Manejo cirúrgico de ferimento auto-infligido por arma de fogo em região maxilofacial / Surgical management of self-inflicted injury by gun in the maxillofacial region

INTRODUÇÃO: O manejo dos pacientes vítimas de PAF possui vertentes divergentes a respeito do tratamento cirúrgico, que pode ser realizado de forma imedata ou tardia. Em lesões auto-infligidas, a distância entre a arma e a região acometida é menor, causando consequências estéticas e funcionais mais devastadoras. Aliado ao fato desse tipo de trauma criar uma ferida suja devido à comunicação com a cavidade oral e seios paranasais, o manejo das lesões representam um desafio mesmo à cirurgiões experientes. OBJETIVO: Estre trabalho relata o manejo cirúrgico de uma ferida auto-infligida por arma de fogo que resultou em avulsão dos tecidos moles na região maxilofacial. DESCRIÇÃO DO CASO: Paciente do sexo masculino, 35 anos, vítima de projétil de arma de fogo auto-infligido em região maxilofacial, cursando com extenso ferimento em região de língua e mento. Clinicamente, o paciente não apresentava sinais de fratura em ossos da face. Ambos os ferimentos apresentavam secreção purulenta e o paciente manifestava disfonia devido a grande destruição tecidual. CONSIDERAÇÕES FINAIS: O tratamento de ferimentos por arma de fogo não só é um grande desafio para o cirurgião, como para toda a equipe multidisciplinar requerida para tais casos, visto que não há protocolos bem definidos para o tratamento dessas lesões(AU)

INTRODUCTION: The management of patients who are victims of FAP has divergent aspects regarding surgical treatment, which can be performed immediately or late. In self-inflicted injuries, the distance between the weapon and the affected region is smaller, causing more devastating aesthetic and functional consequences. Allied to the fact that this type of trauma creates a dirty wound due to the communication with the oral cavity and paranasal sinuses, the management of injuries represents a challenge even for experienced surgeons. OBJECTIVE: This paper reports the surgical management of a self-inflicted gunshot wound that resulted in soft tissue avulsion in the maxillofacial region. CASE DESCRIPTION: Male patient, 35 years old, victim of a self-inflicted firearm projectile in the maxillofacial region, coursing with extensive injury in the region of the tongue and chin. Clinically, the patient did not show signs of facial bone fractures. Both wounds had purulent secretion and the patient had dysphonia due to extensive tissue destruction. FINAL CONSIDERATIONS: The treatment of gunshot wounds is not only a great challenge for the surgeon, but also for the entire multidisciplinary team required for such cases, since there are no well-defined protocols for the treatment of these injuries(AU)

Non-muscle myosin heavy chain 9 gene-related disorders with thrombocytopenia: report of two pedigrees and literature review / 中华儿科杂志

Objective: To summarize the clinical characteristics and gene variants of 2 pedigrees of non-muscle myosin heavy chain 9 related diseases (MYH9-RD) in children. Methods: The basic information, clinical features, gene variants and laboratory tests of MYH9-RD patients from 2 pedigrees confirmed in the First Affiliated Hospital of Zhengzhou University in November 2021 and July 2022 were analyzed retrospectively. "Non-muscle myosin heavy chain 9 related disease" "MYH9" and "children" were used as key words to search at Pubmed database, CNKI and Wanfang database up to February 2023. The MYH9-RD gene variant spectrum and clinical data were analyzed and summarized. Results: Proband 1 (male, 11 years old) sought medical attention due to epistaxis, the eldest sister and second sister of proband 1 only showed excessive menstrual bleeding, the skin and mucous membrane of the their mother were prone to ecchymosis after bumping, the uncle of proband 1 had kidney damage, and the maternal grandmother and maternal great-grandmother of proband 1 had a history of cataracts. There were 7 cases of phenotypic abnormalities in this pedigree. High-throughput sequencing showed that the proband 1 MYH9 gene had c.279C>G (p.N93K) missense variant, and family verification analysis showed that the variant was inherited from the mother. A total of 4 patients including proband 1 and family members were diagnosed with MYH9-RD. The proband 2 (female, 1 year old) sought medical attention duo to fever and cough, and the father's physical examination revealed thrombocytopenia. There were 2 cases of phenotypic abnormalities in this pedigree. High-throughput sequencing showed that there was a c.4270G>A (p.D1424N) missense variant in the proband 2 MYH9 gene, and family verification analysis showed that the variant was inherited from the father. A total of 2 patients including proband 2 and his father were diagnosed with MYH9-RD. A total of 99 articles were retrieved, including 32 domestic literatures and 67 foreign literatures. The MYH9-RD cases totaled 149 pedigrees and 197 sporadic patients, including 2 pedigrees in our study. There were 101 cases with complete clinical data, including 62 sporadic cases and 39 pedigrees. There were 56 males and 45 females, with an average age of 6.9 years old. The main clinical manifestations were thrombocytopenia, skin ecchymosis, and epistaxis. Most patients didn't receive special treatment after diagnosis. Six English literatures related to MYH9-RD caused by c.279C>G mutation in MYH9 gene were retrieved. Italy reported the highest number of cases (3 cases). Twelve literatures related to MYH9-RD caused by c.4270G>A mutation in MYH9 gene were retrieved. China reported the highest number of cases (9 cases). Conclusions: The clinical manifestations of patients in the MYH9-RD pedigrees varied greatly. MYH9 gene c.279C>G and c.4270G>A mutations are the cause of MYH9-RD.

Púrpura trombocitopénica idiopática (pti): su diagnóstico a través de lesiones en cavidad oral / Purple Idiopathic Thrombocytopenic (Itp): diagnosis through lesions in the oral cavity

La PTI es una alteración hemorrágica de instalación súbdita, adquirida, que se manifiesta inicialmente con petequias, equimosis o hematomas en piel y mucosas, sangrado nasal y gingival, sin causa aparente. La mucosa bucal puede ser el sitio donde las lesiones se observen con frecuencia y por primera vez. Se reporta el caso de un paciente masculino de 28 años de edad, con manifestaciones clínicas de un cuadro purpúrico, se describen signos, síntomas, terapéutica y manejo estomatológico (AU)

PTI is a hemorrhagic alteration of sudden installation, acquired, which manifests initially with petechiae, esquimosis or bruises on skin and mucosae, nasal and gingival bleeding without apparent cause. Bucal mucosae can be the site where lesions are observed with frequency, and for the first time. The case of a male patient with 28 years of age with clinical manifestationsofpurpuric syndrome is reported, signs, symptoms, therapeutic and stomatological handling are described (AU)

Hemofilia adquirida / Acquired hemophilia

Resumen La hemofilia adquirida (HA) es un trastorno hemostático autoinmune ocasionado por autoanticuerpos dirigidos contra el factor VIII: C. En 52 % de los casos, la causa se desconoce o no se asocia con otra entidad patológica; en el resto, existen factores concomitantes: lupus, artritis reumatoide, cáncer, embarazo y medicamentos. En México no existe registro ni conciencia de la enfermedad entre el personal de salud. Los grupos de mayor incidencia son las mujeres en edad reproductiva y los individuos mayores de 70 años. Se caracteriza por hemorragia grave, sobre todo posterior a traumatismos y parto o cesárea, y equimosis grandes en tronco y extremidades. La sospecha es simple, basta que concurran hemorragia súbita, grave y un TTPa prolongado que no se corrige con plasma. El tratamiento consiste en lograr la hemostasia y erradicar el anticuerpo; lo primero se logra con el factor VII activado recombinante o concentrado del complejo de protrombínico activado. La ciclofosfamida, prednisona o rituximab sirven para erradicar el anticuerpo. La mayoría de los casos no son diagnosticados y la mortalidad es alta. Ya que los médicos desconocen el problema, no se sospecha, no se diagnostica y no se trata. Este documento revisa los datos más recientes de la HA y abunda en el diagnóstico y tratamiento.

Abstract Acquired hemophilia (AH) is an autoimmune hemostatic disorder mediated by autoantibodies directed against factor VIII: C. In 52% of cases, the cause is unknown or is not associated with other pathological entities; in the rest, there are concomitant factors: lupus, rheumatoid arthritis, cancer, pregnancy, and medications. In Mexico, there is not a registry of AH, and awareness of the disease among health personnel is low. The groups with the highest incidence are women of childbearing age and individuals older than 70 years. It is characterized by severe bleeding, especially after trauma and normal childbirth or cesarean delivery, and large ecchymoses in the trunk and extremities. The suspicion is simple, it just takes for sudden, severe hemorrhage and a prolonged activated partial thromboplastin time that is not corrected with plasma to concur in an individual. Treatment involves achieving hemostasis and eradicating the antibody. The former is achieved with recombinant activated factor VII or activated prothrombin complex concentrate. Cyclophosphamide, prednisone or rituximab are used to eradicate the antibody. Most cases of AH are not diagnosed, which translates into a high mortality rate. Given that awareness about the disease among physicians is low, it is not suspected, neither diagnosed, and nor is it treated. This document reviews the most recent data on AH and expands on its diagnosis and treatment.

Parathyroid Adenoma Causing Spontaneous Cervical Hematoma: A Case Report and Review of Literature / 대한두경부종양학회지

Parathyroid adenoma can cause extracapsular bleeding. In 1934, Capps first reported a case of massive hemorrhage secondary to rupture of a parathyroid adenoma. Recently, we experienced a 73-year-old female presented with pharyngeal discomfort and extensive ecchymosis over the neck without history of trauma. Endoscopic investigation revealed submucosal hemorrhage in the posterior wall of the hypopharynx. CT scan and ultrasonography demonstrated the presence of a mass below the left thyroid lobe. Serum calcium level was normal and PTH level was elevated. We underwent left thyroidectomy and parathyroidectomy 2 weeks later from first visit. During the operation, hypopharyngeal mucosa was teared and it was treated with pharyngostoma formation and L-tube feeding. We report a rare case of normocalcemic parathyroid adenoma with spontaneous hemorrhage and propose the proper management period with a literature review

Prevenção e tratamento de equimose, edema e fibrose no pré, trans e pós-operatório de cirurgias plásticas / Prevention and treatment of ecchymosis, edema, and fibrosis in the pre-, trans-, and postoperative periods of plastic surgery

Introdução: A fibrose, o edema intenso e a equimose são as intercorrências que representam um grande desafio ao fisioterapeuta dermatofuncional no pós-operatório de cirurgia plástica de lipoaspiração e abdominoplastia. O objetivo é propor uma abordagem inédita desde o pré, trans e pós-operatório para prevenir e minimizar as fibroses, edema intenso e equimoses, acelerando a recuperação do paciente e reduzindo o número de sessões. Método: Ensaio clínico controlado, composto por 20 pacientes do sexo feminino, com idade entre 18 e 56 anos, divididos em dois grupos: 10 no grupo controle (GC) e 10 no grupo experimental (GE), que apresentavam indicação cirúrgica de abdominoplastia ou lipoaspiração abdominal, associadas ou não, e que se encontravam com no mínimo 7 dias de pré-operatório. Os dois grupos foram avaliados no pré-operatório. O GC recebeu atendimento somente a partir do 4º dia de pós-operatório, enquanto que o grupo GE recebeu atendimento durante o pré, trans e pós-operatório. Resultados: O grupo experimental apresentou uma média menor do número de sessões (p = 0,0032), perimetria menor no 4º dia de pós-operatório (p < 0,05) nos pontos antômicos: sulco inframamário e crista ilíaca, média menor na resolução da fibrose (p = 0,0058) e média menor na resolução da equimose (p = 0,0002) em relação ao grupo controle. Conclusão: Pode-se concluir com este estudo inédito que o tratamento no pré, trans e pós-operatório reduz o edema, a formação de equimose e principalmente a formação de fibrose no pós-operatório. Também diminui o número de sessões fisioterapêuticas e acelera o restabelecimento do paciente no pós-operatório das cirurgias abdominais.

Introduction: Fibrosis, intense edema, and ecchymosis are complications that represent a great challenge to dermatofunctional physiotherapists in the postoperative period of liposuction and abdominoplasty. Here we aimed to propose a new approach in the pre-, trans-, and postoperative periods to prevent and minimize fibrosis, intense edema, and ecchymosis, thereby expediting the patient's recovery and reducing the number of required physiotherapy sessions. Method: This controlled clinical trial included 20 female patients aged 18-56 years who were divided into the control group (CG; n = 10) and experimental group (EG; n = 10). All were scheduled to undergo abdominoplasty or abdominal liposuction at least 7 days after enrollment. The two groups were evaluated preoperatively. The CG received care only from the 4th postoperative day, while the EG received care during the pre-, trans-, and postoperative periods. Results: The EG required fewer mean physiotherapy sessions (p = 0.0032) and had lower perimetry values on the 4th postoperative day (p < 0.05) in the inframammary groove and iliac crest, lower mean resolution of fibrosis (p = 0.0058), and lower mean resolution of ecchymosis (p = 0.0002) compared to the CG. Conclusion: The findings of this unprecedented study indicate that treatment in the pre-, trans-, and postoperative periods reduces edema, ecchymosis, and fibrosis formation in the postoperative period. It also decreases the number of required physiotherapy sessions and accelerates patient recovery from abdominal plastic surgery.

Avaliação da equimose após osteotomia nasal lateral contínua interna e externa na rinoplastia aberta / Ecchymosis evaluation after internal and external continuous lateral nasal osteotomy in open rhinoplasty

INTRODUÇÃO: O objetivo é avaliar a presença de equimose com 7 e 15 dias após osteotomia nasal lateral interna e externa na rinoplastia aberta. Métodos: Análise prospectiva, dos pacientes submetidos à rinoplastia aberta, com osteotomia nasal lateral com total de 15 pacientes. Os pacientes foram alocados em dois grupos. Aqueles submetidos à osteotomia nasal lateral externa formaram o grupo A (n = 6) e os submetidos à osteotomia interna, o grupo B (n = 9). Foram avaliados com 7 e 15 dias de pós-operatório e registrada a presença ou ausência de equimose. Resultados: Dentro do grupo A evidenciamos no 7º dia de pós-operatório 3 (50%) pacientes com equimose e 3 (50%) sem alteração na tonalidade da pele. Com 15 dias de pós-operatório, o mesmo grupo apresentava 2 (25%) pacientes com equimose e 4 (75%) sem alteração. Já no grupo B foram identificados no 7º dia após o procedimento 3 (33,4%) pacientes com presença de equimose e 6 (66,6%) sem alteração. O mesmo grupo após 15 dias do procedimento apresentou 1 (11,1%) paciente com equimose e 8 (88,9%) sem alteração. Conclusão: Apesar da fratura interna apresentar menor incidência de equimose no sétimo e décimo quinto dias de pós-operatório, não houve relevância estatística na comparação entre as técnicas.

Introduction: The objective is to evaluate the presence of ecchymosis 7 and 15 days after internal and external lateral nasal osteotomy in open rhinoplasty. Methods: A prospective evaluation of 15 patients who underwent open rhinoplasty with lateral nasal osteotomy was conducted. The patients were allocated into two groups. Those who underwent external lateral nasal osteotomy were included in group A (n = 6), while those who underwent internal osteotomy were included in group B (n = 9). The patients were evaluated on postoperative days 7 and 15, and the presence or absence of ecchymosis was recorded. Results: In group A, we observed that on postoperative day 7, 3 patients (50%) had ecchymosis and 3 (50%) showed no changes in skin color. On postoperative day 15, the same group had 2 patients (25%) with ecchymosis and 4 (75%) without changes. On the other hand, in group B, 3 patients (33.4%) had ecchymosis and 6 (66.6%) showed no changes on postoperative day 7. In the same group, 1 patient (11.1%) had ecchymosis and 8 (88.9%) showed no changes 15 days after surgery. Conclusion: Despite the lower incidence of ecchymosis in internal fractures on postoperative days 7 and 15, no statistical significance was observed between the two techniques.

Surgical plane positioning with a disposable circumcision suture device for the treatment of phimosis and redundant prepuce / 中华男科学杂志

<p><b>Objective</b>To investigate the clinical effects of circumcision by surgical plane positioning with a disposable circumcision suture device in the treatment of phimosis and redundant prepuce.</p><p><b>METHODS</b>From September 2016 to June 2017, we treated 250 patients with phimosis or redundant prepuce, 127 by conventional circumcision (the control group) and the other 123 by surgical plane positioning with a disposable circumcision suture device (the observation group). We compared the operation time, intra-operative bleeding, preputial frenulum alignment, postoperative ecchymosis, and postoperative penile appearance between the two groups of patients.</p><p><b>RESULTS</b>Compared with the controls, the patients in the observation group showed significantly longer operation time (［4.48 ± 1.18］ vs ［7.17 ± 1.42］ min, P<0.05), lower rates of intra-operative frenulum bleeding (15.0% ［19/127］ vs 4.1% ［5/123］, P<0.05) and frenulum misalignment (26.8% ［34/127］ vs 0.8% ［1/123］, P<0.05), higher incidence of postoperative ecchymosis (41.7% ［53/127］ vs 21.1% ［26/123］, P<0.05), and higher satisfaction of the patients with the postoperative penile appearance (92.9% ［18/127］ vs 98.4% ［121/123］, P<0.05). However, no statistically significant difference was found between the control and observation groups in intra-operative non-frenulum bleeding (4.7% ［6/127］ vs 1.6% ［2/123］, P = 0.164).</p><p><b>CONCLUSIONS</b>Circumcision by surgical plane positioning with a disposable circumcision suture device can effectively avoid preputial frenulum misalignment, reduce intra-operative bleeding, and improve postoperative penile appearance.</p>

Focused low-intensity extracorporeal shock wave therapy for erectile dysfunction: Preliminary observation of 32 cases / 中华男科学杂志

<p><b>Objective</b>To make a preliminary investigation on the safety and efficacy of focused low-intensity extracorporeal shock wave therapy (LI-ESWT) in the treatment of erectile dysfunction (ED).</p><p><b>METHODS</b>We treated 32 ED patients by focused LI-ESWT with the device of Medispec's ED1000. Before and at 4 and 12 weeks after treatment, we evaluated the erectile function of the patients using the International Index of Erectile Function-erectile function domain (IIEF-EF), Erection Hardness Score (EHS), Sexual Encounter Profile questions 2 and 3 (SEP2 and SEP3), and Global Assessment Questionnaire questions 1 and 2 (GAQ1 and GAQ2), and recorded the incidence rate of adverse events.</p><p><b>RESULTS</b>The patients averaged 30.69 years of age. Compared with the baseline, the mean IIEF-EF score of the patients was significantly increased at 4 and 12 weeks after LI-ESWT (14.94 vs 20.97 and 21.47, P <0.01), and so were the EHS (1.75 vs 2.66 and 2.56, P <0.01) and the "Yes" answers to SEP2 (21.88% vs 68.75% and 71.88%), SEP3 (0 vs 43.75% and 56.25%), GAQ1 (NA vs 81.25% and 71.88%) and GAQ2 (NA vs 65.63% and 68.75%). The total effectiveness rates at 4 weeks and 12 weeks were 75% and 71.88% respectively. One of the patients felt penile shaft pain with mild ecchymosis after LI-ESWT but was recovered without special treatment a week later.</p><p><b>CONCLUSIONS</b>LI-ESWT can significantly improve the erectile function of ED patients with no obvious adverse effects within 12 weeks after treatment.</p>

Perfil clínico y epidemiológico de pacientes con hemofilia registrados en la Liga de Hemofílicos de Antioquia (Colombia) / Clinical and epidemiological profile of patients with hemophilia in Liga de Hemofilicos de Antioquia (Colombia)

Introducción: La hemofilia es una enfermedad hemorrágica hereditaria caracterizada por la ausencia o deficiencia de factores VIII y IX de la coagulación. Objetivo. Determinar el perfil clínico y epidemiológico de los pacientes con hemofilia registrados en la liga de hemofílicos de Antioquia (LIHEA) durante 2005-2011. Metodología. Estudio descriptivo transversal, la población fueron pacientes con hemofilia de la LIHEA que cumplieron con criterios de selección. Se diseñó un instrumento de recolección de información y se aplicó el instrumento Modelo de actitud en pacientes con hemofilia (MAPACHE). Las variables cuantitativas se analizaron con medidas de tendencia central y dispersión, a las variables cualitativas se les estimó frecuencias absolutas, proporciones y razones. Resultados. Se incluyeron 36 hombres con hemofilia, con una mediana de 22 años de edad. En cuanto a los antecedentes personales los más frecuentes fueron HTA (8.3%) y tromboflebitis (5.6%). El sedentarismo fue el factor de riesgo de estilo de vida más común (8.3%). Las manifestaciones clínicas más frecuentes fueron hemartrosis (94.4%), hematomas musculares (80.6%) y equimosis (77.8%). En la mitad de los pacientes la enfermedad generó algún tipo de discapacidad, siendo la más frecuente la física (44.4%). El tratamiento farmacológico más frecuente fue profilaxis con factor VIII con un 88.9%, acompañado de la natación como principal tratamiento no farmacológico con un 77.8%. En cuanto al MAPACHE el 30.6% manifestó una actitud negativa hacia la enfermedad, un 5.6% fue neutra y para el 63.9% restante fue positiva. Conclusión. La hemofilia tuvo grandes repercusiones físicas y emocionales para los pacientes estudiados que la padecen

Introduction: Hemophilia is a hereditary hemorrhagic disorder characterized by the absence or deficiency of factors VIII and IX of the coagulation. Objective. To determine the clinical and epidemiological profile of patients with hemophilia recorded in the Liga de Hemofilicos de Antioquia (LIHEA) during 2005-2011. Methodology. Descriptive transversal study, population were patients with hemophilia from LIHEA which met selection criteria. We designed a data collection instrument and applied the attitude instrument in patients with hemophilia (MAPACHE). The quantitative variables were analyzed using measures of central tendency and dispersion, the qualitative variables were estimated absolute frequencies, proportions and reasons. This research had the respective ethical guarantee. Results. We included 36 men with hemophilia, with a median of 22 years of age. In terms of the personal history, the most frequent were hypertension (8.3%) and thrombophlebitis (5.6%). Sedentariness was the most common lifestyle risk factor (8.3%). The most frequent clinical manifestations were hemarthrosis (94.4%), muscle hematomas (80.6%) and ecchymosis (77.8%). In half of the patients, disease generated some kind of disability, being the most common the physics (44.4%). The most common drug treatment was prophylactic factor VIII with 88.9 %, accompanied by swimming as the main non-pharmacological treatment with 77.8 %. Respect MAPACHE, the 30.6% expressed a negative attitude towards the disease, a 5.6% was neutral and the 63.9% was positive. Conclusion. Hemophilia is still a disease of great physical and emotional implications for studied patients who suffer it

Validação da definição de termos identificados em registros eletrônicos de enfermagem de um hospital universitário / Validation of the definition of terms identified in electronic records of nursing of a university hospital / Validación de la definición de términos identificados en registros electrónicos de enfermería de un hospital universitario

Este estudo objetivou validar a definição de termos registrados por enfermeiros na evolução do paciente de um hospital universitário, com base na Classificação Internacional para as Práticas de Enfermagem (CIPE® ). A base empírica foi composta por 15 termos não constantes na CIPE® , extraídos das evoluções registradas por enfermeiros em prontuário eletrônico do paciente, de um hospital da região Sul do país. As definições foram analisadas por 36 enfermeiros, por meio da proporção de concordância geral de utilização e do Índice de Validade de Conteúdo (IVC) geral e por princípios de definição terminológica. Os termos "anasarca", "equimose" e "posição de Fowler" atingiram proporção de concordância geral de utilização acima de 80%, enquanto agonia obteve a menor proporção (25%). A variável ocupação não interferiu no resultado, porém enfermeiros com menor tempo de atuação na instituição reconheceram a utilização de mais seis termos. A definição dos termos "anasarca" e "equimose" foi validada com IVC de 0,98 e 0,90, respectivamente; por outro lado, a de posição de Fowler não foi validada (IVC = 0,67), tendo sido limitada por sua concisão. Concluiu-se que o reconhecimento ou não de termos por enfermeiros assistenciais é determinado pelas características da clientela assistida na instituição. [AU]

This study aimed to validate the definition of terms recorded by nurses at the patient's evolution of a university hospital, based on the International Classification for Nursing Practice (ICNP® ).The empirical base was composed of 15 terms that not listed on ICNP® , extracted of the evolutions registered by nurses in electronic patient record, a hospital in the South of the country. The definitions reviewed by 36 nurses, by proportion of general use agreement and Content Validity Index (CVI) general terminology definition and principles. The terms "anasarca", "bruise" and "fowler position" reached proportion of general agreement of use above 80%, while the smallest proportion obtained agony (25%). The variable occupation did not interfere in the outcome, but nurses with shorter performance in institution recognized the use of six more terms. The definition of the terms "anasarca" and "bruise" validated with CVI to 0,98 and 0,90, respectively; on the other hand, the Fowler position not validated (CVI = 0,67), having been limited by your brevity. It was concluded that the recognition or otherwise of terms for assisting nurses is determined by the characteristics of the clients assisted at the institution. [AU]

Este estudio tuvo el objetivo de validar la definición de términos registrados por enfermeros en la evolución del paciente de un hospital universitario, con base en la Clasificación Internacional para las Prácticas de Enfermería (CIPE® ). La base empírica fue compuesta por 15 términos no constantes en la CIPE® , extraídos de las evoluciones registradas por enfermeros en registro médico electrónico del paciente, de un hospital de la región Sur del país. Las definiciones fueron analizadas por 36 enfermeros, por medio de la proporción de concordancia general de utilización y del Índice de Validez de Contenido (IVC) general y por principios de definición terminológica. Los términos "anasarca", "equimosis" y "posición de Fowler" alcanzaron proporción de concordancia general de utilización arriba del 80%, mientras que "agonía" obtuvo la menor proporción (25%). La variable "ocupación" no interfirió en el resultado, sin embargo enfermeros con menor tiempo de actuación en la institución reconocieron la utilización de más seis términos. La definición de los términos "anasarca" y "equimosis" fue validada con IVC de 0,98 y 0,90, respectivamente; por otro lado, la de posición de Fowler no fue validada (IVC = 0,67), siendo limitada por su concisión. Se concluye que el reconocimiento, o no, de términos por enfermeros asistenciales es determinado por las características de la clientela asistida en la institución. [AU]

The Results of Unilateral Osteotomy to Correct the Deviated Nose / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Osteotomy, usually carried out bilaterally, is a commonly performed procedure to correct the bony dorsum of deviated nose. However, it is an invasive maneuvers which can affect the stability of nasal bone and develop complications, such as, edema and ecchymosis. This study aims to evaluate the usefulness of unilateral osteotomy in correcting a deviated nose with various scoliosis. SUBJECTS AND METHOD: We studied 9 of the 69 patients who underwent corrective rhinoplasty with unilateral osteotomy to correct the bony nasal dorsum between 2010 and 2014. For patients whose bony nasal dorsum was corrected well after performing osteotomy on the convex side of the bony dorsum, the opposite side was not operated on; however, if correction was incomplete, osteotomy was additionally performed on the opposite side. For this study, patients who underwent bilateral osteotomy were excluded from the study. The improvement of correction was assessed by comparing the preoperative and postoperative photos. RESULTS: Of the nine patients treated with unilateral osteotomy, 5 cases were C or reverse C type deviations, 1 case was S type deviation and 3 were straight deviations. Five of the nine patients improved greatly and the rest improved significantly. None of the patients experienced worsening change postoperatively. CONCLUSION: Osteotomy is essential but invasive maneuver, so it is desirable to reduce the number of times to execute. By performing osteotomy on the convex side of the nose first, we can correct the deviated nose effectively while reducing the number of implementation.

Acquired Hemophilia A Combined with Systemic Lupus Erythematosus: A Case Report and Literature Review

Acquired hemophilia A (AHA) is a rare hemorrhagic disorder caused by autoantibodies against factor VIII (FVIII). An 80-year-old woman presented multiple bruises on her upper and lower extremities, along with gross hematuria. Extensive ecchymosis and swelling were observed on the buttocks. She had anemia and normal platelet count. The initial coagulation results showed prolonged activated partial thromboplastin time (aPTT, 68.5 seconds) and normal prothrombin time. According to the mixing test, we observed a decreased FVIII activity (2%), increased factor VIII inhibitor (FVIII-I) titer (74.4 BU), and negative lupus anticoagulant. AHA was diagnosed based on late onset bleeding and increased FVIII-I titer. Additionally, she met the criteria for systemic lupus erythematosus (oral ulcer, photosensitivity, renal disorder, and positivity for antinuclear and anti-β2-glycoprotein-I antibodies). She was started on oral prednisolone for FVIII-I eradication. Post-treatment, her bleeding tendency, aPTT (47.3 seconds), and FVIII-I titer decreased (1.24 BU), and FVIII activity increased (10%).

Cavernous sinus thrombosis following dental extraction: a rare case report and forgotten entity

Prior to the advent of efficacious antimicrobial agents, the mortality rate from cavernous sinus thrombosis (CST) was effectively 100%. There have been very few reports of CST associated with tooth extraction. A 40-year-old female presented to the emergency room with swelling over the right side of the face and history of extraction in the upper right region by an unregistered dental practitioner. The patient presented with diplopia, periorbital ecchymosis, and chemosis of the right eye. A computed tomography scan revealed venous dilatation of the right superior ophthalmic vein. The patient was immediately treated with incision and drainage, intravenous antibiotics, and heparin (low molecular weight). Unfortunately, the patient died two days after surgery due to complications from the disease. CST is a rare disease with a high mortality rate. Therefore, dental health education in rural areas, legal action against unregistered dental practitioners, early diagnosis, and aggressive antibiotic treatment can prevent future mortality resulting from CST.

Cavernous sinus thrombosis following dental extraction: a rare case report and forgotten entity

Prior to the advent of efficacious antimicrobial agents, the mortality rate from cavernous sinus thrombosis (CST) was effectively 100%. There have been very few reports of CST associated with tooth extraction. A 40-year-old female presented to the emergency room with swelling over the right side of the face and history of extraction in the upper right region by an unregistered dental practitioner. The patient presented with diplopia, periorbital ecchymosis, and chemosis of the right eye. A computed tomography scan revealed venous dilatation of the right superior ophthalmic vein. The patient was immediately treated with incision and drainage, intravenous antibiotics, and heparin (low molecular weight). Unfortunately, the patient died two days after surgery due to complications from the disease. CST is a rare disease with a high mortality rate. Therefore, dental health education in rural areas, legal action against unregistered dental practitioners, early diagnosis, and aggressive antibiotic treatment can prevent future mortality resulting from CST.

Saphenous vein occlusion with cyanoacrylate: a systematic review

Saphenous vein occlusion with cyanoacrylate is a new technology for the treatment of incompetent veins by endovascular embolization with cyanoacrylate glue. The objective of this review was to evaluate the safety and effectiveness of saphenous vein occlusion with cyanoacrylate. A literature search was conducted using 8 Korean databases, Medline, Embase, and the Cochrane Library. From the 1,730 articles that were initially identified, 8 studies (1 randomized controlled trial, 1 non-randomized controlled trial, and 6 case series/case reports) were included in this review. The results show that similar levels of adverse events or complications occurred in patients treated with cyanoacrylate ablation compared to the other treatment groups (laser ablation or radiofrequency ablation), but the ecchymosis and closure rates of the treated veins were significantly better in the cyanoacrylate ablation group. Improvements in symptoms and quality of life after the treatment were also observed. On the basis of the current data, saphenous vein occlusion with cyanoacrylate can be recommended as a safe and effective treatment for patients with saphenous vein reflux.

Evaluación médico legal de las equimosis cutaneas / Medicolegal evaluation of skin ecchymosis

Las equimosis cutáneas representan la más frecuente de las lesiones encontradas en casos de agresión física.Se producen por de la ruptura de vasos sanguíneos (principalmente capilares), que conduce a extravasación de la sangre y acumulo en el tejido intradérmico, subcutáneo o en ambos. Posterior a esto se inicia un proceso inflamatorio local que conlleva a la degradación de la hemoglobina en subproductos cromóforos (hemosiderina, biliverdina, bilirrubina, metahemoglobina) que dan la coloración inicial y sus cambios. El método visual usado durante décadas es poco efectivo y lo más recomendable es la evaluación las lesiones con respecto a la aparición de la coloración amarillenta. Se están desarrollando nuevos métodos para mejorar la datación de las lesiones, que parecen bastante prometedores (espectrofotometría y resonancia magnética).

Skin bruising are the most frequent lesions found in cases of physical aggression. Product of blood vessels rupture (especially capillaries), leading to extravasation and accumulation of blood in the intradermic tissue, subcutaneous tissue or both. After that, begins a local inflammatory process leading to the degradation of hemoglobin chromophore subproducts (hemosiderin, biliverdin, bilirubin, methemoglobin) which give the initial coloring and changes over the time. The visual method used for decades is ineffective and the best approach is looking por the presence of the color yellow into the bruise. At present, new methods are developing to improve the dating of injuries that seem quite promising (spectrophotometry and magnetic resonance).

Fatal Intracranial Hemorrhage in a Patient with Disseminated Intravascular Coagulation associated with Sepsis / 대한구급학회지

In critically ill patients, disseminated intravascular coagulation (DIC) is a common and fatal hematological disorder. DIC is a physiological response to a variety of underlying stimuli that provoke generalized activation of the hemostatic mechanism and is common in septic patients and those with hematological or non-hematological malignant neoplasms. Bleeding is a common clinical feature, and diffuse or multiple-site mucocutaneous bleeding, such as petechia, ecchymosis and hemorrhage from gastrointestinal tract, is often seen. A 58-year-old male was recently diagnosed with intracranial hemorrhage (ICH) caused by DIC associated with sepsis. Mortality of ICH caused by DIC is very high because the underlying condition cannot be quickly treated. Awareness of the possibility of DIC developing in a critically ill patient and the need for immediate initiation of plasma or platelet replacement therapy are important. To the best of our knowledge, this is the first reported case of intracranial hemorrhage in a Korean patient with DIC associated with sepsis.

Hepatic Hemangioma with Kasabach-Merritt Syndrome in an Adult Patient / 대한소화기학회지

Hemangiomas are the most common benign tumors of the liver. They are generally asymptomatic, but giant hemangiomas can lead to abdominal discomfort, bleeding, or obstructive symptoms. Kasabach-Merritt syndrome is a rare but life-threatening complication of hemangioma, characterized by consumptive coagulopathy with large vascular tumors. More than 80% of Kasabach-Merritt syndrome cases occur within the first year of life. However, there are few reports of Kasabach-Merritt syndrome with giant hepatic hemangioma in adults and, as far as we know, no reports of Kasabach-Merritt syndrome with hepatic hemangioma treated with first line medical treatment only. The most important treatment for this syndrome is removal of the large vascular tumor. However, surgical treatment entails risk of bleeding, and the patient's condition can mitigate against surgery. We herein present a case of unresectable giant hepatic hemangioma with disseminated intravascular coagulopathy. The patient was a 60-year-old woman who complained of hematochezia, ecchymosis, and abdominal distension. She refused all surgical management and was therefore treated with systemic glucocorticoids and beta-blockers. After two weeks of steroid therapy, she responded partially to the treatment. Her laboratory findings and hematochezia improved. She was discharged on hospital day 33 and observed without signs of bleeding for three months.