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Purpose: To report the computed tomography features of a case with complete luxation of the globe after a road traffic accident. Case Report: A 35-year-old male presented with pain, loss of vision, and bleeding from the left eye 48 hr after a road traffic accident. The ophthalmic examination of the left upper and lower eyelids showed edema with subcutaneous hematoma, crepitus, and complete blepharoptosis. On retracting the eyelids, the left eyeball was not visible and the patient was not able to perceive light. The left temporal region appeared filled with a soft, palpable globular structure situated beneath the temporalis muscle. A non-contrast computed tomography (NCCT) of the head and orbits showed a comminuted and displaced fracture of the floor, medial, and lateral orbital walls in addition to a displaced tripod fracture of the left zygomatic bone. The intact left eyeball was seen below the temporalis muscle without any optic nerve or extraocular muscle attachment. The virtual reality reconstruction highlighted a contributory supero-temporal defect in the bony orbit, which appeared large enough to accommodate the intact eyeball. Conclusion: The computed tomography of the orbits provided a detailed location of the luxated eyeball and provided guidance in further management of the case.

Keishibukuryogan is a Kampo medicine that induces vasodilation and improves the blood flow velocity in subcutaneous blood vessels. We herein report two cases in which keishibukuryogan completely diminished subcutaneous hematoma after cardiac resynchronization therapy pacemaker implantation and defibrillator battery replacement within a month. Keishibukuryogan can be a good option for treating or preventing subcutaneous hematoma after surgical procedures for devices.

We report a case with rare signs of subcutaneous hematoma, ecchymoses, and pleural effusion resulting from rupture of a thoracic aneurysm and aortic dissection. An 81-year-old woman had a history of aneurysm for 4 years. Ruptured chronic thoracic aortic dissection was diagnosed in the patient. After 2 weeks of medical therapy, the hematoma in the chest wall was absorbed, the pleural effusion almost disappeared, and the patient’s general condition improved. At 6 months follow-up, the patient had no chest discomfort. This case highlights an uncommon sign of ruptured thoracic aneurysm and aortic dissection that clinicians should be aware of.

Background: This study compares the efficacy of two elastic bandages in treating forearm hematoma after transradial coronary intervention.Methods: A total of 60 patients with moderate or severe forearm hematoma following transradial coronary intervention were enrolled in this study. They were randomly divided into two groups, as follows: an Idealast-haft elastic bandage group (the observation group) and a control group. The patients in the Idealast-haft elastic bandage group received compression bandaging with Idealast-haft elastic bandages and the patients in the control group received compression bandaging with Nylexorgrip elastic bandages. Observation indexes related to, for example, forearm pain, arterial pulsation, blistering, skin color, and hemostasis time were compared between the two groups.Results: The results revealed that the times taken for pain disappearance, arterial pulse recovery, blister disappearance, skin color recovery, and compression hemostasis were significantly shorter in the Idealast-haft elastic bandage group than in the control group, and the differences were statistically significant (P < 0.05). The hematoma range and the arm circumference at the severest part of the hematoma decreased faster in the observation group than in the control group, and the differences were statistically significant (P < 0.05).Conclusion: The Idealast-haft elastic bandage is more effective than the Nylexorgrip elastic bandage in patients with forearm hematoma following transradial coronary intervention and should therefore be used in such cases.

Background The use of cranial fixation devices in neurosurgery is very common, which is considered to be an important auxiliary method for many craniotomies. However, previous studies have reported complications of using cranial fixation devices, including brain tissue, nerve and blood vessel damage, scalp laceration, subcutaneous hematoma, etc. Some of the complications are serious and even potentially fatal, and the causes of which may be related to the incorrect use of cranial fixation devices. Although there are no serious complications in our review, the cause of that needs to be further summarized and analyzed, as so to minimize the serious consequences caused by the cranial fixation device slippage and ensure the safety of the patients’ surgical procedure. Case presentation In our recent work, we have continuously found three cases of unstable cranial fixation devices, which make us to analyze the possible factors and summarize experience combined with the review of other senior neurosurgeons (more than 3 years of working experience) from different departments of neurosurgery. Conclusions Based on our recent incidents of unstable cranial fixation and the experience of investigating and analyzing senior doctors from different neurosurgery centers, we summarized experience to minimize the risk of unstable cranial fixation. We tried a variety of options, including a safe anatomical location for cranial fixation, teamwork, and communication with anesthesiologists and itinerant nurses, to ensure the stability of the patient’s cranial fixation devices. The data obtained in this survey has great limitations, including the doctor’s personal prejudice and dependence on anecdotal memories. Therefore, the data should be interpreted with caution. However, there are still some modes that can help to better understand the use of safe cranial fixation. Based on the above research and analysis, we have made recommendations that may help neurosurgeons to avoid preventable complications

Ever since clozapine’s introduction, as a second-generation antipsychotic drug (SGA), it is thought to be one of the most...

Introduction Tension hematoma is a frequent traumatic condition in elderly population under anticoagulation treatments. However, scarce literature exists focused in the management of this condition. In this article, a retrospective study of patients that suffered from traumatic tension hematomas treated at a plastic surgery department is reported. The objective was to evaluate the approach that provided better clinical outcomes, and the establishment of an evidence-based protocol. Methods This retrospective study comprised 180 patients suffering from tension hematomas. Patients were divided in four groups: the first and second groups included patients that underwent debridement and coverage in one stage and two stages, respectively. The third group included patients that required debridement without skin grafting, and the fourth group, patients with hematomas that only necessitated drainage. Demographic variables, comorbidities, timing and complication rates of each technique were evaluated. Results Length of hospital stay, medical complication and mortality rates were significantly higher in patients who underwent debridement and coverage surgeries in two separate procedures (p < 0.05). Patients with small-sized hematomas (avg 0.63% of total body surface) required only debridement. Patients that only required hematoma drainage, were treated during the first 24 h after injury (p < 0.03). Conclusions Treatment of tension hematomas through early drainage should be performed as soon as possible from the time of injury. An evidence-based protocol should be established in every emergency department to improve patient clinical outcomes. When debridement and coverage surgery are required, they should be performed in one stage, to reduce length of hospital stay and the incidence of medical complications.

Background Failed back surgery syndrome (FBSS) is a challenging condition that lacks a curative treatment. In selected patients, spinal cord stimulation (SCS) has provided a satisfactory outcome. Objective To evaluate the long-term outcome of SCS in FBSS, as measured by (1) the explantation rate, (2) complications, and (3) patient satisfaction with the global perceived effect (GPE). Methods We studied 224 consecutive FBSS patients who underwent an SCS trial with surgically implanted leads at our hospital between January 1996 and December 2014. The patients' satisfaction with the GPE of treatment was measured through a postal questionnaire at the end of follow-up. Results Based on a 1-wk trial, permanent SCS was implanted in 175 (78%) patients. Out of these patients, 153 (87%) reported satisfactory outcomes after 2 mo. During the mean follow-up of 6 yr, 34 (19%) of SCS devices were permanently explanted due to inadequate pain relief, and 11 (6%) were explanted for other reasons.Electrode revision due to inadequate pain relief was done for 22 patients. In total, 26 complications were reported due to: 7 deep infections, 11 hardware malfunctions, 1 subcutaneous hematoma, 4 instances of discomfort due to the pulse generator, and 3 electrode migrations.One hundred thirty patients (74%) continued with SCS until the end of follow-up. Of them, 61 (47%) returned the questionnaire, and 42 (69%) reported substantially improved or better GPE. Conclusion SCS can provide a good outcome in the treatment of FBSS. Patient selection could be further improved by developing novel predictive biomarkers.

Knowing the elapsed time from subcutaneous hematoma generation can suggest appropriate treatment strategies. Today, ultrasound imaging, X-ray CT, and MRI are mainly used for diagnosis. However, they have difficulty in distinguishing hematoma from surrounding tissues because of their low image contrast and large device size. Furthermore, X-ray CT entails radio exposure; MRI is contraindicated for patients with embedded metal such as pacemakers. This study evaluated the feasibility of visualizing hematoma and evaluating its characterization using the handheld photoacoustic imaging system we developed. To evaluate the feasibility of estimating the bilirubin concentration, which increases as time passes from hematoma generation, simulated hematomas containing different bilirubin concentrations embedded into optical and acoustical transparent media were measured. Measurements of simulated hematoma using biological tissues were also conducted. The samples and linear ultrasound probe were set in degassed water. Pulses of laser light were guided to the sample surface by an optical fiber bundle close to the probe. Photoacoustic signals were obtained at 700–1030 nm wavelengths. Then photoacoustic spectra at high brightness areas in reconstructed images were calculated. Spectra differed by bilirubin concentrations. The photoacoustic signal ratio between two wavelengths was calculated. For both measurements, the feasibility of estimating bilirubin concentration using wavelengths of around 700 nm and around 900 nm were indicated. These analyses demonstrated the feasibility of visualizing subcutaneous hematoma and of evaluating its characterization using our handheld photoacoustic imaging system with multiple wavelengths.

Background and Objective. Transilluminated powered phlebectomy using the TriVex system is a new procedure for minimally invasive varicose vein surgery. We used the TriVex system for the removal of benign superficial subcutaneous soft tissue masses, and we also achieved satisfactory clinical effects. The objective of this study was to explore the feasibility, benefits, and technique-related complications of using the TriVex system for the removal of benign superficial masses as a novel and minimally invasive surgical technique. Method. Between January 2010 and August 2016, 452 patients with benign superficial soft tissue masses underwent surgical removal of masses using the TriVex II system in our department. The surgical complications, postoperative cosmetic outcome, and personal satisfaction were reviewed at a mean follow-up of 24 months. Results. The TriVex procedure was successfully completed in all patients using only local tumescent anesthesia without any technical problem and serious complications. The mean operation duration was 8.5 minutes, and the average blood loss was 5 mL. Surgical complications were observed in 69 cases (15.3%) of subcutaneous ecchymosis, 34 cases (7.5%) of skin perforation, 14 cases (3.1%) of subcutaneous hematoma, 13 cases (2.9%) of wound infection, and 7 cases (1.5%) of induration of operation area. Eleven patients (2.4%) showed recurrence during the follow-up and were cured by reoperation by the TriVex system. Overall, the majority of patients (N = 436, 96.5%) were very satisfied or satisfied with the outcome. Conclusion. The TriVex procedure for the removal of benign superficial masses is simple, safe, and effective with advantages of short operation time, small incisions, and good cosmetic outcome, which is predicted as a new minimally invasive surgery of superficial masses.

Following lumbar fusion, adjacent segment degeneration has been frequently reported. Dynamic systems are believed to reduce main fusion drawbacks. We conducted a retrospective study on patients with degenerative lumbar disease treated with posterior dynamic stabilization with monoaxial hinged pedicular screws and lumbar decompression. VAS and ODI were used to compare clinical outcomes. As radiological outcomes, LL and SVA were used. 51 patients were included with an average follow-up of 24 months. 13 patients were revised because of postoperative radiculopathy (n=4), subcutaneous hematoma(n=2), L5 screw malposition (n=1) and adjacent segment disease (n=6). The mean ODI score 41 preoperatively compared to 36 postoperatively. The mean VAS scores for back and leg pain were 5.3 and 4.2, respectively compared to 4.5 and 4.0 post-operatively. The mean SVA was 5.3 cm pre-operatively, and 5.7 cm postoperatively. The mean LL was 47.5° preoperatively and 45.5° postoperatively. From our data, whichfail to show significant improvements andreflect a high revision rate, we cannot generally recommend dynamic stabilization as an alternative to fusion. Comparative trials with longer follow-ups are required.

In cases of auricular surgery, postoperative dressings are thought to be important for keeping auricular contour and in helping to prevent from dressing failures due to edema or subcutaneous hematoma, which may result in fibrous or cartilaginous proliferation. However, it is often difficult to achieve success with standard dressings because of the complicated shape of the auricle. We used 2-octyl-cyanoacrylate skin adhesive to dress the auricle after different types of auricular procedures (five cases of cryptotia, two of prominent ear, two of severe auricular laceration, two of skin grafting and one of flap repair of the partial auricle defect). The 2-octyl-cyanoacrlaate skin adhesive was applied to the suture line and the operated and peripheral areas for wider coverage. No dressing materials were placed over the surface. In all cases, the desired outcome was achieved, without subcutaneous hematoma, wound dehiscence, and wound infection. Contact dermatitis caused by the skin adhesive was not observed in any of the cases. Dressing and splinting after auricular surgery can be simply and successfully achieved using 2-octyl-cyanoacrylate skin adhesive. There is no need for more complicated dressings and post-surgical dressing changes, resulting in higher patient satisfaction.

Objectives The purpose of this study was to report the effects of treatments to traumatic subcutaneous hematoma on the shin using herbal medication and external application without venesection, which had no change in spite of previous 3 weeks medical conservative treatment so it had a risk of sepsis.Methods The patient diagnosed as Soyangin was prescribed with Yangkyuksanhwa-tang. The subcutaneous hematoma lesion was treated by external application of Daehwangchija-san(大黃梔子散). We evaluated the size of hematoma, pain and gait disturbance.Results and Conclusions Subcutaneous hematoma and relevant symptoms disappeared within 11 days of admission. Any kind of sequela did not show up and skin color was recovered after 4 month later follow-up.

espanolEl tratamiento con farmacos anticoagulantes hace que el paciente que lo toma tenga el riesgo de presentar un hematoma subcutaneo ante un minimo traumatismo, cuyas consecuencias seran variables en funcion de la zona donde se produzca, las condiciones del paciente, asi como del adecuado tratamiento del mismo. Se expone el caso de un paciente varon de 85 anos de edad en tratamiento con acecumarol, que tras sufrir una caida accidental presento hematoma subcutaneo en extremidad inferior izquierda, siendo derivado al Hospital Comarcal de Alcaniz (Teruel) ante la persistencia y mala evolucion del mismo. Se realiza una valoracion enfermera segun el modelo de Virginia Henderson y se establecen diagnosticos de Enfermeria desarrollando el plan de cuidados, para ello se utilizan las clasificaciones de North American Nursing Diagnosis Association (NANDA), Nursing Outcome Classification (NOC) y Nursing Interventions Classification (NIC). Al seguir un plan de cuidados individualizado y con el uso de la terapia de presion negativa (TPN) como eje principal del tratamiento de heridas complejas y de amplia extension, se consiguio una rapida y satisfactoria resolucion de la herida gracias al trabajo de un equipo multidisciplinar. EnglishAnticoagulant drug treatment leads patients to be at risk of presenting a subcutaneous hematoma caused even by a minor injury, with consequences that will vary according to the area where it appears and patient status, as well as to the adequate treatment received. We present the case of a male 85-year-old patient on treatment with acecoumarol who, after an accidental fall, presented a subcutaneous hematoma in his lower left limb, and was referred to the Hospital Comarcal de Alcaniz (Teruel) due to its persistence and bad evolution. Nursing assessment was conducted according to Virginia Henderson’s model, and nursing diagnosis was established for developing the plan of care, using the classifications by the North American Nursing Diagnosis Association (NANDA), Nursing Outcome Classification (NOC) and Nursing Interventions Classification (NIC). By following an individualized plan of care and using Negative Pressure Therapy (NTP) as the cornerstone for the treatment of complex and large wounds, a fast and satisfactory solution was found for the wound, through the work of a multidisciplinary team

Aim The aim of this study was to evaluate cure rate and mid-term results of tension-free vaginal tape for recurrent stress urinary incontinence after failed transobturator tape surgery. Material and Methods Between January 2006 and December 2011, 42 women were enrolled in this study. Patient characteristics and operating parameters were recorded, and any complications were noted. All patients were followed up for at least 24 months after the second surgery. The Incontinence Impact Questionnaire and the Urinary Distress Inventory were used to identify satisfaction level. Results The mean age of the patients was 49.07 ± 8.6 years, and median period between transobturator surgery and the tension-free vaginal tape procedure was 12.8 (range 9.2–17.8) months. The cure rate was 83.3% and 76.2% at the first- and second-year follow-up visits, respectively. Intraoperative complications were transient and slight. Bladder injury in five patients and subcutaneous hematoma above the pubis in two patients were the most serious complications, but they were managed conservatively. We found the scores of the Incontinence Impact Questionnaire and Urinary Distress Inventory to be significantly lower at follow-up, compared to the preoperative assessment. De novo urgency was the most common complaint at follow-up and occurred in 11.9% of the women. Conclusions We suggest that tension-free vaginal tape is a feasible surgical option for recurrent stress urinary incontinence. Further studies with larger patient numbers and longer follow-up periods are needed to support this finding.

It is common to treat bromhidrosis by surgery, but postoperative complications such as subcutaneous exudate and subcutaneous hematoma can occur and lead to delayed healing of the wound and eventually lead to the formation of unattractive scars. In this study, we evaluated our new surgical treatment for bromhidrosis, which we believe improves prognosis over conventional surgery. The new procedure was performed on 22 patients with bromhidrosis. Our procedure is as follows. One centimeter-long incisions are made along the skin and cleaning of the subcutaneous apocrine glands using a special serrated scraping device is completed. Then, several 0.5 cm-long drainage holes are made according to the design of the Sudoku puzzle and 4 anchoring points identified to stabilize the oil gauze. Finally, the incisions were sutured and the wound covered with a bandage. Of 44 axillas, the bromhidrosis of 42 axillas was completely cured, and greatly reduced in 2 axillas. Local epidermal necrosis occurred in 5 axillas, but there was no full-thickness skin necrosis. Subcutaneous hematoma was not observed, and postoperative scarring was minimal. We found that our modified surgery can effectively reduce the occurrence of subcutaneous hematoma, avoid delayed healing of the wound, and minimize postoperative scarring. Level II, therapeutic study.

Life-threatening large subcutaneous hematomas after minor injury are rare clinical states for young people; however these patients may have hidden diseases, which can cause a tendency to bleed. A 31-year-old woman visited our hospital after minor injury. The first computed tomography (CT) scan revealed a small subcutaneous hematoma, but her head bulged and the second CT scan revealed her subcutaneous hematoma had become enlarged. Two surgeries were needed to stop the bleeding and. Though she received intensive care, she died 48 days after onset. The new Ehlers-Danlos syndrome (EDS), known as EDS Kosho type (EDSKT), is a connective tissue disease, in which patients often experience large subcutaneous hematomas. We suspected our patient had EDSKT because her clinical features were compatible with this syndrome. Our findings support the notion that large subcutaneous hematomas in young patients with connective tissue disease can be fatal; a careful follow-up is required.

Introduction: Transthoracic ultrasound is an important tool in assessing pleural effusions and placement of chest drains. It also demonstrates pleural-based masses and lung tumours abutting the pleura, lesions usually suitable for US-guided biopsy (USGB). This procedure is not being widely performed by chest physicians. Objective: To assess safety and efficacy of USGB performed by chest physicians in outpatient setting. Methods: The procedures were carried out in outpatient setting between August 2015-January 2016. Apart from informed written consent, checking clotting and omitting antiplatelet/anticoagulants, no special preparations were undertaken. Under real-time US, lesions involving/abutting the pleura which were >15mm were sampled 1-3 times with a full-core biopsy needle (Biopince® 18G). Repeat US was done 10 minutes and 30 minutes post-biopsy, ruling-out pneumothorax. Patients were discharged home 30 minutes post-biopsy. Results: 48 patients had USGB for lung/mediastinal tumours. Biopsies were histologically deemed adequate in 97.9%, with overall yield 97.9% and yield for malignancy 91.6% (44/48), all in accordance with The Royal College of Radiologists. In 1 patient with a negative biopsy, malignancy was diagnosed at surgery. Complications were minimal with one case of minor haemoptysis (2%) and one case of small subcutaneous hematoma (2%). We had no pneumothoraces and no deaths (0%). After the introduction of the service the waiting list for tissue diagnosis has disappeared. Conclusion: USGB can be performed by trained chest physicians with excellent yield and very low complication rate in outpatients. When used appropriately, it reduces the waiting list for tissue diagnosis.

A coagulopathy with subcutaneous bleeding and muscular or peritracheal/periesophageal bleeding occurred in two male Japanese Brown calves of the same dam. One of the affected calves died three days after the onset of bleeding and the other survived normally until being slaughtered despite once suffering from subcutaneous hematoma. Hemostatic tests of the latter case showed prolonged activated partial thromboplastin time (APTT), and severely reduced factor VIII activity. In addition, von Willebrand factor activity, determined by the human platelet aggregation test, was within the normal range; therefore, the calf was diagnosed with hemophilia A. These are the first bovine cases of hemophilia A definitely diagnosed clinicopathologically.

We present two cases of subcutaneous hematoma in which color Doppler US revealed colored areas under probe compression, and Doppler waveforms obtained from these areas changed rapidly (from a constant flow to a pulsatile flow, and from a high-velocity flow to a slow-velocity flow) according to the degree of probe compression. In our cases, a sufficient number of blood cells within the lesion moving under probe compression was thought to give rise to Doppler signals and changes in Doppler waveforms.