Chronic Hematoma Research Articles

Chronic Subepicardial Hematoma: A Multimodality Imaging Diagnostic Approach After Elective Percutaneous Transluminal Coronary Angioplasty.

Chronic Subepicardial Hematoma: A Multimodality Imaging Diagnostic Approach After Elective Percutaneous Transluminal Coronary Angioplasty.

Space-occupying chronic hematoma of the Achilles tendon after rupture 10 years ago

Space-occupying chronic hematoma of the Achilles tendon after rupture 10 years ago

In vivo comparison of mesh fixation solutions in open and laparoscopic procedures for inguinal hernia repair: A meta-analysis

BackgroundAbdominal hernia repair surgeries involve the fixation of a surgical mesh to the abdominal wall with different means such as suture, tacks, and glues. Currently, the most effective mesh fixation system is still debated. This review compares outcomes of mesh fixation in different surgical procedures, aiding surgeons in identifying the optimal technique. MethodsA meta-analysis was conducted according to PRISMA guidelines. Articles published between January 2003 and January 2023 were searched in electronic databases. Randomized controlled trials (RCTs) comparing mesh fixation with cyanoacrylate-based or fibrin glues with classical fixation techniques (sutures, tacks) in open and laparoscopic procedures were included. Results17 RCTs were identified; the cumulative study population included 3919 patients and a total of 3976 inguinal hernias. Cyanoacrylate-based and fibrin glues were used in 1639 different defects, suture and tacks in 1912 defects, self-gripping mesh in 404 cases, and no mesh fixation in 21 defects. Glue fixation resulted in lower early postoperative pain, and chronic pain occurred less frequently. The incidence of hematoma was lower with glue fixation than with mechanical fixation. Recurrence rate, seroma formation, operative and hospitalization time showed no significant differences; but significantly, a higher number of people in the glue group returned to work by 15- and 30-days after surgery when compared to the tacker and suture groups in the same time frame. ConclusionCyanoacrylate and fibrin glue may be effective in reducing early and chronic pain and hematoma incidence without increasing the recurrence rate, the seroma formation, or the operative and hospitalization time.

Initial Experience with Unidirectional Barbed Suture for Abdominal Donor Site Closure in Deep Inferior Epigastric Perforator Flap Breast Reconstruction.

The deep inferior epigastric perforator (DIEP) flap is a predominant technique for autologous breast reconstruction. However, the best method of abdominal fascial closure in this technique is not well defined. This study details our initial experience with unidirectional barbed suture-only repair of abdominal donor site fascia. Patients who underwent DIEP flap breast reconstruction and abdominal fascial closure with Stratafix Symmetric Polydioxanone PDS Plus were retrospectively reviewed. Information regarding pertinent patient history, medical comorbidities, risk factors, and surgical technique was extracted, along with the incidence of eight separate postoperative abdominal surgical site occurrences. Retrospective review identified 43 patients who underwent 19 unilateral and 24 bilateral DIEP flap breast reconstruction procedures (n = 67). Average patient follow-up was 791 days (range 153-1769). Six patients (14%) had a complication of the donor site. Seroma was most frequent (n = 3, 7%), followed by surgical site infection (n = 2, 5%). One patient had incisional dehiscence (2%) and another patient developed bulging (2%). No patients had chronic pain, weakness, hematoma, or hernia postoperatively. Patients with donor site complications had a history of abdominal/pelvic surgery significantly more often than the patients without donor site complications (100% versus 49%; P = 0.032). Abdominal fascial repair with Stratafix Symmetric suture alone led to low rates of abdominal donor site morbidity, including no hernia and rare bulging, following DIEP flap breast reconstruction. Additional advantages of this technique may be reduced operative times and lower operative costs compared with alternative methods of fascial repair, although prospective and randomized studies are warranted.

Comparison of brain imaging and physical health between research and clinical neuroimaging cohorts of ageing.

To compare brain MRI measures between Adult Changes in Thought (ACT) participants who underwent research, clinical, or both MRI scans, and clinical health measures across the groups and non-MRI subjects. Retrospective cohort study leveraging MRI, clinical, demographic, and medication data from ACT. Three neuroradiologists reviewed MRI scans using NIH Neuroimaging Common Data Elements (CDEs). Total brain and white matter hyperintensity (WMH) volumes, clinical characteristics, and outcome measures of brain and overall health were compared between groups. 1166 MRIs were included (77 research, 1043 clinical, and 46 both) and an additional 3146 participants with no MRI were compared. Compared to the group with research MRI only, the clinical MRI group had higher prevalence of the following: acute infarcts, chronic haematoma, subarachnoid haemorrhage, subdural haemorrhage, haemorrhagic transformation, and hydrocephalus (each P < .001). Quantitative WMH burden was significantly lower (P < .001) and total brain volume significantly higher (P < .001) in research MRI participants compared to other MRI groups. Prevalence of hypertension, self-reported cerebrovascular disease, congestive heart failure, dementia, and recent hospitalization (all P < .001) and diabetes (P = .002) differed significantly across groups, with smaller proportions in the research MRI group. In ageing populations, significant differences were observed in MRI metrics between research MRI and clinical MRI groups, and clinical health metric differences between research MRI, clinical MRI, and no-MRI groups. This questions whether research cohorts can adequately represent the greater ageing population undergoing imaging. These findings may also be useful to radiologists when interpreting neuroimaging of ageing.

Ossification of Cranial Epidural Hematomas: A Systematic Review of Management Strategies and Presentation of an Illustrative Case.

The presence of a calcified or ossified chronic cranial epidural hematoma (EDH) is rare and has been described in only a few case reports in the literature. Consequently, clear treatment strategies remain elusive and may entail conservative and surgical approaches. In this study, we performed a systematic review of reported cases to evaluate the clinical course and treatment options for these patients. A comprehensive systematic search of two databases was performed, and information on patient characteristics, symptomatology, and treatment was extracted from eligible articles. A total of 56 cases were included in our analyses. Forty patients were male, 16 were female, with an average age of 21.38 years at the time of diagnosis. Assumed etiology was previous trauma in 35 cases, previous cranial surgery in 17 patients, and birth trauma and epidural bleeding after the utilization of the Mayfield clamp in 1 case each. The origin remained unclear in two cases. The time between trauma or surgery and diagnostics ranged between one and a half weeks and 50 years, with a median of 4 years (SD 9.8 years). The symptoms were very heterogeneous, ranging from acute neurological deterioration to chronic symptoms. In 15 cases, patients were asymptomatic, and cranial imaging was performed as part of a new trauma or a screening for other disease. Forty-one patients received surgical treatment by craniotomy and hematoma evacuation, and 13 patients were treated conservatively. In two cases, the liquid hematoma portion was aspirated through a burr hole. The localization of calcified or ossified EDH was mainly supratentorial. Young male patients most commonly present with calcified or ossified EDH after trauma, according to the epidemiological trend of acute EDH. Clinical presentation varies from asymptomatic to severe neurological deficits and signs of increased intracranial pressure. There is no standardized treatment; decisions must be made on an individual basis.

Lead Toxicity from Retained Bullet Fragments in Soft Tissue

Introduction The full extent of adult lead poisoning and toxicity is difficult to ascertain because of limited data; existing data and research findings suggest that it remains an important environmental and public health problem even if population levels are decreasing. The prevalence of elevated lead levels is decreasing in the United States. The consequences of lead exposure may be reduced by taking an occupational and environmental health history, recognizing the early symptoms of elevated blood lead levels (BLLs) and lead poisoning, having a low threshold for suspecting asymptomatic lead exposure based on an occupational and environmental history or medical findings, and checking BLL in such cases to verify the diagnosis and provide appropriate advice and treatment. Case Presentation A 19-year-old Hispanic male presented to the emergency department with symptoms of worsening abdominal pain, anorexia, weight loss (10 lbs. over 2 months), constipation, low back pain, right knee pain, and headache that has been going on for two weeks. Complete blood counts showed microcytic anemia with a peripheral smear showing basophilic stippling; Computerized tomography of the head, abdomen, and pelvis showed no acute findings. Iron profile was within normal limits. Upon careful history and examination, he revealed that he had suffered an accidental gunshot injury to his right knee 6 years ago with retained bullet and had undergone a popliteal artery repair. His knee ray showed retained bullet fragment encased in a chronic calcified hematoma. This led us to suspect lead poisoning and ordering of venous lead level. His blood lead level came back and was elevated to a toxic level of 136.2 mcg/dl (Normal &amp;lt;5.0 mcg/dl). The patient was taken to the operation theatre for extraction of bullet fragments, and the hematoma that was evacuated showed that the inside of the capsule had blackish-grey discoloration possibly from lead. Simultaneously the patient was started on the chelating agent, Succimer. The patient's symptoms gradually improved and were at baseline with no active complaints. He was followed as an outpatient and lead levels were noted to be down trending. He continues to be followed with monthly checks of his blood lead levels. Discussion In lead poisoning, symptoms are most likely to occur in adults with blood lead levels (BLL) &amp;gt;80 mcg/dL. With BLL 40 to 80 mcg/dL, the symptoms are less severe and are variable. Adults with BLL &amp;lt;40 mcg/dL are usually asymptomatic and lead toxicity should be a diagnosis of exclusion. While acute intoxication leads to gastrointestinal, musculoskeletal, neuropsychiatric, and hematological effects, chronic exposure is linked to increased risks of mortality from oncological and cardiovascular causes. Because lead poisoning often presents with nonspecific symptoms and signs, the diagnosis must be suspected based on exposure, occupational history, and other associated symptoms. BLL should be obtained as this forms the basis upon which management and decisions are made. Chelation therapy is suggested for patients with a BLL &amp;gt;80 mcg/dL and all patients with a BLL &amp;gt; 100 mcg/dL. At a minimum, for patients with BLL &amp;lt;10 mcg/dL, surveillance with repeat BLL testing should be done at least annually if lead exposure continues. For BLL 10 to 29 mcg/dL, a repeat BLL should be obtained every three months until BLL is reduced to &amp;lt;10 mcg/dL. For BLL &amp;gt;30 mcg/dL, BLL should be repeated every month.

COMPARATIVE ANALYSIS OF COMPLEX INFORMATION SYSTEM TESTING METHODS

&#x0D; &#x0D; &#x0D; &#x0D; The research has been based on surgical experience of multiple decades and on retrospect study of more that 4000 clinical cases, among them 3500 surgical invasion due to different types of traumas. Since it relies on the latter, it shows the evolution of our approaches towards severe cerebral cranial traumon includes different matters regarding diagnostics and surgical treatment with neuropathogenetic approach. We have shown the advantages of certain surgical procedures in cases of cerebral cranial trauma and also the way approaches were changing after introduction of high medical technology and taking into consideration bio mechanisms and pathological data. Computer diagnostics changed several surgical procedures and opportunities. In cases of traumas impacted in immobilized condition method of choice used to be plastic craniotomy, when in cases of cerebral congestion would cause decompression, placing bone fragment under the skin. 902 surgeries were performed among 1990. In 894 cases surgeries were performed using plastic trepanation, 217 among them was performed with improved modified method. In cases of negligible brain congestion, bone fragment was left in its place without suture fixation and after the congestion resolution fragment would return to its anatomical location. In several times it would be ligated in 2-3 points. This method was the most efficient in bi-frontal low craniotomy. The need of removing bone fragment was observed in zero cases.&#x0D; In cases of acceleration traumas, which is characterized by diffuse damage, multifocal hemorrhages and bruises, in 157 cases double decompression method was used, in some case with falcostomy, effective in 49 cases. Trafination and resection trepanation were removed from practice.&#x0D; Trafination method was sometimes use in cases of chronic hematomas and acute hydromas. In Recurrent and chronic hydromas method was less effective, in such conditions plastic trepanation method was used in order to create extra space for fluid. In singular cases of collapsed brain and for resolving tunica arachnoidea broken surface, we used to infuse 25-35 cubic oxygen or 20-25 distillate in spinal cord. This method was proved effective in 70 cases. Therefore, taking into consideration patho-mechanisms and pathology data, using differential pathogenetic methods of surgical invasion and computer monitoring of post-operative period we managed to decrease mortality in severecerebro-cranial traumas to 29-30% comparing to pre computer periods 36-38 % and comparing to data of other clinics 35-45%.&#x0D; &#x0D; &#x0D; &#x0D;

Minimally Invasive Endoscopic Interventions in the Treatment for Traumatic Intracranial Hematomas

Traumatic brain injuries are a global problem, with more than 50 million people suffering from brain injuries every year. A frequent consequence of severe traumatic brain injury is intracranial hematoma (ICH), causing mortality, disability, post-traumatic epilepsy. ICH has different clinical manifestations and physical characteristics. Standard treatment for ICH includes conservative monitoring for small volume hematomas or surgical evacuation of the hematoma. Craniotomy is often used to remove hematomas, because acute and subacute hematomas contain clots, and drainage of the hematoma cavity alone is not enough. In chronic hematomas, drainage through a hole is usually used, but this is effective only if the hematoma is represented by one cavity and its contents are completely liquid, which is not always the case. Thus, widely used techniques do not always meet modern requirements for effectiveness and low invasiveness of surgical treatment.The review considers endoscopic methods of surgical treatment for all variants of traumatic ICH; 31 publications have been found on this topic, mentioning 602 interventions. Differences in patient selection criteria make it difficult to compare the methods and outcomes. From the technical point of view, the procedures were also very diverse. The article analyzes the main features of different authors’ methods.None of the authors comes to the conclusion about outcome worsening after endoscopic intervention. With regard to acute and subacute hematomas, there are currently no reliable statistical data, but the results obtained can generally be assessed as positive.In acute and subacute hematomas, endoscopic intervention is perceived by the authors not as providing more opportunities, but only as a less invasive replacement for conventional craniotomy. In chronic hematomas, endoscopic intervention is considered to have more opportunities and advantages over the standard treatment.At present, the widespread use of endoscopic minimally invasive methods of surgical treatment for traumatic hematomas is hampered mainly by the lack of clear criteria for selecting patients and well-established methods of intervention. More high-quality research is needed to determine the role of these methods in general clinical practice.

A case of multiple median sternotomy for infection and expanding hematoma in 10 years

BackgroundAfter a median sternotomy, mediastinitis may develop, necessitating reopening of the chest. Rarely, reoperation due to hematoma after cardiovascular surgery is experienced. In the present case, we experienced a patient who initially had mediastinitis, but later developed a chronic hematoma and underwent multiple surgeries.Case presentationThe patient was a 40-year-old man who underwent aortic valve replacement for a bicuspid aortic valve and a graft for a dilated ascending aorta. Postoperatively, he developed hematoma in the anterior mediastinum on multiple occasions with repeated episodes of infection that required multiple median sternotomies.ConclusionsWe reported our experience with a rare case of multiple median sternotomies. In the early stage, mediastinitis due to infection was observed, and in the late stage, mediastinal dilatation due to hemorrhage was observed.

Chronic expanding hematoma

Chronic expansive hematoma (CEH) is a rare lesion, characterized by the persistence and increase in size of an hematoma for a period greater than one month since the initial hemorrhage. The clinical importance of this pathology is due to the fact that it can simulate malignant soft tissue neoplasms, both clinically as a result of its progressive growth and radiologically for its findings in imaging studies. This article will review three cases of CEH in different scenarios, explaining the radiological findings in different imaging techniques such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and PET-CT.

1316 Chronic Epidural Hematoma: A Systematic Review and Meta-Analysis

Abstract Background Epidural hematoma constitutes a common condition in neuro-traumatology. If its acute form is well known, the chronic one remains less described. In this study, we aimed to evaluate the epidemiology, presentations, management, and outcomes of chronic epidural hematoma (CEDH). Method Systematic searches of PubMed, Google Scholar, and ScienceDirect were performed from a database searching for all studies reporting CEDH. Pooled statistics were calculated using measures of central tendency and spread. Results Totally, 3009 studies were identified, of which 95 were included with 359 patients. CEDH was more common in intracranial than spinal (91.9% vs 8.1%). The average age of onset was 37.2 +/- 4.83 years. The common cause found was trauma (n = 279; 77,72%) with 271 (97.1%) cases for the head and 8 (2,9%) cases for the spine. The median delay between the trauma and the first symptoms was 13.31 +/- 3.43 days in intracranial level and 16.37 +/- 5.87 days in spinal level. CT-scan constituted the main diagnosis tool. The lesion was predominantly located in the temporal region at the intracranial level and lumbar region at the spinal level. Craniotomy and laminectomy constituted the most reported treatment option respectively at the intracranial and spinal level. The outcome was commonly uneventful. Correlation and Regression test for publication bias assessment show no significant Funnel plot asymmetry with high p-value (p = 0.8458 and p = 0.9596, respectively). Conclusions There was no clear risk factor found for CEDH. The treatment was mostly surgical.

Characteristic imaging findings in a patient with chronic expanding hematoma on the floor of the mouth.

Chronic expanding hematoma (CEH) is defined as chronic hematoma enlargement for more than 1month. Although CEH rarely occurs on the floor of the mouth, the need to distinguish these cases from malignant disease is critical, given the need for potentially extensive resection in patients with malignancy. We report a case of CEH on the floor of the mouth, which required differentiation from malignant tumor. A 42-year-old woman was referred to our hospital for a submucosal mass on the right floor of the mouth, with a diagnosis of class 3 on aspiration cytology. Computed tomography revealed a submucosal mass with peripheral calcification on the floor of the mouth, which exhibited a hypointense rim on T2-weighted imaging and gradual nodular-like enhancement in the periphery on contrast-enhanced magnetic resonance imaging. Enucleation was performed to reach a definitive diagnosis, and CEH was confirmed pathologically. Well-defined morphology, presence of calcification, a hypointense rim on T2-weighted imaging, and weak peripheral nodular-like enhancement may be characteristic findings of CEH on the floor of the mouth. Accordingly, these imaging features may aid in differentiating CEH from low-grade malignancies and in determining the optimal management strategy.

Marjinal rezeksiyon sonrası gelişen tek merkezli 31 elastofibroma dorsi vakalarında komplikasyonları etkileyen faktörler

Aim: Elastofibroma dorsi (ED) is an uncommon benign connective-tissue tumor, usually seen in the subscapular region of women after the fifth decade. We present the clinical features, management, and long-term outcomes of cases of ED treated surgically in a single institution.&#x0D; Material and Method: The data of 31 patients (7 male, 24 female) with a histopathological diagnosis of ED between January 2010 and January 2021 and mean age of 56.6 years were reviewed retrospectively from their records. The mean follow-up duration was 80.2 (19-144) months. Nine cases were bilateral. Marginal resection surgery was performed in all cases diagnosed radiologically and clinically, and preoperative biopsies were performed for three patients. The results were evaluated using a visual analogue scale (VAS) for pain during follow-up.&#x0D; Results: Complications such as chronic pain (n=5), hematoma (n=5), seroma (n=5), and infection (n=2) were seen in 11 patients (35%) in the early postoperative period and improved over the course of follow-up. A local recurrence observed in one patient during follow-up was re-excised. Significantly more complications were observed in patients with bilateral ED (p=0.015), manual laborers and heavy laborers (p=0.013), patients with comorbidities (p=0.006), those who slept in the supine position (p=0.031), and those who underwent synchronized surgery (p=0.013). In addition, statistically significantly more complications were observed in cases of masses with longer longitudinal length (p=0.016), patients with longer preoperative symptom duration (p=0.009), and longer operative times (p=0.025). The average VAS score improved significantly from 4.97 to 1.52 after surgery (p

Chronic Expanding Hematoma in Device Pocket Developing 5 Years After Implantation.

Chronic Expanding Hematoma in Device Pocket Developing 5 Years After Implantation.

SELECTIVE, BIONEUROPATHOGENETIC APPROACH TO THE CHOICE OF INTERVENTION IN VARIOUS CLINICAL AND ANATOMICAL FORMS OF SEVERE TRAUMATIC BRAIN INJURY

The research has been based on surgical experience of multiple decades and on retrospect study of more that 4000 clinical cases, among them 3500 surgical invasion due to different types of traumas. Since it relies on the latter, it shows the evolution of our approaches towards severe cerebral cranial traumon includes different matters regarding diagnostics and surgical treatment with neuropathogenetic approach. We have shown the advantages of certain surgical procedures in cases of cerebral cranial trauma and also the way approaches were changing after introduction of high medical technology and taking into consideration bio mechanisms and pathological data. Computer diagnostics changed several surgical procedures and opportunities. In cases of traumas impacted in immobilized condition method of choice used to be plastic craniotomy, when in cases of cerebral congestion would cause decompression, placing bone fragment under the skin. 902 surgeries were performed among 1990. In 894 cases surgeries were performed using plastic trepanation, 217 among them was performed with improved modified method. In cases of negligible brain congestion, bone fragment was left in its place without suture fixation and after the congestion resolution fragment would return to its anatomical location. In several times it would be ligated in 2-3 points. This method was the most efficient in bi-frontal low craniotomy. The need of removing bone fragment was observed in zero cases. In cases of acceleration traumas, which is characterized by diffuse damage, multifocal hemorrhages and bruises, in 157 cases double decompression method was used, in some case with falcostomy, effective in 49 cases. Trafination and resection trepanation were removed from practice. Trafination method was sometimes use in cases of chronic hematomas and acute hydromas. In Recurrent and chronic hydromas method was less effective, in such conditions plastic trepanation method was used in order to create extra space for fluid. In singular cases of collapsed brain and for resolving tunica arachnoidea broken surface, we used to infuse 25-35 cubic oxygen or 20-25 distillate in spinal cord. This method was proved effective in 70 cases. Therefore, taking into consideration patho-mechanisms and pathology data, using differential pathogenetic methods of surgical invasion and computer monitoring of post-operative period we managed to decrease mortality in severecerebro-cranial traumas to 29-30% comparing to pre computer periods 36-38 % and comparing to data of other clinics 35-45%.

Clinical Study of Inguinal Hernia Its Management at TRR Institute of Medical Sciences, Patancheru

Inguinal hernias are 75% off all abdominal wall hernias, life time risk of developing hernias is 24%. In the present study to analyze age incidence, type of complications and duration of presentation to analyze post operative to analyze the post-operative complications in inguinal hernia swelling like infection, chronic grin pain, hematoma, scrotal swelling and recurrences, at the end of study Lichtenstein hernioplasty has least complications, ambulate early, return to work early, less post operative pain, reduced incidence of chronic groin pain and least recurrence after surgery was concluded.

Hematoma crónico expansivo

Chronic expansive hematoma (CEH) is a rare lesion, characterized by the persistence and increase in size of an hematoma for a period greater than one month since the initial hemorrhage. The clinical importance of this pathology is due to the fact that it can simulate malignant soft tissue neoplasms, both clinically as a result of its progressive growth and radiologically for its findings in imaging studies. This article will review 3 cases of CEH in different scenarios, explaining the radiological findings in different imaging techniques such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and PET-CT.

A Case of Chronic Expanding Hematoma of the Digit Cured by En Bloc Resection

A Case of Chronic Expanding Hematoma of the Digit Cured by En Bloc Resection

Idiopathic pancreatic haematoma in a lurcher dog

AbstractA 5‐year‐old, male, neutered lurcher dog was presented for investigation of a cranial abdominal mass and suspected acute pancreatitis. Advanced diagnostic imaging revealed the presence of a cavitated mass, multiple splenic nodules and coeliac lymphadenopathy. Fluid analysis from ultrasound‐guided mass‐lesion aspiration was suggestive of a pancreatic origin. After medical stabilisation, the dog underwent celiotomy where partial left limb pancreatectomy, splenectomy and coeliac lymphadenectomy were performed. Histopathological examination was consistent with a chronic pancreatic haematoma, splenic nodular hyperplasia with sinus histiocytosis and sinus erythrocytosis of the coeliac lymph node. Post‐operatively, the dog recovered rapidly with supportive care. Re‐examination 3 months later showed that it remained clinically normal with no symptoms of pancreatitis, and no evidence of recurrence of the haematoma or metastatic disease. This report describes the presentation of a large pancreatic lesion, compatible with a haematoma, and its successful surgical treatment in a dog.