The spleen
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
The adult form normally affects females between the ages of 15 and 50 years, although it can be associated with other conditions, including systemic lupus erythematosus, chronic lymphatic leukaemia and Hodgkin’s disease. The childhood form is distributed equally between males and females and commonly presents before the age of 5 years. Purpuric patches (ecchymoses) occur on the skin and mucous membranes. Following trauma or pressure, examination often reveals numbers of petechial haemorrhages in the skin. There is a tendency to spontaneous bleeding from mucous membranes (e.g. epistaxis); in women, menorrhagia and the prolonged bleeding of minor wounds are common. Haemorrhage from the urinary and gastrointestinal tracts and haemarthrosis are rare. Although intracranial haemorrhage is also uncommon, it is the most frequent cause of death. The diagnosis is made based upon the presence of cutaneous ecchymoses and a positive tourniquet test. The spleen is palpable in fewer than 10% of patients, and the presence of gross splenic enlargement should raise the suspicion of an alternative diagnosis.
Venous anatomy and pathophysiology
Helane S Fronek in The Fundamentals of Phlebology: Venous Disease for Clinicians, 2007
A simple hydrophilic pad or several layers of gauze are applied for absorption of tumescent drainage at the incision sites. Next, a layer of adhesive or short-stretch bandage is used in order to secure these dressings. The bandage is extremely important in order to minimize the ecchymosis and allow the patient to be discharged ambulatory. Alternatively, a class II, 30-40 mmHg graduated compression stocking is placed on top of the hydrophilic pad or absorptive material in order to apply extra pressure and keep the wrapping in place. In the elderly, this stocking can be removed at night. The bandages are removed after 1-7 days, depending on the size and location of the veins that have been removed. The compression stocking is worn for at least 2-4 weeks, depending on the amount of ecchymosis present.2,5,11
Changing “Unchangeable” Bodily Processes by (Hypnotic) Suggestions: A New Look at Hypnosis, Cognitions, Imagining, and the Mind-Body Problem
Anees A. Sheikh in Imagination and Healing, 2019
It seems that some of the pneomena can be produced in a substantial proportion of physiologically predisposed individuals. For instance, a substantial proportion of individuals who exhibit spontaneous ecchymoses may be expected to manifest the same type of bruises when given (believed-in) suggestions to reexperience situations in which spontaneous bruising occurred. Apparently, a substantial number of individuals who are hypersensitive to a chemical found in poison ivy-type plants will manifest some degree of dermatitis when they are convinced that they have been in contact with the plant even though they actually have not touched it. It also appears that a substantial proportion of women who focus for several months on self-suggestions for breast growth may be expected to show an increase in breast size, especially if they held negative attitudes toward their breasts during puberty which may have inhibited their breast development.
Spontaneous periocular ecchymosis: a major review
Published in Orbit, 2023
Matthew J. Hartley, Pav Gounder, Huw Oliphant
Periocular ecchymosis, or periocular bruising, is a common clinical finding where patients present with a variable degree of discoloration to the eyelids and periocular tissues, sometimes bilaterally. The skin of the eyelids is unique and among the thinnest in the human body.1 This, combined with an extensive vascular network with numerous anastomoses, means the periocular region is prone to bruising.2 The most common etiology is trauma including soft tissue injury, facial fractures, and skull base fractures, where mastoid ecchymosis – known as Battle’s sign – can also be observed. Various surgical and laser procedures including those performed by otolaryngologists, maxillofacial, ophthalmic, and plastic surgeons can also lead to periocular ecchymosis. The pathophysiology of bruising in these traumatic settings is crush damage and/or shearing forces to vascular beds that leads to extravasation of blood into soft periocular tissue planes.
Fractional radiofrequency in the treatment of skin aging: an evidence-based treatment protocol
Published in Journal of Cosmetic and Laser Therapy, 2020
Ileana Afroditi Kleidona, Dimitrios Karypidis, Nicholas Lowe, Simon Myers, Ali Ghanem
The safety profile and the downtime of a cosmetic procedure is key for the patient’s compliance and satisfaction. Traditionally, skin resurfacing has been associated with complications, such as the risk of scarring and dyspigmentation. Metelitsa et Alster divided these complications into mild (erythema, purpura, acne, superficial erosions), moderate (infection, dyspigmentation, eruptive keratoacanthomas) and severe (scarring, disseminated infection, ectropion) (51). The striking point from the studies above is that the procedure was well tolerated with topical anesthetic. Most frequently, mild to moderate pain was reported (Table 1). The majority of subjects developed mild to moderate erythema and edema which resolved in few days. Occasionally, bruising and ecchymosis occurred for 7–10 days. Interestingly, dyspigmentation appeared to be a possible risk. Two studies on periorbital wrinkles treated with insulated microneedles RF, reported hyperpigmentation in type III-IV skin but this resolved spontaneously after 4 weeks (23,42). Similarly, Park et al. noted dyspigmentation in 1% of type II-IV skin treated with non-insulated microneedle RF (27). In a multicentre trial done by Calderhead, hydroquinone was utilized to treat pigmentary complications in 2.3% of patients (30). These results demonstrate that FRF carries some inherent risks and patients should be made aware. Severe adverse events such as scarring, infection or ectropion were not described.
Clinical features and treatment effect of HIV-associated immune thrombocytopenia—single center Ten-Years data summary
Published in Platelets, 2023
YaXian Tan, Lei Che, Hui Bi, ShanShan Fan, ZePing Zhou, HaiYan Min
Among the 45 patients, 26 (57.78%) were male and 19 (42.22%) were female. The median age was 43 (8–71) years old, and 46.67% (21/45) were under 40 years old. Two (4.44%) patients were classified as men who have sex with men (MSM) and 25 (55.56%) heterosexual. Among all patients, 8(17.78%) also had history of intravenous drug use (IVDU). Ten patients (22.22%) had unknown routes of infection (Four of these patients had history of blood transfusions or surgery). Patients had platelet count of 10 (0–64, M, range) × 109/L at admission, 37 patients (82.22%) with platelet count <20 × 109/L, the hemoglobin count was 132 (60–160, M, range)g/L, 14 patients (31.11%) had hemoglobin below 90 g/L, and neutrophil count was 2.86 (1.05–19.06 (M, range)) × 109/L. The common bleeding sites were skin ecchymosis and epistaxis. The clinical characteristics of patients are shown in Table I. The total follow-up duration was 79 (14–368) days, the platelet count of final follow-up was 37 (2–309, M, range) × 109/L, significantly higher than that at admission (Z = −5.662, P < .001).