Bluish Discoloration Research Articles

Rectal bleeding due to cavernous hemangioma in Klippel–Trenuany syndrome: a rare presentation and review of management

Introduction and importance: Klippel–Trenaunay syndrome (KTS) is a rare congenital disorder with an incidence of about 2–5:100 000. It is characterized by the triad of cutaneous hemangiomas, soft tissue or bone hypertrophy, and venous malformations. Gastrointestinal (GI) involvement in KTS, although uncommon, can lead to severe complications such as profuse GI bleeding. Our case highlights the challenges and management strategies of a patient with KTS. Case presentation: A 5-year-old child presented with rectal bleeding since birth, accompanied by swelling and bluish discoloration on left flank, and multiple varicose veins on left leg. Examination revealed small hemangiomatous lesions scattered along the torso and trunk. Barium enema showed diffuse mucosal irregularity with polypoidal filling defects in the rectum and sigmoid colon. Doppler ultrasound revealed slow-flow vascular lesions in the left flank and leg without arteriovenous communication. Computed tomography (CT) scan showed diffuse cavernous hemangiomas in the descending colon, sigmoid colon, and rectum. Histopathology demonstrated numerous dilated, irregular vascular channels with calcification and hemosiderin-laden macrophages. Clinical discussion: GI tract cavernous hemangiomas can cause chronic bleeding and anemia, necessitating careful evaluation. Imaging modalities like CT and Doppler ultrasound are crucial for assessing vascular lesions. Surgical interventions, including partial proctocolectomy and colorectal anastomosis, effectively control bleeding and improve outcomes. A multidisciplinary approach is essential for managing such cases. Conclusion: This case underscores the importance of multidisciplinary management in KTS with GI bleeding. Effective diagnostic imaging and surgical treatment are key to managing severe complications and achieving successful outcomes. Long-term follow-up is crucial to monitor for recurrence and residual lesions.

Kinetic Modeling of Brilliant Blue Discoloration by Ozonation

This paper presents the results of investigations on the kinetic modeling of Brilliant Blue FCF (BB) discoloration reactions in aqueous solutions with different ozone concentrations and pH conditions. Kinetic studies involve knowledge of the structure and properties of dye and ozone, as well as of the experimental conditions. In general, scientists admit that the predominant oxidation pathway is direct (by free oxygen atoms) or indirect (by free hydroxyl radicals); this will depend on influencing factors such as the physicochemical properties of the dye, the pH of the aqueous solution, ozone concentration, reaction time, and the contact mode with/without stirring. In this experimental research, two pathways were chosen following CBB = f(t)—1. a constant dye concentration and different ozone concentrations, in the concentration range of 100–250 mg/L, in three pH media (acidic, neutral, and basic), with and without stirring; 2. a constant concentration of ozone and different dyes in the concentration range of 2.5–10 mg/L, under the conditions of point 1. With the obtained experimental data, the curves CBB = f(t) were drawn and processed according to the integral method of classical kinetics, based on first- and second-order equations. Unfortunately, this simple procedure did not give any results for the pH values studied. The rate constants were negative, and/or the reaction order depended on the initial conditions. Due to its structure, the BB dye has several chromophore groups, and thus multiple attack centers, resulting in several oxidation by-products, which is why the 1H-NMR spectrum was recorded for the discoloration of BB with ozone. Since the stoichiometry of the overall oxidation reaction, as well as the relationship between the rate constant and the reaction conditions mentioned above, is not known, a kinetic model based on mass transfer coupled with a chain reaction in the bulk liquid phase was proposed and successfully tested at pH = 7. This research approach also involves the consolidation of the theoretical bases of the ozonation process through the kinetic study carried out, as well as the proposal of a kinetic model. These systematics lead to results that are applicable to other aqueous systems that are impure with dyes, allowing for generalizations and the development of the field, ensuring the sustainability of the research.

Preparation and Complex Characterisation of Stabilised Gold Nanoparticles: Biodistribution and Application for High Resolution In Vivo Imaging.

The Turkevich method was optimized to prepare gold nanoparticles (AuNP) stabilized by polyethyleneglycol (PEG) for µCT. Using various independent modalities, we thoroughly characterized the optimized PEG-AuNPs. Here, we show that PEG-AuNPs are retained in the blood and provide a high contrast in the high-resolution µCT imaging of blood vessels and inner organs. The biodistribution is characterized by prolonged circulation in the blood and accumulation in the liver, spleen and skin. The accumulation of AuNP in the skin resulted in the blue discoloration of eyes and the whole skin. In vitro experiments using a leukemic monocyte THP-1 cell line model expressing high levels of NLRP3 demonstrated that the NLRP3inflammasome was not activated by PEG AuNP. Over 9 months, the mice were scanned by µCT and were in good health. Scans in mice using PEG-stabilized AuNPs in this study were sharper, with a higher contrast, when compared to a commercial contrasting agent at the same dose. The PEG-AuNPs were morphologically and chemically stable for at least two years when stored in the refrigerator.

Facial changes in individuals deceased from ethanol poisoning

BACKGROUND: Changes in the facial area (facial edema, its purplish or bluish color, drooling, tearing, and a sign described by A.P. Kurdyumov) are among the most commonly observed signs of ethanol poisoning. However, their diagnostic capabilities are not investigated, and the mechanisms of development are not described. AIM: To study the occurrence of changes in the facial area in individuals who died from ethanol poisoning. From a modern perspective, the mechanism of their development, characteristics, and specificity were assessed. MATERIALS AND METHODS: A single-center retrospective observational cross-sectional study was conducted based on the archive of the State Budgetary Healthcare Institution of Moscow Region “Bureau of Forensic Medical Examination,” including cases of death from January 1, 2020, to December 31, 2020. Cases were grouped into five categories: ethanol poisoning, poisoning with other alcohols, asphyxia, other violent causes of death, and natural death. RESULTS: The study included 1,181 cases, with a median age of 52 (range, 19–95) years. Women were older, with no significant difference in blood ethanol concentration. Facial puffiness was observed in 53.1% of ethanol poisoning cases and bluish discoloration in 59.5%. The sign described by A.P. Kurdyumov was less frequently observed. Facial puffiness (p=0.002) and the sign described by A.P. Kurdyumov (p=0.014) were more common in poisoning with other alcohols than in deaths from asphyxia. However, no such differences were observed for facial bluish discoloration (p=0.176). Facial bluish discoloration had the highest sensitivity in both alcohol and other alcohol poisoning cases (59.53% and 40.74%, respectively) but had the lowest specificity in the same groups among the examined signs. The sign described by A.P. Kurdyumov had the highest specificity among those examined for both ethanol poisoning and poisoning with other alcohols. CONCLUSION: In ethanol poisoning, facial bluish discoloration was the most sensitive sign, and the sign described by A.P. Kurdyumov was the most specific among the analyzed signs. The examined signs were observed in both ethanol and other alcohol poisoning but less frequently. The forensic medical signs considered are largely similar to the clinical signs observed in flush syndrome.

Indocyanine green fluorescence perfusion testing in robot-assisted hepatic arterial infusion pump placement

BackgroundHepatic arterial infusion pump (HAIP) treatment is a technique used to treat liver localized malignancy with intra-arterial chemotherapy. Methylene blue is generally administered to verify hepatic perfusion and exclude inadvertent extrahepatic perfusion. The use of indocyanine green dye (ICG) combined with near-infrared (NIR) fluorescence imaging during robot-assisted HAIP placement may be an attractive alternative by providing high contrast without blue discoloration of the operative field.MethodsData was collected retrospectively from 2 centers in the Netherlands. Intraoperative perfusion of the liver segments and extrahepatic perfusion were assessed using ICG/NIR as well as methylene blue on video imaging and correlated to postoperative 99 m-Tc perfusion scintigraphy.Results13 patients underwent robot-assisted surgery for HAIP placement; median length of stay was 4 days, complications occurred in 4 patients. Hepatic perfusion showed identical patterns when ICG was compared with methylene blue. In 1 patient, additional extrahepatic perfusion was found using ICG, leading to further vessel ligation. Intraoperative ICG perfusion was concordant with 99 m-Tc perfusion scintigraphy.DiscussionLiver and extrahepatic perfusion determined by ICG fluorescence imaging is concordant with blue dye perfusion and 99 m-Tc perfusion scintigraphy. Therefore, ICG fluorescence imaging is deemed a safe and reliable technique for perfusion testing during robot-assisted HAIP placement.Graphical abstract

Effect of agitation speed on methylene blue discoloration kinetics via ambient air cold plasma

AbstractThis research investigates the kinetics of methylene blue (MB) discoloration using ambient air cold plasma, with a focus on the impact of agitation speed (100 and 750 rpm). The study revealed pseudo‐first‐order kinetics for MB discoloration, pinpointing optimal conditions at 35.00°C and 100 rpm. These parameters minimized half‐life times, correlated with observed kobs values. A decreasing pH trend, more pronounced at 750 rpm, was attributed to increased acidic nitrogen species (HNO3 and HNO2) production, adversely affecting dye discoloration. Concurrently, enhanced electrolyte concentration was noted from rising conductivity due to plasma production of reactive species followed by solubilization in the aqueous phase. The calculated thermodynamic activation parameters comprised: Ea = 7.96 kJ mol−1, ΔH‡ = +5.53 kJ mol−1, ΔS‡ = −253.23 J K−1 mol−1, and ΔG‡ = +79.77 kJ mol−1 (100 rpm); and Ea = 12.94 kJ mol−1, ΔH‡ = +13.78 kJ mol−1, ΔS‡ = −239.06 J K−1 mol−1, and ΔG‡ = +80.58 kJ mol−1, (750 rpm). The lowest Ea and ΔG‡ values at 100 rpm reinforced lower agitation favoring the reaction. The study demonstrated a linear decay of the reaction rate constant with the square root of ionic strength. This result, besides the negative activation entropy and moderate activation enthalpy led to a proposition to the determinant step for the transition state formation, involving an associative step between a solvated electron and the protonated substrate. The optimal dye discoloration rate and energy yield were observed at 35.00°C and 100 rpm, with values of 97.2% and 3.371 × 10−2 g kW−1 h−1, respectively.

From diagnosis to recovery – a detailed case report on a nail bed glomus tumor

Introduction and aim. Glomus tumors represent benign neoplastic proliferations of the glomus body, an integral thermoregulatory component within the cutaneous microvasculature. Although they can manifest at various anatomical sites, they are predominantly observed in the subungual region. The tumors present as painful, firm, purplish, solitary nodules of the extremities, especially in the nail bed. They may be solitary or multiple; solitary lesions are encapsulated and most commonly subungual, while multiple tumors are unencapsulated and rarely subungual. Description of the case. Here, we present a case of multiple glomus tumors of the right hand in an 18-year-old female who presented with complaints of painful bluish discoloration of the right little finger for six years and progressive asymptomatic nodules on the right index finger for six months. A clinical examination revealed acute tenderness in both fingers. Love’s pin test and Hildreth’s test were positive. Excision of all lesions was done and sent for histopathology, which confirmed the diagnosis. The patient was symptom-free immediately following surgery. No nail deformities were noticed, and there was no recurrence of symptoms after one year of follow-up. Conclusion. The transungual approach is a safe and effective minimally invasive surgical technique for the treatment of symptomatic nail bed glomus tumors. It offers high success rates, promising cosmetic outcomes, and minimal complications. However, careful patient selection and meticulous surgical technique are essential to avoid potential nail deformities.

Anesthesia in Emergency PDA Stenting with Pulmonary Arteri Atresia

Pulmonary atresia with an intact ventricular septum is a condition that is characterized by a complete obstruction to right ventricular outflow. This condition is fatal if untreated. Ductus arteriosus communicate between pulmonary artery and proximal descending aorta. It is essential in fetal life as a communicating shunt to send blood from right ventricle bypassing the underdeveloped lungs. Ductal patency may be lifesaving in few cyanotic congenital heart diseases to maintain pulmonary blood flow.Case Illustration : We present a case of a 1‑day‑old, 3405 g child who presented to casualty with bluish discoloration. The child had central cyanosis, tachypnea with saturation 80% on 1 L/minute nasal cannula and desaturate to 40%. Transthoracic echocardiography (TTE) revealed intact intraventricular septum with pulmonary atresia and patent ductus arteriosus (PDA). The patient scheduled to an emergency PDA stenting. A heating blanket is installed on the operation table, oxygen saturation with Pulse‑oxymeter, noninvasive blood pressure, end-tidal CO2 monitor, and temperature monitoring were done. Anesthesia induction was performed with 50% oxygen in air, fentanyl 3 µg/kg, ketamine 2 mg/kg, atracurium 0.5 mg/kg and maintained with sevoflurane. The procedure was performed about 20 to 30 minutes. After procedure, oxygen saturation was increased up to 60%. The child was successfully extubated after 24 hours in the Neonatal Intensive Care Unit (NICU) with saturation 92%.Conclusion: PDA stenting is a less invasive palliative procedure for ductal dependent complex congenital heart diseases. Anesthesiologist's role were maintaining arterial saturation and hemodynamics, securing vascular assess, maintaining temperature. It needs thorough understanding of underlying physiology.

Bovine Renal Lipofuscinosis in a Tanzanian Crossbred Yearling Male Calf: A Case Report

Aim: To report a rare case of bovine renal lipofuscinosis (BRL) that was encountered incidentally at necropsy. Presentation of the Case: In June 2023 an yearling male calf was found dead in one of the dairy cattle farms in Mbeya city, Tanzania; after being sick for about a week. The owner requested a necropsy service to establish the cause of the death of the animal. Necropsy revealed significant gross pathological changes in a liver that was cooked-like and shrunken, with flabby consistence and large pale necrotic foci. Furthermore, dark blue discoloration of both kidneys with normal morphology was evident. Based on the history and gross pathological findings, the animal was diagnosed to have died from acute hepatitis. Differential diagnosis for kidney discoloration included hemachromatosis, renal hemosiderosis, BRL, and melanotic renal cell carcinoma (MRCC). After ruling out hemachromatosis, renal hemosiderosis and MRCC in the list of possible causes of kidney discoloration based on the lack of gross pathological findings, particularly hepatic fibrosis, pallor, and a mass of tumor tissue in the kidneys that are characteristic of hemachromatosis, renal hemosiderosis and MRCC, respectively; the cause of kidney discoloration was diagnosed as BRL. Discussion: In this necropsy, the history and gross pathology suggested that the animal’s death could be attributed to acute liver failure, which is one of the sequelae of acute hepatitis. Kidney discoloration was not considered an attribute factor to the animal’s death because, with the exception of discoloration, the kidneys did not have gross pathological changes. Moreover, to date there has been no report of a clinical disease in cattle associated with BRL. However, BRL is an important disorder because it leads to condemnation of the affected kidneys as unfit for human consumption. Conclusion: The case of BRL reported here was an incidental finding at necropsy, and is not associated with the death of the animal.

Evaluation of Catalytic Conditions for Dye Discoloration Using Nano‐TiO2 Films: A Fractional Factorial Design Approach

AbstractIn this research, selected catalytic activity conditions of nano Cu‐TiO2 films were evaluated through a 2IV4−1 Fractional Factorial Design for methylene blue discoloration. The following conditions were set at two levels: dye concentration (mg/L) (A) at 3.13 and 5.81; aeration (psi) (B) with and without; radiation (nm) (C) at 320 (UV) and 470 (Visible); and nano‐TiO2 films (D) without and with Cu‐doping. Films were prepared by the Sol‐Gel dip‐coating method and characterized using X‐ray diffraction, revealing an anatase phase in TiO2; and anatase, rutile, and brookite crystalline phases in Cu‐doped nano‐TiO2, with average band gap energies of 3.82 and 3.77 eV. The catalytic activity of films was significantly affected (p<0.05) by aeration (0.0002), radiation (0.001), and Cu‐doped nano‐TiO2 (0.004). Dye concentration did not have a significant effect; however, the AC interaction was significant (p=0.015). A discoloration efficiency of 46.23 % was obtained with 5.81 mg/L dye concentration using Cu‐doped TiO2, with UV radiation and without aeration, whereas a 52.32 % efficiency was achieved with 3.13 mg/L dye concentration using non Cu‐doped TiO2. Using factorial designs allows us to identify the main variables and their interactions to determine the optimal conditions for the catalytic activity of nano‐TiO2.

Estimating Time Since Death From Post Mortem Lividity: An Autopsy Study Conducted in Government Medical College and Ssg Hospital ofCentral Gujarat State of India

Background: Evaluation and estimation of time since death is a fundamental part of medico-legal investigations. Post mortem lividity or post-mortem staining is a bluish or reddish-purple discoloration due to capillo-venous distension with blood, at the under surface of the skin on the dependant parts of the body, as a result of settling of blood in those areas following pulling by gravity, after circulation of the blood in motion ceases. A study was conducted in the department of forensic medicine, GovernmentMedical College and SSG hospital, Vadodara to evaluate time since death by method of studying post mortem lividity. This was prospective and observational study conducted on 256 dead bodies brought for post mortem examination from November 2021 to August 2022. It was observed that the Post mortem Lividity starts appearing as a patchy form by 1-7 hours and well develops by 7-13 hours. Post mortem Lividity gets fixed by 8-18 hours following death. It was concluded that compared to other methods, the post mortem lividity assessment can be used as the most conventional, easy and quicker method for estimating time since death

Evaluation of vat blue removal by Aspergillus niger using scanning electron microscopy and glucose oxidase enzyme activity

AbstractThe use of fungi to reduce dye removal in water from diverse industries can be an efficient option for solving environmental problems. However, the mycoremediation processes involved in color removal are unknown. In this article, Aspergillus niger CDBB‐H‐175 was applied for vat blue discoloration (DC). Hence, inactive biomass by two methods (metabolic inhibitor and heat) and active biomass were studied by scanning electron microscopy and enzyme activities to determine the vat blue DC. When using active biomass, 62% of DC, glucose oxidase (GOX) enzyme activity, 1.19 U/mL and 1.43 mg/L of H2O2 were obtained. It was observed that 68% of DC was due to the degradation process and 32% was due to biomass sorption. When the biomass was inactivated with sodium azide, DC increased by 90% (1.45‐fold), low GOX activity (0.138 U/mL), and H2O2 (0.25 mg/L) were detected. High DC might be due to a high dye sorption in hyphae, since an increase in the thickness and morphology of the hyphae were observed by SEM. Inactivated biomass through heating, showed a 69.5% of DC, where 0.01 U/mL GOX and 0.25 mg/L H2O2 were reached, demonstrating that inactivation of A. niger biomass by sodium azide can be considered as an alternative treatment for colored wastewater.

Systemic and cutaneous side effects of COVID-19 vaccines in Iraq, A cross-sectional study

BackgroundCoronavirus disease has recently emerged as a major health concern. The rapid development of vaccines for this infection raises concerns regarding its efficacy and safety. These concerns may lead to the refusal of vaccination, which will only open room for further pandemic flare-ups.The aim of this study was to assess the cutaneous and systemic side effects of COVID-19 vaccines (Pfizer/BioNTech, Oxford/AstraZeneca, and Sinopharm). MethodsA cross-sectional descriptive analytical study included 677 participants, both vaccinated and non-vaccinated, the questionnaire was distributed online through Google form. Questions about vaccine preference, awareness, fear and side effects of vaccination. Three types of vaccines were used in Iraq (Pfizer/BioNTech, Oxford/AstraZeneca, and Sinopharm) and their side effects were compared. ResultsThe three different vaccines have shown variable side effects. The major source of knowledge regarding vaccination was social media (44.5 %). ConclusionPfizer/BioNTech vaccine was the most preferred vaccine in this study. Refusal to vaccinate was mainly attributed to fear of thromboembolic complications. Most of the side effects were mild to moderate among the participants. The most prevalent side effects were pain at the site of injection, tenderness and exhaustion. While the most common cutaneous side effects were redness at site of injection, urticaria and bluish discoloration of the skin respectively.

Brittle cornea syndrome—A rare genetic disease

To report a case of an 8-year-old girl who presented with bluish discoloration of sclera, keratoconus, and progressive high myopia. She had a history of recurrent shoulder dislocation. A general physical examination showed a midfacial hypoplasia, upturned nares, thick and tented upper lip, and hyperextensible joints. The genetic analysis showed ZNF469 mutation suggestive of Brittle cornea syndrome 1 (BCS-1). We aim to highlight the importance of timely diagnosis and early provision of protective glasses seems to be the most important step in treating BCS.

Eco-friendly synthesis of Zn0.97La0.03O compound with natural polysaccharide and its application in methylene blue and eosin dyes discoloration

Herein, a study about to eco-friendly synthesis of Zn0.97La0.03O compound using Mangifera Indica gum and its application in the methylene blue and eosin dyes discoloration was conducted. The compound presented lattice and surface defects that enhanced the photocatalytic activity. Defect concentrations were determined by area percentages under Gaussian curves fitted from the Photoluminescence spectrum. The concentrations were V0 = 39.63 %, V0+ = 11.82 %, and VZn = 48.55 %. Furthermore, the compound exhibited a significant surface area measuring 12.2 m2 g−1 and an average particle size of 34 nm. The photocatalytic test showed that the Zn0.97La0.03O compound had a discoloration rate of 100 % for methylene blue and 77.8 % for yellow eosin. The scavenger tests confirmed that holes and hydroxyl radicals were the crucial species in the decolorization mechanisms. Finally, after three cycles, the material effectively removed methylene blue (100 %), but only removed 48.1 % of eosin in the third cycle.

Frequency of the prominent transverse nasal root vein in children.

The presence of a vascular, blue linear discoloration on the nasal root of infants and young children is a frequent incidental feature, rarely reported in the medical literature. It is related to the trajectory of the transverse nasal root vein (TNRV). To study the frequency and clinical characteristics of the vascular discoloration of the nasal root in children. A prospective study was performed to address the presence or absence of vascular discoloration of the nasal root in all children under 6 years of age attending a pediatric dermatology clinic from November 2022 to November 2023. Data on age and skin phototype (Fitzpatrick classification I-VI) were also collected. Of 701 patients examined, 345 (49.2%) presented with a vascular discoloration of the nasal root. This was present in 97 of 193 (50.3%), 127 of 261 (48.7%), and 121 of 247 (49.0%) patients for the age groups 0-1, 1-3, and 3-6 years, respectively. The presence of vascular discoloration of the nasal root was more frequent in patients with lighter Fitzpatrick skin phototypes: 49 of 69 (71.0%) phototype II, 157 of 290 (54.1%) phototype III, and 137 of 337 (40.7%) phototype IV. A vascular discoloration of the nasal root is a frequent skin feature in infants and children, persisting at least until the age of 6. It does not constitute any medical problem aside from cosmetic concern and parents can be reassured of its benign nature. We propose the medical term "prominent TNRV" to describe this condition.

Minocycline-Induced Black Bone Disease in Foot and Ankle Surgery: A Case Report.

Bone and periarticular tissue discoloration can be an unexpected finding that is often disconcerting for surgeons and may alter surgical plans and overall patient management. Common causes of bone discoloration include infection, avascular necrosis, and bone inflammation. Minocycline-induced black bone disease is a rare and relatively benign abnormality encountered in foot and ankle surgery that can cause significant black, blue, and gray discoloration of bone. Unanticipated intraoperative findings of diffuse black, blue, and gray bone discoloration during an elective forefoot operation raised concern for a metabolically malignant process and prompted the conversion of plans for a first metatarsophalangeal joint implant arthroplasty to a Keller arthroplasty. The plan for proximal interphalangeal joint arthroplasties of the lesser digits were continued as planned. Bone specimens were sent for pathologic analysis. Postoperative analysis identified chronic use of a minocycline for acne vulgaris. Pathologic analysis of the specimens ruled out malignant processes. Altogether, the data available led to the diagnosis of minocycline-induced black bone disease. Since the last follow-up, the patient has healed well without complications. Our case report underscores the importance of including the chronic use of tetracyclines in medical history intake during preoperative visits to assist the surgeon in intraoperative decision-making.

Pilomatricoma of the Neck in a Young Boy: An Overlooked Entity

Pilomatricoma is known as one of the benign tumors of the skin appendages. This tumor originates from the matrix cells of the hair follicle. It usually presents as a superficial, firm mass, commonly found in the head and neck region which may pose a diagnostic challenge as it may resemble other common benign lesions such as, sebaceous and epidermoid cysts. Pilomatricoma is best diagnosed by excisional biopsy and histopathological examination. Pathologically, these skin lesions show the presence of basaloid cell islands, eosinophilic cytoplasmic cells without nuclei, as well as haemorrhage and calcification. They typically present as a superficial, firm, solitary, slow-growing mass of the dermis. The overlying skin may exhibit a bluish discoloration or tethering. Treatment consists of surgical excision. Recurrence is rare after complete resection. Malignant pilomatricomas have rarely been reported. We report a case of a young boy with pilomatrixoma of neck, surgical management and histopathological findings.

Acute Upper Limb Ischemia Secondary to Primary Left Subclavian Thromboembolism: A Case Report

Acute primary subclavian thromboembolism by itself is an infrequent occurrence. There is a prevalence of less than 1% in the world population. It remains crucial to have a high suspension of such cases as they are usually asymptomatic. Early treatment is imperative to avoid complications. Treatment modalities vary depending on the cause of the disease. We report a 46-year-old previously healthy female in the Emergency Department who presented with excruciating pain and bluish discoloration of the fourth and fifth digits of the left upper limb. A Computed tomography angiogram showed partial thromboembolism of the left subclavian artery.

Acute Compartment Syndrome in a Neonate: May Be the First Manifestation of Hemophilia A

Abstract Background: Acute compartment syndrome (ACS) most commonly results from traumatic or ischemic injuries, though rarely it may result from an underlying bleeding disorder. Reports of ACS in hemophilia are present; however, neonatal presentation secondary to hemophilia A is extremely rare. Clinical Description: A 5-day-old neonate presented with increasing swelling and hematoma over the dorsum of both hands following venipuncture. There was no other bleeding manifestations. Antenatal history and natal history were uneventful, and the baby had received a birth dose of Vitamin K. On examination, the hematoma was larger on the right hand than the left, extending from the proximal interphalangeal joints of all the digits to the wrist proximally, with tension on palpation and increased capillary refilling time, associated with bluish discoloration of hands and fingers with claw hand appearance. Oxygen saturation on pulse oximeter was 80%–85%. Management and Outcome: The baby had a hemoglobin of 16.3 g/dL, white blood cell count of 5300/mm3, platelet count of 2.33 lakhs/mm3, and elevated activated partial thromboplastin time >120 s with a normal prothrombin time of 12 s. Factor assay confirmed severe factor VIII deficiency (<1%). Ultrasonography Doppler of the hand confirmed compartment syndrome. Cryoprecipitate was given perioperatively, and fasciotomy was done. Perfusion of the hand improved, and oxygen saturation normalized. Healing was accomplished without any closure, with good cosmesis and complete functional recovery by 14 days. Conclusion: ACS may be an unusual primary presentation of hemophilia as early as in the neonatal period. Timely identification of ACS and early suspicion of an underlying bleeding disorder can help in undertaking appropriate evaluation and management strategies and preventing catastrophic consequences.