Background: Hematoma in the rectus sheath is not common but if happens it will become major bleeding. Sometimes anticoaglation of deep vein thrombosis (DVT) causes the hematoma in the rectus sheath. Case Report: A 74-...Background: Hematoma in the rectus sheath is not common but if happens it will become major bleeding. Sometimes anticoaglation of deep vein thrombosis (DVT) causes the hematoma in the rectus sheath. Case Report: A 74-year-old female patient after total knee arthroplasty (TKA) due to osteoarthritis. Postoperation, residual DVT was noted in the right soleus vein on ultrasonography of the veins of the lower limbs. Anticoaglation was started 7.5 mg/day Arixtra for treatment of DVT. Anticoaglation was administered throughout rehabilitation, and abdominal pain developed on postoperative day 9. Since respiratory distress developed on day 10, then thoracoabdominal contrast CT was performed. Although no PE was observed, a hematoma was detected in the rectus sheath, and it perforated into the abdominal cavity. The hemoglobin level was reduced by about 4 g/dL, and the patient was admitted to the ICU. Surgical treatment was not performed, anticoagulant treatment was discontinued, and conservative treatment was administered. During management in the ICU, a total of 24 units of red blood cells were transfused. Conclusions: Rectus sheath hematoma should be in mind of surgeons during differential diagnosis of acute abdominal pain especially in patients receiving anticoagulants. Early recognition can be of great importance for patients’ recovery, preventing from severe complications. Management is usually supportive although surgical intervention in some patients should be considered.展开更多
We fitted a halo-vest on patients with a fracture of the odontoid process of the axis and evaluated the effects of conservative treatment on cervical muscular atrophy and the number and type of patient complaints afte...We fitted a halo-vest on patients with a fracture of the odontoid process of the axis and evaluated the effects of conservative treatment on cervical muscular atrophy and the number and type of patient complaints after bone union. Four patients had Anderson Type II fractures and 6 patients had Type III fractures. Bone union was observed in all patients within 3 months after injury. After halo-vest fitting, cervical muscular atrophy increased with time, however, it gradually improved after removal of the halo-vest. Patients fixed with a halo-vest for more than 10 weeks complained of cervical discomfort and limited range of motion. No patients with fixation for less than 10 weeks had problems in bone union or had cervical complaints. Thus, less than a 10-week fixation period was considered to be appropriate.展开更多
We experienced 2 cases of spinal fracture in patients aged 80 years or older with diffuse idiopathic skeletal hyperostosis (DISH). Since they decided not to undergo surgical treatment, we provided conservative treatme...We experienced 2 cases of spinal fracture in patients aged 80 years or older with diffuse idiopathic skeletal hyperostosis (DISH). Since they decided not to undergo surgical treatment, we provided conservative treatment with teriparatide. There has been no previous study on teriparatide for spine fracture in DISH. This is the first report of the successful use of teriparatide to treat spine fracture in DISH without surgical intervention. Our patients were treated with teriparatide for 8-9 months after diagnosis of the fracture. Union was obtained in two cases and no adverse events were observed during treatment. Our report showed that teriparatide could be an alternative to conventional intervention in spinal fracture of DISH.展开更多
文摘Background: Hematoma in the rectus sheath is not common but if happens it will become major bleeding. Sometimes anticoaglation of deep vein thrombosis (DVT) causes the hematoma in the rectus sheath. Case Report: A 74-year-old female patient after total knee arthroplasty (TKA) due to osteoarthritis. Postoperation, residual DVT was noted in the right soleus vein on ultrasonography of the veins of the lower limbs. Anticoaglation was started 7.5 mg/day Arixtra for treatment of DVT. Anticoaglation was administered throughout rehabilitation, and abdominal pain developed on postoperative day 9. Since respiratory distress developed on day 10, then thoracoabdominal contrast CT was performed. Although no PE was observed, a hematoma was detected in the rectus sheath, and it perforated into the abdominal cavity. The hemoglobin level was reduced by about 4 g/dL, and the patient was admitted to the ICU. Surgical treatment was not performed, anticoagulant treatment was discontinued, and conservative treatment was administered. During management in the ICU, a total of 24 units of red blood cells were transfused. Conclusions: Rectus sheath hematoma should be in mind of surgeons during differential diagnosis of acute abdominal pain especially in patients receiving anticoagulants. Early recognition can be of great importance for patients’ recovery, preventing from severe complications. Management is usually supportive although surgical intervention in some patients should be considered.
文摘We fitted a halo-vest on patients with a fracture of the odontoid process of the axis and evaluated the effects of conservative treatment on cervical muscular atrophy and the number and type of patient complaints after bone union. Four patients had Anderson Type II fractures and 6 patients had Type III fractures. Bone union was observed in all patients within 3 months after injury. After halo-vest fitting, cervical muscular atrophy increased with time, however, it gradually improved after removal of the halo-vest. Patients fixed with a halo-vest for more than 10 weeks complained of cervical discomfort and limited range of motion. No patients with fixation for less than 10 weeks had problems in bone union or had cervical complaints. Thus, less than a 10-week fixation period was considered to be appropriate.
文摘We experienced 2 cases of spinal fracture in patients aged 80 years or older with diffuse idiopathic skeletal hyperostosis (DISH). Since they decided not to undergo surgical treatment, we provided conservative treatment with teriparatide. There has been no previous study on teriparatide for spine fracture in DISH. This is the first report of the successful use of teriparatide to treat spine fracture in DISH without surgical intervention. Our patients were treated with teriparatide for 8-9 months after diagnosis of the fracture. Union was obtained in two cases and no adverse events were observed during treatment. Our report showed that teriparatide could be an alternative to conventional intervention in spinal fracture of DISH.
