Epidural Hematoma Following Cervical Spine Surgery.

STUDY DESIGN: A multicentered retrospective case series. OBJECTIVE: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. METHODS: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. RESULTS: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment (P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. CONCLUSION: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements

Psychological Barriers in Long Term Non-Operative Treatment of Retroperitoneal Hematoma

The retroperitoneal hematoma can have, mainly, a traumatic etiology - blunt abdominal trauma (falls from height, road accidents, aggression of any kind, etc.), or open (incised wounds, puncture, penetration or gunshot wounds). Ruptured arterial aneurysms can cause hemorrhage in the retroperitoneal space. There is also spontaneous retroperitoneal trauma in patients with chronic treatment with anticoagulant or antiaggregant drugs (1). Hemorrhage in the retroperitoneal space can be iatrogenic, after surgical, open or laparoscopic, interventions (2, 3). A particular type of retroperitoneal hematoma is the psoas muscle hematoma in patients with chronic oral anticoagulant treatment (Acenocumarol, Warfarin)

Intramural duodenal hematoma: clinical course and imaging findings

Background: Intramural duodenal hematoma is a rare condition. Different imaging modalities are at hand for diagnosis. Purpose: To identify patients with intramural duodenal hematoma and report imaging findings and clinical courses. Material and Methods: Typical imaging patterns using ultrasound, computed tomography, and magnetic resonance imaging were carried out on 10 patients. Results: The mean patient age was 7.5 years. The average disease duration was 13 months. Clinical signs of improvement were observed within 16 days. Residues were still detectable at long-term follow-up. Conclusion: For patients with intramural duodenal wall hematoma, diagnosis should be considered early. Typical imaging findings should be known to ensure optimal treatment

Early pH Changes in Musculoskeletal Tissues upon Injury-Aerobic Catabolic Pathway Activity Linked to Inter-Individual Differences in Local pH

Local pH is stated to acidify after bone fracture. However, the time course and degree of acidification remain unknown. Whether the acidification pattern within a fracture hematoma is applicable to adjacent muscle hematoma or is exclusive to this regenerative tissue has not been studied to date. Thus, in this study, we aimed to unravel the extent and pattern of acidification in vivo during the early phase post musculoskeletal injury. Local pH changes after fracture and muscle trauma were measured simultaneously in two pre-clinical animal models (sheep/rats) immediately after and up to 48 h post injury. The rat fracture hematoma was further analyzed histologically and metabolomically. In vivo pH measurements in bone and muscle hematoma revealed a local acidification in both animal models, yielding mean pH values in rats of 6.69 and 6.89, with pronounced intra- and inter-individual differences. The metabolomic analysis of the hematomas indicated a link between reduction in tricarboxylic acid cycle activity and pH, thus, metabolic activity within the injured tissues could be causative for the different pH values. The significant acidification within the early musculoskeletal hematoma could enable the employment of the pH for novel, sought-after treatments that allow for spatially and temporally controlled drug release

Unintended complication of intracranial subdural hematoma after percutaneous epidural neuroplasty.

Percutaneous epidural neuroplasty (PEN) is a known interventional technique for the management of spinal pain. As with any procedures, PEN is associated with complications ranging from mild to more serious ones. We present a case of intracranial subdural hematoma after PEN requiring surgical evacuation. We review the relevant literature and discuss possible complications of PEN and patholophysiology of intracranial subdural hematoma after PEN

Subdural Hematoma in Grave’s Disease Induced Thrombocytopenia.

Subdural hematoma (SDH) usually occurs secondary to trauma, in bleeding disorders it may occur spontaneously. It is a rare complication of immune thrombocytopenia. Here we report a case of 45 years female presenting with presenting with complaints of headache, palpitation and menorrhagia and later diagnosed to be a case of Grave's disease with thrombocytopenia with sub dural hematoma. No such case reports are available in literature

The treatment of penetrating wounds of the inferior vena cava

During the last 5 years, 10 gunshot and 2 stab wounds of the inferior vena cava have been treated, with 11 survivals and 1 death. The lacerations were above the renal veins in 4 cases and below in the others. All patients had other serious visceral injuries. Treatment consisted of suture repair in 11 cases and ligation in the twelfth. Upon exploration, free intraperitoneal bleeding from the caval wound had ceased in every case. The signal finding was a retroperitoneal hematoma which was often deceptively small. Commonly, the surgeon explored the retroperitoneal space in order to treat other visceral injuries, only to be confronted with unexpected massive hemorrhage when the hematoma was entered. Difficulties in controlling the bleeding are often related to the well-developed collateral system by which different segments of the inferior vena cava are freely connected. When a hematoma is found in the vicinity of the great vessels and the retroperitoneal space is to be explored, certain precautions should be observed. These include provision for adequate exposure, procurement of blood, and adjustment of lighting. Additional help can be summoned and vascular instruments should be brought to the operating table. A large-bore needle or cut-down should be placed in an arm vein. The posterior peritoneal incision should be planned for maximum and rapid exposure, so that hemorrhage can be quickly controlled when the plane of the hematoma is entered. © 1962

Natural History of Acute Subdural Hematoma

Although guidelines for surgical decision-making in patients with acute subdural hematomas (ASDHs) are widely available, the evidence supporting these guidelines is weak, and management of these patients must often be individualized. Smaller ASDHs in patients in good neurologic condition usually can be successfully managed without surgery. Large ASDHs with minimal mass effect in patients with minimal symptoms also may be considered for nonoperative management. The literature is divided about the effects of anticoagulant and antiplatelet medications on rapid growth of ASDHs and on their likelihood of progression to large chronic subdural hematomas, but it is reasonable to reverse the effects of these medications promptly. Close clinical and radiologic follow-up is needed in these patients, both acutely to detect rapid expansion of an ASDH, and subacutely to detect formation of a large subacute or chronic subdural hematoma

Antegrade common femoral artery closure device use is associated with decreased complications.

ObjectiveAntegrade femoral artery access is often used for ipsilateral infrainguinal peripheral vascular intervention. However, the use of closure devices (CD) for antegrade access (AA) is still considered outside the instructions for use for most devices. We hypothesized that CD use for antegrade femoral access would not be associated with an increased odds of access site complications.MethodsThe Vascular Quality Initiative was queried from 2010 to 2019 for infrainguinal peripheral vascular interventions performed via femoral AA. Patients who had a cutdown or multiple access sites were excluded. Cases were then stratified into whether a CD was used or not. Hierarchical multivariable logistic regressions controlling for hospital-level variation were used to examine the independent association between CD use and access site complications. A sensitivity analysis using coarsened exact matching was performed using factors different between treatment groups to reduce imbalance between the groups.ResultsOverall, 11,562 cases were identified and 5693 (49.2%) used a CD. Patients treated with a CD were less likely to be white (74.1% vs 75.2%), have coronary artery disease (29.7% vs 33.4%), use aspirin (68.7% vs 72.4%), and have heparin reversal with protamine (15.5% vs 25.6%; all P < .05). CD patients were more likely to be obese (31.6% vs 27.0%), have an elective operation (82.6% vs 80.1%), ultrasound-guided access (75.5% vs 60.6%), and a larger access sheath (6.0 ± 1.0 F vs 5.5 ± 1.0 F; P < .05 for all). CD cases were less likely to develop any access site hematoma (2.55% vs 3.53%; P < .01) or a hematoma requiring reintervention (0.63% vs 1.26%; P < .01) and had no difference in access site stenosis or occlusion (0.30% vs 0.22%; P = .47) compared with no CD. On multivariable analysis, CD cases had significantly decreased odds of developing any access site hematoma (odds ratio, 0.75; 95% confidence interval, 0.59-0.95) and a hematoma requiring intervention (odds ratio, 0.56; 95% confidence interval, 0.38-0.81). A sensitivity analysis after coarsened exact matching confirmed these findings.ConclusionsIn this nationally representative sample, CD use for AA was associated with a lower odds of hematoma in selected patients. Extending the instructions for use indications for CDs to include femoral AA may decrease the incidence of access site complications, patient exposure to reintervention, and costs to the health care system

Secondary Hematoma Expansion and Perihemorrhagic Edema after Intracerebral Hemorrhage: From Bench Work to Practical Aspects.

Intracerebral hemorrhages (ICH) represent about 10-15% of all strokes per year in the United States alone. Key variables influencing the long-term outcome after ICH are hematoma size and growth. Although death may occur at the time of the hemorrhage, delayed neurologic deterioration frequently occurs with hematoma growth and neuronal injury of the surrounding tissue. Perihematoma edema has also been implicated as a contributing factor for delayed neurologic deterioration after ICH. Cerebral edema results from both blood-brain barrier disruption and local generation of osmotically active substances. Inflammatory cellular mediators, activation of the complement, by-products of coagulation and hemolysis such as thrombin and fibrin, and hemoglobin enter the brain and induce a local and systemic inflammatory reaction. These complex cascades lead to apoptosis or neuronal injury. By identifying the major modulators of cerebral edema after ICH, a therapeutic target to counter degenerative events may be forthcoming