Hematoma subcapsular del hígado: morfología y resultados del tratamiento quirúrgico / Hepatic subcapsular hematoma: morphology and results of surgical treatment

RESUMEN: El hematoma subcapsular del hígado (HSH), es una entidad poco frecuente. La mayoría de casos reportados se asocian al embarazo, en el contexto de síndrome de recuento bajo de plaquetas, elevación de enzimas hepáticas, y hemólisis. Otras patologías relacionadas son ruptura de carcinoma hepatocelular, adenoma, hiperplasia nodular focal; y amilosis. El objetivo de este artículo fue reportar morfología y resultados del tratamiento quirúrgico observados en una serie de pacientes con HSH, en términos de morbilidad postoperatoria (MPO). Serie de casos retrospectiva de pacientes con HSH intervenidos de forma consecutiva en Clínica RedSalud Mayor Temuco, entre 2004 y 2019. La variable resultado fue MPO. Otras variables de interés fueron edad, sexo, etiología, diámetro, necesidad de transfusión y tiempo de hospitalización. Se utilizó estadística descriptiva. Se trató a 7 pacientes (71,4 % mujeres), con una mediana de edad de 46 años. La mediana del diámetro del HSH, tiempo quirúrgico y estancia hospitalaria fueron 11 cm, 105 min y 5 días, respectivamente. No hubo necesidad de reintervenciones. Con una mediana de seguimiento de 31 meses, no se verificó MPO ni mortalidad. El HSH es una condición poco frecuente, y la evidencia disponible escasa. Puede asociarse a condiciones benignas y malignas. Requiere un alto índice de sospecha para un diagnóstico oportuno.Su pronóstico depende de la etiología.

SUMMARY: Subcapsular hematoma of the liver (SHL) is a rare entity. The majority of cases are associated with pregnancy, in the context of low platelet count syndrome, elevated liver enzymes, and hemolysis. Other related pathologies are ruptured hepatocellular carcinoma, adenoma, focal nodular hyperplasia, and amyloidosis. The aim of this article was to report morphology and results of the surgical treatment observed in a series of patients with SHL, in terms of postoperative morbidity (POM). Retrospective case series of patients with SHL who were intervened consecutively at Clínica RedSalud Mayor Temuco, between 2004 and 2019. The results variable was MPO. Other variables of interest were age, sex, etiology, diameter, need for transfusion, and length of hospitalization. Descriptive statistics were used; 7 patients (71.4% women) were treated with a median age of 46 years. The median diameter of SHL, surgical time, and hospital stay were 11 months, no POM and mortality were verified. SHL is a rare condition, and the available evidence is scarce. It can be associated with benign and malignant diseases. It requires a high index of suspicion for a timely diagnosis. Its prognosis depends on the etiology.

Sinonasal organising haematoma - a little known entity / Hematoma nasossinusal em organização - uma entidade pouco conhecida

Abstract Introduction: Sinonasal organising haematoma is a recently described, rare, benign inflammatory condition, which closely resembles malignancy in its clinical presentation. Objective: To describe the clinical features of organising haematoma and to review the evolution of surgical options successfully used. Methods: A retrospective review of charts of all patients with a histopathological diagnosis of sinonasal organising haematoma was performed. Results: Six (60%) of the 10 patients were male with a mean age of 47.4 years. All patients had unilateral disease with recurrent epistaxis as the presenting symptom. Maxillary sinus was the most commonly involved sinus. There was no history of trauma in any of the patients. Hypertension (80%) was the most commonly associated comorbidity. Contrast-enhanced CT scan of the paranasal sinuses showed heterogeneous sinus opacification with/without bone erosion. Histopathological examination was diagnostic. Complete endoscopic excision was done in all patients resulting in resolution of the disease. Conclusion: Awareness of this relatively new clinical entity and its evaluation and treatment is important for otolaryngologists, maxillofacial surgeons and pathologists alike. Despite the clinical picture of malignancy, histopathological features of benign disease can safely dispel such a diagnosis.

Resumo Introdução: Hematoma nasossinusal em organização é uma condição inflamatória benigna rara, recentemente descrita, que se assemelha a lesões malignas em sua apresentação clínica. Objetivo: Descrever as características clínicas do hematoma em organização e analisar a evolução das opções cirúrgicas usadas com sucesso. Método: Foi feita a revisão retrospectiva dos prontuários de todos os pacientes com diagnóstico histopatológico de hematoma nasossinusal em organização. Resultados: Seis (60%) dos 10 pacientes eram do sexo masculino, com média de 47,4 anos. Todos os pacientes apresentavam doença unilateral com epistaxe recorrente como sintoma de apresentação. O seio maxilar era o mais comumente afetado. Não havia histórico de trauma em qualquer dos pacientes. Hipertensão (80%) foi a comorbidade mais comumente associada. A tomografia computadorizada dos seios paranasais com contraste mostrou opacificação heterogênea do seio com/sem erosão óssea. O exame histopatológico foi diagnóstico. A excisão endoscópica completa foi feita em todos os pacientes, resultou na resolução da doença. Conclusão: A conscientização a respeito dessa entidade clínica relativamente nova e sua avaliação e tratamento são importantes para os otorrinolaringologistas, cirurgiões buco-maxilo-faciais e patologistas. Apesar do quadro clínico de malignidade, as características histopatológicas da doença benigna podem descartar com segurança esse diagnóstico.

Hemorragia intracraniana espontânea em pediatria: relato de paciente hemofílico que sobreviveu devido a cisto cerebral / Spontaneous intracranial hemorrhage in children: report of a hemophilia patient who survived due to a brain cyst

RESUMO Relatamos o caso de um uma criança de 2 anos de idade que sobreviveu após um episódio agudo de hemorragia intracraniana espontânea grave com sinais clínicos e radiológicos de hipertensão intracraniana e herniação transtentorial. O paciente foi para cirurgia de urgência para drenagem do hematoma, sendo inserido um cateter para monitorar a pressão intracraniana. Na análise da tomografia de crânio inicial, antes da drenagem do hematoma, constatou-se um cisto cerebral contralateral ao hematoma que, segundo análise do neurocirurgião e do neuroradiologista, possivelmente evitou um desfecho pior, visto que o cisto serviu de acomodação para o cérebro após a hemorragia maciça. Após investigação, constatou-se tratar de um caso de hemofilia tipo A sem diagnóstico prévio. O paciente foi tratado em terapia intensiva com controle da pressão intracraniana, reposição de fator VIII e obteve alta sem sequelas neurológicas evidentes.

ABSTRACT We report the case of a 2-year-old child who survived an acute episode of severe spontaneous intracranial hemorrhage with clinical and radiological signs of intracranial hypertension and transtentorial herniation. The patient underwent emergency surgery to drain the hematoma, and a catheter was inserted to monitor intracranial pressure. In the initial computed tomography analysis performed prior to hematoma drainage, a brain cyst was evident contralateral to the hematoma, which, based on the analysis by the care team, possibly helped to avoid a worse outcome because the cyst accommodated the brain after the massive hemorrhage. After the investigation, the patient was determined to have previously undiagnosed hemophilia A. The patient underwent treatment in intensive care, which included the control of intracranial pressure, factor VIII replacement and discharge without signs of neurological impairment.

Role of high mobility group box-1 and protection of growth hormone and somatostatin in severe acute pancreatitis

In this study, we investigated the potential role of high-mobility group box 1 (HMGB1) in severe acute pancreatitis (SAP) and the effects of growth hormone (G) and somatostatin (S) in SAP rats. The rats were randomly divided into 6 groups of 20 each: sham-operated, SAP, SAP+saline, SAP+G, SAP+S and SAP+G+S. Ileum and pancreas tissues of rats in each group were evaluated histologically. HMGB1 mRNA expression was measured by reverse transcription-PCR. Levels of circulating TNF-α, IL-1, IL-6, and endotoxin were also measured. In the SAP group, interstitial congestion and edema, inflammatory cell infiltration, and interstitial hemorrhage occurred in ileum and pancreas tissues. The levels of HMGB1, TNF-α, IL-1, IL-6 and endotoxin were significantly up-regulated in the SAP group compared with those in the sham-operated group, and the 7-day survival rate was 0%. In the SAP+G and SAP+S groups, the inflammatory response of the morphological structures was alleviated, the levels of HMGB1, TNF-α, IL-1, IL-6, and endotoxin were significantly decreased compared with those in the SAP group, and the survival rate was increased. Moreover, in the SAP+G+S group, all histological scores were significantly improved and the survival rate was significantly higher compared with the SAP group. In conclusion, HMGB1 might participate in pancreas and ileum injury in SAP. Growth hormone and somatostatin might play a therapeutic role in the inflammatory response of SAP.

Ritidoplastia videoassistida do terço inferior da face: corset videoendoscópico / Endoscopically assisted rhytidoplasty of the lower third of the face: the videoendoscopic corset

INTRODUÇÃO: Após um período em que a controvérsia em cirurgias faciais teve como foco a abordagem ao SMAS, atualmente se persegue a melhora do contorno cervical. Descolamentos maiores, como os praticados pelo acesso submentoniano, podem aprimorar os resultados, entretanto acarretam aumento das complicações, sobretudo de hematomas, desencorajando seu emprego. No intuito de minimizar estes riscos, propõe-se o uso adjuvante do videoendoscópio durante a realização de cervicoplastias, segundo a Técnica de Feldman. As adaptações necessárias para a realização do procedimento são detalhadas. MÉTODO: Estudo retrospectivo de 16 pacientes submetidos a procedimento cirúrgico nos últimos 12 meses, sequencialmente, de acordo com a técnica apresentada. Os resultados foram graduados pelo autor principal (RR) e por três cirurgiões plásticos independentes (EC, RN, AM), sem que estes conhecessem detalhes da técnica empregada. Os fotogramas pré e pós-operatórios de seis meses foram avaliados e pontuados conforme os parâmetros definidos por Ellenbogen & Karlin, gerando notas 'de 0 a 10', que foram aplicadas à Grade de Labbé. RESULTADOS: A média geral do grupo foi 8,29, escore ótimo, segundo a Escala de Labbé. Em dez casos (62,5%), atingiu-se resultado ótimo (8-10 pontos); cinco casos (31,25%), bom (6-7 pontos), e apenas um caso (6,25%), escore abaixo de 6 pontos, classificado como mediano. Não houve ocorrência de hematomas, aderências cutâneas ou recidiva das bandas platismais. CONCLUSÃO: A técnica apresentada parece propiciar resultados adequados, sem aumento das complicações. Adicionalmente, possibilita uma cicatriz submentoniana de menor extensão, além da visualização magnificada e direta de todas as estruturas abordadas, por todos os membros da equipe.

INTRODUCTION: In contemporary facial surgery, the focus of controversy has shifted from superficial muscular aponeurotic system approaches, to methods by which to improve the neck contour. Larger detachments, such as those resulting from the use of submental access, can provide better outcomes. However, the associated potential for increased complication rates, particularly hematomas, discourages the practice of such detachments. In order to minimize these risks, we propose the use of videoendoscopic assistance during cervicoplasty procedures, such as Feldman's method. The adjustments required to carry out this procedure are described in this study. METHOD: This retrospective study included 16 patients, who were sequentially submitted to a surgical procedure in the preceding 12 months, using the technique described above. The results were scored by the main author (RR) and 3 independent plastics surgeons (EC, RN, AM), who were unaware of the details of the technique used. Preoperative and 6-month postoperative photographs were evaluated and scored according to the parameters defined by Ellenbogen and Karlin, with values ranging from 0-10 subsequently applied to the grading system of Labbé. RESULTS: The group average postoperative score was 8.29, the optimal grade according to the scale of Labbé. An optimal outcome (8-10 points) was reached in 10 cases (62.5%); a good outcome (6-7 points) was reached in 5 cases (31.25%); a score below 6, rated as average, occurred in only one case (6.25%). There was no occurrence of hematomas, skin adhesions or recurrent platysmal bands. CONCLUSION: The proposed technique appears to provide satisfactory results without increasing the rate of complications. Moreover, use of the technique was associated with less extended submental scar, in addition to improving the direct view of the structures manipulated for all members of the surgical team.

Trombo aortico intraluminal e hematoma intramural apos manobra de ressuscitacao cardiopulmonar / Aortic luminal thrombus and intramural hematoma after cardiopulmonary resuscitation

Descrevemos o caso de um paciente com hematoma intramural e trombo flutuante após ressuscitação cardiopulmonar. Esse homem, de 92 anos de idade, teve uma parada cardíaca causada por fibrilação atrial e testemunhas iniciaram imediatamente manobras manuais de ressuscitação cardiopulmonar. Ao ser admitido no hospital, o paciente apresentava-se em choque cardiogênico, sendo, então, imediatamente submetido a ecocardiografia transesofágica. Além de uma parede anterior acinética, o exame da aorta torácica descendente mostrou um hematoma intramural e um trombo intra-aórtico flutuante a uma distância de 40cm do arco dental. Não havia dissecção da aorta. O trombo foi atribuído à compressão aórtica durante a ressuscitação cardiopulmonar. Embora o trombo aórtico e o hematoma intramural não tenham se associado a qualquer complicação nesse paciente, a inserção de um balão intra-aórtico poderia ter levado a uma ruptura da aorta ou a eventos embólicos. Recomenda-se a realização de ecocardiografia transesofágica, quando disponível, antes da inserção de um balão intra-aórtico de contrapulsação em pacientes submetidos à ressuscitação cardiopulmonar.

We describe the case of a patient with an intramural hematoma and floating thrombus after cardiopulmonary resuscitation. The 92-year old man had a cardiac arrest due to ventricular fibrillation and witnesses immediately initiated manual cardiopulmonary resuscitation. Transesophageal echocardiography was performed immediately on hospital admission because the patient was in cardiogenic shock. In addition to an akinetic anterior wall, examination of the descending thoracic aorta demonstrated an intramural hematoma and a floating intra-aortic thrombus at a distance of 40cm from the dental arch. There was no aortic dissection. The thrombus was attributed to aortic compression during cardiopulmonary resuscitation. Although the aortic thrombus and intramural hematoma were not associated with any complications in this patient, insertion of an intra-aortic balloon may have led to aortic rupture or embolic events. Transesophageal echocardiography should be performed, when available, prior to insertion of an intra-aortic balloon for counterpulsation in patients who have undergone cardiopulmonary resuscitation.

Lesiones focales hepáticas en niños / Focal liver lesions in children

Las lesiones focales del hígado comprenden un grupo heterogéneo de entidades como tumores benignos y malignos, sólidos o quistes, vasculares, masas inflamatorias y metástasis, entre otras. Reportar lesiones focales hepáticas en niños, características clínicas, estudios por imágenes y conducta terapéutica. Estudio descriptivo, retrospectivo, basado en la revisión de 16 historias clínicas de niños con lesiones focales hepáticas en el periodo comprendido entre enero 2007 a enero 2012. Se excluyeron los abscesos hepáticos. El 68,75%11 eran del sexo masculino y 31,25%5 del sexo femenino; con edad promedio de 9,5 años (rango: 10 días - 14 años). Las lesiones focales benignas fueron: hemangioma 4/16 (25%), hematoma hepático 4/16 (25%), quiste hepático 3/16 (18,75%), hiperplasia nodular focal 1/16 (6,25%) adenoma 1/16 (6,25%) y las malignas: hepatocarcinoma 2/16 (12,50%) y hepatoblastoma 1/16 (6,25%). La mayoría de los pacientes (56,25%) se encontraban asintomáticos, 3/16 (18,75%) presentaron dolor abdominal, 3/16 (18,75%) masa palpable y 2/16 (12,5%) ictericia. La lesión fue identificada por ultrasonido abdominal en todos los pacientes y sólo el 56,25% (9/16) ameritaron tomografía con contraste. Al 43,75% (7/16) se les realizó marcadores tumorales y de estos el 42,85% (3/7) reportaron neoplasias. El funcionalismo hepático reportó normal en el 75% de los casos. El ultrasonido abdominal es el método de elección para el diagnóstico y seguimiento de las lesiones focales hepáticas, mientras el origen de las mismas, guía la conducta terapéutica

Focal liver lesions comprise a heterogeneous group of entities such as benign and malignant, solid or cysts, vascular, inflammatory masses and metastasis among others. To report focal liver lesions in children, clinical features, imaging and therapeutic behavior. A descriptive, retrospective study based on a review of 16 case histories of children with focal liver lesions in the period from January 2007 to January 2012. Liver abscesses were excluded. 68.75%11 were male and 31.25%5 females, mean age 9.5 years (range: 10 days - 14 years). Focal lesions were benign: Hemangioma 4/16 (25%), liver hematoma 4/16 (25%), hepatic cyst 3/16 (18.75%), nodular focal hyperplasia 1/16 (6.25%) and adenomas 1/16 (6.25%) and malignant: Hepatocellular carcinoma 2/16 (12.50%) and hepatoblastoma 1/16 (6.25%). Most patients (56.25%) were asymptomatic, 3/16 (18.75%) had abdominal pain, 3/16 (18.75%) and palpable mass 2/16 (12.5%) jaundice. The lesion was identified by abdominal ultrasound in all patients and only 56.25% (9/16) needed tomography with contrast. To 43.75% (7/16) underwent tumor markers and of these 42.85% (3/7) reported neoplasm. Normal hepatic function reported in 75% of cases. An abdominal ultrasound is the method of choice for the diagnosis and management of focal liver lesions, while the origin of them, guide therapeutic conduct

Hematoma disecante de la parte torácica de la aorta: estudio anatomopatológico de siete casos de autopsias / Dissecting hematoma of the thoracic aorta: pathology study of seven autopsy cases

El hematoma disecante de aorta (HDA) se define como la disección de la pared aórtica por la sangre, con formación de una nueva luz. Es la patología letal de la aorta más frecuentemente diagnosticada y ocurre con una frecuencia tres veces mayor que la rotura del aneurisma de la aorta abdominal. Nuestro objetivo es presentar siete casos de HDA observados en autopsias, describir los hallazgos anatomopatológicos y comentar la literatura. Los casos estudiados corresponden al Servicio de Patología del Instituto de Medicina Forense de Córdoba, Argentina. Los tejidos fueron fijados en formol al 10 por ciento, incluidos en parafina y coloreados con hematoxilina-eosina, tricrómico de Masson y PAS (Peryodic Acid Schiff). De los siete casos presentados cuatro correspondieron a mujeres (57,1 por ciento) y tres a hombres (42,8 por ciento). Todos los casos estudiados tenían antecedentes de hipertensión arterial. La evolución posible de la disección aórtica incluye: rotura de la adventicia con hemorragia masiva y muerte, comunicación nuevamente con la luz aórtica, propagación al ostium coronario, isquemia de órganos y la formación de un aneurisma.

Dissecting aortic hematoma (DAH) is defined as the dissection of the aortic wall by the blood, with formation of a new light. It is the deadliest disease of the aorta and occurs more frequently diagnosed at a rate three times greater than the ruptured aneurysm of the abdominal aorta. Our goal is to present seven cases of DAH observed in autopsies, describe the autopsy findings and comment on the literature. All cases studied belong to the Department of Pathology, Institute of Forensic Medicine of Cordoba, Argentina. The tissues were fixed in 10 percent formalin, embedded in paraffin and stained with hematoxylin-eosin, Masson trichrome and PAS (Peryodic Acid Schiff). Of all the cases studied, four were women (57.1 percent) and three men (42.8 percent). All had a history of hypertension. Evolution of aortic dissection may include: failure of the adventitia with massive hemorrhage and death, again communication with the aortic lumen, spread the coronary ostium, organ ischemia and aneurysm formation.

Hematoma de músculo iliopsoas na vigência de tratamento com varfarina / Iliopsoas muscle hematoma during treatment with warfarin / Hematoma de músculo iliopsoas en la vigencia de tratamiento con warfarina

A varfarina é droga amplamente utilizada na prevenção de fenômenos tromboembólicos e o conhecimento de seus efeitos adversos faz-se necessário para o acompanhamento dos pacientes. Embora o desenvolvimento de discrasias sanguíneas seja complicação potencial nesses pacientes, a ocorrência de sangramento retroperitoneal é rara. Este artigo discute o caso de um paciente que evoluiu com hematoma do músculo iliopsoas durante tratamento com a referida droga, pós-implante de prótese aórtica metálica, com quadro clínico envolvendo importantes diagnósticos diferenciais.

Warfarin is a widely used drug for the prevention of thromboembolic events. Knowledge of its adverse effects is necessary for patient follow-up. Although the development of blood dyscrasias is a potential complication in these patients, retroperitoneal bleeding is rare. This article reports the case of a patient who developed iliopsoas muscle hematoma during treatment with warfarin after implantation of a metallic prosthetic aortic valve. The clinical manifestations involved important differential diagnoses.

La warfarina es un fármaco ampliamente utilizado en la prevención de fenómenos tromboembólicos, y el conocimiento de sus efectos adversos se hace necesario para el seguimiento de los pacientes. Aunque el desarrollo de discrasias sanguíneas es la complicación potencial en estos pacientes, la ocurrencia de sangrado retroperitoneal es rara. Este artículo discute el caso de un paciente que evolucionó con hematoma del músculo ileopsoas durante tratamiento con el referido fármaco en el postimplante de prótesis mitral metálica, con cuadro clínico implicando importantes diagnósticos diferenciales.

Measurement of intracranial hematoma using the improved cubature formula / 法医学杂志

OBJECTIVE@#The more accurate calculate method was investigated according to the improved formula of intracranial hematoma using segment deducing.@*METHODS@#The improved formula was deduced to calculate the intracranial hematoma using the volume formula of the solid geometry. The volume of intracranial hematoma was measured as a related accurate standards using software. The volumes of intracranial hematoma calculated by the improved formula, Tada's formula and the software were compared.@*RESULTS@#The measure accuracy of the improved formula was higher than that of Tada's formula, and showed a similarity with that by using software method.@*CONCLUSION@#The improved formula method shows a more accurate result than Tada's formula, and can be used in forensic practice.

Trombohematoma subcorionico masivo: una patología placentaria emergente / Massive subchorionic thrombohematoma

El trombohematoma subcoriónico es una extravasación de sangre localizada en la placa coriónica, entre amnios y corion. Es muy infrecuente, el diagnóstico no es común, tiene alto riesgo perinatal y no hay casos comunicados en nuestro medio. Se presentan 12 casos de sospecha diagnóstica antenatal, confirmada en el examen histopatológico placentario. Se describe y discute el cuadro clínico, las complicaciones maternas y perinatales, el diagnóstico ultrasónico, el manejo y los resultados obtenidos. En nueve casos se identifcó una fase latente con hematoma de tamaño estable, entre el inicio de los síntomas y el parto, que duró en promedio 7,3 semanas. En ocho casos la fase latente fue seguida por una fase activa con aumento del hematoma asociado al parto prematuro. Tres embarazadas presentaron patología médica compleja con una muerte materna. Seis casos hicieron anemia severa y tres patología miscelánea. Hubo ocho amenazas de parto prematuro con tocolisis, tres rotura prematura de membranas, una colestasis y una preeclampsia. Los partos fueron prematuros, dos de 36 y 33 semanas y diez menores a 32 semanas. Siete prematuros tuvieron peso inferior a 1000 gramos y seis hicieron restricción fetal grave, en percentil <5 de la curva de crecimiento. Hubo complicaciones neonatales relacionadas con prematurez, restricción y bajo peso, manejados con hospitalización prolongada con promedio de 74 días (rango: 6-298 días). Diez neonatos sobrevivieron; hubo un mortinato y un mortineonato. La sobrevida fue 83,3 por ciento y la mortalidad de 16,6 por ciento que se comparan favorablemente con las cifras comunicadas.

Subchorial thrombohaematoma is caused by blood extravasations in the corionic plate, between amnion and chorion. It is a rare pathologic entity, that carries a high perinatal risk, which has not being published in our country up to now. We report 12 cases in which the diagnosis was suspected before birth, and confirmed in the placentary pathological examination. We describe the clinical presentation, fetal and maternal risks, ultrasonographic findings, treatment and clinical outcomes. In 9 patients a latent phase was identified with a stable size hematoma, which had a mean duration of 7.3 weeks. In 8 cases the latent phase was followed by an active phase, with increasing size of the hematoma associated with preterm labour. Three pregnant women had severe complications which caused one maternal death. Six had severe anemia and other three had minor complications. Eight had preterm labor symptoms which required tocolysis. Three had prelabour rupture of membranes, one cholestasis disease and preeclampsia. Preterm labours were at 36, 33 and other ten before 32 weeks of gestation. Seven preterm newborns weight less than 1000 grams and six had severe fetal restriction (p<5). Newborn complications were related with prematurity, requiring prolonged hospitalization (mean 74 days, range 6-298 days). Ten newborns survived. There were 1 still birth and 1 dead newborn. Survival rate was 83.3 percent and 16.6 percent mortality, better rates than previously published.

Chronic Expanding Hematoma of the Thorax

We report the first case in Korea of a chronic expanding hematoma, which presented as a huge mass in the pleural cavity. A 67-year-old woman exhibiting a slowly-expanding intrathoracic mass, as revealed by a chest radiograph, was admitted to our hospital. The patient had undergone a pneumonectomy 37 years earlier during treatment for pulmonary tuberculosis. Computed tomography revealed a huge mass in her right hemithorax. The differential diagnosis of this mass included chronic empyema combined with a malignancy, such as lymphoma or a soft tissue sarcoma. The tumor, which was classified as an encapsulated chronic hematoma, was removed surgically. Samples sent for histopathological and microbiological analysis revealed no evidence of neoplasia or infection. The patient was finally diagnosed with a chronic expanding hematoma of the thorax. This case is particularly rare due to the patient's development of a very large mass after undergoing treatment for tuberculosis more than 30 years earlier.

Spontaneous onset corneoscleral hematic cyst.

Corneoscleral cysts are a rare entity. We report a case of spontaneous corneoscleral hematic cyst, which was treated by cyst excision and lamellar corneal patch graft. No recurrence of cyst was noticed during the 6 years of followup.

Comparative study for the methods on measuring intracranial hemorrhage volume / 法医学杂志

OBJECTIVE@#To explore a method of measuring intracranial hemorrhage to be applied in clinical forensic science.@*METHODS@#The accurace of the methods of Tada formula, Stereology and Software boundary to measure intracranial hemorrhage and their practicability were compared.@*RESULTS@#The measured results of Stereology and Software boundary are precise, but the irregularity haematoma volume measured by the method of Tada formula has a high error value.@*CONCLUSION@#The method of stereolgy is the best in measuring intracranial hemorrhage for clinical forensic science.

Perihematoma damage at different time points in experimental intracerebral hemorrhage / 华中科技大学学报（医学）（英德文版）

The damage degree of neurons in perilesion at different time points was observed in order to explore the optimal operation occasion. Piglet lobar hematomas were produced by pressure-controlled infusions of 2.5 mL autonomous blood into the right frontal hemispheric white matter over 15 min, and the metabolic changes were ambulatorily detected with MRS at 3rd, 12th, 24th and 48th h after hematoma induction. Brain tissues of perihematoma were also obtained at different time points. The transcription level of Bax gene was detected by in situ hybridization and apoptosis by TUNEL technique, and the pathologic change of neurons was observed under an electron microscope. The results showed that the number of Bax positive cells reached the peak at 24 h (79.00 +/- 4.243/5 fields). There was no significant difference in A values between 3 h and 6 h, 12 h (P > 0.05), but there significant difference between 24 h and 3 h, 6 h, 12 h (P 0.05). Lac peak mainly occurred at 24 h and 48 h, while on the healthy side, no Lac peak was detectable. The ratio of NAA/Cr presented a descent tendency, but there was no significant difference among the groups before 12 h (P > 0.05), there was very significant difference between 3, 6 and 24, 48 h (P < 0.01). Under electronic microscopy, the neuronal damage surrounding hematoma in 3 to 6 h was milder than in 24 h to 48 h. It was concluded that the secondary apoptosis, damage and metabolic disturbance of the neurons surrounding hematoma was milder in 3-6 h in acute intracerebral hemorrhage, while obviously aggravated in 24-48 h. An effective intervention is needed to reduce secondary damage as soon as possible.

Spontaneous appearing and disappearing acute traumatic intracranial haematomas - an interesting clinical entity case reports and review of literature

Two cases of appearing and disappearing traumatic intracranial haematomas have been described. In the first case, with an initiol normal CT brain scan, a delayed intracerebral haematomas appeared ten hours after injury, while in the second case, an acute subdural haematoma, seen immediately after traumatic brain injury [TBI], disappeared ten hours later. The importance of a delayed CT brain scan in cases of TBIs has been emphasised

Necrosis hemorrágica hepatocelular y hematoma hepático subcapsular en 20 casos de enfermedad hipertensiva del tercer trimestre del embarazo (Toxemia) / Hepatocellular hemorrhagic necrosis and subcapsular hepatic hematoma in 20 cases of hypertensive disease of third trimestre of pregnancy (Toxemia)

La necrosis hemorrágica hepatocelular se encontró en 11 casos, que corresponden a 55 por ciento de 20 casos fallecidos por enfermedad hipertensiva del tercer trimestre del embarazo: eclampsia;81.8 por ciento fue difusa, 18.1 por ciento focal; se presentó desde los 18 años hasta los 38 años de edad, a los 25.5 años de edad promedio; 36.3 por ciento fueron primíparas, 36.3 por ciento multíparas. El hematoma hepático subcapsular se encontró en cinco casos: 60 por ciento con cápsula conservada y 40 por ciento con cápsula rota. De los cinco casos: 60 por ciento fueron multíparas; 80 por ciento se desarrolló durante el tercer trimestre del embarazo, 20 por ciento durante el segundo trimestre; 80 por ciento cursaron con dolor asociado a vómito; 80 por ciento evolucionaron hacia la eclampsia. Estos cinco casos de hamatoma hepático subcapsular, en principio, desarrollaron un síndrome de hematoma hepático subcapsular, posteriormente con el desarrollo del cheque se constituyó el síndrome de hematoma hepático subcapsular con ruptura de la cápsula. Consideramos a la necrosis hemorrágica hepatocelular, al hematoma hepático subcapsular con cápsula de Glisson conservada y al hematoma hepático con cápsula rota, tres estadios de una misma enfermedad

Alteraçöes morfológicas em ovários de éguas: tumores e hematomas / Morphological changes in the mare ovaries: tumors and hematomas

Descrevem-se as alteraçöes morfológicas diagnosticadas nos ovários de 14 éguas. Foram constatados 12 tumores das células de granulosa e 2 hematomas nos animais submetidos à ovariectomia unilateral no Hospital Veterinário da FMVZ-UNESP-BOTUCATU