Tolerated nitrite therapy in experimental intracerebral hemorrhage: Rationale of nitrite therapy in a broad range of hyperacute strokes

Nitrite therapy is more effective in cerebral ischemia when administered earlier. It would be beneficial during the hyperacute stages of stroke if the nitrite effect is demonstrated in intracerebral hemorrhage (ICH). When nitrite is injected intravenously 3 h after ICH induction in rats, most doses of nitrite provided no beneficial effects on behavioral deficits, brain edema and hematoma volumes. A high dose of nitrite, however, decreased hematoma volume, but not brain edema. Peri-hematomal apoptosis and inflammation were similar between the control and nitrite groups. Nitrite therapy may be considered a therapeutic option in hyperacute stroke because nitrite therapy is tolerated in ICH as well.     

Low back pain during pregnancy caused by a sacral stress fracture: a case report

Introduction

Sublingual hematoma secondary to excessive anticoagulation is a rare but potentially fatal condition, and few cases have been documented in the literature.

Case presentation

We report the case of a 73-year-old Caucasian woman who attended our Accident and Emergency department with massive sublingual hematoma causing superior displacement of the tongue. The condition was found to be the result of an elevated international normalized ratio, further complicated by a traumatic mandibular denture.

Conclusions

In summary, we recommend the immediate reversal of anticoagulation therapy on admission of patients with severe sublingual hematoma. We further advise surgical decompression/drainage if required and to continue meticulous monitoring. In all cases of early recognition of sublingual hematoma, prompt medical treatment and continuous clinical monitoring is essential, and may prevent the need for a surgical airway procedure.     

Small Bowel Obstruction Due to Intramural Hematoma During Anticoagulant Therapy—A Non-Surgical Condition

Intramural hematoma of the small bowel should be suspected in any patient with signs or symptoms of small bowel obstruction who is having anticoagulant drug therapy, especially if it is longterm therapy and if the prothrombin time is excessively prolonged. A barium study is indicated and if the roentgen pattern is characteristic, conservative treatment is indicated. Unless there is an associated abdominal lesion requiring operation, most patients will improve in four to six days. Those not improving usually have other complicating conditions.     

Splenic hematoma as a first manifestation of cytomegalovirus infection

Splenic rupture is rare but life threatening complication of mononucleosis syndrome. It has been suggested that subcapsular splenic hematoma formation precedes rupture. The case of 44-year-old, previously healthy, male with splenic hematoma occurring after rising of heavy cargo is reported. Mononucleosis syndrome was suggested based on routine laboratory tests (elevated white blood cell count with predominance of lymphocytes and raised serum transaminases) and CMV infection was confirmed by serological test. Nonoperative management was used since the patient was hemodynamically stable with no further signs of splenic rupture. The same approach has been used in growing number of cases of patients with spontaneous splenic rupture in mononucleosis syndrome. Importance of considering splenic hematoma and/or rupture if abdominal pain occurs in the course of mononucleosis syndrome is outlined as well as importance of routine laboratory tests in suspecting mononucleosis syndrome in otherwise clinically silent patient.     

CT-guided stereotactic surgery for evacuation of hypertensive intracerebral hematoma

During the last 3 years, 46 cases of hypertensive intracerebral hemorrhage were treated by CT-guided stereotactic surgery. Our present report is concerned with the evaluation of this procedure in the treatment of hypertensive intracerebral hematoma, in terms of the rate of aspirated hematoma and follow-up study of patients. It is difficult to draw any definite conclusion about the operative indications. CT-guided stereotactic aspiration, however, can be evaluated as a less invasive and more definitive treatment of intracerebral hematoma in the basal ganglia and thalamus.     

Safety and efficacy in an accredited outpatient plastic surgery facility: a review of 5316 consecutive cases

Advances in medicine have improved the delivery of health care, making it more technologically superior than ever and, at the same time, more complex. Nowhere is this more evident than in the surgical arena. Plastic surgeons are able to perform procedures safely in office-based facilities that were once reserved only for hospital operating rooms or ambulatory surgery centers. Performing procedures in the office is a convenience to both the surgeon and the patient. Some groups have challenged that performing plastic surgery procedures in an office-based facility compromises patient safety. Our study was done to determine whether outcomes are adversely affected by performing plastic surgery procedures in an accredited outpatient surgical center. A retrospective review was performed on 5316 consecutive cases completed between 1995 and 2000 at Dallas Day Surgical Center, Dallas, Texas, an outpatient surgical facility. Most cases were cosmetic procedures. All cases were analyzed for any potential morbidity or mortality. Complications requiring a return to the operating room were determined, as were infection rates. Events leading to inpatient hospitalization were also included. During this 6-year period, 35 complications (0.7 percent) and no deaths were reported. Most complications were secondary to hematoma formation (77 percent). The postoperative infection rate for patients requiring a return to the operating room was 0.11 percent. Seven patients required inpatient hospitalization following their procedure secondary to arrhythmias, angina, and pulmonary emboli. Patient safety must take precedence over cost and convenience. Any monetary savings or time gained is quickly lost if safety is compromised and complications are incurred. The safety profile of the outpatient facility must meet and even exceed that of the traditional hospital-based or ambulatory care facility. After reviewing our experience over the last 6 years that indicated few complications and no deaths, we continue to support the judicious use of accredited outpatient surgical facilities by board-certified plastic surgeons in the management of plastic surgery patients.     

Attitude of zoo visitors to the idea of feeding live prey to zoo animals

Two hundred UK zoo visitors were asked about their attitudes regarding the feeding of live prey to zoo animals. All visitors agreed with live insects being fed to lizards, providing it was done off-exhibit, and only 4% objected if done on-exhibit. Seventy-two percent of visitors agreed with live fish being fed to penguins on-exhibit and 84.5% agreed to feeding live fish off-exhibit. However, only 32% agreed to a live rabbit being fed to a cheetah on exhibit, whereas 62.5% agreed to this if done off-exhibit. In general we found female interviewees more likely to object to the feeding of live vertebrate prey. Comments volunteered by interviewees suggested that they agreed with feeding live vertebrate prey because ‘it is natural’. If they objected, it was because ‘it would upset them or their children’. Zoo Biol 16:343–347, 1997. © 1997 Wiley-Liss, Inc.     

Shock wave lithotripsy and renal hemorrhage

Although shock wave lithotripsy is a safe and efficacious treatment for nephrolithiasis, the most common acute complication is renal hemorrhage. Shock wave-induced renal hemorrhage is a potentially devastating injury if not promptly recognized and treated appropriately. The authors report a large perirenal hematoma occurring after shock wave lithotripsy and review the causes, prevention, and treatment of shock wave-induced renal hemorrhage.     

FUNNEL CHEST (PECTUS EXCAVATUM) IN INFANCY AND ADULT LIFE

Funnel chest, unless corrected, may lead to cardiorespiratory distress or psychic problems or both. Since operation to correct the deformity is relatively simple in infancy and much more extensive if done later, early surgical intervention is indicated. If the condition is not noted until the patient is beyond infancy, cardiorespiratory studies will aid in determining the advisability of operation.     

POSTOPERATIVE ESOPHAGEAL COMPLICATIONS—Prevention and Treatment

Postoperative esophagitis and stricture formation may be more serious than the disease for which operation was done.The best treatment is prevention by avoiding use of a nasogastric tube if possible. If it has to be used, the tube should have a small lumen and be removed as soon as possible.When surgical operation is necessary, the cardioesophageal junction should not be sacrificed unless it is absolutely necessary to do so.Conservative treatment if begun early can minimize or prevent the development of esophagitis and subsequent stricture formation.     

Behavioral Studies with Electromagnetic Fields: Implications for Psychobiology

Research In the behavioral effects of non-ionizing radiation has progressed very slowly over the past twenty years. Of the little that has been done, much of it has been in imitation of Soviet work using archaic, insensitive behavioral techniques. Much of this work has been done by scientists not qualified in experimental psychology and they seem to be unaware of the elegance and sensitivity of behavioral techniques that have been developed in the United States. A critical review of the literature available, though, reveals that (1) effects are most clearly and reliably discerned when time-based schedules of reinforced behavior are used; (2) pulsed or modulated fields have more impact than CW fields, something that can be observed only if the behavioral measure is reliable and sensitive; and (3) magnetic fields may be especially potent for some species, if not all. Directions for future research are suggested.     

The in vitro cell fusion of embryonic chick muscle without DNA synthesis

A system has been developed for the in vitro development of chick skeletal muscle monolayers, in which a burst of synchronous fusion occurs, such that some 40% of the spindle-shaped cells fuse in a 10-hr period. Cells inhibited from synthesizing DNA by ara-C do fuse, but at a later time than the normal burst. If ara-C is added to cultures 6 hr or more before the normal fusion time, fusion is delayed, but no delay results when the drug is added after this time. A medium change will delay the fusion if done 4 hr or more before fusion, but gives no delay if done later. Cells grown in conditioned medium fuse some 10 hr earlier than controls, even in the presence of ara-C, as do cultures prepared at higher than normal cell densities. The data suggest that muscle cell fusion is independent of DNA synthesis in vitro, but depends upon a modification of the culture medium to a sufficient degree required for initiating the synthetic program for fusion.     

Multi-component model of intramural hematoma

A novel multi-component model is introduced for studying interaction between blood flow and deforming aortic wall with intramural hematoma (IMH). The aortic wall is simulated by a composite structure submodel representing material properties of the three main wall layers. The IMH is described by a poroelasticity submodel which takes into account both the pressure inside hematoma and its deformation. The submodel of the hematoma is fully coupled with the aortic submodel as well as with the submodel of the pulsatile blood flow. Model simulations are used to investigate the relation between the peak wall stress, hematoma thickness and permeability in patients of different age. The results indicate that an increase in hematoma thickness leads to larger wall stress, which is in agreement with clinical data. Further simulations demonstrate that a hematoma with smaller permeability results in larger wall stress, suggesting that blood coagulation in hematoma might increase its mechanical stability. This is in agreement with previous experimental observations of coagulation having a beneficial effect on the condition of a patient with the IMH.     

Splenic Subcapsular Hematoma—Ultrasonic Diagnosis

In five patients with varying histories of blunt abdominal trauma, examinations were carried out with ultrasonography and other imaging modalities. In all five patients, large, fluid-filled masses were noted in the left upper quadrant. Two patients had nonpalpable hematomas, but examinations were done because of history and vague clinical symptoms. Three patients had palpable masses. In all five patients there was surgical confirmation of the ultrasonic findings, and all recovered without complications. Ultrasonic tomography offers a convenient noninvasive method for assessing suspected splenic hematoma and can also exclude the possibility in a careful examination.     

Endoscopic surgery versus conservative treatment for the moderate-volume hematoma in spontaneous basal ganglia hemorrhage (ECMOH): study protocol for a randomized controlled trial

ABSTRACT: BACKGROUND: Spontaneous intracerebral hemorrhage is a disease with high morbidity, high disability rate, high mortality, and high economic burden. Whether patients can benefit from surgical evacuation of hematomas is still controversial, especially for those with moderate-volume hematomas in the basal ganglia. This study is designed to compare the efficacy of endoscopic surgery and conservative treatment for the moderate-volume hematoma in spontaneous basal ganglia hemorrhage. METHODS: Patients meet the criteria will be randomized into the endoscopic surgery group (endoscopic surgery for hematoma evacuation and the best medical treatment) or the conservative treatment group (the best medical treatment). Patients will be followed up at 1, 3, and 6 months after initial treatment. The primary outcomes include the Extended Glasgow Outcome Scale and the Modified Rankin Scale. The secondary outcomes consist of the National Institutes of Health Stroke Scale and the mortality. The Barthel Index(BI) will also be evaluated. The sample size is 100 patients. DISCUSSION: The ECMOH trial is a randomized controlled trial designed to evaluate if endoscopic surgery is better than conservative treatment for patients with moderate-volume hematomas in the basal ganglia.     

Chronic expanding hematoma

Two cases of chronic expanding hematoma are presented. Although the location and presentation vary, chronic expanding hematoma has a distinct histopathologic pattern. A diagnosis of neoplasm is suggested by its slow growth pattern. The criteria for their formation are incompletely understood, and in one case, a hematoma occurred despite apparent adequate drainage. Computed tomography is helpful in distinguishing chronic expanding hematoma from other soft-tissue masses.     

Detection of cancer of the lung; results of a chest x-ray survey in Los Angeles

In a mass survey by x-ray minifilm in Los Angeles County, apparently suspicion of cancer of the lung was reported in more than 90 per cent of cases in which the condition existed. Of the patients who were appropriate for resection with intent to cure, 35.8 per cent had "three-year cures." This high cure rate indicates that if the condition is detected early by the survey method and "curative" operation is done, cure rate for lung cancer may be much higher than is usually thought.     

一组有或无CT 脑灌注" 点征"的自发性脑内出血患者临床效果观察

目的:观察有或无CT脑灌注"点征"自发性脑内出血(sICH)患者的临床疗效。方法:以本院2013年5月~2015年5月就诊的100例s ICH,均接受基线CT脑灌注检查,依据是否有"点征"将患者分为观察组(有"点征")与对照组(无"点征"),24内行CT平扫复查,比较两组影像学结果及临床结果。并通过Logistic多因素分析影响s ICH患者预后不良(死亡)危险因素。结果:观察组24h内CT平扫复查血肿增长6 mL以上、血肿增长相对值33%及以上比率均明显高于对照组(P0.05);观察组血肿进展发生率、3个月内死亡率分别为63.04%、36.96%,显著高于对照组的14.81%、7.41%(P0.05)。Logistic回归分析发现sICH患者预后不良独立危险因素包括基线血肿体积、"点征"。结论:有或无CT脑灌注"点征"自发性脑内出血患者血肿进展、预后不同,基线血肿体积、"点征"为sICH患者预后不良的独立危险因素。     

The canine tail artery as a model for cerebral aneurysm studies

The occluded canine tail artery, which comes off in the same plane as the aortoiliac junction, has been used as a flow model for cerebral aneurysms. These experiments were designed to determine if it is a realistic distensible model of human intracranial aneurysms. Distensibility studies were done on the aorta, and the iliac and tail arteries of four dogs. From these pressure-volume studies, tension-strain curves, elastances, and collagen slack were obtained. The tail artery is stiffer longitudinally and more distensible circumferentially than the other vessels. The iliac arteries and the aorta are not significantly different. The elastance of elastin and collagen is lower in the tail artery, and the collagen is more wavy circumferentially. Longitudinally, the collagen slack is least for the tail artery, and the elastance of elastin is not different in all three vessels. The number of elastin layers in the iliac and tail arteries seen in cross section is not significantly different, but the aorta is different from both these vessels. In another four dogs the aorta proximal to the trifurcation was cannulated and infused with saline to increase pressure. India ink marks were put on the surface to measure changes in length. Photographs were taken at intervals of 10 mmHg(1 mmHg = 133.3 Pa). This was done with the vessels tethered and untethered in the body and then taken out and studied with the same method in vitro. Arteries tethered in the body expanded circumferentially more than longitudinally. The tail artery becomes less distensible if untethered in the body and therefore acts more like an aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)     

The fate of breast implants with infections around them.

In a retrospective study of 41 infected breasts following the insertion of implants, a high incidence of postoperative hematoma was noted. When infection occurred, cultures usually demonstrated the causative organism to be Staphylococcus aureus. Treatment by conservative drainage and vigorous antibiotics was generally successful in salvaging those implants which had been inserted through an areolar incision for simple augmentation, or under the pectoralis muscle (or a dermal pedicle) after a subcutaneous mastectomy. Those patients whose augmentations had been done through an inframammary incision, or whose implant after a subcutaneous mastectomy was under the skin flap, had a statistically higher incidence of implant loss. Most breasts will salvaged implants became firm.