1.Surgical repair of the tunica albuginea for penis fracture: Selection of incision.
Yuan-Shen MAO ; Bao HUA ; Wei-Xin PAN ; Wen-Feng LI ; Yu-Fei GU ; Hai-Jun YAO ; Zhi-Kang CAI ; Zhong WANG ; Chao LU
National Journal of Andrology 2018;24(4):331-334
ObjectiveTo investigate the diagnosis and management of penile fracture.
METHODSFrom June 1993 to May 2017, 46 cases of penile fracture were treated in our hospital, averaging 33.5 (25-42) years of age and 3.45 (1-10) hours in duration, of which 41 occurred during sexual intercourse, 4 during masturbation and 1 during prone sleeping, 4 with hematuria, but none with dysuria or urethral bleeding. Hematoma was confined to the penis. Emergency surgical repair was performed for all the patients, 45 under spinal anesthesia and 1 under local anesthesia, 16 by coronal proximal circular incision and the other 30 by local longitudinal incision according to the rupture location on ultrasonogram. The tunica albuginea ruptures averaged 1.31 (0.5-2.5) cm in length, which were sutured in the "8" pattern for 6 cases and with the 3-0 absorbable thread for 18 cases. The skin graft or negative pressure drainage tube was routinely placed, catheters indwelt, and gauze used for early pressure dressing. In the recent few years, elastic bandages were employed for 3-5 days of pressure dressing and antibiotics administered to prevent infection. The stitches and catheter were removed at 7 days after surgery.
RESULTSShort-term postoperative foreskin edema occurred in 14 of the 16 cases of circular degloving incision, but no postoperative complications were observed in any of the cases of local incision. Twenty-eight of the patients completed a long-term follow-up of 49.4 (10-125) months, which revealed good erectile function, painless erection, and satisfactory sexual intercourse.
CONCLUSIONSFor most penile fractures, local longitudinal incision is sufficient for successful repair of the tunica albuginea, with mild injury, no influence on the blood supply or lymph reflux, and a low rate complications. It therefore is obviously advantageous over circular degloving incision except when the cavernous body of urethra is to be explored, which necessitates circular degloving incision below the coronal groove.
Adult ; Coitus ; Edema ; etiology ; Hematoma ; diagnosis ; etiology ; Humans ; Male ; Masturbation ; complications ; Penile Erection ; Penis ; injuries ; Postoperative Complications ; etiology ; Rupture ; diagnosis ; etiology ; surgery ; Surgical Wound ; Ultrasonography ; Urethra ; surgery
3.A Case of Hepatocellular Carcinoma Presented as a Huge Intrahepatic Hematoma.
Won Sang YOO ; Nam Hee KIM ; Min Ho KANG ; Se Young YUN ; Suk Bae KIM ; Jung Eun SHIN ; Yun Chan PARK ; Il Han SONG
The Korean Journal of Gastroenterology 2008;51(6):385-390
Spontaneous intrahepatic bleeding is a rare condition. In the absence of trauma, intrahepatic hematoma may be due to underlying liver disease. We report a case of hepatocellular carcinoma in the patient who had huge intrahepatic hematoma without definite intrahepatic tumor at the time of initial presentation. A 54-year-old man was admitted to our hospital with a sudden onset of upper abdominal pain. Initial abdominal CT scan showed huge hematoma measuring more than 13 cm in diameter in the right lobe of the liver. However, there was no enhancing lesion in the liver. Laboratory data showed high alanine aminotransferase, alpha-fetoprotein and positive HBsAg. The MRI and angiography could not also depict any mass in the liver. The patient was treated with percutaneous drainage on the intrahepatic hematoma. The cytology from drainaged blood revealed no malignant cell. After hematoma decreased, follow-up CT scan depicted an enhancing tumor in the liver. He underwent right hepatic lobectomy and histopathological examination showed hepatocellular carcinoma.
Carcinoma, Hepatocellular/*diagnosis/pathology/surgery
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Hematoma/*diagnosis/etiology
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Humans
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Liver Diseases/*diagnosis/etiology
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Liver Neoplasms/*diagnosis/pathology/surgery
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Magnetic Resonance Angiography
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Magnetic Resonance Imaging
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Male
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Middle Aged
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Tomography, X-Ray Computed
4.Postoperative Spinal Epidural Hematoma: Risk Factor and Clinical Outcome.
Seong YI ; Do Heum YOON ; Keung Nyun KIM ; Sang Hyun KIM ; Hyun Chul SHIN
Yonsei Medical Journal 2006;47(3):326-332
We report a series of epidural hematomas which cause neurologic deterioration after spinal surgery, and have taken risk factors and prognostic factors into consideration. We retrospectively reviewed the database of 3720 cases of spine operation in a single institute over 7 years (1998 April-2005 July). Nine patients who demonstrated neurologic deterioration after surgery and required surgical decompression were identified. Factors postulated to increase the postoperative epidural hematoma and to improve neurologic outcome were investigated. The incidence of postoperative epidural hematoma was 0.24%. Operation sites were cervical 3 cases, thoracic 2 cases, and lumbar 4 cases. Their original diagnoses were tumor 3 cases, cervical stenosis 2 cases, lumbar stenosis 3 cases and herniated lumbar disc 1case. The symptoms of epidural hematomas were neurologic deterioration and pain. After decompression, clinical outcome revealed complete recovery in 3 cases (33.3%), incomplete recovery in 5 cases (55.6%) and no change in 1 case (11.1%). Factors increasing the risk of postoperative epidural hematoma were coagulopathy from medical illness or anticoagulation therapy (4 cases, 44.4%) and highly vascularized tumor (3 cases, 33.3%). The time interval to evacuation of complete recovery group (29.3 hours) was shorter than incomplete recovery group (66.3 hours). Patients with coagulopathy and highly vascularized tumor were more vulnerable to spinal epidural hematoma. The postoperative outcome was related to the preoperative neurological deficit and the time interval to the decompression.
Treatment Outcome
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Spinal Diseases/*surgery
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Risk Factors
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Retrospective Studies
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Postoperative Complications/diagnosis/*epidemiology
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Middle Aged
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Male
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Humans
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Hematoma, Epidural, Spinal/diagnosis/*epidemiology/*etiology
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Female
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Aged
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Adult
5.Postoperative Spinal Epidural Hematoma: Risk Factor and Clinical Outcome.
Seong YI ; Do Heum YOON ; Keung Nyun KIM ; Sang Hyun KIM ; Hyun Chul SHIN
Yonsei Medical Journal 2006;47(3):326-332
We report a series of epidural hematomas which cause neurologic deterioration after spinal surgery, and have taken risk factors and prognostic factors into consideration. We retrospectively reviewed the database of 3720 cases of spine operation in a single institute over 7 years (1998 April-2005 July). Nine patients who demonstrated neurologic deterioration after surgery and required surgical decompression were identified. Factors postulated to increase the postoperative epidural hematoma and to improve neurologic outcome were investigated. The incidence of postoperative epidural hematoma was 0.24%. Operation sites were cervical 3 cases, thoracic 2 cases, and lumbar 4 cases. Their original diagnoses were tumor 3 cases, cervical stenosis 2 cases, lumbar stenosis 3 cases and herniated lumbar disc 1case. The symptoms of epidural hematomas were neurologic deterioration and pain. After decompression, clinical outcome revealed complete recovery in 3 cases (33.3%), incomplete recovery in 5 cases (55.6%) and no change in 1 case (11.1%). Factors increasing the risk of postoperative epidural hematoma were coagulopathy from medical illness or anticoagulation therapy (4 cases, 44.4%) and highly vascularized tumor (3 cases, 33.3%). The time interval to evacuation of complete recovery group (29.3 hours) was shorter than incomplete recovery group (66.3 hours). Patients with coagulopathy and highly vascularized tumor were more vulnerable to spinal epidural hematoma. The postoperative outcome was related to the preoperative neurological deficit and the time interval to the decompression.
Treatment Outcome
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Spinal Diseases/*surgery
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Risk Factors
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Retrospective Studies
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Postoperative Complications/diagnosis/*epidemiology
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Middle Aged
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Male
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Humans
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Hematoma, Epidural, Spinal/diagnosis/*epidemiology/*etiology
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Female
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Aged
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Adult
6.Spontaneous spinal epidural hematoma: early recognition and clinical evaluation.
Bang-Ping QIAN ; Yong QIU ; Bin WANG ; Yang YU ; Ze-Zhang ZHU ; Feng ZHU ; Wei-Wei MA
Chinese Journal of Surgery 2008;46(13):977-980
OBJECTIVETo investigate early recognition and clinical evaluation of spontaneous spinal epidural hematoma (SSEH) and to analyze the factors related to prognosis.
METHODSNine patients with SSEH were include in current study. There were 7 men and 2 women with a mean age of 45.4 years (range, 18-83 years). Etiological factors were noted in 9 patients, 3 with hypertension, 2 with angioma, 2 with laminar osteoblastoma, 1 with neuroblastoma, and 1 with thrombolysis treatment. Six patients presented with acute onset of neck or back pain. Two patients initially presented with incomplete paralysis. One patient emerged with ascending bilateral lower extremity weakness and loss of sensation after thrombolysis treatment. Neurologic deficit was four as Frankel A, two as Frankel B, one as Frankel C and two as Frankel D. Evacuation of the hematoma was carried out in eight patients. One patient of thrombolysis treatment was treated conservatively because of loss of optimum for operation.
RESULTSEight hematomas were located in thoracic region, one was found in the cervicothoracic region. Mean extension was 3.7 segments (range, 2-8 segments). One patient died of severe pulmonary infection 50 days postoperatively. The average follow-up observation was 7. 5 months. Evaluation of the neurological function showed that 2 patients being classified as Frankel B, 1 as Frankel D and 4 patients as Frankel E. There was no improvement of neurological function in 1 patient with conservative treatment.
CONCLUSIONSThe keys to the early diagnosis of SSEH are the characteristic of clinical symptoms, and the lesion site, the extent of the lesion demonstrated by MRI. The prognosis is worse for SSEH with etiological factor of hypertension. Early diagnosis and surgical treatment might get better results for SSEH resulting from tumour.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Early Diagnosis ; Female ; Follow-Up Studies ; Hematoma, Epidural, Spinal ; diagnosis ; etiology ; surgery ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies
7.Bowel Obstruction Caused by an Intramural Duodenal Hematoma: A Case Report of Endoscopic Incision and Drainage.
Chang Il KWON ; Kwang Hyun KO ; Hyo Young KIM ; Sung Pyo HONG ; Seong Gyu HWANG ; Pil Won PARK ; Kyu Sung RIM
Journal of Korean Medical Science 2009;24(1):179-183
Complications associated with an intramural hematoma of the bowel, is a relatively unusual condition. Most intramural hematomas resolve spontaneously with conservative treatment and the patient prognosis is good. However, if the symptoms are not resolved or the condition persists, surgical intervention may be necessary. Here we describe internal incision and drainage by endoscopy for the treatment of an intramural hematoma of the duodenum. A 63-yr-old woman was admitted to the hospital with hematemesis. The esophagogastroduodenoscopy (EGD) showed active ulcer bleeding at the distal portion of duodenal bulb. A total of 10 mL of 0.2% epinephrine and 2 mL of fibrin glue were injected locally. The patient developed diffuse abdominal pain and projectile vomiting three days after the endoscopic treatment. An abdominal computed tomography revealed a very large hematoma at the lateral duodenal wall, approximately 10X5 cm in diameter. Follow-up EGD was performed showing complete luminal obstruction at the second portion of the duodenum caused by an intramural hematoma. The patient's condition was not improved with conservative treatment. Therefore, 21 days after admission, endoscopic treatment of the hematoma was attempted. Puncture and incision were performed with an electrical needle knife. Two days after the procedure, the patient was tolerating a soft diet without complaints of abdominal pain or vomiting. The hematoma resolved completely on the follow-up studies.
Drainage
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Duodenal Diseases/*diagnosis/pathology/surgery
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Endoscopy, Digestive System
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Female
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Gastrointestinal Hemorrhage/*etiology/therapy
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Hematoma/*diagnosis/pathology/surgery
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Humans
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Intestinal Obstruction/*etiology/therapy
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Middle Aged
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Tomography, X-Ray Computed
8.A case of idiopathic hypertrophic cranial pachymeningitis presenting as chronic subdural hematoma.
Zhan HE ; Fang DING ; Jiandong RONG ; Yongli GAN
Journal of Zhejiang University. Medical sciences 2016;45(5):540-543
A 26-year-old male presented with a 6-day history of paroxysmal headache which was worsen with nausea and vomiting for 1 day. Head CT on admission revealed left chronic subdural hematoma with midline shift. An emergency Burr hole drainage for hematoma was performed. Headache recurred 6 days later. MRI of the brain revealed a diffuse thickening and a gadolinium-enhancement of the falx, cranial dura mater and tentorium cerebelli on the left side with pia mater involved. Lumber puncture showed increased intracranial pressure and elevated IgG level in cerebrospinal fluid. Histological examination of the biopsy specimen showed thickened, fibrotic dura with a sterile chronic inflammation. According to pathological examination, idiopathic hypertrophic cranial pachymeningitis was considered as the final diagnosis. Symptoms were improved with steroid pulse therapy.
Adult
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Biopsy
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Brain
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pathology
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Drainage
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Dura Mater
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pathology
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Hematoma, Subdural, Chronic
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etiology
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surgery
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Humans
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Hypertrophy
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diagnosis
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Immunoglobulin G
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cerebrospinal fluid
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Intracranial Hypertension
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etiology
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Magnetic Resonance Imaging
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Male
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Meningitis
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diagnosis
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Steroids
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administration & dosage
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therapeutic use
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Tomography, X-Ray Computed
9.MR Imaging in a Child with Scurvy: a Case Report.
Seung Woo CHOI ; Sun Won PARK ; Young Se KWON ; In Suk OH ; Myung Kwan LIM ; Won Hong KIM ; Chang Hae SUH
Korean Journal of Radiology 2007;8(5):443-447
Scurvy is very rare disease in industrialized societies. Nevertheless, it still exists in higher risk groups including economically disadvantaged populations with poor nutrition, such as the elderly and chronic alcoholics. The incidence of scurvy in the pediatric population is very low. This study reports a case of scurvy in a 5-year-old girl with cerebral palsy and developmental delay based on MRI findings.
Ascorbic Acid/blood/therapeutic use
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Bone Diseases, Metabolic/etiology
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Cerebral Palsy/complications
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Child, Preschool
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Cholecalciferol/blood
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Developmental Disabilities/complications
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Drainage
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Female
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Femur/pathology/radionuclide imaging/surgery
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Fever/etiology
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Follow-Up Studies
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Hematoma/diagnosis/etiology/surgery
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Humans
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Knee/radiography
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Magnetic Resonance Imaging/*methods
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Muscle Weakness/etiology
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Rare Diseases
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Scurvy/complications/*diagnosis/drug therapy
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Thigh/pathology
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Vitamins/therapeutic use
10.Transcatheter coil embolization of the inferior epigastric artery in a huge abdominal wall hematoma caused by paracentesis in a patient with liver cirrhosis.
Yun Ji PARK ; Sang Yeon LEE ; Seong Hun KIM ; In Hee KIM ; Sang Wook KIM ; Seung Ok LEE
The Korean Journal of Hepatology 2011;17(3):233-237
Therapeutic paracentesis is considered to be a relatively safe procedure and is performed commonly for the control of massive ascites in patients with liver cirrhosis. The commonest puncture site, approximately 4 or 5 cm medial of left anterior superior iliac spine, can be located across the route of the inferior epigastric artery, which is one of the sites of potential massive bleeding. In a 46-year-old woman with liver cirrhosis and refractory ascites, a huge abdominal wall hematoma developed after therapeutic paracentesis. The patient was not stabilized by conservative treatment, and inferior epigastric artery injury was confirmed on angiography. Angiographic coil embolization of the inferior epigastric artery was conducted, after which the bleeding ceased and the hematoma stopped growing. This case indicates that physicians performing paracentesis should be aware of the possibility of inferior epigastric artery injury and consider early angiographic coil embolization when a life-threatening abdominal wall hematoma develops.
Abdominal Wall
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Angiography
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Ascites/surgery
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Embolization, Therapeutic
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Epigastric Arteries/*injuries
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Female
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Hematoma/*etiology/radiography/therapy
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Humans
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Liver Cirrhosis/*diagnosis
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Middle Aged
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Paracentesis/*adverse effects
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Tomography, X-Ray Computed
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Wounds, Nonpenetrating/complications