BACKGROUNDThe influence of blood pressure (BP) lowering on intracerebral hemorrhage (ICH) patients is unclear. To assess the safety and efficacy of aggressive antihypertensive therapies in acute ICH patients, we carried out a systematic review and meta-analysis.

METHODSPubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and VIP database up to July 2014 were searched. High-quality randomized controlled trials were included. Low-quality trials were excluded. Serious adverse events were defined as the primary outcome. The secondary outcomes were hematoma enlargement (HE) at 24 h after onset, mortality, and favorable clinical outcome at 90 days.

RESULTSFour high-quality trials involving a total of 1427 patients met the inclusion criteria and were analyzed. Odds ratios (ORs) of primary outcome was 0.96 (95% confidence interval [CI ]: 0.82-1.13, P = 0.61). ORs of HE at 24 h after onset, mortality and favorable clinical outcome at 90 days were 0.91 (95% CI: 0.72-1.17, P = 0.47), 0.97 (95% CI: 0.79-1.20, P = 0.81), 1.13 (95% CI: 0.98-1.30, P = 0.09) respectively.

CONCLUSIONSAggressive BP management policies are safe and might have a potency of reducing HE and improving clinical outcome.

Antihypertensive Agents ; therapeutic use ; Blood Pressure ; drug effects ; Cerebral Hemorrhage ; drug therapy ; Hematoma ; drug therapy ; Humans ; Randomized Controlled Trials as Topic

Endogenously eliminating the hematoma is a favorable strategy in addressing intracerebral hemorrhage (ICH). This study sought to determine the role of retinoid X receptor-α (RXR-α) in the context of hematoma absorption after ICH. Our results showed that pharmacologically activating RXR-α with bexarotene significantly accelerated hematoma clearance and alleviated neurological dysfunction after ICH. RXR-α was expressed in microglia/macrophages, neurons, and astrocytes. Mechanistically, bexarotene promoted the nuclear translocation of RXR-α and PPAR-γ, as well as reducing neuroinflammation by modulating microglia/macrophage reprograming from the M1 into the M2 phenotype. Furthermore, all the beneficial effects of RXR-α in ICH were reversed by the PPAR-γ inhibitor GW9662. In conclusion, the pharmacological activation of RXR-α confers robust neuroprotection against ICH by accelerating hematoma clearance and repolarizing microglia/macrophages towards the M2 phenotype through PPAR-γ-related mechanisms. Our data support the notion that RXR-α might be a promising therapeutic target for ICH.
Anilides/pharmacology* ; Cerebral Hemorrhage/drug therapy* ; Hematoma/drug therapy* ; Humans ; Macrophages ; Microglia ; Neuroprotection ; PPAR gamma ; Retinoid X Receptor alpha

PURPOSE: To evaluate the results and complications of placement of implantable port according to approach routes and methods. MATERIALS AND METHODS: Between April 2001 and October 2002, a total of 103 implantable chemoport was placed in 95 patients for chemotherapy using preconnected type (n=39) and attachable type (n=64). Puncture sites were left subclavian vein (n=35), right subclavian vein (n=5), left internal jugular vein (n=9), right internal jugular vein (n=54). We evaluated duration of catheterization days, complications according to approach routes and methods. RESULTS: Implantable chemoport was placed successfully in all cases. Duration of catheterization ranged from 8 to 554 days(mean 159, total 17,872 catheter days). Procedure related complications occurred transient pulmonary air embolism (n=1), small hematoma (n=1) and malposition in using preconnected type (n=2). Late complications occurred catheter migration (n=5), catheter malfunction (n=3), occlusion (n=1) and infection (n=11). Among them 15 chemoport was removed (14.5%). Catheter migration was occured via subclavian vein in all cases (13%, p=.008). Infection developed in 10.7% of patients(0.61 per 1000 catheter days). There were no catheter-related central vein thrombosis. CONCLUSION: Implantation of chemoport is a safe procedure. Choice of right internal jugular vein than subclavian vein for puncture site has less complications. And selection of attachable type of chemoport is convenient than preconnected type. Adequate care of chemoport is essential for long patency.
Catheterization ; Catheters ; Drug Therapy ; Embolism, Air ; Hematoma ; Humans ; Jugular Veins ; Punctures ; Subclavian Vein ; Thrombosis ; Veins

Among metastatic brain tumors, choriocarcinoma has a highly malignant nature and because of the vascular invasion of trophoblastic cells,tends to hemorrhage. Surgery is recommended for patients with a single cerebral metastasis, or for those who fail to respond to chemotherapy. We encountered two unusual cases in which early rebleeding occurred after the total removal of a hematoma arising from metastatic choriocarcinoma, and confirmed by post-operative tissue biopsy.
Biopsy ; Brain Neoplasms ; Choriocarcinoma* ; Drug Therapy ; Female ; Hematoma* ; Hemorrhage ; Humans ; Neoplasm Metastasis ; Pregnancy ; Trophoblasts

Although antithrombotic drug therapy is not a substitute for precise surgical technique, it has become an important adjunct for the microsurgeon performing replantation and elective free-tissue transfers. Systemic anticoagulant use in 60 free flap procedures performed from January 2001 to February 2004 was reviewed to determine the flap loss rate, associated risk of hematoma formation and heparin-induced thrombocytopenia. Patients were divided into two groups: a single intraoperative bolus of 1250 units of heparin(20 flaps, Group 1), 2500 units(40 flaps, Group 2) respectively. Partial and complete flap loss rate was higher in Group 1(35 percent) than in Group 2(10 percent). Neither the difference in hematoma incidence nor the difference in thrombocytopenia incidence between two groups was significant and there was no case presenting heparin- induced thrombocytopenia. We have encountered unusually high flap loss rate in the group who received a single intraoperative bolus of 1250 units of heparin. Although a cause-and-effect relationship between the use of systemic heparin and flap loss or prevention of thrombosis could not be established, it seems to be beneficial that a single bolus of 2500 units of heparin is given intraoperatively without significantly increasing the risk of hematoma or heparin-induced thrombocytopenia.
Drug Therapy ; Free Tissue Flaps* ; Hematoma ; Heparin* ; Humans ; Incidence ; Replantation ; Thrombocytopenia ; Thrombosis

Spontaneous chronic subdural hematoma (SDH) is a rare condition that could develop in association with hematologic disease. A 66-year-old male developed a chronic SDH as an initial manifestation of chronic myelomonocytic leukemia (CMML). He experienced recurrent chronic subdural hemorrhage and newly developed intracerebral hemorrhage. Considering the scheduled long-term chemotherapy, bilateral middle meningeal artery (MMA) embolization was performed to prevent recurrence of subdural hemorrhage. Although pancytopenia occurred during the 7 months' follow-up period, residual chronic subdural hemorrhage was absorbed without recurrence. To our best knowledge, this is the first report of CMML with spontaneous chronic SDH. MMA embolization is potentially a useful and safe treatment option in the challenging clinical situations with underlying pathologies.
Aged ; Cerebral Hemorrhage ; Drug Therapy ; Follow-Up Studies ; Hematologic Diseases ; Hematoma, Subdural* ; Hematoma, Subdural, Chronic ; Humans ; Leukemia ; Leukemia, Myelomonocytic, Chronic ; Male ; Meningeal Arteries ; Pancytopenia ; Pathology ; Recurrence

Wilms' tumor is composed of a mixture of epithelial, stromal and blastematous elements in varing proportions. Adult Wilms' tumor, unlike that of childhood is a rare disease. Spontaneous rupture of the kidney with subcapsular or perirenal hematoma also is rarely seen in malignant renal tumor. A case of adult Wilms' tumor in 65-year old female is here reported, associated with spontaneous renal rupture, which was treated with radical nephrectomy and chemotherapy (vincristine, actinomycin D and doxorubicin).
Adult* ; Aged ; Dactinomycin ; Drug Therapy ; Female ; Hematoma ; Humans ; Kidney ; Nephrectomy ; Rare Diseases ; Rupture* ; Rupture, Spontaneous ; Wilms Tumor*

The orbital rhabdomyosarcoma is the most common primary malignant tumor of the orbit in childhood. It was first described in 1854 by Weber and has been increased possibly due to improvement of diagnostic procedures. A 7-year-old boy with the complaints of proptosis and visual disturbance coincidently had an ocular trauma. Incision and drainage of intraorbital hematoma was performed in the right orbit which was confirmed with orbital CT scan. Microscopic findings showed ovoid and spindle shaped rhabdoblasts, hyperchromatic nuclei, and characteristic cross striation in the cytoplasm of the giant cells. He was diagnosed as embryonal rhabdomyosarcoma. The intraorbital hematoma and surrounding tissue in the right orbit were excised and the right eye was enucleated. He received chemotherapy and radiation therapy.
Child ; Cytoplasm ; Drainage ; Drug Therapy ; Exophthalmos ; Giant Cells ; Hematoma ; Humans ; Male ; Orbit* ; Rhabdomyosarcoma* ; Rhabdomyosarcoma, Embryonal ; Tomography, X-Ray Computed

We report a case of a 13-year-old girl who presented with a 2-month history of intermittent abdominal pain. Laboratory examination showed hepatitis and pancreatitis. Because of persistent vomiting, computed tomography (CT) was performed, which revealed a circumferential soft tissue density in the duodenal wall, causing partial obstruction. Supportive therapy failed. Repeat CT showed no significant change from the initial study. The patient underwent upper endoscopy, which revealed a mass in the second portion of the duodenum, which occluded most parts of the lumen. The histopathological finding was consistent with an anaplastic large cell lymphoma, a rare form of small bowel neoplasm. After the third course of chemotherapy, complete resolution of the mass was noted, and her symptoms were relieved.
Abdominal Pain ; Adolescent ; Drug Therapy ; Duodenum ; Endoscopy ; Female ; Hematoma ; Hepatitis ; Humans ; Lymphoma, Large-Cell, Anaplastic ; Pancreatitis ; Vomiting

OBJECTIVETo study the efficiency of Liqi decoction on false intestinal obstruction caused by retroperitoneal hematoma.

METHODSSeventy-five patients were randomly divided into two groups involving Liqi groups and control group. In Liqi group, therer were 45 patients including 28 males and 17 females with an average age of (41.45+/-13.58) years, 32 cases of pelvic fracture, 13 cases of lumber fracture and Liqi decoction were given oral for 2 to 3 days. In control group, there were 30 cases including 19 males and 11 females with an average age of (43.28+/-9.49) years, 24 cases of pelvic fracture, lumber fracture in 6 cases, and 30 cases was fasting and enema, 14 cases were gastrointestinal decompression.

RESULTSAccording to New Chinese Medicine Clinical Research on the Guiding Principles, the efficacy of intestinal obstruction was evaluated, in Liqi group the results were excellent in 25 cases, good in 13, fair in 7, and in control group,excellent in 5, good in 7, fair in 18. The fineness rate were compared between two groups by chi2 test, the difference was significant (P<0.05).

CONCLUSIONLiqi decoction is a simple and effective way to treated the retroperitoneal hecatomb caused by pseudo-obstruction.

Adult ; Aged ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Fractures, Bone ; drug therapy ; Hematoma ; drug therapy ; Humans ; Intestinal Obstruction ; drug therapy ; Lumbosacral Region ; injuries ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Pelvic Bones ; injuries ; Treatment Outcome