Made by DATEXIS (Data Science and Text-based Information Systems) at Beuth University of Applied Sciences Berlin
Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Treatment for light bruises is minimal and may include RICE (rest, ice, compression, elevation), painkillers (particularly NSAIDs) and, later in recovery, light stretching exercises. Particularly, immediate application of ice while elevating the area may reduce or completely prevent swelling by restricting blood flow to the area and preventing internal bleeding. Rest and preventing re-injury is essential for rapid recovery. Applying a medicated cream containing mucopolysaccharide polysulfuric acid (e.g., Hirudoid) may also speed the healing process. Other topical creams containing skin-fortifying ingredients, including but not limited to retinol or alpha hydroxy acids, such as DerMend, can improve the appearance of bruising faster than if left to heal on its own.
Very gently massaging the area and applying heat may encourage blood flow and relieve pain according to the gate control theory of pain, although causing additional pain may indicate the massage is exacerbating the injury. As for most injuries, these techniques should not be applied until at least three days following the initial damage to ensure all internal bleeding has stopped, because although increasing blood flow will allow more healing factors into the area and encourage drainage, if the injury is still bleeding this will allow more blood to seep out of the wound and cause the bruise to become worse.
In most cases hematomas spontaneously revert, but in cases of large hematomas or those localized in certain organs ("e.g.", the brain), the physician may optionally perform a puncture of the hematoma to allow the blood to exit.
Bruises can be scored on a scale from 0-5 to categorize the severity and danger of the injury.
The harm score is determined by the extent and severity of the fractures to the organs and tissues causing the bruising, in turn depending on multiple factors. For example, a contracted muscle will bruise more severely, as will tissues crushed against underlying bone. Capillaries vary in strength, stiffness and toughness, which can also vary by age and medical conditions.
An alternate bruise severity ranking system called the Chien Intensity Scale is slowly growing in popularity in some research circles. Although not widely used, the Chien Intensity Scale is used by institutes including the Ryan Mackey Memorial Research Institute and the Sydney Medical Center.
Low levels of damaging forces produce small bruises and generally cause the individual to feel minor pain straight away. Repeated impacts worsen bruises, increasing the harm level. Normally, light bruises heal nearly completely within two weeks, although duration is affected by variation in severity and individual healing processes; generally, more severe or deeper bruises take somewhat longer.
Severe bruising (harm score 2-3) may be dangerous or cause serious complications. Further bleeding and excess fluid may accumulate causing a hard, fluctuating lump or swelling hematoma. This has the potential to cause compartment syndrome as the swelling cuts off blood flow to the tissues. The trauma that induced the bruise may also have caused other severe and potentially fatal harm to internal organs. For example, impacts to the head can cause traumatic brain injury: bleeding, bruising and massive swelling of the brain with the potential to cause concussion, coma and death. Treatment for brain bruising may involve emergency surgery to relieve the pressure on the brain.
Damage that causes bruising can also cause bones to be broken, tendons or muscles to be strained, ligaments to be sprained, or other tissue to be damaged. The symptoms and signs of these injuries may initially appear to be those of simple bruising. Abdominal bruising or severe injuries that cause difficulty in moving a limb or the feeling of liquid under the skin may indicate life-threatening injury and require the attention of a physician.
There are many causes of subcutaneous hematomas including ecchymoses. Coagulopathies such as Hemophilia A may cause ecchymosis formation in children. The medication betamethasone can have the adverse effect of causing echhymosis.
Hematomas can be subdivided by size. By definition, ecchymoses are 1 centimeter in size or larger, and are therefore larger than petechiae ( less than 2 millimeters in diameter) or purpura (2 millimeters to 1 centimeter in diameter). Ecchymoses also have a more diffuse border than other purpura.
Pulmonary ultrasound, performed at the bedside or on the accident scene, is being explored as a diagnosis for pulmonary contusion. Its use is still not widespread, being limited to facilities which are comfortable with its use for other applications, like pneumothorax, airway management, and hemothorax. Accuracy has been found to be comparable to CT scanning.
Computed tomography (CT scanning) is a more sensitive test for pulmonary contusion, and it can identify abdominal, chest, or other injuries that accompany the contusion. In one study, chest X-ray detected pulmonary contusions in 16.3% of people with serious blunt trauma, while CT detected them in 31.2% of the same people. Unlike X-ray, CT scanning can detect the contusion almost immediately after the injury. However, in both X-ray and CT a contusion may become more visible over the first 24–48 hours after trauma as bleeding and edema into lung tissues progress. CT scanning also helps determine the size of a contusion, which is useful in determining whether a patient needs mechanical ventilation; a larger volume of contused lung on CT scan is associated with an increased likelihood that ventilation will be needed. CT scans also help differentiate between contusion and pulmonary hematoma, which may be difficult to tell apart otherwise. However, pulmonary contusions that are visible on CT but not chest X-ray are usually not severe enough to affect outcome or treatment.
Since cerebral swelling presents a danger to the patient, treatment of cerebral contusion aims to prevent swelling. Measures to avoid swelling include prevention of hypotension (low blood pressure), hyponatremia (insufficient sodium), and hypercapnia (increased carbon dioxide in the blood). Due to the danger of increased intracranial pressure, surgery may be necessary to reduce it. People with cerebral contusion may require intensive care and close monitoring.
Diagnosis is by medical imaging with either plain X ray or CT scan.
Lipedema is commonly misdiagnosed. At this time, only Germany and the Netherlands have standardized ways of diagnosing lipedema. Other countries do not currently have a standardized diagnosis protocol, and therefore the diagnosis is typically made clinically via physical inspection (palpating the adipose tissue).
Some trained clinicians and therapists can feel the physical differences in the adipose tissue, characterized as nodules with "beans in a bag" feeling. When the tissue has excess fluid the nodules are no longer easily palpable. Testing of the major components of the lymphatic system can be done through tools such as lymphoscintigraphy, but lack of noticeable lymphatic impairment does not indicate lipedema is not present, only that the major lymphatics are not (yet) affected.
The death rate of people with flail chest depends on the severity of their condition, ranging from 10 to 25%.
A hickey, hickie or love bite in British English, is a bruise or bruise-like mark caused by the kissing or sucking of the skin, usually on the neck or arm. While biting might be part of giving a hickey, sucking is sufficient to burst small superficial blood vessels under the skin.
The origin of the word is from its earlier meaning of "pimple, skin lesion" (c. 1915); perhaps a sense extension and spelling variation from the earlier word meaning "small gadget, device; any unspecified object" which has a unknown origin (1909).
Hickeys typically last from 5 to 12 days and may be treated in the same way as other bruises. Ways to reduce the appearance of hickeys include icing recent hickeys to reduce swelling, rubbing them with a chilled spoon to remove the bruise, and applying a warm compress to older hickeys to dilate vessels and promote blood flow. They can be covered with a concealer or powder corresponding to the sufferer's skin tone, or a fake tan. Alternatively, articles of clothing such as scarves, snoods, turtle necks, or sleeves may be used to conceal hickeys.
Lymphedema is usually asymmetrical and can be either acquired (through surgery, trauma or infection damaging the lymphatic system) or congenital (hereditary changes in the lymphatic system). However, symmetrical enlargement of both lower limbs, from waist to ankles (i.e. gynoid fat) is a hallmark of lipedema. As the swelling continues and spreads from lower extremities to other parts of the body, the swelling is likely caused by slower lymphatic flow and changes in the lymphatic vessel structure caused by pressure in the lipedematous limbs. This is known as lipo-lymphedema. Lipo-lymphedema may also develop in combination with chronic venous insufficiency and other vascular disorders.
Lipedema can be underdiagnosed due the difficulty in differentiating it from other edemas and obesity. Trayes 2013 published some tools including tables and a flow chart that can be used to diagnose lipedema and other edemas.
Lipedema / Dercum’s Disease Differentiation
These conditions may co-exist. Dercum’s Disease is characterized by painful lipomas around the body.
Numerous small contusions from broken capillaries that occur in grey matter under the cortex are called multiple petechial hemorrhages or multifocal hemorrhagic contusion. Caused by shearing injuries at the time of impact, these contusions occur especially at the junction between grey and white matter and in the upper brain stem, basal ganglia, thalamus and areas near the third ventricle. The hemorrhages can occur as the result of brain herniation, which can cause arteries to tear and bleed. A type of diffuse brain injury, multiple petechial hemorrhages are not always visible using current imaging techniques like CT and MRI scans. This may be the case even if the injury is quite severe, though these may show up days after the injury. Hemorrhages may be larger than in normal contusions if the injury is quite severe. This type of injury has a poor prognosis if the patient is comatose, even with no apparent causes for the coma.
There is no specific treatment for rib fractures, but various supportive measures can be taken. In simple rib fractures, pain can lead to reduced movement and cough suppression; this can contribute to formation of secondary chest infection. Flail chest is a potentially life-threatening injury and will often require a period of assisted ventilation. Flail chest and first rib fractures are high-energy injuries and should prompt investigation of damage to underlying viscera (e.g., lung contusion) or remotely (e.g., cervical spine injury). Spontaneous fractures in athletes generally require a cessation of the cause, e.g., time off rowing, while maintaining cardiovascular fitness.
Treatment options for internal fixation/repair of rib fractures include:
- Judet and/or sanchez plates/struts are a metal plate with strips that bend around the rib and then is further secured with sutures.
- Synthes matrixrib fixation system has two options: a precontoured metal plate that uses screws to secure the plate to the rib; and/or an intramedullary splint which is tunneled into the rib and secured with a set screw.
- Anterior locking plates are metal plates that have holes for screws throughout the plate. The plate is positioned over the rib and screwed into the bone at the desired position. The plates may be bent to match the contour of the section.
- U-plates can also be used as they clamp on to the superior aspect of the ribs using locking screws.
Rest, Ice, Compression and Elevation (RICE) are standard treatments in the first 48 hours of an injury to the hip pointer. After 48 hours, patients can begin gently stretching, strengthening exercises, flexibility and coordination. For the first 7–10 days, patients can take anti-inflammatories such as ibuprofen and apply ice. Since this injury is very painful, recovery is usually very slow. When the person is without pain, sports massage and range-of-motion activities may reduce tension and swelling and prevent scar tissue buildup. Furthermore, an injection of corticosteroids into the affected area may reduce symptoms in the short term and accelerate rehabilitation. Operative treatment is rarely indicated and is reserved for patients suffering from significant displacement or fractures of the bones.
To prevent hip pointer, the equipment must be adequate in the sport and be well positioned and good size. It should also maintain excellent flexibility, strength and endurance of the hip, pelvis and lower back muscles.
Signs one may have a broken rib are:
- Pain on inhalation
- Swelling in chest area
- Bruise in chest area
- Increasing shortness of breath
- Coughing up blood (rib may have damaged lung)
Because children have more flexible chest walls than adults do, their ribs are more likely to bend than to break; therefore the presence of rib fractures in children is evidence of a significant amount of force and may indicate severe thoracic injuries such as pulmonary contusion. Rib fractures are also a sign of more serious injury in elderly people.
Erythema nodosum is diagnosed clinically. A biopsy can be taken and examined microscopically to confirm an uncertain diagnosis. Microscopic examination usually reveals a neutrophilic infiltrate surrounding capillaries that results in septal thickening, with fibrotic changes in the fat around blood vessels. A characteristic microscopic finding is radial granulomas, well-defined nodular aggregates of histiocytes surrounding a stellate cleft.
Additional evaluation should be performed to determine the underlying cause of erythema nodosum. This may include a full blood count, erythrocyte sedimentation rate (ESR), antistreptolysin-O (ASO) titer and throat culture, urinalysis, intradermal tuberculin test, and a chest x-ray. The ESR is typically high, the C-reactive protein elevated, and the blood showing an increase in white blood cells.
The ESR is initially very high, and falls as the nodules of erythema nodosum. The ASO titer is high in cases associated with a streptococcal throat infection. A chest X-ray should be performed to rule out pulmonary diseases, in particular sarcoidosis and Löfgren syndrome.
Signs and symptoms include immediate pain, bruising and swelling, obvious weakness, spasms and a rapid decline in the hip / leg function, resulting in a decreased range of motion.
The U.S. Preventive Services Task Force recommends a single screening ultrasound for abdominal aortic aneurysm in males age 65 to 75 years who have a history of smoking. There is an estimated number needed to screen of approximately 850 people. It is unclear if screening is useful in women aged 65 to 75 who have smoked and they recommend against screening in women who have never smoked.
Repeat ultrasounds should be carried out in those who have an aortic size greater than 3.0 cm. In those whose aorta is between 3.0 and 3.9 cm this should be every three years, if between 4.0 and 4.4 cm every two year, and if between 4.5 and 5.4 cm every year.
In the United Kingdom one time screening is recommended in all males over 65 years of age. Australia has no guideline on screening.
The ASCOT probability of survival encapsulates several of the variables measured in the Glasgow Coma Scale but also includes systolic blood pressure, respiration rates upon admission, and anatomic injuries. The ASCOT was found to be the most sensitive tool for determining severity of head injuries in children and is effective in predicting the outcome of injury.
Diagnosis is typically obtained by an allergist or other licensed practitioner performing a cold test. During the cold test, a piece of ice is held against the forearm, typically for 3–4 minutes. A positive result is a specific looking mark of raised red hives. The hives may be the shape of the ice, or it may radiate from the contact area of the ice." However, while these techniques assist in diagnosis, they do not provide information about temperature and stimulation time thresholds at which patients will start to develop symptoms."which is essential because it can establish disease severity and monitor the effectiveness of treatment.
There are several different types of treatment available to those who have suffered a closed-head injury. The treatment type chosen can depend on several factors including the type and severity of injury as well as the effects that injury has on the patient.
The course of treatment differs for each patient and can include several types of treatment, depending on the patient’s specific needs.
Early treatment is vital to recovering lost motor function after an injury, but cognitive abilities can be recovered regardless of time past since injury.
Onychomadesis is a periodic idiopathic shedding of the nails beginning at the proximal end, possibly caused by the temporary arrest of the function of the nail matrix.One cause in children is hand foot and mouth disease. This generally resolves without complication.
Onychomadesis can also occur if the nail is damaged or suffers a loss of blood supply, i.e. due to a bruise. The nailbed turns black, and the nail drops off shortly afterwards. It takes around 6 to 12 months to regrow.
Metatarsalgia, literally metatarsal pain and colloquially known as a stone bruise, is any painful foot condition affecting the metatarsal region of the foot. This is a common problem that can affect the joints and bones of the metatarsals.
Metatarsalgia is most often localized to the first metatarsal head – the ball of the foot just behind the big toe. There are two small sesamoid bones under the first metatarsal head. The next most frequent site of metatarsal head pain is under the second metatarsal. This can be due to either too short a first metatarsal bone or to "hypermobility of the first ray" – metatarsal bone and medial cuneiform bone behind it – both of which result in excess pressure being transmitted into the second metatarsal head.
Erythema nodosum is self-limiting and usually resolves itself within 3–6 weeks. A recurring form does exist, and in children it is attributed to repeated infections with streptococcus. Treatment should focus on the underlying cause. Symptoms can be treated with bedrest, leg elevation, compressive bandages, wet dressings, and nonsteroidal anti-inflammatory agents (NSAIDs). NSAIDs are usually more effective at the onset of EN versus with chronic disease.
Potassium iodide can be used for persistent lesions whose cause remains unknown. Corticosteroids and colchicine can be used in severe refractory cases. Thalidomide has been used successfully in the treatment of Erythema nodosum leprosum, and it was approved by the U.S. FDA for this use in July 1998.