likely to cause unintended bleeding than other thrombolytic agents due to its effects on blood components, yet these cases suggest that the risk may not be as small as expected. Continued reporting of intracranial hemorrhage in patients receiving tPA is needed so that the mechanism, and potential patient risk factors, can be identified. Use of heparin in combination with tPA may not be warranted if no benefit can be demonstrated and the risk for bleeding is shown to be enhanced. (Consumer Summary produced by Reliance Medical Information, Inc.)

A 29-year-old female presented with facial cellulitis. Past medical history includes DVT of the right upper extremity secondary to PICC line for which she was receiving coumadin. Physical exam was notable for facial pustular cellulitis and she showed good response with IV Vancomycin but subsequently developed progressively worsening dyspnea with hypoxia. Auscultation of chest revealed bilateral scattered crackles with poor bilateral air entry. CXR showed bilateral interstitial markings of the lungs, with a diffuse nodular pattern. The labs revealed drop in Hct and INR of 6.95. CT angiogram showed diffuse ill-defined interstitial opacities with nodular appearance. Bronchoalveolar lavage revealed bloody aliquots consistent with DAH secondary to supratherapeutic INR. Coumadin was discontinued and steroids were administered for a potential capillaritis and the patient responded well. This case highlights a relatively unusual presentation of DAH due to supratherapeutic INR, which was likely precipitated by concurrent warfarin therapy and antibiotic administration. Keywords: Warfarin | Intra Alveolar Hemorrhage | Coumadin | drug induced, Introduction Diffuse alveolar hemorrhage (DAH) refers to a clinical syndrome resulting from injury to the alveolar capillaries, arterioles, and venules leading to red blood cell accumulation in the distal air [...]

Background: Soft-tissue sarcomas comprise, Case report An 80-year-old gentleman came to the surgical outpatient department with a swelling for the last 6 months, an ulcer over the swelling for the last month and bleeding [...]

An 86 year-old man resented to the emergency department after falling down a flight of stairs with a chief complaint of lower back pain. Physical examination was unremarkable except for tenderness to palpation along the lumbar paraspinal musculature. Although a trauma workup revealed no visceral injury or bony fracture the patient had lower back pain severe enough to require intravenous hydromorphone and so he was admitted for pain management., Introduction An 86 year-old man resented to the emergency department after falling down a flight of stairs with a chief complaint of lower back pain. Physical examination was unremarkable except [...]

We present the case of a 42-year-old woman who developed nystagmus and dizzness after a whiplash injury. Cerebral Magnetic Resonance Imaging showed in the right cerebellopontine angle a meningioma which was asymptomatic before the trauma. The patient underwent surgical excision of the mass through an extended trans-apical translabirintic approach. The specimen revealed areas of microhemorrhage dispersed throughout the tumour. Since the signs and symptoms developed shortly after the accident and the patient was completely asymptomatic just before, it is likely that the whiplash injury participated in the microhemorrhagic event due to the acceleration-deceleration mechanism. Keywords: meningioma, whiplash injury, videonystagmography, intratumoral microhemorrhage, Table of Contents Abstract Introduction Case Report Discussion References Introduction This work presents a case of intracranial meningioma which was revealed by a possible intratumoral bleeding secondary to neck injury. [...]

Perthes' syndrome (traumatic asphyxia) is a rare occurrence, caused by sudden compressive chest trauma and characterized by subconjunctival hemorrhage, facial edema, craniocervical cyanosis, and petechiae on the upper chest and face. We present a 4-year-old girl who developed traumatic asphyxia associated with intramedullary spinal cord hemorrhage following by thorax compression. This is the first report of Perthes' syndrome associated with intramedullary spinal cord hemorrhage. Keywords: traumatic asphyxia, Perthes syndrome, intramedullary hemorrhage, Table of Contents Abstract Introduction Case Report Discussion Conclusion References Introduction The acute thoracic compression syndrome was first described over 150 years ago by Olivier, and has been variously termed [...]

Table of Contents Abstract Introduction Case Summary Discussion References Abstract Postpartum haemoperitoneum after normal vaginal delivery is a rare clinical entity. We encountered a 23 years old primipara woman who [...]

Table of Contents Abstract Introduction Case Discussion References Abstract Nowadays, drug-induced pulmonary toxicity is increasing and early diagnosis is important because of the associated morbidity and mortality. Diffuse alveolar haemorrhage [...]

Table of Contents Abstract Introduction Case report Discussion References Abstract During the last two decades laparoscopic surgery became popular and has been used for the removal of several lesions and [...]

Byline: BOBBAK VAHID, MD, BERNADETTE WILDEMORE, MD, TIMOTHY LIN, MD, NEIL MUSHLIN, DO, FREDRIC JAFFE, DO, and GREGORY C. KANE, MD Allopurinol, commonly used to treat patients with gout, has [...]

Is this patient's second disc hemorrhage also related to normotensive glaucoma? An 86-year-old white female presented as a new patient in May 2001. Her glasses were broken, and she needed [...]

A 58-year-old man who had primary open-angle glaucoma presented for an intraocular pressure evaluation. He used the topical β-blocker timolol maleate, 0.25%, in each eye twice a day. His intraocular [...]

A 66-year-old woman is transferred to your facility for evaluation of a posterior fossa hemorrhage with decreased level of consciousness. Upon the patient's arrival, the nurse informs you that the [...]