Hematoma gigante coagulado del gastrocnemio medial de localización atípica. Tratamiento con fibrinolíticos en el drenaje ecoguiado: a propósito de un caso / Giant coagulated hematoma of the medial gastrocnemius of atypical location. Treatment with fibrinolytics in ultrasound-guided drainage: a case report

A propósito de un paciente de 57 años con rotura de gastrocnemio medial y hematoma gigante coagulado de localización atípica, se revisan las consideraciones epidemiológicas, las pruebas de diagnóstico a realizar y el tratamiento utilizado (drenaje del hematoma mediante punciones seriadas ecoguiadas con la utilización de urocinasa intracavitaria), además de describir su evolución clínica.(AU)

Regarding a 57-year-old patient with medial gastrocnemius tear and a giant coagulated hematoma of atypical location, the epidemiology, diagnostic test and treatment used are reviewed (hematoma drainage by means of serial punctures, echo-guided, with the use of intracavitary urokinase), as well as its clinical evolution is described.(AU)

Transcultural influence on female genital mutilation done in late pregnancy: A case report.

A complicated case of female genital mutilation (FGM) type 2b done in late-pregnancy is presented and the interplay of Yoruba and Kwale culture, in this case, is discussed. A Yoruba who grew up among Kwales/Urhobos had FGM at 38 weeks and 4 days gestation (to assure vaginal delivery) and presented with vulvar hematoma, septicemia, obstructed labor, and a distressed fetus. 5 days after FGM procedure, she had an emergency cesarean section (EmCS), repair of FGM site and baby was admitted in special care. There was the obvious synergy of the Yoruba culture of FGM in infancy and Kwale/Urhobo culture of FGM in pregnancy. The patient and her fetus/baby almost became mortalities but for prompt intervention. The role of sociocultural factors in the practice of FGM is recommended to be further investigated as FGM even in educated women and at the dangerous stage of term pregnancy is still prevalent.

Rehabilitation Augments Hematoma Clearance and Attenuates Oxidative Injury and Ion Dyshomeostasis After Brain Hemorrhage.

BACKGROUND AND PURPOSE: We assessed the elemental and biochemical effects of rehabilitation after intracerebral hemorrhage, with emphasis on iron-mediated oxidative stress, using a novel multimodal biospectroscopic imaging approach. METHODS: Collagenase-induced striatal hemorrhage was produced in rats that were randomized to enriched rehabilitation or control intervention starting on day 7. Animals were euthanized on day 14 or 21, a period of ongoing cell death. We used biospectroscopic imaging techniques to precisely determine elemental and molecular changes on day 14. Hemoglobin content was assessed with resonance Raman spectroscopy. X-ray fluorescence imaging mapped iron, chlorine, potassium, calcium, and zinc. Protein aggregation, a marker of oxidative stress, and the distribution of other macromolecules were assessed with Fourier transform infrared imaging. A second study estimated hematoma volume with a spectrophotometric assay at 21 days. RESULTS: In the first experiment, rehabilitation reduced hematoma hemoglobin content (P=0.004) and the amount of peri-hematoma iron (P<0.001). Oxidative damage was highly localized at the hematoma/peri-hematoma border and was decreased by rehabilitation (P=0.004). Lipid content in the peri-hematoma zone was increased by rehabilitation (P=0.016). Rehabilitation reduced the size of calcium deposits (P=0.040) and attenuated persistent dyshomeostasis of Cl- (P<0.001) but not K+ (P=0.060). The second study confirmed that rehabilitation decreased hematoma volume (P=0.024). CONCLUSIONS: Rehabilitation accelerated clearance of toxic blood components and decreased chronic oxidative stress. As well, rehabilitation attenuated persistent ion dyshomeostasis. These novel effects may underlie rehabilitation-induced neuroprotection and improved recovery of function. Pharmacotherapies targeting these mechanisms may further improve outcome.

Aphasia and unilateral spatial neglect due to acute thalamic hemorrhage: clinical correlations and outcomes.

Thalamic hemorrhages are associated with a variety of cognitive dysfunctions, and it is well known that such cognitive changes constitute a limiting factor of recovery of the activities of daily living (ADL). The relationship between cognitive dysfunction and hematomas is unclear. In this study, we investigated the relationship between aphasia/neglect and hematoma volume, hematoma type, and the ADL. One hundred fifteen patients with thalamic hemorrhage (70 men and 45 women) were studied. Their mean age was 68.9 ± 10.3 years, and patients with both left and right lesions were included. We calculated hematoma volume and examined the presence or absence of aphasia/neglect and the relationships between these dysfunctions and hematoma volume, hematoma type, and the ADL. Fifty-nine patients were found to have aphasia and 35 were found to have neglect. Although there was no relationship between hematoma type and cognitive dysfunction, hematoma volume showed a correlation with the severity of cognitive dysfunction. The ADL score and ratio of patient discharge for patients with aphasia/neglect were lower than those for patients without aphasia/neglect. We observed a correlation between the hematoma volume in thalamic hemorrhage and cognitive dysfunction. Aphasia/neglect is found frequently in patients with acute thalamic hemorrhage and may influence the ADL.

[Clinical characteristics and rehabilitation treatment of iliopsoas hemorrage in 41 patients with hemophilia].

OBJECTIVE: To analyze the clinical characteristics and effects of rehabilitation treatment on hemophiliacs with iliopsoas hemorrage. METHODS: The hemophilia patients with iliopsoas bleeding treated in Peking Union Medical College Hospital between January 2006 to December 2010 were enrolled. The clinical characteristics including symptoms, signs, complications, and rehabilitation treatment were analyzed retrospectively. RESULTS: All of the forty-one hemophiliacs with iliopsoas bleeding were male, 20 cases wee the left bleeding, 18 the right, and 3 the bilateral. The median median age was 18 (6 - 61) years old(y). The median age of the iliopsoas bleeding for the first time was 17 (6 - 20) y. 34 patients accompanied with femoral nerve injury, 19 of them had secondary knee bleeding on the same side. 20 patents had quadriceps atrophy. Pelvic pseudotumor developed in 2 patients and permanent abnormal posture in 2 patients. The main finding of the ultrasound image was low-echo mass in iliopsoas muscles or inguinal region. 34 patients received rehabilitation therapy for 8 - 12 weeks under the support of factor replacement, complete hematomas absorption in 33 of them, with hip range of motion recovering back to baseline. 27 of 32 (84.4%) cases with femoral nerve injury got quadriceps strength above 4/5 grade, 20 cases of femoral nerve injury (62.5%) still had numbness on front of their thigh after treatment. CONCLUSIONS: In this cohort of iliopsoas bleeding, most of the patients are adolescent. High prevalence of the femoral nerve injury and the secondary knee bleeding are found. Rehabilitation treatment under the support of factor replacement is safe and effective on hematoma absorption and neurological function recovery.

Tetraparesia secundaria a hematoma epidural postbloqueo epidural cervical / Tetraparesis secondary to epidural hematoma postcervical epidural block

El bloqueo epidural es una técnica cada vez más utilizada en las Unidades del Dolor. Los hematomas epidurales son una complicación poco frecuente de las infiltraciones epidurales, pero de extrema gravedad y que deben ser diagnosticados y tratados en las primeras horas para conseguir una buena recuperación clínica. Presentamos el caso de un paciente con un cuadro agudo de tetraparesia secundaria a un hematoma epidural post-infiltración cervical, diagnosticado y tratado de forma precoz con corticoides, sin precisar drenaje quirúrgico y presentando una evolución favorable hasta su recuperación completa. Destacamos la importancia de la correcta indicación de esta técnica y en el caso de que se produzca esta complicación realizar un diagnóstico y tratamiento precoces (AU)

Epidural block is a technique increasingly used in Pain Units. Epidural hematomas are a rare complication of epidural injections, but of great seriousness, so they must be diagnosed and treated in the early hours to achieve good clinical recovery. We report the case of a patient with an acute tetraparesis, epidural hematoma secondary to a cervical post-infiltration, which was diagnosed and treated early with corticosteroids, without requiring surgical drainage and whose evolution was favorable until complete recovery. We highlight the importance of proper indication of this technique and in the case of occurrence of this complication of making an early diagnosis and treatment (AU)

Management of muscle haematomas in patients with severe haemophilia in an evidence-poor world.

Treatment studies in haemophilia focus on joint bleeds; however, some 10-25% of bleeds occur in muscles. This review addresses management of muscle haematoma in severe haemophilia, defines gaps in the published evidence, and presents a combined clinician and physiotherapist perspective of treatment modalities. The following grade 2C recommendations were synthesized: (i) Sport and activity should be based on individual factor levels, bleeding history and physical characteristics, (ii) Musculoskeletal review aids the management of children and adults, (iii) 'Time to full recovery' should be realistic and based on known timelines from the healthy population, (iv) Diagnosis should be carried out by both a clinician and physiotherapist, (v) Severe muscle bleeds should be treated similarly to surgical patients: a 50% trough for 10-14 days followed by high-level prophylaxis, (vi) Protection, rest, ice, compression and elevation should be implemented in the acute stage, and (vii) Physiotherapy and rehabilitation should be divided into: control of haemorrhage (phase 1); restoration of Range of Movement (ROM) and strength (phase 2); functional rehabilitation and return to normal living (phase 3). Recommendations specifically for inhibitor patients include: (i) Minor to moderate bleeds should be managed by home-treatment within 1 h of bleed onset using either one injection of rFVIIa 270 µg kg(-1), or two to three injections of rFVIIa 90 µg kg(-1) (2-3 h intervals), or FEIBA 50-100 U kg(-1) (repeated at 12-hourly intervals, if necessary) and (ii) Severe muscle bleeds should be supervised by the treatment centre and include bypassing agents until clinical improvement is observed.

[Muscle injuries: diagnostics and treatments]. / Muskelverletzungen: Diagnostik und Behandlungen.

Muscle injuries are common in sports. They are usually caused by either acute (mostly eccentric mechanisms) or chronic overloading with a lack of muscle coordination. They present in clinical practice as bruises and muscle sprains. Due to the rigours of a modern society and the high economic cost of time off work, an effective treatment needs to be employed. The key to an optimised therapy rests in the appropriate timing between immobilisation and mobilisation. The interval to muscle repair might be shortened by certain adjuvant therapies. In doing so, it is important that no physiological phases of wound healing are overlooked. Muscle healing can be accelerated by externally induced higher metabolic turnover. Surgical therapy is sometimes necessary in selected cases and in serious injuries.

Conservative physiotherapeutic management of chronic haematomata and haemophilic pseudotumours: case study and comparison to historical management.

A conservative, non-operative physiotherapeutic regime for the management of chronic haematomata and pseudotumours in patients suffering from haemophilia is described in this article. Two cases are described where physiotherapy treatment is applied to large masses at the shoulder and femur respectively, where therapy commenced within the first 6 months following onset. These are presented relative to a case that was managed over a much longer period without early physiotherapy input, and the relative outcomes are examined. While both the early physiotherapy-managed cases showed a complete resolution at follow-up examination, the more established chronic pseudotumour required surgical excision, with significant residual muscle contractility, length and strength issues noted on clinical and magnetic resonance imaging reviews. No adverse symptoms or haemostatic issues were reported in response to this less invasive treatment regime by either patient in the two conservative physiotherapy cases.

Cortical reorganization demonstrated by diffusion tensor tractography analyzed using functional MRI activation.

The diffusion tensor tractography (DTT) allows the corticospinal tract(CST) to be visualized at the subcortical level and functional MRI (fMRI) is capable of precisely identifying activation sites at the cortex. Therefore, it seems that combined DTT/fMRI would allow more accurate evaluation of the state of the CST. We have attempted to demonstrate cortical reorganization in a patient with cortical hemorrhage using DTT analyzed by fMRI activations. Six normal subjects and a 12-year-old female patient with a hemorrhage in the left fronto-parietal cortex were recruited. fMRI was performed at 1.5-T with timed hand grasp-release movements, and DTT was performed using 1.5-T with a Synergy-L Sensitivity Encoding head coil. Three-dimensional reconstructions of the fiber tracts were obtained using the fMRI activation as the seed region of interest and the CST area of the anterior pons as the target region of interest. The tract of the affected hemisphere originated from the lateral area of the injured precentral knob and descended along the known corticospinal tract pathway. It seems that the motor function of the affected hand was reorganized into the lateral area of the injured precentral knob. Therefore, these combined modalities would be helpful in elucidating the state of the CST.

Rehabilitación de los hematomas musculares en los pacientes hemofílicos / Rehabilitation of muscular haematomas in the haemophilic patients

Introducción. La hemofilia es una enfermedad congénita de carácter recesivo, ligada al cromosoma X, que se caracteriza por episodios hemorrágicos que afectan principalmente al sistema musculosquelético. Los pacientes hemofílicos presentan concentraciones disminuidas de los factores de coagulación circulantes en plasma. El déficit de factor VIII se denomina hemofilia A y el déficit de factor IX hemofilia B; ambas hemofilias son clínicamente indistinguibles. El valor normal de los factores de la coagulación está alrededor de 1 U/ml (100 % o 100 U/dl). La hemofilia se clasifica engrave (nivel 5 %). Los individuos que presentan niveles superiores al 50 % de factor no suelen presentar problemas. La incidencia hemorrágica es, obviamente, mayor en la hemofilia grave, siendo los hematomas musculares, el hemartrosy la sinovitis las lesiones más comunes que, en este proceso, pueden provocar lesiones irreversibles e invalidantes. La prevención y el tratamiento de las lesiones del aparato locomotor requiere una rehabilitación específica y esto es de especial importancia para mejorar la calidad de vida del paciente hemofílico. El objetivo de este trabajo es el análisis de la incidencia de hematomas musculares y la revisión de los tratamientos de rehabilitación. Material y métodos. Se revisaron las historias de 232 pacientes afectados de hemofilia, 217 hemofilia A y 15 hemofilia B; 80 grave, 42, moderada, y 110, leve. Resultados. Durante el año 2002, 75 pacientes (50 graves,16 moderados y 9 leves) sufrieron hematomas musculares de gravedad, que requirieron tratamiento hematológico y rehabilitador .Conclusiones. En el paciente hemofílico el 100 % de los hematomas que afectan al sistema musculosquelético precisaron para su resolución, en primera instancia, inmovilización y crioterapia, además de la administración de factor VIII/IX, posteriormente requirieron cinesiterapia progresiva para la recuperación funcional

Introduction. Haemophilia is a congenital disease of recesive character, linked to the X chromosome, which is characterized by spontaneus bleeding affecting principally the musculoskeletal system. Haemophilic patients present diminished levels of the circulating coagulation factors in plasma. The deficit of factor VIII is termed haemophilia And the deficit of factor IX haemophilia B; both haemophilia sare clinicallly indistinguishable. Normal values for most clotting factors is around 1 UI/ml (100 % or 100 UI/dl). Three different degrees of severity are recognized: Severe (level 5 %). The individuals who present factor levels above 50 % are not in the habit of presenting problems. Bleeding effects are, obviously, major in the severe haemophilia. The most typical bleeding symptom are muscular haematomas, haemarthrosis and synovitis; in this pathology can appear irreversible injuries and dissability. The prevention and treatment of the injuries of the locomotive device need a specific rehabilitation and this is of special importance to improve the quality of life of the haemophilic patient. The aim of this work is the analysis of frequency of muscular haematomas and the review of the treatments of rehabilitation. Material and methods. We checked the histories of 232haemophilic patients, 217 A and 15 B; 80 severe, 42 moderate and 110 mild. Results. In the year 2002, 75 patients (50 severe, 16 moderate and 9 mild) suffered serious muscular haematomas, which needed haematologic treatment and rehabilitation. Conclusions. In the haemophilic patients, the 100 % of haematomas in the musculoskeletal system needed for their resolution, in the first instance, immobilization and criotherapy, besides the administration of factor VIII/IX, laterthey needed progressive cinesitherapy for the functional recovery

Tortícolis congénita: incidencia y actuación fisioterápica en neonatos con contractura en el esternocleidomastoideo / Congenital torticollis: Incidence and physiotherapeutic performance in newborns with contracture of sternocleidomastoid

Con el objeto de diferenciar casos de Tortícolis congénita por hematoma o por contractura en el ECM, tanto en su evaluación como en su tratamiento, hemos realizado este estudio en una muestra de 45 neonatos de una Zona Básica de Atención Primaria de Badajoz durante el primer año de vida. Se pretende demostrar la importancia en todos los casos del tratamiento precoz y seguimiento, precedido de una buena evaluación.Antes de iniciar el método de tratamiento realizamos una evaluación del desarrollo psicomotor del niño teniendo en cuenta la Actividad Refleja y los Hitos en las Etapas del Desarrollo. Destacar además la valoración de la musculatura tónica del cuello, tronco y extremidades para así hacer un tratamiento más diferenciado. La metodología empleada ha sido Tratamiento Neurodesarrollante de Bobath, y Reequilibración Tónica, así como enseñanza a los padres de medidas paleativas durante este primer año de vida. Los resultados más significativos han sido una mayor incidencia de contractura que de hematoma, más incidencia en niños que en niñas, mejores resultados obtenidos cuanto antes nos fueron derivados, siendo la edad media de derivación de 2,5 meses, así como mayor presencia de plagiocefalia como patología asociada (AU)

[Experience in using ultrasonic and laser therapy in surgical diseases]. / Opyt ispol'zovaniia ul'tratono- i lazeroterapii pri khirurgicheskikh zabolevaniiakh.

Experience is presented gained with the use of ultratonotherapy, low-intensity laser radiation of infrared actions, and a number of drug electrophoreses in the treatment of 358 surgical patients over 1994-1996. A complex of combinations of different techniques common in physiotherapy has been designed with those of drug therapy during different phases of surgical disorders. Methods and complexes of the therapy treatments to be administered are submitted together with relevant indications. The proposed variants of complex physiotherapy make for earlier recovery, shorter treatment courses, longer remission.

[Outcome evaluation in putaminal hemorrhage by multiple regression analysis].

The aim of this study was to determine the factors that influence the prognosis of hypertensive putaminal hemorrhage. We investigated the outcome of the activity of daily living (ADL 1: full recovery at social life, 2: self cared, 3: required partial care at home, 4: remained bedridden, 5: vegetative state, 6: dead) one year after the onset of putaminal hemorrhage in comparison with initial data obtained on the day when it occurred. The following parameters were assessed: sex, age, side of hematoma, classification of computed tomography (CT) findings, neurological grade, degree of muscle power, hematoma volume, treatment, past history of cerebrovascular disease, and laboratory data. In 67 patients with putaminal hemorrhage, the relationships among these parameters were examined using Spearman's rank correlation analysis. Additionally, in 55 patients (24 male and 31 female) with complete data from the day of onset, multiple regression analysis was performed. The data of muscle power were handled by the quantification method. The result of Spearman's rank correlation coefficient indicated that the outcome had a positive correlation with age (correlation coefficient = 0.375), CT classification (0.595), neurological grade (0.714), hematoma volume (0.689), a past history of cerebrovascular disease (0.475), the white blood cell count (0.541), and the lactate dehydrogenase level (0.347). The outcome had a negative correlation with muscle power (-0.579) and the cholinesterase (-0.340).(ABSTRACT TRUNCATED AT 250 WORDS)

Extradural hematomas in children.

The authors studied 58 patients, under 12 years of age, admitted to the Emergency Room of the Sao Paulo University Hospital between September 1987 and November 1991 with the diagnosis of traumatic extradural hematoma. Emphasis was given to the etiology of injury, the time interval from head injury to emergency room evaluation, the clinical features and the outcome after surgical and nonsurgical management. The site of hematoma was defined and correlated with the presence of skull fractures. Computerized tomography is the main diagnostic method, although it is not definitive. Fifteen patients were treated nonsurgically according to rigid clinical and radiological parameters. The overall mortality rate was 3.4%.

[Our method of management of the cases of intracranial hematoma--late results of the treatment]. / Wlasna metoda postepowania w przypadku nieurazowego krwiaka sródmózgowego--odlegle wyniki leczenia.

An original method of qualification for surgical treatment of patients with non-traumatic intracerebral haematoma is described. The qualification is based on the main elements of the intracranial volume compensation: 1. function of midline structures (F), 2. intracranial pressure features (I), 3. midline structure shift (S). The FIS method was applied in 134 patients; 83 of them were treated surgically and 51 were treated conservatively. The control group comprised 60 patients treated surgically or conservatively with qualification based on other criteria. The use of the FIS method in the preliminary management of patients with non-traumatic intracerebral haematoma made possible a great increase of the survival rate and improvement of the late results of treatment.