ABSTRACT
Subperiosteal hemorrhages are typically the result of blunt orbital or facial trauma. Nontraumatic subperiosteal hemorrhages are uncommon and are usually attributed to increase in central venous pressure and bleeding disorders. Here, we report the case of a 38-year-old female who underwent an upper gastrointestinal (GI) endoscopy and developed bilateral nontraumatic subperiosteal hemorrhages that resolved with conservative treatment. Here, we discuss the source of bleeding and the mechanisms for the occurrence of orbital subperiosteal bleeds. GI surgeons and ophthalmologists should be sensitive to the possibility that orbital hemorrhage that can occur following endoscopy, especially when retching or gagging occurs during the procedure.
ABSTRACT
Aims and Objectives : A number of retrospective and prospective studies have demonstrated a peak in the onset of MI in the morning hours and a trough at night. This has led to investigations of the factors which can affect or modify the circadian pattern of onset of MI. The current study was undertaken with an objective of assessing whether the presence of diabetes can or cannot affect the circadian pattern of onset of myocardial infarction in an Indian population. Material & methods : 50 non diabetic subjects and 50 diabetic subjects were randomly selected from among patients admitted to cardiac ICCU of LTMMC and GH Sion, Mumbai. For all patients the time of onset of MI was noted and the results were tabulated. Results : 44% of non-diabetic subjects experienced onset of myocardial infarction in the period between midnight to 6:00 a.m. as compared to 32% in case of diabetics but an application of Chi Square Test, did not come out to be significant. But on comparing diabetics with >5 years and <5 years history, a significant loss of circadian rhythm was observed in case of diabetics of >5 years duration, indicating that autonomic neuropathy may play a role in the loss of circadian rhythm. Conclusion: It has important implications for the treatment of myocardial infarction in case of diabetics. This study can be followed up with additional studies to verify other factors which can affect circadian pattern of onset of myocardial infarction. Loss of biorhythms can result in increased incidence of thrombotic events throughout the day leading to increased cardiovascular mortality and morbidity.
ABSTRACT
To determine Left ventricular thrombus [LVT] in acute Myocardial infarction [MI] and to find out the correlation of risk factors with development of LVT. Hospital based observational study. Department of Cardiology, Liquate University Hospital Hyderabad between November 2005 to November 2006. 280 consecutive patients presented with first episode of acute Myocardial infarction were included. Patients with previous history of Myocardial infarction, rheumatic heart disease, dilated cardiomyopathy and mural thrombus were excluded. Baseline characteristics were recorded on the proforma. Two dimensional echocardiography was performed on day 3, at the time of discharge, 3 and 6 months after infarction. Two echo cardiographers blinded to clinical details separately reviewed the echo images. Descriptive and inferential statistical analysis was performed using SPSS version 16.0. Two hundred and eighty patients with first episode of acute MI were studied; 214[76.4%] were male and 66[23.6%] were female. Mean age of patients was 54.08 +/- 11.9 SD. Left Ventricular Thrombi [LVT] was found in 50,280 [17.86%] patients detected by 2-D echo method. 3[6%] patients died while in the coronary care unit and 7 [14%] with LVT failed to follow up. In remaining 14140 [35%] patients' thrombus once detected, was present during the entire echocardiographic follow up and became organized. However in 36/40 [65%] patient's thrombus disappearance was noted on follow up echocardiographic studies. Only 3/50 [6%] patients had complication of systemic embolization, all in the CNS. Among risk factors only smoking and Diabetes Mellitus were found to be statistically significant. LVT was seen in patients with decreased left ventricular wall motion especially anterioapical wall akinesia. LVT is important complication of acute myocardial infarction. If diagnosed and anticoagulated earlier, further risk of complications and its potential to embolize can be minimized