A Case of Late Unilateral Hematoma and Subsequent Late Seroma of the Breast After Bilateral Breast Augmentation

Background  A previously unreported case of unilateral recurrent late collections, namely, a hematoma and a subsequent seroma, in an otherwise healthy female patient after breast augmentation is presented. Methods  A case is reported together with a review of the world literature published and presented regarding late postoperative breast augmentation complications. Results  The patient was a 49-year-old woman who underwent bilateral breast augmentation in 2006. Spontaneous swelling of the left breast developed 1 year postoperatively. The patient was taken to the operating theater, where a large hematoma was found and drained and the prosthesis reinserted. No cause for the complication was identified at the operation. The patient’s symptoms of left-sided breast swelling with discomfort recurred 9 months later. A large seroma was found at surgery but no blood staining. On both occasions, the implant was extracted and examined, with no fault discovered. Capsulectomy was performed, and the pocket was examined, debrided, and cauterized as necessary. On neither occasion was any remarkable pathology found clinically or in laboratory samples sent for analysis. The patient was investigated for any sensitivities or hematologic abnormalities, with no significant results. Conclusion  A previously unreported case of recurrent late postaugmentation collections, namely, a seroma and a subsequent hematoma, in an otherwise well female patient is reported. The authors found no obvious reason for the recurrence in this patient.     

Ultrasonography as a predictor of overt bleeding after renal biopsy

Background  Renal biopsy is essential for the diagnosis of kidney diseases, but complications, particularly bleeding incidents, remain problematic. Methods  To evaluate the frequency of renal biopsy complications, and to reveal clinical and laboratory factors associated with overt bleeding complications, focusing on those available at hospital ward, we conducted a retrospective observational study for the period between 2001 and 2005 at Mie University Hospital in patients who underwent percutaneous renal biopsy of a native kidney. Of a total of 323 patients, 317 met the inclusion criteria. Results  Only one patient (0.3%) required blood transfusion or intervention to stop bleeding. The mean decrease in hemoglobin (Hb) after biopsy was 0.43 ± 0.7 g/dL. Hb decreased ≥1.0 g/dL in 66 patients (20.8%) and ≥10% in 32 patients (10.1%). On ultrasonography, perirenal hematoma was detected immediately after biopsy in 273 patients (86.1%), and 41 patients (12.9%) showed hematoma ≥2 cm in width. Analgesics were required for back pain in 67 patients (21.1%). Vasovagal response developed in 31 patients (9.8%). Macrohematuria occurred in 12 patients (3.8%). Urinary catheter was used in 161 patients (50.8%). For Hb decrease ≥10% after biopsy, multivariate analysis revealed perirenal hematoma (≥2 cm) as a significant factor. Other significant factors were prolonged international normalized ratio of prothrombin time, elevated blood pressure on hospital admission, older age, increased serum creatinine level, and steroid use. Conclusion  Perirenal hematoma ≥2 cm on ultrasonography immediately after biopsy might well represent a predictive factor for bleeding complications.     

冠脉造影术后拔除动脉鞘管的时间与血肿关系观察

目的：观察冠脉造影术（CAG）毕动脉鞘管拔除时间与血肿发生率的关系。方法：将403例CAG患者随机分为实验组和对照组,实验组在CAG后30-40min拔除动脉鞘管,对照组在术后立即拔除动脉鞘管;拔管后均以股动脉压迫止血器止血：观察两组患者CAG后血肿发生率。结果：实验组血肿的发生率为3．81％,对照组为8．81％,实验组较对照组显著降低（P〈0．05）。结论：CAG后30～40min拔除动脉鞘管较术后立即拔除动脉鞘管可明显降低血肿的发生率。     

婴幼儿头皮血肿及合并症的处理

目的 探讨婴幼儿头皮血肿及合并症的处理.方法 2004年1月至2006年6月诊治99例婴幼儿头皮血肿及合并症,均经头颅CT扣描证实.头皮血肿白行吸收16例,穿刺44例,血肿机化硬块切除39例.结果 44例头皮血肿穿刺和39例机化硬块术后,无一例感染和再出血,并恢复正常头颅外形.颅内合并症经综合治疗后,恢复良好.结论 婴幼儿头皮血肿及合并症应早期诊断和治疗,效果佳.     

慢性硬膜下血肿的穿刺持续等压冲洗治疗观察

目的：探讨慢性硬膜下血肿的穿刺持续等压冲洗的临床疗效。方法：术前CT确定穿刺点,消毒后穿刺,使用生理盐水持续性等量等压冲洗,待流出的冲洗液澄清时,外接无菌真空引流袋。结果：总有效率达100%;术后一周治愈率77.78%,有效者8例,CT查硬膜下均有少量积气;术后4周查原硬膜下有积气患者积气均已消失;治愈率94.44%;本组患者中无死亡,无复发,仅1例于引流时出现恶心症状,未经处理于30min后症状消失。结论：采用穿刺持续等压冲洗治疗慢性硬膜下血肿具有较好疗效,该术式创伤小、不易复发、并发症少,术后虽易产生颅内积气,但能够较短时间内被吸收,不影响康复,适合临床广泛应用。     

皮肤创面无机诱导活性敷料对股动脉穿刺后血管并发症止痛效果观察

目的：观察皮肤创面无机诱导活性敷料对股动脉介入术后血管并发症止痛效果。方法：将股动脉穿刺处并发出血、淤血、血肿导致穿刺伤口剧烈疼痛的40例患者随机分为实验组和对照组,实验组以皮肤创面无机诱导活性敷料喷撒型粉剂均匀喷洒伤口,每日2次,连续3d;对照组以传统的磁疗方法治疗15min,每日1次,连续3d。分别记录两种不同治疗方法淤血、血肿部位止痛起效时间,疼痛缓解程度和消肿情况。结果：实验纽和对照组止痛起效平均时间分别为（18．4±6．2）min和（48．5±13．7）min（P〈0．01）;治疗24h后,实验组75％的患者无痛,25％的患者有轻、中度疼痛,对照组100％患者存在轻、中、重度疼痛（P〈0．01）;治疗72h两组血肿疗效比较无显著性差异（P〉0．05）。结论：皮肤创面无机诱导活性敷料用于股动脉穿刺伤口血管并发症治疗止痛效果好,操作简单,有一定的临床应用价值。     

Postpartum spinal cord injury in a woman with HELLP syndrome

OBJECTIVE: To report a rare cause of spinal cord injury. STUDY DESIGN: Case report. CASE REPORT: A 36-year-old woman presented with acute onset of paresis of the upper and lower extremity (level C5, ASIA B) the day after delivering a healthy daughter (39 weeks' gestation). Prior to giving birth, she was admitted with gestational hypertension. Directly postpartum, blood pressure increased markedly, and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome was diagnosed. The next day, tetraplegia developed. Magnetic resonance imaging showed multiple epidural and subdural hematomas in the cervical and thoracic spinal canal extending from C2 to T8, with displacement and compression of the cord. Three weeks after treatment with intravenous labetalol, she made a significant recovery (level T1, ASIA D). CONCLUSIONS: This rare cause of spinal cord injury shows the importance of closely monitoring pregnant patients with hypertension complicated with HELLP syndrome both pre- and postpartum.     

Hematoma-Directed Ultrasound-Guided (HUG) Breast Lumpectomy

Background Needle localization breast biopsy (NLBB) is presently the primary means of localizing non-palpable lesions. Disadvantages of NLBB include vasovagal episodes, patient discomfort, and miss rates. Because hematomas naturally fill the cavity after vacuum-assisted breast biopsies (VABB), we hypothesized that ultrasound (US) could be used to find and accurately excise the actual biopsy site of non-palpable breast lesions without a needle. Methods This is a retrospective study from January 2000 to July 2005. Electronic chart review identified patients with non-palpable breast lesions detected by means of mammogram who then underwent lumpectomy via NLBB or the hematoma-directed ultrasound-guided technique (HUG). HUG involved localizing the hematoma with a 7.5-MHz US probe and using the “line of sight” technique straight down toward the chest wall. A block of tissue encompassing the hematoma was then excised. Results Localization procedures were performed in 186 patients—63 (34%) via needle localization and 123 (66%) via HUG. The previous VABB site in 100% of patients was successfully excised using HUG, 65 of 123 (53%) were benign and 58 of 123 (47%) were malignant; margins were positive in 13 of these 58 (22%). NLBB was successful in 100% of patients, 44 of 63 (70%) were benign and 19 of 63 (30%) were malignant; margins were positive in 14 of these 19 (73%). Margin positivity was significantly higher for NLBB than HUG (P = 0.0001, Fisher Exact). Conclusions This study suggests that HUG is more accurate in localizing non-palpable lesions than NLBB. By eliminating the additional procedure needed for NLBB, HUG may also be more time- and cost efficient. HUG makes VABB not only a less invasive diagnostic procedure, but also a localization procedure. Margaret Thompson: Supported by the Virginia Clinton Kelley/Fashion Footwear Association of New York Breast Cancer Research Fellowship Aaron Margulies: Supported by the Susan G. Komen Breast Cancer Clinical Fellowship     

A giant parietal wall hematoma: unusual complication of laparoscopic appendectomy.

Laparoscopic appendectomy is an established procedure in the treatment of appendicitis. Complications of the procedure are related to the Veress needle and trocar insertions or pertain to actual operative procedures. Trocar-elated major bleeding is rare, and, if it occurs, is detected on the table or during the immediate postoperative period. Delay in recognition may lead to significant morbidity and mortality. We report a case of giant parietal wall hematoma in a 34-year-old female, presenting one week after discharge from the hospital. The hematoma was completely evacuated by exploration through paramedian incision, followed by an uneventful recovery.     

外伤性基底节区血肿42例临床分析

目的　研究外伤性基底节区血肿 ( TBGH)的发病机制、临床特点及预后因素。方法　回顾分析了42例 TBGH病人的临床资料。结果　 TBGH常见于车祸所致的减速性损伤 ,血肿多位于受力对侧 ;伤后早期出现偏瘫而意识障碍相对较轻为临床特征 ;年龄 >60岁 ,原发性脑损伤重 ,血肿量 >3 0 m L ,瞳孔异常 ,GCS评分 <8分者死亡率高。结论　中间脑挫伤概念可解释 TBGH形成 ;其临床表现具有特点 ,正确认识该病 ,动态 CT可明确诊断 ;原发性脑损伤程度、年龄、瞳孔变化、血肿量、意识状态是影响预后的主要因素