Mild Bruising Research Articles

Efficacy of Subdermal Poly-d,l-Lactic Acid Injections for the Treatment of Melasma.

Melasma is a chronic, recurrent skin disorder with limited long-term treatment success using conventional therapies like hydroquinone and laser treatments, which primarily target epidermal components while leaving dermal aspects untreated. To evaluate the efficacy and safety of poly-d,l lactic acid (PDLLA) subdermal injections for treating moderate melasma. Three female patients (age range: 45-59 years) with Fitzpatrick skin types III and IV received three PDLLA injection sessions at 3-week intervals. Treatment outcomes were assessed using the Melasma Area and Severity Index (MASI) and patient satisfaction scores at 12-week follow-up. All patients showed significant MASI score improvements (reduction range: 3.60-6.30 points). Patient satisfaction ratings ranged from 3 to 4 out of 4. Temporary side effects included mild edema and bruising, resolving within 72 h. PDLLA subdermal injections showed promising results in melasma treatment, potentially due to its biostimulatory effects on collagen production and dermal remodeling. Further research, including histopathological analysis, is needed to confirm long-term efficacy and safety, and understand underlying mechanisms.

Spontaneous bruising in an elderly female

Bruising in the elderly can be relatively common due to changes in the skin and blood vessels that occur with aging. Several factors such as skin changes, medications, comorbidities contribute to an increased susceptibility to bruising in older individuals. While mild bruising is often a normal part of aging, it's important to pay attention to any unusual or severe bruising, especially if it occurs without apparent cause or is accompanied by other concerning symptoms. We report a case of asymptomatic bruising in an elderly woman with multifactorial aetiology secondary to medications, liver dysfunction and probable occult malignancy.

Short-Term Efficacy of Combination Therapy with Recombinant Human Thrombopoietin (rh-TPO) and Thrombopoietin Receptor Agonists (TPO-Ra) in Patients with Severe Immune Thrombocytopenia

Introduction: Bleeding manifestations in patients with immune thrombocytopenia (ITP) range from mild skin bruises to lifethreatening intracranial hemorrhage. When the risk of bleeding is becoming high or life-threatening bleeding events occurs, we often use a combination of therapies to rapidly raise platelets to the safe range, including platelet transfusions, high-dose glucocorticoid, and intravenous immunoglobulins. Recombinant human thrombopoietin (rh-TPO) and thrombopoietin receptor agonists (TPO-Ra) are two kinds of thrombopoietic drugs commonly used in China. In patients with severe ITP refractory to glucocorticoids, we lack experience with the use of rh-TPO and TPO-Ra in this emergency situation. Patients and methods： We included ITP patients with platelets <10*10 9/L and bleeding symptoms requiring treatment, who were refractory to glucocorticoids and used thrombopoietic drugs. The bleeding score was calculated with reference to the Chinese guidelines for adult ITP. The patients were divided into three groups according to the medication used: rh-TPO group(rh-TPO 30000IU Qd), TPO-Ra group(Eltrombopag 25mg-75mg/d or Avatrombopag 2.5mg-7.5mg/d or Hetrombopagolamine 20mg-60mg/d), and rh-TPO+TPO-Ra group(combination of two drugs at the same dosage). The platelet count should be rechecked every 1-2 days during the treatment. Platelet transfusion and hemostatic drugs can be used as needed. According to the standardized and international criteria, and taking into account the characteristics of this study, platelet counts were classified as short-term Complete Response(sCR), short-term Response(sR), and short-term No Response (sNR), based on the highest value of platelet counts from the start of treatment to the time of hospital discharge, short-term Overall Response(sOR)=sCR+sR. The three groups were compared the effective time(defined as the time to first sCR/sR after treatment) , peak platelet count after treatment, time to peak platelet count after treatment and other short-term efficacy indicators. Results Nineteen patients were include in this study, with 68.4% (13/19) was female. The median age was 58 years [range 17-79]. 15.8%(3/19) were newly diagnosed with ITP, 10.5%(2/19) had persistent ITP, and 73.7%(14/19) had chronic ITP. All patients were treated with glucocorticoids prior to this treatment, but they had a poor response. The median platelet count was 3*10 9/L [range 1-9] and the median bleeding score was 4 [range 2-9] before treatment. The common bleeding sites were skin ecchymosis and oral mucous membrane hemorrhage in 100%(19/19)and 47.3%(9/19), respectively. Severe bleeding symptoms were the manifestation in 3 cases: including 2 heavy menstrual flow and 1 hemoptysis and gastrointestinal. 100%(19/19) achieved a sOR and 31.6%(6/19) achieved a sCR. The median bleeding score was 0[0-2] after treatment and none had active bleeding symptoms. Platelet transfusion and hemostatic drugs were administered to all patients. Further details are provided in Table 1. Among 19 patients, 7(36.8%) used rh-TPO alone, 6(31.6%) TPO-Ra alone and 6(31.6%) used rh-TPO+TPO-Ra. There was no statistically significant difference in Clinical characteristics, including ages, gender, platelet counts and bleeding score among the three groups of patients before treatment (P=0.727, 0.594, 0.719, 0.299). In terms of treatment efficacy, we were unable to perform a statistical analysis of sOR rates because all three groups reached 100%. The sCR and the peak platelet count after treatment of rhTPO+TPO-Ra group was higher than the other two groups, 28.6%(2/7), 16.7%(1/6) and 50%(3/6) of patients achieved sCR respectively, the peak platelet counts after treatment in the three groups were 62*10 9/L, 72*10 9/L, 79.5*10 9/L respectively in this treatment, but there was no statistically significant difference (P=0.425，0.924). In addition, the effective time and time to peak platelet count after treatment of the three group are also no statistically significant difference(p=0.692,0.505). Further details are provided in Table 2. Conclusion This retrospective study suggests that the patients with severe ITP who were refractory to glucocorticoids, the use of rh-TPO and TPO-Ra may rapidly increase to safe ranges, but the combination is not necessary.

Early bruising detection of 'Korla' pears by low-cost visible-LED structured-illumination reflectance imaging and feature-based classification models.

Nondestructive detection of thin-skinned fruit bruising is one of the main challenges in the automated grading of post-harvest fruit. The structured-illumination reflectance imaging (SIRI) is an emerging optical technique with the potential for detection of bruises. This study presented the pioneering application of low-cost visible-LED SIRI for detecting early subcutaneous bruises in 'Korla' pears. Three types of bruising degrees (mild, moderate and severe) and ten sets of spatial frequencies (50, 100, 150, 200, 250, 300, 350, 400, 450 and 500 cycles m-1) were analyzed. By evaluation of contrast index (CI) values, 150 cycles m-1 was determined as the optimal spatial frequency. The sinusoidal pattern images were demodulated to get the DC, AC, and RT images without any stripe information. Based on AC and RT images, texture features were extracted and the LS-SVM, PLS-DA and KNN classification models combined the optimized features were developed for the detection of 'Korla' pears with varying degrees of bruising. It was found that RT images consistently outperformed AC images regardless of type of model, and LS-SVM model exhibited the highest detection accuracy and stability. Across mild, moderate, severe and mixed bruises, the LS-SVM model with RT images achieved classification accuracies of 98.6%, 98.9%, 98.5%, and 98.8%, respectively. This study showed that visible-LED SIRI technique could effectively detect early bruising of 'Korla' pears, providing a valuable reference for using low-cost visible LED SIRI to detect fruit damage.

Hi5 Protocol for the Use of Microfocused Ultrasound with Visualization.

Microfocused ultrasound with visualization (MFU-V) is used for lifting and tightening of facial tissues. Standard protocols are completed in a single session. Despite excellent outcomes, we identified several barriers of entry for a significant number of patients. Therefore, we devised an individualized pan-facial protocol that is delivered as a series of short, intense treatments to address these issues. We enrolled 12 participants with mild-to-moderate skin and fibromuscular laxity to receive one superficial and one deep pass per visit (average 280 lines). Qualitative improvements were rated by both patients and physicians at 6 or 10 months due to COVID-19 delays. Changes in the submentum and eyebrow heights were quantified. Ten patients (age range: 31-61 years) underwent an average of four MFU-V treatments. Two patients were excluded after massive weight gain. Skin and fibromuscular ptosis and overall soft tissue laxity improved in all patients. Mean brow height increased by 1.7 mm, whereas the mean submental lift was 78.7 mm2. All patients and treating physicians rated an improvement in appearance, whereas independent physicians rated improvements in 87% of cases. Four patients self-rated as "markedly improved." Pain was rated at up to 6.2 (out of 10). Although mask-wearing was mandatory, loss of elasticity, wrinkles, and skin roughness all improved. Superficial welts (n = 5), erythema (n = 3), tenderness (n = 3), and mild bruising (n = 2) occurred, but all resolved within a few days and no severe or permanent adverse events occurred. The Hi5 protocol was noninferior to standard single-session protocols and improved brow heights and submental lifting.

Patient satisfaction of microfocused ultrasound treatments on the face and neck laxity: A narrative review.

Microfocused ultrasound with visualization (MFU-V) delivers focused ultrasound energy to heat tissue and has emerged as a fast and effective noninvasive method for treating skin laxity. After obtaining approval in 2009 by the Food and Drug Administration, satisfactory feedback was recorded using several scoring systems for MFU-V treatment for facial and neck laxity. To evaluate the efficacy and satisfaction rates of MFU-V for facial and neck laxity treatment by providing a basis for developing a validated scoring system for MFU-V treatment. A constrictive survey was carried out by selecting relevant publications on MFU-V treatment of facial and neck laxity using PubMed, Medline, and Embase electronic databases from January 2017 to March 2022. Of the 11 original articles used in this review, the majority of the scoring methods used were the subjective global aesthetic improvement scale and the 5-point scale rating global aesthetic improvement in appearance. Around half of the patients were described as much improved or very much improved on days 30 and 90, while most returned to baseline on Day 360. Most of the adverse events reported were mild bruising, redness, and pain. None of the patients reported serious adverse events. A burn occurred in one case because of improper application of the probe. The MFU-V provides excellent and promising responses for treating facial and neck laxity. A few mild events were observed, such as erythema, pain, edema, and injection-site induration, all of which resolved within approximately 2-3 days.

V03-08 BILATERAL ROBOTIC NEPHRECTOMY USING A SUPINE ROBOTIC APPROACH WITHOUT REPOSITIONING THROUGH 8-18mm INCISIONS IN A YOUNG FEMALE WITH FOCAL AND SEGMENTAL GLOMERULOSCLEROSIS: A VIDEO CASE REPORT

You have accessJournal of UrologyCME1 Apr 2023V03-08 BILATERAL ROBOTIC NEPHRECTOMY USING A SUPINE ROBOTIC APPROACH WITHOUT REPOSITIONING THROUGH 8-18mm INCISIONS IN A YOUNG FEMALE WITH FOCAL AND SEGMENTAL GLOMERULOSCLEROSIS: A VIDEO CASE REPORT Luca Antonelli, Adrian Duss, Leutrim Zahiti, Agostino Mattei, and Christian D. Fankhauser Luca AntonelliLuca Antonelli More articles by this author , Adrian DussAdrian Duss More articles by this author , Leutrim ZahitiLeutrim Zahiti More articles by this author , Agostino MatteiAgostino Mattei More articles by this author , and Christian D. FankhauserChristian D. Fankhauser More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal segmental glomerulosclerosis (FSGS) is a histologic pattern that is associated with nephrotic syndrome in children and adults and represents an important cause of end-stage renal disease worldwide. The underlying podocytopathy is a consequence of multiple pathways either individually or collectively. The associated heavy proteinuria represents a perioperative risk factor for complications after transplantation. Therefore, a bilateral nephrectomy before transplantation is recommended to stop protein loss by the kidneys. METHODS: A 19 years-old woman with therapy resistant FSGS had a persistently low serum albumin level requiring 70g human albumin supplementation each week. A bilateral kidney embolization or surgical removal before listing for a kidney transplantation was required. To improve perioperative outcomes and cosmesis in a young female patient, she was scheduled for a robotic subumbilical access to avoid scar tissue in the upper abdomen.The patient was positioned in a supine position with 30° head down. Four robotic 8mm trocars were placed in a subumbilical line and a 5mm and 12mm assistant trocar were positioned laterally of the medial umbilical ligaments. No repositioning of the patient during the whole case was required. The peritoneum was incised at the level of the ileocecal valve up to the ligament of Treitz. A hammock-like barrier is created by suturing both lateral edges of the parietal peritoneum to the anterior abdominal wall. Subsequently the renal hilus was dissected and the kidney mobilized. The renal vessels were clipped. A 18mm laparoscopic morcellator was introduced after extending the 12mm assistant trocar incision and the kidneys were removed through the morcellator. RESULTS: Blood loss was <50 mL and theatre time 325 minutes. After the surgery the patient had mild bruises on both shoulders because of the long-time period in the Trendelenburg position but resolved without further treatment. Postoperative length of stay was 4 days. After successful removal of both kidneys, the patient was listed for a kidney transplant with priority given her age < 20 years. CONCLUSIONS: Bilateral robotic nephrectomy using a subumbilical access and removal of the kidney using a morcellator is technically demanding but feasible. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e248 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luca Antonelli More articles by this author Adrian Duss More articles by this author Leutrim Zahiti More articles by this author Agostino Mattei More articles by this author Christian D. Fankhauser More articles by this author Expand All Advertisement PDF downloadLoading ...

Skin Rash and Mild Bruising: Is Montelukast a Safe Drug?

Montelukast is one of the commonly used drugs in asthma patients. It is prescribed along with inhalational corticosteroids. Although a relatively safe drug, there is a probability of occurrence of skin rashes and skin bruising. Authors present a case report of a 64-year-old chronic asthmatic woman, reporting widespread erythematous eruptions with mild skin bruising and generalized pruritus mostly affecting her lower abdomen and upper extremities. The rash appeared 28 days after introduction of montelukast (10 mg OD). The physician excluded other attributable factors such as trauma, autoimmune disorders such as Churg-Strauss syndrome, and food allergy. Reappearance of rashes after montelukast introduction and complete resolution of the skin rashes after discontinuing it confirms montelukast as offending drug. Naranjo causality assessment score also revealed a “certain/definite” relationship to the montelukast. Long-term safety of montelukast needs to be reviewed by prescribing physicians to prevent adverse reaction.

Default distal radial approach for all coronary procedures – a prospective study

Abstract Background Radial artery approach for coronary interventions has substantially improved the outcome especially in acute coronary syndrome patients. However, radial artery occlusion is the achilles' heel of such an approach. Purpose To obviate such problems, distal radial artery (DRA) approach is evolving but technical challenge is the small size of the artery. We looked at the feasibility, safety and advantages of it. Methods Patient population included any patient requiring a diagnostic or percutaneous coronary interventions (PCI) in our catheterization laoratory from March 2020 to March 2022. A primary operator performed all procedures as default, if the patient had a palpable DRA. After local anaesthesia infiltration, using seldinger technique and micropuncture kit, 5 to 7F hydrophilic sheaths were introduced and a cocktail of verapamil and heparin was given routinely. Sheaths were removed immediately after procedure but dedicated side specific compression devices were used but removed 45 min after diagnostic and 2 hours after PCI. Clinical patency of radial artery was assessed at discharge and follow up. Results A total of 682 procedures were performed (50% were diagnostic). Out of all PCIs 59% were for ACS). Elective PCIs included very complex cases including PCI for bifurcation, left main and rota assisted complex PCIs. 651 patients had right distal radial approach and 28 had left. Mean age of patients were 66.8±12.9 years (26 to 97). Females constituted 218 (32%). Mean time from 1st needle puncure to successful vascular access took 1.2±0.8 min (20 sec to 6 min). Average attempts to obtain successful vascular access was 1.3±0.7 (1 to7 attempts). There were 15 failures (2%) to obtain DRA access requiring change over to 6 ipsilateral radial, 2 ulnar, 4 contralateral distal radial, 2 femoral and 1 brachial access. Interestingly, in 5 different occaisions previous procedure related occluded radial arteries were recanalized through this access. Most importantly, no case of radial artery occlusion was encountered at discharge or at follow up by clinical examinations. No other vascular complications were encountered except mild transient bruising in 6 cases and early small hematoma in 3 cases. Patient's comfort, nursing staffs' satisfaction and trend towards early discharges were also noticed. There was a distinct improvement in obtaining faster access with lower failure rates by the operator after initial 90, especially after 150 procedures. Conclusions A default approach through distal radial artery in anatomical snuff box for all coronary interventions is feasible, safe and possibly superior to conventional radial access with better patient comfort and caring staff's satisfaction. Though learning curve is longer and more challenging, success rates were much higher and vascular access was faster after initial phase. Clinically radial artry occlusion was not seen but needs further study and more objective evidence. Funding Acknowledgement Type of funding sources: None.

Platelet-Rich Plasma Injections for Erectile Dysfunction and Peyronie's Disease: A Systematic Review of Evidence.

Erectile Dysfunction (ED) and Peyronie's Disease (PD) are debilitating medical conditions affecting patients' quality of life (QoL). Platelet-rich plasma (PRP) injections are one of the various emerging approaches proposed to treat these medical conditions. To describe the evidence of the potential role of PRP injections in ED and PD. The authors conducted a systematic review according to the PRISMA statement using the following databases in November 2019: The National Library of Medicine (PubMed), Ovid Medline, Cochrane, Scopus, Embase, and Embase classic. The search was performed using keywords drawn from studies on the use of PRP in ED and PD in clinical and preclinical studies. Eighteen articles met the inclusion criteria for review, including 12 studies on the use of PRP in humans and 6 on the use of PRP in rats. Ten studies reported on the efficacy of PRP in ED exclusively, 7 in PD exclusively and one in both conditions. In humans, 6 and 3 studies showed promising results in PD and ED, respectively. No major complications were noted. Unwanted minor side effects were noted by studies reporting on PD, including mild penile bruising, ecchymosis, hematomas as well as transient hypotension noted in 2 out of 90 patients. PRP injections for the treatment of ED may be promising, but no recommendation can be made because of scarce evidence. Safety and effectiveness of this therapy in the treatment of ED and PD require further preclinical and clinical studies with standardized protocols to gain an adequate insight into its potential implications. Patients should be offered to be part of such trials to better understand PRP potential. Alkandari MH, Touma N, Carrier S, Platelet-Rich Plasma Injections for Erectile Dysfunction and Peyronie's Disease: A Systematic Review of Evidence. Sex Med Rev 2022;10:341-352.

Single session of combined microfat and subcision in the treatment of Grade 4 atrophic acne scars.

Severe atrophic acne scars (AAS) remain the "Achilles's heel" of AAS treatment. The combination of microfat and subcision treatment is a potential solution for severe AAS. This study aimed to evaluate the efficacy and safety of combined microfat and subcision treatment for severe (Grade 4) AAS. Data of patients with Grade 4 AAS who underwent combined microfat and subcision treatment between September 2016 and December 2020 were reviewed. Post-treatment evaluation was performed at least 3months postoperatively. The severity of AAS was graded based on Goodman's qualitative classification. The volume of concavities was measured using an Antera 3D camera. Complications were documented. A total of 42 patients received a single treatment session. Excellent response was observed in 5 (11.9%) patients, very good in 13 (31.0%), good in 22 (52.4%), and poor response in 2 (4.7%). The average reduction of the total volume of concavities was 28.0%. The most common minor side effects were mild swelling and bruising. No major complications were observed. Combined microfat and subcision treatment is a safe and effective treatment for severe AAS. The approach will be a significant treatment for severe AAS.

Efficacy of breast augmentation using an external breast tissue expander for a shorter period while applying higher pressure: a preliminary study

Background Various types of external breast tissue expanders have been found to be effective for aesthetic breast augmentation. However, their use has been limited when compared with implant-based breast augmentation due to the burdensome nature of their application. This article reports the possibility that external breast tissue expanders may be applied safely and effectively with higher pressure and shorter application time.Methods The participants comprised patients who desired breast augmentation using the EVERA-RAPHA device between January 2020 and March 2020. A double-blinded prospective study was conducted on two groups of eight patients each, with either 60 mmHg or 100 mmHg of pressure applied. Standardized photographs were taken and blinded measurements of volume and circumference were made. The Mann-Whitney and paired t-tests were conducted.Results Sixteen patients were evaluated after 1 month of treatment. The women in groups 1 and 2 (60 mmHg and 100 mmHg, respectively) used EVERA-RAPHA for 15.400± 0.704 and 15.300±0.477 minutes per day, respectively. The mean volume increases in groups 1 and 2 were 39.000±42.526 cc and 27.700±20.260 cc, respectively. No patients dropped out of the study. All patients reported that the device was tolerable. Mild bruising was found in 62.5% of the patients in group 2.Conclusions Breast augmentation using external tissue expanders can be a safe, effective, and practical option. Pressures of 60 mmHg or 100 mmHg can be safely applied for a shorter duration. Larger studies are needed to further confirm our findings.

Evaluation of Cannula Safety in Injection of Poly-L-Lactic Acid.

Background and ObjectivePoly-L-lactic acid (PLLA) has been used in various medical applications for decades, including aesthetic ones. The use of a cannula technique in injecting PLLA has been proposed in order to lower the incidence rate of adverse events (AEs) following treatment. Such AEs include nodule formation, which may occur less frequently by fanning the product with a cannula, thus creating a more uniform product placement compared to that resulting from the use of a needle. Currently, however, there is a lack of comparative research regarding the safety of cannulas versus needles for PLLA injections, as the selection of either remains highly subjective. Therefore, the objective of our study was to investigate the safety of cannula use in the administration of PLLA, in order to report safety outcomes.Materials and MethodsA single-center, retrospective chart review was conducted to examine the data of patients who had previously undergone treatment with PLLA in the form of Sculptra® Aesthetic™ in the face and/or neck regions. Twenty-seven subject charts met eligibility. Descriptive data regarding treatment and follow-up visits were collected and analyzed.ResultsA total of seven AEs resulted from eighty-two treatment sessions (8.54%), with 6/27 patients having experienced at least one AE (22.22%). Mild bruising was the most commonly reported AE (57.14%). The majority of the AEs were mild and transient in nature, with one moderate AE being a nodule that was possibly related to a concomitant treatment. All AEs were resolved with follow-up care.ConclusionMild AEs such as bruising, swelling and pain should be expected following the use of a cannula for PLLA injections. However, the incidence rates of AEs following treatment can remain low if proper product preparation and treatment techniques are utilized.

Single Treatment Protocol With Microneedle Fractional Radiofrequency for Treatment of Body Skin Laxity and Fat Deposits.

Background and ObjectivesTreatment modalities have been developed to address patient concerns with skin laxity and focal adipose excess. A previously published multicenter clinical trial reported improvement in cellulite severity after a single dermal and subcutaneous treatment on the upper thigh with a microneedle radiofrequency device. In the current study, this device was used to improve the esthetic appearance of body skin laxity and localized fat deposits above the knee, upper arms, and upper‐mid back/axillary region (“bra‐line”).Study Design/Materials and MethodsSubjects with cellulite, skin laxity, and/or subcutaneous adipose excess in the suprapatellar region of the anterior thigh, upper arms, and bra‐line underwent a single dermal and/or subcutaneous treatment. Investigators and subjects assessed outcome at 1‐, 3‐, and 6‐month follow‐up, using 5‐point Likert scales for global esthetic improvement, skin laxity improvement, and satisfaction.ResultsIn total, 31 females (mean age 51 ± 9 years) with Fitzpatrick skin types I–IV received a single treatment on 62 treatment areas: 22 upper arms, 34 suprapatellar, and 6 bra‐lines. Investigator assessments at 1, 3, and 6 months for global esthetic improvement and skin laxity for the upper arms and bra‐line demonstrated improvements in 100% of subjects at all timepoints; for the suprapatellar region, these values were 69%, 92%, 65%, and 85%, 92%, 65%, respectively. Investigator satisfaction at each timepoint was satisfied or very satisfied in 80%, 100%, 90% for upper arms; 80%, 80%, 80% for bra‐line; and 50%, 81%, 65% for suprapatellar region. Subject self‐assessments at 1, 3, and 6 months for global esthetic improvement and skin laxity for the upper arms demonstrated improvements in 100% of subjects at all timepoints; for the bra‐line, these values were 40%, 60%, 80%, and 60%, 60%, 80%, respectively; for the suprapatellar region, these values were 81%, 92%, 88%, and 69%, 85%, 88%, respectively. Subject satisfaction at each timepoint was satisfied or very satisfied in 80%, 100%, 100% for upper arms; 40%, 40%, 80% for bra‐line; and 50%, 77%, 65% for suprapatellar. Treatments were well tolerated with subjects reporting transient erythema and edema associated with 69% and 46% of treatments, respectively. Mild bruising, resolving within 5 days, was reported after 32% of the treatments.ConclusionMicroneedle fractional radiofrequency provides a single treatment protocol to improve the esthetic appearance of body skin laxity and localized adipose excess to the upper arms, bra‐line, and suprapatellar regions. Further study is warranted to evaluate the degree of improvement and long‐term effect beyond 6 months post‐treatment. Lasers Surg. Med. © 2021 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC

Signs of connective tissue dysplasia in women with genital prolapse

Introduction. Despite a long history of the disease, genital prolapse still have not been definitively solved. A relevance of pelvic organ prolapse in women has been increasing in recent years largely due to a change in the quality of life and desire to sustain their youth. The number of studies pinpointing the cause of the disease in connective tissue dysplasia (CTD) has been increasing annually.Aim: to conduct a systematic analysis and determine most common signs of CTD in women with genital prolapse.Materials and methods. CTD criteria and the relationship with genital prolapse were analyzed. The study was conducted using questionnaires and including clinical studies examining residents of the Belgorod region (135 women). The main group included 91 patients who had signs of pelvic organ prolapse, and control group consisted of 44 healthy women. CTD intensity score proposed by T.Yu. Smolnova et al. (2003) was used to assess signs of dysplasia in women examined allowing to build up three groups in which each symptom was evaluated as severity score.Results. Asthenic constitution was noted in high percentage of women suffering from genital prolapse (16.70 ± 0.38 %) compared with healthy women (2.30 ± 0.15 %; p = 0.016). Mild bruising, increased tissue bleeding tended to rise in main vs. control group (16.50 ± 0.37 % in main group and 0.0 in control group; p = 0.016). Signs of varicose veins and hemorrhoids requiring no surgical treatment were found in 33.00 ± 0.47 % and 4.50 ± 0.21 % in main vs. control group (p = 0.0002), respectively. Genital prolapse and hernia in first-line relatives were recorded in 9.90 ± 0.30 % in main group (p = 0.031), women without signs of prolapse did not indicate prolapse in close relatives.Conclusion. Asthenic constitution, hernias, varicose veins and hemorrhoids, female pelvic and hernial prolapse in close female relatives, a tendency to mild bruising, skeletal anomalies, elastosis skin were among common CTD signs in women with genital prolapse.

A Glance into Botulinum Toxin Outpatient Clinic in Movement Disorders Practice: Self Experience

Aim: Aim of this study is to determine socio-demographic and disease features of patients who underwent Botulinum toxin injections, and to present our clinical experience via documenting intervals of Botulinum toxin injections and effect-side effect profiles.Material and Methods: Socio-demographic features of patients and characteristic features of Botulinum toxin treatment were recorded. The diagnosis of the patients who underwent Botulinum toxin injections, disease durations and the onset of Botulinum toxin treatments were investigated. Possible side-effects were recorded.Results: Thirty-two patients (20 men, 12 women) with the diagnosis of various types of movement disorders were enrolled the study. Mean age of patients was 60.65±14.40 years (range= 22-83 years). Diagnosis of the patients who underwent Botulinum toxin injections were cervical dystonia, blepharospasm, clonic hemifacial spasm, focal hand dystonia/writer’s cramp, oromandibular dystonia, and dystonic tremor. All patients had repetitive Botulinum toxin injections. There were no remarkable adverse effects, other than mild temporary bruises in injection site in two patients with blepharospasm.Conclusion: Botulinum toxin is an important treatment option in patients with focal dystonia. Botulinum toxin as a neurotoxin of Clostridium botulinum bacteria, suppresses muscle contractions via inhibiting acetylcholine release to the synaptic gap. This reversible effect lasts three to four months due to the neuronal sprouting. It is important to share clinical experiences, data of Botulinum toxin outpatient clinics or clinics from the movement disorders perspective to increase awareness of Botulinum toxin effectivity in patients with movement disorders, focal dystonia particularly.

Blunt Cardiac Trauma Review.

Patients suffering blunt cardiac trauma vary widely in the severity of their condition on presentation. Although some may present with mild sternal bruising, others may present with acute valvular rupture or malignant arrhythmia. Disposition for these patients ranges from discharge home to admission for urgent cardiac surgery. This article discusses some of the common types of blunt cardiac trauma and reviews the current literature and guidelines for their triage and initial management.

Physical, physiochemical and electrochemical responses of ‘Galaxy’ apples to mild bruising

Physical, physiochemical and electrochemical responses of ‘Galaxy’ apples to mild bruising

Effect of thread embedding acupuncture for facial wrinkles and laxity: a single-arm, prospective, open-label study

BackgroundThere is a growing trend for patients to seek the least invasive treatments with less risk of complications and downtime for facial rejuvenation. Thread embedding acupuncture has become popular as a minimally invasive treatment. However, there is little clinical evidence in the literature regarding its effects. MethodsThis single-arm, prospective, open-label study recruited participants who were women aged 40–59 years, with Glogau photoaging scale III–IV. Fourteen participants received thread embedding acupuncture one time and were measured before and after 1 week from the procedure. The primary outcome was a jowl to subnasale vertical distance. The secondary outcomes were facial wrinkle distances, global esthetic improvement scale, Alexiades–Armenakas laxity scale, and patient-oriented self-assessment scale. ResultsFourteen participants underwent thread embedding acupuncture alone, and 12 participants revisited for follow-up outcome measures. For the primary outcome measure, both jowls were elevated in vertical height by 1.87mm (left) and 1.43mm (right). Distances of both melolabial and nasolabial folds showed significant improvement. In the Alexiades–Armenakas laxity scale, each evaluator evaluated for four and nine participants by 0.5 grades improved. In the global aesthetic improvement scale, improvement was graded as 1 and 2 in nine and five cases, respectively. The most common adverse events were mild bruising, swelling, and pain. However, adverse events occurred, although mostly minor and of short duration. ConclusionIn this study, thread embedding acupuncture showed clinical potential for facial wrinkles and laxity. However, further large-scale trials with a controlled design and objective measurements are needed.

Correction of sunken upper eyelid with orbital fat transposition flap and dermofat graft

Sunken upper eyelid is a commonly found deformity among Asians, mostly due to the aging process and excessive orbital fat removal during oriental blepharoplasty procedures. This deformity is frequently accompanied by multiple, poorly defined upper eyelid folds and blepharoptosis. To date, autologous fat graft has been the treatment of choice for this group of patients. However, accurate placement of the graft in the orbital fat is quite challenging, and it can result in contour irregularities when injected into the preseptal plane. From 2008 to 2013, 60 patients with sunken upper eyelids were treated with either an orbital fat transposition flap or a dermofat graft according to the severity of the deformity. Mild sunken upper eyelids were corrected during upper blepharoplasty by exposing the central orbital fat sac and transposing it in a flap-like manner. In more severe cases, a dermofat graft harvested from the intergluteal crease was used. Postoperative complications included difficulty in eye opening because of the weight of the dermofat graft and swelling of the periorbit, which gradually resolved with time. Mild bruising, tenderness, asymmetry, and blepharoptosis were also noted, but no additional treatments were necessary. During the 13-month follow-up period, two patients from the orbital fat transposition flap group and one patient from the dermofat graft group underwent revision surgeries. Anatomy of the orbit, prior surgical history, and sunkenness of the upper eyelid were all considered during preoperative planning. Either an orbital fat transposition flap or a dermofat graft was applied, according to the severity of the deformity, with successful results. Particularly in mild cases of sunken upper eyelid deformity, an orbital fat transposition flap is an easy and effective method that requires no additional procedures.