Visible Bruising Research Articles

Of the green grasses

of the green grasses ire'ne lara silva (bio) I was already there when she was given by the Chontal Maya of Potonchán to the Spaniards. They were as strange to her eyes as they were to mine. In her mind, I heard her remark on the paleness of their faces and the strangeness of their light-colored hair and the oddness of the metal covering every inch of their bodies. She told herself she would not betray any fear, that she would stand tall and very, very still. The women around her shivered and cried silently. At first, I did not understand that she was being given as a slave, as a tribute, as a spoil of battle. She refused to even think it as she was presented to Cortés. She did not lower her eyes as his fell upon her. I saw him through her eyes, felt her register his sudden stillness. His eyes and hers and mine flared simultaneously with a sudden piercing light. I shivered though I had no body to shiver with. But she was given to someone else, one of Cortés' lieutenants, Alonso Hernández Puertocarrero. I shuddered whenever he entered the tent. She never betrayed herself, not a single flinch, not a single tear—only the involuntary grunts that escaped the back of her throat. I could have shut myself away, closed myself off from what she experienced, but I stayed with her. I couldn't leave her to suffer alone. At the very least, I could share her pain and shed her tears. Hernández was careful never to touch her face or to leave visible bruising. The other women did not fare as well. A few of them had been given individually to some of Cortés' lieutenants. The others were used by all his men. They were bruised, often bloody, and never lifted their eyes. _______ I've inhabited other bodies, but none like this, with senses so close to my own. And even amongst my own people, I'd never felt this intense connection. I hadn't thought I'd explore this world in the body of a woman. In a body so much smaller than mine. Our peoples both have two legs, two arms, one head, similar nervous, digestive, and reproductive systems, but there the similarities end. I didn't know I'd feel through her skin as I might feel through mine. I see and hear and taste and touch everything through her. Her pain is my pain. Nightly, he grabs her from behind and pushes her face down into the rough mat she sleeps on. I want to scream. So does she, but she forces herself to remain silent, forces her body to remain still. This is blasphemy among my people. We do not even have a word for this violence upon the body. I cannot see his face. Is it slack with desire? Is it filled with rage? Blank with satisfaction? She is not a human to him, not even a body, only a thing to slake his need. She lies a moment on the floor where he leaves her. I am weeping for her, because she will not let him see her pain. Or perhaps because she knows it is of no use. Hernández, they said his name was. She curses it with the taste of blood in her mouth. _______ She does not know my name. If she hears my voice, she does not understand my words. She never [End Page 201] betrays my presence. But sometimes, in her sleep, she holds her own shoulders in her hands as if she is reaching for me. And in her sleep, she sighs when I wrap my long furred arms around her. I do not forget why I have come to this world, but still, my flesh clings to hers, my eyes, my hands, my breath. It was not love. She simply became half of me, and I became half of her. There was no separating us. _______ I am the Dreamer of the Seventh Family of the Northern Circle. The youngest son, promised to the service of the Mother. I...

Subcutaneous hematomas from prophylactic heparin use.

Key Clinical MessageHeparin is an anticoagulant, which is frequently used in hospitalized patients for prophylaxis of deep vein thrombosis (DVT). Subcutaneous administration of heparin may lead to complications such as bruising, hematoma, and pain at the injection site. Hematomas can develop without visible bruising, as in our case.

Bruise susceptibility of banana peel in relation to genotype and post-climacteric storage conditions

The aim of this study was to understand the genotypic factors and post-climacteric storage conditions that affect bruise susceptibility of banana peel. Putative physicochemical indicators of bruise susceptibility, including peel electrolyte leakage (PEL), total polyphenolic content, hardness, water content, and peel thickness, were investigated. Bruise susceptibility is the lowest impact energy needed to produce visible bruising by an object dropped on post-climacteric banana fruit from a pre-determined height, converted into impact energy (20–200mJ with a 20mJ increment). The bananas were stored either at 18°C throughout ripening or at 13°C between the 2nd and 6th day after ethylene induction. Five cultivars with contrasting susceptibility to impact bruises were used. Neither Grande Naine nor hybrid Flhorban925 bruised at the maximum impact energy (200mJ) during ripening whatever the storage conditions. A gradient in bruise susceptibility was observed among the other cultivars: French Corne>Fougamou>hybrid Flhorban916. Bruise susceptibility increased during ripening and was higher in bananas stored at 18°C. The lower ripening temperature resulted in a two-day delay to fruit maturity as well as in bruise susceptibility. Bruise susceptibility was positively correlated with PEL (R=0.78) and to a lesser extent negatively correlated with hardness (R=−0.45), and was not correlated with polyphenolic content. In conclusion, membrane permeability provides the first clue to understanding bruise susceptibility.

Osseous avulsion of adductor longus presenting as incarcerated inguinal hernia

An acute rupture of adductor longus tendon is a rare injury[1]. In most cases, distal insertion of the tendon is involved[2]. The rupture of proximal attachment of the tendon iseven rarer [3].There has been only handful of cases reportedin the literature [4, 5]. Treatment of this ranges from non-operative to complete excision of the muscle [1]. A typicalmechanism of injury is eccentric overload when forcedabduction of the leg occurs during contraction of the adduc-tor muscle group.We describe a case report where an acute onset ofgroin swelling presenting as an incarcerated inguinalhernia was surgically explored by the general surgeons.During the operation, an avulsion of the adductor lon-gus muscle was diagnosed and an immediate repair wasperformed by the orthopaedic surgeons. Informed con-sent was obtained from the patient for the publication ofthis case report.Case reportA 33-year-old male with groin swelling and pain around thegroin presented to general surgeons. This was acute in onsetand was sustained while playing football. The time to pre-sentation from the time of injury was 48 h. There were nogastrointestinal symptoms on presentation. On examination,there was a tender lump around the groin. The lump wasbelow the pubic tubercle. There was no visible bruising. Thelump was irreducible, non-pulsatile and there was no coughimpulse. The surgical team suspected an incarcerated ingui-nal hernia. An ultrasound scan was performed which wasinconclusive for hernia.A surgical exploration of his groin was performed by thegeneral surgeons. At operation, a 3×3-cm mass was found4 cm inferior to the pubic tubercle. Superior to the mass, acavity extended up to the pubis which could easily bepalpated. An avulsion of the attachment of adductor longustendon from the pubis was suspected. They asked for thehelp from orthopaedic team.The bikini line incision in the groin was extended forbetter exposure. Osseous avulsion of adductor longus wasconfirmed. The edge of the tendon was debrided back to ahealthy margin. Soft tissues were elevated form the sym-physis. The periosteum was elevated and a small burr usedto create a bleeding cancellous surface. Two 3.5 bioabsorb-able suture anchors were inserted into the pubis. The sutureswere then passed through the tendon edge and secured (seeFig. 1). The leg was abducted postoperatively to check therepair. Washout of the wound was done and wound wasclosed with interrupted non-absorbable ethilon.Postoperatively, partial weight bearing was allowed for2 weeks followed by weight bearing as tolerated. No abduc-tion beyond neutral was advised for initial 3 weeks followedby strengthening exercises at 6 weeks. He returned to fullactivity with no pain after 3 months.DiscussionThe adductor longus muscle arises from the superior pubicramus and inserts onto the middle part of the linea aspera.The muscle is narrow proximally and expands for a broadinsertion on the femur. The adductor longus is innervated bythe obturator nerve and is involved in the adduction of thehip. Acute tears of the proximal attachment are very rare,and best treatment for these is still debatable. Managementoptions include conservative, surgical excision of the entiremuscle and repair. The recent trend is towards surgical

Musculoskeletal: what’s different in children? Kicked in lower right leg; now limping and refusing to bear weight

Our patient, a 3-year-old male came in to our Emergency Room (ER) because of persistent pain and inability to bear weight on his right leg. What happened was that his 11year-old sister kicked his lower leg and that’s when the problems began and persisted, and so something was not right. Upon presentation to our ER the patient was in good health with no abnormal findings except those related to his right lower extremity. He clearly did not want to bear weight on the extremity, was limping a lot, and complained of pain around the knee when walking. There was no visible bruising and physical examination was somewhat obtuse. Again however, something was wrong and radiographs of the lower extremities were obtained (Fig. 1). Upon evaluation of these images the attending physician did not see an obvious fracture but because of the patient’s clinical findings and complaints the patient was immobilized in a splint. This was important because the attending physician, even though not seeing any abnormality on the radiographs, still was concerned. Upon reread of the images by the Radiology Faculty the next morning, a subtle fracture was detected and the patient returned or our ER for further evaluation. When he arrived he still did not want to bear full weight on the extremity but at the same time wanted to get rid of the splint and begin walking. This is the way little kids are, but upon reexamination there was point tenderness over the upper anterior tibia and when all of this was considered the patient was referred to our Pediatric Orthopedic Department where he was subsequently placed in a plaster cast. Do you see a fracture in Fig. 1?

Outpatient angioplasty and stenting facilitated by percutaneous arterial suture closure devices

To review our practice of outpatient percutaneous vascular interventions facilitated by an arterial suture device. A retrospective review of all patients attending this tertiary centre for iliac or femoral intervention was undertaken between February 2001 and December 2004. All patients who underwent angioplasty or stenting had their puncture sites closed using a Perclose suture. Patients were kept flat for 15min and allowed to fully mobilize at 60min. Puncture sites were scored for visible bruising, haematoma and pain at discharge and on outpatient follow-up. Patient preference for future outpatient treatment was assessed. Fifty-seven outpatients underwent 81 punctures. Forty-eight (84%) patients underwent iliac angioplasty; of those 42% underwent stent placement. Six patients (10%) required inpatient admission, five secondary to failed suture deployment. One patient had a non-closer-related puncture site intimal flap occlusion successfully repaired at surgery. Fifty-one (90%) patients discharged with a mean time of 157min (60-280min). Forty-six (92%) patients had no visible bruising or palpable haematoma on discharge. No patient had a haematoma greater than 2.5cm. No discharged patient required readmission. Thirty percent reported a moderate to severe groin pain score (2-5/5) at discharge, increasing to 40% at follow-up. Forty-seven (98%) of the 48 patients, who expressed a preference, would be happy to undergo outpatient treatment again. Outpatient treatment is feasible, well tolerated and preferable to patients, but 10% will require inpatient admission. A planned post-procedure analgesia regimen or advice should be considered.

Therma-lifting of the face, neck and brows

Our patients are increasingly focused on improving their appearance without any time necessary for healing. They are often even willing to achieve a less dramatic result and to return for multiple treatment sessions in exchange for a no downtime procedure. Thus, new and effective non-invasive techniques have become eminently important. The course of twenty consecutive patients were reviewed retrospectively. Prelimary results following radiofrequency enhanced Therma-lifting (Thermage, Hayward, Ca) indicate that facial tightening, eyebrow lifting and neck lifting can be achieved without visible skin inflammation or bruising.

Early Mobilization Following Angioplasty

AIM: To assess the incidence of puncture site complications in in-patients undergoing early mobilization following angioplasty with a view to performing day case angioplasty.MATERIALS AND METHODS: One hundred and twenty-eight patients undergoing peripheral and renal angioplasty using a sheath size of up to 6 French were recruited prospectively. The mobilization protocol consisted of supine bed rest for 2h, followed by gradual mobilization, so that the patient was ambulant 4h after the procedure. Mobilization was delayed if clinically appropriate. Puncture sites were scored for discomfort, paraesthesia, visible bruising and palpable haematoma after groin compression and the following morning.RESULTS: One hundred and forty-four puncture sites were studied. There were 44 haematomas in total, of which 37 (26%) were less than 2.5cm and seven (4.9%) were between 2.5cm and 7.5cm. Four patients (2.8%) had visible bruising greater than 7.5cm. No patient assessed discomfort higher than moderate at any stage. Mobilization was delayed in 15 patients. In 11 this was due to puncture site oozing, haematoma in one, two were hypertensive and one required surgery for limb ischaemia. All complications occurred within 4h of angioplasty. No patient required surgery or transfusion for haemorrhagic complications.CONCLUSION: Mobilization at 4h was successful in 90% of cases but 10% require more prolonged bed rest. No delayed complications occurred. These results suggest that day case angioplasty is feasible in most cases.Butterfield, J. S. (2000). Clinical Radiology55, 874–877

Effect of Storage Humidity and Post-storage Handling Temperature on Bruising of CA-stored `McIntosh' Apples

In a 2-year study, `McIntosh' apples were stored in a CA regime of 4.5% CO2 + 2.5% O2. Within the CA cabinets there were three humidity levels: >75% RH (CaCl2 salt in the chamber), >90% RH (ambient), or >95% RH (distilled water in the chamber). After removal at 4 and 8 months, the fruit were warmed to handling temperatures of 0C, 10C, or 20C and subjected to three levels of impact bruising of 0, 10, or 20 lb with a Ballauf pressure tester with a 1.5 × 1.5-cm tip. The results showed that low-humidity CA storage decreased visible bruising. Although visible shrivel was not observed, the low-humidity treatment may increase the possibility of its occurrence. Respiration, measured as O2 consumption or CO2 production immediately after removal from CA storage, was lowest in low humidity (>75% RH) and highest in ambient humidity (>90% RH) CA storage. The humidity treatments did not affect firmness, soluble solids, titratable acids, or ethylene production. Increasing the temperature during post-storage handling decreased the amount of visible bruising without affecting other variates such as firmness, soluble solids, titratable acids, respiration, or ethylene production.

Effect of Storage Humidity and Post-storage Handling Temperature on Bruising of CA-stored `McIntosh' Apples

In a 2-year study, `McIntosh' apples were stored in a CA regime of 4.5% CO2 + 2.5% O2. Within the CA cabinets there were three humidity levels: >75% RH (CaCl2 salt in the chamber), >90% RH (ambient), or >95% RH (distilled water in the chamber). After removal at 4 and 8 months, the fruit were warmed to handling temperatures of 0C, 10C, or 20C and subjected to three levels of impact bruising of 0, 10, or 20 lb with a Ballauf pressure tester with a 1.5 × 1.5-cm tip. The results showed that low-humidity CA storage decreased visible bruising. Although visible shrivel was not observed, the low-humidity treatment may increase the possibility of its occurrence. Respiration, measured as O2 consumption or CO2 production immediately after removal from CA storage, was lowest in low humidity (>75% RH) and highest in ambient humidity (>90% RH) CA storage. The humidity treatments did not affect firmness, soluble solids, titratable acids, or ethylene production. Increasing the temperature during post-storage handling decreased the amount of visible bruising without affecting other variates such as firmness, soluble solids, titratable acids, respiration, or ethylene production.

Some Growth Regulator Effects on Fruit Quality, Mesocarp Composition, and Susceptibility to Postharvest Surface Marking of Sweet Cherries1

Abstract Gibberellic acid (GA3) sprays applied approximately 4 weeks before harvest reduced postharvest surface marking of ‘Van’ and ‘Lambert’ sweet cherries (Prunus avium L.). Surface pitting was reduced more consistently than was visible bruising. GA3-treated fruits were larger and firmer when harvested at a prescribed color maturity. Mesocarp tissue of treated fruits was higher in alcohol insoluble solids, higher in dry weight and contained less nitrogen per unit of fresh or dry weight. Ethephon applied a few days before harvest reduced fruit removal force but did not consistently reduce the incidence of bruising or surface pitting. ‘Lambert’ fruits picked without stems developed more surface pitting than stemmed fruits. It is proposed that GA3 improves postharvest fruit condition by more than one mechanism. Increased fruit firmness may reduce the tendency to bruise but pitting appears to be suppressed by some other physiological effect of the GA3 treatment.