Minimal Swelling Research Articles

Management of Intravenous Contrast Extravasations with Ultrasonography: A Case Report

Extravasation of ionic and nonionic contrast materials is a well-recognized complication of contrast-enhanced imaging studies. Complications vary from minimal swelling to severe skin and subcutaneous ulceration, necrosis, and compartment syndrome. We report a case of Omnipaque (iohexol) extravasation in a 50-year-old man with erythema, blistering, and compartment syndrome who was treated medically but was not cured. Using gray scale ultrasonography, we determined the characteristics of the lesion, its distance from the skin, and its proximity to the vessels. We then determined the depth of the lesion, and then inserted the tip of the needle into the lesion. We also used ultrasonography in locations where extravasation was near an artery. After aspiration, the diameter of the lesion decreased significantly. The patient was cured by ultrasonography-guided aspiration from the extravasated site.

Using a 980 nm, 7w/cm2 Diode Laser in Oral Surgeries

At this paper, we discussed the use of laser in oral surgeries. The aim of this discussion and study were to verify the reliability and efficacy of one of these compact portable diode instruments, emitting a maximum power density of 7W/cm2 not requiring pre-warming or controlling, and delivering a wavelength of 980nm. In addition to that, we compared between the healing time of some cases were treated by diode laser. Recently, laser is one of the most common surgical procedures in the field of oral surgery, implant dentistry, endodontic treatment as well. The role of laser surgery in the oral cavity is well established. The use of diode laser removing a haemangioma as a special case is currently under investigation. The benefits of oral laser surgery are many benefits, i.e., a relatively bloodless surgical and post-surgical course, minimal swelling and scarring and reduction of post-surgical pain are discussed. An interesting cases of removal; a haemangioma, fibroma and performin a frenectomy with a 980nm diode laser are presented.

Investigations of crystallinity and chain entanglement on sorption and conductivity of proton exchange membranes

Proton-conducting hydrocarbon membranes often require an ion exchange capacity (IEC) in excess of 2mmeq/g to achieve a conductivity sufficiently high for technological applications (typically >50mS/cm). Membranes with high IEC are often brittle when dry and swell excessively when fully hydrated. Increasing the crystallinity of hydrocarbon membranes is hypothesized to increase phase segregation thereby enhancing their mechanical integrity in water by reducing their propensity to swell excessively, and to provide an ionic network when water contents are reduced when RH<100% and under elevated temperatures. In this work we examine the effect of increasing the crystallinity of highly sulfonated graft copolymer membranes by blending with polycrystalline poly(vinylidene difluoride) (PVDF). The addtion of PVDF increases the crystallinity, reduces the ion exchange capacity, reduces swelling, yet does not deleteriously affect proton conductivity. The extent to which crystalinity increases and water swelling is reduced was found dependent on the molecular weight of the PVDF. The incorporation of high m. wt. PVDF enhanced crystallinity to a lesser degree than incorporating low m. wt. PVDF but swelling was reduced to a greater extent. This observation is explained by an increase in elastic forces of the membrane that oppose osmotic swelling due to an increase in physical connectivity of the PVDF crystallites via long PVDF polymer chains that span multiple crystallites. The addition of PVDF did not compromise proton mobility in the ionic phase and as a consequence of the much higher proton concentrations attained, proton conductivities were significantly enhanced. Finally, the properties of membranes containing different ratios of ionomer and high m. wt. PVDF are described. Optimal compositions of these components are found in membranes which possess minimal swelling in water and have proton conductivity that is less susceptible to large fluctuations in RH.

A prospective, open-label, multicenter, observational, postmarket study of the use of a 15mg/mL hyaluronic acid dermal filler in the lips.

Hyaluronic acid (HA)-based injectable fillers three-dimensionally restore the natural contours of the lips and perioral area, thereby reducing some signs of aging lips. To evaluate the short-term aesthetic impact of treatment with the HA dermal filler Juvéderm® VOLBELLA® with Lidocaine, formulated utilizing VYCROSS™ technology, for enhancement or correction of asymmetry of the lips, evaluated using a patient-centric approach. Sixty-two subjects were enrolled in this study, conducted at two sites in Germany. Primary endpoints were satisfaction with improvement, look and feel of the lips, assessed by subject and physician at first visit and 4 weeks post-treatment. Immediately after injection at first visit, 83.6% of subjects were Extremely Satisfied, Very Satisfied or Satisfied with improvement in the lips, which increased to 94.1% and 93.0% of subjects with/without top-up treatment at follow-up, respectively. After injection at first visit, 61.7% of subjects rated the look and feel of their lips as Extremely Natural or Very Natural, which increased to 75.0% and 93.0% of subjects with/without top-up treatment, respectively. The HA dermal filler was associated with minimal discomfort, bruising or swelling of the lips; almost two-thirds of subjects (62%) returned to social engagements on the same day. The high degree of subject satisfaction with aesthetic improvement in the lips, as well as the natural look and feel, indicates that this HA dermal filler represents an effective treatment option for patients requiring lip enhancement.

C-31 Free Communication/Poster - Exercise in Person with Chronic Disease

HISTORY: A 33-year-old female presented to sports medicine clinic with a 2-month history of right knee pain and swelling. She first noticed the pain after sustaining a twisting injury to her knee while playing beanbag toss. She had minimal swelling that worsened over the next several weeks. The patient believed her symptoms would be self-limited and initially did not seek treatment. After 6 weeks of no improvement, she visited her family physician, complaining of persistent knee pain, swelling, and stiffness. Her family physician also noticed that the patient had bilateral non-healing great toe ulcers. According to the patient, these ulcers developed from cuts occurring while collecting seashells in the ocean several months earlier, prior to her knee injury. She was referred to our sports medicine clinic for further evaluation. PHYSICAL EXAMINATION: The patient ambulated with an antalgic gait. She had a significant knee effusion, mild erythema, and passive knee range of motion from 20 to 80 degrees with pain at the extremes. There was diffuse tenderness to palpation. Her knee was stable to varus and valgus stress at 0 and 30 degrees. Negative anterior and posterior drawer tests, stable Lachman’s, and negative McMurray test. Patellar tracking was central. DIFFERENTIAL DIAGNOSIS: 1. Septic arthritis 2. ACL tear 3. Intra-articular fracture 4. MCL tear 5. Meniscus tear TEST AND RESULTS: Weight-bearing AP, lateral, oblique, and merchant’s view radiographs of bilateral knees were obtained. There was no bony malalignment, acute fracture, degenerative changes, or loose bodies. An MRI of the right knee showed a soft tissue abscess anterior to her distal femur, with connection to the knee joint and an associated knee effusion. Aspiration of her right knee revealed a nucleated cell count of 89,000, 90% neutrophils, and culture positive for Candida albicans. FINAL WORKING DIAGNOSIS: Septic arthritis of the knee and distal femur soft tissue abscess with Candida albicans TREATMENT AND OUTCOMES: 1. Open irrigation and debridement of the right knee and connecting thigh abscess 2. Oral Fluconazole 200mg four times a day for 8 weeks 3. Infectious Disease consult 4. Return to clinic in 2 weeks for a wound check and suture removal

Hemostatic Matrix During Corporotomy Closure

FIGURE 1 The “no touch” enhancement to the placement of a virgin inflatable penile prosthesis decreases the infection rate to 0.46%. An additional step to the “no touch” technique aids in the reduction of potential postoperative hematoma formation. Two well-documented methods of preventing a postimplant scrotal hematoma are a closed-suction drain and a “mummy wrap.” A novel technique to facilitate reliable and safe cylinder placement with minimal postoperative scrotal swelling is described along with patient outcomes. © 2014 International Society for Sexual Medicine

Scrotal Edema in Dilated Cardiomyopathy

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A case report on chronic massive pre-patellar bursa

Inflammation of the pre-patellar bursa results in bursitis that is trouble free in most of the instances. It is most commonly caused by trauma to the knee, either by a single instance or by repeated trauma over time. Often they are associated with minimal swelling, very rarely do they present with large cystic swelling. Here, we present a case report on a large pre-patellar bursa in an elderly gentleman. Operative excision of the bursa was done in view of a sudden increase in size and pain. The biopsy revealed features of chronic bursitis. He had no recurrence of swelling or wound complications at follow-up.

Crown lengthening using diode laser: A case series

Crown lengthening is a surgical procedure used to increase the extent of supragingival tooth structure for restorative or esthetic purposes. Crown lengthening involves the surgical removal of hard and soft periodontal tissues to gain supracrestal tooth length, allowing longer clinical crowns and reestablishment of the biologic width. Crown lengthening can be done by scalpel, electrosurgery and laser. However, the use of lasers provides many advantages compared to other methods. The advantages of laser over scalpel surgical procedures include greater precision, a relatively bloodless surgical and postsurgical course, sterilization of the surgical area, minimal swelling and scarring, coagulation, vaporization, cutting, minimal or no suturing, and less or no postsurgical pain. The present case series describes three cases of crown lengthening using diode laser.

Performance and biocompatibility of extremely tough alginate/polyacrylamide hydrogels

Although hydrogels now see widespread use in a host of applications, low fracture toughness and brittleness have limited their more broad use. As a recently described interpenetrating network (IPN) of alginate and polyacrylamide demonstrated a fracture toughness of ∼9000 J/m2, we sought to explore the biocompatibility and maintenance of mechanical properties of these hydrogels in cell culture and in vivo conditions. These hydrogels can sustain a compressive strain of over 90% with minimal loss of Young's Modulus as well as minimal swelling for up to 50 days of soaking in culture conditions. Mouse mesenchymal stem cells exposed to the IPN gel-conditioned media maintain high viability, and although cells exposed to conditioned media demonstrate slight reductions in proliferation and metabolic activity (WST assay), these effects are abrogated in a dose-dependent manner. Implantation of these IPN hydrogels into subcutaneous tissue of rats for 8 weeks led to mild fibrotic encapsulation and minimal inflammatory response. These results suggest the further exploration of extremely tough alginate/PAAM IPN hydrogels as biomaterials.

SP0177 Lyme disease – old and new insights

Lyme disease was recognized as a separate entity in 1976 because of geographic clustering of children in Lyme, Connecticut who were thought to have juvenile rheumatoid arthritis, a presumed autoimmune...

Behaviour of hydrogen bonding and structure of poly(acrylic acid) in water–ethanol solution investigated by explicit ion molecular dynamics simulations

Molecular dynamics simulations of polyelectrolyte poly(acrylic acid) at infinitely dilute conditions in aqueous solutions containing up to 6 vol% ethanol were performed with explicit solvent and counter-ion description for varying degree of neutralisation. In the range of ethanol concentration employed, this study shows a swelling in the case of non-ionised chain, chain collapse for 25% ionised system, minimal swelling for 50% ionised chain and no significant change in conformation for 75–100% ionised chains. Ethanol interacts with non-ionised residues via hydrogen bonding and is found to be dominant in the solvation cage surrounding them, whereas no such interaction is seen with ionised residues. Thus, chains with higher charge densities show a preference for the aqueous environment in comparison to ethanol and hydrogen bonding to water is unaltered. For chains with lower charge density, a reduction in the hydrogen bonding with water is seen with an increase in ethanol concentration.

Forearm Compartment Syndrome of a Newborn Associated with Extravasation of Contrast Agent

Extravasation of contrast agents is a possible complication of imaging studies. Although extravasations typically cause minimal swelling or erythema, they can lead to compartment syndrome when the volume of extravasation is high. In this article, we will present an exceptional case where an insignificant amount of contrast agent extravasation led to a forearm compartment syndrome in a newborn, who was treated with an extended fasciotomy. We would like to emphasize the preventive techniques and treatment options of this iatrogenic complication in newborns. Close followup of the patient by the nurses, awareness of the parents and the personnel in the radiology department are the most important preventive measures in this extremity-threatening complication. Forearm compartment syndrome due to contrast agent extravasation may progress more rapidly in newborns even with smaller amounts of extravasation and prompt recognition of the pathology and immediate intervention are unevitable.

What Does Therapeutic Ultrasound Add to Recovery From Acute Ankle Sprain? A Review

To evaluate the effectiveness of therapeutic ultrasound (US) for acute ankle sprains. The Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched to September 2010, for trials in any language; CINAHL to 2004, and PEDro to 2009. The Cochrane Rehabilitation and Related Therapies Field database, reference lists of articles, and the World Health Organization International Clinical Trials Registry Platform were also searched for additional trials. Criteria for selection were randomized or quasi-randomized trials; $1 study group was treated with therapeutic US; participants had acute lateral ankle sprains; and outcome measures included general improvement, pain, swelling, functional disability, or range of motion. Two authors independently selected the studies, and disagreements were resolved by consensus. Of 9 potentially relevant studies, 6 (4 from MEDLINE and 2 from other sources) met selection criteria. Data on participants, treatments, outcomes, duration of followup,and study methods (using the 10-point Amsterdam-Maastricht Consensus List for Quality Assessment) were independently extracted by the investigators who selected the studies. Results were pooled if the data were sufficiently homogeneous. The trials included 606 participants in 5 comparisons of US therapy with sham US (placebo) and 3 comparisons with 3 other treatments(immobilizing elastic bandage, Felbinac anti-inflammatory gel, or electrotherapy). The studies varied in time since injury(<48-100 hours), final assessments (1-4 weeks), and number and spacing of US treatments (3-10 sessions over 3 days-2 weeks). Studies varied in using pulsed or continuous US. None of the studies comparing US therapy with sham US reported statistically significant differences on any outcome, but most participants were fully recovered at final follow-up. For the 3 homogeneous studies, the pooled risk ratio after US therapy for general improvement was 1.04 (95% confidence interval [CI], 0.92-1.17), and the pooled risk difference was 3.0% (95% CI, 26%-12%). In 3 studies, no differences in pain at 7, 14, or 21 days or in swelling were found. In 4 studies, differences in functional disability(ability to walk or bear weight or postural stability) were small and nonsignificant.No significant differences were found in range of motion or plantar or dorsal flexion in 2 studies. Adverse reactions were only documented in 1 study (11 nonserious gastrointestinal events and skin reactions and 1 skin reaction that caused the participant to withdraw). In the comparison between US therapy and immobilization with elastic bandage,estimated risk difference in recovery favored US therapy after 2 weeks(27%; 95% CI, 8%-46%). The comparison between US therapy and Felbinac gel detected no differences after 1 week in overall improvement, pain, or ability to bear weight. The comparison between US therapy and electrotherapy found no significant differences after 1 week in pain-free status, minimal swelling, or ability to walk. The methods of the studies were lacking in details of allocation concealment, baseline similarity of groups, and adherence to treatment. Follow-up of participants was, except for 1 study, inadequate or not reported. Ultrasound therapy had few beneficial effects on overall improvement,pain, or ability to bear weight in acute ankle sprain. Follow-up of 2 to 4 weeks suggested that most participants would recover regardless of intervention.

Treatment of Peripheral Ossifying Fibroma using Er,Cr:YSGG Laser: Report of Two Cases

Peripheral ossifying fibroma (POF) is a non-neoplastic growth on the gingiva thought to arise from the periodontal ligament. Histopathologic analysis always reveals immature bone and osteoid within the lesion. Surgical excision is the treatment of choice. This report comprises of two cases of POFs which were removed using an Er,Cr:YSGG laser. Two patients of age 36 and 25 years reported with the growths which were causing constant irritation as well as esthetic problem. Lesions were removed using an Er,Cr:YSGG laser. The healing was uneventful and no suture or analgesic was required. The histopathological report confirmed them as POF. No relapse was observed till 1 year after surgery. Therefore with this laser, there is relatively bloodless and painless surgery and in postsurgical course there is minimal swelling and scarring so patient’s compliance is much better with this laser as compared to other techniques and lasers.

Ewings sarcoma of 4th metacarpal bone of right hand, a rare case report

Ewings sarcoma of the hand is relatively rare. Ewings sarcoma can present with minimal pain and swelling of the affected digit. The Erythrocyte sedimentation rate and C-reactive protein may be high. Because of these features, this can be confused with an inflammatory lesion. This leads to starting of inappropriate treatment and delay in diagnosis. Radiologically, Ewings sarcoma can present with a plethora of features from permeative bone destruction to expansile lesions with or without periosteal reaction. We present a case of 10 year old male, with complaints of pain and swelling in right hand, which on X-ray showed periosteal reaction, giving a sun burst appearance. So the provisional diagnosis of osteosarcoma was made. The diagnosis of ewings sarcoma was made on FNAC [fine needle aspiration cytology] which was later on confirmed on histopathology. We intend to report this case, because it is very rare location and the radiological features can mimic other lesions which commonly occur in this location like chronic osteomyelitis, osteosarcoma so it can be easily missed especially at preliminary evaluations.

Comparison of pain and swelling after removal of oral leukoplakia with CO2 laser and cold knife: A randomized clinical trial

Objective: The aim of this study was to compare conventional surgery with carbon dioxide (CO2) laser in patients with oral leukoplakia, and to evaluate the postoperative pain and swelling. Study design: A total of 48 patients (27 males and 21 females) with a mean age of 53.7 ± 11.7 years and diagnosed with oral leukoplakia were randomly assigned to receive treatment either with conventional surgery using a cold knife or with a CO2 laser technique. A visual analog scale (VAS) was used to score pain and swelling at different postoperative time points. Results: Pain and swelling reported by the patients was greater with the conventional cold knife than with the CO2 laser, statistically significant differences for pain and swelling were observed between the two techniques during the first three days after surgery. Followed by a gradual decrease over one week. In neither group was granuloma formation observed, and none of the patients showed malignant transformation during the period of follow-up. Conclusions: The CO2 laser causes only minimal pain and swelling, thus suggesting that it may be an alternative method to conventional surgery in treating patients with oral leukoplakia. Key words:Oral leukoplakia, treatment, laser surgery, cold knife, pain, swelling.

A patient with new onset seizures

A 79-year-old woman presented with a new onset generalized tonic–clonic seizure. She also complained of a 4-day history of nausea, and headaches. Her vital signs were stable. She had intermittent confusion with an otherwise normal neurological exam. MRI brain (Fig. 1) showed a focal area of hyperintensity with minimal swelling on the medial aspect of the right temporal lobe, no diffusion restriction and lack of contrast enhancement. An electroencephalogram (Fig. 2) showed right hemispheric, periodic epileptiform discharges.

Evaluation of subgroups of the human sperm hypoosmotic swelling test in normozoospermic male cases with recurrent fertilization failure: a prospective case-controlled study

To compare subgroups of the human sperm hypoosmotic swelling test subgroups in both recurrent fertilization negative infertile cases with normal semen analysis and fertilization positive controls. This was a prospective case-controlled study performed with normospermic 33 previously fertile male (secondary infertility) and 41 infertile men who had undergone two or three unsuccessful in vitro fertilization attempts. HOS test was investigated in 4 subgroups including HOS 1, HOS 2, HOS 3, and HOS 4 according to the degree of sperm tail swelling and compared between the two groups. Four subgroups were compared and statistical significance was demonstrated in HOS 1, HOS 3 and HOS 4 tests (p < 0.001) in fertile and infertile men. Highest HOS 1 and lowest HOS 4 grades were determined in Group A. However, no statistical significance was determined between two groups in HOS 2 test which was minimal swelling in sperm tails. HOS 1, HOS 3 and HOS 4 subgroups of HOS test are reliable and useful methods providing important information regarding the sperm function. A high HOS test 1 grade plus a low HOS test 4 grade should suggest a fertility problem, despite a normal semen analysis. HOS test subgroups provide additional information in normospermic cases with unexplained infertility.

Highly hydrated Nafion/activated carbon hybrids

The incorporation of highly porous activated carbon (aC) to Nafion membranes confers unprecedented levels of water uptake (4 times higher for 10 wt% aC compared to neat Nafion) at a minimal dimensional swelling and results in dramatic enhancements in ionic conductivity at low relative humidity. This behavior reveals the development of a robust network of water nanochannels formed by the carbon pores and the polymeric ionic domains which are structurally stabilized by the rigid Nafion backbone and the non-deformable aC particles.