Number Of Hematomas Research Articles

External Validation of a Tool to Identify Low-Risk Patients With Isolated Subdural Hematoma and Preserved Consciousness

The SafeSDH Tool was derived to identify patients with isolated (no other type of intracranial hemorrhage) subdural hematoma who are at very low risk of neurologic deterioration, neurosurgical intervention, or death. Patients are low risk by the tool if they have none of the following: use of anticoagulant or nonaspirin antiplatelet agent, Glasgow Coma Score (GCS) <14, more than 1 discrete hematoma, hematoma thickness >5 mm, or midline shift. We attempted to externally validate the SafeSDH Tool. We performed a retrospective chart review of patients aged ≥16 with a GCS ≥13 and isolated subdural hematoma who presented to 1 of 6 academic and community hospitals from 2005 to 2018. The primary outcome, a composite of neurologic deterioration (seizure, altered mental status, or symptoms requiring repeat imaging), neurosurgical intervention, discharge on hospice, and death, was abstracted from discharge summaries. Hematoma thickness, number of hematomas, and midline shift were abstracted from head imaging reports. Anticoagulant use, antiplatelet use, and GCS were gathered from the admission record. The validation data set included 753 patients with isolated subdural hematoma. Mortality during the index admission was 2.1%; 26% of patients underwent neurosurgical intervention. For the composite outcome, sensitivity was 99% (95% confidence interval [CI] 97 to 100), and specificity was 31% (95% CI 27 to 35). The tool identified 162 (21.5%) patients as low risk. Negative likelihood ratio was 0.03 (95% CI 0.01 to 0.11). The SafeSDH Tool identified patients with isolated subdural hematoma who are at low risk for poor outcomes with high sensitivity. With prospective validation, these low-risk patients could be safe for management in less intensive settings.

65 External Validation and Comparison of Three Predictive Tools to Identify Low-Risk Patients With Isolated Subdural Hematomas

Three predictive scoring tools have been developed to identify low-risk patients with isolated subdural hematoma and preserved consciousness: the Orlando criteria, the SafeSDH Tool, and the Brain Injury Guidelines (BIG) criteria. We aim to validate and compare these three predictive tools in a single cohort of patients with isolated subdural hematomas. We performed a retrospective chart review of patients age > 16 with GCS >= 13 with CT-confirmed isolated subdural hematomas who presented to 1 academic and 3 community EDs. The Orlando criteria, SafeSDH Tool, and BIG criteria were applied to this dataset with a primary composite outcome (CO) of neurologic deterioration (severe headache, altered mental status, seizure, intubation), neurosurgical intervention, or death. Predictors used in the Orlando tool were: hematoma size and the presence of acute-on-chronic hematoma. The Orlando criteria was applied using the maximum sensitivity cutoff of 0.0235 from the derivation study. The Orlando Tool was also tested on both neurosurgical intervention (NI) (as in the derivation study), as well as the primary CO. The SafeSDH Tool includes the following predictors: use of warfarin, use of clopidogrel, number of hematomas, hematoma thickness, GCS, and midline shift. Cutoff used for this model was 0.0432, as in derivation. BIG criteria predictors included: intoxication, hematoma size, number of hematomas, and presence of skull fracture. Patients meeting both BIG1 and BIG2 criteria were considered low risk as these patients were deemed safe for management without neurosurgical consultation in derivation. The BIG criteria were not derived via regression, so no threshold cutoff was used and area under the receiver-operator curve (AUROC) was not calculated. The validation dataset consisted of 599 patients. 173 patients (28.9%) met the composite outcome. 157 (26.2%) underwent neurosurgical intervention, 22 patients (3.7%) had clinical deterioration, and 10 patients (1.7%) died. The performance of these tools in identifying low-risk patients, their sensitivity, specificity, and AUROC are summarized in Table 1 below. This is the first study to externally validate and compare performance of the Orlando criteria, SafeSDH Tool, and BIG Criteria in identifying low-risk patients with isolated subdural hematomas using a multicenter cohort. All rules had a similarly high sensitivity in predicting need for neurosurgical procedure, neurologic decline, or death. Although specificity is limited, with prospective validation all three tools could be used to identify patients who do not require neurosurgical consultation or transfer to tertiary care centers.

Type of Blunt Expansion of the Low Transverse Uterine Incision During Caesarean Section and the Risk of Postoperative Complications: A Prospective Randomized Controlled Trial

ObjectiveTo evaluate two techniques of uterine incision expansion (cephalad-caudad vs. transverse) during Caesarean section (CS). MethodsA total of 839 patients were randomized to either a cephalad-caudad blunt expansion of uterine incision during CS versus a transverse (lateral-lateral) expansion. The primary outcome was blood loss, measured with the descent of hemoglobin level. Secondary outcomes were the need for blood transfusion and the number of surgical or postoperative complications presented in both groups. ResultsThere was no statistical difference with regard to decrease in hemoglobin level, but there was a higher number of surgical complications in the transverse expansion group (Cephalad-caudad: 11.53% vs. transverse: 16.42%; odds ratio [OR] 0.66; 95% confidence interval [CI] 0.45–0.98; P = 0.04). There were more cases of unintended extensions of uterine incision (10.35% vs. 16.18%; OR 0.6; 95% CI 0.4–0.9; P = 0.01) but no statistical difference in the number of hematomas, uterine vessel injury, or the need to transfuse. ConclusionThe cephalad-caudad blunt expansion technique of the low transverse uterine incision is safer than the transverse expansion. There was no difference in regard to decrease in hemoglobin level, but there is a lower risk of surgical complications not associated with an increased need for blood transfusions when compared with the transverse expansion.

Estudio diagnóstico del bienestar de bovinos durante el transporte a una planta de beneficio de la región caribe de Colombia

Se realizó un estudio diagnóstico de bienestar animal (BA) durante el transporte terrestre de vacunos hacia una planta de faenado de la región Caribe de Colombia. Se hizo un estudio transversal analítico a 20 transportistas, evaluando variables demográficas, de actitud frente a los bovinos y del manejo dado. Se analizaron datos de 59 viajes (588 vacunos), evaluando las condiciones de los vehículos y determinando densidad de carga, heterogeneidad en peso, distancia recorrida, tiempo de espera antes del desembarque y el empleado en el desembarque. Parte de vehículos no se usan exclusivamente para el transporte de vacunos y no cumplen totalmente con lo dispuesto por el ICA. Las densidades de carga fueron inferiores a las recomendadas, con valores de 320,5 kg/m2 (DE=6,3) y 285,2 kg/m2 (DE=83,48), para vehículos pequeños y grandes, respectivamente y la distancia recorrida fue de 21,6 km, en promedio. Los tiempos promedios de espera total y de descargue fueron de 11,1 y 2.8 min., respectivamente. La distancia recorrida, la densidad de carga y el tiempo de descargue se correlacionaron con el número de hematomas y el pH de la canal fría. Se evidenciaron fallas que repercuten negativamente en el bienestar de vacunos durante el transporte y descargue en la planta de faenado y sobre la calidad de la canal, aunado a la falta de capacitación de los conductores en el tema del BA.

Prenatal effects of peat combustion products and afobazole correction thereof in the rat progeny.

Female outbred albino rats were daily subjected to forced inhalations of peat smoke (4 cores packed with a mixture of peat (70%) and wood pulp (30%); 0.46 g, pH ≥ 5.5) per se and in combination with oral afobazole (anxiolytic) on days 1-20 of pregnancy. Exposure to peat smoke inhibited body weight gain in pregnant rats, caused an increase of postimplantation deaths, reduction of fetal weights, and an increase in the number of hematomas and hemorrhages in fetuses. Afobazole in doses of 1 and 10 mg/kg reduced significantly the untoward effects of peat smoke on fetal development.

The Buttonhole Technique: How to Convert a Fistula into a Catheter

The buttonhole technique (BT) is an alternative to the standard needling for the cannulation of arterio-venous fistula (AVF). The balance between benefits and harms associated with the BT is unclear.In order to analyze the recent literature we searched PubMed for “randomized controlled study on buttonhole” and “review of buttonhole cannulation”, published between January 2011 and November 2013.We identified 3 randomized trials and 3 reviews. One randomized trial showed a better survival of the AVFs (100% vs 82%), fewer interventions (19% vs 39%), and lower growth of pre-existing aneurysms (23% vs 67%) in the BT group. A second study showed a greater number of infections and hematomas, and a greater perception of pain in the BT group. A third study showed no differences in perception of pain and bleeding time between the BT group and the control group; additionally, it reported a greater number of hematomas in the control group and a greater number of local infections and sepsis in the BT group. The three ...

Problems With Diagnosis by Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging in Patients With Acute Aneurysmal Subarachnoid Hemorrhage

The diagnostic efficacy of fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging and computed tomography (CT) for acute subarachnoid hemorrhage (SAH) were compared and the problems with diagnosis were investigated in 81 patients with aneurysmal SAH within 24 hours after onset who underwent FLAIR imaging and CT on admission. The number of hematomas in the cisterns and ventricles were evaluated by clot scores. In addition, the frequency of undetected hematomas was calculated for the cisterns and ventricles. Clot scores were significantly higher for FLAIR imaging than for CT in the lateral sylvian, quadrigeminal, and convexity cisterns. On the other hand, clot scores were significantly higher for CT than for FLAIR imaging in the interhemispheric and medial sylvian cisterns. The overall frequency of undetected SAH was 2% for FLAIR imaging and 14% for CT. With the exception of the interhemispheric and medial sylvian cisterns, the frequency of undetected SAH was higher for CT than for FLAIR imaging. In this study, FLAIR imaging was more sensitive than CT for the detection of acute SAH within 24 hours after onset. However, the diagnostic efficacy of FLAIR imaging was reduced in comparatively tight cisterns.

Autologous Platelet Gel Fails to Show Beneficial Effects on Wound Healing after Saphenectomy in CABG Patients

Wound healing impairment in the leg after removal of the saphenous vein within the framework of a coronary artery bypass graft (CABG) operation represents a clinically significant problem. Patients suffer from this complication, and treatment of the wounds is costly in terms of both time and money. No method is known to date that reliably prevents postoperative wound healing disturbances. The effect of autologous platelet gel to stimulate wound healing is known from various medical disciplines. Within a prospective randomized study, we wanted to determine whether intraoperative use of autologous platelet gel on the leg during a CABG operation could reduce the incidence of postoperative wound healing disturbances. The application group (AG) included 35 patients and was compared to a control group (CG) that also had 35 patients. The platelet gel, as well as the thrombin required to activate the platelets, was prepared from autologous patient blood during the operation. Validation of the platelet gel comprised measurement of the growth factors platelet–derived growth factor AB (PDGF AB) and epidermal growth factor (EGF), as well as the thrombocyte and leukocyte counts. Wound healing was photographically documented after surgery, and the patients were contacted by telephone on day 50 after surgery to obtain information on wound healing status. After cell separation, the platelet count was 1616 ± 845/μL, which is higher than in whole blood by a factor of 7.1 ± 2.0, with a platelet yield of 47.0% ± 13.2%. The PDGF AB concentration after activation of the platelets was raised by a median factor of 158 and EGF by a median factor of 64 compared with whole blood. During the primary clinical stay, no statistically significant differences were recorded in the number of hematomas, postoperative leg swelling, or pain level. Large-area hematomas were less frequent in the application group (AG, 29.4% vs. CG, 60%,p= .007). In the follow-up 51 ± 9 days after surgery, 17.6% (6/34) of the patients from the AG and 31.4% (11/35) of the patients from the CG showed leg wound healing disturbances (p= .184). Using the cell separation system, a biological product that contains high concentrations of platelets, leukocytes, and growth factors can be prepared reproducibly. Despite optimum application of the autologous platelet gel to the wound, no clinically relevant differences were found between the groups, either during the primary clinic stay or in the follow-up period.

Decreasing the Recovery Time from Breast Augmentation: Changing the Mind-Set of the Patient, the Technique of the Surgeon, and the Postoperative Care

Introduction: Dr John Tebbetts first described his 24-hour recovery from breast augmentation in Plastic and Reconstructive Surgery in 2002. His original article describes the inframammory approach, using direct visualization, implants ranging in size from 220 to 350 cc, and postoperative exercises. Dr Tebbetts limited the administration of muscle relaxants to the intraoperative period and did not administer narcotics in the postoperative period. Critics of Dr Tebbetts' work have stated that his ability to return patients to normal daily activities in such a short time is, in large part, due to his use of smaller implants. Although other articles have been written on augmentation recovery, the goal of our study was to institute Dr Tebbetts' ideas with our patient population, without limiting the size of the implants used or limiting the procedure to augmentation, and to analyze the results. Materials and Methods: We instructed 100 consecutive primary breast augmentation patients on postoperative exercises, limited the administration of narcotics, immediate postoperative use of ibuprofen, and encouraged the mentality of an earlier return to normal activities. Our patients were administered a survey on postoperative day 7. Results: The overall ability to return to work was 4.0 days after surgery. The use of narcotics was least in the groups where dissection was completed using direct visualization. Ninety-five percent of all patients thought that the postoperative exercises decreased their pain. We did have 5 patients (5%) who developed hematomas requiring evacuation, which was an increase for the practice, but still fell within the national average of 1–6%. Discussion: Our conclusions are that early postoperative arm exercises and encouraged activity, coupled with dissection under direct visualization, does allow for limited use of postoperative narcotics and an earlier return to normal activity. We observed an increase in the number of hematomas, which may suggest that ibuprofen in the immediate postoperative period affects the patients' platelets.

Biological effects of shock waves: Kidney damage by shock waves in dogs—Dose dependence

The effect of shock waves on normal canine kidneys was examined in three groups of dogs whose right kidneys were exposed to 500, 1500, or 3000 shock waves. Autopsy was performed 24-30 h later. The kidneys were enlarged with haemorrhages in the outer and inner renal capsule and intraparenchymally. Macroscopically intraparenchymal haemorrhages were restricted to the high pressure field of the shock wave and consisted of haematomas up to 18 mm diameter (most frequently 6 mm or less) and diffuse haemorrhages. Histologically, haemorrhages were shown to originate from interlobular and arcuate veins. Venous thrombosis, tubular dilatation, and diffuse interstitial haemorrhage occurred in the same area. The number of haematomas was larger, and diffuse haemorrhages were more extended after the application of 1500 and 3000 than after 500 shock waves. No difference was seen between 1500 and 3000 shock waves.